ARTICLE TITLE: Accuracy of three-dimensional echocardiography with
unrestricted selection of imaging planes for measurement of left
ventricular volumes and ejection fraction.
ARTICLE SOURCE: Am Heart J (United States), Sep 2000, 140(3)
p469-75
AUTHOR(S): Hibberd MG; Chuang ML; Beaudin RA; Riley MF; Mooney MG;
Fearnside JT; Manning WJ; Douglas PS
AUTHOR'S ADDRESS: Cardiovascular Division, Charles A. Dana Research
Institute and the Harvard-Thorndike Laboratory of Medicine, Boston,
MA, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
CONCLUSIONS: The novel three-dimensional echocardiography (3DE)
system allows unrestricted selection and combination of acoustic
windows in a single examination, improves accuracy of estimates of
left ventricular (LV) volumes and ejection fraction (EF) 3-fold
compared with 2DE, and is practical for routine clinical assessment
of LV size and function in patients with a wide range of cardiac
pathology.
ARTICLE TITLE: Preventing neurologic complications in coronary artery
surgery: the "off-pump, no-touch" technique [editorial]
ARTICLE SOURCE: Am Heart J (United States), Sep 2000, 140(3)
p345-7
AUTHOR(S): Ricci M; Karamanoukian HL; D'ancona G; Bergsland J;
Salerno TA
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Long-distance air travel soon after an acute coronary
syndrome: a prospective evaluation of a triage protocol.
ARTICLE SOURCE: Am Heart J (United States), Aug 2000, 140(2)
p241-2
AUTHOR(S): Zahger D; Leibowitz D; Tabb IK; Weiss AT
AUTHOR'S ADDRESS: Coronary Care Unit, Department of Medicine,
Hadassah University Hospital, Mt Scopus, Jerusalem, Israel.
dzagher@md.huji.ac.il.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: An increasing number of patients have an acute
coronary syndrome while abroad. Such an event may entail significant
emotional and financial stress, and patients are usually anxious to
return home as soon as possible. The safety of long-distance air
travel soon after an acute coronary syndrome is, however, uncertain,
and few data exist regarding the evaluation of such patients, the
proper timing and conditions of the flight, and short-term
complications. METHODS AND RESULTS: We prospectively evaluated 21
tourists who had an acute coronary syndrome in Jerusalem. Patients at
high risk were offered angiography; others underwent stress testing.
Telephone interviews were conducted a few weeks after the patients
returned home, and follow-up information was obtained. Patients flew
home 18.2 +/- 11 days (mean +/- SD) after the acute event. Flight
duration was substantial (12.5 +/- 3 hours). No patient had cardiac
symptoms en route. At follow-up (21.3 +/- 13 days), all but 2
patients were alive and free of cardiac symptoms. CONCLUSIONS: A
long-distance flight within 2 to 3 weeks after an acute coronary
syndrome is reasonably safe, provided significant ischemia is
excluded or treated.
ARTICLE TITLE: Is informed consent to clinical trials an "upside
selective" process in acute coronary syndromes? [see
comments]
COMMENTS: Comment in: Am Heart J 2000 Jul; 140(1):2-3
ARTICLE SOURCE: Am Heart J (United States), Jul 2000, 140(1)
p94-7
AUTHOR(S): Kucia AM; Horowitz JD
AUTHOR'S ADDRESS: Department of Cardiology, The Queen Elizabeth
Hospital, Adelaide, South Australia, Australia.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: METHODS: Patient understanding of clinical trial details
was assessed on 2 occasions (10 +/- 4 and 24 +/- 3 hours after
randomization) in 20 patients enrolled for randomized investigation
of pharmacotherapy for unstable angina pectoris or non-Q-wave
myocardial infarction in the Platelet IIb/IIIa Antagonist for the
Reduction of Acute Coronary Syndrome Events in a Global Organized
Network (PARAGON B) and Organization to Assess Strategies in Ischemic
Syndromes (OASIS-2) trials. RESULTS: Initial total score for
understanding of 52.0% (+/-15.7%) of maximal values improved to 67.7%
(+/-18.3%) at repeat interview (P <.001). The mean initial score
for knowledge of potential benefit was 85.0% (+/-33.3%) with no
significant improvement at repeat interview. Scores for knowledge of
risk improved from 35.0% (+/-36.6%) to 68.2% (+/-41.2%) at repeat
interview (P <.005). Significant determinants of poor initial
score were female sex, limited education, and presence of pain during
the consent process; young age was the only determinant of
improvement on repeat assessment. CONCLUSION: Thus initial
understanding of the research protocols for patients with unstable
angina pectoris or non-Q-wave acute myocardial infarction was
imperfect, with far greater impairment of knowledge of risk than of
benefit.
MB: The 'consenting' process could make the patient worse.
ARTICLE TITLE: Is the emperor really wearing new clothes? Informed
consent for acute coronary syndromes [editorial; comment]
COMMENTS: Comment on: Am Heart J 2000 Jul; 140(1):94-7
ARTICLE SOURCE: Am Heart J (United States), Jul 2000, 140(1) p2-3
AUTHOR(S): Sugarman J
PUBLICATION TYPE: COMMENT; EDITORIAL
MB: They recognise that the informed consent may be impossible but
persist with the dogma that it is essential. I have heard it said, "I
am informed & the patient consents."
ARTICLE TITLE: Heart diseases affecting the liver and liver diseases
affecting the heart.
ARTICLE SOURCE: Am Heart J (United States), Jul 2000, 140(1)
p111-20
AUTHOR(S): Naschitz JE; Slobodin G; Lewis RJ; Zuckerman E; Yeshurun
D
AUTHOR'S ADDRESS: Department of Internal Medicine A, the Bnai Zion
Medical Center, Haifa, Israel.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (50 references); REVIEW,
TUTORIAL
CONCLUSION: Classification of a patient to any of the 3
categories-heart diseases affecting the liver, liver diseases
affecting the heart, and cardiac and hepatic disorders with joint
etiology-permits the physician to narrow the span of the possible
diagnoses and allows for a more simple workup.
ARTICLE TITLE: Should we revise our diagnostic methods for Q-wave
myocardial infarction in the presence of right bundle branch block?
[editorial]
ARTICLE SOURCE: Am Heart J (United States), Jul 2000, 140(1)
p10-1
AUTHOR(S): Gussak I; Wright RS; Kopecky SL
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Dual randomization in cardiovascular trials
[editorial]
ARTICLE SOURCE: Am Heart J (United States), Jul 2000, 140(1) p1
AUTHOR(S): Califf RM
PUBLICATION TYPE: EDITORIAL
MB: About doing more than one trial at the same time. They note that
control groups are likely to be better treated than where a trial is
not being performed.
ARTICLE TITLE: Anaesthesia and fatigue: an analysis of the first 10
years of the Australian Incident Monitoring Study 1987-1997.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Jun 2000, 28(3)
p300-4
AUTHOR(S): Morris GP; Morris RW
AUTHOR'S ADDRESS: Department of Anaesthesia, St George Hospital,
Sydney, New South Wales.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: The Australian Incident Monitoring Study (AIMS) database of
the Australian Patient Safety Foundation (APSF) was reviewed from its
inception in April 1987 to October 1997. A total of 5600 AIMS reports
were lodged in that period. Reports in which fatigue was listed as a
Factor Contributing to Incident were examined. This occurred in 152
reports, or 2.7% of all reports. Confidence interval analysis
suggested that fatigue was associated with various concurrently
reported factors. These included pharmacological incidents
(especially syringe swaps) and time of day. Other factors
significantly associated with fatigue reports were haste,
distraction, inattention and failure to check equipment. Relieving
anaesthetists and healthy patients were reported more often as
factors minimizing incidents. Anaesthetists reporting fatigue more
often reported incidents during induction. These data suggest that
fatigue alleviation strategies and equipment checking routines,
improved workplace design (including drug ampoule and syringe
labelling protocols) and regulation of working hours will facilitate
minimization of fatigue-related incidents. Definitive prospective
studies might be most usefully targeted at these and related
interventions.
MB: I doubt that prospective studies apart from further studies of
incident reports would be sensible. The incidence of incidents is not
common enough.
ARTICLE TITLE: The effect of PVC packaging on the acidity of 0.9%
saline.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Jun 2000, 28(3)
p287-92
AUTHOR(S): Story DA; Thistlethwaite P; Bellomo R
AUTHOR'S ADDRESS: Physical Chemistry Laboratory, School of Chemistry,
University of Melbourne, Victoria. ]
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Intravenous fluids in polyvinyl chloride (PVC) packaging
are known to be acidic. We proposed to determine the effect of PVC
packaging on the pH of 0.9% saline solutions by comparing the
predicted and measured pH of 0.9% saline equilibrated with
atmospheric carbon dioxide and the measured pH of commercial
solutions of 0.9% saline in PVC and polypropylene packaging.
Calculation of pH was made from available physical chemistry
constants and data. Measurement was made of the pH of 12 samples of
prepared 0.9% saline equilibrated with atmospheric carbon dioxide.
Comparison with the pH of seven commercial samples of saline in PVC
packaging for intravenous use was undertaken. Further comparison was
made between commercial samples of 0.9% saline in PVC or
polypropylene packaging. The calculated pH of 0.9% saline was 5.61 at
20 degrees C. The median pH of the prepared samples was statistically
significantly less acidic than the median pH of the PVC packaged
samples for intravenous use: 5.47 vs 4.60, P < 0.05. The median pH
of the PVC packaged saline was also statistically significantly more
acidic than the pH of the polypropylene packaged saline: 4.62 vs
5.71, P < 0.05. The acidity of the intravenous solutions of 0.9%
saline packaged in PVC was much greater than expected and is only
partially explained by dissolved carbon dioxide. This acidity could
be a result of packaging in PVC.
MB: I would think that the pH differences seen would represent a
trivial quantity of acid in a non-buffer solution.
ARTICLE TITLE: Measurement of quality of recovery in 5672 patients
after anaesthesia and surgery.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Jun 2000, 28(3)
p276-80
AUTHOR(S): Myles PS; Reeves MD; Anderson H; Weeks AM
AUTHOR'S ADDRESS: Department of Anaesthesia and Pain Management,
Alfred Hospital, Melbourne, Victoria.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Quality of recovery after an operation is an important
dimension of the patient's experience and may be related to the
quality of anaesthesia care. Satisfaction with anaesthesia is a vital
component of quality care but difficult to measure. We examined our
database of 5672 adult patients to determine if quality of recovery
is associated with satisfaction with anaesthesia and to identify the
perioperative factors that might influence both these outcome
measures. We found that a nine-item quality of recovery score ("QoR
Score") was related to satisfaction with anaesthesia (P < 0.0005):
the overall level of satisfaction was high (97.2%; median QoR Score
16); 106 patients (2.1%; median QoR Score 14) were "somewhat
dissatisfied" and 32 patients (0.6%; median QoR Score 13) were
"dissatisfied" with their anaesthesia care. Patients who experienced
any of a number of perioperative complications had lower QoR Scores
(P < 0.0005). We have further demonstrated the validity and
clinical utility of the QoR Score, and in particular, its
relationship to patient satisfaction in adult surgical patients.
ARTICLE TITLE: Subhypnotic dose of propofol for the prevention of
nausea and vomiting during spinal anaesthesia for caesarean
section.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Jun 2000, 28(3)
p262-5
AUTHOR(S): Numazaki M; Fujii Y
AUTHOR'S ADDRESS: Department of Anaesthesiology, University of
Tsukuba Institute of Clinical Medicine, Ibaraki, Japan.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
In conclusion, a subhypnotic dose (1.0 mg/kg/h) of propofol is
effective for preventing nausea and vomiting in parturients
undergoing caesarean section under spinal anaesthesia.
MB: What effect has it on Apgar scores.
ARTICLE TITLE: Sedation during spinal anesthesia.
ARTICLE SOURCE: Anesthesiology (United States), Sep 2000, 93(3)
p728-34
AUTHOR(S): Pollock JE; Neal JM; Liu SS; Burkhead D; Polissar N
AUTHOR'S ADDRESS: Department of Anesthesiology, Virginia Mason
Medical Center, Seattle, Washington, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: Spinal anesthesia is accompanied by significant sedation
progressively when compared with controls as measured by Observer's
Assessment of Alertness/Sedation Scale (OAA/S) and self-sedation
scores. This effect was not related to block height. The late
sedation observed by OAA/S at 60 min may indicate a second mechanism
of sedation, such as delayed rostral spread of local anesthetics. BIS
was not a sensitive measure of the sedation associated with spinal
anesthesia in the randomized, blinded portion of this study.
MB: I think that this means that it is useless.
ARTICLE TITLE: Core cooling by central venous infusion of ice-cold (4
degrees C and 20 degrees C) fluid: isolation of core and peripheral
thermal compartments.
ARTICLE SOURCE: Anesthesiology (United States), Sep 2000, 93(3)
p629-37
AUTHOR(S): Rajek A; Greif R; Sessler DI; Baumgardner J; Laciny S;
Bastanmehr H
AUTHOR'S ADDRESS: Department of Anesthesia and Perioperative Care,
University of California-San Francisco, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Central venous infusion of cold fluid decreases core
temperature more than would be expected were the reduction in body
heat content proportionately distributed. It thus appears to be an
effective method of rapidly inducing therapeutic hypothermia. When
the infusion is complete, there is a spontaneous partial recovery in
core temperature that facilitates rewarming to normothermia.
ARTICLE TITLE: Acute opioid tolerance: intraoperative remifentanil
increases postoperative pain and morphine requirement.
ARTICLE SOURCE: Anesthesiology (United States), Aug 2000, 93(2)
p409-17
AUTHOR(S): Guignard B; Bossard AE; Coste C; Sessler DI; Lebrault C;
Alfonsi P; Fletcher D; Chauvin M
AUTHOR'S ADDRESS: Department of Anesthesiology, Hopital Ambroise
Pare, Boulogne-Billancourt, France.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: Relatively large-dose intraoperative remifentanil
increased postoperative pain and morphine consumption. These data
suggest that remifentanil causes acute opioid tolerance and
hyperalgesia.
MB: Well, where do we go from here.
ARTICLE TITLE: Competence of the internal jugular vein valve is
damaged by cannulation and catheterization of the internal jugular
vein.
ARTICLE SOURCE: Anesthesiology (United States), Aug 2000, 93(2)
p319-24
AUTHOR(S): Wu X; Studer W; Erb T; Skarvan K; Seeberger MD
AUTHOR'S ADDRESS: Department of Anesthesia and Research, University
of Basel/Kantonsspital, Switzerland.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: Cannulation and catheterization of the IJV may cause
persistent incompetence of the IJV valve. Choosing a more distal site
for venous cannulation may slightly lower the risk of causing
valvular incompetence but does not reliably avoid it.
MB: I have never heard that this is important. They admit as
much.
ARTICLE TITLE: Anesthesia-related cardiac arrest in children: initial
findings of the Pediatric Perioperative Cardiac Arrest (POCA)
Registry [see comments]
COMMENTS: Comment in: Anesthesiology 2000 Jul; 93(1):1-3
ARTICLE SOURCE: Anesthesiology (United States), Jul 2000, 93(1)
p6-14
AUTHOR(S): Morray JP; Geiduschek JM; Ramamoorthy C; Haberkern CM;
Hackel A; Caplan RA; Domino KB; Posner K; Cheney FW
AUTHOR'S ADDRESS: Department of Anesthesiology, Virginia Mason
Medical Center, Seattle, WA 98105, USA. jmorra@chmc.org.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: The Pediatric Perioperative Cardiac Arrest
(POCA) Registry was formed in 1994 in an attempt to determine the
clinical factors and outcomes associated with cardiac arrest in
anesthetized children. METHODS: Institutions that provide anesthesia
for children are voluntarily enrolled in the POCA Registry. A
representative from each institution provides annual institutional
demographic information and submits anonymously a standardized data
form for each cardiac arrest (defined as the need for chest
compressions or as death) in anesthetized children 18 yr of age or
younger. Causes and factors associated with cardiac arrest are
analyzed. RESULTS: In the first 4 yr of the POCA Registry, 63
institutions enrolled and submitted 289 cases of cardiac arrest. Of
these, 150 arrests were judged to be related to anesthesia. Cardiac
arrest related to anesthesia had an incidence of 1.4 +/- 0.45 (mean
+/- SD) per 10,000 instances of anesthesia and a mortality rate of
26%. Medication-related (37%) and cardiovascular (32%) causes of
cardiac arrest were most common, together accounting for 69% of all
arrests. Cardiovascular depression from halothane, alone or in
combination with other drugs, was responsible for two thirds of all
medication-related arrests. Thirty-three percent of the patients were
American Society of Anesthesiologists physical status 1-2; in this
group, 64% of arrests were medication-related, compared with 23% in
American Society of Anesthesiologists physical status 3-5 patients (P
< 0.01). Infants younger than 1 yr of age accounted for 55% of all
anesthesia-related arrests. Multivariate analysis demonstrated two
predictors of mortality: American Society of Anesthesiologists
physical status 3-5 (odds ratio, 12.99; 95% confidence interval,
2.9-57.7), and emergency status (odds ratio, 3. 88; 95% confidence
interval, 1.6-9.6). CONCLUSIONS: Anesthesia-related cardiac arrest
occurred most often in patients younger than 1 yr of age and in
patients with severe underlying disease. Patients in the latter
group, as well as patients having emergency surgery, were most likely
to have a fatal outcome. The identification of medication-related
problems as the most frequent cause of anesthesia-related cardiac
arrest has important implications for preventive strategies.
ARTICLE TITLE: Bringing light to the dark side [editorial;
comment]
COMMENTS: Comment on: Anesthesiology 2000 Jul; 93(1):6-14
ARTICLE SOURCE: Anesthesiology (United States), Jul 2000, 93(1)
p1-3
AUTHOR(S): Rothstein P
PUBLICATION TYPE: COMMENT; EDITORIAL
MB: When I was a registrar at the Royal Alexandra Hospital For
Children (1960), excluding cardiac surgery, there were no cardiac
arrests during that year or in the 6 months after that. The incidence
would therefore be about 1 in 8,000. The incidence in this report
cannot be deduced because they don't know the total number. It is
pretty hopeless that overdosage of inhalational agents was so common
in this day and age.
ARTICLE TITLE: Relation between perioperative hypertension and
intracranial hemorrhage after craniotomy.
ARTICLE SOURCE: Anesthesiology (United States), Jul 2000, 93(1)
p48-54
AUTHOR(S): Basali A; Mascha EJ; Kalfas I; Schubert A
AUTHOR'S ADDRESS: Cleveland Clinic Foundation Health Science Center
of the Ohio State University, 44195-5154, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Intracranial hemorrhage (ICH) after craniotomy is
associated with severely prolonged hospital stay and mortality. Acute
blood pressure elevations occur frequently prior to postcraniotomy
ICH. Patients who develop postcraniotomy ICH are more likely to be
hypertensive in the intraoperative and early postoperative
periods.
ARTICLE TITLE: The three components of hyperoxia [editorial;
comment]
COMMENTS: Comment on: Anesthesiology 2000 Jul; 93(1):15-25
ARTICLE SOURCE: Anesthesiology (United States), Jul 2000, 93(1)
p3-5
AUTHOR(S): Knight PR; Holm BA
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Anaphylaxis to penicillin on reperfusion during liver
transplantation.
ARTICLE SOURCE: Anesthesiology (United States), Jul 2000, 93(1)
p280-1
AUTHOR(S): Xi-Moy S; Thorvilson NK; Edmiston CE; Woehlck HJ
AUTHOR'S ADDRESS: Departments of Anesthesiology and Surgery, Medical
College of Wisconsin, Milwaukee 53226, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Attenuation of the preoperative stress response with
midazolam: effects on postoperative outcomes.
ARTICLE SOURCE: Anesthesiology (United States), Jul 2000, 93(1)
p141-7
AUTHOR(S): Kain ZN; Sevarino F; Pincus S; Alexander GM; Wang SM;
Ayoub C; Kosarussavadi B
AUTHOR'S ADDRESS: Departments of Anesthesiology, Pediatrics, and
Child and Adolescent Psychiatry, Yale University School of Medicine,
New Haven, CT 06510, USA. zeev.kain@yale.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSION: Subjects treated with midazolam preoperatively
self-report improved postoperative psychological and pain recovery.
However, the clinical significance of these findings is unclear at
the present time.
ARTICLE TITLE: Analysis of risk factors for myocardial infarction and
cardiac mortality after major vascular surgery.
ARTICLE SOURCE: Anesthesiology (United States), Jul 2000, 93(1)
p129-40
AUTHOR(S): Sprung J; Abdelmalak B; Gottlieb A; Mayhew C; Hammel J;
Levy PJ; O'Hara P; Hertzer NR
AUTHOR'S ADDRESS: Department of General Anesthesiology, The Cleveland
Clinic Foundation, OH 44195, USA. sprungj@ccf.org.
PUBLICATION TYPE: JOURNAL ARTICLE
METHODS: From the Vascular Surgery Registry (6,948 operations from
January 1989 through June 1997) the authors identified 107 patients
in whom for perioperative myocardial infarction (PMI) developed
during the same hospital stay. Case-control patients (patients
without PMI) were matched at a 1x:x1 ratio with index cases according
to the type of surgery, gender, patient age, and year of surgery. The
authors analyzed data regarding preoperative cardiac disease and
surgical and anesthetic factors to study association with PMI and
cardiac death. RESULTS: By using univariable analysis the authors
identified the following predictors of PMI: valvular disease (P =
0.007), previous congestive heart failure (P = 0.04), emergency
surgery (P = 0.02), general anesthesia (P = 0.03), preoperative
history of coronary artery disease (P = 0.001), preoperative
treatment with beta-blockers (P = 0.003), lower preoperative (P =
0.03) and postoperative (P = 0.002) hemoglobin concentrations,
increased bleeding rate (as assessed from increased cell salvage; P =
0.025), and lower ejection fraction (P = 0.02). Of the 107 patients
with PMI, 20.6% died of cardiac cause during the same hospital stay.
The following factors increased the odds ratios for cardiac death:
age (P = 0.001), recent congestive heart failure (P = 0.01), type of
surgery (P = 0.04), emergency surgery (P = 0.02), lower
intraoperative diastolic blood pressure (P = 0.001), new
intraoperative ST-T changes (P = 0.01), and increased intraoperative
use of blood (P = 0.005). Patients who underwent coronary artery
bypass grafting, even more than 12 months before index surgery, had a
79% reduction in risk of death if they had PMI (P = 0.01).
Multivariable analysis revealed preoperative definitive diagnosis of
coronary artery disease (P = 0.001) and significant valvular disease
(P = 0.03) were associated with increased risk of PMI. Congestive
heart failure less than 1 yr before index vascular surgery (P = 0.
0002) and increased intraoperative use of blood (P = 0.007) were
associated with cardiac death. The history of coronary artery bypass
grafting reduced the risk of cardiac death (P = 0.04) in patients
with PMI. CONCLUSIONS: The in-hospital cardiac mortality rate is high
for patients who undergo vascular surgery and experience clinically
significant for perioperative myocardial infarction (PMI). Stress of
surgery (increased intraoperative bleeding and aortic, peripheral
vascular, and emergency surgery), poor preoperative cardiac
functional status (congestive heart failure, lower ejection fraction,
diagnosis of coronary artery disease), and preoperative history of
coronary artery bypass grafting are the factors that determine
perioperative cardiac morbidity and mortality rates.
ARTICLE TITLE: Mesh compared with non-mesh methods of open groin
hernia repair: systematic review of randomized controlled trials.
ARTICLE SOURCE: Br J Surg (England), Jul 2000, 87(7) p854-9
AUTHOR(S): Collaboration EH
AUTHOR'S ADDRESS: Correspondence to: Professor A. Grant, EU Hernia
Trialists Collaboration Secretariat, Health Services Research Unit,
University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen
AB25 2ZD, UK.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (23 references); REVIEW,
ACADEMIC
CONCLUSION: Although the rigorous search maximized trial
identification, formal meta-analysis was limited by the variation in
trial reporting. Within the data available, mesh repair was
associated with fewer recurrences.
ARTICLE TITLE: Second gas effect of N2O on oxygen uptake.
ARTICLE SOURCE: Can J Anaesth (Canada), Jun 2000, 47(6) p506-10
AUTHOR(S): Nishikawa K; Kunimoto F; Isa Y; Miyoshi S; Takahashi K;
Morita T; Arii H; Goto F
AUTHOR'S ADDRESS: Department of Anesthesiology, Gunma University
School of Medicine, Maebashi, Japan.
nishikaw@news.sb.gunma-u.ac.jp.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: PURPOSE: The concept of the second gas effect is well
known, however, there have been no studies that showed the
relationship between alveolar oxygen concentration and arterial
oxygen tension (PaO2) after the inhalation of nitrous oxide (N2O) in
humans. The purpose of this study was to examine the changes in both
end-tidal oxygen fraction (F(ET)O2) and PaO2 after N2O inhalation in
patients under general anesthesia. METHODS: Fifteen patients
scheduled for elective orthopedic surgery were enrolled in this
study. Anesthesia was maintained with the continuous infusion of
propofol and with nitrogen (N2) and oxygen (O2) (6 L x min(-1), F1O2,
0.33). In all patients, the lungs were ventilated with a Servo 900C
ventilator equipped with a gas mixer for O2, N2O, and N2. After
obtaining baseline data, N2 was replaced with N2O maintaining FIO2
constant at 0.33. The changes in fractional concentration of O2, N2O,
and N2 were continuously measured using mass spectrometer in a
breath-by-breath basis. PaO2 and hemodynamic data were obtained at 1,
5, 10, 30 and 60 min after the start of N2O inhalation. RESULTS: Five
minutes after N2O inhalation, F(ET)O2 increased from 0.27+/-0.01 to
0.31+/-0.02 (P<0.01) and PaO2 increased from 172.0+/-22.5 mm Hg to
201.0+/-10.3 mm Hg (P<0.01). These effects produced by N2O were
observed for 30 min. CONCLUSIONS: These results confirm the concept
of second gas effect of N2O on oxygen uptake in humans and provide
evidence that the PaO2 increase correlated with the increase in
F(ET)O2 after N2O inhalation.
MB: The second gas & concentration effects are due to increases
in tidal volume due to mass uptake of nitrous. This study sets the
ventilation which would interfere with the process. A study with Eger
himself Anes. Analg 1999,89, 774, done to counter another study which
said the phenomenon did not occur in a study which kept the minute
volume constant, keeps the CO2 constant by ventilating. I would think
that spontaneous ventilation would be necessary for demonstration of
these effects. The effects are not really very important.
The terms have been so confused that maybe it would be better to stop
using them. This article is about a possible second gas effect on the
oxygen. It was meant to apply to gases in a low % ie the potent
inhalational agents.
ARTICLE TITLE: Inadvertent placement of pulmonary artery catheter
into right carotid artery.
ARTICLE SOURCE: Can J Anaesth (Canada), May 2000, 47(5) p460-2
AUTHOR(S): Kanbak M; Ocal T
AUTHOR'S ADDRESS: Department of Anesthesiology and Reanimation,
Hacettepe University, Faculty of Medicine, Ankara, Turkey.
ok05-k@tr-net.net.tr.
PUBLICATION TYPE: JOURNAL ARTICLE
CLINICAL FEATURES: A 20-mo-old boy underwent open heart surgery (VSD
repair). On the first day postoperatively, he had severe pulmonary
hypertension and a PAC was inserted via the left internal jugular
approach without complication. Two hours later, chest radiography
showed the PAC in the right internal carotid artery which it had
reached via the right and left ventricles and aorta. The PAC was
withdrawn and a new PAC was inserted and its position was confirmed
by chest radiography. Two years later echocardiography failed to
demonstrate the second VSD or a residual leak through the patch
although a PAC could be passed from the right ventricle to the left
ventricle and subsequently into the aorta and right carotid artery.
CONCLUSION: Correct placement of a PAC should be confirmed by chest
radiography or other techniques to prevent complication.
MB: I would have thought that has always been necessary.
ARTICLE TITLE: Effect of hydrocortisone on phenylephrine--mean
arterial pressure dose-response relationship in septic shock.
ARTICLE SOURCE: Clin Pharmacol Ther (United States), Sep 2000, 68(3)
p293-303
AUTHOR(S): Bellissant E; Annane D
AUTHOR'S ADDRESS: Laboratoire de Pharmacologie Experimentale et
Clinique, Faculte de Medecine, Universite de Rennes I, France.
Eric.Bellissant@univ-rennes1.fr.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: Septic shock is characterized by decreased
responsiveness to catecholamines. Because endogenous steroids are
known to play a role in the modulation of vasomotor tone, the purpose
of our study was to investigate the phenylephrine-mean arterial
pressure dose-response relationship in patients with septic shock and
the effect of a physiological dose of hydrocortisone on it. METHODS:
Twelve patients meeting usual criteria for septic shock and 12
age-matched control subjects were investigated before and 1 hour
after receiving 50 mg intravenous hydrocortisone. Sixteen incremental
doses of phenylephrine (microg/kg/min) were infused, and the effects
on mean arterial pressure (mm Hg) were recorded. A sigmoid model, E =
E0 + [Emax x Dgamma/(ED50gamma + Dgamma)], was fitted to
individual data. In this model, E is the predicted effect and D is
the dose of phenylephrine infused. E0 represents the basal value of
effect (ie, the value of mean arterial pressure without drug), Emax
is the maximum theoretical effect, ED50 is the dose of phenylephrine
for which an effect of 50% of Emax is observed, and gamma is the Hill
coefficient which accounts for the sigmoidicity of the curve.
RESULTS: As compared with in control subjects, in patients, E0 was
decreased before (58 +/- 8 versus 73 +/- 7 mm Hg) and after (64 +/-
12 versus 82 +/- 10 mm Hg) administration of hydrocortisone (P =
.0001 for group), Emax was reduced before (39 +/- 17 versus 84 +/- 18
mm Hg) and after (77 +/- 26 versus 106 +/- 21 mm Hg) administration
of hydrocortisone (P = .0001 for group), ED50 was not modified, and
gamma was increased before (3.5 +/- 1.8 versus 1.3 +/- 0.3) and after
(1.9 +/- 1.1 versus 1.3 +/- 0.3) administration of hydrocortisone (P
= .0010 for group). Hydrocortisone similarly increased E0 in both
groups (P = .0003 for sequence, P = .2883 for interaction), increased
more Emax in patients than in control subjects (P < .0001 for
sequence; P = .0280 for interaction), did not change ED50, and
decreased y in patients but not in control subjects (P = .0025 for
sequence, P = .0025 for interaction). CONCLUSIONS: In patients with
septic shock, the Emax of phenylephrine is decreased, whereas its
ED50 is not modified, both before and after administration of
hydrocortisone. A physiological dose of hydrocortisone tends to
normalize the relationship.
ARTICLE TITLE: Invited review: what do we know about the effects of
spaceflight on bone?
ARTICLE SOURCE: J Appl Physiol (United States), Aug 2000, 89(2)
p840-7
AUTHOR(S): Turner RT
AUTHOR'S ADDRESS: Departments of Orthopedics and Biochemistry and
Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA.
turner.russell@mayo.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (64 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Physiology of a microgravity environment invited
review: microgravity and skeletal muscle.
ARTICLE SOURCE: J Appl Physiol (United States), Aug 2000, 89(2)
p823-39
AUTHOR(S): Fitts RH; Riley DR; Widrick JJ
AUTHOR'S ADDRESS: Department of Biology, Marquette University,
Milwaukee, WI 53201, USA. robert.fitts@marquette.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (103 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Physiology in microgravity.
ARTICLE SOURCE: J Appl Physiol (United States), Jul 2000, 89(1)
p379-84
AUTHOR(S): West JB
AUTHOR'S ADDRESS: Department of Medicine, University of California
San Diego, La Jolla, California 92093-0623, USA. jwest@ucsd.edu.
PUBLICATION TYPE: HISTORICAL ARTICLE; JOURNAL ARTICLE
ARTICLE TITLE: Is US health really the best in the world?
ARTICLE SOURCE: JAMA (United States), Jul 26 2000, 284(4) p483-5
AUTHOR(S): Starfield B
AUTHOR'S ADDRESS: Department of Health Policy and Management, Johns
Hopkins School of Hygiene and Public Health, 624 N Broadway, Room
452, Baltimore, MD 21205-1996, USA. bstarfie@jhsph.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
The order is Japan. Sweden, Canada, France, Australia, Spain,
Finland, Holland, UK, Denmark, Belgium, US, Germany.
ARTICLE TITLE: Is routine screening for melanoma a benign
practice?
ARTICLE SOURCE: JAMA (United States), Aug 16 2000, 284(7) p883-6
AUTHOR(S): Edman RL; Klaus SN
AUTHOR'S ADDRESS: Department of Medicine (Dermatology),
Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: The shocking truth about automated external
defibrillators [comment]
COMMENTS: Comment on: JAMA 2000 Sep 20; 284(11):1435-8
ARTICLE SOURCE: JAMA (United States), Sep 20 2000, 284(11)
p1438-41
AUTHOR(S): Brown J; Kellermann AL
AUTHOR'S ADDRESS: Department of Emergency Medicine, Emory University
School of Medicine, 1518 Clifton Rd NE, Atlanta, GA 30322, USA.
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE
ARTICLE TITLE: Is it time for over-the-counter defibrillators?
[see comments]
COMMENTS: Comment in: JAMA 2000 Sep 20; 284(11):1438-41
ARTICLE SOURCE: JAMA (United States), Sep 20 2000, 284(11)
p1435-8
AUTHOR(S): Eisenberg MS
AUTHOR'S ADDRESS: University of Washington Medical Center, Box
356123, Seattle, WA 98195-6123, USA. gingy@u.washington.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
MB There should be defibrillators everywhere!
ARTICLE TITLE: Use of colonoscopy to screen asymptomatic adults for
colorectal cancer. Veterans Affairs Cooperative Study Group 380
[see comments]
COMMENTS: Comment in: N Engl J Med 2000 Jul 20; 343(3):207-8
ARTICLE SOURCE: N Engl J Med (United States), Jul 20 2000, 343(3)
p162-8
AUTHOR(S): Lieberman DA; Weiss DG; Bond JH; Ahnen DJ; Garewal H;
Chejfec G
AUTHOR'S ADDRESS: Division of Gastroenterology, Oregon Health
Sciences University, Portland Veterans Affairs Medical Center, 94207,
USA.
PUBLICATION TYPE: JOURNAL ARTICLE; MULTICENTER STUDY
ABSTRACT: BACKGROUND AND METHODS: The role of colonoscopy in
screening for colorectal cancer is uncertain. At 13 Veterans Affairs
Medical Centers, we performed colonoscopy to determine the prevalence
and location of advanced colonic neoplasms and the risk of advanced
proximal neoplasia in asymptomatic patients (age range, 50 to 75
years) with or without distal neoplasia <snip> RESULTS: Of
17,732 patients screened for enrollment, 3196 were enrolled; 3121 of
the enrolled patients (97.7 percent) underwent complete examination
of the colon. The mean age of the patients was 62.9 years, and 96.8
percent were men. Colonoscopic examination showed one or more
neoplastic lesions in 37.5 percent of the patients, an adenoma with a
diameter of at least 10 mm or a villous adenoma in 7.9 percent, an
adenoma with high-grade dysplasia in 1.6 percent, and invasive cancer
in 1.0 percent. Of the 1765 patients with no polyps in the portion of
the colon that was distal to the splenic flexure, 48 (2.7 percent)
had advanced proximal neoplasms. Patients with large adenomas (>
or = 10 mm) or small adenomas (< 10 mm) in the distal colon were
more likely to have advanced proximal neoplasia than were patients
with no distal adenomas (odds ratios, 3.4 [95 percent confidence
interval, 1.8 to 6.5] and 2.6 (95 percent confidence interval,
1.7 to 4.1], respectively). However, 52 percent of the 128
patients with advanced proximal neoplasia had no distal adenomas.
CONCLUSIONS: Colonoscopic screening can detect advanced colonic
neoplasms in asymptomatic adults. Many of these neoplasms would not
be detected with sigmoidoscopy.
ARTICLE TITLE: Organ donation by unrelated donors [comment]
[editorial]
COMMENTS: Comment on: N Engl J Med 2000 Aug 10; 343(6):404-10;
Comment on: N Engl J Med 2000 Aug 10; 343(6):433-6
ARTICLE SOURCE: N Engl J Med (United States), Aug 10 2000, 343(6)
p430-2
AUTHOR(S): Levinsky NG
MB: Sounds ethically impossible to me.
ARTICLE TITLE: Phantom pain and phantom sensations in upper limb
amputees: an epidemiological study.
ARTICLE SOURCE: Pain (Netherlands), Jul 2000, 87(1) p33-41
AUTHOR(S): Kooijman CM; Dijkstra PU; Geertzen JH; Elzinga A; van der
Schans CP
AUTHOR'S ADDRESS: Department of Rehabilitation, University Hospital
Groningen, Netherlands.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: <snip>. One hundred twenty-four upper limb amputees
participated in this study. Subjects were asked to fill out a
self-developed questionnaire scoring the following items: date, side,
level, and reason of amputation, duration of experienced pain before
amputation, frequencies with which phantom sensations, phantom pain,
and stump pain are experienced, amount of trouble and suffering
experienced, respectively, related to these sensations, type of
phantom sensations, medical treatment received for phantom pain
and/or stump pain, and the effects of the treatment, self medication,
and prosthesis use. The response rate was 80%. The prevalence of
phantom pain was 51%, of phantom sensations 76% and of stump pain
49%; 48% of the subjects experienced phantom pain a few times per day
or more; 64% experienced moderate to very much suffering from the
phantom pain. A significant association was found between phantom
pain and phantom sensations (relative risk 11.3) and between phantom
pain and stump pain (relative risk 1.9). No other factors associated
with phantom pain or phantom sensations could be determined. Only
four patients received medical treatment for their phantom pain.
Phantom pain is a common problem in upper limb amputees that causes
considerable suffering for the subjects involved. Only a minority of
subjects are treated for phantom pain. Further research is needed to
determine factors associated with phantom pain.
ARTICLE TITLE: Doctors who kill themselves: a study of the methods
used for suicide.
ARTICLE SOURCE: QJM (England), Jun 2000, 93(6) p351-7
AUTHOR(S): Hawton K; Clements A; Simkin S; Malmberg A
AUTHOR'S ADDRESS: Centre for Suicide Research, Department of
Psychiatry, University of Oxford, Oxford, UK.
keith.hawton@psycyhiatry.oxford.ac.uk.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Medical practitioners have a relatively high rate of
suicide. Death entry data for doctors who died by suicide or
undetermined cause between 1979 and 1995 in England and Wales were
used to compare methods used for suicide by doctors with those used
by the general population. Methods used were analysed according to
gender, occupational status and speciality, to assess the extent to
which access to dangerous means influences the pattern of suicide.
Self-poisoning with drugs was more common in the doctors than in
general population suicides (57% vs. 26.6%; OR=3.65, 95% CI 2.85-4.
68), including in retired doctors. Barbiturates were the most
frequent drugs used. Half of the anaesthetists who died used
anaesthetic agents. Self-cutting was also more frequently used as a
method of suicide. The finding that the greater proportion of suicide
deaths in doctors were by self-poisoning may reflect the fact that
doctors have ready access to drugs, and have knowledge of which drugs
and doses are likely to cause death. The specific finding that a
large proportion of suicides in anaesthetists involved anaesthetic
agents supports this explanation. Availability of method may be a
factor contributing to the relatively high suicide rate of doctors.
This fact might influence clinical management of doctors who are
known to be depressed or suicidal.
ARTICLE TITLE: Traveller's thrombosis.
ARTICLE SOURCE: Thorax (England), Aug 2000, 55 Suppl 1 pS32-6
AUTHOR(S): Kesteven PL
AUTHOR'S ADDRESS: Freeman Hospital, High Heaton, Newcastle upon Tyne,
UK.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (25 references); REVIEW,
TUTORIAL
MB: Not just plane travel.
ARTICLE TITLE: Supplementary oxygen therapy in COPD: is it really
useful? [editorial; comment]
COMMENTS: Comment on: Thorax 2000 Jul; 55(7):539-43; Comment on:
Thorax 2000 Jul; 55(7):544-6
ARTICLE SOURCE: Thorax (England), Jul 2000, 55(7) p537-8
AUTHOR(S): Calverley PM
PUBLICATION TYPE: COMMENT; EDITORIAL
MB: Helps a bit.
ARTICLE TITLE: Adverse drug events and near misses: who's counting?
[comment] [editorial]
COMMENTS: Comment on: Am J Med 2000 Aug 1; 109(2):87-94; Comment on:
Am J Med 2000 Aug 1; 109(2):122-30
ARTICLE SOURCE: Am J Med (United States), Aug 1 2000, 109(2)
p166-8
AUTHOR(S): Wu AW
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: How many deaths occur annually from adverse drug
reactions in the United States? [see comments]
COMMENTS: Comment in: Am J Med 2000 Aug 1; 109(2):166-8
ARTICLE SOURCE: Am J Med (United States), Aug 1 2000, 109(2)
p122-30
AUTHOR(S): Chyka PA
AUTHOR'S ADDRESS: Department of Pharmacy Practice and
Pharmacoeconomics, University of Tennessee, and Southern Poison
Center, Memphis, Tennessee, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: The numbers of deaths reported in these data sets varied
34-fold and were up to several 100-fold less than values based on
extrapolations of surveillance programs. These differences indicate
that better and more comprehensive data are needed to develop
appropriate health care policies to improve drug safety.
ARTICLE TITLE: The fate of rejected manuscripts [comment]
[editorial]
COMMENTS: Comment on: Am J Med 2000 Aug 1; 109(2):131-5
ARTICLE SOURCE: Am J Med (United States), Aug 1 2000, 109(2)
p162-3
AUTHOR(S): Colaianni LA
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: The fate of manuscripts rejected by a general medical
journal [see comments]
COMMENTS: Comment in: Am J Med 2000 Aug 1; 109(2):162-3
ARTICLE SOURCE: Am J Med (United States), Aug 1 2000, 109(2)
p131-5
AUTHOR(S): Ray J; Berkwits M; Davidoff F
AUTHOR'S ADDRESS: Annals of Internal Medicine (JR, MB, FD),
Philadelphia, PA, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: The majority of the manuscripts that were rejected from
a large general medical journal were eventually published after an
average of 18 months. Most were published in specialty journals with
lower impact factor and immediacy index ratings.
MB: Specialty journals may have greater impact in/via the specialty
involved
ARTICLE TITLE: Third-generation thrombolytic drugs.
ARTICLE SOURCE: Am J Med (United States), Jul 2000, 109(1) p52-8
AUTHOR(S): Verstraete M
AUTHOR'S ADDRESS: Center for Molecular and Vascular Biology,
University of Leuven, Leuven, Belgium.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (62 references); REVIEW,
TUTORIAL
ABSTRACT: Several third-generation thrombolytic agents have been
developed. They are either conjugates of plasminogen activators with
monoclonal antibodies against fibrin, platelets, or thrombomodulin;
mutants, variants, and hybrids of alteplase and prourokinase
(amediplase); or new molecules of animal (vampire bat) or bacterial
(Staphylococcus aureus) origin. These variations may lengthen the
drug's half-life, increase resistance to plasma protease inhibitors,
or cause more selective binding to fibrin.Compared with the
second-generation agent (alteplase), third-generation thrombolytic
agents such as monteplase, tenecteplase, reteplase, lanoteplase,
pamiteplase, and staphylokinase result in a greater angiographic
patency rate in patients with acute myocardial infarction, although,
thus far, mortality rates have been similar for those few drugs that
have been studied in large-scale trials. Bleeding risk, however, may
be greater.
ARTICLE TITLE: Special problems in laparoscopic surgery. Previous
abdominal surgery, obesity, and pregnancy.
ARTICLE SOURCE: Surg Clin North Am (United States), Aug 2000, 80(4)
p1093-110
AUTHOR(S): Curet MJ
AUTHOR'S ADDRESS: Department of Surgery, University of New Mexico
School of Medicine, Albuquerque, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (122 references); REVIEW,
ACADEMIC
ABSTRACT: Previous surgery, obesity, and pregnancy should no longer
be considered contraindications to laparoscopic surgery. Surgeons
should exercise good judgement in patient selection, use meticulous
surgical techniques, and prepare thoroughly for the planned
procedure. Patients and surgeons should be aware of increased
conversion rates. With these caveats in mind, these patients can
still experience the advantages of minimally invasive surgery without
increased risks.
ARTICLE TITLE: Ultrasound and other imaging technologies in the
intensive care unit.
ARTICLE SOURCE: Surg Clin North Am (United States), Jun 2000, 80(3)
p975-1003
AUTHOR(S): Lee SY; Frankel HL
AUTHOR'S ADDRESS: Department of Surgery, Hospital of the University
of Pennsylvania, Philadelphia, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (112 references); REVIEW,
TUTORIAL
ABSTRACT: As technology advances, more imaging and procedures are
performed at the bedside on critically ill patients in ICUs, thereby
eliminating the risks of transporting patients. These imaging
techniques can serve as diagnostic and therapeutic tools in treating
the acute and chronic consequences of injured, critically ill
patients. One area of growth is ultrasonography. Critical care
applications of ultrasonography are expanding, and the learning curve
of surgeons and intensivists performing some of these studies is
improving. Ultrasonography can supplement physical examination and
provide useful "real-time" information on nearly every body cavity.
Other imaging technology is also available in a portable form,
enabling imaging directly at the bedside. Images are now becoming
readily and easily available with the advancement of teleradiology.
Some of the imaging modalities are still in development, and their
clinical effectiveness is being studied. In the future, more uses of
these various imaging technologies may become evident and
cost-effective.
ARTICLE TITLE: Anesthetics, sedatives, and paralytics. Understanding
their use in the intensive care unit.
ARTICLE SOURCE: Surg Clin North Am (United States), Jun 2000, 80(3)
p933-47, x-xi
AUTHOR(S): Aranda M; Hanson CW 3rd
AUTHOR'S ADDRESS: Department of Anesthesia, University of
Pennsylvania School of Medicine, Philadelphia, USA.
maranda@mail.med.upenn.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (23 references); REVIEW,
TUTORIAL
ABSTRACT: This article reviews the use of inhalational, intravenous,
and epidural agents used in the operating room and ICU. An emphasis
is placed on the rationale for their selection. Additionally, the
side effects and expected complications are discussed. By developing
expertise with one's own repertoire of sedatives, narcotics, and
neuromuscular blocking agents, one may decrease postoperative
complications and lengths of stay.
MB: I would have thought that we should be using methods that do not
depend on the individual doctor. This applies especially to intensive
care. I never had to sedate or paralyse any 'ICU' patients that I had
before we had a real (lowest common denominator) ICU---1961-1972.
ARTICLE TITLE: Respiratory failure. Conventional and high-tech
support.
ARTICLE SOURCE: Surg Clin North Am (United States), Jun 2000, 80(3)
p871-83
AUTHOR(S): Shapiro MB; Anderson HL 3rd; Bartlett RH
AUTHOR'S ADDRESS: Department of Surgery, University of Pennsylvania
Health System, Philadelphia, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (52 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Hypothermia, coagulopathy, and acidosis.
ARTICLE SOURCE: Surg Clin North Am (United States), Jun 2000, 80(3)
p845-54
AUTHOR(S): Eddy VA; Morris JA Jr; Cullinane DC
AUTHOR'S ADDRESS: Department of Surgery, Vanderbilt University
Medical Center, Nashville, Tennessee, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (40 references); REVIEW,
TUTORIAL
ABSTRACT: The management of patients requiring a damage control
approach taxes the abilities of the best equipped trauma center.
These patients present with severe metabolic abnormalities, most
notably characterized by a deadly triad of hypothermia, coagulopathy,
and acidosis. Using volumetric, oxymetric pulmonary artery catheters,
hypothermia and any ongoing cardiovascular abnormalities can be
identified quickly and treatment can be monitored. External, forced
air rewarming is a valuable technique in treating the patient with
hypothermia, as are more invasive modalities, including body cavity
lavage. Although there is no shotgun approach to blood component
transfusion therapy, the coagulopathy shown by these patients has a
time course that is more rapid than stat laboratories can presently
keep up with. Given the fulminant nature of this coagulopathy, the
authors feel justified in empirically initiating platelet and plasma
or cryoprecipitate transfusion on identification of visible
coagulopathy. The willingness of trauma surgeons to push the envelope
in treating these most severely afflicted patients has allowed
patients who once would have certainly died to lead meaningful
lives.
MB: Does not sound very rational. They should obviously be doing
other (non-stat) laboratory studies so that they start to get some
idea of what is going on retrospectively.
ARTICLE TITLE: A critical assessment of endpoints of shock
resuscitation.
ARTICLE SOURCE: Surg Clin North Am (United States), Jun 2000, 80(3)
p825-44
AUTHOR(S): Dabrowski GP; Steinberg SM; Ferrara JJ; Flint LM
AUTHOR'S ADDRESS: Department of Surgery, University of Pennsylvania
School of Medicine, Philadelphia, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (80 references); REVIEW,
TUTORIAL
ABSTRACT: Modern hemodynamic therapy is not only the recognition and
treatment of hypotension but also the avoidance and treatment of
shock in its broadest sense. The major issues include the recognition
of hypoperfusion of the body as a whole or its individual tissues and
organ systems and the determination of the best endpoints for the
treatment of shock. Even if all of the commonly used clinical
indicators of shock are "normal," shock on a cellular, tissue, or
organ basis may still be present. Whether "organ-specific"
assessments, such as gastric tonometry or tissue oxygen tension
measurement, are the ultimate answer to this problem remains to be
seen. The determination of adequate intravascular volume (preload)
continues to present major difficulties in the care of critically ill
or injured patients. Although PCWP is frequently helpful, it is not a
gold standard. A bedside ultrasonic technique, such as esophageal
Doppler sonography, may replace the Swan-Ganz catheter technique in
many patients.
MB: Does not sound very helpful.
ARTICLE TITLE: Termination of life support after major trauma.
ARTICLE SOURCE: Surg Clin North Am (United States), Jun 2000, 80(3)
p1055-66
AUTHOR(S): Sullivan DJ; Hansen-Flaschen J
AUTHOR'S ADDRESS: Division of Trauma and Surgical Critical Care,
Hospital of the University of Pennsylvania, Philadelphia, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (32 references); REVIEW,
TUTORIAL
The authors propose the following guidelines for discussing
limitation or termination of life support with patients and their
families. Physicians should (1) discuss the patient's wishes
regarding life support on admission or early in the hospital course;
(2) at the initial discussion, establish who the decision maker will
be if the patient is or becomes incapacitated; (3) maintain regular
communication and continuity of care; and (4) inevitably, when
conflict occurs, involve consultants and a hospital ethics committee
for assistance in its resolution.
ARTICLE TITLE: Issues in potential organ donor management.
ARTICLE SOURCE: Surg Clin North Am (United States), Jun 2000, 80(3)
p1021-32
AUTHOR(S): Razek T; Olthoff K; Reilly PM
AUTHOR'S ADDRESS: Division of Trauma and Surgical Critical Care,
Hospital of the University of Pennsylvania, Philadelphia, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (75 references); REVIEW,
TUTORIAL
ABSTRACT: The shortage of organ donors has become a serious problem
in modern medicine. Room for improvement exists in our ability to
convert potential donors to actual donors based on the available
numbers and a significant amount of recent research. A significant
percentage of the potential donors represent head-injured patients,
so a significant amount of responsibility falls on surgeons to
optimize the opportunity for donation. There are clear steps along
the pathway from potential to actual donor where physicians can have
a significant effect on the rate of successful donation: 1. Identify
all potential donors and institute a review system to verify that all
potential donors are being identified in your area. 2. Establish an
acceptable method to rapidly and accurately determine brain death in
potential donors using the local available services. 3. Approach all
potential donor families for consent, decouple death notification and
consent request, use a member of the hospital team and an OPO
representative to approach the family, and make the request in a
private setting. 4. Use an aggressive, proactive approach to the
medical management of the potential donor using the techniques
described to limit the number of medical failures and maximize the
number of organs donated per donor. Institute a review process to
evaluate any medical failures that occur. Given the difference
between the numbers of potential versus actual donors, the authors'
significant contact with potential donors, and the clear
opportunities for improvement in their approach, the surgical
community must address these issues surrounding the optimal
management of potential donors and their families.