ARTICLE TITLE: Successful strategies for improving operating room
efficiency at academic institutions.
ARTICLE SOURCE: Anesth Analg (United States), Apr 1998, 86(4)
p896-906
AUTHOR(S): Overdyk FJ; Harvey SC; Fishman RL; Shippey F
AUTHOR'S ADDRESS: Department of Anesthesia and Perioperative
Medicine, Medical University of South Carolina, Charleston
29425-2207, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: In this prospective study, we evaluated the etiology of
operating room (OR) delays in an academic institution, examined the
impact of multidisciplinary strategies to improve OR efficiency, and
established OR timing benchmarks for use in future OR efficiency
studies. OR times and delay etiologies were collected for 94 cases
during the initial phase of the study. Timing data and delay
etiologies were analyzed, and 2 wk of multidisciplinary OR efficiency
awareness education was conducted for the nursing, surgical, and
anesthesia staff. After the education period, timing data were
collected from 1787 cases, and monthly reports listing individual
case delays and timing data were sent to the Chiefs of Service. For
the first case of the day, patient in room, anesthesia ready,
surgical preparation start, and procedure start time were
significantly earlier (P 0.01) in the posteducation period compared
with the preeducation period, and the procedure start time for the
first case of the day occurred, on average, 22 min earlier than all
other procedures. For all cases combined, turnover time decreased, on
average, by 16 min. Unavailability of surgeons, anesthesiologists,
and residents decreased significantly (P 0.05) as causes of OR
delays. Anesthesia induction times were consistently longer for the
vascular and cardiothoracic services, whereas surgical preparation
time was increased for the neurosurgical and orthopedic services (P
0.05). Identification of the etiology of OR inefficiency, combined
with multidisciplinary awareness training and personal
accountability, can improve OR efficiency. The time savings realized
are probably most cost-effective when combined with more flexible OR
staffing and improved OR scheduling. Implications: We achieved
significant improvements in operating room efficiency by analyzing
operating room data on causes of delays, devising strategies for
minimizing the most common delays, and subsequently measuring delay
data. Personal accountability, streamlining
ARTICLE TITLE: Unsuccessful resuscitation under hypotensive
epidural anesthesia during elective hip arthroplasty.
ARTICLE SOURCE: Anesth Analg (United States), Apr 1998, 86(4)
p847-9
AUTHOR(S): Heidegger T; Kreienbuhl G
AUTHOR'S ADDRESS: Department of Anesthesiology, Kantonsspital St.
Gallen, Switzerland.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: A comparison of the efficacy, safety, and patient
satisfaction of ondansetron versus droperidol as antiemetics for
elective outpatient surgical procedures. S3A-409 and S3A-410 Study
Groups.
ARTICLE SOURCE: Anesth Analg (United States), Apr 1998, 86(4)
p731-8
AUTHOR(S): Fortney JT; Gan TJ; Graczyk S; Wetchler B; Melson T;
Khalil S; McKenzie R; Parrillo S; Glass PS; Moote C; Wermeling D;
Parasuraman TV; Duncan B; Creed MR
AUTHOR'S ADDRESS: Department of Anesthesiology, Duke University,
Durham, North Carolina 27710, USA.
There were no significant differences between ondansetron and either
droperidol dose for emesis prevention during the 0 to 24 h
postoperative period. Implications: More than 2000 patients at high
risk of postoperative nausea and vomiting were given either placebo,
ondansetron 4 mg, or droperidol 0.625 mg or 1.25 mg i.v. before the
administration of general anesthesia. After surgery, the incidence of
nausea, vomiting, medication side effects, and patient satisfaction
were evaluated for 24 h. Droperidol 0.625 or 1.25 mg i.v. compared
favorably with ondansetron 4 mg i.v. for the prevention of
postoperative nausea and vomiting after ambulatory surgery.
ARTICLE TITLE: Endogenous heparin-like substances significantly
impair coagulation in patients undergoing orthotopic liver
transplantation.
ARTICLE SOURCE: Anesth Analg (United States), Apr 1998, 86(4)
p691-5
AUTHOR(S): Kettner SC; Gonano C; Seebach F; Sitzwohl C; Acimovic S;
Stark J; Schellongowski A; Blaicher A; Felfernig M; Zimpfer M
AUTHOR'S ADDRESS: Department of Anesthesiology and General Intensive
Care, University of Vienna, Austria.
stephan.kettner@akh-wien.ac.at.
PUBLICATION TYPE: JOURNAL ARTICLE
Administration of coagulation factors is the usual treatment of
coagulopathies during OLT. The comparison of native versus
heparinase-modified TEG can distinguish between heparin activity or
coagulation factor deficiency as a cause of bleeding complications
and provides a rational approach to the treatment of bleeding during
OLT. Implications: Impaired coagulation function, contributed to by
heparin or heparin-like substances, is frequently observed after
reperfusion of a transplanted liver. This study demonstrates that a
heparinase-modified thrombelastography can identify significant
heparin effects in the absence of exogenous heparin administration in
patients undergoing liver transplantation.
ARTICLE TITLE: Patient-controlled versus
anesthesiologist-controlled conscious sedation with propofol for
dental treatment in anxious patients.
ARTICLE SOURCE: Anesth Analg (United States), May 1998, 86(5)
p967-72
AUTHOR(S): Oei-Lim VL; Kalkman CJ; Makkes PC; Ooms WG
AUTHOR'S ADDRESS: Department of Anesthesiology, Academic Medical
Center, University of Amsterdam, The Netherlands.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
Implications: In a randomized, cross-over study, the blood propofol
concentrations necessary to achieve conscious sedation in anxious
dental patients using a target-controlled infusion conducted by the
anesthesiologist versus patient-controlled sedation were not
different. With the patient-controlled sedation settings, a
satisfactory level of conscious sedation and a high level of patient
satisfaction were achieved.
ARTICLE TITLE: The arterial to end-tidal carbon dioxide gradient
increases with uncorrected but not with temperature-corrected PaCO2
determination during mild to moderate hypothermia.
ARTICLE SOURCE: Anesth Analg (United States), May 1998, 86(5)
p1131-6
AUTHOR(S): Sitzwohl C; Kettner SC; Reinprecht A; Dietrich W; Klimscha
W; Fridrich P; Sladen RN; Illievich UM
AUTHOR'S ADDRESS: Department of Anesthesiology and General Intensive
Care, University of Vienna, Austria.
PUBLICATION TYPE: JOURNAL ARTICLE
Implications: We investigated the impact of induced hypothermia (36
degrees C-32 degrees C) on the gradient between PaCO2 and PETCO2
(PA-ETCO2). The PA-ETCO2 increased 2.5-fold when CO2 determinations
were not temperature-corrected. Hypothermia should be added to the
differential diagnosis of an increased PA-ETCO2 when the alpha-stat
acid-base regimen is used.
ARTICLE TITLE: Rapid development of tolerance to analgesia during
remifentanil infusion in humans.
ARTICLE SOURCE: Anesth Analg (United States), Jun 1998, 86(6)
p1307-11
AUTHOR(S): Vinik HR; Kissin I
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Alabama
at Birmingham, USA. ronald.vinik@ccc.uab.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: We conclude that the development of tolerance should be
included in the calculations for target-controlled infusions.
Implications: Our study shows that tolerance to analgesia during
remifentanil infusion is profound and develops very rapidly. The
administration of opioids during anesthesia based on
target-controlled infusions should include corrections for the
development of tolerance.
ARTICLE TITLE: Spinal and epidural blockade and perioperative low
molecular weight heparin: smooth sailing on the Titanic
[editorial]
ARTICLE SOURCE: Anesth Analg (United States), Jun 1998, 86(6)
p1153-6
AUTHOR(S): Horlocker TT; Wedel DJ
ARTICLE TITLE: Perioperative cost-finding analysis of the routine
use of intraoperative forced-air warming during general
anesthesia.
ARTICLE SOURCE: Anesthesiology (United States), May 1998, 88(5)
p1357-64
AUTHOR(S): Fleisher LA; Metzger SE; Lam J; Harris A
AUTHOR'S ADDRESS: Department of Anesthesiology, Johns Hopkins Medical
Institutions, Baltimore, Maryland, USA.
lfleishe@welchlink.welch.jhu.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: BACKGROUND: Despite the well-documented ability of
forced-air warming (FAW) to maintain normothermia, it is unclear
whether this technique results in a net increase or decrease in
costs. RESULTS: The time from completion of surgical dressing until
tracheal extubation was significantly reduced in the FAW group (10
+/- 1 min compared with 14 +/- 1 min; mean +/- SEM; P 0.01). There
was no demonstrable difference in attainment of postanesthesia care
unit discharge criteria between the two groups, although the FAW
group used one less cotton blanket there. The net savings related to
the use of the FAW depends on the percentage of the intraoperative
costs that are fixed rather than variable ($15 additional for FAW if
all costs are fixed compared with $29 savings if all costs were
variable). CONCLUSIONS: Routine intraoperative FAW significantly
reduced time until extubation and use of cotton blankets in the
postanesthesia care unit. These results suggest that the influence of
FAW on net total perioperative costs depends on patient and surgical
characteristics and institutional factors related to cost
accounting.
ARTICLE TITLE: Metabolic changes during recovery in normothermic
versus hypothermic patients undergoing surgery and receiving general
anesthesia and epidural local anesthetic agents.
ARTICLE SOURCE: Anesthesiology (United States), May 1998, 88(5)
p1211-8
AUTHOR(S): Motamed S; Klubien K; Edwardes M; Mazza L; Carli F
AUTHOR'S ADDRESS: Department of Anesthesia, McGill University,
Montreal, Quebec, Canada.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: BACKGROUND: Mild hypothermia is accompanied by metabolic
changes. Epidural local anesthetic agents attenuate the surgical
stress response, but it is not known whether they modulate thermal
stress. RESULTS: Core and mean skin temperatures decreased
significantly in the control group (P 0.001) but not in the warmed
group. Catecholamine concentrations in plasma decreased significantly
after epidural block, and although concentration of epinephrine in
plasma increased from baseline sharply in the control group at the
end of surgery (P = 0.004), it decreased in the warmed group (P =
0.007). During recovery, there was no difference between the two
groups for norepinephrine concentrations in plasma, body
weight-adjusted oxygen consumption, pain visual analogue score, and
metabolites. CONCLUSIONS: The postoperative metabolic changes
obtained with epidural block were similar except for an attenuated
concentration of epinephrine in normothermic patients compared with
those who were mildly hypothermic.
ARTICLE TITLE: Early extubation following cardiac surgery in a
veterans population [see comments]
COMMENTS: Comment in: Anesthesiology 1998 Jun; 88(6):1429-33
ARTICLE SOURCE: Anesthesiology (United States), Jun 1998, 88(6)
p1447-58
AUTHOR(S): London MJ; Shroyer AL; Coll JR; Ma Whinney S; Fullerton
DA; Hammermeister KE; Grover FL
AUTHOR'S ADDRESS: University of Colorado Health Sciences
Center/Denver Veterans Affairs Medical Center, 80220, USA.
martin.london@uchsc.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
CONCLUSIONS: In this population, early tracheal extubation was
accomplished in 48% of patients. Intraoperative clinical process
variables are important factors to be considered in the timing of
postoperative extubation after fast track cardiac surgery.
ARTICLE TITLE: Fast track cardiac surgery pathways: early
extubation, process of care, and cost containment [editorial;
comment]
COMMENTS: Comment on: Anesthesiology 1998 Jun; 88(6):1437-46; Comment
on: Anesthesiology 1998 Jun; 88(6):1447-58
ARTICLE SOURCE: Anesthesiology (United States), Jun 1998, 88(6)
p1429-33
AUTHOR(S): Cheng DC
ARTICLE TITLE: Trainees' attitudes to research as part of
anaesthetic training.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Feb 1998, 26(1)
p92-5
AUTHOR(S): Kluger MT
AUTHOR'S ADDRESS: Department of Anaesthesia, Auckland Hospital, New
Zealand.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: The formal project has been a requirement for the
F.A.N.Z.C.A. diploma for the past few years. A questionnaire was sent
to all registrars on a formal program asking questions relating to
the formal project, perceived advantages, disadvantages, value of
formal research teaching methodology and future career intentions.
All years of training were represented. Forty-nine of the fifty-six
(86%) respondents replied to the survey. Of these 15% felt the formal
project had no value, 54% found it possibly useful whilst 31%
perceived is as very useful. Advantages of the formal project
included appreciation of research skills and the ability to
critically appraise research. Disadvantages included lack of
dedicated time, space and funding and production of poor quality
research. A majority (63%) favoured formal teaching of research
methods for the F.A.N.Z.C.A. diploma, which ideally should be taught
before the Primary (30%) or in the Provisional Fellowship year (36%).
Few respondents indicated a willingness to undertake a major
commitment to research in the future (4%) but 46% wanted some contact
with research and teaching as part of their normal work practice. A
more structured teaching in research methodology, assessment of
published work and presentation skills may be more suited to the
longterm goals of the majority of clinical anaesthetists.
ARTICLE TITLE: The physician workforce and financing of graduate
medical education. American College of Physicians.
ARTICLE SOURCE: Ann Intern Med (United States), Jan 15 1998, 128(2)
p142-8
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: This paper addresses key issues concerning the physician
workforce and the financing of graduate medical education. The
American College of Physicians recommends the establishment of a
national advisory organization to develop a coherent and coordinated
national policy on the health professions workforce. Given the
increasing oversupply of physicians, the College recommends that no
new medical schools be created, that total enrollment in U.S. medical
schools not increase, and that the number of international medical
graduates entering residency training in the United States be
restricted. All health care payers should share the cost of graduate
medical education, funding should be predictable and stable, and
funding should include ambulatory training sites. The number of
first-year residents should be linked more closely to the annual
number of medical graduates in the United States, and Medicare
payments for medical education and training should be made only to
the health maintenance organizations that actually incur these costs.
The College advises that hospitals providing care primarily to
underserved populations and indigent persons need stable funding with
which to pay for personnel to replace residents. The College calls
for research to evaluate the feasibility of establishing a voucher
system, in which each resident would receive payment authorization
certificates to fund training at accredited residency sites.
Additional research is also recommended to distinguish the individual
costs involved in graduate medical education from other costs
associated with graduate medical education and the costs of care of
indigent persons.
ARTICLE TITLE: Management of chronic stable angina: medical
therapy, percutaneous transluminal coronary angioplasty, and coronary
artery bypass graft surgery. Lessons from the randomized trials.
ARTICLE SOURCE: Ann Intern Med (United States), Feb 1 1998, 128(3)
p216-23
AUTHOR(S): Solomon AJ; Gersh BJ
AUTHOR'S ADDRESS: Georgetown University Medical Center, Division of
Cardiology, Washington, DC 20007, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (35 references); REVIEW,
TUTORIAL
ABSTRACT: PURPOSE: To review the available data on the treatment of
chronic stable angina and formulate a rational approach to the use of
pharmacologic therapy, percutaneous transluminal coronary angioplasty
(PTCA), and coronary artery bypass graft surgery (CABG). DATA
SOURCES: A MEDLINE search of English-language literature published
between 1976 and 1996 and the bibliographies of relevant articles.
CONCLUSIONS: In low-risk patients, a strategy of initial medical
therapy is reasonable. In moderate-risk patients, PTCA and CABG
produce similar mortality rates and rates of myocardial infarction
but PTCA-treated patients require more revascularization procedures.
In high-risk patients, CABG is usually preferred.
ARTICLE TITLE: Renal dysfunction after myocardial
revascularization: risk factors, adverse outcomes, and hospital
resource utilization. The Multicenter Study of Perioperative Ischemia
Research Group.
ARTICLE SOURCE: Ann Intern Med (United States), Feb 1 1998, 128(3)
p194-203
AUTHOR(S): Mangano CM; Diamondstone LS; Ramsay JG; Aggarwal A;
Herskowitz A; Mangano DT
AUTHOR'S ADDRESS: Stanford University School of Medicine, Department
of Anesthesia, CA 94305-5115, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; MULTICENTER STUDY
ABSTRACT: BACKGROUND: Acute changes in renal function after elective
coronary bypass surgery are incompletely characterized and represent
a challenging clinical problem. OBJECTIVE: To determine the incidence
and characteristics of postoperative renal dysfunction SETTING: 24
university hospitals. PATIENTS: 2222 patients having myocardial
revascularization with or without concurrent valvular surgery.
MEASUREMENTS: Multivariable analysis identified five independent
preoperative predictors of renal dysfunction: age 70 to 79 years
(relative risk [RR], 1.6 [95% CI, 1.1 to 2.3]) or age
80 to 95 years (RR, 3.5 [CI, 1.9 to 6.3]); congestive heart
failure (RR, 1.8 [CI, 1.3 to 2.6]); previous myocardial
revascularization (RR, 1.8 [CI, 1.2 to 2.7]); type 1 diabetes
mellitus (RR, 1.8 [CI, 1.1 to 3.0]) or preoperative serum
glucose levels exceeding 16.6 mmol/L (RR, 3.7 [CI, 1.7 to
7.8]); and preoperative serum creatinine levels of 124 to 177
mumol/L (RR, 2.3 [CI, 1.6 to 3.4]). Independent perioperative
factors that exacerbated risk were cardiopulmonary bypass lasting 3
or mor hours and three measures of ventricular dysfunction.
ARTICLE TITLE: United Kingdom Prospective Diabetes Study 24: a
6-year, randomized, controlled trial comparing sulfonylurea, insulin,
and metformin therapy in patients with newly diagnosed type 2
diabetes that could not be controlled with diet therapy. United
Kingdom Prospective Diabetes Study Group.
ARTICLE SOURCE: Ann Intern Med (United States), Feb 1 1998, 128(3)
p165-75
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Because initial insulin therapy induced more
hypoglycemic reactions and weight gain without necessarily providing
better control, it may be reasonable to start with oral agents and
change to insulin if goals for glycemic levels are not achieved.
ARTICLE TITLE: Transesophageal echocardiography and atrial
fibrillation: added value or expensive toy? [editorial;
comment]
COMMENTS: Comment on: Ann Intern Med 1998 Apr 15; 128(8):630-8;
Comment on: Ann Intern Med 1998 Apr 15; 128(8):639-47
ARTICLE SOURCE: Ann Intern Med (United States), Apr 15 1998, 128(8)
p685-7
AUTHOR(S): Manning WJ; Douglas PS
ARTICLE TITLE: Transesophageal echocardiography to assess embolic
risk in patients with atrial fibrillation. ELAT Study Group. Embolism
in Left Atrial Thrombi [see comments]
COMMENTS: Comment in: Ann Intern Med 1998 Apr 15; 128(8):685-7
ARTICLE SOURCE: Ann Intern Med (United States), Apr 15 1998, 128(8)
p630-8
AUTHOR(S): Stollberger C; Chnupa P; Kronik G; Brainin M; Finsterer J;
Schneider B; Slany J
AUTHOR'S ADDRESS: Ustav kardiovaskularnych chorob, Bratislava,
Slovakia.
PUBLICATION TYPE: JOURNAL ARTICLE
BACKGROUND: Transesophageal echocardiography visualizes the left
atrium and its appendage, thrombi, and spontaneous echocardiographic
contrast.CONCLUSIONS: In outpatients with atrial fibrillation and
without recent stroke, thrombi of the left atrium or left atrial
appendage and length and width of the left atrial appendage were
associated with stroke or embolism in univariate analysis. In a
multivariate analysis, age, hypertension, and previous stroke were
risk factors for stroke or embolism, and thrombi of the left atrium
or left atrial appendage were possible risk factors. In these
patients, history may be more useful than transesophageal
echocardiography for the assessment of embolic risk.
ARTICLE TITLE: Have we treated AIDS too well? Rationing and the
future of AIDS exceptionalism.
ARTICLE SOURCE: Ann Intern Med (United States), May 1 1998, 128(9)
p756-9
AUTHOR(S): Casarett DJ; Lantos JD
AUTHOR'S ADDRESS: University of Iowa Hospitals and Clinics, Iowa City
52242, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (29 references); REVIEW,
TUTORIAL
ABSTRACT: During the past decade, medical therapy for AIDS has become
more effective but also prohibitively expensive. A medical tragedy
has been transformed into a financial crisis, and society has
responded by establishing special programs and sources of funding for
AIDS. These maneuvers parallel earlier approaches to HIV testing and
reporting that have collectively come to be known as
'exceptionalism.' This paper suggests that exceptionalism in resource
allocation is a fragile, short-term solution. In the long run, AIDS
exceptionalism will create growing injustice and should be avoided.
However, we should not eliminate the advances that this
exceptionalism has already achieved. Instead, we need a working
dialogue between these advances and public policy.
ARTICLE TITLE: Low-molecular-weight heparins in the treatment of
venous thromboembolism [editorial]
ARTICLE SOURCE: Ann Intern Med (United States), Jun 15 1998, 128(12
Pt 1) p1037-9
AUTHOR(S): Koopman MM; Buller HR
ARTICLE TITLE: On the death of house officers.
ARTICLE SOURCE: Ann Intern Med (United States), Jun 1 1998, 128(11)
p949-50
AUTHOR(S): Fitzgerald F; Murray TJ
AUTHOR'S ADDRESS: Department of Medicine, University of California,
Davis, School of Medicine, Sacramento 95817, USA.
ARTICLE TITLE: Guidelines for surgical procedures after liver
transplantation.
ARTICLE SOURCE: Ann Surg (United States), Apr 1998, 227(4) p590-9
AUTHOR(S): Testa G; Goldstein RM; Toughanipour A; Abbasoglu O;
Jeyarajah R; Levy MF; Husberg BS; Gonwa TA; Klintmalm GB
AUTHOR'S ADDRESS: Baylor University Medical Center, Transplant
Department, Dallas, Texas 75246, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: OBJECTIVE: The first purpose of this study is to identify
the types and incidences of surgical procedures in patients who have
previously undergone liver transplantation, with particular focus on
the complication rates and the lengths of hospital stay. RESULTS: A
large proportion of patients (24.2%) underwent some type of surgical
procedure 2 to 10 years after liver transplantation. The authors
demonstrate that most of the elective procedures can be safely
carried out without an increased incidence of complication and
without longer hospital stay than the general population. Conversely,
emergent procedures are plagued by a greater incidence of
complications that not only affect the function of the liver graft
but may risk the life of the patient.
ARTICLE TITLE: "Renal dose" dopamine in surgical patients: dogma
or science?
ARTICLE SOURCE: Ann Surg (United States), Apr 1998, 227(4) p470-3
AUTHOR(S): Perdue PW; Balser JR; Lipsett PA; Breslow MJ
AUTHOR'S ADDRESS: Department of Surgery, Johns Hopkins University
School of Medicine, Baltimore, Maryland, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (38 references); REVIEW,
TUTORIAL
OBJECTIVE: "Renal dose" dopamine is widely used in the perioperative
period to provide renal protection. RESULTS: Studies of the
perioperative use of dopamine fail to demonstrate any benefit of
dopamine in preventing renal failure. Studies in congestive heart
failure, critical illness, and sepsis also fail to show any benefit
of dopamine other than diuresis. Further, dopamine administration is
not completely without risk, because of dopamine's catecholamine and
neuroendocrine functions. CONCLUSIONS: Routine use of prophylactic
"renal dose" dopamine in surgical patients is not recommended.
ARTICLE TITLE: Aprotinin versus lysine analogues: the debate
continues.
ARTICLE SOURCE: Ann Thorac Surg (United States), Apr 1998, 65(4
Suppl) pS9-19; discussion S27-8
AUTHOR(S): Royston D
AUTHOR'S ADDRESS: Department of Cardiothoracic Anesthesia, Harefield
Hospital, Middlesex, England.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (94 references); REVIEW,
ACADEMIC
ABSTRACT: The decision to use any pharmacologic intervention
inevitably rests on balancing the efficacy and safety of the
intervention. The advent of the acquired immunodeficiency syndrome
epidemic greatly increased awareness of transfusion-related illnesses
and focused attention on methods to prevent the need for blood and
blood products. There is, however, no obvious or consistent reduction
in the transfusion of blood and blood products in patients given
lysine analogues. In contrast, there is a consistent reduction in the
need for blood transfusions in patients given aprotinin therapy. The
next major section will discuss the evidence to suggest that these
drugs may, because of their known effects on the processes related to
inflammation, hemostasis, and cellular repair, contribute to an
improvement or worsening of outcome after cardiac operations. These
effects may be related to improved outcome in patients by reducing
the incidence of permanent neurologic deficit or stroke after heart
operations, as well as inhibiting pulmonary vascular hyperreactivity
and hypertension in susceptible individuals. Finally, this brief
review discusses the safety issues that have been raised in regard to
each of these classes of agents, specifically problems associated
with abnormal renal function, hypersensitivity reactions, and
thrombotic complications.
ARTICLE TITLE: Brain damage during cardiopulmonary bypass.
ARTICLE SOURCE: Ann Thorac Surg (United States), Apr 1998, 65(4
Suppl) pS20-6; discussion S27-8
AUTHOR(S): Taylor KM
AUTHOR'S ADDRESS: National Heart and Lung Institute, Imperial College
of Science, Technology and Medicine at Hammersmith Hospital, London,
England.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (26 references); REVIEW,
TUTORIAL
ABSTRACT: Indeed, it is fair to say that the period of bypass still
contributes to significant morbidity in most patients. In particular,
cerebral injury, the focus of this review, is a significant problem
for patients and their caregivers and for funding of health-care
systems. Incidence rates for stroke are around 2% to 3%, with
increased risk in elderly patients and other high-risk groups. The
incidence of cognitive defects is as high as 60% at 8 days
postoperative with reduction to 25% to 30% incidence at 8 weeks and
12 months. There are a variety of ways, at least potentially, in
which the brain may be injured during an operation with
cardiopulmonary bypass, including reduced cerebral blood flow,
microembolism and macroembolism, and a systemic inflammatory
response. These mechanisms interrelate and produce synergistic,
cumulative effects on brain function during and after the operation.
Reducing the incidence and effects of this altered brain function
will rely on both preventive and therapeutic strategies. These, in
turn, must be based on an understanding of the pathophysiology of
these mechanisms of cerebral injury and directed toward ways to
optimize cerebral perfusion, minimize embolic vascular occlusion, and
develop pharmacologic approaches to modify the systemic inflammatory
response.
ARTICLE TITLE: Management of bleeding complications in redo
cardiac operations.
ARTICLE SOURCE: Ann Thorac Surg (United States), Apr 1998, 65(4
Suppl) pS2-8; discussion S27-8
AUTHOR(S): Smith CR
AUTHOR'S ADDRESS: Division of Cardiothoracic Surgery,
Columbia-Presbyterian Medical Center, New York, New York 10032,
USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (29 references); REVIEW,
TUTORIAL
ABSTRACT: A recent study specifically sought to identify the presence
of disseminated microvascular platelet-fibrin thrombi present at
autopsy in patients who had received aprotinin therapy. The study
concluded that diffuse platelet-fibrin thrombi were not a direct
complication of aprotinin therapy. Finally, modern molecular biology
has led to the recent development of an inhibitor for factor IXa that
competitively replaced IXa in the intrinsic complex and blocked the
conversion of factor X to factor Xa. This compound is under
investigation in animal studies. These have so far shown efficacy in
reducing blood loss after bypass in comparison with standard heparin
anticoagulation.
ARTICLE TITLE: Jugular venous bulb oxygen saturation depends on
blood pressure during cardiopulmonary bypass.
ARTICLE SOURCE: Ann Thorac Surg (United States), Mar 1998, 65(3)
p653-7; discussion 658
AUTHOR(S): Grubhofer G; Lassnigg AM; Schneider B; Rajek MA;
Pernerstorfer T; Hiesmayr MJ
AUTHOR'S ADDRESS: Department of Cardiothoracic and Vascular
Anesthesia and Intensive Care, University Clinic, Vienna, Austria.
georg.grubhofer@univie.ac.at.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Because cerebral autoregulation is impaired during
cardiopulmonary bypass, phenylephrine is effective in increasing the
cerebral blood flow and may contribute to the prevention of
postoperative neurologic dysfunction, especially in patients who have
a low jugular venous bulb oxygen saturation.
ARTICLE TITLE: Anesthetic technique influences brain temperature
during cardiopulmonary bypass in dogs.
ARTICLE SOURCE: Ann Thorac Surg (United States), Feb 1998, 65(2)
p454-60
AUTHOR(S): Wass CT; Cable DG; Schaff HV; Lanier WL
AUTHOR'S ADDRESS: Department of Anesthesiology, Mayo Clinic and Mayo
Medical School, Rochester, Minnesota 55905, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Deep barbiturate anesthesia resulted in a brain-to-core
temperature gradient during CPB that was of a magnitude greater than
the 1 degrees C previously reported to modulate ischemic neurologic
injury. We speculate that the timely administration of barbiturates
(eg, during the latter stages of CPB) may be useful as part of a
cerebroprotective regimen in humans undergoing CPB, in part because
the barbiturates influence brain temperature.
ARTICLE TITLE: Diuretic-based treatment and cardiovascular events
in patients with mild renal dysfunction enrolled in the systolic
hypertension in the elderly program.
ARTICLE SOURCE: Arch Intern Med (United States), Jun 22 1998, 158(12)
p1340-5
AUTHOR(S): Pahor M; Shorr RI; Somes GW; Cushman WC; Ferrucci L;
Bailey JE; Elam JT; Applegate WB
AUTHOR'S ADDRESS: Department of Preventive Medicine, University of
Tennessee, College of Medicine, Memphis 38105, USA.
mpahor@utmem1.utmem.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSION: Diuretic-based treatment of patients with isolated
systolic hypertension prevents the development of cardiovascular
events in older persons with mild renal dysfunction.
ARTICLE TITLE: Effective lipid modification by partial ileal
bypass reduced long-term coronary heart disease mortality and
morbidity: five-year posttrial follow-up report from the POSCH.
Program on the Surgical Control of the Hyperlipidemias.
ARTICLE SOURCE: Arch Intern Med (United States), Jun 8 1998, 158(11)
p1253-61
AUTHOR(S): Buchwald H; Varco RL; Boen JR; Williams SE; Hansen BJ;
Campos CT; Campbell GS; Pearce MB; Yellin AE; Edmiston WA; Smink RD
Jr; Sawin HS Jr
AUTHOR'S ADDRESS: Department of Surgery, University of Minnesota,
Minneapolis 55455, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
BACKGROUND: In 1990, when the Program on the Surgical Control of the
Hyperlipidemias (POSCH) reported its in-trial results strongly
supporting the conclusion that effective lipid modification reduces
progression of atherosclerosis, the differences for the end points of
overall mortality and mortality from atherosclerotic coronary heart
disease (ACHD) did not reach statistical significance. CONCLUSION: At
5 years after the trial, all POSCH mortality and atherosclerosis end
points, including overall mortality and mortality from ACHD,
demonstrated statistically significant differences between the study
groups.
ARTICLE TITLE: Elderly patients receive less aggressive medical
and invasive management of unstable angina: potential impact of
practice guidelines.
ARTICLE SOURCE: Arch Intern Med (United States), May 25 1998, 158(10)
p1113-20
AUTHOR(S): Giugliano RP; Camargo CA Jr; Lloyd-Jones DM; Zagrodsky JD;
Alexis JD; Eagle KA; Fuster V; O'Donnell CJ
AUTHOR'S ADDRESS: Cardiac Unit, Massachusetts General Hospital,
Harvard Medical School, Boston, USA.
rgiugliano@rics.bwh.harvard.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Older patients were less likely to receive standard
therapies for unstable angina before release of the 1994 AHCPR
guideline. Patients presenting with congestive heart failure also
received care that was more discordant with guideline
recommendations. The AHCPR guideline allows identification of
patients who receive nonstandard care and, if applied to those
patients with the greatest likelihood to benefit, could lead to
improved health care delivery.
ARTICLE TITLE: Accuracy of an automated blood pressure device in
stable inpatients: optimum vs routine use.
ARTICLE SOURCE: Arch Intern Med (United States), Apr 13 1998, 158(7)
p714-21
AUTHOR(S): Shuler CL; Allison N; Holcomb S; Harlan M; McNeill J;
Robinett G; Bagby SP
AUTHOR'S ADDRESS: Medical Center/Portland Division, Department of
Veterans Affairs, OR 97207, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
BACKGROUND: Despite widespread use of the automated blood pressure
(BP) device (IVAC model 4200, IVAC Corporation, San Diego, Calif),
there is little formal validation in the literature on its accuracy.
CONCLUSIONS: The IVAC 4200 yields substandard estimates of systolic
and diastolic BP even under standardized, thus optimum conditions.
The presence of arrhythmias or low K5 values and the selection of
inappropriate cuff size by the ward staff also contributed to
inaccuracy.
ARTICLE TITLE: Decrease in ventilation time with a standardized
weaning process.
ARTICLE SOURCE: Arch Surg (United States), May 1998, 133(5) p483-8;
discussion 488-9
AUTHOR(S): Horst HM; Mouro D; Hall-Jenssens RA; Pamukov N
AUTHOR'S ADDRESS: Department of Surgery, Henry Ford Hospital,
Detroit, Mich 48202, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: Protocol-guided weaning from mechanical ventilation leads
to more rapid extubation than physician-directed weaning and has
great potential for cost savings.
ARTICLE TITLE: Reexploration for hemorrhage following coronary
artery bypass grafting: incidence and risk factors. Northern New
England Cardiovascular Disease Study Group.
ARTICLE SOURCE: Arch Surg (United States), Apr 1998, 133(4)
p442-7
AUTHOR(S): Dacey LJ; Munoz JJ; Baribeau YR; Johnson ER; Lahey SJ;
Leavitt BJ; Quinn RD; Nugent WC; Birkmeyer JD; O'Connor GT
AUTHOR'S ADDRESS: Department of Surgery, Dartmouth-Hitchcock Medical
Center, Lebanon, NH, USA. lawrence.j.dacey@hitchcock.org.
PUBLICATION TYPE: JOURNAL ARTICLE; MULTICENTER STUDY
CONCLUSIONS: Hemorrhage requiring reexploration after CABG is
associated with markedly increased mortality and length of stay.
Patients predicted to have increased risks of bleeding may benefit
from prophylactic use of aprotinin, aminocaproic acid, or other
agents shown to reduce hemorrhage.
ARTICLE TITLE: Preemptive pain control in patients having
laparoscopic hernia repair: a comparison of ketorolac and
ibuprofen.
ARTICLE SOURCE: Arch Surg (United States), Apr 1998, 133(4)
p432-7
AUTHOR(S): Mixter CG 3rd; Meeker LD; Gavin TJ
AUTHOR'S ADDRESS: Department of Surgery, Exeter Hospital, NH,
USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: Pain relief from ibuprofen, 800 mg, administered orally
an hour before laparoscopic hernia repair was not statistically
different from that obtained with intravenous ketorolac, 60 mg,
administered intraoperatively when comparing the hospital discharge
pain score and the mean and highest pain scores 18 hours after
discharge. Ibuprofen offers equivalent pain control at a lower cost
and reduced potential for adverse drug events compared with
intravenous ketorolac in patients having laparoscopic hernia repair.
No patient required narcotic supplementation, and pain control was
judged satisfactory by all the patients.
ARTICLE TITLE: Two hundred one consecutive living-donor
nephrectomies.
ARTICLE SOURCE: Arch Surg (United States), Apr 1998, 133(4)
p426-31
AUTHOR(S): Shaffer D; Sahyoun AI; Madras PN; Monaco AP
AUTHOR'S ADDRESS: Division of Organ Transplantation, Beth Israel
Deaconess Medical Center and Harvard Medical School, Boston, Mass
02215, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Living-donor nephrectomy is associated with low surgical
morbidity. Recent trends include shortened lengths of stay in the
hospital, the use of computed tomographic angiography instead of
digital subtraction angiography for preoperative imaging of donor
vascular anatomy, and an expanded use of unrelated living donors.
ARTICLE TITLE: Left ventricular filling pressures during exercise:
a cardiological blind spot?
ARTICLE SOURCE: Chest (United States), Jun 1998, 113(6) p1695-7
AUTHOR(S): West JB
AUTHOR'S ADDRESS: Department of Medicine, University of California
San Diego, La Jolla, USA.
ARTICLE TITLE: Early extubation following coronary artery bypass
surgery: a prospective randomized controlled trial. The Fast Track
Cardiac Care Team.
ARTICLE SOURCE: Chest (United States), Jun 1998, 113(6) p1481-8
AUTHOR(S): Silbert BS; Santamaria JD; O'Brien JL; Blyth CM; Kelly WJ;
Molnar RR
AUTHOR'S ADDRESS: Department of Anaesthesia, St. Vincent's Hospital,
Melbourne, Victoria, Australia.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
STUDY OBJECTIVES: To determine the safety of early extubation (EE)
after coronary artery surgery. CONCLUSIONS: By using an appropriate
anesthetic technique and postoperative management, EE can be achieved
following coronary artery bypass surgery without major
complications.
ARTICLE TITLE: Physiology of lung resection: no rules, just...Rx
[editorial; comment]
COMMENTS: Comment on: Chest 1998 Jun; 113(6):1511-6
ARTICLE SOURCE: Chest (United States), Jun 1998, 113(6) p1438-9
AUTHOR(S): Olsen GN
ARTICLE TITLE: The assault on the Swan-Ganz catheter: a case
history of constrained technology, constrained bedside clinicians,
and constrained monetary expenditures.
ARTICLE SOURCE: Chest (United States), May 1998, 113(5) p1379-86
AUTHOR(S): Weil MH
AUTHOR'S ADDRESS: Institute of Critical Care Medicine, Palm Springs,
Calif 92262-6167, USA.
ARTICLE TITLE: Pathophysiology of cardiac tamponade.
ARTICLE SOURCE: Chest (United States), May 1998, 113(5) p1372-8
AUTHOR(S): Spodick DH
AUTHOR'S ADDRESS: Cardiology Division, Saint Vincent Hospital,
University of Massachusetts Medical School, Worcester, USA.
ARTICLE TITLE: A scandalous incompetence...continued
[editorial; comment]
COMMENTS: Comment on: Chest 1998 May; 113(5):1175-7
ARTICLE SOURCE: Chest (United States), May 1998, 113(5) p1153-4
AUTHOR(S): Reichman LB
ARTICLE TITLE: It's not "just a virus" anymore
[editorial]
ARTICLE SOURCE: Chest (United States), Apr 1998, 113(4) p859-60
AUTHOR(S): Judson MA
MAJOR SUBJECT HEADING(S): Lung Transplantation;
ARTICLE TITLE: Preoperative smoking reduction: all or nothing at
all? [editorial; comment]
COMMENTS: Comment on: Chest 1998 Apr; 113(4):856-8
ARTICLE SOURCE: Chest (United States), Apr 1998, 113(4) p856-8
AUTHOR(S): Lillington GA; Sachs DP
ARTICLE TITLE: Right ventricular end-diastolic volume as a
predictor of the hemodynamic response to a fluid challenge.
ARTICLE SOURCE: Chest (United States), Apr 1998, 113(4) p1048-54
AUTHOR(S): Wagner JG; Leatherman JW
AUTHOR'S ADDRESS: Division of Pulmonary and Critical Care Medicine,
Hennepin County Medical Center, Minneapolis, MN 55415, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
OBJECTIVE: To compare thermodilution right ventricular end-diastolic
volume index (RVEDVI) and pulmonary artery occlusion pressure (Ppao)
as predictors of the hemodynamic response to a fluid
challenge.CONCLUSION: RVEDVI was not a reliable predictor of the
response to fluid. As a predictor of fluid responsiveness, Ppao was
superior to RVEDVI. In an individual patient, adequacy of preload is
best assessed by an empiric fluid challenge.
ARTICLE TITLE: Cardiac output in 1998.
ARTICLE SOURCE: Heart (England), May 1998, 79(5) p425-8
AUTHOR(S): Singer M
AUTHOR'S ADDRESS: UCL Medical School, Department of Medicine, London,
UK. m.singer@ucl.ac.uk.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (53 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Nocturnal desaturation in patients with stable
heart failure.
ARTICLE SOURCE: Heart (England), Apr 1998, 79(4) p394-9
AUTHOR(S): Staniforth AD; Kinnear WJ; Starling R; Cowley AJ
AUTHOR'S ADDRESS: Department of Cardiovascular Medicine, Queens
Medical Centre, Nottingham, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
OBJECTIVE: To determine the prevalence of sleep disordered breathing
within a United Kingdom heart failure population. SUBJECTS: 104
patients and 21 matched normal volunteers. CONCLUSIONS: Nocturnal
desaturation is common in patients with treated heart failure. Low
ejection fraction was related to dip frequency. Lack of correlation
between dips and ESS suggests that arousal from sleep is more
important than hypoxia in the aetiology of daytime sleepiness in
heart failure. Overnight oximetry is a useful screening test for
Cheyne-Stokes respiration in patients with known heart failure.
ARTICLE TITLE: Predicting operative risk for coronary artery
surgery in the United Kingdom: a comparison of various risk
prediction algorithms.
ARTICLE SOURCE: Heart (England), Apr 1998, 79(4) p350-5
AUTHOR(S): Bridgewater B; Neve H; Moat N; Hooper T; Jones M
AUTHOR'S ADDRESS: Department of Cardiothoracic Surgery, Wythenshawe
Hospital, Manchester, UK. bbridge@nznet.gen.nz.
PUBLICATION TYPE: JOURNAL ARTICLE; MULTICENTER STUDY
OBJECTIVE: To compare the ability of four risk models to predict
operative mortality after coronary artery bypass graft surgery (CABG)
in the United Kingdom. DESIGN: Prospective study. SETTING: Two
cardiothoracic centres in the United Kingdom. CONCLUSIONS: There are
differences between the British and American populations for CABG and
the North American algorithms are not useful for predicting mortality
in the United Kingdom. The UK Society of Cardiothoracic Surgeons
algorithm is the best of the models tested but still only has limited
predictive ability. Great care must be exercised when using methods
of this type for comparisons of units and surgeons.
ARTICLE TITLE: Analysis of deaths while waiting for cardiac
surgery among 29,293 consecutive patients in Ontario, Canada. The
Steering Committee of the Cardiac Care Network of Ontario.
ARTICLE SOURCE: Heart (England), Apr 1998, 79(4) p345-9
AUTHOR(S): Morgan CD; Sykora K; Naylor CD
AUTHOR'S ADDRESS: Department of Medicine, Sunnybrook Health Science
Centre, University of Toronto, Ontario, Canada.
PUBLICATION TYPE: JOURNAL ARTICLE; MULTICENTER STUDY
CONCLUSIONS: Patients waiting for valve surgery have a higher risk of
death than patients waiting for isolated CABG. Guidelines to promote
safer and fairer queuing for non-CABG cardiac surgery are needed.
Shorter waiting lists, better compliance with existing guidelines,
and guideline revisions to upgrade patients with left ventricular
dysfunction could generate additional reductions in the already low
risk of death for patients waiting for isolated CABG.
ARTICLE TITLE: The clinical value of ambulatory blood pressure
monitoring [editorial]
ARTICLE SOURCE: Heart (England), Feb 1998, 79(2) p115-7
AUTHOR(S): Gibbs CR; Murray S; Beevers DG
ARTICLE TITLE: Effects of lowering average of below-average
cholesterol levels on the progression of carotid atherosclerosis:
results of the LIPID Atherosclerosis Substudy. LIPID Trial Research
Group.
ARTICLE SOURCE: Circulation (United States), May 12 1998, 97(18)
p1784-90
AUTHOR(S): MacMahon S; Sharpe N; Gamble G; Hart H; Scott J; Simes J;
White H
AUTHOR'S ADDRESS: Department of Medicine, University of Auckland, New
Zealand. macmahon@ctru.auckland.ac.nz.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
BACKGROUND: Cholesterol lowering in patients with above-average
cholesterol levels has been shown to reduce the progression of
atherosclerosis and lower the risk of coronary heart disease events.
However, there has been uncertainty about the effects of cholesterol
lowering in patients with average or below-average cholesterol
levels. CONCLUSIONS: Treatment with pravastatin reduced the
development of carotid atherosclerosis among patients with coronary
heart disease and a wide range of pretreatment cholesterol levels.
Treatment with this agent prevented any detectable increase in
carotid wall thickening over 4 years of follow-up.
ARTICLE TITLE: Statin trials and goals of cholesterol-lowering
therapy [editorial; comment]
COMMENTS: Comment on: Circulation 1998 Apr 21; 97(15):1440-5; Comment
on: Circulation 1998 Apr 21; 97(15):1446-52; Comment on: Circulation
1998 Apr 21; 97(15):1453-60
ARTICLE SOURCE: Circulation (United States), Apr 21 1998, 97(15)
p1436-9
AUTHOR(S): Grundy SM
ARTICLE TITLE: Defibrillation aboard a commercial aircraft
[news]
ARTICLE SOURCE: Circulation (United States), Apr 21 1998, 97(15)
p1429-30
AUTHOR(S): Page RL; Hamdan MH; McKenas DK
ARTICLE TITLE: Cholesterol reduction yields clinical benefit:
impact of statin trials.
ARTICLE SOURCE: Circulation (United States), Mar 17 1998, 97(10)
p946-52
AUTHOR(S): Gould AL; Rossouw JE; Santanello NC; Heyse JF; Furberg
CD
AUTHOR'S ADDRESS: Merck Research Laboratories, West Point, PA 19486,
USA. goulda@merck.com.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
BACKGROUND: We determined the effect of incorporating the results of
eight recently published trials of Hmg CoA reductase inhibitors
("statins") on the conclusions from our previously published
meta-analysis regarding the clinical benefit of cholesterol
lowering.CONCLUSIONS: Adding the results from the statin trials
confirmed our original conclusion that lowering cholesterol is
clinically beneficial. The relationships (slope) between cholesterol
lowering and reduction in CHD and total mortality risk became
stronger, and the standard error of the estimated slopes decreased by
about half. Use of statins does not increase non-CHD mortality risk.
The effect of the statins on CHD and total mortality risk can be
explained by their lipid-lowering ability and appears to be directly
proportional to the degree to which they lower lipids.
ARTICLE TITLE: Beneficial effects of leukocyte depletion of
transfused blood on postoperative complications in patients
undergoing cardiac surgery: a randomized clinical trial.
ARTICLE SOURCE: Circulation (United States), Feb 17 1998, 97(6)
p562-8
AUTHOR(S): van de Watering LM; Hermans J; Houbiers JG; van den Broek
PJ; Bouter H; Boer F; Harvey MS; Huysmans HA; Brand A
AUTHOR'S ADDRESS: Department of Immunohematology and Blood Bank,
Leiden University Medical Centre, The Netherlands.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: In cardiac surgery patients, especially when more than
three blood transfusions are required, leukocyte depletion by
filtration results in a significant reduction of the postoperative
mortality that can only partially be explained by the higher
incidence of postoperative infections in the PC group.
ARTICLE TITLE: Guidelines for carotid endarterectomy: a statement
for healthcare professionals from a Special Writing Group of the
Stroke Council, American Heart Association.
ARTICLE SOURCE: Circulation (United States), Feb 10 1998, 97(5)
p501-9
AUTHOR(S): Biller J; Feinberg WM; Castaldo JE; Whittemore AD;
Harbaugh RE; Dempsey RJ; Caplan LR; Kresowik TF; Matchar DB; Toole
JF; Easton JD; Adams HP Jr; Brass LM; Hobson RW 2nd; Brott TG;
Sternau L
AUTHOR'S ADDRESS: American Heart Association, Public Information,
Dallas, TX 75231-4596, USA.
PUBLICATION TYPE: GUIDELINE; JOURNAL ARTICLE; PRACTICE GUIDELINE;
REVIEW (79 references); REVIEW, TUTORIAL
ARTICLE TITLE: Psychological risk factors for cardiac events:
could there be just one? [editorial; comment]
COMMENTS: Comment on: Circulation 1998 Jan 20; 97(2):167-73
ARTICLE SOURCE: Circulation (United States), Jan 20 1998, 97(2)
p128-9
AUTHOR(S): Carney RM
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Carotid stenting and angioplasty: a statement for
healthcare professionals from the Councils on Cardiovascular
Radiology, Stroke, Cardio-Thoracic and Vascular Surgery,
Epidemiology, and Prevention, and Clinical Cardiology, American Heart
Association.
ARTICLE SOURCE: Circulation (United States), Jan 6-13 1998, 97(1)
p121-3
AUTHOR(S): Bettmann MA; Katzen BT; Whisnant J; Brant-Zawadzki M;
Broderick JP; Furlan AJ; Hershey LA; Howard V; Kuntz R; Loftus CM;
Pearce W; Roberts A; Roubin G
PUBLICATION TYPE: GUIDELINE; JOURNAL ARTICLE; PRACTICE GUIDELINE
ARTICLE TITLE: Acute myocardial infarction in diabetes mellitus:
lessons learned from ACE inhibition [editorial]
ARTICLE SOURCE: Circulation (United States), Jan 6-13 1998, 97(1)
p12-5
AUTHOR(S): Nesto RW; Zarich S
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Ondansetron in the prophylaxis of postoperative
vomiting: a meta-analysis.
ARTICLE SOURCE: J Clin Anesth (United States), May 1998, 10(3)
p211-21
AUTHOR(S): Figueredo ED; Canosa LG
AUTHOR'S ADDRESS: Department of Anesthesia, Torrecardenas Hospital,
Almeria, Spain.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
CONCLUSIONS: While ondansetron is an effective antiemetic with
minimal adverse effects, the data obtained on the numbers needed to
be treated calculation for prophylaxis of postoperative vomiting
should be considered in future cost-effective strategies of
postoperative management.
ARTICLE TITLE: Subcutaneous morphine is superior to intrathecal
morphine for pain control in a patient with hypernephroma.
ARTICLE SOURCE: J Clin Anesth (United States), Mar 1998, 10(2)
p163-5
AUTHOR(S): Devulder JE
AUTHOR'S ADDRESS: Department of Anaesthesia-Section Pain Clinic,
University Hospital of Ghent, Belgium.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: This case report illustrates differences in analgesia
quality and morphine consumption between an intrathecal infusion and
the subcutaneous instillation of morphine in a cancer patient with
hypernephroma. Superior analgesia was obtained with a 450 mg dose of
subcutaneous morphine [i.e., visual analog scale (VAS) score
0/10] than with 10 mg intrathecal morphine/day administered at
the thoracolumbar (twelfth dorsal vertebra) level (VAS score 2/10).
If the instillation occurs at the lumbosacral level (between the last
lumbar and the first sacral vertebra), a dosage of 70 mg morphine/day
cannot induce the same pain relief as 450 mg subcutaneous morphine
(VAS score 5/10 vs. 0/10). In some cancer patients, subcutaneous
morphine offers superior pain control than intrathecal morphine.
ARTICLE TITLE: Value of mild hypothermia in patients who have
severe circulatory insufficiency even after intra-aortic balloon
pump.
ARTICLE SOURCE: J Clin Anesth (United States), Mar 1998, 10(2)
p120-5
AUTHOR(S): Yahagi N; Kumon K; Watanabe Y; Tanigami H; Haruna M;
Hayashi H; Imanaka H; Takeuchi M; Ohashi Y; Takamoto S
AUTHOR'S ADDRESS: Surgical Intensive Care Unit, National
Cardiovascular Center, Osaka, Japan.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
CONCLUSIONS: Mild hypothermia is a simple and useful procedure for
improving the circulation of postcardiac surgical patients with
severe heart failure despite the use of IABP.
ARTICLE TITLE: Management of perioperative pain in hospitalized
patients: a national survey.
ARTICLE SOURCE: J Clin Anesth (United States), Feb 1998, 10(1)
p77-85
AUTHOR(S): Carr DB; Miaskowski C; Dedrick SC; Williams GR
AUTHOR'S ADDRESS: Department of Anesthesia, New England Medical
Center and Tufts University School of Medicine, Boston, MA 02111,
USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: A survey was carried out to provide "benchmark" data on
current practices of in-hospital perioperative pain management. The
59-item survey questionnaire incorporated all key points contained in
the Agency for Health Care Policy and Research and the American
Society of Anesthesiologists published guidelines concerning
institutional policies as well as practice patterns. The
questionnaire was mailed to designated pain specialists in a sample
of 400 hospitals that were systematically stratified by bed size and
geographic region. Of the 400 questionnaires mailed, 223 (56%) were
returned. Of the 223 respondents, 85% were board-certified
anesthesiologists. There was good to excellent overall adherence to
most of the guideline recommendations; significant exceptions were
the infrequent use of nonpharmacologic techniques for pain control
and the relatively high frequency of intramuscular opioid use. In
general, large hospitals have a greater adherence to the
recommendations of the guidelines than do smaller hospitals. No
noteworthy variations in institutional policies or practice patterns
were evident. These results provide comprehensive baseline data
against which future developments in the field of perioperative pain
management can be assessed.
ARTICLE TITLE: Statistics and hypothermia [editorial]
ARTICLE SOURCE: J Neurosurg Anesthesiol (United States), Jan 1998,
10(1) p1-4
AUTHOR(S): Hartung J; Cottrell JE
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Trends in the incidence of myocardial infarction
and in mortality due to coronary heart disease, 1987 to 1994 [see
comments]
COMMENTS: Comment in: N Engl J Med 1998 Sep 24; 339(13):915-7
ARTICLE SOURCE: N Engl J Med (United States), Sep 24 1998, 339(13)
p861-7
AUTHOR(S): Rosamond WD; Chambless LE; Folsom AR; Cooper LS; Conwill
DE; Clegg L; Wang CH; Heiss G
AUTHOR'S ADDRESS: Department of Epidemiology, School of Public
Health, University of North Carolina, Chapel Hill 27599, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: From 1987 to 1994, we observed a stable or slightly
increasing incidence of hospitalization for myocardial infarction.
Nevertheless, there were significant annual decreases in mortality
from CHD. The decline in mortality in the four communities we studied
may be due largely to improvements in the treatment and secondary
prevention of myocardial infarction.
ARTICLE TITLE: Should we accept mediocrity? [letter]
ARTICLE SOURCE: N Engl J Med (United States), Aug 27 1998, 339(9)
p638
AUTHOR(S): Levenback C
ARTICLE TITLE: Beta-blockers after myocardial infarction--for few
patients, or many? [editorial; comment]
COMMENTS: Comment on: N Engl J Med 1998 Aug 20; 339(8):489-97
ARTICLE SOURCE: N Engl J Med (United States), Aug 20 1998, 339(8)
p551-3
AUTHOR(S): Radford MJ; Krumholz HM
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Effect of beta-blockade on mortality among
high-risk and low-risk patients after myocardial infarctio [see
comments]
COMMENTS: Comment in: N Engl J Med 1998 Aug 20; 339(8):551-3
ARTICLE SOURCE: N Engl J Med (United States), Aug 20 1998, 339(8)
p489-97
AUTHOR(S): Gottlieb SS; McCarter RJ; Vogel RA
AUTHOR'S ADDRESS: Department of Medicine, University of Maryland
School of Medicine, Baltimore, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: After myocardial infarction, patients with conditions
that are often considered contraindications to beta-blockade (such as
heart failure, pulmonary disease, and older age) and those with
nontransmural infarction benefit from beta-blocker therapy.
ARTICLE TITLE: A comparison of noninvasive positive-pressure
ventilation and conventional mechanical ventilation in patients with
acute respiratory failure.
ARTICLE SOURCE: N Engl J Med (United States), Aug 13 1998, 339(7)
p429-35
AUTHOR(S): Antonelli M; Conti G; Rocco M; Bufi M; De Blasi RA; Vivino
G; Gasparetto A; Meduri GU
AUTHOR'S ADDRESS: Institute of Anesthesiology and Intensive Care,
Universita La Sapienza, Policlinico Umberto I, Rome, Italy.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: In patients with acute respiratory failure, noninvasive
ventilation was as effective as conventional ventilation in improving
gas exchange and was associated with fewer serious complications and
shorter stays in the intensive care unit.
ARTICLE TITLE: Natriuretic peptides.
ARTICLE SOURCE: N Engl J Med (United States), Jul 30 1998, 339(5)
p321-8
AUTHOR(S): Levin ER; Gardner DG; Samson WK
AUTHOR'S ADDRESS: Department of Medicine, University of California,
Irvine, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (67 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Enoxaparin plus compression stockings compared with
compression stockings alone in the prevention of venous
thromboembolism after elective neurosurgery.
ARTICLE SOURCE: N Engl J Med (United States), Jul 9 1998, 339(2)
p80-5
AUTHOR(S): Agnelli G; Piovella F; Buoncristiani P; Severi P; Pini M;
D'Angelo A; Beltrametti C; Damiani M; Andrioli GC; Pugliese R; Iorio
A; Brambilla G
AUTHOR'S ADDRESS: Istituto di Medicina Interna e Medicina Vascolare,
Universita di Perugia, Italy.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Enoxaparin combined with compression stockings is more
effective than compression stockings alone for the prevention of
venous thromboembolism after elective neurosurgery and does not cause
excessive bleeding.
ARTICLE TITLE: Interpretation of blood lactate concentrations in
patients with sepsis.
ARTICLE SOURCE: Lancet (England), Sep 19 1998, 352(9132) p921-2
AUTHOR(S): Kirschenbaum LA; Astiz ME; Rackow EC
AUTHOR'S ADDRESS: Department of Medicine, St Vincent's Hospital and
Medical Center, New York Medical College, NY 10011, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Does quality of reports of randomised trials affect
estimates of intervention efficacy reported in meta-analyses?
[see comments]
COMMENTS: Comment in: Lancet 1998 Aug 22; 352(9128):590-1
ARTICLE SOURCE: Lancet (England), Aug 22 1998, 352(9128) p609-13
AUTHOR(S): Moher D; Pham B; Jones A; Cook DJ; Jadad AR; Moher M;
Tugwell P; Klassen TP
AUTHOR'S ADDRESS: Children's Hospital of Eastern Ontario Research
Institute, and Department of Epidemiology and Community Medicine,
University of Ottawa, Canada.
PUBLICATION TYPE: JOURNAL ARTICLE
INTERPRETATION: Studies of low methodological quality in which the
estimate of quality is incorporated into the meta-analyses can alter
the interpretation of the benefit of intervention, whether a scale or
component approach is used in the assessment of trial quality.
ARTICLE TITLE: Can quality of clinical trials and meta-analyses be
quantified? [comment]
COMMENTS: Comment on: Lancet 1998 Aug 22; 352(9128):609-13
ARTICLE SOURCE: Lancet (England), Aug 22 1998, 352(9128) p590-1
AUTHOR(S): Ioannidis JP; Lau J
AUTHOR'S ADDRESS: Therapeutics Research Program, DAIDS/NIAID,
National Institutes of Health, Bethesda, MD 20852, USA.
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE
ARTICLE TITLE: Acid-base.
ARTICLE SOURCE: Lancet (England), Aug 8 1998, 352(9126) p474-9
AUTHOR(S): Gluck SL
AUTHOR'S ADDRESS: Department of Medicine, Washington University
School of Medicine, St Louis, MO 63110, USA.
sgluck@imgate.wustl.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (55 references); REVIEW,
TUTORIAL
ABSTRACT: Acid-base disorders are common clinical problems resulting
from a wide variety of pathophysiological conditions, including newly
recognised acquired and genetic causes. The history and physical
examination and measurement of blood and urinary indices allow
identification of the underlying cause of these disorders in most
cases. Treatment directed at correction of electrolyte abnormalities
and the underlying cause for the disorder is essential for preventing
the acute and long-term metabolic consequences of acid-base
derangements.
TITLE: 15 years of heart-failure trials: what have we learned?
ARTICLE SOURCE: Lancet (England), Aug 1998, 352 Suppl 1 pSI29-33
AUTHOR(S): Massie BM
AUTHOR'S ADDRESS: Department of Medicine and Cardiovascular Research
Institute of the University of California, Department of Veterans
Affairs Medical Center, San Francisco 94121, USA.
massie.barry@sanfrancisco.va.gov.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (33 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Time for reflection after the Bristol case
[letter]
ARTICLE SOURCE: Lancet (England), Jul 18 1998, 352(9123) p232-3
AUTHOR(S): Pande PN
PUBLICATION TYPE: LETTER
There are several letters (MB)
ARTICLE TITLE: Should we accept mediocrity?
ARTICLE SOURCE: N Engl J Med (United States), Apr 9 1998, 338(15)
p1067-9
AUTHOR(S): Manian FA
AUTHOR'S ADDRESS: Infectious Diseases Consultants, St. Louis, MO
63141, USA.