ARTICLE TITLE: Nonsteroidal antiinflammatory drugs after acute
myocardial infarction
ARTICLE SOURCE: Am Heart J (United States), Mar 2002, 143(3)
p475-81
AUTHOR(S): Ko D; Wang Y; Berger AK; Radford MJ; Krumholz HM
AUTHOR'S ADDRESS: Section of Cardiovascular Medicine, Department of
Medicine, Yale-New Haven Hospital, New Haven, Conn, USA.
PUBLICATION TYPE: Journal Article
CONCLUSION: The prescription of nonsteroidal antiinflammatory drugs
(NSAIDs) therapy at hospital discharge for elderly Medicare
beneficiaries who survived acute myocardial infarction was associated
with similarly lower 1-year mortality rates as compared with aspirin
therapy. The addition of aspirin to NSAID therapy was not associated
with an additional survival benefit.
ARTICLE TITLE: Are we asking too much of our trials?
COMMENTS: Comment On: Comment On: RefSource:Am Heart J. 2002 Jan;
143(1):22-8
ARTICLE SOURCE: Am Heart J (United States), Jan 2002, 143(1) p1-3
AUTHOR(S): Skali H; Solomon SD; Pfeffer MA
PUBLICATION TYPE: Comment; Editorial
ARTICLE TITLE: Venous air embolism during liver
transplantation
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Dec 2001, 29(6)
p668-9
AUTHOR(S): Wong AY; O'Regan A; Irwin MG
PUBLICATION TYPE: Letter
MB: This is from Hong Kong. We had one in case 3 in 1986. Since then
we have not used nitrous, applied PEEP & kept the CVP at about 15
mmHg during dissection.
ARTICLE TITLE: Current usage of dopamine in New Zealand intensive
care units
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Dec 2001, 29(6)
p623-6
AUTHOR(S): McHugh GJ
AUTHOR'S ADDRESS: Department of Anaesthesia and Intensive Care,
Palmerston North Hospital, New Zealand.
PUBLICATION TYPE: Journal Article
ABSTRACT: A nation-wide evaluation of dopamine usage in New Zealand
Intensive Care Units (ICUs) was undertaken. Twenty-six public
hospital ICUs participated. Twenty-two ICUs (85%) use dopamine as an
inotrope. Seventeen ICUs use dopamine for presumed selective renal
effects at least occasionally, but with wide variation in what is
considered to be "renal-dose". Level 3 ICUs were less likely to use
"renal-dose" dopamine than levels 1 and 2 (P= 0.01). Nineteen units
(83%) use weight-referenced (i.e., microg x kg(-1) x min(-1))
dopamine administration. Weight-referenced administration and
"renal-dose" dopamine were likely to be in use together (P=0.02).
Standard dopamine dilutions varied widely with a median of 2 mg x
ml(-1) (range 0.4 to 8 mg x ml(-1)). Given a demonstrated association
between weight-referenced administration and "renal-dose" dopamine,
along with particular pharmacokinetic and pharmacodynamic
reservations, the value of weight-referenced administration of
dopamine in adult patients is questioned.
MB: The whole process should be more than questioned.
ARTICLE TITLE: A randomized trial comparing two laryngeal mask
airway insertion techniques
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Dec 2001, 29(6)
p613-5
AUTHOR(S): Koay CK; Yoong CS; Kok P
AUTHOR'S ADDRESS: Department of Anaesthesia and Surgical Intensive
Care, Changi General Hospital, Singapore.
PUBLICATION TYPE: Status: In-Process
Journal Article
ABSTRACT: This study was undertaken to compare laryngoscopic-guided
LMA insertion with a standard insertion technique. A total of 149
patients undergoing elective general surgical and orthopaedic
procedures were randomly divided into two groups. Study endpoints
included ease of insertion, haemodynamic changes, local trauma
bleeding, and postoperative sore throat. There were no statistically
significant differences found. The laryngoscope may aid laryngeal
mask airway insertion in some circumstances.
MB: & why not?
ARTICLE TITLE: Comparison of three methods to estimate plasma
bicarbonate in critically ill patients: Henderson-Hasselbalch,
enzymatic, and strong-ion-gap
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Dec 2001, 29(6)
p585-90
AUTHOR(S): Story DA; Poustie S; Bellomo R
AUTHOR'S ADDRESS: Department of Anaesthesia, Austin and Repatriation
Medical Centre, University of Melbourne, Victoria.
PUBLICATION TYPE: Journal Article
ABSTRACT: We have previously found poor agreement between
Henderson-Hasselbalch and enzymatic methods for estimating plasma
bicarbonate concentration in critically ill patients. In this study
we compared these two established methods with a new method for
estimating bicarbonate using the strong-ion-gap equation. The
strong-ion-gap is derived from the Stewart approach to acid-base
physiology. One hundred data sets were collected from records of
routine daily blood samples in critically ill patients. Bland-Altman
analyses were used to compare the three methods. We proposed that
bias greater than +/- 1 mmol/l and limits of agreement wider than
bias +/- 2 mmol/l were clinically important, Comparing the
Henderson-Hasselbalch method to the enzymatic method, the bias was
2.1 mmol/l and the limits of agreement were -1.8 mmol/l to 5.9
mmol/l. Comparing the Henderson-Hasselbalch method to the
strong-ion-gap method, the bias was -9.1 mmol/l and the limits of
agreement were -17.1 mmol/l to -1.1 mmol/l. Comparing the enzymatic
to the strong-ion-gap method, the bias was -11.2 mmol/l and the
limits of agreement were -18.2 mmol/l to -4.2 mmol/l. This study
found poor agreement between the two established bicarbonate assays
and worse agreement between the established assays and the
strong-ion-gap method. The strong-ion-gap method is currently too
inaccurate for clinical application, but may have future use.
MB: They suggest that 1-2 mmol difference would be clinically
important. I would have considered such differences would be trivial.
They found much bigger differences.
ARTICLE TITLE: High Incidence of Cardiac Arrest following Spinal
Anesthesia
ARTICLE SOURCE: Anesthesiology (United States), Feb 2002, 96(2)
p515
AUTHOR(S): Pollard JB
PUBLICATION TYPE: Journal Article . Letter.
MB: Emphasises high frequency and then a high incidence permanent
damage. In closed claim information it is commoner than damage due to
aspiration which is a common justification for neuraxial block.
ARTICLE TITLE: Brain Tumor Presenting with Fatal Herniation
following Delivery under Epidural Anesthesia
ARTICLE SOURCE: Anesthesiology (United States), Feb 2002, 96(2)
p508-9
AUTHOR(S): Su TM; Lan CM; Yang LC; Lee TC; Wang KW; Hung KS
AUTHOR'S ADDRESS: Department of Neurosurgery, Chang Gung Memorial
Hospital, Kaohsiung, Taiwan.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Anesthetic management of deep hypothermic
circulatory arrest for cerebral aneurysm clipping
ARTICLE SOURCE: Anesthesiology (United States), Feb 2002, 96(2)
p497-503
AUTHOR(S): Young WL; Lawton MT; Gupta DK; Hashimoto T
AUTHOR'S ADDRESS: Departments of Anesthesia and Perioperative Care,
Neurological Surgery, and Neurology, and the Center for
Cerebrovascular Research, University of California, San Francisco,
San Francisco, California.
PUBLICATION TYPE: Journal Article . Review
MB: I was associated with about 20 of these around 1970. They allude
to the problems we thought about.
ARTICLE TITLE: Efficacy of Clonidine for Prevention of
Perioperative Myocardial Ischemia: A Critical Appraisal and
Meta-analysis of the Literature
ARTICLE SOURCE: Anesthesiology (United States), Feb 2002, 96(2)
p323-9
AUTHOR(S): Nishina K; Mikawa K; Uesugi T; Obara H; Maekawa M; Kamae
I; Nishi N
AUTHOR'S ADDRESS: Department of Anesthesia and Perioperative
Medicine, Faculty of Medical Sciences, Kobe University Graduate
School of Medicine, Kobe, Japan.
PUBLICATION TYPE: Journal Article. Meta-analysis.
ABSTRACT: BACKGROUND: There is a belief that clonidine may be
effective in reducing perioperative myocardial ischemic events,
although the results of several trials are conflicting. The aim of
the current study was to provide a systematic review of randomized
controlled trials that tested the efficacy of clonidine in this
regard. METHODS: Data was collected from a MEDLINE search of
English-language studies published from 1980 to 1999 and a manual
search of bibliographies from retrieved articles. A total of 28
studies were assessed. According to the selection criteria (study
design, population, intervention, and outcome) and a quality scoring
system, seven studies were finally included in the meta-analysis.
After homogeneity was established by Q value, the data were then
combined using the fixed-effects model. The pooled odds ratio was
calculated. A subgroup analysis based on the types of surgery and
administration route was also performed to qualify the results. The
results were expressed as odds ratio and 95% confidence interval.
RESULTS: Heterogeneity of outcome data was negative in the trials.
The pooled odds ratio was 0.49 (95% confidence interval 0.34-0.71).
In the subgroup analysis, clonidine reduced the incidence of
myocardial ischemia in patients undergoing cardiac and noncardiac
surgery. Rates of bradycardia were similar in clonidine and placebo
groups. CONCLUSION: The meta-analysis suggests that perioperative
clonidine reduces cardiac ischemic episodes in patients with known,
or at risk of, coronary arterial disease without increasing the
incidence of bradycardia. Therefore, these findings strongly justify
planning and execution of a definitive study seeking the benefits of
clonidine.
MB: How about ensuring optimal cardiac management of all patients
presenting for surgery before doing this type of study. The
proportion of patients in the general population having 'best
practice' for cardiac managements is not high. That should be fixed
first.
ARTICLE TITLE: Closed-loop control of anesthesia using Bispectral
index: performance assessment in patients undergoing major orthopedic
surgery under combined general and regional anesthesia.
ARTICLE SOURCE: Anesthesiology (United States), Jan 2002, 96(1)
p67-73
AUTHOR(S): Absalom AR; Sutcliffe N; Kenny GN
AUTHOR'S ADDRESS: University Department of Anaesthesia, Glasgow Royal
Infirmary, United Kingdom. tabsalom@compuserve.com.
PUBLICATION TYPEJournal Article
ABSTRACT: BACKGROUND: The Bispectral Index (BIS) is an
electroencephalogram-derived measure of anesthetic depth. A
closed-loop anesthesia system was built using BIS as the control
variable, a proportional-integral-differential control algorithm, and
a propofol target-controlled infusion system as the control actuator.
Closed-loop performance was assessed in 10 adult patients. METHODS:
Ten adult patients scheduled to undergo elective hip or knee surgery
were enrolled. An epidural cannula was inserted, and 0.5% bupivacaine
was used to provide anesthesia to T8 before general anesthesia was
induced using the propofol target-controlled infusion system under
manual control. After the start of surgery, when anesthesia was
clinically adequate, automatic control of anesthesia was commenced
using the BIS as the control variable. Adequacy of anesthesia during
closed-loop control was assessed clinically and by calculating the
median performance error, the median absolute performance error, and
the mean offset of the control variable. RESULTS: The median
performance error and the median absolute performance error were 2.2
and 8.0%, respectively. Mean offset of the BIS from the set point was
0.9. Cardiovascular parameters were stable during closed-loop
control. Operating conditions were adequate in all patients but one,
who began moving after 45 min of stable anesthesia. No patients
reported awareness or recall of intraoperative events. In three
patients, there was oscillation of the measured BIS around the set
point. CONCLUSIONS: The system was able to provide clinically
adequate anesthesia in 9 of 10 patients. Further studies are required
to determine whether control performance can be improved by
alterations to the gain factors or by using an effect site-targeted,
target-controlled infusion propofol system.
MB: 90% is not very good. Why are we having faith based research as
well as faith based medicine/anaesthesia. Evidence based is bad
enough.
ARTICLE TITLE: Detection of awareness with the bispectral index:
two case reports.
ARTICLE SOURCE: Anesthesiology (United States), Jan 2002, 96(1)
p241-3
AUTHOR(S): Luginbuhl M; Schnider TW
AUTHOR'S ADDRESS: Department of Anestesiology, University Hospital of
Bern, Switzerland. martin.luginbuehl@dfk2.unibe.ch.
PUBLICATION TYPE: Journal Article
MB: Sounds as though they were not much good in making sure that
there were no technical problems. They did not respond or detect the
technical failures in these cases. The BIS could not guarantee
non-recall under those circumstances.
ARTICLE TITLE: The effectiveness of video technology as an adjunct
to teach and evaluate epidural anesthesia performance skills.
COMMENTS: Comment In: Comment In: RefSource:Anesthesiology. 2002 Jan;
96(1):1-2
ARTICLE SOURCE: Anesthesiology (United States), Jan 2002, 96(1)
p5-9
AUTHOR(S): Birnbach DJ; Santos AC; Bourlier RA; Meadows WE; Datta S;
Stein DJ; Kuroda MM; Thys DM
AUTHOR'S ADDRESS: Department of Anesthesiology, College of Physicians
and Surgeons of Columbia University, New York, NY, USA.
djb2@columbia.edu.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized
Controlled Trial
METHODS: Twenty-two second-year (CA-2) anesthesiology residents
beginning their first obstetric anesthesia rotation were assigned to
video or non-video groups. <snip> Four experienced attending
anesthesiologists independently judged videotapes taken on days 1,
15, and 30 and scored the residents for "overall" skill (range of
summed overall grades, 0-40), as well as on 13 predetermined
criteria. RESULTS: As determined by kappa coefficients, interrater
reliability was high among the judges (k = 0.7-0.8). Residents in the
video group improved to a greater degree than residents in the
non-video group. On day 1, the median overall grades for the video
and non-video groups were 21 and 12, respectively. By day 15, the
corresponding grades had increased to 32 and 24, respectively (P <
0.01). However, overall median grades continued to improve between
days 15 and 30 in the video group only (P < 0.01). CONCLUSIONS:
Review of resident videotapes resulted in greater improvement in
overall and predetermined performance criteria. In addition, video
review was helpful in identifying skills that were inadequately
learned, thus allowing for specific teaching in those areas.
MB: It's a good idea. The video group were better than the controls
on the 1 st day ---not significantly. I don't know what
that really means. They may have been inherently better or done
epidurals before. It should be used to teach GA too. I frequently see
inefficient technique in relatively experienced registrars who often
don't like it being suggested that they could improve.
ARTICLE TITLE: Testing for malignant hyperthermia.
ARTICLE SOURCE: Anesthesiology (United States), Jan 2002, 96(1)
p232-7
AUTHOR(S): Rosenberg H; Antognini JF; Muldoon S
AUTHOR'S ADDRESS: Department of Anesthesiology, Thomas Jefferson
University, Jefferson Medical College, Philadelphia, Pennsylvania
19107, USA. Henry.Rosenberg@mail.tju.edu.
PUBLICATION TYPE Journal Article
ARTICLE TITLE: Postoperative titration of intravenous morphine in
the elderly patient.
COMMENTS: Comment In: Comment In: RefSource:Anesthesiology. 2002 Jan;
96(1):2-4
ARTICLE SOURCE: Anesthesiology (United States), Jan 2002, 96(1)
p17-23
AUTHOR(S): Aubrun F; Monsel S; Langeron O; Coriat P; Riou B
AUTHOR'S ADDRESS: Department of Anesthesiology, Groupe Hospitalier
Pitie-Salpetriere, Assistance Publique-Hopitaux de Paris, Universite
Pierre et Marie Curie, France.
frederic.aubrun@psl.ap-hop.paris.fr.
PUBLICATION TYPE: Journal Article
CONCLUSION: Intravenous morphine titration can be safely administered
to elderly patients. Because titration is adapted to individual pain,
the same protocol can be applied to young and elderly patients.
MB: Well there you go.
ARTICLE TITLE: Are estimates of MAC reliable?
ARTICLE SOURCE: Anesthesiology (United States), Dec 2001, 95(6)
p1362-70
AUTHOR(S): Paul M; Fisher DM
AUTHOR'S ADDRESS: Department of Anesthesia, University of California,
San Francisco, USA.
PUBLICATION TYPE: Clinical Trial; Journal Article
ABSTRACT: BACKGROUND: Potency of inhaled anesthetics (minimum
alveolar concentration [MAC]) is typically studied in humans
using an "up-down" approach in which the (quantal) response to skin
incision is assessed only once for each individual, so that each
individual's MAC is never determined. The authors examined the
influence of interindividual variability and study design issues
(e.g., the number of patients enrolled in a study) on the accuracy of
MAC estimates. METHODS: The typical sequence of a MAC study was
simulated. The authors varied and tested the impact of several
factors: anesthetic concentration used to start a study; number of
"crossovers" (successive patients having different responses to skin
incision) to terminate a study; concentration increment between
consecutive patients; interindividual variability; and "measurement
error." For each factor, simulations were replicated 500 times, and
the resulting estimates were summarized. RESULTS: Starting an
experiment below or above the "true" value led to slightly biased MAC
estimates; in contrast, variability was underestimated with starting
concentrations close to the true value. More than six crossovers
improved MAC estimates minimally but increased variability estimates
toward true values. A larger increment size affected MAC minimally
and increased variability estimates toward true values. A larger
interindividual variability led to more "outlier" estimates for MAC.
Under many conditions, several of 500 replicates yielded MAC
estimates that deviated more than 10% or even more than 25% from the
"true" value. CONCLUSION: Individual experiments may yield inaccurate
MAC estimates. This inaccuracy is minimized as the number of
crossovers increases; however, improvement diminishes as the number
of crossovers exceeds six.
MB: This shows how useless MAC is for individual patients. BIS won't
fix the problem. Having some neuromuscular function does.
ARTICLE TITLE: A brief history of the origin of minimum alveolar
concentration (MAC). (Classic papers revisited)
ARTICLE SOURCE: Anesthesiology (United States), Jan 2002, 96(1)
p238-9
AUTHOR(S): Eger EI
AUTHOR'S ADDRESS: Department of Anesthesia, University of California,
San Francisco, 94143-0464, USA. egere@anestesia.ucsf.edu.
PUBLICATION TYPE: Journal Article
MB: Eger seems a bit bemused by the success of his invention. I am
too in light of the small amount of data in the classic papers he
cites. Only Anesthesiol 1964; 25: 302 gives a small amount of human
data. Anesthesiol 1965; 26: 756, 764 & 771 are about dogs.
ARTICLE TITLE: Internal jugular vein occlusion test for rapid
diagnosis of misplaced subclavian vein catheter into the internal
jugular vein.
ARTICLE SOURCE: Anesthesiology (United States), Dec 2001, 95(6)
p1377-9
AUTHOR(S): Ambesh SP; Pandey JC; Dubey PK
AUTHOR'S ADDRESS: Department of Anesthesiology and Critical Care
Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences,
Lucknow, India. ambeshsp@hotmail.com.
PUBLICATION TYPE: Clinical Trial; Journal Article; Validation
Studies
METHODS: One hundred adult patients scheduled for subclavian vein
cannulation were included in this study. After placement of
subclavian vein catheter, chest radiography was performed. While the
x-ray film was being processed, the authors performed an IJV
occlusion test by applying external pressure on the IJV for
approximately 10 s in the supraclavicular area and observed the
change in central venous pressure and its waveform pattern.
<snip> CONCLUSION: The internal jugular vein (IJV). occlusion
test successfully detects the misplacement of subclavian vein
catheter into the IJV. However, it does not detect any other
misplacement. The test may allow avoidance of repeated exposure to
x-rays after catheter insertion and repositioning.
MB: In the first world an image intensifier should be used in such
cases. The technique described would work of course.
ARTICLE TITLE: The visual analog scale for pain: clinical
significance in postoperative patients.
ARTICLE SOURCE: Anesthesiology (United States), Dec 2001, 95(6)
p1356-61
AUTHOR(S): Bodian CA; Freedman G; Hossain S; Eisenkraft JB; Beilin
Y
AUTHOR'S ADDRESS: Department of Biomathematical Sciences, Mount Sinai
School of Medicine of New York University, New York, USA.
bodian@camelot.mssm.edu.
PUBLICATION TYPE: Clinical Trial; Journal Article
CONCLUSIONS: When pain is an outcome measure in research studies,
grouping final visual analog scale (VAS) scores into a small number
of categories provides greater clinical relevance for comparisons
than using the full spectrum of measured values or changes in value.
Seeing an earlier VAS form has no apparent influence on later
values.
MB: ie the actual number of the VAS does not suggest changes in
analgesic administration.
ARTICLE TITLE: Echocardiography and anesthesiology successes and
challenges.
COMMENTS: Comment On: Comment On: RefSource:Anesthesiology. 2001 Dec;
95(6):1507-12
ARTICLE SOURCE: Anesthesiology (United States), Dec 2001, 95(6)
p1313-4
AUTHOR(S): Thys DM
PUBLICATION TYPE: Comment; Editorial
ARTICLE TITLE: Newspaper reporting of screening mammography.
ARTICLE SOURCE: Ann Intern Med (United States), Dec 18 2001, 135(12)
p1029-37
AUTHOR(S): Wells J; Marshall P; Crawley B; Dickersin K
AUTHOR'S ADDRESS: Health Services Research Unit, Department of Public
Health and Primary Care, University of Oxford, Institute of Health
Sciences, Old Road, Oxford OX3 7LF, United Kingdom.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Newspapers tended to overrepresent support for screening
mammography for women aged 40 to 49 years. Reports would have been
improved by identification of all sources for information cited, less
reliance on relatively few sources, and discussion of benefits in
absolute as well as relative terms. Medical journalism may benefit
from identification of standards similar to those used for reporting
medical research.
MB: That's why we are in a mess.
ARTICLE TITLE: Reported methodologic quality and discrepancies
between large and small randomized trials in meta-analyses.
ARTICLE SOURCE: Ann Intern Med (United States), Dec 4 2001, 135(11)
p982-9
AUTHOR(S): Kjaergard LL; Villumsen J; Gluud C
AUTHOR'S ADDRESS: Cochrane Hepato-Biliary Group, Copenhagen Trial
Unit, Center for Clinical Intervention Research, Copenhagen
University Hospital, H:S Rigshospitalet, DK-2100 Copenhagen, Denmark.
kjaergard@ctu.rh.dk.
PUBLICATION TYPE: Status: Completed
Journal Article
CONCLUSIONS: Inadequate generation of the allocation sequence,
allocation concealment, and double blinding lead to exaggerated
estimates of intervention benefit and may contribute to discrepancies
between the results of large randomized trials and small randomized
trials in meta-analyses.
ARTICLE TITLE: Potential cost-effectiveness of prophylactic use of
the implantable cardioverter defibrillator or amiodarone after
myocardial infarction.
ARTICLE SOURCE: Ann Intern Med (United States), Nov 20 2001, 135(10)
p870-83
AUTHOR(S): Sanders GD; Hlatky MA; Every NR; McDonald KM; Heidenreich
PA; Parsons LS; Owens DK
AUTHOR'S ADDRESS: Center for Primary Care and Outcomes Research, 179
Encina Commons, Stanford University, Stanford, CA 94305-6019, USA.
sanders@standford.edu.
PUBLICATION TYPE Journal Article
CONCLUSIONS: Use of implantable cardioverter defibrillators (ICDs) or
amiodarone in patients with past myocardial infarction and severely
depressed left ventricular function may provide substantial clinical
benefit at an acceptable cost. These results highlight the importance
of clinical trials of ICDs in patients with low ejection fractions
who have had myocardial infarction.
ARTICLE TITLE: Summaries for patients. Cost-effectiveness of
implantable defibrillators versus the drug amiodarone to prevent
abnormal heart rhythms after heart attack.
ARTICLE SOURCE: Ann Intern Med (United States), Nov 20 2001, 135(10)
pS-56
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Development and validation of a multifactorial risk
index for predicting postoperative pneumonia after major noncardiac
surgery.
COMMENTS: Comment In::Ann Intern Med. 2001 Nov 20; 135(10):919-21
ARTICLE SOURCE: Ann Intern Med (United States), Nov 20 2001, 135(10)
p847-57
AUTHOR(S): Arozullah AM; Khuri SF; Henderson WG; Daley J
AUTHOR'S ADDRESS: Section of General Internal Medicine (M/C 787),
University of Illinois College of Medicine, 840 South Wood Street,
Room 440-M, Chicago, IL 60612-7323, USA. arozulla@uic.edu; Collective
Name: Participants in the National Veterans Affairs Surgical Quality
Improvement Program.
PUBLICATION TYPE: Journal Article; Validation Studies
RESULTS: A total of 2466 patients (1.5%) developed pneumonia, and the
30-day postoperative mortality rate was 21%. A postoperative
pneumonia risk index was developed that included type of surgery
(abdominal aortic aneurysm repair, thoracic, upper abdominal, neck,
vascular, and neurosurgery), age, functional status, weight loss,
chronic obstructive pulmonary disease, general anesthesia, impaired
sensorium, cerebral vascular accident, blood urea nitrogen level,
transfusion, emergency surgery, long-term steroid use, smoking, and
alcohol use. Patients were divided into five risk classes by using
risk index scores. Pneumonia rates were 0.2% among those with 0 to 15
risk points, 1.2% for those with 16 to 25 risk points, 4.0% for those
with 26 to 40 risk points, 9.4% for those with 41 to 55 risk points,
and 15.3% for those with more than 55 risk points. The C-statistic
was 0.805 for the development cohort and 0.817 for the validation
cohort. CONCLUSIONS: The postoperative pneumonia risk index
identifies patients at risk for postoperative pneumonia and may be
useful in guiding perioperative respiratory care.
MB: & may not.
ARTICLE TITLE: Predicting postoperative pulmonary complications:
the sleeping giant stirs.
COMMENTS: Comment On: Comment On: RefSource:Ann Intern Med. 2001 Nov
20; 135(10):847-57
ARTICLE SOURCE: Ann Intern Med (United States), Nov 20 2001, 135(10)
p919-21
AUTHOR(S): Lawrence VA
PUBLICATION TYPE: Comment; Editorial
ARTICLE TITLE: Physician participation in executions: time to
eliminate anonymity provisions and protest the practice.
COMMENTS: Comment On: Comment On: RefSource:Ann Intern Med. 2001 Nov
20; 135(10):884-8
ARTICLE SOURCE: Ann Intern Med (United States), Nov 20 2001, 135(10)
p922-4
AUTHOR(S): Emanuel LL; Bienen LB
PUBLICATION TYPE: Comment; Editorial
ARTICLE TITLE: Physicians' willingness to participate in the
process of lethal injection for capital punishment.
COMMENTS: Comment In: Comment In: RefSource:Ann Intern Med. 2001 Nov
20; 135(10):922-4
ARTICLE SOURCE: Ann Intern Med (United States), Nov 20 2001, 135(10)
p884-8
AUTHOR(S): Farber NJ; Aboff BM; Weiner J; Davis EB; Boyer EG; Ubel
PA
AUTHOR'S ADDRESS: Department of Medicine, Christiana Care Health
System, 501 West 14th Street, Wilmington, DE 19899, USA.
nfarber@christianacare.org.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: It has been found that physicians condone
colleague involvement in capital punishment. Physicians' own
willingness to participate has not been explored. OBJECTIVE: To
examine physicians' willingness to be involved in cases of capital
punishment. DESIGN: Survey exploring physicians' willingness to
participate in 10 aspects of capital punishment by lethal injection,
8 of which are disallowed by the American Medical Association.
SETTING: United States. PARTICIPANTS: 1000 randomly selected
practicing physicians. MEASUREMENTS: Questions assessing willingness
to be involved in and attitudes toward capital punishment. RESULTS:
41% of respondents indicated that they would perform at least one
action disallowed by the American Medical Association; 25% would
perform five or more disallowed actions. Perceived duty to society (P
< 0.001), approval of the death penalty (P < 0.001), and
approval of assisted suicide (P = 0.015) correlated with increased
willingness to perform disallowed actions. Only 3% of respondents
knew of any guidelines on this issue. CONCLUSIONS: Despite medical
society policies, many physicians would be willing to be involved in
the execution of adults. The medical profession needs to be better
informed about the ethical issues involved in physician participation
in capital punishment.
ARTICLE TITLE: Extended out-of-hospital low-molecular-weight
heparin prophylaxis against deep venous thrombosis in patients after
elective hip arthroplasty: a systematic review.
ARTICLE SOURCE: Ann Intern Med (United States), Nov 20 2001, 135(10)
p858-69
AUTHOR(S): Hull RD; Pineo GF; Stein PD; Mah AF; MacIsaac SM; Dahl OE;
Butcher M; Brant RF; Ghali WA; Bergqvist D; Raskob GE
AUTHOR'S ADDRESS: Thrombosis Research Unit, University of Calgary,
Foothills Hospital, Room 601 South Tower, 1403- 29th Street NW,
Calgary, T2N 2T9 Alberta, Canada.
jeanne.sheldon@calgaryhealthregion.ca.
PUBLICATION TYPE: Journal Article; Meta-Analysis; Review; Review,
Academic
CONCLUSIONS: Extended low-molecular-weight heparin (LMWH) prophylaxis
showed consistent effectiveness and safety in the trials (regardless
of study variations in clinical practice and length of hospital stay)
for venographic deep venous thrombosis and symptomatic venous
thromboembolism. The aggregate findings support the need for extended
out-of-hospital prophylaxis in patients undergoing hip arthroplasty
surgery.
MB: Note there is no mention of type of anaesthesia.
ARTICLE TITLE: Update in psychiatry
ARTICLE SOURCE: Ann Intern Med (United States), Feb 19 2002, 136(4)
p293-301
AUTHOR(S): Schneider RK; Levenson JL
AUTHOR'S ADDRESS: Department of Psychiatry, Medical College of
Virginia Campus of Virginia Commonwealth University, PO Box 980268,
Richmond, VA 23298-7675.
PUBLICATION TYPE: Journal Article. Literature review.
ARTICLE TITLE: Aspirin for the primary prevention of
cardiovascular events: a summary of the evidence for the u.s.
Preventive services task force
ARTICLE SOURCE: Ann Intern Med (United States), Jan 15 2002, 136(2)
p161-72
AUTHOR(S): Hayden M; Pignone M; Phillips C; Mulrow C
AUTHOR'S ADDRESS: Division of General Medicine, Department of
Medicine, 11C Ambulatory Care, Veterans Administration Medical
Center.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The net benefit of aspirin increases with increasing
cardiovascular risk. In the decision to use aspirin chemoprevention,
the patient's cardiovascular risk and relative utility for the
different clinical outcomes prevented or caused by aspirin use must
be considered.
ARTICLE TITLE: Aspirin for the primary prevention of
cardiovascular events: recommendation and rationale
ARTICLE SOURCE: Ann Intern Med (United States), Jan 15 2002, 136(2)
p157-60
AUTHOR(S): Sox HC
AUTHOR'S ADDRESS: American College of Physicians-American Society of
Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA
19106.
PUBLICATION TYPE: Journal Article
ABSTRACT: This statement summarizes the recommendation of the third
U.S. Preventive Services Task Force (USPSTF) for aspirin for the
primary prevention of cardiovascular events, as well as the
supporting scientific evidence. <snip>
ARTICLE TITLE: Update in hematology
ARTICLE SOURCE: Ann Intern Med (United States), Jan 15 2002, 136(2)
p136-43
AUTHOR(S): Catlett JP; Alving BM
AUTHOR'S ADDRESS: Hematology/Oncology Section, Washington Hospital
Center, 110 Irving Street NW, Washington, DC 20010-2975.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Summaries for patients. Factors associated with
Helicobacter pylori infections in the United States that are
resistant to usual antibiotics.
COMMENTS: Original Report In: Original Report In: RefSource:Ann
Intern Med. 2002 Jan 1; 136(1):13-24
ARTICLE SOURCE: Ann Intern Med (United States), Jan 1 2002, 136(1)
pS-67
AUTHOR(S): Meyer JM; Silliman NP; Wang W; Siepman NY; Sugg JE; Morris
D; Zhang J; Bhattacharyya H; King EC; Hopkins RJ
PUBLICATION TYPE: Journal Article; Patient Education Handout
ARTICLE TITLE: A comparison of junior hospital doctors
interpretation of acute radiographs using an X-ray box and a
window.
ARTICLE SOURCE: Ann R Coll Surg Engl (England), Nov 2001, 83(6)
p435-6
AUTHOR(S): Maxwell-Armstrong C; Lloyd J; Abercrombie J
AUTHOR'S ADDRESS: Department of Surgery, Queen's Medical Centre,
Nottingham, UK. charles.maxwell-armstrong@talk21.com.
PUBLICATION TYPE: Journal Article
ABSTRACT: A statistically significant number of clinically important
features are missed when radiographs are interpreted by holding an
X-ray up against the window when compared with using an X-ray box.
These findings are most probably accounted for by a quantifiable
difference in light intensity.
MB: It is more likely that uneven illumination and incompetence are
the casues.
ARTICLE TITLE: Airway fire during tracheostomy: prevention
strategies for surgeons and anaesthetists.
ARTICLE SOURCE: Ann R Coll Surg Engl (England), Nov 2001, 83(6)
p376-80
AUTHOR(S): Rogers ML; Nickalls RW; Brackenbury ET; Salama FD; Beattie
MG; Perks AG
AUTHOR'S ADDRESS: Department of Cardiothoracic Surgery, Nottingham
City Hospital, Nottingham, UK.
PUBLICATION TYPE: Journal Article; Review; Review of Reported
Cases
ABSTRACT: Airway fires are an uncommon but real and devastating
complication of tracheostomy. One such fire in a 31-year-old man is
described. Surgical fires are discussed, and 15 reported cases of
tracheostomy fire are reviewed. A tracheostomy protocol, adopted by
our department and designed to avoid this life-threatening
complication, is described. Surgeons and anaesthetists involved in
tracheostomy must understand the fire hazard and how to avoid it.
MB: Make sure oxygen rich gas is not around when diathermy is used
after the trachea is open. CO2 fire extinguisher should be near by.
Remember nitrous supports combustion.
ARTICLE TITLE: Resuscitation in near drowning with extracorporeal
membrane oxygenation.
ARTICLE SOURCE: Ann Thorac Surg (United States), Aug 2001, 72(2)
p607-8
AUTHOR(S): Thalmann M; Trampitsch E; Haberfellner N; Eisendle E;
Kraschl R; Kobinia G
AUTHOR'S ADDRESS: Department of Cardiothoracic Surgery, General
Hospital Klagenfurt, Austria. herz-thorax.abteilung@lkh-klu.at.
PUBLICATION TYPE: Journal Article
ABSTRACT: We report a case of near drowning of a 3-year-old girl, who
was admitted to our emergency room with a core temperature of 18.4
degrees C. After rewarming on cardiopulmonary bypass and restitution
of her circulation, respiratory failure resistant to conventional
respiratory therapy prohibited weaning from cardiopulmonary bypass.
Therefore, we instituted extracorporeal membrane oxygenation (ECMO).
Fifteen hours later, she could be weaned from ECMO but required
assisted ventilation for another 12 days. Twenty months later there
are no neurologic deficits.
ARTICLE TITLE: Postoperatively administered aprotinin or epsilon
aminocaproic acid after cardiopulmonary bypass has limited
benefit.
ARTICLE SOURCE: Ann Thorac Surg (United States), Aug 2001, 72(2)
p521-6
AUTHOR(S): Ray MJ; Hales MM; Brown L; O'Brien MF; Stafford EG
AUTHOR'S ADDRESS: Department of Haematology, The Prince Charles
Hospital, Brisbane, Australia. michael_ray@health.qld.gov.au.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized
Controlled Trial
CONCLUSIONS: Aprotinin or epsilon aminocaproic acid (EACA)
administered in the early postoperative period was ineffective in
reducing postoperative bleeding with the exception of a small group
of patients having valve operations in whom aprotinin treatment may
have shown some benefit.
ARTICLE TITLE: Hospital volume is related to clinical and economic
outcomes of esophageal resection in Maryland.
ARTICLE SOURCE: Ann Thorac Surg (United States), Aug 2001, 72(2)
p334-9; discussion 339-41
AUTHOR(S): Dimick JB; Cattaneo SM; Lipsett PA; Pronovost PJ;
Heitmiller RF
AUTHOR'S ADDRESS: Department of Surgery, The Johns Hopkins University
School of Medicine, Baltimore, Maryland 21287-4605, USA.
PUBLICATION TYPE: Journal Article
Conclusions. Hospitals that perform high volumes of esophageal
resection have superior clinical and economic outcomes. By referring
these patients to high volume centers, we may improve quality and
reduce costs.
MB: It pretty obvious that big numbers should give better
results.
ARTICLE TITLE: The National Emphysema Treatment Trial: a paradigm
for future surgical trials.
ARTICLE SOURCE: Ann Thorac Surg (United States), Aug 2001, 72(2)
p327-9
AUTHOR(S): Wood DE; De Camp MM
PUBLICATION TYPE: Editorial
MB: This & the next are about the difficulty in doing trials for
surgery particularly for conditions likely to be fatal soon without
the operation
ARTICLE TITLE: Paying the piper: the NETT strikes a sour note.
National Emphysema Treatment Trial.
COMMENTS: Comment On: :Ann Thorac Surg. 2001 Aug; 72(2):641-8;
Comment On::Ann Thorac Surg. 2001 Aug; 72(2):649-57
ARTICLE SOURCE: Ann Thorac Surg (United States), Aug 2001, 72(2)
p330-3
AUTHOR(S): Cooper JD
PUBLICATION TYPE: Comment; Editorial
ARTICLE TITLE: Prevention and detection of spinal cord injury
during thoracic and thoracoabdominal aortic repairs.
ARTICLE SOURCE: Ann Thorac Surg (United States), Jul 2001, 72(1)
p80-4; discussion 85
AUTHOR(S): Wada T; Yao H; Miyamoto T; Mukai S; Yamamura M
AUTHOR'S ADDRESS: Department of Thoracic and Cardiovascular Surgery,
Hyogo College of Medicine, Nishinomiya, Japan.
wadatora@hyo-med.ac.jp.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: These results strongly suggest that somatosensory evoked
potentials (SEP), mean distal aortic pressure, cerebrospinal fluid
pressure should be monitored during aortic cross-clamping.
Maintaining spinal cord perfusion pressure at more than 40 mm Hg by
increasing mean distal aortic pressure or withdrawal of cerebrospinal
fluid is valuable for preventing paraplegia.
ARTICLE TITLE: Thoracic epidural anesthesia does not influence the
occurrence of postoperative sustained atrial fibrillation.
ARTICLE SOURCE: Ann Thorac Surg (United States), Jul 2001, 72(1)
p65-71
AUTHOR(S): Jideus L; Joachimsson PO; Stridsberg M; Ericson M; Tyden
H; Nilsson L; Blomstrom P; Blomstrom-Lundqvist C
AUTHOR'S ADDRESS: Department of Surgical Sciences, University
Hospital, Uppsala, Sweden. lena.jideus@kirurgi.uu.se.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized
Controlled Trial
CONCLUSIONS: thoracic epidural anesthesia (TEA) has no effect on the
incidence of postoperative sustained of atrial fibrillation (AF),
despite a significant reduction in sympathetic activity.
ARTICLE TITLE: Evaluating routine diuretics after coronary
surgery: a prospective randomized controlled trial.
ARTICLE SOURCE: Ann Thorac Surg (United States), Jan 2002, 73(1)
p153-5
AUTHOR(S): Lim E; Ali ZA; Attaran R; Cooper G
AUTHOR'S ADDRESS: Department of Cardiothoracic Surgery, Northern
General Hospital, Sheffield, United Kingdom.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized
Controlled Trial
CONCLUSIONS: Routine diuretics promote an earlier diuresis but no
clinical benefits are apparent in low risk patients with normal renal
function. Clinicians should reconsider routine diuretic prescription
in this setting.
MB: Why did they consider it in the first place. I suppose because
they had no idea of renal physiology.
ARTICLE TITLE: Management of catheter-induced pulmonary artery
perforation: a rare complication in cardiovascular operations.
ARTICLE SOURCE: Ann Thorac Surg (United States), Dec 2001, 72(6)
p2056-9
AUTHOR(S): Sirivella S; Gielchinsky I; Parsonnet V
AUTHOR'S ADDRESS: Department of Cardiovascular and Thoracic Surgery,
Newark Beth Israel Medical Center, New Jersey, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Pulmonary artery perforation is a rare and often fatal
complication of pulmonary artery catheterization. This was apparent
with patients who had airway hemorrhages as a result of weaning from
cardiopulmonary bypass or after balloon inflation. Recurrent and
fatal hemorrhage was frequent in patients treated by conservative
therapy alone. Surgical intervention was effective in control of
hemorrhage but did not reduce the number of deaths. Treatment remains
highly individualized. It is advisable to be cautious in inserting
Swan-Ganz catheters and to avoid their use unless absolutely
necessary.
MB: Some patients are at high risk. They should have the catheter
floated in for each reading. Under image intensifier I have seen that
sometimes at least the catheter comes back into a proximal part of
the pulmonary artery having been wedged and pops back into a more
peripheral vessel when the balloon in inflated again. I have had 2
fatal and probably preventable pulmonary artery injuries.
ARTICLE TITLE: Conventional carbon dioxide application does not
reduce cerebral or myocardial damage in open heart surgery.
ARTICLE SOURCE: Ann Thorac Surg (United States), Dec 2001, 72(6)
p1940-4
AUTHOR(S): Martens S; Dietrich M; Wals S; Steffen S;
Wimmer-Greinecker G; Moritz A
AUTHOR'S ADDRESS: Department for Thoracic and Cardiovascular Surgery,
University Hospital J. W. Goethe, Frankfurt am Main, Germany.
martens.herz@gmx.de.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized
Controlled Trial
CONCLUSIONS: Although mortality was lower with CO2 insufflation, no
benefit could be demonstrated for markers of cardiac ischemic damage
or neurocognitive outcome in this high-risk population. As CO2
concentrations in the thoracic cavity did not necessarily reach
anticipated levels, our method of application is in question.
ARTICLE TITLE: Brain injury under general anesthesia: is
monitoring of the EEG helpful?
COMMENTS: Comment On::Can J Anaesth. 2001 Dec; 48(11):1066-9
ARTICLE SOURCE: Can J Anaesth (Canada), Dec 2001, 48(11) p1055-60
AUTHOR(S): Billard V
PUBLICATION TYPE: Comment; Editorial
ARTICLE TITLE: Intraoperative blood losses and transfusion
requirements during adult liver transplantation remain difficult to
predict.
ARTICLE SOURCE: Can J Anaesth (Canada), Dec 2001, 48(11) p1075-9
AUTHOR(S): Steib A; Freys G; Lehmann C; Meyer C; Mahoudeau G
AUTHOR'S ADDRESS: Departments of Anaesthesia, and Transplantation,
Hopitaux Universitaires, Strasbourg, France.
Annick.Steib@chru-strasbourg.fr.
PUBLICATION TYPE: Journal Article
CONCLUSION: Despite our efforts we were unable to identify predictive
risk factors of bleeding during orthotopic liver transplantation
(OLT)even in a homogeneous population. Centres should evaluate their
practice individually in an attempt to identify patients at high risk
of being transfused.
MB: We can't either. Why not assume all are at high risk. I have a
personal communication from another unit of a series of 4 deaths on
the operating table recently.
ARTICLE TITLE: The laryngeal mask airway is effective (and
probably safe) in selected healthy parturients for elective Cesarean
section: a prospective study of 1067 cases.
COMMENTS: Comment In: Comment In: RefSource:Can J Anaesth. 2001 Dec;
48(11):1061-5/PMID:11744579
ARTICLE SOURCE: Can J Anaesth (Canada), Dec 2001, 48(11) p1117-21
AUTHOR(S): Han TH; Brimacombe J; Lee EJ; Yang HS
AUTHOR'S ADDRESS: Department of Anesthesiology Samsung Medical
Center, SungKyunKwan University School of Medicine, Seoul, Korea.
PUBLICATION TYPE: Clinical Trial; Journal Article
ABSTRACT: PURPOSE: To report on the use of the laryngeal mask airway
(LMA) for elective Cesarean section in 1067 consecutive ASA I-II
patients preferring general anesthesia. METHODS: Patients were
excluded if they had pharyngeal reflux, a pre-pregnancy body mass
index >30, or had a known/predicted difficult airway. Patients
were fasted for six hours and given ranitidine/sodium citrate. A
rapid sequence induction was performed with thiopentone and
suxamethonium. The LMA was inserted by experienced users. Anesthesia
was maintained with N(2)O and 50% O(2) and a volatile agent. Cricoid
pressure was maintained until delivery, but was relaxed if
insertion/ventilation was difficult. Patients were intubated if an
effective airway was not obtained within 90 sec, or SpO(2) <94%,
or end-tidal CO(2) >45 mmHg. Postdelivery, vecuronium and fentanyl
were administered. RESULTS: An effective airway was obtained in 1060
(99%) patients, 1051 (98%) at the first attempt and nine (1%) at the
second or third attempt. Air leakage or partial airway obstruction
occurred in 22 (21%) patients, and seven (0.7%) patients required
intubation. There were no episodes of hypoxia (SpO(2) <90%),
aspiration, regurgitation, laryngospasm, bronchospasm or gastric
insufflation. Surgical conditions were satisfactory and all APGAR
scores were >/=7 after five minutes. CONCLUSION: We conclude that
the LMA is effective and probably safe for elective Cesarean section
in healthy, selected patients when managed by experienced LMA
users.
MB: This does no show that aspiration cannot occur when an LMA is
used in Caesarian section. Intubation has been standard of practice
only since about 1960. Most did not aspirate before that. Open ether
was routine for forceps deliveries when I was a registrar (1961). I
introduced rapid sequence + intubation for these cases where I
was.
ARTICLE TITLE: The evolving role of the laryngeal mask airway in
obstetrics.
COMMENTS: Comment On: Comment On: RefSource:Can J Anaesth. 2001 Dec;
48(11):1117-21
ARTICLE SOURCE: Can J Anaesth (Canada), Dec 2001, 48(11) p1061-5
AUTHOR(S): Preston R
PUBLICATION TYPE: Comment; Editorial
MB: Rather critical of the preceding article.
ARTICLE TITLE: Continuous cardiac output measurements do not agree
with conventional bolus thermodilution cardiac output
determination.
ARTICLE SOURCE: Can J Anaesth (Canada), Dec 2001, 48(11) p1143-7
AUTHOR(S): Zollner C; Goetz AE; Weis M; Morstedt K; Pichler B; Lamm
P; Kilger E; Haller M
AUTHOR'S ADDRESS: Departments of Anesthesiology, and Cardiac Surgery,
Ludwig-Maximilians University of Munich, Munich, Germany.
PUBLICATION TYPE:Clinical Trial; Journal Article; Randomized
Controlled Trial
ABSTRACT: PURPOSE: To evaluate the performance of two different
continuous cardiac output monitoring systems based on the
thermodilution principle in critically ill patients. METHODS:
Nineteen cardiac surgical patients were randomly assigned to
continuous cardiac output monitoring using one of the two systems
under study (group I, IntelliCath(TM) catheter, n=9; group II,
Opti-Q(TM) catheter, n=10). Each patient was studied over a period of
three hours. Conventional bolus thermodilution cardiac output
measurements were carried out every 15 min leading to 13 measurements
in each patient. The continuous cardiac output values were compared
with the bolus thermodilution measurements. Bias (mean difference
between continuous and bolus thermodilution) and precision (SD of
differences) were calculated as a measure of agreement between the
respective continuous method and conventional bolus thermodilution.
RESULTS: The range of measured cardiac outputs was 3.8-15.4 L*min(-1)
(IntelliCath(TM)) and 3.5-8.3 L*min(-1) (OptiQ(TM)). Bias and
precision was 0.06 +/- 0.76 L*min(-1) (IntelliCath(TM)) and -0.04 +/-
0.74 L*min(-1) (OptiQ(TM)), respectively. There was no difference in
bias between the two systems (P=0.38). +/- 2 SD of the differences
(i.e., 95% of the differences) did not fall within the predetermined
limits of agreement of +/- 0.5 L*min(-1). CONCLUSIONS: There was no
difference between the two systems regarding the agreement with
conventional bolus thermodilution as the standard. A discrepancy
between bolus and continuous thermodilution cardiac output
measurement techniques above the clinically acceptable limits suggest
that they are not interchangeable.
ARTICLE TITLE: On smooth extubation without coughing and
bucking
ARTICLE SOURCE: Can J Anaesth (Canada), Mar 2002, 49(3) p324
AUTHOR(S): Chan PB
AUTHOR'S ADDRESS: Hong Kong, China.
PUBLICATION TYPE: Journal Article
MB: I want coughing on extubation.
ARTICLE TITLE: Pulmonary artery catheters in cardiovascular
surgery.
ARTICLE SOURCE: Can J Anaesth (Canada), Mar 2002, 49(3) p226-31
AUTHOR(S): Thomson IR
AUTHOR'S ADDRESS: Department of Anesthesia, University of Manitoba,
Winnipeg, Manitoba, Canada.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Antidepressant treatment for chronic depressed
patients should not be discontinued prior to anesthesia:
ARTICLE SOURCE: Can J Anaesth (Canada), Feb 2002, 49(2) p132-6
AUTHOR(S): Kudoh A; Katagai H; Takazawa T
AUTHOR'S ADDRESS: Departments of Anesthesiology, Hakodate Watanabe
Hospital, and Hirosaki National Hospital, Hirosaki, Aomori,
Japan.
PUBLICATION TYPE: Status: In-Process
Journal Article
.CONCLUSION: Antidepressants administered to depressed patients
should be continued before anesthesia. Discontinuation of
antidepressants did not increase the incidence of hypotension and
arrhythmias during anesthesia, but increased symptoms of depression
and delirium or confusion.
MB: Hypotension occurred if the drugs were stopped or not.
ARTICLE TITLE: Should we use breathing filters in anesthesia?
ARTICLE SOURCE: Can J Anaesth (Canada), Feb 2002, 49(2) p115-20
AUTHOR(S): Lessard MR; Trepanier CA
AUTHOR'S ADDRESS: Departement d'anesthesie-reanimation, Centre
hospitalier affilie universitaire de Quebec, (hopital Enfant-Jesus),
Universite Laval, Quebec, Quebec, Canada.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: The chips are down for Helicobacter pylori
ARTICLE SOURCE: Gut (England), Mar 2002, 50(3) p293-4
AUTHOR(S): Atherton JC
AUTHOR'S ADDRESS: Division of Gastroenterology and Institute of
Infections and Immunity, University Hospital, Nottingham NG7 2UH,
UK.
PUBLICATION TYPE: Journal Article
MB: It's about the genome.
ARTICLE TITLE: Surgical tracheostomy versus percutaneous
dilatational tracheostomy. A prospective-randomized study with
long-term follow-up
ARTICLE SOURCE: J Cardiovasc Surg (Torino) (Italy), Feb 2002, 43(1)
p113-21
AUTHOR(S): Melloni G; Muttini S; Gallioli G; Carretta A; Cozzi S;
Gemma M; Zannini P
AUTHOR'S ADDRESS: Department of Thoracic Surgery, Vita-Salute San
Raffaele University, San Raffaele Scientific Institute, Milan,
Italy.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: This study confirms that percutaneous dilatational
tracheostomy (PDT) is a simpler and quicker procedure than surgical
tracheostomy (ST) and that it has a lower rate of early postoperative
complications. Late tracheal complications were more frequent,
although the difference was not statistically-significant, in the PDT
group. Further investigations of long-term outcome following PDT are
therefore necessary.
ARTICLE TITLE: The internal morality of clinical medicine: a
paradigm for the ethics of the helping and healing professions
ARTICLE SOURCE: J Med Philos (Netherlands), Dec 2001, 26(6)
p559-79
AUTHOR(S): Pellegrino ED
AUTHOR'S ADDRESS: Center for Clinical Bioethics, Georgetown
University Medical Center, Washington, DC 20007, USA. patchelu@
gunet.georgetown.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: The moral authority for professional ethics in medicine
customarily rests in some source 'external' to medicine, i.e., a
pre-existing philosophical system of ethics or some form of social
construction, like consensus or dialogue. Rather, 'internal' morality
is grounded in the phenomena of medicine, i.e., in the nature of the
clinical encounter between physician and patient. From this, a
philosophy of medicine is derived which gives moral force to the
duties, virtues and obligations of physicians qua physicians.
Similarly, an ethic specific to the other healing professions, law,
teaching or ministry, can be derived from the specific ends to telos
of each of these professions, which like medicine, are focused on a
special type of human relationship.
ARTICLE TITLE: Internal and external standards for medical
morality
ARTICLE SOURCE: J Med Philos (Netherlands), Dec 2001, 26(6)
p601-19
AUTHOR(S): Beauchamp TL
AUTHOR'S ADDRESS: The Kennedy Institute of Ethics, Georgetown
University, Washington, DC 20057, USA. Beauchat@georgetown.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: What grounds and justifies conclusions in medical ethics?
Is the source external or internal to medicine? Three influential
types of answer have appeared in recent literature: an internal
account, an external account, and a mixed internal/external account.
The first defends an ethic derived from either the ends of medicine
or professional practice standards. The second maintains that
precepts in medical ethics rely upon and require justification by
external standards such as those of public opinion, law, religious
ethics, or philosophical ethics. The third claims that distinct
medical ethics have emerged from distinct cultural frameworks, each
with norms that govern physicians. There is merit in each
perspective, but each over reaches its supporting arguments and fails
to appreciate what is legitimate in the theses of its competitors. I
propose a fourth account that offers a way to escape limitations of
the other three, while retaining their most attractive features.
ARTICLE TITLE: The impossibility of a morality internal to
medicine
ARTICLE SOURCE: J Med Philos (Netherlands), Dec 2001, 26(6)
p621-42
AUTHOR(S): Veatch RM
AUTHOR'S ADDRESS: Kennedy Institute of Ethics, Georgetown University,
Washington, DC 20057, USA. veatchr@georgetown.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: After distinguishing two different meanings of the notion
of a 'morality internal to medicine' and considering a hypothetical
case of a society that relied on its surgeons to 'eunuchize'
priest/cantors to permit them to play an important religious/cultural
role, this paper examines three reasons why morality cannot be
derived from reflection on the ends of the practice of medicine: (1)
there exist many medical roles and these have different ends or
purposes, (2) even within any given medical role, there exists
multiple, sometimes conflicting ends, and, most critically, (3) the
ends of any practice such as medicine must come from outside the
practice, that is, from the basic ends or purposes of human living.
The paper concludes by considering whether these ends external to
medicine are universally part of the moral reality or whether they
are socially constructed. The paper argues that, even if various
cultural accounts of the common, universal morality are 'socially
constructed,' they may, nevertheless, be reflections, however,
imperfect, of a more universal common morality that should be thought
of as real. Therefore, the morality of medicine must come from a more
fundamental morality external to medicine. That external morality
will be socially constructed, but may nevertheless reflect an
underlying common morality.