ARTICLE TITLE: Nausea and vomiting after major arthroplasty with
spinal anaesthesia including morphine: a randomised trial of
subhypnotic propofol infusion as prophylaxis.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Jan 1998, 42(1)
p124-7
AUTHOR(S): Grattidge P
AUTHOR'S ADDRESS: Department of Anaesthesia, General Hospital,
Oskarshamn, Sweden.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: BACKGROUND: Postoperative nausea and vomiting (PONV)
following major arthroplasty with spinal anaesthesia and intrathecal
morphine is reported in 45-74% of patients. This randomised,
double-blind, placebo-controlled trial was undertaken to determine
whether a subhypnotic infusion of propofol has a prophylactic
antiemetic effect in this patient population. METHODS: 82 patients
undergoing hip or knee replacement under subarachnoid bupivacaine
anaesthesia plus morphine 0.25 mg were randomised at the end of
surgery to receive either propofol 30 mg x h(-1) or fat emulsion
(Intralipid) 3 ml x h(-1) for 20 h postoperatively. Blinded observers
recorded episodes of nausea, vomiting and pruritus. RESULTS: PONV in
the intervention group was 40% vs 59% in the controls (P=0.1, not
significant). Pruritus occurred in 34%, with a similar rate in both
groups. CONCLUSION: These results suggest that routine use of
postoperative, subhypnotic propofol infusion as PONV prophylaxis is
not justified in this patient population.
ARTICLE TITLE: Prevention of nausea and vomiting in female
patients undergoing breast surgery: a comparison with granisetron,
droperidol, metoclopramide and placebo.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Feb 1998, 42(2)
p220-4
AUTHOR(S): Fujii Y; Tanaka H; Toyooka H
AUTHOR'S ADDRESS: Department of Anaesthesiology, Toride Kyodo General
Hospital, Ibaraki, Japan.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: BACKGROUND: Breast surgery is associated with a relatively
high incidence of postoperative nausea and vomiting (PONV). This
study was undertaken to evaluate the efficacy of granisetron,
droperidol and metoclopramide for preventing PONV after breast
surgery. METHODS: In a randomized, double-blind, placebo-controlled
trial, 120 female patients received granisetron 40 micrograms.kg-1,
droperidol 1.25 mg, metoclopramide 10 mg or placebo (saline) (n = 30
for each) intravenously immediately before the induction of
anaesthesia. A standard general anaesthetic technique was employed
throughout. Postoperatively, during the first 24 h after anaesthesia,
the incidence of PONV and adverse events was recorded. RESULTS: The
incidence of PONV was 17% with granisetron, 37% with droperidol, 43%
with metoclopramide and 50% with placebo (P 0.05; overall Fisher's
exact probability test). The incidence of adverse events was not
different among the groups. CONCLUSION: Granisetron is highly
effective for reducing the incidence of PONV in female patients
undergoing breast surgery. Droperidol and metoclopramide are
ineffective in this population.
ARTICLE TITLE: Intravenous fluid and postoperative nausea and
vomiting after day-case termination of pregnancy.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Feb 1998, 42(2)
p216-9
AUTHOR(S): Elhakim M; el-Sebiae S; Kaschef N; Essawi GH
AUTHOR'S ADDRESS: Department of Anaesthesia, Faculty of Medicine,
Ain-Shams University, Cairo, Egypt.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: METHODS: In a randomized study, 100 patients were allocated
into one of two groups; receiving 1000 ml of compound sodium lactate
solution during surgery or no intraoperative fluid. RESULTS: The
scores of nausea were significantly lower in the fluid group (P 0.05)
compared with the control group at 1, 2, 4 h and during 24-48 h
following surgery. The incidence of emesis was lower (P 0.01) after
discharge, and the time to first oral fluid was shorter (P 0.05) in
the fluid group. There was no difference in pain score or analgesic
consumption between the groups. Five patients (10%) in the control
group requested antiemetic medication compared with none in the fluid
group. CONCLUSION: Intraoperative fluid administration may offer some
benefit in decreasing the incidence of postoperative nausea and
vomiting following day-case surgery.
ARTICLE TITLE: Comparison of subhypnotic doses of thiopentone vs
propofol on the incidence of postoperative nausea and vomiting
following middle ear surgery.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Feb 1998, 42(2)
p211-5
AUTHOR(S): Honkavaara P; Saarnivaara L
AUTHOR'S ADDRESS: Department of Anaesthesia, Otolaryngological
Clinic, Helsinki University Central Hospital, Finland.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: BACKGROUND: Middle ear surgery is associated with a high
incidence of emetic sequelae and propofol has been reported to have
antiemetic activity in subhypnotic doses. METHODS: In a double-blind,
randomized study, the patients received either thiopentone 1.0
mg.kg-1 (n = 26) or 0.5 mg.kg-1 propofol (n = 26) at the end of
middle ear surgery under isoflurane-N2O-fentanyl-vecuronium
anaesthesia. Trained nurses, unaware of the group assignment,
assessed postoperative nausea, retching and vomiting up to 24 h after
the end of anaesthesia. Droperidol 10 micrograms.kg-1 was used as a
"rescue" antiemetic. RESULTS: The main result was that the patient in
the propofol group did not suffer from retching and vomiting
(R&V) during the first 6 h, whereas these symptoms occurred in
46% (P 0.001) of the patients in the thiopentone group. The patients
in the propofol group needed significantly less droperidol during the
first 24 h (mean number of doses 0.39 +/- 0.57 (SD)) than the
patients in the thiopentone group (1.35 +/- 1.47, P 0.005). Treatment
with propofol was a predictor for lowered incidence of R&V, as
well as male gender and negative history of motion sickness.
CONCLUSION: Propofol at a subhypnotic dose of 0.5 mg.kg-1 provides
prophylaxis against retching and vomiting for the first 6 h
postoperatively after middle ear surgery. The incidence of nausea was
not reduced by propofol.
ARTICLE TITLE: Can we predict who will vomit after surgery?
[editorial; comment]
COMMENTS: Comment on: Acta Anaesthesiol Scand 1998 May;
42(5):495-501; Comment on: Acta Anaesthesiol Scand 1998 May;
42(5):502-9
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), May 1998, 42(5)
p493-4
AUTHOR(S): Korttila K
ARTICLE TITLE: Clinical predictors of worsening heart failure
during withdrawal from digoxin therapy.
ARTICLE SOURCE: Am Heart J (United States), Mar 1998, 135(3)
p389-97
AUTHOR(S): Adams KF Jr; Gheorghiade M; Uretsky BF; Young JB;
Patterson JH; Tomasko L; Packer M
AUTHOR'S ADDRESS: Department of Medicine, School of Medicine,
University of North Carolina at Chapel Hill, 27599-7075, USA.
kfa@med.unc.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Previous work provides limited information concerning
predictors of clinical deterioration after digoxin withdrawal. We
investigated the association between selected baseline clinical
characteristics and symptomatic deterioration in two similarly
designed trials: Prospective Randomized Study of Ventricular Function
and Efficacy of Digoxin (PROVED) and Randomized Assessment of Digoxin
and Inhibitors of Angiotensin-Converting Enzyme (RADIANCE). Cox
proportional-hazards analysis found the following independent
predictors of worsening during follow-up in the combined PROVED and
RADIANCE patients: heart failure score, left ventricular ejection
fraction, cardiothoracic ratio, use of an angiotensin-converting
enzyme inhibitor, use of digoxin, and age. When these factors, except
for digoxin use, were tested in the subgroup of patients withdrawn
from digoxin, they all were significant independent predictors of
worsening heart failure. In contrast, only use of
angiotensin-converting enzyme inhibitor predicted deterioration in
patients who continued digoxin. Patients with more congestive
symptoms, worse ventricular function, greater cardiac enlargement, or
who were not taking an angiotensin-converting enzyme inhibitor were
significantly more likely to worsen early after digoxin
discontinuation than patients without these characteristics.
ARTICLE TITLE: Early assessment and in-hospital management of
patients with acute myocardial infarction at increased risk for
adverse outcomes: a nationwide perspective of current clinical
practice. The National Registry of Myocardial Infarction (NRMI-2)
Participants.
ARTICLE SOURCE: Am Heart J (United States), May 1998, 135(5 Pt 1)
p786-96
AUTHOR(S): Becker RC; Burns M; Gore JM; Spencer FA; Ball SP; French
W; Lambrew C; Bowlby L; Hilbe J; Rogers WJ
AUTHOR'S ADDRESS: Cardiovascular Thrombosis Research Center, Division
of Cardiovascular Medicine, University of Massachusetts Medical
School, Worcester 01655, USA. richard.becker@banyan.ummed.edu.
ABSTRACT: BACKGROUND: Therapeutic decision making in critically ill
patients requires both prompt and comprehensive analysis of available
information. Data derived from randomized clinical trials provide a
powerful tool for risk assessment in the setting of acute myocardial
infarction (MI); however, timely and appropriate use of existing
therapies and resources are the key determinants of outcome among
high-risk patients. METHODS: Demographic, procedural, and outcome
data from patients with MI were collected at 1073 U.S. hospitals
collaborating in the National Registry of MI (NRMI 2). Patients were
classified on hospital arrival as either "low risk" or "high risk"
according to a modified Thrombolysis in Myocardial Infarction II Risk
Scale based on predetermined demographic, electrocardiographic, and
clinical features. RESULTS: Among the 170,143 patients enrolled,
115,222 (67.5%) were classified as low risk and 55,521 (32.5%) as
high risk for in-hospital death, recurrent ischemia, recurrent MI,
congestive heart failure, and stroke. Using a composite
unsatisfactory outcome measure, in-hospital adverse events were had
by a greater proportion of patients initially classified as high risk
compared with those classified as low risk. By multivariate analysis,
age 70 years, prior MI, Killip class 1, anterior site of infarction,
and the combination of hypotension and tachycardia were independent
predictions of poor outcome in patients with or without ST-segment
elevation on the presenting electrocardiogram. High-risk patients
with ST-segment elevation were treated with thrombolytics (47.5%) or
alternative forms of reperfusion therapy (9.3%) within 62 minutes and
226 minutes of hospital arrival, respectively. High-risk patients
offered reperfusion therapy were also more likely to receive aspirin,
beta-blockers (intravenous, oral) and angiotensin-converting enzyme
inhibitors within 24 hours of infarction (all p 0.0001), survive
their event (8.4% versus 21.4% p 0.0001), and leave the hospital
sooner than those not reperfused. CONCLUSIONS: This large registry
experience included more than 150,000 nonselected patients with MI
and suggests that high-risk patients can be identified on initial
hospital presentation. The current use of reperfusion and adjunctive
therapies among high-risk patients is suboptimal and may directly
influence outcome. Randomized trials designed to test the impact of
specific management strategies on outcome according to initial risk
classification are warranted.
ARTICLE TITLE: Malignant hyperthermia and central core disease:
disorders of Ca2+ release channels.
ARTICLE SOURCE: Am J Med (United States), May 1998, 104(5)
p470-86
AUTHOR(S): Loke J; MacLennan DH
AUTHOR'S ADDRESS: Banting and Best Department of Medical Research,
Toronto Hospital, Ontario, Canada.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (212 references); REVIEW,
ACADEMIC
ARTICLE TITLE: When housestaff die: musings of a program
director.
ARTICLE SOURCE: Am J Med (United States), Mar 1998, 104(3)
p319-20
AUTHOR(S): Gibbons RB
MB> A registrar died in the hospitals ICU of a mysterious acute
illness
ARTICLE TITLE: The influence of chronic prearrest health
conditions on mortality and functional neurological recovery in
cardiac arrest survivors.
ARTICLE SOURCE: Am J Med (United States), Apr 1998, 104(4)
p369-73
AUTHOR(S): Mullner M; Sterz F; Behringer W; Schorkhuber W; Holzer M;
Laggner AN
AUTHOR'S ADDRESS: Department of Emergency Medicine, Vienna General
Hospital, University of Vienna, Medical School, Austria.
CONCLUSIONS: A large proportion of patients with cardiac arrest had
chronic diseases before the event. The presence of impaired
functional performance in patients with structural heart disease
increased unfavorable outcome within 6 months in primary cardiac
arrest survivors. However, the impact of chronic prearrest conditions
on outcome seems to be very small, and should not influence decisions
whether to withhold or withdraw therapy.
ARTICLE TITLE: Independent association between acute renal failure
and mortality following cardiac surgery.
ARTICLE SOURCE: Am J Med (United States), Apr 1998, 104(4) p343-8
AUTHOR(S): Chertow GM; Levy EM; Hammermeister KE; Grover F; Daley
J
AUTHOR'S ADDRESS: Department of Medicine, Brigham and Women's
Hospital, Boston, Massachusetts 02115, USA.
ABSTRACT: PURPOSE: To determine whether there is an independent
association of acute renal failure requiring dialysis with operative
mortality after cardiac surgery. PATIENTS AND METHODS: The 42,773
patients who underwent coronary artery bypass or valvular heart
surgery at 43 Department of Veterans Affairs Medical Centers between
1987 and 1994 were evaluated to determine the association between
acute renal failure sufficient to require dialysis and operative
mortality, with and without adjustment for comorbidity and
postoperative complications. ---- CONCLUSIONS: Acute renal failure
was independently associated with early mortality following cardiac
surgery, even after adjustment for comorbidity and postoperative
complications. Interventions to prevent or improve treatment of this
condition are urgently needed.
ARTICLE TITLE: Epidemiology of nonsteroidal anti-inflammatory
drug-associated gastrointestinal injury.
ARTICLE SOURCE: Am J Med (United States), Mar 30 1998, 104(3A)
p23S-29S; discussion 41S-42S
AUTHOR(S): Griffin MR
AUTHOR'S ADDRESS: Department of Medicine, Vanderbilt University
School of Medicine, Nashville, Tennessee 37232, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (92 references); REVIEW,
TUTORIAL
ABSTRACT: ----In Alberta, Canada, it has been estimated that NSAID
use accounts for 28% of all prescriptions for anti-ulcer drugs in
people aged at least 65 years. Many studies have now shown that
NSAIDs increase the risk of peptic ulcer complications by 3-5-fold,
and in several different populations it has been estimated that
15-35% of all peptic ulcer complications are due to NSAIDs. In the
United States alone, there are an estimated 41,000 hospitalizations
and 3,300 deaths each year among the elderly that are associated with
NSAIDs. Factors that increase the risk of serious peptic ulcer
disease include older age, history of peptic ulcer disease,
gastrointestinal hemorrhage, dyspepsia, and/or previous NSAID
intolerance, as well as several measures of poor health.
ARTICLE TITLE: Local radiant heating increases subcutaneous oxygen
tension.
ARTICLE SOURCE: Am J Surg (United States), Jan 1998, 175(1) p33-7
AUTHOR(S): Ikeda T; Tayefeh F; Sessler DI; Kurz A; Plattner O;
Petschnigg B; Hopf HW; West J
AUTHOR'S ADDRESS: Department of Anesthesia and Perioperative Care,
University of California, San Francisco, 94143-0648, USA.
ABSTRACT: BACKGROUND: We evaluated a novel bandage that incorporates
a thermostatically controlled radiant heater. ----- CONCLUSIONS: Our
data suggest that radiant heating at 38 degrees C significantly
increases subcutaneous oxygen tension, and presumably resistance to
infection. However, prolonged heating at this temperature does not
increase wound collagen deposition.
ARTICLE TITLE: The utility of hemodynamic measurements acquired by
pulmonary artery catheterization.
ARTICLE SOURCE: Am J Surg (United States), Apr 1998, 175(4)
p293-6
AUTHOR(S): Mostafa G; Kumar M; Schlotthauer J; Murray MJ
AUTHOR'S ADDRESS: Department of Surgery, Mayo Clinic and Foundation
Rochester, Minnesota 55905, USA.
CONCLUSIONS: Data derived from the PAC are infrequently used to guide
therapy in patients who undergo abdominal aortic reconstructive
surgery.
ARTICLE TITLE: Thoracic epidural analgesia and coronary artery
bypass graft surgery [letter]
ARTICLE SOURCE: Anaesthesia (England), May 1998, 53(5) p512-3;
discussion 513-4
AUTHOR(S): Alston RP; Sinclair CJ; Scott DH
PUBLICATION TYPE: LETTER
ARTICLE TITLE: The efficacy of ginger root in the prevention of
postoperative nausea and vomiting after outpatient gynaecological
laparoscopy.
ARTICLE SOURCE: Anaesthesia (England), May 1998, 53(5) p506-10
AUTHOR(S): Visalyaputra S; Petchpaisit N; Somcharoen K; Choavaratana
R
AUTHOR'S ADDRESS: Department of Anaesthesia, Siriraj Hospital,
Mahidol University, Bangkok, Thailand.
We conclude that ginger powder, in the dose of 2 g, droperidol 1.25
mg or both are ineffective in reducing the incidence of postoperative
nausea and vomiting after day case gynaecological laparoscopy.
ARTICLE TITLE: The effect of education, assessment and a
standardised prescription on postoperative pain management. The value
of clinical audit in the establishment of acute pain services.
ARTICLE SOURCE: Anaesthesia (England), May 1998, 53(5) p424-30
AUTHOR(S): Harmer M; Davies KA
AUTHOR'S ADDRESS: Department of Anaesthetics and Intensive Care
Medicine, University of Wales College of Medicine, Cardiff, UK.
ABSTRACT: A study involving 2738 patients in 15 hospitals in the
United Kingdom was undertaken to evaluate the effect of simple
methods of pain assessment and management on postoperative pain. The
study consisted of four parts: a survey of current practice in each
hospital; a programme of education for staff and patients regarding
pain and its management; the introduction of formal assessment and
recording of pain and the use of a simple algorithm to allow more
flexible, yet safe, provision of intermittent intramuscular opioid
analgesia; and a repeat survey of practice. One hospital from each of
the former health regions of England and Wales was selected for
inclusion in the project. Hospitals included representatives of
different size units (university, large and small district general
hospitals). As a result of the study, there was an overall reduction
in the percentage of patients who experienced moderate to severe pain
at rest from 32% to 12%. The incidence of severe pain on movement
decreased from 37% to 13% and moderate to severe pain on deep
inspiration from 41% to 22%. Similar decreases were seen in the
incidence of nausea and vomiting. There was also a slight reduction
in the incidence of postoperative complications. This study shows
that simple techniques for the management of postoperative pain are
effective in reducing the incidence of pain both at rest and during
movement and should form part of any acute pain management
strategy.
ARTICLE TITLE: Recurrent respiratory depression after total
intravenous anaesthesia with propofol and alfentanil.
ARTICLE SOURCE: Anaesthesia (England), Apr 1998, 53(4) p378-81
AUTHOR(S): Sternlo JE; Sandin RH
AUTHOR'S ADDRESS: Department of Anaesthesia, Kalmar County Hospital,
Sweden.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (11 references); REVIEW OF
REPORTED CASES
ABSTRACT: Since first commented upon by Lamarche in 1984, several
cases of recurrent respiratory arrest after alfentanil infusions have
been reported. In all these cases the alfentanil infusions have been
used to supplement conventional anaesthetic techniques with nitrous
oxide and/or inhalational agents and in most cases rather high total
alfentanil doses have been administered. We have seen two cases of
severe recurrent respiratory depression in healthy patients after
relatively minor procedures performed under total intravenous
anaesthesia with propofol-alfentanil infusions, air-oxygen
ventilation and muscle relaxation, where the alfentanil doses
administered were quite small. These cases are presented in detail
and compared within a tabulated presentation with the earlier
published cases of alfentanil-related recurrent respiratory
depression.
ARTICLE TITLE: Body posture during simulated tracheal
intubation.
ARTICLE SOURCE: Anaesthesia (England), Apr 1998, 53(4) p331-4
AUTHOR(S): Matthews AJ; Johnson CJ; Goodman NW
AUTHOR'S ADDRESS: Department of Anaesthesia, Southmead Hospital,
Bristol, UK.
ABSTRACT: Seventeen experienced anaesthetists and 15 novices were
filmed intubating the trachea of a training manikin. Measurements
were made of the distance from manikin's chin to subject's nose and
of the angles at the elbow, the shoulder and of the forearm with the
horizontal. Trained subjects stood further back (trained: median 43
cm, interquartile range 41-56 cm; novices 35 cm, 26-38 cm;
Mann-Whitney U, p 0.01), with a straighter arm (trained elbow angle:
108 degrees, 99-121 degrees; novices': 92 degrees, 88-102 degrees;
Mann-Whitney U, p 0.01). Trained subjects tended to hold the
laryngoscope closer to the hinge, with a pincer grip; novices were
more likely to use a full grip of the handle. Trainers should
consider giving novices explicit instructions on how to stand and how
to hold the laryngoscope.
MB. The authors are confused although it is true that beginners are
often not elegant.
ARTICLE TITLE: Patient-controlled analgesia: an assessment by 200
patients.
ARTICLE SOURCE: Anaesthesia (England), Mar 1998, 53(3) p216-21
AUTHOR(S): Chumbley GM; Hall GM; Salmon P
AUTHOR'S ADDRESS: Department of Anaesthesia, St. George's Hospital
Medical School, London, UK.
ABSTRACT: Two hundred patients completed a questionnaire about their
experiences of patient-controlled analgesia. The questionnaire
covered the following topics: pre-operative information, reasons for
pressing and not pressing the button, pain relief, side-effects,
safety, advantages and disadvantages of patient-controlled analgesia,
worries associated with its use and control over pain. A high level
of satisfaction with the device, together with a view that it
afforded control over pain, emerged from replies to simple, general
questions. However, more detailed questions revealed side-effects and
fears that constrained its use and hence patients' ability to control
pain. Control is predominantly a feature of the professional's view
of patient-controlled analgesia, rather than the patient's experience
of this analgesic technique.
ARTICLE TITLE: The theoretical ideal fresh-gas flow sequence at
the start of low-flow anaesthesia.
ARTICLE SOURCE: Anaesthesia (England), Mar 1998, 53(3) p264-72
AUTHOR(S): Mapleson WW
AUTHOR'S ADDRESS: Department of Anaesthetics and Intensive Care
Medicine, University of Wales College of Medicine, Cardiff, UK.
ABSTRACT: A spreadsheet model of a circle breathing system and a
70-kg anaesthetised 'standard man' has been used to simulate the
first 20 min of low-flow anaesthesia with halothane, enflurane,
isoflurane, sevoflurane and desflurane in oxygen. It is shown that,
with the fresh-gas flow set initially equal to the total ventilation
and the fresh-gas partial pressure to 3 MAC, the end-expired partial
pressure can be raised to 1 MAC in 1 min with desflurane and
sevoflurane, 1.5 min with isoflurane, 2.5 min with enflurane and 4
min with halothane. Sequences of lower fresh-gas flow and partial
pressure settings are given for then maintaining 1 MAC end-expired
partial pressure, with a minimum usage of anaesthetic, e.g. 13 ml of
liquid desflurane in 20 min (of which only 33% is taken up by the
patient) if the minimum acceptable flow is 11.min-1, or 8 ml (with
57% in the patient) if the minimum is 250 ml.min-1.
ARTICLE TITLE: Recovery of post-tetanic count and train-of-four
responses at the great toe and thumb.
ARTICLE SOURCE: Anaesthesia (England), Mar 1998, 53(3) p244-8
AUTHOR(S): Saitoh Y; Fujii Y; Takahashi K; Makita K; Tanaka H; Amaha
K
AUTHOR'S ADDRESS: Department of Anaesthesiology and Critical Care
Medicine, Faculty of Medicine, Tokyo Medical and Dental University,
Japan.
ABSTRACT: We have studied the recovery of post-tetanic count and
train-of-four responses at the great toe and thumb
accelerographically after the administration of vecuronium 0.2
mg.kg-1. Sixty adult patients scheduled for anaesthesia with nitrous
oxide and isoflurane were studied. The times to the return of the
first post-tetanic twitch were comparable at the great toe and thumb
(mean (SD) times: 30.0 (6.5) min and 35.0 (8.5) min, respectively).
Recovery of post-tetanic count followed similar time courses at the
great toe and thumb. Also, time to the return of the first twitch of
the train-of-four did not differ significantly at the great toe and
the thumb (47.5 (9.6) min vs. 49.7 (10.5) min). Similarly, time to
the return of the second, third and fourth twitches of the
train-of-four did not significantly differ at the great toe and the
thumb. However, the value of the first twitch of the train-of-four,
expressed as a proportion of control twitch, was significantly higher
than that at the thumb between 50 min and 110 min after the
vecuronium injection, and the train-of-four ratio at the great toe
was significantly higher than that at the thumb between 60 min and
100 min after the vecuronium injection.
ARTICLE TITLE: The Swiss heroin trials: testing alternative
approaches [editorial]
ARTICLE SOURCE: BMJ (England), Feb 28 1998, 316(7132) p639
AUTHOR(S): Farrell M; Hall W
PUBLICATION TYPE: EDITORIAL
MB. There is little of relevance to the possible trial here which was
proposed a while ago. W. Hall is a Sydney expert. I don't know what
his view when the matter was in public discussion here.
ARTICLE TITLE: Drug treatment in heart failure
[editorial]
ARTICLE SOURCE: BMJ (England), Feb 21 1998, 316(7131) p567-8
AUTHOR(S): Steeds RP; Channer KS
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Stress and peptic ulcer: life beyond
Helicobacter.
ARTICLE SOURCE: BMJ (England), Feb 14 1998, 316(7130) p538-41
AUTHOR(S): Levenstein S
AUTHOR'S ADDRESS: Gastroenterology Service, Nuovo Regina Margherita
Hospital, Rome, Italy. 100424.3254@compuserve.com.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (38 references); REVIEW,
TUTORIAL
MB. A rearguard action to defend psychological factors in peptic
ulcer.
ARTICLE TITLE: Many NSAID users who bleed don't know when to stop
[editorial]
ARTICLE SOURCE: BMJ (England), Feb 14 1998, 316(7130) p492
AUTHOR(S): Herxheimer A
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Missed problems and missed opportunities for
addicted doctors [editorial]
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Do silicone breast implants cause connective tissue
disease? [editorial; comment]
COMMENTS: Comment on: BMJ 1998 Feb 7; 316(7129):417-22
ARTICLE SOURCE: BMJ (England), Feb 7 1998, 316(7129) p403-4
PUBLICATION TYPE: COMMENT; EDITORIAL
M.B. It appearss that the whole thing has been a beat up.
ARTICLE TITLE: Periodontitis for medical practitioners.
ARTICLE SOURCE: BMJ (England), Mar 28 1998, 316(7136) p993-6
AUTHOR(S): Watts TL
AUTHOR'S ADDRESS: Department of Periodontology and Preventive
Dentistry, United Medical and Dental School of Guy's Hospital,
London.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (29 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Fluid resuscitation with colloid or crystalloid
solutions in critically ill patients: a systematic review of
randomised trials.
ARTICLE SOURCE: BMJ (England), Mar 28 1998, 316(7136) p961-4
AUTHOR(S): Schierhout G; Roberts I
AUTHOR'S ADDRESS: Department of Epidemiology and Public Health,
University College London Medical School.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
ABSTRACT: OBJECTIVE: To determine the effect on mortality of
rescuscitation with colloid solutions compared with resuscitation
with crystalloids. DESIGN: Systematic review of randomised controlled
trials of resuscitation with colloids compared with crystalloids for
volume replacement of critically ill patients; analysis stratified
according to patient type and quality of allocation concealment.
SUBJECTS: 37 randomised controlled trials were eligible, of which 26
unconfounded trials compared colloids with crystalloids (n = 1622).
(The 10 trials that compared colloid in hypertonic crystalloid with
isotonic crystalloid (n = 1422) and one trial that compared colloid
in isotonic crystalloid with hypertonic crystalloid (n = 38) are
described in the longer version on our website www.bmj.com). MAIN
OUTCOME MEASURES: Mortality from all causes at end of follow up for
each trial. RESULTS: Resuscitation with colloids was associated with
an increased absolute risk of mortality of 4% (95% confidence
interval 0% to 8%), or four extra deaths for every 100 patients
resuscitated. The summary effect measure shifted towards increased
mortality with colloids when only trials with adequate concealment of
allocation were included. There was no evidence for differences in
effect among patients with different types of injury that required
fluid resuscitation. CONCLUSIONS: This systematic review does not
support the continued use of colloids for volume replacement in
critically ill patients.
ARTICLE TITLE: Informed consent: edging forwards (and backwards)
[editorial; comment]
COMMENTS: Comment on: BMJ 1998 Mar 28; 316(7136):955; Comment on: BMJ
1998 Mar 28; 316(7136):1000-5
ARTICLE SOURCE: BMJ (England), Mar 28 1998, 316(7136) p949-51
AUTHOR(S): Smith R
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Two arrested in US for selling organs for
transplantation [news]
ARTICLE SOURCE: BMJ (England), Mar 7 1998, 316(7133) p725
AUTHOR(S): Josefson D
PUBLICATION TYPE: NEWS
ARTICLE TITLE: Continuing medical education: where next?
[editorial]
ARTICLE SOURCE: BMJ (England), Mar 7 1998, 316(7133) p721-2
AUTHOR(S): Toghill P
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Blood transfusion risk: protecting against the
unknown [editorial; comment]
COMMENTS: Comment on: BMJ 1998 Mar 7; 316(7133):726
ARTICLE SOURCE: BMJ (England), Mar 7 1998, 316(7133) p717-8
AUTHOR(S): Barbara J; Flanagan P
PUBLICATION TYPE: COMMENT; EDITORIAL
M.B. UK blood products not to be used because of damger of C.J.
disease. Pooled plasma in involver. I assume FFP and packed cells are
not.
ARTICLE TITLE: Antibiotic resistance: an increasing problem?. It
always has been, but there are things we can do [editorial;
comment]
COMMENTS: Comment on: BMJ 1998 Apr 25; 316(7140):1261
ARTICLE SOURCE: BMJ (England), Apr 25 1998, 316(7140) p1255-6
AUTHOR(S): Hart CA
PUBLICATION TYPE: COMMENT; EDITORIAL
M.B. Pretty useless.
ARTICLE TITLE: Systematic review of dietary intervention trials to
lower blood total cholesterol in free-living subjects.
ARTICLE SOURCE: BMJ (England), Apr 18 1998, 316(7139) p1213-20
AUTHOR(S): Tang JL; Armitage JM; Lancaster T; Silagy CA; Fowler GH;
Neil HAW
AUTHOR'S ADDRESS: Division of Public Health and Primary Care,
University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE, UK.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
CONCLUSIONS: Individualised dietary advice for reducing cholesterol
concentration is modestly effective in free-living subjects. More
intensive diets achieve a greater reduction in serum cholesterol
concentration. Failure to comply fully with dietary recommendations
is the likely explanation for this limited efficacy.
ARTICLE TITLE: Randomised comparison of cost effectiveness of
guided self management and traditional treatment of asthma in
Finland.
ARTICLE SOURCE: BMJ (England), Apr 11 1998, 316(7138) p1138-9
AUTHOR(S): Lahdensuo A; Haahtela T; Herrala J; Kava T; Kiviranta K;
Kuusisto P; Pekurinen M; Peramaki E; Saarelainen S; Svahn T; Liljas
B
AUTHOR'S ADDRESS: Department of Pulmonary Diseases, Tampere
University Hospital, Pikonlinna, Finland.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ARTICLE TITLE: Doctors in training: wasteful and inefficient?
[editorial]
ARTICLE SOURCE: BMJ (England), Apr 11 1998, 316(7138) p1107-8
AUTHOR(S): Rosborough TK
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Unscientific practice flourishes in science
[editorial]
ARTICLE SOURCE: BMJ (England), Apr 4 1998, 316(7137) p1036
AUTHOR(S): Smith R
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Prostate cancer screening reduces deaths
[news]
ARTICLE SOURCE: BMJ (England), May 30 1998, 316(7145) p1626
AUTHOR(S): Charlatan FB
PUBLICATION TYPE: NEWS
ARTICLE TITLE: Pain relief in children. Doing the simple things
better [editorial]
ARTICLE SOURCE: BMJ (England), May 23 1998, 316(7144) p1552
AUTHOR(S): Zacharias M; Watts D
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Calcium channel blockers. The jury is still out on
whether they cause heart attacks and suicide [editorial]
ARTICLE SOURCE: BMJ (England), May 16 1998, 316(7143) p1471-3
AUTHOR(S): Stanton AV
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Hypertonic saline resuscitation of patients with
head injury: a prospective, randomized clinical trial.
ARTICLE SOURCE: J Trauma (United States), Jan 1998, 44(1) p50-8
AUTHOR(S): Shackford SR; Bourguignon PR; Wald SL; Rogers FB; Osler
TM; Clark DE
AUTHOR'S ADDRESS: Department of Surgery, College of Medicine,
University of Vermont, Burlington, USA.
sshackfo@salus.med.uvm.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
ABSTRACT: ---- CONCLUSION: As a group, HTS patients had more severe
head injuries. HTS and LRS used with other therapies effectively
controlled the ICP. The widely held conviction that sodium
administration will lead to a sustained increase in ICP is not
supported by this work.
International Classification of Diseases, ninth revision-based
prediction tool, outperforms both ISS and TRISS as predictors of
trauma patient survival, hospital charges, and hospital length of
stay.
ARTICLE SOURCE: J Trauma (United States), Jan 1998, 44(1) p41-9
AUTHOR(S): Rutledge R; Osler T; Emery S; Kromhout-Schiro S
AUTHOR'S ADDRESS: Department of Surgery, University of North Carolina
at Chapel Hill, 27599-7210, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: In addition to predicting mortality, quality tools that
can accurately predict resource utilization are necessary for
effective trauma center quality-improvement programs. ICISS-derived
predictions of survival, hospital charges, and hospital length of
stay consistently outperformed those of ISS and TRISS. The neural
network-augmented ICISS was even better. This and previous studies
demonstrate that TRISS is a limited technique in predicting survival
resource utilization. Because of the limitations of TRISS, it should
be superseded by ICISS.
ARTICLE TITLE: Base deficit is superior to pH in evaluating
clearance of acidosis after traumatic shock.
ARTICLE SOURCE: J Trauma (United States), Jan 1998, 44(1) p114-8
AUTHOR(S): Davis JW; Kaups KL; Parks SN
AUTHOR'S ADDRESS: Department of Surgery, University of South Florida,
Tampa, USA.
CONCLUSION: Base deficit reveals differences in metabolic acidosis
between survivors and nonsurvivors not shown by pH determinations and
is clearly a better marker of acidosis clearance after shock.
ARTICLE TITLE: Randomized, prospective comparison of increased
preload versus inotropes in the resuscitation of trauma patients:
effects on cardiopulmonary function and visceral perfusion.
ARTICLE SOURCE: J Trauma (United States), Jan 1998, 44(1) p107-13
AUTHOR(S): Miller PR; Meredith JW; Chang MC
AUTHOR'S ADDRESS: Department of General Surgery, The Bowman Gray
School of Medicine of Wake Forest University, Winston-Salem, North
Carolina 27157, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSION: Patients resuscitated at higher levels of preload have
significantly better visceral perfusion than those resuscitated at
normal preload with addition of inotropes. This higher preload does
not adversely affect pulmonary function.
ARTICLE TITLE: Massive transfusion exceeding 150 units of packed
red cells during the first 15 hours after injury.
ARTICLE SOURCE: J Trauma (United States), Feb 1998, 44(2) p410-2
AUTHOR(S): Hakala P; Lindahl J; Alberty A; Tanskanen P; Nieminen H;
Porras M
AUTHOR'S ADDRESS: Department of Anaesthesia, University of Helsinki,
Toolo Hospital, Finland.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Resuscitation after uncontrolled venous hemorrhage:
Does increased resuscitation volume improve regional perfusion?
ARTICLE SOURCE: J Trauma (United States), Apr 1998, 44(4) p701-8
AUTHOR(S): Smail N; Wang P; Cioffi WG; Bland KI; Chaudry IH
AUTHOR'S ADDRESS: Center for Surgical Research and Department of
Surgery, Brown University School of Medicine and Rhode Island
Hospital, Providence 02903, USA.
CONCLUSIONS: Fluid resuscitation after uncontrolled venous bleeding
transiently increased cardiac output and mean arterial blood pressure
compared with nonresuscitated animals. Moderate fluid administration,
i.e., 10 mL, however, did increase total hepatic blood flow. In
contrast, increasing the resuscitation volume to 30 mL did not
improve hemodynamic parameters or regional perfusion. Thus moderate
instead of no resuscitation or larger volume of resuscitation is
recommended in an uncontrolled model of venous hemorrhage.
ARTICLE TITLE: A randomized, prospective, blinded comparison of
postoperative pain, metabolic response, and perceived health after
laparoscopic and small incision cholecystectomy.
ARTICLE SOURCE: Surgery (United States), May 1998, 123(5) p485-95
AUTHOR(S): Squirrell DM; Majeed AW; Troy G; Peacock JE; Nicholl JP;
Johnson AG
AUTHOR'S ADDRESS: Department of Surgical and Anaesthetic Sciences,
University of Sheffield, U.K.
CONCLUSIONS: LC appears to be associated with less tissue destruction
and pain than SC, but this did not confer any advantage in the degree
of postoperative respiratory impairment, length of hospital stay, or
postoperative perceived health. The neuroendocrine component of the
metabolic response evoked by each procedure was similar and had a
significant correlation to patient's postoperative hospital stay.
This finding may explain the similar postoperative recovery after LC
and SC.
ARTICLE TITLE: Effects of preinduction and intraoperative warming
during major laparotomy.
ARTICLE SOURCE: Br J Anaesth (England), Feb 1998, 80(2) p159-63
AUTHOR(S): Bock M; Muller J; Bach A; Bohrer H; Martin E; Motsch J
AUTHOR'S ADDRESS: Department of Anaesthesiology, University of
Heidelberg, Germany.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: We have investigated the influence of active warming before
and during operation on blood loss, transfusion requirements,
duration of stay in the post-anaesthesia care unit (PACU) and
perioperative costs in 40 patients undergoing major abdominal
surgery. Patients were allocated randomly to one of two groups: in
the study group (n = 20), patients were actively warmed using forced
air for 30 min before induction of general anaesthesia and during
anaesthesia. Passive protection against heat loss consisted of
circulating water mattresses, blankets and fluid warming devices, and
was used both in the active warming group and in the control group (n
= 20). At the end of surgery the change in core temperature was
significantly less in the group of actively warmed patients (0.5 (SD
0.8) degree C vs 1.5 (0.8) degree C; P or = 0.01). Blood loss and
transfusion requirements were less in the actively warmed patients,
who had a shorter duration of stay in the PACU (94 (SD 42) min vs 217
(169) min; P or = 0.01) and a 24% reduction in total anaesthetic
costs.
ARTICLE TITLE: Effects of hypothermia on thrombelastography in
patients undergoing cardiopulmonary bypass.
ARTICLE SOURCE: Br J Anaesth (England), Mar 1998, 80(3) p313-7
AUTHOR(S): Kettner SC; Kozek SA; Groetzner JP; Gonano C;
Schellongowski A; Kucera M; Zimpfer M
AUTHOR'S ADDRESS: Department of Anaesthesiology and General Intensive
Care, University of Vienna, Austria.
ABSTRACT: Thrombelastography (TEG) correlates with postoperative
chest drain output in patients undergoing cardiopulmonary bypass
(CPB). In vitro incubation with heparinase allows TEG monitoring
during CPB, despite heparin anticoagulation. Hypothermia impairs
coagulation, but these effects cannot be assessed by standard
coagulation tests performed at 37 degrees C. The aim of this study
was to assess the effects of hypothermia on TEG. Therefore, we have
compared normothermic and temperature-adapted TEG in 30 patients
undergoing CPB. Our data showed significantly impaired reaction time
(r), kinetic time (k), and angle alpha (alpha) in temperature-adapted
compared with normothermic TEG. Maximum amplitude (MA), reflecting
absolute clot strength, was not affected at temperatures of 33-37
degrees C. These findings indicate a decrease in the speed of clot
formation, but not absolute deterioration in clot quality.
Furthermore, heparinase-modified TEG indicated that there were nine
cases in which heparin effects persisted after heparin reversal with
protamine, providing a rational guide to protamine therapy.
ARTICLE TITLE: Does ketorolac cause postoperative renal failure:
how do we assess the evidence? [editorial]
ARTICLE SOURCE: Br J Anaesth (England), Apr 1998, 80(4) p420-1
AUTHOR(S): Myles PS; Power I
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Pain after amputation: is prevention better than
cure? [editorial]
ARTICLE SOURCE: Br J Anaesth (England), Apr 1998, 80(4) p415-6
AUTHOR(S): Thompson HM
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Myocardial protection: is there anything better
than ice?
ARTICLE SOURCE: Can J Anaesth (Canada), May 1998, 45(5 Pt 2)
pR32-9
AUTHOR(S): Finegan BA; Cohen M
AUTHOR'S ADDRESS: Department of Anaesthesia, University of Alberta,
Edmonton, Canada. bfinegan@gpu.srv.ualberta.ca.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (52 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Comparative effects of desflurane and isoflurane on
recovery after long lasting anaesthesia.
ARTICLE SOURCE: Can J Anaesth (Canada), May 1998, 45(5 Pt 1)
p429-34
AUTHOR(S): Beaussier M; Deriaz H; Abdelahim Z; Aissa F; Lienhart
A
AUTHOR'S ADDRESS: Departement d'Anesthesie-Reanimation chirurgicale,
Hopital St-Antoine, Paris, France.
RESULTS: Mean anaesthesia duration was 292 +/- 63 and 304 +/- 91 min
in the desflurane and isoflurane groups respectively. After
desflurane and isoflurane discontinuation, the time to opening eyes
was 12 +/- 7 and 24 +/- 11 min respectively (P 0.001); to squeeze
fingers at command was 17 +/- 11 and 35 +/- 19 min (P 0.001); to
extubation was 16 +/- 6 and 33 +/- 13 min (P 0.001); to give their
name was 22 +/- 12 and 43 +/- 21 min (P 0.001); to achieve a Steward
score of 6 was 28 +/- 16 and 57 +/- 33 min (P 0.001), to be fit for
discharge from the recovery room was 46 +/- 19 and 81 +/- 37 min (P
0.003). Ranges of times to reappearance of recovery variables in the
desflurane group were less than those after isoflurane (P 0.05).
CONCLUSION: After long duration anaesthesia lasting up to three
hours, desflurane allowed recovery and extubation in approximately
half the time required by isoflurane. Less variability in results
suggests better predictability of recovery with desflurane.
M.B. It seems to me too slow for isoflurane.
ARTICLE TITLE: Cardiac output during liver transplantation.
ARTICLE SOURCE: Can J Anaesth (Canada), Feb 1998, 45(2) p133-8
AUTHOR(S): Colbert S; O'Hanlon DM; Duranteau J; Ecoffey C
AUTHOR'S ADDRESS: Department of Anesthesia and Intensive Care,
Hopital Paul Brousse, Villejuif, France.
CONCLUSION: The use of the ODM results in cardiac output measurements
which are considerably different from those obtained using
thermodilution and its use cannot be recommended in patients
undergoing orthotopic liver transplantation.
ARTICLE TITLE: Oesophageal, rectal, axillary, tympanic and
pulmonary artery temperatures during cardiac surgery.
ARTICLE SOURCE: Can J Anaesth (Canada), Apr 1998, 45(4) p317-23
AUTHOR(S): Robinson J; Charlton J; Seal R; Spady D; Joffres MR
AUTHOR'S ADDRESS: Department of Pediatrics, University of Alberta,
Edmonton, Canada. jr3@gpu.srv.ualberta.ca.
CONCLUSION: Oesophageal temperature is more accurate and will reflect
rapid changes in body temperature better than tympanic, axillary, or
rectal temperature. When oesophageal temperature cannot be measured,
tympanic temperature done by a trained operator should become the
reading of choice.
M.B. They don't mention NP temp.MB