Current Issue : January - March Volume : 2013 Issue Number : 1 Articles : 7 Articles
Background: To examine whether acute lung injury from direct and indirect origins differ in susceptibility to\r\nventilator-induced lung injury (VILI) and resultant systemic inflammatory responses.\r\nMethods: Rats were challenged by acid instillation or 24 h of sepsis induced by cecal ligation and puncture,\r\nfollowed by mechanical ventilation (MV) with either a low tidal volume (Vt) of 6 mL/kg and 5 cm H2O positive\r\nend-expiratory pressure (PEEP; LVt acid, LVt sepsis) or with a high Vt of 15 mL/kg and no PEEP (HVt acid, HVt\r\nsepsis). Rats sacrificed immediately after acid instillation and non-ventilated septic animals served as controls.\r\nHemodynamic and respiratory variables were monitored. After 4 h, lung wet to dry (W/D) weight ratios, histological\r\nlung injury and plasma mediator concentrations were measured.\r\nResults: Oxygenation and lung compliance decreased after acid instillation as compared to sepsis. Additionally, W/\r\nD weight ratios and histological lung injury scores increased after acid instillation as compared to sepsis. MV\r\nincreased W/D weight ratio and lung injury score, however this effect was mainly attributable to HVt ventilation\r\nafter acid instillation. Similarly, effects of HVt on oxygenation were only observed after acid instillation. HVt during\r\nsepsis did not further affect oxygenation, compliance, W/D weight ratio or lung injury score. Plasma interleukin-6\r\nand tumour necrosis factor-a concentrations were increased after acid instillation as compared to sepsis, but\r\nplasma intercellular adhesion molecule-1 concentration increased during sepsis only. In contrast to lung injury\r\nparameters, no additional effects of HVt MV after acid instillation on plasma mediator concentrations were\r\nobserved.\r\nConclusions: During MV more severe lung injury develops after acid instillation as compared to sepsis. HVt causes\r\nVILI after acid instillation, but not during sepsis. However, this differential effect was not observed in the systemic\r\nrelease of mediators....
Ultrasound guided sciatic nerve block (SNB) at the popliteal fossa is performed with the lateral approach in the supine position\r\nor with the lateral or posterior approach in the prone position. When the sciatic nerve (SN) is blocked with the lateral approach\r\nin the supine position, the lower limb must be sufficiently elevated to enable adequate space around the knee joint for transducer\r\napplication.When the SN is blocked in the prone position, the patientsââ?¬â?¢ position needs to be changed.We report a medial approach\r\nto the SNB at the popliteal fossa in the supine position with ultrasound guidance. Ten patients scheduled for elective knee or foot\r\nsurgery participated in this study. Patients were placed in the supine position, with the hip and knee on the operated side flexed\r\nand the thigh externally rotated at approximately 45 degrees. A block needle was inserted in-plane with the transducer toward the\r\nSN bifurcation from the medial side of the thigh. The block performance time for SNB was 1.8Ã?±0.5 min (1.3ââ?¬â??3.1 min). All blocks\r\nwere effective. Our medial approach to the SN in the supine position with ultrasound guidance does not require elevation of the\r\npatientââ?¬â?¢s lower limb or a change in the patientââ?¬â?¢s position....
Background: Reduced muscle strength- commonly characterized by decreased handgrip strength compared to\r\npopulation norms- is associated with numerous untoward outcomes. Preoperative handgrip strength is a\r\npotentially attractive real-time, non-invasive, cheap and easy-to-perform ââ?¬Å?bedsideââ?¬Â assessment tool. Using\r\nsystematic review procedure, we investigated whether preoperative handgrip strength was associated with\r\npostoperative outcomes in adults undergoing surgery.\r\nMethods: PRISMA and MOOSE consensus guidelines for reporting systematic reviews were followed. MEDLINE,\r\nEMBASE, and the Cochrane Central Register of Controlled Clinical Trials (1980-2010) were systematically searched by\r\ntwo independent reviewers. The selection criteria were limited to include studies of preoperative handgrip strength\r\nin human adults undergoing non-emergency, cardiac and non-cardiac surgery. Study procedural quality was\r\nanalysed using the Newcastle-Ottawa Quality Assessment score. The outcomes assessed were postoperative\r\nmorbidity, mortality and hospital stay.\r\nResults: Nineteen clinical studies (17 prospective; 4 in urgent surgery) comprising 2194 patients were identified\r\nbetween1980-2010. Impaired handgrip strength and postoperative morbidity were defined inconsistently between\r\nstudies. Only 2 studies explicitly ensured investigators collecting postoperative outcomes data were blinded to\r\npreoperative handgrip strength test results. The heterogeneity of study design used and the diversity of surgical\r\nprocedures precluded formal meta-analysis. Despite the moderate quality of these observational studies, lower\r\nhandgrip strength was associated with increased morbidity (n = 10 studies), mortality (n = 2/5 studies) and length\r\nof hospital stay (n = 3/7 studies).\r\nConclusions: Impaired preoperative handgrip strength may be associated with poorer postoperative outcomes,\r\nbut further work exploring its predictive power is warranted using prospectively acquired, objectively defined\r\nmeasures of postoperative morbidity....
Background. Effective 2007, the ACGME required scholarly activity during residency. Although many programs have ongoing\r\nresearch, residents� involvement may be limited. This US anesthesiology residency survey assesses the current scholarly environment,\r\nresearch activity and program support during training. Methods. Following IRB approval, 131 US anesthesiology program\r\ndirectors were invited to participate in a web-based survey. Questions to directors and residents included program structure,\r\nresearch activity, funding and productivity. We categorized residencies threefold based on their size. Results are summarized\r\ndescriptively. Results. The response rate was 31.3% (n = 41) for program directors and 15.3% (n = 185) for residents. Residents�\r\nresponses mirrored those of programdirectors� regarding the presence of didactic curricula (51% versus 51.9%), research rotations\r\n(57% versus 56.2%) and a project requirement (37% versus 40%). Demands of residency (27.0%) and early stage in training\r\n(22.2%) were the main obstacles to research cited by trainees. Residents� financial support was available in 94.3% of programs.\r\nMedium and large programs had multiple funding sources (NIH, industrial and private). Conclusion. Programs are dedicated\r\nto incorporate research into their curriculum. Residents� financial support and mentorship are available, while research time is\r\nlimited. Systematic improvements are needed to increase trainee research in US anesthesiology residencies....
Background: The effect of adding clonidine to local anesthetics for nerve or plexus blocks remains unclear. Most\r\nof the studies in adults have demonstrated the positive effects of clonidine on intra- and postoperative analgesia\r\nwhen used as an adjunctive agent or in some cases as a single to regional techniques. In the pediatric population,\r\nthere are only few trials involving clonidine as an adjunct to regional anesthesia, and the analgesic benefits are not\r\ndefinite in this group of patients. The evidence concerning perineural administration of clonidine is so far\r\ninconclusive in children, as different types and volume of local anesthetic agents have been used in these studies.\r\nMoreover, the efficacy of regional anesthesia is largely affected by the operatorâ��s technique, accuracy and severity\r\nof operation.\r\nMethods: The use of clonidine alone or combined with 0.2% ropivacaine for effective analgesia after mild to\r\nmoderate painful foot surgery was assessed in 66 children, after combined sciatic lateral popliteal block (SLPB) plus\r\nfemoral block. The patients were randomly assigned into three groups to receive placebo, clonidine, and clonidine\r\nplus ropivacaine. Time to first analgesic request in the groups was analyzed by using Kaplan-Meier and the logrank\r\ntest (mean time, median time, 95% CI).\r\nResults: In our study, clonidine administered alone in the SLPB seems promising, maintaining intraoperatively the\r\nhemodynamic parameters SAP, DAP, HR to the lower normal values so that no patient needed nalbuphine under\r\n0.6 MAC sevoflurane anesthesia, and postoperatively without analgesic request for a median time of 6 hours. In\r\naddition, clonidine administered as adjuvant enhances ropivacaineâ��s analgesic effect for the first postoperative day\r\nin the majority of children (p = 0.001). Clonidine and clonidine plus ropivacaine groups also didnâ��t demonstrate\r\nPONV, motor blockade, and moreover, the parents of children expressed their satisfaction with the excellent\r\nperioperative management of their children, with satisfaction score 9.74 �± 0.45 and 9.73 �± 0.70 respectively. On the\r\ncontrary all the patients in the control group required rescue nalbuphine in the recovery room, and\r\npostoperatively, along with high incidence of PONV, and the parents of children reported a low satisfaction score\r\n(7.50 �± 0.70).\r\nConclusions: Clonidine appears promising more as an adjuvant in 0.2% ropivacaine and less than alone in the\r\nSLPB plus femoral block in children undergoing mild to moderate painful foot surgery, with no side effects....
Background: Randomized controlled trials (RCTs) are routinely used in systematic reviews and meta-analyses that\r\nhelp inform healthcare and policy decision making. The proper reporting of RCTs is important because it acts as a\r\nproxy for health care providers and researchers to appraise the quality of the methodology, conduct and analysis of\r\nan RCT. The aims of this study are to analyse the overall quality of reporting in 23 RCTs that were used in a metaanalysis\r\nby assessing 3 key methodological items, and to determine factors associated with high quality of\r\nreporting. It is hypothesized that studies with larger sample sizes, that have funding reported, that are published in\r\njournals with a higher impact factor and that are in journals that have adopted or endorsed the CONSORT\r\nstatement will be associated with better overall quality of reporting and reporting of key methodological items.\r\nMethods: We systematically reviewed RCTs used within an anesthesiology related post-operative pain management\r\nmeta-analysis. We included all of the 23 RCTs used, all of which were parallel design that addressed the use of\r\nfemoral nerve block in improving outcomes after total knee arthroplasty. Data abstraction was done independently\r\nby two reviewers. The two main outcomes were: 1) 15 point overall quality of reporting score (OQRS) based on the\r\nConsolidated Standards for Reporting Trials (CONSORT) and 2) 3 point key methodological item score (KMIS) based\r\non allocation concealment, blinding and intention-to-treat analysis.\r\nResults: Twenty-three RCTs were included. The median OQRS was 9.0 (Interquartile Range = 3). A multivariable\r\nregression analysis did not show any significant association between OQRS or KMIS and our four predictor\r\nvariables hypothesized to improve reporting. The direction and magnitude of our results when compared to\r\nsimilar studies suggest that the sample size and impact factor are associated with improved key\r\nmethodological item reporting.\r\nConclusions: The quality of reporting of RCTs used within an anesthesia related meta-analysis is poor to moderate.\r\nThe information gained from this study should be used by journals to register the urgency for RCTs to be clear\r\nand transparent in reporting to help make literature accessible and comparable....
Ultrasound-guided regional anaesthesia is rapidly growing in popularity. Initially, most evidence was for the benefits when used in\r\nadults, but there is now amultitude of well-documented benefits in children. The practice of regional anaesthesia in children differs\r\nsomewhat from that of adults in that in the majority of cases it is used for analgesia and performed under general anaesthesia to\r\nallow placement, rather than alone for anaesthesia as in adults. The purpose of this paper is to review the basic aspects of ultrasound\r\nregional anaesthesia before going into detail regarding specific techniques....
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