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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Month: October 2012 (Page 1 of 3)

Anesthesia techniques for carotid endarterectomy

Abstract

Stroke is one of the leading causes of death in the modern countries. Mainstay treatment for stroke prevention is carotid endarterectomy (CEA). Patients scheduled for surgery often have many associate systemic illnesses that pose a risk of perioperative cardiac and neurological complications. Detailed preoperative evaluation of neurological and cardiac function with optimization of the systemic illnesses therapy is obligatory. Ideal anesthesiology technique should provide adequate analgesia, minimal stress response, optimal brain perfusion and oxygenation, optimal hemodynamic and myocardial oxygen balance while assuring calm and relaxed patients with good surgical comfort. Both regional anesthesia and general anesthesia have some advantages and drawbacks. Regarding to cerebral and myocardial ischemia and adverse outcome after CEA, especially in high risk patients, today still it is not clear which anesthesia technique is preferred for CEA. Greatest risk in the early postoperative period is new neurological deficit caused by cerebral ischemia end myocardial infarction caused with hemodynamic instability and therefore CEA patients are placed in the Intensive Care Unit for at least six or more hours where they are monitored for neurological and hemodynamic complications.

 

Key words: anesthesia, carotid endarterectomy

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Induced mild hypothermia in children

Abstract

The objective of this study was to measure outcomes and to determine the safety and effectiveness of mild induced hypothermia in children after traumatic and posthypoxic brain injury.
Methods. Forty patients, following traumatic or posthypoxic brain injury, were involved in the study. Mean age was 10.7 ± 0.8 years. Median GCS (Glasgow Coma Scale) was  6.0 (4-7) and mean PIM2 (Pediatric Index of Mortality) 14.6 ± 3.8 %.
Results. GOS (Glasgow Outcome Scale) of 5 was assigned for 15 (37.5%) patients, GOS 4 for 14 (35.0%), GOS 3 for 7 (17.5%) and GOS 2 for 4 (10%) patients. The average GOS in patients after severe head trauma was 3.6 ± 0.9 points and in patients with posthypoxic brain injury 5 points, (p < 0.05). No life threatening complications occurred.
Conclusion. Mild induced hypothermia can be safely used in pediatric patents after severe traumatic or posthypoxic brain injury. This method may be of benefit while improving outcomes in children.

 

Key words: traumatic brain injury, posthypoxic brain injury, children, hypothermia, outcome, Pediatric Index of Mortality

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Excessive endotracheal tube cuff pressure: Is there any difference between emergency physicians and anesthesiologists?

Abstract

Introduction. Endotracheal tube (ETT) cuff pressure is not usually measured by manometer and the providers rely on their estimation of cuff pressure by palpating the pilot balloon. In this study, we evaluated the pressure of ETT cuffs inserted by emergency physicians or anesthesiologists, and assessed the accuracy of manual pressure testing in different settings using a standard manometer.
Methods. In this cross sectional study, the cuff pressure of 100 patients in emergency department (ED) and intensive care units (ICU) of two university hospitals was evaluated by using a sensitive and accurate analog standard manometer after insertion of the ETT and checking the pilot balloon by the provider. All measurements were performed by a person who was blinded to the study purpose and an ideal pressure range of 20 to 30 cmH2O was used for analysis.
Results. Emergency physicians (n=58) and anesthesiologists (n=42) performed the intubations. The mean measured cuff pressure in our study was 69.2±29.8 cmH2O (range: 10-120 cmH2O) which was significantly different from the recommended standard value of 25 cmH2O (P<0.0001, one-sample t-test). No difference was found between anesthesiologists and emergency physicians in cuff inflation pressures (Anesthesiologists = 71.1 ± 25.7; Emergency physicians = 67.9±32.6).
Conclusion. Estimation of cuff pressure using palpation techniques is not accurate. In order to prevent adverse effects of cuff overinflation, it is better to recheck the pressure using a manometer, regardless of place, time and the inserter of the endotracheal tube.

 

Key words: endotracheal tube, cuff pressure, emergency physicians, anesthesiologist

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Occurrence of seizures in hospitalized patients with a pre-existing seizure disorder

Abstract

Objective. To assess the frequency of seizures in hospitalized patients with a pre-existing seizure disorder.
Patients and Methods. A retrospective review was conducted on all patients with a documented seizure disorder who were hospitalized between January 1, 2002 and December 31, 2007. Children aged < 2 years and hospital admission for seizure control or surgical or obstetric indications were excluded. The first hospital admission of at least 24 hours was identified for each patient. Patient demographics, details of the seizure disorder, details of the hospital admission, and clinically-apparent seizure activity documented during the inpatient stay were recorded from the medical record.
Results. During the 6-year study period, 720 patients with a documented seizure disorder were admitted for at least 24 hours. Thirty-nine patients experienced seizure activity for an overall frequency  of 5.4% (95% CI: 3.8-7.1%). Younger age (p = 0.001), greater frequency of baseline seizure activity (p < 0.001), recent seizure activity (p < 0.001), greater number of chronic antiepileptic medications (p = 0.01), and admission for neurological (p = 0.03) conditions were associated with increased frequency of seizure activity during hospitalization.
Conclusions. The majority of seizures occurring in hospitalized patients with a pre-existing seizure disorder appear related to the patient’s underlying seizure disorder. Because patients with frequent seizures on numerous anti-epileptic medications are likely to experience a seizure while hospitalized, it is essential to be prepared to treat seizure activity regardless of the reason for admission.

 

Key words: seizure disorder, hospitalization, anticonvulsants

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Thrombosis in newborns: experience from 31 cases

Abstract

Thrombosis is the result of congenital or acquired prothrombotic risk factors. The incidence of thrombosis in the paediatric population is highest in newborns, as about 10% of thrombotic events occur in the first four weeks of life. Haemostasis in a newborn, though still developing, is a well balanced mechanism. About 90% of all thrombotic events are due to acquired and the rest to congenital risk factors.
The aim of our study was to estimate the incidence of thrombosis in a population of Slovenian newborns and to study risk factors, location and treatment of thrombotic events.
Inpatient charts of newborns with thrombosis, admitted to a tertiary neonatology centre and paediatric intensive care unit between 2004 and 2011, were studied retrospectively. Family history, location, aetiology and treatment of thrombosis were analysed.
Thirty one newborns, 17 boys (54.8%) and 14 girls (45.2%), with 31 thrombotic events were found. There were 17 cases (54.8%) of arterial and 14 cases (45.2%) of venous thrombosis. A  family history of thrombophilia was found in two cases (6.5%). Twenty six cases (83.9%) were contributed to acquired risk factors and five (16.1%) to congenital aetiology. Four cases (12.8%) were treated, two with anticoagulation, one with thrombolysis and one with both. The estimated incidence of thrombosis was 0.17 per 1000 live births. Our data showed a higher incidence of thrombosis in Slovenian newborns and a higher incidence of congenital prothrombotic risk factors than in the data published so far.

 

Key words: newborn, thrombosis, incidence, risk factor, treatment

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