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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

Inhalation sedation with the ‘Anaesthetic Conserving Device’ for patients in intensive care units: A literature review


Background. The Anaesthetic Conserving Device is a modified heat and moisture exchanger that enables the application of inhalation sedation with existing ventilators in intensive care units. The following review describes the advantages of inhalation sedation using the Anaesthetic Conserving Device in comparison to standard intravenous sedation for patients in intensive care units and highlights the technical aspects of its functioning.

Methods. The literature search was limited to PubMed, Sage Journals and CINAHL databases, using the terms »anaesthetic conserving device«, »volatile anaesthetic reflection filter«, »AnaConDa« independently and in connection with the terms »sedation« and »intensive care unit«. Included are articles published up until December 2014.

Results. Use of inhalation sedation with the Anaesthetic Conserving Device enables faster transition to spontaneous breathing and a shorter awakening time than with intravenous sedation. Even short-term inhalation sedation of patients after open heart procedures has a cardioprotective effect and reduces troponin T values. Despite increased concentrations of inorganic fluoride in serum after sevoflurane exposure, no clinical studies to date have shown its nephrotoxic effect, even after long-term (48 h) sedation. The Anaesthetic Conserving Device is accurate in maintaining target values of volatile anaesthetics. However, increased dead space volume was found in several studies, exceeding the internal volume of the Anaesthetic Conserving Device.

Conclusion. Results to date show that inhalation sedation with the Anaesthetic Conserving Device may be an effective and safe alternative to existing protocols of intravenous sedation for patients requiring intensive treatment.

Key words: anaesthetic conserving device, inhalational sedation, intravenous sedation, intensive care unit

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History of professional education on podiatry emergencies and disasters: a Spanish point of view


Mainstreaming between podiatry practice and podiatry studies is needed. Podiatry practice evolution in Spain has allowed this medical discipline to obtain its own academic, institutional and legislative framework to increase and improve professional decisions in the podiatric medical practice. For that reason, there is a great interest and relevancy on emergencies and urgencies education in podiatry clinical and welfare activity. It is an essential component, the different and inherent risk conditions of welfare activity require to give an immediate, accurate and sure response that protects people life. Podiatry faculties could and should establish joint actions that integrate on an effective way the complexity and multiplicity of vital situations that the podiatric activity involves, as well as to establish strategic plans in the activity of professional podiatrists that come together in an improvement of graduates.

Key words: education, Emergency medicine, podiatry, disasters

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Does basic life support training simplification foster retention of life saving maneuvers?


Objectives. Simplification of Basic Life Support was proposed with the introduction of Chest-Compression only Cardio-Pulmonary Resuscitation (CC-CPR) as an alternative to Standard CPR (S-CPR). This study aimed to compare retention of knowledge, in the general public, of both CPR techniques (CC-CPR vs. S-CPR).

Design, setting and participants. Multicentric prospective comparative cohort study. A training program was conducted among 906 individuals who were assigned to CC-CPR or to S-CPR group. They were evaluated before training (T0), after training (T1) and six months later (T2) on 17 CPR assessment criteria, they were evaluated twice at each time period and one global CPR performance score.

Results. Initial knowledge was low. At T1, all CPR performance criteria improved significantly. Results were similar in both groups except for the rate of trainees calling for help and the time to turn on the automated external defibrillator and to deliver the first shock. At T2, the knowledge level was lower than at T1. Finally, CPR performance score was lower in both groups at T2 compared to T1 but statistically higher than at T0. CPR performance score was higher in the CC-CPR group than in the S-CPR group at T2 (p=0.041).

Conclusions. Performance score was significantly higher in the CC-CPR group. CC-CPR training seems to result in better retention and a faster reaction in the setting of an out of hospital cardiac arrest. Moreover, the retention of knowledge among a trained population fades partially with time. Regular CPR training should therefore be proposed to avoid the loss of benefit with time.

Key words: cardio-pulmonary resuscitation, basic life support, chest compression, mouth-to-mouth ventilation, training, retention

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Effects of epidural magnesium sulphate on intraoperative sufentanil and postoperative analgesic requirements in thoracic surgery patients


Introduction. Thoracic surgery is associated with high levels of pain.

Magnesium has antinociceptive effects in animal and human models of pain.

Objectives. The aim of this randomized prospective study was to assess the effects of continuous epidural magnesium infusion during thoracic surgery on intraoperative sufentanil consumption and postoperative analgesic requirements during the first 48 hours after surgery.

Materials and methods. Seventy patients were randomized into two groups of 35 patients: Group 1 (magnesium group) received an epidural with 10% magnesium sulfate (MgSO4) along with anesthetic drugs (midazolam, propofol, rocuronium, sufentanil, levobupivacain), and group 2 (control group) received an epidural with 0.9% sodium chloride (NaCl) solution along with anesthetic drugs intraoperatively. Postoperatively, group 1 patients were administered the 10% magnesium sulfate epidural in addition to a local anesthetic and opioid, whereas group 2 patients were administered the local anesthetic and opioid alone. Primary outcomes of the study were to determine the cumulative doses of intraoperatively administered sufentanil and cumulative doses of sufentanil and levobupivacaine administered during the first 48 h postoperatively.

Secondary outcomes were a visual analog scale (VAS) score for rest and movement every 4 hours, level of sedation, cardiovascular, respiratory and neurological complications, incidence of postoperative shivering, nausea and vomiting and global patient satisfaction.

Results. The cumulative sufentanil dose required intraoperatively was significantly lower in the magnesium group: 43.00 μg vs 56.3 μg ( p = 0.001). VAS scores measured every 4 hours at rest and movement during the first 48 hours postoperatively, cumulative analgesic consumption, incidence of shivering, nausea and vomiting were significantly lower in the magnesium group. The global satisfaction score was significantly higher in the magnesium group (4.3 vs 3.7; p = 0.005).

Conclusion. The addition of magnesium in the epidural mixture of sufentanil and levobupivacaine led to more efficient intraoperative and postoperative analgesia, lower sufentanil and levobupivacaine consumption, lower incidence of postoperative shivering, nausea and vomiting. Epidural with magnesium appears to be a useful adjunct to anesthetic drugs, which can exert positive effects on the course and outcome of thoracic surgery patients.

Key words: thoracic surgery, postthoracotomy pain, perioperative analgesia, magnesium

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The Effect of the Rapid Antigen Test for Influenza on Clinical Practice in the Emergency Department: A Comparison of Periods before and After the 2009 H1N1 Influenza Pandemic


Introduction. The rapid antigen test (RAT) plays an important role in the Emergency Room (ER). In this study, we investigated the effect of the RAT for influenza on clinical practice in an emergency department.

Methods. A retrospective chart review was conducted considering two periods, namely before and after the 2009 influenza pandemic. The rate of antibiotic administration, the use of blood sample tests, the use of simple chest X-rays, the rate of antibiotic administration according to the result of the RAT, and the duration of ER stay in the case of influenza-like illnesses were investigated for the two study periods considered.

Results. The use of the RAT increased from 23.9% to 39.8% in influenza-like pediatric patients (p<0.05) and from 4.9% to 67.6% in adult patients (p<0.001). After the 2009 influenza pandemic, the number of cases of antibiotic administration, blood sample test and simple chest X-ray decreased by 19.0%, 46.2%, and 27.4%, respectively, in pediatric patients with the use of RAT. Among RAT-positive patients, after the 2009 influenza pandemic, none of the pediatric patients and only 3 of the adult patients (17.6%) were administered antibiotics. The duration of ER stay was longer in patients who underwent RAT than in those who did not.

Conclusion. The increased use of RAT for influenza has led to a decrease in antibiotic administration and a reduction in additional diagnostic tests in influenza-like illnesses. However, the use of RAT has not contributed to a decrease in the duration of ER stay.

Key words: influenza, rapid antigen test, antibiotic, duration of stay

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