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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

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Effect of population-based training programs on bystander willingness to perform cardiopulmonary resuscitation


Objective. This study was performed to determine the factors related to unwillingness of bystanders to perform cardiopulmonary resuscitation (CPR), and improvement of willingness among the lay public after CPR training.

Design. Retrospective design

Methods. We collected questionnaires received from laypersons attending CPR training courses implemented by the CPR Improvement Program of Chang Gung Memorial Foundation. Pre- and post-training questionnaires were given to participants attending CPR training courses between September 2013 and January 2014.

Results. Among the 401 respondents at pre-training, higher educational level (odds ratio, 3.605; 95% confidence interval [CI], 3.055 – 8.284) and previous CPR training (odds ratio, 1.754; 95% CI, 1.049 – 2.932) were significantly associated with willingness to perform bystander CPR. Significant improvements in willingness to perform conventional CPR and hands-only CPR on a stranger were observed after training (P = 0.016 and P < 0.0001, respectively). Approximately half of the respondents claimed that fear of doing further harm was the primary reason for their lack of willingness to administer conventional CPR on a stranger.

Conclusions. We showed that CPR training significantly increased the rate of willingness to perform CPR on strangers as well as acquaintances among the lay public. This study also showed that fear of doing further harm was the most significant barrier after training. This concern should be addressed in future training programs.

Key words: cardiopulmonary resuscitation, cardiopulmonary resuscitation training, bystander willingness

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Is NIRS monitoring well tolerated in term and preterm neonates?


Background. Near infrared spectroscopy (NIRS) is a new, non-invasive monitoring method in neonates, which has now become part of routine monitoring in many neonatal intensive care units (NICU). New, additional, non-invasive technical monitoring might have an influence on neonatal wellbeing.

Objectives. The aim of the present study was to evaluate the wellbeing of neonates during peripheral and cerebral NIRS monitoring and venous occlusions.

Methods. In the present study, secondary outcome parameters of prospective observational studies with NIRS in term and preterm neonates were analysed. Heart rate (HR), arterial oxygen saturation (SpO2), respiratory rate (RR), mean arterial blood pressure (MABP), pain score and skin condition at four defined time points during NIRS measurements of regional tissue oxygenation were recorded and analysed.

Results. Thirty-six term and preterm neonates were included (gestational age (GA) 36±1 week, 2779±930g birth weight). SpO2 and peripheral tissue oxygenation index (pTOI) increased and HR dropped while RR, mean MABP and pain scores remained unchanged during NIRS measurements. In eight infants, a mildly irritated area of skin was noted where the NIRS sensors had been attached.

Conclusion. Cerebral and peripheral NIRS monitoring and venous occlusions were painless and well tolerated by term and preterm neonates.

Key words: neonates, NIRS, vital signs

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Neutrophil to Lymphocyte ratio of Synthetic Cannabinoid Intoxication


Synthetic cannabinoids represent an increasingly popular trend, and acute intoxication is widely seen in emergency rooms and intensive care units (ICU), as they are inexpensive and easily accessible. Cannabinoids mediate their effects through binding specific receptors which are members of the G protein coupled receptor superfamily. Cannabinoid-2 receptors are primarily found in the immune system and mediate immunosuppression by inducing apoptosis, inhibition of proliferation and suppression of cytokine and chemokine production. Many studies have discussed the effects of cannabinoids on the hematological and immune systems but controversial results have been reported. The aim of this study was to identify laboratory findings of acute synthetic cannabinoid intoxication. Forty-two patients, admitted to the ‘Anesthesia intensive care unit’ between 2014 and 2015 with synthetic cannabinoid intoxication, were studied retrospectively to assess the relationship between synthetic cannabinoid intoxication and complete blood count (white blood cells (WBC), neutrophils, lymphocytes, monocytes, eosinophils, basophils) and neutrophil to lymphocyte ratio. WBC neutrophil count decreased at ICU discharge when compared to ICU admission (p<0.001). The ratio of neutrophils to lymphocytes was also lower at ICU discharge when compared to ICU admission (p<0.05).

Key words: synthetic cannabinoids, intoxication, neutrophil to lymphocyte ratio

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Efficacy and Safety of an Acute Pain Service among 10,760 Postoperative Patients


Introduction. Post-operative pain control improves surgical outcome and many hospitals created multidisciplinary teams, called “Acute Pain Services” (APS). We collected APS data on 10,760 adult patients over a five year period, including complications, side effects and patient satisfaction.

Methods. Data on patients managed by APS in a high surgical-volume university hospital over a 5-year period were collected and analyzed. Data included demographic characteristics, primary analgesic modality, adjuvant analgesic treatment, type of surgical procedure, Visual Analogue Scale, and analgesia-related side-effects and complications.

Results. Patient controlled analgesia with morphine was used in 4,992 surgical patients while epidural analgesia was used in 3,687 surgical patients and 1,670 pregnant women for delivery analgesia. A total of 411 patients received other forms of analgesia. No epidural haematoma was observed. A single case of respiratory depression occurred in an elderly patient using the patient controlled analgesia system. Acetaminophen was the most frequently adjuvant drug prescribed. Postoperative nausea and vomiting was the most frequent analgesia-related side effect. Visual Analogue Scale at rest and on movement was low on day one (0.84±1.15 and 2.05±1.67) and decreased thereafter with epidural analgesia associated with better pain control following hip and liver surgery, and with less postoperative nausea and vomiting (5.0%) when compared to morphine patient controlled analgesia (7.2%).

Conclusions. An APS, with daily postoperative visits, permits adequate post-operative pain control without serious adverse events. Epidural analgesia was associated with less postoperative nausea and vomiting and had at least similar pain control than morphine patient controlled analgesia.

Key words: acute pain service, epidural analgesia, patient controlled analgesia, anesthesia, surgery

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Does magnesium sulfate affect the incidence of respiratory complications in children undergoing esophageal dilatation? An observational pilot study


Background. In this pilot observational study, we aimed to investigate the effect of preoperative magnesium infusion on laryngospasm frequency and other respiratory complications in children with respiratory findings undergoing esophageal dilatation after the ingestion of caustic substances.

Methods. Sixty children between the ages of 2 and 12 scheduled for esophageal dilatation were divided into two groups: the magnesium group (Group M), which consisted of children with respiratory symptoms and who received IV 30 mg/kg magnesium sulfate preoperatively, and the control group (Group C), who received the same volume of saline. Anesthesia was induced with fentanyl, propofol, and mivacurium and maintained using a 60% N2O and 2-3% sevoflurane mixture in oxygen. Demographic and hemodynamic data, as well as the incidence of respiratory complications (laryngospasm, bronchospasm, apnea, cough, and desaturation) during the perioperative period were recorded until the time of discharge from the recovery room.

Results. Demographic data and hemodynamics were similar in the two groups. The laryngospasm, bronchospasm, apnea, and cough incidences were also similar between the groups, although the desaturation incidence was lower in Group M than in Group C (p=0.013). The number of complications in total was lower in Group M as well (p=0.008), although the number of children who experienced complications in each group was similar.

Conclusion. Prophylactic administration of 30 mg/kg of magnesium to children with respiratory symptoms may decrease the frequency of postoperative respiratory complications in children undergoing esophageal dilatation.

Key words: corrosive stricture, magnesium sulfate, general anesthesia, complication, respiratory tract

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