European journal of anaesthesiology
-
Randomized Controlled Trial Clinical Trial
Antiseptic-impregnated central venous catheters reduce the incidence of bacterial colonization and associated infection in immunocompromised transplant patients.
The incidence of bacterial colonization of central venous catheters using a standard polyurethane catheter was compared with that using an antiseptic (silver sulphadiazine and chlorhexidine) impregnated catheter in a group of patients with thoracic organ transplantation. Colonization was reduced from 25 of 35 standard catheters to 10 of 44 study catheters (P < 0.002), a 68% reduction. Similarly, the incidence of concomitant infection, by the same organism at another site was reduced from 10 of 35 standard catheters to 4 of 44 study catheters (P < 0.03), a 63% reduction.
-
Comparative Study Clinical Trial
Biplane transoesophageal echocardiographic detection of myocardial ischaemia in patients with coronary artery disease undergoing non-cardiac surgery: segmental wall motion vs. electrocardiography and haemodynamic performance.
Intra-operative segmental wall motion abnormalities (SWMA) detected by transoesophageal echocardiography (TOE) have been shown to be a sensitive indicator of myocardial ischaemia. To determine the incidence and characteristics of segmental wall motion abnormalities and to relate these changes to perioperative myocardial ischaemia, biplane TEE, electrocardiogram (ECG) (II+V5) and pulmonary capillary wedge pressure (PCWP) were continuously monitored in 62 consecutive patients with ischaemic heart disease undergoing non-cardiac surgery. Short-axis view at mid-papillary level in transverse scan (T-scan) and long-axis in longitudinal (L-scan) two-chamber view were used for wall motion analysis. ⋯ Monoplane transoesophageal echocardiography showed a sensitivity of 75% and a specificity of 100%, electrocardiogram two lead showed a sensitivity of 56% and a specificity of 98%, whereas pulmonary capillary wedge pressure had a sensitivity of 25%, and a specificity of 93% and pressure rate quotient (PRQ) < 1 demonstrated sensitivity of 19% and a specificity of 92% in the detection of myocardial ischaemia. It is concluded that the long-axis view of the left ventricle provides additional information for the detection of segmental wall motion abnormalities. Neither changes in haemodynamic performance nor in electrocardiography leads II and V5 match those of transoesophageal echocardiography for the identification of myocardial ischaemia.
-
There are only limited data on sevoflurane minimum alveolar concentration (MAC) in rats. This study was designed to determine the minimum alveolar concentration value for sevoflurane in younger and older rats. Minimum alveolar concentration determination was performed in spontaneously breathing animals, 9-week-old rats (younger, n = 8) and more than 13-month-old rats (older, n = 8). ⋯ Minimum alveolar concentration for sevoflurane in younger rats was significantly higher than in the older rats (2.68 +/- 0.19 vs. 2.29 +/- 0.19, P < 0.001). Subgroup analysis indicated that minimum alveolar concentration for sevoflurane was not affected by the presence of an arterial catheter in the abdominal aorta (younger, 2.75 +/- 0.08 vs. 2.67 +/- 0.21; older, 2.23 +/- 0.19 vs. 2.30 +/- 0.18). Minimum alveolar concentration is profoundly affected by the age of the animal, but not by limited instrumentation.
-
Case Reports
A complication of percutaneous tracheostomy whilst using the Combitube for airway control.
We report the occurrence of oesophageal perforation and dilatation during percutaneous tracheostomy. The Combitube was used for airway maintenance during this procedure. This case highlights the limitations of the Combitube when used in this situation.