The Journal of international medical research
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Randomized Controlled Trial
Pre-measured length using landmarks on posteroanterior chest radiographs for placement of the tip of a central venous catheter in the superior vena cava.
Central venous catheterization (CVC) is a common procedure but catheter misplacement is a frequent complication and can be lethal. Most CVCs are inserted at a recommended mean depth of 15 cm from the skin puncture site. Chest radiographs are used to confirm the positioning of CVCs, with the carina regarded as a reliable landmark for tip placement. ⋯ To test the accuracy of C-length based CVC placement, 637 adult patients scheduled to undergo elective major abdominal procedures and neurological surgical procedures requiring CVC were randomized to undergo either the 15-cm guided method or the C-length guided method for placement of the CVC tip into the superior vena cava (SVC). All the CVC tips in the C-length group were successfully placed in the SVC. These findings indicate that the pre-measured C-length using two landmarks can be used to determine the insertion length and to place the CVC tip successfully into the SVC.
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Randomized Controlled Trial
Neuromuscular blockade by vecuronium during induction with 5% sevoflurane or propofol.
This randomized trial investigated whether 5% sevoflurane potentiated neuromuscular blockade by vecuronium. General anaesthesia was induced with 5% sevoflurane in oxygen in 16 patients or with propofol in 16 patients. After loss of consciousness, vecuronium was administered to all participants at randomly assigned doses of 25, 30, 35 or 40 μg/kg. ⋯ In both groups, maximum blockade at the corrugator supercilii was significantly less intense than that achieved at the adductor pollicis. In the dose-response analysis, the 50% and 95% effective doses were lower for sevoflurane than for propofol in both muscles, although this did not reach statistical significance. It is concluded that induction of general anaesthesia with sevoflurane might provide improved conditions for intubation and reduce airway problems.
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Comparative Study
The cut-off rate of skin temperature change to confirm successful lumbar sympathetic block.
The purpose of this study was to find the best cut-off value for the rate of change in temperature of the plantar surface of the foot for predicting the success of lumbar sympathetic block (LSB). A total of 185 LSBs were performed on 82 patients via a posterolateral approach under fluoroscopic guidance. ⋯ The area under the ROC curve was 0.971 at the rate of 0.4 degrees C/min with a sensitivity of 89.5% and a specificity of 91.8%. Achieving a rate of temperature change of 0.4 degrees C/min within approximately 5 min of the injection of local anaesthetic could be used as an indicator of the onset of successful LSB.
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Randomized Controlled Trial
Procalcitonin: a novel cardiac marker with prognostic value in acute coronary syndrome.
Procalcitonin (PCT) is implicated as an inflammatory marker in early atherosclerosis. In order to investigate the clinical consequences of increased PCT levels in acute coronary syndrome (ACS), 77 patients (29 with non-ST-elevation myocardial infarction [MI], 34 with ST-elevation MI and 14 with unstable angina pectoris) were included and followed up for 6 months. ⋯ The PCT levels within 48 h post-admission in the nine patients who died within 6 months were also significantly higher compared with the survivors (0.451 +/- 0.44 versus 0.406 +/- 1.37 ng/ml, respectively). It is concluded that higher PCT levels within 48 h post-admission may reflect an inflammatory state that is associated with increased early and 6-month mortality.
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This prospective, multicentre, epidemiological study was designed to assess the prevalence of neuropathic pain among adults with chronic low-back pain (LBP) in the Arabian Gulf region. A total of 1134 patients recruited from the outpatient medical setting were assessed using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale. ⋯ Factors associated with neuropathic pain included advanced age, female gender and diabetes with or without hypertension. It was concluded that neuropathic pain is a major contributor to chronic LBP in the Gulf region, and that the LANSS Pain Scale is a practical and rapidly administered screening test for distinguishing the relative contributions of neuropathic and nociceptive pain in patients with chronic LBP that resulted in the use of a more appropriate treatment.