Anesthesia and the child with asthma DOHERTY, GARY M.; CHISAKUTA, ANTHONY; CREAN, PETER ...
Paediatric anaesthesia,
June 2005, Letnik:
15, Številka:
6
Journal Article
Therapeutic hypothermia (TH) is a process of cooling a patient post ventricular tachycardia/ventricular fibrillation (VT/VF) cardiac arrest to 32-34 degrees C for 24 hours. This improves neurological ...outcome and is part of current guidelines. Hypothermia prolongs QT interval, which can precipitate torsades de pointes (TdP). We performed a retrospective review of all patients who received TH in our hospital over a period of 2 years to assess the effect of TH on the corrected OT interval (QTc) and any possible pro-arrhythmia. A total of 13 patients received TH. QTc prolonged in all patients with an average of 80.3 + 57.2 ms., and up to 109.8 + 80.4 ms in patients who received Amiodarone concurrently. No TdP was seen in any patient. We conclude that TH is safe, though careful monitoring of the OTc interval is advisable especially with concurrent use of QT prolonging drugs.
Alternate-day buprenorphine dosing was compared to daily dosing in opioid-dependent outpatients and choice of alternate-day versus daily dosing was assessed. Four dosing schedules were presented in ...random order under blind and open dosing conditions. Subjects received two exposures to each dosing schedule. During daily dosing, subjects received maintenance doses every 24 h. During blind alternate-day dosing, subjects received double maintenance doses every 48 h; placebo was interposed on intervening days. During open alternate-day dosing, subjects received twice their maintenance dose on Monday, Wednesday and Friday and maintenance doses on Sunday. After completing two exposures to each dosing schedule, subjects chose either daily or alternate-day schedules each week for 1 month. Study participation was contingent on daily attendance and opioid abstinence. Ten subjects were exposed to the four conditions once. Seven subjects repeated these conditions and participated in the choice phase. The effects of daily versus alternate-day dosing were not influenced by blind or open dosing conditions. Subjects' ratings of withdrawal, "sick" and sedation were lower during daily than during alternate-day dosing, but the difference between treatments was small. Nonetheless, subjects still chose alternate-day dosing on 96% of occasions, suggesting that the subject-rated differences between dosing schedules were not influential. These results extend prior findings to open-dosing conditions, and replicate the safety and acceptability of alternate-day buprenorphine treatment. Choice of alternate-day buprenorphine administration underscores the procedure's clinical utility and potential use as a positive reinforcer to enhance opioid treatment.
Background
Syncope is a common clinical problem accounting for up to 6% of hospital admissions. Little is known about resource utilisation for patients admitted for syncope management in Ireland.
Aim
...To determine the utilisation of resources for patients admitted for syncope management.
Methods
Single centre observational case series of consecutive adult patients presenting to an acute hospital Emergency Department with syncope over a 5-month period.
Results
Two-hundred and fourteen of 18,898 patients (1.1%) had a syncopal episode, 110 (51.4%) of whom were admitted. Mean length of stay was 6.9 days. Sixty-four of these admissions were deemed unnecessary by retrospective review when compared to ESC guidelines. Eighty-five (77.3%) admitted patients had cardiac investigations and 56 (51%) had brain imaging performed.
Conclusions
Syncope places a large demand on overstretched hospital resources. Most cases can be managed safely as an outpatient and to facilitate this, hospitals should develop outpatient Syncope Management Units.
Every year hundreds of patients voluntarily participate in clinical trials across Ireland. However, little research has been done as to how patients find the experience. This survey was conducted in ...an attempt to ascertain clinical trial participants' views on their experience of participating in a clinical trial and to see and how clinical trial participation can be improved. One hundred and sixty-six clinical trial participants who had recently completed a global phase IV cardiovascular endpoint clinical trial were sent a 3-page questionnaire. Ninety-one (91%) respondents found the experience of participating in a clinical trial a good one with 85 (84.16%) respondents saying they would recommend participating in a clinical trial to a friend or relative and eighty-five (87.63%) respondents feeling they received better healthcare because they had participated in a clinical trial.
Aims Diabetes mellitus (DM) is associated with chronic endothelial dysfunction. Diabetic patients presenting with acute coronary syndromes have a worse prognosis than non‐diabetics. An acute ...inflammatory reaction at the site of coronary plaque rupture and increased expression of surface and soluble cellular adhesion molecules (CAMs) are pathological features of acute coronary syndromes. We set out to characterize the expression of soluble CAMs in patients with and without diabetes presenting with unstable angina (UA) and non Q‐wave myocardial infarction (NQMI).
Methods Patients presenting with UA and NQMI had serum samples taken on presentation, after 72 h and then 3, 6 and 12 months after discharge. Levels of soluble intercellular adhesion molecule‐1 (ICAM‐1), vascular cell adhesion molecule‐1 (VCAM‐1), E‐selectin and P‐selectin were measured using an ELISA technique.
Results We studied 15 diabetic patients and 15 age‐ and sex‐matched non‐diabetic patients presenting with either UA or NQMI. Levels of soluble E‐selectin were elevated in the diabetic patients in comparison with the non‐diabetic patients at all measured time points: 74 ± 10 ng/ml vs. 47
± 3 ng/ml, P < 0.03 at t = 0 h, 55
± 5 ng/ml vs. 38
± 2 ng/ml, P < 0.02 at t = 72 h. However, levels of soluble P‐selectin were lower in the diabetic cohort during follow‐up: 134 ± 15 ng/ml vs. 225 ± 32 ng/ml, P < 0.02 at t = 3/12 and 112 ± 8 ng/ml vs. 197 ± 23 ng/ml, P < 0.02 at t = 6/12. There was no significant difference in levels of soluble ICAM‐1 and VCAM‐1 between diabetic and non‐diabetic patients.
Conclusions Levels of soluble E‐selectin are significantly elevated in diabetic patients presenting with UA and NQMI in comparison with non‐diabetics. This finding may reflect enhanced endothelial activation which may contribute to the adverse prognosis of diabetic patients with acute coronary syndromes.
Diabet. Med. 18, 979–983 (2001)
We investigated whether use of low-dose enteric-coated (EC) aspirin for secondary prevention of cardiovascular events has sufficient bioavailability to achieve complete platelet cyclooxygenase (COX) ...inhibition in all individuals.
Aspirin reduces cardiovascular morbidity and mortality in patients with pre-existing vascular disease; however, there is variability in the way individuals respond. Persistent normal platelet function despite therapy, referred to as “aspirin resistance,” is associated with an increased risk of major cardiovascular events.
We studied 131 stable cardiovascular patients between March and September 2002 who were taking 75 mg EC aspirin. Serum thromboxane (TX) B2levels were assayed as a measure of COX activity. Mean arachidonic acid (AA)-induced platelet aggregation ≥20% was deemed evidence of persistent platelet activity and an incomplete aspirin response.
Patients of median age 63 years (61% men) were enrolled. Forty-four percent of patients had elevated serum TX B2levels (>2.2 ng/ml). Arachidonic acid-induced platelet aggregation occurred more frequently in these patients (21% vs. 3%; p = 0.004). In all cases addition of exogenous aspirin during the assay abolished platelet aggregation. Patient weight and age were significant independent predictors of an incomplete response to EC aspirin (p = 0.025 and p < 0.001, respectively). These patients were also more likely to have a history of myocardial infarction (MI) (p = 0.038).
Many patients who are prescribed low-dose EC aspirin for secondary prevention of cardiovascular events have persistent uninhibited platelet COX activity. Younger and heavier patients and those with a previous MI are most likely to have an inadequate response to treatment.
Summary A pilot to assess a process of interdepartmental peer review of paediatric anaesthetic departments in the United Kingdom was undertaken. Departments were assessed in relation to the standards ...which should characterise anaesthetic departments throughout the country. Examples of good practice and areas for further development were identified. Peer review visits were conducted by teams which included medical and non‐medical members. The importance of the inclusion of lay people in such visits is being increasingly recognised. All of those who participated in the process felt their time had been usefully spent, and they were enthusiastic for the process to continue.
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