Background
Syringes of ephedrine are usually prepared ahead of time in order to reduce the time to injection. Commercial pre‐filled syringes of ephedrine have been introduced to minimize the amount ...of waste. Our primary objective was to determine the economic impact of commercial syringes. We hypothesized that costs could be reduced compared to standard syringes.
Methods
Using data extracted from our medical records system, we retrospectively measured the total dose of ephedrine received per patient in 2013 to estimate the number of administered standard syringes. The proportion of administered standard syringes was calculated as the total number of administered standard syringes divided by the number of delivered ampoules in 2013. Thereafter, we calculated the annual cost difference as the difference between the cost for commercial syringes and the cost for standard syringes. Endpoints were calculated overall and for each operating room.
Results
At least one dose of ephedrine was given in 19,422 patients (44,943 administrations). The overall proportion of administered standard syringes was estimated to 52.8%. The threshold proportion of administered standard syringes for which commercial syringes would add no extra cost was 20.4%. In 30/32 operating rooms, the proportion of administered standard syringes was higher than 20.4%. The overall cost increase with commercial syringes was estimated to 51,567 €. Among operating rooms, incremental costs varied between −703 and 5086 €.
Conclusion
Based on our findings, pre‐filled ephedrine commercial syringes do not appear to reduce costs.
Le prime raccomandazioni per la rianimazione cardiopolmonare sono state emesse dall’American Heart Association nel 1974 e aggiornate regolarmente fino al 2015. La specificità della rianimazione ...cardiopolmonare intraospedaliera è stata riconosciuta per la prima volta nel 1997, il che spiega il ritardo nell’instaurazione della “catena di sopravvivenza intraospedaliera”. Questa catena di sopravvivenza richiede una formazione con il mantenimento delle competenze del personale ospedaliero nei gesti di rianimazione cardiopolmonare di base e l’uso di un defibrillatore esterno automatizzato, la fornitura di carrelli di urgenza e defibrillatori in diverse zone strategiche degli stabilimenti, una valutazione delle pratiche da parte di un comitato intraospedaliero e un registro di tali eventi. Occorre distinguere tra l’arresto cardiaco del paziente monitorato e quello del paziente non monitorato. L’arresto cardiaco del paziente monitorato è quello che si verifica in sala operatoria o in terapia intensiva: presenta particolarità nella diagnosi e nel trattamento, legate alla presenza del monitoraggio e frequentemente della ventilazione artificiale. In caso di arresto cardiaco legato a un sovradosaggio di anestetici locali durante un’anestesia locoregionale in un paziente non ventilato, sono ora proposti trattamenti “specifici”. L’arresto cardiaco del paziente non monitorato si inserisce nell’algoritmo terapeutico generale dell’arresto cardiaco extraospedaliero. Viceversa, pone un vero e proprio problema di politica medica attraverso l’applicazione della catena di sopravvivenza intraospedaliera raccomandata nelle raccomandazioni internazionali e nazionali.
Le prime raccomandazioni per la rianimazione cardiopolmonare sono state pubblicate dall’American Heart Association nel 1974 e sono state aggiornate nel 1980, nel 1986, nel 1992, nel 2000, nel 2005 e ...nel 2010. La specificità della rianimazione cardiopolmonare intraospedaliera è stata presa in considerazione dalle prime raccomandazioni unicamente nel 1997, il che spiega il ritardo accumulato nell’implementazione della «catena di sopravvivenza intraospedaliera». Si deve distinguere l’arresto cardiaco (AC) del paziente monitorato da quello del paziente non monitorato. L’AC del paziente monitorato è quello che si verifica in sala operatoria o in rianimazione: esso presenta delle particolarità nella diagnosi e nel trattamento, associate alla presenza del monitoraggio e, spesso, della ventilazione artificiale. In caso di AC legato a un sovradosaggio di anestetici locali nel corso di un’anestesia locoregionale in un paziente non ventilato, sono attualmente proposti dei trattamenti «specifici». L’AC del paziente non monitorato si inserisce nell’algoritmo terapeutico generale dell’AC extraospedaliero. Viceversa, esso pone un vero e proprio problema di politica medica attraverso l’applicazione della catena di sopravvivenza intraospedaliera consigliata nelle raccomandazioni internazionali e nazionali.
There is no standard treatment for patients with pleural malignancies. The aim of this prospective study was to investigate the toxicity and long-term results of a multimodality treatment consisting ...of surgery and intrathoracic chemohyperthermia (ITCH) for the treatment of patients with pleural malignancies. From January 1990 to August 2000, 24 patients with mesothelioma (n=17), fibrosarcoma (n=3), pleural adenocarcinoma (n=3) and thymoma (n=1) were included. The mesothelioma stages were T1 or T2 in 10 cases, and T3 or T4 in seven cases. After cytoreductive surgery, ITCH was carried out for over 60 min, at inflow temperatures less than 45 degrees C, either with mitomycin C (n=7) or cisplatin (n=5) or both (n=12). One patient died from major thoracic air leaks after major decortication and pleurectomy. Seven patients had complications, one pleural clotting necessitating reoperation. After a median follow-up of 89 months, the overall 1-year and 5-year survival rates were 74 and 27%, respectively. For T1 and T2 mesothelioma patients, the median survival was 41.3 months, and for T3 and T4 tumours, it was 4.5 months (P=0.001). The fibrosarcoma patients are alive with no evidence of recurrence at 24, 43 and 54 months. In the conclusion, the combination of surgery with ITCH with mitomycin and/or cisplatin is relatively safe. This procedure may offer unexpected long-term survival in a selected group of patients (T1 and T2 mesothelioma patients and fibrosarcoma patients).
To assess the accuracy of respiratory inductive plethysmography (RIP) waveforms to those obtained with whole body plethysmograph (BP) as this device gives a plethysmographic signal and a ...pneumotachograph (PNT).
Randomized controlled trial.
Physiologic laboratory in a university hospital.
Eleven subjects from the laboratory staff.
This study was achieved during four consecutive periods in subjects breathing spontaneously and through different added resistive loads. Using the least square method calibration, two RIP waveforms, VRIP.BP(t) and VRIP.PNT(t), were simultaneously calculated with coefficients obtained from BP and from PNT volume waveforms, respectively VBP(t) and VPNT(t). For each recording, to compare volume waveforms, we calculated their differences in term of distances, DRIP-BP and DRIP-PNT, between the normalized RIP volume signal (respectively, VRIP.BPt and VRIP.PNTt) and its normalized reference (respectively, VBPt and VPNTt). We also calculated the distance DPNT-BP between the two normalized references VBP(t) and VPNT(t).
No significant effect of load or time on the distance occurred. Including all the recordings, the mean distance DRIP-BP (3.4+/-1.1%) appears significantly lower than both the mean distance DRIP-PNT (4.5+/-1.3%; p<0.04) and the mean distance DPNT-BP (4.6+/-0.9%; p<0.008). For each period or load level, DRIP-BP appears to be lower than DRIP-PNT and DPNT-BP.
The RIP seems reasonably accurate for analysis of respiratory waveform while subjects subsequently breathe against resistive loads.
Intraperitoneal chemo-hyperthermia with mitomycin C was used to treat 28 patients with far advanced digestive adenocarcinoma and histologically confirmed peritoneal carcinomatosis. Surgical resection ...of the primary tumor was possible in 17 cases. After closure of the abdominal wall, intraperitoneal chemo-hyperthermia was performed for 90 to 120 minutes under general anesthesia and 32 degrees C hypothermia, through 3 intraperitoneal drains forming a closed circuit, using 10 mg/l of mitomycin C in 6 liters of peritoneal dialysate heated to an inflow temperature of 46-49 degrees C. No mortality occurred, and there were 2 post-operative complications, with transitory biological side effects. In 9 out of 10 patients with preoperative malignant ascites, the ascites cleared after treatment. One-year survival rate was 54.2%. These encouraging preliminary results show that intraperitoneal chemohyperthermia with mitomycin C is a safe and reliable treatment for peritoneal carcinomatosis in far advanced digestive cancers.
ObjectifsPrésenter une méthode d’estimation de la fuite entre trachée et sonde endotrachéale chez le nouveau-né afin de compenser l’erreur sur la mesure du débit et de surveiller les caractéristiques ...mécaniques respiratoires par l’analyse des signaux de débit et de pression mesurés à l’origine de la sonde.MéthodesOn suppose la résistance de fuite (Rf) constante sur un cycle et on mesure les caracténstiques résistives du tube endotrachéal. La méthode a été validée avec un modèle mécanique de poumon et appliquée aux enregistrements de trois nouveau-nés prématurés admis en réanimation néonatale pour des détresses respiratoires. Une méthode des moindres carrés a permis d’estimer, avant et après correction du débit, la pression positive de fin d’expiration (PEEP).RésultatsPour les simulations, l’estimation deRf concorde avec la mesure directe. En clinique, l’efficacité de la correction est démontrée: le débit corrigé revient à zéro pendant la pause de fin d’inspiration. En simulation, avant correction du débit, la PEEP est sous-estimée de 10 à 20 cm H2O, alors qu’après correction l’erreur est inférieure à 2 cm H2O. En clinique, la PEEP estimée passe de valeurs négatives (−0,3 ± 1,3 cm H2O avant correction) à des valeurs positives (3.6 ± 0,7 cm H2O après correction) supérieures à la PEEP imposée (2 cm H2O).ConclusionsL’efficacité de cette méthode simple a été démontrée. Elle pourrait être utilisée avec profit sur des patients adultes, la correction sur le débit n’étant pas effectuée en l’absence de fuite.
The abdominal wall lift (AWL) has been proposed for laparoscopic cholecystectomy to reduce hemodynamic effects caused by carbon dioxide (CO2) and high intraabdominal pressures (IAP). Data concerning ...effects of AWL on respiratory mechanics are scant. We therefore used a noninvasive method to evaluate whether the AWL could offset these effects. The PETCO2, airflow, and airway pressure were continuously measured in nine patients undergoing laparoscopic cholecystectomy using an AWL with minimal CO2 insufflation. We used a least-squares method to calculate maximal airway pressure (Pmax), elastance (Ers), and resistances (Rrs) of the respiratory system. After CO2 insufflation, the initiation of AWL resulted in a significantly decreased IAP (from 13 to 6 mm Hg; P < 0.001) and Rrs (from 20.6 to 17.8 cm H2O.L(-1).s(-1); P = 0.029), whereas Ers was partly modified (34.0 to 33.3 cm H2O/L; not significantly different). With AWL, we hypothesized that the diaphragm remained flat and stiff, outweighing the beneficial effect of the decrease of IAP on Ers. PETCO2 significantly increased after AWL and at the end of the procedure. We conclude that AWL partly reverses the impairment of the respiratory mechanics induced by CO2 insufflation during laparoscopic surgery.
The abdominal wall lift (AWL), acting on the abdominal chest wall, had some benefits during laparoscopic surgery by limiting CO2 peritoneal insufflation and several side effects, such as hemodynamics. We examined the consequences of this technique on respiratory mechanics in nine patients undergoing laparoscopic cholecystectomy. Our findings suggest that the AWL decreases intraabdominal pressure and respiratory resistances without a significant effect on respiratory elastance.
The aim of this work is to estimate the 24-hour distribution and elimination of mitomycin C (MMC) during and after intraperitoneal chemohyperthermia (IPCH) in 18 patients (13 gastric adenocarcinoma, ...3 pancreatic adenocarcinoma, 2 malignant mesothelioma) who received 60 mg MMC during 90-120 min in 6 liters of heating solution HS; (42 degrees C) or HS flowing at 0.4 liters/min in a closed circuit. MMC assay in the serum, urine, HS and in local biopsies were performed by high performance liquid chromatography. The amount of MMC in HS decreased by 54.1 +/- 13.6% during IPCH. The maximum MMC levels in serum reached 0.4 +/- 0.18 mg/l 45 min after the start of IPCH, then rapidly decreased. Only 1.77 +/- 0.93 mg were recovered in urine in 24 h. These data are consistent with a large and rapid absorption, mostly in local tissue, demonstrated by the level in 7 post-IPCH biopsies (8.3 +/- 7.6 mg/kg).
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