ISSN:0003-3022    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundThe health-related effects of the operating room environment are unclear. The authors compared mortality risks of anesthesiologists to those of internal medicine physicians between 1979 and 1995.MethodsThe Physician Master File database, a listing of all US physicians, was used to identify anesthesiologists and general internists. The cohort of internists (n = 40,211) was a stratified random sample of all internists, frequency-matched to the cohort of anesthesiologists (n = 40,242) by gender, decade of birth, and US citizenship. The National Death Index was used to confirm death status and to determine specific causes of death. Mortality risks, adjusted for age, gender, and race, were compared using the Cox proportional hazards regression model.ResultsThe standardized mortality ratios for all physicians were well below 1.0, except for suicide. The all-cause mortality ratios, and the risks of death caused by cancer and heart disease, did not differ between anesthesiologists and internists. Anesthesiologists had an increased risk of death from suicide (rate ratio [RR] = 1.45, 95% confidence interval [CI] = 1.07 − 1.97), drug-related death (RR = 2.79, 95% CI = 1.87 − 4.15), death from other external causes (RR = 1.53, 95% CI = 1.05 − 2.22), and death from cerebrovascular disease (RR = 1.39, 95% CI = 1.08 − 1.79). Male anesthesiologists had an increased risk of death from HIV (RR = 1.82, 95% CI = 1.09 − 3.02) and viral hepatitis (RR = 7.98, 95% CI = 1.0 − 63.84). Although the risk to anesthesiologists of drug-related deaths was highest in the first 5 years after medical school graduation, it remained increased over that of internists throughout the career.ConclusionsSubstance abuse and suicide represent significant occupational hazards for anesthesiologists. New methods to combat substance abuse among anesthesiologists should be developed.

ISSN:0003-3022    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundThe safety and antiemetic efficacy of CP-122,721, a novel neurokinin-1 antagonist, was evaluated when administered alone or in combination with ondansetron.MethodsUsing a randomized, double-blind, placebo-controlled study design, CP-122,721 was initially compared with placebo and subsequently to ondansetron alone and in combination for prophylaxis against postoperative nausea and vomiting in 243 women undergoing abdominal hysterectomy. In the dose-ranging studies (n = 86), patients received either CP-122,721 100 mg (vs. placebo) or 200 mg (vs.placebo) orally 60–90 min before induction of anesthesia. In the interaction study (n = 157), patients received CP-122,721 200 mg or placebo 60–90 min before induction of anesthesia, and ondansetron 4 mg or saline 2 ml intravenously 15–30 min before the end of surgery. Patients assessed their level of nausea and pain on arrival in the postanesthesia care unit and at 0.5-, 1-, 1.5-, 2-, 4-, 8-, 12-, and 24-h intervals postoperatively. Emetic episodes, need for rescue antiemetic–antinausea medication, postoperative complications, and patient satisfaction were recorded.ResultsIn the initial dose-ranging study, only 10% of the patients experienced emesis within the first 8 h after surgery with CP-122,721 200 mg compared with 50% in the placebo group. CP-122,721 200 mg also decreased the need for rescue medication (25%vs.48%). CP-122,721 100 mg was less effective than 200 mg in decreasing the incidence of repeated episodes of emesis. In the interaction study, 6% of the patients receiving CP-122,721 200 mg orally experienced emesis less than 2 h after surgery compared with 17% with ondansetron alone. With combined therapy, only 2% experienced emesis. In addition, the median times for 75% of patients to remain free from postoperative nausea and vomiting were 82, 75, and 362 min in the ondansetron, CP-122,721, and combination groups, respectively.ConclusionsOral CP-122,721 200 mg decreased emetic episodes compared with ondansetron (4 mg intravenously) during the first 24 h after gynecologic surgery; however, there was no difference in patient satisfaction.

ISSN:0003-3022    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundThe goal of this project was to study the frequency and natural history of perioperative lower extremity neuropathies.MethodsA prospective evaluation of lower extremity neuropathies in 991 adult patients undergoing general anesthetics and surgical procedures while positioned in lithotomy was performed. Patients were assessed with use of a standard questionnaire and neurologic examination before surgery, daily during hospital stay in the first week after surgery, and by phone if discharged before 1 postoperative week. Patients in whom lower extremity neuropathies developed were observed for 6 months.ResultsLower extremity neuropathies developed in 15 patients (1.5%; 95% confidence interval, 0.8–2.5%). Unilateral or bilateral nerves were affected in patients as follows: obturator (five patients), lateral femoral cutaneous (four patients), sciatic (three patients), and peroneal (three patients). Paresthesia occurred in 14 of 15 patients, and 4 patients had burning or aching pain. No patient had weakness. Symptoms were noted within 4 h of completion of the anesthetic in all 15 patients. These symptoms resolved within 6 months in 14 of 15 patients. Prolonged positioning in a lithotomy position, especially for more than 2 h, was a major risk factor for this complication (P = 0.006).ConclusionsIn this surgical population, lower extremity neuropathies were infrequent complications that were noted very soon after surgery and anesthesia. None resulted in prolonged disability. The longer patients were positioned in lithotomy positions, the greater the chance of development of a neuropathy. These findings suggest that a reduction of duration of time in lithotomy positions may reduce the risk of lower extremity neuropathies.

ISSN:0003-3022    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundIntrathecal neostigmine causes analgesia by inhibiting the breakdown of acetylcholine. Experimental data suggest that the production of endogenous nitric oxide is necessary for tonic cholinergic inhibition of spinal pain transmission. The purpose of this study was to determine whether association of transdermal nitroglycerine would enhance analgesia from a low dose of intrathecal neostigmine in patients undergoing gynecologic surgery during spinal anesthesia.MethodsForty-eight patients were randomized to one of four groups. Patients were premedicated with use of 0.05–0.1 mg/kg intravenous midazolam and received 15 mg bupivacaine plus 1 ml test drug intrathecally (saline or neostigmine, 5 &mgr;g). Twenty to 30 min after the spinal puncture, a transdermal patch of either 5 mg nitroglycerin or placebo was applied. The control (Con) group received spinal saline and transdermal placebo. The neostigmine group received spinal neostigmine and transdermal placebo. The nitroglycerin group received spinal saline and a transdermal nitroglycerine patch. Finally, the neostigmine–nitroglycerin group received spinal neostigmine and transdermal nitroglycerine. Pain and adverse effects were evaluated using a 10-cm visual analog scale.ResultsPatients in the groups were similar regarding age, weight, height, and American Society of Anesthesiologists status. Sensory level to pin prick at 10 min, surgical duration, anesthetic duration, and visual analog scale score for pain at the time of administration of first rescue medication were statistically the same for all groups. The time to administration of first rescue analgesic (min) was longer in the neostigmine–nitroglycerin group (550 min; range, 458–1,440 min; median, 25–75th percentile) compared with the other groups (P < 0.001). The neostigmine–nitroglycerin group required fewer rescue analgesics in 24 h than did the control group (P< 0.0005), whereas the neostigmine group required less analgesics compared with the control group (P< 0.02). The incidence of perioperative adverse effects (nausea, vomiting, headache, back pain) was similar among groups (P> 0.05).ConclusionAlthough neither intrathecal 5 &mgr;g neostigmine alone nor transdermal nitroglycerine alone (5 mg/day) delayed the time to administration of first rescue analgesics, the combination of both provided an average of 14 h of effective postoperative analgesia after vaginoplasty, suggesting that transdermal nitroglycerin and the central cholinergic agent neostigmine may enhance each other’s antinociceptive effects at the dose studied.

ISSN:0003-3022    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundCerebral oximetry is a noninvasive bedside technology using near-infrared light to monitor cerebral oxygen saturation (Sco2) in an uncertain mixture of arteries, capillaries, and veins. The present study used frequency domain near-infrared spectroscopy to determine the ratio of arterial and venous blood monitored by cerebral oximetry during normoxia, hypoxia, and hypocapnia.MethodsTwenty anesthetized children aged < 8 yr with congenital heart disease of varying arterial oxygen saturation (Sao2) were studied during cardiac catheterization. Sco2, Sao2, and jugular bulb oxygen saturation (Sjo2) were measured by frequency domain near-infrared spectroscopy and blood oximetry at normocapnia room air, normocapnia 100% inspired O2, and hypocapnia room air.ResultsAmong subject conditions, Sao2ranged from 68% to 100%, Sjo2from 27% to 96%, and Sco2from 29% to 92%. Sco2was significantly related to Sao2(y = 0.85 × −17, r = 0.47), Sjo2(y = 0.77 × +13, r = 0.70), and the combination (Sco2= 0.46 Sao2+ 0.56 Sjo2− 17, R = 0.71). The arterial and venous contribution to cerebral oximetry was 16 ± 21% and 84 ± 21%, respectively (where Sco2= &agr; Sao2+ &bgr; Sjo2with &agr; and &bgr; being arterial and venous contributions). The contribution was similar among conditions but differed significantly among subjects (range, ≈ 40:60 to ≈ 0:100, arterial:venous).ConclusionsCerebral oximetry monitors an arterial/venous ratio of 16:84, similar in normoxia, hypoxia, and hypocapnia. Because of biologic variation in cerebral arterial/venous ratios, use of a fixed ratio is not a good method to validate the technology.

ISSN:0003-3022    

出版商:OVID    

年代:2000

数据来源: OVID