ISSN:0003-3022    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundOccupational exposure to natural rubber latex has led to sensitization of health‐care workers. However, the prevalence of latex allergy among occupationally exposed workers in American hospitals has not been reproducibly determined. The objectives of the current study were to determine the prevalence of and risk factors for latex sensitization among a cohort of highly exposed health‐care workers.MethodsParticipants were 168 of 171 eligible anesthesiologists and nurse anesthetists working in the Department of Anesthesiology and Critical Care Medicine. A clinical questionnaire was administered, and testing was performed using a characterized nonammoniated latex reagent for puncture skin testing, a Food and Drug Administration‐approved assay to quantify latex‐specific immunoglobulin E antibody in serum, and, when required for clarification, a validated two‐stage (contact‐inhalation) latex glove provocation procedure.ResultsThe prevalence of latex allergy with clinical symptoms and latex sensitization without clinical symptoms was 2.4% and 10.1%, respectively. The prevalence of irritant or contact dermatitis was 24%. The risk factors identified for latex sensitization were atopy (odds ratio, 14.1; 95% CI, 1.8–112.1; P = 0.012); history of allergy to selected fruits, such as bananas, avocados, or kiwis (odds ratio, 9.8; 95% CI, 1.6–61.9; P = 0.015); and history of skin symptoms with latex glove use (odds ratio, 4.6; 95% CI, 1.6–13.4; P = 0.006).ConclusionsThe prevalence of latex sensitization among anesthesiologists is high (12.5%). Of these, 10.1% had occult (asymptomatic) latex allergy. Hospital employees may be sensitized to latex even in the absence of perceived latex allergy symptoms. These data support the need to transform the health‐care environment into a latex‐safe one that minimizes latex exposure to patients and hospital staff.

ISSN:0003-3022    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundTo determine whether music influences intraoperative sedative and analgesic requirements, two randomized controlled trials were performed.MethodsIn phase 1, 35 adults undergoing urologic procedures with spinal anesthesia and patient‐controlled intravenous propofol sedation were randomly assigned to hear favorable intraoperative music via headset or to have no music. In phase 2, 43 adults undergoing lithotripsy treatment of renal or ureteral calculi and receiving patient‐controlled intravenous opioid analgesia were randomly assigned to either a music or no‐music group. The effect of music on sedatives and analgesics requirements, recovery room duration, and adverse outcomes was assessed.ResultsIn phase 1, patients in the music group required significantly less propofol for sedation than patients in the control group (0 [0–150] mg vs. 90 [0–240] mg, median[range]; P < 0.001). These findings persisted after adjusting for duration of surgery (0.3 +/‐ 0.1 mg/min vs. 1.6 +/‐ 0.4 mg/min; P < 0.001). Similarly, in phase 2, patients who listened to music had a significant reduction in alfentanil requirements (1,600 [0–4,250] [micro sign]g vs. 3,900 [0–7,200] [micro sign]g; P = 0.005). This persisted after adjusting for duration of surgery (52 +/‐ 9 [micro sign]g/min vs. 119 +/‐ 16 [micro sign]g/min, mean +/‐ SD, P < 0.001). Duration of stay in the postanesthesia care unit and the rate of adverse events was similar in both groups (P = NS).ConclusionsUse of intraoperative music in awake patients decreases patient‐controlled sedative and analgesic requirements. It should be noted, however, that patients in the no‐music group did not use a headset during operation. Thus, the decrease in sedative and analgesic requirements could be caused by elimination of ambient operating room noise and not by the effects of music.

ISSN:0003-3022    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundLow‐flow sevoflurane anesthesia is associated with increasing circuit concentrations of compound A, which is nephrotoxic in rats, but the effect of compound A and low‐flow sevoflurane anesthesia on renal function in humans is unclear. The authors compared the effects of high‐ and low‐flow sevoflurane and isoflurane anesthesia on renal function and on several possible markers of nephrotoxicity in humans.MethodsForty‐two patients without preexisting renal disease underwent either low‐flow isoflurane (1 l/min, n = 14), low‐flow sevoflurane (1 l/min, n = 14), or high‐flow sevoflurane (6 l/min, n = 14) anesthesia for body‐surface‐area surgery scheduled to last at least 4 h. Twenty‐four‐hour urinary excretion of N‐acetyl‐[small beta, Greek]‐glucosaminidase (NAG), [small beta, Greek]2‐microglobulin, protein, glucose, blood urea nitrogen (BUN), and serum creatinine concentrations were measured before and after anesthesia.ResultsThere were no differences in blood urea nitrogen, creatinine, and creatinine clearance among the three groups after anesthesia. Increased urinary N‐acetyl‐[small beta, Greek]‐glucosaminidase excretions were seen in the low‐flow and high‐flow sevoflurane groups, but not in the low‐flow isoflurane group (P < 0.01). Ten patients in the low‐flow sevoflurane group had 24‐h urinary excretion of protein that exceeded the normal ranges after anesthesia, but only one patient in the isoflurane and none in the high‐flow sevoflurane groups had this.ConclusionsLow‐flow sevoflurane anesthesia was associated with mild and transient proteinuria. However, the observed proteinuria was not associated with any changes in blood urea nitrogen, creatinine, and creatinine clearance in these patients with no preexisting renal disease.

ISSN:0003-3022    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundTo help elucidate the relationship between anesthetic‐induced changes in the electroencephalogram (EEG) and the concurrent cerebral metabolic changes caused by anesthesia, positron emission tomography data of cerebral metabolism obtained in volunteers during anesthesia were correlated retrospectively with various concurrently measured EEG descriptors.MethodsVolunteers underwent functional brain imaging using the18fluorodeoxyglucose technique; one scan always assessed awake‐baseline cerebral metabolism (n = 7), and the other scans assessed metabolism during propofol sedation (n = 4), propofol anesthesia (n = 4), or isoflurane anesthesia (n = 5). The EEG was recorded continuously during metabolism assessment using a frontal‐mastoid montage. Power spectrum variables, median frequency, 95% spectral edge, and bispectral index (BIS) values subsequently were correlated with the percentage of absolute cerebral metabolic reduction (PACMR) of glucose utilization caused by anesthesia.ResultsThe percentage of absolute cerebral metabolic reduction, evident during anesthesia, trended median frequency (r = ‐ 0.46, P = 0.11), and the spectral edge (r = ‐ 0.52, P = 0.07), and correlated with anesthetic type (r = ‐ 0.70, P < 0.05), relative [small beta, Greek] power (r = ‐ 0.60, P < 0.05), total power (r = 0.71, P < 0.01), and bispectral index (r = ‐ 0.81, P < 0.001). After controlling for anesthetic type, only bispectral index (r = 0.40, P = 0.08) and [small alpha, Greek] power (r = 0.37, P = 0.10) approached significance for explaining residual percentage of absolute cerebral metabolic reduction prediction error.ConclusionsSome EEG descriptors correlated linearly with the magnitude of the cerebral metabolic reduction caused by propofol and isoflurane anesthesia. These data suggest that a physiologic link exists between the EEG and cerebral metabolism during anesthesia that is mathematically quantifiable.

ISSN:0003-3022    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundAirway pressure‐release ventilation provides ventilation comparable to controlled mechanical ventilation (CMV), but with lower peak airway pressures and less deadspace ventilation. To obtain these advantages for patients administered general anesthesia, the authors (1) designed a mode similar to airway pressure‐release ventilation, intermittent continuous positive airway pressure (CPAPI), and compared its efficiency with that of CMV; and (2) assessed the accuracy of end‐tidal carbon dioxide tension (PET (CO)2) as a monitor of the partial pressure of carbon dioxide in arterial blood (PaCO2) during CPAPI compared with during CMV.MethodsTwenty anesthetized, tracheally intubated patients received baseline CMV that produced a PETCO2of approximately 35 mmHg and a pulse oximetry value > 90%. Patients were assigned to undergo alternating trials of CMV and CPAPI. During CPAPI, CPAP was applied to the airway, removed for 1 s, and reapplied at a rate equal to the ventilator rate during CMV. The difference between the carbon dioxide tension in arterial blood and end‐tidal gas [P(a ‐ ET)CO2] and the calculation of PaCO2/minuteventilation quantified the efficiency of ventilation. Data were summarized as mean +/‐ SD and compared using the Student's test.ResultsPeak airway pressure (13 +/‐ 2 vs. 23 +/‐ 5 cm H2O; P < 0.001) and minute ventilation (3.5 +/‐ vs. 4.6 +/‐ 1.2 l/min; P < 0.0001) were lower during CPAPI than during CMV. The value for PaCO2/minuteventilation (11.1 +/‐ 2.9 vs. 7.9 +/‐ 2.6 mmHg [middle dot] 1‐1[middle dot] min‐1; P < 0.0001) was greater during CPAPI. P(a ‐ ET)CO2was always greater during CMV (6.3 +/‐ 1.6 vs. 1.7 +/‐ 0.9 mmHg; P < 0.0001) and was never > 3.5 mmHg during CPAPI.ConclusionsDuring CPAPI, less ventilation was necessary to produce a PaCO2comparable to that during CMV. This represents a significant reduction in dead‐space ventilation, improved efficiency of ventilation, and a lower value for P(a ‐ ET)CO. Compared with CMV, CPAPI also improves the accuracy of PETCO2as a monitor PaCO2.

ISSN:0003-3022    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundAutomated border detection (ABD) allows semiautomated measurement of left ventricular (LV) areas. They can be combined with left ventricular pressure signals to generate pressure‐area loops and pressure‐dimension indices of contractility. This study compared conventional indices of ventricular performance (fractional area change [FAC] and circumferential fiber shortening [Vcfc]) with pressure‐dimension indices of contractility. A secondary aim was to compare the effects of volatile anesthetics on the indices.MethodsUsing transesophageal echocardiography with automated border detection, FAC and Vcfcwere obtained in 23 patients after cardiopulmonary bypass. Left ventricular pressures were obtained with a left ventricular catheter. Preload reduction by inferior vena caval occlusion was used to obtain end‐systolic elastance (Ees), preload recruitable stroke force (PRSF), and dP/dtmax[middle dot] EDA‐1(EDA = end‐diastolic area). In 11 patients, the measurements were repeated at 1 end‐tidal minimum alveolar concentration of halothane or isoflurane. The results are expressed as mean +/‐ SD.ResultsAfter cardiopulmonary bypass, FAC was 31.1 +/‐ 7.9%, Vcfcwas 0.6 +/‐ 0.2 circ [middle dot] s‐1, Ees was 25.8 +/‐ 11.6 mmHg [middle dot] cm‐2, PRSF was 60.8 +/‐ 26.6 mmHg, and dP/dtmax[middle dot] ‐EDA‐1was 245 +/‐ 123.4 mmHg [middle dot] s‐1[middle dot] cm‐2. At 1 minimum alveolar concentration of a volatile anesthetic agent, FAC, Vcfc, and dP/dtmax[middle dot] EDA‐1remained unchanged. Significant decreases in Ees (19%) and PRSF (28%) were observed.ConclusionsThe association between pressure‐dimension indices and Vcf (c) or FAC was weak or nonexistent. A reduction in myocardial contractility induced by the administration of volatile anesthetic agents was detected by Ees and PRSF, but not by FAC, Vcfc, or dP/dtmax[middle dot] EDA (‐1). After myocardial revascularization, Ees and PRSF appear more sensitive than FAC or Vcfcfor measuring changes in contractility.

ISSN:0003-3022    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundLimitations in the imaging views that can be obtained with transesophageal echocardiography (TEE) have hindered development of a widely adopted Doppler method for cardiac output (CO) monitoring. The authors evaluated a CO technique that combines steerable continuous‐wave Doppler with the imaging capabilities of two‐dimensional multiplane TEE.MethodsFrom the transverse plane transgastric, short‐axis view of the left ventricle, the imaging array was rotated to view the left ventricular outflow tract (LVOT) and ascending aorta. Steerable continuous‐wave Doppler was subsequently used to measure aortic blood flow velocities. Aortic valve area was determined using a triangular orifice model. Matched thermodilution and Doppler CO measurements were obtained serially during surgery.ResultsThe left ventricular outflow tract was imaged in 32 of 33 patients (97%). Data analysis reveal a mean difference between techniques of ‐ 0.01 l/min, and a standard deviation of the differences of 0.56 l/min. Multiple regression showed a correlation of r = 0.98 between intrasubject changes in CO. Multiplane TEE correctly tracked the direction of 37 of 38 serial changes in thermodilution CO but with a modest 14% underestimation of the magnitude of these changes.ConclusionsThese results indicate that multiplane TEE can provide an alternative method for the intraoperative measurement of CO. The ability of the rotatable imaging array to align with the left ventricular outflow tract and the need for only minimal adjustments in probe position advance the utility of intraoperative TEE.

ISSN:0003-3022    

出版商:OVID    

年代:1998

数据来源: OVID