Epidural steroid and clonidine for chronic intractable post-thoracotomy pain: a pilot study.

BACKGROUND: Chronic post-thoracotomy pain is relatively common after major thoracic surgery. The primary results of a pilot study using thoracic epidural steroid and clonidine injection to treat chronic intractable post-thoracotomy pain are presented. METHODS: Twenty-one patients with intractable post-thoracotomy pain participated in the study. Thirteen patients received thoracic epidural injection of a mixture of 150 µg clonidine and 80 mg of methylprednisolone acetate diluted in 8 mL 0.5% lidocaine. Eight patients continued with comprehensive medical management and served as a control group. A visual analog scale (VAS) for pain was recorded before treatment, 30 minutes after the epidural injection and before discharge, at 3 weeks and 6 months. Pain, sleep disturbances, appetite changes and daily activity, as well as the incidence of complications were recorded. The need for opioid rescue medications was recorded. RESULTS: Twelve of 13 patients in the injection group reported improvement (> 50% reduction of pain) at 3 weeks and 6 months following the injection. Allodynia improved in all injection group patients compared to four of eight in the control group. Sleep disturbance, appetite changes and daily activity were improved in the injection group. The number of patients requiring opioid rescue medications was reduced from 61.5% to 15.3% during the 6-month duration of study. Injection caused transient hypotension in 46.2% of patients. Mild sedation was noted in 30.7% of patients receiving injection; 15.3% of the patients had localized back pain at the site of injection. DISCUSSION: Our preliminary data suggest possible efficacy of thoracic epidural steroid and clonidine mixture in the treatment of chronic post-thoracotomy pain. No serious adverse effects were noted in this pilot study.

The effectiveness of vitamin "E" in the treatment of oral mucositis in children receiving chemotherapy.

The aim of this study was to study the effect of vitamin "E" in the treatment of oral mucositis. 80 patients with oral mucositis were randomly distributed into 2 groups: group A, topically applied vitamin "E" and group B, vitamin "E" was given systemically. The 2 groups were evaluated for 5 days. Results showed that in group A grades of oral mucositis improved significantly, while in group B no significant improvement was noticed. It is concluded that topical application of 100 mg vitamin "E" twice daily is an effective measure for the treatment of chemotherapy-induced oral mucositis.

Assessment of oral complications in children receiving chemotherapy.

The aim of this study was to assess the early oral complications in pediatric patients receiving chemotherapy. An interview and oral examination was conducted on 150 pediatric cancer patients receiving standard dose chemotherapy. Results showed that oral pain and dry mouth were the most frequent patients' complaints. The prevalences of chemotherapy-induced oral mucositis and oral infections were relatively high. The chemotherapeutic antimetabolites were the most frequently associated with oral complications than other types of chemotherapy. The present results indicate that the oral complications among patients receiving chemotherapy are common.

The impact of closed endotracheal suctioning systems on mechanical ventilator performance.

BACKGROUND: Closed endotracheal suctioning during mechanical ventilation is increasingly used, but its impact on ventilator function has not been fully studied. METHODS: We evaluated the impact of closed suctioning with 11 critical-care ventilators, during assisted ventilation in pressure-support mode, pressure-assist/control mode, volume-assist/control mode, and during continuous positive airway pressure, with 2 suctioning pressures (-120 mm Hg and approximately -200 mm Hg), and with 2 tidal volumes (450 mL and 900 mL). We continuously measured airway pressure, flow at the airway, and pressure distal to the catheter tip, before, during, and after a single 15-second period of continuous suctioning. RESULTS: No ventilator malfunctioned as a result of the closed suctioning. During suctioning, end-expiratory pressure markedly decreased in all modes, and peak flow increased in all modes except volume-assist/control (p < 0.001). Respiratory rate increased during suctioning in pressure- and volume-assist/control (p < 0.001) but not during pressure support or continuous positive airway pressure. Gas delivery was most altered during volume-assist/control with the smaller tidal volume (p < 0.05) and least altered during pressure-assist/control with the larger tidal volume. CONCLUSION: There are large differences between the ventilators evaluated (p < 0.001). Closed suctioning does not cause mechanical ventilator malfunction. Upon removal of the suction catheter, these ventilators resumed their pre-suctioning-procedure gas delivery within 2 breaths, and, during all the tested modes, all the ventilators maintained gas delivery. However, closed suctioning can decrease end-expiratory pressure during suctioning.

Cellular phone interference with the operation of mechanical ventilators.

OBJECTIVE: To determine whether a cellular phone would interfere with the operation of mechanical ventilators. DESIGN: Laboratory study. SETTING: University medical center. SUBJECTS: Fourteen mechanical ventilators. INTERVENTIONS: We evaluated change in operation and malfunction of the mechanical ventilators. MEASUREMENTS AND MAIN RESULTS: The cellular phone (Nokia 6120i) was computer controlled, operating at 828.750 MHz analog modulation. It was operated at 16, 40, 100, 250, and 600 mW, 30 cm from the floor and 30, 15, and <3 cm from all sides of each ventilator. Six of the 14 ventilators tested malfunctioned when a cellular phone at maximum power output was placed < or =15 cm from the device. None of these responses were considered immediately life threatening except for the response of the Puritan Bennett 840, which stopped ventilating when the cellular phone at maximum power output was placed < or =30 cm from the ventilator. One ventilator doubled the ventilatory rate and another increased the displayed tidal volume from 350 to 1033 mL. In one of the infant ventilators, displayed tidal volume increased from 21 to 100 mL. In another ventilator, the high respiratory rate alarm sounded but the rate had not changed. CONCLUSIONS: In a controlled laboratory setting, cellular phones placed in close proximity to some commercially available intensive care ventilators can cause malfunctions, including irrecoverable cessation of ventilation. This is most likely to occur if the cellular phone is <30 cm from the device and ringing. Based on our data and the available literature, we believe it is reasonably safe to permit the use of cellular phones in the intensive care unit, as long as they are kept > or =3 feet from all medical devices. The current electromagnetic compatibility standards for mechanical ventilators are inadequate to prevent malfunction. Manufacturers should ensure that their products are not affected by wireless technology even when placed immediately next to the device.