Subject(s)
Hernia, Inguinal , Herniorrhaphy , Laparoscopy , Surgical Mesh , Humans , Hernia, Inguinal/surgery , Herniorrhaphy/methods , Laparoscopy/methodsSubject(s)
Hernia, Inguinal , Hernia, Ventral , Laparoscopy , Humans , Herniorrhaphy , Hernia, Ventral/surgery , Surgical Mesh , Hernia, Inguinal/surgerySubject(s)
Airway Management , Intubation, Intratracheal , Hospitals , Humans , Patients , Retrospective StudiesSubject(s)
Colorectal Neoplasms , Troponin I , Humans , Hypoxia , Postoperative Period , Prospective StudiesSubject(s)
Nurse Anesthetists , Quality Improvement , Airway Management , Anesthetists , Critical Care , Humans , Prospective StudiesSubject(s)
Intubation, Intratracheal/methods , Laryngoscopes , Laryngoscopy/methods , Female , Humans , MaleABSTRACT
This study investigated the effects of pre-procedural anxiety (assessed using the Beck Anxiety Inventory) on sedative requirements in 135 patients undergoing sedation for colonoscopy. Deep sedation was defined as loss of consciousness and no response to colonoscopy, and was achieved by target-controlled infusion of propofol. Patients' characteristics, baseline haemodynamic profiles, Beck Anxiety Inventory scores, effect-site propofol concentration at loss of consciousness and characteristics of recovery were recorded. No correlations were found between Beck Anxiety Inventory scores and effect-site propofol concentration at loss of consciousness or baseline haemodynamic profiles. There was no statistical difference in the characteristics of recovery among patients with different levels of anxiety. In conclusion, in patients receiving deep sedation for colonoscopies, the level of pre-procedural anxiety did not relate to the sedative requirement or post-procedural recovery characteristics.
Subject(s)
Anxiety/psychology , Colonoscopy/psychology , Deep Sedation/psychology , Preoperative Care/methods , Adult , Aged , Aged, 80 and over , Anxiety/diagnosis , Deep Sedation/methods , Dose-Response Relationship, Drug , Female , Humans , Hypnotics and Sedatives , Infusions, Intravenous , Male , Middle Aged , Patient Satisfaction/statistics & numerical data , Propofol , Psychiatric Status Rating Scales/statistics & numerical dataABSTRACT
We examined the pre-emptive analgesic effect of a cyclooxygenase (COX)-2 inhibitor in a rat surgical pain model and characterised the changes in cutaneous COX-2 around a surgical site. Thermal hyperalgesia and mechanical allodynia were tested in the rats for three days after incision and skin tissues were collected for analysis of COX-2. There was decreased expression of cutaneous COX-2 one day after surgical incision. Pre-incision injection of the COX-2 inhibitor significantly inhibited expression of COX-2 and also reduced thermal hyperalgesia (but not mechanical allodynia) compared with the post-incision COX-2-inhibitor injection group, one day after incision.
Subject(s)
Cyclooxygenase 2 Inhibitors/therapeutic use , Pain Management/methods , Pain, Postoperative/prevention & control , Pyrazoles/therapeutic use , Sulfonamides/therapeutic use , Acute Disease , Analysis of Variance , Animals , Behavior, Animal , Blotting, Western , Cyclooxygenase 2/biosynthesis , Hot Temperature , Hyperalgesia/prevention & control , Male , Pain Measurement/drug effects , Pain Threshold/drug effects , Physical Stimulation , Rats , Rats, Sprague-DawleyABSTRACT
BACKGROUND: Despite the ability of tissue Doppler imaging (TDI) to detect left ventricular (LV) systolic and diastolic myocardial functions in patients with heart failure, the added value of TDI to clinical variables and conventional echocardiography in predicting the symptoms and outcome of advanced heart failure has not been clearly defined. METHODS AND RESULTS: Two hundred and thirty adult patients diagnosed with congestive heart failure were assigned to study groups based on the New York Heart Association functional classes. Pulsed-wave TDI (PWTDI), including average of peak systolic (Sm), early (Em) and late diastolic (Am) velocities from six mitral annular sites was evaluated. PWTDI was also calculated to create a combined index (EAS index) of diastolic and systolic performances. All patients were followed up for cardiac-related death and hospitalisation as a result of heart failure. Patients with functional class III-IV had a significantly higher EAS index (0.21 ± 0.19 vs. 0.13 ± 0.08, p < 0.05) than those with class I-II and the control (0.10 ± 0.04, p < 0.05). Except for Sm and Em, all conventional echocardiographic Doppler parameters and TDI variables significantly correlated with functional class. Moreover, according to multiple stepwise analysis, EAS index and percentage of chronic renal insufficiency (CRF) were the only two independent predictors of functional class (EAS index, p = 0.006; CRF, p = 0.019). During follow-up (median, 30 months), 93 participants had cardiac events. EAS index, LV mass index and CRF were significant predictors of cardiac mortality and hospitalisation [EAS index, hazard ratio (HR) 4.962, p = 0.006; LV mass index, HR 1.007, p = 0.003; CRF, HR 1.616, p = 0.040]. CONCLUSIONS: The EAS index, which reflects systolic and diastolic performances, is a highly effective means of differentiating between patients with functional class I-II and those with III-IV. The index also correlates with cardiac mortality and hospitalisation for worsening heart failure, thus providing additional value to conventional echocardiographic measures.
Subject(s)
Echocardiography, Doppler/methods , Heart Failure/diagnostic imaging , Aged , Blood Flow Velocity/physiology , Case-Control Studies , Death, Sudden, Cardiac , Diastole , Echocardiography, Doppler/mortality , Female , Heart Failure/mortality , Heart Failure/physiopathology , Hospitalization , Humans , Male , Middle Aged , Observer Variation , Prognosis , Reproducibility of Results , Severity of Illness Index , Survival Analysis , SystoleABSTRACT
Increased tracheal cuff pressure during mechanical ventilation is associated with reduced mucosal blood flow and ischaemia, as well as postoperative sore throat. We assessed the potential effects of transoesophageal echocardiography probe insertion on the tracheal cuff pressure in patients undergoing cardiac surgery. Using a manometer, the cuff pressure of a high-volume, low-pressure tracheal tube (inner diameter 7.0 mm for women and 7.5 mm for men) was adjusted to 25-30 cm H(2)O before blind insertion of a transoesophageal echocardiography probe. The pressure changes were then recorded for 1 min. After probe insertion, the mean (SD) intra-cuff pressure increased from 27.7 (1.5) to 36.2 (6.4) cm H(2)O (p < 0.001) and was > 35 cm H(2)0 in 17/38 patients (45%). Our results suggest that transoesophageal echocardiography probe insertion may increase the tracheal cuff pressure more than that is generally recommended and therefore the latter should be routinely monitored under such circumstances.