RESUMEN
BACKGROUND: Since there is a growing use of analgesia and sedation in spontaneously breathing patients undergoing diagnostic or therapeutic interventions, recommendations by national societies of anesthesiologists call for the application of capnometry during all anesthetic procedures. METHODS: We compared readings from a transcutaneous capnometer (Tosca) and an end-tidal capnometer (Microcap Plus) to P(aCO2) measurements made via arterial-blood-gas analysis. We studied 30 spontaneously breathing patients who were recovering from general anesthesia, and we used Bland Altman analysis to compare the capnometry readings to the arterial-blood-gas values. Expiratory gas samples for end-tidal capnometry were taken either from a conventional face mask or an oral/nasal cannula. RESULTS: The Tosca significantly overestimates P(aCO2) (mean +/- SD difference 5.6 + 3.4 mm Hg). The Microcap Plus significantly underestimates P(aCO2) (mean +/- SD difference -14.1 +/- 7.4 mm Hg). There was no significant difference between the face mask and oral/nasal cannula with regard to collecting end-tidal samples. CONCLUSION: Both the Tosca and Microcap Plus provide just an approximate estimation of P(aCO2). Clinical use of these monitors can not be proposed under actual conditions but will be advantageous after correction of the limiting errors.
Asunto(s)
Anestesia General , Capnografía/instrumentación , Monitoreo Fisiológico/métodos , Anciano , Anestesia General/métodos , Análisis de los Gases de la Sangre , Capnografía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , RespiraciónRESUMEN
In patients with cerebral ischemia, a frequent finding is atheromatous plaques in the ascending aorta and the aortic arch. Since we were able to demonstrate that patients with atrial fibrillation have an increased coagulatory activity, we wanted to evaluate a potential systemic activation of the coagulatory system in patients with aortic arch atheromatosis (Aortic AA). In 134 consecutive patients, we determined several parameters of the coagulatory and fibrinolytic systems as well as several thrombophilia risk factors and compared the results with 134 age- and sex-matched healthy controls. In 90 of the 134 patients, transesophageal echocardiography showed Aortic AA, and in the remaining 44 patients, there were no aortic findings. The Aortic AA group showed higher concentrations of thrombin-antithrombin (TAT) and plasmin-antiplasmin complexes (PAP). Further division into 4 subgroups of different severity (grade I: no plaques; grade II: plaques 2-5 mm, grade III: plaques > 5 mm, grade IV: mobile plaques), revealed increasing concentrations of fibrinogen, D-dimers and tissue-type plasminogen activator. The grade IV-group displayed the highest values in comparison to all other groups. In conclusion, Aortic AA as such is a risk factor for cerebral ischemia. It causes a systemically detectable activation of coagulation which substantially exceeds the values for controls. This observation is in accordance with our findings in patients with atrial fibrillation.
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Síndromes del Arco Aórtico/complicaciones , Coagulación Sanguínea , Isquemia Encefálica/etiología , Adulto , Anciano , Anciano de 80 o más Años , Síndromes del Arco Aórtico/sangre , Arteriosclerosis/sangre , Arteriosclerosis/complicaciones , Biomarcadores/sangre , Estudios de Casos y Controles , Femenino , Fibrinólisis , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Índice de Severidad de la Enfermedad , Trombofilia/sangreRESUMEN
OBJECTIVES: Pain among children and adolescents has been identified as an important public health problem. Most studies evaluating recurrent or chronic pain conditions among children have been limited to descriptions of pain intensity and duration. The effects of pain states and their impact on daily living have rarely been studied. The objective of this study was to investigate the impact of perceived pain on the daily lives and activities of children and adolescents. In addition, we sought to delineate self-perceived triggers of pain among children and adolescents. In this study, we (1) document the 3-month prevalence of painful conditions among children and adolescents, (2) delineate their features (location, intensity, frequency, and duration), (3) describe their consequences (restrictions and health care utilization), and (4) elucidate factors that contribute to the occurrence of pain episodes among young subjects. METHODS: The study was conducted in 1 elementary school and 2 secondary schools in the district of Ostholstein, Germany. Children and adolescents, as well as their parents/guardians, were contacted through their school administrators. The teachers distributed an information leaflet, explaining the conduct and aim of the study, to the parents a few days before the official enrollment of the youths in the study. Parents of children in grades 1 to 4 of elementary school were asked to complete the pain questionnaire for their children at home, whereas children from grade 5 upward completed the questionnaire on their own during class, under the supervision of their teachers. The response rate was 80.3%. As previously stated, chronic pain was defined as any prolonged pain that lasted a minimum of 3 months or any pain that recurred throughout a minimal period of 3 months. The children and adolescents were surveyed with the Luebeck Pain-Screening Questionnaire, which was specifically designed for an epidemiologic study of the characteristics and consequences of pain among children and adolescents. The questionnaire evaluates the prevalence of pain in the preceding 3 months. The body area, frequency, intensity, and duration of pain are addressed by the questionnaire. In addition, the questionnaire inquires about the private and public consequences of pain among young subjects. Specifically, the questionnaire aims to delineate the self-perceived factors for the development and maintenance of pain and the impact of these conditions on daily life. RESULTS: Of the 749 children and adolescents, 622 (83%) had experienced pain during the preceding 3 months. A total of 30.8% of the children and adolescents stated that the pain had been present for >6 months. Headache (60.5%), abdominal pain (43.3%), limb pain (33.6%), and back pain (30.2) were the most prevalent pain types among the respondents. Children and adolescents with pain reported that their pain caused the following sequelae: sleep problems (53.6%), inability to pursue hobbies (53.3%), eating problems (51.1%), school absence (48.8%), and inability to meet friends (46.7%). The prevalence of restrictions in daily living attributable to pain increased with age. A total of 50.9% of children and adolescents with pain sought professional help for their conditions, and 51.5% reported the use of pain medications. The prevalence of doctor visits and medication use increased with age. Weather conditions (33%), illness (30.7%), and physical exertion (21.9%) were the most frequent self-perceived triggers for pain noted by the respondents. A total of 30.4% of study participants registered headache as the most bothersome pain, whereas 12.3% cited abdominal pain, 10.7% pain in the extremities, 8.9% back pain, and 3.9% sore throat as being most bothersome. A total of 35.2% of children and adolescents reported pain episodes occurring > or =1 time per week or even more often. Health care utilization because of pain differed among children and adolescents according to the location of pain. Children and adolescents with back pain (56.7%), limb pain (55.0%), and abdominal pain (53.3%) visited a doctor more often than did those with headache (32.5%). In contrast, children and adolescents with headache (59.2%) reported taking medication because of pain more often than did those with back pain (16.4%), limb pain (22.5%), and abdominal pain (38.0%). The prevalence of self-reported medication use and doctor visits because of pain increased significantly with age (chi2 test). The prevalence of self-reported medication use was significantly higher among girls than among boys of the same age, except between the ages of 4 and 9 years (chi2 test). The prevalence of restrictions in daily activities varied among children and adolescents with different pain locations; 51.1% of children and adolescents with abdominal pain and 43.0% with headache but only 19.4% with back pain reported having been absent from school because of pain. The prevalence of restrictions attributable to pain was significantly higher among girls than among boys of the same age, except between the ages of 4 and 9 years (chi2 test). The self-reported triggers for pain varied between girls and boys. Girls stated more often than boys that their pain was triggered by weather conditions (39% vs 25%), illness (eg, common cold or injury) (35.9% vs 23.9%), anger/disputes (20.9% vs 11.9%), family conditions (12.1% vs 5.2%), and sadness (11.9% vs 3.4%). In contrast, boys stated more often than girls that their pain was triggered by physical exertion (28% vs 17.2%). We used a logistic regression model to predict the likelihood of a child paying a visit to the doctor and/or using pain medication. Health care utilization was predicted by increasing age, greater intensity of pain, and longer duration of pain but not by the frequency of pain. We used a logistic regression model to predict restrictions in daily activities. Only the intensity of pain was predictive of the degree of restrictions in daily life attributable to pain; the duration of pain and the frequency of pain episodes had no bearing on the degree to which the daily lives of the children were restricted because of pain. CONCLUSIONS: More than two thirds of the respondents reported restrictions in daily living activities attributable to pain. However, 30 to 40% of children and adolescents with pain reported moderate effects of their pain on school attendance, participation in hobbies, maintenance of social contacts, appetite, and sleep, as well as increased utilization of health services because of their pain. Restrictions in daily activities in general and health care utilization because of pain increased with age. Girls > or =10 years of age reported more restrictions in daily living and used more medications for their pain than did boys of the same age. We found gender-specific differences in self-perceived triggers for pain. Pain intensity was the most robust variable for predicting functional impairment in > or =1 areas of daily life. Increasing age of the child and increasing intensity and duration of pain had effects in predicting health care utilization (visiting a doctor and/or taking medication), whereas restrictions in daily activities were predicted only by the intensity of pain. Our results underscore the relevance of pediatric pain for public health policy. Additional studies are necessary and may enhance our knowledge about pediatric pain, to enable parents, teachers, and health care professionals to assist young people with pain management, allowing the young people to intervene positively in their conditions before they become recurrent or persistent.
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Actividades Cotidianas , Atención a la Salud/estadística & datos numéricos , Dolor/epidemiología , Adolescente , Niño , Enfermedad Crónica , Femenino , Alemania/epidemiología , Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Dolor/etiología , Dimensión del Dolor , Prevalencia , Encuestas y CuestionariosRESUMEN
BACKGROUND AND PURPOSE: In Germany, the discharge medication is usually reported to the general practitioner (GP) by an inital short report (SR)/notification (handed over to the patient) and later by a more detailed discharge letter (DL) of the hospital. The quality and appropriateness of these reports have been occasionally objected. Until now, a systematic survey has not been reported. METHODS: N = 536 GPs (from Franfurt am Main and Luebeck) were asked after the typical report format of their patients discharge medication by the local hospitals. The questionnaire asked for 26 items covering (1) the designation of the medication (brand name, generic name) in SR and DL, (2) further specifications, e. g., possibilities of generic substitution or supervision of sensible medications, (3) reasons why GPs do not follow the hospitals recommendations, and (4) possibilities for an improvement in the medication-related communication between GP and hospitals. RESULTS: 39% GPs responded sufficiently to the questionnaire. The majority of the GPs (82%) quoted that in the SR only brand names are given (often or ever) and neither the generic name nor any further information on generic substitution is available (seldom or never). 65% of the responders quoted that even in the DL only brand names are given. Only 41% of the reponders quoted that further treatment-relevant specifications are given (often or ever). 95% responded that new medications or change of custom medication are seldom or never explained in the DL and GP were not explicitly informed about relevant medication changes. 58% of the responders quoted economic reasons for readjustment of the discharge medication, e.g., by generic substitution. The majority of responders (83%) are favoring (useful or very useful) a predischarge information (e. g., via fax) about the medication and 54% a hot line to some relevant person in the hospital should treatment problems emerge. 67% of the responders quoted in favor of regular meetings between GPs and hospital doctors regarding actual pharmacotherapy. CONCLUSION: This survey points to marked deficiencies in reporting the discharge medication to GPs, which leave room for improvement.
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Correspondencia como Asunto , Prescripciones de Medicamentos/normas , Alta del Paciente/normas , Educación del Paciente como Asunto/normas , Atención Ambulatoria , Recolección de Datos , Documentación/normas , Medicina Familiar y Comunitaria , Femenino , Alemania , Humanos , Masculino , Registros Médicos/normas , Garantía de la Calidad de Atención de Salud/normasRESUMEN
STUDY OBJECTIVE: To evaluate the profile of molecular hemostatic markers in patients receiving either spinal or balanced general anesthesia for total hip arthroplasty. DESIGN: Open, randomized, observational study. SETTING: Orthopedic unit and central laboratory of a university hospital. PATIENTS: 26 consenting ASA physical status II and III inpatients undergoing total hip arthroplasty with general balanced anesthesia (n = 10) or spinal (regional) anesthesia (n = 16). INTERVENTIONS: The time course of seven procoagulatory and fibrinolytic parameters was examined during and after surgery in both groups of patients (general and regional). Blood samples were drawn on the day before surgery, directly before induction of general anesthesia or regional anesthesia, respectively, intraoperatively (before bone manipulation), at the end of surgery, and on the mornings of postoperative days 1 and 5. MEASUREMENTS AND MAIN RESULTS: The coagulation samples were centrifuged within 1 hour of collection at 2,300 g for 15 minutes at 4 degrees C. Hemoglobin, hematocrit, platelets, fibrinogen, prothrombin time, thrombin time, activated partial thromboplastin time, antithrombin, and protein C were measured immediately on arrival at the laboratory. Specimens were then aliquoted and stored at -70 degrees C. Within 2 weeks, samples were thawed and prepared for the following assays: thrombin-antithrombin complexes (TAT complexes), D-dimers, plasminogen activator inhibitor type 1 (PAI-1), and plasminogen and plasmin inhibitor. Maximum activation of coagulation was not reached until 2 hours postoperatively and then slowly decreased until normal values were reached around the fifth postoperative day. Parameters displaying the greatest changes were antithrombin and D-dimers. No statistically significant differences were found between the two groups at the individual time points. CONCLUSION: Our initial hypothesis that the lesser risk of postoperative DVT in patients undergoing total hip arthroplasty in regional anesthesia is reflected in the course of the plasmatic molecular markers of hemostasis could not be verified. There were no significant differences in the timely course of the markers at any given time point.
Asunto(s)
Anestesia General , Anestesia Raquidea , Artroplastia de Reemplazo de Cadera , Hemostasis , Anciano , Anciano de 80 o más Años , Antitrombina III/análisis , Pruebas de Coagulación Sanguínea , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Fibrinógeno/análisis , Humanos , Masculino , Persona de Mediana Edad , Péptido Hidrolasas/análisis , Recuento de Plaquetas , Complicaciones Posoperatorias/prevención & control , Protrombina/análisis , Tiempo de Protrombina , Trombosis de la Vena/sangre , Trombosis de la Vena/etiología , Trombosis de la Vena/prevención & controlRESUMEN
OBJECTIVE: Measurement of functional residual capacity (FRC) is of considerable interest for monitoring ventilated patients in ICUs. However, the lack of instruments that can be used in the clinical setting has so far impeded the routine application of this measurement. It was the aim of our study to evaluate the accuracy and the reproducibility of a simplified oxygen washout technique (FRC[O2]). MATERIALS AND METHODS: For the evaluation of FRC[O2J, gas flow, CO2 and O2 concentrations were determined by the flow probe of an ICU ventilator, a mainstream capnometer and O2 analyser. In 30 volunteers FRC[O2] as measured during spontaneous breathing was compared to: 1. Helium dilution technique (FRC[He], n = 21), 2. Body plethysmography (FRC[bp], n = 9). In n = 7 male patients FRC[O2] was repeatedly evaluated during mechanical ventilation and compared to the preoperative FRC[bp]. RESULTS: FRC[O2J corresponded well with FRC[He] (range: 1.9 to 6.0 l, bias of FRC[O2]: 0.53 l (95% CI 0.24 l to 0.82 l)) and FRC[bp] (range: 2.1 to 4.3 l, bias of FRC[O2] 0.03 l (95% CI -0.30 l to 0.37 l)). The mean of the repeated FRC[O2]-measurements (basic range: 1.3 to 3.6 l) during mechanical ventilation with unchanged ventilator settings stayed unchanged. The within subject-between error ranged from 0.1 to 0.4 l (mean = 0.23 1). Mean FRC[O2] during mechanical ventilation decreased to 66.6 percent of the preoperative mean FRC[bp]. CONCLUSIONS: The automated oxygen washout technique is a simple method to measure FRC in the ICU patient.