Use of continuous subcutaneous anesthetic infusion in cardiac surgical patients after median sternotomy

The use of opioid analgesics to control pain after median sternotomy in cardiac surgical patients is worldwide accepted and established. However, opioids have a wide range of possible side effects, concerning prolonged extubation time, gastrointestinal tract dyskinesia and urinary tract disorders mostly retention. All these may lead to a prolonged ICU stay or overall hospitalization time increase

Air pollution and lung cancer incidence in 17 European cohorts: prospective analyses from the European Study of Cohorts for Air Pollution Effects (ESCAPE)

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Long-term exposure to elemental constituents of particulate matter and cardiovascular mortality in 19 European cohorts: Results from the ESCAPE and TRANSPHORM projects

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Auditory function after subarachnoid anaesthesia (pharmacological and mechanical influences)

This study was designed to evaluate the degree of cochlear dysfunction following spinal anesthesia administered through spinal needles of different shape and diameter.We studied 120 patients ASA I, II aged 55-85 years who underwent transurethral prostatectomy. The patients were randomly allocated to six groups in which the anaesthetic was administered through 22G Quincke, or 22G Whitacre, or 25G Quincke, or 25G Whitacre, or 26G Quincke, or 26G Atraucan. Spinal anaesthesia was administered through L3/4 or L4/5 interspace using lidocaine 5% 2ml. Audiometrie evaluation was made with pure tone audiometry. On the second postoperative day a new audiogram was performed. All results are presented as means (± SD). In all groups the preoperative minus the postoperative hearing levels for any change at each frequency were compared using the student's t-test p<0.05 was considered significant. In the group which received spinal anaesthesia via 22G Quincke or via 22G Whitacre needle an increase in the hearing threshold of 10-15dB was found at the lower and at the higher frequencies. In the group which received anaesthesia via 25G Quincke or via 25G Whitacre needle an increase in hearing threshold of 10-15dB was found at the lower frequencies. In the group which received anasthesia via 26G Quincke or via 26G Atraucan needle no significant change in hearing was observed. In comparing the 22G Quincke and the 22G Whitacre group there was a statistically significant hearing loss at 250Hz and at 500Hz. In comparing the 25G Quincke and 25G Whitacre group there was a statistically significant hearing loss at 125Hz. In comparing 26 G Quincke and 26G Atraucan needle there was no statistically significant hearing loss. In comparing the 22G vs 25G vs 26G Quincke needle group there was a statistically significant hearing loss at 125Hz, 250Hz, 500Hz, 1000Hz, 2000Hz, 3000Hz and at 4000Hz. In comparing the 22G Quincke vs 25G Whitacre vs 26G Atraucan needle group there was a statistically significant hearing loss at 125Hz, 250 Hz, 500Hz and at 2000Hz.The shape and the diameter of the spinal needle used for dural puncture are related to the degree of cochlear dysfunction.Σκοπός της μελέτης αυτής ήταν να διερευνηθεί ο βαθμός της κοχλιακής δυσλειτουργίας μετά την εφαρμογή υπαραχνοειδούς αναισθησίας με βελόνες διαφορετικής διαμέτρου με τύπου.Μελετήθηκαν 120 ασθενείς ASA I, II ηλικίας 55 -80 ετών που υποβλήθηκαν σε διουρηθρική προστατεκτομή. Με τυχαία κατανομή οι ασθενείς χωρίστηκαν σε 6 ομάδες στις οποίες εφαρμόσθηκε υπαραχνοειδής αναισθησία με βελόνες 22G Quincke ή 22G Whitacre ή 25G Quincke ή 25G Whitacre ή 26G Quincke ή 26 G Atraucan, στο O3-4 μεσοσπονδύλιο διάστημα με τοπικό αναισθητικό λιδοκαΐνη 5%, 2 ml. Ο ακουολογικός έλεγχος εγένετο με τη μέθοδο της ακουομετρίας την παραμονή της χειρουργικής επέμβασης και τη δεύτερη μετεγχειρητική ημέρα. Στους ασθενείς όλων των ομάδων αξιολογήθηκε η μέση μεταβολή της ακοής από τις προεγχειρητικές τιμές του ακουογράμματος μείον τις μετεγχειρητικές τιμές σε κάθε συχνότητα σε κάθε αυτί με το t-test. Για τη σύγκριση των ομάδων όσον αφορά στη διάμετρο για κάθε τύπο βελόνης χωριστά (Quincke, Whitacre) χρησιμοποιήθηκε το Anova test. Ο βαθμός στατιστικής σημα- ντικότητας αξιολογήθηκε με ρ < 0.05 στατιστικά σημαντική διαφορά.Από τα αποτελέσματα φαίνεται στατιστικά σημαντική μείωση της ακοής ρ < 0.05 της τάξης των 10-15dB στις χαμηλές συχνότητες στις ομάδες που χορηγήθηκε υπαραχνοειδής αναισθησία με βελόνη 22G Quincke ή 22 G Whitacre.Στατιστικά σημαντική διαφορά όσον αφορά στη μείωση της ακοής της τάξης των 10-15 dB στις χαμηλές συχνότητες παρατηρήθηκε και στις ομάδες βελόνης 25G Quincke ή 25 G Whitacre. Δεν παρατηρήθηκε στατιστικά σημαντική διαφορά όσον αφορά στη μείωση της ακοής στους ασθενείς που χορηγήθηκε υπαραχνοειδής αναισθησία με βελόνες 26G Quin-eke ή 26 G Atraucan. Από τη σύγκριση των ομάδων βελόνης 22G Quincke και 22 G Whitacre παρατηρήθηκε στατιστικά σημαντική μείωση της ακοής στα 250 Hz και στα 500Ηζ (η μεγαλύτερη μείωση ήταν στην ομάδα βελόνης 22 G Quincke). Από τη σύγκριση των ομάδων βελόνης 25 G Quincke και 25 G Whitacre παρατηρήθηκε επίσης στατιστικά σημαντική διαφορά στα 125 Hz (η μεγαλύτερη μείωση ήταν στην ομάδα βελόνης 25 G Quincke), ενώ από τη σύγκριση των ομάδων 26 G Quincke και 26 G Atraucan δεν υπήρξε στατιστικά σημαντική διαφορά. Από τη σύγκριση των ομάδων ίδιου τύπου βελόνης Quincke, διαφορετικής διαμέτρου 22 G vs 25G vs 26 G παρατηρήθηκε στατιστικά σημαντική διαφορά στα 125 Hz, 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz και 4000Hz. Από τη σύγκριση των ομάδων ίδιου τύπου Whitacre, διαφορετικής διαμέτρου 22 G vs 25 G vs 26 G η διαφορά που παρατηρήθηκε όσον αφορά στη μεταβολή του επιπέδου ακοής ήταν σημαντική στα 125 Hz, 250 Hz, 500 Hz και 2000 Hz.Συμπερασματικά καταλήγουμε ότι ο τύπος και η διάμετρος της βελόνης που χρησιμοποιείται για υπαραχνοειδή αναισθησία έχει άμεση σχέση με το βαθμό της κοχλιακής δυσλειτουργίας.eke ή 26 G Atraucan. Από τη σύγκριση των ομάδων βελόνης 22G Quincke και 22 G Whitacre παρατηρήθηκε στατιστικά σημαντική μείωση της ακοής στα 250 Hz και στα 500Ηζ (η μεγαλύτερη μείωση ήταν στην ομάδα βελόνης 22 G Quincke). Από τη σύγκριση των ομάδων βελόνης 25 G Quincke και 25 G Whitacre παρατηρήθηκε επίσης στατιστικά σημαντική διαφορά στα 125 Hz (η μεγαλύτερη μείωση ήταν στην ομάδα βελόνης 25 G Quincke), ενώ από τη σύγκριση των ομάδων 26 G Quincke και 26 G Atraucan δεν υπήρξε στατιστικά σημαντική διαφορά. Από τη σύγκριση των ομάδων ίδιου τύπου βελόνης Quincke, διαφορετικής διαμέτρου 22 G vs 25G vs 26 G παρατηρήθηκε στατιστικά σημαντική διαφορά στα 125 Hz, 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz και 4000Hz. Από τη σύγκριση των ομάδων ίδιου τύπου Whitacre, διαφορετικής διαμέτρου 22 G vs 25 G vs 26 G η διαφορά που παρατηρήθηκε όσον αφορά στη μεταβολή του επιπέδου ακοής ήταν σημαντική στα 125 Hz, 250 Hz, 500 Hz και 2000 Hz.Συμπερασματικά καταλήγουμε ότι ο τύπος και η διάμετρος της βελόνης που χρησιμοποιείται για υπαραχνοειδή αναισθησία έχει άμεση σχέση με το βαθμό της κοχλιακής δυσλειτουργίας

Long-term exposure to traffic-related air pollution and cardiovascular health in a Greek cohort study

Our objective is to evaluate the association of exposure to traffic-related air pollution with the incidence of fatal and non-fatal ischemic heart disease (IHD), stroke and total cardiovascular disease (CVD) events in a Greek cohort. We used data from the European Prospective Investigation on Nutrition and Cancer (EPIC) for 2752 subjects followed from 1997 to 2011, whose residence was in 10 municipalities of the Greater Athens area. Air pollution exposure estimation was based on a spatio-temporal land use regression model linking geo-coded residential addresses to long-term average NO2 and PM10 concentrations. We conducted Cox proportional hazards regression analysis, adjusting for potential confounders. Hazard ratios (HR) above 1 (not all statistically significant) were associated with higher PM10 exposure for all outcomes. Weaker associations were found with NO2 exposure. Specifically, the estimated HR for a CVD event associated with 10 mu g/m(3) increase in long-term exposure to PM10 was 1.50 (1.05-2.16, p-value: 0.027). The relationship was more evident for subjects &lt;= 50 years old at recruitment. Associations of PM10 and NO2 exposure with IHD events were found only among women with HRs respectively of 2.24 (0.89-5.64, p-value: 0.086) and 1.54 (1.01-2.37, p-value: 0.046) associated with 10 mu g/m(3) increase in the corresponding pollutant. In conclusion, the present study suggests that long-term exposure to traffic-related air pollution has an impact on CVD and IHD morbidity, particularly among women and younger subjects. (C) 2014 Elsevier B.V. All rights reserved

Natural-cause mortality and long-term exposure to particle components : an analysis of 19 European cohorts within the multi-center ESCAPE project

Studies have shown associations between mortality and long-term exposure to particulate matter air pollution. Few cohort studies have estimated the effects of the elemental composition of particulate matter on mortality.; Our aim was to study the association between natural-cause mortality and long-term exposure to elemental components of particulate matter.; Mortality and confounder data from 19 European cohort studies were used. Residential exposure to eight a priori-selected components of particulate matter (PM) was characterized following a strictly standardized protocol. Annual average concentrations of copper, iron, potassium, nickel, sulfur, silicon, vanadium, and zinc within PM size fractions ≤ 2.5 μm (PM2.5) and ≤ 10 μm (PM10) were estimated using land-use regression models. Cohort-specific statistical analyses of the associations between mortality and air pollution were conducted using Cox proportional hazards models using a common protocol followed by meta-analysis.; The total study population consisted of 291,816 participants, of whom 25,466 died from a natural cause during follow-up (average time of follow-up, 14.3 years). Hazard ratios were positive for almost all elements and statistically significant for PM2.5 sulfur (1.14; 95% CI: 1.06, 1.23 per 200 ng/m3). In a two-pollutant model, the association with PM2.5 sulfur was robust to adjustment for PM2.5 mass, whereas the association with PM2.5 mass was reduced.; Long-term exposure to PM2.5 sulfur was associated with natural-cause mortality. This association was robust to adjustment for other pollutants and PM2.5

Air Pollution and Nonmalignant Respiratory Mortality in 16 Cohorts within the ESCAPE Project

Rationale: Prospective cohort studies have shown that chronic exposure to particulate matter and traffic-related air pollution is associated with reduced survival. However, the effects on nonmalignant respiratory mortality are less studied, and the data reported are less consistent. Objectives: We have investigated the relationship of long-term exposure to air pollution and nonmalignant respiratory mortality in 16 cohorts with individual level data within the multicenter European Study of Cohorts for Air Pollution Effects (ESCAPE). Methods: Data from 16 ongoing cohort studies from Europe were used. The total number of subjects was 307,553. There were 1,559 respiratory deaths during follow-up. Measurements and Main Results: Air pollution exposure was estimated by land use regression models at the baseline residential addresses of study participants and traffic-proximity variables were derived from geographical databases following a standardized procedure within the ESCAPE study. Cohort-specific hazard ratios obtained by Cox proportional hazard models from standardized individual cohort analyses were combined using metaanalyses. We found no significant associations between air pollution exposure and nonmalignant respiratory mortality. Most hazard ratios were slightly below unity, with the exception of the traffic-proximity indicators. Conclusions: In this study of 16 cohorts, there was no association between air pollution exposure and nonmalignant respiratory mortality

Long-term Exposure to Air Pollution and Cardiovascular Mortality: An Analysis of 22 European Cohorts.

BACKGROUND:: Air pollution has been associated with cardiovascular mortality, but it remains unclear as to whether specific pollutants are related to specific cardiovascular causes of death. Within the multicenter European Study of Cohorts for Air Pollution Effects (ESCAPE), we investigated the associations of long-term exposure to several air pollutants with all cardiovascular disease (CVD) mortality, as well as with specific cardiovascular causes of death.\n\nMETHODS:: Data from 22 European cohort studies were used. Using a standardized protocol, study area-specific air pollution exposure at the residential address was characterized as annual average concentrations of the following: nitrogen oxides (NO2 and NOx); particles with diameters of less than 2.5 μm (PM2.5), less than 10 μm (PM10), and 10 μm to 2.5 μm (PMcoarse); PM2.5 absorbance estimated by land-use regression models; and traffic indicators. We applied cohort-specific Cox proportional hazards models using a standardized protocol. Random-effects meta-analysis was used to obtain pooled effect estimates.\n\nRESULTS:: The total study population consisted of 367,383 participants, with 9994 deaths from CVD (including 4,992 from ischemic heart disease, 2264 from myocardial infarction, and 2484 from cerebrovascular disease). All hazard ratios were approximately 1.0, except for particle mass and cerebrovascular disease mortality; for PM2.5, the hazard ratio was 1.21 (95% confidence interval = 0.87-1.69) per 5 μg/m and for PM10, 1.22 (0.91-1.63) per 10 μg/m.\n\nCONCLUSION:: In a joint analysis of data from 22 European cohorts, most hazard ratios for the association of air pollutants with mortality from overall CVD and with specific CVDs were approximately 1.0, with the exception of particulate mass and cerebrovascular disease mortality for which there was suggestive evidence for an association

Effects of long-term exposure to air pollution on natural-cause mortality : an analysis of 22 European cohorts within the multicentre ESCAPE project

Background Few studies on long-term exposure to air pollution and mortality have been reported from Europe. Within the multicentre European Study of Cohorts for Air Pollution Effects (ESCAPE), we aimed to investigate the association between natural-cause mortality and long-term exposure to several air pollutants. Methods We used data from 22 European cohort studies, which created a total study population of 367 251 participants. All cohorts were general population samples, although some were restricted to one sex only. With a strictly standardised protocol, we assessed residential exposure to air pollutants as annual average concentrations of particulate matter (PM) with diameters of less than 2.5 mu m (PM2.5), less than 10 mu m (PM10), and between 10 mu m and 2.5 mu m (PMcoarse), PM2.5 absorbance, and annual average concentrations of nitrogen oxides (NO2 and NOx), with land use regression models. We also investigated two traffic intensity variables-traffic intensity on the nearest road (vehicles per day) and total traffic load on all major roads within a 100 m buff er. We did cohort-specific statistical analyses using confounder models with increasing adjustment for confounder variables, and Cox proportional hazards models with a common protocol. We obtained pooled effect estimates through a random-effects meta-analysis. Findings The total study population consisted of 367 251 participants who contributed 5 118 039 person-years at risk (average follow-up 13.9 years), of whom 29 076 died from a natural cause during follow-up. A significantly increased hazard ratio (HR) for PM2.5 of 1.07 (95% CI 1.02-1.13) per 5 mu g/m(3) was recorded. No heterogeneity was noted between individual cohort effect estimates (I-2 p value=0.95). HRs for PM2.5 remained significantly raised even when we included only participants exposed to pollutant concentrations lower than the European annual mean limit value of 25 mu g/m(3) (HR 1.06, 95% CI 1.00-1.12) or below 20 mu g/m(3) (1.07, 1.01-1.13). Interpretation Long-term exposure to fine particulate air pollution was associated with natural-cause mortality, even within concentration ranges well below the present European annual mean limit value