Ekstubacija nakon anestezije: randomizirana usporedba triju tehnika

The mode of ventilation used during awake extubation has not previously been studied. We conducted a randomised controlled trial comparing spontaneous respiration, intermittent positive pressure ventilation, and pressure support ventilation (each n=13) for incidence and severity of peri-extubation complications following routine elective surgery. We found the severity of peri-extubation cough was significantly affected by mode of ventilation used at extubation (p=0.049), with lowest severity grades for those in the pressure support ventilation group. The mean arterial pressure at extubation was lowest in the intermittent positive pressure ventilation group (p=0.007). Other peri-extubation complications and time to extubation following cessation of anaesthesia were not significantly different across the three groups. We suggest that the use of pressure support ventilation for awake extubation may offer an advantage over spontaneous and intermittent positive pressure ventilation extubation strategies.Dosad nije ispitivan način ventilacije tijekom budne ekstubacije. Proveli smo randomizirano kontrolirano ispitivanje uspoređujući spontanu respiraciju, povremenu ventilaciju pozitivnim tlakom i ventilaciju uz tlačnu potporu (n=13 svaka) u odnosu na incidenciju i težinu periekstubacijskih komplikacija nakon rutinske elektivne kirurške operacije. Nalazi su pokazali da na težinu periekstubacijskog kašlja značajno utiče način ventilacije primijenjen kod ekstubacije (p=0,049), pričem su najniži stupnjevi težine kašlja zabilježeni u skupini bolesnika kod kojih je primijenjena ventilacija uz tlačnu potporu. Srednji arterijski tlak kod ekstubacije bio je najniži u skupini kod koje je primijenjena povremena ventilacija pozitivnim tlakom (p=0,007). Ostale periekstubacijske komplikacije i vrijeme do ekstubacije nakon prestanka anestezije nisu se značajno razlikovale među trima skupinama. Smatramo da bi primjena ventilacije uz tlačnu potporu mogla imati prednost pred strategijama spontane respiracije i povremene ventilacije pozitivnim tlakom

Neural responses to a modified Stroop paradigm in patients with complex chronic musculoskeletal pain compared to matched controls: an experimental functional magnetic resonance imaging study

Background: Chronic musculoskeletal pain (CMSKP) is attentionally demanding, complex and multi-factorial; neuroimaging research in the population seen in pain clinics is sparse. A better understanding of the neural activity underlying attentional processes to pain related information compared to healthy controls may help inform diagnosis and management in the future. Methods: Blood oxygenation level dependent functional magnetic resonance imaging (BOLD fMRI) compared brain responses in patients with CMSKP (n=15) and healthy controls (n=14) while completing a modified Stroop task using pain-related, positive-emotional, and neutral control words. Results: Response times in the Stroop task were no different for CMSKP patients compared with controls, but patients were less accurate in their responses to all word types. BOLD fMRI responses during presentation of pain-related words suggested increases in neural activation in patients compared to controls in regions previously reported as being involved in pain perception and emotion: the anterior cingulate cortex, insula and primary and secondary somatosensory cortex. No fMRI differences were seen between groups in response to positive or control words. Conclusions: Using this modified Stroop tasks, specific differences were identified in brain activity between CMSKP patients and controls in response to pain-related information using fMRI. This provided evidence of differences in the way that pain-related information is processed in those with chronic complex musculoskeletal pain that were not detectable using the behavioural measures of speed and accuracy. The study may be helpful in gaining new insights into the impact of attention in those living with chronic pai

Infection prevention during anaesthesia ventilation by the use of breathing system filters (BSF): Joint recommendation by German Society of Hospital Hygiene (DGKH) and German Society for Anaesthesiology and Intensive Care (DGAI)

An interdisciplinary working group from the German Society of Hospital Hygiene (DGKH) and the German Society for Anaesthesiology and Intensive Care (DGAI) worked out the following recommendations for infection prevention during anaesthesia by using breathing system filters (BSF). The BSF shall be changed after each patient. The filter retention efficiency for airborne particles is recommended to be >99% (II). The retention performance of BSF for liquids is recommended to be at pressures of at least 60 hPa (=60 mbar) or 20 hPa above the selected maximum ventilation pressure in the anaesthetic system

Plasma and Muscle Myostatin in Relation to Type 2 Diabetes

OBJECTIVE: Myostatin is a secreted growth factor expressed in skeletal muscle tissue, which negatively regulates skeletal muscle mass. Recent animal studies suggest a role for myostatin in insulin resistance. We evaluated the possible metabolic role of myostatin in patients with type 2 diabetes and healthy controls. DESIGN: 76 patients with type 2 diabetes and 92 control subjects were included in the study. They were matched for age, gender and BMI. Plasma samples and biopsies from the vastus lateralis muscle were obtained to assess plasma myostatin and expression of myostatin in skeletal muscle. RESULTS: Patients with type 2 diabetes had higher fasting glucose (8.9 versus 5.1 mmol/L, P<0.001), plasma insulin (68.2 versus 47.2 pmol/L, P<0.002) and HOMA2-IR (1.6 versus 0.9, P<0.0001) when compared to controls. Patients with type 2 diabetes had 1.4 (P<0.01) higher levels of muscle myostatin mRNA content than the control subjects. Plasma myostatin concentrations did not differ between patients with type 2 diabetes and controls. In healthy controls, muscle myostatin mRNA correlated with HOMA2-IR (r = 0.30, P<0.01), plasma IL-6 (r = 0.34, P<0.05) and VO2 max (r = -0.26, P<0.05), however, no correlations were observed in patients with type 2 diabetes. CONCLUSIONS: This study supports the idea that myostatin may have a negative effect on metabolism. However, the metabolic effect of myostatin appears to be overruled by other factors in patients with type 2 diabetes

A paramedic study comparing the use of the Airtraq®, Airway Scope and Macintosh laryngoscopes in simulated prehospital airway scenarios

In a randomised, cross-over study, we compared the use of the Airtraq®, Airway Scope and Macintosh laryngoscopes by paramedics for tracheal intubation in three simulated prehospital scenarios. Fifty-four paramedics were invited to take part. When evaluated in a difficult airway manikin, median IQR [range] time to intubation with the Airtraq (21 (16–37 [6–80] s) and Airway Scope (16 (5–75 [12–23] s) was shorter than that with the Macintosh laryngoscope (39 (25–54 [7–120] s; p < 0.0001). The success rate within 30 s was greater with the Airtraq (61%) and Airway Scope (93%) than with the Macintosh laryngoscope (22%; p < 0.0001). When used for a standard intubation and in the sitting position, we found minimal differences among the three laryngoscopes. We conclude that the Airway Scope and Airtraq have significant advantages over the Macintosh laryngoscope and that of the two, the Airway Scope is the more effective device to use in the prehospital environment

The effect of volatile anaesthetic agents on the filtration performance of paediatric breathing system filters

The aim of this study was to determine the filtration performance of five commonly used paediatric breathing system filters following exposure to desflurane, isoflurane and sevoflurane. It has been suggested that oil may degrade the performance of filter material. Volatile anaesthetic vapours are organic and hence may affect the filtration performance of breathing system filters during anaesthesia. This has not been tested for various concentrations of volatile agent, type and duration of exposure. The filtration performance of the filters was measured following exposure to desflurane, isoflurane and sevoflurane at 1 and 2 minimum alveolar concentration (MAC) for 1 and 4 h. Penetration of particles through the Clear-Therm Micro, Clear-Therm Mini and Humid-Vent Filter Pedi increased by between 2.4 and 2.8 times after exposure to desflurane at 2 MAC for 4 h compared to that through unexposed filters (p < 0.0001 for all three filters). Further investigation is required to determine whether this reduction in filtration performance by desflurane is clinically significant