The effect of ultra-fast track cardiac anaesthesia in infants and toddlers: a randomised trial

Abstract Background: The usefulness of ultra-fast track cardiac anaesthesia may give great benefits to patients; however, its usefulness has not been completely evaluated in infants and toddlers, who are generally considered the most difficult group for ultra-fast track cardiac anaesthesia. Method: A total of 130 children were allocated randomly into to a ultra-fast track cardiac anaesthesia group (Group D) or a conventional anaesthesia group (Group C) (each n = 65). In Group D, dexmedetomidine was administrated at a dosage of 1 µg/kg/hour after induction. The patient- controlled intravenous analgesia was dexmedetomidine and sufentanil. In Group C, patients were infused with of the same volume of normal saline, and sufentanil alone for patient-controlled intravenous analgesia. The dosages of sufentanil, extubation time, haemodynamic parameters, postoperative hospitalisation conditions, pain and sedation scores, blood gas analysis, and inotropic scores were all recorded. Results: The dosage of sufentanil (1.49 ± 0.05 vs. 3.81 ± 0.04 µg, p < 0.001) and extubation time (2.63 ± 0.52 vs. 436.60 ± 22.19 minutes, p < 0.001) in Group D were all significantly lower than those in Group C. Moreover, cardiac intensive care unit stay time, total hospital stay, hospitalisation costs, postoperative lactate levels, and inotropic scores were also significantly lower in Group D. Conclusions: Using of ultra-fast track cardiac anaesthesia in infants and toddlers is effective, it not only reduce the perioperative requirement for opioids and shorten the extubation time but also decreases the inotrope requirement and provide a better postoperative condition for young children.

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Abstract 89: The Prognostic Factor of Patients with Asystole on Arrival

Circulation ◽

10.1161/circ.116.suppl_16.ii_942-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Tomoki Shokawa ◽

Koich Tanigawa ◽

Hideya Yamamoto

Keyword(s):

Prognostic Factor ◽

Serum Potassium ◽

Potassium Concentration ◽

Univariate Analysis ◽

Blood Gas Analysis ◽

Gas Analysis ◽

University Hospital ◽

Serum Potassium Concentration ◽

Admission Data ◽

Lactate Levels

Background: Patients with asystole on arrival (AOA) at hospital have a poor prognosis. However, little is known about the prognostic factor of patients with AOA. Objective: The purpose of this study was to determine predictors for 24 hours survival in patients with AOA. Methods and results: Consecutive patients with AOA admitted to the Hiroshima University Hospital (Hiroshima, Japan) from April 2002 to January 2007 were retrospectively analyzed. Patients were divided into two groups according to the outcomes, i.e. non-survivors vs. survivors at 24 hours after admission. Data including blood gas analysis, lactate levels, and levels of minerals on admission were obtained and analyzed. Of 102 (male; 60) patients with AOA, fourteen patients survived for 24 hours. Univariate analysis found that pH, PaO2, PaCO2, base excess, lactate, and serum potassium concentration were associated with survival (p< 0.05) (Table ). Multivariate analysis determined that serum potassium concentration independently affected 24 hours survival. Conclusions: These results suggested that the serum potassium level on admission is a strong, independent predictor of survival of patients with AOA. survivors vs. non-survivors

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Can Peripheral Venous Lactate Levels Substitute for Arterial Lactate Levels in The Emergency Department? An Observational Study

10.21203/rs.3.rs-69284/v1 ◽

2020 ◽

Author(s):

Yasufumi Oi ◽

Kosuke Mori ◽

Hidehiro Yamagata ◽

Ayako Nogaki ◽

Tomoaki Takeda ◽

...

Keyword(s):

Emergency Department ◽

Observational Study ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Gas ◽

Altman Analysis ◽

Arterial Lactate ◽

Cutoff Value ◽

Bland Altman Analysis ◽

Lactate Levels

Abstract Background: Arterial lactate (AL) level is an important parameter used to predict patients’ prognosis. AL and peripheral venous lactate (PVL) in blood gas analysis have a low concordance rate, and PVL cannot be used as a substitute for AL. However, if the AL range can be predicted from PVL, PVL may be an alternative method of predicting patient prognosis, and the risk of arterial puncture complications with AL may be reduced. This could become a safe and rapid test method.Methods: This was a retrospective observational study of 143 cases in which blood gas analysis was performed on both arterial blood and venous blood in an emergency department. Spearman's rank correlation coefficient (r) and Bland–Altman analysis were performed. Sensitivity, specificity, and the area under the curve (AUC) were calculated for PVL to predict AL < 2 mmol/L or < 4 mmol/L.Results: The median [interquartile range] AL and PVL were 1.82 [1.25–2.58] vs 2.09 [1.57–3.29], respectively, r was 0.799 (p<0.0001), and a strong correlation was observed; however, Bland–Altman analysis showed disagreement. When AL < 2 mmol/L was used as the outcome, AUC was 0.974, the PVL cutoff value was 2.55 mmol/L, sensitivity was 87.9%, and specificity was 94.1%. If PVL < 2 mmol/L was the outcome, the sensitivity for AL < 2 mmol/L was 100%, and for PVL levels ≥ 3 mmol/L, the specificity was 100%. When AL < 4 mmol/L was used as the outcome, AUC was 0.970, the PVL cutoff value was 3.4 mmol/L, sensitivity was 100%, and specificity was 84.5%. When PVL < 3.5 mmol/L was the outcome, the sensitivity for AL < 4 mmol/L was 100%, and for PVL levels ≥ 4 mmol/L, the specificity was 93.8%.Conclusions: This study revealed that PVL and AL levels in the same critically ill patients do not perfectly agree with each other but are strongly correlated. Furthermore, the high accuracy for predicting AL ranges from PVL levels explains why PVL levels could be used as a substitute for AL level ranges.

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Elevated admission lactate levels in the emergency department are associated with increased 30-day mortality in non-trauma critically ill patients

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-020-00777-y ◽

2020 ◽

Vol 28 (1) ◽

Cited By ~ 2

Author(s):

Michael Bernhard ◽

Stephanie Döll ◽

Andre Kramer ◽

Lorenz Weidhase ◽

Thomas Hartwig ◽

...

Keyword(s):

Emergency Department ◽

Critically Ill ◽

Critically Ill Patients ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Study Endpoint ◽

Resuscitation Room ◽

Patients At Risk ◽

Risk Patients ◽

Lactate Levels

Abstract Background Elevated blood lactate levels were reported as useful predictors of clinical outcome and mortality in critically ill patients. To identify higher-risk patients, this investigation evaluated the relationship between patient mortality and admission lactate levels during the management of non-trauma critically ill patients in the emergency department (ED). Methods In this prospective, single centre observational study in a German university ED, all adult patients who were admitted to the ED resuscitation room were evaluated between September 1, 2014 and August 31, 2015. Blood samples for blood gas analysis, including lactate levels, were obtained immediately at admission. Study endpoint was 30-day mortality. Results During the study period, 532 patients were admitted to the resuscitation room of the ED. The data of 523 patients (98.3%) were available. The overall 30-day mortality was 34.2%. Patients presenting to the resuscitation room with admission lactate levels < 2.0 mmol/l had a 30-day mortality of 22.7%, while admission lactate levels above 8.0 mmol/l were associated with higher mortality (8.0–9.9 mmol/l: OR: 2.83, 95%CI: 1.13–7.11, p = 0.03, and ≥ 10 mmol/l: OR: 7.56, 95%CI: 4.18–13.77, p < 0.001). Conclusion High lactate levels at admission are associated with an increased 24-h and 30-day mortality. These measurements may be used not only to predict mortality, but to help identify patients at risk for becoming critically ill. The breakpoint for mortality may be an ALL ≥8.0 mmol/l.

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High Anion Gap Metabolic Acidosis due to Euglycemic Diabetic Ketoacidosis Caused by Sodium-Glucose Co-transporter 2 inhibitor

10.31227/osf.io/zbw26 ◽

2019 ◽

Author(s):

Awad Magbri ◽

Eusera El-Magbri ◽

Mariam El-Magbri ◽

Brar Balhinder ◽

Shauket Rashid

Keyword(s):

Metabolic Acidosis ◽

Vital Signs ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Anion Gap ◽

Urine Ph ◽

History Of ◽

Lactate Levels ◽

Breathing Room ◽

Work Up

The case is that of 58 year-male with type 2 diabetes mellitusfor 7 years, hypertension, hypercholesterolemia, who was admittedto the hospital with left lower limb cellulitis over the past 8 days.On work-up he was found to have high anion-gap metabolic acidosis(AGMA) with anion gap of 25, his lactate levels were normal (Dand L-lactate). He denies overdosing with any medications and histoxicology screen for methanol, ethanol, aspirin, and ethylene glycolwere negative. He has no psychiatric history of note. He denies usingover the counter medications like acetaminophen. No bowel surgerycould be elicited. He felt dehydrated and nauseous but otherwisefine.His medications includes; carvedalol 25mg twice daily,hydrochlothiazide 25 mg daily, Lipitor 20 mg daily, insulin, aspirin81 mg daily, and was started on canagliflozoin 300 mg daily 4 weeksago to control his blood sugar level and A1C.Physical examination of the patient revealed, slightly dehydratedbut well-nourished man, his vital signs; heart rate of 78 BPM andregular, BP 143/85 mmHg, temperature 98.7 F, and his oxygensaturation while breathing room air was 92%. Examination of theheart, abdomen, and chest were unremarkable. He had left lower legcellulitis but no edema or tenderness.His work-up including chemistry-7 which showed sodium of142 mmol/L, potassium of 4.3 mmol/L, chloride of 102 mmol/L,bicarbonate of 13 mmol/L, BUN and creatinine of 18 mg/L and 0.78mg/L respectively. His blood glucose level was 178 mg/L with A1Cof 8.2. His serum osmolality was 312 mosm/L, and his arterial bloodpH was 7.2 with a carbon dioxide in blood gas analysis (Pco2) of32mmHg. His calculated anion gap was 25 given his normal albuminlevel. His investigation also showed positive ketones in the serumand urine. His urine PH was 5.5 and the urine contain >800 mg ofglucose

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Blood Gas Analysis Results and Serum Lactate Levels in Patients with Psychogenic Hyperventilation and Urinary Tract Infection with Suspected Sepsis: A Retrospective Comparative Study

Internal Medicine ◽

10.2169/internalmedicine.8434-21 ◽

2022 ◽

Author(s):

Seigo Urushidani ◽

Akira Kuriyama ◽

Masami Matsumura

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Blood Gas Analysis ◽

Serum Lactate ◽

Gas Analysis ◽

Blood Gas ◽

Suspected Sepsis ◽

Lactate Levels ◽

Retrospective Comparative Study

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Efficacy of Near-Infrared Spectrometry for Monitoring the Cerebral Effects of Severe Dilutional Anemia

The Heart Surgery Forum ◽

10.1532/hsf98.2013293 ◽

2014 ◽

Vol 17 (3) ◽

pp. 154 ◽

Cited By ~ 10

Author(s):

Arıtürk Cem ◽

Ustalar Serpil ◽

Toraman Fevzi ◽

Ökten Murat ◽

Güllü Ümit ◽

...

Keyword(s):

Blood Flow ◽

Cardiac Surgery ◽

Blood Lactate ◽

Near Infrared ◽

Bypass Graft ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Infrared Spectrometry ◽

Control Group ◽

Near Infrared Spectrometry

Introduction: Clear guidelines for red cell transfusion during cardiac surgery have not yet been established. The current focus on blood conservation during cardiac surgery has increased the urgency to determine the minimum safe hematocrit for these patients. The aim of this study was to determine whether monitoring of cerebral regional oxygen saturation (rSO2) via near-infrared spectrometry (NIRS) is effective for assessing the cerebral effects of severe dilutional anemia during elective coronary arterial bypass graft surgery (CABG).Methods: The prospective observational study involved patients who underwent cerebral rSO2 monitoring by NIRS during elective isolated first-time CABG: an anemic group (N=15) (minimum Hemoglobin (Hb) N=15) (Hb >8 g/dL during CPB). Mean arterial pressure (MAP), pump blood flow, blood lactate level, pCO2, pO2 at five time points and cross-clamp time, extracorporeal circulation time were recorded for each patient. Group results statistically were compared.Results: The anemic group had significantly lower mean preoperative Hb than the control group (10.3 mg/dL versus 14.2 mg/dL; P = .001). The lowest Hb levels were observed in the hypothermic period of CPB in the anemic group. None of the controls exhibited a >20% decrease in cerebral rSO2. Eleven (73.3%) of the anemic patients required an increase in pump blood flow to raise their cerebral rSO2.Conclusions: In this study, the changes in cerebral rSO2 in the patients with low Hb were within acceptable limits, and this was in concordance with the blood lactate levels and blood-gas analysis. It can be suggested that NIRS monitoring of cerebral rSO2 can assist in decision making related to blood transfusion and dilutional anemia during CPB.

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