Wheezing during Induction of General Anesthesia in Patients with and without Asthma 

1995 ◽  
Vol 82 (5) ◽  
pp. 1111-1116 ◽  
Author(s):  
Reuven Pizov ◽  
Robert H. Brown ◽  
Yuval S. Weiss ◽  
Dimitry Baranov ◽  
Hans Hennes ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
General Anesthesia ◽  
Physical Status ◽  
Inhalational Anesthesia ◽  
Exact Test ◽  
Asthmatic Patients ◽  
Anesthetic Agents ◽  
Increased Risk ◽  
Chi Squared ◽  
Double Blinded

Background Patients with asthma who require general anesthesia and tracheal intubation are at increased risk for the development of bronchospasm during induction. The incidence of wheezing during induction with different intravenously administered agents is unknown. A randomized, double-blinded prospective study was undertaken to evaluate the incidence of wheezing in asymptomatic asthmatic and nonasthmatic patients receiving three commonly used intravenous anesthetic agents for induction of anesthesia. Methods Fifty-nine asymptomatic asthmatic and 96 nonasthmatic patients of ASA physical status 1 and 2 were studied. All patients received 1.5 micrograms/kg fentanyl, oxygen, followed by either 5 mg/kg thiopental or thiamylal, 1.75 mg/kg methohexital or 2.5 mg/kg propofol, 1.5 mg/kg succinylcholine, tracheal intubation, and inhalational anesthesia. Wheezing was assessed by an independent blinded observer, auscultating the lungs at 2 and 5 min postintubation. Data were analyzed by Pearson's chi-squared, Fisher's exact test, and multiple logistic regression with significance set at P < 0.05. Results Both asthmatic and nonasthmatic patients who received a thiobarbiturate for induction had a greater incidence of wheezing than did patients receiving propofol. In asthmatic patients, 45% (23, 67) (mean and 95% confidence interval) who received a thiobarbiturate, 26% (8, 44) who received an oxybarbiturate, and none (0, 17) who received propofol wheezed after intubation. In nonasthmatic patients, 16% (3, 28) who received thiobarbiturate and 3% (0, 9) who received propofol wheezed. Conclusions This study suggests that propofol should be considered for induction of anesthesia in patients, particularly those with asthma, who require timely intubation.

Induction of labor in patients with an unfavorable cervix after a cesarean using an osmotic dilator versus vaginal prostaglandin

2018 ◽  
Vol 46 (3) ◽  
pp. 299-307 ◽  
Author(s):  
Josefine T. Maier ◽  
Melanie Metz ◽  
Nina Watermann ◽  
Linna Li ◽  
Elisabeth Schalinski ◽  
...  
Keyword(s):  
Birth Rate ◽  
Induction Of Labor ◽  
Cervical Ripening ◽  
Exact Test ◽  
Safe Delivery ◽  
Trial Of Labor ◽  
Increased Risk ◽  
Chi Squared ◽  
Maternal And Neonatal Outcomes ◽  
Unfavorable Cervix

Abstract Background: Trial of labor after cesarean (TOLAC) is a viable option for safe delivery. In some cases cervical ripening and subsequent labor induction is necessary. However, the commonly used prostaglandins are not licensed in this subgroup of patients and are associated with an increased risk of uterine rupture. Methods: This cohort study compares maternal and neonatal outcomes of TOLAC in women (n=82) requiring cervical ripening agents (osmotic dilator vs. prostaglandins). The initial Bishop scores (BSs) were 2 (0–5) and 3 (0–5) (osmotic dilator and prostaglandin group, respectively). In this retrospective analysis, Fisher’s exact test, the Kruskal-Wallis rank sum test and Pearson’s chi-squared test were utilized. Results: Vaginal birth rate (including operative delivery) was 55% (18/33) in the osmotic dilator group vs. 51% (25/49) in the dinoprostone group (P 0.886). Between 97% and 92% (32/33 and 45/49) (100%, 100%) of neonates had an Apgar score of >8 after 1 min (5, 10 min, respectively). The time between administration of the agent and onset of labor was 36 and 17.1 h (mean, Dilapan-S® group, dinoprostone group, respectively). Time from onset of labor to delivery was similar in both groups with 4.4 and 4.9 h (mean, Dilapan-S® group, dinoprostone group, respectively). Patients receiving cervical ripening with Dilapan-S® required oxytocin in 97% (32/33) of cases. Some patients presented with spontaneous onset of labor, mostly in the dinoprostone group (24/49, 49%). Amniotomy was performed in 64% and 49% (21/33 and 24/49) of cases (Dilapan-S® group and dinoprostone group, respectively). Conclusions: This pilot study examines the application of an osmotic dilator for cervical ripening to promote vaginal delivery in women who previously delivered via cesarean section. In our experience, the osmotic dilator gives obstetricians a chance to perform induction of labor in these women.

scholarly journals Effectivity battle between C-MAC and McGrath® video laryngoscope in a patient with general anesthesia at Sanglah Hospital: A pilot study

2021 ◽  
Vol 4 (2) ◽  
pp. 47-50
Author(s):  
Jhoni Pardomuan Pasaribu ◽  
Tjokorda Gde Agung Senapathi ◽  
Pontisomaya Parami
Keyword(s):  
Pilot Study ◽  
Tracheal Intubation ◽  
General Anesthesia ◽  
Video Laryngoscope ◽  
Hemodynamic Change ◽  
Successful Intubation ◽  
Success Rates ◽  
Physical Status ◽  
Hemodynamic Stability ◽  
Pros And Cons

Background: Intubation is a common essential procedure to maintain the airway during general anesthesia. Various video laryngoscopes (VL) on the market today assist anesthesiologists in improving intubation success rates and also in complicated airway cases. There are two types of VL found in our institution, which are C-MAC and McGrath®. Each of them has its pros and cons, which withdrawn our curiosity to compare their effectiveness.  Methods: A pilot study was conducted in our center; we included all patients undergoing general anesthesia with physical status ASA I-III and consent to the study and divide them into two groups, C-MAC and McGrath®. We compare C-MAC and McGrath® VL effectiveness in terms of time for intubation, ease of intubation, total attempt, failure to intubate, Cormack Lehane degree, POGO Score, and hemodynamic stability.  Results: A total of 20 patients were intubated with two different VL, ten patients for each group. Both VLs accommodate ease of intubation, and overall first attempt successful intubation, though C-MAC showed better laryngeal and glottic visualization, shorter tracheal intubation times, and less hemodynamic change. Conclusion: C-MAC gives better results in laryngeal and glottic visualization, shorter tracheal intubation times, and less hemodynamic change.

scholarly journals Vaginal Progesterone Has No Diabetogenic Potential in Twin Pregnancies: A Retrospective Case-Control Study on 1686 Pregnancies

2020 ◽  
Vol 9 (7) ◽  
pp. 2249
Author(s):  
Klara Rosta ◽  
Katharina Al-Bibawy ◽  
Maria Al-Bibawy ◽  
Wilhelm Temsch ◽  
Stephanie Springer ◽  
...  
Keyword(s):  
Binary Logistic Regression ◽  
Control Group ◽  
Retrospective Case ◽  
Smoking During Pregnancy ◽  
Exact Test ◽  
Vaginal Progesterone ◽  
Increased Risk ◽  
Chi Squared ◽  
Student’S T ◽  
Twin Pregnancies

Background: In this study, we aimed to investigate the incidence of gestational diabetes mellitus (GDM) in women who carried twin pregnancies and received vaginal progesterone. Methods: In this retrospective cohort study, 203 out of 1686 women with twin pregnancies received natural progesterone (200 mg/day between gestational weeks 16 + 0 and 36 + 0) vaginally for ≥ 4 weeks. The control group consisted of 1483 women with twin pregnancies without progesterone administration. Pearson’s Chi squared test, Fisher’s exact test, and Student’s t-test was used to compare differences between the control and the progesterone-treated groups. A multivariate binary logistic regression was performed to assess relative independent associations on the dependent outcome of GDM incidence. Results: Vaginal progesterone treatment in twin pregnancies had no significant influence on developing GDM (p = 0.662). Higher pre-pregnancy BMI (OR 1.1; p < 0.001), GDM in previous pregnancy (OR 6.0; p < 0.001), and smoking during pregnancy (OR 1.6; p = 0.014) posed an increased risk for developing GDM. Conclusion: In twin pregnancies, the use of vaginal progesterone for the prevention of recurrent preterm delivery was not associated with an increased risk of GDM.

scholarly journals The Relationship Between COVID-19-induced Death and Chronic Diseases

2021 ◽  
Vol 7 (3) ◽  
pp. 167-174
Author(s):  
Hasan Alinejad ◽  
◽  
Reza Vazirinejad ◽  
Ahmadreza Sayadi ◽  
Zeinab Hajaliakbari ◽  
...  
Keyword(s):  
Chronic Diseases ◽  
Multivariate Regression Analysis ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Exact Test ◽  
Risk Of Death ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Chi Squared ◽  
The Relationship

Background: Morbidity and mortality due to Coronavirus Disease 2019 (COVID-19) are mainly related to age and comorbidity diseases (hypertension, diabetes, cardiovascular disease, malignancies, etc.). These conditions are associated with poorer clinical outcomes and sometimes lead to long-term hospitalization. The current study aimed to investigate the relationship between COVID-19-induced mortality and various chronic diseases in patients admitted to Ali Ibn Abitaleb Hospital in Rafsanjan City, Iran, in 2020. Methods: In this retrospective, descriptive, and cross-sectional study, patients with COVID-19 referring to Ali Ibn Abitaleb Hospital in Rafsanjan City, Iran, from March 2020 to September 2020 were assessed. The required data were collected using patients’ records and telephone calls by a researcher-made checklist and analyzed by Independent Samples t-test, Chi-squared test, Fisher’s Exact test, Kaplan-Meier plots, and multivariate regression analysis in SPSS v. 20. Results: This study assessed 238 hospitalized patients with COVID-19. The risk of death was significantly higher in patients aged over 75 years; they were 5.5 times more prone to expire, compared to the youngest age group (P<0.001). Chronic diseases, such as hypertension, heart disease, lung disease, and various cancers were more prevalent in patients who expired, compared to those who survived (P≤0.05). Of the patients who died, 73.8% were transferred to the Intensive U (ICU), while only 7.5% of surviving patients were transferred to the ICU (P<0.001). Longer hospitalization was associated with an increased risk of death among patients with underlying diseases and hypertension (P<0.05). Conclusion: This study identified the role of chronic diseases and other important indicators in the survival of patients with COVID-19 who were admitted to a hospital in Rafsanjan. It is recommended that nurses and healthcare staff consider these findings in the care of patients with COVID-19.

Development of cavitation while on bevacizumab (BV) therapy in patients (pts) with non-small cell lung cancer (NSCLC): Results from ARIES—A bevacizumab (BV) treatment observational cohort study (OCS)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e19045-e19045
Author(s):  
M. P. Kosty ◽  
P. Kumar ◽  
A. Wozniak ◽  
M. Jahanzeb ◽  
C. Chung ◽  
...  
Keyword(s):  
Pulmonary Hemorrhage ◽  
Final Analysis ◽  
Prior History ◽  
Exact Test ◽  
Increased Risk ◽  
Chi Squared ◽  
Potential Risk Factors ◽  
Independent Review ◽  
History Of ◽  
Grade 3

e19045 Background: BV (Avastin), an anti-VEGF monoclonal antibody, prolongs progression-free and overall survival in advanced NSCLC pts. Severe (≥grade 3) pulmonary hemorrhage (sPH) is a rare but serious event that has been associated with BV-based therapy in phase 3 trials (rate of 2–4%). Potential risk factors include squamous histology, prior history of hemoptysis, and presence of tumor cavitation. Rates of baseline (BL) cavitation in NSCLC pts and development of cavitation on BV therapy are unknown. Pts in ARIES, an OCS of approximately 2,000 pts with NSCLC, had BL scans assessed for tumor cavitation. A substudy of approximately 250 pts also had follow-up scans to analyze the likelihood of developing cavitation on BV therapy. For the entire ARIES population, any pt developing sPH is assessed for tumor cavitation. Methods: Pts at specified ARIES sites submitted on-treatment CT scans to an independent review facility (IRF), in addition to BL scans. Evaluable pts had measurable disease at BL and at least one-post-BL scan. Correlations between cavitation (pre-existing or developing on-study) and clinical, tumor and treatment characteristics are evaluated using a chi-squared test or t-test. Incidence of sPH based on cavitation status will be assessed using Fisher's exact test. Results: As of 9/15/08, 210 pts had a post-BL CT scan reviewed by the IRF. Of these pts, 171 had measurable tumors at BL. For the 171 pt cohort: median F/U is 9.2 m; 99% have ≥1 quarterly update. Key BL characteristics for the substudy and overall cohorts, respectively, include: 44% vs 51% ≥65 yrs; 67% vs 67% adenocarcinoma; 6% vs 5% therapeutic AC. BL radiographic features: 41% vs 39% presence of central tumor; 13% vs 15% presence of cavitation. In substudy pts, there is 1 sPH to date in a pt without baseline cavitation. Conclusions: sPH is a rare, potentially serious event in pts with NSCLC receiving BV. Whether cavitation (BL or developing on-treatment) is associated with an increased risk of sPH has not been defined. The final analysis of an ARIES Lung substudy assessing on-study development of cavitation and association with sPH will be presented at the meeting. [Table: see text]

scholarly journals Supraglottic airway versus endotracheal tube during interventional pulmonary procedures – a retrospective study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kyle M. Behrens ◽  
Richard E. Galgon
Keyword(s):  
Airway Management ◽  
General Anesthesia ◽  
Endotracheal Tube ◽  
Anesthetic Management ◽  
Pulmonary Complications ◽  
Neuromuscular Blocking ◽  
Supraglottic Airway ◽  
Lung Pathology ◽  
Anesthetic Agents ◽  
Increased Risk

Abstract Background As the field of interventional pulmonology (IP) expands, anesthesia services are increasingly being utilized when complex procedures of longer duration are performed on sicker patients with high risk co-morbidities and lung pathology. Yet, evidence on the optimal anesthetic management for these patients remains lacking. Our aim was to characterize the airway management and, secondarily anesthetic maintenance patterns used for IP procedures at our institution. Methods From 2894 identified encounters, charts of 783 patients undergoing an IP procedure with general anesthesia over a 5-year period, employing an endotracheal tube (ETT) or a supraglottic airway (SGA) for airway maintenance, were identified and reviewed after exclusions. Patients posted for a concurrent thoracic surgical procedure and those already intubated at presentation were excluded. Baseline patient demographics, procedure, proceduralist type, anesthesia maintenance modality, neuromuscular blocking drug (NMBD) use, and airway management characteristics were extracted and analyzed. Results Inhaled general anesthesia with an ETT for airway maintenance was most commonly employed; however, SGAs were used in one-third of patients with a very low conversion rate (0.4%), and their use was associated with a significant reduction in NMBD use. Conclusions In this large series of patients receiving general anesthesia for IP procedures, inhaled anesthetic agents and ETTs were favored. However, in appropriately selected patients, SGA use was effective for airway maintenance and allowed for a reduction in NMBD use, which may have implications in this patient population who may have an increased risk for pulmonary complications and warrants further investigation.

Micropapillary Thyroid Carcinoma and Hashimoto's Thyroiditis

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P40-P40
Author(s):  
Michael Navid Pakdaman ◽  
Michael P Hier ◽  
Martin J Black ◽  
Michael Tamilia ◽  
Richard J Payne
Keyword(s):  
Thyroid Carcinoma ◽  
Hashimoto’S Thyroiditis ◽  
Statistical Significance ◽  
Hashimoto's Thyroiditis ◽  
P Value ◽  
Exact Test ◽  
Increased Risk ◽  
Chi Squared ◽  
Pathology Reports ◽  
The Relationship

Objective An increase in papillary thyroid carcinoma in patients with Hashimoto's thyroiditis has been described. We have yet to find literature discussing a relationship with micropapillary thyroid carcinoma(MPC). Our objective is (1) to assess the relationship between Papillary Microcarcinoma and Hashimoto's Thyroiditis in thyroids without malignant disease, (2) compare effect of the presence of Hashimoto's on prognostic factors in patients. Methods Pathology reports were reviewed for consecutive patients undergoing total thyroidectomy over a 6-year period from 2002 to 2007. Patients with benign pathologies were included. Patients with MPC and no other malignancy were also included. This lead to a cohort of 314 patients. Statistical significance was calculated using Fisher's exact test and a chi-squared analysis. Results Out of the 314 patients, 98 were positive for Hashimoto's thyroiditis on biopsy of the removed thyroid. 58% of the patients with Hashimoto's thyroiditis had an incidental MPC, as compared to 42% of patients where Hashimoto's was not found. Additionally, in Hashimoto patients, 61% of the MPCs were multifocal versus 43% multifocal in the non-Hashimoto group (p-value <0.05 in each comparison). Bilaterality of MPC was also increased in patients with Hashimoto's (22% vs 39%). Conclusions Patients with Hashimoto's thyroiditis in this study had an incidence of MPC of 58%, which is significantly greater than the 42% in those without. Hashimoto's was also associated with an increased risk of bilaterality and multifocality. Studies are needed to further corroborate these findings.

scholarly journals Informative Supraglottic Airway versus Endotracheal Tube During Interventional Pulmonary Procedures – A Retrospective Study

2019 ◽  
Author(s):  
Kyle M Behrens ◽  
Richard E Galgon
Keyword(s):  
Airway Management ◽  
General Anesthesia ◽  
Endotracheal Tube ◽  
Anesthetic Management ◽  
Pulmonary Complications ◽  
Neuromuscular Blocking ◽  
Supraglottic Airway ◽  
Lung Pathology ◽  
Anesthetic Agents ◽  
Increased Risk

Abstract Background: As the field of interventional pulmonology (IP) expands, anesthesia services are increasingly being utilized when complex procedures of longer duration are performed on sicker patients with high risk co-morbidities and lung pathology. Yet, evidence on the optimal anesthetic management for these patients remains lacking. Our aim was to characterize the airway management and, secondarily anesthetic maintenance patterns used for IP procedures at our institution. Methods: From 2894 identified encounters, charts of 783 patients undergoing an IP procedure with general anesthesia over a 5-year period, employing an endotracheal tube (ETT) or a supraglottic airway (SGA) for airway maintenance, were identified and reviewed after exclusions. Patients posted for a concurrent thoracic surgical procedure and those already intubated at presentation were excluded. Baseline patient demographics, procedure, proceduralist type, anesthesia maintenance modality, neuromuscular blocking drug (NMBD) use, and airway management characteristics were extracted and analyzed. Results: Inhaled general anesthesia with an ETT for airway maintenance was most commonly employed; however, SGAs were used in one-third of patients with a very low conversion rate (0.4%), and their use was associated with a significant reduction in NMBD use. Conclusions: In this large series of patients receiving general anesthesia for IP procedures, inhaled anesthetic agents and ETTs were favored. However, in appropriately selected patients, SGA use was effective for airway maintenance and allowed for a reduction in NMBD use, which may have implications in this patient population who may have an increased risk for pulmonary complications and warrants further investigation.

scholarly journals A Retrospective Study Assessing the Effect of Infections in Myocardial Infarction Patients: Mortality and Complications

2022 ◽  
Author(s):  
Antoine El Khoury ◽  
Pascale Salameh ◽  
Sarah Hammoudeh ◽  
Ahmad El Mahmoud ◽  
Tonia Harb ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Escherichia Coli ◽  
Length Of Stay ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Concomitant Infection ◽  
Increased Risk ◽  
Chi Squared ◽  
Established Relationship ◽  
Dichotomous Outcomes

Abstract Background: There is a well-established relationship between myocardial infarction and infection. Multiple articles describe the increased risk of myocardial infarction, both type 1 and 2, following an infectious process. However few articles have described the relation between concomitant myocardial infarction and infections on same admission mortality and complications. Methods: The aim is to assess the effect of an acquired or concomitant infection on complications and mortality during hospitalized cases of myocardial infarction. 1197 patients of different types of myocardial infarction were studied in correlation to infectious processes. Cultures from different sites were collected and isolation of various bacterial agents were studied. Mortality and various complications were compared between infected and non-infected subjects. Pearson's chi squared test was used to compare percentages (or the Fisher exact test when expected values were lower than 5). Moreover, means were compared through ANOVA, after checking data normality and homoscedasticity. A likelihood ratio backward stepwise method was used to conduct dichotomous logistic regressions, taking dichotomous outcomes as dependent variables, and sociodemographic and biological characteristics as independent variables (potential confounders).Results: Wound, sputum, blood and urine infections were associated with increased same admission mortality and complications. Microorganisms were then studied alone regardless of the site of infection and it was shown that Escherichia Coli, Escherichia Coli ESBL, Candida Albicans, Pseudomonas Aeruginosa and Staphylococcus of any type were significantly associated with same admission complications when associated with myocardial infarction. Length of stay was significantly elevated in patients with concomitant infection and it increased with the addition of positive cultures from different sites. Conclusion: Concomitant infections with myocardial infarction significantly increase the risk of same admission complications, mortality and length of stay regardless of the site of infection and type of microorganisms.

Integrin subunit β1 and laminin γ1 chain expression: a potential prognostic biomarker in cervical cancer

2020 ◽  
Vol 14 (15) ◽  
pp. 1461-1471
Author(s):  
Ana E Zacapala-Gómez ◽  
Luz del C Alarcón-Romero ◽  
Miguel A Mendoza-Catalán ◽  
Eric G Salmerón-Bárcenas ◽  
Ma I Zubillaga-Guerrero ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Odds Ratio ◽  
Prognostic Value ◽  
Prognostic Biomarker ◽  
Integrin Subunit ◽  
Cytological Diagnosis ◽  
Exact Test ◽  
Increased Risk ◽  
Chi Squared

Aim: The aim of this study was to analyze the prognostic value of integrin subunit β1 and laminin γ1 chain in patients with cervical cancer (CC). Materials & methods: The study included 96 samples. Cytological diagnosis, human papillomavirus (HPV) genotyping, HPV integration status and integrin subunit β1 and laminin γ1 chain expressions were performed or determined using Papanicolaou smear, INNO-LiPA® Genotyping Extra Kit, in situ hybridization, and immunocytochemistry, respectively. The association between variables was calculated using chi-squared and Fisher’s exact test; logistic regression analysis was performed to calculate odds ratios and CI at 95%. Results: Our results show that integrin subunit β1 and laminin γ1 chain expressions increase according to tumor progression. Integrin subunit β1 and laminin γ1 chain expressions are associated with cytological diagnosis (p < 0.001 and p = 0.001, respectively) and laminin γ1 chain expression with the integration status of HPV (p < 0.001). Moderate/high expressions of integrin subunit β1 and laminin γ1 chain were correlated with overall survival and increased risk of CC (6.86 and 3.75, respectively), the odds ratio was 12.91 when the moderate/high expression of integrin subunit β1 and laminin γ1 chain were combined. Conclusion: Our results suggest that integrin subunit β1 and laminin γ1 chain expressions could be a prognostic biomarker in CC.

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