scholarly journals No Association between Intraoperative Hypothermia or Supplemental Protective Drug and Neurologic Outcomes in Patients Undergoing Temporary Clipping during Cerebral Aneurysm Surgery

2010 ◽  
Vol 112 (1) ◽  
pp. 86-101 ◽  
Author(s):  
Bradley J. Hindman ◽  
Emine O. Bayman ◽  
Wolfgang K. Pfisterer ◽  
James C. Torner ◽  
Michael M. Todd ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Glasgow Outcome Score ◽  
Aneurysm Surgery ◽  
Regression Methods ◽  
Neurologic Outcomes ◽  
Outcome Score ◽  
Intraoperative Hypothermia ◽  
Surgery Trial ◽  
Temporary Clipping

Background Although hypothermia and barbiturates improve neurologic outcomes in animal temporary focal ischemia models, the clinical efficacy of these interventions during temporary occlusion of the cerebral vasculature during intracranial aneurysm surgery (temporary clipping) is not established. Methods A post hoc analysis of patients from the Intraoperative Hypothermia for Aneurysm Surgery Trial who underwent temporary clipping was performed. Univariate and multivariate logistic regression methods were used to test for associations between hypothermia, supplemental protective drug, and short- (24-h) and long-term (3-month) neurologic outcomes. An odds ratio more than 1 denotes better outcome. Results Patients undergoing temporary clipping (n = 441) were assigned to intraoperative hypothermia (33.3 degrees +/- 0.8 degrees C, n = 208) or normothermia (36.7 degrees +/- 0.5 degrees C, n = 233), with 178 patients also receiving supplemental protective drug (thiopental or etomidate) during temporary clipping. Three months after surgery, 278 patients (63%) had good outcome (Glasgow Outcome Score = 1). Neither hypothermia (P = 0.847; odds ratio = 1.043, 95% CI = 0.678-1.606) nor supplemental protective drug (P = 0.835; odds ratio = 1.048, 95% CI = 0.674-1.631) were associated with 3-month Glasgow Outcome Score. The effect of supplemental protective drug did not significantly vary with temperature. The effects of hypothermia and protective drug did not significantly vary with temporary clip duration. Similar findings were made for 24-h neurologic status and 3-month Neuropsychological Composite Score. Conclusion In the Intraoperative Hypothermia for Aneurysm Surgery Trial, neither systemic hypothermia nor supplemental protective drug affected short- or long-term neurologic outcomes of patients undergoing temporary clipping.

scholarly journals AN ANALYSIS OF TRAUMATIC BRAIN INJURY [TBI] IN TERMS OF 3-MONTH GLASGOW OUTCOME SCORE [GOS] AT A TERTIARY CARE CENTRE

2021 ◽  
pp. 13-15
Author(s):  
Shrikant Govindrao Palekar ◽  
Kailash K Mogal ◽  
Vedanti Rajesh Patil ◽  
I Vijay Sundar
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Clinical Features ◽  
Tertiary Care ◽  
Glasgow Outcome Score ◽  
Tertiary Care Centre ◽  
Mild Tbi ◽  
Outcome Score ◽  
Severe Tbi

INTRODUCTION - Traumatic brain injury [TBI] most affects the working population and their earning capacity. The various sub categories of TBI in terms of clinical features,Glasgow coma scale [GCS] and radiology are well defined.We have attempted an analysis in terms of long term Glasgow outcome score [GOS] and tried to correlate with the various factors of TBI. MATERIALS AND METHODS – All patients of TBI over 12 years and below 60 years and those without other major trauma were included over a period of about two years. The clinical features, presentation GCS, treatment given, and outcomes were assessed.The three month GOS was scored for all patients and was used to analyse the the initial data in its light. RESULTS – A total of 200 patients were eligible for the study and were included. Of these 159 were males and 41 were females.The average age was 37.16 years.There was a relatively higher proportion of mild TBI and greater prevalence of fractures and EDH [extradural hematoma].On analyzing with three month GOS we found that 90.4 % of the patients with mild TBI had a three month GOS of 5 whereas only 31.9% of patients with moderate or severe TBI had a three month GOS of 5. CONCLUSION – The long term GOS is most representative of the extent to which the patient has been able to return to their pre TBI lives. In our study the three month GOS co related well with the initial GCS. Further prospective data can elaborate more on the effect of other clinical features and radiology on long term GOS

scholarly journals Effect of Nitrous Oxide on Neurologic and Neuropsychological Function after Intracranial Aneurysm Surgery

2008 ◽  
Vol 108 (4) ◽  
pp. 568-579 ◽  
Author(s):  
Diana G. McGregor ◽  
William L. Lanier ◽  
Jeffrey J. Pasternak ◽  
Deborah A. Rusy ◽  
Kirk Hogan ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Brain Injury ◽  
Neuropsychological Testing ◽  
Multivariate Logistic Regression Analysis ◽  
Outcome Data ◽  
Outcome Variable ◽  
Aneurysm Surgery ◽  
Intraoperative Hypothermia ◽  
Surgery Trial ◽  
The Impact

Background Laboratory studies suggest that nitrous oxide augments brain injury after ischemia or hypoxia. The authors examined the relation between nitrous oxide use and outcomes using data from the Intraoperative Hypothermia for Aneurysm Surgery Trial. Methods The Intraoperative Hypothermia for Aneurysm Surgery Trial was a prospective randomized study of the impact of intraoperative hypothermia (temperature = 33 degrees C) versus normothermia (temperature = 36.5 degrees C) in patients with aneurysmal subarachnoid hemorrhage undergoing surgical clipping. Anesthesia was dictated by a limited-options protocol with the use of nitrous oxide determined by individual anesthesiologists. All patients were assessed daily for 14 days after surgery or until hospital discharge. Neurologic and neuropsychological testing were conducted at 3 months after surgery. Outcome data were analyzed via both univariate tests and multivariate logistic regression analysis correcting for factors thought to influence outcome. An odds ratio (OR) greater than 1.0 denotes a worse outcome in patients receiving nitrous oxide. Results Outcome data were available for 1,000 patients, of which 373 received nitrous oxide. There was no difference between groups in the development of delayed ischemic neurologic deficit. At 3 months after surgery, there were no significant differences between groups in any outcome variable: Glasgow Outcome Score (OR, 0.84; 95% confidence interval [CI], 0.63-1.14; P = 0.268), National Institutes of Health Stroke Scale (OR, 1.29; 95% CI, 0.96-1.73; P = 0.087), Rankin Disability Score (OR, 0.84; 95% CI, 0.61-1.15; P = 0.284), Barthel Activities of Daily Living Index (OR, 1.01; 95% CI, 0.68-1.51; P = 0.961), or neuropsychological testing (OR, 1.26; 95% CI, 0.85-1.87; P = 0.252). Conclusions In a population of patients at risk for ischemic brain injury, nitrous oxide use had no overall beneficial or detrimental impact on neurologic or neuropsychological outcomes.

scholarly journals Use of catheter with 2-methacryloyloxyethyl phosphorylcholine polymer coating is associated with long-term availability of central venous port

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yuuki Iida ◽  
Kumiko Hongo ◽  
Takanobu Onoda ◽  
Yusuke Kita ◽  
Yukio Ishihara ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Polymer Coating ◽  
Venous Access ◽  
Preventive Effect ◽  
Central Venous ◽  
Factors Associated ◽  
Central Venous Port ◽  
Venous Port ◽  
Venous Access Device

AbstractCentral venous port (CVP) is a widely used totally implantable venous access device. Recognition of risks associated with CVP-related complications is clinically important for safe, reliable, and long-term intravenous access. We therefore investigated factors associated with CVP infection and evulsion, including the device type. A total of 308 consecutive patients with initial CVP implantation between January 2011 and December 2017 were retrospectively reviewed, and the association of clinical features with CVP-related complications were analyzed. Intraoperative and postoperative complications occurred in 11 (3.6%) and 39 (12.7%) patients, respectively. The overall rate of CVP availability at six months was 91.4%. Malignancy and 2-Methacryloyloxyethyl phosphorylcholine (MPC) polymer-coated catheter use were negatively associated with the incidence of CVP infections. Accordingly, malignancy and MPC polymer-coated catheter use were independent predictors for lower CVP evulsion rate (odds ratio, 0.23 and 0.18, respectively). Furthermore, both factors were significantly associated with longer CVP availability (hazard ratio, 0.24 and 0.27, respectively). This retrospective study identified factors associated with CVP-related complications and long-term CVP availability. Notably, MPC polymer-coated catheter use was significantly associated with a lower rate of CVP infection and longer CVP availability, suggesting the preventive effect of MPC coating on CVP infection.

Determinants of Anthropometric Failure Among Tribal Children Younger than 5 Years of Age in Palghar, Maharashtra, India

2021 ◽  
Vol 42 (1) ◽  
pp. 55-64
Author(s):  
Angeline Jeyakumar ◽  
Swapnil Godbharle ◽  
Bibek Raj Giri
Keyword(s):  
Odds Ratio ◽  
Composite Index ◽  
Z Score ◽  
Short Term ◽  
Cross Sectional Survey ◽  
Crude Odds Ratio ◽  
Cross Sectional ◽  
Independent Variables ◽  
Child Undernutrition

Background: Measuring undernutrition using composite index of anthropometric failure (CIAF) and identifying its determinants in tribal regions is essential to recognize the true burden of undernutrition in these settings. Objective: To determine anthropometric failure and its determinants among tribal children younger than 5 years in Palghar, Maharashtra, India. Methods: A cross-sectional survey employing CIAF was performed in children <5 years to estimate undernutrition in the tribal district of Palghar in Maharashtra, India. Anthropometric measurements, maternal and child characteristics were recorded from 577 mother–child pairs in 9 villages. Results: As per Z score, prevalence of stunting, wasting, and underweight were 48%, 13%, and 43%, respectively. According to CIAF, 66% of children had at least one manifestation of undernutrition and 40% had more than one manifestation of undernutrition. Odds of anthropometric failure were 1.5 times higher among children of mothers who were illiterate (adjusted odds ratio [AOR] =1.57, 95% CI: 1.0-2.3), children who had birth weight >2.5 kg had lesser odds (AOR: 0.63, 95% CI: 0.4-0.9) of anthropometric failure, and children who had initiated early breastfeeding had 1.5 times higher odds of anthropometric failure (crude odds ratio: 1.5, 95% CI: 1.0-2.1). However, when adjusted for other independent variables, the results were not significant. Conclusion: The alarming proportion of anthropometric failure among tribal children calls for urgent short-term interventions to correct undernutrition and long-term interventions to improve maternal literacy and awareness to prevent and manage child undernutrition.

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