scholarly journals Observational audit of sevoflurane consumption during paediatric anaesthesia

2019 ◽  
Vol 47 (3) ◽  
pp. 251-254
Author(s):  
Benjamin FH van der Griend ◽  
Annabelle R Vincent ◽  
R Ross Kennedy
Keyword(s):  
Global Warming ◽  
Median Duration ◽  
Interquartile Range ◽  
Operating Theatre ◽  
Paediatric Anaesthesia ◽  
Anaesthetic Gases

There is a recognition of the contribution to global warming from emissions of anaesthetic gases into the atmosphere. We audited sevoflurane use to help guide future initiatives to reduce consumption. We observed sevoflurane use during paediatric anaesthesia in a single operating theatre over eight weeks. We recorded demographics, timing of induction and maintenance of anaesthesia, type of circuit used and amount of liquid sevoflurane used (in mL). Ninety-four cases were available for analysis. Of these, 65 had gas inductions and 29 had intravenous (IV) inductions. The median sevoflurane use was 19 mL (interquartile range, IQR 13–24 mL). The median duration of cases was 50.5 min (IQR 35–78 min). The median sevoflurane consumption for cases with a gas induction was 22 mL (IQR 16–26 mL) and for those with an IV induction was 11 mL (IQR 7–17 mL; P < 0.00001). The duration of cases for the gas and IV induction cohorts were similar. During maintenance of anaesthesia, there was no difference between the IV and gas induction cohorts. There was little difference in sevoflurane use between the T-piece and circle system groups. Cases performed with gas inductions consumed twice the sevoflurane as those with IV inductions. Future interventions to reduce sevoflurane consumption should focus on this period.

scholarly journals Pathogen-Negative Sepsis—An Opportunity for Antimicrobial Stewardship

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Gabriel C Lockhart ◽  
Jacob Hanin ◽  
Scott T Micek ◽  
Marin H Kollef
Keyword(s):  
Median Duration ◽  
Antimicrobial Stewardship ◽  
Hospitalized Patients ◽  
Interquartile Range ◽  
Common Reason ◽  
Empiric Antibiotics

Abstract Sepsis is a common reason for empiric antibiotics among hospitalized patients. We found that the median duration of empiric antibiotics (interquartile range) was 6 (4–9) days among 1047 survivivors with pathogen-negative sepsis. These findings suggest that patients with pathogen-negative sepsis could represent an important opportunity for antimicrobial stewardship.

scholarly journals Implementing a socio-technical system for computer-aided tuberculosis diagnosis in Peru: A field trial among health professionals in resource-constraint settings

2020 ◽  
Vol 26 (4) ◽  
pp. 2762-2775
Author(s):  
Cesar Ugarte-Gil ◽  
Maria Icochea ◽  
Juan Carlos Llontop Otero ◽  
Katerine Villaizan ◽  
Nicola Young ◽  
...  
Keyword(s):  
Median Duration ◽  
Field Trial ◽  
Interquartile Range ◽  
Technical System ◽  
Health Centers ◽  
Successful Implementation ◽  
X Rays ◽  
X Ray ◽  
Computer Aided ◽  
Tuberculosis Diagnosis

A major challenge of tuberculosis diagnosis is the lack of universal accessibility to bacteriological confirmation. Computer-aided diagnostic interventions have been developed to address this gap and their successful implementation depends on many health systems factors. A socio-technical system to implement a computer-aided diagnostic tuberculosis diagnosis was preliminary tested in five primary health centers located in Lima, Peru. We recruited nurses (n = 7) and tuberculosis physicians (n = 5) from these health centers to participate in a field trial of an mHealth tool (eRx X-ray diagnostic app). From September 2018 to February 2019, the nurses uploaded images of chest X-rays using smartphones and the physicians reviewed those images on web-based platforms using tablets. Both completed weekly written feedback about their experience. Each nurse participated for a median duration of 12 weeks (interquartile range = 7.5–15.5), but image upload was only possible at a median of 58 percent (interquartile range = 35.1%–84.4%) of those weeks. Each physician participated for a median duration of 17 weeks (interquartile range = 12–17), but X-ray image review was only possible at a median of 52 percent (interquartile range = 49.7%–57.4%) of those weeks. Heavy workload was most frequently provided as the reason for missing data. Several infrastructural and technological challenges impaired the effective implementation of the mHealth tool, irrespective of its diagnostic accuracy.

Air Flow Patterns in the Operating Theatre

1980 ◽  
Vol 9 (2) ◽  
pp. 87-92 ◽  
Author(s):  
F H Howorth
Keyword(s):  
Air Flow ◽  
High Volume ◽  
Clinical Results ◽  
Flow Patterns ◽  
Operating Theatre ◽  
Anaesthetic Gases ◽  
Theatre Staff ◽  
Clean Air ◽  
Schlieren Photography ◽  
Total Body

Bacteria-carrying particles and exhaled anaesthetic gases are the two contaminants found in the air flow patterns of operating rooms. Their origin, direction and speed were illustrated by a motion picture using Schlieren photography and smoke tracers. Compared with a conventionally well air conditioned operating theatre, it was shown that a downward flow of clean air reduced the number of bacteria-carrying particles at the wound site by sixty times. The Exflow method of achieving this without the restriction of any side panels or floor obstruction was described. The total body exhaust worn by the surgical team was shown to reduce the bacteria count by a further eleven times. Clinical results show that when both these systems are used together, patient infection was reduced from 9 per cent to between 0.3 per cent and 0.5 per cent, even when no pre-operative antibiotics were used. Anaesthetic gas pollution was measured and shown to be generally 1000 p.p.m. at the head of the patient, in induction, operating and recovery rooms, also in dental and labour rooms. A high volume low pressure active scavenging system was described together with its various attachments including one specially for paediatric scavenging. Results showed a reduction of nitrous oxide pollution to between zero and 3 p.p.m. The economy and cost effectiveness of both these pollution control systems was shown to be good due to the removal of health hazards from patients and theatre staff.

scholarly journals Is Transition between Peritoneal Dialysis and Hemodialysis Really a Gradual Process?

2013 ◽  
Vol 33 (4) ◽  
pp. 391-397 ◽  
Author(s):  
Lucie Boissinot ◽  
Isabelle Landru ◽  
Eric Cardineau ◽  
Elie Zagdoun ◽  
Jean-Philippe Ryckelycnk ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Median Duration ◽  
Charlson Comorbidity Index ◽  
Transition Period ◽  
Self Care ◽  
Interquartile Range ◽  
Median Score ◽  
Gradual Process ◽  
Duration Of Hospitalization ◽  
Comorbidity Index

BackgroundTransfer to hemodialysis (HD) is a frequent cause of peritoneal dialysis (PD) cessation. In the present study, we set out to describe the transition period between PD and HD.MethodsAll patients in 4 centers of Basse-Normandie who had been treated with PD for more than 90 days and who were permanently transferred to HD between 1 January 2005 and 31 December 2009 were retrospectively reviewed. The rate of unplanned HD start was evaluated.ResultsIn the 60 patients (39 men, 21 women) included in the study, median score on the Charlson comorbidity index at PD initiation was 5 [interquartile range (IQR): 3 – 7], median age at HD initiation was 62 years (IQR: 54 – 76 years), and median duration on PD was 22 months (IQR: 12 – 36 months). Among the 60 patients, 37 had an unplanned HD initiation. Peritonitis was the most frequent cause of unplanned HD start ( n = 20), and dialysis inadequacy ( n = 11), the main cause of planned HD start. During the transition period, all patients were hospitalized. Median duration of hospitalization was 4.5 days (IQR: 0 – 25.5 days). Within 2 months after HD initiation, 9 patients died. Two months after starting HD, 6 of the remaining 51 patients were being treated in a self-care HD unit and only 23 patients had a mature fistula.ConclusionsUnplanned HD start is a common problem in patients transferred from PD. Further studies are needed to improve the rate of planned HD start in PD patients transferred to HD.

scholarly journals Analysis of chemotherapy-induced peripheral neuropathy using the Japanese Adverse Drug Event Report database

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Misaki Inoue ◽  
Kiyoka Matsumoto ◽  
Mizuki Tanaka ◽  
Yu Yoshida ◽  
Riko Satake ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
Peripheral Neuropathy ◽  
Confidence Interval ◽  
Median Duration ◽  
Adverse Drug Event ◽  
Vinca Alkaloid ◽  
Interquartile Range ◽  
Drug Event ◽  
Event Report ◽  
Time To Onset

AbstractChemotherapy-induced peripheral neuropathy (CIPN) is a common adverse event associated with several antineoplastic drugs; however, the precise risks and time course of reactions of particular drugs are not clearly understood. The aim of this study was to evaluate the relationship between anticancer agents and CIPN development using data from the Japanese Adverse Drug Event Report (JADER) database and to characterize the time-to-onset and outcomes of CIPN. Chemotherapy-induced peripheral neuropathy was defined using the Medical Dictionary for Regulatory Activities preferred terms. Disproportionality analysis was performed by calculating the reporting odds ratio (ROR) with 95% confidence interval for signal detection. Data of nine Anatomical Therapeutic Chemical (ATC) drug categories correlated with CIPN development, in addition to the data of the time-to-onset and outcomes. Among 622,289 reports in the JADER database from April 2004 to March 2020, there were 1883 reports of adverse events corresponding to peripheral neuropathy. The ROR (95% confidence interval) for vinblastine, sorbent-based paclitaxel (sb-PTX), oxaliplatin, and bortezomib was 20.4 (12.5–33.4), 13.6 (11.9–15.7), 26.2 (23.6–29.1), and 30.8 (26.6–35.8), respectively. The median duration (interquartile range) to CIPN development after the administration of vinca alkaloids and analogues, taxanes, platinum compounds, and monoclonal antibodies was 11.0 (5.0–46.5), 22.5 (6.0–82.5), 22.0 (6.0–68.5), and 32.5 (11.3–73.8) days, respectively. The median duration (interquartile range) of sb-PTX and nanoparticle albumin-bound (nab)-PTX was 35.0 (7.0–94.0) and 5.5 (3.0–29.3) days, respectively. Our analysis of records in the JADER database revealed several drugs associated with a high risk for CIPN development. In particular, the development of CIPN after vinca alkaloid administration should be closely monitored for 2 weeks after administration. CIPN caused by nab-PTX showed significantly faster onset than that by sb-PTX. Patients who receive taxanes or monoclonal antibodies often do not show an improvement; accordingly, early treatment is required.

The effect of anaesthetic gases on global warming

2020 ◽  
Vol 11 (3) ◽  
pp. 134-137
Author(s):  
Dimitra Saliakelli ◽  
Kathryn Harley
Keyword(s):  
Global Warming ◽  
The Earth ◽  
Anaesthetic Gases

Essential for medicine, damaging for the Earth: how can we reduce anaesthetic waste and pollution?

CHRONIC EXPOSURE TO ANAESTHETIC GASES IN THE OPERATING THEATRE AND RECOVERY ROOM

1973 ◽  
Vol 17 (5) ◽  
pp. 464
Author(s):  
P. NIKKI ◽  
P. PF??FFLI ◽  
K. AHLMAN ◽  
R. RALLI
Keyword(s):  
Recovery Room ◽  
Chronic Exposure ◽  
Operating Theatre ◽  
Anaesthetic Gases

The use of extracorporeal membrane oxygenation in human immunodeficiency virus–positive patients: a review of a multicenter database

Perfusion ◽  
2020 ◽  
Vol 35 (8) ◽  
pp. 772-777
Author(s):  
Thomas V Brogan ◽  
Ravi R Thiagarajan ◽  
Roberto Lorusso ◽  
D Michael McMullan ◽  
Matteo Di Nardo ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Renal Replacement Therapy ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Replacement Therapy ◽  
Median Duration ◽  
Interquartile Range ◽  
Membrane Oxygenation ◽  
Immunodeficiency Virus ◽  
Ventilator Settings

Aim: We chose to evaluate the survival of extracorporeal membrane oxygenation among patients with human immunodeficiency virus in a multicenter registry. Methods: Retrospective case review of the Extracorporeal Life Support Organization Registry respiratory failure of all patients with human immunodeficiency virus supported with extracorporeal membrane oxygenation. Results: A total of 126 patients were included. Survival to discharge was 36%. Eight infants were supported with extracorporeal membrane oxygenation and three (37.5%) survived to discharge. Respiratory extracorporeal membrane oxygenation was the primary indication (78%) with a 39% survival, while cardiac and extracorporeal cardiopulmonary resuscitation indications accounted for 16% and 6% of patients with survivals of 30% and 12.5%, respectively. These differences did not reach significance. There were no significant differences between survivors and non-survivors in demographic data, but non-survivors had significantly more non–human immunodeficiency virus pre–extracorporeal membrane oxygenation infections than survivors. There were no differences in other pre–extracorporeal membrane oxygenation supportive therapies, mechanical ventilator settings, or arterial blood gas results between survivors and non-survivors. The median duration of mechanical ventilation prior to cannulation was 52 (interquartile range: 13-140) hours, while the median duration of the extracorporeal membrane oxygenation exposure was 237 (interquartile range: 125-622) hours. Ventilator settings were significantly lower after 24 hours compared to pre–extracorporeal membrane oxygenation settings. Complications during extracorporeal membrane oxygenation exposure including receipt of renal replacement therapy, inotropic infusions, and cardiopulmonary resuscitation were more common among non-survivors compared to survivors. Central nervous system complications were rare. Conclusion: Survival among patients with human immunodeficiency virus infection who receive extracorporeal membrane oxygenation was less than 40%. Infections before extracorporeal membrane oxygenation cannulation occurred more often in non-survivors. The receipt of renal replacement therapy, inotropic infusions, or cardiopulmonary resuscitation during extracorporeal membrane oxygenation was associated with worse outcome.

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