Carbon Dioxide Elimination After Sodium Bicarbonate Administration as a Novel Method to Assess Cardiac Output: A Pilot Study.

Introduction Cardiac output/pulmonary blood flow measurement is an important way to assess patients during the perioperative period, as well as patients who are critically ill. Current methods of assessing cardiac output have limitations. One indicator of cardiac output may be the expired carbon dioxide (CO) partial pressure response to intravenous sodium bicarbonate (IVSB), which is rapidly converted to CO.

Effects of a Single Rapid Infusion System on Platelet Function in Stored Whole Blood: An Ex Vivo Study.

Introduction Rapid infusion systems (RIS) are used to warm and rapidly infuse crystalloids and blood products. Current guidelines do not approve of platelet transfusion through a RIS, but data supporting these guidelines are scarce. Our hypothesis was that an infusion of whole blood through a RIS would degrade platelet quantity, impede viscoelastic clot strength, and inhibit platelet aggregation response to adenosine diphosphate pathway (ADP) activation.

Should Percussion Pacing Have a Role in Perioperative Advanced Cardiac Life Support?: A Case Report.

Percussion pacing involves using one's fist to repeatedly strike a patient's left sternal border in a rhythmic manner. The resulting increase in ventricular pressure can trigger myocardial depolarization and subsequent contraction. We describe the successful treatment of acute preoperative symptomatic sinus bradycardia with percussion pacing in a 63-year-old patient scheduled for placement of a gastric feeding tube after trauma involving spinal cord injury.

A Simple Diagnostic Test to Confirm Correct Placement of Dysfunctional Central Venous Catheters Before Chemotherapy in Children.

Background: In children undergoing intravenous chemotherapy, partial dysfunction of the central venous catheter (CVC) is common. Fluids can be infused into the catheter; however, blood cannot be aspirated. In those situations, chemotherapy is withheld and a catheter investigation is performed.

A simple diagnostic test to confirm correct intravascular placement of peripheral catheters in order to avoid extravasation.

Background: Intravenous catheters are ubiquitous among modern medical management of patients, yet misplaced or tissued cannulas can result in serious iatrogenic injury due to infiltration or extravasation of injectate. Prevention is difficult, and currently few reliable tests exist to confirm intravascular placement of catheters in awake spontaneously breathing patients.

Methods: Twenty conscious spontaneously breathing healthy volunteers were injected with 50 mL normal saline and 50 mL 4.

A simple diagnostic test to confirm correct placement of intravenous catheters before chemotherapy.

Purpose: To determine the feasibility and effectiveness of using a single injection of diluted sodium bicarbonate, while monitoring exhaled carbon dioxide changes, to reliably confirm correct placement of intravenous (IV) catheters.

Methods: The study was conducted in the oncology day care clinic at a tertiary care center and included a selected group of patients with various oncological conditions who required IV chemotherapy. In each patient a newly inserted peripheral IV catheter or newly accessed central line was deemed positively intravascular if they had good blood return or most probably intravascular if there was no blood return but they flushed easily.

A functional test for the detection of infusion lines extravasation.

Extravasation during intravenous (IV) infusion is a common secondary effect with potentially serious clinical consequences. The correct positioning of the needle in the vein may be difficult to confirm when no blood return is observed. In this paper, a novel method is proposed for the detection of extravasation during infusion therapy.

Electroencephalography for children with autistic spectrum disorder: a sedation protocol.

Objectives: To report the effectiveness and efficiency of a predetermined sedation protocol for providing sedation for electroencephalograph (EEG) studies in children with autism.

Methods: Sleep EEG has been advocated for the majority of children with autism spectrum disorder. In most cases, sedation is required to allow adequate studies.

Inconsistency between simultaneous blood pressure measurements in the arm, forearm, and leg in anesthetized children.

Study Objective: To determine the accuracy and precision of simultaneous noninvasive blood pressure (NIBP) measurement in the arm, forearm, and ankle in anesthetized children.

Design: Prospective, randomized study.

Setting: University medical center.

Deficits in the provision of cardiopulmonary resuscitation during simulated obstetric crises: results from the Israeli Board of Anesthesiologists.

Cardiac arrest in the parturient is often fatal, but appropriate resuscitation in this special situation may save the lives of the mother and/or unborn baby. Concern has arisen as to application of recommended techniques for resuscitation in the obstetric patient. The Israel Board of Anesthesiology has incorporated simulation assessment into accreditation examinations.

Intravenous sodium bicarbonate verifies intravenous position of catheters in ventilated children.

Background: Vascular access in children carries a significant risk of accidental extravasation of IV fluids and medications with the potential for tissue injury. In this prospective controlled study we assessed the diagnostic utility of using IV diluted sodium bicarbonate to confirm placement of IV catheters in ventilated children. Diluted sodium bicarbonate was created using undiluted standard 8.

Intravenous sodium bicarbonate verifies intravenous position of catheters in ventilated patients.

Background: Extravasation is the unintentional injection or leakage of fluids into the perivascular or subcutaneous space resulting in potential tissue injury. In this 2-part prospective, controlled study, we assessed the safety of subcutaneously injected sodium bicarbonate in rats first. In the second part, the diagnostic utility of using IV diluted sodium bicarbonate to confirm placement of IV catheters in endotracheally intubated and ventilated rats and patients was tested.

Blood lactate levels differ significantly between surviving and nonsurviving patients within the same risk-adjusted Classification for Congenital Heart Surgery (RACHS-1) group after pediatric cardiac surgery.

This study aimed to examine the association between lactate levels in the first hours after surgery for congenital heart defects and the results of Risk-Adjusted Classification for Congenital Heart Surgery (RACHS-1) scoring and to evaluate serial lactate levels over time to determine whether they can serve as a supplementary tool for postoperative assessment within the same RACHS-1 group of patients. A retrospective cohort study was performed using data retrieved from a clinical database of 255 children who had surgery for congenital heart defects between 1999 and 2001 at Sheba Medical Center. Lactate levels were measured postoperatively four times (mg/dL units).

A randomized trial of outcomes of anesthetic management directed to very early extubation after cardiac surgery in children.

Objectives: Intraoperative management directed to early extubation of children undergoing cardiac surgery has been suggested as a viable alternative to prolonged postoperative mechanical ventilation. The authors evaluated the safety and efficacy of this approach in a randomized prospective trial.

Design: A prospective randomized observational study.

Clowns for the prevention of preoperative anxiety in children: a randomized controlled trial.

Objective: To determine if specially trained professional clowns allayed preoperative anxiety and resulted in a smooth anesthetic induction compared to the use of midazolam or no intervention.

Methods: This was a randomized, controlled, and blinded study conducted with children 3-8 years of age undergoing general anesthesia and elective outpatient surgery. Patients were assigned to one of three groups: Group 1 did not receive midazolam or clown presence; group 2 received 0.

Enhancing patient safety during pediatric sedation: the impact of simulation-based training of nonanesthesiologists.

Objective: To evaluate the impact of simulation-based education on patient safety during pediatric procedural sedation.

Design: A prospective, observational, single-blind, controlled study of pediatric procedural sedation outside the operating room.

Setting: Two university teaching hospitals in Israel.

[A Hebrew version of the FLACC scale: measurement of pain in non-verbal children].

Background: The Israeli Ministry of Health requires that every patient have their pain routinely and systematically measured when there are treated in any of the country's medical institutions. Measurement guides treatment and enables follow-up of pain over time. Self-assessment of pain is the gold standard.

The practice of pediatric procedural sedation and analgesia in the emergency department.

The treatment of acute pain and anxiety in children undergoing therapeutic and diagnostic procedures in the emergency department has improved dramatically over the last few years. The availability of noninvasive monitoring devices and the use of short-acting sedative and analgesic medications enable physicians to conduct safe and effective sedation and analgesia treatment. In today's practice of pediatric emergency medicine, sedation and analgesia has been considered as the standard of care for procedural pain.

The impact of educational intervention programs on pain management in a pediatric emergency department.

Management of pain and anxiety is an important part of patient care in the pediatric emergency department (ED). Even though it has improved significantly over the past few years, it is still suboptimal. The objective of this study was to evaluate the effect of informal and formal education on pain and anxiety management in the pediatric ED.