Temporal trends in patient characteristics and survival of intensive care admissions with sepsis: a multicenter analysis*.

Objective: To estimate in-hospital, 1-yr, and long-term mortality and to assess time trends in incidence and outcomes of sepsis admissions in the intensive care unit.

Design: A population-based, multicenter, retrospective cohort study.

Patients: Patients hospitalized with sepsis in the intensive care unit in seven general hospitals in Israel during 2002-2008.

Anaesthesia for caesarean delivery: low-dose epidural bupivacaine plus fentanyl.

To determine the acceptability of epidural bupivacaine-induced sixth thoracic (T6) sensory blockade and the analgesic efficacy of epidural fentanyl 50 microg, 24 parturients undergoing elective caesarean section were given a test dose of lidocaine 60 mg plus epinephrine followed by 10 ml of either 0.5 % bupivacaine (control group) or 0.5 % bupivacaine plus 50 microg fentanyl (fentanyl group) in a randomized double-blind manner.

Alternating patient position following the induction of obstetric epidural analgesia does not affect local anaesthetic spread.

To assess the influence of gravity on epidural-induced sensory blockade during the first stage of labour, 60 parturients were recruited to a randomized, controlled, single-blinded study. In all cases an epidural catheter was placed with the patient in the left lateral position. Thereafter, patients were randomized to one of three groups.

Delivery room analgesia: an analysis of maternal satisfaction.

On the first post-partum day, 324 mothers completed a questionnaire designed to assess maternal perception of delivery room experience. Antenatal pain expectation, actual pain severity, analgesia received, as well as maternal satisfaction and choice of analgesia for future deliveries were recorded. Forty-five percent of primiparae and 36% of multiparae reported that they anticipated suffering extreme pain during delivery.

Hepatic infarction in preeclampsia as part of the HELLP syndrome: CT appearance.

We describe the computed tomographic (CT) findings of hepatic infarctions in two preeclamptic pregnant women. These infarcts were part of the HELLP syndrome (hemolysis, elevated liver function tests, and low platelets count). In both cases, CT disclosed features characteristic of multiple nonenhancing, low-attenuation, peripheral lesions with vessels coursing through and a mottled appearance.

Effect of spinal versus general anesthesia on bladder compliance and intraabdominal pressure during transurethral procedures.

Study Objective: To evaluate the influence of spinal versus general anesthesia on bladder compliance and intraabdominal pressure in elderly males undergoing elective transurethral resection of the prostate.

Design: Prospective, randomized, open-label study.

Setting: Teaching hospital.

The induction, maintenance, and recovery characteristics of spinal versus general anesthesia in elderly patients.

Study Objective: To compare the induction and recovery profiles of three combinations of general anesthesia when used as an alternative to spinal anesthesia for elderly patients.

Design: Randomized, prospective, open-label study.

Setting: Large referral hospital.

Acute normovolaemic haemodilution decreases postoperative allogeneic blood transfusion after total knee replacement.

We hypothesized that the success of postoperative blood conservation after acute normovolaemic haemodilution (NVHD) is influenced by the extent of intraoperative bleeding and surgical trauma, and the timing of autologous blood transfusion. As total knee replacement is associated with minimal intraoperative but extensive postoperative blood loss, this procedure is ideally suited to acute NVHD. Therefore, to test our hypothesis, 30 patients undergoing elective total knee replacement were enrolled in a prospective, randomized, controlled study.

Role of the anesthesiologist in the early diagnosis of life-threatening complications during laparoscopic surgery.

Two cases of massive hemorrhage following blind introduction of laparoscopic instruments are presented. The role of the anesthesiologist in the early diagnosis of potentially life-threatening complications of laparoscopic surgery is discussed.

The antinociceptive effect of epidural lignocaine and fentanyl during lithotripsy.

To determine the antinociceptive effect of combining epidural fentanyl with lignocaine during non-immersion lithotripsy, 56 healthy patients were enrolled into a prospective, randomized, double-blind study. Epidural anaesthesia was induced with either lignocaine 300 mg alone, or lignocaine 300 mg, or 200 mg in combination with fentanyl 100 micrograms. Throughout the procedure analgesia was assessed by comparing the incidence of (a) spontaneous complaints of pain, (b) patients' attempts to withdraw from the painful stimulus, (c) supplemental epidural lignocaine requirements, (d) the haemodynamic response to lithotripsy and (e) the time to first postoperative pain.

Ketorolac does not decrease postoperative pain in elderly men after transvesical prostatectomy.

Purpose: To assess the postoperative analgesic efficacy and morphine-sparing effect of ketorolac in elderly patients.

Methods: Sixty ASA-physical status I to III men, aged 60-88 yr, undergoing transvesical prostatectomy were studied according to a randomized, placebo controlled, double-blind study protocol. A standard general anaesthetic was administered.

A comparative study of ketorolac and diclofenac on post-laparoscopic cholecystectomy pain.

In a randomized, double-blind, placebo-controlled study designed to assess the post-operative analgesic efficacy and cost-effectiveness of ketorolac and diclofenac 60 ASA I and II patients undergoing laparoscopic cholecystectomy were studied. Prior to concluding the operative procedure, an injection (i.m.

Tracheal anaesthesia for transthoracic endoscopic sympathectomy: an alternative to endobronchial anaesthesia.

When using endobronchial anaesthesia for the management of transthoracic endoscopic sympathectomy (TES), excessive insufflation of carbon dioxide into the pleural space may cause haemodynamic instability, hypoxaemia and tension pneumothorax. We prospectively studied an alternative technique using a tracheal tube, i.v.

Residual pneumoperitoneum: a cause of postoperative pain after laparoscopic cholecystectomy.

After laparoscopic cholecystectomy, residual gas is inevitably retained in the peritoneal cavity. An active attempt is not always made to remove it. Using a double-blind prospective protocol in 40 healthy patients, we evaluated the effect of residual pneumoperitoneum on post-laparoscopic cholecystectomy pain intensity.

Endoscopic transthoracic sympathectomy in the treatment of primary hyperhidrosis. A review of 290 sympathectomies.

Objectives: To describe the surgical technique of endoscopic transthoracic sympathectomy for the treatment of palmar hyperhidrosis and to identify associated complications.

Design: Prospective clinical study.

Setting: University referral center.

Intraoperative anaesthetic management of hypoxaemia during transthoracic endoscopic sympathectomy.

Objective: To present our experience and evaluate intraoperative arterial oxygen desaturation during anaesthesia for transthoracic endoscopic sympathectomy (TES).

Design: Prospective open study.

Setting: University Hospital in Israel.

Intertwining and knotting of a guidewire with a central venous catheter.

A guidewire, inserted into a 65-year-old patient with multisystem organ failure through the left subclavian vein, intertwined and knotted with an existing central venous catheter previously inserted via the right subclavian vein. Both the guidewire and catheter were removed without any harm to the patient.

Acute normovolaemic haemodilution and idiopathic scoliosis surgery: effects on homologous blood requirements.

After the introduction of acute normovolaemic haemodilution(NVHD) in our hospital, we prospectively studied 19 patients managed with moderate NVHD (mean haematocrit 0.28, SD 0.02) during idiopathic scoliosis surgery (mean angle 53.

The opioid-sparing effect of diclofenac sodium in outpatient extracorporeal shock wave lithotripsy (ESWL).

Study Objective: To evaluate the opioid-sparing and analgesic effect of diclofenac sodium in ambulatory nonimmersion extracorporeal shock wave lithotripsy (ESWL).

Design: Randomized, double-blind, placebo-controlled study.

Setting: Large referral hospital.

Anaesthesia for transthoracic endoscopic sympathectomy in the treatment of upper limb hyperhidrosis.

Renewed interest has been shown in transthoracic endoscopic sympathectomy (TES) for the treatment of upper limb hyperhidrosis. We review our experience and discuss the anaesthetic technique and perioperative problems encountered in 58 patients undergoing TES for hyperhidrosis. Patients were monitored for arterial pressure, heart rate, ECG, pulse oximetry (SpO2), end-tidal carbon dioxide concentration, peak inspired airway pressure and skin temperature.

[Necrotic pheochromocytoma presenting with shock and abdominal pain].

Pheochromocytoma is a rare tumor, the diagnosis of which is based on a history of hypertension, and symptoms, signs and laboratory data associated with increased release of catecholamines. The combination of pheochromocytoma and shock is uncommon, but when it does occur, is often associated with necrosis of the tumor. We report an unusual case of a patient whose clinical findings suggested fulminating septic shock.

The AR-8800--a new impedance pneumograph (plethysmograph) respiratory monitor.

The Atlas AR-8800, an impedance pneumograph respiratory monitor, is claimed to detect both apnea and hypoventilation. The authors tested the monitor on eight anesthetized patients and found the apnea alarm to be effective and efficient. In addition, the ventilation alarm index, a system specific to this monitor, detected hypoventilation and also differentiated between irrelevant body movements and apnea.

Disseminated intravascular coagulopathy and adult respiratory distress syndrome: life-threatening complications of hysteroscopy.

A 23-year-old, healthy woman underwent hysteroscopy during which Hyskon solution was injected into the uterine cavity. Soon afterward she developed a bleeding coagulopathy followed by acute respiratory insufficiency and pulmonary edema, necessitating endotracheal intubation and artificial ventilation with positive end-expiratory pressure. This rare complication of hysteroscopy was most probably due to the injection of Hyskon solution.