Expression of aquaporin channels 1 and 5 during mechanical ventilation

G. Fabregat; E. Pastor; J. García de la Asunción; B. Sarriá; F. J. Belda

Expression of aquaporin channels 1 and 5 during mechanical ventilation

Gustavo Fabregat

2010, European Journal of Anaesthesiology

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AI-generated Abstract

This study investigates the expression of aquaporin channels 1 and 5 during mechanical ventilation, focusing on their roles in fluid homeostasis and cellular responses in the lungs. The research highlights changes in the levels of these channels under various mechanical ventilation settings, contributing to our understanding of ventilatory impact on pulmonary function and the potential for targeting aquaporins in therapeutic strategies.

Figures (435)

Figure 1. Effects of postsurgical LPS on neuroinflammation and behavior. Hippocampi were harvested at days 3 and 7 after surgery and stained with anti-CD11b. Pictures show CA\1 (scale bar 50 um, 20X), photomicrographs were blindly scored and microglia activation was graded on a scale 0 (lowest) — 3 (highest). PANEL 1: SURGERY.

Figure 1. ROC-curves of variables in order to predict a 15% increase in stroke volume at different experimental time-points. hours hours after ROSC all variables enabled indication of fluid responsiveness. During the first hour after ROSC, however, AVpeak may be superior to SVV-TEE and AVTI.

Results and Discussion: The pharmacokinetic of propofol in infants followed two compartement model among the different groups are shown in Table 1.In the current study the estimate for systemic clearance for infants was 29.77+9.46 ml/kg/min. There was higher clearance value in smaller babies than the older ones. In the present study, volume of distribution (volume of centeral compart- ment and volume at steadt state) were also higher in in smaller infants than the older ones, this may explain why infants requirede a higher induction dose and probably and higher maintenance. Conclusion(s): Smaller infants have a larger volume of distribution and a higher clearance of propofol. Therefore, the induction and maintenanace doses should be increased in this young age with using population based pharmacokinetic parameters for accurate propofol dosing stategy. Mean Propofol Pharmacokinetic parameters in different groups

Neurologic Deficit Fisher's exact test, two-tailed P = 0.97.

Figure 1. A) Number of genes upregulated as compared to control. B) Number of genes downregulated as compared to control. HP = high pressure, LP = low pressure, Genes were considered differentially expressed if having a fold change >2 as compared to control. Data are derived from pooled samples analysis.

Results and Discussion: The area under the ROC for IAP, APP and FG were all significantly>>0.5, indicating better prediction of SICU mortality than guess- ing. Prognostic potential of APP was significantly higher than those of IAP and FG; (p<0.05 for all comparisons). Increase in IAP or decrease in APP corre- sponds to an increase in LR. LR approaches to indefinite at IAP=21mmHg or APPs50mmqg, indicating that probability of poor outcome approaches to one. The optimal cut-off values for IAP and APP for prediction of SICU outcome was defined as IAP=20mmHg with LR 8.417 (95% Cl=11.538-5.295) and APP=60 mmHg with LR 14.446 (95% Cl=18.398-10.494). Conclusion(s): IAP and APP are useful prognostic tests with APP having the maximum prognostic potential for discrimination of survivors and non-survivors in SICU. Both IAP2220 mmHg and APPs<50mmHg are harbingers of poor prognosis in SICU.

Conclusion(s): In mice, desflurane and NS1619 alone significantly reduced myocardial infarct size to a similar extent. The combination of desflurane and NS1619 did not further reduce myocardial IS, indicating a similar signal trans- duction pathway. Desflurane-induced postconditioning was abolished by block- ade of BK,,. These results indicate that desflurane-induced postconditioning is mediated by BK,..

BAPCAP2-6 Conclusion(s): The cumulative number of ‘Triple Low’ minutes was a better predictor of 30-day mortality than numbers of alerts requiring 2 or more contigu- ous minutes of ‘Triple Low’ state, however, clinicians may disregard 1-min alerts as too frequent. Use of parameters which generate similarly high AUCs at lower alert frequencies may be more effective.

Results and Discussion: In 23,999 available non-cardiac cases AUC decreased with the number of contiguous minutes required to generate ar alert (Table 1). However, the number of alerts using 1-min threshold condi- tions was sufficiently high to likely be disregarded by clinicans. We expect implementing a longer threshold condition which produces a more acceptable alert frequency. Figure 2 shows the number of alerts produced by various MAC and MAP combinations lasting for 5 contiguous minutes (at a fixed BIS threshold of 45).

Figure 894a EEg mean power spectrogram including all 10 subjects as a function of time. Black markers indicate moment of verbal command (pre-LOC as the last meaningful response, moment of no response (LOC), and regaining of consciousness (ROC) as the first meaningful response to the request). White arrows indicate effects of verbal command on the EEG spectrum. X-axis presents time in minutes. Materials and Methods: Ten healthy men aged 19-28 years were enrolled. Propofol was administered i.v. using target control infusion aiming at escalating pseudo steady-state plasma concentrations of 1.0-1.5-1.75-2.0-etc. mg/ml at 10 min intervals until LOC was reached. LOC was defined as no response to the request “open your eyes”. After LOC, the administration of the drug was discontinued. Consciousness was assessed at 5 min intervals until LOC was reached. EEG was recorded using 20-channel digital EEG. Time-varying spec- tral changes in EEG induced by verbal command were estimated with a Kalman smoother algorithm (2).

Figure 894b Representative subject under propofol anesthesia (drug concentration at LOC 1.75 g/ml). Kaiman smoother time-varying specturm (top) for the EEG band 0.5-25 Hz. Peak frequency whthin the band 9-25 Hz as a function of time (bottom) and an adaptive band (6 Hz wide) around the peak frequency. White arrows indicate moment of verbal command (pre- LOC. LOC and ROC as in fig.1). The time is presented in minutes from the beginning of the experiment Kalman smoother algorithm tracks meaningful brain reactions in multiple signal

Conclusion(s): Only upper body forced-air method has proven to be effective in this clinical trial to avoid hypothermia.

aty popertaiawe: retrieved from Oenwtedi ct t. Asesthesatogy 2005 = Kopp | ipl et af Aesthesadogy 7008 Results and Discussion: Amino acid infusion increased the rate of appear- ance (Ra) of leucine (p<0.001), and protein synthesis (p<0.001) in all patients. In diabetic patients, Ra of leucine and protein breakdown showed a tendency towards being lower in the group with EDA (p=0.056 and p=0.07). Leucine oxidation was suppressed to a higher extent in diabetic patients with EDA (p=0.02); this effect was even more pronounced when this group received amino acids (p=0.001). Diabetic patients achieved a higher positive protein bal- ance than non-diabetic patients (o=0.032) and particularly benefited from the anti-catabolic effects of EDA compared to PCA (p=0.012) and from amino acid infusion (0=0.014). 1AP1-9

ANALYSIS POST MATCHING BASED ON PROPENSITY SCORE Without: without prophylaxis; With: with prophylaxis

Average incidence of postoperative nausea and vomiting in patients with Apfel’s scores 2, 3 and 4 who underwent mastectomy Conclusion(s): Patients at high risk for PONV, especially those who undergo mastectomy, will benefit most from the ondansetron-dexamethasone combina- tion than ondansetron alone.

Materials and Methods: After suffering two cases of possible reactions in operating room. We review what has been done retrospectively and the it- erature, we found gaps in the diagnostic phase that generated an increase in avoidable costs, so we set contact the Allergy Service of our hospital, result of this collaboration is this article and following algorithm. Results and Discussion: As a guideline the Community of Castilla la Mancha sets prices for specialized medical tests, diagnosis and treatment in the first consultation by 185.22 euros and 69.42 euros in successives. [8]. These patients have an average of three consultations of allergy to the final diagnosis. If we stick to our hospital surgical activity in 2005: 44.367 events, applying the percentages of the introduction there would be 3 “true” allergic reactions which require monitoring by the Department of Allergy and 30 cases of anaphylactoid reaction in which an initial determination of tryptase would have saved 9721.8 euros to the hospital.

Data comparison between the 2 groups Results are median (interquartil range), or %

Abstract 1AP3-7 — Relationship between mortality risk and perioperative data

Conclusion(s): The combination of low BIS and low MAP at low minimum alve- olar concentration (MAC) is associated with increased 1-yr postoperative mor- tality. This result is especially concerning since the average low values for each state were well within the range that many anesthesiologists tolerate routinely.

Results and Discussion: 224 patients were followed up post operatively during a 3 week period. 94.5% patients were visited by the anaesthetist pre operatively in the ward. 92% patents said they got enough time to talk to their anaesthetist. 82% patients admitted that the pre operative visit helped with the anxiety and stress. The incidence of severe post operative pain increased from 4.8% in the theatre recovery to 12.5% in the ward with in 24 hours. Post operative nausea and vomiting among gynaecology patients was 25.7%. 34.3% patients had sore throat post operatively. Only 9.8% patients were followed up after the anaesthetic by their own anaesthetist. More than 75% patients scored either excellent or very good to their anaesthetic. Anaesthesia and the quality of the care delivered to patients should be assessed regularly in every institution. Follow up of the patients could provide excellent training experience. All ASA IIl and IV patients should be seen by the anaesthetist in the following 24 hours as recommended. It is possible to develop a regular ward based follow up as similar to the critical care out reach team. Conclusion(s): Follow up after the anaesthetic could bring into picture many issues. Ward based anaesthetic follow-up is part of good practice and care. It also contributes towards anaesthetic training.

The number of anesthetic services using different types of documentation in tertiary care and local community hospitals, n (%) * Statistically significant difference (p<0.05) between both groups.

Intraoperative complications Conclusion(s): The new uses for transoesophageal echocardiography include the control of pacemaker an defibrillator electrodes removal. The intraopera- tive use allows to diagnosticate early complications and change the surgical tecnique in the same time that it occurs. Anesthesiologist has an important role controling this thecnique.

Conclusion(s): The three dimensions leadership, job satisfaction und quality of care climate are correlated in a signifcant manner. However leadership is the only direct influencing factor and has the power to influence the other two items. Investing in leadership development may be an investment in both the quality of care climate and the employee's percieved job satisfaction. Leadership deter- mines the cultural values in a anaesthesiological department.

Results and Discussion: The requested survey had a 53.2% response rate- 33 from 62 physicians answered the questionnaire: 18 residents (48.6%) and 15 senior staff members (62.5%). The mix between the two levels had no sig- nificance on the results. The results were as follows with a maximum grade of 5 being possible. The leadership grading correlated significantly with the quality of care climate (e<0.0001) and in addition the job satisfaction also correlated well with ratings for leadership. (p<0.001).

Materials and Methods: We did a retrospective study of elective surger- ies scheduled for 1year.Data collected,obtained from OR listings and clinical records,was:surgeries scheduled,performed and canceled by specialty;timing and cause of cancellation;clinical reason and preventability when anesthetic/ surgical risk (ASR) was evoked.

Abstract 1AP5-5 — Table 1. Reasons for cancellation of elective surgeries Materials and Methods: A team comprised of employees representing differ- ent functions within the value stream map was assembled, with an outside con- sultant serving as a facilitator. A team charter defined five expected outcomes: 1) implementing a clear visual system for organizing equipment, instruments, and supplies 2) reducing storage space 3) improving accuracy of inventory lev- els 4) reducing total inventory cost and 5) improving workflow and OR on-time start. Improvements in these metrics were linked to an incentive plan for the OR employees. Following the Lean Six Sigma improvement methodology DMAIC, several process improvement tools were used to define the “target system,’ analyze the current state, and design the future state. A SIPOC diagram and 4 cross-functional process flowchart helped define the target system. Structured Background and Goal of Study: Beyond the impact on patients,cancellation of scheduled surgery has financial and logistical implications for institutions. Knowing the reality of a service is a major step to increase efficiency,allowing identification and correction of errors.Similar published studies show cancellation rates from 5.6% to 33%,averaging 15%. Goal:to identify the rate and reasons of cancellations of elective surgery in our hospital.

Conclusion(s): Our survey shows a remarkable variety in organization and practice of preoperative medicine throughout Europe and that practice is often not in accordance with guideline recommendations. Furthermore, our survey confirms that there is a shift towards selective testing and also that the majority of the respondents support the development towards minimization of preopera- tive testing.

Comparison 2 groups Results are median (interquartil range), or %

n = number of patients COMPARISON OF POSTOPERATIVE SHIVERING AMONG STUDY GROUPS AT DIFFERENT TIME INTERVAL Conclusion(s): The prophylactic use of tramadol 1mg/kg with propofol as an induction agent, significantly reduces the incidence of POS, with less require- ment of postoperative analgesia in patients recovering from general anesthesia.

Table 2. Perioperative cardiovascular events (CKD-EPI)

Results and Discussion: 77 adult patients underwent operations during the study period and the average duration of operation was 103.3 minutes. Average age of the patients was 54.6 years. 27(85%) patients were admitted to the PACL with temperatures below 36°C. 5% patients were discharged from PACU wit femperature below 36°C. Patients with temperatures above 36°C on admissior io PACU stayed in for an average duration of QOminutes. On the other hand average length of stay in PACU was increased by 30minutes to a total of 12¢ minutes for hypothermic patients before discharge to the ward. More than 50% of the patients did not receive any active warming measures during their opera ‘ion. 98% of the patients admitted to PACU required some form of the warming measures. This was the re-warming time for the hypothermic patient which was about 30 minutes per patient above the routine PACU stay time. Based on the National Institute for Health and Clinical Excellence (NICE) guidance, patients with temperatures below 36°C should be warmed before induction of anaesthe sia. Patient risk should be assessed with regard to hypothermia. Starting tem erature should be at least 36°C and intraoperatively check temperature even Materials and Methods: We looked into the core body temperatures of all adult patients admitted to PACU following operations during a period of one week. The temperatures are recorded during admission and discharge from periopera- tive care unit. Infrared ear thermometers were used to record temperatures.

Table 1: i.v.-intravenous, p.0.- per os, MO-Morphine, PET-Pethidine, HM-Hydromorphone, PIR-Piritrinamid, MET-Methadone, BUP-Buprenorphine, FEN-Fentanyl, SUF-Sufentanil, REM-Remifentanil, OXY-Oxycodone, TRA-Tramadol, ALF-Alfentanil, NAL-Naloxone, n/a- not applicable

Abstract 1AP7-10 — Table 1. Efficacy of interventions to reduce propofol injection pain

Table 1: Intention-to-treat analysis. There was no statistically significant difference between groups (p>0.05). Conclusion(s): Anesthetic requirements for patients randomized to a BIS o 50-65 were significantly less than those for patients randomized to a BIS o' 30-45, yet the incidence of PONV was similar.

Fig 1: PARTIAL PRESSURE OF CARBON DIOXIDE (PaCO2) Results and Discussion: Demographic data comparable. PaCO2 values in Study group increased significantly (o< 0.005) at 20,40 and 60 minutes (Fig 1). No difference in systolic BP but a significant increase in diastolic BP in study group observed. No change in heart rate or rhythm noted in both groups. Respiratory rate increased significantly at 30 min after draping. PaO2 remained constant in both groups. Several studies reported CO2 increase under ophthal- mic drapes in spontaneously breathing patients. Significant rise in PaCO2 seen in our Study group. Increase in respiratory rate correlated with PaCO2 rise. No hypoxia observed. Holter monitoring showed no arrythmias. Rise in diastolic BP in study group corresponded with high PaCO2.

Effects of Face Tent on O2 Saturation during Colonscopy *Significantly different from NC; #Significantly different from 5-min 02

Conclusion(s): Placing the A at the outlet of the chamber of the MR with sequen- tial operation of the MR before the A (exp 4) seems to be the most efficient combi- nation of the 2 devices and should now be evaluated in the clinical setting.

VTE Risk factors Conclusion(s): Patients undergoing laparotomy for bowel resection represent a high-risk group for VTE. More elective patients were deemed to be high-risk however compliance with VTE guidelines was better in this group. The introduc- tion of local VTE guidelines has ensured safe standards with respect to timing of pharmacological doses but some Clinicians are unaware of the correct dose. rc... ...... Results and Discussion: High-risk patients were very common in both groups although there were significantly more high-risk patients in the elective group. Compliance with VTE prophylaxis guidelines in high-risk patients was better in the elective group. Most patients received pharmacological VTE prophylaxis. All patients received doses at safe intervals with respect to the timing of epidural procedures and subsequent doses post epidural. 8/89 (9%) of patients received the wrong dose of enoxaparin (20mg vs 40mg) suggesting that some clinicians were unaware of current guidelines.

Conclusion(s): The combination of prolonged steep Trendelenburg position and CO,-pneumoperitoneum was well tolerated by the patients. Hemodynamic and pulmonary parameters remained within safe limits. SctO, remained well Results and Discussion: While patients were in the Trendelenburg position, all investigated parameters remained within a clinically acceptable range. The Cerebral Perfusion Pressure decreased from 77 mmHg at baseline to 71 mmHg (p=0.07), and SctO, increased from 70 % to 73 % (p<0.001). Figure 1 shows the evolution of the average values in 31 patients. There were 178 paired EtCO,- PaCO, values. The EtCO, increased from 31 mmHg to 36 mmHg (p<0.001) and the arterial-to-EtCO, tension difference increased from 8.0 mmHg in the normal position to a maximum of 10.6 mmHg (p<0.001) after two hours in the Trendelenburg position.

Legend:GA:General anesthesia; AG+Epi. GA+Epidural analgesia

1AP9-10 above the safe threshold value of 55% in each patient. The cerebral perfusion pressure remained within the limits between which cerebral blood flow is usually considered to be maintained by cerebral autoregulation. Maintaining an EtCO, between 30-35 mmHg will result in a PaCO, between 35-45 mmHg.

Values are expressed as number of patients (%). CRO: complete response(CR) of PACU 1 min, CR1: CR of postoperative 1hr CR2: CR of postoperative 2hr CR6: CR of postoperative 6hr CR24: CR of POD 1 CR48: CR of POD 2, No vomiting 24: no vomiting 0-24h after surgery, tP < 0.05, compared with control group. [table2]Percent of complete response and proportion of no vomiting

Values are expressed as mean(SD) or number of patients. There were no significant differences between groups.

Pneumorectus quality and tumours’ distance/ CO2 absorption

Abstract 2AP1-4 Effect of Face Tent on 02 Sat during Retrobulbar Block *Significantly different from NC; #Significantly different from 5-min O2

Conclusion(s): Intra-anal catheter for triple hemorroidectomy is not enough to control analgesia in ambulatory surgery. Most of them need both drugs rescue analgesia during the first 48h. Another analgesia therapy must be given in this kind of surgery.

Conclusion(s): The creation of the position of Director of OOORA, and proper departmental support, seems to facilitate and solve the challenges posed by the increasing demands for anesthesia at sites different and far from the main operating room.

Fig.1 Patient-controlled sedation in ERCP: Desaturation frequency Results and Discussion: Patient —controlled sedation method was success- ful in 77/85 (91%)of ERCP sedations without differences between groups. Significant desaturation (SpO2<90%) and post procedural nausea occurred most frequently(e<0.05) in remifentanil group. Patient’s and endoscopist’s satis- faction was equally high in both groups.

Selected clinical data of the study groups: to achieve an Aldrete score of 10 was similar in both groups. Dexmedetomidine patients have significantly lower VAS for pain, similar surgeon’ satisfaction with patients’ sedation, and higher patients’ satisfaction than propofol patients.

Data are presented as mean + SD and number of patients (n) (*: p < 0.05)

Materials and Methods: The London hospital at which the audit was con- ducted has dedicated 7 day surgery theatres with separate staff as well as management system. This is one of the largest service provider in the region. We looked at the computer stored data and identified the cancellations made on the day of the operation. We divided the causes as hospital non-clinical, hospital clinical and patient reasons. The avoidable causes are sub classified and a plan of action was formulated. Results and Discussion: Total patients booked in 2008 were 14004. 6.45% operations were cancelled on average every month. This is the data from November 2008 to October 2009 and classified the cancellations. The hospital non-clinical reasons were responsible for156 cancellations out of which 62(89.7%) was avoidable. Of the 395 cancellations made due to clinical reasons,

Results and Discussion: Statistical analysis were carried out using the chi- square and Anova test: p<0,05 was considered significant. 1. Induction time P=98 seconds S=102 seconds p>0,05 2. Incidence of intraoperative cardio- vascular events 3. Recovery time P: 11,5 min +/- 2,21 min S: 10,9 min +/- 2,1 min p< 0,05 Both groups had a statistically similar time to reach an Aldete score of 9 4. Sedation score. 5. Discharging time from the surgical unit P: 8h +/- 32 min S: 8h +/-27min p< 0,05 6. Induction experience. Materials and Methods: 96 ASA |-II patients, over 75, scheduled for minor plastic surgery were randomised in 2 groups: Group P received i.v. fen- tanyl 2 yg/kgc and propofol 2 mg/kge for induction, followed by propofol 10 mg/min and fentanyl 2 ug/kgc/h after intubation Group S received vital capacity breathe technique of induction with 8% sevoflurane and were main- tained with 2% sevoflurane All patients were premedicated with midazolam 0,05mg/kge and fentanyl! 1ug/kgc, 30 min before surgery Induction times, intraoperative cardio-vascular events and recovery times were recorded. We also assessed the sedation score, patient satisfaction and discharging time from hospital

Conclusion(s): In elderly population not receiving cardio-vascular drugs, VIMA technique was a practical, safe and liked alternative In terms of cardio-vascular stability, sevoflurane induction is comparable with propofol

Conclusion(s): These findings suggest that the PICC can be a reasonable alternative to the CICC for CVP measurement in situations of dynamic systemic compliance and preload, such as those observed during LT. Results and Discussion: A total of 1342 data pairs were collected from 35 patients. Overall, the PICCP was 8.12 + 3.93 mmHg, and the CICCP was 7.98 + 3.90 mmHg (p=0.1435). The differences of two CVPs among each period were not clinically significant (0.83 mmHg for preanhepatic, 0.832 mmHg for anhe- patic, -0.15 mmHg for reperfusion, and -0.10 mmHg for neohepatic period). The PICCPs and the CICCPs highly correlated overall (r = 0.970, p<0.001), and at each period (r = 0.963 for preanhepatic, r = 0.959 for anhepatic, r = 0.971 for reperfusion, and r = 0.981 for neohepatic period). Bland-Altman analysis dem- onstrated an overall bias of 0.14 mmHg with 95% confidence interval 0.09 to 0.19 and the PICCP tended to give a higher reading by between 0.09 and 0.19. The limit of agreement was -1.74 to 2.02 overall. Bland-Altman plot calculation of bias and precision for all data pairs

SW at pre and during Pringle+IVCHO and Pringle alone *:significantly difference P((0.05

Conclusion(s): The British Hypertension Society criteria for accuracy of BP machines are met when a BP machine achieves grade A/B when compared to the sphygmomanometer method. We found similar accuracy of the Finometer, but in comparison with the arm cuff monitor. The Finometer shows potential for use in anaesthesia and surgery, in particular whenever continuous BP monitor- ing is required. nS Results and Discussion: The averaged values of BP measurements from arm cuff compared to the Finometer were 130 (27) vs. 131 (80) mmHg for SBP, 72 (17) vs. 76 (17) mmHg for DBP and 94 (20) vs. 97 (21) mmHg for MBP. The measurements from arm cuff and Finometer showed a significant correlation, and the 95% limits of agreement (mean difference + 1.96 SD) for the MBP were 18.3 to -24.6 mmHg.

Results and Discussion: There was a statistically significant relationship between APP and ARDII (r = 0.79, p < 0.01) (Figure 1). The threshold ARDI| value of 13 % allowed discrimination between patients with a APP > 13 % (n= 12) and patients with a APP < 13 % with a sensitivity of 89 % and a specificity of 88 %.

Comparison between Y%changes of lowest blood pressure readings from baseline (arm cuff vs. Finometer). Data presented as mean (SD) Conclusion(s): Significant decreases in blood pressure and stroke volume are encountered during induction of anaesthesia. Their magnitude is underestimated, and detection is delayed or missed by conventional intermittent BP monitoring. The Finometer’s ability to detect haemodynamic changes as they occur, and the potential for their early detection and treatment, may add extra safety during anaesthesia. Further studies are required to explore this potential.

Table 1. Results of Bland-Altman analysis Conclusion(s): Our data show that PRV derived from non-invasive blood pressure waveforms obtained with the Nexfin corresponds well with traditional HRV derived from ECG. These results indicate that under standard conditions blood pressure waveforms may replace HRV in the evaluation of autonomic function and that the use of PRV in the perioperative setting should be further evaluated.

Conclusion(s): There was no trend towards improved accuracy over time. | conclude that using weighing scales to measure drug dose involves insur- mountable sources of inaccuracy. Reference: 1 Read M. A system for automated real-time capture of drug administration data. Eur J Anaesthesiol 2004; 21: A101, p 25. Results and Discussion: Results are shown in Table 1.

Materials and Methods: Syringe labels incorporated radio frequency “RFID” tags. Having remotely identified drug, concentration, syringe size from the unique RFID code, the length of the syringe was measured via moving laser beam. The dose given was calculated from the plunger move- ment versus its (remembered) previous position. The internal microproces- sor had embedded “C” software — no “boot up” required. Drug doses and times were (i) were printed on a “till-roll” printer (ii) displayed on a screen (iii) sent via USB cable to a PC if desired (iv) “spoken” by machine to the user via speech synthesizer. Incremental doses of distilled water were ejected from 2 and 5ml syringes. The residual volume was measured using the device and mass of ejected water measured via high precision scales — resolution 0.01g (0.01 mL). Results and Discussion: The device demonstrated a high level of agree- ment with the weighing method. The mean difference between the two methods was 0.06ml with +/-1.96SD limits of +0.15 to -0.02 for the 2ml syringe and -0.06m! with +/-1.96SD limits of +0.05 to -0.18 for the Sml syringe.

Conclusion(s): When using the two AGMs, concentrations determination of isoflurane and sevoflurane were dose-dependently influenced by methane. In general, in clinic and experimental states, concentrations determinations of iso- flurane and sevoflurane were not affected by methane for their low concentra- tion range.

Conclusion(s): Technically the device worked well and would be accurate enough for clinical use. We intend to evaluate it with a wider range of syringe sizes and types followed by a clinical evaluation. It may also have potential in anaesthesia simulator systems.

Results and Discussion: Results are expressed as mean + SD, time in minutes:seconds. The concordance between both techniques was poor for onset (longer with EMG, especially for low dose blocks), but excellent for the recovery parameters. Conclusion(s): The Mustineg EMG performance is close to the MMG during neuromuscular block recovery. Reference: 1 Lin L. Aconcordance correlation coefficient to evaluate reproducibility. Biometrics 1989; 45; 255-268.

Fig.1- (a) Estimated Plasma Concentration at Rugloop | and ASYS (b) Infusior Rate administration in Simulation mode by Rugloop | and ASYS. Results and Discussion: Predicted infusion volumes and rates, estimated Cx did not differ between ASYS with the NA and Rugloop@ |, fig. 1.

Conclusion(s): In patients undergoing elective intubation in the operating the- atre, analysis of ventilation pressure profiles discriminated between tracheal and oesophageal intubation with high accuracy.

Conclusion(s): The repeatability of Mustimeg’s twitch height and TOF ratio measurements were of the same magnitude than MMG. References: 1 Jaumain M. et al. EJA 2009;26 Sup 45:31. 2 Fuchs-Buder T et al. Acta Anaesthesiol Scand 2007;51:789-808. Results and. Discussion: The results showed no statistically significant dif- ference between the repeatability coefficients of EMG compared to MMG. The final baselines were statistically different from the initial ones, but that lack of recovery did not differ between EMG and MMG.

Conclusion(s): Increasing CWD decrease ArtSt disturbances but require < higher intensity to obtain a maximal EMG response. An optimal approach for further developments might be to lower CWD and to subtract the ArtSt from the recorded EMG. Results and Discussion: Fig1: a typical result of the CWD influence on I.,.. Fig2: the influence of CWD on the ArtSt amplitude with a constant stimula- tion current. Tab1 presents the distribution of I90 for three CWD. The 3 CWD induced statistically significantly different 190 intensity (o=0.005 for all com- parisons: cwd3<cwd6<cwd9). With a CWD of 9cm, a stabilization of EMG response was no longer obtained for one patient despite a stimulation current of 80 mA.

*:p<0.05 vs supine. The comparison of SDPTG before and after upright position Results and Discussion: The b/a and c/a ratios of the SDPTG significantly increased during upright position. However, d/a and e/a ratio were not affected by upright position.

Conclusion(s): The capacity of SPI to predict patient analgesic regimen during anaesthesia is equivalent to that of MAP and HR, and is improved by taking into account volaemia and chronic anti-hypertensive treatment. Combining SPI with MAP and HR offers the best accurate prediction.

Results and Discussion: Maximum PK for ApEn analysis was 0.83 (C4), and it was 0.93 for XApEn (CZ-CP6). PK(ApEn) for FP1/FP2 was 0.72 /0.71. PK (XApEn) was below 0.8 for channel combinations involving frontal electrodes (FP1/FP2). Figure1: PK for single channel (ApEn, left) and all channel combi- nations (XApEn, right). Red dots/lines indicate 0.5<PK<0.6; yellow represents 0.6<PK<0.8 and green indicates PK20.8.

Conclusion(s): We conclude that P-ESC is useful to predict the response to verbal command during the wake-up test in scoliosis surgery.

Values are expressed as mean (+ standard deviation), TP:Total Power; LF/HF: Low/High Frequency; LF: Low Frequency; HF: High Frequency; VLF: Very Low Frequency Values are expressed as mean (+ standard deviation); RCRI: revised cardiac risk index; CE: cardiac event; ICU: intensive care unit HRV of group No CE vs. group CE

Results and Discussion: The value of this index, which measures the activ- ity of the cerebral cortex, falls due to many reasons. At prompt, one cannot ascertain with certainty what is the causative agent; however, it may suggest Materials and Methods: The patient was a 46-yr-old male scheduled for an elective Transsphenoidal Hypophysectomy. After 3 hours of surgery, the surgeon requested the anesthesiologist to raise the mean arterial pressure (MAP) in order to check for possible hemorrhages. After 5 mg ephedrine IV, MAP rose from 70 mmHg to 160 mmHg and the BIS™ value dropped from AO to zero. All anesthetic agents were discontinued, but after 30 minutes the patient did not awaken. A computed angiotomography scan showed an acute hemorrhagic stroke and failure of the contrast dye to fill the cerebral arteries.

Incidence of cardiac events and mean ICU stay Results and Discussion: RCRI differed significantly in patients with CE: RCR 1: 2 out of 56, RCRI 2: 4 out of 92, RCRI 3: 5 out of 20, p<0.05. Mean ICU stay of patients with CE was 5.643 days. Patients without CE were not admitted tc the ICU. HRV analysis did not differ significantly: TP(no CE): 289+411*108 vs. TP(CE): 427+427*108; LF/HF(no CE): 3.243.4 vs. LF/HF(CE): 1.5+0.7; LF(nc CE): 52+135*108 vs. LF(CE): 128+135*108; HF(no CE): 48+98*108 vs. HF(nc CE): 13384167*10%; VLF(no CE): 146+286*108 vs. VLF(CE): 164+289*1 08.

Results and Discussion: Normal value range of DO, lies within 480-800 ml/ min/m?. So we have to draw two parabolas corresponding to these values on the chart. These lines divide the chart into three zones: left — hypoxia, central — normal oxygen delivery and right — hyperoxia. Each time the location of the new point on the chart will demonstrate the system oxygen delivery state.

STEER SiR ares esr ees Mee OR ehteaieiae ae a ie. ae Results and Discussion: For | mean, systolic and diastolic BP. bias and per- centage error of CNAP compared to IBP were: mean BP (bias -3,5mmHg, PE = 28,9%, fig. 1a) systolic BP (bias 4,0mmHg, PE = 30,8%) and diastolic BP (bias -5,0mmHg, PE = 33,0%). Lowest bias (-2,2mmHg) and highest PE (40%) were observed comparing NBP with IBP (fig. 1b).

JO ee eee ee ee Se er ee ee ee le le Results and Discussion: The lowest mean values for BIS, SE and RE were recorded at LOC with all three anaesthetic agents but the inter-individual varia- tion was extensive. BIS and Entropy performed poorly in detecting the transition from consciousness to unconsciousness. Conclusion(s): BIS and Entropy were not able to differentiate consciousness from unconsciousness during stepwise increasing concentrations of dexme- detomidine, propofol and sevoflurane anaesthesia. PK values (standard error) of BIS, SE and RE

Mean (SD) MBP and SV during induction of anaesthesia Conclusion(s): Significant and often prolonged decreases in blood pressure and stroke volume are encountered during routine induction of anaesthesia. Heart rate and total peripheral resistance remain stable. Further studies are required to evaluate whether extra information about haemodynamic changes, as assessed by Finometry, have an impact on clinical management of haemo- dynamics during anaesthesia.

Conclusion(s): We do not recommend the use of the CNAP monitor for con- tinuous blood pressure monitoring, although in the future is likely to be a “must have” in the critical care unit or the operating room. ee ee Results and Discussion: 614 pairs of measurements were recorded from 2¢ patients (in one patient 44 pairs were recorded). Bias (nean + SD of the difference and precision (mean + SD of absolute difference) are shown in table 1. Bland-Altmar plots are shown in figure 1. The CNAP monitor trends to underestimate systolic blooc pressure in the lower blood pressure range and to overestimate it in its high range. The tendency is the contrary regarding heart rate, mean and diastolic blood pressure.

rSO2 measurement during first and second EDAS surgery

N1: non-operation site during first EDAS, O1:operation site during first EDAS, O02: operation site during second EDAS, N2: non-operation site during second EDAS

Statistical analysis of esCCO, CCO vs ICO Conclusion(s): The present study shows that esCCO is a good alternative of pul- monary artery catheter to estimate CO. However, recalibration of esCCO will be mandatory while the peripheral vascular tone could be affected, such as after CPB.

Conclusion(s): Indexed LIDCO measurements of SV correlates well with echocardiography for LVF assessment. We suggest that ind-SV after fluid opti- mization could be used for assessment of LVF in the perioperative period.

aN Se a a ee ee EE ee aS ae ee and were randomly assigned to receive either balanced xenon or sevoflurane anaesthe- sia with remifentanil titrated to clinical needs. BIS monitoring was blinded to the perform- ing anaesthetist and values were continuously assessed by accessory study personnel. Results and Discussion: 30 patients were enrolled in each group, comparable in respect to age, gender, height, ASA status, baseline systolic blood pressure anc baseline heart rate. BIS values during induction and maintenance of xenon anaesthe- sia correlated well with the value range recommended for deep hypnosis and with val- ues obtained during sevoflurane anaesthesia.Bispectral Index monitoring thoroughly indicated an adequate level of hypnosis during balanced xenon anaesthesia guidec according to clinical parameters. Controversial results obtained from former studies [2] indicating unpredictable influences of xenon on the BIS were not confirmed.

Pk of distinguishing consciousness from unconsciousness for PeEn (beta-lband) and PeEn (0-30Hz) Results and Discussion: Table 1 shows the Pk values. Materials and Methods: EEG was recorded during 2 studies with (i) 15 volun- teers undergoing propofol (study 1) and (ii) 15 volunteers undergoing propofol and propofol-remifentanil (study 2) anaesthesia at stable levels “awake” and “general anaesthesia”. PeEn was calculated all sequences for frequency ranges 0.5-7.5Hz (8, 8); 12-30Hz (B) and O-30Hz. Pk values were calculated for sepa- rating consciousness from unconsciousness. Conclusion(s): Analyzing only B activity seems to be beneficial for some data sets. If 6 and @ bands are included in analysis, their activation with increasing anaesthetic level may disturb the result. PeEn tends to remain stable or increase slightly if it is used on these low frequency bands while it decreases in the B range and on the 0-30Hz band. The next step is to test, if a combination of overall PeEn (O-30Hz) and PeEn calculated over selected frequency ranges will result in a better performance for distinguishing con- sciousness from unconsciousness than only PeEn calculated over a wider frequency range. SAP6-7

Conclusion(s): During sevoflurane anaesthesia, both EEG and EMG arousals are frequently seen. Beta and delta arousal have opposite effects on the Entropy values. EMG arousal is abolished by rocuronium at TOF level 0/4. All anesthe- siologists using these monitors should be familiar with the effects of EMG and EEG arousal patterns and understand why they may cause misleading values.

Conclusion(s): This study shows that CVI and HR events occur together at about twice the rate expected by random chance. However, only 40% of HR events or 20% of CVI events are coincident with each other. This suggests that even though increased CVI and HR are correlated, there are many times when we would expect cortical or autonomic responses to occur without the other. Results and Discussion: We identified 185 CVI events and 88 HR events from 7342 minutes of intraoperative data. 36 (41%) HR events coincided with a CVI event (Table 1). The expected probability of at least one CVI event occurring within five minutes of a HR event is 0.22. Using a binomial test, we ruled out the probability that 36 coincident HR and CVI events were observed by random chance (p = 0.0003).

Figure 1. Correlation between RBC laboratory (Hb Lab) and the spectrophotometry haemoglobin measurement (SpHb) Results and Discussion: 20 patients subjected to an urologic surgery proce- dure with hemorrhagic risk are included. 54 couples of measures are realized. The correlation between laboratory and the spectrophotometry values is 0.88. The bias is 0,26 with a standard deviation of 1,11 on Bland and Altman test.

Tablet. Distribution of 110 and I90 - Cathode Distal (A) - cathode Proximal (B)

Fig1. Current Polarity Influence Fig1. ISED Influence

Tablet. Distribution of T1 on Artefact and on Corrected EMG Results and Discussion: Fig 1: Monitor responses recorded before and during NMB (at 50mA). Fig 2: relationship between the EMG amplitude at time T1 (Fig1) and the stimulation current. During NMB, the artefact grows with the stimulation intensity. Subtracting the artefact from the raw EMG measured before NMB dem- onstrates a stable supramaximal muscular response. Tab1 shows the distribution of the amplitude of artefact and corrected EMG at T1 for a 70mA stimulation.

Daca cts Figure 2. Steady-state detection results for one patient outside the training set. From top to bottom: drug's effect-site concentration targets and arithmetic rule DIF; filtered BIS, filtered mean blood pressure and filtered ECG heart rate with the input steady-state periods overlapping; combined measure of output steady-state. Results and Discussion: 22 patients, 12 men, 55.9+13.0 years, 69.3413.4kg and 164.346.9cm. Fig. 2 presents the results for one patient outside the training set, with the inputs SS detection followed by the filtered signals (BIS, ECG heart rate and blood pressure) and combined measure of SS. The performance of the method was visually evaluated, with the results indicating an adequate detection of the SS periods. We also observe that SS in the inputs is not always followed by SS in the output signal [4], this may be the result of external interferences not only related to the input drugs.

Figure 1. Diagram presenting the algorithm steps: the patient is the system, with propofol and remifentanil drugs effect-site concentrations (Cc) as inputs, and mean blood pressure (MBP), ECG heart rate (HR) and BIS as measurable outputs. On top we have the steady- state detection arithmetic rule for the inputs, and on bottom we have the wavelet based algorithm summary to determine the combined steady-state index. Materials and Methods: Data collected every 5 s (Rugloopll) during 22 urologi- cal procedures under TCI of propofol and remifentanil (Gchnider [1] and Minto’s [2] PkPd models). Data from 5 patients used to extract periods of SS by visual analysis, and tuning parameters for the wavelet detector [4]. The tuned algorithm was applied to all patients. Drugs SS periods were identified by an arithmetic rule. Fig. 1 summa- rizes the algorithm. The SS index varies from O (non-SS) to 1 (SS), with smoothing period of 15s. MATLAB R2007a was used for signal analysis.(Data: Mean+SD)

*: p<0.05 TZEPvsTbaseline; $:p<0.05 TPEP5vsTZEP; U:p<0.05 cardiac vs control eR NEI Gate ARERR DAA PN Rea TRS SALT LORI SEEMS SS | LEARNER ECE YET Eas RUE CE RTI Department of Anaesthesiology, Toho University, School of Medicine, Tokyo, Japan Background and Goal of Study: Heart rhythm disturbances are common symptoms for several heart disorders. One of the most effective used exami-

Conclusion(s): Nexfin® monitoring can be useful under conditions continuous BP measurement is mandatory and an invasive technique is not necessarily indicated such as C-sections, medium or minimal surgery performed on geriatric patients or ENT surgery requiring hypotension. However, it will not replace the golden standard in all conditions since the measurements cannot considered as fully exchangeable. References:

Conclusion(s): To sum up, CECG recording by contactless, capacitively cou- pled electrodes integrated into a chair, is a convenient screening method for heart rhythm disturbances. It can be realized economically without more efforts for patient or doctor. Results and Discussion: Data of thirty patients, mostly without any heart dis- orders, were collected during our study. Due to the easy and quick application of the cECG system, the feedback of the examined patients and the medical staff was consistently positive. The recorded CECG signals show a good cor- relation to the simultaneously recorded second lead of ECG. Data recorded in supine position contained less motion artefacts, especial less breathing arti- facts. Nevertheless, recorded cECG data in a sitting position had a sufficient quality. Reducing the artefacts, which are caused by moving and breathing of the patient and interferences of the electromagnetic environment, could be reached by improving the signal filtering and using triax cables.

Conclusion(s): In patients undergoing triple-H-therapy and needing extensive vasoactive support, CO values obtained by arterial waveform analysis using 3rd generation software showed good agreement with intermittent transpulmonary thermodilution CO measurements. Rafaranra: pressure of 100+11mmHg and a systemic vascular resistance index of 17884447. 1dynesecm® em”. Eighty-four CO-data pairs were analyzed. Transpulmonary thermodilution CO ranged from 5.30to014.28lemin (mean 8.45+2.05lemin') and FloTrac/VigileoTM-CO ranged from 5.1to13.7lemin" (mean 7.37+1.84lemin'). Bias and precision (1.96 SD of the bias) were 1.07lemin' and 2.32lemin", resulting in an overall percentage error of 27.5%.

Results and Discussion: Regional myocardial function was significantly (p< 0.05) reduced during all graded occlusions. Vmax was reduced from 0.81 (0.71;0.92) cm/s at baseline to 0.64 (0.45;0.77) cm/s during 75% LIMA-flow and was further decreased at 50% (0.34 (0.22;0.72) cm/s) and 25% (0.24 (0.11;0.39) cm/s ), (fig. 1A). No changes were seen in the LCx region. Invasive hemodynamic measurements were insensitive to detect low and moderate cor- onary flow reduction, although a small but significant decrease in LVP occurred at 25% LIMA-flow (P<0.05) (fig. 1B).

Results and Discussion: A total of 195 pairs of CO measures from 25 patients were analysed. Bias was 0.3 litre min! (95% Cl +2.9), precision was 1.1+1 litre min’ and percentage error was 59%. 113 pairs of measures excluding the clamping and declamping periods were also analysed. Bias was 0.2 litre min (95% Cl £2.5), precision was 1+0.9 litre min’’ and percentage of error was 51%. 23 pairs of CO measures were collected before and after aortic clamp- ing and declamping. Aortic clamping induced a decrease of CO_,, (-11.3%) and an increase of CO, (+21.7%). Aortic declamping produced a decrease of CO. (-23.4%) whereas CO,,,. measurements showed no variation during the same period. A high correlation between blood pressure changes and CO,,, was observed.

Conclusion(s): Patients suffering morbidity following both types of surgical inter- vention had mean AT values which stratify them as high risk (<1 1mlO,/kg/min). This patient group also had higher mean VE/VCO, values which consolidates results of previous work suggesting this maybe a good predictor of adverse outcome. Despite small patient numbers, consistency of our results with previous work rein- forces CPET parameters currently used to assess risk. Our results for EVAR surgery provide an invaluable addition to sparse literature available for these patients.

Procedural Characterisctics LE=Logistic EuroSCORE; AoD=Aortic diameter (mm); PVA=Preoperative valvular area(cm2); Pre=Preoperative peak gradient; Pos=Postoperative peak gradient; Time=Procedure time (h); Stay=Hospital stay (d)

Table 1. CPET results Conclusion(s): In this series TTE does not accurately identify LVI in high risk patients. The sensitivity of the test is low which is consistent with the findings of Kleber. For accurate risk stratification of patients undergoing high risk surgery, we recommend dynamic non-invasive testing rather than TTE.

Conclusion(s): In contrast to our hypothesis ANH did not increase EPO more than in the C group and has no cardioprotective effects. There was no correla- tion between increase in EPO and cTnl. Further studies in off pump surgery are needed to elucidate if CPB induces EPO production.

Postoperative data Data are expressed as mean + SD.

a a I a Results and Discussion: Overall, fluid loading induced a decrease in SWextra (1445% vs 1042%, p<0.01) and in SVWVstd (27£10% vs 24+10%, p<0.05). Fluid responsiveness was observed in 21 out of 56 boluses. SVVextra was higher in responders than in non-responders (19+5% vs 12+3%, p<0.05) while SVVstd (29£7% vs 27£11%, p=0.4), was not different. ROC curve analysis showed that SWextra is an accurate predictor of fluid responsiveness (sensitivity = 86%, specificity = 85%, best cut-off value = 14%, area under the curve=0.892+0.052) while SVVstd was not (area under the curve=0.596+0.077). Se NSRP eR Seer aE RRORUSe eae Men? SvmR eee es see

FCD is given as mean + SD; MFI is given as mean (95% Cl of mean) Microcirculatory parameters in age groups Conclusion(s): Our study confirmed that the basic microcirculatory param- eters such as FCD and MFI decrease as age increases, with the higher percent of changes occurring after the age of 70 years.Age should be taken as an important factor in microcirculatory studies and clinical trails focusing on the human circulation.

Figure 1: Typical morphology of primary pig heart cells cultured in-vitro (left). Effects of IL-1. On cell proliferation (right). Bar, * P<0.05 vs. control. MOreOVver, Cell Pronreraulon Was Measured VY EMpPlOylng COIOMMEUWIC VITO assays, Results and Discussion: Pig heart cells express receptors for IL-1B and appli cation of 1-100ng/ml IL-1 resulted in a dose-dependent increase of cell prolifera: tion (P<0.05 vs. control at 24h and 100ng/ml IL-1B). MMP-2 gene expression anc MMP-2 enzymatic activity were increased by 10 and 100ng/ml IL-1. Statistical significant differences were however only observed with concentrations o 100ng/ml IL-1B (P<0.05 vs. control; 3h stimulation for PCR, 24h stimulation fo zymography). No significant effects of IL-1B were detected on the expression o MMP-9. RT-PCR studies showed that stimulation with 100ng/ml IL-1B caused ar enhanced expression of the tissue inhibitor of MMPs (TIMP-2; P<0.05 vs. control 100ng/ml IL-1B, 3h stimulation), an observation that might be interpreted as < protective mechanism to avoid excessive matrix remodelling by MMPs.

rate is substantially reduced, and indicates that increased heart rate should be avoided during therapeutic hypothermia.

Abstract 4AP5-10 Variation of hemoglobin and CO during the hemodilution Table 1. CO: cardiac output. Data expressed as mean + standard desviation.

Effect of varying the fraction of inspired oxygen (FiO2) during progressive haemorrhage. H: hemodilution.

Conclusion(s): Whilst redistribution of blood flow may occur during circula- tory failure (vasoconstriction of lesser vital organs), impairement of microcir- culation and tissue hypoperfusion indicators are of particular importance. Both hypovolemia and intravascular volume expansion are associated with significant modifications in the dynamic recovery slope of StO2.

Figure2. Kaplan-Meier Survival Analysis of Patients with normal and elevated Postoperative Troponin I. Results and Discussion: Findings: Of 378 patients, who underwent major head and neck cancer surgery, 57 patients (15%) developed an elevated Tnl; 90% of which occurred within the first 24 hours after surgery. Pre-existing renal insufficiency (unadjusted OR [OR]: 4.60, 95% Cl 1.53-13.82), coronary artery disease (OR: 2.33, 95% Cl 1.21-4.50), peripheral vascular disease (OR: 2.83, 95%Cl 1.31-6.14), hypertension (OR: 2.22, 95% Cl 1.20-4.12), and previous combined chemotherapy and radiation (OR: 2.68, 95% Cl 1.04-6.91) were asso- ciated with elevated postoperative TnI. Patients with elevated Tnl had a signifi- cantly longer length of stay in the hospital (8.5 vs. 10.1 days; p= 0.014) and ICU (8 vs. 4.5 days; p= 0.001) and an 8-fold increased risk of death at 60 days after surgery (OR 7.62; 95% Cl 1.98 — 29.31). At one year, patients with an abnormal postoperative Tnl were twice as likely to die (OR 1.93; 95% Cl 1.02 — 3.63).

tet tt rear Results and Discussion: There was minimal change in BP, but a significant fall in TPR (p = <0.001 repeated values ANOVA), which was compensated for by an increase in SV (p=<0.001). There was considerable interpersonal variation in the response to salbutamol both in terms of magnitude of effect and duration of action. The vascular stiffness parameters measured by the pulse plethysmo- graph were poorly correlated with these changes. Conclusion(s): There were significant hemodynamic changes associated with this technique of endothelial function testing which would not have been evident using either routine BP measurement or PPG. Whilst these changes are well toler- ated in healthy volunteers, the impact of up to a 20% fall in TPR must be consid- ered if endothelial testing is to be used clinically. Further studies to characterise the hemodynamic effects of endothelial testing in patient populations are warranted. [a ee

Mean (SD) of maximum changes in SBP and the corresponding SV and TPR values Conclusion(s): Interpatient variability in haemodynamic responses to haemo- dialysis, along with significant haemodynamic changes that occur during the course of routine haemodialysis, may urge the need for conducting further stud- ies to justify the regular use of Finometry in the haemodialysis setting, which might provide safer haemodynamic practice, through early diagnosis and treat- ment of haemodynamic mishaps.

Mean maximal change in vascular stiffness indices with study agents. Conclusion(s): This study gives the baseline characteristics and time course of the change in the values of SI and RI in healthy volunteers. The data will serve as a benchmark for sample size calculations in future patient based studies.

Results and Discussion: We observed 53 responders (increase in SVL, >15%) after PLR and 39 non-responders (increase in SVI,,,,.<15%). CVP showed no sig- nificant correlation with ASVL.,., (r=-0.06, p=0.58), in contrast to PPV (r=0.71, p<0.0001), GEDVI (r=-0.54, p<0.0001) and AVTI,., (r=0.54, p<0.0001). The best area under the ROC curve was found for PPV (AUC: 0.82, p<0.0001), followed by AVTI Vor /Sub|(AUC: 0.74, p<0.0001) and GEDVI (AUC: 0.71, p=0.0006), whereas CVP was not able to reliably predict fluid responsiveness (AUC: 0.58, p=0.18). ROC analysis yielded threshold values of PPV >11%, GEDVI <725 mlemin'em? and AVTI,,,,,>4.5% to discriminate between responders and non-responders. Conclusion(s): AVTI,,, and GEDVI reliably predicted fluid responsiveness under closed chest conditions. References:

Conclusion(s): Despite the good predictive value of PPV using the ROC curve analysis, more recent statistical tools suggest that about 40 % of PPV values are Results and Discussion: Overall, 145 (65 %) patients were responders. A PPV value>11% was able to predict fluid responsiveness with a sensitivity of 85% and a specificity of 84%. Area under the ROC curve was 0.88+0.02. However, the gray zone thresholds for PPV were 5% (g,,.,) and 15% Q,,) and 91 patients (41%) were inside the gray zone (Figure).

Comparison with basic measurment **p<0.001 Results and Discussion: The CO alterations during time period A and B are shown in Figure 1 and Table 1. The effects of different PEEP levels during time period A are simi- lar as described in the literature. During time period B, incremental increase of PEEP enhanced CO, which was tremendously reduced after the ventilator disconnection.

Abstract 4AP8 — Relationship between clamping blood pressure in patients with PC and in patients with PCVD.

NSS* non statistical significant, SBP systolic blood pressure “Abraha et al. Thoracic stent graft versus surgery for thoracic aneurysm. Cochrane Database of Systematic Reviews, Issue 3, 2009.

N=10, * P<0.05 compared with IR group Table 1. Comparison of lung tissue MPO activities and protein levels, PMN%, and cell numbers in BALF between groups

Nitrite in plasma from central vein and radial artery after OLV or TLV in patients undergoing thoracoabdominal oesophagectomy (Rank Sum Test).

Conclusion(s): As OLV does not affect pulmonary vascular tone more than TLV it should remain standard of care during oesophagectomy since it improves surgical exposure.

Results and Discussion: Oxygenation was significantly lower in the KET/XYL than in the SEVO and PRO groups. A trend to improved Oxygenation was found in SEVO as compared to PRO groups. Wet/Dry (W/D) ratio did not differ signifi- cantly among groups. MPO was lower in PRO and SEVO groups, although the difference did not reach statistical significance.

Patient characteristics and comparison of PC and VC with constant flow settings during surgery Data are presented as whole numbers or meanststandard deviation, * indicates statistically significant differences between groups (p<0.05)

Respiratory parameters during both periods (n=82) Conclusion(s): During OLV, PEP does not maintain oxygenation when V, is reduced. Lowering Vt might be efficient in reducing lung injury but the use o' such protocol may require the acceptance of possibly lower PaO, and alveolar ventilation. Results and Discussion: ]V, = tidal volume, RR = respiratory rate, Pplateau = end inspiratory plateau pressure, PEEP = positive end expiratory pressure, Pmean = mean alveolar pressure, Pe,CO, = end tidal CO,, PaCO, = arterial carbon dioxide tension, PaO, = arterial oxygen tension, SAP=Systolic arterial pressure. HR = Hear Rate. The PaO,/FiO, ratio significantly decreased during low Vt ventilation (mean difference = -18.8; 95% IC [-34.0 to -3.5], P=0.02). Any significant increase of intrinsic PEEP has been observed between both groups.

Conclusion(s): The present data validate our formula with sufficient accuracy to be used in critical care settings. Future work will assess the usefulness of the formula. eee eee eee ees ee ee ee eee en nn ee eee ne eee ee se mene neem ene FN SON DE PN NIN DSDNA Results and Discussion: The mean (SD) change in FO, was 0.2 (0.04) in those which increased and -0.13 (0.04) in those which decreased. We derived a for- mula that combined ease of use and acceptable accuracy: _.,PaO, =k x ,.,,FO. ew 1-2 X ygPaO, / ygF|O, where k = 1 - (\4F'O, — jew jO,) / 2 Limits of agreement (LA,,.,) between predicted and measured size of change for PaO, were -2.86 -2.46 (bias: -0.2) kPa. Predicted vs. measured magnitude of change in PaO, are shown in the figure. The new formula is acceptably accurate and consistent in predicting the change in PaO, in response to FO, adjustment in mechanically ventilated patients. Its simplicity may allow its regular use in the critical care setting.

Conclusion(s): Desflurane at 1.5 MAC increased Rrs due to a significant increase of airway resistance (Rmin). A possible favourable effect on the com- ponent of resistance attributed to tissue viscoelastic properties and alveolar time-constant inequality was suggested (DRrs).

Materials and Methods: After local Ethics committee approval, 74 morbid obese (body mass index (BMI) > 40 kg.nv) patients undergoing LGB were included. Anaesthesia was standardized. Intraoperative desaturation was defined as arterial oxygen saturation (SaO,) < 90% during at least 5 minutes. Characteristics of the pop- ulation, sleep studies, respiratory function test, arterial blood gases were registered in each patient. Results are presented as mean + SD. Differences between desaturation (DESAT) group or not (not DESAT) were analyzed by Chi-square and Fisher tests for the qualitative variables and by Wilcoxon test for quantitative variables. P<0.05 con- sidered as significant ("). A step-by-step logistic regression (Wald test) was performed to determine the predictive risk factors of intraoperative desaturation.

Conclusion(s): High-degree airway obstruction will severly reduce lung pres- sure amplitude AP. It is unclear whether increases of inspiratory pressure will improve ventilation or will further increase intrinsic PEEP. a late alienate iets irae eterna) tliat ienticlietiont:~ jet! Mk ei fal Results and Discussion: High-degree airway obstruction resulted in reduction Of P..., from 14.0 cmH,O to 8.6 cm H,O (-37%), while PEEP reached 67% of maximal lung pressure (Fig. 1). The pressure amplitude AP decreased from 14.0 cm H,O to 2.83 cm H,O (-79.8 %). Such changes of AP may be associated with highly reduced tidal volumes and may indicate inefficient ventilation.Figure 1: Reduction of peak lung pressures (P.o24 obstruction Generation of intrinsic PEEP, and reduction of pressure amplitude AP

Results and Discussion: |n all patients (n=14) EIT measurements were suc- cessfully performed. Belt position was higher than usual: ICR 4 in 7, ICR 3 in 3 and ICR 2 in 4 cases. In 2 cases there were problems with skin contact of one dorsal electrode, but all images were valid. EIT measurement cannot be facilitated during electrical cautery for reasons of patient safety. Thus, we unplugged the belt from the device and measured EIT when no cautery was done. No patient experienced burns or other skin lesions after wearing the belt for several hours. Tidal volume distribution shifted significantly after intubation towards ventral areas, indicated by a decrease of global impedance change in dorsal regions from 0.42 to 0.27 (p<0.05, Figure 1). However, after extubation, this effect was reversed and tidal volume distribution returned to the pattern before intubation (0.41, p>0.05). Conclusion(s): Intraoperative EIT measurement is safe and feasible during upper abdominal surgery.

Oxidative stress markers in exhaled water after lung reexpansion Conclusion(s): Collapsed lung during the surgery and the next reexpansion of operated lung after lobectomy causes oxidative stress. Remote preconditioning by ischemia-reperfusion protects against lung oxidative damage during lung lobectomy.

(a) P< 0.05 in A vs. B; (b) P< 0.05 in B vs. C; (c) P< 0.05 in Avs. C Oxidative stress markers in blood after lung reexpansion during lung lobectomy Conclusion(s): Reexpansion of the operated lung after lobectomy causes oxi- dative stress with FiO, 0.35 and anaesthesia with thiopental and sevoflurane. However, FiO, 0.80 plus Propofol protects against lung oxidative damage dur. ing lung lobectomy.

Patient characteristics CAD = coronary artery disease; ESS = Epworth Sleepiness Scale (score >10 pathologic); BQ 2-3 = Berlin Questionnaire with 2-3 categories (out of 3) positive, indicating high risk of OSA

Conclusion(s): The change from aprotinin to tranexamic acid was not associ- ated with a change in mortality or morbidity, nor with a change in transfusion requirements.

* p<0.05 Results and Discussion: Demographic and surgical characteristics were no different between groups.

* p<0.05 Results and Discussion: Demographic and surgical characteristics did not differ between groups except for a lower incidence of female sex and cyanotic diseases in the T group. Conclusion(s): In our population, the switch from A to T had no negative effects on transfusion requirements and postoperative morbidity and mortality.

Results and Discussion: Patients who bled >1L had lower FIX-XI, platelets and longer aPTT compared to those who bled <1L, with lower ETP, peak and rate of TG. ROC analysis shows post-operative aPTT and rate of TG were potentially most useful for predicting bleeding. Pre-operative ETP and TG rate were lower in those who bled >1L (P<0.03) despite being in normal range. ROC analysis AUC (95%Cl): ETP 0.68 (0.54-0.82) P=0.03, rate 0.76 (0.62-0.89) P=0.004. No other pre-operative tests predicted post-operative bleeding. Conclusion(s): Pre and post-operative TG assay and post-operative aPTT are potentially useful for predicting bleeding in the first 24h after CPB surgery.

Results and Discussion: Standard INR (sINR) ranged from 1.08 to 3.43 (median 1.29) and INR of i-Stat (INR) from 1.02 to 2.29 (median 1.27) with a Spearman correlation of r=0.85 (p<0.001). Figure 1: Comparison of sINR and iINR values; r=0.853 (p<0.001). Figure 2: Bland-Altman-Plot of sINR and ilINR (bias=0.10; 1.96SD=0.40). While INR values were reported from the standard laboratory 53.8 min (413.4) after blood sampling, i-Stat results were available after 5.5 min (42.6). The overall correlation between sINR and ilINR values was good. The two upper most outliers in the Bland-Altman-Plot had extreme low Quick values of 21 and 31%, representing a severe coagulopathy. Conclusion(s): For INR values < 1.62 (Quick values > 35%), the i-Stat device with PT/INR cartridge represents a fast and reliable alternative to the standard laboratory PT/INR testing.

t-test; Chi square test, p<0.05 was considered statistically significant Conclusion(s): Massive blood transfusion and PRS is associated with primary graft non-function after OLT.

Coagulation parameters before and after PCC administration

Results and Discussion: None of the patients in group A suffered massive bleeding (median blood loss 5774381 ml). The FFP dose transfused in group A patients was 10 ml/kg. Both groups had normal intraoperative and postopera- tive PT, PTT and INR. Group A patients suffered significantly higher (o=0,00029 postoperative blood loss compared to group B patients. One patient in grou A developed postoperative haemodynamic instability possibly associated with the FFP transfusion. Conclusion(s): The clinical impression of increased bleeding tendency was not confirmed by abnormal values of PT, PTT and INR and may require further testing. FFP transfusion did not have a beneficial effect on blood loss or clotting profile postoperatively. Therefore anaesthetic and surgical clinical practice must comply with the indications of FFP transfusion in the intraoperative period.

ANOVA -PEARSON CORRELATION- Conclusion(s): With the limitations of size sample, absence of a control sam- ple, and initial functional iron deficiency in all patients selected we can say that none of the analyzed parameters allows us to predict response to our combina- tion therapeutic.

Results and Discussion: In the study there is 60% of positive response (increase haemoglobin in 1,5 gr.di") after this treatment. None of the variables analyzed showed positive correlation-r to the treatment response. However the three variables have been chosen with greater partnership, were analyzed by the ROC curves to observe the sensitivity and specifity of test used as predictors of treatment response. Observing that, none of them would be valid as a single test and no differences between them to suspect that with larger sample could be. We can also say that there is a statistical trend (r=0,45, p=0,06) between sTfR increased and hemoglobin increased during the preoperative period with the estimated treatment.

Results and Discussion: 2449 pts from 23 centres were included (median 100, range 50-202 per centre). Mean age was 66, 61% were women and 51% were hip surgeries. There were no bilateral surgeries, and 9% were revisions. Blood sparing techniques were used in 4%. Pre-op Hb was determined <7 days pre-op in 37% of pts, 8-21 days pre-op in 33%, and >21 days pre-op in 30%. Mean pre-op Hb was 13.9 g/dl (range of mean Hb per centre 13.4 — 14.3). Hb was <13q/dl in 24% of patients. 17% of pts were transfused (range per centre 2-53%). Timing of transfusions: day of surgery: 16%, post-op day 1: 16%, day 2-4: 40%, day 5+: 28%. Mean decrease in Hb from pre-op to last measured was 3.2 g/dl (range per centre 2-4.5). Mean pre-transfusion Hb was 8.2 g/ dl (range per centre 7.1-9.3). Figure 1 shows the variability in blood loss and transfusion rates. Note: blood loss could not be calculated where volume of transfusions was not known.

“All values are reported 45 mean (standard deviation), except Ferritin expressed os median aud Interquartit rang Cite: Reticatocyte hae meglobin coment, rT: soleble transferrin receptor. Table 1. Haemoglobin, reticulocytes and iron parameters*

Conclusion(s): Severe AT deficiency is associated with increased risk of DIC in patients with SIRS. INR in comparison with AT has a higher prognostic value in SIRS patients.

Conclusion(s): Aspirin is underused in our surgical population with interme- diate or high thrombotic risk. No statistical significant differences were found related to in-hospital cardiac events. Attention is needed on restarting chronic aspirin therapy in the postoperative period.

Variables, predicting outcome at the 30th day

Conclusion(s): This preliminary study implied that the pro-aggregatory effect of dexmedetomidine might be taken into consideration when using the drug on high-risk patients. Further studies on mechanisms of dexmedetomidine- enhanced platelet aggregation and activation have being undertaken. Results and Discussion: Low concentration of ADP (5uM) could induce plate- lets to form loose aggregates. Dexmedetomidine at concentration between 1-5 ng/ml had minimal effect on the aggregation. Nonetheless, higher concentration of dexmedetomidine (60 and 500 ng/ml) could potentiate ADP-induced loose platelet aggregation to form the firm aggregates. Around plasma concentration of clinical effects (1 — 5 ng/ml), we first demonstrated that dexmedetomidine may increase P-selectin expression induced by ADP. At high concentration of 50 and 500 ng/ml, dexmedetomidine may increase P-selectin expression to the extent of 3 — 5 times when compared with that induced by ADP alone.

*P < 0.05 compared to controls (Mann-Whitner U test), data from triplicate experiments presented as mean + SD Results and Discussion: Investigation of glycine transporter expression con- firmed a predominant expression of GlyT1 in rat astrocytes, while GlyT2 was barely detectable. Uptake of glycine was strongly inhibited by pretreatment with ALX5407 (200 nM), sarcosine (1 mM) and glycine (10 mM), while ALX1393 (200 nM) had no effect. The lidocaine metabolites MGEX, GX and EG significantly reduced glycine uptake while lidocaine reduced glycine uptake only at toxic concentrations (Fig. 1).

Oxygen content and glucose concentration in radial artery and right internal jugular vein bulbus *p<0,05 compared to previous stage; #p<0,05 compared to the second stage

Results and Discussion: A significant increase (*) of extravasation of FITC- albumin could be demonstrated using an apparent fluorescence index comparing intra and extra vascular brightness of fluorescence (Mann-Whitney U, P<0,001). Boxplots are given with a median and 25%/75% percentile. A significant increase of IL-4, -6, KC and TNF could be demonstrated in LPS treated animals. Conclusion(s): Severe sepsis like syndrome could be induced by systemic LPS administration. Neuroinflammation shown as septic encephalopathy involves disruption of the BBB and cerebral oedema formation. For the first time the direct effect of LPS induced sepsis like syndrome on the pial vessels could be shown in vivo by using fluorescence IVM. An increase in the number of adherinc leukocytes to the endothelium could be shown as a secondary effect. The BBE and the sepsis related inflammatory response is elucidated as an importan target for the development of new therapeutic strategies. This finding might alsc be important for other conditions that involve breakdown of the BBB such as cardiopulmonary bypass, trauma and toxic encephalopathy.

Table 1. The changes in regional cerebral oxygen saturation (rSO2) and mean arterial pressure (MAP) Values are mean + SD. * P < 0.05 versus T1; ¢P = 0.051 versus T2; +P < 0.05 versus T2; by repeated measures of analysis of variance with Bonferroni correction.

7AP4-7 Conclusion(s): Advantage of RA over GA in carotid artery surgery is at least in a decrease of incidence of placement temporary shunt.

Results and Discussion: introduction of RA with possibility of dynamic neurolog- ical control induced 4,3% decrease of incidence of placement of temporary shunt (fig.1), without any increase of incidence of permanent neurological deficit (tab.1). Placement of temporary shunt during CE may be difficult on anatomical reason and dangerous concerning specific complications (mainly thromboembolic). So, it is reasonable to keep the incidence of shunt placement as low as possible. Introduction of RA was associated with substantial decrease of incidence of shunt placement without any increase of permanent postoperative neurological deficit.

Abstract 7ap4-9 — Vmca changes during anaesthesia with SEVO (cm/s) PISO GM MIQSVUVOIVET. HI A POUUOMOULIVNG OLUUY VI OV VAUSIILO VWILET OUNA™ rachnoid haemorrhage, 11 (13.75%) had seizures at the onset of bleeding. None had a previous history of seizures. Hunt and Hess grade >3 were sig- nificantly more frequent in patients with seizures at the onset of subarachnoid haemorrhage. The location of aneurysm was not significant for the incidence of seizures episodes. Mortality or severe disability at discharge (GOS) were more frequent in these patients, so seizures were a significant predictor of prognosis. Background and Goal of Study: There are few studies showing the influ- ence of aging on the outcome of patients after the clipping of ruptured cerebral aneurism (1). Goal of the study is to determine the influence of pre-existing

Conclusion(s): Our data show that only in our younger patients (G |) pre- existing diseases as CAD, hypertension or dysrythmia exert influence on the mortality rate after the clipping of ruptured cerebral aneurism and suggest that they could be used as predictors of outcome. However initial neurologic and Fisher grade findings can predict mortality in both groups. Therefore better con- trol of pre-existing diseases might decrease the mortality after the clipping of ruptured cerebral aneurism in younger patients. Results and Discussion: : Although the mortality rate showed no significant differ- ence between groups (G1=12.08% and G2=17.31%, p= 0.28) it was higher in G2. There was no significant statistical difference in H&H, WFNS, Fisher grade or GCS scores between groups on admission and in our patients all of them have predic- tive power on postoperative mortality in both groups (p<0.085). It is interesting that presence of co-morbidities as hypertension, CAD or dysrythmia have significant impact (p<0.05) on postoperative mortality only in the younger patients (G1).

Impact of the factors on mortality rate 7AP4-9 Differences of cerebral circulation for patients undergoing resection of brain tumours or clipping of cerebral arterial aneurysms

*ps0.05(meantsd) Conclusion(s): The value of BISmax is related to outcome of brain-injured adult patients. Based on our previous model the recovery of consciousness has been adequately predicted in 82% of this new set of patients. Differences in brain metabolism (PET) could be the anatomo-physiological basis of the differences in BIS values.

Values shown as Mean (range) The patient with GOS 4 was the one with the highest EMG in both monitors. Our previous predictive model couldn’t be validated in this brain injury aetiol- ogy. Patients PETscan images presented lower global cerebral metabolism, with higher cortical/subcortical uptake ratios than control healthy subjects. Conclusion(s): High BIS values were not predictive of consciousness recovery in anoxic patient aplying our probability model. Low AEP values could fit bet- ter with the bad outcome, although the EMG activity could be an important artefact.

*ps0.01, * ps0.001 Results and Discussion: Peroperative hypoxemic events were reverted prior to extubation. Data showed significant decrease of PaO2 in first 20 min after extubation corresponding to movement of the patients to PACU (SpO2<91% in 54pts breathing 40%O02). ABG obtained at arrival in PACU (10min after extuba- tion) showed PaO2s90 in 58 patients (18.1%). 11 patients were reintubated and mechanically ventilated. Hypothermia strongly parallels PaO2<90 in first 10 minutes. It was mostly present in long-lasting interventions (68 lasting over 3.5 hours) and after extubation for more than 10 min despite heating (p<0.05). 7.1% of patients developed insults after surgery. There was no correlation (o=0.245) between ASA and hypoxemia in our patients.

Conclusion(s): This indicates that the cerebral microcirculation and the cere- bral autoregulation remain preserved in this clinical setting. increase of the ZFP above the ICP, even after prolonged head-down position of three hours. Also, the pulsatility index and resistivity index did not increase significantly over the course of the operation.

Conclusion(s): 4D ultrasound can give a more complete visualization of bony structures, and allows for rotation of an image in real time. This may facilitate the visualization of needle tip when advancing towards the neuraxis and may give more information than 2D alone. Results and Discussion: Using the rendered volume mode, viewed initially from a lateral perspective, the needle was advanced until bony structures obscured the initial view. Using image rotation processing, the image was rotated on the x-axis; this allowed visualization of the oblique saggital window into the neuraxial structures. The needle tip could be visualized again and the needle advanced towards the neuraxis. By altering the 4D display, the volume view could be seen simultaneously with short & long axis views and the plan (overhead) view with- out moving the probe. The 4D technology allows a wide “slice” of tissue to be reconstructed in a volume mode which can convey an impression of volume and distance. Both these features enhance visualization of the needle by the opera- tor and may prove valuable in preventing overshoot of the needle towards the target; potentially an important benefit when the target is neuraxis or peripheral nerve. We have also shown that it is possible in volume mode to rotate an image of the vertebrae to better view a needle tip aimed at neuraxis.

Results and Discussion: The catheter and target were adequately seen simultaneously in all axis views. We were able to maintain the visualization of the catheter tip beside the target throughout its entire course. 4D imaging allowed us to verify the catheter location. The short axis view allowed us to confirm the catheter position lateral to the target during advancement. In a clinical setting this is important when assessing catheter migration away from the nerve. The plan view was also useful to confirm the position of the catheter in this respect. The volumetric image of this view provided additional spatial information that operators found useful. Although we think this quality of image is difficult to reproduce clinically with the current technology; clinical use would benefit from further advancement in this technique. ARNE ERT Nise eS ae NT NT me PO gg aE em Re eee Man Ni Soom Materials and Methods: A 20G catheter was placed using ultrasound guid- ance next to a target (plastic tube) in a membrane covered water bath at 4cm distance from the surface. We used an HD11 XE ultrasound machine with a V8-4 transducer (Philips Medical Systems, USA). A Tuohy needle was advanced until the needle tip was seen approaching the target in all three planes, in addition to the volumetric view. The catheter was inserted at this point. The advancing catheter was followed by moving the ultrasound probe along its length. The catheter was seen in all four views on the side of the target during advancement.

Results and Discussion: In 13 patients (3 in A and 10 in B) it was neces- sary to tilt the operating table >10 degrees to reach Th10, and these patients were excluded. Despite this Th10 analgesia was not reached in four B patients. Analgesia at Th10 was reached in 4 min (median, range 2-20) in A and in 10 min (2-25) in B, p<0.001. The sensory block remained at Th10 for 75 min, but recovery was faster in A (median 165 min) than in B (median 195 min), p<0.005. A complete bilateral motor block was observed in all A patients but only 50 % of those in the B group, p<0.001. The time to motor recovery was similar in both groups (A, median 105 min, B 90 min). None of the patients reported neurological symptoms. Conclusion(s): Intrathecal hyperbaric articaine 84 mg produced faster anal- gesia, a more intense motor block and faster sensory recovery than hyperbaric bupivacaine 7 mg plus fentanyl 10 yg. The duration of motor block was short enough for efficient ambulatory surgical activity in both groups. There were no transient neurological symptoms in either group.

Results and Discussion: A patient in group Ce was rejected, because of dural tap. In Group Ca the mean dose(SD) was 23.73(1.5)mg and in Group Ce 17.69(0.67)mg. The difference was statistically significant with P<0.001. Conclusion(s): When intrathecal anaesthesia is used for VH, namely surgical analgesia for 120 min up to the T8 level, different doses of local anaesthetic should be chosen according the bevel direction of Whitacre 26G needle. Vice versa, when different doses are compared, the bevel direction should be taken into account.

Verbal Numeric Rating Scale-Pain Assessment mean +/— standard deviation, p.0.: postoperative, max: maximum

Demographics and surgical characteristics of patients undergoing arteriovenous fistula creation with three different anesthetic techniques.

Figure Arteriovenous fistula occlusion rates 6-weeks and 3-months after surgery. Data expressed as percentage of patients GA, general anesthesia, RA, regional anesthesia, LA, local anesthesia GA, general anesthesia; RA, regional anesthesia; LA, local anesthesia; LOS, length of stay. Data expressed either as mean + SD, median [range], or number of patients (%).

Figure 722b Index of LBP concentration relative to preoperative values. T1: preoperative levels; T2: before clamping of portal triad; T3: after release of the clamping; T4: the first postoperative day. Figure 722a Index of IL-6 concentration relative to preoperative values. T1: preoperative levels; T2: before clamping of portal triad; T3: after release of the clamping; T4 the first postoperative day.

a a a a a a Results and Discussion: |I-6 levels significantly increased after release of PTC in all patients in correlation with the duration of PTC. Il-6 levels were higher in TEA group in blood samplies after PTC release. LBP levels were lower in TEA group at the end of operation. These results were not statistically signifi- cant. Increase of Il-6 level may indicate emphasised inflammatory response in patients with TEA anesthesia. Lower LBP levels in TEA group suggest better preserved gut mucosa integrity during hypoperfusion.

Infusion time: The time needed to fill the catheter with bupivacaine was 1.3 s for both infusion rates and is neglected. Table 1. Effects of bupivacaine infusion on T-wave and heart rate. Results are given as median (range). Conclusion(s): Higher doses of intravenously applied bupivacaine may cause T-wave elevation. However, it is not a reliable indicator for the early detection of an inadvertent intravascular applied local anaesthetic. With a slower injec- tion technique T-elevation can already be detected at lower bupivacaine doses administered.

Pain scores in the two groups before & after intervention (Mean (SD)) Conclusion(s): Positioning for spinal anaesthesia may cause significant pain and distress. The use of FICB significantly reduces pain scores, which may allow for improved positioning and overall patient satisfaction. Results and Discussion: Thirty-nine patients completed the study; one patient was withdrawn from the FICB group due to new onset arrhythmia. The average age of the 39 patients was 78 years. Complete FICB occurred within 10 min in 15/19 patients & in 15 min in the remaining four. Additional ketamine 10 mg was required in 7/20 patients in the sedation group. The pain scores were similar before FICB or sedation. FICB was associated with better pain control with a significantly greater improvement in pain scores (p<0.01).

Association between Cervical Epidural Pressure and Covariates

Materials and Methods: Thirty-two patients were randomly allocated to either the prone or sitting group. We measured and compared CEPs in two groups using a closed pressure measurement system under fluoroscopic guidance.

Conclusion(s): The CEP is significantly higher in the prone position than in the sitting position. Even in the sitting position, the CEP is not consistently negative. These results suggest that the hanging drop technique might not be appropriate for identifying the cervical epidural space in either the prone or sitting position. +F value shows the strength of association of body position and cervical epidural pressure by ANCOVA regression analysis.

Pain scores at rest after laparoscopic inguinal hernia repair Data = https://www.academia.edu/28010776/mean + SD — Pain scores at rest after laparoscopic inguinal hernia repair Data = mean + SD

Conclusion(s): Propofol does not affect ECG signs of early or late inadvertent intravascular administration of local anaesthetics.

Table 1: ECG alterations after injection of 0.2 ml/kg bupivacaine 0.125% + epinephrine 1:200'000 Table 2: Effects of bupivacaine infusion on T-wave and heart rate

IPB = interscalene plexus block, TIVA = total intravenous anaesthesia, NRS = numeric rating scale, * = p<0.05 Conclusion(s): IPB was successfully applied in all patients. Postoperative pain and time to discharge was lower in IPB compared to TIVA without differences in induction time. Thus, IPB for outpatient shoulder surgery may be superior compared to TIVA.

Table 1: Pain score and patient satisfaction Results and Discussion: Demographic data and duration of surgery were comparable. IPB was complete or satisfactory in all patients. Anaesthesia induction time and time to approval were comparable. A significant difference between groups was found in terms of time to PACU discharge ability (fig. 1). Postoperative pain scores were significantly higher in the TIVA group (fig. 2) without differences in patient satisfaction (IPB: 9,7+0,6 vs. TIVA: 9,7+0,5).

Conclusion(s): Results suggest relevant interactions between ketamine and remifentanil on the MAC of sevoflurane. These interactions were highly depen- dent on the dose of both drugs. Although high doses of both drugs resulted in a potentiation of the MAC reduction, interestingly, low doses of ketamine actually blocked the effect of low doses of remifentanil on the MAC. Therefore,

Conclusion(s): The results of current investigation demonstrated that NTG increased NO release in the rat brain and simultaneous administration of propo- fol or midazolam showed a biphasic effect on the NTG-induced NO release. This property might be a common property of intravenous anesthetics. Results and Discussion: Propofol, midazolam and sevoflurane anesthesia itself decreased NOx in a dose dependent manner. Systemic administration of NTG significantly increased NOx. NTG-induced NO release was enhanced by the low dose propofol (10 and 30 mg/kg) anesthesia, whereas, larger dose of propofol (100mg/kg) administration failed to increase the concentration of NOx. Midazolam anesthesia also showed the same biphasic effect. Whereas, sevo- flurane anesthesia (both 1 and 3% inhalation) showed no significant change in NO release induced by NTG.

Results and Discussion: The area under plasma concentration-time curve (AUC) values for oxycodone and its metabolites are summarized in Table 1 anc Figure 1. Although paroxetine substantially reduced the formation of CYP2DE dependent metabolite oxymorphone, it had no effect on oxycodone. Paroxetine- itraconazole pre-treatment increased the AUC of oxycodone 2.9-fold (P<0.001). However, only minor changes in opioid action were noted. The formation o' secondary metabolite noroxymorphone was ceased when both the CYP2DE and the CYP3A4 pathways were inhibited.

Conclusion(s): Dobutamin exhibits cytoprotective properties. Pre-incubtation with KNK437 abolished D mediated anti-apoptotic properties. In contrats, pre- incubation with 17-AAG does not reduce the anti-apoptotic effect of D. We therefore conclude that the cyto-potective properties of D in vitro are mediated by an induction of Hsp70.

Conclusion(s): Since the inhibition of CYP2D6 with paroxetine did not change the exposure to the oral oxycodone, Clinically relevant drug interactions with oxycodone and CYP2D6 inhibitors are unlikely. The concomitant inhibition of both CYP2D6 and CYP3A4 results in a profound increase in exposure to oral oxycodone.

Values are presented as mean + SD. *;p<0.02 compared with sham operated control mouse. t; p<0.01 compared with sham operated «7 KO mice. +; p<0.01 compared with immobilized «7 KO mice. The Effective Dose of Rocuronium 9AP2-5

Results and Discussion: ‘The dose- response ¢ curve to rocuronium was sig- nificantly shifted to right in the immobilized side of WT mice compared to the contralateral side. In contratst, no differences in EDs were observed between the immobilized and contralateral side in the «7KO mice.

Conclusion(s): By adopting this hot compressing technique, we will be able to fabricate biodegradable bupivacaine pellets for long-term drug delivery. Results and Discussion: The HPLC analysis showed that the pellets can pro: long the total effectively release period of bupivacaine from the beads by usin¢ lower anesthetic to polymer ratio (1:5). Bupivacaine pellets had slower releasec rate than lidocaine pellets during the first 5 days.

*p<0.05 compared with Control group, #p<0.05 compared with Sevoflurane group, ap<0.05 compared with Halothane Abstract 9AP2-6 — Table 1. Laboratory findings after repeated anaesthesia with inhalation anaesthetics

Conclusion(s): Administration of a single dose of 0.3 mg flumazenil to healthy unpremedicated patients at the end of sevoflurane/remifentanil anaesthesia results to earlier emergence from anaesthesia and significantly expedites recov- ery. This could redefine the role of flumazenil in general anaesthesia implicating endozepine-depended mechanisms. Data are means+ SD. * Mann-Whitney test

Table 1. Emergence and Clinical Recovery

Table 3. Neuromuscular Blocking Properties after Rocuronium (0.6 mg/kg)

Figure 15 . The linear dependence of the time to TOF70 on the diagnostic duration during neuromuscular blockade caused by rocuronium (0.6 mg/kg) in the patients with renal failure is illustrated. Adjusted: R2 = 0.79, P < 0.001. The individual data points and exponential fitted curve are shown. Values are mean + SD. TOF70: recovery to a TOF ratio of 70%.

Conclusion(s): Intravenous lidocaine does not affect the spontaneous recov- ery from cisatracurium neuromuscular block in a clinically relevant manner in this series of patients. Improved power is necessary to confirm these results. Reference: Results and Discussion: Patient demographic data, haemodynamic param- eters, end-tidal CO, pressure and nasopharyngeal temperature were similar between groups. The time to spontaneous recovery of a TOFR 2 0.9 was 101418 min in the lido group and 95+17 min in the saline group (P=0.4, stu- dent's t-test). This study had a power of 0.7 to detect a 15 min difference at an 0.05 « level.

Mean (Standard Deviation) * p< 0.001. ** p< 0.05

Values are means + standard error of the mean (SEM). tRecovery index=time between 25 and 75% recovery (min). *Significantly different (p < 0.05 level; unpaired t-test) Results and Discussion: Neither saline nor flucloxacillin infusion had any effect on twitch height. No difference in the onset and depth of vecuronium- induced NMB was observed between the two groups. Sugammadex produced a similar rapid and effective recovery in both groups (Table).

Conclusion(s): The effective dose 50 (ED50) of sugammadex required to reverse the level of neuromuscular block at a train-of-four count of four is 1.03 mg/Kg. Pharmacoeconomical cost benefit analysis should be performed. EL A EC NCAA rt UE GP ENS LB ES PR ed NE EN Bk ON Ys Results and Discussion: The results are demonstrated in Figure 1. The ED50 of sugammadex to reverse a light level of neuromuscular block was calculated as 1.03 mg/Kg with SD 0.06 mg/Kg, SE 0.02 mg/Kg and Confidence Interval (Cl) 95% 0.99-1.07 mg/Kg. A dose of 1.1 mg/Kg reversed train-of-four count of four to T,/T, ratio >0.9 in 5 min in 87.5% of our patients, who received this dose. There were no serious adverse effects related to study treatments. 9AP4-10

Data are number of patients (proportion). Severity of cough (number of coughs observed in one minute): mild (1-2), moderate (3-4), severe (5 or >5). P = not significant between groups. Table 2. Incidence and severity of cough among the groups.

Data are mean SD or number of patients (proportion). Current smokers = those still smoking; Former smokers = patients who had stopped smoking for more than 6 mo before being included in the study; Never smokers = patients who had never smoked. Table 1. Patient characteristics.

Figure 1. Oxycodone plasma concentrations after administration of oral oxycodone hydrochloride 10 mg and grapefruit juice or water 200 ml t.i.d. for 5 days in 12 healthy volunteers.

Conclusion(s): The mean bioavailability of intranasal dexmedetomidine is good, but the intraindividual variation makes the effect somewhat unpredict- able. The onset of the action of dexmedetomidine is slower after intranasal than after intravenous administration.

Results and Discussion: The patient characteristics did not differ among the two groups. BP and HR decrease after induction in both groups, but this decrease was more pronounced in the bolus group. There was no significant difference in time to LOC between the two groups (59 + 9 sec bolus group vs 64 + 8 sec TCI group). The BP increased in both groups after LAR and

* p<0.05 Tablet. Time quantum, intubating condition score, and adverse events (number of patients and percentage of group) in the two groups

Data = https://www.academia.edu/28010776/effect site concentrations of Propofol (mean + SD (ug/ml); * P<0.05 as compared to saline Table 1. Effect of Clonidine on Propofol requirements haemodynamics were aicilar in both groups. Effect site concentrations of PROP [table 1] and REMI [table 2] were significantly less in clonidine group (respectively P=0.029 et P=0.05). — Data = effect site concentrations of Propofol (mean + SD (ug/ml); * P<0.05 as compared to saline Table 1. Effect of Clonidine on Propofol requirements haemodynamics were aicilar in both groups. Effect site concentrations of PROP [table 1] and REMI [table 2] were significantly less in clonidine group (respectively P=0.029 et P=0.05).

Table 2. Effect of Clonidine on Remifentanil requirements data = https://www.academia.edu/28010776/effect site concentrations of remifentanil (mean + SD (ng/ml); * = Ps0.05 as compared to saline — Table 2. Effect of Clonidine on Remifentanil requirements data = effect site concentrations of remifentanil (mean + SD (ng/ml); * = Ps0.05 as compared to saline

Fig 1. Changes of respiratory rate, heart rate, and near arterial pressure at different time points

Size correlation and clinical parameters

Sealing pressure at five different head and neck positions Conclusion(s): Adjustment of the head and neck position often allows opti- mizing poor ventilation with supraglottic devices. This preliminary study sug- gests that the I-gel ® is a reliable airway device at five different head anc neck positions in the paediatric population. Its position undergoes a smal modification in the rotated position. This is of particular interest for the pae- diatric anaesthesiologists, since many of the anaesthetic techniques involve the realization of caudal neuroaxial block with the child in the lateral decubitus position.

* 1=full view of glottic aperture, 2=partial view, 3=only epiglottis visible, 4=no glottic structures visible Supraglottic Mask Performance

Data shows median(SD) or number(percentage).(*)p<0.05

Incidence of PONV and rescue antiemetic requirements Values are number (%).

Conclusion(s): Age, gender, profession of the performer and type of sur- gery, and not BMI and skin color, are predictors for difficult IV cannulation. Nevertheless, there is still much unexplainable variation remaining. The present study shows that IV cannulation is difficult in more than a quarter of the patients and that cannulation is not very well predictable by easy accessible patient characteristics. Results and Discussion: |V cannulation was difficult (more than one puncture was necessary) in about 27% of the children. Median time of cannulation was 77 s (46-150) with a maximum of 55 min. The logistic regression showed age, profession of the performer and type of surgery to be predictive for single punc- ture rate (P<.001), with an R? of 8%. A younger age, a profession other than anesthetic nurse and being scheduled for maxillofacial surgery, neurosurgery and general surgery were predictive for a lower single puncture rate. However, contrary to general assumptions, BMI or weight-to-age and skin color were not found to be related to difficulty of cannulation.

Values are means (SD). VCV group: volume controlled ventilation, PCV group: pressure controlled ventilation. T1: 10 min before pneumoperitoneum, T2: 30 min after pneumoperitoneum.*: P < 0.05, compared with VCV group. t: < 0.05, compared with T1 value within the group. The changes of haemodynamic and ventilatory parameters during laparoscopy

Conclusion(s): Subjecting the uterine horn of parturients to hypoxia/ischemia directly before birth may represent a more Clinically-relevant perinatal asphyxia model. Studies to assess the neurological function are ongoing. Results and Discussion: The prolonged period (> 10 min) of hypoxia caused a significant increase of caspase 3 cells when compared to that of controls at PND 1. The same pattern changes with a much less increase of caspase 3 were revealed at PND 3 and 7 (Figure 1). Survival rate for controls was 89 % and for 5, 10, 15, 18 and 20 min hypoxia were 89, 92, 85, 58, O and 0% respectively.

*p<0.001 Results and Discussion: The incidence of MAP<50 mmHg was higher in DES gr (10% vs 1% of all recordings; p<0.001), which was mainly due to lower values of DBP. Mean Cl was lower in PRO gr. Extremely low Cl (<2.5 I/min/m?) was very rare in both groups. Cl>5.5 I/min/m? was observed more often in DES gr (12% vs 5%, p<0.001). Both methods of anaesthesia produced very signifi- cant reduction of SVRI: values <1,600 dyns:cr*m? were observed in 94% of all recordings in PRO gr and in 98% in DES gr. Very low SVI (<40 ml/beat/m’) occurred more often in PRO group (8.8% vs 0.77%, p<0.001), while SVI>70 ml/ beat/m? - in DES gr (65% vs 25%, p<0.001).

Abstract 10AP3-10 - Table 1. Serum and urine laboratory data

Conclusion(s): This study suggests that ED80 is lower for levobupivacaine than ropivacaine, which may confirm that levobupivacaine is more potent than ropivacaine at this concentration (ED80) close to the one targeted in clinical practice.

Conclusion(s): Within the limits of this observational and preliminary study, we observed that rocking motion during epidural procedure was associated with a significant decrease in labor pain. Results and Discussion: Only one patient refused to rock during the proce- dure. Five women alternated moving and still periods. Pain scores were similar in the lying (7.9 + 1.7) and then sitting position (8.0 + 1.7), whereas it signifi- cantly decreased while rocking (6.4 + 1.7; p < 0.001 vs. both lying and sitting still positions). This decrease in pain score was individually felt by 72% of the women. Satisfaction associated with rocking chair motion was 8.9 + 1.4. 90% of the women felt a well-being perception as they were rocking back and forth. The rocking motion didn’t disturb the anesthetic’s technical work. No complica- tions occurred such as dural punctures. This rocking procedure was also well accepted by healthcare givers. Involvement in an action that focuses parturi- ent attention, loss of parturient landmarks and/or vestibular system stimulation producing a change in the cognitive perception of the body’ may explain these effects.

Pain scores during TS and DNIC tests (median, IQR) Conclusion(s): These preliminary results seem to show that inhibitory mecha- nisms (DNIC) rather than excitatory mechanisms (TS) are influenced by preg- nancy. Similarly, sexual hormones influence DNIC analgesia but not TS during the menstrual cycle (2). Results and Discussion: Non pregnant (n=20) and pregnant women (n=23) did not differ for age and health status. Sensitivity to noxious mechanical but not thermal stimulus was reduced in late pregnancy. Positive DNIC score (i.e. efficient DNIC, > 0) was present in 58% of pregnant women but only in 25% of non pregnant women (* p=0.038). Positive TS was found in 31% and 28% of pregnant and non pregnant women respectively.

Results and Discussion: 15 pts were excluded from the study due to pro- tocol violations. No differences in demographics, labor data and VAPS were observed. Results in table and figure.

Continuous vs. Discontinuous BP monitoring BP = blood pressure, SPA = spinal anaesthesia, * = p<0.05

Conclusion(s): The absence of continuous perfusion in the PCEA reduced total LA consumption for labour analgesia with no change on analgesia levels, maternal satisfaction and labour time, and does not implicate an overload of work of the anesthesiologist. Results and Discussion: Three patients of group A where excluded for violation of the protocol. Demographic parameters and labour duration (A 3854143 min B: 3554167 min p=NS) were comparable between groups. AL dose was lower in patients of group B compared with those in group A (A 70,3+31,4 mL B:38,5+23,5 mL p<0,001). The number of auto-administratec bolus was higher in group B compared with group A (A: 1,4+1,6 B:3,9+24 p<0,001). Patients in group B didn’t require more extra doses administered by the anaesthesiologist than those in group A (A: 2/17 patients (11,8%) B: 3/2C patients (15%) p=NS), suggesting a comparable incidence of irruptive pain Pain levels where comparable between groups (Figure 1) suggesting a gooc management of labour pain in both groups. Maternal satisfaction was compa: rable between groups (A:9,65+0,7 B:9, +1,2 p=0,07).

Results and Discussion: Six patients were identified,all of whom had some form of neuraxial blockade. Table 2 shows the risk factors for each patient. [table1]Many of these risk factors relate to being in labour itself but when com- bined with neuraxial blockade,surgery or a critical care stay,parturients are at high risk of developing pressure ulcers.

Number of patients and table tilt Results and Discussion: 40 patients had spinal or epidural and 2 had GA. All anaesthetists had knowledge of 15 degree tilt for Caesarean section. Visually guess was grossly inaccurate in 42/43. Average tilt given was only 8.09 degrees.Maternal hemodynamics were maintained within normal limits with flu- ids and metarominol boluses.Apgar from 8-10 and cord pH from7.1 to 7.5 were found.

Conclusion(s): Rational dosing of VAN in ICU patients should include an increased loading dose according to severity of iIness and a maintenance dose proportional to renal function, which should be measured rather than estimated.

FetalAChR Adult AChR =MuSK *p<0.05 immobilization vs. sham operation; §p<0.05 denervation vs. orthosis; IHC-Score: Arbitrary units

Box plots distribution of E/E* values (left) and E/Vp values (right) at TTEMV and at TTESV

Conclusion(s): The introduction of flotrac in our unit has resulted in an increase in flow based haemodynamic monitoring in a greater number of patients and high levels of nurse satisfaction with a strong preference for FloTrac over other devices.

Proportion of time spent in each glycaemic band Results and Discussion: Table 1 demonstrates the relationship between the percentage of time spent by patients within the six different glycaemic bands. Over 91% of patients remained within 4.4 mmol/l to 10 mmol/l using the local protocol.

Conclusion(s): Therapy with melatonin or ramelteon improves survival after polymicrobial sepsis in rat; this effect was completely abolished by luzindole, indicating that the protective mechanism of melatonin and ramelteon may rely on melatonin receptor activation, rather than direct antioxidant effects.

Results and Discussion: Table 1 reports general characteristic of the patient groups; table 2 reports the CD64 values, sensibility specificity and predictive val- ues; graphic 1 represents the distribution curve of CD64. C reactive protein (CRP) and WBC count did not demonstrate any statistical difference between the two groups, and so were not useful to identify septic patient but highlightened only an not specific inflammatory response.CD64 is the only marker showing two different peak between the groups and high sensibility/specificity with cutoff of 2500.

expressed as medians (interquartile range) Results and Discussion: Indication, MELD score and age were not signifi- cantly different between groups. There were significantly reduced requirements for fluid, vasopressors, renal replacement therapy, invasive ventilation and ITU stay in group 2 compared with group 1.

Results and Discussion: We recruited 228 patients with and average age of 68.87 years; 131 males (57.5%) and 97 females (42.5%). 201 (88.2%) under- went elective surgery and 27 (11.8%) underwent urgent surgery; 40 patients needed reintervention.199 (87.3%) patients suffered hemodynamic failure, 173 (75.9%) respiratory failure, 140 (61.4%) renal failure, 51 (22.4%) hema- tologic failure and 11 (4.8%) digestive failure. In the bivariate analysis, signifi- cant relationship was found between mortality and respiratory failure (6=0.002) and hemodynamic failure (o=0.021). In the multivariate analysis, both variables remain statistically significantly related. Rea REO RTOS MRM!) NMRA P ES ag TEN DRA) ot Oa ERE OTT OE AER EN in A gg SEBS TET Conclusion(s): No association between mortality and age, sex, kind of surgery or length of stay in Postsurgical Critical Care Unit was demonstrated in this study. A significant association between mortality, in postsurgical patients with severe sepsis, and the variables used in this study was demonstrated only for respiratory failure and hemodynamic failure.

Conclusion(s): Clinical implementation of a standardized order set for the management of severe sepsis in the Postoperative Intensive Care Unit was associated with an outstanding reduction in mortality. No statistically significan decrease in mortality was demonstrates, as this study was not sufficiently pow ered to assess mortality benefits. Results and Discussion: We recruited 228 patients, with and average age of 68.87 years; 131 males (57.5%) and 97 females (42.5%). The higher inci- dence of mortality occurred in 2005 (89.62%) and the year with a lower mortal- ity rate was 2008 (26.44%). We found a high reduction of mortality (incidence ratio =0.68), despite not being statistically significative (0=0.372).

Results [All data presented as median (lQR)]

Re-establishment of normal Diuresis in both groups in the first 24 hours of treatment Conclusion(s): Continued furosemid infusion, combined with dopamine is more efficient treatment in attaining faster the normal urine output in the first 24 hours of oligoanurias

Conclusion(s): The creatinine clearance following cytoreductive surgery and perioperative intra-peritoneal chemotherapy for pseudomyxoma peritonei in our unit is significantly higher for the first 14 post-operative days leading to the suspicion that there may be an extra-renal source of creatinine loss in patients undergoing this procedure. Results and Discussion: The median eCCr rose from 76.06 ml.min-1 to 81.85 / 100.11 / 101.31 and 89.64 ml.min-1 on post-operative days 1, 3, 7 and 14 respectively as shown in figure 1 (0<0.0001). In order for creatinine clearance to increase, either the rate of creatinine production must be reduced or its rate of removal from the plasma must be increased. We postulate that the large surface area burn caused by high power diathermy to the peritoneal cavity during these procedures results in a loss of creatinine via the peritoneum and ultimately the abdominal drains. This would explain the apparent improvement in eCCr seen in the first 14 post-operative days but further study would be needed to identify the level of renal function at a longer time interval. This is clearly an area in which further study is needed and the authors are currently preparing an investigation into the abdominal loss of creatinine in drain fluid and the longer term outcome of renal function in patients who pass through our unit.

Need of transfusion RBCt: red blood cell transfusion, EBL: estimated blood loss

Correlation: chloride levels and complications RBCt: red blood cell transfusion, FFPt: fresh frozen plasma transfusion, EBL: estimated blood loss, UO: urine output

Comparison between PCT24, CRP24, APACHE II, SOFA Conclusion(s): We concluded that increase in PCT level at 24th hour compare to admission values can be helpful to estimate prognosis of critically ill patients evaluated with APACHE II and SOFA scoring systems.

Conclusion(s): Patients who developed hospital complications had statistically significant higher lactic acid values in the first 12 postoperative hours than non- complicated postoperative patients. Results and Discussion: In the Graph we asses the differences of postopera- tive lactic acid values between patients with and without complications during hospital stay.

*Statistically significant difference between patients without and with complications p<0,001; Repeated measures ANOVA p<0,001 in each group over time Preoperative and postoperative day 1-5 protein C concentrations (%) in patients without and with complications Delirium vs non-delirium

Conclusion(s): More pharmacological trials are awaited, the mainstay of treat- ment remains minimizing the risk factors. We have to look at other potential risk factors, such as anaesthetic drugs or inflammatory, metabolic markers. Regular medications should be prescribed. Prophylactic use of medications in high risk population has no evidence so far.

Results and Discussion: Characteristics corresponding to the sedation car- ried out and physical conditions are in table 1. Results of monitor analysis are in table 2. Materials and Methods: We evaluated environmental pollution and profes- sional exposure to sevofluorane, during inhalatory sedation in mechanical ventilation, using AnaConDa® in different suppositions. First determination (Case A) was the control. Second one (Case B) was using gases extraction. And the third (Case C) was with scavenging device: contrafluorane. SKC- 575-002 monitors, of passive catchment, were placed in recovery room for the environmental study and trace concentrations were measured from the breathing zone of the nurse who handle the AnaConDa® for professional exposure study. Analysis of monitors has been made according to OSHA 29 procedures. (Figure shows distribution of passive monitors placed in reani- mation room. Letter A represents the mechanical ventilator and B, the bed of patients).

Values in ppm. Difference of the average of ranks (<0.05) is shown by Kruskal-Wallis test

Data described as mean + standar desviation. Sev: sevoflurane, Prop: propofol, IC: cardiac index, Vdf: physiologic dead space. *: p<0,05 in each time between groups

Results and Discussion: The patients included in the study were between 33 and 76 years old. The placement of the Edi catheter has been simple and without any complications. The figure shows the maximum and minimum dia- phragmatic activity in each NAVA level: NAVA level of 0.5 during 20 minutes provides a successful weaning in our patients, without any reintubation needed. The media time employed in each NAVA level was 5 minutes (minimum 5 min- utes, maximum 11 minutes). The media total time for weaning was 49+/- 7 minutes. These results make possible to propose the use of shorter time in the middle NAVA levels in later studies. Conclusion(s): The proposed weaning protocol with NAVA provides a safety ventilator disconnection. Nevertheless, this protocol should be validated with a major number of patients to establish a definitive protocol.

F=Female;CET= Craneoencephalic traumatism;ARI= acute respiratory failure;SL= single lumen DEMOGRAPHIC AND PATIENT DATA pressures were avoided by using tidal volumes of 5-6 ml/kg. Daily checks were conducted with fiberoptic bronchoscopy in order to assess the evolution and resolution.

Conclusion(s): Conservative treatment in iatrogenic tracheal rupture is the first choice in mechanically ventilated patients, regardless of lesion size, location, radiographic evidence or the presence of severe symptoms.

A=emphysem;B=pneumothorax;C=acute respiratori failure Results and Discussion: |n all patients treated conservatively were able to solve the problem of ventilation. Four of the five patients were extubated when checking through fiberoptic vision solution trachea rupture once solved the box respiratory distress, and discharge monitoring and plant every 7,15,24 and 30 days. The fourth patient died from causes unrelated to the resuscitation episode of tracheal rupture.

Conclusion(s): Unfortunately, some generally accepted procedures for the man- agement of trauma patients are still not currently followed in our country. However, specific training of the trauma team significantly improved their implementation. We do believe, that periodical training is useful to improve management of trauma patients, especially on those measures that are applied sparingly. Results and Discussion: 378 patients were included in the first period and 501 patients in the second one. No statistical difference on demographic data, mechanism or severity of injuries was observed. Educational training induced a clear improvement on the application of the standard care guidelines, especially on standards with lower fulfilment. No differences in mortality was observed between groups.

Time to Peripheral Oxygen Desaturation of SoO2=70% with FiO2 of 1.0, 0.5, and 0.21 vs. Normovolemia, 15 mL/kg, 30 mL/kg and 45 mL/kg Blood Loss. Results and Discussion: During normovolemia, peripheral oxygen desatura- tion to <70% occurred after 33 + 7 sec (FiIO2=0.21), 89 + 12 sec (FiO2=0.5), and 165 + 22 sec (FiO2=1.0; P<.001). During increasing blood loss, peripheral oxygen desaturation to <70% occurred significantly (P<.001) faster compared to normovolemia, but no effect of fluid resuscitation was observed. With 45 mL/ kg blood loss, pe-ripheral oxygen desaturation to <70% occurred after approxi- mately 15 sec (Fi02 0.21) to 65 sec (FiO2 0.5) to 140 sec (FiO2 1.0).

Conclusion(s): The insulation method of plastic and hospital blankets is cheap, easy to use, has low volume and has the best effect. ia I Sa a a ka ala a aaa eS | Results and Discussion: The test subjects in the plastic bag combined with hospital blankets (MH) had a significantly higher difference in mean skin temper- ature (MSK) compared to bubble wrapping and single hospital blankets, (MH: 5,70 C, HB: 4,3 C, BW:3,7 C, p< 0,01). Discussion Bubble wrapping, the most frequently used method in Norway today, is not effective and we need a change in prehospital practice and understanding of the hypothermic patient.

Conclusion(s): Amiodarone was bound to the lipoid plasma to an extent which eliminated its hypotensive side-effect. Lipid binding of the potentially hypoten- sive ingredients of the drug formulation might have contributed to the hemody- namic stability.

Background and Goal of Study: The Parkland formula is used to guide initia fluid resuscitation in major burns. 4 ml/kg/TBSA burn of lactated Ringer's solu: tion is given over 24 hours from the time of burn, half over the first eight hours the remaining half over the next 16. On arrival at a burns unit, patients may be several hours post-burn and may have received either too much or too little fluid prior to or during transfer. In addition to the above calculations, doctors may therefore plan a correction of this excess/deficit. We wished to investigate whether it would be possible to construct a dedicated hand-held electronic device to perform this task. The device should be as simple as possible to use require no external computer, and suggest corrections for fluid excess/deficits. Materials and Methods: A microcontroller (Arduino Duemilanove 328 open: source) was programmed using “C.” This embedded software is upgradeable tc incorporate alternative formulae. Data input was via numeric keypad, output was via a backlit liquid crystal display. Fig 1 The only other controls were power anc system-reset buttons to keep the user interface straightforward. Fig 2 Selectec key screen views during a calculation (read from left to right). Reminders are given e.g. concerning burn area in children. The device was used to calculate fluid requirements in ten simulated burn scenarios. In five scenarios, insufficien fluid had been administered prior to arrival, in five an excess had been given The device output was compared with manually calculated infusion plans, an) errors being recorded.

Results and Discussion: The first patient, a 67-year-old male with COPD stage IV and coronary artery disease presented to the prehospital emergency physician with shortness of breath, but no characteristic crackles. Ultrasound scan of the lung revealed B-Lines indicative of pulmonary edema and allowed targeted treatment of the pulmonary congestion with anti-hypertensives. The second dyspnoeic patient with a history of COPD and congestive heart failure presented with ankle edema and rales over both lungs, but sonography of the lungs showed A-lines and a positive lung sliding phenomenon. Thus, pulmonary edema was considered unlikely and the patient was treated for exacerbated COPD with prednisolone and nebulized terbutaline, which lead to immediate clinical improvement. In the third case, the prehospital emergency physician was called to a young man in panic with shortness of breath, retrosternal pain and dyspnoe. Sonography displayed the absence of lung sliding on the left, but not on the right side (Figure1) indicating a left-sided pneumothorax, which was confirmed and treated in the receiving hospital. Conclusion(s): This case series demonstrates that lung sonography may be a useful diagnostic tool in the prehospital setting. Further studies are needed to assess necessary training intervals for emergency physicians and possible outcome benefits.

MRA images in the (a) meningeal, (b) facial, and (c) ophthalmic arteries of three subjects before and after SGB. Results and Discussion: Substantial changes were observed in the main trunk of the external carotid artery (ECA) and its branches, e.g., superficial temporal artery (STA). In the signal intensity change measurements of the major arteries, a significant signal increase was observed in the main trunk of the ECA ipsilateral to the SGB site (11.16+5.76%; P<0.001). In addition, we observed striking changes in the ipsilateral meningeal artery(MA) and facial artery(FA), which were rarely detectable by routine MRA prior to SGB (Figure 1(a) and (b)). The MA and FA were not quantitatively analyzed due to the inabil- ity to visualize these vessels before SGB administration in several subjects. Representative ophthalmic artery(OA) images before and after SGB are also displayed in Figure 1(c).

Conclusion(s): This study finds a decreased VAS compared to baseline and more than a 50 % subjective improvement at five years follow-up in patients with CRPS treated with SCS. These results are consistent with previous observations. Results and Discussion: The mean follow-up time was 33.8 months (range 3-96). The figures summarise the changes in VAS (figure 1) and subjective improve- ment (figure 2) over time. A statistically significant decrease in VAS was observed until GO months, except at 36 months. The subjective improvement that reflects the satisfaction with the treatment is also significantly increased until 60 months.

Materials and Methods: The same patient with C4-5 disc herniation had con- ventional T1-2 interlaminal midline single shot ESI via epidural needle (Figure-1) and a radiopaque spring reinforced catheter delivered injection to the lateral recess of the affected level (Figure-2) under fluoroscopy guidance. After equal amount of X-ray contrast dye injection, 4 ml steroid solution was administered and fluoroscopy was used to demonstrate the subsequent contrast spread.

Results and Discussion: The catheter delivered injection clearly spread to the C4-5 area while the single shot did not spread beyond the top of the C7 level. An additional advantage of the catheter delivered injection may be the anterior epidural spread. Administration of lower volume may be necessary to maximize steroid deposition at the affected level and prevent spread to healthy cervical disks. Further prospective studies needed to evaluate the clinical benefit and possible added risks of the targeted cervical ESI via the catheter.

Median (25th/75th percentiles) pain scores at rest/ during head movement * p<0.01 in comparison with FPS (McNemar’s test), POD=postoperative day.

Grade of correlation:Kappa and Lin coefficient(<0.21poor;0.21-0.40fair;0.41- 0.60moderate;0.61 -0.80substantial;>0.80almost perfect)

Conclusion(s): Our results shows that tDCS tended to improve the seconc postoperative day pain scores. The technique will be tested more extensively tc precise its ability to boost multimodal analgesia in clinical practice. References: 1 Borckardt JJ Brain Stimulation 2008; 1: 122-127. 2 Beam W Brain Stimulation 2009; 2: 50-54. Results and Discussion: Results are expressed as mean + SD. No side effect occurred during tDCS. Despite a classical wide inter-individual variability of the VAS scores, tDCS reduced significantly the D2 r VAS, and reached border- line significance for D2 d VAS. No statistically significant difference was found concerning morphine consumption and D1 pain scores. But more patients are needed to improve the power of the study.

Materials and Methods: We quantified the pharmacological profile of Nk and K in an in vitro model of xenopus laevis frog recombinantly expressing human NMDAR. In vivo protocols (Sprague-Dawley rats) were defined for managing acute (heat) and chronic pain (spared nerve injury). To differentiate between Nk/K effects on opioid (OR) and NMDAR during acute pain, we also adminis- tered Nk/K on OR antagonist background.

Conclusion(s): Nk is acting on NMDAR and OR, showing analgesic potency. We measured dose-dependent acute antinociception effects for both drugs, with two-time lower potency for Nk vs K. In a chronic pain model, Nk was more efficient in alleviating allodynia and improving locomotor function.

Materials and Methods: 117 ASA | or Il patients, scheduled for carpal tun- nel syndrome surgery were enroled in this prospective, randomized, placebo- controlled study. All patients received i.v. plus local anesthesia intraoperatively and were divided into three groups: Group A: 150mg pregabalin per os before surgery and 150 mg twice a day starting two hours after surgery, for 48 hours. Group B: 10mg ketorolac before surgery and 10 mg each 8 hours postoperatively for 48 hours. Group C: placebo pill before surgery and a pill each 8 hours post- operatively. All 3 groups received in addition the same paracetamol regimen: 2g i.v. 30 minutes before surgery and 1g each 8 hours postoperatively for 48 hours. Pain score was recorded for up to 48 hours: VAS > 30 mm = moderate/severe pain indicator and patients received 100mg i.v. tramadol as rescue therapy. We recorded patients’ satisfaction (0 to 10 scale) and the persistence of chronic pain 3 months after surgery. A Mann-Whitney U-test was performed for signifficant differences (<0,05).

Table 1.Analgetic requirements for the first 48h Conclusion(s): In addition to improving analgesia and patient comfort multi- modal regimen may prevent the development of chronic pain after carpal tun- nel syndrome surgery by stopping central hemoplastic changes determined by injury. Pregabalin remains an interesting, still to explore drug in pain therapy.

Table 1: Results (mean+SE) for placebo versus 15 mg, 30 mg or 60 mg of oral morphine. *significant differences versus placebo group (p < 0.01) Results and Discussion: For pain rating, the maximum effects as well as the AUCs were significantly larger for each morphine dose as compared to placebo, whereas there were no significant differences between the three morphine doses (table 1). For the hyperalgesic areas, there was no significant impact of any oral dose of morphine compared to placebo, neither for the maximum effect nor for the AUC of the effect (table 1).

Table 1. Demographic and anesthetic-surgical data Data are presented as meantSEM or number of patients.

RESULTS Nr patients (%); xtSD;* statistical differences; VAS= Visual Analogic Scale 1-10; NPS=Neuropathic Pain Signs score

Table 1: Morphine requirement (mean+SD) and pain rating (median and range) Conclusion(s): Intraoperative opioid selection and dosing significantly influ- enced postoperative morphine consumption and pain. Based on our results during cardiac surgery a low sufentanil concentration of 0.40 ng mI-1 (0.5 - 0.7 ug kg" ht) may be preferred. References: 1 Cabanero D, Celerier E et al. Pain. 2009;141:88. 2 Fassoulaki A, Melemeni et al. Acta Anaesthesiol Belg. 2008;59:241. 3. Fishbain DA, Cole B et al. Pain Med. 2009;10:829.

Values are expressed as mean + standard deviation; There were no significant differences between groups

Table 1. Shoulder pain reported in the postoperative period

Values are number (proportion). There were no significant differences between groups. Table 2. Verbal rating scale (VRS) of postoperative shoulder pain and cumulative ketorolac consumptions in the TTV and LTV groups

Data are mean and SD (4). Materials and Methods: After IRB approval and written informed consent, 120 women, ASA I-IIl scheduled for elective gynecologic laparoscopic surgery were enrolled. Patients were randomized to receive either intraperitoneal nebu- lization of ropivacaine 30 mg before surgery (NEBU PRE Group); intraperitoneal nebulization of ropivacaine 30 mg after surgery (NEBU POST Group); intraperi- toneal instillation of ropivacaine 100 mg before surgery (INSTILLATION Group) or intraperitoneal nebulization of saline 3 ml before and after surgery (CONTROL Group). Solutions were nebulized using the Aeroneb Pro® system (Aerogen, Galway, Ireland) through the 12-mm umbilical port. Analgesia was provided with port sites infiltration, IV paracetamol 15 mg/kg every 6 h and IV morphine PCA. Pain scores after coughing (NRSD 0 to 10 points), morphine consumption time to ambulation and PONV were collected in PACU, at 6h, and 24h. Data were analyzed using ANOVA or Mann-Whitney/Wilcoxon, chi-squared or Fisher exact tests, as appropriate. A p 0,05 was considered statistically significant.

Conclusion(s): No difference was observed between the postoperative opi- oid analgesia and epidural analgesia groups in recurrence- and metastasis-free survival. There is a need for large randomized controlled trials to determine the Results and Discussion: All 1113 patients received general anesthesia with inhalation anesthetic agent. 931 patients received postoperative opioid analgesia, and 182 patients received epidural analgesia. There were no significant differences in patients or surgical details, tumor presentation, or prognostic factors. Metastatic spread or cancer recurrence was observed in 155/931 opioid analgesia patients and 42/182 epidural analgesia patients. Mean recurrence- and metastasis-free survival for the study as a whole was 61.926 months (95% confidence interval, 60.501-63.352 months). The hazard ratio for metastatic spread or cancer recur- rence in the epidural analgesia group compared with the opioid analgesia group was 1.326 (95% confidence intervals 0.940-1.871; P = 0.107 by log-rank test).

(* - statistically significant difference, p < 0,02) (the values represent median, * - statistically significant difference) Conclusion(s): Both regional anaesthetic techniques provide comparable postoperative analgesia which is superior on movement and associated with less opioid-related adverse effects (nausea/vomiting, sedation) compared with intravenous PCA. Patient-controlled femoral nerve blockade provides effective analgesia after THA and is less likely to cause a severe neuraxial complication; therefore, the peripheral neural analgesia is the preferred technique.

Results and Discussion: 135 patients received in the postoperative period intravenous patient-controlled analgesia (PCA) with morfine, 217 epidural PCA and 95 femoral nerve PCA. Following pain scores (numeric rating scale) were observed: Following complications, adverse effects and patient satisfaction were observed:[table2]Patients with epidural and femoral nerve PCA had lower pain scores on movement 24 and 48 hours postoperatively and less nausea/ vomiting and sedation than patients with intravenous PCA with morfine.

Results and Discussion: Data were collected from 808 patients: 91 DH, 657 non DH and 60 non responder. All were older than 6 years. 36.2% of patients had pain in the last 24 hours, significantly less than in 2007(p<0.01; y:8.61) and 2004 (p<0.05; x:4.49). 38.5 % of women and 34.1 % of men complained of pain in the last 24 hours. The prevalence in women in 2009 has been lower than in 2007 (p<0.01; ¥:7.4) and 2004(p<0.05; x: 4.07). The moderate(NRS4-7) and severe(8-10) pain has lowered, with an increase of light(1-3) pain.

Results and Discussion: The 30 patients audited (24 female, 6 male) had ar average age of 37.9 years and weight of 139.7Kg. 28/30 underwent laparo- scopic roux-en-y gastric bypass, 2 had laparoscopic gastric banding. 27/3C yad 10mg Morphine and 17/30 had 1gram Paracetamol documented to be given intraoperatively. Morphine PCA was commenced immediately in recovery The average pain score was 6.2 immediately post op, falling to 0.9 at 24 hours 00st op. The average amount of morphine used in 12 hours via PCA pump was 45mg. At 48 hours the average pain score rose to 1.5. Regular analgesia pos op at 24 hours included Paracetamol for 29/30 and NSAIDs for 3/30. By 4€ jours all were receiving regular paracetamol, 16/30 had regular NSAIDs, anc 4/30 had regular codeine phosphate. Conclusion(s): Our data suggest high pain scores immediately post op. This may reflect inadequate use of analgesia intraoperatively. We suggest the use of Morphine up to a dose of 0.2mg/kg and an increased dose of Paracetamol up to 2grams to be given intraoperatively. This may reduce early post op pain scores. Regular use of NSAIDs with Paracetamol post operatively may also reduce the second rise in pain scores at 48 hours. We plan to re-audit following implementation of these recommendations.

Conclusion(s): There are a wide range of anaesthetic techniques used for TKA in the SW of England. The PROSPECT consensus recommendations were designed to support evidence based practise however they have not been uni- versally recognised or implemented in the South West of England. Results and Discussion: The initial survey identified significant variation in prac- tise throughout the region. 36 respondents revealed 46 different TKA anaesthetic techniques. None of the 13 departments had a departmental consensus guideline. In the repeat survey 29 respondents described 32 techniques. 6 (21%) reportec a guideline within their department, 19 (66%) were aware of PROSPECT while 5 (26%) reported a change in practice as a result of this guidance. 4 respondents disagreed with the PROSPECT recommendations citing local audit to support their practise. The survey also revealed a significant drop in epidural use between the two surveys (1 vs. 8) with 66% vs. 48% now using some form of periphera block.

Conclusion(s): NMDAR antagonists prove to be effective therapeutic drugs against mechanical allodynia, in this rat model of neuropathic pain. The central finding in our preliminary study demonstrates the potential of NMDAR antago- nists to improve functional recovery, with more time spent on the injured paw and a more even distribution of the body weight. Trx exhibited a superior thera- peutic index for efficacy versus side effects.

Abbreviations:VAS visual analogue scale. Data in meantSD

Results and Discussion: There was a large variation in the 24 hour mor- phine (range 4-165 mg) and fentanyl(range 200 -1300 mcg) consumption. Mean total 24 hour morphine consumption were as follows: BMI (40-44)-32.3 mg,BMI(45-49)-26.2 mg,BMI(50-60)-33.1 mg. 34.6 % received morphine I.V Patient Controlled Analgesia(PCA) while 6.4% received fentanyl |.V. PCA post- operatively in PACU and HDU.

Pain scores and analgesics use in male and female patients regarding analgesic technique (median, IQR) *P<0.05 between female (F) and male (M) patients

Mean values of Visual Analogic Scale measured during first 72h

Conclusion(s): Airway management is one of the main causes of death, severe brain damage, airway and esophagus injuries. Adequate training can be pro- moted by mandatory airway rotations and accredited european centers. The CEDIVA centers offers an adequate level of of training. +/- 2, ETco2 (mm Hg) at intubation 35 +/- 4. A progressive reduction in intuba- tion time was noted. The results are compatible with previous studies.

Results and Discussion: Uneventful sessions and critical incident sessions of 7 residents and uneventful sessions of 2 residents were analyzed. Mean dura- tion of trials was 579 (+/-145) s in uneventful sessions and 884 (+/- 199) s in critical incident sessions. Distribution between ROIs depended significantly on simulator state (p < 0,001). After induction, 20% of VA was related to vital parameters. In case of the critical incident, this increased to 30%, while VA related to manual tasks decreased slightly. VA related to manual tasks in critical incidents tended to be higher in experienced subjects (not significant).

p<0.05. Data show number, median (range), number (percentage) or mean (SD) Conclusion(s): |-gel laryngeal mask is easier to insert than LMA-ProSeal, effec- tive ventilation is achieved in a larger number of cases and time for insertion is shorter. With LMA-ProSeal, insertion time could be too long and facial mask ventilation is needed in some cases to prevent patient’s desaturarion.

Conclusion(s): According to our results, patients perception of the role of anaesthesiologists is still far from recognizing the value of this professional fig- ure. Reasons for this finding could be several, although in our opinion anaesthe- siologists have to further assert their role. This could be obtained with a greater communicative effort both in the physician-patient relationship and, possibly, through media.

**p=0.037; ¢ ¢p=0.041; tp=0.014. Chi-square tests

Figure 1 The responds of the residents on the opinion that anesthesiologists have too much work and insufficient family time. Figure 2 The responds on the idea that anesthesia rotation is benefit to the improvement of clinical techniques like intubation, laryngeal mask application and spinal puncture. Figure 3 The responds of the residents on the opinions that rotation is helpful for the familiar of the guideline of the medicine treatment.

Conclusion(s): This survey highlights the divided opinion as to what makes a good anaesthetist. 29 different attributes were listed among the respondents’ top five. Whilst some attributes feature more regularly than others, such as “keeping calm under pressure” and “clinical knowledge”, others hypothesised by us to be important are less so, such as “low morbidity and mortality.” The survey has generated much discussion amongst our colleagues. Whilst it would also be interesting to see if the above results are applicable to other European or interna- tional countries, we have instigated further work into the subject, as we pose the same question to others from the multidisciplinary team including medics and surgeons. No doubt their responses will prove fascinating and insightful. calm under pressure (12.4%) 2) Clinical judgement (12.0%) 3) Clinical knowledge (11.6%) 4) Communication skills (10.0%) 5) Attention to detail (8.8%)

RoCAES Factors Assessed Conclusion(s): The overall reliability of the ROCAES in a different sample group has been established however further refinements and validation should be undertaken before a recommendation can be made for its use. Results and Discussion: 102 anaesthetists completed the questionnaire (response rate 62%). The overall reliability of the questionnaire in the study group was established (a = 0.76 vs original paper aa = 0.83) however the individual factors identified in the original paper were found to be unreliable in this population. Trainees showed significantly more negative attitudes than consultants in two factors: ‘perceived blame’ and ‘perceived clarity of report- ing procedures’. Anaesthetists who reported complying with safety recom- mendations for epidural insertion had more positive attitudes to adverse incident reporting. Strategies for improving local incident reporting service were also suggested e.g: improve clarity of reporting procedures and improve feedback.

Materials and Methods: We designed a checklist based on the first edition of the WHO Guidelines for Safe Surgery. It was approved by the chiefs of Anesthesia, Digestive Surgery and Surgical Nursing. We began the imple- mentation on October 2009, in two Digestive Surgery operating rooms in the morning shift. We prospectively collected data on the filling in rate of the checklist, the mistakes in the hospital system and in the filling in itself. We present the results of the first two months of implementation, October and November 2009. Results and Discussion: The total number of patients was 184. We filled in the checklist in 107, rate of filling in 58,15%. The checklist was incomplete in 44 patients (41,12%). There was one mistake in the checklist in 25 patients (56,82%), two mistakes in 10 patients (22, 73%) and there were 3 or more

Structure of cardiac complications MI - myocardial infarction

Conclusion(s): Routine events consumed a quarter of conversation time dur- ing handovers from OR to recovery room or ICU. The data implicate that for- mally structuring the handover process might lead to more efficient and com- plete handovers.

tt A eet tear iil Materials and Methods: A total of 102 patient handovers from OR to the recovery room (n=51) and from OR to the ICU (n=51) were videotaped in two academic hospitals, four teaching hospitals and one community hospital in the Netherlands. Two observers using event logging software (The Observer XT, Noldus, The Netherlands) independently coded what percentage of time was used to: 1. Simultaneously transferring equipment and information; 2. Only ver- bally exchanging information; 3. Only connecting equipment.

Results and Discussion: Five clinical areas including operating theatres and the A&E department were evaluated. Questionnaires were completed by 82 members of staff. 92% of consultant anaesthetists questioned knew what Intralipid 20%® was used for, increasing to 100% following education. 69% of these knew where it was located, increasing to 92%. 100% of anaesthetic trainees knew what Intralipid 20%® was used for and 67% knew where it was located, increasing to 89%. 73% of anaesthetic nurses, 50% of recovery nurses, 44% of theatre nurses and 40% of midwives questioned knew where Intralipid 20%® was located (increasing to 100%, 83%, 82% and 80% respectively). When questioned regarding the location of guidelines the results were lower across all groups. Intralipid 20%® with guidelines for its use were present in 3/5 of the areas audited, this standard improved to 4/5 with education. Guidelines for use were present in 4/5 of the clinical areas. Neither Intralipid 20%® nor its guidelines were present in the A&E Department. Conclusion(s): Theatre areas across our hospital site now all stock Intralipid 20%® in accordance with AAGBI guidelines. It is important to educate all staff when new drugs are introduced to practice, especially nursing and midwifery staff who may be asked to run and get the drug or treatment in the emergency situation. Intralipid 20%® guidelines should be stored with the drug.

Table 1. Positive diagnostic tests for the patients with mild and severe symptoms. Conclusion(s): The severity of clinical manifestations predicts the chance of positivity for at least one diagnostic tests. References: 1 Hausmann OV, Gentinetta T, Bridts CH, Ebo DG. The Basophil activation test in immedi- ate -type drug allergy. Immunol Allergy Clin N Am 2009; 29: 555-566. 2 Asem ESK. Anapphylactic anaesthetic reactions. Anaesthesia 1990; 45:1032-1038.

BAT accuracy, sensitivity and specificity compared to SPT and IDT.

Conclusion(s): Performance of electrostatic filters in the clinical setting may not be worse than pleated filters. Factors other than patient contamination levels Results and Discussion: 8/86 (9%) filters had excessive contamination on the machine side. However, only one of these was also contaminated on the patient side. Previous studies have mainly shown contamination on the machine side if it also occurred on the patient side. Lower levels of contamination on the machine side were observed in the current study compared to previous testing of electrostatic filters (9% versus 13%) [ref 2]. However, previous data for electrostatic filters was from a paediatric population where patient side con- tamination levels were higher. There did not appear to be a significant difference in ‘failure rate’ between the small electrostatic filter in this study and a pleated filter in a previous study (8% vs 9%) [ref 2].

Conclusion(s): The study confirms a significant increase in IOP during LRP. The IOP are kept at values outside normal ranges (normal 10-21 mmHg) in all M3 and M4 measures. The IOP did not regain its initial value at the end of surgery and remained with an increase with regard to the initial measure (M1). The maximum elevation of IOP belonged to M4, after three hours of surgery. The IOP increase is related to the Trendelenburg position and the increase in abdominal pressure caused by CO2 insufflation. The other studied parameters that can influence IOP do not vary significantly during surgery (TA average, FC, pressure of airways, ET CO, ). Results and Discussion: We have found increases in the average IOP (mmHg) compared to baseline (M1=10.5+3) of 10.6 when placing the Trendelenburg position and intraabdominal CO, insufflation (M2=21.07+3.7); of 14.5 after an hour of surgery (M3=25+4.9); of 16.5 after 3 hours of surgery (M4=27+6.9) and a persistence of an increase in IOP of 5.5 at the end of the surgery (M5= 16+7.4). The other confussion variables studied have not proven to influence the variation of IOP.

*p<0.05; ** p<0.001 Results and Discussion: CO, Cl, PAS and PAD were higher in the xenon group compared to sevorane due to the lack of myocardial depression. The other parameters were similar. All these values did not influence the mainte- nance of anaesthesia and did not require supplemental doses of fentanyl. The awakening time was sensibly shorter and the Aldrete score was higher in the xenon group (250 +55 sec vs 600+45, p< 0.001; 10/10 vs 6/10).

Improved our Operating rate within 48 hours by 29% and reduced our 30 day mortality rate by 48% and reduced our mortality in patients with 3 or >3 comorbidities by 50%

Results and Discussion: The main effect of spinal anesthesia was the reduction of systemic resistances (SVRI) which were reduced by 18% + 17,2%. The average cardiax index (Cl) was initially reduced by 6,6 + 5,2 %, and it was persistently reduced during the surgical period. Stroke volume index (SVI) had the most important effect on MAP, compared to the HR. The average MAP was manteined within 15% of baseline value for 69,7 + 14,4 % of the surgical time. Just 4 patients were initially considered “fluid responders” because of a rising of SVI more than 15% after fluid challenge and they received fluids as first line treatment of hypotension. Hypotension occurred to “fluid non responders” was treated with ephedrine. Patients “fluid responders” had a smaller Cl reduction after spinal anesthesia compared to “non responders” (p = 0,02). Conclusion(s): The effects of monolateral spinal anesthesia are complex and not just related to SVRI reduction. Continuous hemodinamic monitoring in elderly high risk patients receiving spinal anesthesia is crucial for a correct treatment of hypotension in order to avoid an excessive and probably useless fluids consumption.

Conclusion(s): Goals for GDHT were not reached suggesting that the algo- rithm should allow an earlier and more rapid increase in inotropic support in this elderly group of patients Results and Discussion: 37 patients were successfully randomised. Patient characteristics were similar (figure 1). The SV was significantly increased in the GDHT group (figure 1). In 12 of 37 patients DO2I<850 ml/min/m? was found as an initial value which could indicate heart failure’. Five patients in GDHT recieved inotropic support and of these two did not reach predefined goals mainly because of a slow increase in dose of inotropics.

Results and Discussion: The GDHT has lower cost (- 4 817 €) and better effect (+ 0.613 QALY). It is dominant for all simulated values for base case and also for scenarios. The result is robust as we used the best available input data.

Table 1 Pharmacodynamics of NMBA in young and elderly males Data are presented as median and interquartile range, “~p < 0.05 compared to group o younger patients Results and Discussion: The results are summarized in Table 1. Conclusion(s): The onset time of all studied NMBA was slower in the elderly. Both clinical duration and interval to full recovery for rocuronium and vecuro- nium was longer in the elderly whereas these parameters for cisatracurium were age-independent. blocking agents: cisatracurium, rocuronium or vecuronium. After setting up neuromuscular monitoring (Datex-Ohmeda S/5 Anaesthesia Monitor with an NMT module, train-of-four (TOF) stimulation of the ulnar nerve at 10-second intervals, electromyographic response of the adductor pollicis muscle), the onset time (an interval from application of NMBA to maximum depression of T1), clinical duration (from application to 25% recovery of T1) and time to ful spontaneous recovery (from application to TOF-ratio = 0.9) were determined for each patient. Mann-Whitney test was used to compare differences between young and elderly patients.

Manufacture Recommendations of Sizing Supraglottic Airways Materials and Methods: Patient weight was measured preoperatively and size of SA in theatre recorded (involving anaesthetists of all grades) and then com- pared with manufacture recommendations. Fannin Integral single use laryngeal mask airway (LMA) and i-gel SAs were included. Patients were asked to score sore throat on a visual analogue scale in recovery. Exclusion criteria were ENT procedures, dementia, <18 years of age and other types of SA. A questionnaire was completed by anesthetists in our department testing their knowledge of weight ranges for SA size.

Conclusion(s): Concerning the risk of artifacts, the Ambu Disposable laryngeal mask and the I-gel supraglottic airway showed the best image quality during MRI procedure, and would be more appropriate when the area of MRI lies ir proximity with the airway.

Conclusion(s): Inappropriate sizing of SAs increases incidence of sore throat. There is a lack of Knowledge amongst anaesthetists of appropriate weight ranges by size. We suggest that by inserting the correct size SA according to patient weight, incidence of sore throat can be minimised. Results and Discussion: 115 patients were studied. Of 83 with LMA, 37.3% were incorrectly sized by weight. Sore throat occurred in 28.8% if correctly vs. 48.4% if incorrectly sized. In the 32 patients with i-gel, 31.3% were incorrectly sized. Incidence of sore throat was 9.1% if correctly vs. 30% if incorrectly sized (fig.1). 87.8% of wrongly sized SAs were too small. 27% of anaesthetists of all grades knew correct weight ranges for LMAs. None knew correct weight ranges for i-gel (n=33).

Conclusion(s): After a period of apnoeic desaturation, rescue ventilation with air is as effective as 100% oxygen in rescuing subjects if the subject was pre- oxygenated before apnoea commenced. If no pre-oxygenation has taken place, then additional oxygen achieves a clinically appropriate arterial saturation more quickly. Results and Discussion: The effect of FO, on re-oxygenation in the subject pre-oxygenated prior to apnoea is shown in figure 1. The initial rate of increase in PaO, was similar for all oxygen concentrations, and all achieved an adequate PaO,. Opening the closed airway resulted in a rapid rise in PaO,, accounted for by the entrainment of gas into hypobaric lungs.The effect of FO, on re- oxygenation when no pre-oxygenation has taken place is shown in figure 2. The rate of rise in PaO, was slower for the lower oxygen concentrations although all eventually achieved an adequate PaO,,.

Conclusion(s): EVA proved to be efficient in restoring oxygenation quickly and limiting hypercarbia over a period of 15 minutes through a 2 mm transtracheal catheter in hypoxic pigs with a completely obstructed upper airway. Results and Discussion: The minute volume necessary to maintain nor- moventilation during IPPV was 9.9 [9.1-12.0] L/min. After 2 minutes of apnea EVA restored oxygenation within 10 seconds.

Conclusion(s): Greater tidal volumes more rapidly achieve an adequate PaO, during rescue ventilation, except where the airway is closed following pre- oxygenation. In this scenario small volumes of oxygen are required. This has implications for rescue ventilation following needle cricothyroidotomy — high pressures and large volumes appear unnecessary.

():%, MVS: mask ventilation scale. Comparison between pre-NMB and post-NMB in MVS grades 1 & 2 vs. 3 & 4: Chi-square test, P< 0,0001, OR= 3.5

*responders chose one or more options. Conclusion(s): The findings of this survey suggest that the majority of units use DLT as the method of lung isolation. This may be related to the well docu- mented advantages of DLT over BB [1]. Our findings suggest that gender and height are most likely to be used to predict DLT size. Although the CXR tracheal diameter is more predictive [2], it was the least used criteria. When managing an unpredicted difficult airway, 73% of units used tracheal tube introducer to guide DLT insertion. Caution is advised when this technique is used as the Frova, cur- rent gold standard single-use introducer, is not recommended for use with DLT. When confirming DLT position, 7.7% of units use clinical examination, 19.2% of units use fibreoptic scope and 73% of the units use both methods. Fibreoptic confirmation is recommended given the anatomical variations in the tracheo- bronchial tree and the adverse complications of a misplaced DLT. Dafavenmnnanc:

Positioning time, collapse quality and malpositions Time in seconds (Mean+SD)

Materials and Methods: LMA CP was measured in theatre and patients scored sore throat on a visual analogue scale in recovery (fig.1). Exclusion criteria were: ENT surgery, <18 years old or dementia. Fannin Integral single use LMA was used in all patients. A questionnaire was completed by anaesthetists in our department, inves- tigating their knowledge of recommended CP and if it was routinely measured.

Conclusion(s): Increasing LMA CP contributes to sore throat. Maximum rec- ommended CP is largely unknown by anaesthetists and CP is not monitored. We suggest that CP should be routinely measured and reduced to <60cmH,0 in accordance with manufacture recommendations.

tp<0,05; t-students, x2 Fee eat SAP AL ONE PORCN A SOLA MON Cine OSCR SNe WL Ge SRN N TiN Se ES CREASE MTN TEN Gagne ear ae Spe gent ret eS Results and Discussion: Data for 32 patients were analyzed and are pre- sented in the table 1 (n=16 for each group). Continuous variables are presented as mean+SD. Failure for the i-gel insertion at the first attemp occurred in 1 patient of each group (6,5%) and the mean time for proper i-gel insertion was similar in both group.

(): %, D/I MV: difficult or impossible MV, *Chi-square test Results and Discussion: The incidence of difficult and impossible MV was 46 (8.5%) and 10 (1.8%) respectively. Table shows characteristics proved to have an aggravating impact in difficult and/or impossible MV. Neck extension and the original Mallampati test do not predict difficult MV.

D/| MV: difficult or impossible MV, *Student t- test, BMI : body mass index, NC : neck circumference, SMD : sternomental distance, TMD : transverse mandibular distance Results and Discussion: Table shows mean values +/- SD (range) of variables proved to have an aggravating impact in difficult and/or impossible MV. Limited mouth opening, thyromental and hyoidomental distance were not associated with difficult MV.

():%, D/I: difficult or impossible Results and Discussion:Chi-square test Yates corrected: comparisons between LV grades 1 and 2a and 2b vs. 3 and 4: P= 0.015, OR= 2.5

FGF: fresh gas flow, * Fisher’s exact test: paired comparisons between difficult MV and impossible MV, **OR= 14.3

Figure 1. Insertion time to achieve an effective airway with |-Gel and LMA Fastrach™

Table1. Accuracy of tests in predicting difficult laryngoscopy PV: Predictive value

Figure 2. Intubation tiem via |-Gel and LMA fastrach™ with 3 Ets. PT, Portex tube; MT, Mallinckrodt tube; LFT, LMA fasttrach tube; LFD< LMA fastrach disposable.

VATS, video-assisted thoracoscopy; (n), number of patients Materials and Methods: We selected 22 ASA I-Il patients (without predicted difficult airway management and with normal pulmonary function tests [FVC> 80% and FEV1 > 80% predicted]) undergoing different thoracic surgery proce- dures in which one lug ventilation was necessary. Lung isolation was achieved introducing the bronquial blocker through the I|-GEL supraglottic device under direct flexible fibrobroncoscopic vision.

Conclusion(s): Non trained anesthesiologists may improve their performance with the use of a suction catheter in easy airways. iin Oa eaied mime result is not in agreement with previous study probably because difficult air ways were excluded from that series. On the contrary, non trained personne achieved a significant improvement with the use of the catheter, even if only for easy airways (mallampati score =1). It is likely that this result may be due to the soft material of the suction catheter, that cannot be easily directed intc the oesophagus.

Conclusion(s): A large variation in force is applied with the GVL depending on type of manikin. This finding has implications for the validity of manikins used to evaluate video laryngoscope devices and as surrogates for training. Further study will compare the current data with the forces exerted in humans to allow- ing a model to be chosen which best simulates video-laryngoscopy and intuba- tion conditions. We will also evaluate consistency between different manikins of the same model.

Abstract 19AP6-1 — Impulse, Peak Force and Time to Intubation with GVL in Four Manikins Data expressed as median [IQR], N=Newton, s=seconc

Abstract 19AP6-2 — Impulse, Peak Force and Time to Inubation with Macintosh in Four Manikins

Conclusion(s): The device works well, and is very popular with participants, who strove to beat the fastest times. It has application in both training and com- petency-based assessment of this particular psychomotor skill. A randomised clinical trial is in progress to see if the skills learned on this device transfer effec- tively to clinical practice. Results and Discussion: The maze cartridges are constructed from poly- urethane components within an ABS plastic shell. The timing device was designed using standard electronic components. Infrared photogates are used, modulated at 38KHz to prevent spurious triggering due to ambient light. APIC microcontroller performs the logic and timing functions. Elapsed time is shown on a four digit 7-segment LED display. If the preset maximum time for the task is exceeded (user definable; default 300s), the device “times out” and that attempt is terminated. The device is powered by a single Qv battery and optimises battery life by automatically shutting down the photo- gates after triggering, and entering “sleep” mode after a preset time interval. A single “reset” button aborts a timing period and wakes the device from sleep mode.

Conclusion(s): Written guidelines should exist in each department to cover number of common or serious airway problems, however there are many situa- tions where strict adherence to guidelines may not be possible. Airway evalua- tion is imperfect in predicting problems and an airway strategy should be drawn up before management of every patient.

Results and Discussion: 1) Attempted direct laryngoscopy with head in-line immobilisation failed. Laryngeal mask airway was inserted to ensure ventila- tion and oxygenation. On fibreoptic examination of the larynx, the glottis was visible, however it was not possible to pass a tracheal tube beyond the glot- tis and an emergency tracheostomy had to performed. Further imaging with MRI scan showed fracture at the c3-4vertebrae with impingement on the pos- terior tracheal wall. 2) Multiple attempts at cricothyroid puncture failed. Direct laryngoscopy showed a large supra-glottic cyst and tracheal intubation was successful without any compromise. 3) An awake cricothyroid puncture was performed. Oxygenation was maintained by trans-tracheal jet ventilation and a tracheostomy was performed. Biopsy of the sub-glottic mass showed a benign amyloid mass.

Collision count correlations Values are pp (p value)

Insertion time (Seconds) to first successful ventilation (mean+SD)

Intubation time and haemodynamic changes Conclusion(s): Laryngoscopy and intubation using AWS was easier and caused less haemodynamic changes compared to intubation using Mac. AWS could be a good alternative to Macintosh laryngoscope not only in patients with difficult airways but also in patients in whom cardiovascularly stable induction is desirable.

Data expressed as median [IQR]. Impulse (Newtons/second). Peak Force (Newtons). A=Laerdal®SimMan, B=Trucorp AirSim™™Advance, C=Laerdal@Airway Management Trainer, D=Ambu®Airway Man. Impulse and Peak Force with MDL and GVL

Conclusion(s): GVL requires less force during laryngoscopy than MDL whilst obtaining superior laryngeal exposure in manikins. If similar differences in forces

p* - effect of temperature on success rate Success rates for tracheal placement at three temperatures. Values are number (%). N = 72.

Conclusion(s): Technically the device worked well. There was no evidence of laryngoscope rotation during tube insertion. We intend to investigate the poten- tial of this system as an intubation training aid with automated assessment and scoring of the technique being used.

Results and Discussion: From a horizontal starting position, the laryngo- scope was rotated (reducing @) at a near-constant rate as the blade entered the mouth, after which it was held at a steady angle during insertion of the tracheal tube. There was considerable variation in the initial rate of rotation while there was much less variation in the steady angle maintained during tube insertion. Years of experience had no effect on either the mean, max or min angle (8) during tube insertion. However there was a small non-significant ten- dency for more experienced users to hold the handle at a larger angle to the vertical axis. technique. Eleven volunteers intubated the mannequin three times giving 32 data sets.

Results and Discussion: There was a good correlation between optimal cuff volume and tracheal diameter on chest X-ray (R2 = 0.83), and a moderate cor- relation between optimal ICV and both height and age (R2 = 0.44). Predicted cuff volume was more likely to give optimal cuff pressure when based on tra- cheal diameter (65% of patients) and when based on both height and age (45%) compared with in the development phase (28%) (P<0.05). Conclusion(s): Optimal cuff volume can be better estimated from tracheal diameter, as determined radiographically, than by patient height and age. However, even the formula based on tracheal diameter proved inadequate in 35% of patients. Existing formulae cannot substitute for manometry. References:

Results and Discussion: Time of tracheal intubation with the Trachway® intu- bating stylet was significantly shorter in tongue edema scenario and the com- bined scenario compared with the Macintosh laryngoscope. (21.6 (1.45) s vs 24.07 (1.58) S, 23.78 (2.05) s vs 26.6 (2.77) s, respectively; p<0.05) Successful rate were 100% for both devices. Difficulty of intubation was significantly higher in tongue edema scenario and combined scenario with the Macintosh laryn- goscope compared to the Trachway® intubating stylet by subjective difficulty score. Materials and Methods: 10 experienced anesthesiologists intubated the manikin’s trachea with the newly commercially available Trachway® intubat- ing stylet and the Macintosh Laryngoscope in four airway scenarios: normal, tongue edema, cervical spine immobilization and tongue edema combined with cervical spine immobilization. Time of tracheal intubation, successful rate and perceived difficulty of intubation for each scenario were compared and analyzed.

Conclusion(s): The Trachway® intubating stylet has a shorter intubation time comparable to the Macintosh laryngoscope in different airway scenarios, thus may act as an alternative intubation device.

Conclusion(s): Our first results indicate that passive pulmonary aspiration of fluid during surgery is signifantly reduced when using an ETT with a polyure- thane cuff.

Stress response: comparison of parameters before and after intubation Conclusion(s): Level of sAA increased in response to laryngoscopy and endo- tracheal intubation related stress in pattern resembles that of changes of nor- epinephrine in plasma and MAP. Acknowledgements: This study was supported in part by European Social re. .dettin. [MOR

Figure 1. Same Size (5.5) Nasotracheal Tubes from Mallinckrodt and Rusch

Abstract 19Ap11-5 — Patients characteristics (categorical variables) stratified by IDS

():%, VC: vocal cords. Comparisons between LV grades 1 & 2a vs. 2b & 3: *Fisher’s exact test, P= 1.0 (NSS); +Chi-square test, P< 0,0001. Results and Discussion: The DLT insertion failure group included: ineffective lung isolation (n= 15), inability to enter the trachea (n= 12), contralateral lung isolation (n= 8). Conclusion(s): The DLT insertion appears easier whenever vocal cords are visible. However, the majority of difficulties were not solely associated with poor laryngeal view, but were probably combined with other features.

():% “comparison between LV grades 2b and 3a vs. 3b and 4: Chi-square test, P Value < 0,0001, OR= 15.1 et a tee Neer ee A ieee eee Si etn eee Results and Discussion: After the application of BURP in 57 patients the LV grade improved from 2b to 2a and in 18 from 2b to 1; in 25 from 8a to 2b, in eight from 8a to 2a and in three from 3a to 1; in two from 3b to 3a; in two from 4 to 2b and in one from 4 to 3b. ey Conclusion(s): The BURP maneuver does improve the degree of visualisation of the larynx, but unfortunately it more often optimises the moderate difficulties in DL. Dafarannac:

Meindert Danhof

British Journal of Anaesthesia, 2005

After alarming reports concerning deaths after sedation with propofol, infusion of this drug was contraindicated by the US Food and Drug Administration in children &lt;18 yr receiving intensive care. We describe our experiences with propofol 6%, a new formula, during postoperative sedation in non-ventilated children following craniofacial surgery. In a prospective cohort study, children admitted to the paediatric surgical intensive care unit following major craniofacial surgery were randomly allocated to sedation with propofol 6% or midazolam, if judged necessary on the basis of a COMFORT behaviour score. Exclusion criteria were respiratory infection, allergy for proteins, propofol or midazolam, hypertriglyceridaemia, familial hypercholesterolaemia or epilepsy. We assessed the safety of propofol 6% with triglycerides (TG) and creatine phosphokinase (CPK) levels, blood gases and physiological parameters. Efficacy was assessed using the COMFORT behaviour scale, Visual Analogue Scale and Bispectral Index monitor. Twenty-two children were treated with propofol 6%, 23 were treated with midazolam and 10 other children did not need sedation. The median age was 10 (IQR 3-17) months in all groups. Median duration of infusion was 11 (range 6-18) h for propofol 6% and 14 (range 5-17) h for midazolam. TG levels remained normal and no metabolic acidosis or adverse events were observed during propofol or midazolam infusion. Four patients had increased CPK levels. We did not encounter any problems using propofol 6% as a sedative in children with a median age of 10 (IQR 3-17) months, with dosages &lt;4 mg kg(-1) h(-1) during a median period of 11 (range 6-18) h.

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Impact of depth of propofol anaesthesia on functional residual capacity and ventilation distribution in healthy preschool children

Andreas Schibler

British Journal of Anaesthesia, 2007

Background. Propofol is commonly used in children undergoing diagnostic interventions under anaesthesia or deep sedation. Because hypoxaemia is the most common cause of critical deterioration during anaesthesia and sedation, improved understanding of the effects of anaesthetics on pulmonary function is essential. The aim of this study was to determine the effect of different levels of propofol anaesthesia on functional residual capacity (FRC) and ventilation distribution. Methods. In 20 children without cardiopulmonary disease mean age (SD) 49.75 (13.3) months and mean weight (SD) 17.5 (3.9) kg, anaesthesia was induced by a bolus of i.v. propofol 2 mg kg 21 followed by an infusion of propofol 120 mg kg 21 min 21 (level I). Then, a bolus of propofol 1 mg kg 21 was given followed by a propofol infusion at 240 mg kg 21 min 21 (level II). FRC and lung clearance index (LCI) were calculated at each level of anaesthesia using multibreath analysis. Results. The FRC mean (SD) decreased from 20.7 (3.3) ml kg 21 at anaesthesia level I to 17.7 (3.9) ml kg 21 at level II (P,0.0001). At the same time, mean (SD) LCI increased from 10.4 (1.1) to 11.9 (2.2) (P¼0.0038), whereas bispectral index score values decreased from mean (SD) 57.5 (7.2) to 35.5 (5.9) (P,0.0001). Conclusions. Propofol elicited a deeper level of anaesthesia that led to a significant decrease of the FRC whereas at the same time the LCI, an index for ventilation distribution, increased indicating an increased vulnerability to hypoxaemia.

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The Effect of Propofol vs. Isoflurane Anesthesia on Postoperative Changes in Cerebrospinal Fluid Cytokine Levels: Results from a Randomized Trial

Miles Berger

Frontiers in immunology, 2017

Aside from direct effects on neurotransmission, inhaled and intravenous anesthetics have immunomodulatory properties. In vitro and mouse model studies suggest that propofol inhibits, while isoflurane increases, neuroinflammation. If these findings translate to humans, they could be clinically important since neuroinflammation has detrimental effects on neurocognitive function in numerous disease states. To examine whether propofol and isoflurane differentially modulate neuroinflammation in humans, cytokines were measured in a secondary analysis of cerebrospinal fluid (CSF) samples from patients prospectively randomized to receive anesthetic maintenance with propofol vs. isoflurane (registered with http://www.clinicaltrials.gov, identifier NCT01640275). We measured CSF levels of EGF, eotaxin, G-CSF, GM-CSF, IFN-α2, IL-1RA, IL-6, IL-7, IL-8, IL-10, IP-10, MCP-1, MIP-1α, MIP-1β, and TNF-α before and 24 h after intracranial surgery in these study patients. After Bonferroni correction fo...

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Propofol Pharmacokinetics and Pharmacodynamics for Depth of Sedation in Nonventilated Infants after Major Craniofacial Surgery

Monique van Dijk

Anesthesiology, 2006

Background To support safe and effective use of propofol in nonventilated children after major surgery, a model for propofol pharmacokinetics and pharmacodynamics is described. Methods After craniofacial surgery, 22 of the 44 evaluated infants (aged 3-17 months) in the pediatric intensive care unit received propofol (2-4 mg . kg-1 . h-1) during a median of 12.5 h, based on the COMFORT-Behavior score. COMFORT-Behavior scores and Bispectral Index values were recorded simultaneously. Population pharmacokinetic and pharmacodynamic modeling was performed using NONMEM V (GloboMax LLC, Hanover, MD). Results In the two-compartment model, body weight (median, 8.9 kg) was a significant covariate. Typical values were Cl = 0.70 . (BW/8.9)0.61 l/min, Vc = 18.8 l, Q = 0.35 l/min, and Vss = 146 l. In infants who received no sedative, depth of sedation was a function of baseline, postanesthesia effect (Emax model), and circadian night rhythm. In agitated infants, depth of sedation was best describe...

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Cerebral and Systemic Hemodynamic Effects of Intravenous Bolus Administration of Propofol in Neonates

Sabine Huffel, J. Vanderhaegen

Neonatology, 2010

suggesting a better balance between oxygen delivery and demand. PNA ^ 10 days, comedication and absence of cardiopathy were associated with more subtle decreases in cerebral oxygenation and faster recovery. Conclusions: Propofol-induced decrease in HR, SaO 2 and cerebral oxygenation is short lasting while a decrease in MABP is observed up to 60 min. The variability in the effects of propofol is influenced by PNA, comedication or cardiopathy. Near-infrared spectroscopy can be used to assess hemodynamic effects of hypnotics on the cerebral oxygenation.

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Do we really know the pharmacodynamics of anaesthetics used in newborns, infants and children? A review of the experimental and clinical data on neurodegeneration

Alicja Bartkowska-Śniatkowska

2014

The practices of anaesthesiology and intensive therapy are difficult to imagine without sedation or general anaesthesia , regardless of whether the patient is a newborn, baby, child or adult. The relevant concerns for children are distinct from those for adults, primarily due to the effects of anatomical, physiological and pharmacokinetic-phar-macodynamic (PK/PD) differences, which become increasingly important in the brains of children as they develop. The process of central nervous system maturation in humans lasts for years, but its greatest activity (myelination and synaptogenesis) occurs during the fetal period and the first two years of life. Many experimental studies have demonstrated that exposure to anaesthetic drugs during this period can induce neurodegenerative changes in the central nervous systems of animals. The extrapolation of these results directly to humans must be performed with great caution, but anaesthesiologists around the world must begin to debate the safet...

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Effects of propofol on cerebral oxygenation during cardiopulmonary bypass in children

Andrew Macnab

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2000

Purpose: Neurologic complications occur following cardiopulmonary bypass surgery. We conducted a randomized, controlled, single-blind study to determine the effect of propofol on the redox status of cytaa 3 , and to evaluate its potential for decreasing neurologic complications. Methods and Materials: Twenty-four children (median age: 3.3 yr; median weight:14.4 kg) scheduled for elective cardiopulmonary bypass surgery were assigned to either the experimental group (Group P, given sufficient propofol to eliminate brain electrical activity as measured on EEG (i.e. burst suppression)) or the control group (Group C, no propofol). Near infrared spectroscopy data were collected at one-second intervals throughout the surgical procedures. Pre-and postoperative neurologic examinations were completed by a physician blinded to the group to which the patient was assigned. Change in cytochrome aa 3 data at 10-min intervals (10, 20, 30, 40 min) following start of bypass were compared between groups by repeated measures analysis of variance. Results: The patterns of change in redox state of cytochrome were different between the two groups (P < 0.002). The pattern of change within Group P was similar to that in hypothermic patients in Group C. There were correlations between change in cytaa 3 redox status and temperature in the control subjects. There were no gross neurologic complications in either group. Conclusions: Propofol appears to stabilize the energy supply/demand equilibrium of the brain during cardiopulmonary bypass surgery and thus theoretically could reduce the incidence or severity of neurologic complications. 3 et la température chez les sujets témoins. Aucune complication neurologique importante n'est survenue dans un groupe ou l'autre. Conclusion : Le propofol semble maintenir l'équilibre entre l'offre et la demande d'énergie cérébrale pendant une intervention chirurgicale avec circulation extracorporelle. Il pourrait ainsi réduire, en théorie, l'incidence ou la sévérité des complications neurologiques.

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Propofol anesthesia induces proapoptotic tumor necrosis factor-α and pro-nerve growth factor signaling and prosurvival Akt and XIAP expression in neonatal rat brain

Selma Kanazir

Journal of Neuroscience Research, 2014

Previously we observed that prolonged exposure to propofol anesthesia causes caspase-3-and calpainmediated neuronal death in the developing brain. The present study examines the effects of propofol anesthesia on the expression of tumor necrosis factor-a (TNFa), pro-nerve growth factor (NGF), and their receptors in the cortex and the thalamus. We also investigated how propofol influences the expression of Akt and X-linked inhibitor of apoptosis (XIAP) expression, proteins that promote prosurvival pathways. Seven-day-old rats (P7) were exposed to propofol anesthesia lasting 2, 4, or 6 hr and killed 0, 4, 16, or 24 hr after anesthesia termination. The relative levels of mRNA and protein expression were estimated by RT-PCR and Western blot analysis, respectively. The treatments caused marked activation of TNFa and its receptor TNFR-1 and pro-NGF and p75 NTR receptor expression. In parallel with the induction of these prodeath signals, we established that propofol anesthesia promotes increased expression of the prosurvival molecules pAkt and XIAP during the 24-hr postanesthesia period. These results show that different brain structures respond to propofol anesthesia with a time-and duration of exposure-dependent increase in proapoptotic signaling and with concomitant increases in activities of prosurvival proteins. We hypothesized that the fine balance between these opposing processes sustains homeostasis in the immature rat brain and prevents unnecessary damage after exposure to an injurious stimulus. The existence of this highly regulated process provides a time frame for potential therapeutic intervention directed toward suppressing the deleterious component of propofol anesthesia. V C 2014 Wiley Periodicals, Inc.

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Correlation of exhaled propofol with Narcotrend index and calculated propofol plasma levels in children undergoing surgery under total intravenous anesthesia - an observational study

tara ghasemi

BMC Anesthesiology, 2021

Background Exhaled propofol concentrations correlate with propofol concentrations in adult human blood and the brain tissue of rats, as well as with electroencephalography (EEG) based indices of anesthetic depth. The pharmacokinetics of propofol are however different in children compared to adults. The value of exhaled propofol measurements in pediatric anesthesia has not yet been investigated. Breathing system filters and breathing circuits can also interfere with the measurements. In this study, we investigated correlations between exhaled propofol (exP) concentrations and the Narkotrend Index (NI) as well as calculated propofol plasma concentrations. Methods A multi-capillary-column (MCC) combined with ion mobility spectrometry (IMS) was used to determine exP. Optimal positioning of breathing system filters (near-patient or patient-distant) and sample line (proximal or distal to filter) were investigated. Measurements were taken during induction (I), maintenance (M) and emergence...

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Propofol Requirement during Propofol and Butorphanol Anesthesia with and without Nitrous Oxide in Short Duration Intracranial Surgeries: A Bispectral Index Guided Study

Rajeevk Dubey

Journal of Anesthesia & Clinical Research, 2012

Introduction: Propofol is a preferred agent in neurosurgical anesthesia because of its favorable effects on cerebral hemodynamics and excellent recovery profile. Butorphanol is a synthetic opioid which is 5-8 times more potent than morphine and is known to provide stable hemodynamics during various surgical procedures. Owing to its unfavorable effects on cerebral metabolism and hemodynamics nitrous oxide has a debatable role in neurosurgical anesthesia. But studies on exact dose requirement during propofol induction and maintenance anesthesia along with butorphanol with and without the use of N2O during craniotomies are lacking. So we aimed at studying the requirement of propofol (used along with butorphanol) with and without the use of nitrous oxide in intracranial surgeries using bispectral index (BIS) monitoring. Material and methods: Fifty ASA grade I/II patients (16-60 years) scheduled for elective intracranial surgeries (≤ 4 hour duration) were included and were randomly allocated into two groups, group P and PN. All received IV midazolam and butorphanol at a dose of 30 µg/kg each. Anesthesia was induced with propofol and maintained on propofol with oxygen in air (1:1 ratio) in group P and nitrous oxide in oxygen (2:1 ratio) in group PN patients. BIS score of ≤ 40 at the time of endotracheal intubation, 50-60 during maintenance and ≥ 70 at extubation was maintained. The overall and maintenance dose requirement of propofol and the recovery profile were studied. Results: The overall and maintenance propofol doses were significantly higher in group P than group PN (100.02 ± 20.28 µg/kg/min Vs 79.62 ± 13.13µg/ kg/min; p<0.001) and (90.82 ± 19.13 Vs 71.26 ± 11.78 µg/kg/min; p<0.001) respectively. The recovery profiles were identical between groups. Conclusion: When used along with butorphanol the overall and maintenance doses of propofol without the use of nitrous oxide are 100.02 ± 20.28 µg/ kg/min and 90.82 ± 19.13 µg/ kg/min respectively which is more (p<0.001) than the dose required in combination with nitrous oxide (79.62 ± 13.13 and 71.26 ± 11.78 µg/kg/min respectively). J o u rn al of A n e s th es ia & C li n ic a l Resea rc h

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