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Minimally invasive surgical management of symptomatic uterine cysts
Darwish AM et al. Aspiration of symptomatic uterine cysts is technically feasible and achieves acceptable results. Uterine cysts may not be ignored as a potential cause of gynecologic symptoms, however, their precise pathogenesis and related co morbidities including impact on fertility should be substantiated by an adequately powered prospective randomized controlled study....
Gynecological Surgery, 07/27/2010

Sand aspiration: a case report and review of the radiological features and management
Appelboam R et al. The authors report a case of severe sand aspiration in association with neardrowning, which led to respiratory failure secondary to the acute respiratory distress syndrome, necessitating mechanical ventilation, repeated therapeutic bronchoscopic lavage, and a stay in the intensive care unit that exceeded one month....
Anaesthesia, 07/27/2010

Comparison of the Intersurgical SolusTM laryngeal mask airway and the i-gel supralaryngeal device
Amini S et al. A better fibreoptic view of the larynx was obtained in patients in the LMA group (p = 0.02) compared to those in the igel group and less airway manipulation was required in the LMA group (p < 0.01). Both devices have good performance with very low perioperative complications. However, the Solus LMA provides a better oropharyngeal seal, provides a better fibreoptic view, and requires less manipulation to secure the airway than the igel....
Anaesthesia, 07/27/2010

Improving verbal communication in critical care medicine
Brindley PG et al. Human errors are the most common reason for planes to crash, and of all human errors, suboptimal communication is the number one issue. Mounting evidence suggests the same for errors during immediate medical care. Strong verbal communication skills are key whether for establishing a shared mental model, coordinating tasks, centralizing the flow of information, or for stabilizing emotions. ...
Journal of Critical Care, 07/27/2010

Immunosupression and Infection After Major Surgery: A Nutritional Deficiency
Zhu X et al. Dietary therapy containing arginine at supraphysiologic concentrations along with other components such as omega3 fat acids, antioxidants, nucleotides, and vitamin A is associated with improvement in T cell function, NO production, and a significant decrease in infection rates. The authors propose that a pathologic decrease in arginine availability is an identifiable nutrition deficiency syndrome that worsens outcomes if left untreated....
Critical Care Clinics, 07/27/2010

Postoperative Delirium and Short-term Cognitive Dysfunction Occur More Frequently in Patients Undergoing Valve Surgery With or Without Coronary Artery Bypass Graft Surgery Compared With Coronary Artery Bypass Graft Surgery Alone: Results of a Pilot Study
Hudetz JA et al. The results indicated that patients undergoing valve surgery with or without CABG surgery have a higher incidence of postoperative delirium and cognitive dysfunction 1 week after surgery compared with those undergoing CABG surgery alone....
Journal of Cardiothoracic and Vascular Anesthesia, 07/27/2010

Sedimentation method for preparation of postoperatively salvaged unwashed shed blood in orthopaedic surgery
Munoz M et al. Salvage and return of unwashed shed blood (USB) after total knee replacement (TKR) is an established bloodsaving technique, but some authors question its efficacy and safety and suggest that the shed blood be washed before returning. Sedimentation of USB with colloid solutions provides a lowcost alternative for improving and standardizing the quality of salvaged USB after TKR....
British Journal of Anesthesia, 07/19/2010

Neurocognitive Dysfunction Following Cardiac Surgery
Lombard FW et al. Postoperative neurocognitive decline (POCD) is the most frequently reported form of brain injury in the cardiac surgery setting. Even though most patients recover over a period of several months, recovery is variable and often transient, and early decline may be a marker of neurocognitive dysfunction after several years. ...
Seminars in Cardiothoracic and Vascular Anesthesia, 07/19/2010

Intravenous fentanyl patient-controlled analgesia for perioperative treatment of neuropathic/ischaemic pain in haemodialysis patients
Karanikolas M et al. Use of opioids is common in perioperative haemodialysis patients because they often suffer from intractable ischaemic or neuropathic lower extremity pain...Concerns about accumulation of active opioid metabolites make provision of adequate analgesia problematic in haemodialysis patients scheduled for amputation, and emergency surgery. These data on a small patient population suggest that IV fentanyl patientcontrolled analgesia (PCA) is safe and effective for severe pain in haemodialysis patients....
Journal of Clinical Pharmacy and Therapeutics, 07/19/2010

The Role of Serum Lactate in the Acute Care Setting
Kjelland CB Traditional measures of illness and end points of resuscitation, such as vital signs, often fail to identify occult hypoperfusion with certain disease processes associated with high morbidity and mortality. Thus, biochemical markers that may predict illness earlier are becoming more relevant. ...
Journal of Intensive Care Medicine, 07/19/2010

Changes in the Mesenteric Lymph Proteome Induced By Hemorrhagic Shock
Mittal A et al. The aim of this study was to provide the first comprehensive description of the proteome of hemorrhagic shockconditioned mesenteric lymph. Mesenteric lymph was collected from 16 male Wistar rats randomized to group 1 (n = 8) sham control and group 2 (n = 8) with hemorrhagic shock. The lymph was subjected to proteomic analysis using iTRAQ and liquid chromatographytandem mass spectrometry. Sixty of the 245 proteins had a significant increase in their relative abundance in the hemorrhagic shock group....
Shock, 07/19/2010

Great auricular nerve blockade using high resolution ultrasound: a volunteer study
Thallaj A et al. The great auricular nerve was successfully seen in all volunteers and the tail of the helix, antitragus, lobula and mandibular angle were blocked in all cases whereas the antihelix and concha were never blocked. Ultrasound imaging of the great auricular nerve can be reliably achieved and successful blockade with minimal volumes of local anaesthetic is another example of the benefits of ultrasoundguided peripheral nerve blocks....
Anaesthesia, 07/13/2010

Energy expenditure during weaning from mechanical ventilation: Is there any difference between pressure support and T-tube?
Santos LJD et al. The objectives of this study were to compare patients' energy expenditure (EE) during pressure support (PS) and Ttube (TT) weaning from mechanical ventilation (MV) through indirect calorimetry (IC) and to crosscheck these findings with the results calculated using HarrisBenedict (HB) equation. Comparison of EE in PS and in TT through IC demonstrated that there is increased EE in the TT mode. The results suggest that the HB equation underestimates the EE of patients in weaning from MV....
Journal of Critical Care, 07/13/2010

Reliability, validity and clinical utility of three types of pain behavioural observation scales for young children with burns aged 0-5 years
de Jong A et al. Pain measurement is a prerequisite for individualized pain management and research into pain interventions. There is a need for reliable and valid pain measures for young children with burns. The aim of this study was to investigate whether the pain observation scale for young children (POCIS), the COMFORT behaviour scale (COMFORTB) and the nurse observational visual analogue scale (VAS obs) are reliable, valid and clinically useful instruments to measure pain in children with burns aged 0–5years...Nurses found POCIS easier and quicker to use, but COMFORTB was found to indicate pain more accurately. Both POCIS and COMFORTB are reliable, valid and practical scales for pain measurement in young children with burns and can be used in practice and research. The VAS obs was found to be unreliable....
Pain, 07/13/2010

Sugammadex: a selective relaxant-binding agent providing rapid reversal
Rex C et al. Sugammadex binds aminosteroidal muscle relaxants by encapsulation. It enables rapid reversal of neuromuscular blockade at any time point and at any depth of block. Its effects are predictable and very reliable, in contrast to cholinesterase inhibitors. This opens up new perspectives in anaesthesia. Even an emergency reversal of highdose rocuroniuminduced neuromuscular blockade is possible with sugammadex and times to full recovery (TOF 0.9) are faster than after spontaneous recovery from suxamethonium....
Current Opinion in Anesthesiology, 07/13/2010

The Role of Suggestions in Hypnosis for Chronic Pain: A Review of the Literature
Dillworth T et al. The goal of this review was to address the issue of differences in the content of hypnotic suggestions, including pain management suggestions, nonpain related suggestions, and posthypnotic suggestions, in the context of published clinical trials of hypnosis for chronic pain management. This review focused on the types of suggestions used in twenty five studies comparing hypnosis to active treatments (e.g., relaxation, biofeedback), nontreatment control groups (e.g., standard care/waitlist control, supportive attention), or both in adult populations with various chronic pain conditions. Overall, these studies found hypnosis to be more effective than nontreatment control groups and similarly effective when compared to active treatments on painrelated outcomes when either painrelated suggestions or nonpain related suggestions were used. However, for studies that included both painspecific and nonpain related suggestions, hypnosis was found to be superior to active treatments on a variety of painrelated outcomes....
The Open Pain Journal, 07/13/2010

Starvation, exercise, injury and obesity
Campbell I Starvation, exercise and injury place a metabolic ‘stress’ on the system. This article describes how the body adapts metabolically to a decreased nutrient supply, increased energy demands and a surfeit of nutrient supply. Many patients are malnourished, have impaired exercise tolerance, become injured, or are obese. An understanding of the metabolic physiology of these conditions is therefore desirable....
Anaesthesia & intensive care medicine, 06/29/2010

Early fluid resuscitation with hyperoncotic hydroxyethyl starch 200/0.5 (10%) in severe burn injury
Bechir M et al. Despite large experience in the management of severe burn injury, there are still controversies regarding the best type of fluid resuscitation, especially during the first 24 hours after the trauma. This small study indicates that the application of hyperoncotic HES 200/0.5 (10%) within the first 24 hours after severe burn injury may be associated with fatal outcome and should therefore be used with caution. ...
Critical Care, 06/29/2010

The Addition of Fentanyl to Local Anesthetics Affects the Quality and Duration of Cervical Plexus Block: A Randomized, Controlled Trial
Sindjelic RP et al. Cervical plexus block is frequently associated with unsatisfactory sensory blockade. The addition of fentanyl to local anesthetics improved the quality and prolonged the duration of cervical plexus block in patients undergoing CEA....
Anesthesia & Analgesia, 06/29/2010

Surgical stress index in response to pacemaker stimulation or atropine
Hocker J et al. The aim of this study was to evaluate the effect on SSI of atropine administration and cardiac pacing. SSI values measured in patients receiving atropine or in patients with pacemakers should be interpreted cautiously....
British Journal of Anesthesia, 06/29/2010

Analgesia in labour: induction and maintenance
Collis RE et al. Labour epidural analgesia underwent marked changes from the mid1980s. The addition of opioids, such as fentanyl, to local anaesthetics reduced motor block as well as improving analgesia and maternal satisfaction. The introduction of new techniques such as combined spinal epidural analgesia and patientcontrolled epidural analgesia has further enhanced regional techniques. Dense motor block, historically associated with labour epidural analgesia, has now been reduced to a level where some mothers can mobilize safely out of bed during their labour. Research continues to focus on finding the ideal technique and combination of drugs to provide reliable analgesia with minimal motor block. No one technique has become universally popular, and the introduction of the new levo or senantiomer local anaesthetics has not had a major impact on labour analgesia practice. Currently, women can enjoy safe, reliable epidurals for labour analgesia with reduced or minimal motor blockade....
Anaesthesia & intensive care medicine, 06/29/2010