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Patient-Controlled Sedation and Analgesia with Propofol and Alfentanil:A Preliminary Safety Evaluation Prior to Use of Non-Anaesthesiology Doctors

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Open Journal of Anesthesiology 2012年第2期2卷 47-52页

作者： Andreas Nilsson Folke Sjoberg Susanne Oster hanne bek-jensen Claes Lennmarken Department of Anesthesiology and Intensive Care Linkoping University HospitalLinkopingSweden Department of Urology Linkoping University HospitalLinkopingSweden

Background: The aim was to evaluate safety aspects of patient-controlled sedation and analgesia (PCS) for extracorporeal shockwave lithotripsy (ESWL) and PCS to be handled by non-anaesthesiology doctors. Methods: Thirty-four ASA I-III patients used PCS with propofol and alfentanil for ESWL in this interventional study. Strict safety limits were defined regarding respiratory rate (RR), heart rate (HR), mean arterial blood pressure (MAP), oxygen saturation from pulse oximetry (SpO2), and transcutaneous partial pressures of oxygen (PtcO2) and carbon dioxide (PtcCO2). The patients' levels of consciousness was graded on a five-point scale and monitored with Bispectral Index (BIS). A nurse anaesthetist was supervising the procedure but was instructed to intervene only if safety limits were breached. No supplementary oxygen was given. Results: All patients responded to verbal stimuli during treatment. Cardiovascular stability was maintained, but respiratory variables were affected. Two patients with SpO2 2 ≥ 6.5 kPa). In 18 patients hypoxaemia was indicated as PtcO2 ≤ 8.0 kPa. All these 18 patients were given supplementary oxygen. There was no correlation between dose of drugs, age, weight or any vital variable. The 34 patients would use PCS again in the case of future treatment. Conclusions: During ESWL treatment PCS can be used with good patients’ satisfaction, and maintained cardiovascular stability, but PCS had an indisputable effect on pulmonary function with hypoxemia (resulting in need for supplementary oxygen) or hypercarbia. The person in charge of PCS must therefore be trained to perform according to the guidelines for sedation and/or analgesia by non-anaesthesiology doctors.

关键词： Anaesthesia Patient-Controlled Sedation Safety European Guidelines

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Performance assessment of borehole arrangements for the design of rectangular shallow foundation systems

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Journal of Rock Mechanics and Geotechnical Engineering 2023年第12期15卷 3291-3304页

作者： Marcin Chwała Danko J.Jerez Hector A.jensen Michael Beer Wrocław University of Science and Technology Poland Institute for Risk and Reliability Leibniz University HannoverGermany Departamento de Obras Civiles Universidad Técnica Federico Santa MaríaChile International Joint Research Center for Resilient Infrastructure&International Joint Research Center for Engineering Reliability and Stochastic Mechanics Tongji UniversityShanghai200092China Institute for Risk and Uncertainty and School of Engineering University of LiverpoolUnited Kingdom

This study proposes a framework to evaluate the performance of borehole arrangements for the design of rectangular shallow foundation systems under spatially variable soil conditions. Performance measures are introduced to quantify, for a fixed foundation layout and given soil sounding locations, the variability level of the foundation system bearing capacities in terms of their mean values and standard deviations. To estimate these measures, the recently proposed random failure mechanism method (RFMM) has been adopted and extended to consider any arrangement of rectangular foundations and boreholes. Hence, three-dimensional bearing capacity estimation under spatially variable soil can be efficiently performed. Several numerical examples are presented to illustrate the applicability of the proposed framework, including diverse foundation arrangements and different soil correlation structures. Overall, the proposed framework represents a potentially useful tool to support the design of geotechnical site investigation programs, especially in situations where very limited prior knowledge about the soil properties is available.

关键词： Foundations Geotechnical engineering Bearing capacity Optimal borehole placement Soil spatial variability

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