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Quantifying the impact of inhalational burns:a prospective study

Burns & Trauma 2018年第3期6卷 209-218页

作者： Si Jack Chong Yee Onn Kok Rosanna Xiang Ying Tay Desai Suneel Ramesh Kok Chai Tan Bien Keem Tan Department of Plastic Reconstructive and Aesthetic SurgerySingapore General HospitalLevel 5AcademiaSingapore 169865Singapore Department of Anaesthesiology Singapore General HospitalLevel 5AcademiaSingapore 169865Singapore

Background:inhalational injury is a major cause of morbidity and mortality in burns patients. This study aims to analyse the clinical outcomes, complications and bacteriology of inhalational burn patients. Methods:A prospective study was done on consecutive admissions to Burn Department, Singapore General Hospital over 15 months from January 2015 to March 2016. Presence of inhalational injury, demographics, complications and outcomes was recorded. Diagnosis of inhalational injury was based on history, symptoms and nasoendoscopy. Diagnosis of acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and infective complications were according to the Berlin criteria, acute kidney injury network (AKIN) classification stage 2 and above and the American Burns Association guidelines. Results:Thirty-five patients (17.3%) had inhalational burns out of 202 patients (63.4%male, 57.4%Chinese population). The average age was 43 ± 16.7 years (range 16–86), and percentage of total body surface area (%TBSA) was 12.1 ± 18.0 (range 0–88). In patients with inhalational injury, age was 38.9 ± 17.2 years and%TBSA was 30.3 ± 32.3. In patients without inhalational injury, age was 44.1 ± 12.8 years and%TBSA was 8.3 ± 9.59. Compared to patients with cutaneous injury alone, patients with inhalational burns had more surgeries (3 ± 7.07 vs 1 ± 1.54, p=0.003), increased length of stay (21 days vs 8 days, p=0.004) and higher in-hospital mortality rate (17.1%vs 0.6%, pinhalational injury (pinhalational injury had increased incidence of bacteraemia (31.4%vs 2.4%, pinhalational injury predicted AKI with an adjusted odds ratio (OR) of 17.43 (95%confidence interval (CI) 3.07–98.87, p<0.001);ARDS, OR=106.71 (95%CI 12.73–894.53, p<0.001) and pneumonia, OR=13.87 (95%CI 2.32–82.94, p=0.004). Acinetobacter ba

关键词： inhalational Burns Injury Acute kidney injury Acute respiratory distress syndrome Pneumonia

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Knowledge of Anaesthesia Providers on Exposure to inhalational Anaesthetic Agents in Ghana

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Journal of Biosciences and Medicines 2017年第4期5卷 21-34页

作者： Ebenezer Owusu Darkwa Robert Djagbletey Ernest Ofosu-Appiah Christian Owoo Daniel A. Y. Sottie Raymond Essuman George Aryee Department of Anaesthesia School of Medicine and Dentistry College of Health Sciences University of Ghana Accra Ghana Department of Anaesthesia Korle-Bu Teaching Hospital Accra Ghana

Background: Chronic exposure to inhaled anaesthetic agents poses an occupational hazard related to the practice of anaesthesia. Therefore, this study sought to find out the perception of anaesthesia providers on exposure to inhalational anaesthetics, evaluate their knowledge on the effects of chronic exposure and strategies to reduce chronic exposure to operating room inhalational anaesthetic agents. Method: This cross-sectional survey was conducted by administering a self-administered questionnaire to 71 anaesthesia providers in Ghana who attended the annual refresher course of the faculty of Anaesthesia, West African College of Surgeons, in 2016. Data collected were analysed and presented as frequencies and percentages. Results: Halothane and isoflurane were the most frequently used inhalational agents by the respondents. Majority (90.1%) of the respondents perceived they are exposed to inhalational anaesthetics in their working environment. Majority of the anaesthetic providers cited poorly functioning scavenging systems (28.2%) and use of paediatric Ayre’s T-piece (28.2%) as sources of exposure to inhalational anaesthetics. All respondents admitted making attempts to reduce their exposure to inhalational anaesthetics. Majority of the respondents mentioned teratogenicity (77.5%) and hepatotoxicity (67.6%) as effects of chronic exposure to inhaled anaesthetic agents. Conclusion: Anaesthesia providers in Ghana perceived they are chronically exposed to inhalational anaesthetic agents in their work environment. They are aware of the sources of inhalational anaesthetic agent exposure, associated health risks and strategies required to reduce chronic exposure to inhaled anaesthetic agents.

关键词： inhalational Anaesthetic Agents Anaesthesiologist Knowledge Perception Exposure

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Effect of sevoflurane preconditioning on astrocytic dynamics and neural network formation after cerebral ischemia and reperfusion in rats

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Neural Regeneration Research 2019年第2期14卷 265-271页

作者： Qiong Yu Li Li Wei-Min Liang Department of Anesthesiology Huashan Hospital Fudan University

Astrocytes, the major component of blood-brain barriers, have presented paradoxical profiles after cerebral ischemia and reperfusion in vivo and in vitro. Our previous study showed that sevoflurane preconditioning improved the integrity of blood-brain barriers after ischemia and reperfusion injury in rats. This led us to investigate the effects of sevoflurane preconditioning on the astrocytic dynamics in ischemia and reperfusion rats, in order to explore astrocytic cell-based mechanisms of sevoflurane preconditioning. In the present study, 2,3,5-triphenyltetrazolium chloride staining and Garcia behavioral scores were utilized to evaluate cerebral infarction and neurological outcome from day 1 to day 3 after transient middle cerebral artery occlusion surgery. Using immunofluorescent staining, we found that sevoflurane preconditioning substantially promoted the astrocytic activation and migration from the penumbra to the infarct with microglial activation from day 3 after middle cerebral artery occlusion. The formation of astrocytic scaffolds facilitated neuroblasts migrating from the subventricular zone to the lesion sites on day 14 after injury. Neural networks increased in the infarct of sevoflurane preconditioned rats, consistent with decreased infarct volume and improved neurological scores after ischemia and reperfusion injury. These findings demonstrate that sevoflurane preconditioning confers neuroprotection, not only by accelerating astrocytic spatial and temporal dynamics, but also providing astrocytic scaffolds for neuroblasts migration to ischemic regions, which facilitates neural reconstruction after brain ischemia.

关键词： nerve regeneration sevoflurane ischemia and reperfusion neuroprotection astrocytes dynamics neuroblast glial scar neural network stroke inhalational anesthetics neural regeneration

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A feasibility study of jaw thrust as an indicator assessing adequate depth of anesthesia for insertion of supraglottic airway device in morbidly obese patients

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Chinese Medical Journal 2019年第18期132卷 2185-2191页

作者： Lei Wan Liu-Jia-Zi Shao Yang Liu Hai-Xia Wang Fu-Shan Xue Ming Tian Department of Anesthesiology Beijing Friendship Hospital Capital Medical University Beijing 100050 China Department of General Surgery Beijing Friendship Hospital Capital Medical University Beijing 100050 China

Background:Jaw thrust has been proven as a useful test determining adequate depth of anesthesia for successful insertion of supraglottic airway device (SAD) in normal adults and children receiving intra-venous or inhalational anesthesia induction.This prospective observational study aimed to determine the feasibility and validity of this test when using as an indicator assessing adequate depth of anesthesia for successful insertion of SAD in spontaneously breathing morbidly obese patients receiving sevoflurane inhalational induction.Methods:Thirty morbidly obese patients with a body mass index 40 to 73 kg/m2 undergoing bariatric surgery in Beijing Friendship Hospital from October 2018 to January 2019 were included in this study.After adequate pre-oxygenation,5% sevoflurane was inhaled and inhalational concentration of sevoflurane was increased by 1% every 2 min.After motor responses to jaw thrust disappeared,a SAD was inserted and insertion conditions were graded.The anatomic position of SAD was assessed using a fiberoptic bronchoscope.Results:The SAD was successfully inserted at the first attempt in all patients.Insertion conditions of SAD were excellent in nine patients (30%) and good in 21 patients (70%),respectively.The fiberoptic views of SAD position were adequate in 28 patients (93%).Conclusions:Jaw thrust test is a reliable indicator determining adequate anesthesia depth of sevoflurane inhalational induction for successful insertion of SAD in spontaneously breathing morbidly obese patients.

关键词： Obesity inhalational induction Sevoflurane Supraglottic airway device Jaw thrust test

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Anthrax:an update

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Asian Pacific Journal of Tropical Biomedicine 2011年第6期1卷 496-501页

作者： Kamal SM Rashid AKM M Bakar MA Aliad MA Department of Medicine Khulna Medical College Department of Paediatrics Khulna Medical College Department of Gastroenterology khulna Medical College

Anthrax is a zoonotic disease caused by Bacillus anthracis.It is potentially fatal and highly contagious disease.Herbivores arc the natural host.Human acquire the disease incidentally by contact with infected animal or animal products.In the 18th century an epidemic destroyed approximately half of the sheep in Europe.In 1900 human inhalational anthrax occured sporadically in the United Stales.In 1979 an outbreak of human anthrax occured in Sverdlovsk of Soviet Union.Anthrax continued to represent a world wide presence.The incidence of the disease has decreased in developed countries as a result of vaccination and improved industrial hygiene.Human anthrax clinically presents in three forms,i.***.cutaneous,gastrointestinal and inhalational.About 95%of human anthrax is cutaneous and 5%is inhalational.Gastrointestinal anthrax is very rare(less than 1%).inhalational form is used as a biological warefare agent. Penicillin,ciprofloxacin(and other quinolones),doxicyclin,ampicillin,imipenem.clindamycin, clarithromycin,vancomycin,chloramphenicol,rifampicin are effective antimicrobials. Antimicrobial therapy for 60 days is recommended.Human anthrax vaccine is available. Administration of anti-protective antigen(PA) antibody in combination with ciprofloxacin produced 90%-100%survival.The combination of CPG-adjuvanted anthrax vaccine adsorbed(AVA) plus dalbavancin significantly improved survival.

关键词： Anthrax Bacillus anthracis Zoonotic disease Contagious disease Cutaneous anthrax inhalational anthrax Gastrointestinal anthrax Human anthrax

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Exertional rhabdomyolysis and heat stroke: Beware of volatile anesthetic sedation

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World Journal of Critical Care Medicine 2017年第1期6卷 21-27页

作者： Karel Heytens Jan De Bleecker Walter Verbrugghe Jonathan Baets Luc Heytens Department of Anesthesiology University Hospital Antwerp Department of Neurology AZ Sint-Lucas Department of Neurology University Hospital Ghent Department of Intensive Care University Hospital Antwerp Department of Neurology University Hospital Antwerp Laboratory of Neurogenetics and Biobank Institute Born-Bunge University of Antwerp MH Research Unit University of Antwerp Departments of Anesthesiology and Neurology University Hospital Antwerp

In view of the enormous popularity of mass sporting events such as half-marathons, the number of patients with exertional rhabdomyolysis or exercise-induced heat stroke admitted to intensive care units(ICUs) has increased over the last decade. Because these patients have been reported to be at risk for malignant hyperthermia during general anesthesia, the intensive care community should bear in mind that the same risk of life-threatening rhabdomyolysis is present when these patients are admitted to an ICU, and volatile anesthetic sedation is chosen as the sedative technique. As illustrated by the three case studies we elaborate upon, a thorough diagnostic work-up is needed to clarify the subsequent risk of strenuous exercise, and the anesthetic exposure to volatile agents in these patients and their families. Other contraindications for the use of volatile intensive care sedation consist of known malignant hyperthermia susceptibility, congenital myopathies, Duchenne muscular dystrophy, and intracranial hypertension.

关键词： Exertional rhabdomyolysis Heat stroke Intensive care sedation inhalational anesthetics Malignant hyperthermia Congenital myopathies

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