Michael E. Goldberg

High-quality filtration allows reuse of anesthesia breathing circuits resulting in cost savings and reduced medical waste

STUDY OBJECTIVES To determine if the new Filta-Therm filter prevents contamination and allows the reuse of breathing circuit with considerable cost and environmental savings. DESIGN Prospective study. PATIENTS 52 ASA physical status I, II, III, and IV patients, aged 18 to 75 years. INTERVENTIONS Each morning a new breathing circuit was assembled. The Filta-Therm filter (Intersurgical, Inc., Liverpool, NY) elbow, and mask, but not the circuit, were changed between patients. The filter was placed between the Y-piece and the elbow of the breathing circuit. Prior to anesthesia, samples were obtained at the Y-piece, and the inspiratory and expiratory ports of breathing circuit. Following anesthesia, samples were obtained at the Murphy eye of endotrachael tube, and at the Y-piece. The samples were incubated, and the results examined at 24 and 48 hours. MEASUREMENTS AND MAIN RESULTS Prior to anesthesia, cultures of the Y-piece and the inspired and expired ports samples showed no growth. Following anesthesia, all 52 samples obtained at the endotracheal tube were contaminated with various organisms, while all 52 Y-piece samples showed negative growth. CONCLUSIONS The single use of Filta-Therm filter prevents bacterial contamination and allows reuse of breathing circuit at least twice, resulting in significant cost savings (

Advances in Translational Neuropathic Research: Example of Enantioselective Pharmacokinetic-Pharmacodynamic Modeling of Ketamine-induced Pain Relief in Complex Regional Pain Syndrome

50,778 per year). Further studies are needed to establish the safety of reusing breathing circuits when appropriate bacterial filters are used.

Analgesic and hemodynamic effects of a single 7.5-mg intravenous dose of morphine in patients with moderate-to-severe postoperative pain

Historically, complex regional pain syndrome (CRPS) was poorly defined, which meant that scientists and clinicians faced much uncertainty in the study, diagnosis, and treatment of the syndrome. The problem could be attributed to a nonspecific diagnostic criteria, unknown pathophysiologic causes, and limited treatment options. The two forms of CRPS still are painful, debilitating disorders whose sufferers carry heavy emotional burdens. Current research has shown that CRPS I and CRPS II are distinctive processes, and the presence or absence of a partial nerve lesion distinguishes them apart. Ketamine has been the focus of various studies involving the treatment of CRPS; however, currently, there is incomplete data from evidence-based studies. The question as to why ketamine is effective in controlling the symptoms of a subset of patients with CRPS and not others remains to be answered. A possible explanation to this phenomenon is pharmacogenetic differences that may exist in different patient populations. This review summarizes important translational work recently published on the treatment of CRPS using ketamine.

Transdermal fentanyl system plus im ketorolac for the treatment of postoperative pain

Study Objectives. To evaluate the analgesic and hemodynamic effects of a single dose of intravenous morphine 7.5 mg in patients experiencing moderate‐to‐severe postoperative pain, and to determine any gender differences in analgesic response.

Clinical pharmacology of rapacuronium bromide, a new short-acting neuromuscular blocking agent.

PurposeTo assess the safety and efficacy of transoermal fentanyl plus im ketorolac vs im ketorolac alone in the treatment of postoperative pain.MethodsNinety-two patients scheduled for surgery involving moderate to severe postoperative pain were randomized to one of two groups. Group A (n=46) received an active fentanyl patch and group P (n=46) received a placebo patch. Patches remained in place for 24 hr. Each patient received intraoperative ketorolac, 60 mgim. Patients were monitored for 36 hr postoperatively and the groups were analyzed for ketorolac usage, pain scores. vital signs, serum fentanyl concentrations, and adverse events. Intramuscular ketorolac was available on demand.ResultsGroup A had lower pain scores at 8, 12, 16 and 24 hr after patch placement (P< 0.05). Group A had lower heart rates, lower respiratory rates and fewer dropouts due to inadequate pain relief (4.3% vs 21.7%, P< 0.05). Group A patients also used less ketorolac than group P patients (P< 0.05). The incidence of pruntus was higher in group A patients (19%vs 2%, P< 0.05), while the incidence of nausea and vomiting was not different between the two groups. Transdermal fentanyl was adequate “stand-alone” analgesia in only 23.8% of group A patients while 93.7% of the remaining group A patients receiving a combination of transdermal fentanyl and ketorolac had adequate pain relief.ConclusionThe transdermal fentanyl delivery system plus ketorolacim was more effective in controlling postoperative pain than ketorolacim alone. The two treatment modalities were comparable in safety with no difference in serious adverse events.RésuméObjectifÉvaluer en rapport avec le traitement de la douleur postopératoire la sécurité et l’efficacité du fentanyl transdermique associé au kétorolac avec celles du kétorolac seul.MéthodesQuatre-vingt-douze patients programmés pour une chirurgie comportant des douleurs postopératoires modérées à graves étaient répartis aléatoirement entre deux groupes. Le groupe A (n = 46) recevait un timbre autocollant au fentanyl et le groupe P (n=46) un timbre placebo. Les timbres demeuraient en place pendant 24 h. Chaque patient recevait 60 mg de kétorolacim pendant l’intervention. Les patients étaient gardés sous surveillance pendant 36 h après l’intervention et la dose de kétorolac utilisée, les scores de douleur, les signes vitaux, les concentrations de fentanyl et les incidents indésirables étaient notés. Du kétorolac était administréim sur demande.RésultatsLes patients du groupe A présentaient les scores de douleur les plus bas à 8, 12. 16 et 24 h après l’application du timbre (P< 0.05). Les patients du groupe A avaient la fréquence cardiaque et respiratoire la plus lente et le moins de décrochage par insatisfaction (4,3%vs 21,7%

Perioperative and critical illness dysglycemia--controlling the iceberg.

, P< 0,05). Les patients du groupe A ont aussi utilisé moins de kétorolac que ceux du groupe P (P< 0.05). Lincidence de prurit était plus élevée chez les patients du groupe A (19% vs 2%. (P< 0.05), alors que l’incidence des nausées et des vomissements était la même dans les deux groupes. Le fentanyl transdermique n’était suffisant comme analgésique unique que dans seulement 23,8% des patients du groupe A; 93.7% des autres patients du groupe A qui avaient reçu une combinaison de fentanyl transdermique et de kétorolac étaient suffisamment soulagés.ConclusionsL’administration transdermique de fentanyl associé au kétorolacim a été plus efficace pour soulager la douleur que le kétorolacim seul. Sous l’aspect de la sécunté et des incidents indésirables, les deux méthodes étaient comparables.

Peripheral neuropathy in healthy men volunteers anesthetized with 1.25 MAC sevoflurane for 8 hours.

Rapacuronium is a new steroidal, nondepolarizing, neuromuscular blocking agent. It appears to be the least potent of all available nondepolarizing muscle relaxants. Its onset of action resembles that of succinylcholine, and its recovery times are shorter than those of other nondepolarizing agents. The clinical duration of rapacuronium can be shortened significantly with early (2 min) administration of neostigmine, which may be beneficial in patients with difficult airway or failed intubation. Rapacuronium appears to be free of significant cardiovascular complications.

Impact of pexelizumab, an anti-C5 complement antibody, on total mortality and adverse cardiovascular outcomes in cardiac surgical patients undergoing cardiopulmonary bypass

Patients with dysglycemia related to known or unrecognized diabetes, stress hyperglycemia, or hypoglycemia in the presence or absence of exogenous insulin routinely require care during the perioperative period or critical illness. Recent single and multicenter studies, a large multinational study, and three meta-analyses evaluated the safety of routine tight glycemic control (80–110 mg/dl) in critically ill adults. Results led to a call for more modest treatment goals (initiation of insulin at a blood glucose >180 mg/dl with a goal of ∼150 mg/dl). In this symposium, an international group of multidisciplinary experts discusses the role of tight glycemic control, glucose measurement technique and its accuracy, glucose variability, hypoglycemia, and innovative methods to facilitate glucose homeostasis in this heterogeneous patient population.

Therapeutic uses of leuprolide acetate

Two men volunteers developed peripheral neuropathy after prolonged anesthesia with 1.25 minimum alveolar concentration sevoflurane at an inflow rate of 2 L/minute of fresh gas that caused concurrent administration of relatively large doses (ppm‐hrs) of the degradation product of sevoflurane, compound A. Other similarly treated volunteers had lesser degrees of transient neuropathy. This result does not prove but raises the question of whether compound A or other factors associated with sevoflurane anesthesia can predispose patients to peripheral neuropathy.