Impact of hospital pharmacist interventions on the combination of citalopram or escitalopram with other QT-prolonging drugs

International Journal of Clinical Pharmacy - Background Citalopram and escitalopram can both induce dose-dependent QT prolongation. The risk of arrhythmia may be increased with concomitant use of...     

A multicentre observational study of intra-operative ventilatory management during general anaesthesia: tidal volumes and relation to body weight

We conducted an observational prospective multicenter study to describe the practices of mechanical ventilation, to determine the incidence of use of large intra‐operative tidal volumes (≥ 10 ml.kg^?1 of ideal body weight) and to identify patient factors associated with this practice. Of the 2960 patients studied in 97 anaesthesia units from 49 hospitals, volume controlled mode was the most commonly used (85%). The mean (SD) tidal volume was 533 (82) ml; 7.7 (1.3) ml.kg^?1 (actual weight) and 8.8 (1.4) ml.kg^?1 (ideal body weight)). The lungs of 381 (18%) patients were ventilated with a tidal volume > 10 ml.kg^?1 ideal body weight. Being female (OR 5.58 (95% CI 4.20–7.43)) and by logistic regression, underweight (OR 0.06 (95% CI 0.01–0.45)), overweight (OR 1.98 (95% CI 1.49–2.65)), obese (OR 5.02 (95% CI 3.51–7.16)), severely obese (OR 10.12 (95% CI 5.79–17.68)) and morbidly obese (OR 14.49 (95% CI 6.99–30.03)) were the significant (p ≤ 0.005) independent factors for the use of large tidal volumes during anaesthesia.     

A new technique for localization of hepatic tumors that are poorly visible with CT fluoroscopy

The purpose of this study was to report a new technique for localization of hepatic tumors that are poorly visible with CT fluoroscopy. Forty-three hepatocellular carcinomas were not visible with CT fluoroscopy. A 22-gauge Chiba end-hole needle was inserted in the approximate location of a lesion estimated on the basis of anatomical landmarks demonstrated on both previous MR and CT images. We injected 3 ml of a mixture of nonionic contrast material and saline solution. Following the first injection, contrast solution filled the hepatic lesion in 29 of 43 cases. In 8 of 43 cases, contrast solution was distributed in the normal surrounding liver. In 7 of these 8 cases, repositioning allowed us to adjust the needle in the tumor. In the other 6 of 43 cases, contrast solution spread within capsule or pseudocapsule (pattern 3). In all 6 cases, repositioning allowed to adjust the needle in the tumor. This new technique allows an accurate localization of hepatic tumors that are poorly visible with CT fluoroscopy.     

Residual neuromuscular blockade

Despite the availability of modern neuromuscular blocking agents with short or intermediate duration of action, incidence of residual neuromuscular blockade remains very high. Evidences have been recently provided that residual curarization must be defined as a train-of-four ratio below 0.9 at the thumb adductor during the recovery period after anaesthesia. Residual curarization may be associated with serious adverse events related to respiratory depression, pharyngeal dysfunction, hypoxemia and prolongation of the length of stay in the recovery room. Appropriate choice of drugs, perioperative monitoring of neuromuscular function and large indications of pharmacological reversal may reduce the incidence of residual curarization and improve the patient's safety in the postoperative setting.