Patients' recollections of therapeutic paralysis in the intensive care unit.

BACKGROUND: Neuromuscular blocking agents used for therapeutic purposes, such as facilitating mechanical ventilation and relieving life-threatening agitation, paralyze patients but leave them fully conscious. Aggressive sedation or analgesia is necessary to reduce awareness, relieve fear, produce comfort, decrease anxiety, induce unconsciousness, and minimize possible complications such as posttraumatic stress syndrome. Little information is available on the extent to which patients experience awareness during therapeutic paralysis. OBJECTIVES: To determine and describe the remembered experiences of critical care patients who were given neuromuscular blocking agents and sedatives and/or analgesics to facilitate mechanical ventilation, improve hemodynamic stability, and improve oxygenation. METHODS: A phenomenological approach with in-depth interviews with 11 patients was used. Data were analyzed by using the constant comparative approach. RESULTS: A total of 4 themes and 3 subthemes were identified. The first theme was back and forth between reality and the unreal, between life and death; the subtheme was having weird dreams. The second theme was loss of control; the 2 subthemes were (1) fighting or being tied down and (2) being scared. The third theme was almost dying, and the fourth theme was feeling cared for. CONCLUSIONS: Patients can remember having both negative and positive experiences during neuromuscular blockade. Steps to improve the experiences of patients receiving neuromuscular blockers include improving assessment parameters, developing and using sedation/analgesia guidelines, and investing in quality improvement programs to provide assessment of awareness during therapeutic paralysis and follow-up and referral as necessary. Ways to decrease the use of neuromuscular blockers would also be useful.     

Atypical form of active melorheostosis and its treatment with bisphosphonate

We present the case of a 38-year-old man in whom extensive bilateral melorheostosis was associated with elevated serum alkaline phosphatase, swelling of the right foot and progressive deformity of the left hand, left leg and right foot. Radiography, computed tomography and bone scintigraphy were performed. Following treatment with bisphosphonate (30 mg/day of pamidronate for 6 days) infusion, the pain and swelling of his right foot showed improvement and his elevated serum alkaline phosphatase decreased.     

In Vitro Evaluation of a New Rotational Thrombectomy Device: The Straub Rotarex Catheter

Purpose: To evaluate the efficacy of a new rotational thrombectomy device, and the procedure-related risk of particle embolization. Methods: The experiments were performed in transparent silicone tubes. The conditions of flow were as close as possible to physiological parameters. Distal embolization was detected by a mesh of nylon filters. Results: The Straub Rotarex catheter was able to remove all clots. The mean number of migrating particles larger than 1000 μm was 0.17 (± 0.38), the mean number of 400–1000 μm migrating particles was 1.08 (± 1.04). The mean intervention time was 67 (± 37) sec. The mean volume of collected liquid was 96.6 (± 24.7) ml. Conclusion: The in vitro results suggest that the Straub Rotarex catheter is able to remove large volumes of thrombus with a limited risk of embolization. The main limitation of our model is the absence of adhesion of the clot to the tube.     

A prospective study of adverse drug reactions in hospitalized children

AIMS: There are few publications of adverse drug reactions (ADRs) among paediatric patients, though ADR incidence is usually stated to be higher during the first year of life and in male patients. We have carried out a prospective study to assess the extent, pattern and profile risk for ADRs in hospitalized patients between 1 and 24 months of age. METHODS: An intensive events monitoring scheme was used. A total of 512 successive admissions to two medical paediatric wards (47 beds) were analysed. The hospital records were screened daily during two periods (summer, 105 days and winter, 99 days), and adverse clinical events observed were recorded. RESULTS: A total of 282 events were detected; of these, 112 were considered to be manifestations of ADRs. The cumulative incidence was 16.6%, no differences being observed between periods. Although there were no differences between patients under and over 12 months of age, risk was found to be significantly higher among girls compared with boys (RR=1.66, 95% CI 1.03-2.52). The gastro-intestinal system was most frequently affected. The therapeutic group most commonly implicated was anti-infective drugs and vaccines (41.5%). The ADRs were mild or moderate in over 90% of cases. A consistent relationship was noted between the number of drugs administered and the incidence of ADRs. CONCLUSIONS: Hospitalized patients exhibited an ADR risk profile that included female sex and the number of drugs administered. No particular age predisposition was observed. The most commonly prescribed drugs are those most often implicated in ADRs in paediatric patients.     

Localization of the mRNA for the 5-HT2 receptor by in situ hybridization histochemistry. Correlation with the distribution of receptor sites

³²P-labelled oligonucleotides complementary to rat 5-HT₂ receptor mRNA were used as probes to study the distribution of cells in rat brain containing the mRNA coding for this receptor by in situ hybridization histochemistry. 5-HT₂ receptor binding sites were visualized by autoradiography using [¹²⁵I]DOI as ligand. Both distributions were comparable, demonstrating that 5-HT₂ receptors are expressed by cells intrinsic to the neocortex (lamina Va), claustrum, olfactory bulb and several nuclei of the brainstem.     

Praktische und theoretische Präzipitinuntersuchungen

Ohne ZusammenfassungOberarzt, Feld-Art, Regt. Nr. 42. früher kommandiert zum Institut.     

Paresthesia in various spinal anesthesia techniques for cesarean section

OBJECTIVE: To determine the incidence of paresthesia with different spinal puncture techniques using a 27-gauge Whitacre needle. MATERIAL AND METHODS: Spinal puncture was performed in 224 elective cesarean sections using different techniques in this single-blind, prospective trial. Patients were randomized to 4 groups: group 1, combined epidural and subarachnoid puncture using an introducer needle; group 2, combined epidural and subarachnoid puncture without an introducer; group 3, subarachnoid puncture with an introducer; and group 4, subarachnoid puncture with an introducer to within a few millimeters of the dural sac, at which point the introducer was withdrawn. RESULTS: Paresthesia developed in 23, 11, 16 and 5 patients in groups 1, 2, 3 and 4, respectively. Various nerve roots were affected. In 2 and 11 cases the fourth and fifth lumbar nerve roots were affected; in 29 and 13 cases, the first and second sacral nerve roots were involved. In comparison with group 4, the risk of paresthesia was 7, 2.5 and 4 times greater in groups 1, 2 and 3, respectively. CONCLUSIONS: Combined epidural-subarachnoid puncture leads to a higher incidence of paresthesia in comparison with simple spinal puncture, probably because the lumbar puncture is performed on a dural sac that has been previously deformed due to the "tent effect" caused by the epidural needle. Fewer cases of paresthesia occur when the subarachnoid puncture is slow and steady and the introducer needle is withdrawn millimeters before it reaches the dural sac.