Risk of mishaps during intrahospital transport of critically ill patients

Background: Mishaps are common during transport and may have major impacts on patients

Aims: The main objectives of our study are: first to determine the incidence of complications during intra hospital transports [IHT] of critically ill patients, and second, to determine their risk factors

Methods: All intra hospital transports for diagnostic and therapeutic purposes of patients consecutively admitted in an 18-bed medical surgical intensive care unit in an university hospital, have been studied prospectively during a period of six months [September 1st 2012 to February 28th 2013]

Results: Of 184 transports observed [164 patients], 85 [46.2%] were associated with mishaps. Eighty two mishaps were patient-related [44.5%].Oxygen desaturation [30 cases], agitation [24 cases] and hemodynamic instability [15 cases] were predominantly. One case of cardiac arrest and 3 cases of accidental extubation were occurred during IHT. Seventy three systems-based mishaps were noted [39.6%]. Emergency transports, mechanical ventilation and positive end-expiratory pressure [PEEP] >/= 6 cmH2O were independent risk factors for a higher rate of mishaps. In our study, complications did not statistically increase ventilator-associated pneumonia

Conclusion: This study confirms that IHT of critically-ill patients still involves considerable risks and mishaps incidence remains high

[Effects of 15 mcg intrathecal clonidine added to bupivacaine and sufentanil for labor analgesia]

For the combined spinal epidural analgesia for labour, 30 mcg of subarachnoid clonidine has proved its effectiveness to extend the analgesia, but increased severe hemodynamic effects. To assess the effectiveness and the safety of 15 mcg intra thecal clonidine for labour analgesia. Four months, prospective, randomised, simple blind Study, including ASA I or II women, with mono foetal pregnancy. Patients were randomised in 2 groups: SB Group received intra thecal isobaric bupivacaine 2.5 mg and sufentanil 5 mcg and SBC Group received 15 mcg clonidine added to the same doses of bupivaca‹ne and sufentanil. Epidural analgesia was used when VAS is more than 30. Studied parameters were: delay of installation, duration of analgesia, VAS score, hemodynamic parameters and the incidence of maternal and neonatal side effects. Sixty pregnant women were included [27 in SBC Group and 33 in SB group]. The duration of initial analgesia was significantly longer in the SBC group [145 +/- 43 min] compared with the SB group [98 +/- 28 min]. The delay of analgesia, sensory level and motor block level were similar. There was neither significant increase of the low incidence of blood pressure nor of the ephedrine consumption. The abnormalities of fetal heart rate, the mode of delivery and the incidence of side effects were also similar. The addition of 15 mcg intra thecal clonidine to the bupivacaine and the sufentanil during combined spinal epidural analgesia for obstetrical labour results in extended significantly duration of analgesia without increasing side effects

Spinal anesthesia for endoscopic urological surgery- low dose vs. varying doses of hyperbaric bupivacaine

The aim of this study is to compare the efficiency of low dose vs. varying doses of hyperbaric bupivacaine in spinal anesthesia for endoscopic urological procedures. Sixty consecutive patients were studied in a randomized prospective manner. They received either of 5 [Gr I], 7.5 [Gr II] or 10 mg [Gr III] of hyperbaric bupivacaine 0.5% combined with 25 micro g of fentanyl, through a 25-gauge W hitacre spinal needle placed in the L3-L4 interspace. Characteristics of sensory and motor block, dose of ephedrine required, secondary effects, the patients, and the surgeons, satisfaction, were noted. The maximum number of blocked segments was 14 +/- 1 [Gr I], 15 +/- 2 [Gr II] and 16 +/- 2 [Gr III]. Time to T12 regression was significantly shorter for Gr I [53 +/- 13 min] than for Gr II [69 +/- 20 min] or Gr III [94 +/- 14 min]. Bromage 3 block was not found in Gr I compared to 4 patients in Gr II and 15 patients in Gr III. The duration of motor block was shorter in Gr 1[51 +/- 18 min] than in Gr II [86 +/- 19 min] and in Gr III [138 +/- 21 min]. Ephedrine was used for 16 patients in Gr III [9.8 +/- 12.2 mg], 5 patients in Gr II [3.7 +/- 7.8 mg] and 2 patients in Gr I [0.5 +/- 1.5 mg]. The difference is statistically significant between Gr III and the other groups. These results suggest that the use of a low dose of bupivacaine [5 mg] added to fentanyl [25 micro g] for endoscopic urological surgery, resulted in short-acting sensory block, without motor block and a lower incidence of cardiovascular side effects, as compared to either of 7.5 or 10 mg bupivacaine with 25 micro g fentanyl

[Successful use of levosimendan in a patient with cardiogenic shock complicating acute myocardial infarction]

Levosimendan is a new inodilator that improves cardiac contractility by sensitizing troponin C to calcium. This drug has proved to be effective in treating advanced congestive heart failure but has not been evaluated in cardiogenic shock. We present the case of a 54-year-old male patient treated successfully with levosimendan for cardiogenic shock following acute myocardial infarction. Treatment with dobulamine, revascularisation and intra-aortic balloon conterpulsation had first failed to improve his hemodynamic variables. Levosimendan induced a steady decline of increased pulmonary capillary wedge pressure, followed by an increase in cardiac index and mixed venous oxygen saturation. Left ventricular ejection fraction improved from 25% to 47%. Infusion of levosimendan can be used in cardiogenic shock without side effects and to improve hemodynamics and left ventricular function