Mobile phones in the hospital--past, present and future.

The phenomenon of electromagnetic interference by mobile phones is real and potentially clinically significant. This has been recognised by the Department of Health and the Medical Devices Agency, leading to bans on phone use in hospitals. Current evidence suggests that mobile phones can cause malfunction of medical equipment, but only when used in close proximity. Allowing phone use in non-patient care areas and improving staff education may improve compliance with hospital policies.

Ultra-fast-track anesthetic technique facilitates operating room extubation in patients undergoing off-pump coronary revascularization surgery.

OBJECTIVE: To determine if implementation of ultra-fast-track anesthetic (UFTA) technique facilitates operating room extubation in patients undergoing off-pump coronary artery bypass graft (CABG) surgery. DESIGN: Retrospective review. SETTING: Referral center for cardiovascular surgery at a university hospital. PARTICIPANTS: Thirty-seven patients undergoing off-pump CABG surgery. INTERVENTIONS: Two groups represented UFTA (n = 10) and standard anesthetic (controls, n = 27) techniques. Anesthesia was conducted with propofol, remifentanil, vecuronium, and thoracic epidural analgesia in the UFTA group and thiopental, fentanyl, pancuronium, and isoflurane in the control group. Active temperature control was an integral part of the UFTA technique but not the standard technique. The active temperature control included intravenous fluid warmer, prewarmed skin preparation, humidified inspired gases, a circulating water warming blanket, and a forced-air warmer, along with the maintenance of the operating room temperature at 24 degrees C. The control group was managed with an intravenous fluid warmer, and the ambient temperature remained constant (20 degrees C). Patients who did not satisfy extubation criteria within 30 minutes from the end of surgery were sedated and transferred to the intensive care unit (ICU). MEASUREMENTS AND MAIN RESULTS: All patients in the UFTA group and 2 in the control group were extubated in the operating room immediately after surgery. None of the patients required reintubation. There was no significant difference in postextubation PaO(2) and PaCO(2) between the groups. Nasopharyngeal temperature decreased from 36.7 +/- 0.4 degrees C to 36.4 +/- 0.3 degrees C in the UFTA group and from 36.6 +/- 0.5 degrees C to 35.6 +/- 0.4 degrees C in the control group (p < 0.0001). Bradycardia occurred significantly more often in the UFTA group but there was no difference in episodes of hypotension. There were no perioperative deaths. Patients who were extubated in the operating room required lower nurse-to-patient acuity ratio (1:2) in the ICU. No difference was found in ICU and hospital length of stay. CONCLUSIONS: Implementation of UFTA technique provided adequate hemodynamic control and facilitated operating room extubation in all patients. The impact of UFTA on earlier patient discharge and actual cost savings within a fully integrated post-cardiac surgery unit requires further evaluation.

Vital capacity inhalation induction with sevoflurane: an alternative to standard intravenous induction for patients undergoing cardiac surgery.

OBJECTIVE: To determine the respiratory and cardiovascular effects of a high concentration vital capacity induction with sevoflurane compared with an intravenous induction with etomidate in patients scheduled for elective coronary artery bypass graft (CABG) surgery. DESIGN: Prospective, randomized, double-blind, controlled clinical trial. SETTING: Cardiothoracic unit at a university hospital referral center. PARTICIPANTS: Twenty-two patients undergoing elective CABG surgery. INTERVENTIONS: The study group (group S) received a vital capacity gaseous induction with sevoflurane 8% (n = 12) and the control group (group E) were given etomidate, 0.2 to 0.3 mg/kg (n = 10). Anesthesia was supplemented with fentanyl, 8 microg/kg, and vecuronium, 0.1 mg/kg, in both groups. MEASUREMENTS AND MAIN RESULTS: The speed of induction of anesthesia was comparable between the groups. There was a significant increase in minute ventilation after induction of anesthesia in both groups. This increase was associated with a small reduction in PaCO2. There were no clinically significant changes in pH and PaO(2). The incidence of breath-holding and the need for an oropharyngeal airway were similar between the groups. Both groups had similar reductions in mean arterial pressure and cardiac output during the study period; however, a downward trend in mean pulmonary artery pressure was noted in group S, whereas in group E it remained unchanged. Absolute plasma epinephrine and norepinephrine values were low during the precardiopulmonary bypass period in both groups. CONCLUSIONS: The technique of vital capacity inhalation induction with 8% sevoflurane offers a rapid onset of anesthesia, satisfactory airway control, and a good hemodynamic profile. Consideration should be given to the benefits of single-agent anesthesia and lowered pulmonary artery pressure during the precardiopulmonary bypass period. In addition to CABG surgery, this technique could be considered in patients with coronary artery disease undergoing noncardiac surgery, particularly for procedures in which spontaneous ventilation is preferred.

Fast-track cardiac anesthesia in patients with sickle cell abnormalities.

UNLABELLED: We conducted a retrospective review of 10 patients with sickle cell trait (SCT) and 30 patients (cohort control) without SCT undergoing first-time coronary artery bypass graft surgery with cardiopulmonary bypass. Demographic, perioperative management, and outcome data were collected. Both groups were matched according to age, weight, duration of surgery, and preoperative hemoglobin (Hb) concentration. Distribution of gender, medical conditions, pharmacological treatment, and preoperative left ventricular function were similar between the groups. The comparisons were analyzed in respect to postoperative blood loss and transfusion rates, as well as duration of intubation, intensive care unit, and hospital length of stay (LOS). All patients underwent fast-track cardiac anesthesia. A combination of cold crystalloid and blood cardioplegia was used. The lowest nasopharyngeal temperature was 33 degrees C. There were no episodes of significant hypoxemia, hypercarbia, or acidosis. None of the patients had sickling crisis during the perioperative period. The postoperative blood loss was 687 +/- 135 vs 585 +/-220 mL in the SCT and control groups, respectively. The trigger for blood transfusion during cardiopulmonary bypass was hematocrit <20% and Hb <75 g/L postoperatively. Three SCT patients (30%) and 10 control patients (33%) received a blood transfusion. Median extubation time was 4.0 vs 3.9 h; intensive care unit LOS was 27 vs 28 h; and hospital LOS was 6.0 vs 5.5 days in the SCT and control groups, respectively. There were no intraoperative deaths. One patient in the SCT group died from multiorgan failure 2 mo after surgery. IMPLICATIONS: Fast-track cardiac anesthesia can be used safely in patients with sickle cell trait undergoing first-time coronary artery bypass graft surgery. Extubation time and intensive care unit and hospital length of stay are comparable to those of matched controls, and blood loss and transfusion requirements are not increased. A hematocrit of 20% seems to be a safe transfusion trigger during cardiopulmonary bypass in these patients.