ABSTRACT
BACKGROUND: Lumbar puncture is a difficult medical skill and is used for administering subarachnoid anesthetic medications. Estimation of skin to subarachnoid space depth (SSD) helps to reduce post spinal anesthetic complications. AIMS: To measure the SDD in overall Egyptian population and to find a formula for predicting SSD in Egyptian patients. SETTINGS AND DESIGN: Four hundred patients of American Society of Anesthesiologist class I and II adult Egyptian patients undergoing surgery using spinal anesthesia in general and obstetric surgery unit, Mansoura University main hospital, were included in this prospective, observational study. SUBJECTS AND METHODS: Patients were divided into three groups: Males (Group M), nonpregnant females (Group F), and pregnant females (Group PF). SSD was measured after performing lumbar puncture. The relationship between SSD and patient characteristics was studied; correlated and statistical analysis was used to find a formula for predicting SSD. STATISTICAL ANALYSIS USED: Statistical analysis was done using Statistical Package for Social Sciences (SPSS 19.0, Chicago, IL, USA). One-way ANOVA with post hoc (Bonferroni correction factor) analysis was applied to compare the three groups. All the covariates in the study further were taken for multivariate analysis. Multivariate regression analysis was performed to evaluate important covariates influencing SSD for each group separately. RESULTS: Mean SSD was 4.99 ± 0.48 cm in the overall population. SSD in adult males (4.93 ± 0.47 cm) was significantly longer than that observed in females (4.22 ± 0.49 cm) but was comparable with SSD in parturient (4.32 ± 0.47 cm). Formula for predicting SSD in the overall population was 2.1+ (0.009 × height) + (0.03 × weight) + (0.02 × body mass index [BMI]) + (0.15 × body surface area [BSA]). Craig's formula when applied correlated best with the observed SSD. CONCLUSIONS: SSD in adult males was significantly longer than that in both pregnant and nonpregnant females, but it was nearly the same in pregnant and nonpregnant females. SSD in Egyptian population can be calculated based on height, weight, BMI, and BSA. Craig's formula was the most suitable to be applied to Egyptian population.
ABSTRACT
BACKGROUND AND AIMS: A pre-puncture estimate of skin to subarachnoid space depth (SSD) may guide spinal needle placement and reduce complications associated with lumbar puncture. Our aim was to determine (1) The SSD in Indian males, females, parturients and the overall population; (2) To derive formulae for predicting SSD and (3) To determine which previously suggested formula best suited our population. METHODS: In this prospective, observational study, 800 adult Indian patients undergoing surgery under spinal anaesthesia were divided into three groups: Males (Group M), females (Group F) and parturients (Group PF). SSD was measured after lumbar puncture. The relationship between SSD and patient characteristics was studied and statistical models were used to derive formula for predicting SSD. Statistical analysis included One-way ANOVA with post hoc analysis, forward stepwise multivariate regression analysis and paired t-tests. RESULTS: Mean SSD was 4.71 ± 0.70 cm in the overall population. SSD in adult males (4.81 ± 0.68 cm) was significantly longer than that observed in females (4.55 ± 0.66 cm) but was comparable with SSD in parturients (4.73 ± 0.73 cm). Formula for predicting SSD in the overall population was 2.71 + 0.09 × Body Mass Index (BMI). Stocker's formula when applied correlated best with the observed SSD. Formulae were derived for the three groups. CONCLUSIONS: We found gender-based differences in SSD, with SSD in males being significantly greater than that observed in the female population. SSD correlated with BMI in the parturient and the overall population. Amongst the previously proposed formulae, Stocker's formula was most accurate in predicting SSD in our population.
ABSTRACT
Introduction: The resting metabolic rate (RMR) can be measured by indirect calorimetry (RMR IC) or estimated by predictive equations, which can overestimate or underestimate energy requirements. Objective: To compare RMRs measured by indirect calorimetry and estimated by predictive equations in young adult and elderly women with normal body mass index (BMI). Subjects and methods: Analytical cross-sectional study. RMR IC was measured and estimated by Harris-Benedict (1919), FAO/WHO/UNU (1985), FAO/ WHO/UNU (2004), and Mifflin-St Jeor equations in 36 young adult women aged20 to 24 years (BMI 20.7 ± 1.6) and29 elderly women aged 60 to 76 years (BMI 25.5 ± 1.6). Measures of central tendency, dispersion, and position were calculated for quantitative variables. The Kruskal-Wallis test was used to compare RMR between the different formulae and the Mann-Whitney test was used to compare RMR IC between groups after verifying normality by the Shapiro Wilks test. The statistical significance level was = 0.05. Results: The Harris-Benedict, FAO/WHO/UNU (2004), FAO/OMS/ UNU (1985), and Mifflin-St Jeor equations showed a statistically significant overestimation (p<0.0001) of 290.5, 196.8,200.1, and 188.0 kcal/d and 220.0, 211.9, 235.8, and 79.4 kcal/d in young adult and elderly women, respectively. The RMRIC between young adult women (1050.0 kcal/d) and elderly women (985,0 kcal/d) exhibited a significant statistical difference (p=0.008). A higher overestimation was found by the Harris-Benedict test and the FAO/ WHO/UNU (1985) equation in young adult and elderly women, respectively. Conclusions: Predictive equations overestimated RMR in young adult and elderly women. Thus, its routine use could lead to malnutrition due to excess intake.
Introducción: La tasa metabólica en reposo (TMR) puede ser medida por calorimetría indirecta (TMR CI) o estimada mediante ecuaciones predictivas, que pueden subestimar o sobreestimar los requerimientos energéticos. Objetivo: Comparar la TMR medida por calorimetría indirecta, con la estimadas por ecuaciones predictivas, en adultas jóvenes y mayores con índice de masa corporal (IMC) normal. Sujetos y métodos: Estudio analítico, transversal. Se midió la TMR CI y se estimó a través de las ecuaciones Harris-Benedict 1919; FAO/OMS/ UNU 1985; FAO/OMS/UNU 2004, y Mifflin St -Jeor, en 36 adultas jóvenes de 20-24 años (IMC 20,7 ± 1,6) y 29 adultas mayores de 60-76 años (IMC 25,5 ± 1,6). Para variables numéricas se calcularon medidas de tendencia central, dispersión y posición. Para comparar la TMR entre las diferentes fórmulas, se usó la prueba de Kruskall Wallis, y para comparar la TMB CI entre grupos, la prueba de Mann- Whitney, previa verificación de normalidad con prueba Shapiro Wilks. Se usó nivel de significancia estadística a= 0,05. Resultados: Las ecuaciones Harris-Benedict, FAO/OMS/UNU 2004, FAO/OMS/UNU 1985 y Mifflin St-Jeor, mostraron sobrestimación estadísticamente significativa (p<0.0001) de 290,5, 196,8, 200,1 y 188,0 kilo-calorías/día en adultas jóvenes, y de 220,0, 211,9, 235,8 y 79,4 kilocalorías/días, en adultas mayores, respectivamente. La TMR CI entre adultas jóvenes (1050,0 kcal/día) y mayores (985,0 kcal/día), presentó una diferencia estadísticamente significativa (p=0,008). En adultas jóvenes Harris - Benedict mostró mayor sobrestimación y en adultas mayores la FAO/ OMS/UNU 1985. Conclusiones: Las ecuaciones predictivas, sobrestimaron la TMR en adultas jóvenes y mayores, por lo cual su uso rutinario, podría facilitar la malnutrición por exceso.
