RESUMEN
This report responds to a resolution that asked the American Medical Association (AMA) to take action to improve airport and airline accommodations for passengers requiring medical oxygen. Information for the report was derived from a search of the MEDLINE database and references listed in pertinent articles, as well as through communications with experts in aerospace and emergency medicine. Based on this information, the AMA Council on Scientific Affairs determined that commercial air travel exposes passengers to altitude-related hypoxia and gas expansion, which may cause some passengers to experience significant symptoms and medical complications during flight. Medical guidelines are available to help physicians evaluate and counsel potential passengers who are at increased risk of inflight hypoxemia. Supplemental oxygen may be needed for some passengers to maintain adequate tissue oxygenation and prevent hypoxemic complications. For safety and security reasons, federal regulations prohibit travelers from using their own portable oxygen system onboard commercial aircraft. Many U.S. airlines supply medical oxygen for use during flight but policies and procedures vary. Oxygen-dependent passengers must make additional arrangements for the use of supplemental oxygen in airports. Uniform standards are needed to specify procedures and equipment for the use of medical oxygen in airports and aboard commercial aircraft. Revision of federal regulations should be considered to accommodate oxygen-dependent passengers and permit them to have an uninterrupted source of oxygen from departure to destination.
Asunto(s)
Aeronaves , Hipoxia/fisiopatología , Terapia por Inhalación de Oxígeno , Política Pública , Guías como Asunto , Humanos , Enfermedades Pulmonares Obstructivas/complicaciones , Formulación de Políticas , Factores de Riesgo , ViajeRESUMEN
This report responds to resolutions asking the American Medical Association (AMA) to develop recommendations for the use of medical equipment and technology onboard commercial airlines. Information for the report was derived from a search of the MEDLINE database and references listed in pertinent articles, as well as through communications with experts in aerospace and emergency medicine. Based on this information, the AMA Council on Scientific Affairs determined that, while inflight morbidity and mortality are uncommon, serious events do occur, which require immediate emergency care. Management of serious problems requires an integrated emergency response system that ensures rapid notification of medical personnel on the ground, assistance from appropriately trained flight crews and passenger volunteers (if available), and adequate medical supplies and equipment to stabilize the victim. Physicians have an important role in the preflight evaluation and counseling of potential passengers who are at risk of inflight medical complications, and in providing inflight medical assistance. Some U.S. and foreign air carriers are upgrading inflight emergency medical kits and placing automated external defibrillators aboard aircraft. Few data are available regarding the effectiveness of such improvements in improving health or survival outcomes. Recent federal legislation requires assessment of the extent of inflight medical emergencies, including the adequacy of emergency medical supplies and equipment carried onboard commercial airliners. This legislation also should alleviate liability concerns by providing immunity for physicians and others who render inflight medical assistance.
Asunto(s)
Medicina Aeroespacial , Aeronaves , Urgencias Médicas , Equipos y Suministros , Muerte Súbita Cardíaca/prevención & control , Cardioversión Eléctrica , Primeros Auxilios , Guías como Asunto , Humanos , Política Pública , Telemedicina/instrumentaciónRESUMEN
BACKGROUND: Controversy exists concerning whether the costs and potential risks outweigh the potential benefits of "crossover" use in the general blood supply of unutilized blood that was donated for autologous transfusion. STUDY DESIGN AND METHODS: Published articles and reports were identified through systematic search of MEDLINE and review of references cited in previously identified articles, textbooks, and reports. Consultation was made with experts in blood donation and transfusion. Additional peer review was received from the American Medical Association (AMA) Council on Scientific Affairs RESULTS: Concern over infectious disease transmission has led to increased interest in and support for autologous transfusion for individuals having planned surgeries. Different requirements exist for collection, labeling, and screening of blood to be used for autologous versus allogeneic transfusions; therefore, procedures for diverting autologous blood donations to the general blood supply involve considerable expense. Several cost-effectiveness studies of autologous blood donation and transfusion conclude that currently this "crossover" appears to be an expensive procedure yielding little increased benefit from a societal perspective. CONCLUSIONS: The recommendations in this report were adopted as AMA Policy at the AMA Annual Meeting in June 1997. The AMA does not encourage blood collection programs to "cross over" units donated for autologous use to the allogeneic blood supply. Practice guidelines are needed, and should be utilized to ensure parsimony in the use of autologous blood donations and transfusions.
Asunto(s)
Donantes de Sangre , Transfusión de Sangre Autóloga , Transfusión Sanguínea/economía , Transfusión de Sangre Autóloga/economía , Análisis Costo-Beneficio , Humanos , Infecciones/transmisión , MEDLINERESUMEN
The effects of subarachnoid block with hyperbaric bupivacaine 0.5% on forearm and calf blood flow and vascular resistance were examined using venous occlusion plethysmography in 10 fit patients. Following blockade there was an increase in mean (SD) calf blood flow from 2.0 (0.4) to 2.6 (1.2) ml.100 ml-1.min-1 (p = 0.057), a decrease in mean (SD) calf vascular resistance from 55 (15) to 38 (14) R units (p < 0.01), a decrease in mean (SD) forearm blood flow from 3.1 (1.2) to 1.8 (0.9) ml.100 ml-1.min-1 (p < 0.01) and an increase in mean forearm vascular resistance from 38 (16) to 62 (24) R units (p < 0.01). Methoxamine 2 mg was administered intravenously when the mean arterial blood pressure decreased by 15%. There was a resultant marked increase in mean (SD) forearm blood flow from 1.8 (0.9) to 3.0 (0.8) ml.100 ml-1.min-1 (p < 0.001) but a decrease in mean (SD) calf blood flow from 2.6 (1.2) to 2.1 (1.4) ml.100 ml-1.min-1 (p = 0.11). Correspondingly, the mean (SD) forearm vascular resistance decreased from 62 (24) to 46 (17) R units (p < 0.01) with an increase in mean (SD) calf vascular resistance from 38 (14) to 56 (22) R units (p < 0.01). These findings indicate that whereas methoxamine produces the anticipated constrictor response in the calf vessels it causes a simultaneous reduction in vascular resistance in the forearm.
Asunto(s)
Anestesia Raquidea , Brazo/irrigación sanguínea , Pierna/irrigación sanguínea , Metoxamina/uso terapéutico , Adulto , Anciano , Humanos , Inyecciones Intravenosas , Masculino , Metoxamina/administración & dosificación , Persona de Mediana Edad , Pletismografía , Flujo Sanguíneo Regional/efectos de los fármacos , Resistencia Vascular/efectos de los fármacosRESUMEN
The effect of two doses of clonidine on forearm blood flow was compared with an inert treatment using mercury strain gauge venous occlusive plethysmography. In the clonidine treated groups, forearm blood flow was unaffected in the resting state, but decreased sharply with tracheal intubation. In the saline group, blood flow increased with intubation. Forearm vascular resistance increased in the clonidine treated groups, but decreased in the saline group. These results suggest that clonidine has a peripheral action in anaesthetised normotensive individuals, and is not a purely centrally acting drug.
Asunto(s)
Clonidina/farmacología , Antebrazo/irrigación sanguínea , Adulto , Anestesia General , Clonidina/administración & dosificación , Humanos , Inyecciones Intravenosas , Intubación Intratraqueal , Flujo Sanguíneo Regional/efectos de los fármacos , Resistencia Vascular/efectos de los fármacosRESUMEN
The effect of clonidine on the pressor and heart rate response to tracheal intubation was studied in a placebo-controlled, randomised, double-blind trial. Thirty patients were pretreated with either clonidine 1.25 micrograms/kg, or clonidine 0.625 microgram/kg or an equivalent volume of normal saline, given intravenously 15 minutes before induction of anaesthesia. The attenuation of the pressor response to intubation of both clonidine groups was statistically significant compared to the saline group. Neither dose of clonidine completely abolished the increase in either heart rate or blood pressure. There was no difference in attenuation between the clonidine treatments; this indicated that the lower dose may be the more appropriate.
Asunto(s)
Presión Sanguínea/efectos de los fármacos , Clonidina/farmacología , Frecuencia Cardíaca/efectos de los fármacos , Intubación Intratraqueal , Adulto , Clonidina/administración & dosificación , Depresión Química , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Inyecciones Intravenosas , Masculino , Factores de TiempoRESUMEN
Some effects of propofol and thiopentone induction on the peripheral circulation of healthy patients are examined using mercury strain gauge venous occlusion plethysmography of the forearm. Results indicate that both drugs produce a statistically significant decrease in mean arterial blood pressure and forearm blood flow. Forearm vascular resistance remains unchanged after either drug. These data suggest that bolus dose induction of anaesthesia with propofol does not cause arterial vasodilatation of the limb and that a cause for the reduction in mean arterial pressure must be sought elsewhere.
Asunto(s)
Antebrazo/irrigación sanguínea , Propofol/farmacología , Tiopental/farmacología , Adulto , Anestesia Intravenosa , Presión Sanguínea/efectos de los fármacos , Depresión Química , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Persona de Mediana Edad , Flujo Sanguíneo Regional/efectos de los fármacos , Resistencia Vascular/efectos de los fármacosRESUMEN
The amplitude of the P300 component of auditory evoked responses was found to be depressed by benzodiazepine sedation and was subsequently used to monitor the recovery of volunteers sedated with midazolam. The amplitude of the evoked responses was found to be highly correlated with blood midazolam levels but to be no more sensitive than standard psychomotor testing in assessing recovery from sedation.
Asunto(s)
Periodo de Recuperación de la Anestesia , Ansiolíticos/farmacología , Potenciales Evocados Auditivos/efectos de los fármacos , Periodo Posoperatorio , Adulto , Método Doble Ciego , Fusión de Flicker/efectos de los fármacos , Humanos , Masculino , Midazolam/sangre , Midazolam/farmacología , Modelos Biológicos , Distribución Aleatoria , Tiempo de Reacción/efectos de los fármacosRESUMEN
In 54 patients presenting for electroconvulsive therapy, the concentration of serum potassium was measured before and after the induced convulsion modified with a standard anaesthetic technique of methohexitone and suxamethonium. It was found that there was a statistically significant rise in serum potassium, but that the duration of convulsion had no significant effect on that rise in serum potassium. In a further 11 patients, methohexitone alone was administered without ECT, and it was found that serum potassium fell. Methohexitone, suxamethonium and ECT in combination cause a rise in serum potassium which is not clinically important unless pre-induction level is abnormally high, and prolonged convulsion does not exaggerate this rise.
Asunto(s)
Terapia Electroconvulsiva , Metohexital/farmacología , Potasio/sangre , Succinilcolina/farmacología , HumanosAsunto(s)
Atención a la Salud/organización & administración , Revisión de Utilización de Seguros/normas , Seguro de Salud/normas , Programas Controlados de Atención en Salud/organización & administración , Revisión de Utilización de Recursos/normas , Protocolos Clínicos , Hospitalización , Concesión de Licencias , Rol del Médico , Derivación y Consulta , Estados UnidosRESUMEN
Alfentanil, a short-acting opioid, was used as an adjuvant to midazolam for sedation of 30 outpatients undergoing upper gastrointestinal endoscopy. The operating conditions and recovery times were compared with those of a similar group of 30 patients sedated with midazolam only. The use of alfentanil resulted in improved operating conditions and a more rapid recovery. Patient acceptance was high.
Asunto(s)
Endoscopía , Fentanilo/análogos & derivados , Hipnóticos y Sedantes/administración & dosificación , Midazolam/administración & dosificación , Adulto , Alfentanilo , Duodenoscopía , Esofagoscopía , Femenino , Fentanilo/administración & dosificación , Tecnología de Fibra Óptica , Gastroscopía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Eighty-four fit, unpremedicated patients who presented for routine surgery and received a standard anaesthetic technique were allocated randomly to three equal groups. Group 1 received tubocurarine 0.05 mg/kg before induction of anaesthesia. Group 2 received soluble aspirin 600 mg orally one hour before surgery, while Group 3 received no pretreatment. Aspirin prophylaxis produced a significant reduction in the incidence of subsequent suxamethonium-induced myalgia and the improvement was similar to that achieved with tubocurarine pretreatment. Pre-operative oral administration of aspirin effectively reduces muscle pains and avoids many of the complications associated with pretreatment with non-depolarising agents.
Asunto(s)
Aspirina/uso terapéutico , Músculos , Dolor/prevención & control , Premedicación , Succinilcolina/efectos adversos , Administración Oral , Adolescente , Adulto , Anciano , Aspirina/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tubocurarina/uso terapéuticoRESUMEN
Acetaminophen (paracetamol) 20 mg/kg was administered orally to 45 gynecological outpatients who had received either alfentanil 5 micrograms/kg, fentanyl 1 microgram/kg, or no analgesic supplement immediately prior to the induction of general anesthesia. Postoperative gastric emptying, assessed by acetaminophen absorption, was significantly inhibited in those given alfentanil. This inhibition is unlikely to be of great clinical importance and was much less than that found in previous studies using longer-acting opioids such as morphine.
Asunto(s)
Alfentanilo/farmacología , Procedimientos Quirúrgicos Ambulatorios , Fentanilo/farmacología , Vaciamiento Gástrico/efectos de los fármacos , Absorción , Acetaminofén/sangre , Adolescente , Adulto , Análisis de Varianza , Periodo de Recuperación de la Anestesia , Anestesia General , Ensayos Clínicos como Asunto , Femenino , Humanos , Persona de Mediana Edad , Factores de TiempoRESUMEN
The speed and quality of recovery after anaesthesia were studied in 60 outpatients. Anaesthesia was induced using propofol and maintained by nitrous oxide in oxygen supplemented with either halothane or isoflurane. Initial clinical recovery was significantly faster in the halothane group but no differences were found during subsequent psychomotor testing. Minor postoperative side effects were common in both groups.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Periodo de Recuperación de la Anestesia , Halotano , Isoflurano , Periodo Posoperatorio , Adolescente , Adulto , Femenino , Genitales Femeninos/cirugía , Humanos , Masculino , Persona de Mediana Edad , Tiempo de Reacción , VasectomíaRESUMEN
Propofol was used to induce anaesthesia in 60 patients undergoing minor outpatient gynaecological procedures. Maintenance was with 66% nitrous oxide in oxygen, plus either isoflurane or 10-mg increments of propofol. Recovery was assessed using both clinical and psychomotor criteria and the results compared with those obtained in a non-anaesthetized control group. As far as the two test groups were concerned, initial recovery was more rapid in the incremental propofol group but, by 1 h after surgery, there were no differences between all three groups.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Periodo de Recuperación de la Anestesia , Anestésicos , Isoflurano , Fenoles , Periodo Posoperatorio , Adolescente , Adulto , Anestesia General , Anestesia Intravenosa , Femenino , Humanos , Persona de Mediana Edad , PropofolRESUMEN
One hundred and one patients underwent surgical correction of fractures of the proximal femur under spinal anaesthesia. There were 14 deaths in the first three months following surgery. Advancing age, poor pre-anaesthetic status, reduced pre-operative mobility and deteriorating mental function were reliable prognostic indicators of fatal outcome. Spinal anaesthesia for this type of surgery may well be the technique of choice because it avoids the use of drugs which depress the respiratory, cardiac and central nervous system. It also reduces the need for potent post-operative analgesics with similar depressant effects, and may afford some protection against thromboembolic complications. The very low early mortality in this series testifies to the safety of the anaesthetic technique.