CI For Median Difference Research Articles

Development and Validation of a Cultural-based Food Frequency Questionnaire (FFQ) against 7-day Food Diary (7d FD) to Assess Fish Intake among Elementary School Children

An accurate dietary fish questionnaire can be used to predict dietary intake status of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA). The aim of this study was to design and validate a food frequency questionnaire (FFQ) to predict fish consumption of primary school children against a 7-day food diary (7d FD). A cross-sectional study was performed in elementary school in Surakarta, Indonesia. A total of 164 children aged 8 to 12 yo which were recruited using multi-stage random sampling were participated in this study. The FFQ consisted of 38 species of fish including 27 species of fresh fish and 11 species of processed fish. Total median (interquartile range) fish intake determined from the FFQ vs 7d FD was similar of 60 (36-114) g/d and 59 (37-108) g/d, respectively. A very good correlation was found between the FFQ and 7d FD by Spearman’s correlation coefficient test (r=0.965, p=0.0001) with an acceptable of the two methods using non-parametric limit of agreement (95% LoA=-10.907-34.619, median difference=0.011, 95% CI for median difference=-2.408-1.193). The FFQ is acceptable a valid tool to determine fish intake in this group.

The effect of suprainguinal fascia iliaca block on the recovery of patients after arthroscopic hip surgery.

Adolescent and young adult patients undergoing arthroscopic hip surgery experience significant pain in the immediate postoperative period. There is a small body of evidence that indicates suprainguinal fascia iliaca blocks can improve comfort during recovery from this intervention. Our hypothesis was that patients undergoing hip surgery would consume fewer opioids and have less pain in the perioperative time frame if they received the block as part of their analgesic regimen. In this study, we evaluated the outcomes of 716 patients, including 275 who received a suprainguinal fascia iliaca block, and 441 who did not have a block. Inclusion criteria included all age groups and American Society of Anesthesiologists, functional classes 1-2. Patients who received other concurrent procedures or those with incomplete data sets were excluded. We utilized a regional anesthesia database that combined data from various repositories into one web-based relational system. The primary outcomes were total opioid consumption and pain scores in the recovery room. Secondary outcomes included opioid side effects, block-related complications, and total recovery room time. Multivariable logistic regression analysis was used to evaluate opioid consumption, side effects, and total recovery times. Pearson chi-square was applied to assess the level of pain between the two groups. Total opioid consumption was significantly less in the block group compared to those not receiving a block (0.28mg/kg vs 0.35mg/kg, P<0.001, 95% CI of difference in medians 0.04-0.10mg/kg), but there was no statistical difference in pain scores. Patients with the regional block had a lower frequency of emesis in the PACU (0.7% vs 4.3%; P<0.005, 95% CI of difference: 2-25) and shorter PACU times (93 vs 108minutes, P<0.001, 95% CI of difference: 8-23minutes). Our study supports the clinical effectiveness of suprainguinal fascia iliaca blocks in young patients undergoing arthroscopic hip surgery.

A comparison of supraglottic devices in pediatric patients.

BackgroundWhen managing patients with a difficult airway, supraglottic airways (SGAs) have been used as rescue devices or to serve as a conduit for endotracheal intubation. The current study compares various clinical outcomes, including the bronchoscopic view of the glottis when using 2 SGAs, the Air-Q® laryngeal mask airway (LMA) and the i-gel® SGA, in pediatric patients.MethodsPatients ≤18 years of age were prospectively randomized to receive either the Air-Q® LMA or the i-gel® SGA. Following SGA placement, a flexible fiberoptic bronchoscope was inserted through the SGA to visualize the glottis. Time taken to obtain the bronchoscopic view and place the SGA, and the ability to seal the airway at 20 cmH2O were compared. The bronchoscopic view obtained was graded as follows: 1) glottic aperture seen completely; 2) glottic aperture seen partially with visual obstruction <50%; 3) glottic aperture seen, but visual obstruction >50%; and 4) glottic aperture not seen.ResultsFifty patients were enrolled and 48 (22/26 male/female) were included in the analysis. Median age was 13 years (IQR: 7, 16) and median weight was 49 kg (IQR: 25, 70). The Air-Q® LMA and i-gel® SGA groups did not differ in device placement time (median of 19 vs 21 seconds; 95% CI of difference in medians: − 2 to 7; P=0.331), the time to achieve fiberoptic view of the glottis (median of 25 vs 21 seconds; 95% CI of difference: − 9 to 8; P=0.489) or the grade of the bronchoscopic view of the airway. Eight Air-Q® and 6 i-gel® supraglottic devices sealed the airway at 20 cmH2O.DiscussionThe time required for successful placement of the SGA, the time required for bronchoscopic view, and the quality of bronchoscopic view through the Air-Q® LMA and the i-gel® SGA did not differ.

Untangling glycaemia and mortality in critical care

BackgroundHyperglycaemia is associated with adverse outcomes in the intensive care unit, and initial studies suggested outcome benefits of glycaemic control (GC). However, subsequent studies often failed to replicate these results, and they were often unable to achieve consistent, safe control, raising questions about the benefit or harm of GC as well as the nature of the association of glycaemia with mortality and clinical outcomes. In this study, we evaluated if non-survivors are harder to control than survivors and determined if glycaemic outcome is a function of patient condition and eventual outcome or of the glycaemic control provided.MethodsClinically validated, model-based, hour-to-hour insulin sensitivity (SI) and its hour-to-hour variability (%ΔSI) were identified over the first 72 h of therapy in 145 patients (119 survivors, 26 non-survivors). In hypothesis testing, we compared distributions of SI and %ΔSI in 6-hourly blocks for survivors and non-survivors. In equivalence testing, we assessed if differences in these distributions, based on blood glucose measurement error, were clinically significant.ResultsSI level was never equivalent between survivors and non-survivors (95% CI of percentage difference in medians outside ±12%). Non-survivors had higher SI, ranging from 9% to 47% higher overall in 6-h blocks, and this difference became statistically significant as glycaemic control progressed. %ΔSI was equivalent between survivors and non-survivors for all 6-hourly blocks (95% CI of difference in medians within ±12%) and decreased in general over time as glycaemic control progressed.ConclusionsWhereas non-survivors had higher SI levels, variability was equivalent to that of survivors over the first 72 h. These results indicate survivors and non-survivors are equally controllable, given an effective glycaemic control protocol, suggesting that glycaemia level and variability, and thus the association between glycaemia and outcome, are essentially determined by the control provided rather than by underlying patient or metabolic condition.

Does a policy of earlier induction affect labour outcomes in women induced for postmaturity? A retrospective analysis in a tertiary hospital in the North of England

Objectivesto investigate whether a change in the management of postmature pregnancy to earlier induction affects the length of labour and the induction process. Secondly, to assess the feasibility of the research process to inform a future larger study. Designa change in management of postmature pregnancy in an NHS hospital in October 2013, from induction at 42 weeks gestation to induction between 41–42 weeks, provided an opportunity to conduct a retrospective analysis. Pre-existing data from the maternity database and casenotes were collected and primary outcomes analysed using the Mann-Whitney test and the Hodges-Lehman confidence interval for differences in medians. Settinga large city based tertiary referral hospital in the North of England. Participants125 women induced before the change in policy were compared with 309 women induced after the change. Measurementsprimary outcomes were length of 1st and 2nd stage of labour, overall length of labour, length of induction to established labour and length of induction to birth. Findingsthe median overall length of labour for women induced at 42 weeks was 6.5hours, while for women induced at 41–42 weeks this was 5.2hours. The difference was not statistically significant (p=0.15, 95% CI for median difference −0.27 to 1.93hours) with a small effect size (Pearson's r=−0.08). The median length of induction to birth was 13.6hours for women induced at 42 weeks and 16.5hours for women induced at 41–42 weeks. This difference was also not statistically significant (p=0.14, 95% CI for median difference −7.25 to 1.20hours) with a small effect size (Pearson's r=−0.13). Key conclusions and implications for practiceThis study demonstrated no statistically significant differences in length of labour and induction following a change in the management of postmature pregnancy to earlier induction. A large study is needed to establish definitively the effects of earlier induction on labour outcomes.

Abstract PR417

Background & Objectives: Gastric volumes of more than 0.4 ml/kg at induction of general anaesthesia is associated with increased risk of pulmonary aspiration. Prevention of pulmonary aspiration is one of the important aspects of safe anaesthetic practices and several measures have been proposed to reduce this risk. This prospective randomised double blind, placebo controlled trial was carried out to compare the effects of metoclopramide, octreotide and placebo on gastric volume when given as premedication prior to induction of anaesthesia. Materials & Methods: Forty five ASA I or II patients scheduled for elective surgery under general anaesthesia were randomly allocated into three groups. Group 1 received 50 ml of intravenous(IV) normal saline (placebo), Group 2 received 10 mg IV metoclopramide diluted in 50 ml saline, and Group 3 received 50 µg IV octreotide diluted in 50 ml saline. All study drugs were infused 30 minutes prior to induction of general anaesthesia. After endotracheal intubation or insertion of supraglottic device, a nasogastric tube size 14G was inserted into the stomach for collection of gastric content. Gastric volumes, blood sugar levels pre and post drug administration as well as the side effects of the studied drugs were recorded. Results: Metoclopramide decreased gastric volume significantly (p < 0.05; 95% CI for median difference: 1.1 – 6.7 ml) compared with both octreotide and saline. Octreotide however did not significantly alter gastric volume (p > 0.05; 95% CI for median difference: 5 – 32 ml) compared with placebo (saline). Mean sugar level was raised from 5.52 to 6.53 after octreotide administration, (p < 0.05). One patient experienced mild abdominal cramps with administration of octreotide. There was no incident of pre-induction nausea, vomiting or adverse drug reactions. Conclusion: Metoclopramide is found to be effective in reducing gastric volume, as compared to octreotide and placebo when given as premedication prior to general anaesthesia. There is no difference between placebo and 50 µg octreotide in reducing gastric volume in these patients.

Cricoid Pressure Impedes Tracheal Intubation With the Pentax-AWS Airwayscope®

Abstract Background It is unclear how cricoid pressure affects tracheal intubation with the Pentax-AWS Airwayscope® (AWS). We conducted a prospective randomized clinical trial in anaesthetized patients. Methods Sixty patients were allocated to either the cricoid pressure (CP) group (n+30) or the sham group (n+30). We compared the two groups with regard to intubation time, number of attempts required for insertion of the Intlock blade (disposable blade of the AWS) and tracheal intubation, percentage of glottic opening (POGO) score, and subjective difficulty of both laryngoscopy and passage of a tube through the glottis. Results Intubation time was significantly longer in the CP group (median 45[IQR40–59] s) than in the sham group (32[28–45] s) (P+0.003, 95% CI for median difference 5–24 s). The number required for insertion of the Intlock blade did not differ between the groups (P+0.08), but the number for tracheal intubation was significantly higher in the CP group (1 attempt in 14 patients, 2 in 7, 3 in 9) than in the sham group (1 attempt in 24 patients, 2 in 6; P+0.002). POGO score did not differ significantly between the groups (P+0.60), nor did the subjective difficulty of laryngoscopy (P+0.06). The visual analogue scale score for passage of a tube through the glottis was significantly higher in the CP group than in the sham group (P Conclusions Cricoid pressure impedes tracheal intubation using the AWS, and is associated with longer intubation time, which can be attributed to increased difficulty in the passage of a tube through the glottis. Clinical Trial registry number UMI18209.

Cricoid pressure impedes tracheal intubation with the Pentax-AWS Airwayscope®: a prospective randomized trial

BackgroundIt is unclear how cricoid pressure affects tracheal intubation with the Pentax-AWS Airwayscope® (AWS). We conducted a prospective randomized clinical trial in anaesthetized patients. MethodsSixty patients were allocated to either the cricoid pressure (CP) group (n+30) or the sham group (n+30). We compared the two groups with regard to intubation time, number of attempts required for insertion of the Intlock blade (disposable blade of the AWS) and tracheal intubation, percentage of glottic opening (POGO) score, and subjective difficulty of both laryngoscopy and passage of a tube through the glottis. ResultsIntubation time was significantly longer in the CP group (median 45[IQR40–59] s) than in the sham group (32[28–45] s) (P+0.003, 95% CI for median difference 5–24 s). The number required for insertion of the Intlock blade did not differ between the groups (P+0.08), but the number for tracheal intubation was significantly higher in the CP group (1 attempt in 14 patients, 2 in 7, 3 in 9) than in the sham group (1 attempt in 24 patients, 2 in 6; P+0.002). POGO score did not differ significantly between the groups (P+0.60), nor did the subjective difficulty of laryngoscopy (P+0.06). The visual analogue scale score for passage of a tube through the glottis was significantly higher in the CP group than in the sham group (P<0.001). ConclusionsCricoid pressure impedes tracheal intubation using the AWS, and is associated with longer intubation time, which can be attributed to increased difficulty in the passage of a tube through the glottis. Clinical Trial registry numberUMIN000018209.

The impact of general anaesthesia for elective adenotonsillectomy in children aged 6-12 years on biomarkers of cerebral injury S100B and NSE

Background and Goal of Study: S100B protein and NSE (neuron specific enolase) can be considered as early markers of cerebral injury. The impact of general anesthesia for elective noncardiac surgery in children on these markers has not been studied before. The goal was to find out whether these markers can be used to access the short term neurological outcome after general anesthesia. The secondary goal was to determine whether different types of anesthesia influence the levels of S100B and NSE. Materials and methods: Prospective study was conducted at the University Hospital on 64 children (aged 6-12, ASA I-II) undergoing elective adenotonsillectomy. The children were randomized into 2 groups:TIVA (n=32) and sevoflurane(S) (n=32). In TIVA group anesthesia was induced with propofol, fentanyl and vecuronium and maintained with continuous infusion of propofol. In S group, anesthesia was induced with fentanyl, sevoflurane and vecuronium and maintained with sevoflurane. S100B and NSE were measured before and after the surgery. S100B and NSE assays were performed using the electrochemiluminiscence immunoassay “ECLIA” used on Roche Cobas e601 immunoassay analyzer (Roche Diagnostics GmbH, Mannheim, Germany). Statistical significance of the differences was accessed by two-tailed asymptotic Wilcoxon Signed Rank test. The 95% CI for median difference was calculated by bootstrapping on 1000 samples in IBM SPSS Statistics version 21. Results and discussion: There was statistically significant increase of S100B median value after surgery with regard to preoperative values (P< 0.001). Median(interquartile range) values of S100B before and after surgery were 0.08 (0.064-0.102) and 0.1 (0.072-0.179), respectively. There was no statistically significant change of NSE median value af ter surgery regarding preoperative values (P=0.567). The prevalence of elevated S100B (≥0.105 ug/l) after the surgery was statistically significantly higher than before (McNemar test, two sided exact P=0.003). There were 12/60 children (20.0% ; 95% CI=(10.5%-29.8%)) with elevated S100 B before and 28/60 (46.7% ; 95% CI=33.3%-59.6%)) after surgery. Conclusion(s): The values of neurological biomarker S100B, but not of NSE, were significantly increased af ter general anesthesia for elective adenotonsillectomy in children, indicating possible cerebral injury.There were no differences regarding 2 types of anaesthesia, TIVA or inhalational.

Effect of cricoid pressure on placement of the I-gel™ : a randomised study.

We studied 40 adult patients to see if cricoid pressure affected placement of the I-gel(™). In a randomised crossover design, the i-gel was placed with and without cricoid pressure, and we compared the success rate of adequate ventilation through the i-gel, time to placement and the rate of optimal position of the device between the two circumstances. Cricoid pressure significantly decreased the success rate of adequate ventilation through the i-gel (40 vs 34 patients) (p = 0.041, 95% CI for difference 4-26%), and significantly decreased the rate of the optimal position (39 vs 17 patients) (p < 0.001). The time to achieve adequate ventilation was significantly longer (p < 0.001) with cricoid pressure than without (median difference 8 s; 95% CI for median difference 3-12 s). Cricoid pressure significantly decreases the success rate of ventilation through the i-gel, but the success rate of ventilation through the i-gel is reasonably high.

Acute Normovolemic Hemodilution Can Aggravate Neurological Injury After Spinal Cord Ischemia in Rats

Acute normovolemic hemodilution (ANH) is currently performed during thoracoabdominal aortic surgery. However, the effects of ANH on spinal cord ischemic injury are currently unknown. Because hemodilution below a certain level of hematocrit (Hct) aggravates the neurological damage after cerebral ischemia, we hypothesized that ANH may increase neurological damage after spinal cord ischemia. The aim of these experiments was to determine the effects of ANH on spinal cord ischemic injury. Thirty male Sprague-Dawley rats were randomly assigned to 1 of the following 3 groups: no hemodilution (group C), target Hct level of 30% (group HD30), and target Hct level of 25% (group HD25). ANH was performed upon withdrawal of blood and simultaneous replacement with the same volume with hydroxyethyl starch. Spinal cord ischemia and reperfusion were induced by using a balloon-tipped catheter placed in the descending thoracic aorta, and changes in mean arterial blood pressure were recorded. Neurological function of the hindlimbs was evaluated for 7 days and recorded using a motor deficit score (MDS) (0 = normal; 5 = complete paraplegia). The number of motor neurons within the spinal cord was counted after final MDS evaluation. Group HD25 developed hypotension during the latter part of the ANH procedure. Group C and group HD30 experienced 3 minutes of reperfusion hypotension, whereas 6 minutes of hypotension was observed in group HD25. Two rats in group HD25 died during the experimental period. Seven days after reperfusion, the MDS of group C, group HD30, and group HD25 was 1.0 (0.5-2.0), 1.0 (0.5-2.0), and 4.0 (2.8-4.2) (median [95% confidence interval]), respectively. Group HD25 showed significantly higher MDS compared with group C (corrected P = 0.0018; 95% CI for median difference = 1.0-3.5). Motor neuron numbers in the anterior horns of group C, group HD30, and group HD25 were 26.5 (25.0-27.5), 23.5 (22.0-26.5), and 12.5 (8.4-16.6) (median [95% CI]), respectively. Motor neuron numbers of group HD25 were significantly lower than those of group C (corrected P < 0.0001; 95% CI for median difference = 9.0-18.0). The results of the present study indicate that intraoperative ANH to an Hct of 25%, combined with coincident hypotension, caused a delayed recovery of baseline mean arterial blood pressure during the reperfusion period and aggravated neurological outcome after spinal cord ischemia.

Dexamethasone and length of hospital stay in patients with community-acquired pneumonia: a randomised, double-blind, placebo-controlled trial

Whether addition of corticosteroids to antibiotic treatment benefits patients with community-acquired pneumonia who are not in intensive care units is unclear. We aimed to assess effect of addition of dexamethasone on length of stay in this group, which might result in earlier resolution of pneumonia through dampening of systemic inflammation. In our double-blind, placebo-controlled trial, we randomly assigned adults aged 18 years or older with confirmed community-acquired pneumonia who presented to emergency departments of two teaching hospitals in the Netherlands to receive intravenous dexamethasone (5 mg once a day) or placebo for 4 days from admission. Patients were ineligible if they were immunocompromised, needed immediate transfer to an intensive-care unit, or were already receiving corticosteroids or immunosuppressive drugs. We randomly allocated patients on a one-to-one basis to treatment groups with a computerised randomisation allocation sequence in blocks of 20. The primary outcome was length of hospital stay in all enrolled patients. This study is registered with ClinicalTrials.gov, number NCT00471640. Between November, 2007, and September, 2010, we enrolled 304 patients and randomly allocated 153 to the placebo group and 151 to the dexamethasone group. 143 (47%) of 304 enrolled patients had pneumonia of pneumonia severity index class 4-5 (79 [52%] patients in the dexamethasone group and 64 [42%] controls). Median length of stay was 6·5 days (IQR 5·0-9·0) in the dexamethasone group compared with 7·5 days (5·3-11·5) in the placebo group (95% CI of difference in medians 0-2 days; p=0·0480). In-hospital mortality and severe adverse events were infrequent and rates did not differ between groups, although 67 (44%) of 151 patients in the dexamethasone group had hyperglycaemia compared with 35 (23%) of 153 controls (p<0·0001). Dexamethasone can reduce length of hospital stay when added to antibiotic treatment in non-immunocompromised patients with community-acquired pneumonia. None.

Outcome Measurements of Arkansas Horsemen of Excellence Program

to investigate whether a change in the management of postmature pregnancy to earlier induction affects the length of labour and the induction process. Secondly, to assess the feasibility of the research process to inform a future larger study.a change in management of postmature pregnancy in an NHS hospital in October 2013, from induction at 42 weeks gestation to induction between 41–42 weeks, provided an opportunity to conduct a retrospective analysis. Pre-existing data from the maternity database and casenotes were collected and primary outcomes analysed using the Mann-Whitney test and the Hodges-Lehman confidence interval for differences in medians.a large city based tertiary referral hospital in the North of England.125 women induced before the change in policy were compared with 309 women induced after the change.primary outcomes were length of 1st and 2nd stage of labour, overall length of labour, length of induction to established labour and length of induction to birth.the median overall length of labour for women induced at 42 weeks was 6.5 hours, while for women induced at 41–42 weeks this was 5.2 hours. The difference was not statistically significant (p=0.15, 95% CI for median difference −0.27 to 1.93 hours) with a small effect size (Pearson's r=−0.08). The median length of induction to birth was 13.6 hours for women induced at 42 weeks and 16.5 hours for women induced at 41–42 weeks. This difference was also not statistically significant (p=0.14, 95% CI for median difference −7.25 to 1.20 hours) with a small effect size (Pearson's r=−0.13).This study demonstrated no statistically significant differences in length of labour and induction following a change in the management of postmature pregnancy to earlier induction. A large study is needed to establish definitively the effects of earlier induction on labour outcomes.

Oral Ibandronate Preserves Trabecular Microarchitecture: Micro-Computed Tomography Findings From the Oral Ibandronate Osteoporosis Vertebral Fracture Trial in North America and Europe Study

Micro-computed tomography (micro-CT) is a quantitative 3-dimensional (3D) scanning procedure used to assess trabecular architecture. In the 3-yr oral iBandronate Osteoporosis vertebral fracture trial in North America and Europe (BONE) study, it was found that oral ibandronate administered daily (2.5 mg) or intermittently (20 mg) significantly reduced vertebral fracture risk by 62% ( p = 0.0001) and 50% ( p = 0.0006), respectively, vs placebo. Two-dimensional histomorphometric analysis of BONE study biopsies indicated that newly formed bone was of normal quality. In the current analysis, micro-CT was used to assess 3D trabecular microarchitecture. Rod and plate distribution was quantified by differential analysis of the triangulated bone surface. Biopsies were obtained from 110 patients, with 84 evaluable by micro-CT. Median structural model index (SMI; a lower SMI indicates an increased ratio of plates to rods and thus, improved trabecular microarchitecture) was 1.001 with ibandronate vs 1.365 with placebo (90% confidence interval [CI] for difference in medians: –0.626, –0.033), and connectivity density was higher in ibandronate-treated patients (median: 3.904 vs 3.112/mm 3, 90% CI for difference in medians: 0.159, 1.517). This indicates that trabecular microarchitecture was better preserved in patients receiving ibandronate than placebo. Taken together with previous results from BONE, these findings indicate that ibandronate treatment preserves bone strength by maintaining good quality trabecular microarchitecture in women with postmenopausal osteoporosis.

Effect of prophylactic bisoprolol plus magnesium on the incidence of atrial fibrillation after coronary bypass surgery: results of a randomized controlled trial

ABSTRACTObjective: Bisoprolol, a highly cardioselective β1‐blockers, is widely used to treat elderly patients with hypertension, coronary artery disease and heart failure. The current literature lacks evidence regarding its potency to prevent atrial fibrillation (AF) following cardiac surgery. Therefore the aim of this study was to evaluate the efficacy of bisoprolol plus magnesium (Mg) in the prophylaxis of AF after coronary artery bypass graft (CABG) surgery.Research design and methods: A total of 100 consecutive patients subjected to elective on-pump CABG (84 men, age 65 ± 8 [SD] years), with no prior AF history, were randomly assigned to the prophylaxis group ( n = 50) receiving after surgery bisoprolol (5 mg/day) plus Mg (intravenous infusion of 2 g of Mg on arrival in the intensive care unit, followed by oral Mg at 1800 mg/day for 1 week), or to the control group ( n = 50), receiving no combined study medication but remaining on their preoperative drugs, including β‐blockers. All patients were continuously monitored to identify the onset of AF.Results: In the prophylaxis group the incidence of postoperative AF was significantly lower, with 20% (10 / 50) compared to 42% (21 / 50) among controls ( p = 0.030, 95% confidence interval [CI] for absolute risk reduction [ARR], 2–42%). Particularly in the elderly, bisoprolol plus Mg was effective in preventing AF; in the prophylaxis group only six of 36 (17%) patients ≥ 65 years of age developed AF, compared to 13 of 20 (65%) in the control group ( p < 0.001, 95% CI for ARR, 17–65%). This was associated with significantly ( p = 0.022) shorter hospital stays in the prophylaxis group (median of 7 vs. 9 days, 95% CI for difference in medians, 0–3 days).Conclusions: The combination of bisoprolol plus Mg effectively reduces the incidence of postoperative AF following on-pump CABG, particularly in elderly patients, and is associated with a shorter hospital length of stay.

Reduced time on the spinal board—effects of guidelines and education for emergency department staff

Prehospital spinal immobilisation is usually accomplished with a spinal board. Prolonged immobilisation on spinal boards in the emergency department (ED) can be detrimental. This study aimed to reduce the time spent by patients on spinal boards using a staff education program. Observational study in a trauma centre ED seeing 180,000ED attendances per year. The length of time immobilised on spinal board was recorded by the trauma nurse coordinator. Guidelines on removal of spinal boards were issued after recording period 1 (January-June 2001) and reinforced several times. The post-training period (period 2) extended from May to October 2003. Medians were compared using Mann-Whitney U-test (non-parametric data); chi-square test was used for categorical data. There were 122 eligible patients in period 1 and 104 eligible patients in period 2. Median time to removal from the spinal board was reduced by 18.5 min from 50 to 31.5 min (Mann-Whitney U-test, p<0.0001, 95% CI for difference in medians 13-29 min). In period 1, 44 of 122 patients (36%) were removed from the spinal board before leaving the ED, compared to 78 of 104 patients (75%) in period 2 (p<0.0001, chi-square test). The introduction of guidelines, reinforced by ED staff education, can significantly reduce the time patients spend on spinal boards after trauma and can increase the proportion of patients who can be removed from the board before leaving the ED.

Efficacy of the laryngeal tube by inexperienced personnel

We compared the laryngeal tube and the laryngeal mask in the ease of insertion, ventilation volume and the incidence of gastric insufflation by inexperienced personnel. In a randomized, cross-over design, each of 28 students of a Fire Defense Academy attempted to insert the laryngeal tube and laryngeal mask in turn using an airway management trainer manikin. A self-inflating bag (2000 ml) was attached and ventilation volume was measured. The number of attempts at the insertion and the presence or absence of gastric insufflation were also recorded. After completion of the study, each student was asked whether insertion of one device was easier than the other. All 28 students could insert the laryngeal tube at the first attempt. As for the laryngeal mask, 27 could insert it at the first attempt, whereas the remaining one student could insert it after two attempts. The tidal volume was significantly greater for the laryngeal tube (median 842 ml) than the laryngeal mask (median 716 ml) (95%CI for median difference: 10–116 ml; P<0.02). The incidence of gastric insufflation was significantly lower for the laryngeal tube (2 times) than for the laryngeal mask (10 times) ( P<0.05). Twenty six of 28 students stated that insertion of the laryngeal tube was easier than insertion of the laryngeal mask, whereas the remaining two stated that there was no difference in the ease of insertion between two devices. Therefore, the laryngeal tube has a potential role in providing a clear airway during cardiopulmonary resuscitation.

Pre-operative oral erythromycin reduces residual gastric volume and acidity

We investigated whether low-dose erythromycin (200 mg) given as an oral premedicant altered the residual gastric volume and its acidity in fasted patients at induction of anaesthesia in a single-blinded study. Sixty patients were allocated randomly to receive either an erythromycin tablet (200 mg) or nothing with 10 ml water 3 h before induction of anaesthesia, and another 60 patients 1 h before induction of anaesthesia. Oral erythromycin significantly reduced residual gastric volume when it was given approximately 3 h (P<0.05; 95% CI for median difference: 0.1-17 ml) or 1 h (P<0.0005; 95% CI for median difference: 6-24 ml) before induction of anaesthesia. Erythromycin significantly reduced gastric acidity when it was given 1 h before induction of anaesthesia (P<0.02; 95% CI for median pH difference: 0.1-1.7). In contrast, when given 3 h before induction of anaesthesia, erythromycin did not significantly alter acidity.