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Wang S, Gilani A, Santikul D, Vohra A. NONINVASIVE CARDIAC OUTPUT MONITORING (NICOM) VS CAVAL INDEX ULTRASONOGRAPHY: A PROSPECTIVE COMPARISON TO PREDICT FLUID RESPONSIVENESS IN PATIENTS WITH SEPSIS. Chest 2019. [DOI: 10.1016/j.chest.2019.02.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Norawat R, Anipindi S, Vohra A, O׳Keeffe N, Parkes A, Maybauer M. Severity grading of anaphylaxis in cardiac surgical patients. J Cardiothorac Vasc Anesth 2018. [DOI: 10.1053/j.jvca.2018.08.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Anipindi S, Anupuba S, Norawat R, Parkes A, Maybauer M, Vohra A. Incidence and outcome of anaphylaxis in cardiac surgical patients – should we proceed to cardiopulmonary bypass and complete surgery? Br J Anaesth 2018. [DOI: 10.1016/j.bja.2017.11.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Altaf Bukhari S, Saad H, Batool K, Pathak D, Vohra A. Inadequate recording in perioperative transoesophageal views highlights the need for a standard approach in documentation of the views: a newly proposed format. J Cardiothorac Vasc Anesth 2015. [DOI: 10.1053/j.jvca.2015.05.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Affiliation(s)
- A Vohra
- Wyre and Fylde CCaTT, Mountcroft, Albert Street, Fleetwood, Lancashire, United Kingdom
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Borbas Z, Caldwell J, Prendergast B, Vohra A, Boyett M, Dobrzynski H, Garratt C. 112 Location of subsidiary atrial pacemakers following ablation of the sinus node in the goat: Abstract 112 Figure 1. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Malignant nonseminomatous germ cell tumors (NSGCT) rarely metastasize to the heart. The first such case presenting with syncope is described. Eight previously described cases of NSGCT with intracaval metastasis to the heart are reviewed and the literature to date is discussed. Transesophageal echocardiography is the diagnostic study of choice and treatment consists primarily of platinum-based chemotherapy followed by surgical resection of residual deposits.
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Affiliation(s)
- A Vohra
- Department of Medicine, Mount Sinai Medical Center, Miami Beach, Florida 33140, USA
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Jeeji R, Vohra A, Jackson M. High thoracic epidurals for cardiac surgery: a three-year review. Anaesthesia 2007. [DOI: 10.1111/j.1365-2044.2006.04942_4.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pratt O, Vohra A. 'Spraying the cords'. Eur J Anaesthesiol 2006; 23:1066. [PMID: 17042969 DOI: 10.1017/s026502150625169x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2006] [Indexed: 11/05/2022]
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Malik RA, Li C, Aziz W, Olson JA, Vohra A, McHardy KC, Forrester JV, Boulton AJM, Wilson PB, Liu D, McLeod D, Kumar S. Elevated plasma CD105 and vitreous VEGF levels in diabetic retinopathy. J Cell Mol Med 2005; 9:692-7. [PMID: 16202216 PMCID: PMC6741635 DOI: 10.1111/j.1582-4934.2005.tb00499.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Diabetic retinopathy is the leading cause of blindness in the industrialized world. Hyperglycaemia induces retinal hypoxia that upregulates a range of vasoactive factors which may lead to macular oedema and/or angiogenesis and hence potentially sight threatening retinopathy. In this study, we have focused on the association of CD105 and vascular endothelial growth factor (VEGF) with the development and progression of diabetic retinopathy by means of quantifying their expression in the plasma and vitreous of diabetic patients. CD105 levels were quantified in the plasma of 38 type I diabetic patients at various stages of retinopathy and 15 non-diabetic controls. In an additional cohort of 11 patients with advanced proliferative retinopathy and 23 control subjects, CD105 and VEGF were measured in the vitreous. The values were expressed as median (range) and statistical analysis was carried out using the non-parametric Mann-Whitney U test. Plasma CD105 levels were significantly increased in diabetic patients [1.8 (1.1-2.4) ng/ml] compared with non-diabetic controls [0.7 (0.3-1.8) ng/ml] (p<0.01). Plasma CD105 levels were elevated in diabetic patients with all stages of retinopathy, the highest level was observed in background retinopathy [2.3 (2.1-2.5) ng/ml] followed by proliferative retinopathy [2.1 (0.9-2.8) ng/ml] and advanced proliferative retinopathy [1.4 (0.6-1.8) ng/ml]. Vitreous contents of CD105 did not differ between controls and patients with advanced proliferative retinopathy, but vitreous levels of VEGF were elevated by approximately 3-fold in patients with advanced proliferative retinopathy [7.2 (1.90-15.60) ng/ml] compared with the control subjects [1.80 (1.10-2.210)] (p<0.01). These observations indicate that plasma levels of CD105 and vitreous levels of VEGF are associated with diabetic retinopathy, suggesting that CD105 and the angiogenic factor VEGF may play a critical role in the development and progression of diabetic retinopathy. Further studies are required to determine whether circulating CD105 levels could serve as a surrogate marker for early stage retinopathy and for monitoring disease progression.
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Affiliation(s)
- R A Malik
- Department of Medicine, Manchester Royal Infirmary, Manchester, M13 9PT, UK.
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Rauf K, Vohra A, Fernandez-Jimenez P, O'Keeffe N, Forrest M. Remifentanil infusion in association with fentanyl–propofol anaesthesia in patients undergoing cardiac surgery: effects on morphine requirement and postoperative analgesia. Br J Anaesth 2005; 95:611-5. [PMID: 16155034 DOI: 10.1093/bja/aei237] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We have prospectively assessed the effects of remifentanil on morphine requirement in the first hour after emerging from general anaesthesia after elective coronary artery bypass surgery and in the first 12 h postoperatively, and pain and agitation scores in the first hour after emerging from general anaesthesia. METHODS Twenty patients undergoing off-pump coronary artery bypass surgery, receiving standardized propofol-fentanyl-based anaesthesia, randomly received infusions of either remifentanil 0.1 microg kg(-1) min(-1) (Group R, n=10) or saline (Group S, n=10), each infused at 0.12 ml kg(-1) h(-1). Propofol and trial drug infusion were continued into the postoperative period until the patients were ready to be woken up. Postoperative analgesia was provided with morphine infusion commenced immediately after operation, and was additionally nurse controlled on the basis of a visual analogue scale (VAS) score (0-10). Agitation score was recorded using a VAS of 0-3. RESULTS In the first hour after discontinuing propofol and trial infusion, morphine requirements were significantly higher in the remifentanil group (8.15 (sd 3.59) mg) compared with the saline group (3.29 (2.36) mg) (P<0.01). There was no difference in the total morphine given during the period after stopping propofol or in the total requirement in the first 12 h postoperatively. There was no significant difference in either pain scores or agitation scores between the two groups. CONCLUSION Use of remifentanil is associated with increased opioid requirement in the first hour after it has been discontinued.
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Affiliation(s)
- K Rauf
- Central Manchester and Manchester Children's University Hospitals NHS Trust, Department of Anaesthesia, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
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Vohra A, Chan A, Odom N. Crit Care 2005; 9:P379. [DOI: 10.1186/cc3442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
AIM Formulation of an inexpensive cane molasses medium for improved cell-bound phytase production by Pichia anomala. METHODS AND RESULTS Cell-bound phytase production by Pichia anomala was compared in synthetic glucose-beef extract and cane molasses media. The yeast was cultivated in 250 ml flasks containing 50 ml of the medium, inoculated with a 12 h-old inoculum (3 x 10(6) CFU ml(-1)) and incubated at 25 degrees C for 24 h at 250 rev min(-1). Different cultural parameters were optimized in cane molasses medium in batch fermentation. The cell-bound phytase content increased significantly in cane molasses medium (176 U g(-1) dry biomass) when compared with the synthetic medium (100 U g(-1) dry biomass). In fed-batch fermentation, a marked increase in biomass (20 g l(-1)) and the phytase yield (3000 U l(-1)) were recorded in cane molasses medium. The cost of production in cane molasses medium was pound 0.006 per 1000 U, which is much lower when compared with that in synthetic medium (pound 0.25 per 1000 U). CONCLUSIONS An overall 86.6% enhancement in phytase yield was attained in optimized cane molasses medium using fed-batch fermentation when compared with that in synthetic medium. Furthermore, the production in cane molasses medium is cost-effective. SIGNIFICANCE AND IMPACT OF THE STUDY Phytase yield was improved in cane molasses when compared with the synthetic medium, and the cost of production was also significantly reduced. This enzyme can find application in the animal feed industry for improving the nutritional status of feed and combating environmental pollution.
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Affiliation(s)
- A Vohra
- Department of Microbiology, University of Delhi, South Campus, New Delhi, India
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Sánchez del Aguila MJ, Jones MF, Vohra A. Premixed solutions of diamorphine in ropivacaine for epidural anaesthesia: a study on their long-term stability. Br J Anaesth 2003; 90:179-82. [PMID: 12538374 DOI: 10.1093/bja/aeg044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Local anaesthetics and opioid mixtures are commonly used to provide anaesthesia or analgesia during the perioperative period. In order to facilitate their preparation and storage it is necessary to establish the stability of such solutions. METHODS In our study, diamorphine was added to ropivacaine 0.2% 200-ml polybags to give a concentration of 25 micro g ml(-1) and to ropivacaine 1% 50-ml syringes to give a concentration of 45 micro g ml(-1). The polybags and syringes were stored at 40 degrees C, 21 degrees C and 4 degrees C for up to 120 days. Samples were taken during this period for measurement of diamorphine and ropivacaine content and pH of the solutions. RESULTS We found that the storage temperature and the initial concentration influenced the rate of degradation of diamorphine in both the polybags and the syringes. In the syringes, 10% degradation of diamorphine [T (0.9)] was: 6 days at 40 degrees C, 16 days at 21 degrees C and 30 days at 4 degrees C. In the polybags, diamorphine T (0.9) was 6 days at 40 degrees C, 28 days at 21 degrees C and 70 days at 4 degrees C. CONCLUSIONS It is feasible to manufacture such solutions in pharmacy aseptic units and to store them for up to 1 month for routine use in epidural infusions.
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Affiliation(s)
- M J Sánchez del Aguila
- Department of Anaesthesia, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
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Wadsworth R, Greer R, MacDonald JMS, Vohra A. The use of remifentanil during general anaesthesia for caesarean delivery in two patients with severe heart dysfunction. Int J Obstet Anesth 2002; 11:38-43. [PMID: 15321574 DOI: 10.1054/ijoa.2001.0910] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We describe the management of two patients with severe heart dysfunction requiring caesarean section because of incipient left ventricular failure. One patient had a bicuspid valve and developed symptoms of severe aortic incompetence during pregnancy. The second patient had known hypertrophic obstructive cardiomyopathy and developed chest pain and symptoms of left ventricular failure at 32 weeks' gestation. In both cases the worsening cardiac disease prompted the decision for operative delivery. We decided to employ general anaesthesia and achieved cardiovascular stability using remifentanil as an adjunct.
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Affiliation(s)
- R Wadsworth
- Saint Mary's Hospital for Women and Children, Whitworth Park, Manchester, UK.
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Abstract
OBJECTIVE To investigate the haemodynamic effects of varying the angle of head up tilt. METHODS 20 healthy subjects (12 female, eight male; mean (SD) age 33.6 (8.4) years) underwent head up tilt for five minutes to each of four angles of tilt in random order, with a five minute rest period at the horizontal between each angle. Forearm blood flow was measured using intermittent occlusion mercury strain gauge plethysmography at two and five minutes. Subjects underwent continuous monitoring of heart rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP) by Finapres and cardiac output and stroke volume by impedance cardiography. Each variable was measured at two and five minutes, averaged over the period of blood flow measurement. RESULTS Every haemodynamic variable at each angle was significantly different from supine values. Head up tilt produced progressive increases in heart rate (11-21%), SBP (12-21%), and DBP (20-33%) with increasing tilt angle. However, although 45 degrees produced significantly less haemodynamic effect, there were no significant differences for angles between 60 degrees and 90 degrees. Cardiac output fell on head up tilt by 17-20% and stroke volume by 28-34%, but increasing tilt angle produced no significant additional reduction in cardiac output and stroke volume because of increases in heart rate and vasoconstriction. CONCLUSIONS Angles < 60 degrees produce significantly less haemodynamic effects than steeper angles. Increasing tilt angle beyond 60 degrees produces no apparent additional effect on cardiac output or sympathetic tone. Increasing tilt angle beyond 60 degrees confers no additional orthostatic stress and may not affect the sensitivity and specificity of head up tilt testing as previously thought. Sixty degrees of tilt is a more practical angle for support of a syncopal patient and is recommended.
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Affiliation(s)
- A Zaidi
- Manchester Heart Centre, The Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
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Abd Elrazek E, Scott NB, Vohra A. An epidural scoring scale for arm movements (ESSAM) in patients receiving high thoracic epidural analgesia for coronary artery bypass grafting. Anaesthesia 1999; 54:1104-9. [PMID: 10540102 DOI: 10.1046/j.1365-2044.1999.01031.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Thoracic epidural analgesia appears to improve the outcome of patients undergoing coronary artery bypass graft surgery. Cranial extension of nerve blockade involving the third, fourth and fifth cervical nerve roots can cause apnoea. However, progressive paraesthesia and weakness due to cephalad spread of thoracic epidural analgesia will affect the arms before the diaphragm. A scale was designed to test three active movements of the arms bilaterally: hand grip (T1/C8), wrist flexion (C8/7) and elbow flexion (C6/5). This epidural scoring scale for arm movements (ESSAM) consists of four grades (0-3) based on the number of absent movements, and suggests appropriate action. The reliability of this scale was tested in 40 patients undergoing coronary artery bypass surgery. Twelve of the 40 patients had their epidural infusion reduced on the basis of the scale. Of these 12 patients, eight had a worst ESSAM score of 1, three had a worst score of 2 and one had a worst score of 3. In each patient, motor power returned following the reduction in infusion rate, taking between 30 min and 3 h. This scale appears to be a simple and reliable method for the early detection of the cephalad spread of thoracic epidural analgesia.
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Affiliation(s)
- E Abd Elrazek
- Central Manchester Healthcare Trust, Manchester Royal Infirmary, UK
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Vohra A, Saiz E, Chan J, Castro J, Amaro R, Barkin J. Splenic abscess caused by Propionibacterium avidum as a complication of cardiac catheterization. Clin Infect Dis 1998; 26:770-1. [PMID: 9524868 DOI: 10.1086/517127] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- A Vohra
- Department of Medicine, Mount Sinai Medical Center, Miami Beach, Florida, USA
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Affiliation(s)
- A Vohra
- Department of Medicine, Mount Sinai Medical Center, Miami Beach, Florida 33140, USA
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Abstract
Twenty healthy volunteers were placed in four different surgical prone positions: on pillows, on an evacuatable mattress, on pelvic props and in the knee-chest position. The normal supine position was used as a control for the measurement of cardiovascular parameters. Mean arterial pressure was measured by automated oscillotonometry. Transthoracic electrical bioimpedance was used to measure cardiac output and heart rate. Cardiac index and total vascular resistance index were derived from these data. No significant changes in heart rate or mean arterial pressure occurred when the volunteers were moved from the supine position to any of the four prone positions or when returned to the supine position again. Cardiac index decreased significantly on going from the supine to the knee-chest position (20%) and onto the props (17%) but not onto the evacuatable mattress (11%) or the pillows (3%).
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Affiliation(s)
- R Wadsworth
- Department of Anaesthesia, Manchester Royal Infirmary
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Verma AK, Vohra A, Maitra A, Banerjee M, Singh R, Mittal SK, Bharadwaj V, Batra V, Bhatia A, Aggarwal P. Epidemiology of chronic suppurative otitis media and deafness in a rural area and developing an intervention strategy. Indian J Pediatr 1995; 62:725-9. [PMID: 10829951 DOI: 10.1007/bf02825128] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Of 613 children evaluated in a village in Haryana 94 (15.3%) were observed to have chronic suppurative otitis media (CSOM). Fifty eight (61.7%) children had hearing impairment. CSOM contributed to 71.6% of the hearing impaired (58/81). On analysis of association of CSOM with literacy and socio-economic status of mothers, and age, sex, and upper respiratory tract infections (URI) in children positive correlation was observed only with URIs (P < 0.001). Literacy and socio-economic status of the mothers did not correlate significantly with knowledge about treatment seeking, and ear cleaning practices, probably due to the narrow range of incomes and literacy levels. An intervention program consisting of play, demonstrations, health charts and slogans, and aural cleaning and antibiotic drops was introduced.
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Affiliation(s)
- A K Verma
- Department of Community Medicine, All India Institute of Medical Sciences, New Delhi
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Eddleston JM, Pearson RC, Holland J, Tooth JA, Vohra A, Doran BH. Prospective endoscopic study of stress erosions and ulcers in critically ill adult patients treated with either sucralfate or placebo. Crit Care Med 1994; 22:1949-54. [PMID: 7988131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To compare the frequency of stress erosions and ulcers in critically ill adult patients treated with either sucralfate or placebo. DESIGN Prospective, randomized study. SETTING Intensive care unit in a university hospital. PATIENTS Twenty-six adult patients. All patients were mechanically ventilated and were at risk of developing stress ulceration. INTERVENTIONS Patients were randomized to receive either sucralfate (2 g every 8 hrs) (group 1) via the nasogastric tube (flushed with 10 mL of sterile water) or 20 mL of sterile water every 8 hrs (group 2) via the nasogastric tube. MEASUREMENTS AND MAIN RESULTS At the time of intensive care unit admission, the frequency of stress (acute) erosions (as assessed with the endoscope) was 21.7%. No ulcers were detected. By day 3, the frequency had increased to 37.5% in group 1 and 88.9% in group 2. Mucosal deterioration was more likely in the patients treated with placebo (water) (p < .05). In total, seven patients developed acute ulceration in group 2 compared with only one patient in group 1 (p < .05). The frequency of gastric colonization with aerobic Gram-negative bacilli was 25.6% in group 1 and 28.6% in group 2. Only one retrograde nosocomial pneumonia developed (group 1). CONCLUSION Based on our findings, we strongly recommend the adoption of sucralfate as opposed to no prophylaxis in the prevention of acute upper gastrointestinal ulceration.
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Vohra A, Kumar S, Charlton AJ, Olukoga AO, Boulton AJ, McLeod D. Effect of diabetes mellitus on the cardiovascular responses to induction of anaesthesia and tracheal intubation. Br J Anaesth 1993; 71:258-61. [PMID: 8123403 DOI: 10.1093/bja/71.2.258] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We have compared cardiovascular responses to induction of anaesthesia and to tracheal intubation after propofol 2.5 mg kg-1 and pancuronium 0.1 mg kg-1 in 10 diabetic and 10 matched, non-diabetic (control) ASA I patients. Anaesthesia was maintained with 0.8% enflurane and 50% nitrous oxide in oxygen, with assisted ventilation. The trachea was intubated 3 min after induction of anaesthesia. All 10 diabetic patients (but no controls) had abnormal autonomic function when tested on the day before surgery. There was no difference between the two groups in the pre-induction cardiovascular state. Mean arterial pressure and vascular resistance decreased after induction in each group (P < 0.05). Heart rate increased (P < 0.01) and cardiac index was sustained in the control group, but in the diabetic group heart rate did not change and cardiac index decreased (P < 0.01). There was an earlier decrease in stroke index in the diabetic group (2 min) compared with the controls (5 min). After tracheal intubation, heart rate and cardiac index in the control group and cardiac index in the diabetic group remained unchanged. However, there was a greater increase in heart rate, mean arterial pressure and vascular resistance in the diabetic group compared with the controls after tracheal intubation (P < 0.05). The exaggerated pressor response to tracheal intubation, in the diabetic patients, may reflect autonomic dysfunction.
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Affiliation(s)
- A Vohra
- Department of Anaesthesia, Manchester Central Hospitals and Community Care NHS Trust
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Eddleston JM, Vohra A, Scott P, Tooth JA, Pearson RC, McCloy RF, Morton AK, Doran BH. A comparison of the frequency of stress ulceration and secondary pneumonia in sucralfate- or ranitidine-treated intensive care unit patients. Crit Care Med 1991; 19:1491-6. [PMID: 1959368 DOI: 10.1097/00003246-199112000-00009] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare the frequency of acute stress ulceration and secondary pneumonia caused by aerobic Gram-negative bacilli in ICU patients treated with either sucralfate or ranitidine. DESIGN Prospective, randomized study. SETTING ICU, university hospital. PATIENTS Sixty adult patients who were mechanically ventilated and at risk of developing stress ulceration. INTERVENTION The patients were randomized to receive either sucralfate (1 g every 6 hrs) via the nasogastric tube or iv ranitidine (50 mg every 6 hrs). If the gastric pH was less than 3.5 in the latter group, 30 mL of 0.3M sodium citrate was given via the nasogastric tube. MEASUREMENTS AND MAIN RESULTS On admission, the frequency rate of erosion/ulceration (assessed with the endoscope) was 13.5%. After 4 days, this rate had increased to 18% in sucralfate-treated patients and 36% in ranitidine-treated patients (NS). Mean gastric pH was more alkaline in the ranitidine-treated patients (5.50) compared with the sucralfate-treated patients (4.26) (p less than .01). This pH permitted a higher occurrence rate of gastric colonization by aerobic Gram-negative bacilli in ranitidine-treated patients (64.3%) compared with sucralfate-treated patients (23.8%) (p less than .01). Retrograde bacterial colonization from the stomach to oropharynx and trachea occurred more frequently in ranitidine-treated patients compared with sucralfate-treated patients. Ultimately, the occurrence rate of pneumonia was greater in the ranitidine-treated (35.7%) than in the sucralfate-treated patients (10.3%) (p less than .05). CONCLUSION Based on our findings, we recommend the adoption of sucralfate for routine prophylaxis against stress ulceration.
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Affiliation(s)
- J M Eddleston
- Department of Anaesthesia, Manchester Royal Infirmary, UK
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Vohra A, Thomas AN, Harper NJ, Pollard BJ. Non-invasive measurement of cardiac output during induction of anaesthesia and tracheal intubation: thiopentone and propofol compared. Br J Anaesth 1991; 67:64-8. [PMID: 1859762 DOI: 10.1093/bja/67.1.64] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We have investigated the haemodynamic changes in response to induction of anaesthesia and tracheal intubation in patients who received either thiopentone 5 mg kg-1 or propofol 3 mg kg-1 followed by atracurium 0.5 mg kg-1 and fentanyl 1.5 micrograms kg-1. Anaesthesia was maintained with 0.6% enflurane and 50% nitrous oxide in oxygen with assisted ventilation. Cardiac output and heart rate (HR) were monitored continuously with a transthoracic impedence monitor. Mean HR did not change after induction in each group, but increased after tracheal intubation in both groups (P less than 0.01). Mean cardiac index (CI) decreased after induction (P less than 0.05) and decreased further after tracheal intubation in both groups (P less than 0.05). There was no difference between the two groups with respect to changes in CI and HR. Mean arterial pressure (MAP) and systemic vascular resistance (SVR) did not change significantly after induction in the thiopentone group. Both variables increased from preinduction values 1 min after tracheal intubation (P less than 0.001). In contrast, both MAP and SVR decreased after induction in the propofol group (P less than 0.001) and did not differ from preinduction values 1 min after tracheal intubation. MAP and SVR were greater in the thiopentone group compared with the propofol group after induction and tracheal intubation (P less than 0.01).
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Affiliation(s)
- A Vohra
- University Department of Anaesthesia, Manchester Royal Infirmary
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Thomas AN, Vohra A, Pollard BJ. Measurement of transthoracic electrical impedance. Br J Anaesth 1991; 66:733-4. [PMID: 2064892 DOI: 10.1093/bja/66.6.733-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Thomas A, Vohra A, Pollard B. The effect of haematocrit on transthoracic electrical impedance and on the calculation of cardiac output by an impedance cardiograph. Intensive Care Med 1991; 17:178-80. [PMID: 2071766 DOI: 10.1007/bf01704724] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The Transthoracic electrical impedance (TEI) was measured using the Bomed NCCOM3 non-invasive cardiac output monitor in 27 patients with polycythemia rubra vera (PCRV) and in a control group of 27 patients with normal haematocrits. The mean haematocrit was 49.4% (SD 2.61) in the patients with PCRV and 42.1% (SD 2.95) in the control group, a difference that was significant (p less than 0.001). The mean TEI was also significantly higher in patients with PCRV than in the control group (p less than 0.05), the respective values being 31.25 (5.48) Ohms and 27.5 (3.31) Ohms. The mean values for cardiac output (CO) and cardiac index (CI) were similar in both groups.
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Affiliation(s)
- A Thomas
- Department of Anaesthesia, Manchester Royal Infirmary, UK
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Abstract
We studied the value of CT scans for all children referred because of headache to one secondary and one tertiary pediatric centre during a 1 year period. Of 117 children who were seen by the Pediatric Neurology Service, at the I.W.K. Children's Hospital, 4 had CT scans and only 1 of these was abnormal. The consultant Pediatrician saw 40 children because of headache. CT scans were done on 3 of these patients and all were normal. None of the children who had a clinical assessment alone had unrecognized neurological disease during 20 months of follow-up. Therefore only 1 of 157 children had significant intracranial pathology. We conclude that CT scans have a limited role in the management of children with headache.
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Affiliation(s)
- J M Dooley
- Department of Pediatrics, Dalhousie University, Nova Scotia, Canada
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Abstract
A controlled randomised double-blind design was used to study the effect of lignocaine on the pain produced by intravenous injection of propofol. Patients received a 2-ml pretreatment solution with temporary venous occlusion, followed by an induction solution. One hundred and three patients were assigned to one of five groups: saline pretreatment, followed by induction with propofol plus saline 2 ml; lignocaine 20 mg pretreatment, followed by induction with propofol plus saline 2 ml; lignocaine 40 mg pretreatment, followed by induction with propofol plus saline 2 ml; saline pretreatment, followed by induction with propofol plus lignocaine 20 mg; or saline pretreatment, followed by induction with propofol plus lignocaine 40 mg. Pain was reduced significantly in all groups in which lignocaine was used and a dose of 40 mg was more effective than 20 mg. There were no significant differences in the incidence of pain among the groups which received lignocaine as pretreatment and the groups which received lignocaine mixed with propofol. Sixty-eight percent of patients who experienced pain or discomfort recalled it in the postoperative period.
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Affiliation(s)
- R A Johnson
- Department of Anaesthesia, Manchester Royal Infirmary
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Vohra A, Pollard BJ. Failure to cannulate the epidural space. Can J Anaesth 1989; 36:598, 600. [PMID: 2791182 DOI: 10.1007/bf03005394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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