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European Journal of Pain
Tables of Contents and Abstracts Online Issue Contents
Chronic non-malignant pain patients and health economic
consequences
Annemarie Bondegaard Thomsen, Jan Sørensen, Per Sjøgren, Jørgen Eriksen
p 341-352, Volume 6, Number 5, October 2002
Abstract
A prospective cohort study on chronic non-malignant pain patients was performed to describe
health consequences and changes in use of health care resources and social transfers following
multidisciplinary pain treatment. Patients, referred to a Danish Multidisciplinary Pain Center
(MPC), were evaluated during four periods: six months prior to referral, waiting list period,
intervention, nine months follow-up. Outcome measures: pain intensity (VAS), The Medical
Outcomes Study 36-Item Short-Form Health Survey (SF-36), The Psychological General WellBeing Index (PGWB), The Hospital Anxiety and Depression Scale (HAD). Use of health care
resources and social transfers were retrieved from public registers. Statistically significant
improvements were obtained in pain intensity, SF-36 bodily pain, PGWB index and subscores
vitality, and general health at discharge and follow-up. Intervention costs amounted to EUR 1102
(SD 721). Health care costs were not significantly reduced, but significant reductions in social
transfers were seen.
August 2002 • Volume 16 • Number 4
Original Articles
The use of a bronchial blocker compared with a double-lumen tube for single-lung
ventilation during minimally invasive direct coronary artery bypass
surgery
Jörg Ender, MD [MEDLINE LOOKUP]
Andreas M. Bury, MD [MEDLINE LOOKUP]
J. Raumanns, MD [MEDLINE LOOKUP]
S. Schlünken, MD [MEDLINE LOOKUP]
H. Kiefer, MD [MEDLINE LOOKUP]
W. Bellinghausen, MD [MEDLINE LOOKUP]
A. Petry, MD [MEDLINE LOOKUP]
Abstract
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Objective: To investigate whether a bronchial blocker (BB) placed through a routinely
used single-lumen tube (SLT) to achieve 1-lung ventilation is appropriate in patients
undergoing a minimally invasive direct coronary artery bypass
(MIDCAB) operation.
Design: Clinical trial.
Setting: University hospital.
Participants: Patients scheduled for elective MIDCAB operation (n = 159).
Interventions: Group A was treated with a left-sided double-lumen tube (DLT) and
served as the control group. Group B was intubated with a routinely used SLT in
combination with a BB.
Measurements and Main Results: The following data were collected: (1) time required for
placement of each tube, (2) ventilation pressures, (3) lung compliance, (4) dislocations of
the DLT or BB, (5) effectiveness of lung collapse, and
(6) PaO2 and fraction of inspired oxygen. In 4 patients (4%) of group B, the BB could
not be placed within an acceptable time so that 155 patients (50 patients in group A, 105
patients in group B) were statistically analyzed. Statistically
significant differences during 1-lung ventilation were found for peak and mean
inspiratory pressure (p < 0.001 and p < 0.05), dynamic and static lung compliance (p <
0.05), and dynamic lung compliance change (p < 0.01). No statistical
significance was found for intubation time (p > 0.05) and PaO2 and fraction of inspired
oxygen (p > 0.05). Lung collapse was insufficient in 1 patient of group A (2%) and in 2
patients of group B (2%).
Conclusion: To achieve 1-lung ventilation during a MIDCAB procedure, the use of a BB
combined with an SLT is an appropriate technique as an alternative to the commonly
used DLT.
Copyright 2002, Elsevier Science (USA). All rights reserved.
Publishing and Reprint Information
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From the Department of Anesthesia and Intensive Care II, Heart-center, University of
Leipzig, Leipzig, Germany.
Address reprint requests to Jörg Ender, MD, Klinik für Anästhesie und
Intensivmedizin, Park-Krankenhaus Leipzig-Südost, Strümpellstrasse 41, 04289 Leipzig,
Germany. E-mail: [email protected]
Copyright 2002, Elsevier Science (USA). All rights reserved.
Original Articles
Coronary revascularization: A procedure in transition from on-
pump to off-pump? The role of glucose-insulin-potassium revisited
in a randomized, placebo-controlled study
Andrew Smith, FRCA [MEDLINE
LOOKUP]
Amanda Grattan, BapplSc
[MEDLINE LOOKUP]
Mark Harper, FRCA [MEDLINE
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David Royston, FRCA [MEDLINE
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Bernhard J.C.J. Riedel, FCA,
MMed [MEDLINE LOOKUP]
Abstract
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Objective: To investigate an optimized glucose-insulin-potassium (GIK) solution
regimen as an alternate myocardial protective strategy in off-pump coronary
artery bypass graft (OP-CAB) surgery and as a supplement to conventional
coronary artery bypass graft (CABG) surgery using cardiopulmonary bypass
(CPB).
Design: Prospective, randomized, placebo-controlled.
Setting: Single institution, cardiothoracic specialty hospital.
Participants: Forty-four patients scheduled for elective multivessel coronary
artery surgery using either conventional CPB (n = 22) or OP-CAB techniques (n
= 22).
Interventions: Preischemic, ischemic, and postischemic administration of GIK
solution was carried out, optimally dosed to ensure nonesterified fatty acid
(NEFA) suppression, and supplemented with magnesium, a glycolytic enzymatic
cofactor.
Measurements and Main Results: GIK solution therapy reduced plasma NEFA
levels (p < 0.001) in OP-CAB surgery and CPB groups but failed to affect the
incidence of non–Q wave perioperative myocardial infarction, incidence of
postoperative atrial fibrillation, incidence of postoperative infection, reduction in
creatinine clearance, or duration of postoperative intensive care unit or hospital
length of stay. After adjusting for GIK solution therapy, OP-CAB surgery resulted
in significantly less ischemic injury (troponin I >15 µg/L, 19.0% v 91.3%; p =
0.0001) and reduced postoperative infections (14.3% v 43.5%; p = 0.049).
Conclusion: GIK solution therapy achieved NEFA suppression and an
insignificant trend toward reduced biochemical parameters of ischemic injury in
OP-CAB surgery and CPB groups, but no major clinical benefit (perioperative
myocardial infarction, intensive care unit length of stay, or hospital length of stay)
was shown after elective CABG surgery in low-risk patients. Compared with
CPB, OP-CAB surgery significantly reduced ischemic injury and postoperative
infections.
Copyright 2002, Elsevier Science (USA). All rights reserved.
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From the Department of Anesthesiology, Royal Brompton and Harefield NHS Trust,
London, United Kingdom.
Funded in part by a grant from the Royal Brompton and Harefield NHS Trust Fund for
research infrastructure development.
Address reprint requests to Bernhard J.C.J. Riedel, FCA, MMed, Department of
Anesthesiology, Box 042, University of Texas M.D. Anderson Cancer Center, 1515
Holcombe Boulevard, Houston, TX 77030-4095. E-mail: [email protected]
ugust 2002 • Volume 16 • Number 4
Original Articles
Intraoperative insulin therapy does not reduce the need for
inotropic or antiarrhythmic therapy after cardiopulmonary bypass
Leanne Groban, MD [MEDLINE
LOOKUP]
John Butterworth, MD [MEDLINE
LOOKUP]
Claudine Legault, PhD [MEDLINE
LOOKUP]
Anne T. Rogers, MBChB
[MEDLINE LOOKUP]
Neal D. Kon, MD [MEDLINE LOOKUP]
John W. Hammon, MD [MEDLINE
LOOKUP]
Abstract
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Objective: To determine whether attempted glucose control through
intraoperative insulin therapy reduces the need for inotropic or antiarrhythmic
therapy after cardiopulmonary bypass (CPB).
Design: Post hoc analysis of a randomized, masked clinical trial of insulin
therapy for prevention of neurobehavioral deficits.
Setting: Single university hospital.
Participants: Nondiabetic patients undergoing elective coronary artery bypass
graft surgery (n = 381).
Interventions: Patients received either insulin infusions in an attempt to maintain
blood glucose at 80 to 120 mg/dL (n = 188) or placebo (saline; n = 193). Inotropic
therapy was defined as the initiation of vasoactive support with epinephrine or
amrinone infusions or mechanical support with the initiation of an intra-aortic
balloon pump in the operating room or within 12 hours postoperatively.
Antiarrhythmic therapy was defined as cardioversion, antiarrhythmic medications,
or pacing.
Measurements and Main Results: Of patients, 64 in the placebo group and 71
in the insulin group required inotropic support after CPB (p = not significant). The
use of cardioversion (55 in placebo group v 61 in insulin group), antiarrhythmic
medications (64 in placebo group v 76 in insulin group), and pacing (118 in
placebo group v 117 in insulin group) was similar between groups. Inotropic drug
support was associated with age >60 years, female gender, reduced
preoperative ejection fraction, history of angina, and increased duration of CPB.
Conclusion: Intraoperative insulin therapy did not reduce the use of inotropic or
antiarrhythmic support after cardiac surgery with CPB. The lack of benefit may be
due to the inability to prevent hyperglycemia during the physiologic stress of CPB
or a tribute to the effectiveness of modern myocardial preservation techniques.
Copyright 2002, Elsevier Science (USA). All rights reserved.
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From the Departments of Anesthesiology, Public Health Sciences, and Cardiothoracic
Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
Funded in part by NS27500-01A2 and by the Departments of Anesthesiology and
Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
Presented in part at the Annual Meeting of the Society of Cardiovascular
Anesthesiologists, Inc, Orlando, FL, May 2000.