Biomedical subjects
J Schierbeck
Publications and source records attributed to J Schierbeck.
High antibiotic consumption in Danish intensive care units?
Decreased antibiotic susceptibility among microorganisms isolated from intensive care unit (ICU) patients is found to be associated with high total antibiotic consumption or inappropriate use of antibiotics in the ICUs. The aims of this study were: 1) to characterize the antibiotic consumption in Danish ICUs, and in four ICUs with expectedly large differences in levels of antibiotic consumption, 2) to estimate the association between antibiotic susceptibility among isolated microorganisms and antibiotic consumption. This was done by: 1) a retrospective questionnaire study of the annual supply of antibiotics in 1995 to 30 ICUs in Denmark, and 2) a 2-month prospective study of patients and microbiological samples in four Danish ICUs in 1996. We found that the supply of antibiotics to Danish ICUs was substantial, with a median value of 124 DDD/100 patient days. No association was found between high consumption of antibiotics and decreased antibiotic susceptibility in the four ICUs.
[Selective pulmonary vasodilation during inhalation of aerosol prostacyclin in critically ill patients].
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[Awareness anesthesia--an anesthesiologic dilemma].
Awareness is a traumatic unintentional event during general anaesthesia. Awareness during anaesthesia is a condition which ranges from a state of alertness to deep anaesthesia with partly preserved senses. Awareness can be divided into four groups, depending on the state of alertness and accessibility of the memories after anaesthesia. Diagnostics and follow-up is complicated when awareness with an impaired recall occurs. We conclude that the incidence of awareness has decreased during the last three decades from approximately 1.5% to 0.2% during general surgery. In clinical practice there is no method for the detection of depth of anaesthesia and no anaesthetic technique that prevents awareness during anaesthesia. Guidelines to further reduce the incidence are suggested. Instant treatment of the condition may relieve the acute trauma and reduce the sequelae. We suggest a postoperative visit to ensure quality development for recording and treatment of awareness during anaesthesia.
Flumazenil facilitates intraoperative arousal during scoliosis surgery: a randomized, double-blind, placebo-controlled study.
Intraoperative arousal was evaluated in 24 patients (median age 16.5 years), undergoing spondylodesis with Cotrel-Dubousset or Harrington-Luque instrumentation. Flumazenil and placebo groups of 12 patients each were similar with respect to age, body weight, dosage of anaesthetic drugs and surgery times. Premedication consisted of diazepam 0.2-0.3 mg kg-1 orally. Anaesthesia was induced with thiopentone 5-7 mg kg-1, and maintained with 66% nitrous oxide in oxygen, and repeated doses of fentanyl, midazolam and atracurium. After placement and fixation of the metal rods, N2O was switched off, and either flumazenil or placebo was given in refracted doses until the patient responded to command. Intraoperative motor response times (medians with ranges), defined as the time from the injection of the first dose until the patient responded to command, were 2.5 min (1.0-5.2 min) after flumazenil, and 8.0 min (1.7-28.5 min) after placebo (P = 0.02). Five patients in the placebo group did not wake up within 10 min and received naloxone. The quality of awakening was similar in both groups. Two patients (one in each group) woke up violently and needed physical restraint. Postoperatively, motor responses were assessed after 12.0 min (5-42 min) in the flumazenil group, and after 15.2 min (4-40 min) in the placebo group (NS). Recovery from anaesthesia took 27.5 min (7-415 min) in the flumazenil group, and 25.0 min (8-160 min) in the placebo group (NS). One patient given flumazenil and one patient given placebo remembered moving their feet, but neither of them could recall anything unpleasant.(ABSTRACT TRUNCATED AT 250 WORDS)
Effect of labetalol on cerebral blood flow and middle cerebral arterial flow velocity in healthy volunteers.
The effect of labetalol, a combined alpha- and beta-adrenoceptor antagonist, on the cerebral circulation was investigated in 7 normotensive subjects. Cerebral blood flow (CBF) was measured with the intravenous 133Xe method and mean flow velocity (Vmean) in the middle cerebral artery was determined using transcranial Doppler (TCD) ultrasound. Examination was performed before and then 15, 60 and 120 min after 0.75 mg/kg i.v. labetalol. Reactivity to inhalation of 5% CO2 in air was studied before, and again 90 min after labetalol administration. Neither CBF nor Vmean changed following labetalol administration, whereas a marked increase occurred during inhalation of CO2. The median CO2 reactivity was 3.2%/mmHg (range: 1.8-4.0) for CBF and 4.4%/mmHg (1.5-5.6) for Vmean. These results indicate that labetalol, given in moderate but clinically relevant doses, does not affect the cerebral circulation in normotensive subjects. Neither does it affect CO2 reactivity. The uniform results obtained with the two methods suggest TCD as a usable alternative to conventional CBF technique in the assessment of cerebral vasoactivity of various drugs in subjects with a normal cerebral circulation.
Total intravenous anaesthesia with propofol or etomidate.
In combination with fentanyl, propofol was compared with etomidate for total intravenous anaesthesia in 21 women (ASA Grades I-II) admitted for elective hysterectomy. They received either propofol (bolus 1.5 mg kg-1, infusion 9 mg kg-1 h-1 for 10 min thereafter 6 mg kg-1 h-1) or etomidate (bolus 0.10 mg kg-1, infusion 3 mg kg-1 h-1 reduced to 0.6 mg kg-1 h-1). Fentanyl 10 micrograms kg-1 was given for induction followed by an infusion of 30 micrograms kg-1 h-1 for 10 min reduced to 6 micrograms kg-1 h-1 for the first hour and successively reduced over time. Induction was smooth and maintenance easy to manage in both groups. There was no difference in time from end of infusion until extubation, but the time until the patients could report their date of birth was significantly shorter in the propofol group. Nausea and vomiting were more pronounced in the etomidate group, and mental side-effects were only seen after etomidate. After 3 months, more patients in the etomidate group complained of reduced power of concentration. We conclude that total intravenous anaesthesia with either propofol or etomidate is equally easy to manage, but in the recovery situation propofol was advantageous in time and quality.
[Cesarean section under epidural anesthesia. A questionnaire study].
Seventy-four women selected at random who had been subjected to Caesarean section replied to questions about their satisfaction with epidural anaesthesia at various stages during the intervention. General discomfort increased during the intervention and pain contributed most to this. 96% of the women would recommend the method to others.
[Hospital appointments widen physicians' knowledge about diseases of divers].
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[Monitoring of labor. A questionnaire study before and after labor].
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[Pain relief during labor. A questionnaire study before and after labor].
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[Total intravenous anesthesia].
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[The latest treatment of severe digoxin poisoning].
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Influence of neural blockade and indomethacin on leucocyte, temperature, and acute-phase protein response to surgery.
Body temperature, P-cortisol, P-glucose, P-transferrin, haematocrit and total and differential leucocyte counts were investigated in 24 men undergoing inguinal herniotomy, but otherwise healthy. The patients were randomized to general anaesthesia (GA, n = 8), epidural analgesia (E, n = 8) or epidural analgesia + indomethacin (E + I, n = 8). The rectal temperature rose significantly after surgery, except in the E + I group, and increase in blood granulocytes was significantly less in these patients than in the GA group. Group E showed intermediate changes. P-transferrin changes were similar in all three groups. Glucose and cortisol showed only slight increase in the GA group and constant values in groups E and E + I. It is concluded that prostaglandins may play a role in mediating the surgical stress response, but that factors other than neural stimuli and prostaglandins are important in releasing postoperative granulocytosis.
[Bisacodyl (Toilax) and oral mannitol as a cathartic in the preparation for radiographic examination of the colon].
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