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High Volume (high + volume)
Terms modified by High Volume Selected AbstractsCuff compliance of pediatric and adult cuffed tracheal tubes: an experimental studyPEDIATRIC ANESTHESIA, Issue 8 2004J.-M. Devys MD Summary Background :,Tracheal mucosal damage related to tracheal intubation has been widely described in pediatric and adult patients. High volume,low pressure cuffs (HVLPC) are being advertised as safe to avoid this particularly unpleasant complication. Compliances of these supposed pediatric and adult HVLPC are not mentioned by manufacturers and still remain unknown. Methods :,The compliance of HVLPC was measured in vitro and defined as the straight portion of the pressure,volume curve. Cuff pressure was measured after incremental 0.1 ml filling volumes of air for sizes 3.0,8.0 of internal diameter of RüschTM and MallinckrodtTM tracheal tubes. Compliances were assessed in air and in a rigid tube. The filling volume to achieve a 25-mmHg intracuff pressure was also measured. Results :,In air, each 0.1 ml step almost linearly increased cuff pressure by 1 mmHg (size 8.0) to 9 mmHg (size 3). In air, the volume needed to maintain a cuff pressure < 25 mmHg was small for sizes 3,5.5 (0.35,2 ml). The 25 mmHg inflated cuff volume and compliance were decreased within a rigid tube, especially for adult sizes. In a rigid tube simulating a trachea, the compliances of almost every RüschTM tracheal tube were statistically higher than those of the MallinckrodtTM. Conclusion :,We conclude that the tested tracheal tube cuffs have low compliance and cannot be defined as high volume,low pressure. [source] A re-examination of distance as a proxy for severity of illness and the implications for differences in utilization by race/ethnicity ,,HEALTH ECONOMICS, Issue 7 2007Jayasree Basu Abstract The study analyzes the hospitalization patterns of elderly residents to examine whether the relation between distant travel and severity of illness is uniform across racial/ethnic subgroups. A hypothesis is made that severity thresholds could be higher for minorities than whites. Hospital discharge data from the Healthcare Cost and Utilization Project (HCUP-SID) of the Agency for Health Care Research and Quality for New York residents is used, with a link to the Area Resource File and American Hospital Association's survey files. Logistic models compare the association of distant admission with severity corresponding to each local threshold level, race, and type of hospital admission. The study uses four discrete distance thresholds in contrast to recent work. Also, an examination of severity thresholds for distant travel for different types of admission may clarify different sources of disparities in health care utilization. The findings indicate that minorities are likely to have higher severity thresholds than whites in seeking distant hospital care, although these conclusions depend on the type of condition. The study results imply that if costly elective services were regionalized to get the advantages of high volume for both cost and quality of care, some extra effort at outreach may be desirable to reduce disparities in appropriate care. Published in 2006 by John Wiley & Sons, Ltd. [source] Pharmacokinetics and pharmacokinetic/pharmacodynamic integration of marbofloxacin in calf serum, exudate and transudateJOURNAL OF VETERINARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2002F. SHOJAEE ALIABADI Aliabadi, F. S., Lees, P. Pharmacokinetics and pharmacokinetic/pharmacodynamic integration of marbofloxacin in calf serum, exudate and transudate. J. vet. Pharmacol. Therap.25, 161,174. Marbofloxacin is a fluoroquinolone antimicrobial drug used in cattle for the treatment of respiratory infections. In this investigation the pharmacokinetics (PK) of marbofloxacin were determined after intravenous and intramuscular dosing at a dosage of 2 mg/kg. In addition the ex vivo pharmacodynamics (PD) of the drug were determined in serum and three types of tissue cage fluid (transudate, inflammatory exudate generated by carrageenan and exudate generated by lipopolysaccharide). Marbofloxacin PK was characterized by a high volume of distribution after dosing by both routes (1.28 L/kg intravenous and 1.25 L/kg intramuscular). Corresponding area under the concentration,time curve (AUC) and elimination half-life (t½el) values were 9.99 and 10.11 ,g h/mL and 4.23 and 4.33 h, respectively. Values of AUC for carrageenan-induced exudate, lipopolysaccharide-induced exudate and transudate were, respectively, 8.28, 7.83 and 7.75 ,g h/mL after intravenous and 8.84, 8.53 and 8.52 ,g h/mL after intramuscular dosing. Maximum concentration (Cmax) values were similar for the three tissue cage fluids after intravenous and intramuscular dosing. For in vivo PK data values of AUC: minimum inhibitory concentration (MIC) (AUIC) ratio for serum were 250 and 253, respectively, after intravenous and intramuscular dosing of marbofloxacin against a pathogenic strain of Mannheimia haemolytica (MIC=0.04 ,g/mL). For all tissue cage fluids AUIC values were >194 and >213 after intravenous and intramuscular dosing, and Cmax/MIC ratios were 9 or greater, indicating a likely high level of effectiveness in clinical infections caused by M. haemolytica of MIC 0.04 ,g/mL or less. This was confirmed by both in vitro (serum) and ex vivo (serum, exudate and transudate) measurements, which demonstrated a concentration-dependent killing profile for marbofloxacin against M. haemolytica. Ex vivo, after 24-h incubation, virtually all bacteria were killed (<10 cfu/mL) in all samples collected up to 9 h (serum), 24 h (carrageenan-induced exudate and transudate) and 36 h (lipopolysaccharide-induced exudate). Application of the sigmoid Emax equation to the ex vivo antibacterial data provided, for serum, AUIC24 h values of 37.1 for bacteriostasis, 46.3 for bactericidal activity and 119.6 for elimination of bacteria. These data may be used as a rational basis for setting dosing schedules which optimize clinical efficacy and minimize the opportunities for emergence of resistant organisms. [source] Delayed Occurrence of Unheralded Phase IV Complete Heart Block After Ethanol Septal Ablation for Symmetric Hypertrophic Obstructive CardiomyopathyPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2006JOANNA J. WYKRZYKOWSKA Ethanol septal ablation has emerged as a less invasive alternative to surgical myomectomy for treatment of asymmetric hypertrophic obstructive cardiomyopathy (ASH). The procedure has very low mortality, but high-degree AV conduction block is a frequent complication. Prior studies have documented baseline left bundle branch block and high volume of ethanol injection (greater than 4 mL) as risk factors. Complete heart block is often preceded by postprocedure conduction abnormalities and generally develops within 48 hours after ethanol ablation. We present a unique case of a patient with symmetric hypertensive hypertrophic obstructive cardiomyopathy (SHOCM) who developed phase IV complete heart block >96 hours postprocedure without preceding conduction abnormalities or other classic risk factors.3 [source] Cuff compliance of pediatric and adult cuffed tracheal tubes: an experimental studyPEDIATRIC ANESTHESIA, Issue 8 2004J.-M. Devys MD Summary Background :,Tracheal mucosal damage related to tracheal intubation has been widely described in pediatric and adult patients. High volume,low pressure cuffs (HVLPC) are being advertised as safe to avoid this particularly unpleasant complication. Compliances of these supposed pediatric and adult HVLPC are not mentioned by manufacturers and still remain unknown. Methods :,The compliance of HVLPC was measured in vitro and defined as the straight portion of the pressure,volume curve. Cuff pressure was measured after incremental 0.1 ml filling volumes of air for sizes 3.0,8.0 of internal diameter of RüschTM and MallinckrodtTM tracheal tubes. Compliances were assessed in air and in a rigid tube. The filling volume to achieve a 25-mmHg intracuff pressure was also measured. Results :,In air, each 0.1 ml step almost linearly increased cuff pressure by 1 mmHg (size 8.0) to 9 mmHg (size 3). In air, the volume needed to maintain a cuff pressure < 25 mmHg was small for sizes 3,5.5 (0.35,2 ml). The 25 mmHg inflated cuff volume and compliance were decreased within a rigid tube, especially for adult sizes. In a rigid tube simulating a trachea, the compliances of almost every RüschTM tracheal tube were statistically higher than those of the MallinckrodtTM. Conclusion :,We conclude that the tested tracheal tube cuffs have low compliance and cannot be defined as high volume,low pressure. [source] Transplant Center Volume and Outcomes After Liver RetransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2009P. P. Reese Liver retransplantation surgery has a high rate of allograft failure due to patient comorbidities and technical demands of the procedure. Success of liver retransplantation could depend on surgeon experience and processes of care that relate to center volume. We performed a retrospective cohort study of adult liver retransplantation procedures performed from January 1, 1996 through December 31, 2005 using registry data from the Organ Procurement Transplantation Network. The primary outcome was 1-year allograft failure. Liver transplant centers were categorized as small, intermediate or high volume by dividing overall liver transplants into three tertiles of approximately equal size. Mean annual volume of overall liver transplants was <50 for low-volume centers, 50,88 for intermediate-volume centers and >88 for high-volume centers. The primary analysis consisted of 3977 liver retransplantation patients. The unadjusted risk of 1-year allograft failure was 37.8%. In multivariable logistic regression, the risk of 1-year allograft failure was not significantly different between low- (reference), intermediate- (OR 0.86, CI 0.72,1.03, p = 0.11) and high-volume centers (OR 0.88, CI 0.74,1.04, p = 0.14). Results were similar when the analysis was limited to retransplantation performed >160 days after initial transplantation. Center volume is an imprecise surrogate measure for 1-year outcomes after liver retransplantation. [source] Prognostic factors in nonoperative therapy for chronic symptomatic calcific tendinitis of the shoulderARTHRITIS & RHEUMATISM, Issue 10 2009P. Ogon Objective To define prognostic factors in chronically symptomatic patients with calcific tendinitis of the shoulder. Methods We evaluated 420 patients (488 shoulders) in the context of a prospective cohort study. Epidemiologic data were assessed. The radiographic and sonographic appearance of the calcific deposits was classified. The mean period of nonoperative therapy was 4.4 years (range 0.5,13.7 years). After referral to our institution, standardized nonoperative therapy was continued for a minimum of 3 months. Failure of nonoperative therapy was defined as the persistence of symptomatic calcific tendinitis of the shoulder after a minimum of 6 months. Prognostic factors (determined at P < 0.05 by chi-square test) were analyzed by logistic regression. Results Of the 420 patients, 269 (64%) were women, 151 (36%) were men. The mean age of the patients was 51.3 years (range 28,84 years). Occurrence of calcific tendinitis of the shoulder was unilateral in 84% and bilateral in 16%. Gärtner type I calcific deposits were found in 37%, type II in 32%, and type III in 31%. Failure of nonoperative therapy was observed in 114 patients (27%). Negative prognostic factors were bilateral occurrence of calcific tendinitis of the shoulder, localization to the anterior portion of the acromion, medial (subacromial) extension, and high volume of the calcific deposit. Positive prognostic factors were a Gärtner type III deposit and a lack of sonographic sound extinction of the calcific deposit. Conclusion Our findings demonstrate the existence of prognostic factors in the nonoperative treatment of chronic symptomatic calcific tendinitis of the shoulder. Guidelines for optimal treatment can be implemented according to these factors to avoid a long-term symptomatic disease course. [source] Stereoselective pharmacokinetics of desbutylhalofantrine, a metabolite of halofantrine, in the rat after administration of the racemic metabolite or parent drugBIOPHARMACEUTICS AND DRUG DISPOSITION, Issue 9 2000Dion R. Brocks Abstract The main objective of this study was to determine the pharmacokinetics of the enantiomers of desbutylhalofantrine (DHF), a metabolite of halofantrine (HF), in the rat. Rats received either intravenous (2 mg/kg) or oral (7 mg/kg) (±)-DHF HCl, or (±)-HF HCl intravenously (3 mg/kg). Enantiomer concentrations in plasma were determined by a stereospecific assay. In all rats, the plasma concentrations of (+)-DHF exceeded those of (,)-DHF. After (±)-DHF, the mean (+):(,) ratios of AUC0,, after oral and intravenous dosing were 3.7 and 2.8, respectively. After intravenous doses of DHF, the (,):(+) enantiomeric ratios of Cl and Vdss were approximately 2.8. There were no significant differences between the enantiomers in t1/2 (mean 14,23 h) or tmax (mean 10,12 h) after intravenous or oral administration of DHF. Oral bioavailability estimates of DHF enantiomers (>59%) were higher than those previously estimated for HF in the rat. The stereoselectivity in HF kinetics was not as pronounced as for DHF. It was estimated that over 44% of the dose of HF is metabolized to DHF enantiomers. It was concluded that DHF possesses a pharmacokinetic profile similar to that of HF, each possessing low values of clearance and high volume of distribution. DHF differed from HF in its degree of stereoselectivity in pharmacokinetics, and in its extent of oral bioavailability. Copyright © 2000 John Wiley & Sons, Ltd. [source] Hospital volume influences the choice of operation for thyroid cancerBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 11 2009J. C. Lifante Background: Many authors advocate total or near-total thyroidectomy for thyroid carcinoma. This study examined the relationship between hospital volume of thyroidectomies and choice of bilateral thyroidectomy for thyroid carcinoma. Methods: Data were extracted from the administrative databases of all hospital discharge abstracts in the Rhône-Alpes area of France. The study population included inpatient stays from 1999 to 2004 with a diagnosis of thyroid disease (benign or malignant) and a procedural code for thyroid surgery. Multivariable logistic regression analyses were performed to determine factors associated with the extent of surgery (unilateral versus bilateral) for thyroid carcinoma. Results: A total of 20 140 thyroidectomies were identified, including 4006 procedures for cancer. Compared with hospitals performing a high volume of procedures for all thyroid diseases (at least 100 annually), the risk of a unilateral procedure for thyroid cancer increased by 2·46 (95 per cent confidence interval 1·63 to 3·71) in low-volume hospitals (fewer than ten operations per year) and by 1·56 (1·27 to 1·92) in medium-volume centres (ten to 99 per year). Conclusion: There is a significant relationship between hospital volume and the decision to perform bilateral surgery for thyroid carcinoma. Thyroid cancer surgery should be performed by experienced surgical teams in high-volume centres. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Safety and efficacy of carotid stenting in the very elderly,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 5 2010Arthur Grant MD Abstract Background: Carotid artery stenting (CAS) has emerged as an alternative to carotid endarterectomy (CEA) in patients at high risk for complications from surgery. The very elderly (,80-year-old) are one subgroup of patients identified as being at increased risk for carotid surgery. However, there is concern that the very elderly are also at increased risk for complications of CAS. A stroke and death rate of 12% was reported in very elderly patients during the roll-in phase of Carotid Revascularization Endarterectomy versus Stent Trial (CREST). We are reporting on a large clinical series of CAS with independent neurological assessment in the very elderly. Methods: Between 1994 and 2008, a consecutive series of 418 CAS patients (,80-year-old) were treated at four high-volume centers with extensive CAS experience. Independent neurologic assessment was performed after CAS procedures. Thirty-day follow-up information was available in 389 patients. Results: The average age was 83.2 ± 2.8 years. Most patients were male (63.2%), and the target lesion carotid stenosis was asymptomatic in two-thirds (68.2%) of patients. The majority of patients treated with CAS had a history of coronary artery disease (74.4%), hypertension (87.8%), and dyslipidemia (71.1%). One third (30.1%) were diabetic and more than half (56.5%) were current or former smokers. Embolic protection devices (EPD) were used in 78.7% of cases with the CAS procedure being performed before EPD availability being the most common reason for not using them. The overall 30-day incidence of stroke and death was 2.8% (11/389). The cumulative incidence of major cardiovascular events (stroke, death, or myocardial infarction) during that time period was 3.3% (13/389). Conclusions: This large series of CAS with independent neurologic assessment is convincing evidence that the very elderly (,80 years) can safely undergo CAS with stroke and death rates comparable to younger patients. The key to obtaining these excellent results is that CAS be performed by high volume, experienced operators who exercise restraint regarding patient selection. © 2009 Wiley-Liss, Inc. [source] Die Häufigkeit von Oenothera -Arten im westlichen MitteleuropaFEDDES REPERTORIUM, Issue 5-6 2003R. Wittig Professor Dr. Auf ausgewählten Industrie- und Verkehrstandorten in drei Ballungsgebieten des westlichen Mitteleuropas (Rhein-Ruhr-Gebiet: Nordrhein-Westfalen/ Deutschland; Frankfurt: Hessen/Deutschland; Oberrheingebiet: Baden-Württemberg/Deutschland und Elsass/ Frankreich) wurde in den Jahren 1999 bis 2002 an ausgewählten, Oenothera -reichen Standorten (Industriegelände, Bahngelände, Hafenanlagen) eine quantitative Bestandsaufnahme der Oenothera -Arten vorgenommen. Hierbei belegten O. biennis und O. fallax nahezu gleichrangig den ersten Platz in der Häufigkeitsliste. Mit teilweise recht deut-lichem Abstand folgen O. pycnocarpa und O. glazioviana auf den Plätzen 3 und 4. Bemerkenswer-terweise ergab eine gleichzeitig in Frankfurt durchgeführte Rasterkartierung der Oenothera -Arten die gleiche Reihenfolge dieser vier Spezies im Hinblick auf die Zahl der von ihnen besiedelten Rasterfelder. Wie der Vergleich mit älteren Arbeiten zeigt, in denen O. biennis stets als die eindeutig häufigste Art genannt wird, hat sich O. fallax offensichtlich erst in jüngster Zeit stark ausgebreitet. Frequency of species of Oenothera in Western Central Europe Between 1999 and 2002 a quantitative inventory of Oenothera species was carried out in three urban agglomeration areas in Western Central Europe [Rhine-Ruhr-Area: North Rhine-Westfalia/Germany; Frankfurt (Main) Hessen/Germany; Upper Rhine Area-Baden-Wurttemberg/Germany and Elsace/ France] in areas with a rich abundance of Oenothera (manufacturing plants, stations, docks) at selected industrial sites and locations with high volumes of traffic. Results revealed that Oenotherabiennis and O. fallax occur most frequently followed after a wide margin by Oenothera pycnocarpa and O. glazioviana in third and fourth position. It is noteworthy that a grid mapping of Oenothera species undertaken simultanously in Frankfurt revealed the same order of frequency for the four species with respect to the number of grid cells they occupy. A comparison with previous studies, which all name Oenothera biennis as the most frequently occurring species, demonstrates clearly that the high frequency of Oenothera fallax is the result of a recent development. [source] Investor Recognition, Liquidity, and Exchange Listings in the Reformed MarketsFINANCIAL MANAGEMENT, Issue 2 2006Pankaj K. Jain We examine multiple facets of firms' descisions to list on the NYSE. Although the average Nasdaq spreads are now comparable to the average NYSE spreads, we find that firms continue to switch from Nasdaq to the NYSE, and that they experience positive cumulative abnormal returns on listing. Using a simultaneous ststem of equations approach, we establish that enhanced investor recognition mainly explains this phenomenon. A logistic regression suggesrts that corporate listing choice is consistent with these findings, since eligible unlisted firms already have high volumes and recognition and might not benefit as much as do firms that actually switch. [source] Selective preconcentration of volatile mercaptans in small SPE cartridges: Quantitative determination of trace odor-active polyfunctional mercaptans in wineJOURNAL OF SEPARATION SCIENCE, JSS, Issue 21 2009Laura Mateo-Vivaracho Abstract A general procedure for the selective preconcentration and purification of mercaptans has been developed. Mercaptans are strongly retained in a small (20,mg) SPE cartridge containing p- hydroxymercurybenzoate. The cartridge can then be rinsed with relatively high volumes of polar (water/methanol mixtures) and non-polar (pentane or pentane/ether mixtures) rinsing solutions to remove nearly all volatile compounds lacking a thiol functionality. Retained analytes are further eluted with a small volume of an organic solvent containing 1,4-dithioerythritol. Some basic aspects of the strategy, such as the retention of p -hydroxymercurybenzoate in the sorbent and its stability versus different rinsing and eluting systems, have been studied in depth. Light sulfur compounds contained in water or wine, including mercaptans such as methanethiol or thioethers, such as diethyl sulfide, can be quantitatively extracted, although only mercaptans can be quantitatively recovered if a polar rinsing is applied. The strategy has been applied to the GC-MS quantitative determination of some trace polyfunctional mercaptans that are key aromas in wine, such as 2-methyl-3-furanthiol, 2-furfurylthiol, 4-mercapto-4-methyl-2-pentanone, 3-mercaptohexyl acetate or 3-mercaptohexanol. The developed method reaches detection limits in the ng/L range and has a satisfactory analytical behavior, being quite simple and fast. [source] Antibiotics in Dutch general practice: nationwide electronic GP database and national reimbursement rates,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2008Annemiek E. Akkerman PhD Abstract Purpose In order to assess whether different databases generate information which can be reliable compared with each other, this study aimed to assess to which degree prescribing rates for systemic antibiotics from a nationwide electronic general practitioner (GP) database correspond with national reimbursement rates, and to investigate for which indications antibiotics are prescribed. Methods Nationwide GP prescribing data were collected from the Second Dutch National Survey of General Practice (DNSGP-2) based on 90 general practices serving 358 008 patients in 2001. Dutch national reimbursement rates for GPs were derived from claims data of the Dutch Drug Information System/Health Care Insurance Board (GIP/CVZ) from 2001. We calculated antibiotic prescribing rates per 1000 patients/inhabitants for each database, and these rates were compared for the total rates and according to antibiotic subgroups. Indications for which GPs prescribed antibiotics were described. Results In national reimbursement data, 339 antibiotic prescriptions per 1000 inhabitants were prescribed by GPs, while the nationwide GP database showed 255 prescriptions per 1000 patients (75% coverage with reimbursement rates). The nationwide GP database showed high volumes of sulphonamides & trimethoprim, and small volumes of macrolides and quinolones. Half of the prescriptions (48%) were prescribed for respiratory diseases, a quarter (26%) for urinary diseases and 7% for ear diseases. Conclusions GPs voluntarily participating in a research network prescribe less antibiotics than Dutch GPs in general, and are cautious in prescribing newer and more broad-spectrum antibiotics. This point has to be taken into account when databases will be compared with each other. Copyright © 2007 John Wiley & Sons, Ltd. [source] Realized kernels in practice: trades and quotesTHE ECONOMETRICS JOURNAL, Issue 3 2009O. E. Barndorff-Nielsen Summary, Realized kernels use high-frequency data to estimate daily volatility of individual stock prices. They can be applied to either trade or quote data. Here we provide the details of how we suggest implementing them in practice. We compare the estimates based on trade and quote data for the same stock and find a remarkable level of agreement. We identify some features of the high-frequency data, which are challenging for realized kernels. They are when there are local trends in the data, over periods of around 10 minutes, where the prices and quotes are driven up or down. These can be associated with high volumes. One explanation for this is that they are due to non-trivial liquidity effects. [source] White matter lesions volume and motor performances in the elderly,ANNALS OF NEUROLOGY, Issue 6 2009Aïcha Soumaré MSc Objectives To investigate the cross-sectional and longitudinal associations between performance-based measures of motor function and volume of white matter lesions (WMLs), and to examine the influence of the localization of these lesions. Methods At baseline, motor performances (maximum walking speed, Tinetti gait and balance subscales) were assessed in 1,702 subjects aged 80 years or younger from the Dijon (France), France center of the Three-City study. Volumes of WMLs lesions (total, periventricular, deep) were measured using an automated method of tissue segmentation and quantification of lesion size. At 8-year follow-up, walking speed was evaluated in 1,086 subjects. Results At baseline, mean and 95% confidence interval (CI) walking speed was lower in subjects with total volumes of WMLs ,90th percentile (1.50 [1.45,1.55] m/s) than in subjects with lower volumes (1.56 [1.55,1.58] m/s; p = 0.004). Baseline total volumes of WMLs above the 90th percentile predicted walking speed decline during follow-up (odds ratio [95% CI] for having the greatest walking speed decline = 2.3 [1.3,4.1], p = 0.006). Moreover, high volumes of periventricular but not deep WMLs were associated with slower walking speed at baseline (p = 0.005) and over time (p = 0.001), and with lower Tinetti gait subscore (p = 0.02). Interpretation Our study shows a cross-sectional and longitudinal association between high total volumes of WMLs, in particular volumes above the 90th percentile, and impaired mobility. These associations were independent of several confounders, including cognition, and were mainly accounted for by volumes of periventricular WMLs. These findings support the hypothesis of a vascular contribution to motor decline in the elderly. Ann Neurol 2009;65:706,715 [source] Ultrasonographic guided axillary plexus blocks with low volumes of local anaesthetics: a crossover volunteer studyANAESTHESIA, Issue 3 2010P. Marhofer Summary Our study group recently evaluated an ED95 local anaesthetic volume of 0.11 ml.mm,2 cross-sectional nerve area for the ulnar nerve. This prospective, randomised, double-blind crossover study investigated whether this volume is sufficient for brachial plexus blocks at the axillary level. Ten volunteers received an ultrasonographic guided axillary brachial plexus block either with 0.11 (,low' volume) or 0.4 (,high' volume) ml.mm,2 cross-sectional nerve area with mepivacaine 1%. The mean (SD) volume was in the low volume group 4.0 (1.0) and 14.8 (3.8) ml in the high volume group. The success rate for the individual nerve blocks was 27 out of 30 in the low volume group (90%) and 30 out of 30 in the high volume group (100%), resulting in 8 out of 10 (80%) vs 10 out of 10 (100%) complete blocks in the low vs the high volume groups, respectively (NS). The mean (SD) sensory onset time was 25.0 (14.8) min in the low volume group and 15.8 (6.8) min in the high volume group (p < 0.01). The mean (SD) duration of sensory block was 125 (38) min in the low volume group and 152 (70) min in the high volume group (NS). This study confirms our previous published ED95 volume for mepivacaine 1% to block peripheral nerves. The volume of local anaesthetic has some influence on the sensory onset time. [source] | |||||||||||||||||||||||||