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Awake Patients (awake + patient)

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Medical Sciences	100%

Selected Abstracts

Use of the McGrath video laryngoscope in awake patients

ANAESTHESIA, Issue 8 2009
B. E. McGuire
Summary Reported are three cases of successful tracheal intubation using the McGrath Video Laryngoscope in awake patients. All three patients had predicted difficult direct laryngoscopy and signs of upper airway obstruction. [source]

DETERMINING NORMAL VALUES FOR INTRA-ABDOMINAL PRESSURE

ANZ JOURNAL OF SURGERY, Issue 12 2006
Joanne J. L. Chionh
Background: Intra-abdominal pressure (IAP) measurements can be used for the early detection and management of the abdominal compartment syndrome. IAP values are widely thought to be atmospheric or subatmospheric. However, there are no reports that describe normal IAP values using urinary bladder pressure measurements in patients not suspected of having a raised IAP level. This study sought to determine these normal values to aid our interpretation of IAP measurements in post-surgical patients or patients with suspected increased IAP. Methods: Urinary bladder pressure measurements were carried out in 40 men and 18 women awake medical or non-abdominal surgery inpatients with existing indwelling catheters. Measurements were made in the supine, 30° and 45° sitting positions. Comparisons were carried out to determine the effects on urinary bladder pressure of body position, sex and a suspected diagnosis of benign prostatic hypertrophy. Results: Median values for IAP were higher if measured in a more upright position (P < 0.0001). Median values were supine, 9.5 cmH2O (range, 1,18 cmH2O); 30° upright, 11.5 cmH2O (range, 3,19 cmH2O); and at 45° upright, 14.0 cmH2O (range, 4,22 cmH2O). Measurements recorded were neither atmospheric nor subatmospheric. IAP was higher in men compared with women in the supine and 30° positions (P < 0.05) but not in the 45° position (P = 0.083). There was no significant difference between patients with and without suspected benign prostatic hypertrophy. Conclusions: Normal IAP using urinary bladder pressure in awake patients are above atmospheric pressure. As a patient is moved from the supine into the upright position, IAP measurements increase. [source]

Blood Pressure Response to the ImpedanceThreshold Device in Hypotensive Emergency Department Patients

ACADEMIC EMERGENCY MEDICINE, Issue 2008
Samuel Luber
Background:, An impedance threshold device (ITD) has been found to enhance circulation during CPR by increasing cardiac preload. Additionally, in the spontaneously breathing patient, the ITD has been found to create a small degree of inspiratory resistance (-6 cm H2O at flow rate of 20L/min). Hypothesis: We sought to determine the effects of the ITD on awake patients with hypotension presenting to the emergency department. We hypothesized that the ITD would improve blood pressure when compared to standard therapy. The main outcome measure was the systolic blood pressure (SBP) change during 10 minutes of ITD use. Methods:, A convenience sample of patients with SBPs <95 mmHg were randomized in double-blind fashion to active or sham ITDs. Patients were enrolled if they were between the ages of 18 and 70 and their hypotension was felt to be due to non-traumatic blood loss or dehydration by the treating physician. Patients were excluded if they were experiencing shortness of breath, chest pain, failed the abbreviated mini-mental status exam, or had predefined cardiac/pulmonary history criteria. After consent and baseline measurements, patients spontaneously breathed through a mouthpiece attached to an active or sham ITD for a 10 minute period during which vital signs and patient status were recorded. Results:, 12 patients were enrolled (5 randomized to the active device, 7 to the sham device). Mean baseline SBPs were similar between groups with the active and sham devices having baseline SBPs of 84.5 mmHg (SD 5.45) and 83.67 mmHg (SD 10.02), respectively. The active ITD produced a statistically significant (p = 0.03) increase in SBP of 13.0 mmHg (SD 4.69) compared to the sham ITD, 2.33 mmHg (SD 0.58). Conclusions:, In spontaneously breathing hypotensive ED patients, the ITD was well-tolerated and increased the SBP. If these results are validated with a larger sample, the ITD may be a useful adjunct in the treatment of hypotension due to volume loss in the ED. [source]

Abnormal respiratory-related evoked potentials in untreated awake patients with severe obstructive sleep apnoea syndrome

CLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 1 2009
Christine Donzel-Raynaud
Summary Aim:, Obstructive sleep apnoeas generate an intense afferent traffic leading to arousal and apnoea termination. Yet a decrease in the sensitivity of the afferents has been described in patients with obstructive sleep apnoea, and could be a determinant of disease severity. How mechanical changes within the respiratory system are processed in the brain can be studied through the analysis of airway occlusion-related respiratory-related evoked potentials. Respiratory-related evoked potentials have been found altered during sleep in mild and moderate obstructive sleep apnoea syndrome, with contradictory results during wake. We hypothesized that respiratory-related evoked potentials' alterations during wake, if indeed a feature of the obstructive sleep apnoea syndrome, should be present in untreated severe patients. Methods:, Ten untreated patients with severe obstructive sleep apnoea syndrome and eight matched controls were studied. Respiratory-related evoked potentials were recorded in Cz-C3 and Cz-C4, and described in terms of the amplitudes and latencies of their components P1, N1, P2 and N2. Results:, Components amplitudes were similar in both groups. There was no significant difference in P1 latencies. This was also the case for N1 in Cz-C3. In contrast, N1 latencies in Cz-C4 were significantly longer in patients with obstructive sleep apnoea syndrome [median 98 ms (interquartile range 16·00) versus 79·5 ms (5·98), P = 0·015]. P2 and N2 were also significantly delayed, on both sides. Conclusions:, The cortical processing of airway occlusion-related afferents seems abnormal in untreated patients with severe obstructive sleep apnoea syndrome. This could be either a severity marker and/or an aggravating factor. [source]