Capnothorax: implications for the anaesthetist

Ten patients underwent a laparoscopic surgical technique for thoracic and cervical dissection of the oesophagus during oesophagogastrectomy. Thoracotomy was avoided with potential benefits to the patient. To facilitate surgical access the right lung was collapsed using a double-lumen bronchial tube and carbon dioxide was insufflated into the right pleural cavity to compress the lung. Changes in haemodynamic and respiratory variables occurred. In the majority of the patients airway pressure and end-tidal CO2 increased, despite alterations in ventilation. In five patients systolic blood pressure decreased suddenly by between 15 and 35 mmHg, and in four patients SpO2 decreased to 91% or less, despite an FIO2 of 1.0. If carbon dioxide was insufflated too fast, or the lung failed to deflate adequately, the clinical picture was that of a tension pneumothorax. One patient developed surgical emphysema and a contralateral pneumothorax. Postoperatively two patients had recurrent laryngeal nerve damage. Suggestions are made to minimise the changes in haemodynamic and respiratory variables during carbon dioxide insufflation into the thorax.     

Drug interactions and the clinical anaesthetist

In clinical practice, anaesthetists encounter many patients who are on concurrent medication which may have the potential to interact with drugs used during anaesthesia. Many patients are receiving as many as a dozen drugs of various kinds, thus, increasing the risk of a drug interaction occurring. Unfortunately anaesthetists tend not to report drug interactions which occur during anaesthesia--especially those of a minor nature such as flushing--and hence, the true number of drug interactions is unknown. We have developed a chart indicating the nature of important interactions that the anaesthetist may encounter.     

Seniors' needs for health-related personal assistance

OBJECTIVES: This article examines social and economic differences in the prevalence of needs and unmet needs for health-related personal assistance among the household population aged 65 and older and the sources from which they received support. DATA SOURCE: The data are from the 1991 Health and Activity Limitation Survey (HALS). ANALYTICAL TECHNIQUES: All calculations were based on weighted data. Age-standardized percentages of people with needs and unmet needs for personal assistance were calculated by sex, marital status, living arrangements, education, and household income. MAIN RESULTS: In 1991, 30% of seniors living in private households had some need for health-related personal assistance. Three-quarters of them required help only with instrumental activities of daily living (IADL); the remainder needed help with basic activities of daily living (ADL). The prevalence of need and unmet need was higher among women than men, was inversely related to household income and education, and was relatively high among formerly married seniors and those living alone. Household seniors were more likely to receive personal assistance from informal than formal sources, although this varied depending on their socioeconomic characteristics and the type of assistance they received.     

Help seeking and the need for academic assistance.

The functional relation between the need for academic assistance and help seeking was examined in a university setting. Six hundred twelve students indicated their perceived need for academic assistance, expected grades, and provided self-reports of help-seeking behavior at the conclusion of an academic term. Results support the proposed curvilinear (inverted U-shaped) relation between help seeking and need for assistance. Rate of help seeking increased from low to moderate need, maximizing in the B– to C+ grade range, then decreased with high need levels. Reasons for minimal help seeking by failing students are discussed in terms of achievement attribution theory, helplessness, and self-worth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Financial assistance for master's degree students.

A survey of 23 psychology departments suggests that funds for master's level psychology students are inadequate and that provisions for greater financial support are needed. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mechanical cardiac assistance

In neuropsychological vulnerability research the visual backward masking task, the Span of Apprehension, the degraded stimulus Continuous Performance Test (dsCPT), and the Wisconsin Card Sorting Test have been described as putative indicators for the predisposition to develop negative (schizophrenic) symptoms. The present study assesses the stability of the association between neuropsychological tests and negative symptoms by examining clinically improved patients. The interdependence between the four cognitive measures and clinical symptomatology was examined in 31 patients with DSM III-R and ICD-10 schizophrenia suffering predominantly from negative symptoms. Backward masking performance was related to affective flattening and anxiety-depression. False alarm rate on dsCPT was associated positively with affective flattening and hallucinations, and negatively with avolition. Card sorting preseverative errors correlated negatively with anhedonia, non-preservative errors correlated positively with avolition. Correlations notwithstanding, the data provide evidence in support of the relative independence of neuropsychological functions and negative symptoms in clinically improved schizophrenics.     

Evolving indications for preoperative intraaortic balloon pump assistance

Over a two-year period about 1,000 operations were performed with cardiopulmonary bypass. Intraaortic balloon pump assistance (IABP) was employed on 150 occasions, and a review of these has permitted clarification of the indications for its use. Sixty patients had IABP for carcinogenic shock either after infarction or cardiotomy, and 37 (62%) survived. Preoperative IABP in 90 high-risk patients resulted in survival for 79 (88%). The indications for prophylactic IABP included: (1) relief of severe pain, which occurred in 42 patients with acute coronary insufficiency, (2) improvement in the coronary perfusion pressure, which was accomplished in 20 patients with significant left main coronary artery occlusion or its equivalent, and (3) protection of left ventricular function, which war carried out in 28 patients with an LV ejection fraction of less than 0.40. The significance of the preoperative endocardial viability ratio (EVR) in relation to prophylactic IABP was also assessed: an EVR below 0.70 appears to be an indication for preoperative IABP.     

Atrial cannulation for left ventricular assistance: superiority of the dome approach

Successful left ventricular support is dependent on adequate inflow drainage. We describe atrial cannulation using the dome of the left atrium, which in our experience has resulted in excellent inflow drainage.     

Information, education and assistance to the patient

Information, Training and Assistance to patients are an ethical requirement for the prescriber as well as a necessary support to setting up the treatment best suitable to meet optimal efficacy expectations. Several phases with regard to providing information to patients can be considered: good knowledge of the patient, providing the patient with information regarding his or her disease, treatment, the overall medical assistance. Limits, hindrance and possible risks for the patient in providing medical information, are highlighted.     

Financial assistance available in Canada for students in psychology.

This report collates information obtained by means of questionnaires on financial assistance available to students of psychology in Canada. Universities and granting agencies are listed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)