Chris Soder - Academia.edu (original) (raw)
Papers by Chris Soder
Pediatric Anesthesia, 2010
Pediatric Emergency Care, Nov 26, 2012
To compare the GlideScope video laryngoscope (GVL) with the classic Macintosh laryngoscope in sim... more To compare the GlideScope video laryngoscope (GVL) with the classic Macintosh laryngoscope in simulated airway scenarios of varying difficulty. A prospective, crossover and randomised study was performed. Four airway scenarios were simulated using the Airsim model as follows: normal; cervical spine immobilisation; tongue oedema and combined cervical spine immobilisation with tongue oedema. Emergency physicians performed tracheal intubations using both devices in each of the scenarios. The time required to intubate, the success rate and the number of intubation attempts were recorded. At the end of each scenario, participants scored vocal cord visualisation using the percentage of glottic opening (POGO) visible and the subjective ease of intubation on a visual analogue scale (VAS). All 25 participants successfully completed the study. There was no difference in the time required for successful tracheal intubation using the GVL compared with using the Macintosh laryngoscope in the four airway scenarios. Only one participant failed to intubate the trachea with the Macintosh laryngoscope for the combined scenario. There was a significant increase in POGO when using the GVL in the cervical spine immobilisation group (p = 0.027). The VAS score of the subjective ease of intubation was lower for the GVL than for the Macintosh laryngoscope device in difficult scenarios but this difference was not significant. This study suggests that the GVL could be an option for airway management even by emergency physicians with little experience and no training in its use.
Canadian journal of surgery. Journal canadien de chirurgie
A novel surgical procedure was performed on a 2-day-old infant with hypoplastic left-heart syndro... more A novel surgical procedure was performed on a 2-day-old infant with hypoplastic left-heart syndrome. It consisted of partitioning the pulmonary trunk thereby creating two channels, one leading to the pulmonary arterial system and the other to the aorta, and atrial septectomy to relieve left atrial pressure and facilitate mixing of blood. The technique avoids the use of conduits.
Canadian family physician Médecin de famille canadien
Pediatric cardiology, 1992
We studied the hemodynamic responses of peritoneal dialysis (PD) in three children following open... more We studied the hemodynamic responses of peritoneal dialysis (PD) in three children following open heart surgery. Hemodynamic measurements were made prior to a dialysis run, following the instillation of dialysis solution (20 ml/kg), and immediately prior to and 5 min after drainage of the peritoneal cavity. The same protocol was repeated 48 h later. There was a significant increase in right atrial pressure (RAP) and mean pulmonary artery pressure upon instillation of the dialysate into the peritoneal cavity (p less than 0.01). However, cardiac index, mean arterial blood pressure (MAP), systemic (SVRI) and pulmonary vascular resistances (PVRI), left atrial pressure (LAP), and oxygen saturation did not change significantly. There were no significant differences between responses in the initial study and that performed 48 h later. PD is associated with modest right-sided hemodynamic changes which, in this small group of patients, did not compromise patient care.
Canadian Journal of Biochemistry, 1976
The relationship between nucleoside triphosphate pyrophosphohydrolase (NTPH) (EC 3.6.1.19) activi... more The relationship between nucleoside triphosphate pyrophosphohydrolase (NTPH) (EC 3.6.1.19) activity in erythrocyte lysates and accumulation of radioactive inosine triphosphate (ITP) in human erythrocytes incubated in vitro with [14C]hypoxanthine, was studied in 93 humans. When ITP accumulation, expressed as percentage of total radioactive nucleotides, was plotted against NTPH specific activity, an inverse relationship was found to exist. A continuous spectrum of NTPH specific activities and ITP accumulation values exists in the human population and the relationship between these two parameters follows the relationship of substrate concentration to enzyme activity predicted by Michaelis–Menten enzyme kinetics. One interpretation of these data is that the ITP concentration in human red blood cells is controlled by the degradation of ITP to IMP and pyrophosphate catalyzed by NTPH.
The Laryngoscope, 1984
Many patients requiring direct examination of the upper airway and gastrointestinal tract under g... more Many patients requiring direct examination of the upper airway and gastrointestinal tract under general anesthesia have chronic obstructive lung disease, yet virtually no work has been done to assess the adequacy of their ventilation during laryngoscopy and in the early postoperative period. This study demonstrates that, using the Carden tube, their blood gases are well maintained even when areas outside the endolarynx, such as the upper esophagus, are examined. The Carden tube is shown to be easy to insert and remove as well as permitting a superior view of the larynx. Also, this study pinpoints the period of maximum danger of respiratory failure as occurring postoperatively in the recovery room. This should be independent of the method of ventilation employed at surgery and indicates the need for cocainization of the vocal cords before extubation, as well as careful, early postoperative monitoring. The problems of ventilation during direct examination of the upper airway and gastrointestinal tract are discussed and alternative methods evaluated.
Pediatric Anesthesia, 2009
Direct laryngoscopy can be challenging in infants and neonates. Even with an optimal line of sigh... more Direct laryngoscopy can be challenging in infants and neonates. Even with an optimal line of sight to the glottic opening, the viewing angle has been measured at 15 degrees . The STORZ DCI video laryngoscope (Karl Storz, Tuttlingen, Germany) incorporates a fiberoptic camera in the light source of a standard laryngoscope of variable sizes. The image is displayed on a screen with a viewing angle of 80 degrees . We studied the effectiveness of the STORZ DCI as an airway tool compared to standard direct laryngoscopy in children with normal airway. In this prospective, randomized study, 56 children (ages 4 years or younger) undergoing elective surgery with the need for endotracheal intubation were divided into two groups: children who underwent standard direct laryngoscopy using a Miller 1 or Macintosh 2 blade (DL) and children who underwent video laryngoscopy using the STORZ DCI video laryngoscope with a Miller 1 blade (VL). Time to best view (TTBV), time to intubate (TTI), Cormack-Lehane (CL), and percentage of glottis opening seen (POGO) score were recorded. TTBV in DL was 5.5 (4-8) s and 7 (4.2-9) s in VL. TTI in DL was 21 (17-29) s and in VL 27 (22-37) s (P = 0.006). The view as assessed by POGO score was 97.5% (60-100%) in DL and 100% (100-100%) in the VL (P = 0.003). Data are presented as median and interquartile range and analyzed using t-test. This study demonstrates that the STORZ DCI video laryngoscope provides an improved view to the glottis in children with normal airway anatomy, but requires a longer time for intubation.
Pediatric Anesthesia, 2009
Pediatric Anesthesia, 2009
Pediatric Anesthesia, 2010
Difficult airway management in children is challenging. One alternative device to the gold standa... more Difficult airway management in children is challenging. One alternative device to the gold standard of direct laryngoscopy is the STORZ Bonfils fiberscope (Karl Storz Endoscopy, Tuttlingen, Germany), a rigid fiberoptic stylette-like scope with a curved tip. Although results in adults have been encouraging, reports regarding its use in children have been conflicting. We compared the effectiveness of a standard laryngoscope to the Bonfils fiberscope in a simulated difficult infant airway. Ten pediatric anesthesiologists were recruited for this study and asked to perform three sets of tasks. For the first task, each participant intubated an unaltered manikin (SimBaby (TM), Laerdal, Puchheim, Germany) five times using a styletted 3.5 endotracheal tube (ETT) and a Miller 1 blade (group DL-Normal). For the second task, a difficult airway configuration simulating a Cormack-Lehane grade 3B view was created by fixing a Miller-1 blade into position in the manikin using a laboratory stand. Each participant then intubated the manikin five times with a styletted 3.5 ETT using conventional technique but without touching the laryngoscope (group DL-Difficult). In the third task, the manikin was kept in the same difficult airway configuration, and each participant intubated the manikin five times using a 3.5-mm ETT mounted on the Bonfils fiberscope as an adjunct to direct laryngoscopy with the Miller-1 blade (group BF-Difficult). Primary outcomes were time to intubate and success rate. A total of 150 intubations were performed. Correct ETT placement was achieved in 100% of attempts in group DL-Normal, 90% of attempts in group DL-Difficult and 98% of attempts in BF-Difficult. Time to intubate averaged 14 s (interquartile range 12-16) in group DL-Normal; 12 s (10-15) in group DL-Difficult; and 11 s (10-18) in group BF-Difficult. The percentage of glottic opening seen (POGO score) was 70% (70-80) in group DL-Normal; 0% (0-0) in group DL-Difficult; and 100% (100-100) in group BF-Difficult. The Bonfils fiberscope-assisted laryngoscopy was easier to use and provided a better view of the larynx than simple direct laryngoscopy in the simulated difficult pediatric airway, but intubation success rate and time to intubate were not improved. Further studies of the Bonfils fibrescope as a pediatric airway adjunct are needed.
European Journal of Pediatric Surgery, 1992
This is a 15-year retrospective study of 64 pediatric surgical patients with traumatic rupture of... more This is a 15-year retrospective study of 64 pediatric surgical patients with traumatic rupture of the spleen from 1976 to 1990. The overall mortality was 14% (9/64). All non-survivors had severe multiple traumata and no fatalities were attributable to splenic injury. During the first 5 years of the study, the traditional surgical approach of immediate laparotomy and splenectomy was employed. During the next 5 years we practised laparotomy with subtotal splenectomy and repair. During the final 5 years conservative management with clinical and ultrasonographic monitoring became predominant (1 splenectomy, 4 repair, 23 conservative treatments). Among the 55 survivors, 11 had splenectomy, 14 had splenic repairs and 30 were treated non-operatively. All survivors had excellent outcomes and there was only one complication: a local abscess following splenic repair. Based on a very strict protocol in conservative management, the total amount of transfused blood could be reduced remarkably during the last period. Splenectomized patients received pneumococcal vaccine and prophylactic antibiotic coverage was prescribed for febrile episodes. None of the splenectomized patients experienced septic episodes or increased rates of infection. Based on our experience, ultrasonographically monitored conservative management is the treatment of choice in most patients with splenic injury in childhood.
Emergency Medicine Journal, 2008
To compare the GlideScope video laryngoscope (GVL) with the classic Macintosh laryngoscope in sim... more To compare the GlideScope video laryngoscope (GVL) with the classic Macintosh laryngoscope in simulated airway scenarios of varying difficulty. A prospective, crossover and randomised study was performed. Four airway scenarios were simulated using the Airsim model as follows: normal; cervical spine immobilisation; tongue oedema and combined cervical spine immobilisation with tongue oedema. Emergency physicians performed tracheal intubations using both devices in each of the scenarios. The time required to intubate, the success rate and the number of intubation attempts were recorded. At the end of each scenario, participants scored vocal cord visualisation using the percentage of glottic opening (POGO) visible and the subjective ease of intubation on a visual analogue scale (VAS). All 25 participants successfully completed the study. There was no difference in the time required for successful tracheal intubation using the GVL compared with using the Macintosh laryngoscope in the four airway scenarios. Only one participant failed to intubate the trachea with the Macintosh laryngoscope for the combined scenario. There was a significant increase in POGO when using the GVL in the cervical spine immobilisation group (p = 0.027). The VAS score of the subjective ease of intubation was lower for the GVL than for the Macintosh laryngoscope device in difficult scenarios but this difference was not significant. This study suggests that the GVL could be an option for airway management even by emergency physicians with little experience and no training in its use.
Critical Care Medicine, 1989
Anterior thigh, pretibial and midfoot surface temperatures (MFT) were measured by an infrared the... more Anterior thigh, pretibial and midfoot surface temperatures (MFT) were measured by an infrared thermometer in 17 children after open heart surgery. Core temperature was measured by pulmonary artery thermistor and cardiac index (CI) by thermodilution. No significant relationship existed between the previous hour's urinary output (ml/m2.h) and either systemic vascular resistance index (SVRI) and CI. MFT was inversely related to SVRI (r = -5.3; p less than .0001) but not to CI. The core/peripheral temperature gradient correlated directly with SVRI (r = .38, p less than .01) and inversely with CI (r = -.28, p less than .05). There was no improvement in any of the correlation coefficients when hemodynamic variables were tested against temperature gradients from core to thigh and thigh to foot. Although these relationships are statistically significant, we conclude that they are not strong enough to be of value in predicting central hemodynamic status in children after heart surgery.
Critical Care Medicine, 1989
We studied the hemodynamic effects of acute alterations in PaCO2 in ten ventilator-dependent chil... more We studied the hemodynamic effects of acute alterations in PaCO2 in ten ventilator-dependent children after open heart surgery. Despite end-tidal CO2 monitoring, five children inadvertently developed PaCO2 greater than 50 torr during the study. Increasing and decreasing PaCO2 in these children resulted in significant parallel changes in cardiac index (CI), oxygen delivery, physiologic shunt, mean pulmonary pressure, and right ventricular stroke work index, and inverse changes in systemic vascular resistance index (p less than .01). No significant hemodynamic changes were observed with alterations in PaCO2 in children whose PaCO2 remained less than 50 torr. These findings are partly related to significantly larger reductions in PaCO2 which occurred in the hypercarbic children compared to the others (25 vs. 12 torr; p less than .001). Heart rate, mean arterial BP, and venous filling pressures did not change significantly in either group. We conclude that mean alterations in PaCO2 less than or equal to 12 torr (range 28 to 50) have no significant effect on CI in children after open heart surgery. However, moderate hypercarbia and its correction to a mean PaCO2 of 30 torr are associated with significant effects on central hemodynamics. Moreover, no significant changes in the commonly monitored physiologic variables were observed despite large variations in PaCO2.
Canadian Anaesthetists’ Society Journal, 1980
The effectiveness and safety of the Carden tube-oxygen injector system for ventilation was studie... more The effectiveness and safety of the Carden tube-oxygen injector system for ventilation was studied in 18 hlgh-rlsk patients with obstructive airways disease during mlcrolaryngeal surgery. Blood gas studies during operation demonstrated a mean Pao2 of 65.6 kPa (493 torr) and a mean Paco~Of4.5 kPa (34 tort) during mechanical ventilation. No serious complications were noted during operation. Fifty per cent of the patients had postoperative hypercapnia and in two the trachea was re-intubated. Airway maintenance and ventilation are discussed in detail and it is concluded that the Carden tube-oxygen injector system is a safe and convenient method for ventilating the lungs of patients with pulmonary disease who require microlaryngeal surgery.
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2004
The responsibility of acute airway management often falls into the hands of non-anesthesiologists... more The responsibility of acute airway management often falls into the hands of non-anesthesiologists. Emergency physicians now routinely use neuromuscular blockade to facilitate intubation. The literature in support of this practice has almost exclusively been published in emergency medicine (EM) journals. This body of literature is presented and issues of educational support are discussed. S So ou ur rc ce e: : A narrative review of the literature on the practice of airway management by non-anesthesiologists. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : A significant proportion of acute airway management occurring outside the operating room is being performed by non-anesthesiologists. Rapid sequence intubation (RSI) is recognized as a core procedure within the domain of EM. RSI is being performed routinely by emergency physicians practicing in larger centres. Anesthesiologist support for the practice of RSI by nonanesthesiologists has been weak. Formal educational support outside of postgraduate training in the form of dedicated programs for advanced airway management are now being offered. The majority of the literature on the use of RSI by non-anesthesiologists represents retrospective case series, observational studies and registry data published in EM journals. The reported success rates for RSI performed by non-anesthesiologists is high. Complication rates are significant, however reporting consistency has been poor. C Co on nc cl lu us si io on ns s: : The role of non-anesthesiologists in acute airway management is significant. Despite shortcomings in methodology, current evidence and practice supports the use of RSI by trained emergency physicians. Constructive collaborative efforts between anesthesiology and EM need to occur to ensure that educational needs are met and that competent airway management is provided. Objectif : La responsabilité de l'assistance respiratoire d'urgence revient souvent à des médecins non-anesthésiologistes. Les urgentistes utilisent maintenant de routine le bloc neuromusculaire pour faciliter l'intubation. La documentation à l'appui de cette pratique a été publiée presque exclusivement dans les journaux de médecine d'urgence (MU). Nous présentons l'ensemble de ces documents et exposons les questions de formation.
Pediatric Anesthesia, 2010
Pediatric Emergency Care, Nov 26, 2012
To compare the GlideScope video laryngoscope (GVL) with the classic Macintosh laryngoscope in sim... more To compare the GlideScope video laryngoscope (GVL) with the classic Macintosh laryngoscope in simulated airway scenarios of varying difficulty. A prospective, crossover and randomised study was performed. Four airway scenarios were simulated using the Airsim model as follows: normal; cervical spine immobilisation; tongue oedema and combined cervical spine immobilisation with tongue oedema. Emergency physicians performed tracheal intubations using both devices in each of the scenarios. The time required to intubate, the success rate and the number of intubation attempts were recorded. At the end of each scenario, participants scored vocal cord visualisation using the percentage of glottic opening (POGO) visible and the subjective ease of intubation on a visual analogue scale (VAS). All 25 participants successfully completed the study. There was no difference in the time required for successful tracheal intubation using the GVL compared with using the Macintosh laryngoscope in the four airway scenarios. Only one participant failed to intubate the trachea with the Macintosh laryngoscope for the combined scenario. There was a significant increase in POGO when using the GVL in the cervical spine immobilisation group (p = 0.027). The VAS score of the subjective ease of intubation was lower for the GVL than for the Macintosh laryngoscope device in difficult scenarios but this difference was not significant. This study suggests that the GVL could be an option for airway management even by emergency physicians with little experience and no training in its use.
Canadian journal of surgery. Journal canadien de chirurgie
A novel surgical procedure was performed on a 2-day-old infant with hypoplastic left-heart syndro... more A novel surgical procedure was performed on a 2-day-old infant with hypoplastic left-heart syndrome. It consisted of partitioning the pulmonary trunk thereby creating two channels, one leading to the pulmonary arterial system and the other to the aorta, and atrial septectomy to relieve left atrial pressure and facilitate mixing of blood. The technique avoids the use of conduits.
Canadian family physician Médecin de famille canadien
Pediatric cardiology, 1992
We studied the hemodynamic responses of peritoneal dialysis (PD) in three children following open... more We studied the hemodynamic responses of peritoneal dialysis (PD) in three children following open heart surgery. Hemodynamic measurements were made prior to a dialysis run, following the instillation of dialysis solution (20 ml/kg), and immediately prior to and 5 min after drainage of the peritoneal cavity. The same protocol was repeated 48 h later. There was a significant increase in right atrial pressure (RAP) and mean pulmonary artery pressure upon instillation of the dialysate into the peritoneal cavity (p less than 0.01). However, cardiac index, mean arterial blood pressure (MAP), systemic (SVRI) and pulmonary vascular resistances (PVRI), left atrial pressure (LAP), and oxygen saturation did not change significantly. There were no significant differences between responses in the initial study and that performed 48 h later. PD is associated with modest right-sided hemodynamic changes which, in this small group of patients, did not compromise patient care.
Canadian Journal of Biochemistry, 1976
The relationship between nucleoside triphosphate pyrophosphohydrolase (NTPH) (EC 3.6.1.19) activi... more The relationship between nucleoside triphosphate pyrophosphohydrolase (NTPH) (EC 3.6.1.19) activity in erythrocyte lysates and accumulation of radioactive inosine triphosphate (ITP) in human erythrocytes incubated in vitro with [14C]hypoxanthine, was studied in 93 humans. When ITP accumulation, expressed as percentage of total radioactive nucleotides, was plotted against NTPH specific activity, an inverse relationship was found to exist. A continuous spectrum of NTPH specific activities and ITP accumulation values exists in the human population and the relationship between these two parameters follows the relationship of substrate concentration to enzyme activity predicted by Michaelis–Menten enzyme kinetics. One interpretation of these data is that the ITP concentration in human red blood cells is controlled by the degradation of ITP to IMP and pyrophosphate catalyzed by NTPH.
The Laryngoscope, 1984
Many patients requiring direct examination of the upper airway and gastrointestinal tract under g... more Many patients requiring direct examination of the upper airway and gastrointestinal tract under general anesthesia have chronic obstructive lung disease, yet virtually no work has been done to assess the adequacy of their ventilation during laryngoscopy and in the early postoperative period. This study demonstrates that, using the Carden tube, their blood gases are well maintained even when areas outside the endolarynx, such as the upper esophagus, are examined. The Carden tube is shown to be easy to insert and remove as well as permitting a superior view of the larynx. Also, this study pinpoints the period of maximum danger of respiratory failure as occurring postoperatively in the recovery room. This should be independent of the method of ventilation employed at surgery and indicates the need for cocainization of the vocal cords before extubation, as well as careful, early postoperative monitoring. The problems of ventilation during direct examination of the upper airway and gastrointestinal tract are discussed and alternative methods evaluated.
Pediatric Anesthesia, 2009
Direct laryngoscopy can be challenging in infants and neonates. Even with an optimal line of sigh... more Direct laryngoscopy can be challenging in infants and neonates. Even with an optimal line of sight to the glottic opening, the viewing angle has been measured at 15 degrees . The STORZ DCI video laryngoscope (Karl Storz, Tuttlingen, Germany) incorporates a fiberoptic camera in the light source of a standard laryngoscope of variable sizes. The image is displayed on a screen with a viewing angle of 80 degrees . We studied the effectiveness of the STORZ DCI as an airway tool compared to standard direct laryngoscopy in children with normal airway. In this prospective, randomized study, 56 children (ages 4 years or younger) undergoing elective surgery with the need for endotracheal intubation were divided into two groups: children who underwent standard direct laryngoscopy using a Miller 1 or Macintosh 2 blade (DL) and children who underwent video laryngoscopy using the STORZ DCI video laryngoscope with a Miller 1 blade (VL). Time to best view (TTBV), time to intubate (TTI), Cormack-Lehane (CL), and percentage of glottis opening seen (POGO) score were recorded. TTBV in DL was 5.5 (4-8) s and 7 (4.2-9) s in VL. TTI in DL was 21 (17-29) s and in VL 27 (22-37) s (P = 0.006). The view as assessed by POGO score was 97.5% (60-100%) in DL and 100% (100-100%) in the VL (P = 0.003). Data are presented as median and interquartile range and analyzed using t-test. This study demonstrates that the STORZ DCI video laryngoscope provides an improved view to the glottis in children with normal airway anatomy, but requires a longer time for intubation.
Pediatric Anesthesia, 2009
Pediatric Anesthesia, 2009
Pediatric Anesthesia, 2010
Difficult airway management in children is challenging. One alternative device to the gold standa... more Difficult airway management in children is challenging. One alternative device to the gold standard of direct laryngoscopy is the STORZ Bonfils fiberscope (Karl Storz Endoscopy, Tuttlingen, Germany), a rigid fiberoptic stylette-like scope with a curved tip. Although results in adults have been encouraging, reports regarding its use in children have been conflicting. We compared the effectiveness of a standard laryngoscope to the Bonfils fiberscope in a simulated difficult infant airway. Ten pediatric anesthesiologists were recruited for this study and asked to perform three sets of tasks. For the first task, each participant intubated an unaltered manikin (SimBaby (TM), Laerdal, Puchheim, Germany) five times using a styletted 3.5 endotracheal tube (ETT) and a Miller 1 blade (group DL-Normal). For the second task, a difficult airway configuration simulating a Cormack-Lehane grade 3B view was created by fixing a Miller-1 blade into position in the manikin using a laboratory stand. Each participant then intubated the manikin five times with a styletted 3.5 ETT using conventional technique but without touching the laryngoscope (group DL-Difficult). In the third task, the manikin was kept in the same difficult airway configuration, and each participant intubated the manikin five times using a 3.5-mm ETT mounted on the Bonfils fiberscope as an adjunct to direct laryngoscopy with the Miller-1 blade (group BF-Difficult). Primary outcomes were time to intubate and success rate. A total of 150 intubations were performed. Correct ETT placement was achieved in 100% of attempts in group DL-Normal, 90% of attempts in group DL-Difficult and 98% of attempts in BF-Difficult. Time to intubate averaged 14 s (interquartile range 12-16) in group DL-Normal; 12 s (10-15) in group DL-Difficult; and 11 s (10-18) in group BF-Difficult. The percentage of glottic opening seen (POGO score) was 70% (70-80) in group DL-Normal; 0% (0-0) in group DL-Difficult; and 100% (100-100) in group BF-Difficult. The Bonfils fiberscope-assisted laryngoscopy was easier to use and provided a better view of the larynx than simple direct laryngoscopy in the simulated difficult pediatric airway, but intubation success rate and time to intubate were not improved. Further studies of the Bonfils fibrescope as a pediatric airway adjunct are needed.
European Journal of Pediatric Surgery, 1992
This is a 15-year retrospective study of 64 pediatric surgical patients with traumatic rupture of... more This is a 15-year retrospective study of 64 pediatric surgical patients with traumatic rupture of the spleen from 1976 to 1990. The overall mortality was 14% (9/64). All non-survivors had severe multiple traumata and no fatalities were attributable to splenic injury. During the first 5 years of the study, the traditional surgical approach of immediate laparotomy and splenectomy was employed. During the next 5 years we practised laparotomy with subtotal splenectomy and repair. During the final 5 years conservative management with clinical and ultrasonographic monitoring became predominant (1 splenectomy, 4 repair, 23 conservative treatments). Among the 55 survivors, 11 had splenectomy, 14 had splenic repairs and 30 were treated non-operatively. All survivors had excellent outcomes and there was only one complication: a local abscess following splenic repair. Based on a very strict protocol in conservative management, the total amount of transfused blood could be reduced remarkably during the last period. Splenectomized patients received pneumococcal vaccine and prophylactic antibiotic coverage was prescribed for febrile episodes. None of the splenectomized patients experienced septic episodes or increased rates of infection. Based on our experience, ultrasonographically monitored conservative management is the treatment of choice in most patients with splenic injury in childhood.
Emergency Medicine Journal, 2008
To compare the GlideScope video laryngoscope (GVL) with the classic Macintosh laryngoscope in sim... more To compare the GlideScope video laryngoscope (GVL) with the classic Macintosh laryngoscope in simulated airway scenarios of varying difficulty. A prospective, crossover and randomised study was performed. Four airway scenarios were simulated using the Airsim model as follows: normal; cervical spine immobilisation; tongue oedema and combined cervical spine immobilisation with tongue oedema. Emergency physicians performed tracheal intubations using both devices in each of the scenarios. The time required to intubate, the success rate and the number of intubation attempts were recorded. At the end of each scenario, participants scored vocal cord visualisation using the percentage of glottic opening (POGO) visible and the subjective ease of intubation on a visual analogue scale (VAS). All 25 participants successfully completed the study. There was no difference in the time required for successful tracheal intubation using the GVL compared with using the Macintosh laryngoscope in the four airway scenarios. Only one participant failed to intubate the trachea with the Macintosh laryngoscope for the combined scenario. There was a significant increase in POGO when using the GVL in the cervical spine immobilisation group (p = 0.027). The VAS score of the subjective ease of intubation was lower for the GVL than for the Macintosh laryngoscope device in difficult scenarios but this difference was not significant. This study suggests that the GVL could be an option for airway management even by emergency physicians with little experience and no training in its use.
Critical Care Medicine, 1989
Anterior thigh, pretibial and midfoot surface temperatures (MFT) were measured by an infrared the... more Anterior thigh, pretibial and midfoot surface temperatures (MFT) were measured by an infrared thermometer in 17 children after open heart surgery. Core temperature was measured by pulmonary artery thermistor and cardiac index (CI) by thermodilution. No significant relationship existed between the previous hour's urinary output (ml/m2.h) and either systemic vascular resistance index (SVRI) and CI. MFT was inversely related to SVRI (r = -5.3; p less than .0001) but not to CI. The core/peripheral temperature gradient correlated directly with SVRI (r = .38, p less than .01) and inversely with CI (r = -.28, p less than .05). There was no improvement in any of the correlation coefficients when hemodynamic variables were tested against temperature gradients from core to thigh and thigh to foot. Although these relationships are statistically significant, we conclude that they are not strong enough to be of value in predicting central hemodynamic status in children after heart surgery.
Critical Care Medicine, 1989
We studied the hemodynamic effects of acute alterations in PaCO2 in ten ventilator-dependent chil... more We studied the hemodynamic effects of acute alterations in PaCO2 in ten ventilator-dependent children after open heart surgery. Despite end-tidal CO2 monitoring, five children inadvertently developed PaCO2 greater than 50 torr during the study. Increasing and decreasing PaCO2 in these children resulted in significant parallel changes in cardiac index (CI), oxygen delivery, physiologic shunt, mean pulmonary pressure, and right ventricular stroke work index, and inverse changes in systemic vascular resistance index (p less than .01). No significant hemodynamic changes were observed with alterations in PaCO2 in children whose PaCO2 remained less than 50 torr. These findings are partly related to significantly larger reductions in PaCO2 which occurred in the hypercarbic children compared to the others (25 vs. 12 torr; p less than .001). Heart rate, mean arterial BP, and venous filling pressures did not change significantly in either group. We conclude that mean alterations in PaCO2 less than or equal to 12 torr (range 28 to 50) have no significant effect on CI in children after open heart surgery. However, moderate hypercarbia and its correction to a mean PaCO2 of 30 torr are associated with significant effects on central hemodynamics. Moreover, no significant changes in the commonly monitored physiologic variables were observed despite large variations in PaCO2.
Canadian Anaesthetists’ Society Journal, 1980
The effectiveness and safety of the Carden tube-oxygen injector system for ventilation was studie... more The effectiveness and safety of the Carden tube-oxygen injector system for ventilation was studied in 18 hlgh-rlsk patients with obstructive airways disease during mlcrolaryngeal surgery. Blood gas studies during operation demonstrated a mean Pao2 of 65.6 kPa (493 torr) and a mean Paco~Of4.5 kPa (34 tort) during mechanical ventilation. No serious complications were noted during operation. Fifty per cent of the patients had postoperative hypercapnia and in two the trachea was re-intubated. Airway maintenance and ventilation are discussed in detail and it is concluded that the Carden tube-oxygen injector system is a safe and convenient method for ventilating the lungs of patients with pulmonary disease who require microlaryngeal surgery.
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2004
The responsibility of acute airway management often falls into the hands of non-anesthesiologists... more The responsibility of acute airway management often falls into the hands of non-anesthesiologists. Emergency physicians now routinely use neuromuscular blockade to facilitate intubation. The literature in support of this practice has almost exclusively been published in emergency medicine (EM) journals. This body of literature is presented and issues of educational support are discussed. S So ou ur rc ce e: : A narrative review of the literature on the practice of airway management by non-anesthesiologists. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : A significant proportion of acute airway management occurring outside the operating room is being performed by non-anesthesiologists. Rapid sequence intubation (RSI) is recognized as a core procedure within the domain of EM. RSI is being performed routinely by emergency physicians practicing in larger centres. Anesthesiologist support for the practice of RSI by nonanesthesiologists has been weak. Formal educational support outside of postgraduate training in the form of dedicated programs for advanced airway management are now being offered. The majority of the literature on the use of RSI by non-anesthesiologists represents retrospective case series, observational studies and registry data published in EM journals. The reported success rates for RSI performed by non-anesthesiologists is high. Complication rates are significant, however reporting consistency has been poor. C Co on nc cl lu us si io on ns s: : The role of non-anesthesiologists in acute airway management is significant. Despite shortcomings in methodology, current evidence and practice supports the use of RSI by trained emergency physicians. Constructive collaborative efforts between anesthesiology and EM need to occur to ensure that educational needs are met and that competent airway management is provided. Objectif : La responsabilité de l'assistance respiratoire d'urgence revient souvent à des médecins non-anesthésiologistes. Les urgentistes utilisent maintenant de routine le bloc neuromusculaire pour faciliter l'intubation. La documentation à l'appui de cette pratique a été publiée presque exclusivement dans les journaux de médecine d'urgence (MU). Nous présentons l'ensemble de ces documents et exposons les questions de formation.