16 Evidence-based Practice and Qualit y Improvement 1AP4-2 Preoperative oral rehydration therapy with 2.5% carbohydrate beverage alleviates insulin resistance in volunteers Nozomi O., Tomoaki Y., Takahiko T., Mayuko H., Masataka Y. Kochi Medical School, Dept of Anaesthesiology & Intensive Care, Nankoku, Japan Background and Goal of Study: The preoperative carbohydrate loading that is recommended in the enhanced recovery af ter surgery (ERAS) protocol en- hances insulin action by approximately 50% [1]. In some Japanese hospitals, preoperative oral rehydration therapy is per formed for preventing dehydration during surgery. We hypothesized that preoperative oral rehydration therapy with a 2.5% carbohydrate beverage that is widely used in Japan can enhance insulin action. Therefore, we investigated the ef fect of this 2.5% carbohydrate beverage on insulin action in healthy volunteers. Material and methods: Six healthy volunteers par ticipated in this crossover randomized study. The participants were segregated into 2 groups: a con- trol group (C group) and an oral rehydration therapy with 2.5% carbohydrate beverage group (OS group). The C group fasted from 9 pm onward on the evening before the investigation, and subjects were allowed to drink only wa- ter; conversely, the OS group fasted from 9 pm onward and drank 500 mL of the beverage containing 2.5% carbohydrate (OS-1; Otsuka Pharmaceutical Factory, Tokushima, Japan) between 9 pm and 12 pm and again at 6.30 am. At 8.30 am, a hyperinsulinemic normoglycemic clamp was initiated using an artificial pancreas STG-22 (Nikkiso, Tokyo, Japan). Insulin resistance was evaluated in both groups using the glucose infusion rate. Statistical analy- sis was per formed, and P values less than 0.05 were considered statistically significant. Results and Discussion: Subject age was 36 ± 8 years (mean ± SD), and body mass index was 23 ± 3 kg/m 2 . Blood glucose levels at the initiation of the clamp procedure were 92 ± 4 mg/dL for the C group and 92 ± 3 mg/dL for the OS group; thus, the dif ference was not statistically significant (P = 0.99). However, the glucose infusion rate for the OS group was significantly higher than that of the C group (8.6 ± 1.5 vs 6.8 ± 2.0 mg/kg/min, P = 0.009). The ef ficacy of insulin action in the OS group was less than that of insulin ac- tion due to the 12.6% carbohydrate beverage, which is recommended in the ERAS. Therefore, we considered that carbohydrate dose is the key factor for improving insulin action. Conclusion: An oral rehydration solution containing 2.5% carbohydrate en- hanced the action of insulin more than fasting alone. Reference: 1. Svanfeldt M, et al. Clin Nutri. 2005;24:815-21. 1AP4-3 Patients safet y during laparoscopic operations Marinchev V., Vasilkov V., Osinkin D. Institute for Postgraduate Study, Dept of Anaesthesiology & Intensive Care, Penza, Russian Federation Background and Goal of Study: The main problem of an anaesthesiologist is to defend the patients from surgical agression by safe and adequate an- aesthesia. Cardiovascular responces to peritoneal insuf flation of CO 2 in lapa- roscopic cholecystectomy (LCHE) is wellknown. How is EEG changed in this time? Goal of study is to make a comparison of hemodynamics and cerebral responses (changes in bispectral index) during LCHE. Patients and methods: Af ter Ethics Commit tee approval, 59 patients ASA 1 - 2, scheduled to undergo LCHE. Mean age 43,7 ± 2,5, 70% from them were women. All patients were screened before the operation according the programme of our clinic. Anaesthesia standar tised: induction with Propofol (1-2mg/kg), Fentanyl (1,5-2µg/kg), Atracurium (0,3-0,5 mg/kg). Anaesthesia was maintained with Sevoflurane (up to 1 - 1,3 MAC) and Fentanyl (1 µg/kg). Patients were ventilated with low flow ox ygen. Monitoring: SBP, DBP, ECG, HR, SpO 2 , etCO 2 and Sevoflurane concentration. BIS monitoring by “ASPECT A-1000”. Hemodynemic (CO, SV, SVR et others) investigated by noninvasive bioimpedance method. Statistical analysis was per formed using Students t test and results were expressed as mean ± standar t deviation. Results and Discussion: 1. The most significant changes in hemodynemic occurred af ter peritoneal insuf flation of CO 2 and transfered the Patients to anti-Trendelenburg 30°. 2. The base thoracic impedance was reduced and indicated of accumulation fluid in the chest. 3. Correction of ar terial hypotension should be done by inotropic drugs, but i.v. fluids should be restricted. 4. We registreted decreasing BIS-index and some hemodynemic parameters (CO, SV, CI) af ter hypotension. 5. BIS-monitoring helped to reduce consumption of drugs for general anaes- thesia and decreased incidence of postoperative nousea and vomiting by 15%. 6. BIS- index is most close connected with expiration concentration of sevoflu- rane - coef ficient of correlation (r) - 0,71. Conclusion: The study demonstrated that the use of standar ted anaesthesia (Propofol + Fentanyl + Sevoflurane) with monitoring hemodynamics and BIS- index in LCHE can be successfully and safet y per formed. 1AP4-4 Preliminar y experience with evaluation of factors influencing burnout syndrome in ICU staf f of a ter tiar y hospital Mangoyan H., Varosyan A. Yerevan State Medical Universit y, Dept of Intensive Care, Yerevan, Armenia Background and Goal of Study: Intensive care unit staf f is a well known high risk contingent for developing burnout syndrome (BOS) due to chronic occu- pational stress exposure. Burnout is associated with lower work ef fectiveness, decreased job satisfaction and ultimately threatens the quality of care and safet y of ICU patients. Age, standing and work regimens (day or night shif ts) are among impor tant factors potentially influencing the frequency and sever- it y of BOS. We aimed at evaluation of these factors relationships with BOS in nurses of a 26 beds general ICU. Materials and Methods: We prospectively evaluated 38 ICU nurses with the Maslach Burnout Inventory (MBI). MBI forms were filled on anonymous basis and surveyed by blinded investigator. Respondent’s age, shif t regimen (day time or night) as well as length of ser vice in ICU were recorded in conjunction with MBI scores. Parameters were categorized into following groups: age - Gr. I: 21-30 (n=17); Gr. II: 31-40 (n=14) and Gr. III: 41-50 years (n=7); standing - 1-5 years (n=18), 6-10 years (n=12) and more than 10 (n=8) consecutive years of ser vice in the same depar tment; shif t t ype - day time - 0 (n=10) and night -1 (n=28). Statistical analysis was per formed by independent samples t-test and between subjects ANOVA with subsequent Post Hoc Tukey test. Values are expressed as means and standard deviations Results and Discussion: BOS prevalence was 33.8 % when cut-of f value of 60 points was applied. Average MBI score in total population was 64.7. We detected an association bet ween increasing MBI scores and age: 61.6 (10.1), 61.8 (10.3) and 78.2 (10.8) for groups I, II, and III respectively with a statisti- cally significant difference between Gr. I and Gr. III (p=0.003) and Gr. II and Gr. III. (p=0.004). There was no similar association between standing or shif t subgroups and MBI points (p=0.68 and 0.83 respectively). Conclusion(s): Our data demonstrated high prevalence of BOS among ICU nurses. From three parameters only increasing age significantly correlated with high MBI scores but we didn’t detect similar relationships with regards to standing and work regimen. Limitations include small sample volume and dif ficulties with exclusion of other factors potentially influencing incidence and severit y of BOS. We’ve planned future expanded studies highlighting interplay bet ween multiple factors and their changes af ter organizational inter ventions. 1AP4-5 The temporal trend (1997-2008) of pat terns of anesthesia under Taiwan National Insurance System: a nationwide population-based study Chu C.-C., Weng S.-F ., Wang J.-J., Hsing C.-H., Medical Research National Health Insurance Team Chi Mei Medical Center, Dept of Anaesthesiology, Tainan, Taiwan, Republic of China Background and Goal of Study: The trends of modes of anesthesia of inpa- tient and ambulatory anesthesia can be an impor tant reference for govern- mental health policy. Based on a nationwide database, we examined the trend changes of inpatient and outpatient anesthesia in Taiwan during 12 years from 1997 to 2008. Material and methods: We used National health insurance discharge claim data to study the temporal change of modes of inpatient anesthesia, and the Longitudinal Health Insurance Database 2000 (LHID2000), a sub-dataset con- tains claim data of one million beneficiaries who were randomly selected from the system in 2000, to study the trend of outpatient anesthesia. Simple linear regression was used to distinguish the temporal trends over time of the modes of anesthesia. Results and Discussion: The annual inpatient anesthetic practice in Taiwan increased gradually, except the Severe acute respiratory syndrome (SARS) outbreak year 2003, during 1997-2008. However, the annual outpatient an- esthetic practice peaked at 2002, and decreased gradually. The predominant