Dexmedetomidine versus propofol for sedation during gastrointestinal endoscopy in pediatric patients

Objective: To compare the sedative, hemodynamic, respiratory and adverse effects of dexmedetomidine versus propofol during gastrointestinal endoscopy (GIE) in pediatrics. Methods: After obtaining approval of the research and ethics committee and informed consent of the parents of the patients, eighty pediatric patients ASA I/II aged 1–14 years, scheduled for gastrointestinal endoscopy were randomized into dexmedetomidine group or propofol group. Sedation was achieved with propofol 2 mg/kg bolus then infused at 100 μg/kg/min or dexmedetomidine 2.5 μg/kg over 10 min then infused at 2 μg/kg/h to achieve a Ramsay sedation scale (RSS) ⩾5. HR, MAP, RR and SPO2 were continuously monitored and analyzed at (T0) baseline, (T1) after induction, (T2) after insertion of endoscope, (T3) during procedure, (T4) recovery period. Times of induction, procedure, and recovery were reported together with any adverse effects. Results: There were no significant differences in demographic data between the two groups. HR values were significantly lower in dexmedetomidine group at T1, T2 and T3 (83.95 ± 13.79 versus 92.95 ± 12.38, 103.35 ± 15.34 versus 112.75 ± 12.79 and 90.80 ± 13.99 versus 104.05 ± 10.73) beats/min respectively, (p-value < 0.05). No significant differences were found in MAP, RR and SPO2 values between groups at all time points. Induction and recovery times were significantly longer in dexmedetomidine group 10.51 ± 1.75 versus 3.17 ± 0.72 min and 28.55 ± 7.95 versus 13.68 ± 3.35 min (p-value < 0.001). Seven patients in dexmedetomidine group (17.5%) versus one patient in propofol group (2.5%) showed unwanted movement (p-value 0.057), and no cases in dexmedetomidine group demonstrated oxygen desaturation versus 6 patients (15%) within propofol group (p-value 0.026). Conclusion: Dexmedetomidine sedation during GIE provides more respiratory safety and HR stability presenting itself as a suitable alternative agent especially for the relatively longer procedures

Entropy-guided end-tidal desflurane concentration during living donor liver transplantation

Background: The three phases of living donor liver transplantation (LDLT) represent different liver conditions. The aim is to study the required end-tidal desflurane concentration (ET-Des) guided with entropy monitoring for the depth of anesthesia. Methods: After the Ethics and Research Committee approval, 40 patients were included in this prospective study. Anesthesia was maintained with Desflurane-O2-air. State entropy (SE) and Response entropy (RE) were kept between 40 and 60. Results: Age and Model for End-stage Liver Disease (MELD) score were 45±10 years and 15.43±3.92, respectively. ET-Des were significantly lower in the anhepatic phase (2.8±0.4%) than in the pre-anhepatic and neohepatic phases (3.3±0.3%, 3.47±0.3%, respectively, P<0.001). The SE and RE for pre-anhepatic, anhepatic, and neohepatic phases were (45.6±3.7, 47.4±3.2), (44.7±2.1, 46.4±2.04), and (46.1±3.3, 47.9±3.3), respectively, with no significant changes between the phases, P > 0.05. Total operative time was 651±88 minutes, and for each phase it was 276±11, 195±55, and 191±24 minutes, respectively. Significant changes were found in hemoglobin g/dl and hematocrit % between the three phases (10.28±1.5, 30.48±4.3), (9.45±1.34, 28.36±4.1), and (8.88±1.1, 26.63±3.5), P<0.05. The heart rate and mean blood pressures were stable despite the cardiac index demonstrated a significant reduction during the anhepatic phase (2.99±0.22) when compared to the pre-anhepatic and neohepatic phases (3.60±0.29) and (4.72±0.32), respectively, ( P<0.05). There was a significant correlation between CI and ET-Des% (r=0.604, P<0.05). Conclusion: Inhalational anesthetic requirements differed from one phase to another during LDLT, with requirements being the least during the anhepatic phase. Monitoring of the anesthesia depth was required, to avoid excess administration, which could compromise the hemodynamics before the critical time of reperfusion

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

•We report INICC device-associated module data of 50 countries from 2010-2015.•We collected prospective data from 861,284 patients in 703 ICUs for 3,506,562 days.•DA-HAI rates and bacterial resistance were higher in the INICC ICUs than in CDC-NHSN's.•Device utilization ratio in the INICC ICUs was similar to CDC-NHSN's. Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. Conclusions: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically