A comparison of soda lime (Intersurgical) with Amsorb® plus: the cost implications

This was a prospective study comparing the cost implications between two carbon dioxide (CO2) absorbers, soda lime (Intersurgical) and AMSORB® PLUS. The study was conducted over two 4-week periods in two dedicated operating theatres using Datex Ohmeda Aestiva/5 anaesthetic machines. AMSORB® PLUS was used during the first four weeks and soda lime (Intersurgical) the following four weeks. General anaesthesia was administered as routinely done but fresh gas flow (FGF) during the maintenance phase was limited to a maximum flow of 2 L/min. The CO2 absorber was only changed when there was evidence of exhaustion. Total duration of anaesthesia, sevoflurane (bottles) and CO2 absorber (kg) consumption, and amount of waste product (kg) was calculated at the end of each study period. The total cost of delivering general anaesthesia was lower in the AMSORB® PLUS group, RM82.40 (USD19.89)/hour versus the soda lime group, RM91.50 (USD 22.09)/hour (p=0.17), which translates to a 10% reduction in cost per hour. Reduction in sevoflurane consumption in the AMSORB® PLUS compared to the soda lime group was also not statistically significant (p=0.22). The only significant finding was the reduction in CO2 absorber consumption in the AMSORB® PLUS group as compared to soda lime group (p=0.001). In conclusion, AMSORB® PLUS consumption was significantly reduced compared to that of soda lime. However, the use of AMSORB® PLUS did not significantly reduce sevoflurane consumption nor the total cost of delivering general anaesthesia. Given the superior safety profile, AMSORB® PLUS may be a suitable, cost-effective alternative to soda lime in the daily practice of anaesthesia

A rare case of Pseudomonas putida ventriculitis in intensive care unit: A case report

Pseudomonas putida is a rare pathogen leading to nosocomial and central nervous system infections. Despite having a low virulence and being a rare organism to cause bacteremia, it can evolve into a multidrug-resistant organism and lead to mortality and morbidity in the intensive care setting. A 64-year-old male gardener was presented with extensive acute subarachnoid hemorrhage with intraventricular extension causing hydrocephalus requiring embolization and coiling following a cerebral angiogram, which showed bilateral posterior circulation aneurysm and left anterior circulation aneurysm. External ventricular drain (EVD) was inserted given the worsening hydrocephalus. During his stay in the intensive care unit (ICU), he was becoming more septic and a full septic workup including a cerebral spinal fluid culture taken from the indwelling catheter of the EVD and was found to be positive for a ceftazidime-sensitive strain of P. putida. Following the treatment with intravenous ceftazidime for 1 week and a revision of the EVD on day 32 of admission, he continued to recover well and showed an improvement in his Glasgow Coma Scale (GCS) and septic parameters. Eventually, he was able to wean off mechanical ventilation. He was discharged from ICU care to the neurosurgical ward with supplemental oxygen on day 42 of admission. It is necessary to be aware of the possibility of nosocomial P. putida infection, especially in patients with indwelling catheters, and to consider the early initiation of appropriate antibiotic regimens once detected as well as strict precautions in hygiene during the management of these patients to avoid further development of multi-drug resistant (MDR) strains

Analysis of cricoid pressure application: anaesthetic trainee doctors vs. nursing anaesthetic assistants

ABSTRACT BACKGROUND AND OBJECTIVE: To evaluate the ability of anaesthetic trainee doctors compared to nursing anaesthetic assistants in identifying the cricoid cartilage, applying the appropriate cricoid pressure and producing an adequate laryngeal inlet view. METHODS: Eighty-five participants, 42 anaesthetic trainee doctors and 43 nursing anaesthetic assistants, were asked to complete a set of questionnaires which included the correct amount of force to be applied to the cricoid cartilage. They were then asked to identify the cricoid cartilage and apply the cricoid pressure on an upper airway manikin placed on a weighing scale, and the pressure was recorded. Subsequently they applied cricoid pressure on actual anaesthetized patients following rapid sequence induction. Details regarding the cricoid pressure application and the Cormack-Lehane classification of the laryngeal view were recorded. RESULTS: The anaesthetic trainee doctors were significantly better than the nursing anaesthetic assistants in identifying the cricoid cartilage (95.2% vs. 55.8%, p = 0.001). However, both groups were equally poor in the knowledge about the amount of cricoid pressure force required (11.9% vs. 9.3% respectively) and in the correct application of cricoid pressure (16.7% vs. 20.9% respectively). The three-finger technique was performed by 85.7% of the anaesthetic trainee doctors and 65.1% of the nursing anaesthetic assistants (p = 0.03). There were no significant differences in the Cormack-Lehane view between both groups. CONCLUSION: The anaesthetic trainee doctors were better than the nursing anaesthetic assistants in cricoid cartilage identification but both groups were equally poor in their knowledge and application of cricoid pressure

Prevention of Shivering Post Subarachnoid Block: Comparison between Different Doses of Intravenous Magnesium Sulphate

Background and Objectives: Shivering is a common complication of subarachnoid block (SAB). Magnesium sulphate has been proven to be effective in preventing shivering. The aim of this study was to compare the effectiveness and adverse effects in hemodynamic parameters between 50 mg/kg and 30 mg/kg of intravenous magnesium sulphate for prevention of shivering post-subarachnoid block. Materials and Methods: Eighty-six patients scheduled for surgery under SAB, aged between 18 to 65 years old with American Society of Anesthesiologists physical status I and II were randomised into two groups. Group A received a bolus of 50 mg/kg, while Group B received 30 mg/kg of intravenous magnesium sulphate, given over a 20 min duration following SAB. Shivering grade was recorded intraoperatively according to the Crossley and Mahajan shivering scale. Mean arterial pressure (MAP), heart rate, tympanic temperature, oxygen saturation and the use of vasopressors were recorded. Results: Forty-five percent of patients in Group A and 20% of patients in Group B did not exhibit shivering (p-value < 0.01). High-grade shivering was observed in 12.5% in Group A and 40% in Group B, respectively (p-value 0.02). The MAP trend was lower in Group B (p-value < 0.01), but the incidence of hypotension was not significant in both groups. The use of vasopressors was also similar between groups. Group B showed a lower oxygen saturation trend (p-value 0.04). The trends of heart rate and tympanic temperature were not significant in both groups. No patients had episodes of bradycardia or oxygen desaturation. Conclusions: In this study, intravenous magnesium sulphate 50 mg/kg is the lowest effective dose for prevention and treatment of high-grade shivering post-SAB without significant hemodynamic adverse events

Performance of Point-of-Care Ultrasonography in Confirming Feeding Tube Placement in Mechanically Ventilated Patients

Background: A feeding tube (FT) is routinely placed in critically ill patients, and its correct placement is confirmed with a chest X-ray (CXR), which is considered the gold standard. This study evaluated the diagnostic accuracy of ultrasonography (USG) in verifying FT placement compared to a CXR in an intensive care unit (ICU). Method: This was a prospective single-blind study conducted on patients admitted to the ICU of a tertiary hospital in Malaysia. The FT placements were verified through a fogging test and USG at the neck and subxiphoid points. The results of confirmation of FT placement through USG were compared with those obtained using CXRs. Results: A total of 80 patients were included in this study. The FT positions were accurately confirmed by overall USG assessments in 71 patients. The percentage of FT placements correctly identified by neck USG was 97.5%, while the percentage of those identified by epigastric USG was 75%. The corresponding patients’ CXRs confirmed correct FT placement in 76 patients. The overall USG assessment had a sensitivity of 92.11% and specificity of 75%, a positive predictive value of 98.59%, and a negative predictive value of 33.33%. The USG findings also showed a significant association between FT size and BMI. FTs with a size of 14Fr were better visualized (p = 0.008), and negative USG findings had a significantly higher BMI (p < 0.001). Conclusion: USG is a simple, safe, and reliable bedside assessment that offers relatively high sensitivity in confirming correct FT placement in critically ill patients