Mortality Associated with Surgical Site Infections Following Cardiac Surgery: Insights from the International ID-IRI Study

Objectives: Surgical site infections (SSIs) after cardiac surgery increase morbidity and mortality rates. This multicenter study aimed to identify mortality risk factors associated with SSIs after heart surgery. Methods: Conducted from January to March 2023, this prospective study included 167 patients aged >16 years with post-heart surgery SSIs. The primary focus was the 30-day mortality. Univariate analysis and multivariate logistic regression utilizing the backward elimination method were used to establish the final model. Results: Several factors significantly correlated with mortality. These included urinary catheterization (odds ratio [OR] 14.197; 90% confidence interval [CI] 12.198-91.721]), emergent surgery (OR 8.470 [90% CI 2.028-35.379]), valvular replacement (OR 4.487 [90% CI 1.001-20.627]), higher quick Sequential Organ Failure Assessment scores (OR 3.147 [90% CI 1.450-6.827]), advanced age (OR 1.075 [90% CI 1.020-1.132]), and postoperative re-interventions within 30 days after SSI (OR 14.832 [90% CI 2.684-81.972]). No pathogens were isolated from the wound cultures of 53 (31.7%) patients. A total of 43.1% of SSIs (n = 72) were due to gram-positive microorganisms, whereas 27.5% of cases (n = 46) involved gram-negatives. Among the gram-positive bacteria, Staphylococci (n = 30, 17.9%) were the predominant microorganisms, whereas Klebsiella (n = 16, 9.6%), Escherichia coli (n = 9, 5.4%), and Pseudomonas aeruginosa (n = 7, 4.2%) were the most prevalent. Conclusions: To mitigate mortality after heart surgery, stringent infection control measures and effective surgical antisepsis are crucial, particularly, in the elderly. The clinical progression of the disease is reflected by the quick Sequential Organ Failure Assessment score and patient re-intervention, and effective treatment is another essential component of SSI management

Etoricoxib - preemptive and postoperative analgesia (EPPA) in patients with laparotomy or thoracotomy - design and protocols

<p>Abstract</p> <p>Background and Objective</p> <p>Our objective was to report on the design and essentials of the <it>Etoricoxib </it>protocol<it>- Preemptive and Postoperative Analgesia (EPPA) </it>Trial, investigating whether preemptive analgesia with cox-2 inhibitors is more efficacious than placebo in patients who receive either laparotomy or thoracotomy.</p> <p>Design and Methods</p> <p>The study is a 2 × 2 factorial armed, double blinded, bicentric, randomised placebo-controlled trial comparing (a) etoricoxib and (b) placebo in a pre- and postoperative setting. The total observation period is 6 months. According to a power analysis, 120 patients scheduled for abdominal or thoracic surgery will randomly be allocated to either the preemptive or the postoperative treatment group. These two groups are each divided into two arms. Preemptive group patients receive etoricoxib prior to surgery and either etoricoxib again or placebo postoperatively. Postoperative group patients receive placebo prior to surgery and either placebo again or etoricoxib after surgery (2 × 2 factorial study design). The Main Outcome Measure is the cumulative use of morphine within the first 48 hours after surgery (measured by patient controlled analgesia PCA). Secondary outcome parameters include a broad range of tests including sensoric perception and genetic polymorphisms.</p> <p>Discussion</p> <p>The results of this study will provide information on the analgesic effectiveness of etoricoxib in preemptive analgesia and will give hints on possible preventive effects of persistent pain.</p> <p>Trial registration</p> <p>NCT00716833</p

Intraperitoneal tramadol and bupivacaine in total abdominal hysterectomy

[Abstract Not Available

Epidural anestezide % 2 kartikain ve % 0.5 bupivakain

In this study, we aimed to compare the quality of anaesthesia and side effects of single dose epidural carticaine and bupivacaine in patients scheduled for urinary, lower abdominal or extremity surgery. The study was planned on 63 cases of ASA I-II and 50 cases with successful sensory blockade were included in the study. The patients were divided into two groups. Group I was administered 6 mg/kg 2 % carticaine (n=25) and Group II was given 1.5 mg/kg 0.5 % bupivacaine (n=25) epidurally. Latent period time, onset time of sensory blockade in different dermatomes (T12, L1, L2, L5, S1), top dermation level and the time to reach this level, the degree of motor blockade and its onset time, quality of sensory and motor blockade and their side effects were recorded in both groups. The latent period time, onset time of sensory blockade in different dermatomes, time of reaching to the top level of sensory blockade and onset time of motor blockade were found to be shorter in the first group (p&lt;0.001). The other parameters in both groups showed no different (p&gt;0.05). In conclusion, 2% carticaine can be preferred during emergencies, operations with short duration and in cases which does not require postoperative analgesics since it has an early onset of sensory and motor blockade and reaches rapidly to desired dermatomes when applied epiduraly. As the other parameters are identical between the two groups, it has been decided that carticaine can be an alternative for bupivacaine

Evaluation of the effects of oral temazepam administration in premedication

[No abstract available

The value of nizatidine and famotidine in prophylaxis of aspiration pneumonia in caesarean section

[Abstract Not Available

The use of magnesium sulfate to prevent pain on injection of propofol

[Abstract Not Available

SEZARYEN AMELIYATLARINDA OMEPRAZOL VE H2 RESEPTOR BLOKERLERININ ASPIRASYON PNOMONISI PROFILAKSISINDEKI DEGERI

The effect of omeprazole famotidine, ranitidine and placebo in decreasing the risk of aspiration were investigated in 80 pregnant women undergoing elective cesarean operation and their 80 newborns. Group A consisted of pregnant women and divided into four subgroups. Subgroup AI were given omeprazole 40 mg, PO, two hours prior to anaesthetic induction and groups AII, AIII and AIV were given famotidine 40 mg PO, ranitidine 150 mg PO and isotonic saline respectively. Gastric fluids were aspirated through the nasogastric tube before and after induction and at the 30th minute of anaesthesia and volumes and pH values were recorded. Urine samples were taken with the same intervals and pH values were recorded. The volume of gastric fluid and pH were measured in all the newborns (group B) following birth and the values were evaluated according to the subgroups their mother included. Omeprazole, famotidine and ranitidine decreased gastric fluid volume and increased pH significantly when compared to placebo in all the women. Urine pH of the women and gastric fluid volume and pH of the newborns did not show significant differences. All drugs used were concluded to be equally effective in the prophylaxis of aspiration pneumonia