Population pharmacokinetics of vancomycin in Jordanian patients

Purpose: To characterize vancomycin pharmacokinetic properties in a Jordanian population and identify patients’ characteristics that influence vancomycin disposition.Method: A non-linear mixed-effects modeling was applied to evaluate vancomycin population pharmacokinetic parameters in Jordanian patients using NONMEM software. Vancomycin concentrations were obtained retrospectively from patients’ medical records. Demographic, clinical, medication-related, and medical history data were collected and examined as potential predictors of vancomycin disposition.Results: A total of 164 plasma vancomycin measurements from 110 patients, including neonates, older children and adults were collected. Vancomycin pharmacokinetics was described using a onecompartment model. Based on NONMEM objective function value, the selection of other models (e.g., two or three compartments) did not improve the performance of the pharmacokinetic model. Identified predictors of vancomycin clearance include: weight, serum creatinine, chronic renal failure, acute kidney injury and gender. Vancomycin volume of distribution was associated with weight and n-acetylcystine administration.Conclusion: The present analysis is a preliminary step toward developing a vancomycin dosing algorithm in Jordanian population.Keywords: Vancomycin, Population pharmacokinetics, NONME

Effect of low-pressure pneumoperitoneum on pain and inflammation in laparoscopic cholecystectomy: a randomized controlled clinical trial

Abstract Objective We aim to assess the effect of low-pressure pneumoperitoneum on post operative pain and ten of the known inflammatory markers. Background The standard of care pneumoperitoneum set pressure in laparoscopic cholecystectomy is set to 12–14 mmHg, but many societies advocate to operate at the lowest pressure allowing adequate exposure of the operative field. Many trials have described the benefits of operating at a low-pressure pneumoperitoneum in terms of lower post operative pain, and better hemodynamic stability. But only few describe the effects on inflammatory markers and cytokines. Methods A prospective, double-blinded, randomised, controlled clinical trial, including patients who underwent elective laparoscopic cholecystectomy. Patients randomised into low-pressure (8–10 mmHg) vs. standard-pressure (12–14 mmHg) with an allocation ratio of 1:1. Perioperative variables were collected and analysed. Results one hundred patients were allocated, 50 patients in each study arm. Low-pressure patients reported lower median pain score 6-hour post operatively (5 vs. 6, p-value = 0.021) in comparison with standard-pressure group. Eight out of 10 inflammatory markers demonstrated better results in low-pressure group in comparison with standard-pressure, but the effect was not statistically significant. Total operative time and surgery difficulty was not significantly different between the two groups even in the hands of inexperienced surgeons. Conclusion low-pressure laparoscopic cholecystectomy is associated with less post operative pain and lower rise of inflammatory markers. It is feasible with comparable complications to the standard of care. Registered on ClinicalTrials.gov (NCT05530564/ September 7th, 2022)