Midazolam versus Propofol monitored anesthesia care sedation in pediatric patients undergoing spinal anesthesia

Cardiorespiratory and Neuromotor Functional Exploration Laboratory, Microbiology and Immunology Research Laboratory, Laboratory of Population Health Research in Correlation with Risk Factors, Clinical Department Faculty of Medicine and Pharmacy, Dunarea de Jos University of Galaţi, Romania, The 5th International Congress of the Society of Anesthesiology and Reanimatology of the Republic of Moldova, 16th Edition of the International Course of Guidelines and Protocols in Anesthesia, Intensive Care and Emergency Medicine, 28th Meeting of the European Society for Computing and Technology in Anesthesia and Intensive Care September 27-29, 2018, Chisinau, the Republic of MoldovaBackground: Spinal anesthesia in children enjoyed an increased interest in the past few years. It proved to be a valid alternative because it is simple, not requiring the instrumentation of the airways, facilitates the postoperative care and is the most suitable technique when general anesthesia should be avoided. Besides its benefits, spinal anesthesia in children often requires additional perioperative sedation. This study was designed to compare the efficacity of two hypnotic drugs Propofol and Midazolam as part of monitored anaesthesia care sedation during surgery. Material and methods: This study was performed in Pediatric Clinical Hospital of Galati and included all the children who underwent spinal anesthesia for lower abdominal or limb surgery between May 2016 and May 2017. These children were premedicated with low doses of midazolam, ketamine and atropine before the lumbar puncture and during surgery some of them were continuously sedated with Propofol and the others with Midazolam. The level of sedation, intaoperative behavior, respiratory and hemodynamic status, awakening and postoperative side effects were our main data of interest. Results: Both hypnotic drugs offered acceptable levels of sedation, some but not significant fluctuations of the respiratory rate, the blood pressure and the pulse and a light awakening. Pediatric patients who were sedated with Midazolam registered more postoperative nausea and vomiting and one patient sedated with Propofol presented purposeless movements during surgery. Conclusions: The monitored anesthesia care sedation with Propofol for spinal anesthesia offers a superior grade of comfort because of the lower risk of postoperative nausea and vomiting

Оценка статуса питания и привычек питания у спортсменов

Departamentul Clinic, Facultatea Medicină şi Farmacie, Universitatea Dunărea de Jos, Galaţi, România, Conferința ştiinţifico-practică naţională cu participare internaţională ”Promovarea sănătăţii – o prioritate a sănătăţii publice” 22-24 iunie 2016 Orhei, Republica MoldovaThe principles of healthy eating nutritional recommendations found in athletes, however, in their case, the caloric and nutritional adaptations specific target: age, type of sport, stage preparation, timing and conduct of the exercise. The present study aims to evaluate the dietary and nutritional status of a batch of 62 male athletes, aged 12 to 18 years in professional Football Sports Club „Danube – Galati”.Принципы здорового питания описаны в рекомендациях по питанию спортсменов, однако необходимо приспособить калории в зависимости от возраста, практикуемого спорта, этапа подготовки и видов упражнений. В статье авторы оценивают питательный рацион и привычки питания у 62-х спортсменов-мужчин, в возрасте от 12 до 18 лет, профессиональных футболистов спортивного клуба «Дунай – Галаць»

MODIFICĂRILE POTASEMIEI ÎN SEPSIS LA SUGAR ŞI COPILUL MIC

Obiectiv: Obiectivele acestui studiu au fost cercetarea unor corelaţii între potasemie şi rata mortalităţii, doza de potasiu administrată pe kilogram corp şi pe zi, valoarea pH-ului seric şi modifi cările electrocardiogramei, în sepsis, la sugar şi copilul mic. Material şi metodă: S-a efectuat un studiu retrospectiv pe un număr de 72 de copii (vârsta 1 lună - 7 ani), internaţi cu diagnosticul de sepsis în Secţia de Terapie Intensivă a Spitalului Clinic de Urgenţă „Sf. Maria“ Iaşi în perioada 2007-2009. A fost alcătuit un protocol de analiză a cazuisticii care să permită corelaţii în dinamică a valorilor potasemiei cu alţi parametrii clinici, biologici şi funcţionali. Rezultate: Pe parcursul internării, 48,6% din pacienţi au avut o potasemie normală, 56,9% hipopotasemie moderată, 37,5% kaliemie sub 2,5 mEq/l, 2% hiperpotasemie. Corelaţia Pearson între potasiu seric şi cantitatea de K+ mEq/kg corp/zi pentru întreg lotul studiat a fost - 0,37 (p=0,00), iar în grupul pacienţilor decedaţi, r = – 0,36, (p= 0,002). Pentru toţi pacienţii afl aţi în studiu între kaliemie şi pH-ul seric s-a obţinut un indice de corelaţie de 0,44 (p=0,00); pentru eşantionul pacienţilor decedaţi, r = 0,39, (p=0,015). Hipopotasemia moderată/ severă s-a reflectat prin subdenivelare de ST în 39,7% cazuri, aplatizarea undei T în 77,9% cazuri, iar prezenţa undei U în 72% cazuri. În acest lot nu s-au semnalat tulburări de ritm. Concluzii: Hipopotasemia a fost principala modifi care a kaliemiei la pacienţii cu sepsis dar, din punct de vedere statistic, valoarea serică a potasiului nu a infl uenţat rata mortalităţii. Nu s-a constatat o concordanţă între potasemie şi modifi cările electrocardiogramei

Postoperative pain after total abdominal hysterectomy and bilateral salpingo-oophorectomy depending on the type of anaesthesia administration

Total abdominal hysterectomy and bilateral salpingo-oophorectomy is a surgical procedure frequently associated with severe or moderate postoperative pain. We conducted a retrospective study on 90 patients who underwent this procedure. One part of the patients (58; 64.4%) was administered bupivacaine 5% without intrathecal opioid administration. The other part (32; 35.6%) underwent general anaesthesia with endotracheal intubation. We evaluated the postoperative analgesic requirements based on the type of anaesthesia used and other factors like age, environment and body mass index. The findings indicated that the patients who received general anaesthesia with endotracheal intubation developed severe postoperative pain more frequently than those who underwent spinal anaesthesia (P = 0.018). A higher percentage of patients from rural areas scored lower in postoperative pain intensity on the numerical rating scale (P = 0.033). There was no statistically significant correlation regarding postoperative pain and age or body mass index

Enhancing the Evidence with Algorithms: How Artificial Intelligence Is Transforming Forensic Medicine

Background: The integration of artificial intelligence (AI) into various fields has ushered in a new era of multidisciplinary progress. Defined as the ability of a system to interpret external data, learn from it, and adapt to specific tasks, AI is poised to revolutionize the world. In forensic medicine and pathology, algorithms play a crucial role in data analysis, pattern recognition, anomaly identification, and decision making. This review explores the diverse applications of AI in forensic medicine, encompassing fields such as forensic identification, ballistics, traumatic injuries, postmortem interval estimation, forensic toxicology, and more. Results: A thorough review of 113 articles revealed a subset of 32 papers directly relevant to the research, covering a wide range of applications. These included forensic identification, ballistics and additional factors of shooting, traumatic injuries, post-mortem interval estimation, forensic toxicology, sexual assaults/rape, crime scene reconstruction, virtual autopsy, and medical act quality evaluation. The studies demonstrated the feasibility and advantages of employing AI technology in various facets of forensic medicine and pathology. Conclusions: The integration of AI in forensic medicine and pathology offers promising prospects for improving accuracy and efficiency in medico-legal practices. From forensic identification to post-mortem interval estimation, AI algorithms have shown the potential to reduce human subjectivity, mitigate errors, and provide cost-effective solutions. While challenges surrounding ethical considerations, data security, and algorithmic correctness persist, continued research and technological advancements hold the key to realizing the full potential of AI in forensic applications. As the field of AI continues to evolve, it is poised to play an increasingly pivotal role in the future of forensic medicine and pathology

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London