Comparison of two different doses of dexmedetomidine (0.25 mcg/kg and 0.5 mcg/kg) in prolonging duration of spinal anaesthesia and postoperative analgesia in patients undergoing trans urethral resection of prostate: a prospective randomized double blinded study

Background: Trans urethral resection of prostate (TURP) under spinal anaesthesia (SAB) in elderly with associated cardio-pulmonary, endocrine or other co-morbidities induces detrimental physiological and psychological stress response to surgery and anaesthesia. Proper sedation during spinal anaesthesia can reduces this response. Aim of this study was to compare the characteristics of spinal block, hemodynamic changes, and postoperative analgesia, following administration of intravenous DMT (0.25 mcg/kg and 0.5 mcg/kg) in elderly patients undergoing TURP under SAB.Methods: Sixty-eight patients were randomly allocated to two groups of 34 patients each. After giving spinal anaesthesia patients received two different doses of dexmedetomidine intravenously; 0.25 mcg/kg (Group D25) and 0.50 mcg/kg (Group D50) respectively. Drugs were given slowly in dilution of 10ml normal saline. Patients were monitored for intraoperative haemodynamics, sensory and motor block characteristics and postoperative analgesia in terms of VAS (visual analogue scale) and first and total dose of rescue analgesic.Results: Mean value of lowest HR in Group D50 and D 25 was comparable (p=0.11) and time taken to achieve lowest HR was also comparable (p=0.13). Mean value of lowest SBP, DBP and MAP were lower in Group D50 than in Group D25 but the difference did not reach statistical significance (p=0.52,0.95 and 0.41 respectively). Onset of sensory block was comparable between the two groups, p=0.62. Maximum sensory block was achieved significantly earlier in Group D50 (10.64±2.75 min versus 12.94±3.04 min in Group D25), p=0.0012. Group D50 patients achieved Bromage score 3 earlier (10.735±1.797 min) than group D25 (12.794±2.52 min) (p=0.00). Recovery from motor block was found earlier in Group D25 group (141.325±4.97 mins) compared to Group D50 (154.41±8.143 mins). Group D50 reported significantly higher sedation than group D25 (p=0.00). Group D25 reported more pain at 4 hours compared to Group D50 (VAS -4.705±0.462 versus 2.588±1.478). Time of requirement of first rescue analgesia was delayed in Group D50 (270.59±50.78 mins) than in Group D25 (172.50±10.46 mins), p=0.000.Conclusions: Dexmedetomidine is effective in relieving anxiety in elderly patients undergoing TURP under spinal anaesthesia. Dose of 0.50 mcg/kg is more effective than 0.25 mcg/kg without increasing the risk of adverse effect.

A Systematic Framework to Rapidly Obtain Data on Patients with Cancer and COVID-19: CCC19 Governance, Protocol, and Quality Assurance

When the COVID-19 pandemic began, formal frameworks to collect data about affected patients were lacking. The COVID-19 and Cancer Consortium (CCC19) was formed to collect granular data on patients with cancer and COVID-19 at scale and as rapidly as possible. CCC19 has grown from five initial institutions to 125 institutions with >400 collaborators. More than 5,000 cases with complete baseline data have been accrued. Future directions include increased electronic health record integration for direct data ingestion, expansion to additional domestic and international sites, more intentional patient involvement, and granular analyses of still-unanswered questions related to cancer subtypes and treatments. When the COVID-19 pandemic began, formal frameworks to collect data about affected patients were lacking. The COVID-19 and Cancer Consortium (CCC19) was formed to collect granular data on patients with cancer and COVID-19 at scale and as rapidly as possible. CCC19 has grown from five initial institutions to 125 institutions with >400 collaborators. More than 5,000 cases with complete baseline data have been accrued. Future directions include increased electronic health record integration for direct data ingestion, expansion to additional domestic and international sites, more intentional patient involvement, and granular analyses of still-unanswered questions related to cancer subtypes and treatments

Obesity, inflammatory and thrombotic markers, and major clinical outcomes in critically ill patients with COVID‐19 in the US

Objective This study aimed to determine whether obesity is independently associated with major adverse clinical outcomes and inflammatory and thrombotic markers in critically ill patients with COVID‐19. Methods The primary outcome was in‐hospital mortality in adults with COVID‐19 admitted to intensive care units across the US. Secondary outcomes were acute respiratory distress syndrome (ARDS), acute kidney injury requiring renal replacement therapy (AKI‐RRT), thrombotic events, and seven blood markers of inflammation and thrombosis. Unadjusted and multivariable‐adjusted models were used. Results Among the 4,908 study patients, mean (SD) age was 60.9 (14.7) years, 3,095 (62.8%) were male, and 2,552 (52.0%) had obesity. In multivariable models, BMI was not associated with mortality. Higher BMI beginning at 25 kg/m2 was associated with a greater risk of ARDS and AKI‐RRT but not thrombosis. There was no clinically significant association between BMI and inflammatory or thrombotic markers. Conclusions In critically ill patients with COVID‐19, higher BMI was not associated with death or thrombotic events but was associated with a greater risk of ARDS and AKI‐RRT. The lack of an association between BMI and circulating biomarkers calls into question the paradigm that obesity contributes to poor outcomes in critically ill patients with COVID‐19 by upregulating systemic inflammatory and prothrombotic pathways