Cost-effectiveness comparison between caudal block and intravenous ketorolac as an early post-operative analgesic in pediatric patients underwent surgery below umbilicus segment

Post-operative pain treatment in pediatric is frequently inadequate that could lead to psychological,physiological and behavioral changes. Therefore, adequate pediatric pain management is needed.Some analgesics such as ketorolac and regional anesthesia techniques such as caudal blockhave been applied to relieve pain. Ketorolac and caudal block have its own advantages anddisadvantages. The aim of study was to compare the cost-effectiveness of ketorolac and caudalblok as a post-operative analgesic in pediatric. This was double blind randomized controlledclinical trial with parallel design conducted in Dr. Sardjito General Hospital. The subjects werechildren who underwent surgery below umbilicus segment. Seventy patients were randomlydivided into two groups with 35 patients in each group. Group I (Caudal block Group) was givencaudal block with bupivacaine 0.12% 1 mL/kg body weight (BW) whereas Group II (KetorolacGroup) was given ketorolac 0.5 mg/kg BW intravenously (IV). The patient’s pain was scored at 0,15, 30, 45 minute and 1, 2, 3 hours after the conscious patients using modified Children’sHospital of Eastern Ontario Pain Scale (mCHEOPS). Furthermore, the cost-effectiveness theboth interventions was also compared. The caudal block was more effective in reducing painthan the ketorolac at minutes 0 (27/8 vs 10/25) and 15 (34/1 vs 18/17) (p<0.05). However, atthird hour the ketorolac revealed more effective than the caudal block (29/6 vs 32/3) (p<0.05).The cost of the caudal block was higher than the ketorolac (IDR 95.860 ± 5.745 vs IDR 7.200± 14.886) (p <0.05). However, the length of stay after the caudal block was shorter than theketorolac (40.43 ± 13.899 vs 48.57 ± 14.068) (p <0.05). Morphine was more needed forrescue analgesic in the ketorolac (p < 0.05) in first hour of operation, whereas after three houroperation paracetamol was more needed in caudal block (p < 0.05). In conclusion, the caudalblock is not more cost-effective than ketorolac in reducing post-operative pain in pediatricpatients underwent surgery below umbilicus segment

Efficacy of pethidine 0.1 and 0.2 mg/kg body weight as an adjuvant of intrathecal bupivacaine 0.5% 10 mg in preventing shivering

Shivering related with spinal anesthesia commonly occurs in patients. It is not only uncomfortablefor the patients, but also related to some complication. The efficacy of pethidine in the preventionof shivering is well known. The aim of this study was to compare the efficacy of intrathecalpethidine 0.1 mg/kg body weight (BW) and 0.2 mg/kg BW as shivering-prevention drug afterspinal anesthesia. This was a randomized, double-blind controlled trial study involving 196subjects between the age 18-40 years with ASA physical status I-II, gestional age 37-42 weeks,BW of 40-70 kg or Body Mass Index (BMI) 145 cm who underwent acaesarean delivery section with spinal anesthesia based of World Health Organization (WHO)procedure in cesarean delivery in Dr. Sardjito General Hospital, Yogyakarta and affiliated hospital.Subjects were divided into two groups with 98 subjects of each group. Group A was given anhyperbaric 0.5% bupivacaine 10 mg and pethidine 0.1 mg/kg BW, and Group B was given anhyperbaric 0.5% bupivacaine 10 mg and pethidine 0.2 mg/kg BW in the same volume (2.5 mL).The seubjects were observed for the incidence and severity of shivering and side effects ofpehtidine. The results showed that the incidence of shivering in Group A (35.70%) was significantlygreater than in Group B (22.44%) (p0.05). Moreover, the incidence of nausea andvomiting in Group A (8.33%) was significantly lower than Group B (22.45%). In conclusion,pethidine 0.2 mg/kg BW is more effective to preven shivering than pethidine 0.1 mg/kg BWalthough the incidence of its side effects is more higher

Understanding the potential impact of different drug properties on SARS-CoV-2 transmission and disease burden : a modelling analysis

Q1Q1Background The unprecedented public health impact of the COVID-19 pandemic has motivated a rapid search for potential therapeutics, with some key successes. However, the potential impact of different treatments, and consequently research and procurement priorities, have not been clear. Methods and Findings develop a mathematical model of SARS-CoV-2 transmission, COVID-19 disease and clinical care to explore the potential public-health impact of a range of different potential therapeutics, under a range of different scenarios varying: i) healthcare capacity, ii) epidemic trajectories; and iii) drug efficacy in the absence of supportive care. In each case, the outcome of interest was the number of COVID-19 deaths averted in scenarios with the therapeutic compared to scenarios without. We find the impact of drugs like dexamethasone (which are delivered to the most critically-ill in hospital and whose therapeutic benefit is expected to depend on the availability of supportive care such as oxygen and mechanical ventilation) is likely to be limited in settings where healthcare capacity is lowest or where uncontrolled epidemics result in hospitals being overwhelmed. As such, it may avert 22% of deaths in highincome countries but only 8% in low-income countries (assuming R=1.35). Therapeutics for different patient populations (those not in hospital, early in the course of infection) and types of benefit (reducing disease severity or infectiousness, preventing hospitalisation) could have much greater benefits, particularly in resource-poor settings facing large epidemics. Conclusions There is a global asymmetry in who is likely to benefit from advances in the treatment of COVID-19 to date, which have been focussed on hospitalised-patients and predicated on an assumption of adequate access to supportive care. Therapeutics that can feasibly be delivered to those earlier in the course of infection that reduce the need for healthcare or reduce infectiousness could have significant impact, and research into their efficacy and means of delivery should be a priorityRevista Internacional - Indexad

Manajemen Pasien Acute Fatty Liver Of Pregnancy (AFLP) di ICU

We reported management of patient in ICU of a woman aged 31 years, 50kg with a diagnosis of acute fatty liver of pregnancy (AFLP) post SC on fetal indications disstres. Patients previously treated on the ward obsgyn after the previous day into labor with cesarean section. Patients look weak, restless and jaundice, consulted the ICU with a diagnosis of post SC emergency dibangsal fi rst day on indications of fetal disstres, preterm, P2A0, sepsis with MODS. The patient is transported to the ICU with the support of oxygenation NRM O2 10 L / min. On the fi fth day in the ICU situation began to improve and steady, day-to-eight patients were allowed to move into the ward

Manajemen Pasien Acute Fatty Liver Of Pregnancy (AFLP) di ICU

We reported management of patient in ICU of a woman aged 31 years, 50kg with a diagnosis of acute fatty liver of pregnancy (AFLP) post SC on fetal indications disstres. Patients previously treated on the ward obsgyn after the previous day into labor with cesarean section. Patients look weak, restless and jaundice, consulted the ICU with a diagnosis of post SC emergency dibangsal fi rst day on indications of fetal disstres, preterm, P2A0, sepsis with MODS. The patient is transported to the ICU with the support of oxygenation NRM O2 10 L / min. On the fi fth day in the ICU situation began to improve and steady, day-to-eight patients were allowed to move into the ward

Epidural Analgesia pada Neonatus Preterm yang Menjalani Operasi Tranversocolostomi Sinistra

We report the anesthetic management of neonates with a history of pre-term birth who underwent surgery tranversocolostomi sinistra. Patient’s Physical Status ASA II , performed under general anesthesia combined with epidural analgesics during surgery. The operation lasted for two hourshemodynamically stable. Post surgery patients admitted to the NICU with continuous epidural for analgesi