Desenvolvimento de fibrilação ventricular por causa de etomidato para indução anestésica: um efeito colateral muito raro, relato de caso

ResumoJustificativa e objetivosA ocorrência de fibrilação ventricular em um paciente pode resultar em complicações inesperadas. Nosso objetivo é apresentar um caso de fibrilação ventricular que ocorreu após a indução anestésica com administração de etomidato.Relato de casoPaciente do sexo feminino, 56 anos, com pré‐diagnóstico de cálculos biliares, foi admitida na sala de cirurgia para colecistectomia laparoscópica. A anestesia foi induzida com a administração de etomidato com uma dose em bolus de 0,3mg/kg. A paciente apresentou uma grave e rápida adução dos braços logo após a indução. Taquicardia com QRS largo e frequência ventricular de 188bpm foram detectadas no monitor. O ritmo converteu‐se em fibrilação ventricular (FV) durante a preparação para a cardioversão. A paciente foi imediatamente submetida a desfibrilação. O ritmo sinusal foi obtido. Decidimos adiar a cirurgia por causa da condição de instabilidade da paciente.ConclusãoAlém dos efeitos secundários conhecidos de etomidato, taquicardia ventricular e fibrilação, embora muito raramente, também podem ser observadas. Até onde sabemos, esse é o primeiro caso na literatura de FV causado por etomidato.AbstractBackground and objectivesVentricular fibrillation occurring in a patient can result in unexpected complications. Here, our aim is to present a case of ventricular fibrillation occurring immediately after anesthesia induction with etomidate administration.Case reportA fifty‐six‐year‐old female patient with a pre‐diagnosis of gallstones was admitted to the operating room for laparoscopic cholecystectomy. The induction was performed by etomidate with a bolus dose of 0.3mg/kg. Severe and fast adduction appeared in the patient's arms immediately after induction. A tachycardia with wide QRS and ventricular rate 188beat/min was detected on the monitor. The rhythm turned to VF during the preparation of cardioversion. Immediately we performed defibrillation to the patient. Sinus rhythm was obtained. It was decided to postpone the operation due to the patient's unstable condition.ConclusionIn addition to other known side effects of etomidate, very rarely, ventricular tachycardia and fibrillation can be also seen. To the best of our knowledge, this is the first case regarding etomidate causing VF in the literature

Prospective Observational Study on acute Appendicitis Worldwide (POSAW)

Background: Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments.Methods: This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study.Results: A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%.Conclusions: The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low.</p

Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections : a prospective multicentre study (WISS Study)

Background: To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression. Methods: The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18-99) were enrolled in the WISS study. Results: Univariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived (p <0.0001). The multivariate logistic regression model was highly significant (p <0.0001, R-2 = 0.54) and showed that all these factors were independent in predicting mortality of sepsis. Receiver Operator Curve has shown that the WSES Severity Sepsis Score had an excellent prediction for mortality. A score above 5.5 was the best predictor of mortality having a sensitivity of 89.2 %, a specificity of 83.5 % and a positive likelihood ratio of 5.4. Conclusions: WSES Sepsis Severity Score for patients with complicated Intra-abdominal infections can be used on global level. It has shown high sensitivity, specificity, and likelihood ratio that may help us in making clinical decisions.Peer reviewe

Prospective Observational Study on acute Appendicitis Worldwide (POSAW)

Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments.info:eu-repo/semantics/publishedVersio

The Analysis of Mean Platelet Volume and Platelet Distribution Width Levels in Appendicitis

We aimed to analyze the diagnostic value of mean platelet volume and platelet distribution width, which are also known as the markers of platelet count, in acute and perforated appendicitis. The data of 202 patients who applied to general surgery clinic in Mustafa Kemal University Hospital from 2007 to 2012 with acute appendicitis were analyzed retrospectively. The findings were separated to two groups due to the perforation status (perforated vs. non-perforated). Age, sex, leukocyte, hemoglobin, hematocrit, mean platelet volume, and platelet distribution width were examined. The mean age of the patients was 35.8. Twenty-one of all cases were perforated appendicitis (10.4 %), and the rest was acute appendicitis (non-perforated) (n=181, 89.6 %). The mean platelet volume value was 9.8 +/- 2.1 fL; mean thrombocyte count, 340.9x10(9)/L; and mean platelet distribution width value, 18.3 %. There were statistically significant differences between sex and age, hemoglobin, hematocrit, leukocyte, mean platelet volume, and platelet distribution width. There was a positive correlation between mean platelet volume, platelet distribution width, and platelet. Age, leukocyte, platelet, mean platelet volume, and platelet distribution width were higher in cases with perforation as a comparison with non-perforated cases. We think that mean platelet volume and platelet distribution width may be valuable markers to detect the risk of perforation in early periods of acute appendicitis

Investigation of the Protective Effect of Erdosteine Against Cyclosporine-Induced Injury in Rat Liver with Histological and Biochemical Methods

Background/aim: In the present study, the protective effect of erdosteine against cyclosporine-induced injury in rat liver was investigated with histological and biochemical methods. Materials and methods: Thirty-two Wistar albino male rats were randomly divided into 4 groups: control (n = 8), cyclosporine (n = 8, 20 mg kg(-1) day(-1) i.p.), cyclosporine + erdosteine (n = 8, erdosteine 12 mg kg(-1) day(-1) orally), and erdosteine (n = 8). At the end of day 12, liver tissues were removed for histological and biochemical analysis. After liver tissues were fixed in 10% buffered neutral formalin, routine histological processes were applied and tissue sections were stained with hematoxylin and eosin, periodic acid-Schiff, and elastic fiber stain methods. One hundred lobules of liver were examined for each group and evaluated statistically. The levels of malondialdehyde and glutathione peroxidase, as well as the activities of superoxide dismutase, were determined. Results: The cyclosporine group showed significant histopathological changes compared to the control. In the cyclosporine + erdosteine group, histopathological changes of hepatic damage were markedly reduced. Histological findings were supported by biochemical results. Conclusion: Erdosteine could attenuate cyclosporine-induced liver injury

SAFETY AND EFFICACY OF TIROFIBAN HYDROCHLORIDE (TH) IN CERULEIN-INDUCED ACUTE PANCREATITIS

Introduction: Tissue perfusion plays an important role in pancreatitis. Free oxygen radicals also have some triggering roles in the severity of acute pancreatitis. Tirofiban hydrochloride (TH) is being used for ischemic disorders for many years and is known as an antiaggregant drug. We aimed to determine the therapeutic effects of tirofiban in cerulein-induced acute pancreatitis in this animal study. Materials and methods: Twenty-four Wistar-Albino male rats were divided into three equal groups; Group I: Sham-operated group, Group II: cerulein induced pancreatitis group, Group III: cerulein induced pancreatitis + treatment group (intraperitoneal 0.25 mg tirofiban hydrochloride in 1 ml isotonic saline solution). Amylase and lipase levels were studied in blood samples and malondialdehyde, glutathione peroxidase and superoxide dismutase activities were measured in tissue samples. Results: Amylase and lipase levels were elevated in acute pancreatitis group. The levels of both enzymes were decreased after the rats were medicated with TH. Malondialdehyde (MDA) was higher in pancreatitis group without treatment. There were no significant differences between groups according to glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) levels. Conclusion: The present findings suggest that TH has an antiaggregant effect and may reduce the progression and improve the healing of acute pancreatitis

The development of ventricular fibrillation due to etomidate for anesthetic induction: a very rare side effect, case report

Background and objectives: Ventricular fibrillation occurring in a patient can result in unexpected complications. Here, our aim is to present a case of ventricular fibrillation occurring immediately after anesthesia induction with etomidate administration. Case report: A fifty-six-year-old female patient with a pre-diagnosis of gallstones was admitted to the operating room for laparoscopic cholecystectomy. The induction was performed by etomidate with a bolus dose of 0.3 mg/kg. Severe and fast adduction appeared in the patient's arms immediately after induction. A tachycardia with wide QRS and ventricular rate 188 beat/min was detected on the monitor. The rhythm turned to VF during the preparation of cardioversion. Immediately we performed defibrillation to the patient. Sinus rhythm was obtained. It was decided to postpone the operation due to the patient's unstable condition. Conclusion: In addition to other known side effects of etomidate, very rarely, ventricular tachycardia and fibrillation can be also seen. To the best of our knowledge, this is the first case regarding etomidate causing VF in the literature