Crecimiento de bacterias en agentes de infusión: El propofol al 2% sustenta el crecimiento, mientras que el remifentanilo y el pantoprazol no

ResumenExperiencia y objetivosFueron evaluados los riesgos de la contaminación de propofol al 2%, remifentanilo y pantoprazol y los efectos de esos agentes in vitro en el crecimiento de agen- tes infecciosos comunes en las unidades de cuidados intensivos.MétodosPara la detección del riesgo de contaminación, fueron testados agentes prepara- dos para el uso inmediato bajo condiciones de la unidad de cuidados intensivos. También se investigaron los efectos de esos tres agentes en el crecimiento bacteriano. Los agentes fueron preparados en las concentraciones utilizadas en la unidad de cuidados intensivos e inoculados con patógenos comunes; enseguida fueron incubados a 4°C, 22°C y 36°C. Fueron obtenidos subcultivos a 0, 2, 4 y 8h y se evaluaron los conteos de las colonias. Fueron determinados los valores de concentración inhibitoria mínima para todos los agentes a 4°C, 22°C y 36°C.ResultadosNo se observó el crecimiento en los agentes preparados en la unidad de cuida- dos intensivos. El Propofol soportó el crecimiento, mientras que el remifentanilo inhibió el crecimiento bacteriano. El efecto de pantoprazol varió dependiendo de la bacteria testada. Ninguno de los agentes demostró actividad antibacteriana en las concentraciones máximas que pueden ser alcanzadas en la sangre de los pacientes.ConclusionesEl Propofol sustenta vigorosamente el crecimiento de los microrganismos testa- dos, lo que no ocurre con el remifentanilo y el pantoprazol. Por tanto, es importante que se practiquen técnicas asépticas rígidas en la preparación del propofol

Increased Heart Rate On First Day In Intensive Care Unit Is Associated With Increased Mortality

Objective: To investigate the association of maximum HR during the first day of intensive care unit (ICU) and mortality. Methods: Data of 850 patients over 45 years of age, who were hospitalized in ICU, was retrospectively analyzed. They were divided into two groups; Group-I, patients with maximum HR<100/min Group-II, patients with maximum HR≥100/min on first day. The groups were compared regarding age, sex, use of beta-blockers, use of inotropic and vasopressor drugs, hemodynamic parameters, anemia, mechanical ventilation, length of hospitalization (ICU and total), mortality (ICU and total), and CHARLSON & APACHE-II scores. Results: The mean age of patients was 63±12 years and 86% were after non-cardiac surgery. Maximum HR was 83±11 in Group-I and 115±14/min in Group-II (p=0.002). Group-II patients had more frequent vasopressor and inotropic drugs usage, (p<0.001), anemia, mechanical ventilation (p<0.005), higher CHARLSON & APACHE-II scores, stayed longer in ICU and hospital, and had higher ICU and hospital mortality compared to group-I (p<0.05). APACHE-II scores and maximum HR<100/min were independent variables predicting ICU mortality in multivariate logistic regression analysis whereas usage of beta-blockers was not. Conclusions: Our study showed that maximum HR less than100/minute during the first day of ICU is associated with decreased mortality in Intensive Care Unit

Effectiveness of preemptive intra-articular levobupivacaine on pain relief after arthroscopic knee surgery

Background and Aim: Severe pain and comfortlessness may be seen in patients after arthroscopic knee surgery despite various commonly administered analgesic methods, particularly based on local anesthetics. The aim of this study was to determine the effect of intraarticular levobupivacaine injected preoperatively on pain relief and time to first analgesic request during the postoperative period. Material and Methods: 40 adult-patients, ASA I and II, undergoing elective arthroscopic surgery were included in the study. Patients in the levobupivacaine group received intra-articular levobupivacaine at 5mg/ml dosages and 20 ml total volume 30 min before the procedure. Patients in the control group received 20 ml of normal saline. Visual analogue scale (VAS) scores were assessed at the 1st, 2nd, 4th, 8th, 12th and 24th hour postoperatively. Time to first analgesic request and total analgesics used over the course of 24 hours after the surgery were recorded. All patients received continuous morphine infusion via patient controlled analgesia (PCA) devices postoperatively. Additionally, patients&#146; pain satisfaction scores were recorded. Results: Lower VAS scores at the 1st, 2nd, 4th and 8th hours postoperatively - both at rest and during motion - were found in the levobupivacaine group compared to the normal saline group (p<0.001, p<0.001, p<0.001 and p<0.02 respectively). Time to first analgesic request was longer with the levobupivacaine group than the group with saline (22.50 vs 15.00 min, p<0.02). A significant difference was found in consumed total opioid doses (9.10 vs 31.75 mg, p<0.001). The number of analgesic demands using PCA were significantly different between groups (10.80 v.s. 36.1 times in 24 hours, p<0.001). Conclusion: Preemptive analgesia using intraarticular levobupivacaine 5 mg/ml (20 ml total volume) provides better pain control-evaluated through VAS scoring, time to first analgesic request and opioid consumption - compared to saline in patients undergoing arthroscopic knee surgery. [Arch Clin Exp Surg 2017; 6(2.000): 91-95

A case of Legionnaires’ disease with severe rhabdomyolysis misdiagnosed as COVID-19

Background: COVID-19 case numbers have begun to rise with the recently reported Omicron variant. In the last two years, COVID-19 is the first diagnosis that comes to mind when a patient is admitted with respiratory symptoms and pulmonary ground-glass opacities. However, other causes should be kept in mind as well. Here we present a case of Legionnaires’ disease misdiagnosed as COVID-19. Case presentation: A 48-year-old male was admitted with complaints of dry cough and dyspnea. Chest computed-tomography revealed bilateral ground-glass opacities; therefore, a preliminary diagnosis of COVID-19 was made. However, two consecutive COVID PCR tests were negative and the patient deteriorated rapidly. As severe rhabdomyolysis and acute renal failure were present, Legionnaires’ disease was suspected. Urine antigen test for Legionella and Legionella pneumophila PCR turned out to be positive. The patient responded dramatically to intravenous levofloxacin and was discharged successfully. Discussion: Legionnaires’ disease and COVID-19 may present with similar signs and symptoms. They also share common risk factors and radiological findings. Conclusions: Shared clinical and radiological features between COVID-19 and other causes of acute respiratory failure pose a challenge in diagnosis. Other causes such as Legionnaires’ disease must be kept in mind and appropriate diagnostic tests should be performed accordingly

Fatal Postpartum Hemorrhage In A Patient With Niemann-Pick Disease Type B

Background Niemann-Pick Disease Type B (NPD B) is a rare lysosomal storage disorder resulting from an inherited deficiency of acid sphingomyelinase activity. Here, we report the case of a splenectomized patient with NPD B who died because of severe postpartum hemorrhage (PPH). Case Presentation A 23-year-old nulliparous woman was admitted to intensive care unit (ICU) after cardiopulmonary arrest during urgent hysterectomy because of severe postpartum bleeding. The patient concealed her disease from her family and obstetricians during her pregnancy, and her NPD B diagnosis was revealed during her stay in ICU while searching for the cause of the splenectomy and severe bleeding. Unfortunately, she had a detrimental course with hypoxic brain injury leading to brain death. Conclusions In conclusion, physicians should keep in mind that patients with a history of splenectomy and/or uncontrollable hemorrhage must be carefully evaluated for rare diseases like lysosomal storage diseases and that NPD B can cause mortality because of postpartum bleeding. Adult intensivists should be familiar with adult presentations of rare metabolic or genetic diseases as more and more children with metabolic or genetic diseases will survive to adulthood and will be admitted to and unfortunately will even die in the adult ICU.PubMe

Major Ayak Cerrahisi Uygulanan Çocuklarda Postoperatif Analjezi İçin Devamlı Siyatik Sinir Bloğu ve İntravenöz Hasta Kontrollü Analjezi Yöntemi ile Morfin Kullanımının Karşılaştırılması

Objective: Peripheral nerve catheter for postoperative analgesia is new method in children. In this study, we aimed to compare the efficacy of systemic opioid use with continuous sciatic nerve blocks after foot surgery in children. Material and Methods: A total of 32 patients aged between 2-8 years were randomized into two groups prospectively. After general anesthesia, Group I (n= 16): Patients in the systemic opioid group were administered patient controlled analgesia (PCA) 30 minutes before the end of surgery and were administered 0.5 ml.mg.(-1) of morphine with a rate of 0.02 mg.kg.(-1) hour(-1). Bolus dose was adjusted as 0.01 mg.kg.(-1), lock out time was determined as 15 minutes and four hour limit was determined as 4 mg. Group II (n= 15): The sciatic nerve catheter was inserted using nerve stimulator under ultrasound and 0.4 ml.kg.(-1) of %0.5 bupivacain was injected and 0.2% bupivacain with a rate of 0.1 ml.kg.(-1) hour(-1) was administered with PCA at recovery through sciatic nerve catheter. Visual pain scale (VPS) (0-100 mm 0= no pain, 100= the worst pain) was used for evaluation of postoperative pain in children and CHIPPS (children and infants postoperative pain score) was used for children under 7 years for evaluation of pain When VAS>40 and CHIPPS >3, 15 mg.kg.(-1) paracetamol IV was administered, and if this was not enough to decrese the scores, 0.02 mg.kg.(-1) morphine was given. Pain scores, rescue analgesics, adverse effects and family satisfaction were recorded. Results: A statistically significant difference was not found between study groups when compared for demographic features, VPS and CHIPPS scores. Rescue analgesic administration, nausea, vomiting, pruritus and urinary retention was found higher in group I and the difference was statistically significant. Parent satisfaction was statistically significantly higher in PNC group. Conclusion: Sciatic nerve catheter is as effective as opioid use with PCA for children after appropriate operations and has fewer adverse effects, less need for rescue analgesics and better parent satisfaction.WoSScopu

Approach To Nutritional Therapy In Patients Who Require Vasopressors General Information And Protocol Proposal

Studies of enteral nutrition (EN) therapy in patients who require vasopressors are limited. Unfortunately, hemodynamically unstable patients or patients receiving vasopressors were mostly excluded from the large randomized controlled trials in nutrition. We aimed to present the protocol by Hacettepe University Adult Hospital Nutrition Support Team as different approaches to EN of these patients.WoSScopu

Maternal Mortality: 10 Year Experience of a Tertiary Center in Turkey

We retrospectively evaluated five maternal mortality cases that occurred in our institution within the last 10 years. Rate of maternal mortality was 24.5 per 100000 live births. Maternal mortality causes were cardiopulmonary failure secondary to veno-occlusive disease, septic shock secondary to osteosarcoma, pulmonary thromboembolism secondary to metastatic breast cancer, septic shock secondary to cholecystitis, and postpartum hemorrhage secondary to Niemann–Pick disease. Four out of five cases were evaluated as indirect maternal mortality cases. Three out of five cases ended up with a healthy newborn, while other cases ended up with abortus and postpartum exitus

Comparison Of Intraarticular Bupivacaine And Levobupivacaine Injection In Rat Synovial Inflammation

Background/aim: Both bupivacaine and levobupivacaine are local anesthetics with strong analgesic efficacy that can be used intraarticularly. The aim of this study was to compare the effects of intraarticular bupivacaine and levobupivacaine injection on inflammation in articular cartilage and the synovium of the rat knee joint. Materials and methods: Twenty Sprague-Dawley rats were injected in the right knee joint with 0.2 mL of bupivacaine, while 0.2 mL of levobupivacaine was injected into the left knee joint. Groups of 5 were sacrificed on days 1, 7, 14, and 21 after bupivacaine and levobupivacaine administration and knee joints were examined for subintimal fibrosis, synovial hyperplasia, chronic inflammation, neutrophil infiltration, edema, and synovial and periarticular congestion by microscopy. Alterations in the articular cartilage structure were evaluated using Mankin scoring. Results: We found that both drugs have similar effects on synovial and articular cartilage resulting in mild to moderate congestion, edema, neutrophil infiltration, chronic inflammation, and synovial hyperplasia, which diminished gradually. However, increases in fibrosis were also seen to varying degrees. Thus, the use of these drugs intraarticularly can be recommended. Conclusion: Careful usage of bupivacaine and levobupivacaine is recommended in intraarticular applications since they cause inflammation shortly after injection and fibrosis at later time points.WoSScopu

The effects of isoflurane, sevoflurane, and desflurane anesthesia on neurocognitive outcome after cardiac surgery: A pilot study

Background. Inhalation anesthetics such as isoflurane, sevoflurane, and desflurane are widely used in clinical practice; however, there is no study for comparing these drugs in cardiac surgery with respect to postoperative cognitive out. come and SIN beta protein (SIOO BP) levels. In this study, we evaluated the effect of sevoflurane, isoflurane, and desflurane anesthesia on neuropsychological outcome and S100 BP levels in patients-undergoing coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB)