Effect of Ephedrine on Pain and Hemodynamic Status on Injection of Propofol

Background: Propofol is one of the drugs most commonly used during induction of anesthesia. The induction dose of propofol can lead to hemodynamic changes such as hypotension and bradycardia. Pain on injection is another side effect of propofol. The purpose of this study was to evaluate the effect of two different doses of ephedrine on hemodynamic status and pain on injection of propofol compared to lidocaine and placebo.Methods: In the present study, 100 patients were enrolled. A 22 gauge cannula was inserted into the veins on the non-dominant hand of all patients. The patients were randomly allocated to 4 groups and 10 ml/kg of saline was administered over 10 minutes from each of the cannulas. Then, patients received either of these pretreatments: 2 ml of Saline (group S); 2 ml lidocaine 2% (40 mg) (group L); Ephedrine (30 ug/kg) (group E1); or Ephedrine (70 ug/kg) (group E2). After 30 seconds all patients were administered 2.5 mg/kg of propofol with a rate of 1 ml per second. The patients were asked to give a score from 0 to 10 (0 = no pain and 10 = most severe pain) every 5 seconds until loss of consciousness. Systolic and diastolic pressures and heart rate were recorded before induction of anesthesia, before intubation, and 1, 3, and 5 minutes after intubation.Results: Systolic, diastolic, and mean arterial pressure and heart rate following induction in E1 and E2 groups were higher than S and L groups (P < 0.001). There were no differences in systolic, diastolic, and mean arterial pressure and heart rate 1, 3, and 5 minutes after intubation between groups. Lidocaine and both doses of ephedrine reduced pain on injection of propofol similarly.Conclusions: Lidocaine and high and low doses of ephedrine reduce the intensity of pain on injection of propofol. Small doses of ephedrine attenuate blood pressure and heart rate reduction after induction of anesthesia with propofol

Prevalence and Risk Factors for Prolonged ICU Stay After Adult Cardiac Surgery

Background: The anticipation of the length of ICU stay would enable physicians to provide reliable information for better treatmentmethods. There are several risk factors for prolonged ICU stays after cardiac surgery in the related studies.Objectives: The aim of this study was to assess the possible factors contributing to the prolonged ICU stay in a referral heart center.Methods: In this retrospective case-control study, 515 adult patients admitted to ICU after cardiac surgery in Madani heart center inTabriz (since March to September 2014) were divided into 2 short and prolonged ICU stay groups. ICU stays more than 3 days wereconsidered prolonged. Various risk factors were compared between the two groups.Results: A total number of 64.9% of the patients were in the prolonged ICU stay group and 35.1% had a short stay. Among35 potentialrisk factors, some were significant factors affecting the length of ICU stay (age, type of surgery, previous cardiac surgery, a high doseof inotropes support, duration of surgery, length of CPB and aortic clamp time, arrhythmia in ICU, and re-operation).Conclusions: We can reduce ICU stay using the correction of high levels of serum creatinine before surgery, improvement of functionalclass with drug treatment, shortening of CPB and aortic cross clamp times, adequate hemostasis with surgeon and morecorrection of the coagulation status of the patient by the anesthesiologist at the end of the surgery

Effect of A Probiotic Preparation on Gut Microbiota in Critically Ill Septic Patients Admitted to Intensive Care Unit: A Pilot Randomized Controlled Trial

Background: Sepsis promotes severe physiologic alterations in patients, and it has been reported to induce profound changes in the gut microbial composition. The decrease of ‘health‑benefiting’ microbes and the increase in dysbiosis in critically ill patients are thought to induce or aggravate sepsis. In this study, we aimed to explore the effect of a probiotic preparation, Lactocare®, on gut microbiota in critically ill septic patients admitted to the intensive care unit (ICU). Methods: Forty critically ill patients diagnosed with sepsis were assessed in this pilot randomized controlled trial. Patients were randomized into two groups: Lactocare and control groups. Patients in the Lactocare group received two capsules of Lactocare® for 10 days. Fecal samples were taken from all patients on days 1 and 10 for determining the gut microbial pattern. The primary outcome was gut microbial flora, and secondary outcomes were intensive care unit (ICU) length of stay and mortality. Results: Intragroup changes showed that all microbial flora considerably changed during the study period; the number of microbial flora significantly decreased in the control group and increased in the Lactocare group. Patients in the Lactocare group had a significantly lower incidence of diarrhea and infection with multidrug-resistant organisms. There was no difference in ICU length of stay in the Lactocare group compared to the control group (p= 0.289). The mortality rate was 30% in the control group compared to 20% in the Lactocare group (p: 0.465). Conclusion: This study showed a remarkable effect of the probiotic preparation on the gut microbiota in critically ill septic patients as it decreased the number of opportunistic pathogens. However, additional clinical research is needed to translate research into clinical practice to refine the clinical indication of the specific probiotic strains

Lipid Profile as a Predictive Marker for Organ Dysfunction after Thoracoabdominal Surgery: A Cross-sectional Study

Background: Plasma total cholesterol is considered a negative acute phase reactant. In various pathological conditions, such as trauma, sepsis, burns, and liver dysfunction, as well as post-surgery, serum cholesterol level decreases. This study aimed to investigate the role of lipid profiles in determining the probability of organ dysfunction after surgery.Methods: This cross-sectional study included patients who underwent thoracoabdominal surgery and were admitted to the intensive care unit of Imam Reza Hospital in Tabriz, Iran, between October 2016 and September 2018. During the first two days of admission, blood samples were taken, and serum levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), Low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and albumin were measured. The relation between the changes in these laboratory markers and six organ functions including cardiovascular, respiratory, renal, central nervous system, hepatic, and hematologic, length of stay in the hospital and intensive care unit, mechanical ventilation duration, and vasopressor use were investigated. The independent t test was used to compare continuous variables. The association between different variables and organ dysfunction and mortality was evaluated by using logistic regression.Results: The serum TC increased the risk of mortality (OR=1.09, 95%CI=1.06-1.11, P<0.001), renal dysfunction (OR=1.09, 95%CI=1.06-1.12; P<0.001), liver dysfunction (OR=1.07, 95%CI=1.03-1.10; P<0.001), respiratory dysfunction (OR=1.08, 95%CI=1.05-1.13; P<0.001). Moreover, LDL, HDL, and TG were found to be inversely related to mortality, organ dysfunction, length of stay in the hospital and intensive care unit, mechanical ventilation duration, and vasopressor use. Conclusion: TC could be considered a risk factor for mortality, organ dysfunction, and clinical outcomes. On the other hand, LDL, HDL, and TG played a protective role in the patients’ mortality, organ dysfunction, and clinical outcomes

Taurine in Septic Critically Ill Patients: Plasma versus Blood

Purpose: Sepsis and systemic inflammatory response syndrome (SIRS) encompass various problems throughout the body, and two of its major problems are the creation of oxidative substances in the body and decrease of the body’s antioxidant capacity to deal with the stress and organ damage. Optimal enteral nutrition fortified with antioxidant or immunomodulator amino acid is a hot topic concerning sepsis in the critical care setting. Taurine plays a protective role as an antioxidant in cells that is likely to have a protective role in inflammation and cytotoxicity. Methods: In the present study, 20 septic patients and 20 healthy volunteers were enrolled. The blood and plasma taurine levels of the patients on days 1, 3 and 7 were measured. Blood and plasma taurine level and the correlation between them, organ failure, and severity of the disease were assessed. Results: Taurine concentrations in the plasma of the septic patients were significantly lower than control group, and the whole blood concentrations were significantly higher than those of the control group (P<0.001). There was not a significant correlation between the blood and plasma taurine levels in control and septic patients. In addition, there was not any correlation between the severity of the disease, organ failure, mortality, and plasma as well as the blood concentration of taurine. Conclusion: In septic patients, taurine concentration in plasma and blood are low and high, respectively. These concentrations are not linked to each other and not associated with the patients’ outcome, and the disease severity, and organ failure

Progressive Paraparesis after CABG Surgery

CABG is one of the most common cardiac surgeries all over the world. Similar to other surgeries, it may be associated with some undesirable complications including neurologic complications which might cause morbidity and mortality after surgery. We will describe a case of Progressive Paraparesis after CABG Surgery and review its etiology, diagnosis and management

Evaluation of the Prevalence and Risk Factors of Delirium in Cardiac Surgery ICU

Introduction: Delirium is defined as an acute cognitive disorder presenting with fluctuation in cognition, apathy and non-organized thinking. It may increase morbidity, mortality, ICU stay and cost. In patients who underwent heart surgery delirium may increase post-operative complications such as respiratory insufficiency, sternum instability and need to re-operation of the sternum. The aim of this study was to evaluate the prevalence and risk factors of delirium in patients admitted to cardiac surgery. Materials and Methods: 18 years or older patients who had undergone cardiac surgeries and stayed for more than 24 hours in ICU following surgery were recruited. All subjects were assessed for signs & symptoms of delirium using CAM-ICU and its risk factors. All data were analyzed by SPSS 16 at the end of the study. Results: The prevalence of delirium in these patients was 23.5% (47 patients). The mean age of patients with delirium was more than other patients (P=0.001). The Incidence of delirium in the patients with cardiopulmonary bypass surgery (CPB) was higher than the patients without CPB (P=0.01). The Incidence of delirium in the patients with Atrial fibrillation was higher than patients without it (P=0.002). The Incidence of delirium in the patients with CVA history was higher than the patients without CVA history (P=0.032). The mean time of mechanical ventilation in the delirious patients was more than other patients (P=0.01). Conclusion: Older Age, CPB, history of CVA, Atrial Fibrillation, and prolonged mechanical ventilation are considered as the risk factors of delirium in cardiac surgery patients

Evaluation of clinical pharmacy services in the intensive care unit of a Tertiary University Hospital in the Northwest of Iran

Objective: Current literature indicates that the presence of clinical pharmacists in hospitals results in improved patient care, rational drug therapy, and treatment costs. This study assessed the clinical pharmacy services in the intensive care unit (ICU) of a tertiary hospital at Tabriz University of Medical Sciences, Iran. Methods: During a 9-month cross-sectional study (2014–2015), the clinical pharmacy interventions in 27 sessions and educational activities for patients and health-care professionals were randomly assessed based on the Australian guideline and standard of practice for clinical pharmacy. The interventions of clinical pharmacist were evaluated in terms of their clinical importance. Findings: In this study, a total of 832 interventions on 242 patients were performed by the clinical pharmacist, and approximately 93.6% of the interventions were approved by the attending physician. Most interventions concerned adding a new medication to a drug regimen or switching to a needed new medication. Each patient received an average of three interventions. The clinical pharmacist provided drug information to employees and medical staff in 108 of the total 832 interventions (13%). Medical residents who were surveyed indicated that the quality of education, research, and patient care was improved by the attendance of a clinical pharmacist. Conclusion: The results of this study show that the collaboration of a clinical pharmacist with the medical staff of an ICU can improve pharmacotherapy approach and increase the quality of education

Effect of a Probiotic Preparation (VSL#3) on Cardiovascular Risk Parameters in Critically-Ill Patients

Introduction: Cardiovascular disease (CVD) counts for a major portion of morbidity and mortality globally mostly accompanied by lipid abnormalities. Being at increased risk of cardiac injury, critically ill patients suffer from various lipid disorders. Lipid homeostasis has been efficiently restored by the introduction of probiotics. The aim of this trial was to determine the effect of probiotics on inflammation, antioxidant capacity and lipid peroxidation in critically ill patients. Methods: Forty patients admitted to the intensive care unit were randomized to receive placebo or probiotic for 7 days. Serum levels of triglyceride (TG), total cholesterol, HDL-C, LDL-C and high- sensitivity C-reactive protein (hs-CRP) were measured before initiation of the study and on the 7th day. Results: There was a significant difference between two groups regarding the levels of TG, HDL and hs-CRP at the end of the study (P= 0.043, <0.001 and 0.003, respectively); however, there was not a significant difference in total cholesterol and LDL-C levels. Conclusion: Administration of probiotics in critically ill patients reduced the levels of TG and hs-CRP and increased HDL-C levels. However, no significant change was detected in levels of total cholesterol or LDL-C