NORMOBARIC HYPEROXIA IN NEUROANESTHESIA

Normobarična hiperoksija se sporadično opisuje u literaturi o neurokirurškoj anesteziji. Mišljenja o toj temi su različita. Dugi niz godina hiperoksiju se povezivalo s mogućim štetnim učincima slobodnih kisikovih radikala, koji se tijekom hiperoksije stvaraju u količini većoj nego što je kapacitet antioksidansa, uzrokujući hiperoksičnu akutnu ozljedu pluća. Nedavna istraživanja pokazuju da normobarična hiperoksija može biti korisna u liječenju traumatske ozljede mozga. Glavni ciljevi u neuroanesteziji su održavanje intrakranijskog tlaka, cerebralnog perfuzijskog tlaka te sprječavanje sekundarne ozljede mozga. Hiperoksija poboljšava oksigenaciju moždanog tkiva i aerobni metabolizam u mozgu zbog čega može biti neuroprotektivna. Dodatna korist hiperoksije je u liječenju poslijeoperacijskog pneumocefalusa, u smanjenju poslijeoperacijske mučnine i povraćanja, učestalosti infekcija kirurških rana te njihovom bržem cijeljenju, što omogućuje bolju kvalitetu oporavka bolesnika. Uzevši u obzir moguće dobrobiti normobarične hiperoksije te njenih neželjenih učinaka potrebna su daljnja istraživanja kako bi se jasno izdvojile skupine bolesnika u kojih hiperoksija može poboljšati ishod liječenja.Normobaric hyperoxia is occasionally mentioned in the literature concerning neurosurgical anesthesia. Opinions vary on this subject. Hyperoxia was long related to the potentially harmful influence of reactive oxygen species that are produced during hyperoxia in the amounts greater than the antioxidant capacity, thus causing hyperoxic acute lung injury. Recent research shows that hyperoxia may be benefi cial in treating traumatic brain injury. The main goals in neuroanesthesia are maintaining intracranial pressure and cerebral perfusion pressure while preventing secondary brain injury. Hyperoxia enhances brain tissue oxygenation and brain aerobic metabolism, thus being neuroprotective. Additional benefi t of hyperoxia may be found in the treatment of postoperative pneumocephalus by diminishing postoperative nausea and vomiting, and reducing the incidence of surgical site infections and facilitating their healing, thus providing better patient recovery. Considering the potential benefi ts of normobaric hyperoxia and its possible detrimental effect, additional investigation is needed to clearly defi ne the patient category where hyperoxia may have positive effect on patient outcome

Effect of adjunctive lidocainebased scalp block and laryngotracheal local anesthesia vs general anesthesia only on plasma and cerebrospinal fluid pro-inflammatory cytokine concentrations in patients with cerebral aneurysm: a randomized controlled trial

Aim To compare the effect of adjunctive lidocaine-based scalp block and laryngotracheal local anesthesia vs general anesthesia only on pro-inflammatory cytokine concentra - tions in patients with non-ruptured brain aneurysms under - going elective open surgery. Methods This parallel, randomized, controlled, open-label trial was conducted at Clinical Hospital Center Zagreb be - tween March 2019 and March 2020. At the beginning of an - esthesia, lidocaine group received 40 mg of 2% lidocaine for laryngotracheal topical anesthesia and 4 mg/kg for the scalp block. Control group underwent general anesthesia only. Plasma concentrations of IL-6, TNF-α, and IL-1β were mea - sured before anesthesia (S0); at the incision (S1); at the end of surgery (S2); 24 hours postoperatively (S3). Cerebrospinal fluid (CSF) cytokine concentrations were measured at the in - cision (L1) and the end of surgery (L2). Results Forty patients (each group, 20) were randomized; 37 were left in the final analysis. IL-6 plasma concentrations increased significantly compared with baseline at S3 in li - docaine group, and at S2 and S3 in control group. In both groups, changes in TNF-α and IL-1β were not significant. CSF cytokine concentrations in lidocaine group did not change significantly; in control group IL-6 and IL-1β were significantly higher at L2 than at L1. CSF IL-6 in control group significantly increased at L2, but TNF-α and IL-1β did not. No differences in clinical outcome and complication rates were observed. Conclusion Adjunctive lidocaine-based scalp block and lar - yngotracheal local anesthesia might attenuate CSF IL-6 con - centration increase in patients with brain aneurysm

The marine diatom Thalassiosira rotula: chemical profile and antioxidant activity of hydroalcoholic extracts

The cosmopolitan centric diatom Thalassiosira rotula produces compounds in its natural habitat that can inhibit copepod reproduction. Moreover, it has been reported to possess compounds with therapeutic effects beneficial for health care. In this experiment, the extraction yield, total phenolic content (TPC), antioxidant activity by 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging ability, ferric reducing/antioxidant power (FRAP) and oxygen radical absorbance capacity (ORAC), and chemical profile by gas chromatography-mass spectrometry (GC-MS) analyses of T. rotula were investigated. Extractions were performed with 50% and 70% ethanol. A higher extraction yield [0.21 ± 0.01 g extract/g dry weight (DW) diatom] was observed for 70% ethanol. In addition, higher TPC (5.80 ± 0.32 mg gallic acid equivalents (GAE)/g DW diatom) and antioxidant activity [DPPH inhibition of 17.53% ± 0.56%, FRAP of 766.67 ± 34.69 µM Trolox equivalents (TE), and ORAC of 58.87 ± 2.03 µM TE] were observed for this extract. Myristic acid, palmitelaidic acid, palmitic acid, eicosapentaenoic acid, 24-methylenecholesterol, and docosapentaenoic acid were identified as dominant compounds in both extracts, while extraction in 70% ethanol yielded a higher content of fatty acids such as myristic acid, eicosapentaenoic acid, docosapentaenoic acid, and sterol 24-methylenecholesterol. Thus, it can be concluded that extraction of T. rotula with 70% ethanol improves antioxidant activity and provides a higher yield of compounds such as polyunsaturated fatty acids and sterols. Therefore, the species T. rotula could be considered a sustainable source of essential fatty acids and other bioactive compounds for further applications

Effect of local anesthesia with lidocaine on perioperative proinflammatory cytokine levels in plasma and cerebrospinal fluid in cerebral aneurysm patients

Cerebral aneurysm surgery has significant mortality and morbidity rate. Inflammation plays a key role in the pathogenesis of intracranial aneurysms, their rupture, subarachnoid hemorrhage and neurologic complications. Proinflammatory cytokine level in blood and cerebrospinal fluid (CSF) is an indicator of inflammatory response. Cytokines contribute to secondary brain injury and can worsen the outcome of the treatment. Lidocaine is local anesthetic that can be applied in neurosurgery as regional anesthesia of the scalp and as topical anesthesia of the throat before direct laryngoscopy and endotracheal intubation. Besides analgesic, lidocaine has systemic anti-inflammatory and neuroprotective effect.Primary aim of this trial is to determine the influence of local anesthesia with lidocaine on the perioperative levels of pro-inflammatory cytokines interleukin-1β, interleukin-6, and tumor necrosis factor-α in plasma and CSF in cerebral aneurysm patients. METHODS: We will conduct prospective randomized clinical trial among patients undergoing craniotomy and cerebral aneurysm clipping surgery in general anesthesia. Patients included in the trial will be randomly assigned to the lidocaine group (Group L) or to the control group (Group C). Patients in Group L, following general anesthesia induction, will receive topical anesthesia of the throat before endotracheal intubation and also regional anesthesia of the scalp before Mayfield frame placement, both done with lidocaine. Patients in Group C will have general anesthesia only without any lidocaine administration. The primary outcomes are concentrations of cytokines interleukin-1β, interleukin-6 and tumor necrosis factor-α in plasma and CSF, measured at specific timepoints perioperatively. Secondary outcome is incidence of major neurological and infectious complications, as well as treatment outcome in both groups. DISCUSSION: Results of the trial could provide insight into influence of lidocaine on local and systemic inflammatory response in cerebrovascular surgery, and might improve future anesthesia practice and treatment outcome

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat