Non-invasive mechanical ventilation and epidural anesthesia for an emergency open cholecystectomy [Ventilação mecânica não invasiva e anestesia peridural em colecistectomia aberta de emergência]

Non-invasive ventilation is an accepted treatment modality in both acute exacerbations of respiratory diseases and chronic obstructive lung disease. It is commonly utilized in the intensive care units, or for postoperative respiratory support in post-anesthesia care units. This report describes intraoperative support in non-invasive ventilation to neuroaxial anesthesia for an emergency upper abdominal surgery. © 2014 Sociedade Brasileira de Anestesiologi

Protective effect of dexmedetomidine in a rat model of ?- naphthylthiourea-induced acute lung injury

Background: We assessed the effects of dexmedetomidine in a rat model of ?-naphthylthiourea (ANTU)-induced acute lung injury. Methods: Forty Wistar Albino male rats weighing 200-240 g were divided into 5 groups (n = 8 each), including a control group. Thus, there were one ANTU group and three dexmedetomidine groups (10-, 50-, and 100-µg/kg treatment groups), plus a control group. The control group provided the normal base values. The rats in the ANTU group were given 10 mg/kg of ANTU intraperitoneally and the three treatment groups received 10, 50, or 100 µg/kg of dexmedetomidine intraperitoneally 30 min before ANTU application. The rat body weight (BW), pleural effusion (PE), and lung weight (LW) of each group were measured 4 h after ANTU administration. The histopathologic changes were evaluated using hematoxylin-eosin staining. Results: The mean PE, LW, LW/BW, and PE/BW measurements in the ANTU group were significantly greater than in the control groups and all dexmedetomidine treatment groups (P < 0.05). There were also significant decreases in the mean PE, LW, LW/BW and PE/BW values in the dexmedetomidine 50-µg/kg group compared with those in the ANTU group (P < 0.01). The inflammation, hemorrhage, and edema scores in the ANTU group were significantly greater than those in the control or dexmedetomidine 50-µg/kg group (P < 0.01). Conclusion: Dexmedetomidine treatment has demonstrated a potential benefit by preventing ANTU-induced acute lung injury in an experimental rat model. Dexmedetomidine could have a potential protective effect on acute lung injury in intensive care patients. © 2012 Elsevier Inc. All rights reserved.The authors would like to thank Dr. E. Schilliger from Schering AG, Berlin, Germany, for his gift of ?-naphthylthiourea (Interchem). We thank Hasan Tahsin Yilmaz and Bayram Cakan for their assistance in the Animal Research Laboratory. This study was supported by intramural funding from the Zonguldak Karaelmas University’s Office of Research and Sponsored Programs

The effects of intrathecal levobupivacaine and opioid combinations in caesarean operations [Sezaryen operasyonlarinda intratekal levobupivakaine eklenen fentanil ve morfin kombinasyonlarinin etkilerinin karşilatirmasi]

Aim: We aimed to investigate the effects of levobupivacaine, fentanyl and morphine's different intrathecal combinations on parturients planned to have elective caesarean operation with spinal anesthesia. We have also investigated the effects of these combinations on newborns. Material and Methods: One hundred and twenty parturients of ASA physical status I-II planned to have Caesarean operation enrolled in the study. Parturients randomized into four groups and Group L received 12 mg 0.5% levobupivacaine, Group LF received 10 mg 0.5% + 12.5 pg fentanyl, Group LM received 11 mg 0.5% levobupivacaine + 100 pg morphine and Group LFM received 11 mg 0.5 % levobupivacaine + 5 µg fentanyl + 50 µg morphine intrathecally. Results: Haemodynamies were affected much more in groups which included fentanyl and sensorial block level raised up faster (p<0.05). In groups where morphine was added sensorial block level increased slowly, time to start surgery get longer and in addition sensorial and motor block ceased later (p<0.05). Postoperative analgesia quality was better in morphine added groups (p<0.05). Levobupivacaine use by itself increased intraoperative nausea incidence whereas morphine addition increased postoperative itching (p<0.05). We did not observe any side effects in infants of four groups. Conclusions: We conclude that combination composed by fentanyl and morphine addition to levobupivacaine rises sensorial block time faster, improves analgesia quality, can be a good alternative for caesarean operations that will be performed under spinal anesthesia with close monitorization and provided by preoperative sufficient hydration

The effect of peroperatively and postoperatively used parasetamol on postoperative morphine consumption in spinal surgery [Spinal cerrahide peroperatif ve postoperatif kullanilan i·ntravenöz parasetamolün postoperatif morfin tüketimine etkisi]

Aim: The aim of this study is to investigate the effects of iv paracetamol with iv morphine PCA on postoperative morphine consumption in lumbar disc surgery. Materials and Methods: After obtaining the approval of the hospital ethics committee and patient's consents, 67 adult patients, in ASA group's I-III, were randomly divided into two groups. Group M (n=37) received iv morphine Patient Control Analgesia (PCA) postoperatively (bolus dose 1 mg, lock out time 10 min, limited 50 mg 24 hrs-1). At the skin closure, iv paracetamol (1 g infused in 15 min, 8 g 48 hrs-1) was also administered with morphine PCA in Group MP. All the patients with Visual Analogue Scale (VAS) scores over 3 were administered iv morphine in fractioned doses at recovery room (0. minute). The systolic and diastolic arterial pressures, hearth rate, SpO2, breathing rate, PCA demand number, replied demand number and total morphine consumption, sedation scores, VAS scores, presence of nausea and vomiting, itching and patches were recorded at 0., 30., 60. min, 2., 4., 6., 12., 18., 24. and 48. hrs. Fractioned morphine amounts and antiemetic consumption were also recorded. Fractioned morphine amounts, total morphine consumption and sedation scores were found to be lowered in Group MP (p&lt;.05). The difference between the total morphine consumption amounts of the study groups (76.4±6.7 mg in Group M and 42.5± 5.2 mg in Group MP) were significant (p&lt;0.05). In addition, the VAS scores of Group M were found to be higher in the first two hours (p&lt;0.05). Conclusion: It is concluded that the combination of iv paracetamol and morphine PCA after spinal surgery enhances the quality of the postoperative analgesic effect of morphine PCA by lowering the morphine consumption amount

Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set

Background: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients. Methods: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson’s Chi-squared and continuous variables by Mann–Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the “full” matching method. Results: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO. Conclusions: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021). Graphical abstract: [Figure not available: see fulltext.]. © 2022, The Author(s)