Anaesthesia, Pain & Intensive Care最新文献

{"title":"Rationality of antibiotic use in COVID-19 patients in the ICU of Dr. Hasan Sadikin General Hospital, Bandung; a cohort study","authors":"Indriasari, Ezra Oktaliansah, Rikda Irham Munazat","doi":"10.35975/apic.v28i1.2384","DOIUrl":"https://doi.org/10.35975/apic.v28i1.2384","url":null,"abstract":"Background and Objectives: Nearly three-quarters of the patients with COVID-19 received antibiotic therapy despite the bacterial coinfection being only less than 10% in many studies and ranging from 8-22% in ICU patients. The use of broad-spectrum antibiotics in COVID-19 patients has not been proven effective. Overuse of antibiotics may be associated with side effects and antibiotic resistance. The purpose of this study was to determine the antibiotic rationality in COVID-19 patients in the ICU of Dr. Hasan Sadikin Hospital, Bandung, Indonesia. \u0000Methodology: This descriptive, retrospective cohort study was carried out by analyzing medical records of COVID-19 patients admitted in the ICU of Dr. Hasan Sadikin Hospital from January-June 2021. \u0000Results: There were 138 patients who met the inclusion criteria. A total of 126 (91.3%) patients received antibiotics. A total of 12 (8.7%) severe/critical patients did not receive antibiotics and 79 (62.70%) received inappropriate antibiotic duration. Inappropriate regimen was found in 59 patients (74.68%) with COVID-19 without HAP/VAP and 15 patients (31.92%) with HAP/VAP. The primary issue identified was the inappropriate regimen of antibiotics, Gyssens category 4a. \u0000Conclusion: This study concludes that 23.02% patients used rational empirical antibiotics and 45.98% used rational definitive antibiotics in COVID-19 patients in the ICU at RSUP Dr. Hasan Sadikin Bandung during January-June 2021. \u0000Abbreviations: ACE- Angiotensin Converting Enzyme; ICU- Intensive Care Unit; HAI- Hospital-Associated Infections; HAP- Hospital-Acquired Pneumonia; IDSA- Infectious Diseases Society of America VAP- Ventilator-Associated Pneumonia \u0000Key words: Antibiotics; Antimicrobial Resistance; COVID-19; Intensive Care Units; Prescribing Pattern \u0000Citation: Indriasari, Oktaliansah E, Munazat RI. Rationality of antibiotic use in COVID-19 patients in the ICU of Dr. Hasan Sadikin General Hospital Bandung; a cohort study. Anaesth. pain intensive care 2024;28(1):115−125. \u0000DOI: 10.35975/apic.v28i1.2384 \u0000Received: November 20, 2023; Reviewed: December 03, 2023; Accepted: December 26, 2023","PeriodicalId":108815,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"19 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139804570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the effects of the local anesthetics on immunity during mastectomy","authors":"Darko Angjushev, M. Sholjakova, A. Kartalov, B. Kuzmanovska, Aleksandar Kishman, Vasko Demjanski, M. Srceva, Anita Kokareva, M. K. Angjushev","doi":"10.35975/apic.v28i1.2383","DOIUrl":"https://doi.org/10.35975/apic.v28i1.2383","url":null,"abstract":"Background & objective: Surgery and some anesthetic techniques can contribute to tumor cells dissemination. It is known that the use of local anesthetics and regional blocks during mastectomy preserved the immune function. We evaluated and compared, the levels of some cytokines (IFNγ, TNFα, IL2, IL12) responsible for immune function, as well as the level of leukocytes before and after breast carcinoma surgery; and to find out and compare the effects of local anesthetics on blood pressure (BP) and on postoperative complications, e.g., pain, vomiting, headache, the need for analgesia and surgical complications. \u0000Methodology: In this randomized prospective study, 45 patients were allocated in 3 equal groups: Group GA (n = 15) for standard general anesthesia; Group LA (n = 15) for general anesthesia and infusion of lidocaine; Group PECS (n = 15) for pectoralis I/II block with bupivacaine and general anesthesia. Blood samples were taken to ascertain cytokines and leukocytes levels before surgery and 24 h after surgery. \u0000Results: Lidocaine caused fall of BP (P = 0.002t), but bupivacaine (PECS I/II block) produced stable BP during mastectomy (P = 0.1). A significant increase of leucocytes after surgery was seen in Group PECS compared to Group GA (P = 0.033). In 24-h intervals after surgery, lidocaine and bupivacaine produced an increase of TNFα (P < 0.05). Bupivacaine showed a significantly low intensity of postoperative pain compared to other techniques and zero postoperative complications. \u0000Conclusion: Local anesthetics lidocaine and bupivacaine enhance the immune response and produce more stable hemodynamics compared to general anesthesia alone during mastectomy in patients with breast carcinoma. \u0000Abbreviations: CTL- Cytotoxic T Lymphocytes; IFNγ- Interferon Gamma; TNFα- Tumour Necrosis Factor α, IL2- Interleukin-2; NKCs- Natural Killer Cells; Th1- Type 1 T Helper Cells; VAS- Visual Analog Scale \u0000Keywords: Breast Carcinoma; Lidocaine; Bupivacaine; PECS I/II block; Cytokines \u0000Citation: Angjushev DL, Sholjakova MV, Kartalov A, Kuzmanovska B, Kishman A, Demjanski V, Srceva MJ, Kokareva A, Angjushev MK. Evaluation of the effects of the local anesthetics on immunity during mastectomy. Anaesth. pain intensive care 2024;28(1):108−114; DOI: 10.35975/apic.v28i1.2383 \u0000Received: November 14, 2023; Reviewed: November 17, 2023; Accepted: December 09, 2023","PeriodicalId":108815,"journal":{"name":"Anaesthesia, Pain &amp; Intensive Care","volume":"30 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139863905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“ESICM guidelines on acute respiratory distress syndrome 2023”- a short summary","authors":"Faraz Mansoor","doi":"10.35975/apic.v28i1.2392","DOIUrl":"https://doi.org/10.35975/apic.v28i1.2392","url":null,"abstract":"New European Society of Intensive Care Medicine (ESICM) guidelines on acute respiratory distress syndrome (ARDS) were published in June, 2023. This is the commentary and the comparison of changes to the previous guidelines that were published in 2017. These new guidelines are applicable to adult patients and cover only non-pharmacological respiratory support strategies that also cover ARDS due to coronavirus disease 2019 (COVID-19). \u0000Abbreviations: AHRF- Acute Hypoxemic Respiratory Failure; ARDS- Acute Respiratory Distress Syndrome; ECMO- Extra Corporeal Membrane Oxygenation; ESICM- European Society of Intensive Care Medicine; CPAP- Continuous Positive Airway Pressure; HFNO- High Flow Nasal Oxygen; NIV- Non-invasive Ventilation; PEEP- Positive End Expiratory Pressure; RM- Recruitment Maneuvers \u0000Key words: Acute Hypoxemic Respiratory Failure; Acute Respiratory Distress Syndrome’ Mechanical Ventilation; Extracorporeal Membrane Oxygenation; Prone Position; Non-Invasive Ventilation; Prognosis. \u0000Citation: Mansoor F. “ESICM guidelines on acute respiratory distress syndrome 2023”- a short summary. Anaesth. pain intensive care 2024;28(1):155−158; DOI: 10.35975/apic.v28i1.2392 \u0000Received: October 05, 2023; Reviewed: January 07, 2024; Accepted: January 07, 2024","PeriodicalId":108815,"journal":{"name":"Anaesthesia, Pain &amp; Intensive Care","volume":"35 1-2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139864177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early hemofiltration as immunomodulation for septic shock in acute on chronic kidney disease: a case report","authors":"Elvia As, Rudyanto Sedono, Yohanes George","doi":"10.35975/apic.v28i1.2271","DOIUrl":"https://doi.org/10.35975/apic.v28i1.2271","url":null,"abstract":"Bacterial endotoxins in sepsis induce dysregulation and excessive release of inflammatory mediators and cytokines, leading to organ dysfunction. Removing excess endotoxins and cytokines from the circulation could potentially reverse the dysregulation of the immune response. oXiris filter is capable of filtration and adsorption middle-size molecule cytokines and large molecular archives such as endotoxins. \u0000A man, 77 years old, weighing 70 kg, with 174 cm height and 23.17 BMI was diagnosed with septic shock with Fournier gangrene, acute on chronic kidney disease, uncontrolled blood sugar, and history of diabetes mellitus. He was put on meropenem antibiotic therapy. After necrotomies, increase in the levels of leukocytes, urea, creatinine, procalcitonin, D-dimer, NT-proBNP, and IL 6 was observed. Vasopressor dose was increased, and the patient also experienced tachycardia and fever. \u0000Meropenem was stopped and replaced with ceftaroline fosamil, and 24 h later hemofiltration with an oXiris filter was performed for 48 h. After hemofiltration, there was a decrease in vasopressor dose, urea, creatinine, and procalcitonin values. The patient′s hemodynamic status was stable without vasopressor, the dose of furosemide was decreased, and the urine output was increased. Then, the patient was transferred to the ward. The current patient had an upregulation of pro-inflammatory mediators as evidenced by clinical symptoms and laboratory findings. Additional treatment with extracorporeal blood purification techniques such as hemofiltration is required in these patients to facilitate the treatment of septic shock through the modulation of the immune response. \u0000Keywords: septic shock, dysregulation, hemofiltration, immunomodulation \u0000Citation: Elvia AS, Sedono R, George YWH. Early hemofiltration as immunomodulation for septic shock in acute on chronic kidney disease: a case report. Anaesth. pain intensive care 2024;28(1):182−186.DOI: 10.35975/apic.v28i1.2271 \u0000Received: August 17, 2023; Reviewed: December 23, 2023; Accepted: December 23, 2023","PeriodicalId":108815,"journal":{"name":"Anaesthesia, Pain &amp; Intensive Care","volume":"20 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139802618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between morphological electrocardiographic characteristics and survival in critical COVID-19 patients","authors":"Mihrican Sayan, H. B. Altinişik","doi":"10.35975/apic.v28i1.2385","DOIUrl":"https://doi.org/10.35975/apic.v28i1.2385","url":null,"abstract":"Background: Myocardial damage is a sign of poor prognosis in coronavirus disease 2019 (COVID-19). Electrocardiography (ECG) would be useful to evaluate the effects of ECG findings on survival in severe COVID-19. We studied the relationship of pathological ECG findings in patients of COVID-19 admitted in ICU with other adverse physiological parameters as well as the mortality. \u0000Methodology: The study population comprised critical COVID-19 patients in the intensive care unit (ICU). Patients with findings other than normal sinus rhythm, atrial extra beat, and ventricular extra beat were defined as patients with pathological ECG findings. Two groups were formed: patients with pathological ECG findings (n = 109) and patients without pathological ECG findings (n = 84). Data were compared and analysed between the groups.  The relationship among the risk factors, and ECG findings with mortality was investigated. \u0000Results: The presence of hypertension (69% vs. 40%, OR 5.49, CI 1.71-17.66, P = 0.004), peripheral oxygen saturation (SpO2) (88 vs. 95, OR 0.8, CI 0.7-0.9, P < 0.001) were found to be related to mortality in multivariable analyses. Patients with pathological ECG finding were older [74 (27-98) vs. 61 (22-89); P < 0.001], and more likely to have hypertension (68% vs. 44%, P = 0.001). Pathological ECG findings (66% vs. 51%, P = 0.02), atrial fibrillation (AF) (37% vs. 20%, P = 0.01), right branch bundle block (RBBB) (10% vs. 3%, P = 0.048) were associated with higher mortality in univariable analyses. \u0000Conclusion: Although abnormal findings on ECG, especially AF and RBBB, are associated with a poor prognosis, they are not primary effective in increasing the mortality of critical COVID-19 patients. \u0000Abbreviations: AF- Atrial Fibrillation; CRP- C-reactive protein; ICU- intensive care unit; RBBB- Right Bundle-Branch Block; RT-PCR- reverse-transcription polymerase chain reaction; VTE- venous thromboembolism \u0000Key words: Atrial Fibrillation; Biomarkers; COVID-19; ECG; Mortality; Right Bundle-Branch Block \u0000Citation: Sayan M, Altinisik HB. The relationship between morphological electrocardiographic characteristics and survival in critical COVID-19 patients. Anaesth. pain intensive care 2024;28(1):139−150. \u0000DOI: 10.35975/apic.v28i1.2385 \u0000Received: November 21, 2023; Reviewed: November 30, 2023; Accepted: December 21, 2023","PeriodicalId":108815,"journal":{"name":"Anaesthesia, Pain &amp; Intensive Care","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139805189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early hemofiltration as immunomodulation for septic shock in acute on chronic kidney disease: a case report","authors":"Elvia As, Rudyanto Sedono, Yohanes George","doi":"10.35975/apic.v28i1.2271","DOIUrl":"https://doi.org/10.35975/apic.v28i1.2271","url":null,"abstract":"Bacterial endotoxins in sepsis induce dysregulation and excessive release of inflammatory mediators and cytokines, leading to organ dysfunction. Removing excess endotoxins and cytokines from the circulation could potentially reverse the dysregulation of the immune response. oXiris filter is capable of filtration and adsorption middle-size molecule cytokines and large molecular archives such as endotoxins. \u0000A man, 77 years old, weighing 70 kg, with 174 cm height and 23.17 BMI was diagnosed with septic shock with Fournier gangrene, acute on chronic kidney disease, uncontrolled blood sugar, and history of diabetes mellitus. He was put on meropenem antibiotic therapy. After necrotomies, increase in the levels of leukocytes, urea, creatinine, procalcitonin, D-dimer, NT-proBNP, and IL 6 was observed. Vasopressor dose was increased, and the patient also experienced tachycardia and fever. \u0000Meropenem was stopped and replaced with ceftaroline fosamil, and 24 h later hemofiltration with an oXiris filter was performed for 48 h. After hemofiltration, there was a decrease in vasopressor dose, urea, creatinine, and procalcitonin values. The patient′s hemodynamic status was stable without vasopressor, the dose of furosemide was decreased, and the urine output was increased. Then, the patient was transferred to the ward. The current patient had an upregulation of pro-inflammatory mediators as evidenced by clinical symptoms and laboratory findings. Additional treatment with extracorporeal blood purification techniques such as hemofiltration is required in these patients to facilitate the treatment of septic shock through the modulation of the immune response. \u0000Keywords: septic shock, dysregulation, hemofiltration, immunomodulation \u0000Citation: Elvia AS, Sedono R, George YWH. Early hemofiltration as immunomodulation for septic shock in acute on chronic kidney disease: a case report. Anaesth. pain intensive care 2024;28(1):182−186.DOI: 10.35975/apic.v28i1.2271 \u0000Received: August 17, 2023; Reviewed: December 23, 2023; Accepted: December 23, 2023","PeriodicalId":108815,"journal":{"name":"Anaesthesia, Pain &amp; Intensive Care","volume":"203 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139862419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“ESICM guidelines on acute respiratory distress syndrome 2023”- a short summary","authors":"Faraz Mansoor","doi":"10.35975/apic.v28i1.2392","DOIUrl":"https://doi.org/10.35975/apic.v28i1.2392","url":null,"abstract":"New European Society of Intensive Care Medicine (ESICM) guidelines on acute respiratory distress syndrome (ARDS) were published in June, 2023. This is the commentary and the comparison of changes to the previous guidelines that were published in 2017. These new guidelines are applicable to adult patients and cover only non-pharmacological respiratory support strategies that also cover ARDS due to coronavirus disease 2019 (COVID-19). \u0000Abbreviations: AHRF- Acute Hypoxemic Respiratory Failure; ARDS- Acute Respiratory Distress Syndrome; ECMO- Extra Corporeal Membrane Oxygenation; ESICM- European Society of Intensive Care Medicine; CPAP- Continuous Positive Airway Pressure; HFNO- High Flow Nasal Oxygen; NIV- Non-invasive Ventilation; PEEP- Positive End Expiratory Pressure; RM- Recruitment Maneuvers \u0000Key words: Acute Hypoxemic Respiratory Failure; Acute Respiratory Distress Syndrome’ Mechanical Ventilation; Extracorporeal Membrane Oxygenation; Prone Position; Non-Invasive Ventilation; Prognosis. \u0000Citation: Mansoor F. “ESICM guidelines on acute respiratory distress syndrome 2023”- a short summary. Anaesth. pain intensive care 2024;28(1):155−158; DOI: 10.35975/apic.v28i1.2392 \u0000Received: October 05, 2023; Reviewed: January 07, 2024; Accepted: January 07, 2024","PeriodicalId":108815,"journal":{"name":"Anaesthesia, Pain &amp; Intensive Care","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139804283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rationality of antibiotic use in COVID-19 patients in the ICU of Dr. Hasan Sadikin General Hospital, Bandung; a cohort study","authors":"Indriasari, Ezra Oktaliansah, Rikda Irham Munazat","doi":"10.35975/apic.v28i1.2384","DOIUrl":"https://doi.org/10.35975/apic.v28i1.2384","url":null,"abstract":"Background and Objectives: Nearly three-quarters of the patients with COVID-19 received antibiotic therapy despite the bacterial coinfection being only less than 10% in many studies and ranging from 8-22% in ICU patients. The use of broad-spectrum antibiotics in COVID-19 patients has not been proven effective. Overuse of antibiotics may be associated with side effects and antibiotic resistance. The purpose of this study was to determine the antibiotic rationality in COVID-19 patients in the ICU of Dr. Hasan Sadikin Hospital, Bandung, Indonesia. \u0000Methodology: This descriptive, retrospective cohort study was carried out by analyzing medical records of COVID-19 patients admitted in the ICU of Dr. Hasan Sadikin Hospital from January-June 2021. \u0000Results: There were 138 patients who met the inclusion criteria. A total of 126 (91.3%) patients received antibiotics. A total of 12 (8.7%) severe/critical patients did not receive antibiotics and 79 (62.70%) received inappropriate antibiotic duration. Inappropriate regimen was found in 59 patients (74.68%) with COVID-19 without HAP/VAP and 15 patients (31.92%) with HAP/VAP. The primary issue identified was the inappropriate regimen of antibiotics, Gyssens category 4a. \u0000Conclusion: This study concludes that 23.02% patients used rational empirical antibiotics and 45.98% used rational definitive antibiotics in COVID-19 patients in the ICU at RSUP Dr. Hasan Sadikin Bandung during January-June 2021. \u0000Abbreviations: ACE- Angiotensin Converting Enzyme; ICU- Intensive Care Unit; HAI- Hospital-Associated Infections; HAP- Hospital-Acquired Pneumonia; IDSA- Infectious Diseases Society of America VAP- Ventilator-Associated Pneumonia \u0000Key words: Antibiotics; Antimicrobial Resistance; COVID-19; Intensive Care Units; Prescribing Pattern \u0000Citation: Indriasari, Oktaliansah E, Munazat RI. Rationality of antibiotic use in COVID-19 patients in the ICU of Dr. Hasan Sadikin General Hospital Bandung; a cohort study. Anaesth. pain intensive care 2024;28(1):115−125. \u0000DOI: 10.35975/apic.v28i1.2384 \u0000Received: November 20, 2023; Reviewed: December 03, 2023; Accepted: December 26, 2023","PeriodicalId":108815,"journal":{"name":"Anaesthesia, Pain &amp; Intensive Care","volume":"6 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139864431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three ultrasound guided plane blocks for perioperative analgesia in patients undergoing radical cystectomy: a randomized clinical trial","authors":"N. Seif, Manar Mahmoud El-Kholy, A. Ali, Moustafa Mohamed Zalat, Mohamed Elshazly","doi":"10.35975/apic.v28i1.2381","DOIUrl":"https://doi.org/10.35975/apic.v28i1.2381","url":null,"abstract":"Background &objective: Transmuscular quadratus lumborum plane block (QLPB), paravertebral plane block (PVPB), and erector spinae plane block (ESPB) are three regional anesthesia techniques for management of perioperative pain for surgical procedures on the trunk, including thorax and abdomen. We compared the effectiveness of PVPB, QLPB type III (QL3), and ESPB for perioperative analgesia during radical cystectomy performed for bladder cancer. \u0000Methodology: This randomized double-blind trial was performed on 120 patients, aged above 18 years, undergoing radical cystectomy under general anesthesia. Individuals were randomly divided into 3 equal groups: ESPB, PVPB, and QLPB. Blocks were performed under ultrasound guidance preoperatively on each side with 30 ml of 0.25% bupivacaine. Time to perform block and time to the first dose of morphine postoperatively, were noted. Intra-operative hemodynamic data, including MAP and heart rate (HR) were noted every 10 min for an hour, and then at 30 min intervals. Postoperatively, MAP and HR were recorded at 0, 2, 6, 12 and 24 hours. The connection between qualitative factors was investigated using the chi-square test and Fisher's exact test. For the purpose of comparing the groups, one-way ANOVA and the Bonferroni correction were used. A two-tailed P value < 0.05 was considered significant. \u0000Results: Time to perform block was substantially reduced in ESPB and QL3 groups compared to PVPB group. Time to the first dose of morphine was substantially delayed in the PVPB group than ESPB and QL3 groups. Total 24 h morphine consumption was substantially lower in the PVPB group than ESPB and QL3 groups. Postoperative visual analog scale measurements were substantially lower at 15 min, 30 min, and 12 h in the PVPB group than ESPB and QL3 groups and at 6 h in the ESPB and QL3 groups than in PVPB group. Postoperative mean arterial blood pressure and heart rate measurements were substantially reduced at 0 and 12 h in the PVPB group than in ESPB and QL3 groups and at 6 h in the ESPB and QL3 groups than in PVPB group. \u0000Conclusions: The ultrasound guided paravertebral plane block was superior to quadratus lumborum plane block type III and erector spinae plane block in providing more effective analgesia but with higher time to perform block. \u0000Abbreviations: ESPB- Erector Spinae Plane Block; PVPB- Paravertebral Plane Block; QLPB- Quadratus Lumborum Plane Block; QL3- Quadratus Lumborum Plane Block Type III \u0000Keywords: Paravertebral Plane Block; Quadratus Lumborum Plane Block; Erector Spinae Plane Block; Ultrasound; Radical Cystectomy \u0000Citation: Seif NE, El-Kholy MM, Ali AR, Zalat MM, Elshazly M. Three ultrasound guided plane blocks for perioperative analgesia in patients undergoing radical cystectomy: a randomized clinical trial. Anaesth. pain intensive care 2024;28(1):85-91; DOI: 10.35975/apic.v28i1.2381 \u0000Received: September 28, 2023; Reviewed: October 31, 2023; Accepted: October 31, 2023","PeriodicalId":108815,"journal":{"name":"Anaesthesia, Pain &amp; Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139806639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of different doses of neostigmine plus metoclopramide on the gastric residual volume in patients under enteral nutrition in intensive care unit","authors":"Mohammadrea Moshari, Zahra Tahmasebi, M. Dahi, M. Vosoughian, S. Dabir, Firoozeh Madadi, Soudeh Tabashi, Mohsen Ariannik, Mohammad Ali Khabiri Khatiri","doi":"10.35975/apic.v28i1.2378","DOIUrl":"https://doi.org/10.35975/apic.v28i1.2378","url":null,"abstract":"Background & Objective: Gastric motility disorder is common in patients admitted to an intensive care unit (ICU), leading to increased morbidity and mortality. We investigated the effects of different doses of neostigmine in combination with metoclopramide on gastric residual volume (GRV) in ICU patients on enteral feeding. \u0000Methods: In this double-blind clinical trial, 144 patients hospitalized in the ICU who were under enteral nutrition through nasogastric (NGT) or orogastric (OG) tube were randomly allocated to four groups. In all four groups, 20 mg of metoclopramide was prescribed IV slowly within one minute. In groups A, B, and C, 1, 1.5, and 2 mg of neostigmine were injected IV, respectively. Group D received only 20 mg of metoclopramide. All patients were gavaged every 4 h with 300 ml. The patient's head was kept at a 45° angle. To determine GRV, aspiration was done through NG tube or OG tube before the start of infusion and then at 3, 6, 9, and 12 h after the end of infusion. \u0000Results: There was no significant difference between the studied groups in terms of demographic variables such as age, blood pressure, heart rate and BMI (P > 0.05). The average difference of SOFA and APACHE and laboratory factors between the groups was not significant. The results of the comparison of the marginal averages of the residual volume of the stomach at different hours of the day showed that the amount of the residual volume at all hours had a significant average difference with each other. The addition of different doses of neostigmine had a significant effect on the residual volume of the stomach after 3 and 6 h (P < 0.05). Meanwhile, a dose of 2.0 mg of neostigmine had the most of the change 3 h after administration. \u0000Conclusion: Administration of neostigmine in combination with metoclopramide in ICU patients on enteral feeding significantly reduces the residual volume of the stomach within 12 hours after the treatment. \u0000Abbreviations: APACHE- Acute Physiology And Chronic Health Evaluation; GRV - Gastric Residual Volume; NG – Nasogastric; OG - Orogastric; SOFA- Sequential Organ Failure Assessment; VAP - ventilator-associated pneumonia \u0000Key words: APACHE; Enteral Nutrition; ICU; Metoclopramide; Neostigmine; SOFA \u0000Citation: Moshari M, Tahmasebi Z, Dahi M, Vosoughian M, Dabir S, Madadi F, Tabashi S, Ariannik M, Khatiri MAK. The effect of different doses of neostigmine plus metoclopramide on the gastric residual volume in patients under enteral nutrition in intensive care unit. Anaesth. pain intensive care 2024;28(1):33-38. \u0000DOI: 10.35975/apic.v28i1.2378 \u0000Received: August 06, 2023; Reviewed: September 11, 2023; Accepted: September 21, 2023","PeriodicalId":108815,"journal":{"name":"Anaesthesia, Pain &amp; Intensive Care","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139806810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}