Pediatric Anesthesia and Critical Care Journal最新文献

{"title":"Early Warning System triggers in Intensive Care Unit after receiving Intrathecal Morphine: A Retrospective Analysis.","authors":"J. Skelly, W. R. Jonker","doi":"10.21203/rs.3.rs-829425/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-829425/v1","url":null,"abstract":"\u0000 BackgroundNeuraxial analgesia, including intrathecal morphine(ITM) administration, provides excellent analgesia in the post-abdominal surgery setting. As a corollary, such patients are commonly admitted to HDU/ICU for post-operative monitoring, and as such, bed availability can curtail its use. Reluctance to ward based postoperative care for this cohort is evident. Ward based postoperative care could benefit post-operative analgesic management.MethodsWe reviewed post-operative vital signs constituting the Irish National Early Warning System (INEWS), for general surgical patients admitted to our ICU after ITM administration, as would be undertaken at ward level. Data analysis for a period between January 2015 and August 2018. Inclusion criteria included: abdominal surgery; preoperative ITM and ICU admission post-operatively. Data for the initial 24 hours of ICU admission were obtained, including: AVPU score; respiratory rate(RR); fraction inspired oxygen(FiO2); arterial oxygen saturation(SpO2); heart rate(HR); systolic blood pressure(sBP). Additional measurements include recorded: ITM dose, age, weight, ASA grade, APACHE II Score, visual analogue pain scale scores, analgesic requirements.ResultsThirty patients were included. The ITM dose was 548.3±28.2mcg(mean±SD). Mean maximum constituent INEWS Scores were: 1.7±0.2(RR); 1.5±0.2(SpO2); 1.6±0.3(AVPU); 1.1±0.2(HR); 2.0±0.2(sBP) giving a mean maximum total INEWS score of 4.9±0.3. Four subjects scored ≥7. No patient had INEWS de-escalated for supplemental oxygen and as such the addition of 3 NEWS points for oxygen supplementation would be applied to 96.7% (n=29) of patients. ConclusionsThe current study demonstrates that patients receiving these doses of ITM can exhibit high INEWS scores which would trigger escalation as outlined by the INEWS scoring system if located on a level 1 ward.","PeriodicalId":41147,"journal":{"name":"Pediatric Anesthesia and Critical Care Journal","volume":"79 4","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72369770","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":"Effect of Progesterone Therapy In Traumatic Subarachinoid Haemorrhage On Clinical Outcome, Resistive Vascular Indices of Middle Cerebral Artery Transcranial Doppler And Thromboelastometry. A Promising Layout.","authors":"M. Raouf, Tamer Alzaeem Ismaeel, G. Hanna","doi":"10.21203/rs.3.rs-800880/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-800880/v1","url":null,"abstract":"\u0000 Rationale . Recent evidence questions for a safe approach to resuscitate population with traumatic sub-arachinoid hemorrhage (tSAH). Progesterone neuro-protective actions are a matter of debate among literatures. This was the epitome of the current research. Primary outcome was to investigate progesterone actions on cerebral blood flow velocimetry using trans-cranial doppler and on visco-elastic properties of the coagulation and fibrinolytic system by rotational thrombo-elastometry (ROTEM) scanning. Secondary outcome were tracking mortality rate and length of ICU stay. Methods. The current research was a prospective, randomized, double-blind, placebo controlled mono-centeric study. Three hundred thirty two (332) adult patients of both sexes aged 25–60 years, recruited with solo tSAH (no other intra- axial lesions) admitted to Minia university hospital, neuro-critical care floor one. Exclusion criteria included poly-trauma patients (accompanying bone fractures or surgical abdomen), Glasgow coma scale less than 8, red blood cell transfusion during the first 6 hours after admission, hematochrit value > 50%, history of deep venous thrombosis. Two groups were designed, Control group and Progesterone (PR) group. PR group received 100 mg (2ml) intramuscular seven days once daily from hospital admission, while Control group received intramuscular isotonic saline (2ml) daily for seven days as a placebo. Trans-cranial doppler was performed on admission, two days and seven days post-admission. ROTEM exploited on admission and seven days after admission.ResultsProgesterone ameliorated hyperfibrinolysis ( prolong LYS 30 min.) of ROTEM scanning but no other impact on other parameters. Progesterone statistically dampened resistive vascular indices namely pulsatality index (P value =0.001, 0.003) and resistive index (P value=0.001,0.003) but no effect on mean flow velocity of bilateral middle cerebral artery scanning, Progesterone also shortened ICU stay. Conclusions.Progesterone can offer neuronal protection in patients with tSAH by impeding over-fibrinolytic activation .Registration number. (NCT04426487) on clinical trial.gov.Date of registration. Eight of June 2020. Institutional review board. (625/4-2020).","PeriodicalId":41147,"journal":{"name":"Pediatric Anesthesia and Critical Care Journal","volume":"14 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76002737","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":"Survey of the Level of Preparedness and Fears among Staff of the Department of Anaesthesia Regarding the Management of COVID-19 Patients in Zaria-Nigeria","authors":"Yakubu Sy, Idris Me, Y. H, Muhammad St, Yunus Aa, Lawal Ii","doi":"10.26502/acc.030","DOIUrl":"https://doi.org/10.26502/acc.030","url":null,"abstract":"Introduction Coronavirus disease (COVID-19) is a respiratory infection caused by a novel coronavirus first observed in Wuhan China in December 2019. Some developed countries were caught unaware by the pandemic and faced a lack of intensive care unit (ICU) beds. The challenge was dire in Africa due to an inadequate number of health personnel, ICU, and ventilators. This survey was to determine the level of preparedness and fears among anaesthesia staff regarding the management of COVID-19 patients in Zaria. Materials and Methods In April 2020 structured questionnaires were sent out by WhatsApp to all anaesthesia staff. Demographic data, professional role, level of preparedness, availability of working materials/equipment, fear of COVID-19, perceived level of stress, stigmatization, and the willingness or otherwise to volunteer in the management of COVID-19 patients were collated. Anesth Crit Care 2021; 3 (4): 88-94 DOI: 10.26502/acc.030 Anesthesia and Critical Care 89 Ethics approval was waived and participants consented. Data were analyzed using SPSS version 21. The level of significance was set at p < 0.05. Results All 45 respondents had no life insurance. Forty-four (97.8%) lacked access to COVID-19 testing while 36 (80%) have not received any training on COVID-19 and the use of personal protective equipment. Twenty-eight of 43 staffs were not prepared to participate in the management of COVID-19 patients. Conclusions This survey showed that most staff had no life insurance, lacked access to COVID-19 testing and training. The fear of being infected with COVID-19 was high and two-thirds were not prepared to participate in the management of infected patients. However, only half became stressed up during the period.","PeriodicalId":41147,"journal":{"name":"Pediatric Anesthesia and Critical Care Journal","volume":"89 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90735635","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":"Clinical Evidence of Ventilator-Induced Lung Injury Vortex in Patients with SARS-CoV-2","authors":"Néstor Pistillo, Pablo Castelluccio, Ricardo Ciano, Eduardo Palermo, Sergio Lage, E. Amundarain, Osvaldo H Fariña","doi":"10.26502/acc.023","DOIUrl":"https://doi.org/10.26502/acc.023","url":null,"abstract":"","PeriodicalId":41147,"journal":{"name":"Pediatric Anesthesia and Critical Care Journal","volume":"60 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78951947","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":"Superficial Cervical Plexus block and Ultrasound-guided styloid process infiltration in Eagle Syndrome","authors":"Yazmín Galván Talamantes, Gerardo Esteban Álvarez Reséndiz, Enrique Kleriga Grossgerge, Jesús Carlos Bustamante Vidales, Mercedes Nicte Lopez Hernandez","doi":"10.26502/acc.022","DOIUrl":"https://doi.org/10.26502/acc.022","url":null,"abstract":"","PeriodicalId":41147,"journal":{"name":"Pediatric Anesthesia and Critical Care Journal","volume":"10 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88467169","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":"Post-Traumatic Stress Disorder Management in a Patient while Undergoing Fracture Shaft Femur Surgery","authors":"Debanjan Bose, Nitu Yadav, N. Kad, M. Yadav","doi":"10.26502/acc.029","DOIUrl":"https://doi.org/10.26502/acc.029","url":null,"abstract":"Post-Traumatic Stress Disorder (PTSD) is a psychiatric disorder that develops after a traumatic event. PTSD in a surgical patient can impact postoperative outcomes. Evidence suggests that the perioperative process can transiently exacerbate PTSD symptoms. Anaesthetist should be aware of its association with cardiovascular dysfunction, chronic pain, depression and cognitive dysfunction. So managing PTSD intraoperatively and trying not to provoke an acute episode perioperatively is extremely challenging for an anaesthetist. Here we are reporting a case of intraoperative onset and management of post-traumatic stress disorder during femur nailing.","PeriodicalId":41147,"journal":{"name":"Pediatric Anesthesia and Critical Care Journal","volume":"99 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83708277","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 Waiting Times for Patients at the Surgical Emergency Reception Service of the Regional Hospital Center (RHC) of Maradi","authors":"Boukari Bm, Maikassoua M, Magagi A, Abdoulaye Mb, A. O, Hassane Ml, Zakari Ms, Rabiu Mb","doi":"10.26502/acc.027","DOIUrl":"https://doi.org/10.26502/acc.027","url":null,"abstract":"Introduction The study of patient management times is one of the essential parameters for evaluating the quality of care in the emergency department. The aim of this work is to assess the time taken to take charge of patients admitted to the medical emergency rooms of the","PeriodicalId":41147,"journal":{"name":"Pediatric Anesthesia and Critical Care Journal","volume":"4 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87798631","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":"Prone-Positioning as an Effective Treatment for Severe Pneumomediastinum in COVID-19 Patients. A Patient Series Cases","authors":"Girardini A, M. A., R. A, Salici F, P. S, Petrucci N","doi":"10.26502/acc.026","DOIUrl":"https://doi.org/10.26502/acc.026","url":null,"abstract":"Pneumomediastinum is a relatively frequent complication of COVID-19. It usually take up to 21 days to reabsorb and, in the critically ill, it could prolong time of mechanical ventilation and healing of the lung. In this case series, we present seven consecutive patients where Pneumomediastinum developed during non-invasive ventilation and was treated by prone positioning. Reabsorption was obtained in 48 hours in all the Cases.","PeriodicalId":41147,"journal":{"name":"Pediatric Anesthesia and Critical Care Journal","volume":"13 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88198901","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":"Hyperammonemia and Pyroglutamic Acidemia in a Sepsis Patient with Gamma-Glutamyl-Cyclus Failure- A Case and Literature Review","authors":"Hans F Ginz, A. Rutherford","doi":"10.26502/acc.024","DOIUrl":"https://doi.org/10.26502/acc.024","url":null,"abstract":"We report the rare case of an adult sepsis patient with very low urea blood values, a high anion gap metabolic acidosis, and high ammonia levels. After exclusion of a primary disturbance of the urea cycle, we found a severe pyroglutamic (also called 5oxoproline) acidemia, 841 μmol l (norm: 5-150), indicating a disrupture of the gamma-glutamyl cycle, a cycle which is responsible for amino acid transportation, redox metabolism, and detoxification of medications, e.g., analgesics and antibiotics. The patient initially was treated with long-term, highdosage rifampicine, linezolid, and piperacillin/tazobactam. Such cycle defects are rarely reported and are mostly found as an inborn disease in early childhood. In adults, diseases of the liver or renal failure, sepsis or diabetes, and certain medications may trigger a secondary cycle disturbance by depletion of vitally important glutathione stores or enzyme inhibition. We recommend that physicians remain aware of extremely low blood urea values that may indicate the beginning of gamma-glutamyl-cycle failure. Anesth Crit Care 2021; 3 (4): 44-49 DOI: 10.26502/acc.024 Anesthesia and Critical Care 45 Countermeasures such as discontinuation of causative medication and nutrition adaption must follow.","PeriodicalId":41147,"journal":{"name":"Pediatric Anesthesia and Critical Care Journal","volume":"40 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76731830","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":"Ketamine - Propofol Combination for Pediatric Procedural Sedation and Analgesia in a Low Resource Setting: an Observational Study","authors":"Bengono Brs, J. B, Metogo Mbengono JA, Amengle Al, Ndikontar R, Kameni Y, Owono Ep, Ze Minkande J","doi":"10.26502/acc.025","DOIUrl":"https://doi.org/10.26502/acc.025","url":null,"abstract":"Background Our objective was to evaluate the efficiency and tolerance of the ketamine-propofol combination for procedural sedation and analgesia in children. Patients and methods It was a prospective and observational study over 6 months involving children aged 1 to 15 years old, ASA I or II, requiring procedural sedation. The Anesth Crit Care 2021; 3 (4): 50-57 DOI: 10.26502/acc.025 Anesthesia and Critical Care 51 children received an initial dose of the mixture made of ketamine 0.75 mg / kg and propofol 0.75 mg / kg. Variables studied included the indication for sedation, time to sedation onset, duration of sedation, recovery time, adverse effects, tolerance of sedation, efficiency of sedation and practitioner satisfaction. Data collection was carried out using a preestablished form, with. analysis performed using Cspro version 7.4 software. Data was expressed as means, medians, and absolute numbers for quantitative variables, and as percentages for qualitative variables. Results Sedation was performed for 46 children. The median age was 3 years. The indications were painful procedures (43.5%) and imaging (34.8%). The median drug dose administered was 0.75 mg / kg of ketamine and propofol (IQR = 0.73 to 0.80 mg / kg). Sedation was adequate in all patients. Minor adverse effects were encountered in 12 children (26.1%), with 8 cases of nystagmus (17.4%) and 2 cases of agitation (4.3%). The mean sedation time was 17 ± 10.4 minutes. The median recovery time was 10 minutes (IQR = 8 to 14.3). The mean time to onset of sedation was 32.2 ± 6.9 seconds. The satisfaction scores were high. Conclusion Procedural sedation and analgesia using the ketamine-propofol combination is an interesting and effective option. It presents with minor adverse effects and recovery time is short.","PeriodicalId":41147,"journal":{"name":"Pediatric Anesthesia and Critical Care Journal","volume":"163 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73256700","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}