Anesthesiology Research and Practice最新文献

{"title":"Effectiveness of Prophylactic Bolus Ephedrine Versus Norepinephrine for Management of Postspinal Hypotension during Elective Caesarean Section in Resource Limited Setting: A Prospective Cohort Study.","authors":"Mitiku Desalegn,&nbsp;Tewoderos Shitemaw,&nbsp;Habtamu Tamrat","doi":"10.1155/2022/7170301","DOIUrl":"https://doi.org/10.1155/2022/7170301","url":null,"abstract":"<p><strong>Background: </strong>Spinal anaesthesia for caesarean section is the preferred technique since it provides better maternal safety and neonatal outcome compared to general anaesthesia. Hypotension is the most common complication after spinal anaesthesia. The study aims to determine the effectiveness of a prophylactic bolus dose of norepinephrine and ephedrine on the management of postspinal hypotension during caesarean section.</p><p><strong>Method: </strong>An institutional-based prospective cohort study was conducted on 84 pregnant women undergoing elective caesarean section. Based on the responsible anaesthetist's postspinal hypotension management plan, patients were divided into two groups. Those patients who received ephedrine are grouped into the ephedrine (EPH, <i>n</i> = 42) group, and patients who received norepinephrine are grouped under the norepinephrine group (NE, <i>n</i> = 42) by data collectors. After aseptic technique, spinal anaesthesia was administered with 0.5% (3 ml) bupivacaine using a 23G spinal needle. During spinal anaesthesia, a prophylactic bolus dose of 10 mg (2 ml) EPH or 16 g (2 ml) NE was given based on management plan of the shift anaesthetist. Mean arterial pressure (MAP), the heart rate (HR), number of boluses of vasopressor used, incidence of nausea and vomiting, and the Apgar score of babies at 1 and 5 min between the groups were recorded.</p><p><strong>Results: </strong>The norepinephrine group had a statistically significant higher MAP compared to the ephedrine group in the first 10 and 15 min (<i>p</i> < 0.05) of the study period. Thereafter, there was no statistically significant difference in MAP between the groups until the end of the study period (<i>p</i> > 0.05). The ephedrine group had a statistically significant higher heart rate throughout the procedure compared to the norepinephrine group (<i>p</i> < 0.05). The norepinephrine group required a lower bolus number of vasopressors compared to the ephedrine group to maintain blood pressure. The Apgar scores of all babies at 1 and 5 min were above seven. Significant differences regarding maternal complications (nausea and vomiting) between the groups were not detected (nausea, <i>p</i>=0.21 and vomiting, <i>p</i>=0.092).</p><p><strong>Conclusion: </strong>Norepinephrine can be used instead of ephedrine to keep a pregnant mother's blood pressure stable during a caesarean section under spinal anaesthesia without causing harm to the mother or baby. Trial registration. ClinicalTrials.gov Identifier: NCT05522088 (Date of registration: 30/08/22).</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":" ","pages":"7170301"},"PeriodicalIF":1.4,"publicationDate":"2022-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9550498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33526644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lumbar Erector Spinae Plane Block for Total Hip Arthroplasty Comparing 24-Hour Opioid Requirements: A Randomized Controlled Study.","authors":"Dahlia Townsend,&nbsp;Nasir Siddique,&nbsp;Atsumi Kimura,&nbsp;Yaacov Chein,&nbsp;Eli Kamara,&nbsp;John Pope,&nbsp;Mitchell Weiser,&nbsp;Singh Nair,&nbsp;Iyabo Muse","doi":"10.1155/2022/9826638","DOIUrl":"https://doi.org/10.1155/2022/9826638","url":null,"abstract":"<p><strong>Design: </strong>Prospective, randomized, controlled trial. <i>Patients</i>. Sixty-three adult patients with an American Society of Anesthesiologists Status I-III who are undergoing elective primary total hip arthroplasty. <i>Interventions.</i> Patients were randomized to the control group (no block) or the ESPB group (preoperative ultrasound-guided lumbar ESPB). Intraoperatively, all patients received spinal anesthesia with moderate sedation. Postoperatively, patients received a standardized multimodal analgesia protocol. <i>Measurements</i>. The primary outcome was cumulative opioid consumption at 24 hours postoperatively. Secondary outcomes included cumulative opioid consumption at 8 hours and through 48 hours postoperatively and pain scores at 24 and 48 hours post surgery. <i>Main Results.</i> Thirty-one patients were randomized to the control group (spinal alone) and 32 patients to the ESPB group. The median opioid requirement in the first 8 hours after surgery was higher in the control group (28 mg of oral morphine equivalents (OME) versus 5 mg of OME in the ESPB group) (<i>p</i> = 0.013). There was no statistically significant difference in opioid consumption between the groups at 24 hours (<i>p</i> = 0.153) or 48 hours (<i>p</i> = 0.357) postoperatively. There was no statistically significant difference in pain scores between the two groups through 24 hours (<i>p</i> = 0.143) or 48 hours (<i>p</i> = 0.617) after surgery.</p><p><strong>Conclusion: </strong>Lumbar ESPB reduces opioid utilization during the first 8 hours postoperatively after total hip arthroplasty but not thereafter. Evaluating the use of either adding a local anesthetic adjunct to the ESPB or using longer-acting local anesthetic warrants further investigation.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":" ","pages":"9826638"},"PeriodicalIF":1.4,"publicationDate":"2022-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9550514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33526645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Emergence Delirium in Children Undergoing Tonsillectomy and Adenoidectomy.","authors":"Katie Liu,&nbsp;Christopher Liu,&nbsp;Seckin O Ulualp","doi":"10.1155/2022/1465999","DOIUrl":"https://doi.org/10.1155/2022/1465999","url":null,"abstract":"<p><strong>Objective: </strong>Emergence delirium (ED) is associated with behavioral disturbances and psychomotor agitation, increased risk of selfinjury, delayed discharge, and parental dissatisfaction with quality of care. Otolaryngology procedures are associated with an increased risk of ED. The aims of this study were to determine the prevalence of ED in children who had tonsillectomy and adenoidectomy (T&A), assess the characteristics of children who had ED, and ascertain the recovery times of patients with ED.</p><p><strong>Methods: </strong>Charts of patients who had tonsillectomy and adenoidectomy between Jan 1, 2018 and March 26, 2020 at a tertiary children's hospital were reviewed. Data collection included demographics, body mass index, indication for T&A, Pediatric Anesthesia Emergence Delirium (PAED) score, American Society of Anesthesiologists (ASA) physical status classification, total anesthesia time, postanesthesia care phase I time, and postanesthesia care phase II time.</p><p><strong>Results: </strong>Of the 4974 patients who underwent T&A, ED occurred in 1.3% of patients. Toddlers (2.9%) and male children (1.6%) had a significantly higher prevalence of ED. Prevalence of ED was similar amongst patients with recurrent tonsillitis, patients with obstructive sleep disordered breathing, and patients with both obstructive sleep apnea (OSA) and recurrent tonsillitis. The prevalence of ED was not different amongst ASA I, ASA II, and ASA III. Males with ED had longer total anesthesia times (41 <i>v</i>. 34 minutes, <i>p</i>=0.02) and ASA I patients with ED had longer phase I times (<i>p</i>=0.04) in the postanesthesia care unit (PACU). There was no significant difference in total anesthesia time, phase I time, or phase II time when compared across the subgroups of gender, age, indication for T&A, severity of obstructive sleep apnea (OSA), and ASA score.</p><p><strong>Conclusions: </strong>Males, toddlers, and preschool-age children were more likely to have ED. Males with ED had longer total anesthesia times. ED was associated with longer phase I times in ASA I patients.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":" ","pages":"1465999"},"PeriodicalIF":1.4,"publicationDate":"2022-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9534659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33517184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contributing Factors to Operating Room Delays Identified from an Electronic Health Record: A Retrospective Study.","authors":"Scott M Pappada,&nbsp;Thomas J Papadimos,&nbsp;Sadik Khuder,&nbsp;Sean T Mack,&nbsp;Peyton Z Beachy,&nbsp;Andrew B Casabianca","doi":"10.1155/2022/8635454","DOIUrl":"https://doi.org/10.1155/2022/8635454","url":null,"abstract":"<p><p>The operating room (OR) is considered a major cost center and revenue generator for hospitals. Multiple factors contribute to OR delays and impact patient safety, patient satisfaction scores, and hospital financial performance. Reducing OR delays allows better utilization of OR resources and staffing and improves patient satisfaction while decreasing operating costs. Accurate scheduling can be the basis to achieve these goals. The objective of this initial study was to identify factors not normally documented in the electronic health record (EHR) that may contribute to or be indicators of OR delays. <i>Materials and Methods</i>. A retrospective data analysis was performed analyzing 67,812 OR cases from 12 surgical specialties at a small university medical center from 2010 through the first quarter of 2017. Data from the hospital's EHR were exported and subjected to statistical analysis using Statistical Analysis System (SAS) software (SAS Institute, Cary, NC). <i>Results</i>. Statistical analysis of the extracted EHR data revealed factors that were associated with OR delays including, surgical specialty, preoperative assessment testing, patient body mass index, American Society of Anesthesiologists (ASA) physical status classification, daily procedure count, and calendar year. <i>Conclusions</i>. Delays hurt OR efficiency on many levels. Identifying those factors may reduce delays and better accommodate the needs of surgeons, staff, and patients thereby leading to improved patient's outcomes and patient satisfaction. Reducing delays can decrease operating costs and improve the financial position of the operating theater as well as that of the hospital. Anesthesiology teams can play a key role in identifying factors that cause delays and implementing mitigating efficiencies.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":" ","pages":"8635454"},"PeriodicalIF":1.4,"publicationDate":"2022-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9489409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33488745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Emergence Delirium and Associated Factors among Older Patients Who Underwent Elective Surgery: A Multicenter Observational Study.","authors":"Gezahegn Tesfaye Mekonin,&nbsp;Megersa Kelbesa Olika,&nbsp;Mitiku Birhanu Wedajo,&nbsp;Ashanafi Tolasa Badada,&nbsp;Abebe Dukessa Dubiwak,&nbsp;Tajera Tageza Ilala,&nbsp;Mamo Nigatu Gebre","doi":"10.1155/2022/2711310","DOIUrl":"https://doi.org/10.1155/2022/2711310","url":null,"abstract":"<p><strong>Background: </strong>Emergence delirium is a common and serious postoperative complication in older surgical patients. It occurs at any time in the perioperative period, during or immediately following emergence from general anesthesia. Unfortunately, it is highly associated with postoperative complications such as a decrease in functional capacity, prolonged hospital stay, an increase in health care costs, and morbidity and mortality. The goal of this study was to determine the prevalence of emergence delirium and associated factors among older patients who underwent elective surgery in the teaching hospitals of Ethiopia at the postanesthesia care unit in 2021.</p><p><strong>Methods: </strong>A multicenter prospective observational study was conducted at the postanesthetic care unit in the four teaching hospitals of Ethiopia. Older surgical patients admitted to the postanesthesia care unit who underwent elective surgery in the four teaching hospitals of Ethiopia were selected by using simple random sampling. Pretested structured questionnaire was used to collect data. Data were entered into EpiData (version 4.6) and exported to the SPSS (version 25.0). Binary logistic regression was used to identify factors independently associated with the emergence delirium.</p><p><strong>Results: </strong>Out of 384 older patients included in the study, the prevalence of emergence delirium was 27.6%. Preoperative low hemoglobin levels (AOR: 2.0, 95% CI; 1.77-3.46), opioid (AOR: 8.0, 95% CI; 3.22-27.8), anticholinergic premedications (AOR: 8.5, 95% CI; 6.85-17.35), and postoperative pain (AOR: 3.10, 95 CI; 2.07-9.84) at PACU were independently associated with emergence delirium.</p><p><strong>Conclusion: </strong>The prevalence of emergence delirium was high among older patients who underwent elective surgery. Opioid and anticholinergic premedication, low preoperative hemoglobin, and the presence of postoperative pain were independently associated with the emergence delirium. Adequate preoperative optimization and postoperative analgesia may reduce the prevalence of emergence delirium.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":" ","pages":"2711310"},"PeriodicalIF":1.4,"publicationDate":"2022-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9481404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40367095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Achieving Lumbar Epidural Block Competency in Inexperienced Trainees after a Structured Epidural Teaching Model: A Randomized, Single Blind, Prospective Comparison of CUSUM Learning Curves.","authors":"Marco Scorzoni,&nbsp;Gian Luigi Gonnella,&nbsp;Emanuele Capogna,&nbsp;Matteo Velardo,&nbsp;Pietro Paolo Giuri,&nbsp;Mariano Ciancia,&nbsp;Giorgio Capogna,&nbsp;Gaetano Draisci","doi":"10.1155/2022/1738783","DOIUrl":"https://doi.org/10.1155/2022/1738783","url":null,"abstract":"<p><strong>Aim: </strong>The aim of this randomized, prospective study was to investigate whether the use of the structured epidural teaching model (SETM) may affect the learning curve for lumbar epidural block in novice trainees when compared with a standard teaching module.</p><p><strong>Introduction: </strong>There is a paucity of literature regarding the efficacy of teaching epidural blocks and comparisons between the different educational approaches.</p><p><strong>Method: </strong>Forty-four PGY3 anesthesia trainees were randomized to receive (study group) or to not receive (control group) the SDM (structured didactic model) before the beginning of their 6 months clinical practice rotation in labor and delivery suites. A CUSUM learning curve was built for every trainee. The scores were assigned by the staff instructor, who was unaware of the group to which the trainee belonged.</p><p><strong>Results: </strong>The number of subjects who achieved an improvement in performance was 8 trainees from the control group and 14 from the study group. The probability of achieving an improvement was higher (<i>p</i> < 05) in the study group than in the control group, with an aOR of 3.25 (CI: 1.01; 12.1). The proportion of subjects in the study group who completed the epidural without help was 1.21 (1.05-1.41) times the proportion of subjects who completed the epidural without help in the control group. The probability of completing the epidural block without any assistance was 21% higher in the study group than in the control group (<i>p</i> < 05).</p><p><strong>Conclusion: </strong>We have demonstrated that the use of the structured epidural teaching model (SETM) may improve the learning curve (CUSUM) for lumbar epidural block in novice, entirely inexperienced, anesthesia trainees.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":" ","pages":"1738783"},"PeriodicalIF":1.4,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9463033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33461595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Cell Salvage on Bleeding and Transfusion Needs in Cardiac Surgery.","authors":"Frixos Tachias,&nbsp;Evangelia Samara,&nbsp;Anastasios Petrou,&nbsp;Agathi Karakosta,&nbsp;Stavros Siminelakis,&nbsp;Efstratios Apostolakis,&nbsp;Petros Tzimas","doi":"10.1155/2022/3993452","DOIUrl":"https://doi.org/10.1155/2022/3993452","url":null,"abstract":"<p><strong>Introduction: </strong>Cell salvaging is well established in the blood management of cardiac patients, but there remain some concerns about its effects on perioperative bleeding and transfusion variables. This randomized controlled study investigated the potential effects of the centrifuged end-product on bleeding, transfusion rates, and other transfusion-related variables in adult cardiac surgery patients submitted to extracorporeal circulation.</p><p><strong>Materials and methods: </strong>Patients were randomly chosen to receive (cell-salvage group, 99 patients) or not to receive (control group, 110 patients) the centrifuged product of a cell salvage apparatus. Bleeding and transfusion rates according to the universal definition of perioperative bleeding (UDPB) classification, postoperative hemoglobin, coagulation, and oxygenation indices were recorded and compared between the groups.</p><p><strong>Results: </strong>Both groups had almost identical bleeding and transfusion rates (median value: 2 units of red blood cells (RBC) and no units of fresh frozen plasma (FFP) and platelets (PLT) for both groups, <i>p</i> > 0.05). Patients in the cell-salvage group presented slightly higher hemoglobin concentrations (10.6 ± 1.1 vs. 10.1 ± 1.7 g/dL, <i>p</i> < 0.05, respectively) and a tendency towards better oxygenation indices (P_aO₂/F_iO₂: 241 ± 94 vs. 207 ± 84, <i>p</i>=0.013) in the postoperative period albeit with a tendency for prolongation of prothrombin time (INR: 1.31 ± 0.18 vs. 1.26 ± 0.12, <i>p</i>=0.008).</p><p><strong>Conclusion: </strong>Within the study's constraints, the perioperative use of the cell salvage concentrate does not seem to affect bleeding or transfusion variables, although it could probably ameliorate postoperative oxygenation in adult cardiac surgery patients. A tendency to promote coagulation disturbances was detected.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":" ","pages":"3993452"},"PeriodicalIF":1.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9458370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33461594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retracted: A Posterior TAP Block Provides More Effective Analgesia Than a Lateral TAP Block in Patients Undergoing Laparoscopic Gynecologic Surgery: A Retrospective Study.","authors":"Anesthesiology Research And Practice","doi":"10.1155/2022/9768905","DOIUrl":"https://doi.org/10.1155/2022/9768905","url":null,"abstract":"<p><p>[This retracts the article DOI: 10.1155/2016/4598583.].</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":" ","pages":"9768905"},"PeriodicalIF":1.4,"publicationDate":"2022-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9420058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33446834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Delirium Risk Predication Model among ICU Patients in Oman.","authors":"Rasha Khamis Al-Hoodar,&nbsp;Eilean Rathinasamy Lazarus,&nbsp;Omar Alomari,&nbsp;Omar Alzaabi","doi":"10.1155/2022/1449277","DOIUrl":"https://doi.org/10.1155/2022/1449277","url":null,"abstract":"<p><strong>Background: </strong>Delirium is a common disorder among patients admitted to intensive care units. Identification of the predicators of delirium is very important to improve the patient's quality of life.</p><p><strong>Methods: </strong>This study was conducted in a prospective observational design to build a predictive model for delirium among ICU patients in Oman. A sample of 153 adult ICU patients from two main hospitals participated in the study. The Intensive Care Delirium Screening Checklist (ICDSC) was used to assess the participants for delirium twice daily.</p><p><strong>Result: </strong>The results showed that the incidence of delirium was 26.1%. Multiple logistic regression analysis showed that sepsis (odds ratio (OR) = 9.77; 95% confidence interval (CI) = 1.91-49.92; <i>P</i> < 0.006), metabolic acidosis (odds ratio (OR) = 3.45; 95% confidence interval [CI] = 1.18-10.09; <i>P</i>=0.024), nasogastric tube use (odds ratio (OR) 9.74; 95% confidence interval (CI) = 3.48-27.30; <i>P</i> ≤ 0.001), and APACHEII score (OR = 1.22; 95% CI = 1.09-1.37; <i>P</i> ≤ 0.001) were predictors of delirium among ICU patients in Oman (<i>R</i> ²=0.519, adjusted <i>R</i> ²=0.519, <i>P</i> ≤ 0.001).</p><p><strong>Conclusion: </strong>To prevent delirium in Omani hospitals, it is necessary to work on correcting those predictors and identifying other factors that had effects on delirium development. Designing of a prediction model may help on early delirium detection and implementation of preventative measures.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":" ","pages":"1449277"},"PeriodicalIF":1.4,"publicationDate":"2022-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9357679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40606228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of High-Dose Vitamin C Infusion on Outcomes in Sepsis Requiring Mechanical Ventilation: A Double-Blind Randomized Controlled Trial.","authors":"Wessam A El Driny,&nbsp;Ibrahim M Esmat,&nbsp;Sara M Shaheen,&nbsp;Nagwa A Sabri","doi":"10.1155/2022/4057215","DOIUrl":"https://doi.org/10.1155/2022/4057215","url":null,"abstract":"<p><strong>Background: </strong>Critically ill patients have an increased requirement for vitamin C in sepsis and these patients have low levels of vitamin C. The researchers validated the efficacy of high-dose vitamin C intravenous infusion (IVI) in patients with sepsis requiring mechanical ventilation.</p><p><strong>Methods: </strong>Forty patients were randomly assigned to 2 groups (20 each) in a 1 : 1 ratio in accordance with the vitamin C treatment regimen: Group I (GI): patients received 1.5 g/6 h vitamin C in 50 ml of dextrose 5% in water (D5W) IVI over 30 minutes for 4 consecutive days; Group II (GII): patients received 100 mg vitamin C/day as a first single dose in 50 ml of D5W IVI over 30 minutes and the other three subsequent doses were 50 ml of plain D5W IVI over 30 minutes for 4 consecutive days. Primary outcomes were the change in sequential organ failure assessment (SOFA) score at day 7, the incidence of ventilator-associated pneumonia (VAP), and the plasma vitamin C level. The glutathione peroxidase (GPX) activity, C-reactive protein (CRP) level, duration of vasopressor therapy, and 28-day mortality were secondary outcomes.</p><p><strong>Results: </strong>The change in SOFA score at day 7 showed a significant difference between GI and GII (<i>p</i> < 0.001). The incidence of early VAP was significantly lower in GI (<i>p</i>=0.044). Vitamin C levels showed a significant rise in GI at day 1 and day 4 (<i>p</i> < 0.001 and <i>p</i> < 0.001, respectively). GPX activity of day 4 and day 7 was significantly higher in GI (<i>p</i>=0.005 and <i>p</i>=0.014, respectively). CRP levels of day 4 and day 7 were significantly higher in GII (<i>p</i> < 0.001 and <i>p</i> < 0.001, respectively). There was a significant difference in 28-day mortality (<i>p</i>=0.038) and duration of vasopressor therapy (<i>p</i>=0.033) in GI compared to GII.</p><p><strong>Conclusion: </strong>The early use of high-dose vitamin C intravenous infusion in patients with sepsis requiring mechanical ventilation in combination with the standard treatment for sepsis lowered the incidence of VAP, increased the antioxidant status, and improved the illness severity. <i>Trial Registration.</i> This trial is registered with ClinicalTrials.gov Identifier (NCT04029675).</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":" ","pages":"4057215"},"PeriodicalIF":1.4,"publicationDate":"2022-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9307402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40533664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}