BMC anesthesiology
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Randomized Controlled Trial
Erythropoietin for the prevention of postoperative neurocognitive disorder in older adult patients undergoing total joint arthroplasty: a randomized controlled study.
Post-operative delirium (PD) is a common post-operative complication with significant clinical and financial impacts on patients. Erythropoietin (EPO), a multi-functional glycoprotein hormone, exhibits erythropoietic and non-erythropoietic anti-inflammatory properties. This study aimed to determine the role of perioperative EPO administration in the development of postoperative delirium in older adult patients undergoing total joint arthroplasty. ⋯ Perioperative EPO reduced the incidence of post-operative delirium, although not statistically significant, with no differences in post-operative cognitive function and inflammatory responses.
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Case Reports
Pharmacogenotyping disproves genetic cause of drug-related problems in family history: a case report.
In clinical practice, family medication history is not routinely assessed as part of a patient's family health history (FHH). The information is self-reported and can depend on the individual's subjective perception. To illustrate how pharmacogenetic (PGx) testing results could be used to validate self-reported family medication history on drug-related problems (DRP), as well as to inform medication-related decisions, we herein present a case involving ten members of the same family. ⋯ The original trigger for PGx testing was the self-reported, conspicuous family medication history of DRP reported by the grandmothers. However, the girl's genotype predicted phenotypes of CYP2B6 IM and CYP2D6 PM, differed from the grandmothers'. With this exemplary case, we propose that hereditary concerns based on self-reported information on DRP should be verified by a PGx panel test, when the respective drug exhibits a PGx association. Also, the girl's PGx testing results provided important medication recommendations, which were considered perioperatively by the anesthetist suggesting to use PGx testing results preemptively to inform medication-related decisions.
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Randomized Controlled Trial Comparative Study
Microbiological comparison of the disinfecting efficacy of small and large cotton swabs in nasotracheal intubation: a randomized trial.
Nasotracheal intubation (NTI) is necessary during surgeries requiring clear access to the surgical field and in patients with respiratory issues. This study investigates the pre-NTI nasal disinfection efficacy of different cotton swab sizes, hypothesizing that smaller swabs could minimize bleeding while maintaining disinfection efficacy. ⋯ Cotton swab thickness did not impact disinfection efficacy, but large swabs increased the risk of nasal bleeding. We recommend FCS for nasal disinfection prior to NTI in ASA 1-2 patients, as they reduce bleeding risk without compromising disinfection.
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Transpulmonary pressure is the effective pressure across the lung parenchyma and has been proposed as a guide for mechanical ventilation. The pleural pressure is challenging to directly measure in clinical setting and esophageal manometry using esophageal balloon catheters was suggested for estimation. However, the accuracy of using esophageal pressure to estimate pleural pressure is debated due to variability in the mechanical properties of respiratory system, esophagus and esophageal catheter. Furthermore, while a vertical pleural pressure gradient exists across lung regions, esophageal pressure balloon provides a single value, representing, at most, the pressure surrounding the esophagus. ⋯ The correction technique, based on the mechanical response of esophageal wall to the balloon inflation, is fundamental for obtaining reliable estimations of absolute intrathoracic pressure values, and for ensuring its correct application in clinical setting.
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Observational Study
Changes of endotracheal tube cuff pressure and its indicators in laparoscopic resection of colorectal neoplasms: an observational prospective clinical trial.
Laparoscopic surgery is a popular alternative for resection of colorectal neoplasms. Carbon dioxide pneumoperitoneum and Trendelenburg positioning in procedure can significantly increase airway pressure, when endotracheal tube cuff pressure is not monitored. This prospective observational study aimed to evaluate indicators, changes and its correlation factors of endotracheal tube cuff pressure during laparoscopic resection of colorectal neoplasms. ⋯ Patients with normal BMI undergoing laparoscopic resection of colorectal neoplasms require continuous monitoring and timely adjustments of tracheal tube cuff pressure. Compared with BMI, waist-to-hip ratio is a better predictor of out-of-range tracheal tube cuff pressure.