Department Of Anesthesiology Research Articles

COMPARISON OF INTRAVENOUS LIGNOCAINE, TRAMADOL, AND KETOROLAC FOR ATTENUATION OF PROPOFOL INJECTION PAIN

Aims: This study aims to study and compare the efficacy of lignocaine, tramadol, and ketorolac in minimizing propofol injection pain. Methods: This is a randomized control research that was conducted on 100 patients between the ages of 18 and 60 years at the department of anesthesiology and critical care. Being planned for elective surgery under general anesthesia with propofol as an inducing drug, with an ASA grade I or II body mass index of 19–30 kg/m2. Each of the four groups of 25 patients was randomly selected from among all the patients. Results: The incidence of pain was 20% in the lignocaine group and 28% in the groups treated with tramadol and ketorolac. 92% of patients in the normal saline group felt discomfort during the propofol injection. In comparison to group N (7.46±2.78), the mean pain score in groups L (0.80±1.32), T (0.98±1.70), and K (1.49±1.55) was statistically significant (p<0.0001). Group N saw noticeably less side effects than the other groups. Statistics showed that groups L, T, and K were comparable. Conclusion: We recommend the use of these agents as pre-treatment to propofol to increase the patient acceptability of this ideal anesthetic agent.

Optimizing Preoperative Iron Deficiency Anemia in Patients Undergoing Cardiac Surgery

Background: Preoperative anemia is common in patients undergoing cardiac surgery, with iron deficiency being the most common cause of anemia in these patients. Patients who are anemic in the preoperative setting have worse perioperative outcomes than patients with normal hemoglobin levels including higher rates of red cell transfusions, acute kidney injury, increased length of stay, and increased mortality. At the University of Virginia (UVA) Medical Center, there was no institutional process in place to identify and treat iron deficiency anemia in patients planned to undergo cardiac surgery. Objective: The UVA Perioperative Blood Management Committee is a newly-formed multidisciplinary group consisting of members from the departments of Hematology, Anesthesiology, Thoracic and Cardiovascular Surgery, Perfusion, and Blood Bank who work together to improve perioperative patient outcomes and blood product utilization. We set out to implement a testing algorithm with the purpose of improving the proportion of anemic patients undergoing cardiac surgery who have iron studies performed in the outpatient setting, thereby improving the percentage of patients receiving intravenous (IV) iron preoperatively. Methods: We adapted two published perioperative treatment algorithms (Lin, Hematology Am Soc Hematol Educ Program 2019; Munting and Klein, Anaesthesia 2019) which recommend iron therapy in patients with hemoglobin < 13 g/dL, ferritin < 100 µg/L, and/or transferrin saturation < 20% for our cardiac surgery preoperative clinic. In November 2022, we implemented a reflex test within Epic electronic medical record that automatically sent ferritin, iron, and transferrin for patients with hemoglobin < 13 g/dL to evaluate for iron deficiency. Patients meeting parameters for iron deficiency (ferritin < 30 ng/mL and/or transferrin saturation < 20%) were then scheduled for iron infusions. We compared the percentage of patients undergoing testing for iron deficiency, as well as the percentage of anemic patients receiving iron infusion preoperatively, to those from a six month period prior to our start date. Results: Between May 31, 2022 and October 31, 2022, 19% of cardiac surgery patients at UVA with hemoglobin values < 13 g/dL had iron studies drawn in the three months prior to surgery. After implementing outpatient reflex iron testing, that number increased to 42% between November 2022 and May 2023 (p < 0.001). In the six months prior to implementation, four iron deficient cardiac surgery patients received preoperative IV iron an average of one day prior to surgery. Between November 1, 2022 and May 29, 2023, fifteen patients received IV iron an average of 5.7 days prior to surgery. The patients who received IV iron had lower rates of blood transfusions than anemic patients who did not receive IV iron (53% vs. 65%) and fewer units of blood transfused per patient who received blood (3.1 vs. 5.7). Conclusions: Results from the first seven months of this project suggest that using a standardized testing methodology in the outpatient setting can increase the uptake of iron testing and thereby treatment of iron deficiency anemia in the preoperative setting. Patients who received IV iron had lower rates of blood transfusions and received fewer units of blood on average than anemic patients who did not receive IV iron. We next plan to implement an iron testing strategy in cardiac surgery inpatients to further improve rates of iron testing and iron infusions in this population. We have created an IRB-approved database to study more patient-centered outcomes such as acute kidney injury, stroke, length of stay, readmissions, and mortality to determine if we can detect a measurable impact from IV iron administration in our patient population.

Predictors of death in seriously injured patients

The purpose of the study. To analyze the structure of the incoming flow in conditions of conducting large-scale military operations at the stage of emergency specialized surgical care and to determine the predictors of an unfavorable outcome in patients with severe combined wounds. Materials and methods. A retrospective cohort study of medical data was performed in seriously wounded during a special military operation who were admitted to the department of anesthesiology, intensive care and intensive care of a level 3 military medical organization with severe combined wounds and trauma in 45 seriously wounded. Depending on the outcome of treatment, the seriously injured and injured were divided into 2 groups: survivors (n=30, 66.6%) and deceased (n=15, 33.4%) within a 30-day period from the moment of injury. Results. In the structure of seriously injured people in need of resuscitation, gunshot wounds predominate 84.5% (fragmentation — 95.4%, bullet — 4.6%), surgical diseases account for 7.2% of cases, closed trauma occurs in 5.1% of cases, thermal lesions — 3.2%. Combined and multiple wounds were diagnosed in 96.2% of cases. Upon admission, the predictors of death are hypothermia (p-value=0.011), the time elapsed from injury to qualified surgical care (p-value=0.035), the severity of the condition on the APACHE II scale (p-value=0.047). During treatment at the stage of emergency specialized surgical care, the predictors of death are the laboratory assessment of total bilirubin (p-value=0.006), the SOFA scale (p-value=0.015), an increase in creatinine levels (p-value=0.018), the appearance of metabolic acidosis (p=0.022), an increase in the dose of norepinephrine (p-value=0.015).value=0.033), as well as an increase in potassium levels (p-value=0.041). Conclusion. The result of the study showed a high frequency of combined injuries admitted to the OARIT. The predictors of an unfavorable outcome at admission were hypothermia; the time elapsed from the moment of injury to the provision of qualified surgical care; the severity of the condition on the APACHE II scale. And during intensive therapy, the predictors were: an assessment on the SOFA scale, an increase in creatinine levels, total bilirubin, potassium levels and metabolic acidosis.

Patent and Bibliometric Analysis of the Scientific Landscape of the Use of Pulse Oximeters and Their Prospects in the Field of Digital Medicine.

This study conducted a comprehensive patent and bibliometric analysis to elucidate the evolving scientific landscape surrounding the development and application of pulse oximeters, including in the field of digital medicine. Utilizing data from the Lens database for the period of 2000-2023, we identified the United States, China, the Republic of Korea, Japan, Canada, Australia, Taiwan, and the United Kingdom as the predominant countries in patent issuance for pulse oximeter technology. Our bibliometric analysis revealed a consistent temporal trend in both the volume of publications and citations, underscoring the growing importance of pulse oximeters in digitally-enabled medical practice. Using the VOSviewer software(version 1.6.18), we discerned six primary research clusters: (1) measurement accuracy; (2) integration with the Internet of Things; (3) applicability across diverse pathologies; (4) telemedicine and mobile applications; (5) artificial intelligence and deep learning; and (6) utilization in anesthesiology, resuscitation, and intensive care departments. The findings of this study indicate the prospects for leveraging digital technologies in the use of pulse oximetry in various fields of medicine, with implications for advancing the understanding, diagnosis, prevention, and treatment of cardio-respiratory pathologies. The conducted patent and bibliometric analysis allowed the identification of technical solutions to reduce the risks associated with pulse oximetry: improving precision and validity, technically improved clinical diagnostic use, and the use of machine learning.

A comparative study of the efficacy of intravenous magnesium sulphate and intravenous dexmedetomidine in attenuating haemodynamic response to laryngoscopy and endotracheal intubation

Both laryngoscopy and tracheal intubation elicit a sympathetic and parasympathetic response, which varies depending on the depth of anaesthesia, duration of laryngoscopy, and patient characteristics. Although different methods have been used to suppress the response, an ideal agent has yet to be discovered. This study compares and contrasts the effectiveness of intravenous dexmedetomidine and intravenous magnesium sulphate in reducing hemodynamic response during laryngoscopy and endotracheal intubation.: This 18-month prospective, randomised, double-blind, placebo-controlled comparative research was conducted in the Department of Anaesthesiology and Critical Care, Bokaro General Hospital, Bokaro Steel City, Jharkhand. One hundred twenty consenting study participants were randomly divided into three groups of forty. Before induction, Group A received IV normal saline as a placebo. Group B received 1 mcg/kg IV dexmedetomidine before induction, while Group C received 30 mg/kg IV 50% magnesium sulphate before induction.: Gender distribution was consistent and equal among 120 patients. Gender, age, weight, ASA, and type of surgery did not differ significantly across groups. The three groups had no statistically significant difference in baseline hemodynamic parameters. When compared to the Control Group (A), there were statistically significant changes in hemodynamic parameters in the Dexmedetomidine (B) and Magnesium sulphate (C) groups. There was no hypotension, bradycardia, nausea, vomiting, dry mouth, or arrhythmias.: Dexmedetomidine and magnesium sulphate efficiently reduced the hemodynamic stress response to laryngoscopy and intubation, although dexmedetomidine attenuated the sympathetic response more effectively.

A Patient Undergoing Laparoscopic Radical Prostatectomy and Atrial Defect Closure Simultaneously: A Case Report

Background: Prostatectomy offers the greatest potential for a definitive cure for localized prostate cancer. Closure devices for secundum atrial septal defects have a good safety and efficacy profile. Simultaneous operation of the two types of surgery has not been reported to date. Case Presentation: A 65-year-old man was admitted to receive laparoscopic radical prostatectomy for prostate cancer under general anesthesia. The chest CT imaging unexpectedly showed that the heart and the pulmonary artery were obviously enlarged. Subsequently, a secundum atrial septal defect (ASD) with left-to-right shunt measuring 27*23mm was observed on transthoracic echocardiography (TTE). After a multi-disciplinary team (MDT) consisting of departments of urology, cardiac surgery, and anesthesiology was assembled to discuss the surgical procedure, an atrial septal defect closure device was scheduled to be implanted, followed by laparoscopic radical prostatectomy. The patient underwent both surgeries and was successfully discharged from the hospital. Conclusions: Adequate perioperative assessment and management are crucial for patients. We should pay more attention to patients with cardiac disease undergoing both cardiac and non-cardiac surgery.

Cardiovascular anesthesia training: A single center survey among fellow doctors.

Despite the proliferation of research on anesthesiology training at all stages of medical education, there is relatively little published literature surveying the perspectives and concerns of anesthesiologists regarding cardiovascular anesthesia training. Therefore, we conducted a survey to investigate the attitudes, barriers, expectations, stress experiences, satisfaction, and future aspirations of anesthesiologists trained at a tertiary cardiovascular specialty hospital in China. A questionnaire survey was conducted among 260 anesthesiologists who received cardiovascular anesthesia training at departments of anesthesiology in a tertiary cardiovascular specialty hospital in China. After the study protocol was approved, electronic questionnaires were distributed to the target group through the online survey software "Wen Juan Xing." Respondents were asked to complete an anonymous questionnaire on their smartphones through WeChat, with the restriction of one response per device enabled. Of the 260 trainees, 240 (98%) completed the questionnaire. The majority of the trainees were 31 years of age or above. A large majority had approximately 10 years of clinical anesthesia practice, and nearly one-third had never undertaken cardiovascular specialty anesthesia practice before. The most common reasons for attending the refresher training were the need to learn basic specialty theory and improve clinical skills. The barriers were mainly time constraints or staff shortages in the department. Sixty-one (93.8%) trainees described the experience as "stressful or highly stressful" and identified poor teacher interaction as the highest-ranking stressor. Anesthesiologists were most dissatisfied with job rewards, with a satisfaction rate of only 15%. Anesthesiologists are highly stressed during the refresher training. Poor teacher interaction and low job rewards were identified as the highest-ranking stressors during cardiovascular anesthesia training. Training providers need to pay more attention to these stressors to enhance the quality of cardiovascular anesthesia training.

COMPARATIVE STUDY OF BUPIVACAINE WITH DEXMEDETOMIDINE AND BUPIVACAINE ALONE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

Objective: The objective is to compare the efficacy of bupivacaine with dexmedetomidine and bupivacaine alone when used for supraclavicular brachial plexus block in patients undergoing upper limb surgeries. Methods: This was a comparative study conducted in the department of anesthesiology of a tertiary care medical college. 80 patients scheduled for upper limb surgeries under supraclavicular brachial plexus block were included on the basis of a predefined inclusion and exclusion criteria. Patients were divided into 2 groups depending on whether they received only Bupivacaine (Group B) or Bupivacaine and Dexmedetomidine (Group BD) for supraclavicular block. The onset and duration of sensory as well as motor blockade, intensity of Pain as assessed by Visual Analog Score, requirement of rescue analgesia, hemodynamic profile, and side effects were compared in both the groups. For statistical purpose p<0.05 was taken as statistically significant. Results: Group BD exhibited significantly faster onset and longer duration of sensory blockade compared to Group B. Group BD also showed significantly faster onset and longer duration of motor blockade compared to Group B. Moreover, Group BD had significantly longer analgesia duration (614.84±52.02 min) compared to Group B (352.62±32.46 min). The hemodynamic parameters, including mean heart rate and mean arterial pressure, were not significantly different between the groups. In addition, side effects such as bradycardia and hypotension were observed in Group BD, but these differences were not statistically significant. Conclusion: Dexmedetomidine, when used as an adjuvant to bupivacaine during supraclavicular brachial plexus block in upper limb surgeries provided longer-lasting analgesia, and reduced pain intensity as compared to Bupivacaine alone with a comparable side effect profile.

Effect of dexmedetomidine on convalescence quality after general anesthesia and postoperative delirium, and on cognitive function in elderly patients undergoing lower limb surgery

Purpose: To investigate the effect of different doses of dexmedetomidine on the quality of postoperative recovery, incidence of postoperative delirium, and cognitive function in elderly patients undergoing lower limb surgery.
 Methods: A total of 112 patients who received treatment in the Department of Anesthesiology, Affiliated Hospital of Inner Mongolia Medical University, Hothot, China from January 2021 to January 2023 were divided into 3 groups, consisting of low-dose group (35 patients received 0.2 mg/kg), medium-dose group (39 patients received 0.4 mg/kg), and high-dose group (38 patients received 0.6 mg/kg). Parameters including, convalescence quality of general anesthesia, incidence of postoperative delirium, adverse reactions, Mini- mental State Examination (MMSE) scores, sedation effect (Ramsay), analgesia effect (visual analogue scale (VAS)), and stress indices, viz, norepinephrine (NE), epinephrine (E), and cortisol (COR) levels), were evaluated and compared.
 Results: There was no significant difference in tracheal extubation time, recovery time of spontaneous breathing, calling eye-opening time, or full awakening time among the three groups (p > 0.05). However, MMSE score was significantly higher in low-dose group on days 1 and 3 after surgery (p < 0.05) and VAS scores were significantly higher in low-dose group at 12 and 24 h after recovery compared to other groups (p < 0.05). Ramsay score was significantly higher in high-dose group (p < 0.05). Levels of NE, E, and COR were significantly lower in medium-dose group compared to other groups (p < 0.05). Incidence of adverse reactions were significantly lower in low and medium-dose groups compared to high- dose group (p < 0.05).
 Conclusion: Medium-dose dexmedetomidine demonstrates favorable sedative and analgesic effects with minimal impact on cognitive function and stress response in elderly patients undergoing lower limb surgery. Furthermore, it does not affect quality of postoperative recovery nor incidence of postoperative delirium. More large-scale, randomized controlled studies are needed to confirm these results.

Association of neurocognitive disorders with morbidity and mortality in older adults undergoing major surgery in the USA: a retrospective, population-based, cohort study

Neurocognitive disorders become increasingly common as patients age, and increasing numbers of surgical interventions are done on older patients. The aim of this study was to understand the clinical characteristics and outcomes of surgical patients with neurocognitive disorders in the USA in order to guide future targeted interventions for better care. This retrospective cohort study used claims data for US Medicare beneficiaries aged 65 years and older with a record of inpatient admission for a major diagnostic or therapeutic surgical procedure between Jan 1, 2017, and Dec 31, 2018. Data were retrieved through a data use agreement between Dartmouth Hitchcock Medical Center and US Centers for Medicare and Medicaid Services via the Research Data Assistance Center. The exposure of interest was the presence of a pre-existing neurocognitive disorder as defined by diagnostic code within 3 years of index hospital admission. The primary outcome was mortality at 30 days, 90 days, and 365 days from date of surgery among all patients with available data. Among 5 263 264 Medicare patients who underwent a major surgical procedure, 767 830 (14·59%) had a pre-existing neurocognitive disorder and 4 495 434 (85·41%) had no pre-existing neurocognitive disorder. Adjusting for demographic factors and comorbidities, patients with a neurocognitive disorder had higher 30-day (hazard ratio 1·24 [95% CI 1·23-1·25]; p<0·0001), 90-day (1·25 [1·24-1·26]; p<0·0001), and 365-day mortality (1·25 [1·25-1·26]; p<0·0001) compared with patients without a neurocognitive disorder. Our findings suggest that the presence of a neurocognitive disorder is independently associated with an increased risk of mortality. Identification of a neurocognitive disorder before surgery can help clinicians to better disclose risks and plan for patient care after hospital discharge. Department of Anesthesiology and Perioperative Medicine at Dartmouth Hitchcock Medical Center.

Equitable anesthesiologist scheduling under demand uncertainty using multiobjective programming

This work addresses the practical anesthesiologist scheduling (AS) problem motivated by the needs of an academic anesthesiology department. The AS problem requires the department to plan and deploy providers to adequately meet clinical demand and institutional protocols of various clinical units over a planning horizon of up to several weeks. A data‐driven two‐step AS framework is developed by exploiting the historical demand data of anesthesia cases. The first step is a shift design which obtains the optimal shifts considering clinical demand under uncertainty using conditional value‐at‐risk constraints, and the second step is provider assignments that generate the schedule considering optimal and equitable workload distribution and provider availability using multiobjective mixed‐integer programming models. Moreover, the AS framework incorporates the provider specialties, and clinical and lifestyle preferences and aligns with the existing scheduling practices. An ɛ‐constraint solution method is applied for multiobjective optimization, and an iterative solution method is developed to improve solution quality for workload equity in clinical applications. Computational experiments are performed to evaluate the performance of three alternative forms of the workload equity objective function, and the results show that the minimization of the sum of the absolute deviations of provider workloads best balances solution runtime and quality. In the concerned academic anesthesiology department, two clinical problems, the budget and hiring planning and the monthly scheduling, are addressed via the application of the proposed AS framework. For budget and hiring, decision‐makers can make trade‐offs based on their preference using the nondominated frontiers obtained via the ɛ‐constraint method. For monthly scheduling, the iterative solution method can accommodate preassigned shifts capturing institutional requirements while improving workload equity. The workload variance has been substantially reduced from 2.92 to 1.39 after the implementation based on the historical schedule data. The provider schedule satisfaction is improved from 3.13/5 to 3.44/5, and at least 82% of scheduling burden on department leaders is relieved. The developed AS framework is generic and can be extended to the scheduling of other types of care providers, including nurses and residents.

임상간호사의 공감역량과 회복탄력성, 자기자비, 환자중심간호에 관한 연구

Objectives The purpose of this study is to identify differences and correlations between variables such as em-pathy capacity, resilience, self-compassion, and patient-centered nursing according to the general character-istics of clinical nurses.&#x0D; Methods A structured questionnaire was distributed to 230 clinical nurses working in three secondary medical in-stitutions with more than 250 beds in U City, and 218 copies of the data were used in the final analysis. This is a descriptive correlation study. Data analysis included descriptive statistics, independent samples t-test, one-way ANOVA, Scheffé post hoc test, Person’s correlation analysis, and tool reliability using the SPSS 25.0 program.&#x0D; Results There was a significant difference in empathy capacity according to general characteristics depending on age, and the age was higher in those aged 50 or older than in those aged 30 to 39 (F=3.81, P&lt;.01). There was a significant difference in resilience depending on age, and it was higher in those aged 50 or older than those aged 29 or younger, 30 to 39, or 40 to 49 (F=7.25, P&lt;.001). There was a statistically significant difference in pa-tient-centered nursing depending on the age, position, and work department of the study subject, with the age range being higher in those aged 50 or older than those aged 29 or younger, 30 to 39, or 40 to 49 (F=7.25). , P&lt;.001), the head nurse was higher than the charge nurse (F=6.18, P&lt;.01), and the working department was high-er in the general ward and intensive care unit than the operating room and anesthesiology department (F=4.76, P). &lt;.001). Looking at the correlation results, resilience is empathy competency (r=.551, p&lt;.01), patient-centered nursing is empathy competency (r=.637, p&lt;.01), and resilience (r=.602, p&lt;.01). .01), self-compassion showed a statistically significant positive correlation with empathy (r=.306, p&lt;.01), resilience (r=.508, p&lt;.01), and It showed a statistically significant positive correlation with patient-centered nursing (r=.269, p&lt;.01).&#x0D; Conclusions Clinical nurses' empathy capacity, resilience, and self-compassion show a positive correlation with patient-centered nursing, so the development and application of programs to improve clinical nurses' resilience and self-compassion and to improve empathy are important in improving the quality of nursing services.

An evaluation of spinal anesthesia results in pediatric patients undergoing pilonidal sinus surgery: a retrospective study

Aims: The aim of this retrospective study was to evaluate the efficacy, side-effects, and complications of spinal anesthesia (SpA) in children undergoing pilonidal sinus surgery with SpA.&#x0D; Methods: The records of pediatric patients who underwent pilonidal sinus surgery with SpA from January 2019 to March 2023 were retrospectively evaluated from the database in the Samsun University Samsun Maternity &amp; Children's Training and Research Hospital, Department of Anesthesiology and Reanimation, Türkiye. Children's sociodemographic characteristics, clinical and vital signs, motor block duration, operative time, and complications were recorded.&#x0D; Results: Eighty-one patients underwent pilonidal sinus surgery with SpA, 54 (66.7%) boys and 27 (33.3%) girls, with a mean age of 14.38±1.29 years. The patients’ mean body mass index was 26.83±1.1 kg.m-2, and the success rate was 96.3% (n=78). Eleven (13.6%) patients received supplemental anesthesia among the 78 procedures completed using SpA. The incidence of complications was 5.1% (n=4). Intraoperative hypotension developed in two cases and postoperative vomiting in two, all of which resolved with no sequelae.&#x0D; Conclusion: Our retrospective analysis suggests that pediatric SpA is a safe and effective technique for children undergoing pilonidal sinus surgery. However, further prospective studies are warranted to confirm these findings.

Association between an anesthesia department development program for junior faculty and long-term production of publications: A longitudinal cohort study

BackgroundAn important mission of academic medical departments is to further the scholarship and education of its junior faculty. In 2013, Hindman et al. described the design and initial outcomes of a faculty development program for junior faculty at the University of Iowa Department of Anesthesia. In the current study, we reassessed whether the program increased the production of publications long-term. We included all department faculty, years before joining the department, and years after leaving the department, to control for the effects of simply being current faculty in the department, benefiting from its resources, and having had progressively more experience working. MethodsThe population studied was the faculty for any period between January 2006 and December 2022. The dependent variable was the count of publications in Scopus each year with the faculty member's Scopus identifier, 1996 through 2022. The two-year faculty development program included non-clinical time, two mentors, defined mentorship plan, didactic program, and financial support for clinical and/or laboratory studies. Statistical analyses were with logistic and Poisson random effect models for panel data, with standard errors estimated using jackknife resampling. ResultsAmong the 128 distinct faculty in the department from 2006 through 2022, the 10% with the most publications per year accounted for 54% of the total annual publications. The two-year program was completed by 41% (53/128). Completion of the faculty development program was associated with a 17% absolute increase in the predicted marginal probability of one or more publications per year, from 25% to 41%. The 95% confidence interval for the 17% absolute increase was 9% to 24% (P < .0001). The predictive marginal effect of completing the program was 1.7 more publications per year per faculty (95% confidence interval 1.1 to 2.4, P < .0001). The estimate was also 1.7 more publications per year while limiting consideration to the 108 faculty who joined the department after 1996 and including as an independent variable the count of publications the year before joining the department. ConclusionsA faculty development program for junior faculty can reliably increase the production of publications in an anesthesiology department by at least one per year. However, there is considerable heterogeneity in publication production among faculty.

BODY COMPOSITION OF FULL-TERM NEWBORNS AGAINST THE BACKGROUND OF INCREASED PROTEIN INTAKE IN THE INTENSIVE CARE UNIT

To evaluate the eff ects of increased protein and L-carnitine supplementation in the feeding program of term infants withperinatal conditions on improving physical development outcomes, changes in body composition and hospital outcomes.The aim is to evaluate the eff ect of short-term increased protein intake in term infants and L-carnitine supplementation onbody composition and key indicators of physical development in children.Material and methods. To test the proposed hypothesis of neonatal nutrition, we studied the vital signs of 59 term infantsrandomized into two groups. The fi rst group (n = 30) received standard breastmilk (BM) or formula feeding, and the second group (n = 29) received a protein- fortifi ed (PF) formula and L-carnitine supplementation during the hospital stay. At the beginning and end of treatment, the children’s physical development and body composition were assessed using bioelectrical impedance.The study protocol was agreed and approved by the Regional Bioethics Committee of the Zaporizhzhia State Medical andPharmaceutical University. The study was conducted in accordance with the moral and ethical standards of the IGH/GCP, theDeclaration of Helsinki (1964 with amendments of 1975, 1983, 1989, 1996, 2000), the Convention of the Council of Europe onHuman Rights and Biomedicine, and the legislation of Ukraine. Written informed consent was obtained from the parents of the patients before the start of the study. All statistical analyses were performed using the software Statistica 13.0, TIBCO Software Inc (licence number JPZ804I382130ARCN10-J) and Microsoft Excel 2013 (licence number 00331-10000-00001-АА404). The probability of the diff erence in the absolute values of the means was determined using non-parametric methods of statistical analysis: the Mann-Whitney test (U) for unrelated groups and the Wilcoxon signed rank test (T) for related groups. Statistical signifi cance was defi ned as p &lt; 0.05. The study was conducted within the framework of the research work of the Department of Anaesthesiology and Intensive Care Medicine of the Zaporizhzhia State Medical and Pharmaceutical University of the Ministry of Health of Ukraine – «Optimization of diagnosis and intensive care of multi etiological lesions of the brain, gastrointestinal tract, kidneys in newborns and older children», state registration number 0118U007142.Results. Infants in both groups had similar characteristics of weight, length and head circumference at baseline. Theproportions of infants of both sexes were within the 50 % percentile. In general, the proposed feeding strategy contributed to better indicators of infant physical development and a statistically signifi cant, faster recovery of body weight in the fortifi ed group. Thus, the generalised indicator of body weight of children in the GZ group was 3966.90 ± 439.08 g, compared to 3554.62 ± 452.28 g in the SC group, p = 0.0033. In general, the children who consumed more protein were transferred out of intensive care sooner – 10.00 (8.00, 12.00) days vs. 12.00 (11.00, 16.00) days, U = 235.00; p = 0.0024; discharged from hospital sooner – 21.00 (19.00, 27.00) days vs. 26.50 (22.00, 31.00) days, U = 267.00, p = 0.0109. This strategy proved to be safe, as evidenced by normal phenylalanine and urea levels at all stages of the children’s examination. Percentage analysis of body composition showed an increase in the formation of more dry mass in children on the standard diet, without protein fortifi cation and without carnitine supplementation. Thus, the percentage of FFM in the children on the standard diet was 84.71 (83.27; 85.47) % at the end of the study, compared with 83.09 (81.93; 83.96) % in the GZ group, U = 117.00; p = 0.0020. The total cohort indicator was infl uenced by the changes in body composition found in the women: in the GZ group, the percentage was 82.21 (81.55;83.10) % versus 84.71 (83.65;85.30) % in the SC group, U = 8.0; p = 0.0051. Thus, increased protein supplementation in term girls was associated with greater accumulation of fat mass, even with short-term supplementation.Conclusions. Consumption of more protein and carnitine supplementation in term neonates in the intensive care unitpromotes better growth against a background of body composition with higher fat content in females, a fact that limits the use of this strategy without further studies.

Exploring Gender and Leadership Trajectories in Academic Anesthesiology: Qualitative Content Analysis of Turkish Department Chairs

Background and aim: In the evolving landscape of anesthesiology, anesthesiologists play a pivotal role that extends beyond providing clinical care. Anesthesiologists exhibit adept collaboration skills, particularly in high-stress environments, showcasing their leadership and management proficiencies. While the terms "leader" and "manager" hold distinct connotations, leaders often fulfill managerial roles. Gender disparities are prevalent in anesthesiology leadership, mirroring broader trends across professions. In 2023, this study conducts a bibliometric analysis of academic professionals holding department head positions in Turkish anesthesiology and reanimation, scrutinizing gender distribution and categorizing them based on their institutions' administrative attributes to illuminate leadership patterns within the field. Material &amp; Methods: The hospitals in our country that offer anesthesiology and reanimation training clinics were categorized into three groups. The official websites of each hospital within the group were individually reviewed to gather information on anesthesiology specialist physicians who serve as department managers in the anesthesiology and reanimation clinics. The quantity of male and female anesthesiology department managers in each group was computed and thereafter compared between the groups. Results: An analysis of the gender distribution among anesthesiology department managers in hospitals with training clinics revealed that 54% were male and 46% were female. There was no difference in the gender distribution between the three categories based on the analysis of data from a total of 100 institutions (p&gt;0.05). Conclusion: In 2023, the proportion of female anesthesiologists in leadership positions within their respective departments in our country exceeds the reported global average for female anesthesiologists. Keywords: Gender equity; leadership; anesthesia; academia

The impact of the coronavirus pandemic on the mental health of critical care workers

The coronavirus pandemic has focused attention on the importance of critical care and highlighted the shortage of critical care specialists. Due to increasing workloads and high mortality rates, healthcare professionals were exposed to higher levels of physical and psychological stress during the pandemic than before. Our study investigated the effects of the coronavirus outbreak on the emotional, mental and moral stress of intensive care professionals. Our workgroup performed paper-based surveys among caregivers in the Department of Anaesthesiology and Intensive Therapy at Semmelweis University. The first survey was conducted at the start of the pandemic in 2020, the second survey was conducted after the third wave in 2021. We applied validated questionnaires (Professional Quality of Life, Demoralization Scale, Perceived Stress Scale, Impact of Event Scale, and Posttraumatic Growth Inventory), collected demographic data and information on lifestyle, recreation, dietary habits, and accepting psychological support. The number and demographic characteristics of the participants in the two studies are different, reflecting the changes in the workforce during the pandemic. Our results revealed no differences between the working and socio-demographic groups before the outbreak, however, one year later, nurses scored significantly higher on all negative psychological scales compared to other groups. Only a minority of the respondents had sought psychological support (9.5-12.7%), although more than a third of respondents reported the need for psychological support. Employees in new work positions showed significantly increased posttraumatic growth (2.91 ± 0.82 vs. 2.20 ± 1.06, p = 0.016). These findings demonstrate that nurses are the most strained workgroup during an uncertain and stressful period. The available mental support alone is not enough to help caregivers. Further steps are needed to improve the mental health of critical care workers. Orv Hetil. 2023; 164(42): 1646-1655.

Ultrasound navigation in pediatric intensive care unit: Realities of the present

BACKGROUND: There have been an increasing number of publications in recent years demonstrating the efficiency and safety of ultrasound imaging techniques in anesthesiology and intensive care, which reduce the risk of complications during invasive manipulation and detecting life-threatening conditions at the earliest stage; however, practical implementation of these techniques is associated with significant difficulties, which served as the basis for this research.&#x0D; AIM: To estimate the adherence of experts in pediatric anesthesiology and intensive care departments to using ultrasound imaging techniques in clinical practice.&#x0D; MATERIALS AND METHODS: A voluntary, anonymous questionnaire study of pediatric intensive care unit heads in 65 Russian Federation regions was conducted.&#x0D; RESULTS: Responses were obtained from 32 (38.4%) respondents. In 30% of cases, the work experience of specialists in the pediatric intensive care unit was around 510 yr, and there was no relationship between the introduction of ultrasound imaging techniques into the departments routine practice and the work experience of the specialists. All the professionals who participated in the study had access to an ultrasound scanner 24 h per day, 7 days a week. When measuring adherence to the use of ultrasound imaging techniques in providing venous access, five (15%) hospitals did not utilize them at all, whereas four (12.5%) medical institutions used them 100% of the time. The average frequency of main vein catheterization using ultrasonic imaging techniques is 49 35.5%. Ultrasonography is used to examine cardiac systolic function by 26 (81) respondents and it is routine in 50% of patients who require continuous catecholamine infusion. The Teicholz method (56% of the time) is used to assess systolic cardiac function; the Simpson method was used in 34% of cases. Ultrasound imaging to assess pulmonary status is used by 56% of responders. It is only used routinely in 28% of patients who require controlled mechanical ventilation. Ultrasound imaging is used in 47% of cases to examine the status of breathing volume. In 72% of instances, ultrasonography is used to assess cerebral perfusion and diagnose intracranial hypertension syndrome. Ultrasound-imaging methods are used by 56% of responders for screening diagnoses of life-threatening disorders in children with polytrauma, and in 44% of cases, it is a routine assessment. Fifty-seven percent of respondents believe that ultrasound diagnostic techniques are highly effective, and 71% believe that their use is safe for patients.

DIAGNOSTIC VALUE OF ADDITIONAL MARKERS FOR ACUTE KIDNEY INJURY IN PRETERM NEONATES WITH PATENT DUCTUS ARTERIOSUS

DIAGNOSTIC VALUE OF ADDITIONAL MARKERS FOR ACUTE KIDNEY INJURY IN PRETERM NEONATES WITH PATENT DUCTUS ARTERIOSUS

Perioperative Management of Patients Receiving Sodium-Glucose Cotransporter 2 Inhibitors: Development of a Clinical Guideline at a Large Academic Medical Center

The use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) is increasing rapidly for patients with diabetes, heart failure, and chronic kidney disease. These medications can cause euglycemic diabetic ketoacidosis in the perioperative period, and the Food and Drug Administration recently updated their recommendations that they be held for at least 3-to-4 days preoperatively. There is a paucity of guidelines for the perioperative management of patients taking SGLT2i who present for emergent surgery or elective surgery having not held the medications per Food and Drug Administration guidelines. At the University of Pennsylvania, a multidisciplinary team from the Departments of Anesthesiology, Endocrinology,and Pharmacy has developed comprehensive guidelines detailing preoperative, intraoperative, and postoperative management for patients using these medications. In this article, the authors present these guidelines and discuss challenges encountered while implementing them at a large academic medical center with satellite hospitals and surgery centers with varying resources and patient populations.