Maintenance Of Hemodynamic Stability Research Articles

Effect of S-Ketamine on Postoperative Nausea and Vomiting in Patients Undergoing Video-Assisted Thoracic Surgery: A Randomized Controlled Trial.

Postoperative nausea and vomiting (PONV) frequently occur in patients after surgery. In this study, the authors investigated whether perioperative S-ketamine infusion could decrease the incidence of PONV in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy. This prospective, randomized, double-blinded, controlled study was conducted a total of 420 patients from September 2021 to May 2023 at Xuzhou Central Hospital in China, who underwent elective VATS lobectomy under general anesthesia with tracheal intubation. The patients were randomly assigned to either the S-ketamine group or the control group. The S-ketamine group received a bolus injection of 0.5 mg/kg S-ketamine and an intraoperative continuous infusion of S-ketamine at a rate of 0.25 mg/kg/h. The control group received an equivalent volume of saline. All patients were equipped with patient-controlled intravenous analgesia (PCIA), with a continuous infusion rate of 0.03 mg/kg/h S-ketamine in the S-ketamine group or 0.03 μg/kg/h sufentanil in the control group. The primary outcome was the incidence of PONV. Secondary outcomes included perioperative opioid consumption, hemodynamics, postoperative pain, and adverse events. The incidence of PONV in the S-ketamine group (9.7%) was significantly lower than in the control group (30.5%). Analysis of perioperative opioid usage revealed that remifentanil usage was 40.0% lower in the S-ketamine group compared to the control group (1414.8 μg vs 2358.2 μg), while sufentanil consumption was 75.2% lower (33.1 μg vs 133.6 μg). The S-ketamine group demonstrated better maintenance of hemodynamic stability. Additionally, the visual analogue scale (VAS) scores on postoperative day 1 (POD-1) and postoperative day 3 (POD-3) were significantly lower in the S-ketamine group. Finally, no statistically significant difference in other postoperative adverse reactions was observed between the two groups. The results of this trial indicate that perioperative S-ketamine infusion can effectively reduce the incidence of PONV in patients undergoing VATS lobectomy.

Comparison of Dexmedetomidine and Fentanyl Infusion on Intraoperative Haemodynamic Changes in Neck Dissection

Background: Perioperative and postoperative pain control, maintenance of hemodynamic stability, proper sedation, and awakening form an integral part of anaesthetic management in head and neck surgeries. Opioids such as fentanyl are widely used for analgesia in routine anaesthetic practice. Newer non-opioid drugs such as dexmedetomidine are being increasingly used to facilitate the recovery process after surgery because of their anaesthetic and analgesic sparing effects. In this study, we compare the efficacy of dexmedetomidine and fentanyl infusion on intraoperative hemodynamic changes in neck dissection. Objectives: The aim of the study was to compare the efficacy of dexmedetomidine and fentanyl on intraoperative hemodynamic changes in neck dissection. Material and Methods: 60 male and female patients, ASA 1 and 2 aged 30–40 years scheduled for neck dissection surgeries under general anaesthesia were randomly allocated into two equal groups: Group D (n = 30) received a bolus dose of IV dexmedetomidine 1 μg/kg over 10 minutes before induction of anaesthesia and followed by infusion at the rate of 0.2 μg/kg/h during surgery. Group F (n = 30) received bolus dose of fentanyl 2 μg/kg before induction of anaesthesia and followed by infusion at the rate of 0.5 μg/kg/h during the surgery. General anaesthesia was induced in all patients using propofol and vecuronium. The following parameters were recorded: systolic blood pressure, mean arterial pressure and heart rate before and after induction of anaesthesia and then every 15 minutes till the end of surgery. Results: The intraoperative systolic blood pressure, mean arterial blood pressure and heart rate were statistically significantly (P < 0.05) lower in dexmedetomidine group compared to fentanyl group. Two patients had bradycardia in dexmedetomidine group and were responded injection atropine. Conclusion: The intravenous dexmedetomidine infusion provides stable intraoperative haemodynamics compared to fentanyl in neck dissection surgeries.

Acute kidney injury post-abdominal surgery in infants: implications for prevention and management.

Acute kidney injury (AKI) is common in critically ill infants and is associated with long-term sequelae including hypertension and chronic kidney disease. The etiology of AKI in infants is multifactorial. There is robust literature highlighting the risk of AKI after cardiothoracic surgery in infants. However, risk factors and outcomes for AKI in infants after abdominal surgery remains limited. This article reviews the epidemiology and association of abdominal surgery with postoperative AKI and suggests methods for AKI management and prevention. Postoperative AKI may result from hemodynamic shifts, hypoxia, exposure to nephrotoxic medications, and inflammation. Infants in the intensive care unit after intraabdominal surgeries have a unique set of risk factors that predispose them to AKI development. Prematurity, sepsis, prolonged operation time, emergent nature of the procedure, and diagnosis of necrotizing enterocolitis increase risk of AKI after intrabdominal surgeries. Prevention, early diagnosis, and management of AKI post-abdominal surgery is imperative to clinical practice. Close monitoring of urine output, serum creatinine, and fluid status is necessary in infants after abdominal surgery. A recent study suggests elevated levels of a urinary biomarker, neutrophil gelatinase-associated lipocalin (NGAL), 24 h after an abdominal procedure may improve early prediction of AKI. Identification of risk factors, avoidance of nephrotoxic medications, careful fluid balance, early detection of AKI, and maintenance of hemodynamic stability is imperative to potentially prevent and/or mitigate AKI.

Gastrointestinal bleeding in athletes.

Gastrointestinal (GI) bleeding (GIB) in athletes has previously been reported in several studies, as an important factor of underperformance in competitive sports events. Yet it is still underreported, partly because it is usually occult and self-limited soon after the effort. It can originate in either the upper or the lower GI tract and can be proportionally related to the amount and duration of effort. Key pathophysiological factors seem to include splanchnic hypoperfusion, mechanical trauma of the GI wall, and the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Appropriate nutrition, hydration and regulation of exercise, along with substances such as arginine and citrulline can relieve upper and lower GI symptoms, including nausea, vomiting, cramping, diarrhea, and possibly hemorrhage. Cessation of NSAIDs, use of proton pump inhibitors and H2-receptor-antagonists, as well as "training" the gut, also seem to be effective in reducing the incidence of GIB in athletes. Maintenance of hemodynamic stability and identification of the source of bleeding are key elements in the management of this condition. Endoscopy might be necessary for both. GIB should not be immediately attributed to endurance exercise, and endoscopy should always be performed to rule out other existing pathology.

Evaluation of markers of cerebral oxygenation and metabolism in patients undergoing clipping of cerebral aneurysm under total intravenous anesthesia versus inhalational anesthesia: A prospective randomized trial (COM-IVIN trial).

Anesthetic goals in patients undergoing clipping of cerebral aneurysm include maintenance of cerebral blood flow, oxygenation, and metabolism to avoid cerebral ischemia and maintenance of hemodynamic stability. We intend to study the influence of anesthetic agents on the outcome of aneurysmal subarachnoid hemorrhage (SAH). This is a prospective, randomized, parallel, single-center pilot trial approved by the Institutional Ethics Committee and is prospectively registered with the Clinical Trial Registry of India. Patients with aneurysmal SAH (aSAH) admitted to our institution for surgical clipping, fulfilling the trial inclusion criteria, will be randomized in a 1:1 allocation ratio utilizing a computerized random allocation sequence to receive either total intravenous anesthesia (n = 25) or inhalational anesthesia (n = 25). Our primary objective is to study the effects of these anesthetic techniques on cerebral oxygenation and metabolism in patients with aSAH. Our secondary objective is to evaluate the impact of these anesthetic techniques on the incidence of delayed cerebral ischemia and long-term patient outcomes in patients with aSAH. The Modified Rankin Score and Glasgow Outcome Scale (GOS) at discharge and 3 months following hospital discharge will be evaluated. An observer blinded to the study intervention will assess the outcome measures. This study will provide more insight as to which is the ideal anesthetic agent that offers a better neurophysiological profile regarding intraoperative cerebral oxygenation and metabolism, thereby contributing to better postoperative outcomes in aSAH patients.

Peri-operative fluid management during neurosurgical procedures

The management of fluids and electrolytes in neurosurgical patients aims to reduce the risk of cerebral oedema, reduce ICP and at the same time maintain haemodynamic stability and cerebral perfusion. Neurosurgical patients commonly receive diuretics (mannitol and furosemide), developing complications such as bleeding and diabetes insipidus. These patients may require large volumes of intravenous fluids and even blood transfusions for volume resuscitation, treatment of cerebral vasospasm, correction of preoperative dehydration or maintenance of haemodynamic stability. Goal-oriented therapy is recommended in neurological patients, with the aim of maintaining circulating volume and tolerating the changes induced by anaesthesia (vasodilation and myocardial depression).

Neonatal Transport - Review Article

Various factors lead to neonatal mortality, in which transport of neonates play an important role in mortalityand morbidity of neonates. In India neonatal transport has not developed well. Many sick neonatessuccumb during transport or become very serious during transport. Transport duration, type of transport,treatment given during transport , if pretransport treatment received, maintenance of hemodynamic stability,maintenance of temperature and blood sugars during transport is essential for reducing the mortality of thebaby. Regionalizing neonatal care, will help in deciding the transport of neonates from one centre to anhigher level of care. Hence a well-organized transport system should be in place for the transport of the sickneonates. This review article discusses about the neonatal transport and its implications.

Comparison of Haemodynamic Stability of Etomidate versus Propofol for Induction of Anaesthesia in Patients undergoing Coronary Artery Bypass Graft Surgery

Background: Maintenance of hemodynamic stability during induction and obtundation of intubationstress response are the prime consideration of general anaesthesia. Aims: The purpose of the study is to compare the hemodynamic effects of etomidate and propofol duringinduction and intubation in patients undergoing Coronary Artery Bypass Graft Surgery(CABG). Materials and Methods: This prospective, double-blind randomized clinical trial, total eighty patientswere randomly allocated and divided into two groups based on the induction agent used for anaesthesia(etomidate group or E group) and (propofol group or P group). Heart rate(HR), Mean Arteriolar Bloodpressure(MAP), Cardiac Output (CO) & Cardiac Index(CI) were recorded at preoperative Baseline(T1), atpremedication(T2), at induction(T3), at intubation (T4), 1 min after induction(T5), 3 min after induction(T6),5 min after induction(T7). The use of vasopressors was also recorded, required for both the groups. Results: Before induction, there was no significant difference in hemodynamics between the groups (p>.05). At induction, intubation & up to 5 min after induction thereafter all the hemodynamic parameterswere significantly different from baseline value in both groups (p < .001). During the comparison betweentwo group, it was noted that, in P group, propofol caused pronounced reduction of HR, MAP, CO & CI incomparison to E group, at induction(T3), at intubation (T4), 1 min after induction(T5), 3 min afterinduction(T6). The use of vasopressors was also in higher incidences in P group than E group. Conclusion: This study confirms that Etomidate provides a stable hemodynamic condition in contextwith propofol during induction, intubation & immediate post induction period and this hemodynamicstability can improve the clinical outcomes in patients undergoing CABG. JBSA 2021; 34(1): 43-49

Haemodynamic Consequences in Immediate Postoperative Period in Comparison between Open and Laparoscopic Cholecystectomy”

Background: Laparoscopic cholecystectomy has emerged as a popular alternative to traditional open cholecystectomy in the management of cholelithiasis. It has several advantages .Pneumoperitoneum and trendelenburg positioning causes release of stress hormones and ultimately changes in hemodynamic parameters. Stretching of peritoneum, abdominal wall associated with postoperative pain. So maintenance of haemodynamic stability, immediate postoperative pain control continues to be a major challenge for the anaesthesiologists.
 Methods: Sample was selected by non-probability sampling technique in two groups distributed as- Group-L (Laparoscopic cholecystectomy, n=30) and Group-O (opencholecystectomy, n=30). Detailed history taking, physical examination and routine lab investigations were done. Approval of the study was obtained by the local Ethical Committee. Post-operative complications, postoperative pain, frequency and pattern of cardiovascular complications, frequency and pattern of respiratory complications were evaluated and compared between thegroups
 Result: In both groups female were predominant. In this study haemodynamic status (Heart rate, SBP, DBP, MBP) in different phases of anaesthesia, surgery and postoperative follow-up (at 4th hour, 8th hour, and 12th hour) has been observed.
 Conclusion: This study confirms the feasibility and safety of laparoscopic cholecystectomy is better than open technique in terms of attenuation of better haemodynamic stability, better postoperative pain control and less requirement of analgesia.
 J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 184-189

Management of Toxic Epidermal Necrolysis in an Adult Patient

An adult male patient who underwent neurosurgery for extradural hematoma following road traffic accident presented with toxic epidermal necrolysis (TEN) secondary to phenytoin. The patient was semiconscious and not responding to verbal commands. The patient was admitted and managed with oral cyclosporine and supportive measures. TEN is a dermatological emergency presenting as acute skin failure. The management requires multidisciplinary approach in an intensive care setup. The treatment includes the administration of immunosuppressant drugs and maintenance of hemodynamic stability. However, the COVID-19 pandemic has resulted in a lot of limitations regarding the use of immunosuppressant drugs and in-patient care because of the possibility of transmission of COVID-19 infection among patients, their caretakers and health-care professionals. Here, we are presenting a case of TEN managed successfully during the pandemic of COVID-19. Strict adherence to all the guidelines recommended by concerned authorities related to the prevention of transmission of COVID-19 and judicious use of immunosuppressant drugs based on risk and benefit ratio is very crucial.

Comparison of Ketofol (Combination of Ketamine and Propofol) and Propofol Anesthesia in Aneurysmal Clipping Surgery: A Prospective Randomized Control Trial.

Background:The maintenance of hemodynamic stability is of pivotal importance in aneurysm surgeries. While administering anesthesia in these patients, the fluctuations in blood pressure may directly affect transmural pressure, thereby precipitating rupture of aneurysm and various other associated complications. We aimed to compare the effects of ketofol with propofol alone when used as an induction and maintenance anesthetic agent during surgical clipping of intracranial aneurysms.Materials and Methods:Forty adult, good-grade aneurysmal subarachnoid hemorrhage patients posted for aneurysm neck clipping were included in the study. The patients were randomized into two groups. One group received a combination of ketamine and propofol (1:5 ratio) and the other group received propofol for induction and maintenance of anesthesia. Intraoperative hemodynamic stability, intraventricular pressure, and quality of brain relaxation were studied in both the groups.Results:The patients were comparable with respect to demographic profile, Hunt and Hess grade, world federation of neurological surgeons (WFNS) grade, Fisher grade, duration of anesthesia, duration of surgery, optic nerve sheath diameter, and baseline hemoglobin. Intraoperative hemodynamics were better maintained in the ketofol group during induction, with only 15% of patients having >20% fall in mean arterial pressure (from baseline) intraoperatively, compared to 45% of patients receiving propofol alone (P = 0.038). The mean intraventricular pressure values in both the groups were in the normal range and the quality of brain relaxation was similar, with no significant difference (P > 0.05).Conclusion:Ketofol combination (1:5) as compared to propofol alone provides better hemodynamic stability on induction as well as maintenance anesthesia without causing an increase in intracranial pressure. Effect of ketofol on cerebral oxygenation and quality of emergence need to be evaluated further by larger multicentric, randomized control trials.

Influencing factors of severe liver disease complicated with toxic shock

Patients with severe liver disease are prone to bacterial and fungal infections, and then develop toxic shock. The onset of the disease may be insidious, but the disease progresses rapidly with a high fatality rate. Current research results show that special conditions such as translocation of intestinal flora and immune paralysis in patients with severe liver disease are susceptible factors for infection and toxic shock. Furthermore, it is currently recognized that the treatment of severe liver disease complicated with toxic shock must be treated with antibiotics and maintenance of hemodynamic stability. Other treatments, such as hydrocortisone and strict glycemic control, are quite controversial and may not necessarily reduce mortality. Herein, we summarize the epidemiology, susceptibility factors; diagnosis and management strategies of severe liver disease complicated with toxic shock, highlighting the characteristics of toxic shock under the background of severe liver disease, so as to detect, prevent and treat septic shock in patients with severe liver disease as early as possible to reduce the fatality rate.

Anesthetic management in tetralogy of fallot with pulmonary atresia and major aortopulmonary collateral arteries in pediatric patients: One year experience.

Background:Unlike the typical tetralogy of fallot (TOF), the presence of pulmonary atresia and major aortopulmonary collaterals is recognized as a rare but severe variant of TOF. The objective was to describe the perioperative anesthetic management of pediatric patients who underwent unifocalization procedure and to describe their postoperative morbidity and mortality.Methods:A retrospective observational study was conducted among pediatric patients who underwent unifocalization procedure at Prince Sultan Cardiac Center (PSCC) between October 2017 and October 2018. Unifocalization procedures were performed in a two-staged approach. Anesthetic management of both stages had similar concerns and challenges but with few peculiar issues. These included preoperative assessment, intraoperative management, vascular access, positioning, ventilation, optimizing hemodynamics, cardiopulmonary bypass monitoring, and postoperative management.Results:A total of 19 unifocalization procedures were included. The average age was one year and 52.6% were females. Two patients (10.5%) arrived in theater already with intubated ventilation. Continuous mandatory ventilation was used in 11 (57.9%) patients while one-lung ventilation was used in the rest of patients. Approximately, 30% of patients encountered a stormy postoperative course, 52.6% underwent cardiopulmonary bypass with or without cross-clamping of the aorta, and 10.5% had reperfusion injury.Conclusions:Despite the major challenges of unifocalization, significantly low rates of morbidity and mortality were observed in our patients. A thorough familiarity of different airway and ventilation issues, besides meticulous hemodynamic and anesthetic management, is of paramount importance. The maintenance of hemodynamic stability, hemostasis, and proper ventilation is critical for the success of the operation.

Hemodynamic stability of closed-loop anesthesia systems: a systematic review.

This systematic review investigates the effect of closed-loop anesthesia delivery on the maintenance of cardiovascular parameters. The specific challenges arise from the fact that many physiological variables used for the control of anesthetic delivery and maintenance of hemodynamic stability are regulated by the autonomic nervous system, which is subject to high inter-individual variability. A systematic database search (MEDLINE, EMBASE and Web of Science) was conducted following the PRISMA guidelines and the principles of the Cochrane Handbook for Systematic Reviews of Interventions. Identified articles were screened and studies that fulfilled the eligibility criteria using the PICO approach (Patient, Intervention, Comparison, Outcome) were included in a random effects model to calculate weighted mean and 95% confidence intervals. Twenty studies (1402 subjects: 706 intervention and 696 control) were included in this review. Meta-analysis showed that closed-loop systems achieved longer duration of heart rate and MAP control, at 90.9% (95% CI: 90.0-91.8%) and 88.2% (95% CI: 87.4-89.0%) respectively, compared to the respective manual control group at 86.6% (95% CI: 85.1-88.0%) and 85.1% (95% CI: 84.3-86.0%). Subgroup analysis demonstrated better performance and faster recovery compared to the control group. The findings support the use of closed-loop systems for anesthetic delivery. Interpretation should take into account limitations, such as the large variations in the selected studies in the type of parameters used to measure outcomes. In summary, this review provides evidence supporting the importance of considering cardiovascular variables in the design of automated anesthetic delivery systems.

Intraoperative Dexmedetomidine Maintains Hemodynamic Stability and Hastens Postoperative Recovery in Patients Undergoing Transsphenoidal Pituitary Surgery

Background Transsphenoidal resection of pituitary tumors is the neurosurgical procedure of choice to excise most of the tumors of the sellar/suprasellar region. The main goals of anesthesia are maintenance of hemodynamic stability, provision of conditions that facilitate good surgical exposure, and a prompt and smooth emergence to allow neurological and visual assessment. Dexmedetomidine (Dex), a selective α-2 agonist, is known to maintain cardiovascular stability and anxiolysis and provide pain relief. Therefore, we hypothesized that intraoperative Dex will attenuate hemodynamic response to nasal speculum (NS) insertion, decrease analgesic requirement, and hasten postoperative recovery. Materials and Methods This prospective, randomized, double-blind, placebo-controlled study was conducted in 60 adult patients of either sex, American Society of Anesthesiologists status I or II undergoing elective pituitary surgery for excision of pituitary adenoma. Randomization was done into two groups; Group D ( n = 30) received Dex bolus 1 μg/kg over 10 minutes, followed by 0.5 μg/kg/h, and group control Group C ( n = 30) received normal saline (0.9%) in a similar manner. A standard anesthesia technique comprising fentanyl, propofol, rocuronium, sevoflurane, nitrous oxide, and oxygen was used. Intraoperative monitoring was uniform and standardized in all the patients; cardiovascular perturbations, if any, were noted and managed appropriately. After completion of surgery, tracheal extubation was performed, and emergence time, extubation time, modified Aldrete score, sedation, pain, time for first analgesic, nausea, vomiting, and shivering were recorded. Results In both the groups, an increase in heart rate and blood pressure occurred at the time of laryngoscopy and intubation, NS insertion, and extubation, but it was more in Group C ( p < 0.05). In Group D, intraoperative requirement of analgesic, neuromuscular relaxant, and inhalational anesthetic was lesser compared with Group C. Emergence time as well as visual analog scale at emergence was less in Group D. Conclusions Intraoperative Dex infusion is a reasonable choice in patients undergoing transsphenoidal pituitary surgery.

Current Controversies in Sepsis Management.

The overarching goals of early sepsis management include early recognition, appropriate antibiotic therapy and source control, maintenance of hemodynamic stability, and supportive care of organ dysfunction. Despite increasing awareness of the global burden of sepsis, and general agreement on the goals of management, there is ongoing controversy regarding the implementation of specific treatment strategies to optimize patient outcomes. This article will address five current points of controversy in the management of sepsis and septic shock. These include optimal timing of antibiotics in patients with potential sepsis, the role of glucocorticoids in septic shock, vitamin C as a novel therapy for sepsis, the ideal intravenous fluid for resuscitation, and the optimal balance of fluid resuscitation and vasopressor administration in septic shock. For each of these topics, we review relevant literature, discuss areas of controversy, and present our current approach to management.

Risk factors for postoperative nausea and vomiting following gastrointestinal surgery in elderly patients

Objective To explore the risk factors of postoperative nausea and vomiting(PONV) in elderly patients after gastrointestinal surgery. Methods Clinical data were collected from 1 021 elderly patients(age≥65 y) who underwent gastrointestinal surgery in Nanjing Drum Tower Hospital from January 2016 to December 2017 and retrospectively analyzed. According to the occurrence of PONV, the patients were divided into two groups. The two groups were compared for the differences in perioperative factors. Furthermore, the Logistic regression analysis was performed to investigate the independent risk factors correlated with PONV. Results The incidence of PONV was 7.3%. The most important risk factors for PONV were aging 75 y or older [odds ratio(OR)=1.74, P=0.027], female(OR=1.69, P=0.039) , intraoperative administration of sevoflurane(OR=2.32, P=0.013), duration of intraoperative hypotension>20 min(OR=1.64, P=0.048) , the use of postoperative opioid analgesics(OR=2.14, P=0.002) and postoperative infection (OR=2.03, P=0.009) . Further analyses suggested that the association remained to be statistically significant only in patients experiencing duration of intraoperative hypotension>20 min(OR=6.28, P=0.006). Conclusions The occurrence of PONV in elderly patients after gastrointestinal surgery is related to multiple perioperative factors. Maintenance of hemodynamic stability, avoiding the use of inhalational anesthetics, preventing postoperative infection and weakening postoperative pain reasonably may reduce the risk of PONV in elderly patients. Key words: Postoperative nausea and vomiting; Elderly patients; Gastrointestinal surgery

A Meta-analysis of Qingre Jiedu and Liangxue Sanyu method in the treatment of sepsis

To systematically review the effect of Qingre Jiedu and Liangxue Sanyu method in patients with sepsis, and to discuss its effect in the treatment of sepsis. The randomized controlled trials (RCTs) on the treatment of Qingre Jiedu and Liangxue Sanyu method for sepsis published on PubMed, Embase, Web of Science, CNKI and Wanfang database from the construction to December 31st, 2017 were searched by electronical way. Conventional treatment measures for sepsis, such as fluid resuscitation, maintenance of hemodynamic stability, anti-infection, improvement of tissue perfusion, maintenance of organ function and nutritional support were used in the control group. While traditional Chinese medicine treatment based on Qingre Jiedu and Liangxue Sanyu method were applied in the experimental group besides the conventional treatment, including Chinese patent medicine or Chinese herbal medicine. The main outcome was 28-day mortality, and the second outcome was acute physiology and chronic health evaluation II (APACHE II), coagulation function, inflammatory mediators, procalcitonin (PCT), lactic acid (Lac), and the length of intensive care unit (ICU) stay. Two researchers independently searched literatures, collected data and evaluated risk bias. The statistical analysis was completed by RevMan 5.3 and STATA 13.0 software. The funnel plot and Egger test were used to evaluate the potential publication bias of the main outcomes. A total of 20 RCTs were enrolled in this Meta-analysis, including 1 347 patients, with 667 patients in the control group and 680 patients in the experimental group. Comprehensive risk bias assessment showed that the risk bias of 11 RCT items was unknown, and the risk bias of 9 RCT items was high. Meta-analysis results showed that compared with the control group, the 28-day mortality of the experimental group was significantly lowered [relative risk (RR) = 0.54, 95% confidence interval (95%CI) = 0.45-0.65, P < 0.000 01], the 7-day APACHE II score was significantly lowered [mean difference (MD) = -3.86, 95%CI = -4.82 to -2.90, P < 0.000 01], the 7-day prothrombin time (PT) and activated partial thromboplastin time (APTT) were significantly shortened (PT: MD = -1.72, 95%CI = -2.29 to -1.14, P < 0.000 01; APTT: MD = -4.36, 95%CI = -5.81 to -2.91, P < 0.000 01), the 7-day D-dimer was slightly improved (MD = -0.13, 95%CI = -0.37-0.11, P = 0.29), the 10-day interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were significantly decreased (IL-6: MD = -40.33, 95%CI = -59.55 to -21.11, P < 0.000 1; TNF-α: MD = -7.26, 95%CI = -11.31 to -3.21, P = 0.000 4), the 7-day Lac was significantly declined (MD = -1.30, 95%CI = -1.91 to -0.68, P < 0.000 1), but no significance in PCT (MD = -1.57, 95%CI = -3.25-0.11, P = 0.07) or the length of ICU stay (MD = -4.02, 95%CI = -8.60-0.56, P = 0.09) was found. The results of publication bias assessment showed that 19 studies reported 28-day mortality were basically "funnel-shaped" distribution without potential publication bias (P = 0.336). The Meta-analysis showed that Qingre Jiedu and Liangxue Sanyu method may reduce the release of inflammatory mediators, improve the coagulation function, and reduce the 28-day mortality in patients with sepsis.

Nicotinamide riboside has protective effects in a rat model of mesenteric ischaemia-reperfusion.

Acute mesenteric ischaemia is a syndrome caused by inadequate blood flow through the mesenteric vessels, resulting in ischaemia and eventual gangrene of the bowel wall. Although relatively rare, it is a potentially life-threatening condition. The maintenance of haemodynamic stability, along with adequate oxygen saturation, and the correction of any electrolyte imbalance, are of the utmost importance. However, nicotinamide adenine dinucleotide (NAD) biosynthesis modulation by precursor introduction can also be a powerful tool for preventing injury. Nicotinamide riboside is a pyridine-nucleoside form of vitamin B3 that functions as a precursor to NAD+ . The present study investigated nicotinamide riboside's effect on endothelium functional state, microcirculation and intestinal morphology in acute mesenteric ischaemia and reperfusion. Mesenteric ischaemia was simulated after the adaptation period (15minutes) by occluding the superior mesenteric artery for 60minutes, followed by a reperfusion period of 30minutes. The functional state of intestinal microcirculation was evaluated by laser Doppler flowmetry. Endothelial functional activity was studied by using wire myography. Intestinal samples were stained with haematoxylin and eosin for histological analysis. The results revealed that nicotinamide riboside protects the intestinal wall from ischaemia-reperfusion injury, as well as improving the relaxation function of mesenteric vessels. Nicotinamide riboside's protective effect in small intestine ischaemia-reperfusion can be used to reduce ischaemia-reperfusion injury, as well as to preserve intestinal grafts until transplant.

Airway challenges in laryngotracheoplasty with Montgomery T-tube for subglottic stenosis

Airway challenges in laryngotracheoplasty with Montgomery T-tube for subglottic stenosis