Mean Oxygen Saturation Research Articles

Comparison between Portable Pulse Oximeter and Conventional ICU Pulse Oximeter measurements in healthy adults: A Cross Sectional Study

ABSTRACT: Objective: To assess the agreement between oxygen saturation reading between portable pulse oximeter and conventional ICU monitor pulse oximeter. Methods: This cross-sectional study was conducted at Department of Medicine, Fatima Hospital Baqai Medical University, Karachi, from 1st March 2023 to 31st March 2023. Participants in the study in- cluded healthy health care workers and medical students who were over the age of 18 and did not have any known co-morbid conditions like hypertension or diabetes that may affect peripheral perfu- sion. None of the participants had hypotension, clinical evidence of anemia, fingernail paint or poor peripheral perfusion as these are the factors that may influence pulse oximetry readings. Both the portable pulse oximeter and the traditional intensive care unit (ICU) monitors were utilized to take and record the oxygen saturation levels of each of the ten fingers in a sequential manner while the patient was seated. Data was analyzed using SPSS version 22. Readings of both instruments were com- pared employing Regression analysis. Bland-Altman analysis was applied to measure the level of agreement between readings of portable pulse oximeter and conventional ICU monitors. Results: Total 200 participants were enrolled for this study and most of them were from younger age group. (Mean age of participants = 33.05 ± 10.31). There was no significant difference between oxy- gen saturation readings of respective finger from portable pulse oximeter and conventional ICU moni- tors on regression analysis (p > 0.05). Highest mean oxygen saturation was recorded in right middle finger using portable pulse oximeter (98.71 ± 1.21). On the ICU monitor pulse oximeter, it was 2nd highest in right middle finger (98.33 ± 2.49). Therefore, Bold-Altman analysis applied between oxygen saturation reading for two devices in right middle finger and was found to be comparable. (Mean dif- ference (bias) = 0.375 with 95% confidence interval). Conclusion: Modern portable pulse oximeters can reliably be used to rule out hypoxemia.

Pattern of Antibiotic Use Among Children With Acute Respiratory Infections in Saudi Arabia: Clinical Assessment.

This study aimed to evaluate the common clinical diagnoses and treatment management of acute respiratory infections (ARIs) in children and determine when antibiotics are recommended and prescribed. A retrospective review of medical charts was carried out at King Salman Bin Abdulaziz Medical City (KSAMC) Hospital to assess pediatric patients diagnosed with ARIs aged 0-14 years, excluding those requiring antibiotics for conditions other than ARIs. Data, including demographic diagnoses and treatment management, were extracted using consecutive sampling, and statistical analyses were conducted using Jamovi software. A total of 285 pediatric patients were included, with a median age of 3 (IQR = 1-6) years and a male predominance of 59.2%. Bronchopneumonia was the most common respiratory disease, diagnosed in 39.1% of participants. The median durations for illness and hospital admission were four and three days, respectively. Clinical evaluations showed an average respiratory rate of 28±10.5 breaths per minute and a mean oxygen saturation of 96.4±3.46% through pulse oximetry. The use of antibiotics was commonly prescribed in ARI patients only when accompanied by certain bacterial infections (46.32%). ARIs are a common viral health issue among children, emphasizing that not all ARIs in children are caused by bacteria and that antibiotics should only be used when there is a bacterial infection present. Enhanced diagnostic precision, patient awareness, and provider education are the global community's recommendations to prevent the presence of antibiotic resistance and the irrational use of antibiotics.

Investigating the Effectiveness of Melatonin in the Treatment of Critically Ill Patients with COVID-19 Hospitalized in the Intensive Care Unit: A Double-Blind Randomized Clinical Trial.

Melatonin, a tryptophan product, has anti-inflammatory and virucidal effects. A study evaluated whether melatonin is more effective than placebo in critically ill COVID-19 patients. The present study used a double-blind, randomized clinical trial in patients with COVID-19 hospitalized in the intensive care unit of Rasool Akram Hospital, Tehran. Iran. Melatonin 10 mg and placebo were given to the patients at night before bed. Patients were randomly divided into 2 groups. The first group was given melatonin with a therapeutic dose of 10 mg daily, and the second group was given a placebo with the same dose of 10 mg daily. Patients received melatonin or placebo for 7 days.The chi-square or Fisher exact test was used to compare qualitative variables. The study analyzed the mean of the variables under investigation by conducting a 2-factor repeated measures analysis of variance at 3 different time intervals in those administered medication or placebo. The study analyzed 44 melatonin patients and 42 placebo groups. The mean intensive care unit (ICU) hospitalization days were 11.23 ± 4.73 days in the melatonin group and 11.90 ± 6.52 days in the placebo group (P = 0.582). The mean days of hospitalization in the melatonin group were 19.70 ± 8.77 days and 21.48 ± 10.85 days in the placebo group (P = 0.407). The mean oxygen saturation before and after discharge from ICU in the melatonin group was 81 ± 6.73%, 91.02 ± 1.17%, and in the placebo group, 83.36 ± 8.27%, 91.21 ± 1.26, respectively (P = 0.467 and P = 0.150). Melatonin can significantly reduce inflammation and oxidative stress markers in patients, making it a promising therapeutic option for COVID-19 patients. Further research is needed to determine the optimal treatment dosage and duration. Nonetheless, these results offer a promising avenue for future research and clinical practice.

Effects of obstructive sleep apnea treatment on neurodegenerative biomarker neurofilament light chain and cognitive performance.

Obstructive sleep apnea is associated with cognitive impairment and increased risk for neurodegenerative diseases. Obstructive sleep apnea treatment with positive airway pressure therapy helps to improve cognitive symptoms and reduces long-term dementia risk. To test whether these treatment effects are due to a reduction in neuronal damage, we examined longitudinal changes in the neurodegenerative serum neurofilament light chain and cognitive performance of patients with obstructive sleep apnea. In this study, 17 patients with obstructive sleep apnea completed baseline and follow-up (9 month after starting PAP treatment) investigation of sleep, daytime symptoms, cognitive testing and serum neurofilament light chain measurements. Depending on treatment adherence and efficacy, participants were assigned either to the effective treatment (n = 10) or non-effective treatment group (n = 7). As results at baseline lower mean oxygen saturation during sleep was associated with higher serum neurofilament light chain. Patients in the non-effective treatment group showed a significant increase of age-adjusted percentile of serum neurofilament light chain levels at follow-up, whereas serum neurofilament light chain values remained constant in the effective treatment group. At a functional level, effective treatment leads to an improvement in processing speed, which was not the case in the non-effective treatment group. Longitudinal changes of age-adjusted serum neurofilament light chain levels were associated with changes in cognitive performance. To conclude, this longitudinal observational study showed that effective obstructive sleep apnea treatment positively affects the amount of neuronal damage as well as working memory performance. As cognitive symptoms might not only be attributed to obstructive sleep apnea-related sleep deficiency, but also neurodegeneration, our results underline the importance of treatment adherence and efficacy for the prevention of neuronal damage and cognitive consequences.

Minimally-invasive airway management and early cleft palate repair in infants born with Robin sequence

The objective of this study was to report outcomes of early cleft palate repair in infants born with Robin sequence (RS). A retrospective case series in a tertiary referral paediatric hospital was carried out, examining a consecutive series of 69 infants born with RS and cleft palate. A minimally invasive approach was taken to upper airway obstruction, with liberal nasopharyngeal airway (NPA) and non-invasive ventilation (NIV) use, guided by sleep studies. The palate was repaired between 6 and 9 months with a modified Malek technique. The most frequently used airway adjunct (59.4% of patients) was an NPA and the median duration of use was 5.6 months. All patients underwent a modified Malek cleft palate repair at a median of 7 months of age. Overnight oximetry demonstrated higher mean oxygen saturation (SpO2) across the group from initial neonatal admission to discharge (median 96.5% (interquartile range [IQR] 95–98%) vs 97.45% (IQR 96.5–98%) (P = 0.2, N = 34). Of those with a cardiorespiratory polysomnogram, the obstructive apnoea-hypopnea index (OAHI) was significantly lower postoperatively (5.9 vs 2.8, P = 0.028). This study supports the use of non-surgical airway strategies and early cleft palate repair in infants born with RS and cleft palate.

Incidence and Demographic Characteristics of Patients with Post Cardiac Surgery Arrhythmias: A Single Center Retrospective Study

Objectives Arrhythmias are a common complication following cardiac surgery, and can significantly affect patients’ outcomes. In some cases, post-operative arrhythmias may lead to hemodynamic instability, congestive heart failure, or even sudden cardiac death. Various types of cardiac surgery result in varying rates of post-operative arrhythmias, with more complex procedures causing higher rates. Risk factors for post-operative arrhythmias include advanced age, pre-existing cardiovascular disease, electrolyte imbalances, and the type of cardiac surgery. In this study, we aim to determine the incidence and demographic characteristics of patients who underwent cardiac surgery from November 15, 2020, till November 30, 2021, in a tertiary center in the Kingdom of Bahrain. Material and Methods All adult patients (18 years or older) who were booked for cardiac surgery during the study period were included. Patients with pre-existing documented arrhythmias were excluded from the study. Data was collected from patients’ clinical notes including demographic information (age, sex, and nationality), medical history, comorbidities, type of cardiac surgery, laboratory investigations, and mortality. Descriptive statistics was used to analyze the data, including frequency distributions, means, and standard deviations. Data was collected from patients’ clinical notes including demographic information (age, sex, and nationality), medical history, comorbidities, type of cardiac surgery, laboratory investigations, length of hospital stay, and mortality. Data was collected from patients’ clinical notes including demographic information (age, sex, and nationality), medical history, comorbidities, type of cardiac surgery, laboratory investigations, length of hospital stay, and mortality. Results A total of 161 patients were enrolled in the study with a mean age of 56.75 ± 1.68 years. Among the total enrolled population, 68.32% were male and 31.68% were female. The majority of patients (61.49%) had undergone urgent surgery. Approximately, half (49.07%) of the patients had coronary artery bypass surgery. Premature ventricular complexes (PVC), atrial fibrillation (AF), junctional rhythm, heart block, and atrial flutter were reported in 30.43%, 29.19%, 11.18%, 9.31%, and 8.07% of patient populations respectively. Pleural effusion (50.31%) and bleeding (19.25%) were common post-surgery complications observed among the patients. The mean oxygen saturation (sO2) of the patients on the day of arrhythmia was 95.67 ± 2.05%. Epinephrine/norepinephrine (71.43%) was the most used inotropic agent used after cardiac surgery. Conclusion Cardiac surgery is associated with various arrhythmias. The two most common arrhythmias observed in patients after cardiac surgery are premature ventricular contractions and atrial fibrillation.

The prevalence and polysomnographic characteristics of treatment-emergent central sleep apnea with obstructive sleep apnea.

To investigate the prevalence of treatment-emergent central sleep apnea (TECSA) in individuals with obstructive sleep apnea syndrome (OSAS) during continuous positive airway pressure (CPAP) titration and assess their polysomnographic characteristics. A total of 116 patients with OSAS who underwent full-night CPAP titration at the Sleep Laboratory of Adana City Research and Education Hospital from September 2017 to January 2018 were recruited for the study. The patients' polysomnographic data related to respiratory events and sleep stages were reviewed in a retrospective manner. While on CPAP titration, 20 of the 116 patients developed central sleep apnea (CSA). The prevalence of TECSA in the patients with OSAS was 17.2%, being separately determined as 16.3% and 2.2% for the male and female patients, respectively. In the baseline PSG, the groups did not statistically significantly differ in relation to the apnea hypopnea index (AHI), central apnea index (CAI), arousal index (AI), or oxygen desaturation index (ODI). However, the TECSA group had a significantly higher mean oxygen saturation value compared to the non-TECSA group (p = 0.01). The total AHI, CAI, and AI values of the TECSA group were significantly higher during the whole CPAP titration compared to the non-TECSA group. No significant difference was observed in the comparison of the two groups in relation to the titration pressure and ODI. TECSA is a phenomenon that can occur with obstructive sleep apnea treatment and mostly regress spontaneously following appropriate CPAP treatment. TECSA is observed at different rates of prevalence. In this study, the prevalence of TECSA was higher than previously reported.

Impact of 25-hydroxy vitamin D levels in severe acute respiratory syndrome coronavirus 2 patients with respect to clinical and biochemical profile: An experience from a tertiary care hospital

IntroductionAmong the many micronutrients, Vitamin D deficiency has been associated with the severity of Severe Acute Respiratory Syndrome Coronavirus 2 patients. Design and MethodsA retrospective observational study was conducted on Severe acute respiratory syndrome coronavirus 2 patients admitted to a tertiary care hospital between April 5, 2021, and May 5, 2021. ResultsAmong 285 patients,77.2% of the patients who stayed for more than 14 days were either Vitamin D insufficient or deficient [P value<0.05]. In our study, the mean oxygen saturation at admission was 85.7% in the Vitamin D deficiency group compared to 95.6% in Vitamin D sufficiency patients. [P value<0.05]. Mean serum ferritin was 398ng/ml in the Vitamin D deficiency group compared to 393ng/ml in Vitamin D sufficiency patients[P value>0.05]. The mean C-reactive protein was 107.6mg/ml in the Vitamin D deficiency group compared to 21.8ng/ml in Vitamin D sufficiency patients[P value<0.05]. The mean D-Dimer was 2268 ng/ml in the Vitamin D deficiency group compared to 781 ng/ml in Vitamin D sufficiency patients. [P value<0.05].In the non-survivor group,97.4% were Vitamin D deficient and insufficient. Only 2% of the patients who survived were Vitamin D deficient. [P value<0.05]. ConclusionWe observed that low 25-hydroxy Vitamin D levels were associated with lower oxygen saturation and higher acute physiology and chronic health evaluation II scores, requiring a more extended stay in the hospital. C-reactive protein and D-dimers were significantly higher in Vitamin D deficient patients, suggesting severe disease. We did not find statistically significant findings in the case of the correlation of serum ferritin levels with Vitamin D status.

Anesthesia for Craniotomy Tumor Removal Patient with Morbid Obesity

Purpose: Obesity is one of the greatest health challenges in the western world. Obesity is defined as a body mass index (BMI) &gt;30 kg/m2, with BMI &gt;35 and &gt;55 kg/m2 considered ‘morbidly’ obese and ‘super morbidly’ obese, respectively. The aim of this study was to examine anesthetic management for craniotomy tumor removal in patients with morbid obesity. Design/methodology/data analysis: This research uses a qualitative descriptive research method with a case study approach of a 39 year old female patient with a body weight of 110 kg, height 160 cm, and body mass index (BMI) 42.9 kg/m2, Mallampati score 2, thyromental distance &gt; 3 fingers hospitalized for removal of meningioma. Data collection techniques in this research used literature study, observation and laboratory tests. The data that has been collected is then analyzed descriptively. Findings: The results of the study showed that in the operating room, the patient was positioned in a neutral position 300 head up and Ramp. Preoxygenation with 100% O2 was performed via a face mask. Anesthesia was maintained with continuous intravenous propofol 25-50 μg/kg/min, intravenous rocuronium 40 mg/h, and volatile anesthesia using sevoflurane 0.5-1%vol with oxygen: air at a fraction of 50%. Monitoring during surgery includes evaluation of systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, oxygen saturation, ECG waves, EtCO2, and urine output. The operation lasted 4 hours in the supine position. Post-surgery patients are then treated in the Intensive Care Unit (ICU) for one day before being transferred to the ward and finally to a regular room. He received treatment for 5 days before being discharged. Problems faced during anesthesia in obese patients are airway management, ventilation, position, drug dosage, presence of comorbidities and post-operative care for recovery from anesthesia and surgery. Originality/value: While addressing common challenges encountered during anesthesia in obese patients, this research takes a step further by proposing innovative solutions. The study acknowledges the complexities of airway management, ventilation, positioning, drug dosage, comorbidities, and post-operative care. However, it introduces novel considerations or techniques to mitigate these challenges, possibly involving emerging technologies or interdisciplinary collaboration for enhanced patient outcomes. Practical implications: The practical implications of this research advocate for a nuanced and individualized approach to anesthetic management in morbidly obese patients undergoing craniotomy tumor removal, fostering improved patient care and safety.

Obstructive Sleep Apnea Plasma-Derived Exosomes Mediate Cognitive Impairment Through Hippocampal Neuronal Cell Pyroptosis

ObjectiveObstructive sleep apnea (OSA) is associated with impaired cognitive function. Exosomes are secreted by most cells and play a role in OSA-associated cognitive impairment (CI). The aim of this study was to investigate whether OSA plasma-derived exosomes cause CI through hippocampal neuronal cell pyroptosis, and to identify exosomal miRNAs in OSA plasma-derived. Materials and MethodsPlasma-derived exosomes were isolated from patients with severe OSA and healthy comparisons. Daytime sleepiness and cognitive function were assessed using the Epworth Sleepiness Scale (ESS) and the Beijing version of the Montreal Cognitive Assessment Scale (MoCA). Exosomes were coincubated with mouse hippocampal neurons (HT22) cells to evaluate the effect of exosomes on pyroptosis and inflammation of HT22 cells. Meanwhile, exosomes were injected into C57BL/6 male mice via caudal vein, and then morris water maze was used to evaluate the spatial learning and memory ability of the mice, so as to observe the effects of exosomes on the cognitive function of the mice. Western blot and qRT-PCR were used to detect the expressions of Gasdermin D (GSDMD) and Caspase-1 to evaluate the pyroptosis level. The expression of IL-1β, IL-6, IL-18 and TNF-α was detected by qRT-PCR to assess the level of inflammation. Correlations of GSDMD and Caspase-1 expression with clinical parameters were evaluated using Spearman's rank correlation analysis. In addition, plasma exosome miRNAs profile was identified, followed by Gene Ontology (GO) term and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. ResultsCompared to healthy comparisons, body mass index (BMI), apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and ESS scores were increased in patients with severe OSA, while lowest oxygen saturation during sleep (LSaO2), mean oxygen saturation during sleep (MSaO2) and MoCA scores were decreased. Compared to the PBS group (NC) and the healthy comparison plasma-derived exosomes (NC-EXOS), the levels of GSDMD and Caspase-1 and IL-1β, IL-6, IL-18 and TNF-α were increased significantly in the severe OSA plasma-derived exosomes (OSA-EXOS) coincubated with HT22 cells. Compared to the NC and NC-EXOS groups, the learning and memory ability of mice injected with OSA-EXOS was decreased, and the expression of GSDMD and Caspase-1 in hippocampus were significantly increased, along with the levels of IL-1β, IL-6, IL-18 and TNF-α. Spearman correlation analysis found that clinical AHI in HCs and severe OSA patients was positively correlated with GSDMD and Caspase-1 in HT22 cells from NC-EXOS and OSA-EXOS groups, while negatively correlated with clinical MoCA. At the same time, clinical MoCA in HCs and severe OSA patients was negatively correlated with GSDMD and Caspase-1 in HT22 cells from NC-EXOS and OSA-EXOS groups. A unique exosomal miRNAs profile was identified in OSA-EXOS group compared to the NC-EXOS group, in which 28 miRNAs were regulated and several KEGG and GO pathways were identified. ConclusionsThe results of this study show a hypothesis that plasma-derived exosomes from severe OSA patients promote pyroptosis and increased expression of inflammatory factors in vivo and in vitro, and lead to impaired cognitive function in mice, suggesting that OSA-EXOS can mediate CI through pyroptosis of hippocampal neurons. In addition, exosome cargo from OSA-EXOS showed a unique miRNAs profile compared to NC-EXOS, suggesting that plasma exosome associated miRNAs may reflect the differential profile of OSA related diseases, such as CI.

Effects of Acapella versus Blow Bottle Positive Expiratory Pressure on Airway Clearance and Peak Expiratory Flow Rate in Post-Covid-19 Patients

Background: The COVID-19 pandemic has led to significant respiratory complications in affected individuals. Positive Expiratory Pressure (PEP) devices, specifically Acapella and blow bottle devices, have been widely used in respiratory rehabilitation, particularly in patients with pulmonary diseases and post-surgical respiratory complications. However, their efficacy in post COVID-19 patients has been less explored. Objective: This study aimed to compare the effectiveness of Acapella and blow bottle devices in improving oxygen saturation, peak expiratory flow rate, shortness of breath, and six-minute walk distance in post COVID-19 patients. Methods: This randomized clinical trial was conducted at Tehsil hospital Kot Addu over six months. Forty-eight post COVID-19 patients were divided equally into two groups: one group received treatment with the Acapella device, and the other with a blow bottle device. Baseline and post-treatment measurements of oxygen saturation, peak expiratory flow rate, and six-minute walk distance were recorded using a pulse oximeter, peak expiratory flow meter, and six-minute walk test, respectively. Results: On day 1, the Acapella group showed a mean oxygen saturation rank of 20.98 with a sum of ranks of 503.50 (p=0.79), while the Blow Bottle group had a mean rank of 28.02 and a sum of ranks of 672.50. By day 7, the Acapella group's mean rank was 17.31 (sum of ranks = 415.50, p=0.000) compared to the Blow Bottle group's 31.69 (sum of ranks = 760.50). For peak expiratory flow rate, no significant differences were found between the groups at day 1 (Acapella: mean rank = 28.06, sum of ranks = 673.50, p=0.078; Blow Bottle: mean rank = 20.94, sum of ranks = 502.50) and day 7 (Acapella: mean rank = 23.77, sum of ranks = 570.50, p=0.717; Blow Bottle: mean rank = 25.23, sum of ranks = 605.50). Similar trends were observed in the six-minute walk test results. Conclusion: The study found that both Acapella and blow bottle devices effectively improve oxygen saturation in post COVID-19 patients, but do not significantly affect peak expiratory flow rate, shortness of breath, and six-minute walk distance. These findings suggest that while these devices are beneficial for enhancing oxygenation, a more comprehensive respiratory rehabilitation approach is necessary for addressing the full spectrum of respiratory complications in post COVID-19 patients.

Assessing the contribution of mild high-altitude exposure to obstructive sleep apnea-hypopnea syndrome comorbidities.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common sleep disorder. The lower atmospheric pressure and decreased oxygen levels of high-altitude areas can exacerbate the severity of OSAHS, but research into OSAHS in high-altitude areas remains limited. This study, from June 2015 to January 2020, involved 4,667 patients with suspected OSAHS and 38 healthy volunteers. The non-OSAHS group (AHI <5/h) had 395 patients, while the larger OSAHS group (AHI ≥5/h) comprised 4,272 patients. The significant size difference between the groups emphasized the study's focus on OSAHS, using the non-OSAHS mainly for comparison. Sleep technicians monitored the OSAHS patient group overnight by polysomnography (PSG), the apnea-hypopnea index (AHI), the mean oxygen saturation (MSpO2), lowest oxygen saturation (LSpO2), the oxygen desaturation index (ODI) and the total sleep time with oxygen saturation less than 90% (TST-SpO2 <90%). Healthy volunteers self-monitored sleep patterns at home, using the CONTEC RS01 respiration sleep monitor with a wristwatch sleep apnea screen meter. The RSO1 wristwatch-style device has already been studied for consistency and sensitivity with the Alice-6 standard multi-lead sleep monitor and can be used for OSAHS screening in this region. LSpO2 recordings from healthy volunteers (86.36 ± 3.57%) and non-OSAHS (AHI <5/h) cohort (78.59 ± 11.99%) were much lower than previously reported normal values. Regression analysis identified no correlations between AHI levels and MSpO2 or TST-SpO2 <90%, weak correlations between AHI levels and LSpO2 or MSpO2, and a strongly significant correlation between AHI levels and the ODI (r = 0.76, p < 0.05). The data also indicated that the appropriate clinical thresholds for OSAHS patients living at mild high altitude are classified as mild, moderate, or severe based on LSpO2 saturation criteria of 0.85-0.90, 0.65-0.84, or <0.65, respectively. The study findings suggest that individuals with an AHI score below 5 in OSAHS, who reside in high-altitude areas, also require closer monitoring due to the elevated risk of nocturnal hypoxia. Furthermore, the significant correlation between ODI values and the severity of OSAHS emphasizes the importance of considering treatment options. Additionally, the assessment of hypoxemia severity thresholds in OSAHS patients living in high-altitude regions provides valuable insights for refining diagnostic guidelines.

Comparison of Complications between Total Intravenous Anaesthesia and Combined Intravenous and Inhalation Anaesthesia after Renal Biopsy in Children.

The objective of this study was to examine the influence of total intravenous anaesthesia (TIVA) compared to combined intravenous and inhalation anaesthesia (CIIA) in paediatric patients undergoing renal biopsy. A total of 86 children with nephrotic syndrome, acute glomerulonephritis, chronic glomerulonephritis, IgG nephropathy, systemic lupus erythematosus and purpura nephritis were selected from January 2018 to January 2023 in our hospital. All children were divided into the total intravenous anaesthesia group and intravenous inhalational anaesthesia group according to the anaesthesia method. The experimental group comprised 46 children with renal diseases who underwent static aspiration compound anaesthesia during renal biopsy at our hospital from January 2018 to January 2023. Conversely, the control group included 40 children with renal diseases who underwent total intravenous anaesthesia during renal biopsy at the hospital within the same period. Hemodynamic parameters, such as mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SPO2), were assessed at four different time points: Before anesthesia induction (T0), during anesthesia induction (T1), after anesthesia induction (T2), and at the conclusion of the surgery (T3). Puncture success rate, time to renal puncture, time to get out of bed, postoperative recovery from anaesthesia (including time to postoperative awakening and time to return to spontaneous respiration) and incidence of adverse anaesthetic reactions were also included. We observed notable variations in HR and MAP at T2 and T3, as well as SPO2 levels, duration of awakening from anaesthesia and time taken to resume spontaneous respiration between the two groups at T2 (p < 0.05). No statistically significant variances were detected between the two groups concerning adverse reactions to anaesthesia, puncture success rate, duration to renal puncture and time to mobilisation from bed (p > 0.05). In conclusion, compared with the total intravenous anaesthesia, the implementation of the sedation-aspiration-combined anaesthesia in renal biopsy in children with renal disease features less haemodynamic fluctuation, better postoperative anaesthesia recovery and does not increase the incidence of adverse reactions.

Effect of Unexpected Prolonged Fasting on Patients Undergoing Elective Surgery under Spinal Anaesthesia: An Observational Study

Introduction: Preoperative fasting is a standard practice aimed at minimising the risk of pulmonary aspiration during surgery. However, patients often experience prolonged fasting periods beyond the recommended duration due to unanticipated delays in the operating theatre, communication failures between teams, inadequate preoperative planning and other factors. Aim: To investigate the effects of unexpectedly prolonged fasting on intraoperative and postoperative parameters in patients undergoing elective surgery under spinal anaesthesia. Materials and Methods: This prospective observational study was conducted from October 2023 to June 2024 at the Department of Anaesthesiology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India. The study included 70 patients undergoing elective surgery under spinal anaesthesia. Patients were divided into two groups: Group A (AM group, n=35), scheduled for surgery between 8:00 AM and 12:00 PM and Group B (PM group, n=35), scheduled for surgery after 12:00 PM or with delayed surgeries. Intraoperative parameters, including Mean Arterial Pressure (MAP), Heart Rate (HR), oxygen saturation (SpO2 ) and random blood glucose levels, were recorded at specific time points. Postoperative outcomes, such as nausea, vomiting and random blood glucose levels, were also assessed. Continuous and discrete variables were summarised as mean±SD and median, while categorical variables were presented as frequencies and percentages. Associations between categorical variables were tested using Pearson’s Chi-square or Fisher’s-exact test, with p-values&lt;0.05 considered statistically significant. Results: The PM group exhibited higher preoperative random blood glucose levels (102.3±18.7 mg/dL) compared to the AM group (89.2±12.5 mg/dL). Postoperative nausea and vomiting were observed in 5 (14.3%) patients in the AM group and 11 (31.4%) patients in the PM group. Both groups showed a gradual decrease in MAP and HR from the preoperative period to 30 minutes after spinal anaesthesia administration, with slightly higher values noted in the PM group. No significant differences in SpO2 were observed between the groups. Conclusion: Unexpected prolonged fasting before elective surgery under spinal anaesthesia may contribute to higher preoperative blood glucose levels and an increased risk of postoperative nausea and vomiting. These findings underscore the importance of adhering to preoperative fasting guidelines and exploring potential strategies to minimise prolonged fasting periods, such as carbohydrate loading or allowing clear fluids closer to surgery

Effects of sufentanil in combination with dexmedetomidine for patient-controlled intravenous analgesia after renal transplantation

Background/Aim. Nowadays, the most convenient analgesic method is patient-controlled intravenous injection of one or more adjuvant drugs. The aim of our study was to evaluate the effects of sufentanil plus dexmedetomidine for patient-controlled intravenous analgesia (PCIA) after renal transplantation. Methods. Seventy-eight patients receiving living-related renal transplantation under general anesthesia were selected. Radioisotope scanning was performed, and the single glomerular filtration rate of the unilateral kidney was ? 40 mL/min/1.73 m2. The control group (CG) and observation group (OG) (39 patients in each group) were analgesic with sufentanil and sufentanil plus dexmedetomidine, respectively. When the Visual Analogue Scale (VAS) score exceeded 4 points, 0.05 mg/kg oxycodone was intravenously injected for remedial analgesia. Plasma levels of endothelin, urea nitrogen, and creatinine were measured by radioimmunoassay. Heart rate (HR), mean arterial pressure, oxygen saturation, VAS score, and sedation score were recorded before anesthesia and after surgery. Analgesic remediation rate, number of effectively pressing the PCIA pump, and incidence rate of adverse reactions within 48 hrs after surgery were recorded. Results. HR of OG was significantly lower than that of CG 6 and 12 hrs after surgery (p &lt; 0.05). VAS score of OG was lower than that of CG 6, 12, and 24 hrs after surgery (p &lt; 0.05). OG had a lower postoperative remedial rate, number of effectively pressing the PCIA pump, and incidence rates of nausea and vomiting (p &lt; 0.05) compared to CG. Endothelin, urea nitrogen, and creatinine levels significantly decreased after surgery compared with those before anesthesia (p &lt; 0.05). The levels of OG were lower than those of CG at each time point after surgery (p &lt; 0.05). Conclusion. Sufentanil plus dexmedetomidine can be safely and effectively used for PCIA after renal transplantation, with superior outcomes to those of sufentanil alone.

Evaluating the influence of closed suction system on oxygen saturation, heart rate, and blood pressure in patients with mechanical ventilation

Objective: To evaluate the influence of closed suction systems on oxygen saturation, heart rate, and blood pressure in patients on mechanical ventilation. Methodology: This study used a pre-experimental one-group pretest-posttest design in an intensive care unit. A purposive sample of 199 respondents was included. Data collection was from February to April 2024. We recorded oxygen saturation, heart rate, and blood pressure before suctioning, immediately, five minutes, and 15 minutes after suctioning. Data were analyzed using frequency, percentage, Friedman, and Wilcoxon for post hoc analysis. Results: A closed suction system before suctioning, immediately after suction, five minutes after suction, and 15 minutes after suction showed mean oxygen saturation was 92%, 94%, 96%, and 98%; heart rates per minute were 108, 109, 100, and 93; and blood pressure (systolic/diastolic mmHg) was 125/77, 128/79, 121/77, and 118/76. The Friedman test showed significant differences in SpO2, heart rate, and blood pressure between before and immediately after suctioning, five minutes after suctioning, and 15 minutes after suctioning (p=0.001). Conclusion: The application of closed suction system in the ICU showed promising results in maintaining the hemodynamic status of patients with mechanical ventilation.

Outcomes of Right Ventricular Outflow Tract Stenting as a Palliative Procedure in Tetralogy of Fallot Patients

Background: Certain groups of tetralogy of Fallot (TOF) patients require a palliative procedure until factors permit a full surgical repair. An aorto-pulmonary shunt is the gold standard palliative procedure but requires a cardiothoracic surgeon in a well-equipped facility. In the government sector in a developing country this limited resource has an overwhelming caseload. Right ventricular outflow tract (RVOT) stenting via cardiac catheterization by a trained paediatric cardiologist is a possible alternative. Objectives: To demonstrate that RVOT stenting is a safe and effective palliative procedure in TOF patients in a resource limited setting. Method: A retrospective, cohort observational study at Steve Biko Academic Hospital from January 2014 to March 2021. Results: 37 patients required RVOT stent placement. Mean oxygen saturation increased from 65% to 95% post-stent insertion. Mean pulmonary artery (PA) growth, measured by McGoon ratio, increased from 1.36 to 2.05. Average Intensive Care Unit stay was 2 days with a zero 30-day mortality. Three stents fractured requiring replacement. Conclusion: Stenting the RVOT in TOF patients who present at an older age, with multiple comorbidities and often in extremis, has yielded good results. Significant improvement in oxygen saturations and PA growth permits majority of our patients to a full TOF surgical repair.

Large-bore aspiration thrombectomy versus catheter-directed thrombolysis for the treatment of pulmonary embolism: A retrospective case review from a community hospital

Objectives: This study aimed to assess acute outcomes following pulmonary embolism (PE) treatment with large-bore aspiration thrombectomy (LBAT) versus catheter-directed thrombolysis (CDT). Material and Methods: This single-center retrospective analysis included patients who received interventional therapy for acute PE from 2018 to 2022. The primary outcomes were changes in pre-procedural mean pulmonary artery pressure (PAP), heart rate (HR), oxygen saturation, and supplemental requirements following the procedure. Mean PAP was measured immediately post-procedure for LBAT patients and on postoperative day 1 (POD#1) for CDT patients. Results: A total of 48 patient cases were reviewed, 31 underwent LBAT and 17 underwent CDT. The majority of patients were female and most had intermediate-high-risk PE. No major bleeding events or device-related complications occurred. LBAT resulted in a significant decrease in average mean PAP immediately post-procedure (31.3 ± 9.0–21.4 ± 8.1 mmHg; P &lt; 0.001). On POD#1, CDT resulted in a significant decrease in mean PAP (31.7 ± 11.2–25.6 ± 7.9 mmHg; P = 0.005). The decrease in mean PAP was greater in the LBAT versus CDT group (P &lt; 0.05). Through POD#1, a similar reduction in average HR was observed between groups; however, a statistically significant reduction in HR was noted immediately post-procedure with LBAT and not with CDT. LBAT patients had a significant reduction in average supplemental oxygen requirements post-procedure. Conclusion: LBAT was associated with a greater reduction in mean PAP than CDT at an earlier post-procedural time point. LBAT may be advantageous over CDT due to rapid thrombus extraction; however, further studies with increased sample sizes are needed. Evidence-based medicine: Level of Evidence: Level 3, Local non-random sample.

Reduction of Environmental Noise Impact on Preterm Babies in NICU by Using Ear Plugs

Objective − To determine if using ear plugs reduce the impact of noise on preterm babies admitted to neonatal intensive care units in terms of changes in their vital parameters and their discomfort level, assessed using the Neonatal Infant Pain Scale (NIPS) score.Materials and Methods − This is an interventional study conducted in a tertiary level neonatal intensive care unit (NICU) (Bangalore, India) over a period of 3 months, ranging from June 2022 to September 2022. This study included 20 preterm babies with different gestational ages and birth weights who were admitted to the NICU during that period. The babies’ response to noise, in terms of changes in heart rate, respiratory rate, blood pressure, oxygen saturation and discomfort level, were assessed with ear plugs and without ear plugs on alternate days and the results were recorded. Descriptive statistics were used for statistical analysis. Results − On days 1 and 3, mean heart rate and systolic blood pressure were lower in babies wearing ear plugs (141.55±2.42 SD and 60.1±11.58, respectively) than in the same babies without ear plugs (157.55±2.52 SD and 61.85±1.6 SD, respectively) on days 2 and 4. The mean oxygen saturation was higher in babies wearing ear plugs (96.7%±0.80 SD) than in the same babies without the intervention (93.75%±1.29 SD). The mean NIPS score was lower with the intervention (2.05±0.22) than without ear plugs (5.05±0.22 SD).Conclusion – Ear plugs were an effective alternative in situations where noise in the NICU cannot be consistently maintained at a lower level than the standard recommendation by the AAP of 45 decibels.

The Baveno Classification as a Predictor of CPAP Titration Pressure in Obstructive Sleep Apnea Syndrome.

Obstructive sleep apnea syndrome (OSAS) is a clinical condition characterised by repeated periods of partial or full obstruction of airflow throughout sleep, with impairment of the quality of life and increased mortality with socioeconomic impacts. CPAP therapy is a simple and effective treatment option for OSAS patients. To overcome the clinical and prognostic limitations of AHI-as a sole index of OSAS-the Baveno classification was recently set out and introduced into clinical practice. This study aims to analyse the effect of the Baveno classification on the optimum CPAP titration pressure. A retrospective analysis of the records of sleep studies in two centres between 2018 and 2021 was carried out. Patients diagnosed with OSAS and recruited for CPAP titration were included. Based on the Baveno classification, the patients were categorised into four groups (A, B, C, and D). Consequently, 700 patients were analysed and 427 patients were included. A significant positive correlation was detected between the CPAP optimum titration pressure and OSAS severity, neck circumference, the oxygen desaturation index (ODI), mean oxygen saturation, the AHI, the BMI, and cumulative sleep time when the SpO2 was <90% (T90) on the other side (p: <0.0001). A non-significant correlation was seen between the Epworth Sleepiness Scale (ESS), symptom severity, end organ impact, and Baveno classification of the CPAP optimum titration pressure (p: 0.8, 0.4, 0.5, and 0.7, respectively). The Baveno classification is not useful in the prediction of CPAP optimum titration pressure. However, the ODI and neck circumference were significant independent predictors of a higher CPAP titration pressure.