Attenuation of systemic inflammatory stress response after preoperative analgesia with clonidine compared to levobupivacaine-a randomised clinical trial

Background and purpose: Use of analgetics before the pain stimulus (preventive analgesia) obstruct development of neuroplastic changes in central nervous system, and reduces pain. Furthermore, preventive analgesia can block harmful central nervous system response and inflammation as an early consequence of operation as well. Investigation hypothesis is that preoperative central clonidine will reduce systemic inflammatory stress response better than levobupivacaine. Materials and methods:. Patients were allocated to three groups, according to preoperative epidural use of 5 μg/kg clonidine (n=17), 0.25% levobupivacaine (n=12) or saline as control group (n=13). Before operation, 1 h after the beginning, 1 h, 6 h, 12 h and 24 h after the operation following parameters were analyzed: procalcitonin (PCT), interleukine-6 (IL-6), C-reactive protein (CRP) and lactate. Results: There were no significant differences between groups in age, gender, body mass index and operation time. We demonstrated significant reduction in PCT, IL-6, CRP and lactate levels in preoperative clonidine group, compared to preoperative levobupivacaine group and controle group. Conclusion. These results support importance of clonidine central effect on pain pathways and systemic inflammatory stress response blockade

Attenuation of systemic inflammatory stress response after preoperative analgesia with clonidine compared to levobupivacaine-a randomised clinical trial

Background and purpose: Use of analgetics before the pain stimulus (preventive analgesia) obstruct development of neuroplastic changes in central nervous system, and reduces pain. Furthermore, preventive analgesia can block harmful central nervous system response and inflammation as an early consequence of operation as well. Investigation hypothesis is that preoperative central clonidine will reduce systemic inflammatory stress response better than levobupivacaine. Materials and methods:. Patients were allocated to three groups, according to preoperative epidural use of 5 μg/kg clonidine (n=17), 0.25% levobupivacaine (n=12) or saline as control group (n=13). Before operation, 1 h after the beginning, 1 h, 6 h, 12 h and 24 h after the operation following parameters were analyzed: procalcitonin (PCT), interleukine-6 (IL-6), C-reactive protein (CRP) and lactate. Results: There were no significant differences between groups in age, gender, body mass index and operation time. We demonstrated significant reduction in PCT, IL-6, CRP and lactate levels in preoperative clonidine group, compared to preoperative levobupivacaine group and controle group. Conclusion. These results support importance of clonidine central effect on pain pathways and systemic inflammatory stress response blockade

The Use of Color Duplex Ultrasound and Magnetic Resonance Imaging in the Dissolution of Idiopathic Recurrent Priapism in Patient with Congenital Penile Curvature – A Case Report

Priapism, penile erection characterized as prolonged and devoid of sexual stimulation or excitement is a rare condition. It is critical to distinguish between low- and high-flow priapism, because the treatment algorithm differs markedly for these 2 conditions. The diagnosis is made clinically and confirmed with color Doppler ultrasonographic imaging (CDUS). We present a 21 year old men with high-flow priapism and left lateral congenital penile curvature. A duplex Winter shunt procedure was employed with corporeal irrigation of heparin solution and adrenalin solution instillation, but the priapism returned 12 hours after. Following several days slow instillation of phenilephrine or adrenaline solution accompanied by oral flutamide therapy resulted in complete detumescence. We used both CDUS and magnetic resonance imaging (MRI) before and after treatment of priapism. Although CDUS has been the primary modality for cross-sectional imaging of the penis, the superior soft-tissue contrast and spatial resolution afforded by MRI provide an opportunity to advance imaging evaluation of this organ

Continuous vs Intermittent Meropenem Administration in Critically Ill Patients With Sepsis

Importance: Meropenem is a widely prescribed β-lactam antibiotic. Meropenem exhibits maximum pharmacodynamic efficacy when given by continuous infusion to deliver constant drug levels above the minimal inhibitory concentration. Compared with intermittent administration, continuous administration of meropenem may improve clinical outcomes. Objective: To determine whether continuous administration of meropenem reduces a composite of mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria compared with intermittent administration in critically ill patients with sepsis. Design, setting, and participants: A double-blind, randomized clinical trial enrolling critically ill patients with sepsis or septic shock who had been prescribed meropenem by their treating clinicians at 31 intensive care units of 26 hospitals in 4 countries (Croatia, Italy, Kazakhstan, and Russia). Patients were enrolled between June 5, 2018, and August 9, 2022, and the final 90-day follow-up was completed in November 2022. Interventions: Patients were randomized to receive an equal dose of the antibiotic meropenem by either continuous administration (n = 303) or intermittent administration (n = 304). Main outcomes and measures: The primary outcome was a composite of all-cause mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28. There were 4 secondary outcomes, including days alive and free from antibiotics at day 28, days alive and free from the intensive care unit at day 28, and all-cause mortality at day 90. Seizures, allergic reactions, and mortality were recorded as adverse events. Results: All 607 patients (mean age, 64 [SD, 15] years; 203 were women [33%]) were included in the measurement of the 28-day primary outcome and completed the 90-day mortality follow-up. The majority (369 patients, 61%) had septic shock. The median time from hospital admission to randomization was 9 days (IQR, 3-17 days) and the median duration of meropenem therapy was 11 days (IQR, 6-17 days). Only 1 crossover event was recorded. The primary outcome occurred in 142 patients (47%) in the continuous administration group and in 149 patients (49%) in the intermittent administration group (relative risk, 0.96 [95% CI, 0.81-1.13], P = .60). Of the 4 secondary outcomes, none was statistically significant. No adverse events of seizures or allergic reactions related to the study drug were reported. At 90 days, mortality was 42% both in the continuous administration group (127 of 303 patients) and in the intermittent administration group (127 of 304 patients). Conclusions and relevance: In critically ill patients with sepsis, compared with intermittent administration, the continuous administration of meropenem did not improve the composite outcome of mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28. Trial registration: ClinicalTrials.gov Identifier: NCT03452839

Effect of bispectral index monitoring on extubation time and analgesic consumption in abdominal surgery: a randomised clinical trial

PRINCIPLES: The aim of this study was to investigate the effect of bispectral index (BIS) monitoring on intra-operative anaesthesia consumption and extubation time. Design: Randomised controlled study. METHODS: The study included 45 patients undergoing major abdominal surgery under general anaesthesia in a six month period (February – July 2011), aged 18 years or older, and classified as ASA (American Society of Anaesthesiologists) physical status II or III. Patients were randomly assigned to receive BIS-guided anaesthesia or routine anaesthesia care as a non BIS-guided group. At the induction of anaesthesia, and during the operation the following parameters were continuously recorded: BIS level, heart rate (HR), systolic blood pressure (sBP), end-tidal CO2 (etCO2).Operation time and time to extubation were also recorded. On the first post-operative day all patients were visited and interviewed about intra-operative recall. RESULTS: BIS levels in the non BIS-guided group were significantly lower from 30 minutes further to the end of the operation, compared to the BIS-guided group (p <0.05). Time to extubation was significantly shorter in the BIS-guided group (17.5 min vs. 75 min, p <0.001). There were no statistically significant differences in the required amounts of anaesthetics. In the post-operative interview, none of the patients reported an episode of intra-operative awareness. CONCLUSION: Guiding anaesthesia according to BIS level will result in significantly faster recovery after anaesthesia. The investigation was registered on ClinicalTrials.gov (NCT01470898)