Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Comparison of preoperative tramadol and pethidine on postoperative pain in cats undergoing ovariohysterectomy

Abstract\ud \ud Background\ud A variety of analgesic agents are available, and which one can be used in dogs and cats is a highly controversial issue, existing however a fear in the use of opiates due to possible adverse effects that these drugs can cause. The aim of this study was to compare the analgesic effect provided by the administration of tramadol or pethidine on early postoperative pain of cats undergoing ovariohysterectomy in a double-blind prospective study. Fourty-two animals were randomly assigned into three groups. Pet received pethidine (6 mg/kg), Tra 2 received tramadol (2 mg/kg) and Tra 4 received tramadol (4 mg/kg); all intramuscularly and associated with acepromazine (0.1 mg/kg). The efficacy of each analgesic regimen was evaluated prior to surgery (baseline - TBL), during surgery and 1, 3 and 6 hours after extubation with subjective pain scale, physiologic parameters, serum concentrations of glucose, cortisol and IL-6.\ud \ud \ud Results\ud Changes in cardiovascular system were not clinically relevant. There were no significant differences in pain scores (P > 0.05) during the study, although the number of rescue analgesia was significantly higher (P < 0.05) at Pet group (5/14) than Tra 4 group (0/14), whereas in Tra 2, two animals (2/14) required additional analgesia. The serum cortisol values of Pet group were significantly higher at T1h T3h (P < 0.05) and T6h (P < 0.01) when compared to baseline (induction), also it was noticed a significant difference among the groups at T6h (Pet values were higher than Tra 2 and Tra 4; P < 0.05).\ud \ud \ud Conclusions\ud Tramadol provided adequate analgesia and it was more effective than pethidine to at least six hours for the studied animals. At the higher dose (4 mg/kg) tramadol is probably more effective, since rescue analgesia was not necessary. No significant changes were observed physiological parameter that could contraindicate the use of these opioid in described doses, for the feline species.The present study was supported by a grant from Fundação de Amparo à\ud Pesquisa do Estado de São Paulo – FAPESP (2010/18900-0)

Evaluation of the effects of methadone and tramadol on postoperative analgesia and serum interleukin-6 in dogs undergoing orthopaedic surgery

Background\ud Acute postsurgical pain is of great interest due to potential risk of becoming chronic if not treated properly, worsening patient’s recovery and quality of life. Twenty-eight dogs with ruptured cruciate ligaments were divided into three groups that received intramuscular injections of 4 mg/kg of tramadol (TRA), 0.5 mg/kg of methadone (MET0.5), or 0.7 mg/kg of methadone (MET0.7). Physiological parameters (heart and respiratory rates and blood pressure) were evaluated at specified times: baseline (TBL), 1 (T1), 2 (T2), 4 (T4), 6 (T6), and 24 (T24) hours after premedication. Pain scores were described by visual analogue scale (VAS), modified Glasgow Composite, and Colorado University Acute Pain scales. Blood samples for measurement of interleukin (IL)-6 were collected at TBL, T1, T6, and T24. This was a prospective, randomised investigation to evaluate the efficacy of tramadol and methadone as premedications in dogs undergoing osteotomies.\ud \ud \ud Results\ud There were no statistically significant differences between groups with respect to age, weight, gender, surgery time, and time to extubation. Heart rate, respiratory rate, and blood pressure values were maintained within acceptable ranges, and a reduction was observed at T2 in MET0.5 and MET0.7 compared with TBL. Increases in VAS scores were observed in TRA at T4 compared with TBL, T1, and T24 and between T1 and T6 (p < 0.001). In MET0.5, there was significant increase in VAS score at T4 compared with T1 (p < 0.001). TRA and MET0.5 showed significantly higher mean ± SD VAS scores (3.4 ± 2.5 and 2.5 ± 2.6, respectively) than MET0.7 (1.1 ± 1.5) at T4 (p < 0.001). TRA showed greater demand of rescue analgesia (four animals in T4 and two in T6) (p < 0.037). There were no statistically significant differences in sedation scores, Colorado Scale scores, or interleukin levels between groups and time points.\ud \ud \ud Conclusions\ud Methadone given as premedication in doses of 0.7 mg/kg was better at controlling pain compared with lower doses and tramadol. However, dosage increases, administered as rescue analgesia, promoted adequate pain control even in tramadol group. Influence of these analgesics on IL-6 release could not be demonstrated, but significant levels were not found.FAPESP [2007/55935-3]PROAPPRPG-USPCape

Veterinary Anaesthesia and Analgesia

Texto completo: acesso restrito. p. 396–400Objective  To evaluate the quality of brachial plexus blockade with 0.75% ropivacaine in domestic chickens. Study design  Prospective experimental trial. Animals  Six 30-week-old female chickens, weighing 4.5 ± 0.4 kg. Methods  Six brachial plexus injections were performed after anesthetic induction with isoflurane. After achieving adequate muscle relaxation, the animals were positioned in dorsal recumbency and injected with ropivacaine (1 mL kg−1). The birds recovered and assessments of motor function and response to pinch were scored every 5 minutes for 180 minutes. The scores were from zero (no response) to three (greatest response). The scores over time were analyzed using a Wilcoxon nonparametric test with statistical significance accepted if p ≤ 0.05. Results  There was a significant difference (p 0.05). Conclusions and clinical relevance  No complications were observed after the technique. Brachial plexus blockade with 0.75% ropivacaine is a simple and effective technique for procedures on the thoracic limb of domestic chickens

Comparison of preoperative tramadol and pethidine on postoperative pain in cats undergoing ovariohysterectomy

Abstract Background A variety of analgesic agents are available, and which one can be used in dogs and cats is a highly controversial issue, existing however a fear in the use of opiates due to possible adverse effects that these drugs can cause. The aim of this study was to compare the analgesic effect provided by the administration of tramadol or pethidine on early postoperative pain of cats undergoing ovariohysterectomy in a double-blind prospective study. Fourty-two animals were randomly assigned into three groups. Pet received pethidine (6 mg/kg), Tra 2 received tramadol (2 mg/kg) and Tra 4 received tramadol (4 mg/kg); all intramuscularly and associated with acepromazine (0.1 mg/kg). The efficacy of each analgesic regimen was evaluated prior to surgery (baseline - TBL), during surgery and 1, 3 and 6 hours after extubation with subjective pain scale, physiologic parameters, serum concentrations of glucose, cortisol and IL-6. Results Changes in cardiovascular system were not clinically relevant. There were no significant differences in pain scores (P > 0.05) during the study, although the number of rescue analgesia was significantly higher (P < 0.05) at Pet group (5/14) than Tra 4 group (0/14), whereas in Tra 2, two animals (2/14) required additional analgesia. The serum cortisol values of Pet group were significantly higher at T1h T3h (P < 0.05) and T6h (P < 0.01) when compared to baseline (induction), also it was noticed a significant difference among the groups at T6h (Pet values were higher than Tra 2 and Tra 4; P < 0.05). Conclusions Tramadol provided adequate analgesia and it was more effective than pethidine to at least six hours for the studied animals. At the higher dose (4 mg/kg) tramadol is probably more effective, since rescue analgesia was not necessary. No significant changes were observed physiological parameter that could contraindicate the use of these opioid in described doses, for the feline species