febrile children younger than 3 years old. Acad Emerg Med. 2014;21:171-9. 15. Nijman RG, Vergouwe Y, Thompson M, et al. Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study. BMJ. 2013:346:f1706. 16. Galetto-Lacour A, Zamora SA, Gervaix A. A score identifying serious bacterial infections in children with fever without source. Pediatr Infect Dis. 2008;27:654-6. 17. Galetto-Lacour A, Zamora SA, Andreola B, et al. Validation of a laboratory index score for the identification of severe
Diana Aniela Moldovan, Maria Despina Baghiu, Alina Balas and Sorana Teodora Truta
Ipek Saadet Edipoglu, Behiye Dogruel, Sevda Dizi, Melis Tosun and Nahit Çakar
Med 2012; 38: 1654-1661. doi: 10.1007/s00134-012-2629-6 4. Sacanella E, Pérez-Castejón JM, Nicolás JM, Masanés F, Navarro M, Castro P, et al. Functional status and quality of life 12 months after discharge from a medical ICU in healthy elderly patients: a prospective observational study. Crit Care 2011; 15: R105. doi: 10.1186/cc10121 5. Leong IY, Tai DY. Is increasing age associated with mortality in the critically ill elderly. Singapore Med J 2002; 43: 33-36 6. Huang Y, Chen J, Zhong S, Yuan J. Role of APACHE-II scoring system in the prediction of
Sebastian Trancă, Cristina Petrișor, Natalia Hagău and Constantin Ciuce
predictor of sepsis and outcome in severe trauma patients: a prospective study. J Lab Physicians. 2013;5:100-8. 8. Angus DC, Wax RS. Epidemiology of sepsis: an update. Crit Care Med. 2001;29:S109-16. 9. Antonelli M, Moreno R, Vincent JL, et al. Application of SOFA score to trauma patients. Sequential Organ Failure Assessment. Intensive Care Med. 1999;25:389-94. 10. Mica L, Furrer E, Keel M, Trentz O. Predictive ability of the ISS, NISS, and APACHE II score for SIRS and sepsis in polytrauma patients. Eur J Trauma Emerg Surg
patients who developed ventilator-associated pneumonia. Annals of Thoracic Medicine. 2015;10:137-42. 4. Antonelli M, Moreno R, Vincent JL, Sprung CL, Mendoça A, Passariello M, et al. Application of SOFA score to trauma patients. Sequential Organ Failure Assessment. Intensive Care Med. 1999;25:389-94. 5. Mica L, Furrer E, Keel M, Trentz O. Predictive ability of the ISS, NISS, and APACHE II score for SIRS and sepsis in polytrauma patients. Eur J Trauma Emerg Surg. 2012;38:665-71 6. Agarwal A, Agrawal A, Maheshwari R
Ayman A. Metry, Noha S. Hussain, George M. Nakhla, Milad Z. Ragaei and Ramy M. Wahba
, Fraschini G, Torri G. Randomized comparison between sevoflurane anaesthesia and unilateral spinal anaesthesia in elderly patients undergoing orthopaedic surgery. Eur J Anaesthesiol 2003; 20: 640-646. doi: 10.1017/S0265021503001030 22. te Winkel-Witlox ACM, Post MW, Visser-Melly JMA, Lindeman E. Efficient screening of cognitive dysfunction in stroke patients: Comparison between the CAMCOG and the R-CAMCOG, Mini Mental State Examination and Functional Independence Measure-cognition score. Disabil Rehabil 2008; 30: 1386-1391. doi: 10.1080/09638280701623000 23
Davina Wildemeersch, Michiel Baeten, Natasja Peeters, Vera Saldien, Marcel Vercauteren and Guy Hans
Background. Pupillary response by pupillary dilatation reflex (PDR) is a robust reflex, even measurable during general anaesthesia. However, the ability of infrared pupillometry to detect PDR differences obtained by intraoperative opioid administration in anaesthesized patients remains largely unknown. We analyzed the performance of automated infrared pupillometry in detecting differences in pupillary dilatation reflex response by a inbuilt standardized nociceptive stimulation program in patients under general anesthesia with a standardized propofol/fentanyl scheme. Methods. In this single center, interventional cohort study 38 patients (24-74 years) were enrolled. Patients were anesthetized with propofol until loss of consciousness. Two dynamic pupil measurements were performed in each patient (before opioid administration and after opioid steady state). Automated infrared pupillometry was used to determine PDR during nociceptive stimulations (10-60 mA) applied by a inbuilt pupillary pain index protocol (PPI) to the skin area innervated by the median nerve. Increasing stimulations by protocol are device specific and automatically performed until pupil dilation of > 13%. Pupil characteristics, blood pressure, heart rate values were collected. Results. After opioid administration, patients needed a higher stimulation intensity (45.26 mA vs 30.79 mA, p = 0.00001). PPI score showed a reduction after analgesic treatment (5.21 vs 7.68, p = 0.000001), resulting in a 32.16% score reduction. Conclusions. PDR via automated increased tetanic stimulation may reflect opioid effect under general anaesthesia. Further research is required to detect possible confounding factors such as medication interaction and optimization of individualized opioid dosage.
Stelian Atila Balan, Şerban Ion Bubenek-Turconi, Gabriela Droc, Elena Marinescu, Elisabeta Nita, Mihaela Camelia Popa, Dana Popescu-Spineni and Dana Tomescu
Background and aims. This study aims to identify the extent to which Burnout syndrome is present among medical staff in the anaesthesia and intensive care units in Romania and if there are significant differences dependant on age or sex.
Methods. Maslach Burnout Inventory (MBI), structured in three dimensions: Emotional Exhaustion – 9 items (EE), Depersonalization – 6 items (D) and Reduction of personal achievement – 10 items (RPA), was used for the evaluation of Burnout Syndrome in 275 medical staff in anaesthesia and intensive care physician and nurses from departments in Romania.
Results. Burnout syndrome among medical staff with MBI had a total score of 68 and average scores for all syndrome categories. There were no statistically significant differences dependant on age and sex (p < 0.05, chi-squared test). The logistic regression has highlighted three elements that are risk factors, which belonged to the psycho-emotional sphere, communication abilities and the degree of organization and professional planning (item – I feel at the end of my rope, item – I do not communicate easily with people regardless of their social status and character, and item – I have professional disillusion). The risk factor with the most reliable range was the item “I feel at the end of my rope”.
Conclusion. The level of Burnout syndrome is medium regardless of sex or age category. Possibly, the concern of the ICU medical staff for the psycho-emotional life is not efficient, as well as for identifying/ developing communication abilities. The association between risk factors for burnout syndrome and psycho-emotional life development require further research.
Amy Willett, Raymond Lew and Richa Wardhan
Background. The classic adductor canal block (ACB) is a regional technique that aims to introduce local anesthetic to the saphenous nerve as it traverses the adductor canal. It offers the benefit of preserved quadriceps strength, and is ideal for rehabilitation. Proximal ACB (PACB) allows the operator to place the block away from the surgical site, permitting preoperative placement. Our primary outcome was total opioid consumption; secondary outcomes included the highest numerical rating scale scores and total gait distance at the indicated time intervals.
Questions/purposes. We asked: 1) Does a Continuous Proximal ACB block with Periarticular knee injection (PACB) provide better analgesia than a Continuous Epidural (CSE)?; 2) Do PACB catheter patients do better with physical therapy compared to CSE patients?; 3) Are PACB patients discharged earlier than CSE patients?
Methods. With IRB approval we performed a retrospective chart review of patients who had underwent primary total knee arthroplasty between October 2015 and September 2016. The selected patients (n = 151) were divided into two groups: CSE group, 72 patients who received a continuous epidural catheter and the PACB group, 79 patients who received at PACB with Periarticular injection. The CSE group received a single-segment combined spinal epidural (CSE) in the operating room. The epidural catheter infusion was started with 0.1% ropivacaine at 8 mL/hour to 14 mL/hour during the post-operative period. The PACB group received a proximal adductor canal catheter with 20 ml of 0.5 % ropivacaine and maintained with ropivacaine 0.2% at 8 ml to 14 ml post operatively. Total opioid consumption, highest numeric rating scores and total gait distance travelled were recorded upon discharge from the PACU and completion of postoperative day (POD) 0, 1, and 2.
Results: We found that the median cumulative morphine consumption was significantly higher in the CSE group compared to the PACB group (194 (0-498) versus 126 (0-354) mg, p = 0.012), a difference that was most notable on POD 1 (84 (16-243) versus 60 (5-370) mg, p = 0.0001). Mean hospital length of stay was also shorter in the PACB group (2.6 ± 0.67 versus 3.0 ± 1.08 days, p = 0.01).
Conclusion: PACB group used significantly lower morphine consumption compared to the CSE group; they were better participants during physical therapy and achieved longer gait distances. The mean hospital length of stay was also shorter in the PACB group
Robert Qiu, Albert C. Perrino, Holly Zurich, Nitin Sukumar, Feng Dai and Wanda Popescu
Background: Patients undergoing video-assisted thoracoscopic surgery (VATS) are particularly vulnerable to opioid-induced sedation and hypoventilation. Accordingly, reducing opioid consumption in these patients is a primary goal of multimodal analgesic regimens. Although administration of preoperative gabapentin and acetaminophen has been shown to decrease postoperative opioid consumption in other surgeries, this approach has not been studied in VATS lobectomy. Our objective was to examine the impact of the addition of preoperative gabapentin and acetaminophen to a VATS lobectomy multimodal analgesic plan on postoperative opioid consumption, nausea/vomiting, and sedation. Methods: With IRB approval, we performed a retrospective chart review of patients who underwent VATS lobectomy at a single center between 2015 and 2016 to identify those that received preoperative gabapentin and acetaminophen and those that received neither. Opioid consumption in the first 24 hours postoperatively was converted to oral morphine equivalents (OMEQs). Postoperative sedation was evaluated using Aldrete scores and the percentage of patients requiring antiemetics in the first 24 hours was also examined. Results: There were 133 patients who were opioid naive: 31 received preoperative gabapentin and acetaminophen and 102 received neither. Median 24 hour postoperative opioid consumption was lower but not statistically significant in the gabapentin and acetaminophen group vs. neither (36 mg vs. 45 mg, p = 0.08). Notably, there was a change in the distribution of opioid consumption, with no patients in the gabapentin and acetaminophen group requiring more than 200 mg OMEQ in the first 24 hours postoperatively. No significant difference in postoperative nausea/vomiting or sedation was observed. Conclusions: The addition of preoperative gabapentin and acetaminophen to a VATS lobectomy multimodal analgesic regimen reduces the incidence of high dose postoperative opioid consumption without observed negative side effects.
Tiberiu Ezri, Ronen Waintrob, Yuri Avelansky, Alexander Izakson, Katia Dayan and Mordechai Shimonov
and evaluation of a new score characterizing the complexity of endotracheal intubation. Anesthesiology 1997; 87: 1290-1297 4. Dohrn N, Sommer T, Bisgaard J, Rønholm E, Larsen JF. Difficult tracheal intubation in obese gastric bypass patients. Obes Surg 2016; 26: 2640-2647. doi: 10.1007/s11695-016-2141-0 5. De Baerdemaeker LEC, Van Limmen JGM, Van Nieuwenhove Y. How should obesity be measured and how should anesthetic drug dosage be calculated?. In: Leykin Y, Brodsky JB (eds.). Controversies in the anesthetic management of the obese