Introduction: Coronavirus disease 2019 (Covid-19) has become a pandemic all over the world. Despite our familiarity with various protection devices, the high incidence among medical personnel is ...still worrisome. In this review, we provide several perioperative strategies regarding the management of daily cases in the Covid-19 pandemic setting. Methods: We used keywords (((coronavirusTitle/Abstract) OR (covid-19Title/Abstract)) OR (ncov-19Title/Abstract)) OR (SARS-cov-2Title/Abstract))) AND (perioperativeTitle/Abstract) in the National Library of Medicine (NLM) database to find eligible reports. Results: We found 32 articles from the NLM database. After eligibility screening, we found 25 eligible articles describing perioperative management during the Covid-19 pandemic that relates to the staff's safety. All eligible articles stress the importance of the negative-pressurized environment to deal with perioperative care of Covid-19 patients. In general, the use of personal protective equipment (PPE) and video laryngoscopy is also essential. Conclusion: The best protective suit to avoid health-care personnel from getting Covid-19 infection is proper training and self-discipline. This combined with cooperative, honest patients and proper PPE supply is vital in efforts to reduce the spread of the disease. Negative-pressure chambers, both in operating rooms and intensive care units, are essential in this pandemic. Unfortunately, they are not easily available in underdeveloped and developing countries.
Introduction: Terminal conditions and their treatment processes initiate actions that can be taken to relieve patients of the pain they suffer. This action is carried out by accelerating the death of ...patients with terminal conditions, known as euthanasia. Euthanasia is still being debated regarding the legal aspects and purpose of the act as part of the patient's treatment. This study aims to determine the perspective of euthanasia as part of the treatment or therapy of terminal conditions. Methods: This research is a literature study from several databases, including Proquest, Science Direct, SpringerLink, and Google Scholar. The article search used keywords combined with booleans. 755 articles were found according to the keywords, and 12 articles were selected using Prism analysis. Results: Euthanasia is seen as a way for terminal patients who have been resistant to treatment to be free from the misery of their illness. Euthanasia in health can be carried out if it is the patient's conscious choice without coercion and has met the medical requirements. Euthanasia can be carried out in areas, regions, or countries where there are regulations, laws, or similar regulations governing the implementation of euthanasia. Conclution: With the existence of clear rules for the implementation of euthanasia, health workers or families involved in euthanasia can provide a clear understanding of how to implement euthanasia.
Background: Hyperglycemia and inflammatory conditions due to surgical stress response in conventional brain tumor resection can increase the morbidity and mortality of neurosurgery patients. Enhanced ...recovery after surgery (ERAS) protocol has been widely used in various types of surgery, but data on the neurosurgery are still limited. The aim of this study was to analyze the role of preoperative oral glucose administration in attenuating surgical stress response in patients undergoing brain tumor resection. Materials and Methods: Thirty-four elective craniotomy brain tumor resection patients underwent a double-blind, randomized controlled trial. Patients were divided into two groups: one group that received oral carbohydrate (CHO; maltodextrin 12.5% 50 g in 400 ml water) 2 h preoperatively and a control group that only received water. Blood glucose level and neutrophil-lymphocyte ratio (NLR) were obtained preoperatively, before induction, and 6 h and 24 h postoperatively. Results: Blood glucose was better in the CHO group at 6 h (117.18 ± 16.25 mg/dl vs. 154.88 ± 28.22 mg/dl, P < .001) and 24 h (118.05 ± 13.89 mg/dl vs. 153.76 ± 34.81 mg/dl, P < .001) postoperatively compared to that in the control group. NLR in the CHO group showed a lower value compared to that in the control group at 6 h (8.21 ± 6.20 vs. 15.47 ± 6.76, P < .001) and 24 h (9.43 ± 7.35 vs. 20.04 ± 10.99, P < .001) postoperatively. Conclusion: Preoperative oral glucose administration can help reduce the stress response in brain tumor resection by maintaining blood glucose level and attenuating the increase of NLR postoperatively better than in routine preoperative fasting.
Thyroid storm in pregnancy Gede Utara Hartawan, I; Agung Senapathi, Tjokorda; Ryalino, Christopher ...
Bali journal of anesthesiology,
04/2021, Volume:
5, Issue:
2
Journal Article
Peer reviewed
Open access
Endocrine emergencies can occur during pregnancy and are associated with the thyroid gland and diabetes. Thyrotoxicosis is a hypermetabolic condition associated with an increase in thyroid hormone in ...the blood. The manifestations of thyrotoxicosis can range from those without symptoms to a life-threatening condition such as thyroid storm. The diagnosis of thyroid storm can be made based on a history of previous thyroid gland disorders; current signs and symptoms; and laboratory tests of thyroid-stimulating hormone, free thyroxine, and triiodothyronine. The thyroid storm is a rare condition, but the mortality rate on these patients is high. Characteristics of thyroid storms are altered consciousness, hyperpyrexia, tachycardia, and gastrointestinal disturbances. Thyroid storm management focuses on the prevention of thyroid hormone synthesis and its conversion in the periphery, identification, and intervention of the thyroid storm causes and the management of systemic disorders that present during thyroid storm. We present a 24-year-old female who presented with a very high suspicion of thyroid storm based on her Burch and Wartofsky's score criteria had a total score with a very high suspicion of thyroid storm. While pregnancy itself can increase the risk of developing severe thyrotoxicosis, the main management is determined by the presence of emergency manifestations. Our concern was not only for the safety of the mother but also for the fetus. Some drugs need special attention because they cross the blood-placental barrier. Previous patient comorbidities should also receive attention in the management of thyroid storm. The patient was being treated in the intensive care unit and managed to move to a regular ward after 3 days.
Background: Burnout is a health problem that may happen to nurses and may impact patient safety and organization in any situations, especially during the second wave of COVID-19 pandemic.
Aims: This ...study aimed to identify the prevalence of burnout among nurses in charge of isolation rooms and its relationship to their demographics factor.
Methods: This research design is descriptive-analytic quantitative and cross-sectional. It involved 124 nurses assigned to isolation rooms for COVID-19 patients admitted to the first referral hospital in Bali. Data were collected using a questionnaire adopted from the Maslach Burnout Inventory to identify burnout symptoms. Demographic questionnaire was administered to garner respondents' demographics.
Results: High category of burnout was related to emotional exhaustion found in 66.1% of the respondents, depersonalization in 33.1%, and reduced personal accomplishment in 0.8%. Age, marital status, education, and gender were not related to burnout. Nurses who worked in non-ICU experienced higher burnout than ICU (p < 0.05).
Conclusions: The prevalence of burnout symptoms in the nurses who were in charge in COVID-19 isolation rooms is in the high category. Hospital management must consider demographic factors to improve the work environment, recruit new employees, conduct routine health checks, and provide mental health treatments consistently.
Background: Successful intubation with the correct endotracheal tube (ETT) size is more difficult to achieve in pediatric patients. Several estimation methods exist, including ultrasonography and ...several conventional methods, but it is unclear which would be the most accurate method. Thus, this study aimed to compare the accuracy between several ETT diameter estimation methods. Materials and Methods: This was an observational study with a cross-sectional design. The sample includes pediatric patients (0-6 years) at a tertiary hospital recruited from January 2022 to March 2022. Primary data evaluated included age, gender, height, weight, actual ETT size used in the procedure, and the estimation of ETT size obtained by four different methods: ultrasonography, little finger diameter, little fingernail width, and age-based formula. Primary analysis was linear regression test between estimated diameter and the actual ETT diameter used in the procedure, controlling for potential confounders. The accuracy of each ETT size estimation method was seen from the values of the B and R2 coefficients from the linear regression test results. Results: Ultrasonography was found as the most accurate method, with B and R2 coefficients of 0.963 and 0.991, respectively. Among conventional methods, the diameter of the little finger was the most accurate (B = 0.918, R2 = 0.772). The age-based formula method was found to be the least accurate (B = 0.797, R2 = 0.735). Conclusion: Linear regression tests confirmed that the ultrasonography was the estimation method with the highest accuracy. For healthcare facilities with limited resources, the estimation method with little finger diameter should be considered.
Postoperative pain, when poorly controlled, will cause chronic pain and prolong the healing process. The use of an epidural catheter is a safe and effective method for pain relief in the ...intraoperative and postoperative period. Opioid as an adjuvant can increase the potency and duration of epidural analgesia. Morphine has been used as an adjuvant in epidural analgesia, but with known side effects such as nausea, vomiting, and pruritus. Oxycodone is one of the opioids which can be given through epidural route as an adjuvant with fewer side effects than morphine. In this case series, we describe six patients with American Society of Anesthesiologists physical status I-II who underwent laparotomy gynecological surgery. All patients were managed by combined general and epidural anesthesia. The regimen for epidural anesthesia is bupivacaine with oxycodone as adjuvant. In this study, we described the hemodynamic profile, quality of analgesia, side effects, and anti-inflammatory effect of oxycodone as an adjuvant in epidural analgesia.
Anesthesia is an effective way to control stress response. Surgical injury, different anesthesia techniques, and related drugs can directly or indirectly affect the immune system. The perioperative ...immunosuppression observed in surgical patients is associated with the neuroendocrine stress exerted through the activation of the autonomic nervous system and the hypothalamic-pituitary-adrenal axis. Dysregulation of this inflammatory process may increase susceptibility to infections and result in postoperative complications, such as wound-healing disturbances and infections leading to sepsis. In this case report which enrolled six patients who underwent femoral bone surgery, three patients were under general anesthesia and three patients were under regional anesthesia. We found that increased neutrophil count and serum C-reactive protein (CRP) concentration were lower in patients under spinal anesthesia compared to those under general anesthesia. In conclusion, the inflammatory response to surgery, which could be seen in the neutrophil count and CRP level, was suppressed during spinal anesthesia to a greater extent than during general anesthesia.
Cesarean section is a surgical procedure. Surgical procedures will induce stress responses, which may have negative impact on postoperative recovery. Ketamine plays a role in the homeostatic ...regulation of inflammatory response in order to attenuate stress response. We tried to determine the effectiveness of low-dose intravenous ketamine to attenuate stress response in patients undergoing emergency cesarean section with spinal anesthesia.
Thirty-six pregnant women undergoing emergency cesarean section with spinal anesthesia were randomly divided into two groups (n=18). Ketamine 0.3 mg/kg (KET group) or NaCl 0.9% (NS group) was administered intravenously before the administration of spinal anesthesia. C-reactive protein (CRP) and neutrophil levels were measured preoperatively and postoperatively.
Elevation of CRP stress response was lower in the KET group and significantly different (
≤0.05) from that in the NS group. Neutrophil level was elevated in both the groups and hence not significantly different from each other (
>0.05). Postoperative visual analog scale pain score was not significantly different between the two groups (
>0.05), but there was a statistically significant (
≤0.05) positive and weak correlation between visual analog scale and CRP level postoperatively.
Low-dose intravenous ketamine effectively attenuates the CRP stress response in patients undergoing emergency cesarean section with spinal anesthesia.
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