Background: Pregnant women and neonates are susceptible populations in many infections. Health-care workers are facing a new challenge as only few data are available on the effect of coronavirus ...disease 2019 (COVID-19) on pregnancy. The aim of this review was to see the current recommendations regarding the perioperative management of the cesarean section in COVID-19 patients. Methods: We used the keywords of (((coronavirus Title/Abstract) OR (covid-19 Title/Abstract)) OR (ncov-19 Title/Abstract)) OR (SARS-cov-2 Title/Abstract))) AND (Cesarean Title/Abstract or Pregnancy Title/Abstract) in the PubMed database to find eligible reports. We studied all titles and abstracts from the search results and removed irrelevant studies that did not comply with our research question. Two authors were assigned to assess the validity and reliability of the studies using the Joanna Briggs Institute's critical appraisal tool. The cutoff point for inclusion was 50% of the total checkmarks in each critical appraisal checklist. Results: We found 16 articles from the PubMed database based on keywords described earlier. After eligibility screening, we found seven eligible articles describing perioperative management of the cesarean section during the COVID-19 pandemic. Conclusion: There is no solid evidence that the cesarean section is protective against the transmission of COVID-19. The use of an appropriate biosafety level-3 protective suits is imperative in managing patients presenting for cesarean section with COVID-19 in an operating room. A negative-pressure environment, both in the operating room and incubator, should be prepared for such cases. Regional anesthesia is the recommended technique, but general anesthesia is preferable in specific maternity conditions.
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.
The most frequent patients' complaints of spinal anesthesia are post-spinal headache and post-spinal backache. As many as 13.4% of the patients have backache as the major reason for refusing spinal ...anesthesia. This systematic review was conducted using keywords: "post spinal backache," "post spinal backpain," "caesarean section," "caesarean delivery," and "obstetric," which were combined using Boolean operator "OR" and "AND." The time filter was set from 2000 until 2020. We included six studies that included a total of 2721 subjects who underwent elective cesarean delivery under spinal anesthesia, of which 675 subjects or about 24% of them experienced backache. Many factors were thought to be responsible for the incidence of post-spinal backache. Trauma due to needle injection, hematoma, and excessive stretching of ligaments until infection which leads to abscess are possibly being the main causes of post-spinal backache. There are several efforts that can be made to reduce the risk of post-spinal backache, such as using a small needle without an introducer, performing spinal anesthesia with a paramedian approach, and reducing the number of attempts.
Background: Health-care system reform in Indonesia is challenging for anesthesiologists in determining the minimum cost of anesthesia and maintaining inflammation and pain to a minimum. This study is ...aimed to analyze the effectiveness of general anesthesia techniques between target-controlled inhalational anesthesia (TCIA) sevoflurane and target-controlled infusion (TCI) propofol in mastectomy surgery from the perspective of cost, C-reactive protein (CRP) levels, postoperative pain level, postoperative opioid consumption, and side effects. Patients and Methods: This was a randomized controlled trial with permuted block randomization of 60 subjects allocated into TCIA sevoflurane (Group S) and TCI propofol (Group P). In Group S, we used sevoflurane 8 vol% for induction and maintained with sevoflurane 1-1.5 vol%, compressed air, and oxygen. In Group P, we used TCI propofol with target effect 4 mcg/mL and maintained with TCI propofol (target effect of 1-3 mcg/ml), compressed air, and oxygen. Results: The cost in Group S was US$ 36.33 compared to US$ 29.69 in Group P (P = 0.002). The CRP level was comparable between the two groups (38.39 42.13 vs. 23.88 45.26. P = 0.487). There is neither difference in pain score, total morphine consumption, and side effects between both groups in the first 24-h postoperative period, nor morphine consumption in 24 h postoperative. Conclusion: The cost of anesthesia-related expense in TCI propofol is lower than TCIA sevoflurane in mastectomy surgery underwent general anesthesia. There is no significant difference in terms of CRP levels, postoperative pain, postoperative morphine consumption, and incidence of side effects.
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.
BACKGROUND: The prevalence of extended-spectrum beta-lactamases (ESBLs)-producing Enterobacteriaceae has increased throughout the world and is a major cause of treatment failure in intensive care ...unit (ICU). ESBL-producing Enterobacteriaceae exhibit resistance to cephalosporins which is one of the most commonly used and effective group of antibiotics.
AIM: The goal of this study was to identify the variables that influence the colonization of Enterobacteriaceae in patients treated at ICU.
PATIENTS AND METHODS: A prospective study involving randomized 70 patients was conducted at ICU of Sanglah General Hospital from October 2018 to March 2019. Specimens were obtained from rectal swabs on admission to and discharged from ICU. Initial bivariate analysis was conducted using Pearson’s Chi-square and considered significant if p <0.05. Adjusted relative risk ratio (RR) was used to estimate the influence of the variables to ESBL colonization.
RESULTS: Respiratory system dysfunction (p = 0.012, RR = 2.828) and antibiotic prescription before ICU admission (p < 0.001) influence ESBL-producing Enterobacteriaceae colonization on patient who was admitted to ICU. On discharged from ICU, ESBL colonization was associated to respiratory system dysfunction (p = 0.008, RR = 1.987), third-generation cephalosporin usage (p = 0.009, RR = 2.909), cefoperazone prescription (p < 0.001, RR = 8.471), ceftriaxone prescription (p = 0.007, RR = 6.316), and antibiotics usage duration ≥3 days (p < 0.001, RR = 7.071). The logistic regression results on influence of antibiotics usage and respiratory system dysfunction to ESBL colonization rate shows that both variables are independent risk factor to EBLS colonization both on admitted to and discharged from ICU.
CONCLUSION: The antibiotics usage and respiratory system dysfunction are independent risk factors to EBLS colonization in ICU patients.
Abstract
BACKGROUND: Ventilator use to treat patients with respiratory failure in the Intensive Care Unit (ICU) is crucial to prevent further organ failure caused by inadequate oxygenation. However, ...as an invasive procedure, the use of a ventilator could lead to nosocomial infection, such as Ventilator-Associated Pneumonia (VAP) caused by opportunistic microorganisms in the ICU. Hence, the author is interested in finding the microbial patterns and its antibiotic sensitivity as a source of data for further researches and providing consideration on antibiotics usage for patients treated with ventilators in the ICU of Sanglah Hospital Denpasar.
AIM: This study is conducted to obtain the microbial pattern and antibiotics sensitivity on patients treated with ventilators in the ICU of Sanglah Hospital Denpasar.
MATERIALS AND METHODS: This research is based on the cross-sectional descriptive method. Research samples were chosen with consecutive sampling that is included in the research’s inclusion criteria. Patient data were collected from the 1st January 2021 to 30th June 2021 within the ICU of Sanglah Hospital Denpasar. Variables in this research were listed as followed: demographic data of the patients that include age, gender, comorbid, diagnosis, ventilator usage indication, bacterial culture, and bacterial susceptibility test.
RESULTS: 185 culture samples were obtained from 113 patients. 18 different species of bacterias were found with the three most common microorganisms being Pseudomonas aeruginosa (22.2%), Acinetobacter baumanii (20%), and Klebsiella pneumoniae (17.3%). Susceptibility pattern found as follows: The prevalence of P aeruginosa was found sensitive towards ceftazidime (68,3%), gentamicin (68,3%), and amikacin (65,9%), A. Baumanii are mostly sensitive to amikacin (56,8%), gentamicin (32,4%), and tigecyline (32,4%), K. Pneumoniae are mostly sensitive to amikacin (83,9%), meropenem (77,4%), and piperacillin/tazobactam (54,8%). Resistance pattern found as follows: The prevalence of P aeruginosa was found resistant towards cefixime (70,7%), cefazolin (58,5%), and cefuroxime (58,5%), A. baumanii are mostly resistant to cefixime (86,5%), cefoperazone (81,1%), and piperacillin/tazobactam (75,7%), K. pneumoniae are mostly resistant to ciprofloxacin (61,3%) and levofloxacin (48,4%).
CONCLUSION: To decrease the spreading of multi-drug resistant organisms that have been found in ventilated patients, prevention strategies and rational use of antibiotics needs to be performed correctly.
Key-words: Ventilator, microbial pattern, antibiotics, sensitivity, resistance
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