Search

Background and Goal of Study: The purpose of our study was to identify the appropriate dosage of continuous remimazolam that would provide satisfactory sedative and hypnotic ef fects to the patients, i.e., to procure a BIS score of 60 to 80 and/or Richmond sedation scale (RASS) value of -2 or -3. Materials and Methods: 23 patients of ASA status II, III or IV undergoing surgical procedures in spinal anaesthesia were studied. Af ter assessing for adequate quality of spinal block, and at the beginning of the surgical procedure, a bolus dose of remimazolam of 5 mg was applied, and syringe pump was set to deliver remimazolam 1 mg/mL at 15 mL/h, adjusting the rate of infusion to maintain BIS values between 60 and 80. BIS, Richmond sedation scale (RASS) and infusion rate were noted every 5 minutes. Side ef fects (hypotension, bradycardia, hypoxia) were monitored. Results and Discussion: Mean patients’ age was 67.3 ± 13.1 years with male frequency of 56.6%. There were 15 (65.2%) ASA II patients and 8 (34.8%) ASA III patients. When the BIS values were between 60 and 80, the median dose of infused remimazolam was 3.2 mcg/ kg/min (ranging from 1.0 to 5.1 mcg/kg/min ; Q1 2.4, Q3 4.1). Results are graphically represented in Figure 1. Median time from discontinuation of infusion until full recovery of consciousness was 3.5 minutes (ranging from 0 to 8 min ; Q1 1.5, Q3 5.0). Hypotension was recorded in 7 patients, with only 4 cases (17.4%) needing treatment with low doses of ephedrine. No other side ef fects were recorded. Patients reported satisfactory amnestic ef fects (86.9%) af terwards. Conclusion(s): Continuous infusion of remimazolam with median dose of 3.2 mcg/kg/min has provided an ef fective and satisfactory sedative and hypnotic levels for non-healthy individuals, measured by BIS and Richmond sedation scale, with rapid of fset and early recovery.

Background and goal of study: The ROX index is defined as the ratio of SpO2 measured by pulse oximetry/FiO2 to respiratory rate. It is used as predictor of the need for intubation in patients receiving HFNC oxygen therapy, but not yet validated for NIV/CPAP ventilation. The goal of this study is to determine if the ROX index could predict risk for intubation in surgical patients receiving NIV/CPAP mask ventilation. Materials and Methods: Patient data was extracted from freely available AmsterdamUMC ICU database containing data from a 32- bed mixed surgical- medical academic ICU with 1 billion clinical data points related to 23106 admissions between 2003 and 2016. We selected patients that were non- invasively mechanically ventilated and extracted their demographic data (age, sex, BMI) and SOFA score at admission, as well as ROX index from 2 hour window mean values of SpO2, RR and FiO2 for the first 12 hours of ventilation. Results and Discussion: From 20106 patients, a cohort of 1075 NIV patients using CPAP/PS modes were identified. We excluded patients that received NIV ventilation after an episode of intubation (n=47) and patients that were intubated more than 24 hours after NIV episode (n=53). Final dataset consisted of 975 patients, 190 were intubated within 24 hours NIV ventilation start. Patient demographic data was similar between intubated and non- intubated group (Table 1). Conclusion(s): Analysing a large database of surgical patients, we found that ROX index significantly correlates with the need for intubation after 4 hours of NIV/CPAP ventilation. ROX index could be a good predictor for intubation in surgical patients receiving NIV CPAP/PS ventilation.

Background and Goal of Study: Carotid endarterectomy (CEA) is a common procedure performed under regional anaesthesia providing monitoring of cerebral function in real time. Numerous techniques of regional cervical blocks exist but superficial cervical plexus block (SCB) is one most commonly used. The aim of this study was to compare regional anaesthesia using only superficial cervical plexus block with an ultrasound-guided carotid sheath block combined with superficial cervical plexus block for CEA. Materials and Methods: Patients undergoing elective CEA surgery were randomly assigned into two groups: one received ultrasoundguided carotid sheath block and SCB (n=12) while another group received SCB only (n=18). Patients did not receive any premedication. All patients were ASA grade II and III and had invasive blood pressure monitoring with parameters noted every 5 minutes. Both groups received mixture of 2 mg/kg 0.5% levobupivacaine and 2 mg/kg 2% lidocaine supplemented with saline to a volume of 50 mL. The onset and duration of sensory block and time to first analgesia were recorded. Analgesia was measured using numeric pain rating scale (NPRS) every 2 hours, up to 12 hours af ter regional block was performed. A log-rank test was performed to compare a probability of NPRS≤ 3 during follow-up time, with results described as Kaplan-Meier curves. Results and Discussion: Demographic data and surgical characteristics were comparable in both groups. Block onset time and duration of sensory block were not statistically dif ferent in both groups. Time to first analgesia was slightly higher in the group of patients receiving ultrasound-guided carotid sheath block with SCB (dif ference of medians 124 minutes), but the dif ference was Regional Anaesthesiology 93 not statistically significant. Also, postoperative pain in the first 12 hours described as a probability of NPRS≤ 3 was more prominent in patients having received only superficial cervical plexus block (66.6% as opposed to 58, 3%), but log-rank test showed no significant dif ference. Conclusion(s): Our early research data do not show benefits of addition of ultrasound-guided carotid sheath block in prolonged postoperative analgesia i.e., time to first analgesia. However, a larger sample size is needed for better statistical power to confirm whether the use of ultrasound-guided technique could prove more beneficial in prolonging postoperative analgesia and sensory block duration time.