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Background and Aims: Anxiety plays a distressing role in cardiothoracic operations. It may trigger hemodynamic instability, increased morbidity, and very crucially, postoperative pain and analgesic use. Our aim is to look at the association between anxiety, postoperative pain, and analgesic use. Materials and Methods: One hundred and twenty-two patients scheduled for cardiothoracic surgeries were asked questions according to the Amsterdam Preoperative Anxiety and Information Scale (APAIS), the evening prior to the surgery. Different factors that could affect anxiety perioperatively were recorded through the patient's hospital records. The visual analog score (VAS) was recorded at arrival in the ICU after surgery. Paracetamol (1 g) and Inj Tramadol (1 mg/kg) were administered as postoperative analgesia. Additional fentanyl boluses (1 mcg/kg) were administered whenever the VAS exceeded 4. Analgesic doses were documented. All the data were then analyzed statistically. Results: Preoperative anxiety was recorded in 63.9% of the 122 subjects included in the study, with younger patients and patients with very low socioeconomic status being the majority. VAS, at 20 and 24 hrs of assessment, was higher in both groups, and there was a statistically significant difference, with patients that were preoperatively anxious, recording higher VAS scores. Postoperative analgesic doses were also significantly higher for patients with anxiety. Conclusions: This clinical trial demonstrated that greater than 60% of the participants presented with preoperative anxiety, the majority being young participants. Lower socioeconomic status is also a risk factor for preoperative anxiety. Patients who suffered from preoperative anxiety are more likely to have greater pain scores and analgesic needs during postsurgical assessment. [ABSTRACT FROM AUTHOR]

Adverse Event: Warfarin‐related nephropathy. Drug Implicated: Warfarin. The Patient: A 31‐year‐old female, managed with warfarin for rheumatic heart disease with atrial fibrillation. Evidence that Links the Drug to the Event: There were no alternative causes of nephropathy that could have caused the adverse event in this patient. Management: Shifting the drug from warfarin to acenocoumarol. Mechanism: Difference in renal elimination between warfarin and acenocoumarol. Implication for Therapy: Clinicians should be aware of this rare adverse effect of warfarin, and acenocoumarol can be considered as an alternative therapy for this condition. Hypotheses to be Tested: Further prospectively designed studies are needed to consider acenocoumarol as an alternative therapy in warfarin‐related nephropathy. [ABSTRACT FROM AUTHOR]

To the Editor, Amphotericin B is often used in the therapeutics of potentially fatal fungal infections. The patient was extubated and put on oral K+ supplementation 40 mEq/day in divided doses, with close monitoring of serum K+ and Mg++ levels, while amphotericin B therapy was continued into the postoperative period. [Extracted from the article]