ABSTRACT
Background: prophylactic antibiotics are effective in preventing surgical-wound infections. However, the clarity about the compelling need for antibiotic administration and the risk associated with their use is missing. The use of antimicrobial prophylaxis against surgical site infection [SSI] is common in plastic surgery, while results from prospective randomized controlled trials are scarce
Aim of the Study: was to evaluate the need for antibiotic prophylaxis in the field of plastic surgery
Methods: Electronic search of available Literatures in the scientific database of recent randomized controlled trials evaluating the indications for and use of antibiotics to reduce and treat SSIs for patients undergoing plastic surgery from 1960 to 2017- [Medline, Embase, the Cochrane Library as well as NHS centre websites were searched for English Publications from both reprint requests and by searching the database. Data extracted included antibiotic dosage, duration and incidence of surgical site infection
Conclusion: surgical procedures must be distinguished based on the risk of infection and the need for antibiotic prophylaxis should be determined accordingly, i.e. on a case by case basis.No prophylaxis is required for superficial skin's and clean surgeries such as mucosal excisions, nevertheless, Antibiotic prophylaxis is recommended microsurgical operations, prosthetic surgery, incisional hernias, clean non-prosthetic osteoarticular surgery, oral cavity and genitourinary system procedures. Still, antibiotic use should be prescribed with caution to avoid profound side effects such as developing resistant bacterial strains, severe allergies and other accompanied comorbidities
ABSTRACT
Background: Subsyndromal delirium [SSD] is a frequent condition and has been commonly described as an intermediate stage between delirium and normal cognition. However, the true frequency of SSD and its impact on clinically relevant outcomes in the intensive care unit [ICU] remains unclear
Aim of the study: To evaluate the significance of SSD on adverse clinical outcomes especially mortality and length of hospital stay
Methods: A systematic search was performed in the scientific database particularly MEDLINE [2000-2017], EMBASE [2000- 2017], Cochrane Central Register of Controlled Trials, CINAHL [2000-2017], Google Scholar, and individual journals to identify publications that evaluated SSD in ICU patients
Results: The search yielded five studies involving 2453 patients. SSD was detected in 849 patients [34.6%]. Three studies evaluated only surgical patients. Three studies used the Intensive Care Delirium Screening Checklist [ICDSC] and two used the Confusion Assessment Method [CAM] score to diagnose SSD. The meta-analysis showed an increased hospital length of stay [LOS] in SSD patients [0.29 [95% CI 0.11-0.48], p = 0.002; I [2] = 33%]. Hospital mortality was described in two studies but it was not significant [hazard ratio 0.93 [0.58-1.43], p = 0.88 and [4 [1.0-6.9] vs 9 [3.6-20.4], p = 0.05]. The use of antipsychotics in SSD patients to prevent delirium was evaluated in one study but it did not modify ICU LOS [6.2 [4-8] vs 7 [4-9] days, p = 0.63 and 2 [2-3] vs 3 [2-3] days, p = 0.517] or mortality [9 [25.8%] vs 7 [20.4%], p = 0.51]
Conclusion: Subsyndromal Delirium is a common and adverse condition that is manifested in almost one-third of ICU patients. According to our findings, SSD has increased the length of hospital stay only with low impact on the other outcomes. Nevertheless, studies on a bigger sample size and larger scale are needed for a better understanding of the relevance of SSD in ICU patients as well as its treatment
ABSTRACT
Background: anesthesia and sedation are an essential part of surgical operations and treatment in the intensive care unit. Sedation in the ICU is essential to keep patients well while they are intubated, mechanically ventilated, or agitated. It is also a cornerstone when they undergo any kind of invasive procedures. Most patients who require anesthesia are in generally bad health condition, such as failed kidney or liver, putting them at a greater danger of the complication of anesthesia itself. Newer agents, however, are trying to overcome these challenges
Aim of the Work: our aim in this study is to understand the mechanism of action of inhaled anesthesia, study their common adverse effects and complication and explore how to prevent them
Material and Methods: we conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 1987, through March 2017. The following search terms were used: anesthesia, complication of anesthesia, inhaled anesthesia, overcoming challenges in surgery
Conclusion: inhaled anesthetics are a basis in both surgical operations and sedation within the intensive care unit and are used for sedation or anesthesia. Most patients who require the use of anesthetics are critically ill, and may have renal dysfunction, hepatic dysfunction, or both. Therefore, the administration of safe anesthetic agent is essential to prevent the occurrence of severe adverse events. Newer agents have been reported to be safer