Surgical Site Infection in a Teaching Hospital: a Prospective Study

Objectives: To investigate the risk factors for surgical site infection together with the identification of the etiological pathogens and their antimicrobial susceptibility at King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. Methods: A prospective case series study conducted at King Khalid University Hospital to all patients admitted to the surgical wards during the period between January 1st and September 30th 2007. The demographic data, diagnostic criteria, associated risk factors and laboratory data including gram stain, culture results and antimicrobial susceptibility of swabs from the surgical sites were collected. Results: Out of the one hundred and thirty one patients recruited in the study, nine patients showed evidence of sepsis yielding an infection rate of 6.8%. Emergency operations and associated diabetes showed significantly higher rates of infection compared to their counterparts. The most commonly isolated bacteria were: E. coli, Pseudomonas aurigenosa and Staphylococcus aureus.Conclusion: The rate of surgical site infection was 6.8% which was comparable to that reported literature. E. coli was the most commonly isolated bacteria. Neither MRSA nor Acinetobacter species were common isolates. The rate of infection in diabetics and those who underwent emergency operations was significantly higher than others. Other comorbidities did not directly affect the rate of surgical site infection in our series

Combined epidural-general anesthesia [CEGA] in patients undergoing pancreatic surgery: comparison between bupivacaine 0.125% and 0.25%

Major abdominal surgery results in homodynamic instability mainly due to endogenous prostacyclin release, bleeding, major intercompartemental fluid shift and the hormonal surgical response. This study compared the effects of low thoracic epidural anesthesia with 0.125% and 0.25% bupivacaine on haemodynamic variables, sevoflurane requirements, and stress hormone responses during pancreatic surgery under combined epidural-general anaesthesia [CEGA]. Forty patients undergoing different pancreatic surgery were randomly allocated into two equal groups to receive 10 ml of either isobaric bupivacaine 0.125% [group I] or 0.25% [group II] by low thoracic epidural with sevoflurane general anaesthesia. Sevoflurane was adjusted to achieve a target bispectral index [BIS] of 40-60. Measurements included the inspired [F'SEVO] and the end-tidal sevoflurane concentrations [E'SEVO], blood pressure [BP] and heart rate [HR] before surgery and every 5 min during surgery for 2 h, and stress hormones. Plasma samples for stress response evaluation were taken before and 1 and 2 h after the start of surgery for measurements of epinephrine, and cortisol. During surgery, both groups were similar for HR, BPand BIS, but [EISEVO] and [E'SEVO] were significantly higher and more fluctuated with bupivacaine 0.125% than with 0.25%. Moreover, the total amount of propofol used for induction of general anesthesia and the total fentanyl used during anesthesia were significantly low in 0.25% bupivacaine group. Intraoperative requirements of ephedrine were higher in 0.25% bupivacaine group, Intraoperative blood loss and fluid requirements were significantly increase in 0.125% group. Plasma concentrations of epinephrine and cortisol were found to be higher with bupivacaine 0.125% as compared with 0.25%. Combined thoracic epidural-general anesthesia [CEGA] for pancreatic surgery, with 0.25% bupivacaine significantly reduces sevoflurane requirements, blood loss and fluid requirements. In addition, bupivacaine 0.25% suppressed the stress hormone responses better than 0.125% did. However this was on the expenses of more ephedrine requirements

Plain versus hyperbaric ropivacaine for spinal anesthesia in cirrhotic patients undergoing ano-rectal surgery

In cirrhotic patients undergoing ano-rectal surgery, spinal anesthesia/analgesia remains a challenge. Coagulopathy and intraoperative hypotension represent a major challenge for the anesthetist during spinal anesthesia in those patients. This study was designed to examine the efficacy and the adverse effects of ropivacaine [plain, hyperbaric] spinal anesthesia for anorectal surgery in cirrhotic. Forty known cirrhotic patients categorized as Child-A, scheduled for ano-rectal surgery under spinal anesthesia were enrolled in this study. Patients were randomly allocated into 2 equal groups. Patients received 2.0 ml ropivacaine 0.6% [6 mg/ml], either. In plain solution [group I] or with glucose [hyperbaric] group II. 10 micro g fentanyl was added for each solution. The extent and duration of sensory and motor block, pulse rate, blood pressure, and time to mobilization were recorded. Any unwanted effects related to spinal blockade were also recorded. There were significant differences in median time to onset of sensory block at T10 [plain 9 min; hyperbaric 3 min; P < 0.01], median maximum extent [plain T8; hyperbaric T6; P < 0.05], and median duration of sensory block at T10 [plain 66 min; hyperbaric 113 min; P < 0.01]. However, median times to complete regression of both sensory [183 vs 156 min; P < 0.05] and motor [158 vs 123 min; P < 0.05] block were longer in the plain group. Patients mobilized sooner in the hyperbaric group [plain 192 vs hyperbaric 131 min; P < 0.01]. All the hyperbaric blocks were adequate for surgery, but three patients receiving plain ropivacaine required sedative/analgesic bolus during anal dilatation. The practice of spinal anesthesia in patients with mild cirrhosis is a safe and reliable anesthetic technique. Addition of glucose 50 mg/ml to plain ropivacaine 6% increases the speed of onset, block reliability, duration of useful block for ano-rectal surgery, and speed of recovery. Moreover hemodynamic stability is a prominent feature of that block