Impact of vaccination on ICU admissions of hospitalized COVID-19 patients in a country with a heterologous vaccine policy.

INTRODUCTION: Vaccination against coronavirus disease-19 (COVID-19) is highly effective in preventing severe disease and mortality. Adenoviral vector and mRNA vaccines were effective against intensive care unit (ICU) admission, but the effectiveness of inactivated vaccine on ICU admission was unclear. We aimed to evaluate the effect of vaccination status on ICU admission in hospitalized COVID-19 patients in a country with heterologous vaccination policy. METHODOLOGY: This is a retrospective multicenter study conducted in three hospitals in Izmir, Turkey between 1 January 2021 and 31 March 2022. Patients aged ≥ 18 years and hospitalized due to COVID-19 were included in the study. Patients who had never been vaccinated and patients who had been vaccinated with a single dose were considered unvaccinated. A logistic regression analysis was performed for evaluating risk factors for ICU admission. RESULTS: A total of 2,110 patients were included in the final analysis. The median age was 66 years (IQR, 53-76 years) and 54% of the patients were vaccinated. During the study period, 407 patients (19.3%) were transferred to the ICU due to disease severity. Patients who were admitted to the ICU were older (median age 68 vs. 65 years, p < 0.001); and the number of unvaccinated individuals was higher among ICU patients (57% vs. 45%, p < 0.001). In multivariate regression analysis, being unvaccinated was found to be the most important independent risk factor for ICU admission with an OR of 2.06 (95% CI, 1.64-2.59). CONCLUSIONS: Vaccination against COVID-19 is effective against ICU admission and hospital mortality.

Current Anesthetic Management in a 20-Month-Old Pediatric Patient With Intestinal Transplantation Due to Microvillous Inclusion Disease.

Intestinal transplantation is a complex procedure both in terms of anesthesia and surgery. In particular, pediatric anesthesia management during intestinal transplant surgery can become even more complicated. It has been stated that propofol, remifentanil, and sevoflurane reduce patient mortality by reducing the incidence of intestinal ischemia-reperfusion injury. Although studies of these agents continue to be conducted in vivo or in vitro, these anesthetics are currently used for specific procedures that have a high risk of incurring ischemia-reperfusion injury. Herein, we present the case of a male child, aged 20 months, who was dependent on total parenteral nutrition and was found to have intestinal failure associated with liver disease type 1. Hematologic tests showed findings of anemia and metabolic acidosis. Propofol was administered for induction of anesthesia. Anesthesia maintenance was achieved using sevoflurane with remifentanil infusion. We ensured safe and adequate vascular access in the patient and performed hematologic and biochemical tests with detailed system controls. Before the procedure, we prepared a leukocyte-poor erythrocyte suspension, leukocyte-poor random or apheresis platelets, and ABO- and Rh-compatible fresh frozen plasma. We monitored for signs of acidosis, hypotension, coagulation disorders, and hyperkalemia during the reperfusion period. We maintained patient normothermia. In this case report on the anesthetic management of a pediatric patient aged 20 months who received a small bowel transplant due to microvillous inclusion disease, we found that the selection of anesthetic agents may affect the prognosis of future surgical procedures.

Effects of Carbon Dioxide Insufflation and Trendelenburg Position on Brain Oxygenation During Laparoscopy in Children.

PURPOSE: Laparoscopic appendectomy has become more popular compared with the open appendectomy in children, but there are limited data on the effects of pneumoperitoneum and Trendelenburg position on cerebral oxygenation. This study was designed to evaluate the changes in cerebral saturation using near-infrared spectroscope during laparoscopic surgery in children. METHODS: The children underwent laparoscopic (LAP Group, n=22) or open appendectomy (OPEN Group, n=22). Right and left cerebral oxygenation (RScO2-LScO2), heart rate (HR), mean arterial pressure (MAP), end-tidal CO2pressure (PETCO2), and peripheral oxygen saturations (SpO2) were recorded between anesthesia induction (T0, baseline), after induction (T1), after intubation (T2), 5 minutes after intubation (T3), 5 minutes after pneumoperitoneum-15th minute at OPEN (T4), 5 minutes after Trendelenburg-20th minute at OPEN (T5), 30 minutes after pneumoperitoneum-45th minute at OPEN (T6), 5 minutes after supine position-skin suturing at OPEN (T7), 5 minutes postextubation (T8). RESULTS: Groups were similar with respect to their demographic data. In LAP group, a significant increase in HR was recorded at T5. No significant difference was observed in the MAP, PETCO2, SpO2, RScO2, and LScO2 values between the groups. There was a significant increase in the perioperative T1 to T8 values compared with the T0 values in LScO2 of the LAP group. CONCLUSIONS: Our results suggest that pneumoperitoneum and Trendelenburg position does not alter the hemodynamic values and can be safely performed in children without altering regional brain oxygenation levels.

Effects of dexmedetomidine infusion during spinal anesthesia on hemodynamics and sedation.

BACKGROUND: We evaluated the effects of intravenous dexmedetomidine during spinal anesthesia on hemodynamics, respiratory rate, oxygen saturation, sedpain, and compared them with those of saline infusion. Sixty American Society of Anesthesiologists physical status I and II cases were randomly divided into two groups. Patients were connected to the monitor after premedication, and spinal anesthesia was administered. Sensory and motor blockades were assessed using pinprick test and Bromage scale, respectively. Group I received dexmedetomidine infusion and Group II received saline infusion. Throughout the infusion process, hemodynamic data, respiratory rate, oxygen saturation, sedation, pain, Bromage score, amnesia, bispectral index, and side effects were recorded. Postoperative hemodynamic measurements, oxygen saturation, sedation, pain scores were obtained. Sedation and pain were evaluated using the Ramsay and visual analog scales, respectively. Analgesics were administered in cases with high scores on the visual analog scale. Postoperative analgesic consumption, side effects, treatments were recorded. No significant differences were found between the groups with respect to oxygen saturation, respiratory rate, pain, and side effects in the intraoperative period. Time to onset of sensorial block, maximum sensorial block, onset of motor block, and maximum motor block; bispectral index values; and apex heartbeat until 80 min of infusion, systolic arterial blood pressure until 90 min, and diastolic arterial blood pressure until 50 min were lower, whereas amnesia and sedation levels were higher in dexmedetomidine group. Postoperative pain and analgesic requirement were not different. Apex heartbeat at 15 min and systolic arterial blood pressure at 30 min were lower and sedation scores were higher in the dexmedetomidine infusion group. We demonstrated dexmedetomidine infusion had a hemodynamic depressant effect intraoperatively whereas it had no significant effect on peripheral oxygen saturation, respiratory rate, visual analog scale scores, and side effects. Dexmedetomidine infusion enhanced motor and sensory blockade quality and induced amnesia and sedation.

Pediatric small bowel transplantation: A single-center experience from Turkey.

BACKGROUND/AIMS: Small bowel transplantation (SBTx) is a treatment option for patients with serious parenteral nutrition-related problems in intestinal failure. Izmir Tepecik Training Research Hospital Organ Transplantation Center is still the only pediatric intestinal transplant center in Turkey. MATERIAL AND METHODS: This study was approved by the local ethics committee. Patients' data were analyzed from the medical charts and the hospital digital database. Seven isolated SBTxs were performed in six children between 2010 and 2016. RESULTS: One jejunal segment and six partial jejuno-ileal segments were used for seven transplants. All grafts were retrieved from deceased donors (one child and six adult donors). The six recipients had a mean age of 8.8±6.9 years (9 months to 17 years; M: 4, F: 2). The mean follow-up period of patients was 727±848 (34 to 1950) days. Acute cellular rejection (ACR) rates were 57% (n: 4) in the first 2 months. Graft loss due to severe ACR was seen in one patient. Central line-associated fungal (n: 3, 42%) and bacterial infections (n: 3, 42%) were seen in the first 2 months. Two Epstein-Barr virus (EBV) infections were recorded between 3 and 8 months in two patients. Our 1-year patient and graft survival rates were 71% and 71%, respectively. CONCLUSION: SBTx has become a treatment modality for patients with intestinal failures. Management of ACR and infections are still challenging problems in SBTx. Appropriate-sized cadaveric donors are very limited in Turkey for pediatric intestinal transplantation candidates. Although the number of SBTxs performed was small, this study shows promising results.