[Clinical and molecular epidemiology of an outbreak of infusion-related Acinetobacter baumannii bacteremia in an Intensive Care Unit] / Epidemiologia clinica e molecolare di una epidemia di batteriemie da Acynetobacter baumannii correlate ad infusioni in una Unita di Terapia Intensiva.

Objective: To describe the clinical and molecular epidemiology of an outbreak of infusion-related Acinetobacter baumannii bacteremia in an intensive care unit (ICU). Methods: Six cases of A. baumannii bacteremia identified in the Foligno Hospital ICU, Italy, were peer reviewed. Antibiotic susceptibility and genotyping (PFGE and RAPD) of A. baumannii isolates were carried out. Results: All A. baumannii blood isolates and a strain isolated from parenteral solution had an identical genotype. The strains were susceptible to carbapenems and the combination of meropenem plus amikacin or piperacillin/ tazobactam plus netilmicin was synergistic. A. baumannii bacteremia persisted for several days in almost all patients; catheter tip cultures were always positive for A. baumannii. Three patients, with an elevated Apache II score, died of sepsis. Conclusions: The outbreak was related to contaminated parenteral solutions improperly prepared in the ward. Aseptic preparation in the hospital pharmacy allowed for an interruption of the outbreak.

[Sedation with continuously infused propofol in caudal block for elective pediatric surgery]. / Sedazione con propofol in infusione continua nel blocco caudale per la chirurgia pediatrica elettiva.

Twenty-nine patients aged between 2 months and 6 years, undergoing general surgery under regional analgesia (caudal block) combined with continuous infusion of propofol (3 mg/kg/h), were studied. During anesthesia the heart rate, the arterial pressure, the SaO2 and respiratory rate were recorded; the electrocardiogram was continuously displayed and all side-effects occurring during maintenance and recovery from anesthesia were noted. Satisfactory sedation without significant respiratory and cardiovascular depression and a rapid recovery, was observed. In conclusion, we feel that the use of combined caudal block and continuous infusion of propofol for paediatric surgery is rational.

[Pharmacologic prevention of Mendelson syndrome. A controlled clinical trial]. / Prevenzione farmacologica della sindrome di Mendelson. Studio clinico controllato.

This controlled study considers the effect of ranitidine, both alone and in association with metoclopramide, on the acidity and volume of the gastric content of 75 patients requiring caesarean section. Ranitidine, when used alone (50 mg intravenously 30-60 minutes before the operation) significantly reduced (p less than 0.01) the acidity (pH greater than 2.5) and the volume (less than 25 ml) of the gastric content of the patient thus treated. Ranitidine in association with metoclopramide may also reduce the pH and the volume, but did not show any significant statistical differences when compared with the use of ranitidine alone.

[Possible effects of pharmacologic prophylaxis for Mendelson's syndrome on newborns]. / Ricerca sul neonato di eventuali effetti della profilassi farmacologica della sindrome di Mendelson.

Forty-eight newborn infants whose mothers underwent both elective and urgent caesarean section were studied. Mothers were randomly assigned to one of the treatment groups for the prophylaxis of Aspiration Pneumonitis: group A was treated with ranitidine, 50 mg i.v.; group B with ranitidine, 50 mg, and metoclopramide, 10 mg i.v.; group C no medication. Neonatal assessment included Apgar score and various haematological laboratory tests: haemogasanalysis, glycemia, electrolites, hematocrit, hemoglobin, bilirubinemia, SGOT, SGPT. Nor clinical or statistic differences were noted among the three infant groups.

[Atracurium, vecuronium and pancuronium. Results of a polygraphic study]. / Atracurio, vecuronio e pancuronio. Risultati di uno studio poligrafico.

The Authors have studied three nondepolarizing muscle relaxants widely used: pancuronium v/s atracurium and vecuronium. The Train of Four was used to detect the magnitude of the neuromuscular blockade. The intubation follows 90 minutes after administration of the drugs and for each patient the Authors valued: 1) the T1 and TR values at intubation; 2) the onset-time; 3) the duration of neuromuscular blockade; 4) the recovery time. Furthermore, the degree of neuromuscular blockade was clinically checked both at the time of induction and at recovery. The results of the present study show, in accordance with the literature, that all three drugs tested are capable of obtaining complete muscle relaxation. Atracurium and vecuronium particularly allow an adequate intubation at the adopted doses (0.6 mg/kg and 0.1 mg/kg respectively) with a relatively short onset-time (medium values 136" in the group of atracurium and 146" in the group of vecuronium) and a restoration time faster than pancuronium.

Buprenorphine vs. morphine via the epidural route: a controlled comparative clinical study of respiratory effects and analgesic activity.

Twelve patients with intense or very intense pain of the non-incident type, secondary to neoplasia, were divided at random into two groups and treated with an epidural dose of 3 mg of morphine in 10 ml of glucose solution (6 patients = group M) or with 0.3 mg of buprenorphine in the same vehicle (6 patients = group B). None of the patients had previously been treated with opioids by any route. After first determining basal values, the following assessments were carried out: (1) evaluation of the analgesic effect of the drugs with checks at 30 min and at 1, 2, 3, 4, 6 and 18 h after administration, using a visual analogue scale, a numerical rating scale and a simple descriptive scale; and (2) evaluation of effects on respiration by means of checks at 30 and 90 min and at 6 and 18 h, on control of breathing indices (P0.1; VE; VA; Ti/Ttot; VT/Ti; RR), gas exchange indices (delta(A-a)O2; VD/VT; pAO2; R) and blood gas and acid-base indices (paO2; paCO2; pH; HCO3-). The data obtained were analyzed statistically using analysis of variance and Student's t test. The study results showed very similar analgesic efficacy for both treatments at a single dosage level of morphine (3 mg) compared to buprenorphine (0.3 mg), which was approximately 3 times greater than an equivalent parenteral dose of morphine (10 mg). Analysis of the results revealed statistically, though not clinically, significant changes in respiratory function indices, only in the buprenorphine-treated group. The effects of buprenorphine on respiratory function, when administered epidurally at the above dosage, are less favourable than those of morphine in the early measurements, probably because of its greater systemic absorption; nevertheless, the risk of delayed respiratory depression appears to be less after buprenorphine than after morphine.