Evaluation of potential drug-drug interactions in intensive care unit.

OBJECTIVE: Potential drug-drug interactions (pDDIs) and adverse drug reactions (ADRs) may be frequently observed in critically ill patients because of multiple drug use. It is important to identify pDDIs before their progression to ADRs. This study aimed to determine the prevalence and effect of pDDIs and possible ADRs in intensive care patients. PATIENTS AND METHODS: In this retrospective cross-sectional study, the medical records of patients in the intensive care unit (ICU) of Bursa Uludag University Faculty of Medicine Hospital between January 1, 2018, and December 31, 2018, were examined. Medication orders were recorded on days 2, 5, and 10. pDDIs, defined using the lexi-interact (UpToDate, 2020), were classified based on the significance level. RESULTS: A total of 144 patients were included in this study, and from the 395 medication orders, 1,776 had pDDIs. Of these interactions, 23.5% were major (n = 418), 71.4% were moderate (n = 1268), and 5.1% (n = 90) were minor. The majority of patients (96.9%) had at least one pDDI. There was a strong correlation between the number of drugs on days 2, 5, and 10 and the number of pDDIs (p < 0.001, ρ = 0.7; p < 0.001, ρ = 0.72; p < 0.001, ρ = 0.73, respectively). No significant correlation was found among the number of pDDIs, the APACHE II score, and the duration of ICU stay. CONCLUSIONS: The prevalence of pDDIs was high and there was a strong correlation between the number of drugs and pDDIs. Detection of potential interactions through clinical decision support systems and checker tools should be used to increase patient safety.

The combination of low-dose levobupivacaine and fentanyl for spinal anaesthesia in ambulatory inguinal herniorrhaphy.

This study investigated whether the addition of 25 microg intrathecal fentanyl to levobupivacaine spinal anaesthesia for outpatient inguinal herniorrhaphy allows a sub-anaesthetic levobupivacaine dose to be used. Forty patients were assigned to receive 5 mg levobupivacaine 0.5% mixed with 25 microg fentanyl (group LF) or 7.5 mg levobupivacaine 0.5% (group L). The highest sensory block levels achieved were T7 (range T5 - T9) and T6 (range T4 - T9) in groups LF and L, respectively. The times to two-segment regression, S2 regression, ambulation, urination and discharge were all significantly shorter in group LF than group L. These results indicate that, for outpatient inguinal herniorrhaphy, intrathecal fentanyl combined with low-dose levobupivacaine provides good quality spinal anaesthesia and minimizes the need for intra-operative analgesia. This protocol is well suited for the outpatient setting because it features rapid recovery of full motor power, sensory function and bladder function.

Combination of ultra-low dose bupivacaine and fentanyl for spinal anaesthesia in out-patient anorectal surgery.

This study investigated whether the addition of 25 microg fentanyl to an ultra-low (sub-anaesthetic) dose of intrathecal bupivacaine provides adequate anaesthesia for out-patient anorectal surgery, without increasing side-effects or delaying hospital discharge. Patients were randomly allocated to receive 2.5 mg 0.5% bupivacaine plus 25 microg fentanyl (group BF, n = 18) or 5 mg 0.5% bupivacaine alone (group B, n = 17). There were no significant differences in intra-operative outcomes, but mean recovery and discharge times were significantly shorter in group BF. There were no between-group differences in hypotension, bradycardia or respiratory depression and post-operative complications were comparable, apart from pruritus which was significantly more frequent in group BF. Fewer patients requested analgesic medication in the early post-operative period in group BF than in group B. In conclusion, 25 microg intrathecal fentanyl added to ultra-low dose (2.5 mg) bupivacaine provided good-quality spinal anaesthesia and reduced post-operative analgesic requirement in patients undergoing ambulatory anorectal surgery.

An unusual cause of ureteral obstruction in a renal transplant recipient: ureteric aspergilloma.

Mycotic infections in various organ transplant recipients represent severe and often fatal complications. Aspergillosis isolated from the urinary tract occurs quite infrequently in renal transplant recipients. Besides, fungus balls are rare causes of ureteral obstruction. We report a 51-year-old patient with the diagnosis of ureteral obstruction caused by aspergillosis in the early post-renal transplant period, who unfortunately died with the clinical picture of disseminated infection and its complications.