Mineralocorticoid Receptor Antagonist (Potassium Canrenoate) Does Not Influence Outcome in the Treatment of COVID-19-Associated Pneumonia and Fibrosis-A Randomized Placebo Controlled Clinical Trial.

In December 2019 the SARS-CoV-2 virus appeared in the world, mainly presenting as an acute infection of the lower respiratory tract, namely pneumonia. Nearly 10% of all patients show significant pulmonary fibrotic changes after the infection. The aim of this study was to evaluate the effectiveness and safety of potassium canrenoate in the treatment of COVID-19-associated pneumonia and pulmonary fibrosis. We performed a randomized clinical trial (RCT) of potassium canrenoate vs placebo. A total of 55 patients were randomized and 49 were included in the final analysis (24 allocated to the intervention group and 25 allocated to the control group). Patients were assessed by physical examination, lung ultrasound, CT imaging and blood samples that underwent biochemical analysis. This RCT has shown that the administration of potassium canrenoate to patients with COVID-19 induced pneumonia was not associated with shorter mechanical ventilation time, shorter passive oxygenation, shorter length of hospitalization or less fibrotic changes on CT imaging. The overall mortality rate was not significantly different between the two groups. Adverse events recorded in this study were not significantly increased by the administration of potassium canrenoate. The negative outcome of the study may be associated with the relatively small number of patients included. Any possible benefits from the use of potassium canrenoate as an antifibrotic drug in COVID-19 patients require further investigation.

Management of perioperative stress in children and parents. Part I--the preoperative period.

Hospitalisation and surgery are undoubtedly one of the most difficult experiences the children and their parents have to face. The lack of appropriately provided information about treatment and other hospitalization-related aspects increases anxiety and uncertainty. Besides showing sincere empathy, physicians working with paediatric patients should know the strategies to reduce perioperative stress in children and their families. The first part of our paper describes various well-tried methods of preoperative management, some of which can be applied before hospitalization. The crucial elements of such a strategy are to dissipate the emerging doubts by providing children and parents with relevant and understandable information and to familiarise them with the hospital setting.

Management of perioperative stress in children and parents. Part II--anaesthesia and postoperative period.

The majority of children, even those well prepared and with positive attitudes, experiences stress in the operating theatre and during the postoperative period. In some cases, the stress is even stronger for their parents. The role of anaesthetists is to minimize the unpleasant sensations by providing painless vein cannulation, uneventful induction of anaesthesia, suitably planned and timed analgesia, and prevention of postoperative vomiting. The effectiveness of combined analgesics, early administration of saturating doses and analgesia supplemented or based on methods of block anaesthesia - particularly on peripheral and local blocks, less appreciated in children, have been highlighted. Such a stress-reducing strategy should be initiated before hospitalisation and consistently continued to its completion or even longer, the example of which are one-day surgery patients who should receive prescriptions for or suitable drugs (mainly analgesics) on discharge for use in the home setting. Preparation of local programmes for management reducing surgery-associated stress in children is worth recommending.