Association of Neutrophil-Lymphocyte Ratio and Red Blood Cell Distribution Width with Poor Outcome in Pediatric Cardiac Surgery - A Retrospective Observational Study.

BACKGROUND: Neutrophil-lymphocyte ratio (NLR) is a valuable indicator for evaluating inflammatory response and red blood cell distribution width (RBDW), a routinely available biomarker of likely erythropoietic dysfunction, which may be associated with adverse outcomes after cardiac surgery. This study aimed to investigate the association between these two readily available haematological parameters, with the poor outcomes in paediatric patients undergoing cardiac surgery. METHODS: A comprehensive review of medical records for paediatric patients who underwent cardiac surgery at our tertiary care centre between April 2022 and June 2023 was carried out. RBDW and NLR values were collected from complete blood count reports obtained on admission to the ICU. Demographic data, surgical details, and postoperative complications were also recorded. A receiver operating characteristic (ROC) curve and multivariable logistic regression were applied to identify the prognosis performance of preoperative NLR and RBDW for poor outcomes. RESULTS: The study included 219 patients meeting the inclusion criteria of which a total of 90 (41%) children experienced at least one of the poor outcomes. Preoperative NLR (AUC=0.88, 95%CI 0.36-0.70, cut off- 4.2) and RBDW (AUC=0.88, 95%CI 0.39-0.73, cut off- 18.5%) showed prognostic significance in the perioperative period. CONCLUSION: This retrospective observational study highlights a significant association between elevated Red Blood Cell Distribution Width (RBDW) and Neutrophil Lymphocyte Ratio (NLR) values and poor outcomes in paediatric patients undergoing cardiac surgery. These readily available haematological parameters could serve as potential prognostic indicators for identifying patients at risk of poor outcomes.

Ambulatory milrinone therapy as a bridge to heart transplantation.

Inotrope therapy for patients with advanced heart failure awaiting a heart transplant or ventricular assist device has been reported to facilitate hospital discharge. We report the case of a 46-year-old man with advanced heart failure (Stage D), initially found unsuitable for a heart transplant due to high pulmonary vascular resistance (PVR) was placed on ambulatory Milrinone therapy leading to significant improvement in PVR. He underwent a successful orthotopic heart transplant.

Comparison of the efficacy of ultrasound guided pectoralis-II block and intercostal approach to paravertebral block (proximal intercostal block) among patients undergoing conservative breast surgery: A randomised control study.

Background and Aims: Regional anesthesia techniques have attributed a multimodal dimension to pain management after breast surgery. The intercostal approach to paravertebral block has been gaining interest, becoming an alternative to conventional paravertebral block, devoid of complexities in its approach, being recognized as the proximal intercostal block. Parallel to the widespread acceptance of fascial plane blocks in breast surgery, pectoralis II block has emerged as being non-inferior to paravertebral block. The aim of this study was to evaluate the efficacy of two independent fascial plane blocks, proximal intercostal block and pectoralis II block, in breast conservation surgery. Material and Methods: This prospective, randomized control, pilot study included 40 patients, randomly allocated among two groups: proximal intercostal block and pectoralis II block. Results: The pectoralis II block group had significantly lower pain scores at rest in the immediate postoperative period but became comparable with the proximal intercostal block group in the late postoperative period. Pain scores on movement though were lower at 0 h postoperatively and became comparable with the proximal intercostal block group subsequently. Although the pectoralis II group had earlier recovery in the post-anesthesia care unit, the overall time to discharge from the hospital was comparable and not influential. Both groups had high patient satisfaction scores and similar perioperative opioid consumption. Sedation, time to first rescue analgesia, and postoperative nausea vomiting scores were comparable. Conclusion: Fascial plane blocks in the form of pectoralis II and proximal intercostal block facilitate pain alleviation, early return to shoulder arm exercise, and enhanced recovery, which should render them to be incorporated into multimodal interdisciplinary pain management in breast conservation surgery.

A study of serum magnesium levels in postoperative ICU patients undergoing major GI surgeries.

Background: Magnesium (Mg++) deficiency can result in life-threatening complications. The incidence of hypomagnesemia, as well as any coexisting hypokalemia and Electrocardiography (ECG) abnormalities, was studied in patients undergoing major gastrointestinal (GI) surgeries. Methods: This observational study on 51 consecutive adult Intensive Care Unit (ICU) patients recorded serum Mg++ and serum potassium (K+) levels, and 12 lead ECGs, preoperatively and postoperatively, at 48 h and 72 h. Paired "t" test, Pearson Correlation Coefficient and chi-square test were used to statistically assess the difference, correlation, and association between serum Mg++, serum K+, and abnormal ECGs, respectively. Results: Mean values for serum Mg++ were 1.72 mg/dl and 1.71 mg/dl on day 2 and 3 postops, respectively, while for serum K+ it was 4.14 meq/l and 4.02 meq/l. The incidence of postop hypomagnesemia was 52.9% with a 95% confidence interval (39.2-66.2) on Day 2 and 47.1%, with a 95% confidence interval (33.7-60.7) on Day 3. The incidence of coexisting hypokalemia was 33.3% on Day 2 and 29.2% on Day 3. There was no significant difference between pre and postop serum Mg++ and serum K+ values. The incidence of abnormal ECG was 33.3% on Day 2 postop and 28.6% on Day 3 and had a significant association with incidence of hypomagnesemia on Day 2 (P = 0.02). Conclusion: Incidence of hypomagnesemia showed no significant difference pre and postoperatively. A significant association was present between the incidence of hypomagnesemia with abnormal ECG on the second postop day, but this was not found significant when compared with cases of hypomagnesemia with coexisting hypokalemia.

Comparison of prophylactic use of ketamine, tramadol, and dexmedetomidine for prevention of shivering after spinal anesthesia.

BACKGROUND AND AIMS: Shivering after spinal anesthesia is a common complication and can occur in as many as 40%-70% of patients after regional anesthesia. This shivering, apart from its physiological and hemodynamic effects, has been described as even worse than surgical pain. The aim of the study was to evaluate and compare the effectiveness of prophylactic use of intravenous (IV) ketamine, dexmedetomidine, and tramadol for prevention of shivering after spinal anesthesia. MATERIAL AND METHODS: Two hundred American Society of Anesthesiologists physical status I and II patients subjected to spinal anesthesia were included in the study. The subjects were randomly divided into four groups to receive either ketamine 0.5 mg/kg IV or tramadol 0.5 mg/kg IV or dexmedetomidine 0.5 microgm/kg IV or 10 mL of 0.9% normal saline (NS). All the drugs/NS were administered as IV infusion over 10 min immediately before giving spinal anesthesia. Temperature (core and surface), heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure, peripheral oxygen saturation were assessed before giving the intrathecal injection and thereafter at 5 min intervals. Important side effects related to study drugs were also noted. RESULTS: Shivering after spinal anesthesia was comparatively better controlled in group receiving dexmedetomidine as compared to other groups (P = 0.022). However, the use of dexmedetomidine was associated with significant hypotension which responded to single dose of mephentermine (3 mg IV). Dexmedetomidine is a better agent for prevention of shivering after spinal anesthesia as compared to ketamine and tramadol. It also provides adequate sedation and improves the surgical conditions. CONCLUSION: Dexmedetomidine is effective and comparably better than tramadol or ketamine in preventing shivering after spinal anesthesia. Dexmedetomidine also provides sedation without respiratory depression and favorable surgical conditions. However, with its use a fall in blood pressure and heart rate is anticipated.