Perioperative Presentations of Kounis Syndrome: A Systematic Literature Review.

Kounis syndrome commonly is described as a complex multisystem phenomenon mainly affecting coronary arteries, resulting in coronary vasospasm in the context of an allergic manifestation. This article reviews the literature regarding perioperative presentations of the syndrome. A systematic search in MEDLINE and Embase databases was performed for case reports through June 16, 2021, on Kounis syndrome triggered by medications administered in the perioperative setting. The authors' search resulted in 35 perioperative reports of Kounis syndrome, with the majority of the cases occurring in men between 40 and 80 years of age, manifesting within 20 minutes following the administration of the suspected trigger. Chest pain and ischemic changes on the electrocardiograph were the most frequent presentations, while intravenous antibiotics and neuromuscular blocking agents were the most common triggers. In most instances, the patients had a good recovery following the event. Coronary vasospasm is often less frequently recognized as a form of allergic manifestation in the perioperative setting. Many potential triggers, such as antibiotics and neuromuscular blocking agents, are routinely administered during surgery. Awareness of this condition, early diagnosis, and effective management of this condition can lead to good outcomes.

Ventilator-Associated Tracheobronchitis: To Treat or Not to Treat?

Ventilator-associated tracheobronchitis (VAT) is an infection commonly affecting mechanically ventilated intubated patients. Several studies suggest that VAT is associated with increased duration of mechanical ventilation (MV) and length of intensive care unit (ICU) stay, and a presumptive increase in healthcare costs. Uncertainties remain, however, regarding the cost/benefit balance of VAT treatment. The aim of this narrative review is to discuss the two fundamental and inter-related dilemmas regarding VAT, i.e., (i) how to diagnose VAT? and (ii) should we treat VAT? If yes, should we treat all cases or only selected ones? How should we treat in terms of antibiotic choice, route, treatment duration?