Does the variant positivity and negativity affect the clinical course in COVID-19?: A cohort study.

The primary aim of the current study is to analyze the clinical, laboratory, and demographic data comparing the patients with Coronavirus Disease 2019 (COVID-19) admitted to our intensive care unit before and after the UK variant was first diagnosed in December 2020. The secondary objective was to describe a treatment approach for COVID-19. Between Mar 12, 2020, and Jun 22, 2021, 159 patients with COVID-19 were allocated into 2 groups: the variant negative group (77 patients before December 2020) and the variant positive group (82 patients after December 2020). The statistical analyses included early and late complications, demographic data, symptoms, comorbidities, intubation and mortality rates, and treatment options. Regarding early complications, unilateral pneumonia was more common in the variant (-) group (P = .019), whereas bilateral pneumonia was more common in the variant (+) group (P < .001). Regarding late complications, only cytomegalovirus pneumonia was observed more frequently in the variant (-) group (P = .023), whereas secondary gram (+) infection, pulmonary fibrosis (P = .048), acute respiratory distress syndrome (ARDS) (P = .017), and septic shock (P = .051) were more common in the variant (+) group. The therapeutic approach showed significant differences in the second group such as plasma exchange and extracorporeal membrane oxygenation which is more commonly used in the variant (+) group. Although mortality and intubation rates did not differ between the groups, severe challenging early and late complications were observed mainly in the variant (+) group, necessitating invasive treatment options. We hope that our data from the pandemic will shed light on this field. Regarding the COVID-19 pandemic, it is clear that there is much to be done to deal with future pandemics.

Effects of epidural anesthesia on acute and chronic pain after coronary artery bypass grafting.

OBJECTIVE: To evaluate the effects of thoracic epidural anesthesia (TEA) as an adjunct to general anesthesia (GA) on postoperative pain after coronary artery bypass grafting (CABG). METHODS: Between April 2009 and March 2010, 40 patients with ischemic heart disease scheduled for elective CABG were prospectively randomized to receive either GA (n = 20) or GA + TEA (n = 20). Through epidural catheters, patients received an infusion of (10-20 mg/h) 0.25%-bupivacaine intraoperatively and during the first 24 hours after surgery. Study endpoints included assessment of postoperative pain at rest and with coughing, rescue analgesic need, and postoperative course. RESULTS: The differences in pain scores were decreased at rest during 6 (0.1 ± 0.3 vs. 2.4 ± 1.8; p < 0.05) and 12 hours (0.1 ± 0.3 vs. 3.9 ± 2.3; p < 0.05) and with coughing at 6 (0.1 ± 0.3 vs. 5.6 ± 2.2; p < 0.05), 12 (0.1 ± 0.3 vs. 5.9 ± 2.3; p < 0.05), and 24 hours (0.05 ± 0.2 vs. 4.6 ± 2.9; p < 0.05) in the GA + TEA group. At one-month follow-up, pain scores were decreased in GA + TEA group (0.3 ± 0.7 vs. 1.6 ± 1.3; p = 003). There was no significant difference at three and six months. Mechanical ventilation time (4.7 ± 1.2 vs. 2.9 ± 1.1 hours; p < 0.05), intensive care unit stay (28.4 ± 9.0 vs. 22.4 ± 3.4 hours; p < 0.05), and hospital stay (7.2 ± 1.1 vs. 6.1 ± 0.3 days; p = 0.001) were reduced in the GA + TEA group. CONCLUSIONS: TEA significantly reduced the intensity of postoperative pain and analgesic consumption in the early postoperative period following CABG. The delivery of effective analgesia along with conventional medications may prevent chronic pain after surgery.

Effects of thoracic epidural anesthesia on flow and endothelium of internal thoracic artery in coronary artery bypass graft surgery.

OBJECTIVES: The internal thoracic artery (ITA) is the preferred conduit for coronary artery bypass graft (CABG) surgery. The authors investigated whether thoracic epidural anesthesia (TEA) as an adjunct to general anesthesia (GA) can increase the blood flow of the ITA. DESIGN: A prospective randomized study. SETTING: A university hospital. PARTICIPANTS: Patients with ischemic heart disease. INTERVENTIONS: Thirty patients scheduled for elective CABG surgery were randomized to receive either GA (n = 15) or GA + TEA (n = 15) after receiving institutional review board approval. Demographics showed similarity between the groups. The epidural catheter was inserted in the thoracic region between T1 and T5 levels. In the GA + TEA group, the patients received a 20-mg bolus of 0.25% bupivacaine through epidural catheters 1 hour before surgery, and this was followed by the infusion (20 mg/h) of 0.25% bupivacaine. In all patients, ITA free blood flow was measured before cardiopulmonary bypass and without the administration of any vasodilatory agent. A short segment of ITA was excised for histologic examination; immunocytochemistry analysis was performed using antirabbit polyclonal VEGF antibody, rabbit polyclonal inducible nitric oxide synthase (i-NOS) antibody, and adenosine anti-A2B receptor antibody. The immunoreactivity rates then were evaluated. MAIN RESULTS: The mean ITA free flow in the GA + TEA group was significantly higher than in the GA group (56.0 ± 9.0 mL/min v 39.6 ± 14 mL/min, p = 0.001). Immunostaining intensity in the sections after incubation with each primary antibody increased in the GA + TEA group compared with the GA group. CONCLUSIONS: The results of this study indicated that TEA increased ITA free blood flow significantly via increased VEGF, i-NOS, and adenosine-A2B receptor expressions. Therefore, the use of TEA as an adjunct to GA might be considered as an alternative to vasoactive agents for increasing ITA flow in CABG surgery.

Efeito preemptivo da morfina por via venosa na analgesia pós-operatória e na resposta ao trauma cirúrgico / The effect of preemptive intravenous morphine on postoperative analgesia and surgical stress response

Justificativa e Objetivos - Embora os primeiros estudos sobre analgesia preemptiva tenham demonstrado que o bloqueio pré-operatório com anestésicos locais ou a medicação pré-anestésica com opióides sistêmicos eram mais eficazes no alívio da dor pós-operatória do que qualquer outro tratamento, o resultado de outros estudos comparando os efeitos doa tratamento pré operatório ao mesmo tratamento iniciado após a cirurgia, produziram efeitos inconsistentes. As razões para essa falta de consistência não são claras. São poucos os estudos sobre a relação entre analgesia preemptiva e o consumo de analgésicos e a resposta ao trauma cirúrgico. O objetivo deste estudo foi avaliar o efeito preemptivo da morfina por via venosa preemptiva no consumo pós-operatório de analgésicos e na resposta ao trauma cirúrgico. Método - Participaram deste estudo 60 pacientes, estado físico ASA I ou II, com idades entre 20 e 60 anos, escalados para histerectomia abdominal total e salpingo-ooferectomia bilateral, que foram aleatoriamente distribuídos em três grupos de 20 pacientes. Grupo I (n=20) ð 0,15 mg.kgðû de morfina após a indução anestésica e soro fisiológico durante o fechamento do peritônio. Grupo II (n=20) ð soro fisiológico após a indução e 0,15 mg.kgðû de morfina durante o fechamento do peritônio. Grupo III (n=20) soro fisiológico durante a indução e o fechamento do peritônio. Foram medidos os níveis sangüíneos de cortisol e de glicose e feita a contagem de leucócitos nos períodos pré e pósðoperatórios. Resultados - O consumo total de morfina pós-operatória foi significativamente mais baixo no grupo I comparado ao grupo III (p < 0,001). Os níveis de cortisol aumentaram significativamente em todos os grupos 4 horas após a cirurgia, quando comparados aos valores préðoperatórios (p < 0,001). Os níveis de glicose plasmática também aumentaram significativamente em todos os grupos 30 minutos e 8 horas após a cirurgia (p < 0,01). Todos os grupos apresentaram leucocitose pósðoperatória e a contagem de leucócitos foi significativamente mais alta no período pósðoperatório do que no préðoperatório (p < 0,01)