The preoperative evaluation of post-COVID-19 patients scheduled for elective surgery - What is important not to miss!

Continuous rise in the number of COVID-19 cases, since it was first diagnosed in 2019, forced the entire medical fraternity to delay elective surgeries. The preoperative evaluation guidelines that were used in the pre-COVID-19 era underwent significant changes, adding modifications to meet the post-COVID patients' specific criteria and requirements. Currently, all patients before or at the time of hospital admission were tested using a nasopharyngeal swab, by RT-PCR for SARS-CoV-2. Apart from this, for a patient undergoing elective surgery in their post-COVID-19 period, it is mandatory to obtain a detailed history of COVID-19 disease/SARS-CoV-2 infection, to identify residual symptoms or any organ dysfunction the infection might have caused. As well as the functional optimization of the patient to achieve the best clinical and biological status before the surgery. After all the systems have been thoroughly investigated, the risk-benefit ratio needs to be calculated, keeping in mind the cytokine storm and inflammatory responses encountered postoperatively. A mere negative RT-PCR test cannot be considered as the only decisive factor to operate, as the post-COVID-19 phase can influence postoperative outcome of the patient. Hence, the pre-operative evaluation protocols of post-COVID patients should be set and followed thoroughly, in order to avoid post-surgical complications. For better surgical and post-surgical management of post-COVID-19 patients, conducting clinical tests, assessing previously administered medications, evaluating the need for deep venous thrombosis prophylaxes, and identifying subclinical inflammatory state are the measures that should be taken.

A small scale oxygenator for cardiopulmonary bypass in rats.

Cardiopulmonary bypass (CPB) devices replace transiently the function of both heart and lungs, allowing the investigator to work safely on a stopped heart. Although this technology has greatly improved since its first applications in the early 1950's there is still no definitive rat CPB model, various experiments reporting drawbacks like pulmonary edema, large priming volumes,etc. We present a new oxygenator that can be used in cardiopulmonary bypass experiments in rats, simple in design and efficient in function,in which the process of blood oxygenation takes place in a vertical cylinder filled up with air or oxygen, with blood being spread onto the wall and then trickling down in a thin layer that facilitates the oxygen transfer. The oxygenation is efficient, the pO2 reaches levels of almost 150 mmHg (physiological level is around 100 mmHg) in conditions of oxygen saturation of over 99% (normal levels 95%-98%).

Conventional treatment or epidural blood patch for the treatment of different etiologies of post dural puncture headache.

Post dural puncture headache (PDPH) represents a complication of anesthesia (with an increased incidence in obstetric patients) or as the consequence of a diagnostic lumbar puncture. The aim of the present study was to evaluate the efficacy of the epidural blood-patch (EBP) versus the conventional medical treatment of post-anesthetic headaches also including the PDPH following a diagnostic puncture, a category of patients rarely referred to the anesthesia consultation in our hospital because it was believed that they might have equal benefit from conventional measures due to the smaller size of needles used. We studied in a prospective, randomized, double-blinded manner 32 obstetric and non-obstetric patients with PDPH having the onset of the symptoms 24 hours before the inclusion in the study. The patients were randomly divided in two groups: group A (16 patients) receiving conventional treatment (oral and intravenous fluid replacement, non-steroidal anti-inflammatory drugs--NSAIDs--, caffeine) and group B (16 patients) in whom an epidural blood-patch was performed. The intensity of the headache was evaluated using a visual analogue scale (VAS) from 0-10, before, 2 hours and 24 hours after the EBP. There were no statistical differences concerning the demographic data and the cause of PDPH between the groups (p > 0.05). The intensity of PDPH was similar before performing the EBP (p > 0.05), with a value on VAS of 8.2 +/- 1,4. in group A and 8,0 +/- 1.6 in group B. Two hours after the treatment, the intensity of headache on VAS diminished extremely significant (p < 0.0001): in group B the value was 1.0 +/- 0,18 versus 8.2 +/- 1.4 in group A. The difference recorded after 24 hours remained statistically significant (p < 0.0001): the VAS scores were 0.7 +/- 0,16 and 7.8 +/- 1.2 respectively. The epidural blood patch represents the first choice treatment of PDPH no matter the etiology, being significantly superior to the conventional treatment which did not affect pain scores. In severe PDPH there is no reason to delay the EBP more than 24 hours after the diagnosis as all except two patients of the conventional treatment group required blood patching following the study period.

[Resistance phenotypes circulating in nosocomial high risk departments]. / Fenotipuri de rezistenta circulante în sectii cu risc nosocomial crescut.

OBJECTIVES: Between November 2001-January 2002 we collected 406 samples from patients hospitalized in Intensive Care adults and new-borns Unit (ICU). The aim was to observe the colonization and infection status with bacteria that may have nosocomial potential and to establish circulating phenotypes in ICUs. METHODS: The identification was performed by API (bioMerieux) method, and we have performed the antimicrobial susceptibility tests by both: API method and by Kirby-Bauer disc-diffusion test. RESULTS: We isolated 295 strains with nosocomial potential: 34 MRSA strains, 23 MRCNS strains, 29 ESBL producing gram negative rods, etc. CONCLUSIONS: We observed the presence of multiple drug resistant bacteria which play an important roll in both: massive colonization of patients and in the etiology of nosocomial infections. This leads us to the conclusion that antibiotic resistance pattern should be interpreted by the bacteriologist and a consistent policy concerning the use of antimicrobial drugs in hospital settings should be instituted.