In-hospital cardiac arrest: Incidence, prognostic factors and results

BACKGROUND AND AIMS

In-hospital cardiac arrest (CA) is a clinical entity with high morbidity and mortality that occurs in up to 2% of hospitalized patients. It is a public health problem with important economic, social, and medical repercussions, and as such its incidence needs to be reviewed and improved. The aim of this study was to determine the incidence of in-hospital CA, return of spontaneous circulation (ROSC), and survival rates at Hospital de la Princesa, and to define the clinical and demographic characteristics of patients with in-hospital CA.

PATIENTS AND METHODS

Retrospective observational chart review of patients presenting in-hospital CA and treated by anaesthesiologists from the hospital's rapid intervention team. Data were collected over 1 year.

RESULTS

Forty four patients were included in the study, of which 22 (50%) were women. Mean age was 75.7 years (±15.78 years), and incidence of in-hospital CA was 2.88 per 100,000 hospital admissions. Twenty two patients (50%) achieved ROSC and 11 patients (25%) survived until discharge home. The most prevalent comorbidity was arterial hypertension (63.64%); 66.7% of cases were not witnessed, and only 15.9% presented a shockable rhythm.

CONCLUSIONS

These results are similar to those reported in other larger studies. We recommend introducing immediate intervention teams and devoting time to training hospital staff in in-hospital CA.

[Clinical Practice Guide for Anaphylaxis in Latin America (Galaxia-Latam)]

Anaphylaxis is a severe allergic reaction with a rapid onset and it is potentially life-threatening. Its clinical manifestations are varied; they may affect the skin, the cardiovascular system, the respiratory system, and the digestive system, among others. The treatment of choice, which is an intra-muscular injection of epinephrine (adrenaline), must be applied promptly. Therefore, being prepared to recognize it properly is of crucial importance. The objective of this clinical practice guide is to improve the knowledge of health professionals about anaphylaxis and, consequently, to optimize the treatment and long-term management of this reaction. This guide is adapted to the peculiarities of Latin America; especially in matters regarding the treatment. The need to introduce epinephrine auto-injectors in countries that don't have them yet is highlighted.

Greater palatine canal injections reduce operative bleeding during endoscopic sinus surgery: a systematic review and meta-analysis

OBJECTIVES

The use of greater palatine canal (GPC) injections of a local anesthetic and a vasoconstrictor to decrease surgical bleeding during endoscopic sinus surgery (ESS) is controversial. We investigated the role of a preoperative GPC injection to minimize intraoperative bleeding during ESS in patients with chronic sinusitis through a meta-analysis of the relevant literature.

DATA SOURCES

PubMed, SCOPUS, and the Cochrane database.

REVIEW METHODS

We screened the relevant literature published before May of 2018. Five articles that compared the pre-operative GPC injection (treatment group) with a placebo or no treatment (control group) were included for this analysis of the outcomes, which included an endoscopic grade of nasal bleeding and intraoperative hemodynamic stability during ESS.

RESULTS

The endoscopic grade in the treatment group was significantly reduced when compared with the control group. No significant adverse effects were reported in the enrolled studies. The subgroup analyses of these results compared the concentrations of adrenalin (1:80,000 or 1:100,000), and adrenalin 1:80,000 showed significant effects on intraoperative bleeding when compared to adrenalin 1:100,000.

CONCLUSION

This study demonstrated that GPC injections of local anesthesia with 1:80,000 adrenaline for ESS effectively reduced intraoperative bleeding. Additionally, this procedure showed no significant adverse effects, such as hemodynamic instability. However, the standardized dosing needs further investigation and more trials.

LEVEL OF EVIDENCE

Ia.

[Not Available]

Zusammenfassung. Die Anaphylaxie als schwerwiegendste Manifestation einer in der Regel allergischen Soforttypreaktion stellt eine potenziell lebensbedrohliche Notfallsituation dar, mit der jeder Arzt auch in der Praxis konfrontiert sein kann. Durch steigende Prävalenzzahlen gewinnt das Thema zunehmend an Bedeutung. Im folgenden Artikel beschreiben wir Auslöser, Klinik, diagnostische Hilfsmittel, Risiko- und Augmentationsfaktoren sowie medikamentöse Therapie in dieser Altersgruppe und klären die Frage, welchem Patienten Sie einen Adrenalinautoinjektor rezeptieren sollen. Daten zur Beeinträchtigung der Lebensqualität nach durchgemachter Anaphylaxie zeigen, wie wichtig die weitere Betreuung nach dem Akutereignis ist. Diagnostik zur Klärung des Auslösers, aber vor allem auch Schulung zur Selbsthilfe und Abgabe eines individualisierten Behandlungsplans können die Situation für die Betroffenen und deren Eltern vereinfachen.

Bullous Dermatitis and Skin Necrosis Developing after Adrenalin Extravasation

Extravasation of vasopressors can have serious complications varying from simple local reactions to skin necrosis and compartment syndrome. Here, we presented bullous dermatitis and skin necrosis which developed due to extravasation of adrenalin infusion in a Hodgkin lymphoma patient with septic shock who was admitted due febrile neutropenia.

Use of adrenalin with lidocaine in hand surgery

OBJECTIVE

Because of the received wisdom within our setting that claims that local anesthesia should not be used with adrenalin in hand surgery; we conducted a study using lidocaine with adrenalin, to demonstrate its safety, utility and efficacy.

METHODS

We conducted a prospective study in which, in wrist, hand and finger surgery performed from July 2012 onwards, we used local anesthesia comprising a 1% lidocaine solution with adrenalin at 1:100,000. We evaluated the quantity of bleeding, systemic alterations, signs of arterial deficit and complications, among other parameters. We described the infiltration techniques for specific procedures individually.

RESULTS

We operated on 41 patients and chose to describe separately the raising of a lateral microsurgical flap on the arm, which was done without excessive bleeding and within the usual length of time. In only three cases was there excessive bleeding or use of bipolar tweezers. No systemic alterations were observed by the anesthesiologists or any complications relating to ischemia and necrosis in the wounds or in the fingers, and use of tourniquets was not necessary in any case.

CONCLUSIONS

Use of lidocaine with adrenalin in hand surgery was shown to be a safe local anesthetic technique, without complications relating to necrosis. It provided efficient exsanguination of the surgical field and made it possible to perform the surgical procedures without using a pneumatic tourniquet, thereby avoiding its risks and benefiting the patient through lower sedation.

Effect of sulfated polysaccharides from Laminaria japonica on vascular endothelial cells in psychological stress rats

ETHNOPHARMACOLOGICAL RELEVANCE

Laminaria japonica is a popular seafood and medicinal plant in China. Laminaria japonica is used in traditional Chinese medicine to treat and prevent hypertension and edema.

MATERIALS AND METHODS

The vascular protective activity and mechanism of sulfated polysaccharides were studied in adrenalin-induced vascular endothelial damage in rats after psychological stress (PS). Vehicle (sham and PS groups), sulfated polysaccharide from Laminaria japonica (LP; 1mg/kg and 5mg/kg) and enoxaparin sodium (1IU/kg, reference drug) were all administered for 10 days. Behavioral changes were recorded. Plasma levels of adrenalin, cortisol, monoamine oxidase (MAO), semicarbazide-sensitive amine oxidase (SSAO), formaldehyde, H2O2, nitric oxide (NO), endothelin-1 (ET-1), 6-keto-prostaglandin F1a (6-keto-PGF1a), and thromboxane B2 (TXB2) were measured. Endothelium-dependent relaxation of the thoracic aorta was measured and transmission electron microscopy of aortic vessels was performed.

RESULTS

Adrenalin metabolites in plasma were significantly lower (P<0.01) in rats after LP administration compared with those in the PS groups. The normalized ratios of plasma NO/ET-1 and 6-keto-PGF1a/TXB2 were maintained and endothelium-dependent relaxation of the aorta was greatly enhanced after LP treatment (P<0.05). Morphological alterations were observed in vascular endothelial cells (VECs) in PS rats, with a higher number of lysosomes and vague mitochondrial cristae compared with those in the sham group. However, these histopathological changes were markedly alleviated after LP treatment.

CONCLUSIONS

This study shows a protective effect of LP on VECs in PS rats. LP can regulate plasma levels of NO, ET-1, and 6-keto-PGF1a, enhance endothelium-dependent relaxation, and alleviate histopathological changes of lysosomes and mitochondria in VECs. The potential mechanism of LP on VECs in PS rats is related to its function of reducing metabolites of adrenalin.

Investigation of whole blood and urine monoamines in autism

Levels of serotonin (5-HT), dopamine (DA), norepinephrine (NE) and epinephrine (E) were determined in the whole blood and urine of 23 children with autism and compared to those of normal children. Very significant group effects (low whole blood 5-HT, high urinary 5-HT and high NE+E in autism) and age effects (urinary 5-HT and DA decrease with age) were found. Moreover, the urinary DA and the whole blood E levels were correlated with clinical findings. The results suggest a maturation defect of noradrenergic systems, possibly disturbed dopaminergic and serotoninergic metabolism, and a functional imbalance among these neurotransmitters in autism.