<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec><h3>Background</h3>
<p>SARS-CoV-2 infection demonstrates a wide range of severity. More severe cases demonstrate a cytokine storm with elevated serum interleukin-6, hence IL-6 receptor antibody tocilizumab was tried for the management of severe cases.</p>
</sec>
<sec><h3>Aims</h3>
<p>Effect of tocilizumab on ventilator-free days among critically ill SARS-CoV-2 patients.</p>
</sec>
<sec><h3>Method</h3>
<p>Retrospective propensity score matching study, comparing mechanically ventilated patients who received tocilizumab to a control group.</p>
</sec>
<sec><h3>Results</h3>
<p>29 patients in the intervention group were compared to 29 controls. Matched groups were similar. Ventilator-free days were more numerous in the intervention group (SHR 2.7, 95% CI: 1.2 – 6.3; p = 0.02), ICU mortality rate was not different (37.9% versus 62%, p = 0.1), actual ventilator-free periods were significantly longer in tocilizumab group (mean difference 4.7 days; p = 0.02). Sensitivity analysis showed a significantly lower hazard ratio of death in tocilizumab group (HR 0.49, 95% CI: 0.25 – 0.97; p = 0.04). There was no difference in positive cultures among groups (55.2% in tocilizumab group versus 34.5% in the control; p = 0.1).</p>
</sec>
<sec><h3>Conclusion</h3>
<p>Tocilizumab may improve the composite outcome of ventilator-free days at day 28 among mechanically ventilated SARS-CoV-2 patients; it is associated with significantly longer actual ventilator-free periods, and insignificantly lower mortality and higher superinfection.</p>
</sec>
</abstract>

Anaesthesia Department, Faculty of Medicine

South Carolina University School of Medicine

Critical Care Department, Keck School of Medicine

Effect of Tocilizumab on “Ventilator Free Days” Composite Outcome in SARS-CoV-2 Patients: A Retrospective Competing Risk Analysis

<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec><h3>Background and aims</h3>
<p>To explore the incidence and risk factors, as well as mortality, in critically ill COVID-19 patients who developed pneumothorax (PTX) and/or pneumomediastinum (PNM).</p>
</sec>
<sec><h3>Methods</h3>
<p>A retrospective cohort study was undertaken to analyse data of all patients with moderate to severe COVID-19 disease who were either RTPCR positive or had a clinico-radiological diagnosis. The exposure group consisted of COVID-19 patients who presented with PTX/PNM, whereas the non-exposure group consisted of patients who did not develop PTX and/or PNM during the stay.</p>
</sec>
<sec><h3>Results</h3>
<p>Incidence of PTX/PNM was observed to be 1.9% among critically ill COVID-19 patients. 94.4% (17/18) of patients in the PTX group received positive pressure ventilation (PPV); the majority of these patients were on non-invasive ventilation when they developed PTX/PNM; only one patient was receiving conventional oxygen therapy. COVID-19 patients who developed PTX/PNM had 2.7 times higher mortality. A mortality rate of 72.2% was observed in COVID-19 patients who developed PTX/PNM.</p>
</sec>
<sec><h3>Conclusion</h3>
<p>Development of PTX/PNM in critically ill COVID-19 patients is associated with more severe disease involvement, and institution of PPV is an additional risk factor. Significantly high mortality was observed following PTX/PNM in critically ill COVID-19 patients and is an independent marker of poor prognosis in COVID-19 disease.</p>
</sec>
</abstract>

Pneumothorax in Critically Ill COVID-19 Patients in the Indian Subcontinent

<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec><h3>Background and Aims</h3>
<p>Securing the airway without morbidity is of prime importance. The difficult airway cart should have some advanced airway aids if not all. In this study we evaluated Airtraq laryngoscope and Intubating Laryngeal Mask Airway (ILMA) as intubating devices in novice users who were well accomplished in intubation using direct laryngoscope with Macintosh blade. Both the devices were used because of relatively lesser cost, portability and all in one compact design not requiring any setup. Methods: 60 consenting American Society of Anaesthesiology (ASA) Grade I and II patients, weighing 50 to 70 were randomly assigned to be intubated by Airtraq or ILMA. Primary Aim was to compare success rate and intubation time. Comparison of ease of intubation and postoperative pharyngeal morbidity were the secondary end points.</p>
</sec>
<sec><h3>Results</h3>
<p>Success rate of intubation was higher in ILMA group (100%) than Airtraq (80%) [P = 0.0237]. However, in successful intubations the time for intubation was significantly less with Airtraq (Group A = 45.37 ± 27.55, Group I = 77.6 ± 31.85; P = 0.0003). No significant difference was noted in ease of intubation, number of optimizing manoeuvres to facilitate intubation and postoperative pharyngeal morbidity.</p>
</sec>
<sec><h3>Conclusion</h3>
<p>In Clinicians who are well versed with laryngoscopy using Macintosh blade but new to Airtraq and ILMA, success rate of intubation is higher with ILMA. Prolonged intubation time in ILMA should not deter its use in difficult airway scenarios because of the ability to ventilate through it.</p>
</sec>
</abstract>

Comparison of Intubation Success Rate using Airtraq Laryngoscope and Intubating Laryngeal Mask Airway in Novice Users with Prior Airway Management Experience: A Prospective Randomised Study

<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec><h3>Background and Aims</h3>
<p>Pain remains the most common reason patients seek assistance in emergency rooms. However, the level of pain management during emergencies, and subsequently during disasters and mass casualty incidents, remainsdisturbing.</p>
</sec>
<sec><h3>Methods</h3>
<p>A cross-sectional study was conducted using a structured anonymous questionnaire among a random sample of doctors working in different tertiary hospitals of Athens and of rural regions. The data were analysed using descriptive statistics and statistical significance tests via R-Studio, version 1.4.1103.</p>
</sec>
<sec><h3>Results</h3>
<p>The aforementioned sample yielded101 questionnaires. Results show suboptimal knowledge and attitudes regarding acute pain management among emergency healthcare providers in Greece. The majority of responders are unaware of the term multimodal analgesia (52%), of newer pain treatment methods (59%), they have not attended pain management seminars (84%), nor are they aware of pain treatment protocols in their workplace (74%). Participants appeared to disregard successful pain relief due to time constraints (58%), while leaving certain parts of the population (children under 3 years of age −75%, pregnant women-48%) significantly undertreated in terms of analgesia. Demographic correlations showed that clinical experience and pain management education were associated with older and more experienced emergency healthcare workers. Specialties with a previous core training containing pain education (anaesthesiologists, emergency physicians) again showed better results in the majority of the questions.</p>
</sec>
<sec><h3>Conclusions</h3>
<p>Educational programs/seminars along with standardised algorithms should be developed in order to cover existing needs and misconceptions.</p>
</sec>
</abstract>

Department of Anaesthesiology and Pain Management

Department of Public and One Health, School of Health Sciences

Neuromodulation and Pain Management Fellow

MSc “Global Health-Disaster Medicine”

Medical School National and Kapodistrian University of Athens

Acute Pain Management and Perceptions among Emergency Healthcare Workers: Feedback From Greece

<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec><h3>Background</h3>
<p>Incidence of postoperative nausea and vomiting (PONV) in susceptible patients can be unacceptably high (70–80% reported incidence). This study was designed to evaluate the effect of palonosetron and ondansetron in preventing PONV in high-risk patients undergoing gynaecological laparoscopic surgery.</p>
</sec>
<sec><h3>Methodology</h3>
<p>In this randomised, controlled, double-blind trial, nonsmoking females 18–70 years and weighing 40–90 kg, scheduled for elective laparoscopic gynaecological surgeries, were enrolled into the ondansetron (Group A, n=65) or palonosetron (Group B, n=65) group. Palonosetron (1 mcg/kg 4) or ondansetron (0.1 mg/kg 4) were administered just before induction. Postoperatively, incidence of nausea, vomiting, PONV (scored on a scale of 0–3), need for rescue antiemetic, complete response, patient satisfaction, and adverse effects were evaluated for up to 48 h following surgery.</p>
</sec>
<sec><h3>Results</h3>
<p>The overall PONV scores and postoperative nausea score during 0–2 h and 24–48 h were comparable, but PONV scores (P=0.023) and postoperative nausea scores (P=0.010) during 2–24 h were significantly lesser in Group B compared to Group A. There was no statistically significant difference in the postoperative vomiting score or retching during 0–48 h. The amount of first-line rescue antiemetic used during 2–24 h was significantly higher in Group A (56%) than in Group B (31%) (P=0.012; P&lt;0.05). Complete response to the drug during 2–24 h was significantly higher (P=0.023) in Group B (63%) compared to Group A (40%), whereas response was comparable during 0–2 h and 24–48 h. Both groups had comparable incidences of adverse effects and patient satisfaction scores.</p>
</sec>
<sec><h3>Conclusion</h3>
<p>Palonosetron has superior antinausea effect, less need of rescue antiemetics, and lesser incidence of total PONV in comparison to ondansetron during 2–24 h and comparable effect to ondansetron during the 0–2 h and 24–48 h postoperative periods in high-risk patients undergoing gynaecological laparoscopic surgery.</p>
</sec>
</abstract>

A Comparative Study of Palonosetron with Ondansetron for Prophylaxis of Postoperative Nausea and Vomiting (PONV) Following Laparoscopic Gynaecological Surgeries

<abstract xmlns="http://www.w3.org/1999/xhtml">

<p>Perioperative shivering is a well-known complication reported in 29 to 54% of patients undergoing a caesarean section under regional anaesthesia. It interferes with pulse oximetry, blood pressure (BP), and electrocardiographic monitoring (ECG). Moreover, it gives the patient a distressing and unpleasant experience. This review aims to examine the mechanism of shivering during the caesarean section under neuraxial anaesthesia and to explore available information for preventing and managing this clinically significant complication.</p>
<p>A literature search of PubMed, MedLine, Science Direct, and Google Scholar was done. The search results were limited to randomised controlled trials (RCT) and systematic reviews.</p>
<p>This review studied the efficacy of various nonpharmacological and pharmacological methods to manage perioperative shivering. We found that pre-warming and intraoperative warming are simple and effective interventions, although the effect seems to depend on the duration of treatment. Multiple pharmacological interventions, including opioids, NMDA receptor antagonists, and alpha-2 adrenergic agonists, have been studied and found to reduce the incidence and severity of perioperative shivering during caesarean section under neuraxial anaesthesia.</p>
</abstract>

Narrative Review on Perioperative Shivering during Caesarean Section under Neuraxial Anaesthesia

AHEAD OF PRINT

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Volume 27 (2020): Issue 1 (July 2020)

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Romanian Journal of Anaesthesia and Intensive Care

 The Romanian Journal of Anaesthesia and Intensive Care (Jurnalul Român de Anestezie Terapie Intensivă) is a biannual, in English, with abstracts in English and Romanian, ranked CNCS B+ and indexed Embase, PubMed and Scopus. This journal publishes papers reporting original clinical and experimental researches, reviews, case reports, editorials, guidelines, letters to Editor, book reviews as well as other materials considered adequate by the Editorial committee. In 2002, the Journal changed its name to “Jurnalul Român de Anestezie Terapie Intensivă” (ISSN 2344-2336) to better reflect its primary purpose. It continued to be published in Romanian, with abstracts in both Romanian and English, while 1-2 articles/issue were published in English only. We encouraged all Romanian authors to submit manuscripts written in English, and gradually the number of articles in English increased. The homepage has been written in English (www.jurnalul-anestezie.ro), and is accessible freely on-line; it was established in 2007 with the aim of widening its readership and promoting the Journal abroad. It contained: the Journal title, the title and abstracts of all published articles and the full text of articles in English. In 2008, the Journal benefited from the addition of an international editorial board of 8 members, which was subsequently enlarged to the current 22 members. The number of articles published in English increased, facilitating the inclusion of international experts tasked with reviewing the submitted manuscripts. The peer review enhanced the quality of the publications, stimulated additional original research, and eventually led to the indexing of the Journal in the Elsevier Bibliographic Database (EMBASE and SCOPUS) in 2009, and in the Romanian Ministry of Education CNCSIS B+ database. In 2014, in order to both increase the Journal’s readership internationally, and to attract a broader base of submissions, the Board decided to publish the Journal entirely in English, under the new name, “The Romanian Journal of Anaesthesia and Intensive Care” (ISSN 2392-7518). A native English-speaker editor has been recruited to assist non-native English-speaking authors with style and grammar, and a statistical editor was also added to the editorial process. In 2017 the Journal was accepted to be indexed in the PubMed Central database of the National Library of Medicine USA. The Romanian Journal of Anaesthesia and Intensive Care (Rom J Anaesth Int Care) is intended for anaesthesia and intensive care clinicians, and for specialists in emergency medical care, pain research and pain management. The principal aim is to stimulate and promote scientific discovery by publishing research papers and manuscripts accompanied by editorials written by experts in the field. The editorials seek to place the research findings in the appropriate clinical context, highlighting how the information is directly applicable to patient care and how it benefits the clinician and the patient. The Journal also seeks to inform and update anaesthesiologists about clinical and regulatory developments by publishing reviews and educational materials such as Clinical Guidelines of the European Society of Anaesthesiology and those of our Romanian National Society.  Archiving  Sciendo archives the contents of this journal in Portico - digital long-term preservation service of scholarly books, journals and collections.  Plagiarism Policy  The editorial board is participating in a growing community of Similarity Check System's users in order to ensure that the content published is original and trustworthy. Similarity Check is a medium that allows for comprehensive manuscripts screening, aimed to eliminate plagiarism and provide a high standard and quality peer-review process. 

Romanian Journal of Anaesthesia and Intensive Care

Volume 29 (2022): Issue 1 (July 2022)

Original paper

Effect of Tocilizumab on “Ventilator Free Days” Composite Outcome in SARS-CoV-2 Patients: A Retrospective Competing Risk Analysis

Pneumothorax in Critically Ill COVID-19 Patients in the Indian Subcontinent

Comparison of Intubation Success Rate using Airtraq Laryngoscope and Intubating Laryngeal Mask Airway in Novice Users with Prior Airway Management Experience: A Prospective Randomised Study

Acute Pain Management and Perceptions among Emergency Healthcare Workers: Feedback From Greece

A Comparative Study of Palonosetron with Ondansetron for Prophylaxis of Postoperative Nausea and Vomiting (PONV) Following Laparoscopic Gynaecological Surgeries

Review

Narrative Review on Perioperative Shivering during Caesarean Section under Neuraxial Anaesthesia

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