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

<p>In critical patients, generally, microorganisms originating from nasal cause Ventilator-Associated Pneumonia (VAP). This systematic review was aimed to identify the toothbrush U shape model usage, in potentially decrease the prevalence of ventilator-associated pneumonia among patients in intensive care units. Search strategy identified 15 potentially eligible articles, were 7 RCTs, 4 Meta-analysis, and 4 Observational studies. A total of 15 studies demonstrated the use of toothbrushing and chlorhexidine in mechanically ventilator patients in preventing VAP. Ten studies found positive association between toothbrushing and the use of chlorhexidine in preventing VAP. However, there were 5 studies that did not reveal an additional decrease of VAP incidence either of CHX and only toothbrushing or combination thereof. We cautiously assumed that toothbrushing and chlorhexidine might reduce VAP but the implementation of brushing should be taken into reconsideration in the terms of maintaining it.</p>
</abstract>

Prevention of Pneumonia due to Ventilator in Critical Patients with U Shape Oral Hygiene Model: A Systematic Review

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<p>Fluid management in the perioperative period is a grey zone in clinical practice of late. Looking back on previous practices, static parameters were the only options. Now, dynamic parameters indicating fluid responsiveness have become a significant part of goal-directed fluid therapy (GDFT). However, the efficacy of this approach has yet to be established in neurosurgery cases where patients are already on lot of diuretics, thus making fluid management more challenging. The present study aims to determine the efficacy of the Pleth Variability Index (PVI) with pulse pressure variation (PPV) in guiding GDFT in patients undergoing neurosurgery for supra-tentorial intracranial space occupying lesions (ICSOLs), in the form of a randomised controlled trial.</p>
<p>After randomisation, the patients were categorised into either PVI or PPV groups. Both received a baseline 2 ml/kg/h Lactated Ringer’s (RL) infusion. Additional fluid boluses consisted of 250 ml of colloid infused over a 10 min period if PVI was > 15% or PPV was > 13% for at least five minutes. The primary outcome was to determine the serum lactate difference between preoperative and postoperative values, which could fairly predict fluid deficit leading to inadequate perfusion.</p>
<p>A total of 74 patients were analysed. Both PVI- and PPV-guided GDFT strategies showed no significant difference in the postoperative lactate values, with a P-value of 0.18. Similarly, the mean total fluid administered, mean blood loss, length of CCU stay, and emetic and hypotension episodes also showed no significant differences among the groups with P-values of 0.41, 0.78, 0.25, 0.30, and 0.67, respectively.</p>
<p>For patients undergoing neurosurgery (supratentorial ICSOLs), PVI seems to guide GDFT comparably to PPV regarding tissue perfusion and postoperative complications. However, both the parameters had low sensitivity and specificity, with an area of curve of 0.577 for PPV and 0.423 for PVI, as far as GDFT was concerned.</p>
</abstract>

A Randomised Controlled Study Comparing Pulse Pressure Variation (PPV) and Pleth Variability Index (PVI) for Goal-Directed Fluid Therapy Intraoperatively in Patients Undergoing Intracranial (Supratentorial ICSOLs) Surgeries

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<p>Pyroglutamic acidosis (PGA) is an underrecognized entity characterised by raised anion gap metabolic acidosis (RAGMA) and urinary hyper-excretion of pyroglutamic acid. It is frequently associated with chronic acetaminophen (APAP) ingestion. We report the case of a 73-year-old man with invasive pulmonary aspergillosis treated with voriconazole and APAP for analgesia with a cumulative dose of 160 g over 40 days. PGA was suspected as he developed severe RAGMA and common causes were excluded. Diagnosis was confirmed via urinary organic acid analysis which showed significant hyper-excretion of pyroglutamic acid. APAP was discontinued, and N-acetylcysteine (NAC) was administered. His RAGMA rapidly resolved following treatment.</p>
</abstract>

Pyroglutamic Acidosis – An Underrecognised Entity Associated with Acetaminophen Use

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<sec>
<h3>Background and aims</h3>
<p>With the development of ultrasound-guided and laparoscopic techniques of rectus sheath block (RSB), regional analgesia promises to be efficient and safe. However, studies show controversial results. Our systematic review with meta-analysis aims to evaluate the effect of rectus sheath block in abdominal surgery.</p>
</sec>
<sec>
<h3>Method</h3>
<p>We searched PubMed, Google Scholar, and the Cochrane Library from inception to October 2021 for randomised controlled trials written in English. We included studies on adult populations undergoing abdominal surgery. The primary outcomes of our meta-analysis were postoperative pain intensity and postoperative opioid consumption. Data analysis was conducted using the Review Manager software (RevMan, v. 5.4). Statistical heterogeneity was estimated by the I<sup>2</sup> statistic. The methodological quality of the included studies was assessed using the Oxford quality scoring system (Jadad Scale).</p>
</sec>
<sec>
<h3>Results</h3>
<p>Eight randomised controlled trials (RCTs) in English with a total of 386 patients were included in this meta-analysis. Patients in the RSB group did not consume fewer anaesthetics and opioids after abdominal surgery when compared with patients in the control group. In addition, postoperative pain intensity (out of 10) was not lower in the RSB group when compared with the control group. Finally, RSB did not improve the time to the first opioid/analgesic (min) compared with the non-RSB option.</p>
</sec>
<sec>
<h3>Conclusion</h3>
<p>There is no statistically significant evidence in favour of RSB over non-RSB in reducing anaesthetics and opioid consumption, postoperative pain intensity, and increasing time to first opioid/analgesic.</p>
</sec>
</abstract>

Rectus Sheath Block in Abdominal Surgery: A Systematic Review with Meta-Analysis

AHEAD OF PRINT

Volume 30 (2023): Issue 1 (April 2023)

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

Volume 28 (2021): Issue 2 (December 2021)

Volume 28 (2021): Issue 1 (July 2021)

Volume 27 (2020): Issue 2 (December 2020)

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

Volume 26 (2019): Issue 1 (April 2019)

Volume 25 (2018): Issue 2 (October 2018)

Volume 25 (2018): Issue 1 (April 2018)

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. 