COMPARATIVE CHARACTERISTICS OF EFFECTIVENESS AND SAFETY OF ADJUVANT SEDATION OF PATIENTS WITH ALCOHOLIC DELIRIUM

Chronic alcoholism is one of the factors of early mortality in the world. The most formidable complication of this addiction is the state of alcohol withdrawal with delirium. It is based on a long-term imbalance of the GABA and glutamatergic systems in the brain. Today, the search for an optimal sedation regimen that would be effective on the one hand, and, on the other hand, would have a sufficient safety profile, remains relevant. Three sedation regimens with the addition of ketamine, sodium oxybutyrate and dexmedetomidine were investigated. All were compared with the traditional sedation (control) regimen and with each other. The control points of the study were the following parameters: the duration of the episode of delirium, hemodynamics, plasma cortisol and serotonin, laboratory parameters of the state of the kidneys and liver. As a result of the study, we found that all of the proposed schemes had a shorter duration of delirium compared to the control. The shortest episodes of delirium were observed in the dexmedetomidine group. None of the proposed groups could adequately normalize hemodynamic parameters. We believe that the reason for this is both the peculiarities of the mechanism of action of the drugs we have chosen, and electrolyte imbalance, in particular, hypomagnesemia. The safety of our proposed sedation regimens requires further comprehensive research

The Efficacy of Ultrasound-Guided Bilateral Transversus Abdominal Plane (TAP) Block in Decreasing the Pain After Laparoscopic Cholecystectomy: A Randomized Clinical Trial

Introduction: Pain after laparoscopic cholecystectomy is complex in nature and several methods are performed to control it. Transversus Abdominis Plane (TAP) block has been used for postoperative pain for some abdominal surgeries. This study was designed to determine the analgesic efficacy of bilateral TAP block for patients undergoing Laparoscopic Cholecystectomy. Methods: Forty-two patients were randomized into 2 groups. Group 1 received TAP block using bupivacaine 0.25% (n=21), and group 2 received TAP block using saline. Before extubation, blocks were performed bilaterally. Tramadol IV was given for breakthrough pain for the first 24 hours. Pain scores using the Visual Analog Scale (VAS) at 0, 1, 2, 4 ,8 ,12, 24 hour-intervals, number of patient demand for Tramadol and patient satisfaction were collected. Results: Patients in the control group have higher VAS scores both during rest and on movement. However, pain was significantly reduced only on the 2nd hour at rest and on the 1st to 4th hours on movement among patients who received Bupivacaine 0.25% on TAP block. Furthermore, there was no significant difference in the requirement for rescue analgesics (p=0.1160) and the satisfaction rate (p=0.2849) between the two groups. Conclusion: TAP block is safe and improved postoperative analgesia in patients receiving laparoscopic cholecystectomy. But its additional analgesic effect in the presence of a dynamic multimodal pain-control regimen is probably rather small and need further investigation in laparoscopic cholecystectomy.

214 Effects of Reducing Digestible Lysine and Tryptophan to Lysine Ratio on Growth Performance of Grow-finish Pigs

Due to packing plant closures or slow-downs, many producers needed to examine ways to reduce average daily gain (ADG) of finishing pigs. Therefore, a total of 1,080 pigs (L337 × 1050, PIC; initially 32.0 kg) were used in a 119-d trial to evaluate the effects of reducing dietary standardized ileal digestibility (SID) Lys and SID Trp:Lys ratio to slow growth of finishing pigs in a commercial setting. Pigs were randomly allotted in weight blocks to 1 of 4 dietary regimens with 27 pigs/pen and 10 replications/regimen. Pigs were fed a control regimen (100% of the estimated SID Lys requirement for pigs in this facility) formulated to contain 1.10, 1.01, 0.91, 0.83, 0.79, 0.71 and 0.67% SID Lys from 32 to 42, 42 to 51, 51 to 72, 72 to 85, 85 to 97, 97 to 112, and, 112 to 130 kg, respectively. Two other regimens contained 90 or 80% of the Lys estimate. These 3 regimes were formulated to a SID Trp:Lys ratio of 19% except for the last dietary phase that contained 17% SID Trp:Lys ratio. The fourth regimen contained 80% of the SID Lys estimate with 16% SID Trp:Lys in all phases. The statistical model included fixed effects of treatment, random effect of block, linear and quadratic effects of SID Lys and pairwise comparison of the two 80% treatments. Overall, decreasing SID Lys decreased (linear, P < 0.01) ADG and final body weight (BW) and tended (P < 0.10) to decrease gain:feed ratio (G:F). Reducing the Trp:Lys ratio decreased (P = 0.014) ADG and final BW compared to pigs fed diets with 80% SID Lys with higher SID Trp:Lys. In summary, decreasing SID Lys reduced ADG and feeding a reduced SID Trp:Lys ratio resulted in a further decrease in ADG of grow-finish pigs.

Postoperative Opioid Utilization and Patient Satisfaction in General Surgery Procedures: A Prospective Observational Study

Background Wide variation of opioid prescribing persists despite attempts to quantify number of opioids utilized postoperatively. We aim to prospectively determine number of opioids used after common surgery procedures to guide future prescribing. Methods A prospective observational trial was performed of opioids prescribed and used postoperatively. Patients filled out pre- and postoperative surveys, and number of opioids utilized was captured at postoperative visit. Results One-hundred-and-thirteen patients met inclusion. Median opioids prescribed exceeded number of opioids taken for all procedures. Median number of opioids taken postoperatively was fewer than 10 for all categories of procedures: simple skin/soft tissue 2 (IQR 1-4), complex skin/soft tissue 1.5 (IQR 0-14), simple laparoscopy 1 (IQR 0-20) and complex laparoscopy 4 (IQR 0-20), laparotomy 0 (IQR 0-26), and open inguinal hernia 2 (IQR 0-2). Nearly 80% of patients had leftover opioids, and 31% planned to keep them. There was little difference between preoperative and postoperative level of satisfaction with a pain control regimen. Discussion Postoperatively, patients utilize opioids less frequently than prescribed and often keep leftover pills. Patient pain control satisfaction is unrelated to number of opioids prescribed and taken postoperatively.

Tuberculosis Burden in the Tea Gardens of Assam: A Discussion on the Risk Factors and Social Determinants

ABSTRACT Tuberculosis (TB) is one of the deadliest diseases identified as the ‘disease of the poor’. India has the highest yearly incidence of TB in the world. Besides bio-medical determinants and risk factors, social determinants increase the risk factors of exposure to TB germs and after-exposure effects on a population. Growing experiences in TB control advocate more focus on intervention in social determinants as a complementary measure to the curative TB control regimen, as the curative TB control programme alone has been unable to control TB effectively. There is a high TB burden in the tea gardens of Assam despite the presence of a TB monitoring mechanism in place. This paper explores the extent of risk factors and social determinants prevalent among the tea garden worker population, which might help policy planning for controlling TB in Assam’s tea gardens.

Efficacy of Methocarbamol for Acute Pain Management in Young Adults With Traumatic Rib Fractures

Background: Rib fractures account for more than one-third of blunt thoracic injuries and are associated with serious complications. Use of nonopioid adjunctive agents such as methocarbamol for pain control has increased considerably. Objective: This study aimed to assess the impact of methocarbamol addition to the pain control regimen on daily opioid requirements for young adults with rib fractures. Methods: This observational, retrospective study included patients aged 18 to 39 years with 3 or more rib fractures who were admitted to a level 1 trauma center between July 2014 and July 2018. Patients were dichotomized based on admission before and after methocarbamol addition to the institutional rib fracture protocol. The primary outcome was to determine the impact of methocarbamol on daily opioid requirements. Secondary outcomes included hospital length of stay (LOS) and diagnosis of pneumonia. Results: A total of 50 patients were included, with 22 and 28 patients in the preprotocol and postprotocol groups, respectively. All patients in the latter group received methocarbamol, whereas no patient in the preprotocol group received methocarbamol. Cumulative opioid exposure was significantly less for patients admitted after methocarbamol addition to the protocol (219 vs 337 mg oral morphine equivalents; P = 0.01), and hospital LOS was also decreased (4 vs 3 days; P = 0.03). No significant differences in the incidence of pneumonia or adverse effects were observed. Conclusion and Relevance: This is the first study to evaluate the impact of methocarbamol on reducing opioid requirements. Given the risks associated with opioids, use of methocarbamol as an analgesia-optimizing, opioid-sparing multimodal agent may be reasonable.

Single-dose fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting in patients receiving moderately emetogenic chemotherapy regimens: a subgroup analysis from a randomized clinical trial of response in subjects by cancer type

Background Results from a phase III, randomized, double-blind, active comparator-controlled, parallel-group trial evaluating fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting (CINV) found that a single-day, triple-antiemetic fosaprepitant regimen resulted in a significantly higher proportion of patients achieving a complete response (CR; no vomiting or rescue medication use) in the delayed phase (25–120 h after chemotherapy initiation), compared with a 3-day control regimen (ClinicalTrials.gov, NCT01594749). As the risk for CINV is dependent on chemotherapy regimen and generally guided by tumor type, this post hoc analysis evaluated the efficacy and safety of this regimen by cancer subpopulations (gastrointestinal [GI] or colorectal, lung, breast, and gynecologic cancers). Methods Subjects with confirmed cancer who were naive to highly and moderately emetogenic chemotherapy (HEC and MEC) and were scheduled to receive intravenous (IV) anthracycline-cyclophosphamide (AC)–based MEC on the first day of chemotherapy were randomly assigned to receive oral ondansetron and oral dexamethasone plus either a single IV dose of fosaprepitant 150 mg (fosaprepitant regimen) or placebo (control regimen). The primary efficacy end point was the proportion of subjects achieving CR in the delayed phase. CR rates in the overall and acute phases (0–120 h and 0–24 h after MEC initiation, respectively) were assessed as secondary end points. Safety and tolerability were also assessed. Results CR rates in the delayed phase favored the fosaprepitant regimen over the control regimen across the GI/colorectal, lung, breast, and gynecologic cancer subgroups (range, 6.2–22%); similar findings were observed for CR in the overall phase. CR in the acute phase was high for all groups (≥87%). The fosaprepitant regimen was well tolerated in all cancer subgroups. Conclusions This post hoc analysis indicated that a single-day fosaprepitant regimen was effective in preventing CINV in patients receiving MEC, regardless of cancer type. Trial registration ClinicalTrials.govNCT01594749, registered May 9, 2012.