593 Colonic Perforation Following Major Burns: A Systematic Review

Introduction Major burns complicated by stress ulceration and perforation of the stomach or duodenum is a recognised clinical phenomenon. Colonic perforation in burns patients is seemingly uncommon, and the overall incidence, clinical signs/diagnosis of perforation, intervention required, and mortality is incompletely described in the literature. Method We performed a systematic review of the literature on severe burns resulting in colonic perforation during admission. Relevant studies from January 1975 to June 2020 were retrieved from MEDLINE and EMBASE databases. Patient demographics, total body surface area (TBSA), site of colonic perforation, management and overall outcome were extracted. We present a case series of five major burns patients who had colonic perforations in our Specialist Burns Centre. Results We identified 54 studies, of which nine (two case series and seven case reports) met the inclusion criteria. In most cases, the TBSA associated with a colonic perforation was ≥ 30% (10/16 patients, 63%) and the abdomen was involved in 9/16 patients (56%). Perforations mainly affected the right colon (12/16 patients, 75%), usually occurring after the second week of admission (13/16 patients, 81%). Right-sided colonic perforations were associated with an increased mortality rate compared to left-sided perforations (42% vs 25%). Conclusions The current literature, mainly limited to case series and case reports, confirms that colonic perforations in burns patients are rare. The resulting perforation is related to the systemic effect of burn injuries including sepsis and gastrointestinal stasis. We have identified patients who are at higher risk of developing colonic perforations in order to prompt early diagnosis and intervention.

Abdominal pain assessment in rabbits: using the CANCRS to recognize pain and testing its internal validity over time

A composite scale for pain assessment in rabbits has been previously designed and tested (CANCRS). The present study describes the refinement of the scale and the evaluation of its ability to detect pain variations over time. Furthermore, a comparison between the CANCRS and the Visual Analogue Scale (VAS) has been performed, to underline the differences between an objective (CANCRS) and a subjective (VAS) assessment of abdominal pain. In the first part of the study, 86 rabbits (n=47 heathy patients and n=39 patients with gastrointestinal stasis syndrome) underwent pain assessments with the VAS and the CANCRS. Thirty-two patients with gastrointestinal stasis syndrome participated to the second part of the study. These patients underwent four pain assessments with the CANCRS. The first assessment took place before meloxicam administration and the others after 30, 60 and 90 minutes. The CANCRS showed differences between healthy and diseased rabbits (P = 0.0001), median scores were 5 (IQR 4 - 6) and 9 (IQR 7 - 11) respectively. The VAS showed differences between healthy and diseased rabbits (P = 0.02), the median scores were 4 (IQR 2 - 5.35) and 5.3 (IQR 2.65 - 6.45) respectively. The cut-off scores for the CANCRS and for the VAS for differentiation between healthy and diseased patients were 7 (Sp 89%, Se 79%) and 4.4 (Sp 59%, Se 69%) respectively. Sensitivity and specificity for each parameter of the CANCRS were calculated, in order to obtain weighting factors. Accordingly, the evaluation of respiratory pattern and vocalizations should be excluded from the CANCRS, since their performances in pain evaluation are poor. Internal validity of the CANCRS was tested assessing pain before and after the analgesic treatment and the results showed significancy at each time point. The CANCRS showed better performances than the VAS and its responsiveness to pain variations has been verified.

Postanaesthetic effects of ketamine–midazolam and ketamine–medetomidine on gastrointestinal transit time in rabbits anaesthetised with isoflurane

BackgroundGastrointestinal stasis is a common perianaesthetic complication in rabbits. The objective of this study was to assess the impact on gastrointestinal transit time of ketamine–midazolam (KMZ) versus ketamine–medetomidine (later antagonised by atipamezole) (KMT-A) in rabbits anaesthetised with isoflurane.MethodsThis was a cross-over, randomised, single-blinded, controlled, experimental trial. Seven healthy adult New Zealand White rabbits were used. Gastrointestinal transit time was assessed by contrast radiography in awake rabbits. Presence of contrast medium in the small intestine (gastric transit time), in the caecum (small intestinal transit time) and in faeces in the colon was assessed. One week later, 55 minutes isoflurane anaesthesia was induced with ketamine (15 mg/kg) and either midazolam (3 mg/kg) or medetomidine (0.25 mg/kg) by intramuscular injection. Thirty minutes after discontinuation of isoflurane, atipamezole (0.5 mg/kg) was administered only to rabbits in KMT-A treatment. Gastrointestinal transit time was then assessed in both treatment groups, beginning 30 minutes after cessation of isoflurane administration. Two weeks later, the treatment groups were interchanged.ResultsGastric and small intestinal transit times were significantly longer with KMT-A (92±109 minutes and 214±119 minutes, respectively) than with KMZ (1±0 minutes and 103±6 minutes, respectively) and in the awake state (7±7 minutes and 94±32 minutes, respectively).ConclusionClinicians should therefore be aware of the potential gastrointestinal side effects of KMT-A, particularly in rabbits at risk for gastrointestinal stasis.