Mildly Reduced Doses of Adrenaline Do Not Affect Key Hemodynamic Parameters during Cardio-Pulmonary Resuscitation in a Pig Model of Cardiac Arrest

Adrenaline is recommended for cardiac arrest resuscitation, but its effectiveness has been questioned recently. Achieving return of spontaneous circulation (ROSC) is essential and is obtained by increasing coronary perfusion pressure (CPP) after adrenaline injection. A threshold as high as 35 mmHg of CPP may be necessary to obtain ROSC, but increasing doses of adrenaline might be harmful to the brain. Our study aimed to compare the increase in CPP with reduced doses of adrenaline to the recommended 1 mg dose in a pig model of cardiac arrest. Fifteen domestic pigs were randomized into three groups according to the adrenaline doses: 1 mg, 0.5 mg, or 0.25 mg administered every 5 min. Cardiac arrest was induced by ventricular fibrillation; after 5 min of no-flow, mechanical chest compression was resumed. The Wilcoxon test and Kruskal–Wallis exact test were used for the comparison of groups. Fisher’s exact test was used to compare categorical variables. CPP, EtCO2 level, cerebral, and tissue near-infrared spectroscopy (NIRS) were measured. CPP was significantly lower in the 0.25 mg group 90 s after the first adrenaline injection: 28.9 (21.2; 35.4) vs. 53.8 (37.8; 58.2) in the 1 mg group (p = 0.008), while there was no significant difference with 0.5 mg 39.6 (32.7; 52.5) (p = 0.056). Overall, 0.25 mg did not achieve the threshold of 35 mmHg. EtCO2 levels were higher at T12 and T14 in the 0.5 mg than in the standard group: 32 (23; 35) vs. 19 (16; 26) and 26 (20; 34) vs. 19 (12; 22) (p < 0.05). Cerebral and tissue NIRS did not show a significant difference between the three groups. CPP after 0.5 mg boluses of adrenaline was not significantly different from the recommended 1 mg in our model of cardiac arrest.

The Effect of Injection of Saline Adrenaline (1/100000) 15ml versus 5ml on the Skin Edema and Thickness in Rhinoplasty Intraoperative

Background Nasal skin edema is a common result of soft and bony tissue trauma during rhinoplastic procedures. In a cosmetic surgery like rhinoplasty, skin edema can fade the cosmetic results and can lead to dissatisfaction for both the surgeon and the patient. Local saline /adrenaline injection is claimed to reduce the nasal skin edema intraoperative. Aim of the work To assess effect of injection of saline adrenaline (1/100000) 15ml versus 5ml on the skin oedema and thickness during rhinoplasty through thesis study. Subjects and Methods In this study 30 cases of rhinoplasty will be operated, 15 cases will be injected by saline adrenaline (1/100000) of 5ml and the others 15 cases will be injected by saline adrenaline (1/100000) of 15 ml, then measuring the skin oedema after 10 minutes of saline adrenaline (1/100000) injection, after 30 minutes and after 60 minutes of the injection at three sites; the dorsum, supratip and the tip of the nose by Seal Gouge Caliper (surgical caliber). Results the intraoperative skin edema was significantly decreased with local injection of large amount (15ml) of saline /adrenaline 1/100000 than the usual injected amount (5ml) saline /adrenaline 1/100000 specially at the tip and the supratip of the nose and specially at 30 min and 60 min after injection, but statistically significance difference only at 60min at the dorsum. Conclusion that the skin oedema much less with injection of 15ml of saline adrenaline (1/100000) in comparison to injection of 5ml of saline adrenaline (1/100000).

Pediatric upper gastrointestinal bleeding in children: etiology and treatment approaches

Objective: Upper gastrointestinal bleeding (UGB) is one of the most important and serious cause of emergency admission in childhood. The aim of the study was to evaluate the etiological factors and the treatment approaches in patients with UGB. Methods: In this retrospective study, children with UGB admitted to emergency clinics of Istanbul Health Sciences University Kanuni Sultan Suleyman Research and Training Hospital, Istanbul Bakirkoy Sadi Konuk Research and Training Hospital and Diyarbakir Children’s Hospital were evaluated between January 2014 and August 2017. Results: Of the 198 children, 14.6% had non-steroid anti-inflammatory drug (NSAID) history, and 12.6% had chronic liver disease. We detected esophagitis, esophagus varices and peptic ulcer with upper gastrointestinal endoscopic evaluation (47%, 11.1%, 18.1%, respectively). Helicobacter pylori was found in 61.6% of patients. Endoscopic therapeutic procedures (band ligation therapy, sclerotherapy, and adrenaline injection) were appied in 11.1% of patients. Eighty-four (42.4%) patients were hospitalized, and erythrocyte transfusion (ET) was ordered in 29 (14.6%) patients. Conclusion: Approximately in 20% of the pediatric patients, the source of gastrointestinal bleeding is the upper gastrointestinal system. The cause of UGB varies with age. Appropriate diagnostic and therapeutic approaches are very important for management and to reduce mortality.

Variation in exposure to endoscopic haemostasis for acute upper gastrointestinal bleeding during UK gastroenterology training

IntroductionGastroenterologists are typically expected to be competent in endoscopic haemostasis for acute upper gastrointestinal bleeding (AUGIB), with the Certificate of Completion of Training (CCT) often heralding the onset of participation in on-call AUGIB rotas. We analysed the volume of haemostasis experience recorded by gastroenterology CCT holders on the Joint Advisory Group on Gastrointestinal Endoscopy Training System (JETS) e-portfolio, the UK electronic portfolio for endoscopy, and assessed for variations in exposure to haemostasis.MethodsUK gastroenterologists awarded CCT between April 2014 and April 2017 were retrospectively identified from the specialist register. Credentials were cross-referenced with JETS to retrieve AUGIB haemostasis procedures prior to CCT. Procedures were collated according to variceal versus non-variceal therapies and compared across training deaneries.ResultsOver the 3-year study period, 241 gastroenterologists were awarded CCT. 232 JETS e-portfolio users were included for analysis. In total, 12 932 haemostasis procedures were recorded, corresponding to a median of 42 (IQR 21–71) per gastroenterologist. Exposure to non-variceal modalities (median 28, IQR 15–52) was more frequent than variceal therapies (median 11, IQR 5–22; p<0.001). By procedure, adrenaline injection (median 12, IQR 6–23) and variceal band ligation (median 10, IQR 5–20) were most commonly recorded, whereas sclerotherapy experience was rare (median 0, IQR 0–1). Exposure to haemostasis did not differ by year of CCT (p=0.130) but varied significantly by deanery (p<0.001), with median procedures ranging from 20–126.ConclusionExposure to AUGIB haemostasis during UK gastroenterology training varied across deaneries and procedural modalities which should prompt urgent locoregional review of access and delivery of training. Endoscopy departments should ensure the availability of supportive provisions in haemostasis (i.e. training/upskilling, supervision, mentorship) during the early post-CCT period.

The effect of adrenaline on the mineral and trace element status in rats

Up until now, changes in biochemical and physiological parameters occurring a long time after stress are not yet elucidated. This is particularly the case for metals, some of which may considerably influence other branches of metabolism, such as bioenergetics and antioxidant defense. The aim of the current study was to investigate changes in levels of minerals (calcium and magnesium) and trace elements (copper and zinc) in erythrocytes and the liver of rats injected once or twice (modeling repeated stress) with adrenaline. The tissues were sampled 0.5 and 24 hours after the injection. A single injection of adrenaline in rats led to a dramatic increase in the levels of zinc (Zn), magnesium (Mg), and calcium (Ca) in their erythrocytes and liver, without a return to the control level (unstressed animals) after 24 hours. The levels of copper (Cu) increased 0.5 hour after a single adrenaline injection in erythrocytes and the liver, but returned to the control level after 24 hours. Double injection of rats with adrenaline led to an increase in the levels of Cu and Zn in their erythrocytes, and Mg in the liver, without a return to the control level after 24 hours. On the other hand, the double injection led to a drastic but transient increase in levels of Mg and Ca in erythrocytes, and Cu, Zn, and Ca in the liver. Thus, injection with adrenaline results in dramatic changes in levels of minerals and trace elements, which do not return to the control level after stress. Low doses of adrenaline lead to more stable changes in levels of essential metals.