Background:The aim of this clinical study was to evaluate the efficacy of neurobehavioral, hemodynamics and sedative characteristics of dexmedetomidine compared with morphine and midazolam-based regimen after cardiac surgery at equivalent levels of sedation and analgesia in improving clinically relevant outcomes such as delirium.Methods:Sixty patients were randomly allocated into one of two equal groups: group A = 30 patients received dexmedetomidine infusion (0.4–0.7 μg/kg/h) and Group B = 30 patients received morphine in a dose of 10–50 μg/kg/h as an analgesic with midazolam in a dose of 0.05 mg/kg up to 0.2 mg/kg as a sedative repeated as needed. Titration of the study medication infusions was conducted to maintain light sedation (Richmond agitation-sedation scale) (−2 to +1). Primary outcome was the prevalence of delirium measured daily through confusion assessment method for intensive care.Results:Group A was associated with shorter length of mechanical ventilation, significant shorter duration of intensive care unit (ICU) stay (P = 0.038), and lower risk of delirium following cardiac surgery compared to Group B. Group A showed statistically significant decrease in heart rate values 4 h after ICU admission (P = 0.015) without significant bradycardia. Group A had lower fentanyl consumption following cardiac surgery compared to Group B.Conclusion:Dexmedetomidine significantly reduced the length of stay in ICU in adult cardiac surgery with no significant reduction in the incidence of postoperative delirium compared to morphine and midazolam.

No abstract

No abstract

Following implementation, immediate decrease in utilisation and costs (p<0.05) and a trend change over the follow-up period were observed. Average monthly reduction was 26% (95%

No abstract

Background: Procalcitonin (PCT) has been increasingly used as a biomarker of bacterial infection and as a tool to guide antimicrobial therapy. Despite its increased use, data in patients with solid organ transplants are limited.The study aim is to assess the frequency of rising procalcitonin associated with infectious complications in immunosuppressed living donated liver transplantation.Methods: A single center, retrospective observational study. Preoperative patients' demographic data, operative, anesthetic data and postoperative clinical course are analyzed till discharge from intensive care unit.Results: Sixty patients were classi ed according to the culture results' into a positive culture group & a negative one, then following up sepsis variables in each group. Total leukocyte count (TLC) and procalcitonin (PCT) were high in the positive culture group in the rst 4 and 5 days respectively and was statistically signi cant (P-value < 0.05).PCT at a cutoff value ≥ 9ng/ml had higher speci city, especially on day three postoperative (90.7%). The TLC cutoff value of ≥ 17.3/mm 3 on day one; had the speci city of > 90%.Conclusions: following up PCT level on day one with TLC is essential and will help to detect sepsis and guide early antimicrobial initiation post liver transplantation.

No abstract

Background: Procalcitonin (PCT) has been increasingly used as a biomarker of bacterial infection and as a tool to guide antimicrobial therapy. Despite its increased use, data in patients with solid organ transplants are limited. The study aim is to assess the frequency of rising procalcitonin associated with infectious complications in immunosuppressed living donated liver transplantation.Methods: A single center, retrospective observational study. Preoperative patients' demographic data, operative, anesthetic data and postoperative clinical course are analyzed till discharge from intensive care unit.Results: Sixty patients were classified according to the culture results' into a positive culture group & a negative one, then following up sepsis variables in each group. Total leukocyte count (TLC) and procalcitonin (PCT) were high in the positive culture group in the first 4 and 5 days respectively and was statistically significant (P-value < 0.05).PCT at a cutoff value ≥ 9ng/ml had higher specificity, especially on day three postoperative (90.7%). The TLC cutoff value of ≥ 17.3/mm3on day one; had the specificity of > 90%. Conclusions: following up PCT level on day one with TLC is essential and will help to detect sepsis and guide early antimicrobial initiation post liver transplantation.Trial registration: NHTMRI, NCT03389360. Registered 7 February, 2018,https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0007O6F&selectaction=Edit&uid=U0003W0U&ts=2&cx=fwyacz