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The QT interval, which is measured from the start of the Q wave (or the R wave when no Q wave is present) to the completion of the T wave, reflects the duration of electrical ventricular systole. The duration of systole varies with heart rate and therefore the measured QT interval is often corrected for heart rate using the following formula, in which QTc represents the rate corrected value: QTc = Qt/VRR interval The QTc interval is normally less than 440 ms [1]. Increased serum concentrations of noradrenaline and a change in the balance between sympathetic and parasympathetic tone may be associated with prolonged QT interval [2, 3]; this may be controlled with either f}-block [4] or stellate ganglion block [5]. Hypomagnesaemia and, more commonly, hypokalaemia cause clinically significant prolongation which may be produced by effects on the repolarizing potassium current. Sleep (which is associated with a reduction in sympathetic tone) prolongs QTc [6]. Induction of anaesthesia with thiopentone prolongs significantly the QT interval [7], whereas Althesin had no effect [8]. The most marked changes follow tracheal intubation facilitated with suxamethonium, but these changes may be reduced by pretreatment with tubocurarine [7] or by (3-block [9], suggesting mediation by the sympathetic nervous system. It has been reported also that the QT interval is significantly prolonged by enflurane [8, 10], but not by halothane anaesthesia [8]. The mechanism underlying these differences has not been explained. It has been reported that these volatile agents and also

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Antimicrobial resistance is escalating and triggers clinical decision-making challenges when treating infections in patients admitted to intensive care units (ICU). Antimicrobial stewardship (AMS) may help combat this problem, but it can be difficult to implement in critical care settings. The implementation of multidisciplinary AMS in ICUs could be more challenging than what is currently suggested in the literature. Our main goal was to analyze the reduction in duration of treatment (DOT) for the most commonly used antibacterial and antifungal agents during the first six months of 2014, and during the same period two years later (2016). A total of 426 and 424 patient encounters, respectively, were documented and collected from the intensive care unit’s electronic patient record system. Daily multidisciplinary ward rounds were conducted for approximately 30–40 min, with the goal of optimizing antimicrobial therapy in order to analyze the feasibility of implementing AMS. The only antimicrobial agent which showed a significant reduction in the number of prescriptions and in the duration of treatment during the second audit was vancomycin, while linezolid showed an increase in the number of prescriptions with no significant prolongation of the duration of treatment. A trend of reduction was also seen in the DOT for co-amoxiclavulanate and in the number of prescriptions of anidulafungin without any corresponding increases being observed for other broad-spectrum anti-infective agents (p-values of 0.07 and 0.05, respectively).

Summary Eighty‐two outpatients who received general anaesthesia for surgical removal of maxillary or mandibular third molars were given either diclofenac 75 mg or nefopam 20 mg intramuscularly for postoperative pain control. They and the control group were also allowed oral paracetamol as required. The results showed that there was no significant pain relief from these single intramuscular injections.

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