Background: Despite improvements over time with regard to morbidity, mortality, and long-term survival, deep sternal wound infection (DSWI) continues to be a major complication after open-heart surgery. This is why it is important to identify possible risk factors for postoperative development of DSWI in patients undergoing coronary artery bypass grafting and valve replacement. The aim of this study was to identify the risk factors for postoperative development of deep sternal wound infection in patients after coronary artery bypass grafting and heart defect surgery at the Department of Thoracic, Cardiac, and Vascular Surgery of the Hospital of Lithuanian University of Health Sciences. Methods: This retrospective study analyzed 201 patients, who underwent coronary artery bypass grafting and heart defect surgery between January 2017 and December 2018. The case group contained 45 patients, who had to be reoperated because of deep sternal wound infection, and the control group consisted of 156 randomly selected patients. For descriptive statistics, we used means, median values, ranges, standard deviations, and 95% confidence intervals, where appropriate. Categorical data were analyzed using the chi-square or Fisher’s exact test. Student T-test and Mann-Whitney used to compare numerical variables. Logistic regression model adjusting for age and gender was used to compare the risk of infection. A P-value of < 0.05 was considered to be statistically significant. SPSS 26.0 was used for calculations. Results: Logistic regression analysis revealed that independent risk factors for sternal wound infection were high BMI (odds ratio [OR] 1.15, CI 1.06-1.24), preoperative CRP (OR 1.08, CI 1.01-1.16), long duration of cardiopulmonary bypass (OR 1.02, CI 1.01-1.03), intraoperative anemia (OR 0.97, CI 0.95-0.99), and postoperative CRP concentration (OR 1.10; CI 1.05-1.16). Conclusions: Preoperative assessment to identify obese individuals as being at risk and techniques to minimize the duration of surgery and intraoperative blood loss may help reduce postoperative deep sternal wound infections.

Objective—to overview, compare and generalize results of randomized clinical trials analyzing different oxytocin doses to prevent postpartum hemorrhage, initiate and maintain uterine contraction after Caesarean delivery. Methods—‘PubMed’, ‘EMBASE’, ‘CENTRAL’, and ‘CINAHL’ electronic databases were searched for clinical trials analyzing the effectiveness of different dose of oxytocin given intravenously during surgery for uterine contraction and to reduce postpartum hemorrhage. A systematic review of relevant literature sources was performed. Results—our search revealed 813 literature sources. A total of 15 randomized clinical trials, comparing different doses of oxytocin bolus and infusion used after caesarean delivery have met the selection criteria. Conclusion—oxytocin bolus 0.5–3 UI is considered an effective prophylactic dose. Recommended effective prophylactic oxytocin infusion dose is 7.72 IU/h, but it is unanswered whether we really need a prophylactic infusion of oxytocin if we choose effective bolus dose size and rate. Adverse hemodynamic effects were observed when a 5 UI oxytocin bolus was used. However, topics such as bolus dose size, infusion dose size and requirement as well as bolus injection rate, still remain unanswered. The doses that are recommended in the guidelines of peripartum hemorrhage prophylaxis are not confirmed by randomized controlled double-blind trials and more research should cover this topic.

Treatment of acute postoperative pain is an essential part of perioperative care and if left untreated could complicate the healing period. Ketamine blocks nociceptive pain and pain arising from inflammation. Therefore, it is potentially beneficial in the postoperative period. After systematic review using “MEDLINE/PubMed (NLM)” database, we analyzed 18 studies published during 2011–2020 and found that 0.5 mg/kg/h ketamine bolus and 0.1–0.25 mg/kg/h ketamine infusion to be the most effective dose to alleviate postoperative acute pain. Ketamine, when compared with a placebo, did not have any impact on patients’ satisfaction with postoperative pain management and overall well-being. Only three studies revealed more frequent adverse reactions to ketamine after surgery suggesting that ketamine did not have any impact on patients’ postoperational rehabilitation. So, it is the option to recommend low-dose ketamine to be part of multimodal analgesia in acute severe postoperative pain treatment. It can be used in both opioid-dependent and opioid-tolerant patients. Ketamine bolus should be ≤0.35 mg/kg and infusion ≤1 mg/kg/h. One should avoid the use of ketamine in pregnant women, people with cardiovascular diseases, acute psychosis, impaired liver function, increased intracranial, and intraocular pressure. Intranasal ketamine may be considered for children during procedures outside of the operation room.