Nutritional assessment is essential to identify patients with acute kidney injury (AKI) who are protein-energy wasting (PEW) and at risk of poor clinical outcomes. This systematic review aimed to investigate the relationship of nutritional assessments for PEW with clinical outcomes in patients with AKI. A systematic search was performed in PubMed, Scopus, and Cochrane Library databases using search terms related to PEW, nutrition assessment, and AKI to identify prospective cohort studies that involved AKI adult patients with at least one nutritional assessment performed and reported relevant clinical outcomes, such as mortality, length of stay, and renal outcomes associated with the nutritional parameters. Seventeen studies reporting eight nutritional parameters for PEW assessment were identified and mortality was the main clinical outcome reported. A meta-analysis showed that PEW assessed using subjective global assessment (SGA) was associated with greater mortality risk (RR: 1.99, 95% CI: 1.36–2.91). Individual nutrition parameters, such as serum chemistry, body mass, muscle mass, and dietary intakes, were not consistently associated with mortality. In conclusion, SGA is a valid tool for PEW assessment in patients with AKI, while other nutrition parameters in isolation had limited validity for PEW assessment.

Background and objective: We compared the effects of sub-Tenon's local anaesthetic block and placebo on perioperative opioid requirement and cardiovascular stability and on postoperative pain, nausea and vomiting in patients undergoing vitreo-retinal surgery under general anaesthesia. Methods: We studied 43 patients undergoing vitreo-retinal surgery under general anaesthesia in a randomized double blind study. Patients received a standard general anaesthetic followed by a sub-Tenon's injection of 4-5 mL of either bupivacaine 0.75% or saline. We recorded intraoperative invasive arterial pressure, then the incidence and severity of pain and of nausea and vomiting, for 24 h postoperatively. Results: In the sub-Tenon's bupivacaine group, there was a significant reduction in the perioperative opioid use and a reduction in the frequency of bradycardia and hypertensive episodes, defined as a rise >25% of baseline for a duration of >3 min. The sub-Tenon's bupivacaine group also had significantly lower pain scores and nausea scores at 12 h, concomitant with a lower consumption of analgesia and antiemetics. Conclusions: This local anaesthetic technique is effective in vitreo-retinal surgery and can be safely applied to this population of patients regardless of axial length.

Background: A feeding tube (FT) is routinely placed in critically ill patients, and its correct placement is confirmed with a chest X-ray (CXR), which is considered the gold standard. This study evaluated the diagnostic accuracy of ultrasonography (USG) in verifying FT placement compared to a CXR in an intensive care unit (ICU). Method: This was a prospective single-blind study conducted on patients admitted to the ICU of a tertiary hospital in Malaysia. The FT placements were verified through a fogging test and USG at the neck and subxiphoid points. The results of confirmation of FT placement through USG were compared with those obtained using CXRs. Results: A total of 80 patients were included in this study. The FT positions were accurately confirmed by overall USG assessments in 71 patients. The percentage of FT placements correctly identified by neck USG was 97.5%, while the percentage of those identified by epigastric USG was 75%. The corresponding patients’ CXRs confirmed correct FT placement in 76 patients. The overall USG assessment had a sensitivity of 92.11% and specificity of 75%, a positive predictive value of 98.59%, and a negative predictive value of 33.33%. The USG findings also showed a significant association between FT size and BMI. FTs with a size of 14Fr were better visualized (p = 0.008), and negative USG findings had a significantly higher BMI (p < 0.001). Conclusion: USG is a simple, safe, and reliable bedside assessment that offers relatively high sensitivity in confirming correct FT placement in critically ill patients.

Rhodotorula mucilaginosa fungemia is rare and highly resistant to antifungal therapy. We herein report a case involving a 31-year-old male admitted after a high-velocity road traffic accident. He sustained a grade IV liver injury with right hepatic vein thrombosis, which necessitated an urgent laparotomy. Post-operatively, repeated imaging of the abdomen revealed the presence of a biloma. Percutaneous subdiaphragmatic drainage was carried out but appeared ineffective, prompting a second surgery for an urgent hemi-hepatectomy. The patient was then nursed in the intensive care unit (ICU); however, during his stay in the ICU, he became more sepsis, which was evident by worsening ventilatory support and a rise in septic parameters from the biochemistry parameters. Despite intravenous piperacillin–tazobactam and fluconazole, his septic parameters did not improve and a full septic workup was conducted and was found to be positive for Rhodotorula mucilaginosa from the blood cultures. After discussion with the infectious disease physicians and clinical microbiologists, it was decided to initiate a course of intravenous meropenem and amphotericin B based on minimum inhibitory concentration (MIC) values, considering the patient’s extended ICU stay and catheter use. Eventually, after successfully weaning off mechanical ventilation, the patient was discharged from ICU care. This case underscores the necessity of individualized approaches, combining timely imaging, appropriate drainage techniques, and tailored treatments to optimize outcomes for such intricate post-traumatic complications.

Aims: To investigate the roles of MDR1 (1236C>T, 2677G>T/A, and 3435C>T) and OPRM1 (118A>G) gene polymorphisms on the anesthetic and adverse effects of propofol–remifentanil total intravenous anest...

Background & objective: Preoperative anxiety is a natural human psychology, and the physicians usually prescribe tranquillizers to allay the anxiety of their anxiety. Various other means have also been employed for this purpose. We aimed to investigate the impact of lavender aromatherapy on preoperative anxiety and propofol requirement at induction of anesthesia. Methodology: A total of 108 female patients were enrolled in the study, and their anxiety levels were evaluated using the Visual Analogue Scale (VAS) at three different time points. Patients were randomly divided into two groups. Group A (Lavender Group) patients were given lavender aromatherapy via a cotton strip infused with two drops of 100% pure lavender essential oil, while the patients in Group B (Control Group) had no aromatherapy. Results: The results showed that the lavender aromatherapy significantly reduced anxiety in Group A (P < 0.001) compared to Group B, and the mean differences of VAS scores for all anxiety assessments were also significantly reduced in Group A (P < 0.000). In addition, the mean total amount of propofol required was significantly less in Group A than in Group B (118.46 ± 40.01 vs 140.38 ± 35.29 mg; P = 0.003), while the mean duration to reach loss of consciousness was similar in both groups. Conclusion: The findings of our study suggest that lavender aromatherapy can be a simple, safe, and cost-effective way to reduce preoperative anxiety and decrease the amount of propofol required for the induction of anesthesia. Therefore, the use of lavender aromatherapy may be a valuable addition to the preoperative care of patients undergoing elective surgeries. Abbreviations: APAIS- Amsterdam Preoperative and Information Scale; LOC- Loss of Consciousness; OT- Operation Theatre; OR- Operating Room; STAI- State-Trait Anxiety Inventory; VAS- Visual Analogue Scale Key words: Aromatherapy; Benzodiazepines; Lavender; Anxiety, Preoperative; Propofol; Anxiety / therapy; Anxiety Disorders Citation: Rahman RA, Vasu Dewan MM, Sayed Masri SNN, Mokhtar MN, Abdullah FH, Md Nor N. Lavender aromatherapy: Its effect on preoperative anxiety and propofol requirement for anesthesia. Anaesth. pain intensive care 2024;28(1):20−25; DOI: 10.35975/apic.v28i1.2376 Received: April 26, 2023; Reviewed: November 22, 2023; Accepted: November 22, 2023