Introduction: Postoperative cognitive dysfunction (POCD) following general anesthesia is frequent among geriatric patients worldwide. Neuroinflammation and neuronal injury have been associated with the incidence of POCD. Some biomarkers of brain damage including neuron-specific enolase (NSE) and S100B protein have been widely studied; however, their association with the incidence of POCD is still controversial. This study aimed to assess the correlation of serum NSE and S100B levels with the incidence of POCD among geriatric patients receiving general anesthesia. Methods: A prospective cohort study was conducted among geriatric patients receiving general anesthesia at Dr. Soetomo Hospital, Surabaya from July to October 2022. The Montreal Cognitive Assessment (MoCA) INA instrument was used to assess POCD, and enzyme-linked immunosorbent assay (ELISA) was used to quantify the levels of serum NSE and S100B. Spearman’s rank correlation was implemented to identify the correlation of MoCA INA scores with the levels of NSE and S100B. Mann-Whitney analysis was used to determine the association between NSE and S100B levels with the incidence of POCD. A p-value of ≤0.05 was considered statistically significant. Results: A total of 48 patients were enrolled in the study and 16.7% of them had POCD. Spearman’s correlation test suggested no significant correlation between MoCA INA score with serum NSE level (rs:-0.095; p=0.522) and S100B level (rs:-0.213; p=0.146). Mann-Whitney analysis indicated no significant difference in the NSE and S100B levels of patients with and without POCD (p=0.3470 and p=0.097, respectively). Conclusion: There was no significant association between NSE and S100B levels with the incidence of POCD among geriatric patients receiving general anesthesia during elective surgeries at Dr. Soetomo Hospital, Surabaya.

Corticosteroid, an immunomodulator agent for treating hyperinflammation, is widely used in severe and critical COVID-19 patients. This study is a retrospective observational cohort clinical study comparing changes in NLR, CRP, and LCR values with and without corticosteroid therapy in critically ill COVID-19 patients. Those samples were chosen due to widespread access and economically sound to be examined repetitively. Samples were collected by total sampling of medical records of patients admitted to the COVID-19 intensive care unit at RSUD Dr Soetomo between March 2020 to July 2021. Inclusion criteria are complete medical records of patients > 18 years with a confirmed COVID-19 diagnosis with severe and/or acute symptoms according to the WHO criteria and receiving corticosteroids (dexamethasone 6 mg/24 h or equivalent dose) for a minimum of 3 days. Patients not receiving corticosteroid treatment were included in the control group. NLR, CRP, and LCR were evaluated on day-0, day-3, day-6, and day-10 after initiation of corticosteroid therapy; in the control group, their hospital admission was designated as day-0. Comorbidities, complications, and other therapies that may affect NLR, CRP, and LCR values are noted. A total of 460 patients were included in the inclusion criteria. The control group had no significant median NLR, CRP, and LCR changes during observation (p-value > 0.05). In the therapy group, there was a significant increase in NLR and LCR and a decrease in CRP (p-value < 0.0001). When compared between control and therapy groups, the median changes in NLR and CRP differed significantly (p-value < 0.05), while significant differences in LCR occurred on days 6 and 10. Corticosteroid increases NLR and LCR and decreases CRP with significant differences between groups. HIGHLIGHTS Corticosteroid treatment significantly increases NLR and LCR levels, while CRP levels decrease significantly in severe and critical COVID-19 patients NLR measurements are unsuitable as indicators of post-therapy inflammatory status during the ongoing immunopathological process of COVID-19 or due to a period of neutrophilia caused by the steroid itself LCR measurement can detect alterations in inflammatory status up to the tenth day following corticosteroid treatment in patients with severe COVID-19 CRP measurements remain a reliable indicators of inflammatory status changes for up to 10 days following corticosteroid therapy in severe and critical COVID-19 patients GRAPHICAL ABSTRACT

Wound healing is a highly coordinated biological event as a response to injured skin. It commonly takes 14 days for a wound to be completely healed. However, the duration of wound healing may vary between individuals due to certain factors. One major factor that delays the wound-healing process is Diabetes Mellitus. Delayed wound healing with poor prognosis commonly occurs in diabetic patients. Chronic hyperglycemia may affect macrophage polarisation, which is essential in the wound healing mechanism. The macrophage polarisation enables the pro-inflammatory M1 phenotype to switch to the anti-inflammatory M2 phenotype. Thus, pro-inflammatory M1 phenotype prevails persistently in diabetic wounds, while the anti-inflammatory M2 phenotype remains deficient. It results in significantly elevated levels of pro-inflammatory cytokines triggered by the M1 phenotype. Prolonged wound healing times increase the risk of infection, which can lead to more severe complications. Vitamin D is widely recognized for its essential role in regulating calcium levels and supporting bone health, as well as its positive effects on the immune system. This vitamin has the potential to skew macrophages towards the M2 phenotype and promote a regenerative and anti-inflammatory environment.

Maxillofacial injury may cause difficulty during airway assessment and management in the emergency setting. Alternative intubation positions and techniques should be considered to ensure patient safety. A 37-year-old male patient arrived at the emergency department with a degloving maxillofacial injury after a high-impact motor vehicle accident. Active bleeding from his wounds prevented him from lying supine and raised concerns of aspiration, requiring immediate securing of the airway. Since the patient was alert and cooperative, awake face-to-face intubation in the upright position was performed. Intubation was successful on the first attempt without any complications using a video laryngoscope with topical anesthesia sprayed intraorally. Awake intubation in the face-to-face upright position can be successful in a cooperative patient with severe maxillofacial trauma.

Background & objective: Intensive Care Unit-Acquired Weakness (ICU-AW) is a weakness found in critically ill patients, and this weakness can persist even after discharge from the Intensive Care Unit (ICU). Various rehabilitation medicine procedures have been shown to be effective in prevention as well as managing the established weakness in this cohort of the patients. We analyzed the effect of Neuromuscular Electrical Stimulation (NMES) therapy on the global muscle strength, quadriceps femoris muscle, and creatine kinase examination in patients known to have ICU-AW. Methodology: The type of study used a pre-experimental one-group pre-posttest, and the study population consisted of 23 patients who experienced ICU-AW. Patients were given NMES therapy at the beginning of treatment in the ICU and then evaluated using the Medical Research Council Scale for Muscle Strength (MRC-SS), Manual Muscle Test (MMT), and creatine kinase levels. Results: NMES therapy provides significant results on increasing muscle strength on the fifth day with MRC-SS 42.78 (24-60) and MMT 3.57 (2-5) (P < 0.001), as well as a significant decrease in creatine kinase levels given therapy at the beginning of ICU admission. Conclusion: NMES therapy increases global muscle strength and quadriceps femoris muscle and decreases creatine kinase levels. Abbreviations: ICU-AW - Intensive Care Unit-Acquired Weakness, NMES - Neuromuscular Electrical Stimulation, ICU - Intensive care unit, MRC-SS - Medical Research Council Scale for Muscle Strength, MMT - Manual Muscle Testing, CK-MM - Creatine kinase muscle specific Key Words: Neuromuscular electrical stimulation; Intensive Care Unit-Acquired Weakness, Creatine kinase Citation: Yustiawan A, Semedi BP, Arfianti L, Maulydia, Edwar PPM, Airlangga PS, Santoso KH, Andriana M. The effect of early neuromuscular electrical stimulation in intensive care unit-acquired weakness. Anaesth. pain intensive care 2024;28(4):706−711; DOI: 10.35975/apic.v28i4.2405 Received: March 04, 2024; Reviewed: April 29, 2024; Accepted: May 10, 2024

Introduction: Acute kidney injury (AKI) is a sudden decrease in kidney function due to damage within seven days or less, thus inducing an early stress response that can be promptly detected by biomarkers, such as Neutrophil Gelatinase-Associated Lipocalin (NGAL). The aim of this study was to analyse the role of NGAL level as a biomarker of postoperative prerenal AKI in patients who underwent otorhinolaryngology surgery with controlled hypotension. Methods: A prospective study was conducted among patients that underwent otorhinolaryngology surgery with controlled hypotension. Patients were selected with purposive sampling. NGAL level was measured using enzyme-linked immunosorbent assay (ELISA) from venous blood collected 1-hour pre- and 2-hour post-surgery. NGAL levels were compared between preoperative and postoperative states. Wilcoxon and Spearman test were used to determine the correlation between NGAL levels and parameters of AKI. Results: A total of 30 patients underwent a varies of otorhinolaryngology surgeries were recruited in this study. Our data suggested no significant different between the level of NGAL during preoperative and postoperative (184.73±120.09 ng/mL vs 175.80±129.97 ng/mL). Pre-operative laboratory parameters of AKI such as blood urea nitrogen (BUN), serum creatine (SCr), BUN/SCr ratio, and GFR had no correlation with postoperative NGAL level. In addition, systolic blood pressure, diastolic blood pressure, MAP, heart rate, EtCO2, duration of surgery and the duration of controlled hypotension had no correlation with postoperative NGAL. Conclusion: NGAL levels have nonsignificant role as biomarker of incidence of postoperative prerenal AKI in patients who receiving otorhinolaryngology surgery with controlled hypotension. However, further study with the bigger sample size is warrant to confirm the findings of this study.