The Influence of Acid-Base Balance on Anesthetic Muscle Relaxants: A Comprehensive Review on Clinical Applications and Mechanisms - Article abstract #944510

Interactions between drugs are a common problem in Intensive Care Unit patients, as they mainly have a critical condition that often demands the administration of multiple drugs simultaneously. Antibiotics are among the most frequently used medications, as infectious diseases are often observed in ICU patients. In this review, the most important antibiotic–drug interactions, based on the pharmacokinetic and pharmacodynamic mechanisms, were gathered together and described. In particular, some of the most important interactions with main groups of antibacterial drugs were observed in patients simultaneously prescribed oral anticoagulants, NSAIDs, loop diuretics, and valproic acid. As a result, the activity of drugs can be increased or decreased, as dosage modification might be necessary. It should be noted that these crucial interactions can help predict and avoid negative consequences, leading to better patient recovery. Moreover, since there are other factors, such as fluid therapy or albumins, which may also modify the effectiveness of antibacterial therapy, it is important for anaesthesiologists to be aware of them.

Introduction: The introduction of sugammadex has created new opportunities for a quick reversal of relaxation caused by steroid relaxants. Aim: The objective of this study was to compare relaxation of striated muscles in laryngeal microsurgery depending on the applied agent: mivacurium or rocuronium. Material and methods: 65 low-risk surgery patients were randomly divided into two groups: MIV (n = 32) and ESM (n = 33) before the scheduled larynx microsurgery. The MIV group used mivacurium to relax the muscles, the ESM group used rocuronium.The following parameters were monitored: pulse rate, arterial blood pressure, arterial blood saturation, ventilation parameters according to the conventional standards and the depth and rate of neuromuscullar blockade (NMB) reversal. The demand for anesthetics and analgesics used during the anesthesia and the frequency of complication occurrence were evaluated. Results and discussion: There were no differences under intubation conditions. The conditions of the operation assessed by its operator were better in the ESM group. The time of the operation was similar in the two groups. The acting time of sugammadex in the ESM group was on average 1 minute. The ESM group reached train-of-four ratio (TOFR) of 0.9 (90% recovery of NMB) far more quickly than the MIV group. There was no statistical difference in side effects. Conclusions: It seems to be reasonable to replace mivacurium with rocuronium and reverse its action by means of sugammadex in patients with a positive family history of allergy and anaesthetized for short-term operations or operations of unpredictable duration.

Introduction: The problem of intraoperative awareness concerns about 0.1%–0.2% of patients .The perfect method to evaluate the depth of sleep should be objective, so that the response is quick and precise – to increase or decrease the depth of anaesthesia. More scales originated in order to detect cases of intraoperative awareness. Also, new equipment was built so that anaesthesiologists could properly monitor the depth of anaesthesia. Aim: The aim is to describe methods and devices monitoring the depth of anaesthesia. Material and methods: This work was based on the available literature and the experience of the authors. Results and discussion: Recently a few devices were constructed, all of which can be divided into passive and active systems. Passive systems assess the collected data, while active ones first stimulate and then receive and process data. Passive systems use computer analysis of electroencephalographic signal, and some of them additionally evaluate alterations of frontal electromyogram. According to some, monitors currently available on the market show around 80% effectiveness in preventing intraoperative awareness. Other researchers showed that evidence of their effect on intraoperative awareness is limited. Conclusions: It seems that when it comes to the effect of anaesthetic agents on such a precise organ as the brain, there is still much to discover. As long as we do not fully know what awareness is and what mechanisms influence the state of staying awake and of anaesthetic sleep, and on which levels it happens, we will not be able to prevent intraoperative awareness effectively.

Introduction: Septic shock is defined as a life-threatening organ failure caused by an abnormal response of the body to infection. Urinary tract infections (UTIs) constitute about 10%–20% of all community-acquired infections and about 40%–50% of hospital-acquired infections. In patients with impaired immunity they may lead to sepsis. Strains of Klebsiella pneumoniae are often multidrug resistant, and therapeutic chances are limited where they occur. Aim: The aim of this paper is to discuss the most recent guidelines in diagnosing and treating sepsis, referring to a clinical case report. Case study: The study presents a case of septic shock in a 44-year-old female patient in a community-acquired UTI caused by K. pneumoniae extended-spectrum β-lactamases (ESBL+). Results and discussion: The course of septic shock proved fatal. As the stay in the intensive care unit (ICU) was short, this precluded implementing full diagnostic procedures and identifying the source of infection. A post mortem examination was performed to establish the cause of death and aetiology of the infection. Conclusions: K. pneumoniae ESBL+ has become a growing epidemiological problem in Poland and all over the world. This pathogen increasingly often leads to community-acquired infections and its multidrug resistance makes the applied therapies ineffective. Diabetes, one of the modern lifestyle diseases, impairs resistance and accelerates rapidly progressing septic shock with multiple organ failure. Late diagnosis of sepsis, because of considerable metabolic and cellular changes, brings about tragic results. Despite implementing new diagnostic methods and therapies, the mortality rate in sepsis still remains very high.

Background/Objectives: Pupillometry offers a non-invasive method for assessing nociceptive responses during anesthesia. This study aimed to evaluate the effects of intravenous lidocaine on pupillary reflex dilation (PDR) and the Pupillary Pain Index (PPI) during general anesthesia with orotracheal intubation. Methods: In this prospective, randomized, single-blind trial, 90 ASA I–II patients aged 18–65 years, scheduled for elective surgery under general anesthesia, were enrolled. Participants were randomized into three groups: control, study (lidocaine 1.5 mg/kg), and placebo. Standardized anesthesia induction was performed using propofol, fentanyl, and rocuronium. Pupil diameter was measured using the Algiscan pupillometer. PDR was assessed during intubation, while PPI was measured five minutes post-intubation through controlled electrical stimulation. Hemodynamic parameters and BIS values were recorded throughout. Eighty-six patients completed the study. No significant differences in demographics, anesthetic drug doses, or hemodynamic parameters were noted between groups. Results: PDR during intubation showed no significant difference between the control and study groups (median dilation: 0.34 mm vs. 0.33 mm; p = 0.76), but was significantly lower in the lidocaine group compared to placebo (median dilation: 0.33 mm vs. 0.50 mm; p = 0.02). PPI scores did not differ significantly between groups (p > 0.05). A positive correlation was observed between PDR and BIS values, indicating that lighter anesthesia depth increased PDR response. No such correlation was found with PPI. Conclusions: Intravenous lidocaine attenuates the pupillary response to nociceptive stimuli during orotracheal intubation but does not influence PPI scores. Pupillometry remains a valuable adjunct for intraoperative nociceptive monitoring.