Single-incision laparoscopic appendectomy (SILA) has recently emerged as a promising alternative for the management of acute appendicitis. This study aimed to compare the surgical outcomes of the SILA with those of three laparoscopic appendectomies (TLA) procedures using the existing equipment, the 10-mm laparoscope, and the surgical-glove port method. Between February 2021 and February 2022, this single-center retrospective study examined 68 patients who underwent laparoscopic appendectomy by a single surgeon. The study excluded patients with severe appendicitis, grade IV-V, following the American Association for the Surgery of Trauma classification. Clinical outcomes were analyzed, including operation time, hospital stay, postoperative pain, and postoperative morbidity. There were no statistically significant differences between SILA and TLA patients, respectively, in operation time (37.5 minutes vs. 35 minutes, p = 0.261) and the median duration of hospitalization (three days vs. three days, p = 0.929). There was no difference in the mean visual analog scale score between the two groups on the first day (p = 0.852), second day (p = 0.540), and the day of discharge from the hospital (p = 0.686), as well as return to diet (two days vs. two days, p = 0.053). Two (10%) cases of short-term complications in the SILA group and one (2.1%) case in the TLA group were noted. SILA performed through a handmade surgical-glove port is a safe and viable therapy option for mild-to-moderate appendicitis. When the hospital lacks a specialized laparoscopic single-incision surgical system, this technique should be used on patients.

Background and Objective: Maternal hypotension is a common consequence of spinal anesthesia for cesarean delivery (CD). A vasopressor is recommended in addition to adequate fluid loading to raise mean arterial pressure in pregnant women. Phenylephrine, a pure α–adrenergic receptor agonist, is the first-line agent to manage it. However, phenylephrine is associated with dose-dependent reflex bradycardia and decreased cardiac output. Noradrenaline is suggested as an alternative due to its mild beta-adrenergic effect, which results in a greater heart rate and cardiac output than phenylephrine. We compared the effectiveness and adverse effects of intermittent boluses of noradrenaline with phenylephrine to treat spinal-induced hypotension during CD. Methodology: A randomized controlled trial was conducted at Bach Mai Hospital, Vietnam, from May 2020 to August 2020. There were 120 pregnant women undergoing elective CD under spinal anesthesia enrolled in the study and divided randomly into two groups: the Group N and the Group P. Group N patients were given noradrenaline 6 µg as an intravenous bolus, and Group P patients were given phenylephrine 100 µg to treat spinal-induced hypotension. The primary outcome was the number of bolus doses of vasopressors needed to treat maternal hypotension. Secondary outcomes were bradycardia, hypertension, nausea, vomiting, umbilical arterial blood gases, and APGAR scores. Results: The number of boluses of vasopressors needed to treat hypotension and maternal hemodynamic changes was equivalent in both groups. The incidence of bradycardia, nausea, and vomiting in the two groups was not significantly different. No pregnant woman suffered from unintended hypertension. APGAR scores were 7 and above at one min and 10 and above at five min for all cases. There were no differences in umbilical arterial pH values between the two groups (7.33 vs. 7.34; P > 0.05). Conclusion: Noradrenaline 6 µg and phenylephrine 100 µg boluses were equally effective in treating spinal-induced hypotension in parturients undergoing cesarean delivery with similar neonatal and maternal outcomes. Abbreviations: CD - Cesarean Delivery; HR - Heart Rate; CO - Cardiac Output; SVR - Systemic Vascular Resistance; SBP - Systolic Blood Pressure; ED 90 - 90 Percent Effective Dose Key words: Anesthesia, Spinal; Hypotension; Cesarean Delivery Citation: Nguyen TT, Nguyen HC, Nguyen ATH, Doan TH, Ngo QS. Comparison of intermittent boluses of noradrenaline vs. phenylephrine for spinal anesthesia induced hypotension during cesarean delivery. Anaesth. pain intensive care 2023;27(5):562−566. DOI: 10.35975/apic.v27i5.2312 Received: August 22, 2023; Reviewed: August 23, 2023; Accepted: August 31, 2023

Background & objectives: Postoperative delirium is a prevalent complication, particularly following cardiac surgery, and has detrimental effects on patient outcomes, including increased morbidity and mortality and prolonged stays in the intensive care unit. This study aims to estimate the incidence and identify the risk factors for delirium. Methodology: This prospective observational study was conducted on adult patients undergoing open-heart surgery with cardiopulmonary bypass at the Cardiovascular Surgery Unit at Bachmai Hospital, Vietnam. The Confusion Assessment Method for the ICU (CAM-ICU) was utilized to assess delirium twice daily during the initial four days post-surgery. Perioperative variables were analyzed by univariable and multivariable logistic regression. Results:  Among the 285 patients included in this study, 56 were diagnosed with delirium using the CAM-ICU, representing a prevalence rate of 19.6%. Multivariate regression analysis revealed several independent risk factors for delirium, including advanced age (odd ratio - OR; 95% confidence interval-CI) (1.07; 1.03-1.10), a history of cerebrovascular accident (3.95; 1.31-11.84), prolonged cardiopulmonary bypass duration (1.02; 1.00-1.03), postoperative atrial fibrillation (2.47; 1.15-5.28), and opioid use time (13.65; 5.69-32.75). Conclusion: The incidence of delirium after open heart surgery with cardiopulmonary bypass was 19.6%. Advanced age and a history of cerebrovascular accidents were identified as non-modifiable risk factors for postoperative delirium. Meanwhile, there were three modifiable risk factors, including cardiopulmonary bypass duration, atrial fibrillation, and the time of opioid administration. Abbreviations: CAM-ICU: Confusion Assessment Method for the Intensive Care Unit Key words: Postoperative Delirium; Risk Factors; Incidence; Open-Heart Surgery; Cardiac Surgery Citation: Nguyen TT, Ta DD, Ho HS, Duong HD. Incidence and risk factors for delirium after open heart surgery with cardiopulmonary bypass. Anaesth. pain intensive care 2023;27(6):639−645; DOI: 10.35975/apic.v27i6.2354 Received: Oct 04, 2023; Revised: Oct 28, 2023; Accepted: Oct 31, 2023

Mục tiêu: Nghiên cứu nhằm đánh giá hiệu quả dự phòng tụt huyết áp và ảnh hưởng không mong muốn của ba liều truyền tĩnh mạch noradrenalin khác nhau trong gây tê tủy sống để mổ lấy thai. Đối tượng và phương pháp nghiên cứu: gồm 120 sản phụ mang thai đủ tháng có chỉ định gây tê tủy sống để mổ lấy thai chủ động được chia ngẫu nhiên làm ba nhóm nhận ba liều noradrenalin truyền tĩnh mạch là 0,025 µg/kg/phút; 0,05 µg/kg/phút và 0,075 µg/kg/phút ngay khi gây tê tủy sống. Các tiêu chí đánh giá chính gồm: tỉ lệ tụt huyết áp, tỉ lệ tăng huyết áp, tần số tim chậm, tỉ lệ buồn nôn và nôn, điểm Apgar và khí máu động mạch rốn. Kết quả: Tỉ lệ tụt huyết áp ở nhóm 0,05 µg/kg/phút và nhóm 0,075 µg/kg/phút (đều là 10%) thấp hơn có ý nghĩa so với nhóm 0,025 µg/kg/phút (27,5%) (p < 0,05). Tỉ lệ tăng huyết áp ở nhóm liều 0,075 µg/kg/phút là 5% (n=2), tuy nhiên sự khác biệt không có ý nghĩa thống kê so với 2 nhóm còn lại. Tỉ lệ tần số tim chậm, buồn nôn và nôn ở mẹ, điểm Apgar sau 1 và 5 phút, khí máu động mạch rốn của sơ sinh là tương đương nhau giữa ba nhóm (p>0,05). Kết luận: Hai liều truyền tĩnh mạch noradrenalin 0,05 µg/kg/phút và 0,075 µg/kg/phút có hiệu quả làm giảm sự tụt huyết áp sau gây tê tủy sống trong mổ lấy thai hơn liều 0,025 µg/kg/phút. Liều 0,075 µg/kg/phút có thể gây tăng huyết áp. Không có sự khác biệt về tỉ lệ tần số tim chậm, buồn nôn và nôn, kết quả trên trẻ sơ sinh giữa ba nhóm nghiên cứu.

Background and Objectives: Intra-abdominal hypertension (IAH) is frequently encountered in patients undergoing major emergency abdominal surgery and is associated with adverse outcomes in the intensive care unit (ICU). This study aims to evaluate the prevalence, risk factors, and outcomes of IAH in a surgical ICU setting. Methodology: This prospective observational study was conducted at the Center for Anesthesia & Surgical Intensive Care, Bach Mai Hospital, from April 2023 to September 2023. We included adult patients who underwent emergency major abdominal surgery and were in the surgical ICU for more than 48 h. Intra-abdominal pressure (IAP) was measured via a urinary bladder catheter upon ICU admission, and subsequently at 24 and 48 h. IAH was classified according to the World Society of the Abdominal Compartment Syndrome guidelines from 2013. The incidence of IAH and treatment outcomes, including the number of days on mechanical ventilation and the 28-day mortality rate, were recorded. Odds ratios (OR) and 95% CI were calculated to assess the effect size of perioperative risk factors. Results: Among 92 patients, 38 were diagnosed with IAH. The majority of these patients had IAH grade I, (31.5%), with no cases of grade IV observed. multivariable Logistic-regression analysis revealed several risk factors for IAH included septic shock (odds ratio [OR]; 95% confidence interval [CI]: 3.31; 1.34–8.01), peritoneal fluid (5.28; 1.33–21.05), massive fluid resuscitation (6.93; 1.38–34.80), intra-abdominal infection (7.19; 2.58–20.04), and coagulopathy (3.73; 1.55–8.94). Patients with IAH had a significantly longer duration of mechanical ventilation and ICU length of stay (P = 0.009 and P = 0.049, respectively). The 28-day mortality rate was markedly higher in the IAH group compared to the non-IAH group (34% vs. 5.6%, P = 0.000). A strong correlation was observed between IAH and 28-day mortality, with each 1 mmHg increase in IAP associated with a 5.3-fold increase in mortality rate. Conclusion: IAH is common among patients undergoing major emergency abdominal surgery and is linked to prolonged ICU stay, extended mechanical ventilation, and increased 28-day mortality. Key risk factors for IAH include septic shock, intra-peritoneal fluid collections, massive fluid resuscitation, intra-abdominal infection, and coagulopathy. Abbreviations: ACS: Abdominal compartment syndrome, BMI: body mass index, ICU: Intensive Care Unit , IAH: Intra-abdominal hypertension, IAP: Intra-abdominal pressure, RRT: renal replacement therapy Keywords: Intra-Abdominal Hypertension; Risk Factors; Outcome; Emergency Abdominal Surgery Citation: Nguyen TT, Kham VV, Giang NT, Quoc LM, Quyen VT, Ho HS. Intra–abdominal hypertension in critically ill patients after emergency abdominal surgery: incidence, risk factors, and patient outcome. Anaesth. pain intensive care. 2025;29(2):248-253. DOI: 10.35975/apic.v29i2.2712 Received: May 09, 2024; Reviewed: October 26, 2024; Accepted: January 01, 2025

Mục tiêu nghiên cứu: So sánh hiệu quả kiểm soát đường thở của mask thanh quản I-gel với mask thanh quản Classic trong phẫu thuật lác ở trẻ em. Đối tượng và phương pháp nghiên cứu: Nghiên cứu thử nghiệm lâm sàng ngẫu nhiên có so sánh trên 100 bệnh nhân chia làm hai nhóm, nhóm I-gel sử dụng mask thanh quản I-gel và nhóm Classic sử dụng mask thanh quản Classic trong gây mê toàn thân tại Bệnh viện mắt trung ương Hà Nội từ tháng 4 năm 2024 đến tháng 7 năm 2024. Kết quả: Thời gian đặt mask thanh quản I-gel nhanh hơn mask thanh quản Classic (12,68 ± 3,39 giây ngắn hơn 38,52 ± 7,38 giây, p < 0,01). Tỷ lệ đặt thành công lần đầu của mask thanh quản I-gel cao hơn mask thanh quản Classic (100% với 84%, p < 0,05). Hiệu quả kiểm soát đường thở tương đương nhau (SpO2, EtCO2, mức độ rò rỉ khí, Ppeak), với p > 0,05. Kết luận: Kiểm soát đường thở bằng mask thanh quản I-gel hiệu quả tốt, tương đương với mask thanh quản Classic.