Background. Infections due to extensively drug resistant Gram-negative bacteria (GNB) after solid organ transplantation are increasing in prevalence and are associated with high morbidity and mortality. Surveillance culture (SC) seems to be an important tool for extensively drug resistant GNB control. The aim of this study was to evaluate colonization rates and subsequent infections by XDR-GNB in liver transplant recipients. Material and Methods. This was a prospective cohort study in patients who underwent liver transplantation (LT) between January 2016 and January 2018. Data on demographics, extensively drug resistant colonization, and 3-month clinical outcomes were obtained. Colonization was defined as a positive surveillance culture (SC-perirectal) immediately before transplantation, once weekly after LT, and after intensive care unit discharge, with emphasis to carbapenem-resistant Gram-negative bacteria (CR-GNB). Results. Forty-four patients who underwent LT were included in the study. Ten patients (22.72%) were colonized with CR-GNB prior to transplantation, and 7/10 (70%) developed infection due to the same pathogen (5 patients bloodstream infections, 2 patients pneumonia) during the study period. Intensive care unit length of stay was significantly longer in colonized with CR-GNB patients (P<.05). Mortality rate was higher in colonized patients (30%) than in noncolonized (11.76%) (P=.2). Conclusion. Our study results suggest an overall 70% risk of CR-GNB infection among colonized patients. Given the high mortality rate and the difficulty in treating these infections, further research to investigate and develop strategies to eliminate the colonization is needed.

Introduction. The importance of preoperative donor/recipient colonization or donor infection by extensively drug-resistant Gram-negative bacteria (XDR-GNB) and its relation to serious post-transplantation infection pathogenicity in liver transplantation (LT) patients has not been clarified. Aim. Prevention of postoperative infection due to XDR-GNB with the appropriate perioperative chemoprophylaxis or treatment based on preoperative donor/recipient surveillance cultures in LT patients, as well as their outcome. Materials and Method. Twenty-six patients (20 male, 6 female) were studied (average preoperative Model for End-Stage Liver Disease score approximate to 15, range: 8-29) from January 2017 to January 2018. In all patients, blood, urine, and bronchial secretions culture samples as well as a rectal colonization culture were taken pre- and postoperatively, once weekly after LT, and after intensive care unit discharge. Recipients with positive XDR-GNB colonization and patients receiving a transplant from a donor with an XDR-GNB positive culture or colonization received the appropriate chemoprophylaxis one half hour preoperatively according to culture results. De-escalation of the antibiotic regimen was done in 2 to 5 days based on the colonization/culture results of the donor and recipient and their clinical condition. Evaluation for serious infection was done at 1 week and at 28 days for outcome results. Results. Fourteen out of 26 recipients (53.8%) were positive for XDR-GNB colonization preoperative, with 2/14 (14.28%) presenting serious infection due to the same pathogen. Intensive care unit length of stay was significantly longer in colonized with XDR-GNB patients (P<.0001). The outcome of colonized patients was 6/14 (42.8%) expired, but only in 2/14 (14.2%) was mortality attributable to infection. Conclusion. Administering appropriate perioperative chemoprophylaxis and treatment may limit the frequency of XDR-GNB infections and intensive care unit length of stay and may improve the outcome in LT recipients.

Tsaousi, G.; Oloktsidou, I.; Tsiaousi, A.; Gkinas, D.; Vasilakos, D. Author Information

Sidiropoulou, I.1; Tsaousi, G.1; Sidiropoulos, A.2; Tsantilas, D.2; Vasilakos, D.1 Author Information

Ntritsou, V.; Kostoglou, C.; Zachariadou, C.; Dimitriadis, G.; Tziris, N.; Vasilakos, D. Author Information

Despite the fact that colloids are widely used, doubt still remains as to which colloid is the best and what is the ideal volume of administration. The aim of our study was to compare the hemodynamic effects of six different colloids.

Background Tracheal intubation is often difficult in the prehospital setting, especially in trapped casualties, when long extrication time is anticipated and conventional laryngoscopy cannot be achieved. The aim of the present study was the comparison of applicability and efficacy of two alternative techniques: intubation using a laryngeal mask airway (ILMA) or an Airtraq laryngoscope in different patient positions, using an airway management manikin. Methods 20 anaesthetists attempted manikin intubations standing behind the manikin (Sup), standing in front and facing the manikin's head (Fac), facing the manikin in the sitting position (Sit) and facing the manikin lying in the lateral decubitus position (Lat), using either Airtraq or ILMA techniques. The intubations were evaluated regarding the success rate, number of attempts and time needed for successful intubation, teeth damage and overall difficulty. Results All intubation attempts were successful for both techniques. Intubations through ILMA were completed with a significantly greater number of attempts and longer time in the Lat position, compared to Fac, Sit and Sup (p<0.05), whereas intubations using Airtraq in the Sup and Fac positions were completed with a significantly greater number of attempts and longer time, compared to Sit and Lat positions (p<0.05). Both ILMA and Airtraq can be used for securing the airway when direct laryngoscopy is impossible due to patient position. ILMA seems to cause greater difficulty in the Lat position, whereas Airtraq intubation is more easily performed in the Sit and Lat positions. Conclusions These preliminary data in manikins could indicate the applicability of the methods to the prehospital setting.

Fyntanidou, B.; Grosomanidis, V.; Karakoulas, K.; Kiourtzieva, E.; Vasilakos, D. Author Information

Trikoupi, A.; Papavramidis, T.; Kyurdzhieva, E.; Kesisoglou, I.; Vasilakos, D. Author Information

Kiourtzieva, E.; Pourzitaki, C.; Zacharas, J.; Tsakiridou, S. I.; Vasilakos, D. Author Information

European Journal of PainVolume 13, Issue S1 p. S211c-S211 734 PREEMPTIVE PARECOXIB AND LORNOXICAM DURING GENERAL ANESTHESIA FOR POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY A. Trikoupi, A. Trikoupi AHEPA University Hospital, Anesthesiology Department, Thessaloniki, GreeceSearch for more papers by this authorI. Kesisoglou, I. Kesisoglou AHEPA University Hospital, Anesthesiology Department, Thessaloniki, GreeceSearch for more papers by this authorV. Grosomanidis, V. Grosomanidis AHEPA University Hospital, Anesthesiology Department, Thessaloniki, GreeceSearch for more papers by this authorE. Kyrdzhieva, E. Kyrdzhieva AHEPA University Hospital, Anesthesiology Department, Thessaloniki, GreeceSearch for more papers by this authorK. Polymerou, K. Polymerou AHEPA University Hospital, Anesthesiology Department, Thessaloniki, GreeceSearch for more papers by this authorI.S. Tsakiridou, I.S. Tsakiridou AHEPA University Hospital, Anesthesiology Department, Thessaloniki, GreeceSearch for more papers by this authorD. Vasilakos, D. Vasilakos AHEPA University Hospital, Anesthesiology Department, Thessaloniki, GreeceSearch for more papers by this author A. Trikoupi, A. Trikoupi AHEPA University Hospital, Anesthesiology Department, Thessaloniki, GreeceSearch for more papers by this authorI. Kesisoglou, I. Kesisoglou AHEPA University Hospital, Anesthesiology Department, Thessaloniki, GreeceSearch for more papers by this authorV. Grosomanidis, V. Grosomanidis AHEPA University Hospital, Anesthesiology Department, Thessaloniki, GreeceSearch for more papers by this authorE. Kyrdzhieva, E. Kyrdzhieva AHEPA University Hospital, Anesthesiology Department, Thessaloniki, GreeceSearch for more papers by this authorK. Polymerou, K. Polymerou AHEPA University Hospital, Anesthesiology Department, Thessaloniki, GreeceSearch for more papers by this authorI.S. Tsakiridou, I.S. Tsakiridou AHEPA University Hospital, Anesthesiology Department, Thessaloniki, GreeceSearch for more papers by this authorD. Vasilakos, D. Vasilakos AHEPA University Hospital, Anesthesiology Department, Thessaloniki, GreeceSearch for more papers by this author First published: 12 January 2012 https://doi.org/10.1016/S1090-3801(09)60737-0Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume13, IssueS1September 2009Pages S211c-S211 RelatedInformation

Few patients with cyanotic congenital heart disease reach adulthood without a cardiac operation. The prognosis for ''unrepaired'' pulmonary atresia with ventricular septal defect is approximately 8% in the 1st decade of age. Consequently, the number of adults with this particular heart disease (unrepaired) who are expected to need a non-cardiac surgery is extremely low. General anesthesia may aggravate the preexisting right to left shunt and lead to persistent severe hypoxemia. The goal of anesthetic management should be to maintain intravascular volume. Systemic and pulmonary vascular resistance changes, such as might occur due to acidosis, hypothermia, hypercarbia or excessive airway pressures, should be avoided. Maintenance of preload, contractility and sinus rhythm is of major importance. The complex pathophysiology of such heart disease, in addition to the circumstances of emergency operation, exacerbate the total anesthetic risk. We present here a rare case of an acute appendectomy with successful outcome in an adult with pulmonary atresia and ventricular septal defect.

BACKGROUND:Abdominal compartment syndrome (ACS) has been recognized as an entity, affecting cardiovascular, pulmonary, and cerebral function, while it is often complicated with sepsis. Goal of the study was the evaluation of brain oxygenation during ACS alone and in combination with endotoxinemia.MATERIALS AND METHODS:Sixteen pigs, undergone intra-abdominal hypertension, were allocated to receive intravenous administration of either saline or endotoxin. Pigs were evaluated regarding brain tissue oxygenation (PbrO2), systemic oxygenation (PaO2) and regional cerebral blood flow (rCBF).RESULTS:Statistical analysis revealed significant reduction of PbrO2 over time for sepsis group, after endotoxin administration. Regarding differences between groups, sepsis group experienced lower PbrO2 values, compared to saline group, only after endotoxin administration. Both groups experienced reduction in arterial oxygenation, with greater pertubations seen after sepsis induction. Regarding rCBF, septic pigs showed greater flow values, while ACS alone did not influence rCBF. ACS has no deleterious effects in cerebral oxygenation and flow, provided systemic oxygenation and CPP are maintained above normal value.CONCLUSIONS:Combined sepsis-ACS lead to perturbations in cerebral oxygenation, in conjunction with greater rCBF values. The latter could be ascribed to abnormalities in oxygen extraction.

Amaniti, E.; Kouvelas, D.; Pourzitaki, C.; Kapoukranidou, D.; Vasilakos, D. Author Information

Amaniti, E.; Vasilakos, D.; Karakoulas, K.; Gorgias, N.; Matsaridou, E. Author Information

Alteration in the pulmonary capillary pressure after endotoxin administration in pigs