The Bezold-Jarisch reflex and anaesthesia.

Spinal anaesthesia is considered an effective and safe method for providing pain relief during procedures below the waist. However, in a small subset of patients, life-threatening vasovagal reactions may develop leading to severe bradycardia and hypotension or ultimately asystole and complete circulatory collapse. Early recognition and prompt treatment of this condition can be lifesaving as illustrated in this case report where the patient developed asystole for ten seconds shortly after placing the spinal anaesthetic.

Herpes Simplex Virus Type 1 Pneumonia-A Review.

BACKGROUND: Pneumonia due to herpes simplex virus (HSV) is uncommon but can be seen in immunocompromised patients and has been associated with poor prognosis in this population. AIM: The aim was to study the results, outcome and mortality of HSV pneumonia in immunocompromised patients and patients receiving mechanical ventilation. Furthermore, it has been unclear whether to initiate prophylactic treatment with acyclovir or not. METHODS: We have conducted a literature search using the keywords herpes simplex pneumonia, critically ill patients and intensive care unit for identification of relevant publications. FINDINGS: HSV pneumonia can cause severe infection or even death in immunocompromised patients and critically ill patients. A clear diagnosis of HSV pneumonia can be difficult to establish. Respiratory condition may improve after initiation of acyclovir but data is scarce. CONCLUSION: HSV pneumonia should be considered in the immunocompromised patient and/or the intensive care patient who continues to deteriorate despite appropriate treatment. The value of prophylactic treatment with acyclovir is unproven but should be considered.

Raoultella Ornithinolytica Diagnosed in a Neurointensive Patient. A Rare Case with Recovery without Antibiotics.

Infection with Raoultella ornithinolytica is rare and normally the infection is present in patients with underlying malignancies or chronic diseases. It is normally treated with antibiotics. In this case report, a neuro-intensive patient without malignancies or other severe chronic diseases was colonized with Pseudomonas aeruginosa but infected with Raoultella ornithinolyca. The patient recovered without treatment with antibiotics.

[Clonidine can reduce opioid medication during post-operative pain]. / Clonidin kan reducere opioidforbrug ved postoperative smerter.

Post-operative pain management can be a challenge, and one of the first choices seems to be opioids. However, opioids have undesirable side effects, and attention may lead to a multimodal analgesia. The use of clonidine is a part of this strategy. We present a study with assessment of routes of administration of clonidine. Overall, there is a good effect of post-operative pain management. Side effects as hypotension and sedation are mentioned but not as a limitation. Many anaesthesiologists do already use clonidine in the management of post-operative pain, but more research about intravenous administration of clonidine is needed.

[Severe bradycardia in general anaesthesia in a patient treated with cholinesterase inhibitors for dementia]. / Svær bradykardi ved generel anæstesi til en patient i behandling for demens med acetylkolinesterasehæmmer.

Patients suffering from Alzheimer's disease, Parkinson's disease and dementia with Lewy bodies can be treated well with the cholinesterase inhibitors rivastigmine or donepezil, and because of the increasing number of these patients undergoing surgery in general anaesthesia we find it urgent to draw attention to possible complications such as severe bradycardia or third-degree heart block when propofol and remifentanil are being used.

Severe septic shock and cardiac arrest in a patient with Vibrio metschnikovii: a case report.

INTRODUCTION: Vibrio metschnikovii is a very rare species and can be fatal to patients with massive comorbidity. Until now only eight other cases have been reported. CASE PRESENTATION: This case report describes a 78-year-old Danish man who presented with fever, hypotension and unconsciousness and he developed cardiac arrest. Vibrio metschnikovii was identified in all his blood samples and effective antibiotics were initiated. CONCLUSIONS: The human sources are believed to include shrimps, birds, water, sewage and seafood. We report the first case of Vibrio metschnikovii from a Nordic country and the report shows that even though isolation of Vibrio metschnikovii from human clinical samples is very rare, it still infects humans and may be fatal, despite sufficient treatment.

Hypoalbuminemia is a strong predictor of 30-day all-cause mortality in acutely admitted medical patients: a prospective, observational, cohort study.

OBJECTIVE: Emergency patients with hypoalbuminemia are known to have increased mortality. No previous studies have, however, assessed the predictive value of low albumin on mortality in unselected acutely admitted medical patients. We aimed at assessing the predictive power of hypoalbuminemia on 30-day all-cause mortality in a cohort of acutely admitted medical patients. METHODS: We included all acutely admitted adult medical patients from the medical admission unit at a regional teaching hospital in Denmark. Data on mortality was extracted from the Danish Civil Register to ensure complete follow-up. Patients were divided into three groups according to their plasma albumin levels (0-34, 35-44 and ≥45 g/L) and mortality was identified for each group using Kaplan-Meier survival plot. Discriminatory power (ability to discriminate patients at increased risk of mortality) and calibration (precision of predictions) for hypoalbuminemia was determined. RESULTS: We included 5,894 patients and albumin was available in 5,451 (92.5%). A total of 332 (5.6%) patients died within 30 days of admission. Median plasma albumin was 40 g/L (IQR 37-43). Crude 30-day mortality in patients with low albumin was 16.3% compared to 4.3% among patients with normal albumin (p<0.0001). Patients with low albumin were older and admitted for a longer period of time than patients with a normal albumin, while patients with high albumin had a lower 30-day mortality, were younger and were admitted for a shorter period. Multivariable logistic regression analyses confirmed the association of hypoalbuminemia with mortality (OR: 1.95 (95% CI: 1.31-2.90)). Discriminatory power was good (AUROC 0.73 (95% CI, 0.70-0.77)) and calibration acceptable. CONCLUSION: We found hypoalbuminemia to be associated with 30-day all-cause mortality in acutely admitted medical patients. Used as predictive tool for mortality, plasma albumin had acceptable discriminatory power and good calibration.