Can subclavian/infraclavicular axillary vein collapsibility index predict spinal anesthesia-induced hypotension in cesarean-section operations?

OBJECTIVE: Spinal anesthesia-induced hypotension (SAIH) is relatively common in pregnant women and has serious maternal and fetal side effects. In patients who are hypovolemic during spinal anesthesia, there may be a significant decrease in blood pressure caused by the decrease in preload. Subclavian vein sonography is a useful method for evaluating preoperative intravascular volume status. This study aimed to evaluate the efficacy of the pre-operative subclavian vein or infraclavicular axillary vein (SCV-AV) collapsibility index for predicting SAIH in cesarean-section (C-section). PATIENTS AND METHODS: In this prospective observational study, 82 women undergoing elective C-sections were recruited. Sonographic evaluation of SCV-AV was assessed before spinal anesthesia. After spinal anesthesia, changes in blood pressure were noted. The main outcome was the association between the SCV-AV measurements (diameter and collapsibility index) and SAIH. RESULTS: Hypotension developed in 53 (64%) patients after spinal anesthesia. The collapsibility index of the SCV-AV during spontaneous breathing and deep inspirium was not a significant predictor of a decrease in mean blood pressure (MBP) after spinal anesthesia (p<0.979, p<0.380). CONCLUSIONS: It was found that the SCV-AV collapsibility index is not a predictor of SAIH in pregnant women undergoing elective C-sections.

The reversing effect of ondansetron on bupivacaine-induced sciatic nerve block.

Background and Aims: This experimental study was designed to test the hypothesis that ondansetron, a selective 5-HT3 receptor antagonist, would decrease the duration of motor, sensory, and proprioception blockade in a dose-dependent fashion in a bupivacaine-induced sciatic nerve blockade. Materials and Methods: Forty-nine male Wistar Albino rats who underwent unilateral sciatic nerve block were divided into seven groups with an equal number in each group. Group B: only perineural block (PB), Group BO200: PB and perineural 200 µg ondansetron, Group BO400: PB and perineural 400 µg ondansetron, Group BO800: PB and perineural 800 µg ondansetron, Group BO800IP: PB and intraperitoneal 800 µg ondansetron, Group O800: only perineural 800 µg ondansetron, Group S: sham-operated. The rats' motor, sensory, and proprioception functions were evaluated by a blinded investigator every 10 min until they returned to normal function. The recovery times of the motor, sensory, and proprioception functions were recorded and compared. All sciatic nerves were removed and examined by electron microscopy for neurotoxic signs. Results: In which sciatic nerve block was formed with bupivacaine, the duration of the motor, sensory, and proprioception functions blockade was decreased, and the duration to return to normal functions was significantly shortened at Group BO800 (p < 0.05). According to electron microscopy results, perineural 200 µg, 400 µg, and 800 µg ondansetron were not neurotoxic. Conclusion: This is the first study showing that perineural ondansetron administration (800 µg dose) reverses the effect of the local anesthetics and shortens the duration of the motor, sensory, and proprioception functions blockade.

Outbreak of postoperative empyema caused by Serratia marcescens in a thoracic surgery unit.

An increase in the number of cases of postoperative empyema due to S. marcescens was recognized in the intensive care unit (ICU) of our Division of Thoracic Surgery between 3 and 19 March 2013. Pleural samples from patients and environmental samples from the operating room and ICU were obtained. A total of eight isolates (six from pleural fluid and two from portable suction devices in ICU) were identified as Serratia marcescens. All isolates were found to be identical by repetitive sequence-based polymerase chain reaction. This is the first report of an outbreak caused by S. marcescens related to a contaminated portable suction machine.