RESUMEN
The anesthesia regimen used during one lung ventilation (OLV) carry the potential to affect intra-operative course and post-operative outcomes, by its effects on pulmonary vasculature and alveolar inflammation. This narrative review aims to understand the pathophysiology of acute lung injury during one lung ventilation, and to study the effects of inhalational versus intravenous anaesthetics on intraoperative and post-operative outcomes, following thoracic surgery. For this purpose, we independently searched 'PubMed', 'Google Scholar' and 'Cochrane Central' databases to find out randomized controlled trials (RCTs), in English language, which compared the effects of intravenous versus inhalational anaesthetics on intraoperative and post-operative outcomes, in elective thoracic surgeries, in human beings. In total, 38 RCTs were included in this review. Salient results of the review are- Propofol reduced intraoperative shunt and maintained better intraoperative oxygenation than inhalational agents. However, use of modern inhalational anaesthetics during OLV reduced alveolar inflammation significantly, as compared to propofol. Regarding post-operative complications, the evidence is not conclusive enough but slightly in favour of inhalational anaesthetics. Thus, we conclude that modern inhalational anaesthetics, by their virtue of better anti-inflammatory properties, exhibit lung protective effects and hence, seem to be safe for maintenance of anesthesia during OLV in elective thoracic surgeries. Further research is required to establish the safety of these agents with respect to long term post-operative outcomes like cancer recurrence.
RESUMEN
How to cite this article: Gaikwad S, Patil VP. Does Presence of Sepsis by Itself Predispose the Patients to HCAIs? Indian J Crit Care Med 2021;25(3):253-254.
RESUMEN
The present work reports preparation of irbesartan (IBS) loaded nanofibre mats using electrospinning technique. The prepared nanofibres were characterized by scanning electron microscopy, Fourier transform infrared spectroscopy, differential scanning calorimetry, X-ray diffraction analysis, in vitro diffusion and ex vivo skin permeation studies. FTIR studies revealed chemical compatibility of IBS and polyvinyl pyrrolidine (PVP K-30). SEM images confirmed formation of nanofibres wherein IBS existed in amorphous form as revealed by DSC and XRD analyses. The prepared nanofibre mats of IBS were found to be superior to IBS loaded as cast films when analysed for in vitro IBS release and ex vivo skin permeation studies since the flux of IBS loaded nanofibres was 17 times greater than as cast film. The improvement in drug delivery kinetics of IBS loaded nanofibres could be attributed to amorphization with reduction in particle size of IBS, dispersion of IBS at molecular level in PVP matrix and enormous increase in the surface area for IBS release due to nanonization. Thus transdermal patch of IBS loaded nanofibres can be considered as an alternative dosage form in order to improve its biopharmaceutical properties and enhance therapeutic efficacy in hypertension.
