Evaluation of parental anxiety following three methods of pre-anesthesia counseling: Video, brochure and verbal communication.

BACKGROUND: The purpose of this study is to provide comprehensive and efficient pre-anesthesia counseling (PAC) utilizing audiovisual aids and to examine their effect on parental anxiety. METHODS: For this prospective, controlled study, 174 parents were recruited and randomized into three groups of 58 (Group A: video, Group B: brochure, and Group C: verbal). During pre-anesthesia counseling, the parent was provided with a detailed explanation of preoperative preparation, fasting instructions, transport to the operating room, induction, the emergence of anesthesia, and nursing in the post-anesthesia care unit based on their assigned group. We evaluated parental anxiety using Spielberger's State-Trait Anxiety Inventory before and after the pre-anesthesia counseling. RESULTS: The results of our study show a statistically significant difference in the final mean STAI scores among the three groups (Group A: 34.69 ± 5.31, Group B: 36.34 ± 8.59, and Group C: 43.59 ± 3.39; p < .001). When compared to the brochure and verbal groups, the parents in the video group have the greatest difference in mean baseline and final Spielberger's State-Trait Anxiety Inventory scores (12.207 ± 5.291, p .001). CONCLUSION: The results of our study suggest that pre-anesthesia counseling by video or a brochure before the day of surgery is associated with a higher reduction in parental anxiety when compared to verbal communication.

Anesthetic Considerations in Multisystem Inflammatory Syndrome in Children: A Case Series.

Multisystem inflammatory syndrome in children (MIS-C) is an immune response inciting multiorgan dysfunction and a shock-like state which is typically seen in children 2 to 6 weeks after either a coronavirus disease-19 infection or exposure. When such a child comes for any surgery, perioperative anesthetic management demands multidisciplinary involvement and individualized case-based decision-making. Due to the novelty of the condition, there are limited data on anesthetic implications in these patients. Anesthetic management in the affected children is dynamic depending on the organ systems involved and the progression of the disease state. Though the long-term effects of the syndrome are largely unknown, we hope that awareness of the MIS-C-associated complications may help anesthesiologists involved in childcare. Herein, we put forward challenges and clinical dilemmas we faced during the anesthetic management of three children with MIS-C presenting for emergency and elective surgery.

Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio as Markers for Predicting the Severity in COVID-19 Patients: A Prospective Observational Study.

Background: Coronavirus disease-2019 (COVID-19) pandemic has shown unpredictable course in individual patients. Few patients develop severe disease with progression after admission to a healthcare facility. Multiple parameters have been investigated to identify a marker to predict disease progression. Neutrophil-to-lymphocyte ratio (NLR) or platelet-to-lymphocyte (PLR) ratio has shown some promise. The current investigation explores the role of NLR and PLR to predict the disease progression. Materials and methods: After obtaining ethics committee approval, 608 patients were screened for inclusion in the prospective observational study, and 201 patients were included in the final analysis. The NLR and PLR were derived from routinely obtained complete blood count analysis. The patients were followed to determine the development of severity of the disease during the course. The NLR and PLR were analyzed in both univariate and multivariable models to assess the association and prediction. Results: In nonsevere (NS) group, the mean age of patients was 50.9 ± 16.3 years, and 66 (61.2%) were male, while in severe group (S), the mean age of patients was 53.7 ± 16.4 years, and 65 (69.89%) were male. NLR at day 1 and day 3 was significantly lower in survivors as compared to nonsurvivors, while the relation of PLR in both the groups was not statistically significant. The NLR is better in predicting the severity of disease as well as mortality than PLR. Conclusion: The NLR calculated at the time of admission has high predictive value for disease deterioration and adverse clinical outcome. How to cite this article: Singh Y, Singh A, Rudravaram S, Soni KD, Aggarwal R, Patel N, et al. Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio as Markers for Predicting the Severity in COVID-19 Patients: A Prospective Observational Study. Indian J Crit Care Med 2021;25(8):847-852.

Outcome of Conservative Therapy in Coronavirus disease-2019 Patients Presenting With Gastrointestinal Bleeding.

BACKGROUND/OBJECTIVE: There is a paucity of data on the management of gastrointestinal (GI) bleeding in patients with Coronavirus disease -2019 (COVID-19) amid concerns about the risk of transmission during endoscopic procedures. We aimed to study the outcomes of conservative treatment for GI bleeding in patients with COVID-19. METHODS: In this retrospective analysis, 24 of 1342 (1.8%) patients with COVID-19, presenting with GI bleeding from 22nd April to 22nd July 2020, were included. RESULTS: The mean age of patients was 45.8 ± 12.7 years; 17 (70.8%) were males; upper GI (UGI) bleeding: lower GI (LGI) 23:1. Twenty-two (91.6%) patients had evidence of cirrhosis- 21 presented with UGI bleeding while one had bleeding from hemorrhoids. Two patients without cirrhosis were presumed to have non-variceal bleeding. The medical therapy for UGI bleeding included vasoconstrictors-somatostatin in 17 (73.9%) and terlipressin in 4 (17.4%) patients. All patients with UGI bleeding received proton pump inhibitors and antibiotics. Packed red blood cells (PRBCs), fresh frozen plasma (FFPs) and platelets were transfused in 14 (60.9%), 3 (13.0%) and 3 (13.0%), respectively. The median PRBCs transfused was 1 (0-3) unit(s). The initial control of UGI bleeding was achieved in all 23 patients and none required an emergency endoscopy. At 5-day follow-up, none rebled or died. Two patients later rebled, one had intermittent bleed due to gastric antral vascular ectasia, while another had rebleed 19 days after discharge. Three (12.5%) cirrhosis patients succumbed to acute hypoxemic respiratory failure during hospital stay. CONCLUSION: Conservative management strategies including pharmacotherapy, restrictive transfusion strategy, and close hemodynamic monitoring can successfully manage GI bleeding in COVID-19 patients and reduce need for urgent endoscopy. The decision for proceeding with endoscopy should be taken by a multidisciplinary team after consideration of the patient's condition, response to treatment, resources and the risks involved, on a case to case basis.

Thoracic epidural analgesia in donor hepatectomy: An analysis.

The purpose of this study is to analyze whether supplementation of general anesthesia (GA) with thoracic epidural analgesia (TEA) for right lobe donor hepatectomy is a safe modality of pain relief in terms of changes in postoperative coagulation profile, incidence of epidural catheter-related complications, and timing of removal of epidural catheter. Retrospective analysis of the record of 104 patients who received TEA for right lobe donor hepatectomy was done. Platelet count, international normalized ratio, alanine aminotransferase, and aspartate aminotransferase were recorded postoperatively until the removal of the epidural catheter. The day of removal of the epidural catheter and visual analogue scale (VAS) scores were also recorded. Any complication encountered was documented. Intraoperatively, central venous pressure (CVP), hemodynamic variables, and volume of intravenous fluids infused were also noted. Statistical analysis was performed by using SPSS statistical package, version 17.0 (SPSS Inc. Chicago, IL). Continuous variables were presented as mean ± standard deviation. A total of 90% of patients had mean VAS scores between 1 and 4 in the postoperative period between days 1 and 5. None of the patients had a VAS score above 5. Although changes in coagulation status were encountered in all patients in the postoperative period, these changes were transient and did not persist beyond postoperative day (POD) 5. There was no delay in removal of the epidural catheter, and the majority of patients had the catheter removed by POD 4. There was no incidence of epidural hematoma. Aside from good intraoperative and postoperative analgesia, TEA in combination with balanced GA and fluid restriction enabled maintenance of low CVP and prevention of hepatic congestion. In conclusion, vigilant use of TEA appears to be safe during donor hepatectomy. Living liver donors should not be denied efficient analgesia for the fear of complications. Liver Transplantation 24 214-221 2018 AASLD.