Health Care Workers' Sick Leave due to COVID-19 Vaccination in Context With SARS-CoV-2 Infection and Quarantine-A Multicenter Cross-Sectional Survey.

Background: Reactogenicity of coronavirus disease 2019 (COVID-19) vaccines can result in inability to work. The object of this study was to evaluate health care workers' sick leave after COVID-19 vaccination and to compare it with sick leave due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and quarantine leave. Methods: A multicenter cross-sectional survey was conducted at Regensburg University Medical Center and 10 teaching hospitals in South-East Germany from July 28 to October 15, 2021. Results: Of 2662 participants, 2309 (91.8%) were fully vaccinated without a history of SARS-CoV-2 infection. Sick leave after first/second vaccination occurred in 239 (10.4%) and 539 (23.3%) participants. In multivariable logistic regression, the adjusted odds ratio for sick leave after first/second vaccination compared with BNT162b2 was 2.26/3.72 for mRNA-1237 (95% CI, 1.28-4.01/1.99-6.96) and 27.82/0.48 for ChAdOx1-S (95% CI, 19.12-40.48/0.24-0.96). The actual median sick leave (interquartile range [IQR]) was 1 (0-2) day after any vaccination. Two hundred fifty-one participants (9.4%) reported a history of SARS-CoV-2 infection (median sick leave [IQR] 14 [10-21] days), 353 (13.3%) were quarantined at least once (median quarantine leave [IQR], 14 [10-14] days). Sick leave due to SARS-CoV-2 infection (4642 days) and quarantine leave (4710 days) accounted for 7.7 times more loss of workforce than actual sick leave after first and second vaccination (1216 days) in all fully vaccinated participants. Conclusions: Sick leave after COVID-19 vaccination is frequent and is associated with the vaccine applied. COVID-19 vaccination should reduce the much higher proportion of loss of workforce due to SARS-CoV-2 infection and quarantine.

Electroencephalographic Narcotrend Index monitoring during procedural sedation and analgesia in children.

BACKGROUND: The electroencephalographic Narcotrend Index (NI) may potentially help to titrate sedative medication during diagnostic and therapeutic procedures in children. METHODS: With local ethics committee approval and informed parental consent, 31 patients, aged 8.9 +/- 4.3 years, scheduled for elective upper gastrointestinal endoscopy were enrolled in this prospective, double-blinded observational study. Initially, patients received a single dose of intravenous piritramide 0.1 mg x kg(-1), followed by propofol 2 mg x kg(-1) and, if necessary, additional propofol doses (0.5 mg x kg(-1)) to achieve and maintain a level of deep sedation throughout the procedure. Sedation was assessed by the University of Michigan Sedation Scale (UMSS). We investigated the relationship between depth of sedation, and the NI, and the classical EEG parameters (cEEG), total EEG power (Power), spectral edge (SEF) and median frequency, and relative power in the beta, alpha, theta and delta bands. The performance of the NI and cEEG parameters was evaluated by prediction probability (P(K)), receiver operating characteristic (ROC) and Spearman rank order correlation analysis. RESULTS: Mean P(K) values for NI (0.88) vs UMSS were higher than for the other cEEG parameters, except for Power (0.82) and SEF(0.81). Spearman correlation analysis revealed superiority of the NI over all cEEG parameters. The area under the curve for the NI was 0.93, which was superior to all other EEG parameters beside Power (0.86) and relative power in alpha (0.82). CONCLUSIONS: The results of this study suggest that the NI may be an objective nondisruptive tool for assessment of hypnotic depth in children under propofol-induced procedural sedation.

The correlation of the Narcotrend Index with endtidal sevoflurane concentrations and hemodynamic parameters in children.

BACKGROUND: The Narcotrend Index (NI) of anesthetic depth is potentially a pharmacodynamic measure of the effects of sevoflurane on the brain. METHODS: In this prospective observational study of 30 pediatric surgical patients (1-11 years), we investigated the correlation between nonsteady-state endtidal sevoflurane (eT(Sevo)), NI, mean arterial pressure (MAP), and heart rate (HR). The performance of the Narcotrend for differentiation between consciousness and unconsciousness was evaluated using prediction probability (P(K)). RESULTS: Spearman correlation analysis showed significant correlations (P < 0.01) between eT(Sevo) and NI (r = -0.85) and MAP (r = -0.43). P(K)-values for differentiation between consciousness and unconsciousness were 1.0 for NI and <0.85 for MAP and HR. During the surgical procedure, NI-values showed a constant rise with each 0.5% step of lowering eT(Sevo) (P < 0.03), whereas MAP remained unaltered and HR showed a constant decline (P < 0.03), except between 1.5 and 1%. CONCLUSIONS: In children, nonsteady-state eT(Sevo) concentrations are more closely related with NI than with MAP or HR. In this study, only NI reliably differentiated consciousness from unconsciousness.