Nonsteroidal anti-inflammatory drugs’ impact on nonunion and infection rates in long-bone fractures

Jeffcoach, David R. MD; Sams, Valerie G. MD; Lawson, Christy M. MD; Enderson, Blaine L. MD, MBA; Smith, Scott T. MD; Kline, Heather PA-C; Barlow, Patrick B. BA; Wylie, Douglas R. PharmD; Krumenacker, Laura A. PharmD; McMillen, James C. PharmD; Pyda, Jordan BS; Daley, Brian J. MD, MBA ; University of Tennessee Medical Center, Department of Surgery

Journal of Trauma and Acute Care Surgery:

March 2014 - Volume 76 - Issue 3 - p 779-783

Long bone fracture  patients who received NSAIDs in the postoperative period were twice as likely and smokers more than three times likely to suffer complications such as nonunion/malunion or infection. They recommend avoiding NSAID in traumatic long bone fractures.

Blood component transfusion increases the risk of death in children with traumatic brain injury

Acker, Shannon N. MD; Partrick, David A. MD; Ross, James T. BS; Nadlonek, Nicole A. MD; Bronsert, Michael PhD; Bensard, Denis D. MDJournal of Trauma and 

Acute Care Surgery:

April 2014 - Volume 76 - Issue 4 - p 1082-1088

Pediatric patients sustaining TBI who receive blood transfusion and do not require operative intervention have worse outcomes compared with patients who do not receive transfusion. This includes an increased risk of death. These data suggest that a transfusion trigger of hemoglobin level at 8.0 g/dL in injured children with TBI may be beneficial.

Stress hyperglycemia and surgical site infection in stable nondiabetic adults with orthopedic injuries

Richards, Justin E. MD; Hutchinson, Julie ACNP; Mukherjee, Kaushik MD, MSCI; Jahangir, Amir Alex MD; Mir, Hassan R. MD; Evans, Jason M. MD; Perdue, Aaron M. MD; Obremskey, William T. MD, MPH; Sethi, Manish K. MD; May, Addison K. MD

Journal of Trauma and Acute Care Surgery:

April 2014 - Volume 76 - Issue 4 - p 1070-1075

Stress hyperglycemia was associated with surgical site infection in this prospective observational cohort of stable nondiabetic patients with orthopedic injuries

Predicting the need for massive transfusion in trauma patients: The Traumatic Bleeding Severity Score

Ogura, Takayuki MD; Nakamura, Yoshihiko MD; Nakano, Minoru MD, PhD; Izawa, Yoshimitsu MD; Nakamura, Mitsunobu MD, PhD; Fujizuka, Kenji MD; Suzukawa, Masayuki MD, PhD; Lefor, Alan T. MD, MPH

Journal of Trauma and Acute Care Surgery:

May 2014 - Volume 76 - Issue 5 - p 1243-1250

In the development phase, five predictors of massive transfusion were identified, including age, systolic blood pressure, the Focused Assessment with Sonography for Trauma scan, severity of pelvic fracture, and lactate level. The maximum TBSS is 57 points. In the validation study, the average TBSS in patients who received massive transfusion was significantly greater (24.2 [6.7]) than the score of patients who did not (6.2 [4.7]) (p < 0.01). The area under the receiver operating characteristic curve, sensitivity, and specificity for a TBSS greater than 15 points was 0.985 (significantly higher than the other scoring systems evaluated at 0.892 and 0.813, respectively), 97.4%, and 96.2%, respectively.

CONCLUSION
The TBSS is simple to calculate using an available iOS application and is accurate in predicting the need for massive transfusion. Additional multicenter studies are needed to further validate this scoring system and further assess its utility.

Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis

D.Fletcher  ,V.Martinez

Br. J. Anaesth. (2014) 112 (6): 991-1004 

This review suggests that high intra-operative doses of remifentanil are associated with small but significant increases in acute pain after surgery.

 

 Comparison of the effect of propofol and sevoflurane anaesthesia on acute and chronic postoperative pain after hysterectomy 
 

M. Ogurlu, S. Sari, M. Küçük, M. Bakis, B. Ugur, YE. Eshraghi, F. Galimberti, A. Turan

Anaesthesia and Intensive Care 

Volume 42, Issue 3 May 2014 

This study was designed to evaluate the hypothesis that propofol reduces acute and chronic postoperative pain compared with sevoflurane. In a randomised, prospective, double-blind trial, we assigned 80 patients having open total abdominal hysterectomy surgery to anaesthesia with either sevoflurane or propofol. Anaesthesia was titrated to clinical needs and bispectral index values to between 40 and 60. Postoperative pain was managed with pethidine and diclofenac. Acute postoperative pain for 24 hours and chronic postoperative pain at one and three months after surgery were evaluated. The Hospital Anxiety and Depression Scale was used to evaluate patient anxiety and depression after one and three months. There were no significant differences between the groups for opioid consumption or opioid-induced side-effects. Pain scores in the first four hours were significantly higher in the sevoflurane group. Persistent surgical pain was observed less frequently (7 out of 40 patients in the propofol group and 21 out of 40 in the sevoflurane group at three months post-surgery, P <0.01) and pain scores were lower at one and three months in the propofol group (0.78±0.55 versus 2.23±0.73 for the sevoflurane group at three months post-surgery, P <0.01). Anxiety and depression scores were significantly lower in the propofol group at three months. In this study, general anaesthesia with propofol was associated with reduced early acute postoperative and persistent pain, compared to sevoflurane-based anaesthesia, among patients undergoing open abdominal hysterectomy.

 

Hydration in contrast-induced acute kidney injury

Carlo Briguori, Gerolama Condorelli

 

 

The Lancet, Volume 383, Issue 9931, Pages 1786 - 1788, 24 May 2014

Contrast-induced acute kidney injury is associated with prolonged hospital stay, increased health-care costs, and raised risk of both further deterioration of kidney function and unfavourable clinical outcome.1 A general consensus exists for the beneficial effect of hydration in preventing contrast-induced acute kidney injury. Hydration increases urine flow rates,2 reduces the concentration of contrast media in the tubule, and expedites excretion of contrast media, thus reducing the length of time that tubular cells are exposed to the toxic effects of contrast media.