Infectious complications of regional anesthesia.
ABSTRACT Although individual cases have been reported in the literature, serious infections of the central nervous system (CNS) such as arachnoiditis, meningitis, and abscess following spinal or epidural anesthesia are rare. However, recent epidemiologic series from Europe suggest that the frequency of infectious complications associated with neuraxial techniques may be increasing. Importantly, while meningitis and epidural abscess are both complications of neuraxial block, the risk factors and causative organisms are disparate. For example, staphylococcus is the organism most commonly associated epidural abscess; often these infections occurred in patients with impaired immunity. Conversely, meningitis follows dural puncture, and is typically caused by alpha-hemolytic streptococci, with the source of the organism the nasopharynx of the proceduralist. In order to reduce the risk of serious infection following neuraxial blockade, the clinician must be knowledgeable in the pathogenesis of CNS infections, patient selection, and use of meticulous aseptic technique. Finally, since delay in the diagnosis may result in morbidity and even death, it is crucial to be aware of the presenting signs and symptoms of meningitis and epidural abscess.
SourceAvailable from: Sami Gökhan Özkal[Show abstract] [Hide abstract]
ABSTRACT: Tobacco seed oil has been evaluated as a feedstock for biodiesel production. In this study, all properties of the biodiesel that was produced from tobacco seed oil were examined and some solutions were derived to bring all properties of the biodiesel within European Biodiesel Standard EN14214 to verify biodiesel quality. Among the properties, only oxidation stability and iodine number of the biodiesel, which mainly depend on fatty acid composition of the oil, were not within the limits of the standard. Six different antioxidants that are tert-butylhydroquinone, butylated hydroxytoluene, propyl gallate, pyrogallol, α-tocopherol and butylated hydroxyanisole were used to improve the oxidation stability. Among them, pyrogallol was found to be the most effective antioxidant. The iodine number was improved with blending the biodiesel produced from tobacco seed oil with a biodiesel that contains more saturated fatty acids. However, the blending caused increasing the cold filter plugging point. Therefore, four different cold flow improvers, which are ethylene–vinyl acetate copolymer, octadecene-1-maleic anhydride copolymer and two commercial cold flow improvers, were used to decrease cold filter plugging point of the biodiesel and the blends. Among the improvers, the best improver is said to be octadecene-1-maleic anhydride copolymer. In addition, effects of temperature on the density and the viscosity of the biodiesel were investigated.Energy Conversion and Management 05/2011; 52(5):2031–2039. DOI:10.1016/j.enconman.2010.12.021 · 3.59 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: In this review we addressed the various analgesic techniques in cardiac surgery, especially regional methods such as thoracic epidural anesthesia (TEA). There are many techniques available for management of postoperative pain after cardiac operation including intravenous administration of analgesic drugs, infiltration of local anesthetics, nerve blocks, and neuroaxial techniques. Although there are many evidences declaring the benefits of neuroaxial blockade in improving postoperative well-being and quality of care in these patients, some studies have revealed limited effect of TEA on overall morbidity and mortality after cardiac surgery. On the other hand, some investigators have raised the concern about epidural hematoma in altered coagulation and risks of infection and local anesthetics toxicity during and after cardiac procedures. In present review, we tried to discuss the most recent arguments in the field of this controversial issue. The final conclusion about either using regional anesthesia in cardiac surgery or not has been assigned to the readers.09/2014; 6(3):133-40. DOI:10.15171/jcvtr.2014.001
[Show abstract] [Hide abstract]
ABSTRACT: Infectious complications of invasive procedures affect patient outcomes adversely. Choice of antiseptic solution at the time of insertion is one of the major factors affecting their incidence. This study was undertaken to compare efficacy of chlorhexidine 2% and povidone iodine 10% for skin disinfection prior to placement of epidural and central venous catheters (CVCs). A prospective randomised trial in the operating rooms of a tertiary referral cancer centre. Sixty consecutive adult patients undergoing elective oncosurgery requiring placement of epidural and CVCs were enrolled. Paired skin swabs were collected before and after application of the antiseptic solution. The samples were incubated in McConkey's media and blood agar at 35°C for up to 24 h. Any bacterial growth was graded as: <10 colonies - poor growth, 10-50 colonies - moderate growth and >50 colonies as heavy growth. Data on demographics and antibiotic prophylaxis and costs was collected for all patients. Student's t-test and Mann-Whitney tests were used to analyse data, P<0.05 was considered significant. Demographics and antibiotic prophylaxis use was similar in both groups. Before application of antiseptic solution, a variety of micro-organisms were grown from most patients with growth ranging from none-heavy. No organism was grown after application of either antiseptic solution from any patient. We found no differences between 2% chlorhexidine and 10% povidone-iodine for skin disinfection in regard to costs, efficacy or side-effects.Indian journal of anaesthesia 05/2013; 57(3):270-5. DOI:10.4103/0019-5049.115619