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Zamstein O, Sheiner E, Binyamin Y, Pariente G, Wainstock T. Examining the relationship between autism spectrum disorder in children whose mother had labour epidural analgesia for their birth: A retrospective cohort study. Eur J Anaesthesiol 2024; 41:282-287. [PMID: 38084085 DOI: 10.1097/eja.0000000000001932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Controversy exists regarding the association between autism spectrum disorder (ASD) in children whose mother had labour epidural analgesia for their birth, as the few existing investigations have reported mixed findings. OBJECTIVE This study aims to evaluate the possibility of an association in our heterogeneous population. DESIGN A retrospective population-based cohort study. SETTING Vaginal deliveries that took place between the years 2005 and 2017 at Soroka University Medical Center, a tertiary referral hospital in Israel, and a follow-up on the incidence of ASD in the children. PATIENTS A hundred and thirty-nine thousand, nine hundred and eighty-one labouring patients and their offspring. MAIN OUTCOME MEASURES The incidence of children diagnosed with ASD (both hospital and community-based diagnoses) was compared based on whether their mothers had received labour epidural analgesia during their labour. A Kaplan-Meier survival curve compared cumulative incidence of ASD. A Cox proportional hazards model was used to control for relevant confounders. RESULTS Labour epidural analgesia was administered to 33 315 women. Epidural analgesia was more common among high-risk pregnancy groups (including pregnancies complicated with diabetes mellitus, hypertensive disorders, intrauterine growth restriction, and oligohydramnios; P < 0.001). In a Cox proportional hazards model, the association between epidural analgesia during labour and ASD in the children lost statistical significance following adjustment for confounders such as maternal age, gestational age, hypertensive disorders, diabetes mellitus, and ethnicity [adjusted hazard ratio = 1.13, 95% confidence interval (CI), 0.96 to 1.34, P = 0.152]. CONCLUSION In our population, after adjusting for confounders, epidural analgesia is not independently associated with autism spectrum disorder in the children. These findings enhance our knowledge regarding the safety of epidural analgesia and enable patients to make informed decisions about their pain relief techniques during labour.
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Affiliation(s)
- Omri Zamstein
- From the Obstetrics and Gynecology Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel (OZ, ES, GP), Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (YB) and Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (TW)
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Binyamin Y, Orbach-Zinger S, Ioscovich A, Reina YY, Bichovsky Y, Gruzman I, Zlotnik A, Brotfain E. Incidence and clinical impact of aspiration during cesarean delivery: A multi-center retrospective study. Anaesth Crit Care Pain Med 2024; 43:101347. [PMID: 38278356 DOI: 10.1016/j.accpm.2024.101347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/17/2023] [Accepted: 12/22/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND The risk of aspiration during general anesthesia for cesarean delivery has long been thought to be increased due to factors such as increased intra-abdominal pressures and delayed gastric emptying in pregnant patients. However, recent studies have reported normal gastric emptying in pregnant patients, suggesting that the risk of aspiration may not be as high as previously believed. METHODS We conducted a retrospective study of 48,609 cesarean deliveries, of which 22,690 (46.7%) were performed under general anesthesia at two large tertiary medical centers in Israel. The study aimed to examine the incidence of potentially severe aspiration during cesarean delivery, both under general and neuraxial anesthesia. RESULTS Among the patients included in the study, three were admitted to the intensive care unit due to suspected pulmonary aspiration. Two of these cases occurred during induction of general anesthesia for emergency cesarean delivery associated with difficult intubation and one under deep sedation during spinal anesthesia. The incidence of aspiration during cesarean delivery during general anesthesia in our study was 1 in 11,345 patients, and the incidence of aspiration during neuraxial anesthesia was 1 in 25,929 patients. No deaths due to aspiration were reported during the study period. CONCLUSIONS Our findings provide another contemporary analysis of aspiration rates in obstetric patients, highlighting increased risks during the management of difficult airways during general anesthesia and deep sedation associated with neuraxial anesthesia.
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Affiliation(s)
- Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Sharon Orbach-Zinger
- Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Ioscovich
- Department of Anesthesia, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yair Yaish Reina
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yoav Bichovsky
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Igor Gruzman
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alexander Zlotnik
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Evgeny Brotfain
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Frenkel A, Shiloh A, Vinokur V, Boyko M, Binyamin Y, Dreiher J. Exploring the association between serum phosphate levels and mortality in patients hospitalized with infectious diseases: a nationwide study. Front Med (Lausanne) 2024; 11:1362106. [PMID: 38590318 PMCID: PMC11000418 DOI: 10.3389/fmed.2024.1362106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/08/2024] [Indexed: 04/10/2024] Open
Abstract
Objective The purpose of this study was to examine associations of serum phosphate levels with mortality, target organ damage and length of hospital stay in adults with infectious diseases hospitalized outside of the intensive care unit. Methods This nationwide retrospective cohort study comprised patients admitted with infections, to medical and surgical departments in eight tertiary hospitals during 2001-2020. The main exposure variable was the first serum phosphate levels at admission (up to 1 week). The analysis included multivariable logistic regression models and quantile regression. Results Of 126,088 patients (49% males, mean age: 69.3 years), 24,809 (19.7%) had decreased phosphate levels, 92,730 (73.5%) normal phosphate levels, and 8,549 (6.8%) elevated phosphate levels on admission. Overall- and in-hospital mortality rates were highest among those with hyperphosphatemia (74.5 and 16.4%, respectively), followed by those with normophosphatemia (57.0 and 6.6%), and lastly the hypophosphatemia group (48.7 and 5.6%); p < 0.001 for all. After adjusting for confounders, the lowest predicted mortality rate was observed in the normophosphatemia group. In the multivariable model, hyperphosphatemia conferred a higher probability of target organ damage (OR [95% CI]: 2.43 [2.06-2.86]), while moderate hypophosphatemia conferred a lower probability (OR [95% CI]: 0.73 [0.65-0.82]), compared to normal phosphate levels and extreme hypophosphatemia showed a non-significant association (OR [95% CI]: 0.87 [0.57-1.28]). The associations were independent of renal failure. In a multivariable model, hyperphosphatemia was associated with a slight increase of 0.33 days in length of stay compared to normal phosphate levels. Conclusion A J-shaped relation was found between phosphate levels and prognosis in patients hospitalized with infectious diseases, regardless of their renal function.
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Affiliation(s)
- Amit Frenkel
- General Intensive Care Department, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Adi Shiloh
- Clinical Research Center, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Victoria Vinokur
- Division of Anesthesiology and Critical Care, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Matthew Boyko
- Division of Anesthesiology and Critical Care, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yair Binyamin
- Division of Anesthesiology and Critical Care, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jacob Dreiher
- Hospital Administration, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Shebelsky R, Sadi W, Heesen P, Aber RN, Fein S, Iluz-Freundlich D, Shmueli A, Azem K, Radyan Tamayev I, Binyamin Y, Orbach-Zinger S. The relationship between postpartum pain and mother-infant bonding: A prospective observational study. Anaesth Crit Care Pain Med 2024; 43:101315. [PMID: 37865216 DOI: 10.1016/j.accpm.2023.101315] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/23/2023]
Abstract
INTRODUCTION Postpartum pain is associated with impaired maternal recovery and may influence mother-infant bonding. METHODS Participants who underwent a vaginal or cesarean delivery were assessed 24 h postpartum. Postpartum pain intensity was measured using the Verbal Numeric Score (VNS) (0-10) and classified as non-severe (<8) or severe pain (≥8). Maternal-infant bonding was evaluated using the Post-Partum Bonding Questionnaire (PBQ; 0-125), with a score > 5 defining impaired bonding. Demographic data included age, BMI, parity, education level, economic status, partnership, prior history of depression, familial history of depression, desire to breastfeed, epidural analgesia during labor, rooming in, and Edinburgh Postnatal Depression Scale (EPDS). Data were analyzed using 2 separate multivariable logistic regression models for vaginal and cesarean deliveries, where maximum postpartum pain was the independent variable and impaired postpartum bonding was the dependent variable and controlled for the other factors collected. RESULTS Severe postpartum pain (VNS ≥ 8) showed no significant relationship with impaired bonding when controlling for confounding variables. In vaginal deliveries, there was an association between a history of depression and impaired bonding (Odds Ratio 2.2 [1.07-4.65], p = 0.04) and EPDS > 10 and impaired bonding (OR 11.5 [3.2-73.6], p < 0.001). For cesarean deliveries, rooming in with the baby had a protective effect (OR 11.5 [3.2-73.6], p < 0.001). CONCLUSIONS Contrary to expectations, severe postpartum pain did not influence maternal-infant binding in the cohort of patients with vaginal and cesarean deliveries. Instead, factors such as maternal mental health and rooming-in practices appeared to exert more significant influence. CLINICAL TRIAL REGISTRATION NCT05206552.
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Affiliation(s)
- Rostislav Shebelsky
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Wadeea Sadi
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | | | - Rachel N Aber
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Shai Fein
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Iluz-Freundlich
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Anat Shmueli
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Karam Azem
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Inbar Radyan Tamayev
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Sharon Orbach-Zinger
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
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Geva N, Geva Y, Katz L, Binyamin Y, Rotem R, Weintraub AY, Yaniv Salem S. Correlation between total deceleration area in CTG records and cord blood pH in pregnancies with IUGR. Arch Gynecol Obstet 2024:10.1007/s00404-023-07240-0. [PMID: 38225432 DOI: 10.1007/s00404-023-07240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/14/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE Fetal cardiotocography is the most common method to assess fetal well-being during labor. Nevertheless, its predictive ability for acidemia is limited, both in low-risk and high-risk pregnancies (Nelson et al. in N Engl J Med 334: 613-9, 1996; Rinciples P et al. in Health and Human Development Workshop Report on Electronic Fetal Monitoring : Update on Definitions. no. 2007, 510-515, 2008), especially in high-risk pregnancies, such as those complicated by growth restriction. In this study we aim examine the association between deceleration and acceleration areas and other measure of fetal heart rate in intrapartum fetal monitoring and neonatal arterial cord blood pH in pregnancies complicated by growth restriction. MATERIALS AND METHODS A retrospective cohort study of 100 deliveries complicated by growth restriction, delivered during 2018, was conducted. Known major fetal anomalies, non-vertex presentation and elective cesarean deliveries were excluded. Total deceleration and acceleration areas were calculated as the sum of the areas within the deceleration and acceleration, respectively. RESULTS In deliveries complicated by growth restriction, cord blood pH is significantly associated with total deceleration area (p = 0.05) and correlates with cumulative duration of the decelerations (Spearman's rank -0.363, p < 0.05), and total acceleration area (-0.358, p < 0.05). By comparing the cord blood pH in deliveries with a total deceleration area that was above and below the median total deceleration area, we demonstrated a significant difference between the categories. CONCLUSIONS Cord blood pH significantly correlates with total deceleration area and other fetal monitoring characteristics in neonates with growth restriction. Future studies using real-time, machine-learning based techniques of fetal heart rate monitoring, may provide population specific threshold values that will support bedside clinical decision making and perhaps achieve better outcomes.
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Affiliation(s)
- Neta Geva
- Department of Neonatology, Ben-Gurion University of the Negev Faculty of Health Sciences, Sheril and Hain Saban Children Hospital, Soroka Medical Center, Beer-Sheva, Israel.
| | - Yael Geva
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Lior Katz
- Pediatric Division, Rambam Health Care Campus, Haifa, Israel
| | - Yair Binyamin
- Department of Anesthesiology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Reut Rotem
- Division of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel
| | - Adi Yehuda Weintraub
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shimrit Yaniv Salem
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Orbach-Zinger S, Azem K, Heesen P, Frenkel A, Binyamin Y. Cosyntropin prophylaxis with intrathecal saline: impact on post-dural puncture headache and epidural blood patch. Anaesthesia 2024; 79:91-92. [PMID: 37816309 DOI: 10.1111/anae.16139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/12/2023]
Affiliation(s)
- S Orbach-Zinger
- Beilinson Hospital, Rabin Medical Center Associated with Sackler Faculty of Medicine, Petach Tikvah, Israel
| | - K Azem
- Beilinson Hospital, Rabin Medical Center Associated with Sackler Faculty of Medicine, Petach Tikvah, Israel
| | - P Heesen
- University of Zurich, Zurich, Switzerland
| | - A Frenkel
- Soroka University Medical Center Associated with Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Y Binyamin
- Soroka University Medical Center Associated with Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Davidor N, Binyamin Y, Kosovsky TH, Nisky I. Design and Assessment of a Bimanual Haptic Epidural Needle Insertion Simulator. IEEE Trans Haptics 2023; 16:736-747. [PMID: 37676807 DOI: 10.1109/toh.2023.3312666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
The case experience of anesthesiologists is one of the leading causes of accidental dural punctures and failed epidurals-the most common complications of epidural analgesia used for pain relief during delivery. We designed a bimanual haptic simulator to train anesthesiologists and optimize epidural analgesia skill acquisition. We present an assessment study conducted with 22 anesthesiologists of different competency levels from several Israeli hospitals. Our simulator emulates the forces applied to the epidural (Touhy) needle, held by one hand, and those applied to the Loss of Resistance (LOR) syringe, held by the other one. The resistance is calculated based on a model of the epidural region layers parameterized by the weight of the patient. We measured the movements of both haptic devices and quantified the results' rate (success, failed epidurals, and dural punctures), insertion strategies, and the participants' answers to questionnaires about their perception of the simulation realism. We demonstrated good construct validity by showing that the simulator can distinguish between real-life novices and experts. Face and content validity were examined by studying users' impressions regarding the simulator's realism and fulfillment of purpose. We found differences in strategies between different level anesthesiologists, and suggest trainee-based instruction in advanced training stages.
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Binyamin Y, Azem K, Heesen M, Gruzman I, Frenkel A, Fein S, Eidelman LA, Garren A, Frank D, Orbach-Zinger S. The effect of placement and management of intrathecal catheters following accidental dural puncture on the incidence of postdural puncture headache and severity: a retrospective real-world study. Anaesthesia 2023; 78:1256-1261. [PMID: 37439056 DOI: 10.1111/anae.16088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/14/2023]
Abstract
Accidental dural puncture during an attempt to establish labour epidural analgesia can result in postdural puncture headache and long-term debilitating conditions. Epidural blood patch, the gold standard treatment for this headache, is invasive and not always successful. Inserting an intrathecal catheter after accidental dural puncture may prevent postdural puncture headache. We evaluated the effect of intrathecal catheter insertion on the incidence of postdural puncture headache and the need for epidural blood patch and whether duration of intrathecal catheterisation or injection of intrathecal saline affected outcome. Our retrospective study was conducted at two tertiary, university-affiliated medical centres between 2017 and 2022 and included 92,651 epidurals and 550 cases of accidental dural puncture (0.59%); 219 parturients (39.8%) received an intrathecal catheter and 331 (60.2%) a resited epidural. Use of an intrathecal catheter versus resiting the epidural did not decrease the odds of postdural puncture headache, adjusted odds ratio (aOR) (95%CI) 0.91 (0.81-1.01), but was associated with a lower need for epidural blood patch (aOR (95%CI) 0.82 (0.73-0.91), p < 0.001). We found no benefit in leaving in the intrathecal catheter for 24 h postpartum (postdural puncture headache, aOR (95%CI) 1.01 (1.00-1.02), p = 0.015; epidural blood patch, aOR (95%CI) 1.00 (0.99-1.01), p = 0.40). We found an added benefit of injecting intrathecal saline as it decreased the incidence of postdural puncture headache (aOR (95%CI) 0.85 (0.73-0.99), p = 0.04) and the need for epidural blood patch (aOR (95%CI) 0.75 (0.64-0.87), p < 0.001). Our study confirms the benefits of intrathecal catheterisation and provides guidance on how to best manage an intrathecal catheter.
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Affiliation(s)
- Y Binyamin
- Department of Anaesthesia, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Karam Azem
- Department of Anaesthesia, Beilinson Hospital, Rabin Medical Center Associated with Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - M Heesen
- Department of Anaesthesia, Kantonsspital Baden, Baden, Switzerland
| | - I Gruzman
- Department of Anaesthesia, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - A Frenkel
- Department of Anaesthesia, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - S Fein
- Department of Anaesthesia, Beilinson Hospital, Rabin Medical Center Associated with Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - L A Eidelman
- Department of Anaesthesia, Assuta Medical Center, Ashdod, Israel
| | - A Garren
- Columbia University, New York, NY, USA
| | - D Frank
- Department of Anaesthesia, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - S Orbach-Zinger
- Department of Anaesthesia, Beilinson Hospital, Rabin Medical Center Associated with Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
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Binyamin Y, Frenkel A, Gruzman I, Lerman S, Bichovsky Y, Zlotnik A, Stav MY, Erez O, Orbach-Zinger S. Prophylactic Administration of Tranexamic Acid Reduces Blood Products' Transfusion and Intensive Care Admission in Women Undergoing High-Risk Cesarean Sections. J Clin Med 2023; 12:5253. [PMID: 37629295 PMCID: PMC10455366 DOI: 10.3390/jcm12165253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Postpartum hemorrhage (PPH) remains a major cause of maternal mortality. Tranexamic acid (TxA) has shown effectiveness in reducing PPH-related maternal bleeding events and deaths. We conducted a cohort study including parturient women at high risk of bleeding after undergoing a cesarean section (CS). Participants were divided into two groups: the treatment group received prophylactic 1-g TxA before surgery (n = 500), while the comparison group underwent CS without TxA treatment (n = 500). The primary outcome measured increased maternal blood loss following CS, defined as more than a 10% drop in hemoglobin concentration within 24 h post-CS and/or a drop of ≥2 g/dL in maternal hemoglobin concentration. Secondary outcomes included PPH indicators, ICU admission, hospital stay, TxA complications, and neonatal data. TxA administration significantly reduced hemoglobin decrease by more than 10%: there was a 35.4% decrease in the TxA group vs. a 59.4% decrease in the non-TxA group, p < 0.0001 and hemoglobin decreased by ≥2 g/dL (11.4% in the TxA group vs. 25.2% in non-TxA group, p < 0.0001), reduced packed red blood cell transfusion (p = 0.0174), and resulted in lower ICU admission rates (p = 0.034) and shorter hospitalization (p < 0.0001). Complication rates and neonatal outcomes did not differ significantly. In conclusion, prophylactic TxA administration during high-risk CS may effectively reduce blood loss, providing a potential intervention to improve maternal outcomes.
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Affiliation(s)
- Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (I.G.); (A.Z.)
| | - Amit Frenkel
- General Intensive Care Department, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (A.F.); (Y.B.)
| | - Igor Gruzman
- Department of Anesthesiology, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (I.G.); (A.Z.)
| | - Sofia Lerman
- Department of Anesthesiology, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (I.G.); (A.Z.)
| | - Yoav Bichovsky
- General Intensive Care Department, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (A.F.); (Y.B.)
| | - Alexander Zlotnik
- Department of Anesthesiology, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (I.G.); (A.Z.)
| | - Michael Y. Stav
- Department of Anesthesia, Beilinson Hospital, Rabin Medical Center Associated with Sakler Medical School, Tel Aviv University, Tel Aviv 6423906, Israel; (M.Y.S.); (S.O.-Z.)
| | - Offer Erez
- Division of Obstetrics and Gynecology, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel;
| | - Sharon Orbach-Zinger
- Department of Anesthesia, Beilinson Hospital, Rabin Medical Center Associated with Sakler Medical School, Tel Aviv University, Tel Aviv 6423906, Israel; (M.Y.S.); (S.O.-Z.)
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Eshkoli T, Baumfeld Y, Yohay Z, Binyamin Y, Speigel E, Dym L, Weintraub AY. Is epidural analgesia an independent risk factor for OASIS? A population-based cohort study. Arch Gynecol Obstet 2023:10.1007/s00404-023-07150-1. [PMID: 37454350 DOI: 10.1007/s00404-023-07150-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION To evaluate whether epidural analgesia is an independent risk factor for OASIS. METHODS A population-based cohort study including all women who delivered by spontaneous vaginal delivery or by instrumental delivery beyond 24 weeks gestation was conducted. Deliveries occurred between 1988 and 2016 at a large university tertiary medical center. Women with multiple gestations and those lacking prenatal care were excluded from the analysis. RESULTS During the study period, 252,542 women delivered at the Soroka University Medical Center and met the inclusion criteria. Of these, 583 (0.23%) were diagnosed with OASIS. Women with OASIS were more likely to be younger, nulliparous, with suspected fetal macrosomia, had higher rates of labor induction and vacuum extraction delivery, higher rates of conceiving after infertility treatments, more advanced gestational age at delivery, higher mean birth weight, higher rates of post-partum hemorrhage and need for blood transfusions. Use of epidural analgesia during pregnancy was significantly high among the OASIS group. Rates of episiotomy were not significantly different between the groups. Using a multimodal logistic regression model, after controlling for vacuum delivery, large for gestational age, nulliparity, gestational age, ethnicity, maternal age, induction of labor, fertility treatments, non-reassuring fetal heart rate and non-progressive second stage of labor, epidural analgesia was found to be significantly associated with OASIS. CONCLUSION Epidural analgesia was found to be an independent risk factor for OASIS in our population.
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Affiliation(s)
- Tamar Eshkoli
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Reger Street, P.O.B 151, 84101, Beersheba, Israel.
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Reger Street, P.O.B 151, 84101, Beersheba, Israel
| | - Zehava Yohay
- Department of Anesthesiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Efrat Speigel
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Reger Street, P.O.B 151, 84101, Beersheba, Israel
| | - Lianne Dym
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Reger Street, P.O.B 151, 84101, Beersheba, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Reger Street, P.O.B 151, 84101, Beersheba, Israel
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Klein M, Hassan L, Katz R, Abuhasira R, Boyko M, Gabay O, Frank D, Binyamin Y, Novack V, Frenkel A. Challenging the Interpretation of White Blood Cell Counts in Patients with Sepsis Following Packed Cell Transfusion. J Clin Med 2023; 12:3912. [PMID: 37373614 DOI: 10.3390/jcm12123912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Critically ill patients with sepsis often require packed cell transfusions (PCT). However, PCT may affect white blood cell (WBC) counts. We conducted a population-based retrospective cohort study to trace changes in WBC count following PCT in critically ill patients with sepsis. We included 962 patients who received one unit of PCT while hospitalized in a general intensive care unit, and 994 matched patients who did not receive PCT. We calculated the mean values of WBC count for the 24 h before and 24 h after PCT. Multivariable analyses using a mixed linear regression model were performed. The mean WBC count decreased in both groups, but more in the non-PCT group (from 13.9 × 109/L to 12.2 × 109/L versus 13.9 × 109/L to 12.8 × 109/L). A linear regression model showed a mean decrease of 0.45 × 109/L in WBC count over the 24 h following the start of PCT. Every 1.0 × 109/L increase in the WBC count prior to PCT administration showed a corresponding decrease of 0.19 × 109/L in the final WBC count. In conclusion, among critically ill patients with sepsis, PCT causes only mild and clinically non-prominent changes in WBC count.
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Affiliation(s)
- Moti Klein
- General Intensive Care Unit, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Lior Hassan
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
- Clinical Research Center, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Rivka Katz
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Ran Abuhasira
- Clinical Research Center, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Matthew Boyko
- Department of Anesthesiology, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Ohad Gabay
- General Intensive Care Unit, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Dmitry Frank
- Department of Anesthesiology, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
- Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - Amit Frenkel
- General Intensive Care Unit, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
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Klein M, Hassan L, Binyamin Y, Frank D, Boyko M, Zlotnik A, Raab T, Novack V, Frenkel A. BODY TEMPERATURE VARIATION AFTER PACKED CELL TRANSFUSION IN ADULT PATIENTS WITH SEPSIS-WHERE WILL THE PENDULUM STOP? Shock 2023; 59:877-881. [PMID: 37119807 DOI: 10.1097/shk.0000000000002129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
ABSTRACT Background : Critically ill patients with sepsis often require packed cell transfusions (PCTs). Packed cell transfusion causes changes in body's core temperature. Objective : To trace the course and amplitude of body core temperature after PCT in adults with sepsis. Methods : We conducted a population-based retrospective cohort study of patients with sepsis who received one unit of PCT during their hospitalization in a general intensive care unit during 2000-2019. A control group was established by matching each of these patients to a patient who did not receive PCT. We calculated the mean values of urinary bladder temperature for the 24 h before and 24 h after PCT. To evaluate the effect of PCT on body core temperature, multivariable analyses using a mixed linear regression model were performed. Results : The study comprised 1,100 patients who received one unit of PCT and 1,100 matched patients. The mean temperature before PCT was 37.3°C. Immediately from initiation of PCT, body temperature decreased, to a minimum of 37.0°C. During the 24 subsequent hours, the temperature increased gradually and consistently, until a peak temperature of 37.4°C. In a linear regression model, body core temperature increased by a mean 0.06°C in the first 24 h after PCT and decreased by a mean 0.65°C for every 1.0°C increase before PCT. Conclusions : Among critically ill patients with sepsis, PCT itself causes only mild and clinically insignificant temperature changes. Thus, significant changes in core temperature during the 24 h after PCT may indicate an unusual clinical event that requires clinicians' immediate attention.
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Affiliation(s)
- Moti Klein
- General Intensive Care Unit, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dmitry Frank
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Matthew Boyko
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alexander Zlotnik
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tehila Raab
- Department of Internal Medicine, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Amit Frenkel
- General Intensive Care Unit, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Shaked G, Bichovsky Y, Golani G, Segal A, Replyanski I, Klein M, Binyamin Y, Frenkel A. The use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in Civilian Trauma in an Israeli Level 1 Trauma Center. Isr Med Assoc J 2023; 25:308-313. [PMID: 37129133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Massive, non-compressible bleeding is a leading cause of preventable trauma mortality. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a minimally invasive procedure in which a balloon catheter is maneuvered into the aorta to temporarily occlude large vessels and enable stabilization of the exsanguinating patient. OBJECTIVES To present experiences in assimilating REBOA at a single level 1 trauma center in Israel, to evaluate the technical aspects of the procedure, and to describe patient characteristics and outcomes. METHODS This retrospective cohort study comprised civilians admitted with hemorrhagic shock to our trauma department who were treated with REBOA between November 2017 and July 2021. Descriptive statistics of the patients, characteristics of the injuries and patient outcomes are presented. RESULTS The study included 22 patients (median age 30.1 years, 21 male). The mean systolic blood pressure (SBP) before REBOA inflation was 59.6 ± 11.4 mmHg, and the mean SBP measured after the procedure was 115.2 ± 26.3 mmHg. In 20 patients (91%), the SBP was normalized (> 90 mmHg) shortly after inflation of the balloon, and they survived the treatment in the trauma department; 15 (75%) survived the first 30 days. CONCLUSIONS REBOA is an effective method for the initial resuscitation and hemorrhage control of patients with massive, non-compressible bleeding and is relatively easy to assimilate in a hospital. The achievement of immediate normalization of SBP enables medical personnel to correct physiological parameters and obtain accurate imaging before proceeding to the operating theater.
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Affiliation(s)
- Gad Shaked
- Department of General Surgery and Trauma Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Yoav Bichovsky
- General Intensive Care Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Guy Golani
- Department of General Surgery and Trauma Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Adi Segal
- Goldman Medical School, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Ilia Replyanski
- Department of General Surgery and Trauma Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Moti Klein
- General Intensive Care Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Amit Frenkel
- General Intensive Care Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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14
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Eshkoli T, Baumfeld Y, Yohay Z, Binyamin Y, Hershkovitz R, Gliklis S, Sade S, Weintraub AY. The impact of epidural analgesia on third stage of labor disorders. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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15
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Stav M, Matatov Y, Hoffmann D, Heesen P, Gliesche V, Binyamin Y, Ioscovich A, Eidelman LA, Orbach-Zinger S. Incidence of conversion to general anaesthesia and need for intravenous supplementation in parturients undergoing caesarean section under spinal anaesthesia: A retrospective observational study. Acta Anaesthesiol Scand 2023; 67:29-35. [PMID: 36056463 DOI: 10.1111/aas.14146] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/14/2022] [Accepted: 08/23/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Conversion from spinal anaesthesia to general anaesthesia (GA) was shown to be associated with more complications. It has been postulated that spinal injection of a low dose of local anaesthetic is a risk factor. We aimed to discover the rate of conversion from spinal anaesthesia to GA in women who received at least 10 mg heavy bupivacaine and opioids and assess its risk factors. METHODS All women that underwent spinal anaesthesia for caesarean section from 1 January 2017 to 31 December 2020 were included in this analysis. Spinal anaesthesia was performed according to department protocol using heavy bupivacaine 0.5% 10-13 mg, fentanyl 20 μg, and morphine 0.1 mg. We examined rate of conversion from spinal anaesthesia to GA and rate of need for analgesia/sedation. RESULTS There were 1.7% of women that required conversion to GA. Bupivacaine dose (OR 0.54 [95% CI 0.38 to 0.75], p < 0.001), surgery time (OR 1.03 [95% CI 1.02 to 1.04], p < 0.001), emergency caesarean section (OR 1.06 [95% CI 1.16 to 3.76], p = 0.015), and postpartum haemorrhage (OR 5.96 [95% CI 1.09 to 25.18], p = 0.025) were independent predictors of need for conversion to GA. Of the women who had CS under spinal anaesthesia, 4.1% of parturients required intraoperative analgesics/sedatives and 9.1% required anxiolysis. CONCLUSIONS A small proportion of women required conversion to GA. This conversion occurred especially with emergency caesarean section and when low spinal bupivacaine doses were used.
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Affiliation(s)
- Michael Stav
- Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Yuri Matatov
- Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Dana Hoffmann
- Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Soroka University Medical Center, Beer Sheva, Israel
| | - Alexander Ioscovich
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Affiliated with the Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Leonid A Eidelman
- Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Orbach-Zinger
- Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
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16
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Frank D, Gruenbaum BF, Semyonov M, Binyamin Y, Severynovska O, Gal R, Frenkel A, Knazer B, Boyko M, Zlotnik A. Assessing Dominant-Submissive Behavior in Adult Rats Following Traumatic Brain Injury. J Vis Exp 2022. [PMID: 36592002 DOI: 10.3791/64548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Competition over resources such as food, territory, and mates significantly influences relationships within animal species and is mediated through social hierarchies that are often based on dominant-submissive relationships. The dominant-submissive relationship is a normal behavioral pattern among the individuals of a species. Traumatic brain injury is a frequent cause of social interaction impairment and the reorganization of dominant-submissive relationships in animal pairs. This protocol describes submissive behavior in adult male Sprague-Dawley rats after the induction of traumatic brain injury using a fluid-percussion model compared to naive rats through a series of dominant-submissive tests performed between 29 days and 33 days after induction. The dominant-submissive behavior test shows how brain injury can induce submissive behavior in animals competing for food. After traumatic brain injury, the rodents were more submissive, as indicated by them spending less time at the feeder and being less likely to arrive first at the trough compared to the control animals. According to this protocol, submissive behavior develops after traumatic brain injury in adult male rats.
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Affiliation(s)
- Dmitry Frank
- Division of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev;
| | | | - Michael Semyonov
- Division of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev
| | - Yair Binyamin
- Division of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev
| | - Olena Severynovska
- Department of Biochemistry and Physiology of the Faculty of Biology and Ecology, Oles Gonchar of the Dnipro National University
| | - Ron Gal
- Division of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev
| | - Amit Frenkel
- Division of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev
| | - Boris Knazer
- Department of Ophthalmology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev
| | - Matthew Boyko
- Division of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev
| | - Alexander Zlotnik
- Division of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev
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Boyko M, Gruenbaum BF, Shelef I, Zvenigorodsky V, Severynovska O, Binyamin Y, Knyazer B, Frenkel A, Frank D, Zlotnik A. Traumatic brain injury-induced submissive behavior in rats: link to depression and anxiety. Transl Psychiatry 2022; 12:239. [PMID: 35672289 PMCID: PMC9174479 DOI: 10.1038/s41398-022-01991-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/19/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022] Open
Abstract
Traumatic brain injury (TBI) affects millions of people worldwide, many of whom are affected with post-TBI mood disorders or behavioral changes, including aggression or social withdrawal. Diminished functionality can persist for decades after TBI and delay rehabilitation and resumption of employment. It has been established that there is a relationship between these mental disorders and brain injury. However, the etiology and causal relationships behind these conditions are poorly understood. Rodent models provide a helpful tool for researching mood disorders and social impairment due to their natural tendencies to form social hierarchies. Here, we present a rat model of mental complications after TBI using a suite of behavioral tests to examine the causal relationships between changes in social behavior, including aggressive, hierarchical, depressive, and anxious behavior. For this purpose, we used multivariate analysis to identify causal relationships between the above post-TBI psychiatric sequelae. We performed statistical analysis using principal component analysis, discriminant analysis, and correlation analysis, and built a model to predict dominant-submissive behavior based on the behavioral tests. This model displayed a predictive accuracy of 93.3% for determining dominant-submissive behavior in experimental groups. Machine learning algorithms determined that in rats, aggression is not a principal prognostic factor for dominant-submissive behavior. Alternatively, dominant-submissive behavior is determined solely by the rats' depressive-anxious state and exploratory activity. We expect the causal approach used in this study will guide future studies into mood conditions and behavioral changes following TBI.
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Affiliation(s)
- Matthew Boyko
- Department of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.
| | - Benjamin F Gruenbaum
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Ilan Shelef
- Department of Radiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Vladislav Zvenigorodsky
- Department of Radiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Olena Severynovska
- Department of Biochemistry and Physiology of the Faculty of Biology and Ecology Oles Gonchar of the Dnipro National University, Dnipro, Ukraine
| | - Yair Binyamin
- Department of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Boris Knyazer
- Department of Ophthalmology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Amit Frenkel
- Department of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Dmitry Frank
- Department of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Alexander Zlotnik
- Department of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
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18
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Orbach‐Zinger S, Lekar Leibzon M, Gonen O, Zribi B, Wazwaz SA, Binyamin Y, Heesen M, Matatov Y, Shimon O, Eidelman LA. Flouroscopic versus conventional epidural blood patch in obstetrics: A retrospective cohort study. Acta Anaesthesiol Scand 2022; 66:563-568. [PMID: 35184286 DOI: 10.1111/aas.14051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 02/03/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epidural blood patch is a common effective treatment for postdural puncture headache after accidental dural puncture during labor and may be done in conventional or fluoroscopy-guided methods. The aim of this study was to compare intensity of headache at the time of discharge from the hospital and to compare blood volumes injected in conventional epidural blood patches versus fluoroscopic-guided blood patches and evaluate the side effects of both method of treatment. METHODS Between the years 2010 and 2020, 84 patients who were diagnosed with postdural puncture headache received either a conventional epidural blood patch or a fluoroscopic-guided blood patch. Blood volumes were compared and evaluation of side effects was made based on data collected during and after the procedure. RESULTS Eighty-four patients were included in this study. Fifty-two women in the conventional epidural blood patch group and 32 in the fluoroscopic-guided blood patch group. Women in the conventional epidural blood patch group received statistically significantly higher doses of blood than women in the fluoroscopic-guided blood patch group: conventional method 29 ml IQR [23-36] versus fluoroscopic method 16 ml, IQR [12-18], p < .001 with no difference in headache pain intensity at hospital release. There was no difference between groups in hospital length of stay, or persistent PDPH. There was also no difference chronic headache or backache between the two groups. CONCLUSIONS Women who received fluoroscopic epidural blood patch required a much lower volume of blood injected while there was no difference between groups in headache pain intensity at discharge.
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Affiliation(s)
- Sharon Orbach‐Zinger
- Department of Anaesthesiology Rabin Medical Centre and Sackler Faculty of Medicine Tel Aviv University Israel
| | - Margarita Lekar Leibzon
- Department of Anaesthesiology Rabin Medical Centre and Sackler Faculty of Medicine Tel Aviv University Israel
| | - Ophir Gonen
- Department of Anaesthesiology Rabin Medical Centre and Sackler Faculty of Medicine Tel Aviv University Israel
| | - Benjamin Zribi
- Department of Anaesthesiology Rabin Medical Centre and Sackler Faculty of Medicine Tel Aviv University Israel
| | - Susan A. Wazwaz
- Department of Anaesthesiology Rabin Medical Centre and Sackler Faculty of Medicine Tel Aviv University Israel
| | - Yair Binyamin
- Department of Anaesthesiology Soroka University Medical Center and the Faculty of Health Sciences Ben‐Gurion University of the Negev Beer‐Sheva Israel
| | - Michael Heesen
- Department of Anaesthesiology Kantonsspital Baden Baden Switzerland
| | - Yuri Matatov
- Department of Anaesthesiology Rabin Medical Centre and Sackler Faculty of Medicine Tel Aviv University Israel
| | - Orit Shimon
- Department of Anaesthesiology Rabin Medical Centre and Sackler Faculty of Medicine Tel Aviv University Israel
| | - Leonid A. Eidelman
- Department of Anaesthesiology Rabin Medical Centre and Sackler Faculty of Medicine Tel Aviv University Israel
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19
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Binyamin Y, Wainstock T, Sheiner E, Battat TL, Reuveni I, Leibson T, Pariente G. The association between epidural analgesia during labor and mother-infant bonding. J Clin Anesth 2022; 80:110795. [PMID: 35489303 DOI: 10.1016/j.jclinane.2022.110795] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 03/19/2022] [Accepted: 03/25/2022] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE This study was aimed to assess the association between the use of epidural analgesia during labor and mother-infant bonding. DESIGN A cross-sectional study. SETTING Maternity ward at Soroka University Medical Center during 2020. PATIENTS Women who delivered a singleton live-born infant vaginally in their immediate post-partum period. INTERVENTIONS Women completed questionnaires. 25 items post-partum bonding questionnaire (PBQ) to assess mother-infant bonding (A high score on the PBQ indicates impaired mother-infant bonding) and the Edinburgh postnatal depression scale (EPDS) questionnaire to assess risk for post-partum depression. MEASUREMENTS The study used PBQ questionnaire and four sub-scales to assess mother-infant bonding and the EPDS questionnaire to assess risk for post- partum depression. Generalized linear regression models (gamma) were constructed to examine the association between epidural analgesia and mother-infant bonding total score and impaired bonding sub- scale, while adjusting for confounders Additional information such as pregnancy complications and sociodemographic data was drawn from women's medical records. MAIN RESULTS A total of 234 women were included in the final analysis, of them 126 (53.8%) delivered with epidural analgesia. The total PBQ score was significantly lower among women who received epidural analgesia compared to women without epidural analgesia (7.6 vs. 10.2, p = 0.024), demonstrating a better mother -infant bonding. Using two multivariable linear regression models, controlling for confounders such as maternal age and educational status, epidural analgesia during labor was independently associated with a better mother -infant bonding total score and better impaired bonding sub-scale score (Beta coefficient-0.252, 95% CI -0.5; -0.006, p = 0.045 and Beta coefficient - 0.34, 95% CI -0.52; -0.08, p = 0.01 for mother-infant bonding total score and sub-scale score, respectively). No differences in post-partum depression risks were found between the groups (EDPS≥13, 5.7% vs. 13%, p = 0.058). CONCLUSION Our study demonstrated better mother -infant bonding among women delivering with epidural analgesia.
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Affiliation(s)
- Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Talya Lanxner Battat
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Inbal Reuveni
- Department of Psychiatry, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Tom Leibson
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, ON, Canada
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
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Binyamin Y, Orbach-Zinger S, Gruzman I, Frenkel A, Lerman S, Zlotnik A, Frank D, Ioscovich A, Erez O, Heesen M. The effect of prophylactic use of tranexamic acid for cesarean section. J Matern Fetal Neonatal Med 2022; 35:9157-9162. [DOI: 10.1080/14767058.2021.2019215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sharon Orbach-Zinger
- Department of Anesthesia, Beilinson Hospital, Rabin Medical Center associated with Sakler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Igor Gruzman
- Department of Anesthesiology, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Amit Frenkel
- Department of Anesthesiology, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sofia Lerman
- Department of Anesthesiology, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alexander Zlotnik
- Department of Anesthesiology, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dmitry Frank
- Department of Anesthesiology, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alexander Ioscovich
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Offer Erez
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Maternity Department “D”, Division of Obstetrics and Gynecology, Soroka University Medical Center, Beer-Sheva, Israel
- Department of Obstetrics and Gynecology, Hutzel Women’s Hospital, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Michael Heesen
- Department of Anesthesia, Kantonsspital Baden, Baden, Switzerland
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21
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Binyamin Y, Pariente G, Wainstock T, Battat TL, Reuveni I, Sheiner E. The association between epidural analgesia during labor on mother-infant bonding. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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22
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Orbach-Zinger S, Grant T, Zahalka M, Ioscovich A, Fein S, Ginosar Y, Matkovski O, Weiniger C, Binyamin Y. A national Israeli survey of neuraxial anesthesia for cesarean delivery: pre-operative block assessment and intra-operative pain management. Int J Obstet Anesth 2022; 50:103255. [DOI: 10.1016/j.ijoa.2022.103255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/29/2021] [Accepted: 01/07/2022] [Indexed: 12/25/2022]
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Orbach-Zinger S, Heesen M, Ioscovich A, Shatalin D, Aptekman B, Weiniger CF, Eidelman LA, Frenkel A, Beilin Y, Katz DJ, Schlosberg I, Binyamin Y. Anesthesiologists' perspectives on why dural punctures occur: a multicenter international survey. Reg Anesth Pain Med 2021; 47:249-250. [PMID: 34893530 DOI: 10.1136/rapm-2021-103285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/19/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Sharon Orbach-Zinger
- Department of Anesthesia, Beilinson Hospital, Rabin Medical Center associated with Sakler Medical School, Tel Aviv, Israel
| | - Michael Heesen
- Department of Anesthesia, Kantonsspital Baden, Baden, Switzerland
| | - Alexander Ioscovich
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, affiliated with the Hebrew University Hadassah Medical School, Shaare Zedek Medical Center, Jerusalem, Jerusalem, Israel
| | - Daniel Shatalin
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, affiliated with the Hebrew University Hadassah Medical School, Shaare Zedek Medical Center, Jerusalem, Jerusalem, Israel
| | - Boris Aptekman
- Division of Anesthesia, Critical Care and Pain, Tel Aviv Ichilov-Sourasky Medical Center, Tel Aviv, Israel, Israel
| | - Carolyn F Weiniger
- Division of Anesthesia, Critical Care and Pain, Tel Aviv Ichilov-Sourasky Medical Center, Tel Aviv, Israel, Israel
| | - Leonid A Eidelman
- Department of Anesthesia, Beilinson Hospital, Rabin Medical Center associated with Sakler Medical School, Tel Aviv, Israel
| | - Amit Frenkel
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Soroka University Medical Center, Beer Sheva, Southern, Israel
| | - Yaakov Beilin
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, New York, USA
| | - Daniel J Katz
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, New York, USA
| | - Ira Schlosberg
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, New York, USA
| | - Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Soroka University Medical Center, Beer Sheva, Southern, Israel
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24
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Keltz A, Heesen P, Katz D, Neuman I, Morgenshtein A, Azem K, Binyamin Y, Hadar E, Eidelman LA, Orbach-Zinger S. Intraoperative pain during caesarean delivery: Incidence, risk factors and physician perception. Eur J Pain 2021; 26:219-226. [PMID: 34448323 PMCID: PMC9291577 DOI: 10.1002/ejp.1856] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/24/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Intraoperative pain is a possible complication of neuraxial anaesthesia for caesarean delivery. There is little information available about its incidence, risk factors and physician perception. METHODS Parturients undergoing spinal anaesthesia for elective caesarean delivery were enrolled. Before surgery, parturients were asked about preoperative anxiety on a verbal numerical scale (VNS), anticipated analgesic requirement, postoperative pain levels, Spielberger STATE-TRAIT inventory index, Pain Catastrophizing Scale. After surgery, parturients were asked to answer questions (intraoperative VNS pain). The anaesthesiologist and obstetrician were asked to fill out a questionnaire asking about perceived intraoperative pain. Influence of preoperative anxiety on intraoperative pain (yes/no) was assessed using logistic regression. Mc Fadden's R2 was calculated. The agreement in physician perception of intraoperative pain with reported pain by the parturient was examined by calculating Cohen's kappa and 95% Confidence Intervals (CI). RESULTS We included 193 parturients in our analysis. Incidence of intraoperative pain was 11.9%. Median intraoperative VNS pain of parturients with pain was 4.0 (1st quartile 4.0; 3rd quartile 9.0). Preoperative anxiety was not a good predictor of intraoperative pain (p-value of β-coefficient = 0.43, Mc Fadden's R2 = 0.01). Including further preoperative variables did not result in a good prediction model. Cohen's kappa between reported pain by parturient and by the obstetrician was 0.21 (95% CI: 0.01, 0.41) and by the anaesthesiologist was 0.3 (95% CI: 0.12, 0.48). CONCLUSIONS We found a substantial incidence (11.9%) of intraoperative pain during caesarean delivery. Preoperative anxiety did not predict intraoperative pain. Physicians did not accurately identify parturients' intraoperative pain. SIGNIFICANCE Intraoperative pain occurred in 11.9% and severe intraoperative pain occurred in 1.11% of parturients undergoing elective caesarean delivery under spinal anaesthesia. We did not find any preoperative variables that could reliably predict intraoperative pain. Obstetricians and anaesthesiologists underestimated the incidence of intraoperative pain in our cohort and thus, more attention must be put to parturients' pain.
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Affiliation(s)
- Amir Keltz
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Philip Heesen
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel Katz
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ido Neuman
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anna Morgenshtein
- Department of women's surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Karam Azem
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eran Hadar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Rabin Medical Center, Helen Schneider Hospital for Women, Beilinson Hospital, Petach Tikva, Israel
| | - Leonid A Eidelman
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Orbach-Zinger
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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25
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Binyamin Y, Heesen P, Orbach‐Zinger S, Gozal Y, Halimi D, Frenkel A, Ioscovich A. Chronic pain in parturients with an accidental dural puncture: A case-controlled prospective observational study. Acta Anaesthesiol Scand 2021; 65:959-966. [PMID: 33725362 DOI: 10.1111/aas.13816] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/10/2020] [Accepted: 02/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND We set out to examine incidence of chronic headache and back pain in women with PDPH after accidental dural puncture during labor. METHODS Chronic headache, backache, and disability were assessed 18-24 months postpartum. Women with PDPH treated with epidural blood patch (PDPH-EBP) were identified and matched with women who had a PDPH without epidural blood patch (PDPH-no EBP), with women with uncomplicated epidural analgesia and with women without epidural analgesia. Our primary outcome was incidence of chronic headache and backache. Secondary outcome was the effect of epidural blood patch on chronic pain development. We used Chi-square or Fisher's exact test to calculate odds ratios. RESULTS There was no statistically significant difference in demographic characteristics between groups. In the no epidural group, no women reported chronic headache and 2/116 (1.7%) reported chronic backache. In the uncomplicated epidural group, no women reported chronic headache and 7/116 (6.0%) reported chronic backache. In the PDPH-no EBP group, 9/56 (16.1%) women reported chronic headache and 10/56 (17.9%) reported chronic backache. In the PDPH-EBP group, 12/59 (20.3%) had chronic headache and 14/59 (23.7%) had chronic backache. No women in the no epidural or uncomplicated epidural group reported disability (chronic pain score of 3 or 4). High disability was reported by 8.9% of women in the PDPH-no EBP group and by 8.4% in the PDPH-EBP group. CONCLUSION Women with PDPH had a high incidence of chronic headache, back pain, and disability. We did not find a statistically significant difference in chronic pain development between conservatively treated and EBP-treated patients.
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Affiliation(s)
- Yair Binyamin
- Department of Anesthesiology Soroka University Medical Center and the Faculty of Health Sciences Ben‐Gurion University of the Negev Beer‐Sheva Israel
| | - Philip Heesen
- Faculty of Medicine University of Zurich Zurich Switzerland
| | - Sharon Orbach‐Zinger
- Department of Anesthesiology Rabin Medical Center Beilinson Hospital Petach Tikva Israel
| | - Yaacov Gozal
- Department of Anesthesiology Perioperative Medicine and Pain Treatment Shaare Zedek Medical Center affiliated with the Hebrew University Hadassah Medical School Jerusalem Israel
| | - David Halimi
- Department of Anesthesiology Perioperative Medicine and Pain Treatment Shaare Zedek Medical Center affiliated with the Hebrew University Hadassah Medical School Jerusalem Israel
| | - Amit Frenkel
- Department of Anesthesiology Soroka University Medical Center and the Faculty of Health Sciences Ben‐Gurion University of the Negev Beer‐Sheva Israel
| | - Alexander Ioscovich
- Department of Anesthesiology Perioperative Medicine and Pain Treatment Shaare Zedek Medical Center affiliated with the Hebrew University Hadassah Medical School Jerusalem Israel
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26
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Binyamin Y, Heesen P, Gruzman I, Zlotnik A, Ioscovich A, Ronen A, Weiniger CF, Frank D, Sheiner E, Orbach-Zinger S. A Retrospective Investigation of Neuraxial Anesthesia Rates for Elective Cesarean Delivery Before and During the SARS-CoV-2 Pandemic. Isr Med Assoc J 2021; 23:408-411. [PMID: 34251121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Our hospital used to perform cesarean delivery under general anesthesia rather than neuraxial anesthesia, mostly because of patient refusal of members of the conservative Bedouin society. According to recommendations implemented by the Israeli Obstetric Anesthesia Society, which were implemented due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, we increased the rate of neuraxial anesthesia among deliveries. OBJECTIVES To compare the rates of neuraxial anesthesia in our cesarean population before and during SARS-CoV-2 pandemic. METHODS We included consecutive women undergoing an elective cesarean delivery from two time periods: pre-SARS-CoV-2 pandemic (15 February 2019 to 14 April 2019) and during the SARS-CoV-2 pandemic (15 February 2020 to 15 April 2020). We collected demographic data, details about cesarean delivery, and anesthesia complications. RESULTS We included 413 parturients undergoing consecutive elective cesarean delivery identified during the study periods: 205 before the SARS-CoV-2 pandemic and 208 during SARS-CoV-2 pandemic. We found a statistically significant difference in neuraxial anesthesia rates between the groups: before the pandemic (92/205, 44.8%) and during (165/208, 79.3%; P < 0.0001). CONCLUSIONS We demonstrated that patient and provider education about neuraxial anesthesia can increase its utilization. The addition of a trained obstetric anesthesiologist to the team may have facilitated this transition.
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Affiliation(s)
- Yair Binyamin
- Department of Anesthesiology, Soroka Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Phillip Heesen
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Igor Gruzman
- Department of Anesthesiology, Soroka Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alexander Zlotnik
- Department of Anesthesiology, Soroka Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alexander Ioscovich
- Department of Anesthesiology, Shaare Zedek Medical Center, Jerusalem, Israel
- Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Ariel Ronen
- Department of Anesthesiology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
| | - Carolyn F Weiniger
- Division of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dmitry Frank
- Department of Anesthesiology, Soroka Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Eyal Sheiner
- Obstetrics and Gynecology, Soroka Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Sharon Orbach-Zinger
- Department of Anesthesiology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
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Frenkel A, Hassan L, Segal A, Israeli A, Binyamin Y, Zlotnik A, Novack V, Klein M. Estimation of Potassium Changes Following Potassium Supplements in Hypokalemic Critically Ill Adult Patients-A Patient Personalized Practical Treatment Formula. J Clin Med 2021; 10:jcm10091986. [PMID: 34063164 PMCID: PMC8125284 DOI: 10.3390/jcm10091986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/16/2021] [Accepted: 04/29/2021] [Indexed: 10/29/2022] Open
Abstract
Hypokalemia is common among critically ill patients. Parenteral correction of hyperkalemia depends on dosages and patient characteristics. Our aims were to assess changes in potassium levels following parenteral administration, and to derive a formula for predicting rises in serum potassium based on patient characteristics. We conducted a population-based retrospective cohort study of adults hospitalized in a general intensive care unit for 24 h or more between December 2006 and December 2017, with hypokalemia. The primary exposures were absolute cumulative intravenous doses of 20, 40, 60 or 80 mEq potassium supplement. Adjusted linear mixed models were used to estimate changes in serum potassium. Of 683 patients, 422 had mild and 261 moderate hypokalemia (serum potassium 3.0-3.5 mEq/L and 2.5-2.99 mEq, respectively). Following doses of 20-80 mEq potassium, serum potassium levels rose by a mean 0.27 (±0.4) mEq/L and 0.45 (±0.54) mEq/L in patients with mild and moderate hypokalemia, respectively. Changes were associated with creatinine level, and the use of mechanical ventilation and vasopressors. Among critically ill patients with mild to moderate hypokalemia, increases in serum potassium after intravenous potassium supplement are influenced by several clinical parameters. We generated a formula to predict the expected rise in serum potassium based on clinical parameters.
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Affiliation(s)
- Amit Frenkel
- General Intensive Care Unit, Soroka University Medical Center, Beer-Sheva 8410101, Israel;
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel; (Y.B.); (A.Z.); (V.N.)
- Correspondence: ; Tel.: +972-8-640-0727; Fax: +972-8-640-3390
| | - Lior Hassan
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva 8410101, Israel; (L.H.); (A.S.); (A.I.)
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel
| | - Adi Segal
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva 8410101, Israel; (L.H.); (A.S.); (A.I.)
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel
| | - Adir Israeli
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva 8410101, Israel; (L.H.); (A.S.); (A.I.)
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel
| | - Yair Binyamin
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel; (Y.B.); (A.Z.); (V.N.)
- Department of Anesthesiology, Soroka University Medical Center, Beer-Sheva 8410101, Israel
| | - Alexander Zlotnik
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel; (Y.B.); (A.Z.); (V.N.)
- Department of Anesthesiology, Soroka University Medical Center, Beer-Sheva 8410101, Israel
| | - Victor Novack
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel; (Y.B.); (A.Z.); (V.N.)
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva 8410101, Israel; (L.H.); (A.S.); (A.I.)
- Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Moti Klein
- General Intensive Care Unit, Soroka University Medical Center, Beer-Sheva 8410101, Israel;
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel; (Y.B.); (A.Z.); (V.N.)
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Frenkel A, Zeldetz V, Gat R, Binyamin Y, Acker A, Frenkel M, Klein M, Novack V, Schwarzfuchs D. Atrial Fibrillation and Mortality in the Oldest Old after Surgery for Hip Fractures. Gerontology 2021; 67:299-305. [PMID: 33596580 DOI: 10.1159/000513450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 11/28/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION One-year mortality following hip fractures increases steeply with age, from 2% in the 60- to 69-year-old population up to 28% in the oldest old (older than 90 years). Of the various factors that contribute to hip fractures, atrial fibrillation (AF) is an independent risk factor at any age. OBJECTIVE The objective of this study was to assess the association of AF with mortality among the oldest old with hip fractures. METHOD This is a retrospective cohort study of 701 persons above age 90 years who underwent orthopedic repair for a hip fracture during 2000-2018. Of them, 218 (31%) had AF at hospital admission. The primary outcome was survival following surgery. We compared patient characteristics and 30-day, 180-day, 1-year, and 3-year survival between patients with and without AF. RESULTS The adjusted odds ratio for 30-day postoperative mortality for those with AF versus without AF group was 1.03 (95% confidence interval [CI] 0.63-1.66). Survival estimates were higher among those without AF than with AF at 180 days postoperative: 0.85 (95% CI 0.82-0.89) versus 0.68 (95% CI 0.61-0.74), p < 0.001; at 1 year postoperative: 0.68 (95% CI 0.63-0.72) versus 0.48 (95% CI 0.42-0.55), p < 0.001; and at 3 years postoperative: 0.47 (95% CI 0.42-0.52) versus 0.28 (95% CI 0.27-0.34), p < 0.001. CONCLUSIONS Among individuals aged >90 years, operated for hip fractures, mortality was similar for those with and without AF at 30 days postoperative. However, the survival curves diverged sharply after 180 days. Our findings suggest that AF is not an immediate surgical risk factor, but rather confers increased long-term risk in this population.
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Affiliation(s)
- Amit Frenkel
- General Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel, .,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel,
| | - Vladimir Zeldetz
- Emergency Medicine Department, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Roni Gat
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asaf Acker
- Orthopedic Surgery Department, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Merav Frenkel
- Endocrine Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Moti Klein
- General Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dan Schwarzfuchs
- Emergency Medicine Department, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Frenkel A, Binyamin Y, Gabai O, Bichovsky Y, Brotfain E, Klein M. Bilateral Pleural Effusion Secondary to Silicone Breast Implants Leaks. Am Surg 2019. [DOI: 10.1177/000313481908501121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Amit Frenkel
- General Intensive Care Unit Soroka University Medical Center and the Faculty of Health Sciences Ben-Gurion University of the Negev Beer-Sheva, Israel
| | - Yair Binyamin
- Department of Anesthesiology Soroka University Medical Center and the Faculty of Health Sciences Ben-Gurion University of the Negev Beer-Sheva, Israel
| | - Ohad Gabai
- General Intensive Care Unit Soroka University Medical Center and the Faculty of Health Sciences Ben-Gurion University of the Negev Beer-Sheva, Israel
| | - Yoav Bichovsky
- General Intensive Care Unit Soroka University Medical Center and the Faculty of Health Sciences Ben-Gurion University of the Negev Beer-Sheva, Israel
| | - Evgeni Brotfain
- General Intensive Care Unit Soroka University Medical Center and the Faculty of Health Sciences Ben-Gurion University of the Negev Beer-Sheva, Israel
| | - Moti Klein
- General Intensive Care Unit Soroka University Medical Center and the Faculty of Health Sciences Ben-Gurion University of the Negev Beer-Sheva, Israel
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Frenkel A, Binyamin Y, Gabai O, Bichovsky Y, Brotfain E, Klein M. Bilateral Pleural Effusion Secondary to Silicone Breast Implants Leaks. Am Surg 2019; 85:e569-e571. [PMID: 31775996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Frenkel A, Binyamin Y, Zeldetz V, Koyfman L, Klein M, Brotfain E. Pneumomediastinum, ST elevation and urgent cardiac catheterisation: a crucial triad? BMJ Case Rep 2019; 12:12/2/bcr-2018-227932. [PMID: 30733249 DOI: 10.1136/bcr-2018-227932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pneumomediastinum (PNMD) entails the presence of air or other gas in the mediastinum and is also known as mediastinal emphysema. PNMD may cause a wide variety of signs and symptoms, as well as ECG abnormality, including ST segment changes. We present a 56-year-old man admitted to our hospital after a facial trauma. After undergoing tracheostomy, he complained of chest discomfort. A chest X-ray in the posteroanterior view showed PNMD, and an ECG was suggestive of inferior-lateral wall myocardial infarction. An urgent cardiac catheterisation identified a critical obstruction at the origin of the right coronary artery. Following a balloon angioplasty, chest discomfort continued; and the ECG ST segments did not show any dynamic change during the subsequent 72 hours. We urge clinicians to perform a comprehensive workup for every patient presenting with PNMD and ST segment changes, to prevent unnecessary invasive procedures.
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Affiliation(s)
- Amit Frenkel
- General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Vladimir Zeldetz
- Emergency Medicine Departemt, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Leonid Koyfman
- General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Moti Klein
- General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Evgeni Brotfain
- General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Binyamin Y, Frenkel A, Brotfain E, Koyfman L, Shliom O, Klein M. Elevated CPK levels after hydrazine inhalation exposure in an F16 aircraft technician. Toxicol Rep 2018; 5:927-928. [PMID: 30225198 PMCID: PMC6139486 DOI: 10.1016/j.toxrep.2018.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 07/25/2018] [Accepted: 08/13/2018] [Indexed: 11/17/2022] Open
Abstract
Hydrazine is a hazardous material that is commonly used in the pharmaceutical industry, as well as in rocket and jet fuels, including the emergency power unit of F-16 model jets. We present four ground crew technicians who were exposed to hydrazine for less than one minute, due to a voltage fall in an F-16 jet. Physical examinations were normal and none of the technicians were symptomatic for toxicity. One of the technicians had abnormal blood chemistry levels for liver and muscle enzymes: serum glutamic-oxaloacetic transaminase(SGOT)-321U/L, serum glutamate-pyruvate transaminase (SGPT)-123U/L, and creatine phosphokinase (CPK) 3300U/L. The CPK level peaked during hospitalization to 20960U/L at 36 h after the exposure, and subsequently declined. Upon release from the hospital, 48 h after the exposure, the CPK level -was 9429U/L. In repeated tests one week and one year after exposure, liver function and CPK levels were normal. We conclude that evaluation of blood tests is important, in addition to a physical examination, in asymptomatic persons following exposure to even short term highly elevated levels of hydrazine.
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Affiliation(s)
- Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Centerand the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Amit Frenkel
- General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Evgeni Brotfain
- General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Leonid Koyfman
- General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ori Shliom
- Department of Family Medicine, Clalit Health Services andFaculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Moti Klein
- General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Frenkel A, Bichovsky Y, Perry ZH, Peiser J, Roy-Shapira A, Brotfain E, Koyfman L, Binyamin Y, Nalbandyan K, Klein M. Management of gastrosplenic fistula in the emergency setting - A case report and review of the literature. Ann Med Surg (Lond) 2018; 29:26-29. [PMID: 29692893 PMCID: PMC5911671 DOI: 10.1016/j.amsu.2018.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 02/15/2018] [Accepted: 03/24/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION A gastrosplenic fistula (GSF) is a very rare complication that arises mainly from a splenic or gastric large cell lymphoma. The proximity of the gastric fundus to the enlarged fragile spleen may facilitate the fistulisation. This complication can lead to massive bleeding, which, though uncommon, may be lethal. We present a patient with massive upper gastrointestinal bleeding secondary to a GSF. CASE PRESENTATION We present a 48-year-old man with a refractory diffuse large B-cell lymphoma who was admitted to our hospital due to hematemesis. On arrival, he was in hemorrhagic shock, and was taken directly to the intensive care unit. The source of bleeding could not be identified on gastroscopy, the patient remained hemodynamically unstable and a laparotomy was performed.A fistula between a branch of the splenic artery and the stomach was identified. The stomach appeared to be involved in the malignant process. After subtotal gastrectomy and splenectomy, the bleeding was controlled. After stabilization, the patient was admitted to the intensive care unit, and 24 hours later was discharged in stable condition. DISCUSSION We describe a fistula between a branch of the splenic artery and the stomach, which was accompanied by massive bleeding. An emergency laparotomy saved the patient's life. CONCLUSION The purpose of this report is to alert physicians that surgical intervention can be lifesaving in this rare malignant condition. A literature review focusing on the presenting symptoms and the epidemiology of GSF is presented.
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Affiliation(s)
- Amit Frenkel
- General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yoav Bichovsky
- General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Zvi H. Perry
- Department of General Surgery, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jochanan Peiser
- Department of General Surgery, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aviel Roy-Shapira
- General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of General Surgery, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Evgeni Brotfain
- General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Leonid Koyfman
- General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Karen Nalbandyan
- Department of Pathology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Moti Klein
- General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Binyamin Y, Shter GE, Gelman V, Avnir D, Grader GS. Activated organically doped silver: enhanced catalysis of methanol oxidation. Catal Sci Technol 2011. [DOI: 10.1039/c1cy00384d] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Binyamin Y, Frenkel A, Barski L, Novack V, Almog YY. [Bedside percutaneous tracheostomy in critically ill medical patients: clinical characteristics, outcome and complications]. Harefuah 2010; 149:143-195. [PMID: 20684163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Tracheostomy is a surgical procedure, frequently used in patients with respiratory failure requiring prolonged mechanical ventilation. It is associated with fewer complications and may facilitate weaning from mechanical ventilation. Over the past 15 years, bedside percutaneous tracheostomy (PDT) has been widely employed as the primary method for performing tracheostomy in intensive care units. However, the ideal technique and timing for this procedure is still controversial. OBJECTIVES To characterize the patients who underwent bedside percutaneous tracheostomy (PDT) in the Medical Intensive Care Unit (MICU) in terms of complications, clinical characteristics upon admission, short and long term outcome. METHODS This retrospective cohort study included all patients hospitalized at the MICU from January 2003 to December 2007 who underwent bedside PDT. The patients' demographic data, past diagnosis, reason for admission to the ICU and a wide variety of data regarding procedure performance and complications were retrieved from the patients' charts. The information was subsequently computerized and analyzed. RESULTS The study population included 126 patients who underwent bedside PDT. Overall, 63.5% were men and the average age was 59.8 years. Patients who survived for 30 days after the procedure had a lower burden of background morbidity as reflected by their Charlson score. The one year mortality rate was 56.6%, of which 70% of the patients died in the first month following the procedure. Overall complication rate was low and occurred in 9 patients (7.1%). There was no procedure-related mortality. The most common pathogens isolated from patients' sputum were Acinetobacter spp. and Pseudomonas aeruginosa. The survival rate was highest among the group of patients who underwent tracheostomy during the first 10 days after initiation of mechanical ventilation. CONCLUSIONS Bedside PDT is a simple, safe and readily available procedure with low morbidity rates when performed by an experienced operator. However, long term outcome remains poor Survival rates were lower among patients who underwent the procedure within ten days of mechanical ventilation.
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