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Since the introduction of immunotherapy and targeted therapies, patients not only have adequate tumoral response to these treatments, but their quality of life has improved due to milder toxicities. However, due to their wide mechanisms of action, the toxicity profile for these therapies is broad, can have an insidious onset, and their recognition can be challenging. Rarely, some of these toxicities can cause significant morbidity if not diagnosed early and lead to intensive care unit (ICU) admission and death. Anesthesiologists are likely to encounter not only a wide spectrum of these toxicities but also a wide range of severity. In some cases, they could be the first to make the diagnosis and therefore need to be prepared to rapidly assess, establish differentials, perform a diagnostic workup, and evaluate the impact the toxicity could have on the patients' care during the perioperative period. In this article, we set to review toxicities of novel cancer therapies such as checkpoint inhibitors and targeted therapies, that could present in the perioperative setting. This article will help as a guide for anesthesiologists to recognize their clinical presentation, the approach to their diagnosis, and their impact on patient care., Competing Interests: Conflicts of Interest, Funding: Please see DISCLOSURES at the end of this article., (Copyright © 2024 International Anesthesia Research Society.)

Immune check inhibitors (ICIs) are a class of biologic therapy used for cancer treatment that enhances T-cell recognition of cancer cells. Toxicities from ICIs are described as immune-related adverse events (irAEs) with Grade 1 to 2 irAEs representing mild-to-moderate toxicity and Grade 3 to 4 irAEs representing severe to life-threatening toxicity. The long half-life of ICIs contributes to the extended and unpredictable nature of irAEs. ICI therapy is typically stopped for Grade 3 to 4 irAEs except for endocrinopathies if clinically optimized. Toxicities can involve any organ system; therefore, a thorough preoperative assessment is imperative to ensure appropriate clinical management., Competing Interests: Disclosure The authors have nothing to disclose., (Published by Elsevier Inc.)

Background: Racial and ethnic differences in health care may result in significant morbidity. The objective of this study was to determine whether there was an association between a patient's race or ethnicity and the receipt of an antiemetic agent preoperatively, during surgery, and in the recovery room., Methods: A single-institution retrospective study of adult patients (>18 years) who had undergone cancer-related operating room procedures under anesthesia between March 2016 and August 2021 was conducted. A multivariable logistic regression model was fitted to estimate the effects of covariates on antiemetic administration., Results: Of the 60,595 patients included in the study, 3053 (5.0%) self-identified as Asian, 5376 (8.9%) as Black, 8431 (13.9%) as Hispanic or Latino, 42,533 (70.2%) as White, and 1202 (2.0%) as belonging to another racial or ethnic group. Multivariable analyses showed significant associations between a patient's race or ethnicity and the receipt of antiemetics in the preoperative holding area, operating room, and recovery room (all P < .001). In the preoperative holding area, White patients (8962 of 42,533 [21.1%]; odds ratio [OR], 1.188; 95% confidence interval [CI], 1.100-1.283; P < .001) had higher odds of receiving an antiemetic than Black patients (1006 of 5376 [18.7%]). Intraoperatively, the odds were significantly greater for Hispanic or Latino (7323 of 8431 [86.9%]; OR, 1.175; 95% CI, 1.065-1.297; P = .001) and patients who identified as belonging to another race (1078 of 1202 [89.7%]; OR, 1.582; 95% CI, 1.290-1.941; P < .001) than for Black patients (4468 of 5376 [83.1%]). In the recovery room, Asian (499 of 3053 [16.3%]; OR, 1.328; 95% CI: 1.127-1.561; P < .001), Hispanic or Latino (1335 of 8431 [15.8%]; OR, 1.208; 95% CI, 1.060-1.377; P < .005), and White patients (6533 of 42,533 [15.4%]; OR, 1.276; 95% CI, 1.140-1.427; P < .001) had significantly higher odds of receiving antiemetics than Black patients (646 of 5376 [12%])., Conclusions: This retrospective study suggests significant differences between the administrations of antiemetics to patients of different races or ethnicities, with Black patients often being less likely to receive an antiemetic than patients belonging to all other races or ethnicities., Competing Interests: Conflicts of Interest, Funding: Please see DISCLOSURES at the end of this article., (Copyright © 2024 International Anesthesia Research Society.)

Objectives: Improving family-centered outcomes is a priority in oncologic critical care. As part of the Intensive Care Unit (ICU) Patient-Centered Outcomes Research Collaborative, we implemented patient- and family-centered initiatives in a comprehensive cancer center., Methods: A multidisciplinary team was created to implement the initiatives. We instituted an open visitation policy (OVP) that revamped the use of the two-way communication boards and enhanced the waiting room experience by hosting ICU family-centered events. To assess the initiatives' effects, we carried out pre-intervention (PRE) and post-intervention (POST) family/caregiver and ICU practitioner surveys., Results: A total of 159 (PRE = 79, POST = 80) family members and 147 (PRE = 95, POST = 52) ICU practitioners participated. Regarding the decision-making process, family members felt more included (40.5% vs. 68.8%, p < 0.001) and more supported (29.1% vs. 48.8%, p = 0.011) after the implementation of the initiatives. The caregivers also felt more control over the decision-making process in the POST survey (34.2% vs. 56.3%, p = 0.005). Although 33% of the ICU staff considered OVP was beneficial for the ICU, 41% disagreed and 26% were neutral. Only half of them responded that OVP was beneficial for patients and 63% agreed that OVP was beneficial for families. Half of the practitioners agreed that OVP resulted in additional work for staff., Significance of Results: Our project effectively promoted patient- and family-centered care. The families expressed satisfaction with the communication of information and the decision-making process. However, the ICU staff felt that the initiatives increased their work load. Further research is needed to understand whether making this project universal or introducing additional novel practices would significantly benefit patients admitted to the ICU and their family.

Background: Management of coagulopathy during major oncologic surgery can be multifactorial and challenging. Viscoelastic assays (VEAs) can be useful in providing vital data about the mechanism of coagulopathy in these dynamic circumstances., Objectives: A prospective nonrandomized observational study with the aim of describing the coagulation parameters of patients undergoing major oncologic surgery using the Quantra® and TEG® 5000 systems. Our secondary objectives included the correlation between Quantra and TEG parameters, and the times to result for both technologies., Methods: This study included 74 adults undergoing oncologic surgery with an anticipated blood loss of more than 500 ml. For each subject, whole blood samples for each device were collected at multiple points perioperatively for comparison., Results: Correlation coefficients between Quantra and TEG parameters were 0.8 and above, indicating a very strong correlation (p < .001). Correlation coefficients between conventional laboratory tests and Quantra ranged from 0.74 to 0.83, indicating a moderate correlation (p < .001). The mean time to obtain results and total processing time was shorter for Quantra in comparison to TEG., Conclusions: Quantra parameters strongly correlated with TEG parameters; however, Quantra parameters were available in shorter amount of time as it is specifically designed as a closed point of care device., (© 2021 Wiley Periodicals LLC.)

Magnesium is known to act at the neuromuscular junction by inhibiting the presynaptic release of acetylcholine and desensitizing the postsynaptic membrane. Because of these effects, magnesium has been postulated to potentiate neuromuscular weakness. We describe the case of a 62-year-old woman with myasthenia gravis and a metastatic thymoma who was admitted to our intensive care unit for management of a myasthenic crisis. The patient's neuromuscular weakness worsened in association with standard intravenous magnesium replacement, and the exacerbated respiratory failure necessitated intubation, mechanical ventilation, and an extended stay in the intensive care unit. The effect of magnesium replacement on myasthenia gravis patients has not been well documented, and we present this case to increase awareness and stimulate research. In addition, we discuss the relevant medical literature.

The study is a description of a sensitive spectrophotometric determination of aceclofenac following azo dye formation with 4-carboxyl-2,6-dinitrobenzenediazonium ion (CDNBD). Spot test and thin layer chromatography revealed the formation of a new compound distinct from CDNBD and aceclofenac. Optimization studies established a reaction time of 5 min at 30 degrees C after vortex mixing the drug/CDNBD for 10 s. An absorption maximum of 430 nm was selected as analytical wavelength. A linear response was observed over 1.2-4.8 μg/mL of aceclofenac with a correlation coefficient of 0.9983 and the drug combined with CDNBD at stoichiometric ratio of 2 : 1. The method has a limit of detection of 0.403 μg/mL, limit of quantitation of 1.22 μg/mL and is reproducible over a three day assessment. The method gave Sandell's sensitivity of 3.279 ng/cm2. Intra- and inter-day accuracies (in terms of errors) were less than 6% while precisions were of the order of 0.03-1.89% (RSD). The developed spectrophotometric method is of equivalent accuracy (p > 0.05) with British Pharmacopoeia, 2010 potentiometric method. It has the advantages of speed, simplicity, sensitivity and more affordable instrumentation and could found application as a rapid and sensitive analytical method of aceclofenac. It is the first described method by azo dye derivatization for the analysis of aceclofenac in bulk samples and dosage forms.

Comprehensive electronic absorption spectra of a new dye series, 4-carboxyl-2,6-dinitrophenylazohydroxynaphthalenes have been investigated in solvents of varying polarities. The solvent dependent UV-vis spectral shifts were analysed using some solvent physical parameters such as refractive index, dielectric function, hydrogen bonding acceptor ability, orientation of polarization and others. The observed spectral shifts were correlated with different solute-solvent interaction mechanisms using simple and multiple linear regression analyses. The results of the curve fitting coefficients enabled us to classify the various interactions of solvents with the dyes and relate the solvatochromic behaviours to the substituent effects on the dye molecules. Charge-transfer complexation occurring between one of the congeners and N,N'-dimethylformamide was extensively studied and discovered to be both concentration- and temperature-dependent. The electronic character and the chemical nature of the solvents as well as the chemical nature of the other substituents, apart from the common hydroxyl group, are important factors for the observed solvatochromic properties of the 4-carboxyl-2, 6-dinitrophenylazohydroxynaphthalenes., (Copyright (c) 2009 Elsevier B.V. All rights reserved.)

Some phenyl azo hydroxynaphthalene dyes (e.g., sunset yellow) are certified as approved colorants for food, cosmetics, and drug formulations. The hydrophobicity of 4 newly synthesized azo dyes of the phenyl azo hydroxynaphthalene class was investigated, as a training set, with the goal of developing models for quantitative structure-property relationships (QSPR). Retention behavior of the molecules reversed-phase thin-layer chromatography (RPTLC) was investigated using liquid paraffin-coated silica gel as the stationary phase. Mobile phases consisted of aqueous mixtures of methanol, acetone, and dimethylformamide (DMF). Basic hydrophobicity parameter (Rmw), specific hydrophobic surface area (S), and isocratic chromatographic hydrophobicity index (phio) were computed from the chromatographic data. The hydrophobicity index (Rm) decreased linearly with increasing concentration of organic modifiers. Extrapolated Rmw values obtained by using DMF and acetone differ significantly from the value obtained by using methanol as organic modifier [P < 0.05, 1-way analysis of variance (ANOVA), Tukey's multiple comparison test]. Structure-property relationships showed that hydrophobicity was dependent on type and position of naphthalene ring substituents. Rm decreased with the presence of a highly polar substituent (e.g., COOH). Owing to intramolecular interaction, Rm increased when the common hydroxyl group (OH) is positioned ortho to the azo group, relative to para positioning, in 2 positional isomers. Pattern recognition data analysis underscores the utility of phio as a more accurate hydrophobicity descriptor than Rmw. Phio is negatively correlated with theoretically calculated density, surface tension, and refractive index for the molecules. These models could be used to predict toxicity (absorption, distribution, metabolism, excretion, toxicity; ADMET) properties of the azo dyes and may also play useful roles in computer-assisted molecular discovery of nontoxic azo dyes.

A simple, sensitive and direct colorimetric method for the determination of indomethacin either in pure form or in capsules has been developed. The method is based on the diazo coupling reaction between indomethacin and a highly reactive arenediazonium ion, 4-carboxyl-2,6-dinitrobenzene diazonium ion, with the consequent formation of an azo dye. The reaction is fast and gave an orange azo dye in ethyl acetate. The assay was carried out at 470 nm and the azo adduct was stable for three hours. Beer's law is obeyed in the concentration range of 3.3-11 microg mL(-1) of indomethacin. Optimization studies established an optimum reaction time of 20 minutes at 30 degrees C and the drug-to-reagent ratio of 1:2 for optimal detector response. The method developed has a low limit of detection of 0.90 microg mL(-1) and is precise (RSD 2.3%). The new method has been successfully applied to the determination of indomethacin in capsules and the method is of equivalent accuracy as the official (BP) spectrophotometric method. The new method could find application as a simple analytical method for the assay of indomethacin in capsules.

This study describes a novel simple, rapid and sensitive colorimetric assay method for diclofenac sodium tablets. The method is based on a simple aromatic ring derivatization technique using newly developed 4-carboxyl-2, 6-dinitrobenzenediazonium ion (CDNBD) as chromogenic derivatizing reagent with subsequent formation of an azo dye. The diazo coupling reaction was carried out between CDNBD and diclofenac. Optimization studies for time and temperature was conducted using the method of steepest ascent. The UV absorption spectrum was recorded and the stoichiometric ratio for the drug and reagent was done by continuous variation method. Optimal calibration range was fixed (1-way ANOVA) and then the method was applied to dosage form analysis. Comparison of dosage form analysis was done with the BP HPLC method. The diazo coupling reaction is very fast and optimization studies established an optimal reaction immediately after mixing the reaction mixture in a vortex mixer for 10 sec. A new absorption maximum (lambdamax) at 470 nm was selected as analytical wavelength. The assays were linear over 1.35-10.8 microg/ml of diclofenac and the reaction required a 2:1 reagent/drug stoichiometric ratio. The new method has a low limit of detection of 0.27 microg/ml, and was reproducible over a three-day assessment of precision (RSD 2.31%). The method has been successfully applied to the assay of diclofenac sodium slow-release tablets and found to be of equivalent accuracy (p>0.05) with the official (B.P 1998) HPLC method. The new method has distinct advantages of speed, simplicity, sensitivity, and more affordable instrumentation and could find application as a rapid analytical method for diclofenac sodium tablets.

The kinetics of thermal decomposition of 4-carboxyl-2,6-dinitrobenzenediazonium ion (CDNBD), an arenediazonium ion newly developed as a derivatizing reagent for drug analysis, are described. The arenediazonium ion, in an optimized concentrated sulfuric acid/orthophosphoric acid medium, was incubated for various time intervals at 30 degrees, 45 degrees, 55 degrees , 65 degrees , 75 degrees, and 85 degrees C. The amount of ion left after each time interval was quantified selectively by colorimetric assay at 490 nm, using mefenamic acid as a model diazo-coupling component. The rate constants for the decomposition were determined graphically. An Arrhenius plot was used to delineate the dependence of the rate constant on temperature and to predict the half-life at 25 degrees C and lower temperatures. The diazonium ion decomposed by first-order kinetics. The rate constants of decomposition, which increased progressively with temperature, were 3.18 +/- 0.41 x 10(-5), 1.19 +/- 0.07 x 10(-4), 4.87 +/- 0.15 x 10(-4), 12.88 +/- 0.73 x 10(-4), and 21.32 +/- 2.74 x 10(-4) (s(-1)) with corresponding half-lives of 363, 97.06, 23.72, 8.97, and 5.42 min at 30 degrees, 45 degrees, 55 degrees, 65 degrees, and 75 degrees C, respectively. CDNBD is highly stable in concentrated acid medium, with half-life values of about 10 h, 10 days, and 7.3 months at 25 degrees, 0 degrees, and -20 degrees C, respectively. The reagent stability profile shows that it could be readily adapted for routine applications in instrumental chemical analysis.

A novel colorimetric assay of propranolol tablets has been developed. The assay is based on chemical derivatization (aromatic ring derivatization technique) using diazotized 4-amino-3,5-dinitrobenzoic acid (ADBA) as the chromogenic derivatizing reagent and resultant formation of azo dyes. Optimization studies established an optimal reaction time of 5 min at 30 degrees C after mixing on a Vortex mixer the drug/reagent mixture for 10 s. A new absorption maximum (lambda(max)) was found at 470 nm, which was selected as the analytical wavelength. The assays were linear over 1-8 microg/mL propranolol, and the reaction occurred by a 1:1 reagent/drug stoichiometric ratio. The developed method has a low limit of detection of 0.76 microg/mL and is reproducible. It has been applied successfully to the assay of propranolol tablets and is of equivalent accuracy (p > 0.05) with the official (British Pharmacopoeia) ultraviolet spectrophotometric method. The new method has the main advantage of using more affordable instrumentation and could be applied to the in-process quality control of propranolol tablets.