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Background: To determine the efficacy and safety of intravenous postoperative morphine titration in the elderly compared with younger patients. Methods: In the post-anaesthesia care unit, patients complaining of pain received morphine until adequate pain relief. Intravenous morphine was titrated as 3 mg boluses in young (age ≤65 yr) and 2 mg in elderly patients (>65 yr) every 5 min. Results: We studied 350 young and 68 elderly patients. There were no significant differences between the two age groups for pain intensity at the onset of titration (numerical rating scale, 7.4 ± 1.7 in young vs. 7.5 ± 1.7 in elderly patients), area under the curve of numerical rating scale vs. morphine boluses (97.7 ± 59.6 vs. 98.2 ± 62), number of boluses required to obtain pain relief (3 ± 1.3 vs. 3 ± 1.3), percentage of titration failures (10% vs. 9%) and incidence of excessive sedation (18% vs. 21%). Renal clearance was significantly reduced in elderly compared with young patients (55 ± 21 vs. 85 ± 15 mL min-1; P<0.0001).Conclusion: Using lower bolus doses, pain relief in the immediate postoperative period with morphine was as efficacious and safe in elderly patients as in younger patients. The decrease in renal clearance of morphine in the elderly justifies the reduction of intravenous morphine boluses for the treatment of postoperative pain. [ABSTRACT FROM AUTHOR]

Summary The post-operative period is particularly dangerous for obese patients. The aim of this study was to compare the immediate post-operative course after either laparoscopic or open gastroplasty. We studied retrospectively 20 and 14 consecutive patients who underwent laparoscopic or open adjustable silicone gastric banding, respectively. After the laparoscopic procedure, patients had a significantly shorter stay in the post-anaesthesia care unit (0.3±0.4 and 1.1±1 days), reduced analgesic requirements, a shorter period of intravenous catheter use (2.3±1.9 and 4.8±1.4 days), were able to walk sooner (1±0.4 and 2.1±1.6 days) and had a significantly shorter duration of in-hospital stay (5.4±2.3 and 15.8±4.5 days) than after an open procedure. This report suggests that the use of laparoscopy for gastroplasty in morbidly obese patients may significantly improve the immediate post-operative course. [ABSTRACT FROM AUTHOR]

In cases of community-acquired peritonitis, the adequacy of empirical antibiotic treatment has been shown to attenuate mortality and morbidity.The impact of empirical antibiotics on the outcome of postoperative peritonitis has never been evaluated. This study included 100 consecutively studied patients with postoperative peritonitis. The adequacy of empirical treatment was determined by means of culture and susceptibility data obtained at the time of reoperation, and the effect of such treatment on outcome was evaluated. One hundred resistant pathogens were isolated from 70 patients, of whom 45% died; by comparison, mortality among those from whom susceptible organisms were isolated was 16% (P < .05). Inadequate empirical treatment was administered to 54 patients and was associatedwith poorer outcome(P ⩽ .05). The outcomeof postoperative peritonitis is affected by the choice and adequacy of the initial empirical antibiotic therapy. Late changes in antibiotic therapy based on culture results did not affect outcome when the initial regimen was inadequate. [ABSTRACT FROM PUBLISHER]

The correlation between the pharmacokinetics of erythromycin, roxithromycin, clarithromycin, spiramycin and azithromycin and their efficacy was investigated in two pneumococcal pneumonia models. Female Swiss and C57B1/6 mice were infected with Streptococcus pneumoniae strain P4241 by the intratracheal per oral route. This virulent strain produces acute pneumonia with death within 3-4 days (Swiss mice), or subacute pneumonia with death within 10 days (C57B1/6 mice) in untreated mice and the outcome of the disease is closely related to progressive weight loss. Swiss mice received three doses of each macrolide 50 mg/kg bd beginning 18 h post-infection. C57B1/6 mice received three doses of each macrolide 25 mg/kg, bd (except azithromycin was 12.5 mg/kg bd) beginning 48 h post-infection. Cure rates were evaluated on the basis of body weight variations recorded daily after the end of treatment. Pharmacokinetic parameters were determined in infected and non-infected mice after a single dose of each macrolide 50 mg/kg sc. The pharmacokinetics of azithromycin was also determined in leucopenic Swiss mice. We observed a hierarchy of in-vivo efficacy as follows: azithromycin > spiramycin = clarithromycin > roxithromycin = erythromycin which did not correlate with in-vitro MIC or MBC. The same hierarchy was found in terms of the lung T1/2. Lung T1/2s of macrolides could thus be predictive of their efficacy in respiratory tract infections. A reduced tissue AUC of azithromycin was seen in leucopenic mice suggesting leucocytes may help transport macrolides to sites of infection. [ABSTRACT FROM AUTHOR]