Background We describe the clinical course of medical and surgical patients who received naloxone on general hospital wards for suspected opioid induced respiratory depression (OIRD). Methods From May 2018 through October 2020, patients who received naloxone on hospital wards were identified and records reviewed for incidence and clinical course. Results There were 86,030 medical and 106,807 surgical admissions. Naloxone was administered to 99 (incidence 11.5 [95%CI 9.4–14.0] per 10,000 admissions) medical and 63 (5.9 [95%CI 4.5–7.5]) surgical patients, P < 0.001. Median oral morphine equivalents administered within 24-hour before naloxone was 32 [15, 64] and 60 [32, 88] mg for medical and surgical patients, respectively, P = 0.002. Rapid response team was activated in 69 (69.7%) vs. 42 (66.7%) and critical care transfers in 51 (51.5%) vs. 30 (47.6%) medical and surgical patients respectively. In-hospital mortality was 21 (21.2%) vs. 2 (3.2%) and discharge to hospice 12 (12.1%) vs. 1 (1.6%), for medical and surgical patients respectively, P = 0.001. Naloxone did not reverse OIRD in 38 (23%) patients, and these patients had more transfers to the intensive care unit and 30-day mortality. Conclusion Medical inpatients are more likely to suffer OIRD than surgical inpatients despite lower opioid dose. Definitive OIRD was confirmed in 77% of patients because immediate naloxone response, while 23% of patients did not respond and this subset were more likely to need higher level of care and had higher 30-day mortality. Careful monitoring of mental and respiratory variables is necessary when opiates are used in hospital.

Objectives: Suggested therapeutic options for Multisystem Inflammatory Syndrome in Children (MIS-C) include intravenous immunoglobulins (IVIG) and steroids. Prior studies have shown the benefit of combination therapy with both agents on fever control or the resolution of organ dysfunction. The primary objective of this study was to analyze the impact of IVIG and steroids on hospital and ICU length of stay (LOS) in patients with MIS-C associated with Coronavirus Disease 2019 (COVID-19).

Background: Nondepolarizing neuromuscular blockade is reversed with neostigmine/glycopyrrolate or sugammadex. Anticholinergic glycopyrrolate decreases bladder detrusor muscle contractility, potentially leading to postoperative urinary retention (POUR). POUR commonly complicates inguinal herniorrhaphy. In this study we assess association between reversal technique and POUR.Methods: Records of adult patients undergoing unilateral inguinal herniorrhaphy with neuromuscular blockade from January 2013 to September 2020 were reviewed for POUR (unplanned postoperative insertion of urinary catheter). A propensity-adjusted analysis was performed to assess POUR in neostigmine/glycopyrrolate versus sugammadex using inverse probability of treatment weighting (IPTW) to adjust for potential confounding.Results: We identified 181 patients who underwent herniorrhaphy with amnio-steroidal neuromuscular blockers, 75 (41.4%) who received sugammadex and 106 (58.6%) neostigmine/glycopyrrolate. Compared with sugammadex, neostigmine/glycopyrrolate group had longer surgical course [unweighted standardized difference (USTD) = 0.38, P = 0.004], received more intraoperative opioids (USTD = 0.704, P < 0.001), more often performed via laparoscopic approach (USTD = 0.407, P = 0.012), and less often with periprocedural urinary catheter insertion (USTD = 0.452, P = 0.003). POUR was observed in 2 (3%) of patients in the sugammadex group, and 16 (15%) in neostigmine/glycopyrrolate [unadjusted odds ratio (OR) = 0.15; 95% confidence interval (CI): 0.03-0.69; P = 0.015, and IPTW OR = 0.13; 95% CI: 0.03-0.64; P = 0.012]. Results remained similar with further analysis adjusted for opioid administration in the postanesthesia care unit (adjusted IPTW OR = 0.18; 95% CI: 0.04-0.88; P = 0.034). Of the POUR patients, 9 required unplanned overnight admission and 4 emergency room visit. Conclusion:These results suggest that neuromuscular blockade reversal with sugammadex is associated with lower rates of POUR following unilateral inguinal herniorrhaphy. Our results need to be reconfirmed in a randomized prospective study.

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Introduction Coronavirus disease 2019 (COVID‐19) is associated with high rates of morbidity and mortality. Primary hypothyroidism is a common comorbid condition, but little is known about its association with COVID‐19 severity and outcomes. This study aims to identify the frequency of hypothyroidism in hospitalized patients with COVID‐19 as well as describe the differences in outcomes between patients with and without pre‐existing hypothyroidism using an observational, multinational registry. Methods In an observational cohort study we enrolled patients 18 years or older, with laboratory‐confirmed severe acute respiratory syndrome coronavirus‐2 infection between March 2020 and February 2021. The primary outcomes were (1) the disease severity defined as per the World Health Organization Scale for Clinical Improvement, which is an ordinal outcome corresponding with the highest severity level recorded during a patient's index COVID‐19 hospitalization, (2) in‐hospital mortality and (3) hospital‐free days. Secondary outcomes were the rate of intensive care unit (ICU) admission and ICU mortality. Results Among the 20,366 adult patients included in the study, pre‐existing hypothyroidism was identified in 1616 (7.9%). The median age for the Hypothyroidism group was 70 (interquartile range: 59–80) years, and 65% were female and 67% were White. The most common comorbidities were hypertension (68%), diabetes (42%), dyslipidemia (37%) and obesity (28%). After adjusting for age, body mass index, sex, admission date in the quarter year since March 2020, race, smoking history and other comorbid conditions (coronary artery disease, hypertension, diabetes and dyslipidemia), pre‐existing hypothyroidism was not associated with higher odds of severe disease using the World Health Organization disease severity index (odds ratio [OR]: 1.02; 95% confidence interval [CI]: 0.92, 1.13; p = .69), in‐hospital mortality (OR: 1.03; 95% CI: 0.92, 1.15; p = .58) or differences in hospital‐free days (estimated difference 0.01 days; 95% CI: −0.45, 0.47; p = .97). Pre‐existing hypothyroidism was not associated with ICU admission or ICU mortality in unadjusted as well as in adjusted analysis. Conclusions In an international registry, hypothyroidism was identified in around 1 of every 12 adult hospitalized patients with COVID‐19. Pre‐existing hypothyroidism in hospitalized patients with COVID‐19 was not associated with higher disease severity or increased risk of mortality or ICU admissions. However, more research on the possible effects of COVID‐19 on the thyroid gland and its function is needed in the future.