Journal of Anaesthesiology, Clinical Pharmacology最新文献

Background and aims: Postspinal hypotension (PSH) is a common adverse event following spinal anesthesia, with a pronounced incidence among diabetic individuals due to autonomic neuropathy. This study aimed to assess the caval aorta index (IVC/AO) and IVC collapsibility index (IVCCI) as predictors of PSH.

Material and methods: One hundred and twenty patients scheduled for elective surgeries under spinal anesthesia were divided into two groups: Group A (Diabetic) and Group B (nondiabetic). IVC and aorta diameters were measured to calculate the IVC/AO index and IVCCI. Patients in both groups received spinal anesthesia using 0.5% bupivacaine (3 ml). Hemodynamic parameters were recorded, and the incidence of PSH was noted. The odds ratio for PSH was ascertained between the groups, and correlations of age, body mass index, diabetes duration, and random blood glucose levels with the IVC/AO index were performed. Receiver operating characteristic curves were used to evaluate the diagnostic value of the IVC/AO index and IVCCI for predicting PSH. A P value of <0.05 was considered statistically significant.

Results: PSH was observed in 82 patients (68%), with 58 in group A and 24 in group B. Diabetics had a lower IVC/AO index (P < 0.002) and a significantly elevated IVCCI (P < 0.001). The IVC/AO index of <1.065 indicated an increased odds ratio (5.5) for developing PSH. A strong negative correlation was noted between the duration of diabetes and IVC/AO index.

Conclusions: Preoperative ultrasonographic measurement of the IVC/AO and IVCCI indices is a useful predictors of PSH in diabetic patients.

Background and aims: This prospective, observational study investigated the performance of internal jugular vein (IJV) point-of-care ultrasonography in the prediction of spinal anesthesia-induced hypotension in aged, dehydrated patients.

Material and methods: Fifty-five elderly, dehydrated patients (blood urea-to-creatinine ratio >20) with a hip fracture were recruited. The 2-dimensional ultrasound area of each IJV was evaluated to determine which vein produced the dominant outflow from the brain. The IJV with the greatest measured area was considered the dominant outflow vein. The following measurements of both veins were obtained: the maximum and minimum area (during spontaneous breathing), the IJV collapsibility index, and the internal jugular maximum area-to-collapsibility index ratio. Receiver operating curve characteristics and gray zone analysis of ultrasound indices were performed to evaluate their prognostic utility in identifying patients with post-spinal anesthesia hypotension.

Results: Thirty-four patients (61.8%) manifested a hypotension incident. The right and the left IJV provided dominant flow in 42 (76%) and 13 (24%) cases, respectively. A collapsibility index of > 0.35 and a maximum area-to-collapsibility index ratio of <2.73 of the non-dominant vein demonstrated moderate diagnostic performance (area under the curve: 0.71 and 0.72, respectively) and were the most predictive indices of post-spinal anesthesia hypotension. However, these two indices were associated with a high number of inconclusive cases, thereby contributing to a prognostic uncertainty (gray zone analysis).

Conclusions: IJV ultrasound measurements are not strong predictors of post-spinal anesthesia hypotension in elderly patients. Anesthesiologists should pursue the prediction of post-spinal anesthesia hypotension by using additional monitoring methods.

Background and aims: Shoulder pain, often characterized by gradual progression and reduced glenohumeral joint mobility, can arise from inflammatory, traumatic, or degenerative causes. Treatment aims to relieve symptoms, improve joint mobility, and enhance quality of life. This study compared the effectiveness of platelet-rich plasma (PRP) injections with a combination of local anesthetic and steroid in patients with chronic shoulder pain, focusing on pain relief and functional improvement.

Material and methods: Fifty patients under 20 years old with shoulder pain unresponsive to 6 weeks of conservative treatment were randomly assigned to two groups. Group I received an injection of 3 mL of 0.25% bupivacaine and 1 mL triamcinolone, while Group II received 3 mL of PRP. Pain and function were evaluated using the Numeric Rating Scale (NRS), Shoulder Pain and Disability Index (SPADI), and patient satisfaction, with side effects monitored.

Results: Demographic variables were comparable. Significantly lower pain scores were observed at half an hour, 2 weeks, and 1 month in group I, while in group II, reduced pain scores were observed at 2, 3, and 6 months (P < 0.05). After 6 months, better patient satisfaction was observed in group II (P < 0.05). SPADI was statistically comparable at all time intervals, except at half an hour, 2 weeks after injection, when it was significantly better in group I.

Conclusions: Both interventions are safe and effective methods for the treatment of chronic shoulder pain, leading to pain relief and improvement in physical disability. However, intra-articular PRP injection offers a more sustained and longer-lasting improvement compared to corticosteroids and bupivacaine.

The purpose of this narrative review is to investigate the existing evidence supporting the use of the snorkel breathing technique in anesthesia practice. In addition, this review aims to identify certain patient scenarios where the snorkel breathing approach can be appropriate. A total of nine articles relevant to anesthesia and airway management were retrieved using the search strategy. A review of the final papers found that the snorkel breathing technique offers a few advantages over using a regular face mask in the operating room. The snorkel or mouthpiece breathing approach can be as effective as the traditional face mask for successful preoxygenation, as defined by an end-tidal oxygen concentration greater than 0.9. The snorkel breathing approach can be a viable option in patient populations where face mask application is challenging. It also has greater acceptance than the face mask among patients and healthy volunteers. Another advantage of the snorkel breathing technique is that it can be utilized to provide apneic oxygenation during rapid sequence induction using short-acting neuromuscular blocking drugs, reducing the use of plastic (face mask). For older children and claustrophobic adults who are apprehensive about masks, snorkel gas induction can make anesthesia induction smoother and more pleasant. The snorkel breathing technique has potential application in certain anesthetic scenarios, and this narrative review also incorporates the author's clinical experience with it. To validate the effect of this novel technique (snorkel preoxygenation and snorkel gas induction) on patient-centered outcomes, more randomized controlled trials are required.

Background and aims: Adductor muscle spasm occurs when the obturator nerve is directly stimulated by the electrical current transmitted by the resectoscope. Ultrasound-guided ONB is regarded as the optimal technique and is classified as the proximal and distal approach based on the anatomical location of the obturator nerve.

Material and methods: This study included 90 adult patients of ASA grades I-III and aged more than 18 years undergoing transurethral resection of bladder tumors under spinal anesthesia. Patients were randomized into two groups: group P received ultrasound-guided obturator nerve block (ONB) by proximal approach, and group D received ultrasound-guided ONB by distal approach. Adductor muscle power after the block, block performance time, complications, and adductor jerks during surgery were compared. A P value of < 0.05 was considered statistically significant.

Results: Adductor jerks during the surgery were absent in 85.7% of patients in group P and 78.0% of patients in group D. The mean block performance time in group P was 4.33 ± 0.38 minutes, and in group D was 4.00 ± 0.34 minutes. Vascular puncture during the block was observed in nine patients in group P and two patients in group D.

Conclusion: The success rate in terms of the absence of adductor spasm during surgery was higher in proximal than in distal ultrasound-guided ONB. However, the proximal technique requires more time to perform the block than the distal technique, as it is technically challenging and carries a risk of vascular puncture.