Journal of Anaesthesiology, Clinical Pharmacology最新文献

Background and aims: Neuraxial anesthesia, including subarachnoid block (SAB), is the preferred technique for the hip surgeries. Positioning of these patients in lateral or sitting position for spinal anesthesia can be very painful due to hip fracture. This often requires systemic opioids or pre-emptive regional techniques. There is a dearth of literature comparing efficacy of two such regional techniques: pericapsular end nerve group (PENG) block and femoral nerve block (FNB). Our study compares analgesic efficacy of PENG block and FNB to facilitate positioning for SAB in patients undergoing hip surgery.

Material and methods: We conducted a prospective randomized interventional comparative study over a period of 18 months in 60 adult patients scheduled for surgery for hip fracture under SAB. Patients were randomly assigned to receive either ultrasound (US)-guided FNB, Group F (n = 30) or PENG block, Group P (n = 30) for reducing pain associated with positioning for spinal anesthesia. VAS scores were assessed every 5 min for 30 min after the block. Subjective assessment of quality of positioning by an anesthetist, requirement of fentanyl, and patient satisfaction level were also assessed and compared between the groups.

Results: FNB while resulted in pain relief (VAS <4) within 10 min, effective pain relief required 20 min for PENG block. The onset of pain relief was faster with FNB as significantly lower VAS scores were observed in patients in FNB group as compared to those in the PENG block group on dynamic movement of hip joint at 10 min after the block (P = 0.023). No statistically significant difference in VAS score was observed in both PENG and FNB block group at 30 min after the block administration on dynamic movement of hip and during the positioning of patient. There was also no significant difference in the quality of positioning, fentanyl boluses, and patient satisfaction between the groups.

Conclusions: USG-guided FNB and PENG block, both regional techniques provided sufficient, comparable, good quality analgesia for positioning the patient for SAB.

Background and aims: For facial nerve monitoring during parotidectomy, neuromuscular blockers should be avoided. Assessment of depth of anesthesia based on clinical signs or end-tidal anesthetic gas concentration is unreliable. We compared intraoperative dexmedetomidine requirement with and without bispectral index (BIS) monitoring in patients undergoing total parotidectomy under general anesthesia (GA) without muscle relaxants.

Material and methods: This was a prospective, randomized study conducted in 60 patients undergoing total parotidectomy under GA with nerve conduction studies. Following induction and intubation, all patients received dexmedetomidine 1 µg/kg bolus. In Group A, BIS values were continuously monitored. Following initial bolus, only when the BIS value was >50, dexmedetomidine infusion was restarted at 0.5 µg/kg/h and adjusted to maintain BIS between 40 and 50. In Group B, dexmedetomidine 1 µg/kg bolus was given, followed by 0.5 µg/kg/h initially and infusion. Infusion rate was titrated based on hemodynamic variables and patient immobility. If patients in any group moved intraoperatively, propofol 0.5 mg/kg, not >30 mg, was given, and dose of dexmedetomidine infusion was increased by 0.1 µg/kg/h increments to a maximum dose of 0.7 µg/kg/h.

Results: Rate of dexmedetomidine infusion was significantly lower in Group A compared to Group B (0.058 ± 0.011 vs. 0.547 ± 0.133 µg/kg/h). Extubation time was significantly lower in Group A (14.40 ± 8.845 vs. 30.27 ± 9.903 min). Hemodynamic responses, sevoflurane and propofol consumption, incidence of intraoperative patient immobility, hypotension, and use of vasopressors were comparable in both groups.

Conclusions: Use of BIS monitoring in patients undergoing total parotidectomy under GA without muscle relaxants resulted in significant reduction in intraoperative dexmedetomidine consumption with significantly shorter extubation time.

Background and aims: The mechanism of paradoxical reaction is still a big question for the medical world, but several theoretical approaches have arisen. Midazolam, a high-potency benzodiazepine, carries a higher risk of paradoxical reaction. Paradoxical reactions associated with midazolam are often misunderstood and mismanaged, with clinicians frequently attributing them to factors like inadequate dosing or low sedation levels. This leads to the common practice of escalating midazolam dosage or exploring alternative sedatives, despite flumazenil offering a safer solution theoretically. Flumazenil emerges as a viable antidote as it swiftly and effectively reverses paradoxical reactions, proving to be a safer alternative to dose escalation strategies.

Material and methods: In this systematic review, we conducted a search regarding the use of flumazenil in midazolam-induced paradoxical reactions over a quarter-century period (1998-2023) in three databases. We include 10 case reports presenting a total of 14 cases, which adhered to the specified inclusion criteria.

Result: We selected 10 case reports published from 1998 to 2023 with a total of 14 cases. Study characteristics, patient demographics, midazolam dose and administration route, incident of paradoxical effect, flumazenil dose and administration route, and outcome of flumazenil administration.

Conclusions: All the cases showed the prosperous effectiveness of flumazenil in reducing paradoxical reaction symptoms with no adverse effect on hemodynamics. Ongoing research and study in this field are essential to refine protocols and enhance patient outcomes.