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Pulmonary Artery Catheter Sutured on the Pulmonary Trunk and Relevant Clinical Consequences 在肺动脉干上缝合肺动脉导管及相关临床后果
Pub Date : 2023-03-14 DOI: 10.31487/j.acr.2023.01.01
E. Samara, S. Siminelakis, A. Karakosta, P. Tzimas
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引用次数: 0
Study in a Simulated Scenario of the Influence of Training and Personality in the Resolution of Critical Situations in Anaesthesiology Residents 训练与个性对麻醉住院医师危急情况解决之影响之模拟研究
Pub Date : 2023-01-13 DOI: 10.31487/j.acr.2022.04.01
Sistac Ballarín JM, Lliteras M, Sistac Palacin JM
Introduction: Empowerment of simulations in emergent situations by resident medical interns has positively demonstrated the acquisition of clinical skills [1]. Even so, it remains unclear what psychological factors influence when assuming leadership in carrying out these simulations or in a real situation. This study aims to analyse, by simulating critical situations in the operating room, the influence of training and personality among anaesthesiology residents on the predisposition to assume such leadership.Materials and Methods: A study was carried out on 22 residents both trained (11) and untrained in simulation, assessing their personality and degree of stress using the Typi and Stay Trait. By observation it was determined that he was the leader, when entering a simulated model of ventricular fibrillation in pairs. Resolution capacity was not valued, but rather the characteristics that define the personality of the resident who assumed leadership.Results: Regarding personality, measured with the TIPI test, the leaders turned out to score high in agreeableness but low in extraversion compared to the helpers. This suggests that they are altruistic, compassionate, trusting, frank, empathic and sensitive to others and on the other hand reserved, socially distant except with close friends. In the trained group, the Stai Trait test revealed a slightly lower mean in helpers compared to the total mean, in addition to a significantly higher SD in leaders (4.57) than in helpers (2.87), obtaining a p> 0.02. In Stai Estado, the opposite occurred in terms of the averages, lower in the group of leaders with respect to the global average. And a very similar SD was obtained in both groups (4.91 and 4.21). In the TIPI test, the leading group stands out with a low score in extraversion, compared to the total mean and compared to assistants, justified data with a p>0.02.Conclusion: The residents of the trained group turned out to have lower anxiety in the stressful situation of the simulation compared to the other group. In addition, the women who turned out to be leaders in the trained group demonstrated control of the situation with lower HRs than the leaders in the untrained group, thus demonstrating the influence of training in resolving critical situations.
导读:住院医师实习生在紧急情况下的模拟授权积极地展示了临床技能的获得[1]。即便如此,在进行这些模拟或在真实情况下担任领导时,心理因素的影响仍不清楚。本研究旨在通过模拟手术室危急情况,分析麻醉住院医师的训练和性格对担任这种领导倾向的影响。材料与方法:本研究对22名住院医生进行了模拟训练(11名)和未进行模拟训练(11名),使用Typi和Stay Trait评估他们的个性和压力程度。通过观察,确定他是领导者,当进入一对心室颤动的模拟模型时。不重视解决问题的能力,而重视决定担任领导的居民的个性的特征。结果:在性格方面,通过TIPI测试,与帮助者相比,领导者的宜人性得分较高,而外向性得分较低。这表明他们是无私的、富有同情心的、信任他人的、坦率的、有同情心的、对他人敏感的;另一方面,他们是保守的,除了与亲密的朋友外,他们在社交上很疏远。在训练组中,斯坦特质测试显示帮助者的平均值略低于总平均值,而领导者的标准差(4.57)显著高于帮助者(2.87),p> 0.02。在爱沙尼亚,就平均水平而言,情况正好相反,与全球平均水平相比,该国领导人群体的平均水平较低。两组的SD值非常相似,分别为4.91和4.21。在TIPI测试中,与总平均值相比,与助理相比,领导组的外向性得分较低,证明数据p>0.02。结论:实验组住院医师在模拟压力情境下的焦虑程度较对照组低。此外,在培训组中成为领导者的女性表现出对情况的控制能力,其hr低于未培训组的领导者,从而证明了培训在解决关键情况方面的影响。
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引用次数: 0
Pulmonary Thrombosis in Acute Respiratory Distress Syndrome: Theory, Evidence, and Clinical Relevance to Resource-Limited Settings 急性呼吸窘迫综合征的肺血栓形成:理论、证据和与资源有限环境的临床相关性
Pub Date : 2022-10-17 DOI: 10.31487/j.acr.2022.03.04
Nicole Greeff, R. Davids
Thrombosis is often seen in acute respiratory distress syndrome (ARDS) patients, increasing morbidity and mortality. This review highlights the pathophysiology of ARDS and how it links to pulmonary thrombosis. Understanding this link is furthermore critical as pulmonary thrombosis a serious issue in coronavirus diseases, such as COVID-19. There is a clear link between ARDS pathophysiology and pulmonary thrombosis as defined by the “two-path unifying theory” and “two-activation theory of the endothelium”. Interestingly, ARDS in influenza versus COVID-19 patients have a slightly different pathophysiology, the latter having more compact fibrin clots that are more difficult to dissolve; this will impact the treatment of COVID-19 ARDS patients. We therefore also reviewed the current treatment options, underlining that potentially life-saving thrombosis-screening procedures could be lacking in resource-limited settings, therefore needing redress.
血栓形成常见于急性呼吸窘迫综合征(ARDS)患者,增加了发病率和死亡率。本文综述了ARDS的病理生理学及其与肺血栓形成的关系。此外,了解这种联系至关重要,因为肺血栓形成是COVID-19等冠状病毒疾病的一个严重问题。根据“双路统一理论”和“内皮双活化理论”,ARDS病理生理与肺血栓形成有明确的联系。有趣的是,流感和COVID-19患者的ARDS病理生理学略有不同,后者具有更紧密的纤维蛋白凝块,更难以溶解;这将影响COVID-19急性呼吸窘迫综合征患者的治疗。因此,我们也回顾了目前的治疗方案,强调在资源有限的情况下可能缺乏潜在的挽救生命的血栓形成筛查程序,因此需要纠正。
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引用次数: 0
Management of Cerebropontine Angle Tumors on Total Intravenous Anaesthesia Facilitating Neuromuscular Monitoring: A Retrospective Observational Study 全静脉麻醉促进神经肌肉监测的脑桥角肿瘤的处理:一项回顾性观察研究
Pub Date : 2022-09-14 DOI: 10.31487/j.acr.2022.03.02
N. Panse, Nikhil Bhoi, Aparajita Pandey, Priyanka Dhananjay Tikait
Background: With the increasing trend of IONM in neurosurgery the role of total intravenous anaesthesia has gained upper hand in the practice of neuro anaesthesia. Propofol based TIVA techniques facilitates rapid recovery of consciousness and psychomotor function with lower incidence of post-operative nausea and vomiting. It also facilitates satisfactory IONM monitoring while maintaining the adequate depth of anaesthesia. Available literature focuses on the surgical aspects with IONM. Few studies are available, which compare TIVA with general anaesthesia that too without IONM. Earlier TIVA for IONM has been studied in patients undergoing kyphoscoliosis correction surgery. This study was conducted to evaluate the efficacy of TIVA in facilitating IONM in resection of intracranial masses and to study its effects on hemodynamics and post op recovery.Methods: In our retrospective study of 23 cases, patients undergoing intracranial tumor mass excision surgeries requiring IONM were given standardized general anaesthesia using intubating dose of short acting muscle relaxant and further maintenance of anaesthesia was done using infusion of propofol and dexmeditomidine with the minimal inhalational agents. IONM was recorded successfully.Results: 18 patients were haemodyanamically stable. 3 patients had intermittent episodes of bradycardia, and 2 patients had hypotension. Three patients elicited dampened response requiring reduction in anaesthetic dose. Six patients exhibited delayed recovery.Conclusion: TIVA with propofol and dexmeditomidine is a good anaesthetic modality to facilitate IONM in resection of intracranial masses.
背景:随着IONM在神经外科应用的日益增多,静脉全麻醉在神经麻醉实践中的作用逐渐占上风。以异丙酚为基础的TIVA技术有助于快速恢复意识和精神运动功能,降低术后恶心和呕吐的发生率。它还有助于在保持足够麻醉深度的同时进行令人满意的离子离子监测。现有文献主要集中在IONM的外科方面。很少有研究将TIVA与不使用IONM的全身麻醉进行比较。在接受脊柱后凸矫正手术的患者中,早期对IONM的TIVA进行了研究。本研究旨在评估TIVA在促进IONM切除颅内肿物中的作用,并研究其对血流动力学和术后恢复的影响。方法:回顾性分析23例颅内肿瘤肿块切除手术中需用IONM的患者,给予标准全身麻醉,插管剂量为短效肌松剂,继续维持麻醉,应用异丙酚、右美托咪定等微量吸入剂输注。成功记录IONM。结果:18例患者血流动力学稳定。3例患者出现间歇性心动过缓,2例患者出现低血压。3例患者出现抑制反应,需要减少麻醉剂量。6例患者出现延迟恢复。结论:异丙酚和右美托咪定联合TIVA是一种很好的麻醉方式,可以促进IONM切除颅内肿物。
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引用次数: 0
Efficacy of Clavipectoral Fascia Plane Block as Analgesic Modality in Clavicle Fractures: Exploring New Horizons 锁骨筋膜平面阻滞作为锁骨骨折镇痛方式的疗效:探索新视野
Pub Date : 2022-08-30 DOI: 10.31487/j.acr.2022.03.01
N. Panse, J. Deshpande
Clavicle fractures are commonly encountered in orthopedic outpatient department but are often managed conservatively. Yet some clavicle fractures need surgical intervention which in turn demand adequate anaesthesia and analgesia. Due to complex sensory innervation there is no sole regional anaesthesia technique which could provide adequate analgesia for clavicle fractures. With the advent of ultra-sonography (USG) and the description of clavipectoral fascia plane block (CPB) by Dr. Valde a lot was simplified. Administration of CPB provides intra as well as postoperative analgesia, maintains hemodynamics, reduces opioid consumption and improvises postoperative recovery of the patients undergoing clavicle surgeries.
锁骨骨折是骨科门诊部常见的病例,但通常采用保守治疗。然而,一些锁骨骨折需要手术干预,这反过来又需要充分的麻醉和镇痛。由于锁骨骨折的感觉神经支配复杂,目前还没有单一的区域麻醉技术可以为锁骨骨折提供充分的镇痛。随着超声技术(USG)的出现和Valde博士对锁骨筋膜平面阻滞(CPB)的描述简化了很多。给予CPB可提供术中及术后镇痛,维持血流动力学,减少阿片类药物消耗,促进锁骨手术患者术后恢复。
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引用次数: 0
Innovative Observation of a 266-nm Laser Inhibiting Egg Laying in Caenorhabditis elegans 266 nm激光抑制秀丽隐杆线虫产卵的创新观察
Pub Date : 2022-07-29 DOI: 10.31487/j.acr.2022.02.04
Ray-Ling Hsiao, Yu-Wei Lin, Chiang-Yun Chen
Infrared laser as a heat source could induce gene expression by activating heat promoter genes in Caenorhabditis elegans, as previously reported. In this study, we innovatively used a 266-nm laser to irradiate C. elegans for only one second and observed a significant inhibition of the overall number of eggs laid (P < 0.0001) and the first day egg laying (P=0.005). This is the first study to establish how light with a wavelength of 266-nm can influence a life activity such as laying eggs in C. elegans.
红外激光作为热源可以通过激活秀丽隐杆线虫的热启动子基因来诱导基因表达。在本研究中,我们创新性地使用266 nm激光照射秀丽隐杆线虫1秒,观察到对总产卵数(P < 0.0001)和第一天产卵量(P=0.005)的显著抑制。这是第一个确定波长为266纳米的光如何影响秀丽隐杆线虫产卵等生命活动的研究。
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引用次数: 0
Pediatric Patients Undergoing Elective Surgeries Below the Umbilicus: Comparative Study of Caudal Bupivacaine (0.25%) and Caudal Bupivacaine (0.25%) with Ketamine 小儿脐下择期手术:0.25%尾侧布比卡因与0.25%尾侧布比卡因与氯胺酮的比较研究
Pub Date : 2022-07-26 DOI: 10.31487/j.acr.2022.02.03
N. Elshalakany
Background: Caudal block has the potential advantage that, by adding other drugs to the local anaesthetic agent, the duration and effectiveness of the block may be extended. Peripheral nerve blocks and caudal anaesthesia are very benign, nonetheless inordinate attention is compulsory to evade side effects.Aim and objectives: We aimed at this study to compare total postoperative analgesic requirement, anaesthetic, analgesic and sedation qualities. Hemodynamic changes, motor block, adverse effect, and parents’ satisfaction in children who received caudal bupivacaine only versus caudal bupivacaine with ketamine in paediatric patients undergoing surgery below the level of the umbilicus. Methods: Prospective randomized double blind controlled clinical trial conduced at operation room in University Hospital in Faculty of Medicine, October 6 University. Sixty children scheduled for elective surgery below umbilicus were randomly allocated to either: Group A (30 patients) includes the children who take saline caudal bupivacaine with dose of 1 ml/kg, afterward initiation of overall anaesthesia or Group B (30 patients) who following the administration of general anaesthesia, receives caudal bupivacaine 0.25 % in a dose of 1 ml/kg and caudal ketamine preservative free in a dose of 0.5 mg/kg. Hemodynamic alterations, parent satisfaction, postoperative analgesia and sedation characteristics, and side effects were noted. Results: The studied groups showed no statically significant difference regarding demographic data. Motor block statistically was significantly lower in ketamine group. Anaesthesia quality statistically was significantly higher in ketamine group. Regarding hemodynamic state, mean arterial blood pressure (MPA) and heart rate showed a statistically significant difference during and up to 30 minute postoperative (P<0.001), and oxygen saturation showed no statistically significant difference during and after surgery (P>0.05). Sedation score was higher in ketamine group, were lower in ketamine group all were statistically significant. Side effects statistically were non-significantly but less frequent in ketamine group. Total 24-hours analgesia dose statistically was significantly lesser in ketamine group. Parent’s satisfaction statistically was suggestively better in ketamine group.Conclusion: Amalgamation therapy of ketamine with bupivacaine is enhanced decision for post-operative pain controller in children enduring surgery below the umbilical. It increased the duration of analgesia and abridged the necessity for post-operative analgesic supplementation as well.
背景:尾侧阻滞具有潜在的优势,通过在局部麻醉剂中加入其他药物,可以延长阻滞的持续时间和有效性。周围神经阻滞和尾侧麻醉是非常良性的,然而过度的注意力是必须的,以避免副作用。目的和目的:本研究旨在比较术后总镇痛需求、麻醉、镇痛和镇静质量。在脐部以下接受手术的儿科患者中,仅接受尾侧布比卡因与尾侧布比卡因加氯胺酮的儿童的血流动力学变化、运动阻滞、不良反应和家长满意度。方法:在10月6日大学医学院附属大学医院手术室进行前瞻性随机双盲对照临床试验。60名计划进行脐部以下择期手术的儿童被随机分配:A组(30名患者)包括在开始全身麻醉后服用生理盐水布比卡因,剂量为1ml /kg; B组(30名患者)在全身麻醉后,接受0.25%布比卡因,剂量为1ml /kg,尾侧不含氯胺酮剂,剂量为0.5 mg/kg。血流动力学改变,家长满意度,术后镇痛和镇静特点,以及副作用。结果:两组人口统计学数据无统计学差异。氯胺酮组运动阻滞发生率明显低于对照组。氯胺酮组麻醉质量明显高于对照组。血流动力学方面,术后30分钟平均动脉压(MPA)和心率差异有统计学意义(P0.05)。镇静评分氯胺酮组较高,氯胺酮组较低,差异均有统计学意义。氯胺酮组副作用发生率较低,但无统计学意义。氯胺酮组24小时镇痛总剂量显著低于对照组。氯胺酮组家长满意度有统计学意义上的提高。结论:氯胺酮与布比卡因混合治疗是控制脐下手术患儿术后疼痛的有效方法。它增加了镇痛的持续时间,并缩短了术后补充镇痛的必要性。
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引用次数: 0
Tailored Routine Sugammadex Reversal is More Cost-Effective Than Neostigmine: A Narrative Review 与新斯的明相比,量身定制的常规苏加麦克斯逆转疗法更具成本效益:叙述性综述
Pub Date : 2022-07-14 DOI: 10.31487/j.acr.2022.02.02
Ryan Erskine, K. Collins, L. Mcdonald
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引用次数: 0
Haematobiochemical Responses of West African Dwarf Goats to Epidural Ropivacaine Anaesthesia 西非矮山羊对罗哌卡因硬膜外麻醉的血液生化反应
Pub Date : 2022-04-28 DOI: 10.31487/j.acr.2022.01.03
C. Oguntoye, Abayomi Kayode Olaifa, Faith Ifeoluwa Adewale
Haematobiochemical responses following epidural administration of ropivacaine to West African Dwarf (WAD) goats were studied. Complete analgesia of the flank, abdomen and hindlimbs was achieved in all the goats. Transient non- significant (p > 0.05) increase in haematocrit and neutrophil values and a transient lymphocytopaenia were observed at 1 hour post epidural drug administration. There was also a transient non- significant increase (p > 0.05) in RBC, haemoglobin, WBC but decrease platelets at 1 hour post epidural drug administration. There was no significant difference in the values of the haematological parameters from baseline values except neutrophil and lymphocyte values which had significant (p<0.05) decrease and increase respectively at 3 hours post anaesthesia compared with the values at 1 hour post drug administration. There was a transient non-significant (p˃ 0.05) decrease in AST and ALT values, and a marked non-significant (p˃ 0.05) decrease in ALP value at 1 hour post drug administration in comparison with base line values. Creatinine and BUN had fluctuating values with no significant change. It was concluded that epidural ropivacaine anaesthesia produced good epidural analgesia with no systemic toxicity and without adverse effects on the haematology, renal and hepatic biomarkers in West African Dwarf goats and may be recommended as an alternative to other local anaesthetic amides especially in West African Dwarf goats with debilitating diseases, prolonged dystocia and chronic ruminal tympany, where drug toxicity and safety are major concerns.
研究了西非矮山羊硬膜外注射罗哌卡因后的血液生化反应。所有山羊的侧腹、腹部和后肢均完全镇痛。硬膜外给药后1小时,红细胞和中性粒细胞短暂性无显著升高(p > 0.05),淋巴细胞短暂性减少。在硬膜外给药后1小时,红细胞、血红蛋白、白细胞也有短暂性无显著性升高(p > 0.05),但血小板下降。除中性粒细胞和淋巴细胞值在麻醉后3 h较给药后1 h分别下降和上升外,血液学参数与基线值无显著差异(p<0.05)。与基线值相比,给药后1 h AST和ALT值有短暂性无显著性(p < 0.05)下降,ALP值有显著性无显著性(p < 0.05)下降。肌酐和BUN有波动值,无明显变化。结论是,硬膜外罗哌卡因麻醉在西非矮山羊中产生了良好的硬膜外镇痛效果,无全身毒性,对血液学、肾脏和肝脏生物标志物没有不良影响,可能被推荐作为其他局部麻醉酰胺的替代品,特别是在患有衰弱性疾病、长期难产和慢性瘤胃中耳炎的西非矮山羊中,药物毒性和安全性是主要问题。
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引用次数: 0
Impact of Target-Controlled Infusion (TCI) of Propofol on State- and Response-Entropy and Sedation Depth During Flexible Bronchoscopy 靶控输注异丙酚对柔性支气管镜术中状态、反应熵和镇静深度的影响
Pub Date : 2022-02-16 DOI: 10.31487/j.acr.2022.01.01
Cornelius Husemann, H. Hautmann
Background: The increasing use of flexible bronchoscopy for diagnostic and interventional purposes requires further knowledge on feasible sedation regimens. We investigated the potential benefit of Target- Controlled Infusion (TCI) of propofol on sedation depth. Methods: Fifty-four patients scheduled for elective flexible bronchoscopy were allocated to receive propofol sedation using either intermittent boluses or Target Controlled Infusion (TCI). Endpoints included Entropy monitoring to evaluate sedation depth, sedation quality and the total amount of propofol. Results: There were no significant differences between both cohorts regarding the number of adverse sedation-related events. The mean applied dose of propofol was significantly higher in the Target-Controlled Infusion group (405±249 mg vs. 324±94 mg, p=0.015). Until patients reached loss of consciousness (LOC), State Entropy (SE) and Response Entropy (RE) levels were comparable among both sedation regimens. During the procedure, both parameters decreased to significantly lower levels in the TCI-cohort (SE: 77.7±13.2 vs. 88.8±8.6 (p=0.002) and RE: 69±12.6 vs. 79±8.7 (p=0.005)). Examination conditions, as rated by proceduralists and assisting nurses, were superior in the TCI-cohort. In addition, restraining measurements, due to uncontrolled movement during the examination needed to be applied more often to patients in the bolus cohort (body restraint: 26 (96%) vs. 18 (67%), p=0.005).Conclusion: Target-Controlled Infusion of propofol complies with the requirements of flexible bronchoscopy by providing a deep and steady level of sedation without impairing patient’s safety. In addition, there is evidence that overall sedation quality is superior, both for bronchoscopist and assisting staff.
背景:越来越多的柔性支气管镜用于诊断和介入目的,需要进一步了解可行的镇静方案。我们研究了异丙酚靶控输注(TCI)对镇静深度的潜在益处。方法:54例选择柔性支气管镜检查的患者被分配接受异丙酚镇静,使用间歇小丸或目标控制输注(TCI)。终点包括熵监测以评价镇静深度、镇静质量和异丙酚总用量。结果:两个队列在镇静相关不良事件的数量上没有显著差异。靶控输注组丙泊酚的平均给药剂量明显高于靶控输注组(405±249 mg vs. 324±94 mg, p=0.015)。在患者达到意识丧失(LOC)之前,两种镇静方案的状态熵(SE)和反应熵(RE)水平具有可比性。在手术过程中,这两个参数在tci队列中显著降低(SE: 77.7±13.2比88.8±8.6 (p=0.002), RE: 69±12.6比79±8.7 (p=0.005))。由程序医师和辅助护士评定的检查条件在tci队列中更胜一筹。此外,由于在检查过程中不受控制的运动,约束措施需要更多地应用于注射队列的患者(身体约束:26(96%)对18 (67%),p=0.005)。结论:靶控输注异丙酚符合柔性支气管镜检查的要求,提供深度稳定的镇静水平,且不影响患者的安全性。此外,有证据表明,整体镇静质量是优越的,无论是支气管镜医师和辅助工作人员。
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引用次数: 0
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Journal of Anesthesia and Clinical Research
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