Pub Date : 2017-12-30DOI: 10.4172/2155-6148.1000788
D. Godoroja, M. Sorbello, D. Cioc
Background: There is a high prevalence of undiagnosed obstructive sleep apnoea (OSA) in patients with obesity undergoing bariatric surgery. We developed two novel scores in order to investigate the extent to which anthropometric and other objective measurements can be used to identify the presence of moderate-severe OSA (Apnoea/Hypopnoea Index (AHI) ≥ 15/h) in surgical patients with obesity.Methods: We prospectively evaluated 1870 adult patients scheduled for elective laparoscopic bariatric surgery. Prior to surgery, body mass index (BMI), sex, neck circumference, STOP-Bang score, SpO2, and neck/trunk fat were recorded. Basic anthropometric measurements were obtained, and the A Body Shape Index (ABSI) was calculated using the Krakauer formula. Patients at high risk for OSA were referred for polysomnography. Auto-titrated positive airway pressure (APAP) therapy was initiated when AHI ≥ 15/h. The Dual-X Ray-Obstructive Sleep Apnoea (DXOSA) score included six items: STOP-Bang score, BMI, neck fat, trunk fat, baseline SpO2, and expiratory reserve volume (ERV). The Anthropometric-OSA (A-OSA) score included STOP-Bang score, BMI, NC, ABSI coupled with WC, baseline SpO2, and ERV. We then compared sensitivity, specificity, positive-predictive values, negativepredictive values, likelihood ratios, and post-test probabilities in these patients.Results: Using a cut-off of 3, the DX-OSA and A-OSA scores exhibited similar sensitivity to STOP-Bang scores, but were associated with improved specificity, lower false positive rates, and increased probability for the diagnosis of moderate-severe OSA.Conclusion: The A-OSA and DX-OSA scores may be useful in the identification of obese surgical patients requiring CPAP treatment for significant OSA, without the need for formal polysomnography.
背景:在接受减肥手术的肥胖患者中，未确诊的阻塞性睡眠呼吸暂停(OSA)患病率很高。我们开发了两个新的评分，以研究在何种程度上人体测量学和其他客观测量可以用于识别肥胖手术患者中重度OSA (Apnoea/ hyponoea Index (AHI)≥15/h)的存在。方法:我们前瞻性评估1870例计划择期腹腔镜减肥手术的成年患者。术前记录体重指数(BMI)、性别、颈围、STOP-Bang评分、SpO2和颈/躯干脂肪。获得基本的人体测量数据，并使用克拉考尔公式计算A型指数(ABSI)。OSA高危患者接受多导睡眠描记术。当AHI≥15/h时开始自动滴定气道正压(APAP)治疗。双x线阻塞性睡眠呼吸暂停(DXOSA)评分包括6个项目:STOP-Bang评分、BMI、颈部脂肪、躯干脂肪、基线SpO2和呼气储备容量(ERV)。人体测量- osa (A-OSA)评分包括STOP-Bang评分、BMI、NC、ABSI合并WC、基线SpO2和ERV。然后，我们比较了这些患者的敏感性、特异性、阳性预测值、阴性预测值、似然比和检测后概率。结果:使用截断值3,DX-OSA和a -OSA评分与STOP-Bang评分具有相似的敏感性，但与改进的特异性、较低的假阳性率和增加的中重度OSA诊断概率相关。结论:A-OSA和DX-OSA评分可能有助于识别需要CPAP治疗的肥胖手术患者，而无需进行正式的多导睡眠图检查。
{"title":"Development and Feasibility of Two Novel Scores (DX-OSA and A-OSA) for the Identification of Significant Obstructive Sleep Apnoea in Surgical Patients with Obesity","authors":"D. Godoroja, M. Sorbello, D. Cioc","doi":"10.4172/2155-6148.1000788","DOIUrl":"https://doi.org/10.4172/2155-6148.1000788","url":null,"abstract":"Background: There is a high prevalence of undiagnosed obstructive sleep apnoea (OSA) in patients with obesity undergoing bariatric surgery. We developed two novel scores in order to investigate the extent to which anthropometric and other objective measurements can be used to identify the presence of moderate-severe OSA (Apnoea/Hypopnoea Index (AHI) ≥ 15/h) in surgical patients with obesity.Methods: We prospectively evaluated 1870 adult patients scheduled for elective laparoscopic bariatric surgery. Prior to surgery, body mass index (BMI), sex, neck circumference, STOP-Bang score, SpO2, and neck/trunk fat were recorded. Basic anthropometric measurements were obtained, and the A Body Shape Index (ABSI) was calculated using the Krakauer formula. Patients at high risk for OSA were referred for polysomnography. Auto-titrated positive airway pressure (APAP) therapy was initiated when AHI ≥ 15/h. The Dual-X Ray-Obstructive Sleep Apnoea (DXOSA) score included six items: STOP-Bang score, BMI, neck fat, trunk fat, baseline SpO2, and expiratory reserve volume (ERV). The Anthropometric-OSA (A-OSA) score included STOP-Bang score, BMI, NC, ABSI coupled with WC, baseline SpO2, and ERV. We then compared sensitivity, specificity, positive-predictive values, negativepredictive values, likelihood ratios, and post-test probabilities in these patients.Results: Using a cut-off of 3, the DX-OSA and A-OSA scores exhibited similar sensitivity to STOP-Bang scores, but were associated with improved specificity, lower false positive rates, and increased probability for the diagnosis of moderate-severe OSA.Conclusion: The A-OSA and DX-OSA scores may be useful in the identification of obese surgical patients requiring CPAP treatment for significant OSA, without the need for formal polysomnography.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"64 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2017-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79638795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-17DOI: 10.4172/2155-6148.1000795
A. Eldemrdash, M. Elsharkawy, Gamal Shams, K. Ismail
Background: Spinal anesthesia (SA) is generally considered a simple and safe procedure, but post spinal headache is a very common symptom appears later SA. Appearance of cranial subdural hematoma after SA is a very rare but life-threatening complication state. PDPH is the primary symptom of hematoma formation, and it should be regarded as a warning sign. Differentiation between subdural hematoma and PDPH may be difficult. Substitutional diagnoses for PDPH should be considered whenever the headache is severe, prolonged or not related to patient position. PDPH should be investigated immediately to exclude any intracranial complications.Objective: The objectives of this study are to increase awareness of hemorrhagic complications following SA and assess post-SA headache to encourage early diagnosis and management. Methods: The study was a pilot study of five cases. Four cases involved postpartum patients after SA who developed small to large subdural hematomas, as assessed by full neurological examination and neurological studies, and one case involved an elderly patient with a stone ureter.Results: One patient was managed conservatively, and the other four patients improved after surgical evacuation.Conclusions: Alternative diagnoses to post spinal headache must be considered for severe, prolonged headaches that are not related to patient position and do not respond to bed rest and analgesia. Early assessment of PDPH and early neuroradiological evaluation are recommended to diagnose post-SA subdural hematoma for early intervention to prevent avoidable morbidity and mortality.
{"title":"Chronic Subdural Hematoma Complicated Spinal Anesthesia: Report and Pilot Study of Five Surgically Treated Cases","authors":"A. Eldemrdash, M. Elsharkawy, Gamal Shams, K. Ismail","doi":"10.4172/2155-6148.1000795","DOIUrl":"https://doi.org/10.4172/2155-6148.1000795","url":null,"abstract":"Background: Spinal anesthesia (SA) is generally considered a simple and safe procedure, but post spinal headache is a very common symptom appears later SA. Appearance of cranial subdural hematoma after SA is a very rare but life-threatening complication state. PDPH is the primary symptom of hematoma formation, and it should be regarded as a warning sign. Differentiation between subdural hematoma and PDPH may be difficult. Substitutional diagnoses for PDPH should be considered whenever the headache is severe, prolonged or not related to patient position. PDPH should be investigated immediately to exclude any intracranial complications.Objective: The objectives of this study are to increase awareness of hemorrhagic complications following SA and assess post-SA headache to encourage early diagnosis and management. Methods: The study was a pilot study of five cases. Four cases involved postpartum patients after SA who developed small to large subdural hematomas, as assessed by full neurological examination and neurological studies, and one case involved an elderly patient with a stone ureter.Results: One patient was managed conservatively, and the other four patients improved after surgical evacuation.Conclusions: Alternative diagnoses to post spinal headache must be considered for severe, prolonged headaches that are not related to patient position and do not respond to bed rest and analgesia. Early assessment of PDPH and early neuroradiological evaluation are recommended to diagnose post-SA subdural hematoma for early intervention to prevent avoidable morbidity and mortality.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"1 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2017-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86047690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-30DOI: 10.4172/2155-6148.1000783
N. Bernal, J. M. Castro, Kimberly Burton, R. Thurer
Objective: To determine if accurate measurement of surgical blood loss using a novel device that photographs surgical sponges and calculates their hemoglobin content affects transfusion practice. Methods: We retrospectively compared transfusion events for patients having wound excisions using visual estimation of blood loss (traditional group; n=178) to similar events following device implementation (study group; n=221). Results: The study group (age 43 ± 22 years, body surface area burn 11.2 ± 18.0%, excision area 624, IQR 757 cm2, preoperative hemoglobin 10.7 ± 2.4 g/dl) did not differ significantly from the traditional group (age 42 ± 23 years (p=0.527), body surface area burn 12.2 ± 22.6% (p=0.661), excision area 753, IQR 505 cm2 (p=0.485), and preoperative hemoglobin 10.7 ± 2.2 g/dl (p=0.833). Postoperative transfusion rates were significantly lower in the study group (6.3% vs. 12.9%; p=0.024), as was the proportion of transfused patients undergoing multiple transfusion events (13.0% vs. 34.9%; p=0.01). Red cell dose (units/transfused patient) was less in the study group compared to the traditional group (1.83 ± 1.09 vs. 2.51 ± 1.61 units; p=0.021). In a subgroup of patients requiring excision of burned areas ≥ 1,000 cm2 (traditional group n=36, study group n=43), these differences were more significant. The postoperative transfusion rate fell from 44.4% to 14.0% (p=0.003), as did the percent of transfused patients experiencing multiple transfusion events (50.0% vs. 14.3%; p=0.004). Conclusions: Accurate measurement of surgical blood loss was associated with a decrease in transfusions suggesting more timely decision making. Informed transfusion decisions may result in fewer transfusions by avoiding over-transfusion related to both excessive hemodilution and inaccurate visual estimates.
目的:探讨一种新型手术纱布照相并计算其血红蛋白含量的装置对手术出血量的准确测量是否影响输血实践。方法:采用目测出血量的方法回顾性比较伤口切除患者的输血事件(传统组;N =178)与器械实施后类似事件(研究组;n = 221)。结果:研究组(年龄43±22岁，体表烧伤面积11.2±18.0%，切除面积624,IQR 757 cm2，术前血红蛋白10.7±2.4 g/dl)与传统组(年龄42±23岁(p=0.527)，体表烧伤面积12.2±22.6% (p=0.661)，切除面积753,IQR 505 cm2 (p=0.485)，术前血红蛋白10.7±2.2 g/dl (p=0.833)差异无统计学意义。研究组术后输血率显著低于对照组(6.3% vs. 12.9%;P =0.024)，多次输血事件的输血患者比例也是如此(13.0% vs. 34.9%;p = 0.01)。与传统组相比，研究组红细胞剂量(单位/输血患者)较少(1.83±1.09比2.51±1.61单位;p = 0.021)。在需要切除≥1,000 cm2烧伤区域的患者亚组中(传统组n=36，研究组n=43)，这些差异更为显著。术后输血率从44.4%下降到14.0% (p=0.003)，多次输血的患者比例也下降了(50.0% vs. 14.3%;p = 0.004)。结论:准确测量手术失血量与输血减少有关，提示更及时的决策。通过避免过度血液稀释和不准确的视觉估计导致的过度输血，知情的输血决定可以减少输血。
{"title":"Accurate Measurement of Intraoperative Blood Loss during Wound Excision Leads to More Appropriate Transfusion and Reduced Blood Utilization","authors":"N. Bernal, J. M. Castro, Kimberly Burton, R. Thurer","doi":"10.4172/2155-6148.1000783","DOIUrl":"https://doi.org/10.4172/2155-6148.1000783","url":null,"abstract":"Objective: To determine if accurate measurement of surgical blood loss using a novel device that photographs surgical sponges and calculates their hemoglobin content affects transfusion practice. \u0000Methods: We retrospectively compared transfusion events for patients having wound excisions using visual estimation of blood loss (traditional group; n=178) to similar events following device implementation (study group; n=221). \u0000Results: The study group (age 43 ± 22 years, body surface area burn 11.2 ± 18.0%, excision area 624, IQR 757 cm2, preoperative hemoglobin 10.7 ± 2.4 g/dl) did not differ significantly from the traditional group (age 42 ± 23 years (p=0.527), body surface area burn 12.2 ± 22.6% (p=0.661), excision area 753, IQR 505 cm2 (p=0.485), and preoperative hemoglobin 10.7 ± 2.2 g/dl (p=0.833). \u0000Postoperative transfusion rates were significantly lower in the study group (6.3% vs. 12.9%; p=0.024), as was the proportion of transfused patients undergoing multiple transfusion events (13.0% vs. 34.9%; p=0.01). Red cell dose (units/transfused patient) was less in the study group compared to the traditional group (1.83 ± 1.09 vs. 2.51 ± 1.61 units; p=0.021). \u0000In a subgroup of patients requiring excision of burned areas ≥ 1,000 cm2 (traditional group n=36, study group n=43), these differences were more significant. The postoperative transfusion rate fell from 44.4% to 14.0% (p=0.003), as did the percent of transfused patients experiencing multiple transfusion events (50.0% vs. 14.3%; p=0.004). \u0000Conclusions: Accurate measurement of surgical blood loss was associated with a decrease in transfusions suggesting more timely decision making. Informed transfusion decisions may result in fewer transfusions by avoiding over-transfusion related to both excessive hemodilution and inaccurate visual estimates.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"9 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2017-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82157784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-30DOI: 10.4172/2155-6148.1000784
M. Ammar
Background: Pleural effusions are common in critically ill patients, causes are multifactorial. Mechanical ventilation and critical illness lead to disturbance of the normal physiological processes which regulate pleural fluid homeostasis. Ultrasound can detect small volume of pleural effusion up to 20 mL. Aim of the work: We investigated the influence of large pleural effusion drainage on oxygenation, hemodynamics, and respiratory mechanics in mechanically ventilated patients. Methodology: We performed a prospective observational study on 65 mechanically ventilated patients examining the effects of large pleural fluid drainage on oxygenation; PaO2/FiO2 and Respiratory mechanics; peak inspiratory pressures, plateau pressures, dynamic compliance and total PEEP. Hemodynamics and complications also recorded at baseline, 6 h and 24 h after drainage. Results: Among 65 patients, the mean volume of effusion drained was (1868 ± 640) ml at 24 h. Uncomplicated pneumothorax occurred in two patients. When compared baseline; 6 h and 24 h after drainage,PaO2/FiO2 ratio significantly improved (196.69 ± 34.27, 227.02 ± 35.81, 269.78 ± 48.39; p<0.001), with a decrease in peak inspiratory pressure (38.23 ± 5.71, 34.14 ± 4.70, 29.89 ± 4.58 cm H2O, p<0.001) and plateau pressures (21.06 ± 3.47, 18.77 ± 3.17, 15.49 ± 2.91 cm H2O, p<0.001) and a large increase in dynamic compliance (17.48 ± 4.12, 21.79 ± 4.47, 26.77 ± 4.94 ml/cm H2O, p<0.001). Hemodynamics were not changed by drainage apart from respiratory rate which decreased significantly (19.4 ± 5.5, 17.4 ± 5, 16.5 ± 6.8 breaths/min, P=0.019). Conclusions: Ultrasound pleural effusion drainage in mechanically ventilated patients is safe. It appears to ameliorate oxygenation and respiratory mechanics and reducing the respiratory rate without affecting hemodynamics.
背景:胸腔积液常见于危重病人，其原因是多因素的。机械通气和危重疾病导致调节胸膜液稳态的正常生理过程受到干扰。超声可以检测到20ml以下的小容量胸腔积液。研究目的:探讨大量胸腔积液引流对机械通气患者氧合、血流动力学和呼吸力学的影响。方法:我们对65例机械通气患者进行了前瞻性观察研究，检查大量胸腔液引流对氧合的影响;PaO2/FiO2与呼吸力学;峰值吸气压力，平台压力，动态顺应性和总PEEP。在基线、引流后6 h和24 h分别记录血流动力学和并发症。结果:65例患者24 h平均排出积液量为(1868±640)ml, 2例发生无并发症气胸。当比较基线时;引流后6 h、24 h PaO2/FiO2比值显著提高(196.69±34.27,227.02±35.81,269.78±48.39;p<0.001)，峰值吸气压力(38.23±5.71,34.14±4.70,29.89±4.58 cm H2O, p<0.001)和平台压力(21.06±3.47,18.77±3.17,15.49±2.91 cm H2O, p<0.001)显著降低，动态顺应性(17.48±4.12,21.79±4.47,26.77±4.94 ml/cm H2O, p<0.001)大幅增加。除呼吸频率显著降低(19.4±5.5、17.4±5、16.5±6.8次/min, P=0.019)外，引流对血流动力学无明显影响。结论:超声胸腔积液引流在机械通气患者中是安全的。它似乎改善氧合和呼吸力学，降低呼吸速率而不影响血流动力学。
{"title":"Effect of Ultrasound-Guided Thoracocentesis on Clinical and Physiological Outcomes in Mechanically Ventilated Patients","authors":"M. Ammar","doi":"10.4172/2155-6148.1000784","DOIUrl":"https://doi.org/10.4172/2155-6148.1000784","url":null,"abstract":"Background: Pleural effusions are common in critically ill patients, causes are multifactorial. Mechanical ventilation and critical illness lead to disturbance of the normal physiological processes which regulate pleural fluid homeostasis. Ultrasound can detect small volume of pleural effusion up to 20 mL. \u0000Aim of the work: We investigated the influence of large pleural effusion drainage on oxygenation, hemodynamics, and respiratory mechanics in mechanically ventilated patients. \u0000Methodology: We performed a prospective observational study on 65 mechanically ventilated patients examining the effects of large pleural fluid drainage on oxygenation; PaO2/FiO2 and Respiratory mechanics; peak inspiratory pressures, plateau pressures, dynamic compliance and total PEEP. Hemodynamics and complications also recorded at baseline, 6 h and 24 h after drainage. \u0000Results: Among 65 patients, the mean volume of effusion drained was (1868 ± 640) ml at 24 h. Uncomplicated pneumothorax occurred in two patients. When compared baseline; 6 h and 24 h after drainage,PaO2/FiO2 ratio significantly improved (196.69 ± 34.27, 227.02 ± 35.81, 269.78 ± 48.39; p<0.001), with a decrease in peak inspiratory pressure (38.23 ± 5.71, 34.14 ± 4.70, 29.89 ± 4.58 cm H2O, p<0.001) and plateau pressures (21.06 ± 3.47, 18.77 ± 3.17, 15.49 ± 2.91 cm H2O, p<0.001) and a large increase in dynamic compliance (17.48 ± 4.12, 21.79 ± 4.47, 26.77 ± 4.94 ml/cm H2O, p<0.001). Hemodynamics were not changed by drainage apart from respiratory rate which decreased significantly (19.4 ± 5.5, 17.4 ± 5, 16.5 ± 6.8 breaths/min, P=0.019). \u0000Conclusions: Ultrasound pleural effusion drainage in mechanically ventilated patients is safe. It appears to ameliorate oxygenation and respiratory mechanics and reducing the respiratory rate without affecting hemodynamics.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"8 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2017-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79481332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-30DOI: 10.4172/2155-6148.1000786
M. Mogahed, E. Salama, M. Elkahwagy
Background: Severe pain caused by multiple rib fractures (MRF) can compromise oxygenation, ventilation and pulmonary functions so can affect patient outcome. Adequate pain control helps to avoid these complications. Thoracic paravertebral analgesia is comparable to thoracic epidural with fewer side effects. Methods: Seventy-five patients were randomly allocated into three groups, (n=25 each). Group (GM) received intravenous morphine with a loading dose of 0.1-0.2 mg/kg followed by PCA bolus of 1mg with a six min lockout. Group (GMD) received also intravenous morphine with a loading dose of 0.1-0.2 mg/kg then PCA bolus of 1 mg morphine plus 5 μg dexmedetomidine with a six min lockout. Group (GPV) received paravertebral morphine loading dose of 0.2 mg/kg then PCA bolus of 0.1 ml/kg of a solution with a concentration of 0.5 mg/ml morphine mixed with 1 μg/ml dexmedetomidine and 60 min lockout. Any patient with VAS score more than 4, a top-up dose was given until VAS ≤ 4 Results: No significant difference between the three groups as regards age, BMI, sex, and ASA. Road traffic accident was the main cause of blunt chest trauma (64%, 76% and 68% in GM, GMD, and GPV respectively). Total morphine requirements were significantly lower in GMD and GPV than GM and in GPV than GMD (GM=190.9 ± 45.26, GMD=117.1 ± 31.9 and GPV=86.2 ± 21.7). There was a significant decrease in nausea and vomiting in GMD and GPV than GM. No significant difference in RR between the three groups although 8 patients in GM developed respiratory depression which was significantly higher than in GMD (2 patients) and GPV (0 patient). No significant difference in HR, MAP, and SpO2 between the groups. VAS scores at rest and with cough were significantly lower in both GMD and GPV than GM. FVC, FEV1 and PaO2/FiO2 ratio were significantly increased and PaCO2 significantly decrease in GMD and GPV than GM. Conclusion: Adding dexmedetomidine to morphine either TPV or IV PCA significantly decreases VAS scores, improves pulmonary functions and also decrease morphine consumption with fewer side effects in patients with MRF.
{"title":"Intravenous versus Ultrasound Guided Thoracic Paravertebral Morphine-Dexmedetomidine Combination in Patients with Multiple Rib Fractures","authors":"M. Mogahed, E. Salama, M. Elkahwagy","doi":"10.4172/2155-6148.1000786","DOIUrl":"https://doi.org/10.4172/2155-6148.1000786","url":null,"abstract":"Background: Severe pain caused by multiple rib fractures (MRF) can compromise oxygenation, ventilation and pulmonary functions so can affect patient outcome. Adequate pain control helps to avoid these complications. Thoracic paravertebral analgesia is comparable to thoracic epidural with fewer side effects. \u0000Methods: Seventy-five patients were randomly allocated into three groups, (n=25 each). Group (GM) received intravenous morphine with a loading dose of 0.1-0.2 mg/kg followed by PCA bolus of 1mg with a six min lockout. Group (GMD) received also intravenous morphine with a loading dose of 0.1-0.2 mg/kg then PCA bolus of 1 mg morphine plus 5 μg dexmedetomidine with a six min lockout. Group (GPV) received paravertebral morphine loading dose of 0.2 mg/kg then PCA bolus of 0.1 ml/kg of a solution with a concentration of 0.5 mg/ml morphine mixed with 1 μg/ml dexmedetomidine and 60 min lockout. Any patient with VAS score more than 4, a top-up dose was given until VAS ≤ 4 \u0000Results: No significant difference between the three groups as regards age, BMI, sex, and ASA. Road traffic accident was the main cause of blunt chest trauma (64%, 76% and 68% in GM, GMD, and GPV respectively). Total morphine requirements were significantly lower in GMD and GPV than GM and in GPV than GMD (GM=190.9 ± 45.26, GMD=117.1 ± 31.9 and GPV=86.2 ± 21.7). There was a significant decrease in nausea and vomiting in GMD and GPV than GM. No significant difference in RR between the three groups although 8 patients in GM developed respiratory depression which was significantly higher than in GMD (2 patients) and GPV (0 patient). No significant difference in HR, MAP, and SpO2 between the groups. VAS scores at rest and with cough were significantly lower in both GMD and GPV than GM. FVC, FEV1 and PaO2/FiO2 ratio were significantly increased and PaCO2 significantly decrease in GMD and GPV than GM. \u0000Conclusion: Adding dexmedetomidine to morphine either TPV or IV PCA significantly decreases VAS scores, improves pulmonary functions and also decrease morphine consumption with fewer side effects in patients with MRF.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"32 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2017-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80058676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-30DOI: 10.4172/2155-6148.1000785
M. Mogahed, E. Salama
Background: Upper gastrointestinal endoscopy in pediatric patients have increased and become more frequent. Selection of a sedative with hemodynamic stability, rapid onset, short action and few side effects is essential. Material and methods: 60 ASAI/II patients between the age of 2-12 yrs of both sexes undergoing upper gastrointestinal endoscopy randomly allocated into two groups, 30 patients each, all patients received ketamine 1 mg/kg intravenous, then group KD received dexmedetomidine 1 μg/kg bolus dose slowly IV and patients in Group KP received propofol 1 mg/kg as initial doses then top-up doses of 2-4 ml of the prepared solutions were given till RSS of ≥ 5. Hemodynamic parameters, total ketamine dose, time to RSS ≥ 5 and PADSS of 9-10, side effects and Parents’ and Endoscopists’ satisfaction were recorded. Results: HR was significantly lower in group KD at T1, T2 and T3, no significant difference as regard MAP, RR, SpO2 and time to achieve RSS and PADSS (p>0.05), significantly higher total ketamine dose in group KD than group KP (P=0.001), Parents’ and Endoscopists’ satisfaction was significantly higher in group KD than KP (p<0.05). Conclusion: Ketamine-dexmedetomidine for sedation in children during upper gastrointestinal endoscopy is an effective, reliable and safe alternative to ketamine-propofol without hemodynamic or respiratory drawbacks with comparable onset and recovery time.
{"title":"A Comparison of Ketamine-Dexmedetomidine versus Ketamine-Propofolfor Sedation in Children during Upper Gastrointestinal Endoscopy","authors":"M. Mogahed, E. Salama","doi":"10.4172/2155-6148.1000785","DOIUrl":"https://doi.org/10.4172/2155-6148.1000785","url":null,"abstract":"Background: Upper gastrointestinal endoscopy in pediatric patients have increased and become more frequent. Selection of a sedative with hemodynamic stability, rapid onset, short action and few side effects is essential. \u0000 Material and methods: 60 ASAI/II patients between the age of 2-12 yrs of both sexes undergoing upper gastrointestinal endoscopy randomly allocated into two groups, 30 patients each, all patients received ketamine 1 mg/kg intravenous, then group KD received dexmedetomidine 1 μg/kg bolus dose slowly IV and patients in Group KP received propofol 1 mg/kg as initial doses then top-up doses of 2-4 ml of the prepared solutions were given till RSS of ≥ 5. Hemodynamic parameters, total ketamine dose, time to RSS ≥ 5 and PADSS of 9-10, side effects and Parents’ and Endoscopists’ satisfaction were recorded. Results: HR was significantly lower in group KD at T1, T2 and T3, no significant difference as regard MAP, RR, SpO2 and time to achieve RSS and PADSS (p>0.05), significantly higher total ketamine dose in group KD than group KP (P=0.001), Parents’ and Endoscopists’ satisfaction was significantly higher in group KD than KP (p<0.05). Conclusion: Ketamine-dexmedetomidine for sedation in children during upper gastrointestinal endoscopy is an effective, reliable and safe alternative to ketamine-propofol without hemodynamic or respiratory drawbacks with comparable onset and recovery time.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"64 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2017-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89759988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-28DOI: 10.4172/2155-6148.1000777
A. Eldemrdash, Nagwa Mohamed Gamaleldeen, M. Ahmed, Shazly Ahmed
Background: Obesity is a serious problem worldwide. During general anesthesia and post-operative period, obese patients more likely to develop post-operative pulmonary complications as atelectasis and impaired pulmonary function compared to non-obese. Intraoperative protective ventilation consisting of low tidal volume, high PEEP and recruitment maneuvers resulted in alveolar recruitment and optimization of intraoperative respiratory mechanics. Objective: This study tested two strategies of mechanical ventilation in obese patients to find out which is best regarding gas exchange optimization, airway mechanics and atelectasis score. Methods: Study was a randomized prospective comparative control study was carried out on 50 obese patients with BMI 30-50 kg/m2. Patients were prepared for laparoscopic cholecystectomy. Patient’s selection according to attendees at time of operation as a single numbers were protective ventilation (group A) and a double numbers were conventional ventilation (group B). Results: Study showed significance between preoperative and postoperative pulmonary function tests and revealed better POST FVC in group A mean 86.04 (± 10.35) L, while in group B was 74.96 (± 14.73) L, p value (0.021). Better POST FEV1 in group A mean 73.56 (± 16.49) L, while in group B was 56.92 (± 8.340) L, p value (0.046). Better post-operative oxygenation in protective ventilation (group A). Mean Post P (A-a) O2 in group A was 27.93 (±7.76) mmHg, while in group B was 35.82 (±11.98) mmHg, p value (0.022). Study found peak and plateau airway pressures were higher in protective group with no change in airway resistance. Pulmonary compliance was improved but, in this study revealed more alterations of the hemodynamics in the patients who were subjected to protective ventilation despite adequate preoperative fluid preload. Hemodynamic instability observed in 24% in group A, but only occurred in 8% in group B. Study found that protective ventilation was superior to standard ventilation in prevention of atelectasis development 64%of the cases in group A revealed normal postoperative CT Chest and 36% showed lamellar atelectasis. In group B, 48% of the cases showed normal postoperative CT Chest, 40% revealed lamellar atelectasis and 12% showed plate atelectasis. Conclusions: Study found protective ventilation was superior to conventional ventilation in prevention of lung atelectasis and associated with better oxygenation and pulmonary function tests in the post-operative in obese laparoscopic cholecystectomy. In spite of it was very effective in optimizing gas exchange, but associated with more hemodynamic affection.
{"title":"A Comparative Study between Protective Lung Ventilation versus Conventional Ventilation in Obese Patients Undergoing Abdominal Laparoscopic Surgery","authors":"A. Eldemrdash, Nagwa Mohamed Gamaleldeen, M. Ahmed, Shazly Ahmed","doi":"10.4172/2155-6148.1000777","DOIUrl":"https://doi.org/10.4172/2155-6148.1000777","url":null,"abstract":"Background: Obesity is a serious problem worldwide. During general anesthesia and post-operative period, obese patients more likely to develop post-operative pulmonary complications as atelectasis and impaired pulmonary function compared to non-obese. Intraoperative protective ventilation consisting of low tidal volume, high PEEP and recruitment maneuvers resulted in alveolar recruitment and optimization of intraoperative respiratory mechanics. \u0000Objective: This study tested two strategies of mechanical ventilation in obese patients to find out which is best regarding gas exchange optimization, airway mechanics and atelectasis score. \u0000Methods: Study was a randomized prospective comparative control study was carried out on 50 obese patients with BMI 30-50 kg/m2. Patients were prepared for laparoscopic cholecystectomy. Patient’s selection according to attendees at time of operation as a single numbers were protective ventilation (group A) and a double numbers were conventional ventilation (group B). \u0000Results: Study showed significance between preoperative and postoperative pulmonary function tests and revealed better POST FVC in group A mean 86.04 (± 10.35) L, while in group B was 74.96 (± 14.73) L, p value (0.021). Better POST FEV1 in group A mean 73.56 (± 16.49) L, while in group B was 56.92 (± 8.340) L, p value (0.046). Better post-operative oxygenation in protective ventilation (group A). Mean Post P (A-a) O2 in group A was 27.93 (±7.76) mmHg, while in group B was 35.82 (±11.98) mmHg, p value (0.022). \u0000Study found peak and plateau airway pressures were higher in protective group with no change in airway resistance. Pulmonary compliance was improved but, in this study revealed more alterations of the hemodynamics in the patients who were subjected to protective ventilation despite adequate preoperative fluid preload. \u0000Hemodynamic instability observed in 24% in group A, but only occurred in 8% in group B. Study found that protective ventilation was superior to standard ventilation in prevention of atelectasis development 64%of the cases in group A revealed normal postoperative CT Chest and 36% showed lamellar atelectasis. In group B, 48% of the cases showed normal postoperative CT Chest, 40% revealed lamellar atelectasis and 12% showed plate atelectasis. \u0000Conclusions: Study found protective ventilation was superior to conventional ventilation in prevention of lung atelectasis and associated with better oxygenation and pulmonary function tests in the post-operative in obese laparoscopic cholecystectomy. In spite of it was very effective in optimizing gas exchange, but associated with more hemodynamic affection.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"151 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2017-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77776587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-28DOI: 10.4172/2155-6148.1000780
M. Mogahed, Mona Raafat Elghamri, Atteia Gad Anwar
Background: The common cause of anesthesia related injury is inability to intubate the trachea. Video laryngoscopes present an enlarged video image of glottis while intubating the trachea. The aim of this study is to compare efficacy of intubation by Macintosh with C-MAC D-Blade and King Vision video laryngoscope (VL) in controlled hypertensive patients. Patients and methods: 105 ASA II T2: just before intubation; T3: 2 min after intubation; T4: 5 min after intubation. Primary outcome: time and number of attempts required to successful intubation. Secondary outcomes: ease of laryngoscope insertion, Quality of view, Assist maneuvers, Intubation difficulty, Complications. Results: Differences in heart rate and mean blood pressure between all groups were statistically significant at T3&T4. Differences in duration of successful intubation were statistically significant between group (M) and group(C), also between group (M) and group (K). Statistically significant differences were obtained between all groups regarding quality of view of glottis, ease of insertion of laryngoscope, and use of assist maneuvers for intubation. Conclusion: Video laryngoscopes provide hemodynamic stability and better view of glottis than Macintosh during intubation. King Vision VL has advantages of ease of insertion, less need of assist maneuvers for intubation, with less complication. Thus, it is beneficial to use King Vision for intubation in hypertensive patients.
背景:麻醉相关损伤的常见原因是气管插管失败。视频喉镜在气管插管时显示声门的放大视频图像。本研究的目的是比较Macintosh与C-MAC D-Blade和King Vision视频喉镜(VL)在控制高血压患者中的插管效果。患者和方法:105 ASA II T2:插管前;T3:插管后2 min;T4:插管后5分钟。主要结果:成功插管所需的时间和次数。次要结果:喉镜插入的容易程度，观察质量，辅助操作，插管困难，并发症。结果:各组t3、t4期心率、平均血压差异均有统计学意义。(M)组与(C)组、(M)组与(K)组插管成功时间差异均有统计学意义。各组间在声门观察质量、喉镜插入难易程度和插管辅助操作使用方面差异均有统计学意义。结论:视频喉镜插管时血流动力学稳定，声门视野较Macintosh更好。King Vision VL具有插入方便、插管辅助操作少、并发症少等优点。因此，在高血压患者中使用王视仪插管是有益的。
{"title":"Comparative Study of Intubation Performance between Macintosh, the Channeled King Vision and the C-MAC D-Blade Videolaryngoscope in Controlled Hypertensive Patients","authors":"M. Mogahed, Mona Raafat Elghamri, Atteia Gad Anwar","doi":"10.4172/2155-6148.1000780","DOIUrl":"https://doi.org/10.4172/2155-6148.1000780","url":null,"abstract":"Background: The common cause of anesthesia related injury is inability to intubate the trachea. Video laryngoscopes present an enlarged video image of glottis while intubating the trachea. The aim of this study is to compare efficacy of intubation by Macintosh with C-MAC D-Blade and King Vision video laryngoscope (VL) in controlled hypertensive patients. \u0000Patients and methods: 105 ASA II T2: just before intubation; T3: 2 min after intubation; T4: 5 min after intubation. Primary outcome: time and number of attempts required to successful intubation. Secondary outcomes: ease of laryngoscope insertion, Quality of view, Assist maneuvers, Intubation difficulty, Complications. \u0000Results: Differences in heart rate and mean blood pressure between all groups were statistically significant at T3&T4. Differences in duration of successful intubation were statistically significant between group (M) and group(C), also between group (M) and group (K). Statistically significant differences were obtained between all groups regarding quality of view of glottis, ease of insertion of laryngoscope, and use of assist maneuvers for intubation. \u0000Conclusion: Video laryngoscopes provide hemodynamic stability and better view of glottis than Macintosh during intubation. King Vision VL has advantages of ease of insertion, less need of assist maneuvers for intubation, with less complication. Thus, it is beneficial to use King Vision for intubation in hypertensive patients.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"35 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2017-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78836124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-28DOI: 10.4172/2155-6148.1000779
A. Agegnehu, Amare Hailekiros Gebreegzi, G. Lemma, Nigussie Simeneh Endalew, E. G. Gebremedhn
Background: Hypotension is one of the common complications of spinal anaesthesia. It has many detrimental effects to the mother and fetus if left untreated. Recently, phenylephrine is introduced for the treatment of hypotension in our hospital. However, its efficacy on the prevention of spinal anaesthesia induced hypotension is still under controversy. We aimed to assess the effectiveness of phenylephrine prophylaxis on spinal hypotension after caesarean section. Methods: A prospective observational study was conducted at the University of Gondar Hospital. Patients were allocated based on treatment received; 50/100 μgm phenylephrine prophylaxis vs. no prophylaxis. PR, SBP, DBP, SPO2 and APGAR score were measured before, immediately after spinal anaesthesia, every 2 min intra operatively till the delivery of the baby and every 5 min after delivery for 20 min, and every 10 min for 1 h in postoperative period. Results: The incidence of hypotension was significantly lower for those participants with prophylactic phenylephrine (26% vs. 81.6%, p<0.001) compared to the non-treatment group. Systolic and diastolic blood pressures immediately after spinal anaesthesia till delivery and after delivery of the baby were significantly lower in the none treatment group at all times (p<0.05). Moreover, the number of rescue treatments and total amount of fluid given during the intraoperative period for the treatment of hypotension were more in the non-treatment group P=0.001). The APGAR scores at 1 and 5 min and postoperative vital signs were comparable between groups. Conclusion and recommendation: The incidence of spinal anaesthesia induced hypotension was high. Prophylactic intravenous phenylephrine bolus remarkably reduced the incidence of spinal induced hypotension compared to the non-treatment group. We recommend prophylactic phenylephrine for parturients undergoing caesarean section under spinal anaesthesia. Moreover, other pharmacological and non-pharmacological methods need to be considered as the incidence of hypotension is still high in the treatment group.
背景:低血压是脊髓麻醉的常见并发症之一。如果不及时治疗，它会对母亲和胎儿产生许多有害影响。近年来，我院开始应用苯肾上腺素治疗低血压。然而，其预防脊髓麻醉所致低血压的效果仍存在争议。我们的目的是评估苯肾上腺素预防剖腹产后脊柱低血压的有效性。方法:在贡达尔大学医院进行前瞻性观察研究。患者根据接受的治疗进行分配;50/100 μgm苯肾上腺素预防与未预防。分别于脊髓麻醉前、麻醉后立即、术中至分娩前每2分钟、分娩后每5分钟、术后每10分钟、1 h测量PR、收缩压、舒张压、SPO2、APGAR评分。结果:与未治疗组相比，预防性使用苯肾上腺素的受试者低血压发生率显著降低(26% vs. 81.6%， p<0.001)。脊髓麻醉后即刻至分娩及分娩后未治疗组收缩压、舒张压均明显低于对照组(p<0.05)。非治疗组抢救治疗次数和术中给液量均高于非治疗组(P=0.001)。两组间APGAR评分1、5 min及术后生命体征具有可比性。结论与建议:脊髓麻醉所致低血压发生率高。与未治疗组相比，预防性静脉注射苯肾上腺素显著降低了脊柱性低血压的发生率。我们建议在脊髓麻醉下剖腹产的产妇预防性使用苯肾上腺素。此外，由于治疗组低血压发生率仍然较高，需要考虑其他药物和非药物方法。
{"title":"Effectiveness of Intravenous Prophylactic Phenylephrine for the Prevention of Spinal Anaesthesia Induced Hypotension during Caesarean Section. A Prospective Observational Study","authors":"A. Agegnehu, Amare Hailekiros Gebreegzi, G. Lemma, Nigussie Simeneh Endalew, E. G. Gebremedhn","doi":"10.4172/2155-6148.1000779","DOIUrl":"https://doi.org/10.4172/2155-6148.1000779","url":null,"abstract":"Background: Hypotension is one of the common complications of spinal anaesthesia. It has many detrimental effects to the mother and fetus if left untreated. Recently, phenylephrine is introduced for the treatment of hypotension in our hospital. However, its efficacy on the prevention of spinal anaesthesia induced hypotension is still under controversy. We aimed to assess the effectiveness of phenylephrine prophylaxis on spinal hypotension after caesarean section. \u0000 Methods: A prospective observational study was conducted at the University of Gondar Hospital. Patients were allocated based on treatment received; 50/100 μgm phenylephrine prophylaxis vs. no prophylaxis. PR, SBP, DBP, SPO2 and APGAR score were measured before, immediately after spinal anaesthesia, every 2 min intra operatively till the delivery of the baby and every 5 min after delivery for 20 min, and every 10 min for 1 h in postoperative period. \u0000 Results: The incidence of hypotension was significantly lower for those participants with prophylactic phenylephrine (26% vs. 81.6%, p<0.001) compared to the non-treatment group. Systolic and diastolic blood pressures immediately after spinal anaesthesia till delivery and after delivery of the baby were significantly lower in the none treatment group at all times (p<0.05). Moreover, the number of rescue treatments and total amount of fluid given during the intraoperative period for the treatment of hypotension were more in the non-treatment group P=0.001). The APGAR scores at 1 and 5 min and postoperative vital signs were comparable between groups. \u0000Conclusion and recommendation: The incidence of spinal anaesthesia induced hypotension was high. Prophylactic intravenous phenylephrine bolus remarkably reduced the incidence of spinal induced hypotension compared to the non-treatment group. We recommend prophylactic phenylephrine for parturients undergoing caesarean section under spinal anaesthesia. Moreover, other pharmacological and non-pharmacological methods need to be considered as the incidence of hypotension is still high in the treatment group.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"109 1","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2017-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83447137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-27DOI: 10.4172/2155-6148.1000778
H. Yimer, Salh Yalew
Background: Anaesthetic drug wastage is a common challenge encountered in current anaesthetic care. Drug wastage is a potential area that significantly contribute for unnecessary health care budget allocation and financial lose. The aim of this study was to assess the amount of anaesthetic drug wastage and to analyze the cost of wasted drug in four operation room. Methods: A prospective observational study was conducted from January 10 to January 26, 2017 in the threemajor surgical and one obstetric operation room of university of Gondar teaching hospital. During consecutive period, data on amount of drug used or discarded were collected on patients undergoing surgical procedures under general or spinal anaesthesia. The total cost of used and wasted drug was estimated. Result: Of 86 patients included in the study, 54.6% were operated under general anaesthesia and 31.4% were under spinal anaesthesia. From 18 commonly used anaesthetic drugs, 16 of drugs were included into the final analysis. Of 16 different anaesthetic drugs, the maximum amount of wastage after loaded in syringes but not used, partially unused in ampoules or vials per case basis were seen in propofol, tramadol, and diclofenac (23.72 mg, 18 mg, and 10.6 mg, respectively). A total of 1967.8 Ethiopian birr (89.44 USD) were the cost of wasted drugs, of these the cost of wasted bupivacaine was maximum (33.8%). Conclusion: There was a significant amount of anaesthetic drugs and financial wastage during perioperative anaesthetic management for different surgical procedure. The use of drugs like neostigmine, metoclopramide, cimetidine and acetaminophen was best practice of usage during the study period no wastage was seen in those drugs. The use of fentanyl was also good which is 3.7% compared to other drugs.
{"title":"Audit on Wastage of Commonly Used Anaesthetic and Analgesic Agentsin Developing Country: The Case of Ethiopian University Teaching Hospital","authors":"H. Yimer, Salh Yalew","doi":"10.4172/2155-6148.1000778","DOIUrl":"https://doi.org/10.4172/2155-6148.1000778","url":null,"abstract":"Background: Anaesthetic drug wastage is a common challenge encountered in current anaesthetic care. Drug wastage is a potential area that significantly contribute for unnecessary health care budget allocation and financial lose. The aim of this study was to assess the amount of anaesthetic drug wastage and to analyze the cost of wasted drug in four operation room. Methods: A prospective observational study was conducted from January 10 to January 26, 2017 in the threemajor surgical and one obstetric operation room of university of Gondar teaching hospital. During consecutive period, data on amount of drug used or discarded were collected on patients undergoing surgical procedures under general or spinal anaesthesia. The total cost of used and wasted drug was estimated. Result: Of 86 patients included in the study, 54.6% were operated under general anaesthesia and 31.4% were under spinal anaesthesia. From 18 commonly used anaesthetic drugs, 16 of drugs were included into the final analysis. Of 16 different anaesthetic drugs, the maximum amount of wastage after loaded in syringes but not used, partially unused in ampoules or vials per case basis were seen in propofol, tramadol, and diclofenac (23.72 mg, 18 mg, and 10.6 mg, respectively). A total of 1967.8 Ethiopian birr (89.44 USD) were the cost of wasted drugs, of these the cost of wasted bupivacaine was maximum (33.8%). Conclusion: There was a significant amount of anaesthetic drugs and financial wastage during perioperative anaesthetic management for different surgical procedure. The use of drugs like neostigmine, metoclopramide, cimetidine and acetaminophen was best practice of usage during the study period no wastage was seen in those drugs. The use of fentanyl was also good which is 3.7% compared to other drugs.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"35 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2017-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85387294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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