Pub Date : 2022-02-14DOI: 10.31487/j.acr.2022.01.02
Kirsten Carlaw, David Tok Fu Ng, Dukyeon Kim, S. Phillips
Background: Pre-operative anxiety is prevalent and associated with adverse patient outcomes. Many anxiolytic techniques have been utilized in the pre-operative setting, with varying degrees of success. The Autonomous Sensory Meridian Response (ASMR) is an increasingly popular method of relaxation used for anxiety reduction in general society. It is a non-invasive, inexpensive intervention with no known adverse effects. It has not been researched in a pre-operative setting. We aimed to investigate the effects of ASMR in the pre-operative patient population. Methods: This prospective, double-blind trial randomly allocated 50 participants into either a placebo or ASMR group. Pre-operative anxiety was compared before and after viewing specially formatted educational video information in either an ASMR or non-ASMR format with validated anxiety scales-Visual Analogue Scale (VAAS), Amsterdam Pre-operative Anxiety and Information Scale (APAIS) and State-Trait Anxiety Inventory. The physiological characteristics of heart rate and blood pressure were measured as secondary outcomes. Results: The control group demonstrated a reduction in pre-operative VAAS of 6.6 (p = 0.01) and 1.1 (p = 0.02) on the APAIS. The ASMR group had a reduction of APAIS of 1.9 (p = 0.005) and no change in the VAAS. Changes in State-Trait Anxiety Inventory for state anxiety score were the same in both groups. Increased trait anxiety was correlated with increased post-intervention VAAS and APAIS scores. There was no effect of pre-existing trait anxiety and pre-interventional anxiety on the efficacy of ASMR. Post-intervention, there was a significant decrease in mean systolic blood pressure by 2.7mmHg in ASMR group. In multivariable analysis, ASMR group had a drop of 3.9mmHg in post-intervention systolic blood pressure compared to placebo (p<0.05). Conclusion: While our findings are inconclusive, potential benefits of ASMR in reducing pre-operative anxiety should be further explored with a larger sample.
{"title":"Does Triggering an Autonomous Sensory Meridian Response Reduce Pre-Operative Anxiety? A Randomized Placebo Controlled Trial","authors":"Kirsten Carlaw, David Tok Fu Ng, Dukyeon Kim, S. Phillips","doi":"10.31487/j.acr.2022.01.02","DOIUrl":"https://doi.org/10.31487/j.acr.2022.01.02","url":null,"abstract":"Background: Pre-operative anxiety is prevalent and associated with adverse patient outcomes. Many anxiolytic techniques have been utilized in the pre-operative setting, with varying degrees of success. The Autonomous Sensory Meridian Response (ASMR) is an increasingly popular method of relaxation used for anxiety reduction in general society. It is a non-invasive, inexpensive intervention with no known adverse effects. It has not been researched in a pre-operative setting. We aimed to investigate the effects of ASMR in the pre-operative patient population.\u0000Methods: This prospective, double-blind trial randomly allocated 50 participants into either a placebo or ASMR group. Pre-operative anxiety was compared before and after viewing specially formatted educational video information in either an ASMR or non-ASMR format with validated anxiety scales-Visual Analogue Scale (VAAS), Amsterdam Pre-operative Anxiety and Information Scale (APAIS) and State-Trait Anxiety Inventory. The physiological characteristics of heart rate and blood pressure were measured as secondary outcomes.\u0000Results: The control group demonstrated a reduction in pre-operative VAAS of 6.6 (p = 0.01) and 1.1 (p = 0.02) on the APAIS. The ASMR group had a reduction of APAIS of 1.9 (p = 0.005) and no change in the VAAS. Changes in State-Trait Anxiety Inventory for state anxiety score were the same in both groups. Increased trait anxiety was correlated with increased post-intervention VAAS and APAIS scores. There was no effect of pre-existing trait anxiety and pre-interventional anxiety on the efficacy of ASMR. Post-intervention, there was a significant decrease in mean systolic blood pressure by 2.7mmHg in ASMR group. In multivariable analysis, ASMR group had a drop of 3.9mmHg in post-intervention systolic blood pressure compared to placebo (p<0.05).\u0000Conclusion: While our findings are inconclusive, potential benefits of ASMR in reducing pre-operative anxiety should be further explored with a larger sample.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74145013","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 : 2021-10-13DOI: 10.31487/j.acr.2021.02.02
S. Virmani, V. Datt, C. Joshi, H. Minhas, Subodh Satyarthi, Indira Mallik
Background: The aim of the present study was to study the hemodynamic profile of dexmedetomidine during induction and distal anastomosis of coronary arteries in patients undergoing OPCAB in comparison to the institutional practice of using midazolam. Methods: In Group I, (n=25) patients were anaesthetised using fentanyl, pancuronium bromide, Isoflurane and midazolam. Group II (n=25) patients received a loading dose of dexmedetomidine infusion (1µg/Kg) over 10 minutes followed by an infusion of dexmedetomidine at the rate of 0.6 µg/Kg/hour, along with fentanyl, Pancuronium bromide and isoflurane. Heart rate (HR) mean arterial pressure (MAP), pulmonary artery (PA) catheter derived data and BIS were recorded at baseline, at 1 and 3 minutes after induction, at 1, 3 and 5 minutes after intubation, and at 5 and 30 minutes after protamine administration. MAP and HR were recorded every 10 min during the operation, except during distal anastomosis of the coronary arteries when it was recorded every 5 minutes after application of the Octopus tissue stabilising system. Results: The intubation response by way of increase in HR was much less in group II and stabilized by 5 min after intubation. The accompanying hypotension at 1 minute after induction was more in group II, but it was clinically acceptable (81.68±21.74 mm Hg). During distal graft anastomoses HR was in the range of 68 beats/min to 85 beats/min in group II vs. 85 beats/min to 100 beats/min in Group I. The MAP was lower in this group during the distal anastomosis, but it was within clinically acceptable range (> 65 mm Hg). Conclusion: Dexmedetomidine is a viable option as an anaesthetic adjunct in a loading dose of 1µg/Kg followed by an infusion of 0.6 µg/Kg. Future studies will be necessary to show if this provides any outcome benefits.
背景:本研究的目的是研究右美托咪定在OPCAB患者冠状动脉诱导和远端吻合期间的血流动力学特征，并与使用咪达唑仑的机构实践进行比较。方法:第一组25例患者采用芬太尼、泮库溴铵、异氟醚和咪达唑仑麻醉。II组(n=25)患者在10分钟内输注右美托咪定负荷剂量(1µg/Kg)，随后以0.6µg/Kg/小时的速度输注右美托咪定，同时输注芬太尼、泮库溴铵和异氟醚。记录基线、诱导后1分钟和3分钟、插管后1分钟、3分钟和5分钟、鱼精蛋白给药后5分钟和30分钟的心率(HR)、平均动脉压(MAP)、肺动脉(PA)导管衍生数据和BIS。MAP和HR在手术期间每10分钟记录一次，冠状动脉远端吻合期间除外，在应用Octopus组织稳定系统后每5分钟记录一次。结果:ⅱ组以HR升高方式引起的插管反应明显减少，并在插管后5 min稳定。诱导后1分钟伴有低血压II组较多，但临床可接受(81.68±21.74 mm Hg)。II组远端吻合时心率在68 ~ 85次/分之间，ⅰ组为85 ~ 100次/分。本组远端吻合时MAP较低，但在临床可接受范围内(> 65 mm Hg)。结论:右美托咪定是一种可行的麻醉辅助剂，负荷剂量为1µg/Kg，然后输注0.6µg/Kg。未来的研究将有必要证明这是否提供了任何结果的好处。
{"title":"Dexmedetomidine as an Anaesthetic Adjunct in Patients Undergoing Elective Off-Pump Coronary Artery Bypass Graft Surgery","authors":"S. Virmani, V. Datt, C. Joshi, H. Minhas, Subodh Satyarthi, Indira Mallik","doi":"10.31487/j.acr.2021.02.02","DOIUrl":"https://doi.org/10.31487/j.acr.2021.02.02","url":null,"abstract":"Background: The aim of the present study was to study the hemodynamic profile of dexmedetomidine during induction and distal anastomosis of coronary arteries in patients undergoing OPCAB in comparison to the institutional practice of using midazolam.\u0000Methods: In Group I, (n=25) patients were anaesthetised using fentanyl, pancuronium bromide, Isoflurane and midazolam. Group II (n=25) patients received a loading dose of dexmedetomidine infusion (1µg/Kg) over 10 minutes followed by an infusion of dexmedetomidine at the rate of 0.6 µg/Kg/hour, along with fentanyl, Pancuronium bromide and isoflurane. Heart rate (HR) mean arterial pressure (MAP), pulmonary artery (PA) catheter derived data and BIS were recorded at baseline, at 1 and 3 minutes after induction, at 1, 3 and 5 minutes after intubation, and at 5 and 30 minutes after protamine administration. MAP and HR were recorded every 10 min during the operation, except during distal anastomosis of the coronary arteries when it was recorded every 5 minutes after application of the Octopus tissue stabilising system.\u0000Results: The intubation response by way of increase in HR was much less in group II and stabilized by 5 min after intubation. The accompanying hypotension at 1 minute after induction was more in group II, but it was clinically acceptable (81.68±21.74 mm Hg). During distal graft anastomoses HR was in the range of 68 beats/min to 85 beats/min in group II vs. 85 beats/min to 100 beats/min in Group I. The MAP was lower in this group during the distal anastomosis, but it was within clinically acceptable range (> 65 mm Hg).\u0000Conclusion: Dexmedetomidine is a viable option as an anaesthetic adjunct in a loading dose of 1µg/Kg followed by an infusion of 0.6 µg/Kg. Future studies will be necessary to show if this provides any outcome benefits.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83790233","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 : 2021-08-26DOI: 10.31487/j.acr.2021.02.01
Takeshi Murouchi
Purpose: It is routine to administer oxytocin following delivery of the neonate during cesarean section. However, there are many kinds of administration methods. Heesen et al. published an international consensus statement in 2019 on the use of uterotonic agents, including oxytocin during cesarean section [1]. Our institution adapted the guideline-based oxytocin infusion method. We verified the validity of the new approach after one year. Methods: A single-center retrospective study of consecutive patients who underwent cesarean section with a new protocol or the conventional manner from November 2019 to December 2020 was conducted. The primary endpoint was a significant difference in the amount of intraoperative hemorrhage and the total oxytocin amount. Secondary endpoints included differences in the incidence of intraoperative complications. Results: The study included 174 patients: 66 in the new protocol group and 108 in the conventional group. There was a statistically significant difference between the two groups for oxytocin amount (new protocol 4.2 [3.2-5.9] vs. conventional 5.0 [5.0-10] IU, p<0.01) with equivalent intraoperative hemorrhages (new protocol 558 [337-963] vs. conventional 683 [484-1012] g, p=0.08). There was no significant difference in the incidence of nausea. Conclusion: The new guideline-based oxytocin administration safely decreased the intraoperative oxytocin amount in our institution.
{"title":"The First International Guideline for Oxytocin Safely Decreased Oxytocin Amount During Cesarean Section: A Single-Institution Retrospective Analysis","authors":"Takeshi Murouchi","doi":"10.31487/j.acr.2021.02.01","DOIUrl":"https://doi.org/10.31487/j.acr.2021.02.01","url":null,"abstract":"Purpose: It is routine to administer oxytocin following delivery of the neonate during cesarean section. \u0000However, there are many kinds of administration methods. Heesen et al. published an international \u0000consensus statement in 2019 on the use of uterotonic agents, including oxytocin during cesarean section \u0000[1]. Our institution adapted the guideline-based oxytocin infusion method. We verified the validity of the \u0000new approach after one year.\u0000Methods: A single-center retrospective study of consecutive patients who underwent cesarean section \u0000with a new protocol or the conventional manner from November 2019 to December 2020 was conducted. \u0000The primary endpoint was a significant difference in the amount of intraoperative hemorrhage and the \u0000total oxytocin amount. Secondary endpoints included differences in the incidence of intraoperative \u0000complications.\u0000Results: The study included 174 patients: 66 in the new protocol group and 108 in the conventional \u0000group. There was a statistically significant difference between the two groups for oxytocin amount (new \u0000protocol 4.2 [3.2-5.9] vs. conventional 5.0 [5.0-10] IU, p<0.01) with equivalent intraoperative \u0000hemorrhages (new protocol 558 [337-963] vs. conventional 683 [484-1012] g, p=0.08). There was no \u0000significant difference in the incidence of nausea.\u0000Conclusion: The new guideline-based oxytocin administration safely decreased the intraoperative \u0000oxytocin amount in our institution.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88392292","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 : 2021-07-08DOI: 10.31487/J.ACR.2021.01.04
L. Krekmanova, A. Robertson
This article is aimed at dentists who treat children under 6 years of age for acute dental care requiring sedation, and where physical restraint may be necessary. Physical restraint means the occasional holding of the child so that invasive procedures can be performed, with little risk of inflicting physical and/or mental harm. Where circumstances require sedation and physical restraint, emphasis should be placed on the dentist’s preoperative information to the guardian for consent. It is crucial that the guardian decides on an active or passive role regarding support of the child. The recording of this information follows lege artis treatment regulations.
{"title":"The Preschool Child in Acute Dental Care - Sedation and Physical Restraint in Collaboration with Guardians","authors":"L. Krekmanova, A. Robertson","doi":"10.31487/J.ACR.2021.01.04","DOIUrl":"https://doi.org/10.31487/J.ACR.2021.01.04","url":null,"abstract":"This article is aimed at dentists who treat children under 6 years of age for acute dental care requiring\u0000sedation, and where physical restraint may be necessary. Physical restraint means the occasional holding\u0000of the child so that invasive procedures can be performed, with little risk of inflicting physical and/or\u0000mental harm. Where circumstances require sedation and physical restraint, emphasis should be placed on\u0000the dentist’s preoperative information to the guardian for consent. It is crucial that the guardian decides on\u0000an active or passive role regarding support of the child. The recording of this information follows lege\u0000artis treatment regulations.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82067331","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 : 2021-05-31DOI: 10.31487/J.ACR.2021.01.03
A. Skorko, M. Pachucki, Samantha Taylor, T. Gould, M. Thomas, K. Rooney, N. Kane
This personal opinion review of the potential role for EEG in the multimodal neuroprognostication of comatose cardiac arrest patients, after resuscitation and targeted temperature management, discusses recent findings along with our personal experience from a large single-center cohort of 220 consecutive patients investigated with electrophysiological tests (EEG and SSEP). Although EEG has its limitations, along with all modalities in the multimodal prognostic framework, when timed appropriately and interpreted in a standardized fashion, it can be probabilistic but not deterministic of an individual patient’s neurological prognosis. The EEG phenotype can indicate both good and poor prognoses for a comatose patient on the Intensive Care Unit, which is a distinct advantage of this widely available modality, whilst an SSEP can reliably predict a poor outcome if absent and may also help predict good outcome using amplitude analysis.
{"title":"A Review of the Electrophysiological Neuroprognostications after Out of Hospital Cardiac Arrest","authors":"A. Skorko, M. Pachucki, Samantha Taylor, T. Gould, M. Thomas, K. Rooney, N. Kane","doi":"10.31487/J.ACR.2021.01.03","DOIUrl":"https://doi.org/10.31487/J.ACR.2021.01.03","url":null,"abstract":"This personal opinion review of the potential role for EEG in the multimodal neuroprognostication of comatose cardiac arrest patients, after resuscitation and targeted temperature management, discusses recent findings along with our personal experience from a large single-center cohort of 220 consecutive patients investigated with electrophysiological tests (EEG and SSEP). Although EEG has its limitations, along with all modalities in the multimodal prognostic framework, when timed appropriately and interpreted in a standardized fashion, it can be probabilistic but not deterministic of an individual patient’s neurological prognosis. The EEG phenotype can indicate both good and poor prognoses for a comatose patient on the Intensive Care Unit, which is a distinct advantage of this widely available modality, whilst an SSEP can reliably predict a poor outcome if absent and may also help predict good outcome using amplitude analysis.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76965829","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}
Context: Postural change during anaesthesia has a complex effect on systemic and cerebral circulations. Aim: The goal of the study was to evaluate the effects of desflurane and propofol on cerebral oxygenation during spinal surgery in the prone position. Settings and Design: A prospective randomized double-blinded trial. Methods and Materials: Fifty-two patients scheduled for spinal surgery were randomly allocated to propofol (n=25) and desflurane (n=27) groups. Anaesthetic agents were maintained to obtain a bispectral index of 50-55. SAP, DAP, HR, SPO2, ETCO2 and right and left rSO2 were assessed at seven-time points: supine position without oxygen administration (T1), supine position with oxygen administration (T2-baseline), intubation in the supine position (T3), just after prone positioning (T4), 10 minutes after prone positioning (T5), at the end of surgery in the prone position (T6) and at the end of anaesthesia in the supine position (T7). PCO2, PO2 and Hb partial were also recorded at T3 and T7. Results: Demographic data, pre-oxygenation hemodynamic variables and rSO2 were comparable between the groups. There was no significant difference between groups in SAP, DAP, HR, SPO2, and ETCO2 (p=0.095, p=0.061, p=0.357, p=0.088, p=0.328 respectively). PCO2, PO2 and Hb were not significant different between groups (p=0.542, p=0.394, p=0.768 respectively). rSO2 values were not significantly different between groups. In the propofol group, right rSO2 was significantly higher at T3 (p=0.017) and significantly lower at T5 (p=0,019) and at T6 (p=0,028) compared to baseline. Left rSO2 decreased significantly from baseline at T5 (p=0.026) in the propofol group. Left and right rSO2 in the desflurane group decreased significantly from baseline at T5 (p=0.0004 and p=0.0115). Conclusion: In the prone position, desflurane and propofol were associated with a significant decrease in rSO2 without differences between these anaesthetics.
{"title":"Effects of Desflurane Versus Propofol Anesthesia on Regional Cerebral Oxygenation during Spinal Surgery in the Prone Position","authors":"Koraki Eleni, Stachtari Chrysoula, Bagntasarian Stella, Gkiouliava Anna, Sifaki Freideriki, Stergiouda Zoi, Kapsokalyvas Ioannis, Chatzopoulos Stavros","doi":"10.31487/J.ACR.2021.01.02","DOIUrl":"https://doi.org/10.31487/J.ACR.2021.01.02","url":null,"abstract":"Context: Postural change during anaesthesia has a complex effect on systemic and cerebral circulations. Aim: The goal of the study was to evaluate the effects of desflurane and propofol on cerebral oxygenation during spinal surgery in the prone position.\u0000Settings and Design: A prospective randomized double-blinded trial.\u0000Methods and Materials: Fifty-two patients scheduled for spinal surgery were randomly allocated to propofol (n=25) and desflurane (n=27) groups. Anaesthetic agents were maintained to obtain a bispectral index of 50-55. SAP, DAP, HR, SPO2, ETCO2 and right and left rSO2 were assessed at seven-time points: supine position without oxygen administration (T1), supine position with oxygen administration (T2-baseline), intubation in the supine position (T3), just after prone positioning (T4), 10 minutes after prone positioning (T5), at the end of surgery in the prone position (T6) and at the end of anaesthesia in the supine position (T7). PCO2, PO2 and Hb partial were also recorded at T3 and T7.\u0000Results: Demographic data, pre-oxygenation hemodynamic variables and rSO2 were comparable between the groups. There was no significant difference between groups in SAP, DAP, HR, SPO2, and ETCO2 (p=0.095, p=0.061, p=0.357, p=0.088, p=0.328 respectively). PCO2, PO2 and Hb were not significant different between groups (p=0.542, p=0.394, p=0.768 respectively). rSO2 values were not significantly different between groups. In the propofol group, right rSO2 was significantly higher at T3 (p=0.017) and significantly lower at T5 (p=0,019) and at T6 (p=0,028) compared to baseline. Left rSO2 decreased significantly from baseline at T5 (p=0.026) in the propofol group. Left and right rSO2 in the desflurane group decreased significantly from baseline at T5 (p=0.0004 and p=0.0115).\u0000Conclusion: In the prone position, desflurane and propofol were associated with a significant decrease in rSO2 without differences between these anaesthetics.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"128 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87940515","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}
Introduction: Myoclonic movement is not common side effect after general anaesthesia. Since we use various intravenous agents during general anaesthesia recently, it is troublesome to find out the exact cause of this neurologic complication. Patient concerns: A 28-year-old male patient without any past medical history underwent mandibular cyst enucleation surgery under general anaesthesia. Diagnoses: Sudden myoclonic movement confined to upper trunk and left upper extremity in recovery room after uneventful GA. Outcomes: There was no significant abnormality in electroencephalography or blood tests, which were taken after the event.
{"title":"Myoclonic Movement After Mandibular Cyst Enucleation Under General Anesthesia, A rare case report during COVID-19 pandemic","authors":"Alaa Ali Elzohary","doi":"10.52803/264IAE","DOIUrl":"https://doi.org/10.52803/264IAE","url":null,"abstract":"Introduction: Myoclonic movement is not common side effect after general anaesthesia. Since we use various intravenous agents during general anaesthesia recently, it is troublesome to find out the exact cause of this neurologic complication. Patient concerns: A 28-year-old male patient without any past medical history underwent mandibular cyst enucleation surgery under general anaesthesia. Diagnoses: Sudden myoclonic movement confined to upper trunk and left upper extremity in recovery room after uneventful GA. Outcomes: There was no significant abnormality in electroencephalography or blood tests, which were taken after the event.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"640 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77524949","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}
Research by Johns Hopkins Hospital physicians found that 40%-95% of chronic pain patients were not properly diagnosed. By using an on-line diagnostic test which gives diagnoses with a 96% correlation with diagnoses of Johns Hopkins Hospital doctors, several physician groups reported an increase use of interventional testing up to 192% of the time.
{"title":"Increasing the use of blocks 192% using an Internet based diagnostic test","authors":"N. Hendler","doi":"10.52803/264NI","DOIUrl":"https://doi.org/10.52803/264NI","url":null,"abstract":"Research by Johns Hopkins Hospital physicians found that 40%-95% of chronic pain patients were not properly diagnosed. By using an on-line diagnostic test which gives diagnoses with a 96% correlation with diagnoses of Johns Hopkins Hospital doctors, several physician groups reported an increase use of interventional testing up to 192% of the time.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91196328","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 : 2021-04-19DOI: 10.1101/2021.04.14.21255104
Rosita Bihariesingh, Rakesh Bansie, Janeri Froberg, N. Ramdhani, Rishi Mangroo, Debra Bustamente, Ernesto Diaz, I. Thakoer, Stephen Vreden, Zaheeb Choudhry, Wouter Jansen Klomp, Dimitri Diavatopoulos, Arno Nierich
Background Although convalescent plasma (CP) treatment is a potential therapeutic option for patients with COVID-19, there is a paucity of data from studies in low-resource settings. The efficacy and safety of CP therapy in intensive care unit (ICU) patients with COVID-19 in Suriname was evaluated. A novel gravity-based filtration method was used to obtain CP. The design was an open-label, multi-centre, non-randomized prospective clinical trial performed in two hospitals in Suriname, from June 2020, to December 2020. A pre-planned interim analysis is reported in 78 PCR-confirmed COVID-19 patients admitted to the ICU with severe or lifethreatening symptoms. CP in combination with standard treatment (n = 28) was compared to standard treatment alone (control) (n = 50), stratified by disease severity. The primary endpoint was 28-day ICU mortality. Secondary (exploratory) endpoints were changes two days after treatment initiation in pulmonary oxygen exchange capacity (PF ratio) and chest xray (CXR) score. Findings The median age of patients was 52 years with 43 [55.1%] being male. Twenty-eight day mortality occurred in 18% (5/28) of the CP group vs 36% (18/50) of the control group. Survival probability was significantly higher in the CP group compared to the control group with standard care (P=0.027). When stratifying into disease severity, the survival probability was the lowest for the control group with life-threatening disease (P=0.0051). CP treatment of severe COVID-19 resulted in a higher probability of survival, with a hazard ratio (HR) of 0.22 (95% CI, 0.074-0.067), correcting for age, the presence of diabetes and COVID-19 severity. Age significantly increased the mortality risk (HR, 1.08 [95%CI, 1.022-1.14]; P =0.006). In the severe group, CP resulted in an improved CXR score (P =0.0013) and increase in PF ratio (P = 0.011) as compared to standard therapy. The gravity-based plasmapheresis method used for CP production was well-tolerated and no adverse events were observed in the donors. Interpretation Among patients with severe or life-threatening COVID-19, CP therapy in combination with standard treatment resulted in 78% reduction of 28-day ICU mortality (HR = 0.22) compared to standard treatment alone. Both CXR-score and PF ratio changes represent indicators of treatment effect of CP after two days and can easily be implemented in low-resource settings. The novel CP production method was effective and represents a practical solution for low and middle income countries (LMICs) to produce CP locally. Although interpretation is limited by the non-randomised design of the trial, these results offer a potential route for broader implementation of CP treatment in LMICs.
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Pub Date : 2021-01-29DOI: 10.31487/J.ACR.2021.01.01
S. Bevilacqua, P. Stefàno
We greatly appreciate the interest that De Melo MS, et al. showed on the use of remifentanil in a rapid sequence intubation technique that we recently proposed for patients undergoing surgery during the current SARS-CoV-2 pandemic [1, 2]. The authors also reported the response that Tang and Wang wrote to comment on that paper [3]. Given the interest aroused by our article, we think it would be worth making some clarifications. In brief, in order to limit aerosolization, we proposed to systematically perform rapid induction and intubation in the surgical patient after he had reached a state of deep analgesia with a continuous infusion of high-dose remifentanil (0.2-0.3 g/kg/min) [2]. Although in the title of the article this method is labeled as a rapid sequence induction, in the text, we explain how this technique, far from being standard rapid sequence intubation, was a rather longer technique in which the patient, although in a state of profound analgesia and sedation induced by remifentanil, breathed spontaneously and at last on command, until hypnosis, and muscle paralysis was rapidly induced with a low dose of propofol (<0.5 mg/kg) or midazolam (0.05-0.1 mg/kg) and a full dose of rocuronium (1 mg/kg) [2].
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