Pub Date : 2020-06-18DOI: 10.31487/j.acr.2020.01.04
Anne Clémence Goubin, C. Motamed, L. Bordenave
In this case a cervico facial cancer patient scheduled for tracheostomy followed by an endoscopy, and known to have a pacemaker, had hemodynamic instability at the start of general anaesthesia which lasted several hours. The anaesthetist in charge used the magnet to override the pace maker which did not respond. Indeed, it was a leadless pacemaker. These devices will be used more frequently and should be carefully scrutinized at the anaesthetic consultation.
{"title":"A Leadless Pace Maker","authors":"Anne Clémence Goubin, C. Motamed, L. Bordenave","doi":"10.31487/j.acr.2020.01.04","DOIUrl":"https://doi.org/10.31487/j.acr.2020.01.04","url":null,"abstract":"In this case a cervico facial cancer patient scheduled for tracheostomy followed by an endoscopy, and known\u0000to have a pacemaker, had hemodynamic instability at the start of general anaesthesia which lasted several\u0000hours. The anaesthetist in charge used the magnet to override the pace maker which did not respond. Indeed,\u0000it was a leadless pacemaker. These devices will be used more frequently and should be carefully scrutinized\u0000at the anaesthetic consultation.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72705866","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 : 2020-06-03DOI: 10.31487/j.acr.2020.01.03
C. Motamed, L. Bordenave, S. Suria
Intraoperative anaesthesia management in oro-facial cancer surgical patients requiring free flap tissue transfer is evolving. In this paper we updated our intraoperative clinical protocol using our own experience in combination with the latest literature. The main areas of change include videolaryngoscopic awake intubation in case of difficult airway management, combination of regional anaesthesia with peripheral catheter to decrease intraoperative opioid consumption, and postoperative pain and finally opioid free anaesthesia techniques using dexmedetomidine.
{"title":"Clinical Update on Anaesthetic Management of Free Flap Surgery in Cervico Facial Cancer Patients","authors":"C. Motamed, L. Bordenave, S. Suria","doi":"10.31487/j.acr.2020.01.03","DOIUrl":"https://doi.org/10.31487/j.acr.2020.01.03","url":null,"abstract":"Intraoperative anaesthesia management in oro-facial cancer surgical patients requiring free flap tissue\u0000transfer is evolving. In this paper we updated our intraoperative clinical protocol using our own experience\u0000in combination with the latest literature. The main areas of change include videolaryngoscopic awake\u0000intubation in case of difficult airway management, combination of regional anaesthesia with peripheral\u0000catheter to decrease intraoperative opioid consumption, and postoperative pain and finally opioid free\u0000anaesthesia techniques using dexmedetomidine.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83918454","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 : 2020-06-02DOI: 10.31487/j.acr.2020.01.02
C. Motamed, L. Bordenave, S. Suria
Postoperative management of complex cervico-facial cancer tumor removal followed by free flap reconstruction is evolving since its early beginning 20 years ago. Flap surveillance is a major goal in this period, however the management of comorbidities to predict a favorable outcome cannot be neglected. Based on our experience in this field and recent literature we updated our postoperative management protocol which focus on management of different comorbidities to maintain favorable outcome for the graft and the patient.
{"title":"Postoperative Management of Patients with Cervicofacial Free Flap in Surgical Intensive Care Unit: An Updated Clinical Protocol","authors":"C. Motamed, L. Bordenave, S. Suria","doi":"10.31487/j.acr.2020.01.02","DOIUrl":"https://doi.org/10.31487/j.acr.2020.01.02","url":null,"abstract":"Postoperative management of complex cervico-facial cancer tumor removal followed by free flap\u0000reconstruction is evolving since its early beginning 20 years ago. Flap surveillance is a major goal in this\u0000period, however the management of comorbidities to predict a favorable outcome cannot be neglected.\u0000Based on our experience in this field and recent literature we updated our postoperative management\u0000protocol which focus on management of different comorbidities to maintain favorable outcome for the\u0000graft and the patient.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80371199","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 : 2018-11-06DOI: 10.4172/2155-6148.1000827
A. Weinbroum
Obese and morbidly obese patients are a growing group of individuals that generates medical, social and economic problems worldwide. They undergo various interventions that require anesthesia and/or analgesia. Despite their healthy look, these individuals are graded at high ASA physical status, mainly because of their impaired respiratory and cardiovascular conditions, and the metabolic changes their body undergoes. Opioids are the default drugs for perioperative analgesia. Nevertheless, their use has reached a frightening epidemic-like condition worldwide. Multimodal analgesia regimens have been recommended as a perioperative standard of care, particularly for the obese. These regimens employ combinations of opioids and non-opioid compounds that augment the formers' analgesic potencies, thus providing superior pain relief at rest, movement, or on effort, while reducing opioid consumption and their concerned adverse effects. The most important perioperative IV adjuvant currently employed is ketamine that sees resurgence among physicians from diverse medical specialties. After summarizing obese patients' perioperative drawbacks, this review will illustrate ketamine’s neuropharmacology, and will describe its therapeutic usefulness as an analgesic adjuvant. Since data regarding the use of the drug in obese patients is scarce, brief examplifications of its benefits in non-obese cohorts will be portrayed as well.
{"title":"Role and Advantageousness of Ketamine in Obese and Non-Obese Patients: Peri-Interventional Considerations","authors":"A. Weinbroum","doi":"10.4172/2155-6148.1000827","DOIUrl":"https://doi.org/10.4172/2155-6148.1000827","url":null,"abstract":"Obese and morbidly obese patients are a growing group of individuals that generates medical, social and economic problems worldwide. They undergo various interventions that require anesthesia and/or analgesia. Despite their healthy look, these individuals are graded at high ASA physical status, mainly because of their impaired respiratory and cardiovascular conditions, and the metabolic changes their body undergoes. Opioids are the default drugs for perioperative analgesia. Nevertheless, their use has reached a frightening epidemic-like condition worldwide. Multimodal analgesia regimens have been recommended as a perioperative standard of care, particularly for the obese. These regimens employ combinations of opioids and non-opioid compounds that augment the formers' analgesic potencies, thus providing superior pain relief at rest, movement, or on effort, while reducing opioid consumption and their concerned adverse effects. The most important perioperative IV adjuvant currently employed is ketamine that sees resurgence among physicians from diverse medical specialties. After summarizing obese patients' perioperative drawbacks, this review will illustrate ketamine’s neuropharmacology, and will describe its therapeutic usefulness as an analgesic adjuvant. Since data regarding the use of the drug in obese patients is scarce, brief examplifications of its benefits in non-obese cohorts will be portrayed as well.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"30 1","pages":"1-17"},"PeriodicalIF":0.0,"publicationDate":"2018-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83090728","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 : 2018-06-21DOI: 10.4172/2155-6148.1000836
Tuan-Yen Wu
Started with the recent turmoil in the White House, the author further collected some examples of failure of disclosure of financial conflicts of interests between drug companies and researchers that lead to scandals and their aftermath. The author concluded that both politicians and researchers should hold high morality as to gain trust to people. The solution is to actively and voluntarily disclose any potential conflicts of interest in advance rather than impose strict regulations, as the latter may have some opposite effects.
{"title":"Demanding Truth is not a Witch-Hunt","authors":"Tuan-Yen Wu","doi":"10.4172/2155-6148.1000836","DOIUrl":"https://doi.org/10.4172/2155-6148.1000836","url":null,"abstract":"Started with the recent turmoil in the White House, the author further collected some examples of failure of disclosure of financial conflicts of interests between drug companies and researchers that lead to scandals and their aftermath. The author concluded that both politicians and researchers should hold high morality as to gain trust to people. The solution is to actively and voluntarily disclose any potential conflicts of interest in advance rather than impose strict regulations, as the latter may have some opposite effects.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"63 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2018-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74095042","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 : 2018-01-29DOI: 10.4172/2155-6148.1000806
Lauretta Mp, L. Caporali, S. Manera, Melotti Rm, Prucher Gm
Background: Anaesthetic management for microvascular reconstructive surgery is challenging and clearly affects the risk of major complications such as flap hypo-perfusion. In this systematic review we explore recent (last 7 years) clinical evidences related to perioperative management and anaesthetic controversy of patients undergoing microvascular reconstructive surgery, especially focused on head and neck surgery with free flaps (FF) and breast reconstructive surgery with deep inferior epigastric perforator flap (DIEP-flap).Methods: A literature search of published clinical studies between 2011 and 2018 was conducted, yielding a total of 4307 papers. Only 150 were eligible, according inclusion and exclusion criteria.Results: 62 studies were selected for this review and categorized in 3 groups: preoperative-intraoperativepostoperative anaesthetic management and areas of controversy for patients undergoing head and neck surgery with FF and breast reconstructive surgery with DIEP-flap.Discussion: Anaesthetic management for flap reconstructive surgery remains an open field of interest with limited evidences regarding a standard care. Main components of research currently are: the need to join standard multidisciplinary enhanced recovery pathways, as well as the necessity to develop a standard intraoperative management. In theatre, the recent hemodynamic parameter “Hypotension Probability Indicator” (HPI) is promising: the advantage to predict a drop in the mean arterial pressure can be more effective than a fluid therapy titrated to maintain SVV less than 13%. Prospective studies are necessary to clarify.
{"title":"Anaesthetic Challenging in Microsurgical Flap Reconstruction: A Systematic Review","authors":"Lauretta Mp, L. Caporali, S. Manera, Melotti Rm, Prucher Gm","doi":"10.4172/2155-6148.1000806","DOIUrl":"https://doi.org/10.4172/2155-6148.1000806","url":null,"abstract":"Background: Anaesthetic management for microvascular reconstructive surgery is challenging and clearly affects the risk of major complications such as flap hypo-perfusion. \u0000In this systematic review we explore recent (last 7 years) clinical evidences related to perioperative management and anaesthetic controversy of patients undergoing microvascular reconstructive surgery, especially focused on head and neck surgery with free flaps (FF) and breast reconstructive surgery with deep inferior epigastric perforator flap (DIEP-flap).Methods: A literature search of published clinical studies between 2011 and 2018 was conducted, yielding a total of 4307 papers. Only 150 were eligible, according inclusion and exclusion criteria.Results: 62 studies were selected for this review and categorized in 3 groups: preoperative-intraoperativepostoperative anaesthetic management and areas of controversy for patients undergoing head and neck surgery with FF and breast reconstructive surgery with DIEP-flap.Discussion: Anaesthetic management for flap reconstructive surgery remains an open field of interest with limited evidences regarding a standard care. Main components of research currently are: the need to join standard multidisciplinary enhanced recovery pathways, as well as the necessity to develop a standard intraoperative management. In theatre, the recent hemodynamic parameter “Hypotension Probability Indicator” (HPI) is promising: the advantage to predict a drop in the mean arterial pressure can be more effective than a fluid therapy titrated to maintain SVV less than 13%. Prospective studies are necessary to clarify.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"44 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2018-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76148985","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 : 2018-01-01DOI: 10.4172/2155-6148.1000858
S. Arafa, A. Sayed
Objectives: A prospective randomized study to demonstrate the ease of intubation between Airtraq, King Vision video laryngoscope, and Macintosh laryngoscope, to compare the different laryngeal views and the need for assisted maneuvers, and hemodynamic changes during intubation in patients scheduled for one level cervical discectomy. Materials & Methods: Ninety patients ASA I&II scheduled for one level cervical discectomy were randomly assigned into three groups to perform endotracheal intubation with Airtraq (group I; 30 patients), King Vision laryngoscope (group II; 30 patients), and Macintosh laryngoscope (group III; 30 patients). Intubation time and success rate for intubation were recorded. Also, observation and recording of vocal cord visualization using Cormack-Lehane grading and intubation difficulty score (IDS), complications and hemodynamic changes occurred with each aid. Results: There were statistically significant differences between the three groups as regard the time needed for successful intubation, the need for assist maneuvers, quality of glottis view, and the incidence of complications during airways manipulations, with better results (less time taken for intubation, better glottis view, less IDS and less complications with more stable hemodynamics during intubation) for king Vision group compared with Airtraq and Macintosh laryngoscope groups. Conclusion: King Vision laryngoscope had advantages of short time for intubation, almost, no complications occurred with it contrary to Airtraq or Macintosh laryngoscope and almost, no significant alterations in hemodynamics during intubation. It might give self-confidence to the anesthesiologist to use it easily, ensures intubation and permits many assistant doctors or trained residents to visualize the field during intubation.
{"title":"Alternative Airway Means for Endotracheal Intubation in Adult Patients for Cervical Discectomy. Comparison between Airtraq, King Vision Video Laryngoscope and Macintosh Laryngoscope: A Prospective Randomized Study","authors":"S. Arafa, A. Sayed","doi":"10.4172/2155-6148.1000858","DOIUrl":"https://doi.org/10.4172/2155-6148.1000858","url":null,"abstract":"Objectives: A prospective randomized study to demonstrate the ease of intubation between Airtraq, King Vision video laryngoscope, and Macintosh laryngoscope, to compare the different laryngeal views and the need for assisted maneuvers, and hemodynamic changes during intubation in patients scheduled for one level cervical discectomy. Materials & Methods: Ninety patients ASA I&II scheduled for one level cervical discectomy were randomly assigned into three groups to perform endotracheal intubation with Airtraq (group I; 30 patients), King Vision laryngoscope (group II; 30 patients), and Macintosh laryngoscope (group III; 30 patients). Intubation time and success rate for intubation were recorded. Also, observation and recording of vocal cord visualization using Cormack-Lehane grading and intubation difficulty score (IDS), complications and hemodynamic changes occurred with each aid. Results: There were statistically significant differences between the three groups as regard the time needed for successful intubation, the need for assist maneuvers, quality of glottis view, and the incidence of complications during airways manipulations, with better results (less time taken for intubation, better glottis view, less IDS and less complications with more stable hemodynamics during intubation) for king Vision group compared with Airtraq and Macintosh laryngoscope groups. Conclusion: King Vision laryngoscope had advantages of short time for intubation, almost, no complications occurred with it contrary to Airtraq or Macintosh laryngoscope and almost, no significant alterations in hemodynamics during intubation. It might give self-confidence to the anesthesiologist to use it easily, ensures intubation and permits many assistant doctors or trained residents to visualize the field during intubation.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74802055","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 : 2018-01-01DOI: 10.4172/2155-6148.1000828
D. Nava, J. Núñez, B. Hernandez, Andilay Pota Barito, A. Diab
Objectives: Dexmedetomidine is a potent agonist of α-2 receptors with sympatholytic, sedative and analgesic properties. Direct laryngoscopy and endotracheal intubation are associated with hemodynamic changes due to reflex sympathetic discharge; causing hypertension, tachycardia and arrhythmias. Several drugs have been used to control this haemodynamic response however, none harmless. Materials and methods: Sample of 60 patients, divided into two groups, the DM1 group received a dexmedetomidine dose of 0.5 μg/kg, and the DM2 group received a dose of 1 μg/kg of the same drug diluted in 100 cc of solution, which it was administered in 10 min. The hemodynamic variables (HR, SBP, DBP and MAP) and sedation during two periods were verified. Results: In the first stage there was a decrease in the SBP in the DM1 group of 9 and 11% with respect to the baseline at 5 and 10 min (p=0.8443 and p=0.1650). Similar trends were found with the DBP and the PAM. In the second stage, SBP, DBP and MAP showed statistically significant differences. Conclusion: Dexmedetomidine at an intravenous loading dose of 0.5 μg/kg presents hemodynamic stability before and after intubation, with no evidence of adverse effects.
{"title":"Evaluation of the Effect of Dexmedetomidine on the Suppression of the Adrenergic Response to Laryngoscopy and Intubation","authors":"D. Nava, J. Núñez, B. Hernandez, Andilay Pota Barito, A. Diab","doi":"10.4172/2155-6148.1000828","DOIUrl":"https://doi.org/10.4172/2155-6148.1000828","url":null,"abstract":"Objectives: Dexmedetomidine is a potent agonist of α-2 receptors with sympatholytic, sedative and analgesic properties. Direct laryngoscopy and endotracheal intubation are associated with hemodynamic changes due to reflex sympathetic discharge; causing hypertension, tachycardia and arrhythmias. Several drugs have been used to control this haemodynamic response however, none harmless. Materials and methods: Sample of 60 patients, divided into two groups, the DM1 group received a dexmedetomidine dose of 0.5 μg/kg, and the DM2 group received a dose of 1 μg/kg of the same drug diluted in 100 cc of solution, which it was administered in 10 min. The hemodynamic variables (HR, SBP, DBP and MAP) and sedation during two periods were verified. Results: In the first stage there was a decrease in the SBP in the DM1 group of 9 and 11% with respect to the baseline at 5 and 10 min (p=0.8443 and p=0.1650). Similar trends were found with the DBP and the PAM. In the second stage, SBP, DBP and MAP showed statistically significant differences. Conclusion: Dexmedetomidine at an intravenous loading dose of 0.5 μg/kg presents hemodynamic stability before and after intubation, with no evidence of adverse effects.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"3 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73627138","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 : 2018-01-01DOI: 10.4172/2155-6148.1000812
R. Altieri, F. Zenga, A. Melcarne, C. Junemann, Emanuela Faccoli, A. Rivera, S. Atlante, Andrea Lavorato, Giuseppe Palmieri, M. Minardi, F. Cofano, A. Ducati, D. Garbossa, R. Savastano
Background: It is well demonstrated that awake surgery for brain tumours is the gold standard to achieve the maximal safe resection. On the other hand, many surgeons prefer general anesthesia in order to avoid useless stress for patients. The aim of our paper is to investigate if there are clinical and biochemical findings demonstrating a different stress level in patients who underwent awake craniotomy compared to those who underwent totally asleep surgery. Methods: We compared our awake craniotomy series performed with conscious sedation using Dexmedetomidine to a group of patients treated in general anesthesia settings in terms of patient stress, rated by blood pressure, heart rate, glycaemia, lactate values, post-operative ischemia or bleeding at the MRI. We also compared the duration of surgeries in the two groups and the relations between time and other parameters. Results: We found that preoperative heart rate was higher in the awake group (63.00 (SD13.58) vs. 76.5 (SD 14.34) p value 0.025) together with preoperative systolic blood pressure 122 (SD 12.95 vs. 135.1 SD (11.78) p value 0.044). However there were no clinical, biochemical and radiological differences in post-operative period in the two groups, suggesting the efficacy of Dexmedetomidine in stress control. It is demonstrated a cause-effect relation between the duration of surgery and the raising of blood pressure, suggesting that conscious sedation can reduce useless anesthesiological time in the awake surgery setting. Conclusions: We showed that the two anesthetic settings are similar in terms of stress parameters after surgery. This finding could be confirmed in a prospective study with a higher number of patients.
背景:清醒手术治疗脑肿瘤是实现最大限度安全切除的金标准。另一方面，许多外科医生更喜欢全身麻醉，以避免给病人带来不必要的压力。我们这篇论文的目的是调查是否有临床和生化结果表明，在接受清醒开颅手术的患者中，与那些接受完全睡眠手术的患者相比，压力水平有所不同。方法:我们比较了使用右美托咪定进行清醒镇静的清醒开颅手术系列与全麻治疗的一组患者在患者压力方面的差异，包括血压、心率、血糖、乳酸值、术后缺血或MRI出血。比较两组手术时间及时间与其他参数的关系。结果:清醒组患者术前心率升高(63.00 (SD13.58) vs. 76.5 (SD 14.34) p值0.025)，收缩压升高(SD 12.95 vs. 135.1, SD (11.78) p值0.044)。但两组术后临床、生化、影像学无差异，提示右美托咪定对应激的控制效果较好。研究表明，手术时间与血压升高之间存在因果关系，表明清醒手术环境下，有意识镇静可以减少无用的麻醉时间。结论:我们发现两种麻醉设置在术后应激参数方面相似。这一发现可以在更多患者的前瞻性研究中得到证实。
{"title":"Conscious Sedation with Dexmedetomidine in Awake Surgery","authors":"R. Altieri, F. Zenga, A. Melcarne, C. Junemann, Emanuela Faccoli, A. Rivera, S. Atlante, Andrea Lavorato, Giuseppe Palmieri, M. Minardi, F. Cofano, A. Ducati, D. Garbossa, R. Savastano","doi":"10.4172/2155-6148.1000812","DOIUrl":"https://doi.org/10.4172/2155-6148.1000812","url":null,"abstract":"Background: It is well demonstrated that awake surgery for brain tumours is the gold standard to achieve the maximal safe resection. On the other hand, many surgeons prefer general anesthesia in order to avoid useless stress for patients. The aim of our paper is to investigate if there are clinical and biochemical findings demonstrating a different stress level in patients who underwent awake craniotomy compared to those who underwent totally asleep surgery. Methods: We compared our awake craniotomy series performed with conscious sedation using Dexmedetomidine to a group of patients treated in general anesthesia settings in terms of patient stress, rated by blood pressure, heart rate, glycaemia, lactate values, post-operative ischemia or bleeding at the MRI. We also compared the duration of surgeries in the two groups and the relations between time and other parameters. Results: We found that preoperative heart rate was higher in the awake group (63.00 (SD13.58) vs. 76.5 (SD 14.34) p value 0.025) together with preoperative systolic blood pressure 122 (SD 12.95 vs. 135.1 SD (11.78) p value 0.044). However there were no clinical, biochemical and radiological differences in post-operative period in the two groups, suggesting the efficacy of Dexmedetomidine in stress control. It is demonstrated a cause-effect relation between the duration of surgery and the raising of blood pressure, suggesting that conscious sedation can reduce useless anesthesiological time in the awake surgery setting. Conclusions: We showed that the two anesthetic settings are similar in terms of stress parameters after surgery. This finding could be confirmed in a prospective study with a higher number of patients.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"90 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76759053","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 : 2018-01-01DOI: 10.4172/2155-6148.1000821
Getahun Dendir Wolde, M. A. Awol, M. S. Obsa, Naol Gorde Wesene, Ashebir Debalike Gemechu, Ephrem Nigussie Tadesse
Background: Definition of Hypoxemia is insufficient amount of oxygen in the blood. There are different contributing risk factors for occurrence of post-operative hypoxemia which may lead to myocardial ischemia, organ dysfunction, wound infection, hospital stay and increase cost for the hospital and patient. Objectives: To assess the magnitude and associated factors of immediate post-operative hypoxemia in elective surgical procedures at Tikur Anbessa specialized Hospital from January 30, 2017 to March 31, 2017 G.C. Methods: Institutional based cross-sectional study design was conducted. Using Systemic random sampling technique and structured questioners data was collected from sampled elective surgical patients’ age ≥ 18 that came during the 2 months period. Data was entered into Epi info version 7 computer software by investigators and transported to SPSS version 20 computer program for analysis. Variables that demonstrated a significant relationship on bivariate analysis (p-value<0.2) were included Multivariate regression analysis was applied to evaluate independent variable relationships with a dependent variable that was continuous. A p-value<0.05 was considered to represent a statistically significant relationship. Results: Among sampled 238 elective surgical patients magnitude of hypoxemia was 54 (22.7%).Frequency of hypoxemia was high in first 10 min after admission to post anesthesia care unit. The independent predictors of hypoxemia were who had Respiratory co morbidity [(AOR=8.8; CI 2.264, 34.117)] (p=0.002) and cardiothoracic surgery [AOR=4.904; CI1.385, 17.368] (p=0.014). Conclusion and recommendation: Magnitude of hypoxemia was high and so specials consideration should give co morbid diseases patients by pre-operative optimization of patient that has other factors additional to the surgical procedure.
背景:低氧血症的定义是血液中氧气量不足。术后低氧血症的发生有不同的危险因素，可导致心肌缺血、脏器功能障碍、伤口感染、住院时间延长，增加医院和患者的费用。目的:评估2017年1月30日至2017年3月31日Tikur Anbessa专科医院择期外科手术后立即低氧血症的程度及相关因素。方法:进行基于机构的横断面研究设计。采用系统随机抽样技术和结构化问询器收集抽样的年龄≥18岁的择期手术患者2个月内的数据。数据由调查人员输入Epi info version 7计算机软件，并传送到SPSS version 20计算机程序进行分析。在双变量分析中显示出显著关系(p值<0.2)的变量被纳入，应用多变量回归分析来评估自变量与连续因变量的关系。p值<0.05被认为是有统计学意义的关系。结果:238例择期手术患者中，低氧血症54例(22.7%)。低氧血症发生率在麻醉后护理单元入院后的前10分钟较高。低氧血症的独立预测因子为呼吸道并发症[AOR=8.8;CI 2.264, 34.117)] (p=0.002)和心胸外科手术[AOR=4.904;[p=0.014]。结论和建议:低氧血症程度高，对有其他手术因素的合并症患者术前优化应给予特殊考虑。
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