Pub Date : 2018-01-01DOI: 10.4172/2155-6148.1000831
Amr M Hilal Abdou, F. Malak
Background: There have been limited data towards the hemodynamic (HD) changes in recipients of living donor liver transplantation (LDLT) especially during the reperfusion phase. Purpose: Does surgical techniques affects the HD of the patients during reperfusion? We evaluated the differences between two surgical techniques done before the reperfusion phase of LDLT; one with liver graft flush and the other without flush. Methods: A retrospective observational study conducted at Ain Shams University Hospitals, Center of organ transplantation. Analysis of 50 recipients HD data, usage of vassopressors, ICU stay and mortality during reperfusion phase and 20 min after it, thus comparing two different methods; one with liver flush through the portal vein (PV) of 100 ml-200 ml (1.5 ml/kg-2.5 ml/kg) of blood and venting it from hepatic vein (HV), other group without liver flush technique. Results: Regarding the use of vassopressors; recipients underwent liver flush showed low initial and maintenance doses of nor-epinephrine compared to patients without flush (P ≤ 0.001), no differences detected regarding the HD state, intensive care unit (ICU) stay and blood products usage between the two techniques. Conclusion: In patients candidates for LDLT there is an increased risk of a complex and not completely understood pathology of postreperfusion syndrome (PRS), antegrade Portal vein (PV) flushing with HV venting is a surgical technique with reduced doses of vassopressors with minimal PRS hemodynamic instability.
背景:关于活体肝移植(LDLT)受者血流动力学(HD)变化的数据有限，特别是在再灌注阶段。目的:手术技术是否会影响再灌注患者的HD ?我们评估了在LDLT再灌注阶段之前进行的两种手术技术之间的差异;一个移植了肝，另一个没有。方法:在艾因沙姆斯大学附属医院器官移植中心进行回顾性观察性研究。分析50例受体HD资料、再灌注期及再灌注后20 min的降压药物使用情况、ICU住院时间及死亡率，比较两种方法的差异;一组通过门静脉(PV)冲洗100 ml-200 ml (1.5 ml/kg-2.5 ml/kg)血液并从肝静脉(HV)排出，另一组不采用肝脏冲洗技术。结果:在降压药的使用方面;与不冲洗肝脏的患者相比，接受肝脏冲洗的患者初始和维持去甲肾上腺素剂量较低(P≤0.001)，两种技术在HD状态、重症监护病房(ICU)住院时间和血液制品使用方面没有发现差异。结论:在候选LDLT患者中，存在复杂且尚未完全理解的灌注后综合征(PRS)病理的风险增加，顺行门静脉(PV)冲洗与HV通气是一种外科技术，减少了加压药物的剂量，最小化了PRS血流动力学不稳定性。
{"title":"Liver Grafts Flush and its Relation to Hemodynamic Status in Recipients of Living Donor Liver Transplantation: An Egyptian Experience","authors":"Amr M Hilal Abdou, F. Malak","doi":"10.4172/2155-6148.1000831","DOIUrl":"https://doi.org/10.4172/2155-6148.1000831","url":null,"abstract":"Background: There have been limited data towards the hemodynamic (HD) changes in recipients of living donor liver transplantation (LDLT) especially during the reperfusion phase. Purpose: Does surgical techniques affects the HD of the patients during reperfusion? We evaluated the differences between two surgical techniques done before the reperfusion phase of LDLT; one with liver graft flush and the other without flush. Methods: A retrospective observational study conducted at Ain Shams University Hospitals, Center of organ transplantation. Analysis of 50 recipients HD data, usage of vassopressors, ICU stay and mortality during reperfusion phase and 20 min after it, thus comparing two different methods; one with liver flush through the portal vein (PV) of 100 ml-200 ml (1.5 ml/kg-2.5 ml/kg) of blood and venting it from hepatic vein (HV), other group without liver flush technique. Results: Regarding the use of vassopressors; recipients underwent liver flush showed low initial and maintenance doses of nor-epinephrine compared to patients without flush (P ≤ 0.001), no differences detected regarding the HD state, intensive care unit (ICU) stay and blood products usage between the two techniques. Conclusion: In patients candidates for LDLT there is an increased risk of a complex and not completely understood pathology of postreperfusion syndrome (PRS), antegrade Portal vein (PV) flushing with HV venting is a surgical technique with reduced doses of vassopressors with minimal PRS hemodynamic instability.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"37 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91137520","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: 10.4172/2155-6148.1000835
G. Enten, Suvikram Puri, M. Copeland, D. Mangar, E. Camporesi
Introduction/Background: This study evaluates the effects of continuous thoracic epidural analgesia (TEA) vs. intravenous pain control methods on the narcotics requirement for common laparoscopic abdominal surgeries. The introduction of new guidelines at Tampa General Hospital for the year 2017 afforded the opportunity for a sequential case series analysis of these two methods of pain management. Methods: A sequential case-series on patients undergoing laparoscopic or robot assisted abdominal surgery was performed. Patients were recruited upon request of surgeons using the same nurses and resident support team. Data were obtained from retrospective chart review following local IRB approval and evaluated for the effects of intravenous analgesia compared to continuous T9-10 epidural analgesia. Primary outcomes were intraoperative, 24 h and post-24 h opioid use in morphine milligram equivalents (MME). Length of hospital stay and VAS pain scores were also collected. Results: There was no significant difference in terms of age, gender, and BMI between groups. When compared patients who received epidural reported significantly lower pain scores in the first 24 h after surgery (p<0.05) and for the remainder of their hospital stay (p<0.05). Significant decreases in narcotic requirement was noted in the PACU (p<0.001), the first 24 h after surgery (p<0.001), and aggregate use per day (p<0.01). Conclusions: Continuous thoracic epidural analgesia is a viable alternative to intravenous pain control for patients undergoing common laparoscopic surgeries. Further research is required to determine the risks and benefits of TEA for laparoscopic colorectal surgery.
{"title":"Analgesia Post Abdominal Surgery: Intravenous vs. Continuous Thoracic Epidural Pain Management","authors":"G. Enten, Suvikram Puri, M. Copeland, D. Mangar, E. Camporesi","doi":"10.4172/2155-6148.1000835","DOIUrl":"https://doi.org/10.4172/2155-6148.1000835","url":null,"abstract":"Introduction/Background: This study evaluates the effects of continuous thoracic epidural analgesia (TEA) vs. intravenous pain control methods on the narcotics requirement for common laparoscopic abdominal surgeries. The introduction of new guidelines at Tampa General Hospital for the year 2017 afforded the opportunity for a sequential case series analysis of these two methods of pain management. Methods: A sequential case-series on patients undergoing laparoscopic or robot assisted abdominal surgery was performed. Patients were recruited upon request of surgeons using the same nurses and resident support team. Data were obtained from retrospective chart review following local IRB approval and evaluated for the effects of intravenous analgesia compared to continuous T9-10 epidural analgesia. Primary outcomes were intraoperative, 24 h and post-24 h opioid use in morphine milligram equivalents (MME). Length of hospital stay and VAS pain scores were also collected. Results: There was no significant difference in terms of age, gender, and BMI between groups. When compared patients who received epidural reported significantly lower pain scores in the first 24 h after surgery (p<0.05) and for the remainder of their hospital stay (p<0.05). Significant decreases in narcotic requirement was noted in the PACU (p<0.001), the first 24 h after surgery (p<0.001), and aggregate use per day (p<0.01). Conclusions: Continuous thoracic epidural analgesia is a viable alternative to intravenous pain control for patients undergoing common laparoscopic surgeries. Further research is required to determine the risks and benefits of TEA for laparoscopic colorectal surgery.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"39 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84092600","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: 10.4172/2155-6148.1000820
Wataru Sakai, N. Hirata, M. Yamakage
Background and aims: Acute Kidney Injury (AKI) after cardiac surgery is a serious complication and a risk factor of postoperative mortality. It has been suggested that Angiotensin Ii Receptor Blockers (ARBs) and Angiotensin- Converting Enzymes (ACE-Is) might be able to reduce the incidence of postoperative AKI after cardiac surgery. However, it remains unknown as to which of these drugs are better for protecting the renal function after cardiac surgery. We hypothesized that each of the ARBs and ACE-Is were able to differentially affect the postoperative AKI after cardiac surgery due to their differential drug efficacies. Thus, this current study investigated the association between the ARBs or ACE-Is and the postoperative AKI after cardiac surgery. Methods: This retrospective single-center observational study was conducted in a community hospital. This study investigated 132 patients undergoing cardiac surgery with cardiopulmonary bypass between January 2013 and December 2015. The association between the incidence of AKI and the usage of ARBs or ACE-Is were analysed by using The Propensity Score Inverse Probability of Treatment Weighting (IPTW) method. Results: Multiple logistic regression analysis after adjustment revealed that of the 132 patients examined, those receiving preoperative ARBs had significantly less incidence of postoperative AKI compared to the other patients (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.11-0.94; P=0.040). However, preoperative administration of ACE-Is were not associated with the incidence of postoperative AKI (OR, 0.73; 95% CI, 0.25-2.17; P=0.58). Conclusions: Our analyses showed that ARBs rather than ACE-Is are potentially the preferable drug for perioperative renal protection. Prospective studies will need to be undertaken in order to elucidate the detailed effects of ARBs and ACE-Is on the kidney after undergoing cardiac surgery.
{"title":"Angiotensin II Receptor Blocker versus Angiotensin-Converting Enzyme Inhibitor for Postoperative Acute Kidney Injury after Cardiac Surgery","authors":"Wataru Sakai, N. Hirata, M. Yamakage","doi":"10.4172/2155-6148.1000820","DOIUrl":"https://doi.org/10.4172/2155-6148.1000820","url":null,"abstract":"Background and aims: Acute Kidney Injury (AKI) after cardiac surgery is a serious complication and a risk factor of postoperative mortality. It has been suggested that Angiotensin Ii Receptor Blockers (ARBs) and Angiotensin- Converting Enzymes (ACE-Is) might be able to reduce the incidence of postoperative AKI after cardiac surgery. However, it remains unknown as to which of these drugs are better for protecting the renal function after cardiac surgery. We hypothesized that each of the ARBs and ACE-Is were able to differentially affect the postoperative AKI after cardiac surgery due to their differential drug efficacies. Thus, this current study investigated the association between the ARBs or ACE-Is and the postoperative AKI after cardiac surgery. Methods: This retrospective single-center observational study was conducted in a community hospital. This study investigated 132 patients undergoing cardiac surgery with cardiopulmonary bypass between January 2013 and December 2015. The association between the incidence of AKI and the usage of ARBs or ACE-Is were analysed by using The Propensity Score Inverse Probability of Treatment Weighting (IPTW) method. Results: Multiple logistic regression analysis after adjustment revealed that of the 132 patients examined, those receiving preoperative ARBs had significantly less incidence of postoperative AKI compared to the other patients (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.11-0.94; P=0.040). However, preoperative administration of ACE-Is were not associated with the incidence of postoperative AKI (OR, 0.73; 95% CI, 0.25-2.17; P=0.58). Conclusions: Our analyses showed that ARBs rather than ACE-Is are potentially the preferable drug for perioperative renal protection. Prospective studies will need to be undertaken in order to elucidate the detailed effects of ARBs and ACE-Is on the kidney after undergoing cardiac surgery.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"2 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80759650","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: 10.4172/12155-6148.1000870
S. Ahmed, M. G. Elmawy, A. Magdy
Objective: This study aimed to investigate the effect of the continuous paravertebral block using either fentanyl or dexmedetomidine as an additive to bupivacaine in patients undergoing renal surgeries. Methods: Ninety adult patients presented for renal surgeries under general anesthesia and ultrasound-guided continuous paravertebral block were allocated in this study and randomly distributed into three groups. All the patients received a loading and a maintenance doses of local anesthetic mixtures composed of bupivacaine alone in Control group with addition of fentanyl or dexmedetomidine in Fentanyl and Dexmedetomidine groups. The measurements included the postoperative analgesic consumption, the time for the first request for rescue analgesia, postoperative pain scores, hemodynamic parameters, and incidence of complication. Results: The addition of fentanyl or dexmedetomidine to plain bupivacaine in continuous paravertebral block significantly decreased the dose of postoperative morphine consumption from (11.33 ± 5.05 mg) to (7.33 ± 4.59 mg) (7.80 ± 4.15mg), significantly prolonged the time for first request of rescue analgesia from (6.87 ± 3.81 h) to (9.80 ± 4.50 h) (10.80 ± 5.22 h), and significantly decrease VAS score 2 h and 6 h postoperatively with insignificant difference between fentanyl and dexmedetomidine (p>0.05). Conclusion: Fentanyl or dexmedetomidine can be helpful as an adjuvant to bupivacaine (0.25%) in the continuous paravertebral block as they decreased the postoperative analgesic consumption without increased incidence of complication.
目的:探讨芬太尼或右美托咪定加布比卡因连续椎旁阻滞对肾脏手术患者的影响。方法:选取90例在全麻下行肾外科手术的成人患者，超声引导下连续椎旁阻滞治疗，随机分为3组。所有患者均给予负荷剂量和维持剂量的局部麻醉混合物，对照组仅布比卡因，芬太尼组和右美托咪定组分别加用芬太尼或右美托咪定。测量包括术后镇痛药消耗、首次请求抢救镇痛的时间、术后疼痛评分、血流动力学参数和并发症发生率。结果:芬太尼或右美托咪定加布比卡因连续椎旁阻滞显著降低术后吗啡用量，从(11.33±5.05 mg)降至(7.33±4.59 mg)(7.80±4.15mg)，显著延长首次请求抢救镇痛时间，从(6.87±3.81 h)降至(9.80±4.50 h)(10.80±5.22 h);术后2 h、6 h VAS评分显著降低，芬太尼与右美托咪定差异无统计学意义(p>0.05)。结论:芬太尼或右美托咪定可作为布比卡因(0.25%)的辅助剂用于连续椎旁阻滞，可减少术后镇痛药的消耗，且不增加并发症的发生率。
{"title":"The Effect of Fentanyl or Dexmedetomidine on the Ultrasound-Guided Paravertebral Block for Patients Undergoing Renal Surgeries: Randomized Controlled Trial","authors":"S. Ahmed, M. G. Elmawy, A. Magdy","doi":"10.4172/12155-6148.1000870","DOIUrl":"https://doi.org/10.4172/12155-6148.1000870","url":null,"abstract":"Objective: This study aimed to investigate the effect of the continuous paravertebral block using either fentanyl or dexmedetomidine as an additive to bupivacaine in patients undergoing renal surgeries. Methods: Ninety adult patients presented for renal surgeries under general anesthesia and ultrasound-guided continuous paravertebral block were allocated in this study and randomly distributed into three groups. All the patients received a loading and a maintenance doses of local anesthetic mixtures composed of bupivacaine alone in Control group with addition of fentanyl or dexmedetomidine in Fentanyl and Dexmedetomidine groups. The measurements included the postoperative analgesic consumption, the time for the first request for rescue analgesia, postoperative pain scores, hemodynamic parameters, and incidence of complication. Results: The addition of fentanyl or dexmedetomidine to plain bupivacaine in continuous paravertebral block significantly decreased the dose of postoperative morphine consumption from (11.33 ± 5.05 mg) to (7.33 ± 4.59 mg) (7.80 ± 4.15mg), significantly prolonged the time for first request of rescue analgesia from (6.87 ± 3.81 h) to (9.80 ± 4.50 h) (10.80 ± 5.22 h), and significantly decrease VAS score 2 h and 6 h postoperatively with insignificant difference between fentanyl and dexmedetomidine (p>0.05). Conclusion: Fentanyl or dexmedetomidine can be helpful as an adjuvant to bupivacaine (0.25%) in the continuous paravertebral block as they decreased the postoperative analgesic consumption without increased incidence of complication.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"40 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":"74021045","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: 10.4172/2155-6148.1000847
T. Kawano, T. Yano, I. Tsuneyoshi
{"title":"Evaluation of the Distance between the Epidural Puncture Point and the Thoracic Cavity Using CT Images in Japanese Adults","authors":"T. Kawano, T. Yano, I. Tsuneyoshi","doi":"10.4172/2155-6148.1000847","DOIUrl":"https://doi.org/10.4172/2155-6148.1000847","url":null,"abstract":"","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":" 46","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91411127","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: 10.4172/2155-6148.1000850
P. Giacomo, Spinoglio Gian Luca, Beltrami Riccardo, S. Maurizio, P. Cesare
{"title":"Non-surgical Treatment of Peri-implantitis: A Systematic Review of theLiterature","authors":"P. Giacomo, Spinoglio Gian Luca, Beltrami Riccardo, S. Maurizio, P. Cesare","doi":"10.4172/2155-6148.1000850","DOIUrl":"https://doi.org/10.4172/2155-6148.1000850","url":null,"abstract":"","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"18 1","pages":"1-16"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82057919","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: 10.4172/2155-6148.1000853
R. Owolabi, O. I. Adeyemi, Sunday Elisha Oyelere
This study investigated the effect of low sub-psychotomimetic dose (0.3 mg/kg) of ketamine on subarachnoid block-induced analgesia with a view to assessing the analgesic effectiveness of combination of low dose ketamine with subarachnoid block in management of post caesarean section pain. Spinal anaesthesia was performed in 120 healthy pregnant women scheduled for elective caesarean delivery using 10 mg hyperbaric bupivacaine. Parturient mothers were randomly selected into four groups (n=30) consisting of K1, K2, NK1 and NK2. K1 received 0.3 mg/kg intravenous ketamine diluted with sterile water for injection to 5 mL, as a bolus dose 2 min before surgical incision; K2 was treated as K1 but at 2 minutes after delivery of baby, while NK1 and NK2 received equivalent volumes of normal saline 2 min before surgical incision and 2 min after baby extraction respectively. Age, weight, duration of surgery (DOS) and the time of first request for analgesia (TFA) for all participants were recorded. Post-operative pain intensity was assessed using a visual analogue scale (VASPI) at 2, 4, 8, 12, 24 and 36 h after spinal anaesthesia induction. Results were analyzed using ANOVA and Kruskal-Wallis tests. Student Newman-Keuls and Man-Whitney rank sum tests were used for post hoc analysis as appropriate. P value<0.05 was considered statistically significant. There was no significant difference in age and weight across groups, but duration of surgery was statistically prolonged in K1 group relative to NK1 group. Low dose ketamine significantly augmented the analgesic effect of spinal block anaesthesia, especially when given at two minutes before surgical incision.
{"title":"Augmenting Subarachnoid Block Analgesia in Caesarean Section Delivery with Sub-Psychotomimetic Dose of Ketamine","authors":"R. Owolabi, O. I. Adeyemi, Sunday Elisha Oyelere","doi":"10.4172/2155-6148.1000853","DOIUrl":"https://doi.org/10.4172/2155-6148.1000853","url":null,"abstract":"This study investigated the effect of low sub-psychotomimetic dose (0.3 mg/kg) of ketamine on subarachnoid block-induced analgesia with a view to assessing the analgesic effectiveness of combination of low dose ketamine with subarachnoid block in management of post caesarean section pain. Spinal anaesthesia was performed in 120 healthy pregnant women scheduled for elective caesarean delivery using 10 mg hyperbaric bupivacaine. Parturient mothers were randomly selected into four groups (n=30) consisting of K1, K2, NK1 and NK2. K1 received 0.3 mg/kg intravenous ketamine diluted with sterile water for injection to 5 mL, as a bolus dose 2 min before surgical incision; K2 was treated as K1 but at 2 minutes after delivery of baby, while NK1 and NK2 received equivalent volumes of normal saline 2 min before surgical incision and 2 min after baby extraction respectively. Age, weight, duration of surgery (DOS) and the time of first request for analgesia (TFA) for all participants were recorded. Post-operative pain intensity was assessed using a visual analogue scale (VASPI) at 2, 4, 8, 12, 24 and 36 h after spinal anaesthesia induction. Results were analyzed using ANOVA and Kruskal-Wallis tests. Student Newman-Keuls and Man-Whitney rank sum tests were used for post hoc analysis as appropriate. P value<0.05 was considered statistically significant. There was no significant difference in age and weight across groups, but duration of surgery was statistically prolonged in K1 group relative to NK1 group. Low dose ketamine significantly augmented the analgesic effect of spinal block anaesthesia, especially when given at two minutes before surgical incision.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81853029","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: 10.4172/2155-6148.1000822
D. D. Patel, Ankita Singh, M. Upadhyay
Context: In patients with chronic sinusitis, Functional Endoscopic Sinus Surgery (FESS) is the preferred surgical option as part of treatment after conservative measures have failed. Aims: To improve the success of this surgery and to minimize complications, bloodless field is required. So our primary objective will be to provide bloodless field intraoperatively. Settings and design: Our study was a single blinded, prospective, randomized and comparative clinical study. It included forty adult patients between 18-60 years of age and of either sex. They all were from ASA Grade I & II. The patients were distributed into two groups of 20 each. Methods and material: Group D (n=20) Patients who received loading dose of Dexmedetomidine 1 microgram/ kilogram (μg/kg) over a period of 10 min before induction of anaesthesia and followed by maintenance infusion in the dose of 0.4-0.8 μg/kg/h after intubation via syringe infusion pump. Group N (n=20): Patients who received Inj. Nitroglycerine 5-10 μg/kg/min after intubation via continuous infusion. Patients were monitored for haemodynamic parameters, arterial oxygen saturation and end tidal CO2 at fifteen minute time interval. Average category scale score was used to assess the Quality of surgical field. Total amount of blood loss was noted. Statistical test used: Student's t-test Results: We observed statistically significant increase in mean pulse rate in the Nitroglycerine group as compared to the Dexmedetomidine group. Mean arterial pressure was successfully reduced to the target value in both the groups. There was no difference in amount of blood loss between the two groups. Conclusions: Dexmedetomidine and Nitroglycerine both can be used with great safety profile to achieve controlled hypotension during FESS.
{"title":"Dexmedetomidine versus Nitroglycerin for Controlled Hypotensive Anaesthesia in Functional Endoscopic Sinus Surgery","authors":"D. D. Patel, Ankita Singh, M. Upadhyay","doi":"10.4172/2155-6148.1000822","DOIUrl":"https://doi.org/10.4172/2155-6148.1000822","url":null,"abstract":"Context: In patients with chronic sinusitis, Functional Endoscopic Sinus Surgery (FESS) is the preferred surgical option as part of treatment after conservative measures have failed. Aims: To improve the success of this surgery and to minimize complications, bloodless field is required. So our primary objective will be to provide bloodless field intraoperatively. Settings and design: Our study was a single blinded, prospective, randomized and comparative clinical study. It included forty adult patients between 18-60 years of age and of either sex. They all were from ASA Grade I & II. The patients were distributed into two groups of 20 each. Methods and material: Group D (n=20) Patients who received loading dose of Dexmedetomidine 1 microgram/ kilogram (μg/kg) over a period of 10 min before induction of anaesthesia and followed by maintenance infusion in the dose of 0.4-0.8 μg/kg/h after intubation via syringe infusion pump. Group N (n=20): Patients who received Inj. Nitroglycerine 5-10 μg/kg/min after intubation via continuous infusion. Patients were monitored for haemodynamic parameters, arterial oxygen saturation and end tidal CO2 at fifteen minute time interval. Average category scale score was used to assess the Quality of surgical field. Total amount of blood loss was noted. Statistical test used: Student's t-test Results: We observed statistically significant increase in mean pulse rate in the Nitroglycerine group as compared to the Dexmedetomidine group. Mean arterial pressure was successfully reduced to the target value in both the groups. There was no difference in amount of blood loss between the two groups. Conclusions: Dexmedetomidine and Nitroglycerine both can be used with great safety profile to achieve controlled hypotension during FESS.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"27 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87010156","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: 10.4172/2155-6148.1000829
P. A. Ramos, T. Barreto, Ana Paula Alves, H. Machado
Introduction: Local anaesthetics are widely used in the daily practice of the anaesthesiologists. Although in most part of the times no adverse effect are observed secondary to its use, accidental intravascular injection can be related to serious consequences. The objective of this case report is to describe an accidental intravascular administration of a local anesthetic during labour epidural analgesia. Methods: Clinical records of a complete epidural labour analgesia case were collected. Results: During an epidural blockade for labour analgesia, local anesthetic toxicity was acutely diagnosed after a bolus dose. This epidural catheter was promptly removed. Following the parturient informed consent and will, a second epidural catheter was introduced at a different lumbar level, with a subsequent successful analgesia, with no complications registered, with a normal delivery in the due time, with no morbidities either to the mother and the newborn. Discussion: After an incomplete success of the first bolus when the first epidural catheter has been used, a diagnostic bolus of Lidocaine showed that this catheter was actually in an intravascular space. The diagnostic was purely clinical, given the highly typical clinical signs that were observed. These signs were so clear that no other diagnostic procedure was necessary. The fact that labour analgesia was resumed after a second catheter was introduced (this time with complete success) showed a good confidence relationship between doctor and patient, which is of paramount importance during Anesthesiology practice. Conclusions: Intravascular injection of local anaesthetics could be prevented following some safe steps. In cases when it is not primarily identified, a transparent dressing could allow observation of blood inside catheter and help to make the diagnosis.
{"title":"Inadvert Intravenous Administration of Local Anaesthetic During Labour: A Case Report","authors":"P. A. Ramos, T. Barreto, Ana Paula Alves, H. Machado","doi":"10.4172/2155-6148.1000829","DOIUrl":"https://doi.org/10.4172/2155-6148.1000829","url":null,"abstract":"Introduction: Local anaesthetics are widely used in the daily practice of the anaesthesiologists. Although in most part of the times no adverse effect are observed secondary to its use, accidental intravascular injection can be related to serious consequences. The objective of this case report is to describe an accidental intravascular administration of a local anesthetic during labour epidural analgesia. Methods: Clinical records of a complete epidural labour analgesia case were collected. Results: During an epidural blockade for labour analgesia, local anesthetic toxicity was acutely diagnosed after a bolus dose. This epidural catheter was promptly removed. Following the parturient informed consent and will, a second epidural catheter was introduced at a different lumbar level, with a subsequent successful analgesia, with no complications registered, with a normal delivery in the due time, with no morbidities either to the mother and the newborn. Discussion: After an incomplete success of the first bolus when the first epidural catheter has been used, a diagnostic bolus of Lidocaine showed that this catheter was actually in an intravascular space. The diagnostic was purely clinical, given the highly typical clinical signs that were observed. These signs were so clear that no other diagnostic procedure was necessary. The fact that labour analgesia was resumed after a second catheter was introduced (this time with complete success) showed a good confidence relationship between doctor and patient, which is of paramount importance during Anesthesiology practice. Conclusions: Intravascular injection of local anaesthetics could be prevented following some safe steps. In cases when it is not primarily identified, a transparent dressing could allow observation of blood inside catheter and help to make the diagnosis.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"4 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75585572","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: 10.4172/2155-6148.1000848
R. Nemes, Boglárka Diószeghy, A. Pongrácz, E. Tassonyi, B. Fülesdi
Objective: The aim of this prospective, unblinded, randomized study was to provide performance data of the prototype of new electromyography-based neuromuscular monitor, the NEAT device (Acacia Designs BV, Amsterdam, the Netherlands) and assess the subjective discomfort associated with neurostimulation in unmedicated healthy volunteers. Methods: The study enrolled ten male and ten female volunteers. Based on a priori randomization the ulnar nerve of the left or right arms was stimulated in 1 Hz single twitch and train-of-four modes. Stimulating current intensity was increased from 10 mA to 60 mA in 10 mA steps. Electromyography recordings were performed at the abductor digiti minimi and adductor pollicis muscles via surface electrodes. The volunteers were asked to rate the discomfort in association with neurostimulation on a 0-10 visual analogue scale. Results: The overall train-of-four ratio was 1.02 (0.98-1.06) {median and (interquartile range)}. The abductor digiti minimi muscle required lower stimulating current intensity to evoke maximal stimulation, than the adductor pollicis (30 vs. 50 mA, p<0.001). The overall intracurrent variability of compound muscle action potential amplitudes was 0.42 (0.21-0.87) mV, that was unaffected by the type of muscle or the stimulating current intensity. Women reported moderately higher visual analogue scale scores than men. The largest recorded difference was 5 (3.75-6) vs. 3 (3-4), p<0.05. Conclusion: The Acacia Designs BV NEAT monitoring device was suitable to deliver neurostimulation, record and analyze the elicited muscle action potentials. The precision of stimulations was acceptable. The volunteers reported the discomfort in association with neurostimulation as tolerable. Registered at the Hungarian Office for Health Authorization and Administrative Procedures (December 30th, 2014). Identifier: 028605-010/2014/OTIG. Registered at clinicaltrials.gov (December 15th, 2015). Identifier: NCT02630576.
{"title":"Performance Assessment of a New Electromyography-based Neuromuscular Monitor and Subjective Discomfort in Unmedicated Volunteers","authors":"R. Nemes, Boglárka Diószeghy, A. Pongrácz, E. Tassonyi, B. Fülesdi","doi":"10.4172/2155-6148.1000848","DOIUrl":"https://doi.org/10.4172/2155-6148.1000848","url":null,"abstract":"Objective: The aim of this prospective, unblinded, randomized study was to provide performance data of the prototype of new electromyography-based neuromuscular monitor, the NEAT device (Acacia Designs BV, Amsterdam, the Netherlands) and assess the subjective discomfort associated with neurostimulation in unmedicated healthy volunteers. Methods: The study enrolled ten male and ten female volunteers. Based on a priori randomization the ulnar nerve of the left or right arms was stimulated in 1 Hz single twitch and train-of-four modes. Stimulating current intensity was increased from 10 mA to 60 mA in 10 mA steps. Electromyography recordings were performed at the abductor digiti minimi and adductor pollicis muscles via surface electrodes. The volunteers were asked to rate the discomfort in association with neurostimulation on a 0-10 visual analogue scale. Results: The overall train-of-four ratio was 1.02 (0.98-1.06) {median and (interquartile range)}. The abductor digiti minimi muscle required lower stimulating current intensity to evoke maximal stimulation, than the adductor pollicis (30 vs. 50 mA, p<0.001). The overall intracurrent variability of compound muscle action potential amplitudes was 0.42 (0.21-0.87) mV, that was unaffected by the type of muscle or the stimulating current intensity. Women reported moderately higher visual analogue scale scores than men. The largest recorded difference was 5 (3.75-6) vs. 3 (3-4), p<0.05. Conclusion: The Acacia Designs BV NEAT monitoring device was suitable to deliver neurostimulation, record and analyze the elicited muscle action potentials. The precision of stimulations was acceptable. The volunteers reported the discomfort in association with neurostimulation as tolerable. Registered at the Hungarian Office for Health Authorization and Administrative Procedures (December 30th, 2014). Identifier: 028605-010/2014/OTIG. Registered at clinicaltrials.gov (December 15th, 2015). Identifier: NCT02630576.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86415348","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：