Pub Date : 2018-01-01DOI: 10.4172/2155-6148.1000849
I. Costa, C. Nunes, H. Machado
{"title":"Mode of Delivery and Labour Analgesia: A Study of Preference in Portuguese Pregnant Women","authors":"I. Costa, C. Nunes, H. Machado","doi":"10.4172/2155-6148.1000849","DOIUrl":"https://doi.org/10.4172/2155-6148.1000849","url":null,"abstract":"","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88160722","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: 10.4172/2155-6148.1000865
Avinash Londhe, Madhu Chavan
Noonan’s syndrome was first described by Noonan and Ehmke in 1963. These patients have facial, cardiovascular, musculoskeletal and developmental abnormalities which may pose problems to the anaesthetist during surgery. It is a rare clinical entity representing the phenotype of Turner’s syndrome with normal chromosome studies. The most common congenital cardiac lesion is pulmonary stenosis, either alone or in combination with a septal defect, which is usually atrial. The potential anaesthetic problems presented by a patient with Noonan’s syndrome relate to impairment of cardiopulmonary function, the possibility of a difficult airway and the problem of technical difficulty with regional anaesthesia We reported a case of 21 years old male, weighing 30 kg, who was diagnosed clinically as a case of Noonan syndrome and had undergone balloon pulmonary valvotomy in past. Patient had severe kyphoscoliosis. This rare case report represents to the successful difficult airway and anaesthetic management due to existence of kyphoscoliosis. Problem with airway management may be fatal for patients.
{"title":"Anaesthetic Challenges and Difficult Airway Management in Noonan Syndrome","authors":"Avinash Londhe, Madhu Chavan","doi":"10.4172/2155-6148.1000865","DOIUrl":"https://doi.org/10.4172/2155-6148.1000865","url":null,"abstract":"Noonan’s syndrome was first described by Noonan and Ehmke in 1963. These patients have facial, cardiovascular, musculoskeletal and developmental abnormalities which may pose problems to the anaesthetist during surgery. It is a rare clinical entity representing the phenotype of Turner’s syndrome with normal chromosome studies. The most common congenital cardiac lesion is pulmonary stenosis, either alone or in combination with a septal defect, which is usually atrial. The potential anaesthetic problems presented by a patient with Noonan’s syndrome relate to impairment of cardiopulmonary function, the possibility of a difficult airway and the problem of technical difficulty with regional anaesthesia We reported a case of 21 years old male, weighing 30 kg, who was diagnosed clinically as a case of Noonan syndrome and had undergone balloon pulmonary valvotomy in past. Patient had severe kyphoscoliosis. This rare case report represents to the successful difficult airway and anaesthetic management due to existence of kyphoscoliosis. Problem with airway management may be fatal for patients.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82732346","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: 10.4172/2155-6148.1000810
F. Mohamed, E. Abdallah, A. Ibrahim, Ahmed Elminshawy, T. ElMelegy
Objectives: To evaluate the role of prophylactic magnesium sulfate administration in preventing postoperative atrial fibrillation (POAF), attenuating the inflammatory response and promoting myocardial protection after isolated cardiac valve replacement surgery in adult patients with rheumatic heart disease. Design: Prospective randomized, double-blind placebo-controlled trial. Methods: Sixty-four adult patients undergoing isolated cardiac valve replacement surgery were divided into two equal groups (32 patients in each). Patients in magnesium group (group M) received 2.5 gm of magnesium sulfate (dissolved in 100 mL of isotonic saline and infused over 2 h), twelve h preoperatively, within the first hour of ICU arrival, and on the 2nd and 3rd postoperative days (group M). Patients in the control group (group C) received a placebo of isotonic saline at the same time periods. Results: Prophylactic magnesium sulfate significantly decreased the incidence of POAF compared to the placebo group (P=0.005). White blood cell (WBC) count showed no significant difference between the two groups. C-reactive protein (CRP) level showed significant reduction during the 3rd, 4th, and 5th postoperative days in group M compared to group C (P=0.001, 0.001 & 0.012 respectively). Serum level of interleukin-6 (IL-6) showed a significant reduction on the 5th postoperative day in group M compared to group C (P=0.001). Both groups showed no significant differences in serum levels of troponin I during the study. Conclusion: Prophylactic use of magnesium sulfate in patients with rheumatic heart disease undergoing isolated cardiac valve replacement surgery can decrease the incidence of POAF. It may play a role in attenuating the inflammatory process associated with the use of cardiopulmonary bypass (CPB).
{"title":"Magnesium Sulfate for Prophylaxis against Postoperative Atrial Fibrillation after Isolated Cardiac Valve Replacement Surgery in Adult Patients with Rheumatic Heart Disease: A Randomized Controlled Trial","authors":"F. Mohamed, E. Abdallah, A. Ibrahim, Ahmed Elminshawy, T. ElMelegy","doi":"10.4172/2155-6148.1000810","DOIUrl":"https://doi.org/10.4172/2155-6148.1000810","url":null,"abstract":"Objectives: To evaluate the role of prophylactic magnesium sulfate administration in preventing postoperative atrial fibrillation (POAF), attenuating the inflammatory response and promoting myocardial protection after isolated cardiac valve replacement surgery in adult patients with rheumatic heart disease. Design: Prospective randomized, double-blind placebo-controlled trial. Methods: Sixty-four adult patients undergoing isolated cardiac valve replacement surgery were divided into two equal groups (32 patients in each). Patients in magnesium group (group M) received 2.5 gm of magnesium sulfate (dissolved in 100 mL of isotonic saline and infused over 2 h), twelve h preoperatively, within the first hour of ICU arrival, and on the 2nd and 3rd postoperative days (group M). Patients in the control group (group C) received a placebo of isotonic saline at the same time periods. Results: Prophylactic magnesium sulfate significantly decreased the incidence of POAF compared to the placebo group (P=0.005). White blood cell (WBC) count showed no significant difference between the two groups. C-reactive protein (CRP) level showed significant reduction during the 3rd, 4th, and 5th postoperative days in group M compared to group C (P=0.001, 0.001 & 0.012 respectively). Serum level of interleukin-6 (IL-6) showed a significant reduction on the 5th postoperative day in group M compared to group C (P=0.001). Both groups showed no significant differences in serum levels of troponin I during the study. Conclusion: Prophylactic use of magnesium sulfate in patients with rheumatic heart disease undergoing isolated cardiac valve replacement surgery can decrease the incidence of POAF. It may play a role in attenuating the inflammatory process associated with the use of cardiopulmonary bypass (CPB).","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"76 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":"83907502","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: 10.4172/2155-6148.1000843
D. Rashwan, Hatem Elmoutaz Mahmoud, Walid H. Nofal, E. A. Sabek
{"title":"Ultrasonographic Evaluation of the Effect of Positive End-expiratory Pressure on Diaphragmatic Functions in Patients Undergoing Laparoscopic Colorectal Surgery: A Prospective Randomized Comparative Study","authors":"D. Rashwan, Hatem Elmoutaz Mahmoud, Walid H. Nofal, E. A. Sabek","doi":"10.4172/2155-6148.1000843","DOIUrl":"https://doi.org/10.4172/2155-6148.1000843","url":null,"abstract":"","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"31 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77146742","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: 10.4172/2155-6148.1000863
M. Carmelo, L. Valeria, Murabito Paolo, Buscema Giovanni, V. Francesco, Scollo Stefano, Scalisi Rita, A. Marinella
{"title":"Target Control Infusion (TCI) Anesthesia in Morquio Syndrome During Cranio Spinal Surgery","authors":"M. Carmelo, L. Valeria, Murabito Paolo, Buscema Giovanni, V. Francesco, Scollo Stefano, Scalisi Rita, A. Marinella","doi":"10.4172/2155-6148.1000863","DOIUrl":"https://doi.org/10.4172/2155-6148.1000863","url":null,"abstract":"","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74872554","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: 10.4172/2155-6148.1000841
H. Machado, J. Completo
Introduction: Several surgical procedures may have efficiency gains with the ambulatory methodology. Patient comorbidities control is key for successful procedures. Anesthetic drugs and neuromuscular blockade reversal strongly contribute to patient safety and satisfaction, allowing evolution to more complex procedures. Purpose: This study evaluated the financial impact on hospital annual income, when transitioning some surgical procedures from inpatient to ambulatory surgical program, with anesthesiology department assentment. Methods: A risk-adjustment method, based on a logistic regression model, calibrated with approximately 1.15 million episodes from Spanish and Portuguese hospitals was used. A list of procedures performed in Centro Hospitalar do Porto was subject to classification with the label ('Yes', 'No' or 'Maybe') regarding the possibility for ambulatory surgery, relying on sugammadex safety. Results: A total of 153 procedures were classified as 'Yes' or 'maybe' (n=16,944 inpatient episodes), in 2014. 73.4% of these episodes were already performed in ambulatory, but it was expected to reach 85.5%. Assuming a consumption of at least 1 inpatient day for each potentially ambulatory episode, an overconsumption of at least 2,044 inpatient days in 2014 was forecasted. The potential financing gain in 2014 would be 4.59 Million Euros. Discussion: To safely ambulatorize and improve revenue, not only patient selection must be optimized, but also safe routines and choices of correct short acting drugs (propofol, rocuronium), and definitive drug reversal policies (sugammadex), must be implemented. Conclusions: To ambulatorize some inpatient surgical procedures increased both case-mix values. These increased complexity values have a direct positive impact on the hospital income.
{"title":"The Financial Impact of Increasing Surgical Complexity: Contribution of Sugammadex as Safer Choice for Neuromuscular Blockade Reversal in an Ambulatory Surgical Center","authors":"H. Machado, J. Completo","doi":"10.4172/2155-6148.1000841","DOIUrl":"https://doi.org/10.4172/2155-6148.1000841","url":null,"abstract":"Introduction: Several surgical procedures may have efficiency gains with the ambulatory methodology. Patient comorbidities control is key for successful procedures. Anesthetic drugs and neuromuscular blockade reversal strongly contribute to patient safety and satisfaction, allowing evolution to more complex procedures. Purpose: This study evaluated the financial impact on hospital annual income, when transitioning some surgical procedures from inpatient to ambulatory surgical program, with anesthesiology department assentment. Methods: A risk-adjustment method, based on a logistic regression model, calibrated with approximately 1.15 million episodes from Spanish and Portuguese hospitals was used. A list of procedures performed in Centro Hospitalar do Porto was subject to classification with the label ('Yes', 'No' or 'Maybe') regarding the possibility for ambulatory surgery, relying on sugammadex safety. Results: A total of 153 procedures were classified as 'Yes' or 'maybe' (n=16,944 inpatient episodes), in 2014. 73.4% of these episodes were already performed in ambulatory, but it was expected to reach 85.5%. Assuming a consumption of at least 1 inpatient day for each potentially ambulatory episode, an overconsumption of at least 2,044 inpatient days in 2014 was forecasted. The potential financing gain in 2014 would be 4.59 Million Euros. Discussion: To safely ambulatorize and improve revenue, not only patient selection must be optimized, but also safe routines and choices of correct short acting drugs (propofol, rocuronium), and definitive drug reversal policies (sugammadex), must be implemented. Conclusions: To ambulatorize some inpatient surgical procedures increased both case-mix values. These increased complexity values have a direct positive impact on the hospital income.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"12 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":"75565570","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: 10.4172/2155-6148.1000856
D. Walsh, M. Finnan, S. Mannion
Introduction: Maple Syrup Urine Disease (MSUD) is a rare, autosomal recessive aminoacidopathy. We report the peri-operative management of an eleven year old girl, with well controlled MSUD who presented to a nonpaediatric, tertiary hospital for a non-emergency procedure, under general anaesthetic. Case Presentation: An 11 year old girl presented to the Emergency Department with a history of nasal bone trauma. She was admitted for a manipulation of nasal bones (MNB) under general anaesthetic (GA). She had a history of MSUD diagnosed on day three of life. The patient was neurologically intact and had leucine levels within the accepted range prior to her surgery. In times of illness her leucine levels were generally well controlled. The patient was admitted the night prior to surgery following her normal evening meal. Her urine was checked for ketones on admission and this was negative. Overnight carbohydrate management was instituted. Her surgery was performed first on the theatre list. The procedure lasted 14 min and was uneventful. Oral intake was recommenced at 10.00 am. Her urine was again checked for ketones post-operatively and was negative. The patient was well over the weekend and her leucine level post-surgery were within normal limits. Discussion: MSUD is a rare disease. There is limited experience of the conduct of anaesthesia in these patients outside of specialist paediatric centers. Most reports advised transfer to a tertiary paediatric center. We demonstrated that low risk surgery can be carried out safely in these patients.
{"title":"Peri-operative Management of a Child with Maple Syrup Urine Disease in a Non-tertiary Paediatric Hospital","authors":"D. Walsh, M. Finnan, S. Mannion","doi":"10.4172/2155-6148.1000856","DOIUrl":"https://doi.org/10.4172/2155-6148.1000856","url":null,"abstract":"Introduction: Maple Syrup Urine Disease (MSUD) is a rare, autosomal recessive aminoacidopathy. We report the peri-operative management of an eleven year old girl, with well controlled MSUD who presented to a nonpaediatric, tertiary hospital for a non-emergency procedure, under general anaesthetic. Case Presentation: An 11 year old girl presented to the Emergency Department with a history of nasal bone trauma. She was admitted for a manipulation of nasal bones (MNB) under general anaesthetic (GA). She had a history of MSUD diagnosed on day three of life. The patient was neurologically intact and had leucine levels within the accepted range prior to her surgery. In times of illness her leucine levels were generally well controlled. The patient was admitted the night prior to surgery following her normal evening meal. Her urine was checked for ketones on admission and this was negative. Overnight carbohydrate management was instituted. Her surgery was performed first on the theatre list. The procedure lasted 14 min and was uneventful. Oral intake was recommenced at 10.00 am. Her urine was again checked for ketones post-operatively and was negative. The patient was well over the weekend and her leucine level post-surgery were within normal limits. Discussion: MSUD is a rare disease. There is limited experience of the conduct of anaesthesia in these patients outside of specialist paediatric centers. Most reports advised transfer to a tertiary paediatric center. We demonstrated that low risk surgery can be carried out safely in these patients.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76124100","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: 10.4172/2155-6148.1000823
Carla Couto, Daniela Almeida, Francisco Xará Leite, M. Pereira, Manuela Araújo, H. Machado
Introduction: Hip fractures are associated with an in-hospital mortality rate of 7-14%, and a profound impairment of independence and quality of life. Current guidelines indicate that surgery for hip fracture should be performed within 24 h of injury. The main purpose of this study was to determine which factors affect in-hospital mortality and the potential role of the anesthetist in its prevention. Methods: A retrospective, observational study of all patients submitted to hip fracture surgery during one year was carried out. Data were collected from medical records and linear regressions and a multivariate analysis with SPSS version 23.0 was run. Results: A total of 372 patients with the diagnosis of hip fracture submitted to surgery were included in this study. No correlation between waiting time for surgery and in-hospital mortality was found. In multivariate analysis, only increased ASA score (p=0,018) and having a fracture treated with an arthroplasty procedure (p=0,028) were statistically significant predictors of postoperative mortality. Conclusion: In our study, the statistically significant predictors of postoperative mortality were an increased ASA score and type of surgery (arthroplasty procedure). The surgical approach should always be a multidisciplinary decision, involving the anesthesiology and the orthopedic teams, and based on patient’s clinical state and not only the type of fracture.
{"title":"Early Mortality After Hip Fracture - Is Type of Surgery Important?","authors":"Carla Couto, Daniela Almeida, Francisco Xará Leite, M. Pereira, Manuela Araújo, H. Machado","doi":"10.4172/2155-6148.1000823","DOIUrl":"https://doi.org/10.4172/2155-6148.1000823","url":null,"abstract":"Introduction: Hip fractures are associated with an in-hospital mortality rate of 7-14%, and a profound impairment of independence and quality of life. Current guidelines indicate that surgery for hip fracture should be performed within 24 h of injury. The main purpose of this study was to determine which factors affect in-hospital mortality and the potential role of the anesthetist in its prevention. Methods: A retrospective, observational study of all patients submitted to hip fracture surgery during one year was carried out. Data were collected from medical records and linear regressions and a multivariate analysis with SPSS version 23.0 was run. Results: A total of 372 patients with the diagnosis of hip fracture submitted to surgery were included in this study. No correlation between waiting time for surgery and in-hospital mortality was found. In multivariate analysis, only increased ASA score (p=0,018) and having a fracture treated with an arthroplasty procedure (p=0,028) were statistically significant predictors of postoperative mortality. Conclusion: In our study, the statistically significant predictors of postoperative mortality were an increased ASA score and type of surgery (arthroplasty procedure). The surgical approach should always be a multidisciplinary decision, involving the anesthesiology and the orthopedic teams, and based on patient’s clinical state and not only the type of fracture.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"361 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":"73993487","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: 10.4172/2155-6148.1000809
Endalew Nigussie Simeneh Endalew, E. G. Gebremedhn, Amare Hailekiros Gebreegzi, Habtamu Getinet Kassahun, Adugna A Kassa, T. Abebe
Background: Nausea and vomiting is a common problem after spinal anaesthesia after cesarean section. Metoclopramide is reported to be effective in reducing the incidence and severity of nausea and vomiting (NV). However, its effectiveness as monotherapy remains unexplored. Aims: We aimed to assess the effectiveness of metoclopramide prophylaxis on the prevention of nausea and vomiting after emergency cesarean section under spinal anaesthesia. Methods and material: A prospective non-controlled study was conducted at a referral hospital. Patients classified as metoclopramide group who received 10 mg IV prophylaxis versus no prophylaxis group. Pre-tested checklist and patient interview were employed to collect the data during operation, at 2 h, 4 h and 6 h after cesarean section. Student’s t-test or Mann-Whitney U tests were used to compare the incidence and severity of nausea and vomiting between the groups. Chi-square and Fisher exact tests were used to compare the proportion of categorical variables between the groups. Results: The overall incidence of intraoperative and early postoperative nausea and vomiting were 25.8% and 48.5% in the treatment (n=66) group and non-treatment (n=66) group respectively. Prophylactic metoclopramide significantly reduced the overall incidence of intraoperative and early postoperative nausea and vomiting (25.8% vs. 48.5%, p=0.012) compared with non-treatment group. The median score for nausea on numeric rating scale was also reduced in the prophylaxis at the end of CS, 2 h and at 4 h after CS. Conclusion: The incidences of nausea and vomiting were high. The administration of prophylactic metoclopramide remarkably reduced the incidence and severity of intraoperative and early postoperative nausea and vomiting compared to the non-treatment group. We recommend metoclopramide prophylaxis for parturients undergoing emergency cesarean section under spinal anaesthesia. In addition, preoperative risk stratification strategies and perioperative nausea and vomiting management protocols need to be established in the hospital.
背景:恶心和呕吐是剖宫产术后脊柱麻醉后的常见问题。据报道，甲氧氯普胺可有效降低恶心和呕吐(NV)的发生率和严重程度。然而，其作为单一疗法的有效性仍未被探索。目的:评价甲氧氯普胺预防脊髓麻醉下紧急剖宫产术后恶心呕吐的效果。方法和材料:在一家转诊医院进行前瞻性非对照研究。甲氧氯普胺组患者接受10 mg静脉预防与不进行预防。采用预试检查表和患者访谈收集术中、剖宫产术后2、4、6小时的数据。使用学生t检验或Mann-Whitney U检验来比较两组之间恶心和呕吐的发生率和严重程度。采用卡方检验和Fisher精确检验比较两组间分类变量的比例。结果:治疗组(n=66)术中及术后早期恶心呕吐总发生率为25.8%，非治疗组(n=66)术后恶心呕吐总发生率为48.5%。与未治疗组相比，预防性甲氧氯普胺显著降低术中及术后早期恶心呕吐的总发生率(25.8% vs 48.5%， p=0.012)。在CS结束、CS后2小时和CS后4小时，预防组的恶心中位数评分也有所降低。结论:恶心、呕吐发生率高。与未治疗组相比，预防性施用甲氧氯普胺显著降低了术中和术后早期恶心呕吐的发生率和严重程度。我们建议在脊髓麻醉下进行紧急剖宫产的产妇预防使用甲氧氯普胺。此外，医院需要建立术前风险分层策略和围手术期恶心呕吐管理方案。
{"title":"Effectiveness of Intravenous Metoclopramide Prophylaxis on the Reduction of Intraoperative and Early Postoperative Nausea and Vomiting after Emergency Caesarean Section under Spinal Anaesthesia","authors":"Endalew Nigussie Simeneh Endalew, E. G. Gebremedhn, Amare Hailekiros Gebreegzi, Habtamu Getinet Kassahun, Adugna A Kassa, T. Abebe","doi":"10.4172/2155-6148.1000809","DOIUrl":"https://doi.org/10.4172/2155-6148.1000809","url":null,"abstract":"Background: Nausea and vomiting is a common problem after spinal anaesthesia after cesarean section. Metoclopramide is reported to be effective in reducing the incidence and severity of nausea and vomiting (NV). However, its effectiveness as monotherapy remains unexplored. Aims: We aimed to assess the effectiveness of metoclopramide prophylaxis on the prevention of nausea and vomiting after emergency cesarean section under spinal anaesthesia. Methods and material: A prospective non-controlled study was conducted at a referral hospital. Patients classified as metoclopramide group who received 10 mg IV prophylaxis versus no prophylaxis group. Pre-tested checklist and patient interview were employed to collect the data during operation, at 2 h, 4 h and 6 h after cesarean section. Student’s t-test or Mann-Whitney U tests were used to compare the incidence and severity of nausea and vomiting between the groups. Chi-square and Fisher exact tests were used to compare the proportion of categorical variables between the groups. Results: The overall incidence of intraoperative and early postoperative nausea and vomiting were 25.8% and 48.5% in the treatment (n=66) group and non-treatment (n=66) group respectively. Prophylactic metoclopramide significantly reduced the overall incidence of intraoperative and early postoperative nausea and vomiting (25.8% vs. 48.5%, p=0.012) compared with non-treatment group. The median score for nausea on numeric rating scale was also reduced in the prophylaxis at the end of CS, 2 h and at 4 h after CS. Conclusion: The incidences of nausea and vomiting were high. The administration of prophylactic metoclopramide remarkably reduced the incidence and severity of intraoperative and early postoperative nausea and vomiting compared to the non-treatment group. We recommend metoclopramide prophylaxis for parturients undergoing emergency cesarean section under spinal anaesthesia. In addition, preoperative risk stratification strategies and perioperative nausea and vomiting management protocols need to be established in the hospital.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"13 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":"77403769","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: 10.4172/2155-6148.1000842
A. Stoker, P. Bolton, Narjeet Khurmi
{"title":"Dexmedetomidine Bolus to Treat Refractory Pain in the PACU Setting, Avoiding an Unplanned Admission in Ambulatory Surgery: A Case Report","authors":"A. Stoker, P. Bolton, Narjeet Khurmi","doi":"10.4172/2155-6148.1000842","DOIUrl":"https://doi.org/10.4172/2155-6148.1000842","url":null,"abstract":"","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"26 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81593445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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