Pub Date : 2018-01-01DOI: 10.4172/2155-6148.1000867
M. Allam
Introduction: Lung contusion due to severe chest trauma considered major problem in the critical care. Not only because of common ARDS (Acute Respiratory Distress Syndrome) but also the devitalized lung tissue due to trauma is major cause of superadded infection. Especially if this lung ventilated for a long time. Ventilator associated pneumonia (VAP) occur in this lung characterized by being developed in short time (early VAP after 4 days only ventilation). And also very resistant to the conventional line of treatment compared to other causes of VAP. As the devitalized lung tissue full with proteinicious material from exudative and infiltrative phase of traumatic inflammation make the lung tissue highly susceptible for bacterial growth. The question is can ECMO be useful in this critical situation? or the conventional way of management of severe VAP is better. Aim of the work: To compare the efficacy and safety of usage ECMO compared to conventional ventilation with nitric oxide using protective strategy in patients with ARDS due to severe lung contusion following severe chest trauma complicated by VAP as regards controlling all parameters of both Murray and CPIS score and early weaning from the ventilator. Patients and methods: This a prospective double blind study done in King Abdulaziz specialist hospital between January 2015 and September 2018 in the intensive care unit on 60 patients chosen after 10 days from conventional ventilation due to ARDS from severe lung contusion those who had more than 3 on Murray score and 6 on CPIS allocated randomly in two groups. Group A (30 patients) continued on the same conventional ventilation but broad spectrum antibiotics according to qualitative sputum culture and nitric oxide were added on the management while group B (30 patients) put on ECMO and started antibiotics. The duration of the study last 16 days during this period the clinical parameters of both Murray score and CPIS were compared between the patients of both groups and recorded. Also both mortality and morbidity recorded. Morbidity considered in our study by no improvement in any or all clinical parameters of both Murray and CPIS scores and failure of weaning of patients from the ventilator at the studied period. Results: By comparing the clinical parameters of both Murray and CPIS scores in both groups all over the studied periods showed significant improvement in the APACH II score <10 of patients of group B (0 patient in group A and 7 patients in group B), significant improvement in arterial oxygen saturation >95 of group B (0 patient in group A, 8 patients from B), significant improvement in hypoxic index >300 of patients of group B (0 patient in group A and 9 patients in B), significant improvement in parenchymatous lung infiltrate in chest X-ray with less than one quadrant infiltration of group B (3 patients in group A and15 patients in B), significant improvement in lung compliance with >80 ml for 1 cm H2O pressure of group B (3 pati
{"title":"Extra Corporal Membrane Oxygenation (ECMO) vs. Conventional Ventilation with Nitric Oxide in ARDS due to Infected Contused Lung","authors":"M. Allam","doi":"10.4172/2155-6148.1000867","DOIUrl":"https://doi.org/10.4172/2155-6148.1000867","url":null,"abstract":"Introduction: Lung contusion due to severe chest trauma considered major problem in the critical care. Not only because of common ARDS (Acute Respiratory Distress Syndrome) but also the devitalized lung tissue due to trauma is major cause of superadded infection. Especially if this lung ventilated for a long time. Ventilator associated pneumonia (VAP) occur in this lung characterized by being developed in short time (early VAP after 4 days only ventilation). And also very resistant to the conventional line of treatment compared to other causes of VAP. As the devitalized lung tissue full with proteinicious material from exudative and infiltrative phase of traumatic inflammation make the lung tissue highly susceptible for bacterial growth. The question is can ECMO be useful in this critical situation? or the conventional way of management of severe VAP is better. Aim of the work: To compare the efficacy and safety of usage ECMO compared to conventional ventilation with nitric oxide using protective strategy in patients with ARDS due to severe lung contusion following severe chest trauma complicated by VAP as regards controlling all parameters of both Murray and CPIS score and early weaning from the ventilator. Patients and methods: This a prospective double blind study done in King Abdulaziz specialist hospital between January 2015 and September 2018 in the intensive care unit on 60 patients chosen after 10 days from conventional ventilation due to ARDS from severe lung contusion those who had more than 3 on Murray score and 6 on CPIS allocated randomly in two groups. Group A (30 patients) continued on the same conventional ventilation but broad spectrum antibiotics according to qualitative sputum culture and nitric oxide were added on the management while group B (30 patients) put on ECMO and started antibiotics. The duration of the study last 16 days during this period the clinical parameters of both Murray score and CPIS were compared between the patients of both groups and recorded. Also both mortality and morbidity recorded. Morbidity considered in our study by no improvement in any or all clinical parameters of both Murray and CPIS scores and failure of weaning of patients from the ventilator at the studied period. Results: By comparing the clinical parameters of both Murray and CPIS scores in both groups all over the studied periods showed significant improvement in the APACH II score <10 of patients of group B (0 patient in group A and 7 patients in group B), significant improvement in arterial oxygen saturation >95 of group B (0 patient in group A, 8 patients from B), significant improvement in hypoxic index >300 of patients of group B (0 patient in group A and 9 patients in B), significant improvement in parenchymatous lung infiltrate in chest X-ray with less than one quadrant infiltration of group B (3 patients in group A and15 patients in B), significant improvement in lung compliance with >80 ml for 1 cm H2O pressure of group B (3 pati","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84330753","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: 10.4172/2155-6148.1000854
N. Rajamohan, Surjya Prasad Upadyay, Hassy Prakassam, F. Nelson, H. Das
{"title":"Effect of Low Dose of Dexmedetomidine Infusion as an Adjunct in Balanced General Anaesthesia in Laparoscopic Colorectal Surgeries: A Prospective Double Blind Randomized Controlled Study","authors":"N. Rajamohan, Surjya Prasad Upadyay, Hassy Prakassam, F. Nelson, H. Das","doi":"10.4172/2155-6148.1000854","DOIUrl":"https://doi.org/10.4172/2155-6148.1000854","url":null,"abstract":"","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":"78361227","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: 10.4172/2155-6148.1000817
A. Sparks, J. Stewart
Thoracic surgical procedure results in severe pain. The pain presents a unique challenge to surgeons and pain management teams. A variety of techniques have been employed with variable success. Currently, thoracic epidural represents the "gold standard" of pain control. However, problems exist with this approach. Problems include cost, constant management/adjustment and exclusion of certain patients, hypotension, urinary retention and possible hematoma. Liposomal bupivacaine provides a long acting local anesthetic. It provides multiple potential benefits. The benefits include single application, decreased overall cost, no catheter related problems, and limited opioid use. We provide an update on thoracic surgery pain control with an emphasis on new long acting liposomal bupivacaine.
{"title":"Review of Pain Management in Thoracic Surgery Patients, 2018","authors":"A. Sparks, J. Stewart","doi":"10.4172/2155-6148.1000817","DOIUrl":"https://doi.org/10.4172/2155-6148.1000817","url":null,"abstract":"Thoracic surgical procedure results in severe pain. The pain presents a unique challenge to surgeons and pain management teams. A variety of techniques have been employed with variable success. Currently, thoracic epidural represents the \"gold standard\" of pain control. However, problems exist with this approach. Problems include cost, constant management/adjustment and exclusion of certain patients, hypotension, urinary retention and possible hematoma. Liposomal bupivacaine provides a long acting local anesthetic. It provides multiple potential benefits. The benefits include single application, decreased overall cost, no catheter related problems, and limited opioid use. We provide an update on thoracic surgery pain control with an emphasis on new long acting liposomal bupivacaine.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"20 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":"91541154","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: 10.4172/2155-6148.1000834
Hung-Shu Chen, Shih-Chieh Yang, Pao-Hsin Liu, Y. Tu
Objective: Confirmation of nasogastric tube (NGT) placement is sometimes difficult in clinical practice. Hence, the purpose of this study is to validate the accuracy of manometry for intragastric NGT placement confirmation in intubated, mechanically ventilated patients. Methods: A total of 100 adult patients who underwent elective open abdominal surgery and required gastric decompression were enrolled in this prospective descriptive study at a university-affiliated teaching hospital. The position of NGTs was verified by two blinded investigators, of whom the first investigator used the manometric technique and the second investigator used a fiberscope for verification. The manometric technique involved using a cuff pressure manometer to verify NGT placement. The primary measurements, sensitivity and specificity of the manometric technique in verifying NGT placement were calculated according to the standard findings of fiberoptic inspection. Results: In 81 of 100 NGT placements, intragastric placement was interpreted by the manometric technique. All of these 81 placements were confirmed by fiberoptic inspection. The manometric technique was therefore 100% sensitive. The 19 placements interpreted as extragastric placement by the manometric technique were confirmed by fiberscopy as being in the oral cavity, trachea, or esophagus, indicating 100% specificity. These results revealed 100% accuracy of the manometric technique in verifying intragastric placement of NGTs in intubated, mechanically ventilated patients. Conclusions: The manometric technique is a convenient, inexpensive, and highly accurate method for verifying NGT placement. This technique may be used to verify correct NGT placement for the purpose of gastric decompression and in those environments where a roentgenogram is not available.
{"title":"Application of Manometry to Verify Nasogastric Tube Placement in Intubated, Mechanically Ventilated Patients: A Prospective Descriptive Study","authors":"Hung-Shu Chen, Shih-Chieh Yang, Pao-Hsin Liu, Y. Tu","doi":"10.4172/2155-6148.1000834","DOIUrl":"https://doi.org/10.4172/2155-6148.1000834","url":null,"abstract":"Objective: Confirmation of nasogastric tube (NGT) placement is sometimes difficult in clinical practice. Hence, the purpose of this study is to validate the accuracy of manometry for intragastric NGT placement confirmation in intubated, mechanically ventilated patients. Methods: A total of 100 adult patients who underwent elective open abdominal surgery and required gastric decompression were enrolled in this prospective descriptive study at a university-affiliated teaching hospital. The position of NGTs was verified by two blinded investigators, of whom the first investigator used the manometric technique and the second investigator used a fiberscope for verification. The manometric technique involved using a cuff pressure manometer to verify NGT placement. The primary measurements, sensitivity and specificity of the manometric technique in verifying NGT placement were calculated according to the standard findings of fiberoptic inspection. Results: In 81 of 100 NGT placements, intragastric placement was interpreted by the manometric technique. All of these 81 placements were confirmed by fiberoptic inspection. The manometric technique was therefore 100% sensitive. The 19 placements interpreted as extragastric placement by the manometric technique were confirmed by fiberscopy as being in the oral cavity, trachea, or esophagus, indicating 100% specificity. These results revealed 100% accuracy of the manometric technique in verifying intragastric placement of NGTs in intubated, mechanically ventilated patients. Conclusions: The manometric technique is a convenient, inexpensive, and highly accurate method for verifying NGT placement. This technique may be used to verify correct NGT placement for the purpose of gastric decompression and in those environments where a roentgenogram is not available.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"7 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":"82175892","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: 10.4172/2155-6148.1000814
Hatem Elmoutaz Mahmoud, D. Rashwan
Background: A laryngeal mask airway (LMA) has been used successfully during surgical procedures in the prone position for adults and children in some cases. In this study, we compared the use of a classic LMA versus an endotracheal tube (ETT) in children undergoing minor surgical procedures in the prone position. Patients and methods: Forty children aged 4-8 years with an American Society of Anesthesiologists' classification of I who were undergoing elective surgery in the prone position were assigned to an airway secured by an uncuffed ETT (n=20) and or an airway secured by an LMA (n=20). SpO2, end-tidal CO2, heart rate, and mean arterial blood pressure were recorded before and after insertion of the LMA or ETT. The numbers of insertion attempts using the ETT or LMA were documented, along with any complications. Results: The time taken to insert the ETT was longer than that taken to insert the LMA (15.35 ± 2.907 vs. 14.35 ± 1.843 s). No intraoperative laryngospasm was reported in either group. Bronchospasm occurred intraoperatively in 2 patients in the ETT group and in one patient in the LMA group. No device displacement was reported. Conclusions: The classic LMA and ETT were both used successfully in spontaneously breathing children undergoing surgical procedures in the prone position. However, LMA was associated with fewer intraoperative and postoperative complications.
背景:在某些情况下，在成人和儿童的俯卧位手术过程中，喉罩气道(LMA)已被成功使用。在这项研究中，我们比较了在俯卧位儿童接受小手术时使用经典LMA和气管内管(ETT)的情况。患者和方法:40名年龄4-8岁的儿童，美国麻醉医师协会分类为I，他们在俯卧位接受择期手术，被分配到由无套管气管插管固定的气道(n=20)和由LMA固定的气道(n=20)。在LMA或ETT插入前后分别记录SpO2、末潮CO2、心率和平均动脉血压。记录了使用ETT或LMA的插入次数，以及任何并发症。结果:ETT插入时间比LMA插入时间长(15.35±2.907 vs. 14.35±1.843 s)，两组均未出现术中喉痉挛。术中支气管痉挛发生在ETT组2例，LMA组1例。无器械移位报告。结论:经典的LMA和ETT都成功地应用于自主呼吸的儿童在外科手术中俯卧位。然而，LMA术中和术后并发症较少。
{"title":"Use of the Classic Laryngeal Mask Airway Versus an Endotracheal Tube in Children Undergoing Elective Surgery in the Prone Position: A Prospective Randomized Feasibility Study","authors":"Hatem Elmoutaz Mahmoud, D. Rashwan","doi":"10.4172/2155-6148.1000814","DOIUrl":"https://doi.org/10.4172/2155-6148.1000814","url":null,"abstract":"Background: A laryngeal mask airway (LMA) has been used successfully during surgical procedures in the prone position for adults and children in some cases. In this study, we compared the use of a classic LMA versus an endotracheal tube (ETT) in children undergoing minor surgical procedures in the prone position. Patients and methods: Forty children aged 4-8 years with an American Society of Anesthesiologists' classification of I who were undergoing elective surgery in the prone position were assigned to an airway secured by an uncuffed ETT (n=20) and or an airway secured by an LMA (n=20). SpO2, end-tidal CO2, heart rate, and mean arterial blood pressure were recorded before and after insertion of the LMA or ETT. The numbers of insertion attempts using the ETT or LMA were documented, along with any complications. Results: The time taken to insert the ETT was longer than that taken to insert the LMA (15.35 ± 2.907 vs. 14.35 ± 1.843 s). No intraoperative laryngospasm was reported in either group. Bronchospasm occurred intraoperatively in 2 patients in the ETT group and in one patient in the LMA group. No device displacement was reported. Conclusions: The classic LMA and ETT were both used successfully in spontaneously breathing children undergoing surgical procedures in the prone position. However, LMA was associated with fewer intraoperative and postoperative complications.","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":"84776696","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: 10.4172/2155-6148.1000840
C. Cavaleiro, Vitor Gonçalves, Joao Costa, H. Machado, S. Pinho
Opioids and hypnotic drugs have undesired side effects including sedation and respiratory depression, which makes these drugs unsuitable in some clinical situations. Lidocaine is a local analgesic with anti-inflammatory and anti-hyperalgic properties, with a promissory applicability in everyday anaesthesia cases. Authors present a case of an urgent colonoscopy procedure on a 67-year-old patient with a pulmonary neoplasm and respiratory insufficiency, managed with lidocaine bolus and infusion, without additional anaesthetic drugs. Good analgesia was achieved and hemodynamic stability was maintained throughout the procedure. The technique was considered satisfactory to the patient and the medical team. This case report suggests that lidocaine seems to provide adequate level of consciousness and analgesia without respiratory depression for colonoscopy procedures, which might be crucial in a frail population.
{"title":"Opioid and Hypnotic Free Anaesthetic Technique for Colonoscopy- Intravenous Lidocaine Infusion in a Frail Patient","authors":"C. Cavaleiro, Vitor Gonçalves, Joao Costa, H. Machado, S. Pinho","doi":"10.4172/2155-6148.1000840","DOIUrl":"https://doi.org/10.4172/2155-6148.1000840","url":null,"abstract":"Opioids and hypnotic drugs have undesired side effects including sedation and respiratory depression, which makes these drugs unsuitable in some clinical situations. Lidocaine is a local analgesic with anti-inflammatory and anti-hyperalgic properties, with a promissory applicability in everyday anaesthesia cases. Authors present a case of an urgent colonoscopy procedure on a 67-year-old patient with a pulmonary neoplasm and respiratory insufficiency, managed with lidocaine bolus and infusion, without additional anaesthetic drugs. Good analgesia was achieved and hemodynamic stability was maintained throughout the procedure. The technique was considered satisfactory to the patient and the medical team. This case report suggests that lidocaine seems to provide adequate level of consciousness and analgesia without respiratory depression for colonoscopy procedures, which might be crucial in a frail population.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"6 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":"81829639","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: 10.4172/2155-6148.1000816
Mariana Oliveira, H. Machado
Introduction: Down syndrome (DS) or Trisomy 21 is associated with a higher morbidity, mortality and surgery need. This syndrome presents a characteristic set of morphologic features regarding several systems: cardiovascular, respiratory, gastrointestinal, nervous, musculoskeletal, immune, hematologic, endocrine, ophthalmic and hearing. Therefore, special care is required to maximize safety before, during and after surgery. This study’s objective is to systematically review these needs in the perioperative (pre, intra and postoperative) period, and how to approach them. Methods: PubMed and Web of Science were searched and 32 articles selected for this revision. Results: DS patients have commonly pulmonary arterial hypertension and congenital heart defects. They may have swallow function abnormalities or gastro-esophageal reflux disease. Airway and respiratory tract conditions, such as aspiration pneumonia, obstructive sleep apnea, congenital tracheal stenosis, and recurrent infections, are common. In addition, cervical instability and nociception disorders may be present. Discussion: In order to prevent perioperative complications, several practices are suggested. In the preoperative period: assess the surgical risk using Aristotle and RACHS-1 scoring systems, analyze a recent echocardiogram, consider prophylactic antibiotic therapy and take strict aseptic precautions. Performing an X-ray looking for cervical instability is a controversial topic. In the intraoperative period: administer intravenous sedation in dental treatments, have anticholinergic agents available, consider aspiration prophylaxis, and position the neck particularly. However, there is no agreement on the best airway device. In the postoperative period: provide longer hospitalizations or stay in intensive unit care, remove catheters as soon as possible, assess the pain with specific tools, administer lower weight-adjusted doses of dexmedetomidine (controversial topic) and use morphine, once no opioid resistance was found. Conclusion: There are variations in the approach to the perioperative period, and even lack of agreement in some topics, making clear the need for specific guidelines to standardize this process and reduce morbidity.
简介:唐氏综合症(DS)或21三体与较高的发病率、死亡率和手术需求相关。该综合征在心血管、呼吸、胃肠、神经、肌肉骨骼、免疫、血液学、内分泌、眼科和听力等几个系统中表现出一组特征性的形态学特征。因此，在手术前、手术中和手术后需要特别注意，以最大限度地提高安全性。本研究的目的是系统地回顾围手术期(术前、术中和术后)的这些需求，以及如何满足这些需求。方法:检索PubMed和Web of Science，选择32篇文章进行本次修订。结果:退行性椎体滑移患者常见于肺动脉高压和先天性心脏缺陷。他们可能有吞咽功能异常或胃食管反流病。气道和呼吸道疾病，如吸入性肺炎、阻塞性睡眠呼吸暂停、先天性气管狭窄和复发性感染是常见的。此外，颈椎不稳和痛觉障碍也可能存在。讨论:为防止围手术期并发症的发生，建议采取以下措施。术前:应用Aristotle和RACHS-1评分系统评估手术风险，分析近期超声心动图，考虑预防性抗生素治疗并采取严格的无菌预防措施。用x光检查颈椎不稳是一个有争议的话题。术中:在牙科治疗中给予静脉镇静，使用抗胆碱能药物，考虑预防误吸，特别是颈部定位。然而，对于最佳的气道设备并没有一致的意见。术后:延长住院时间或留在重症监护病房，尽快拔除导管，用特定工具评估疼痛，一旦没有发现阿片类药物耐药，给予较低体重调整剂量的右美托咪定(有争议的话题)并使用吗啡。结论:围手术期的入路存在差异，甚至在一些议题上缺乏共识，明确需要制定具体的指南来规范这一过程，降低发病率。
{"title":"Perioperative Management of Patients with Down Syndrome: A Review","authors":"Mariana Oliveira, H. Machado","doi":"10.4172/2155-6148.1000816","DOIUrl":"https://doi.org/10.4172/2155-6148.1000816","url":null,"abstract":"Introduction: Down syndrome (DS) or Trisomy 21 is associated with a higher morbidity, mortality and surgery need. This syndrome presents a characteristic set of morphologic features regarding several systems: cardiovascular, respiratory, gastrointestinal, nervous, musculoskeletal, immune, hematologic, endocrine, ophthalmic and hearing. Therefore, special care is required to maximize safety before, during and after surgery. This study’s objective is to systematically review these needs in the perioperative (pre, intra and postoperative) period, and how to approach them. Methods: PubMed and Web of Science were searched and 32 articles selected for this revision. Results: DS patients have commonly pulmonary arterial hypertension and congenital heart defects. They may have swallow function abnormalities or gastro-esophageal reflux disease. Airway and respiratory tract conditions, such as aspiration pneumonia, obstructive sleep apnea, congenital tracheal stenosis, and recurrent infections, are common. In addition, cervical instability and nociception disorders may be present. Discussion: In order to prevent perioperative complications, several practices are suggested. In the preoperative period: assess the surgical risk using Aristotle and RACHS-1 scoring systems, analyze a recent echocardiogram, consider prophylactic antibiotic therapy and take strict aseptic precautions. Performing an X-ray looking for cervical instability is a controversial topic. In the intraoperative period: administer intravenous sedation in dental treatments, have anticholinergic agents available, consider aspiration prophylaxis, and position the neck particularly. However, there is no agreement on the best airway device. In the postoperative period: provide longer hospitalizations or stay in intensive unit care, remove catheters as soon as possible, assess the pain with specific tools, administer lower weight-adjusted doses of dexmedetomidine (controversial topic) and use morphine, once no opioid resistance was found. Conclusion: There are variations in the approach to the perioperative period, and even lack of agreement in some topics, making clear the need for specific guidelines to standardize this process and reduce morbidity.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"20 1","pages":"1-14"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85915132","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: 10.4172/2155-6148.1000811
A. B. Fernández
The successful practice of Anesthesiology relies on a number of competencies, including a store of current medical knowledge, the ability to efficiently apply that medical knowledge, the capacity to exercise sound medical judgment in a broad range of circumstances, the ability to effectively work with other members of the surgical team, and the ability to perform a myriad of intrincate cognitive and technological tasks.
{"title":"Emotional Regulation Techniques in Trainee Anaesthetics: Enhancing Self-Compassion, Emphaty and Resilience","authors":"A. B. Fernández","doi":"10.4172/2155-6148.1000811","DOIUrl":"https://doi.org/10.4172/2155-6148.1000811","url":null,"abstract":"The successful practice of Anesthesiology relies on a number of competencies, including a store of current medical knowledge, the ability to efficiently apply that medical knowledge, the capacity to exercise sound medical judgment in a broad range of circumstances, the ability to effectively work with other members of the surgical team, and the ability to perform a myriad of intrincate cognitive and technological tasks.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"443 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88145477","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: 10.4172/2155-6148.1000826
L. E. N. Ferreira, D. Hasan, B. V. Muniz, J. Burga-Sánchez, M. Volpato, F. Groppo
Objectives: Local anesthetics (LAs) cause the loss of sensitivity to the nociceptive stimulus by the reversible blockade of the neural electrical impulse. These drugs are widely used for pain control in many clinical procedures and in other therapeutic applications. Besides the effects on voltage-gated sodium channels, LAs can modulate different cellular pathways. The review seeks to address the effects of local anesthetics on the cellular viability, apoptosis induction and inflammatory response. Methods: Data was collected from MEDLINE®, Scopus® and Web of Science, the searches were performed between November 2017 and April 2018. Results: LAs induce necrosis and apoptosis in a time and dose-dependent manner. Apoptosis occurs primarily by the intrinsic pathway through the loss of mitochondrial membrane potential. These molecules were able to reduce the release of pro-inflammatory cytokines, chemokines, COX-2, PGE2 and decrease the activation of NF-κB. Conclusion: The cytotoxic effects of LA are relate to high concentrations and prolonged exposure times. LAs activate the intrinsic pathway of apoptosis through cytochrome c release. In concentrations lower than required to perform sensory and motor block, LAs show anti-inflammatory effects.
目的:局部麻醉剂通过对神经电脉冲的可逆阻断，导致对伤害性刺激的敏感性丧失。这些药物在许多临床程序和其他治疗应用中广泛用于疼痛控制。除了对电压门控钠通道的作用外，LAs还可以调节不同的细胞通路。本文旨在探讨局麻药对细胞活力、诱导凋亡和炎症反应的影响。方法:数据收集自MEDLINE®、Scopus®和Web of Science，检索时间为2017年11月至2018年4月。结果:LAs诱导细胞坏死和凋亡具有时间和剂量依赖性。细胞凋亡主要通过线粒体膜电位丧失的内在途径发生。这些分子能够减少促炎细胞因子、趋化因子、COX-2、PGE2的释放，降低NF-κB的活化。结论:LA的细胞毒性作用与高浓度和长时间暴露有关。LAs通过释放细胞色素c激活细胞凋亡的内在途径。当浓度低于执行感觉和运动阻断所需时，LAs显示出抗炎作用。
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{"title":"A Comparative Study between Transversus Abdominis Plane Block and Wound Site Local Anesthesia Infiltration for Effective Post-Operative Pain Control for Lower Abdominal Surgery: A Prospective Cohort Study, Ethiopia","authors":"Biruk Wayu, Bethelehem Germa, Tewoderos Shitemaw, Getahun Dendir","doi":"10.4172/2155-6148.1000859","DOIUrl":"https://doi.org/10.4172/2155-6148.1000859","url":null,"abstract":"","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"209 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77748522","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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