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Emergency Management of Unexpected Life-Threatening Septic Shock in a Patient Undergoing Ureteroscopic Stone Removal 输尿管镜下取石术中意外危及生命的感染性休克的紧急处理
Pub Date : 2018-01-01 DOI: 10.4172/2155-6148.1000807
N. R. Tripathy, S. Tripathy
We present a case of life-threatening septic shock undergoing ureteroscopic stone removal in the operation theatre just after the surgery. Patient was symptomatically diagnosed on the operation table and intensively managed to stabilize quickly without wasting time and later it was confirmed by investigations that it was a septic shock resulted due to Gram negative bacilli E-coli.
我们报告一例危及生命的脓毒性休克,手术后在手术室接受输尿管镜取石术。患者在手术台上进行了对症诊断,并进行了集中管理,迅速稳定下来,没有浪费时间,后来经检查证实是由革兰氏阴性杆菌大肠杆菌引起的感染性休克。
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引用次数: 0
Potassium Concentration in Cardioplegic Solutions in Pediatric Patients Undergoing Tetralogy of Fallot Repair: Impact on Myocardial Protection 在接受法洛四联症修复的小儿患者心脏麻痹溶液中钾浓度:对心肌保护的影响
Pub Date : 2018-01-01 DOI: 10.4172/2155-6148.1000851
M. A. Ali, S. Elshafy, A. Mandour, K. Kassem, M. Sherif, H. Elmorabaa, A. A. A. Glalah, A. Sleem
Objective: We investigated the cardioprotective effects of two different potassium concentrations in crystalloid cardioplegic solutions in pediatric patients undergoing tetralogy of Fallot (TOF) repair under cardiopulmonary bypass (CPB). Methods: Eighty seven pediatric patients with Tetralogy of Fallot (TOF) were randomly allocated into two groups according to the type of cardioplegic solution. Group L received large volume with low potassium concentration (K+ 10 mmol/L) cardioplegia; 30 ml/kg for induction of arrest and repeated every 20 min at a dose of 15 ml/kg. Group S received small volume with high potassium concentration (K+ 30 mmol/L) cardioplegia; 10 ml/kg for induction of arrest and repeated every 20 min at a dose of 5 ml/kg. Results: Group L showed earlier return of cardiac rhythm (33.8 ± 4.9 sec) compared to 38.9 ± 5.6 sec in group S with most of the cases had sinus rhythm. The maximum Inotropic Score in the first 24 h was lower in group L; 13 (5) compared to group S; 15 (10). Less increase in cardiac troponin I (cTnI) in all postoperative readings, shorter duration of mechanical ventilation, ICU length, and hospital stay in group L. No changes in hemodynamic parameters between both groups. Conclusion: Better myocardial protection in pediatric cardiac patients perfused by cardioplegia with low potassium concentration.
目的:探讨体外循环(CPB)下行法洛四联症(TOF)修复的小儿晶体截瘫液中两种不同钾浓度的心脏保护作用。方法:将87例小儿法洛四联症(TOF)患者按停药方式随机分为两组。L组大容量低钾(K+ 10 mmol/L)停搏;30ml /kg诱导骤停,每20分钟以15ml /kg的剂量重复一次。S组采用小容量高钾(K+ 30 mmol/L)停搏;10ml /kg诱导骤停,每20分钟以5ml /kg的剂量重复一次。结果:L组心律恢复较S组(38.9±5.6秒)早(33.8±4.9秒),以窦性心律为主。L组大鼠前24 h最大肌力评分较低;与S组比较13 (5);15(10)。术后所有读数中心肌肌钙蛋白I (cTnI)的增加较少,l组机械通气时间、ICU长度和住院时间较短。两组之间血流动力学参数无变化。结论:低钾心脏骤停灌注对小儿心脏患者心肌保护作用较好。
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引用次数: 0
Emergency Caesarean Section in Systemic Sclerosis: Multidisciplinary Management 系统性硬化症急诊剖宫产:多学科管理
Pub Date : 2018-01-01 DOI: 10.4172/2155-6148.1000864
Murabito Paolo, L. Valeria, Scarpinati Giuseppe, Bonsignore Christian, Tringali Eleonora, M. Carmelo, P. Sofia, A. Marinella
Systemic sclerosis (Ss) is a rare autoimmune disease, it is associated with abnormal deposition of extracellular collagen in visceral organs and skin. Another feature of Systemic sclerosis is vascular dysfunction, causing distal amputation secondary to multiple Raynaud’s Phenomenon. Ss it is an anaesthetic challenge from different point of views, patients usually show poor oral aperture and consequently difficult airway management. Moreover they may even be affected by restrictive pulmonary disease, representing an obstacle for adequate mechanical ventilation. Ss it is also associated with cardiovascular and respiratory comorbidities. Management of systemic sclerosis involved many different specialties such as: paediatrician and gynecologist who gave 32 weeks of pregnancy as an acceptable moment to perform caesarean delivery if needed. Also thoracic surgeon was engaged to help us in managing difficult airways by flexible bronchoscopy if general anesthesia would have been necessary. Patients affected by Ss, are usually young woman, so we should expect to manage pregnancy in this rare pathology also because the immunosuppressant therapies are more effective now than in the past. In this case report, a pregnant women affected by Ss was managed even in emergency situation. In order to reduce mistake and to manage any possible condition such as elective caesarean section or emergency one, we decided to adopt an anesthesiologic protocol to manage our patient. Our protocol established three attempt for each anesthesia technique, first line anesthesia was epidural anesthesia, then spinal anesthesia and as last chance general anesthesia. As a result of non-reassuring fetal heart rate, patient underwent an emergency caesarean section, we had to perform spinal anesthesia because it was difficult to place epidural catheter. Patient was stable after spinal anesthesia and surgery, so our case report strongly recommends to plan carefully anesthesia, in this case spinal anesthesia is a viable solution for women with Scleroderma undergoing caesarean section.
系统性硬化症(Ss)是一种罕见的自身免疫性疾病,它与内脏器官和皮肤细胞外胶原蛋白的异常沉积有关。系统性硬化症的另一个特征是血管功能障碍,导致继发多发性雷诺现象的远端截肢。从不同的角度来看,这是一种麻醉挑战,患者通常表现为口腔开口差,因此气道管理困难。此外,他们甚至可能受到限制性肺部疾病的影响,这对充分的机械通气构成了障碍。它也与心血管和呼吸合并症有关。系统性硬化症的治疗涉及许多不同的专业,例如:儿科医生和妇科医生,他们认为怀孕32周是一个可以接受的时间,如果需要,可以进行剖腹产。如果需要全身麻醉,胸外科医生也会帮助我们通过灵活的支气管镜检查来处理困难的气道。受Ss影响的患者通常是年轻女性,所以我们应该期望在这种罕见的病理中管理妊娠,因为免疫抑制疗法现在比过去更有效。在本案例报告中,即使在紧急情况下,也对一名感染s的孕妇进行了管理。为了减少错误和处理任何可能的情况,如选择性剖宫产或紧急剖宫产,我们决定采用麻醉方案来处理我们的病人。我们的方案建立了每种麻醉技术的三次尝试,第一次麻醉是硬膜外麻醉,然后是脊髓麻醉,最后是全身麻醉。由于胎儿心率不稳定,患者接受了紧急剖腹产手术,由于硬膜外导管难以放置,我们不得不实施脊髓麻醉。患者在脊髓麻醉和手术后病情稳定,因此我们的病例报告强烈建议仔细计划麻醉,在这种情况下,脊髓麻醉是硬皮病女性剖腹产手术的可行解决方案。
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引用次数: 0
Adductor Canal vs. Femoral Continuous Peripheral Nerve Blocks for Knee Arthroplasty: A One-year Follow-up Pilot Study of 2 Randomized, Controlled Clinical Trials 内收管与股骨连续周围神经阻滞用于膝关节置换术:一项为期一年的2项随机对照临床试验的跟踪研究
Pub Date : 2018-01-01 DOI: 10.4172/2155-6148.1000838
E. Davidson, Anthony T Machi, Jacklynn F. Sztain, Nicholas J. Kormylo, S. Madison, Wendy B. Abramson, Amanda M. Monahan, Bahareh Khatibi, S. Ball, Francis B. Gonzales, D. Sessler, B. Ilfeld
Author(s): Davidson, Evan N. | Abstract: For patients undergoing tricompartment or unicompartment knee arthroplasty, previous studies have shown that a continuous femoral block provides superior analgesia in various circumstances compared with a continuous adductor canal block during the local anesthetic infusion. However, the long-term outcomes of these two approaches remains unknown. We thus evaluated functional outcomes with each approach 1, 4, and 12 months after surgery.
摘要:对于接受三腔室或单腔室膝关节置换术的患者,先前的研究表明,在局部麻醉输注期间,与连续内收管阻滞相比,连续股动脉阻滞在各种情况下提供更好的镇痛效果。然而,这两种方法的长期效果尚不清楚。因此,我们在术后1、4和12个月评估了每种入路的功能结局。
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引用次数: 0
Evaluation of Ventilator-induced Diaphragmatic Dysfunction by Diaphragmatic Excursion During Spontaneous Breathing Trials 自主呼吸试验中膈肌漂移对呼吸机诱导的膈功能障碍的评价
Pub Date : 2018-01-01 DOI: 10.4172/2155-6148.1000824
Y. Nassar, M. Elbanna, Moamen Arafa, A. Hussein
Introduction: Ventilator-induced diaphragmatic dysfunction (VIDD) leads to difficulties in weaning. Diaphragmatic excursion assessment by ultrasonography is a feasible bedside assessment of the diaphragm in the ICU. Our primary aim was to identify the presence of VIDD using US in patients undergoing Spontaneous breathing trials (SBT). Our secondary aim was to assess the impact of VIDD impact on weaning outcome. Methods: This study was conducted in the Critical Care Department of Cairo University Hospital between March 2014 and March 2015. All consecutive subjects who required MV for ≥ 72 h and were ready for SBT were prospectively recruited. Exclusion criteria: Any history of aminoglycoside use, paralytics, central or neuromuscular disease, chemotherapy, cachexia, severe electrolyte imbalance or intra-abdominal pressure (IAP)>7 mmHg Thirty minutes from the start of SBT, each hemi-diaphragm was evaluated by M-mode sonography with the patient in the supine position. Five measurements were recorded and averaged. Ventilator Induced diaphragmatic dysfunction (VIDD) was diagnosed if diaphragmatic excursion (DE) was 0.05). Successful weaning was present in [18/26 (69%) vs. 13/24 (54.2%), p=0.06] and weaning time was shorter [29 ± 18 vs. 43 ± 28 h, p=0.02] in the NDD group versus the VIDD group respectively. The median DE was higher in successfully weaned vs. failed weaning subjects [14.4 (1.9-40) vs. 9.2 (6.6-35.1), p=0.01]. The receiver operator characteristic curves (ROC) showed a cut-off for weaning DE 14 mm for right hemi-diaphragm with an area under the curve (AUC) 0.8. Conclusions: VIDD is present in nearly half of our mechanically ventilated patients ≥ 72 h. VIDD is associated with lower DE and longer weaning time. Diaphragmatic excursion may serve as a valuable tool for predicting weaning outcome as traditional volumetric respiratory indices.
简介:呼吸机诱发的膈肌功能障碍(VIDD)会导致脱机困难。超声评估膈肌偏移是一种可行的床边评估方法。我们的主要目的是在进行自发性呼吸试验(SBT)的患者中使用US识别VIDD的存在。我们的第二个目的是评估VIDD对断奶结局的影响。方法:本研究于2014年3月至2015年3月在开罗大学医院重症监护科进行。所有要求MV≥72小时并准备好SBT的连续受试者均被前瞻性招募。排除标准:任何氨基糖苷使用史、麻痹史、中枢或神经肌肉疾病史、化疗史、恶病质史、严重电解质失衡史或腹内压(IAP)>7 mmHg。SBT开始30分钟后,患者仰卧位,通过m型超声评估每半膈肌。记录5次测量并取平均值。若膈移位(DE)值为0.05,则诊断为呼吸机诱发性膈功能障碍(VIDD)。NDD组脱机成功率为[18/26(69%)比13/24 (54.2%),p=0.06],脱机时间较VIDD组短[29±18比43±28 h, p=0.02]。断奶成功组的中位DE高于未断奶组[14.4(1.9-40)比9.2 (6.6-35.1),p=0.01]。受试者操作者特征曲线(ROC)显示右半膈肌断奶DE为14 mm,曲线下面积(AUC)为0.8。结论:在≥72小时的机械通气患者中,近一半存在VIDD。VIDD与较低的DE和较长的脱机时间有关。膈肌偏移与传统的容积呼吸指数一样,可以作为预测断奶结果的有价值的工具。
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引用次数: 2
Anaesthetic Management in a Case of Wilson's Disease in Pregnancy 妊娠期威尔逊氏病1例的麻醉处理
Pub Date : 2018-01-01 DOI: 10.4172/2155-6148.1000845
B. Mohanty
Wilson’s disease (WD) is an inherited autosomal recessive disease results due to deficiency of ceruloplasmin leading to copper deposition mainly liver, brain and cornea. This accumulation can cause liver cirrhosis, ataxia and kayser Fleischer ring (KF) in cornea. I present a case of 21-year-old primigravida diagnosed WD 3 years back on treatment with Zinc was referred to our hospital for elective caesarean section (CS). She had thrombocytopenia, extrahepatic portal vein obstruction with hypersplenism and mild ascites. She has undergone CS under general anaesthesia (GA) with successful outcome. The anaesthetic management in presence of hepatic dysfunction and thrombocytopenia was challenging and there are only few case reports on WD patients undergoing CS under GA.
威尔逊氏病(WD)是一种遗传性常染色体隐性遗传病,由于铜蓝蛋白缺乏导致铜沉积,主要发生在肝脏、脑和角膜。这种积累可引起肝硬化、共济失调和角膜的凯泽-弗莱舍环(KF)。我报告一个21岁的初产妇诊断为WD 3年前治疗锌被转介到我院择期剖宫产(CS)。她有血小板减少,肝外门静脉阻塞伴脾功能亢进和轻度腹水。她在全身麻醉(GA)下接受了CS,结果成功。存在肝功能障碍和血小板减少的麻醉管理具有挑战性,只有少数WD患者在GA下接受CS的病例报道。
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引用次数: 2
Mental Nerve and Field Blocks for Lip Cancer Radiotherapy: A Case Report 唇部肿瘤放射治疗中的精神神经阻滞1例
Pub Date : 2018-01-01 DOI: 10.4172/2155-6148.1000869
S. Saraf, Ravikiran Nikhade
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引用次数: 0
Behavioral changes in children receiving anesthesia 儿童接受麻醉后的行为改变
Pub Date : 2018-01-01 DOI: 10.4172/2155-6148-c2-004
pHany Mohamed Elzahabyp
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引用次数: 0
Neurologic Dysfunction after Aortic Dissection Surgery: Different Cerebral Hypothermic Antegrade Perfusion Techniques 主动脉夹层术后神经功能障碍:不同的脑低温顺行灌注技术
Pub Date : 2018-01-01 DOI: 10.4172/2155-6148.1000813
C. Bassano, P. Nardi, D. Colella, E. Bovio, M. Pugliese, M. Russo, P. Prati, A. Tartaglione, R. Scaini, A. Scafuri, G. Ruvolo
Introduction: Neurologic dysfunction remains one of the most disabling complications of emergency aortic arch surgery. Many cerebral protection techniques are described, but their comparison has always been hampered by the wide spectrum of preoperative conditions, pathologic anatomies, complications, and surgical procedures. The aim of our study was to evaluate the incidence of early permanent neurologic injury and in-hospital mortality after emergency aortic arch surgery splitted by different antegrade cerebral perfusion techniques combined with hypothermic circulatory arrest (HCA). Methods: Between January 2005 and December 2015, 249 patients underwent emergent surgery for acute, type A aortic dissection. Of these, 112 (45%) (Mean age 63.8 ± 12.8 years, 82 males) received cerebral protection through antegrade perfusion of the supra-aortic vessels. Unilateral perfusion (UACP) was performed in 55 (49.1%) patients, while bilateral perfusion (BACP) was achieved via right axillary artery cannulation alone in 25 (22.3%) cases or with the Kazui technique in 32 (28.6%). Permanent neurologic injury was defined as the post-operative onset of focal stroke or lethal coma. Results: In-hospital mortality was 17.9% (UACP 20% vs. BACP 15.8%; p=0.56). The global rate of the early permanent neurologic injury was 12.3% (UACP 10.9% vs. BACP 15.8%; p=0.45). Conclusion: There is no evidence that BACP combined with HCA is superior to UACP combined with HCA for emergency aortic arch surgery in preventing early permanent neurologic injury and in-hospital mortality.
简介:神经功能障碍仍然是急诊主动脉弓手术最致残的并发症之一。许多脑保护技术被描述,但它们的比较一直受到术前条件、病理解剖、并发症和手术程序的广泛影响。本研究的目的是评估采用不同顺行脑灌注技术联合低温循环停搏(HCA)的紧急主动脉弓手术后早期永久性神经损伤的发生率和住院死亡率。方法:2005年1月至2015年12月,249例急性A型主动脉夹层急诊手术治疗。其中112例(45%)(平均年龄63.8±12.8岁,男性82例)接受了主动脉上血管顺行灌注脑保护。55例(49.1%)患者进行了单侧灌注(UACP), 25例(22.3%)患者单独通过右腋窝动脉插管实现了双侧灌注(BACP), 32例(28.6%)患者采用了Kazui技术。永久性神经损伤定义为术后发生局灶性中风或致死性昏迷。结果:住院死亡率为17.9% (UACP为20%,BACP为15.8%;p = 0.56)。早期永久性神经损伤的全球发生率为12.3% (UACP为10.9%,BACP为15.8%;p = 0.45)。结论:没有证据表明BACP联合HCA在预防急诊主动脉弓手术早期永久性神经损伤和院内死亡率方面优于UACP联合HCA。
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引用次数: 3
Effect of Preoperative Pregabalin on Induced Hypotension and Postoperative Analgesia with Functional Endoscopic Sinus Surgery 普瑞巴林对功能性鼻内镜手术诱导低血压及术后镇痛的影响
Pub Date : 2017-12-30 DOI: 10.4172/2155-6148.1000789
Hesham M. Marouf, N. Khalil
Background: Our target was to estimate the effect of pregabalin as premedication on deliberate hypotension and quality of the surgical site during functional endoscopic surgery for nasal sinuses (FESS) and its postoperative analgesic effect.Materials and methods: Eighty patients ASA I-II prepared for FESS were included in this randomized research. The study encompassed 2 groups [control group (C) and pregabalin group (P)]. Patients were given either placebo capsule [group (C)] or pregabalin capsule 150 mg [group (P)] 1 h preoperatively. During surgery mean arterial blood pressure (MAP) was maintained between 55-60 mmHg by intravenous infusion of nitroglycerin (NTG) at a rate of 0.5-10 μg/kg/min. We recorded quality of surgical site [using average category scale (ACS)], the overall dose of NTG used, postoperative pain, the overall dose of morphine used postoperatively, and number of patients requesting analgesia.Results: Pregabalin group (P) showed better ACS, lower overall dose of NTG used, less postoperative pain, lower overall dose of morphine, and less number of patients requesting analgesia than control group (C).Conclusion: Preoperative oral pregabalin improved the quality of the surgical site during FESS, and decreased the required dose of intraoperative hypotensive agent and postoperative morphine with better postoperative analgesia.
背景:我们的目的是评估普瑞巴林作为预用药对鼻窦功能性内窥镜手术(FESS)中故意降压和手术部位质量的影响及其术后镇痛效果。材料和方法:本随机研究纳入80例为FESS准备的ASA I-II型患者。研究分为两组[对照组(C)和普瑞巴林组(P)]。术前1 h给予安慰剂胶囊[C组]或普瑞巴林胶囊150 mg [P组]。术中以0.5 ~ 10 μg/kg/min的速率静脉滴注硝酸甘油(NTG),维持平均动脉血压(MAP)在55 ~ 60 mmHg之间。我们记录手术部位的质量[使用平均分类量表(ACS)]、使用的NTG总剂量、术后疼痛、术后吗啡总剂量以及需要镇痛的患者人数。结果:普瑞巴林组(P) ACS较对照组好,NTG总剂量较低,术后疼痛较轻,吗啡总剂量较低,需要镇痛的患者较少(C)。结论:术前口服普瑞巴林改善了FESS手术部位质量,降低了术中降压药和术后吗啡的需药量,术后镇痛效果较好。
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引用次数: 2
期刊
Journal of Anesthesia and Clinical Research
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