Pub Date : 2021-10-01DOI: 10.4103/roaic.roaic_94_20
M. Abdelrady, Golnar Fathy, Omar Ali, K. Abdel-Rahman
Background We aimed to compare the influence of adding ketorolac as an adjunct to lidocaine for intravenous regional anesthesia (IVRA) on postoperative analgesia and both motor and sensory blockade. Patients and methods A total of 51 patients undergoing operations under IVRA were randomly assigned to receive lidocaine 3 mg/kg (group 1), lidocaine 3 mg/kg plus ketorolac 30 mg (group 2), and lidocaine 3 mg/kg plus paracetamol 300 mg (group 3). Results There was rapid sensory and motor blockade onset and slower recovery in ketorolac group when compared with the other groups and also in paracetamol when compared with lidocaine (P≤0.05). The mean time to first request of intramuscular diclofenac was longer in the ketorolac group (5.6±0.8 h) compared with the lidocaine group (2.5±0.4 h) and paracetamol group (4.4±0.3 h, P=0.000). The total consumption of intramuscular diclofenac was 75 mg (75–150 mg) in the ketorolac group versus 75 mg (75–150 mg) in the paracetamol group and 150 mg (75–150 mg) in lidocaine group (P=0.001). The mean visual analog scale (VAS) scores were lesser in the ketorolac group when compared with the other groups at all time points (P≤0.05), except before tourniquet and immediately after tourniquet, with the highest VAS (P>0.05). Patient satisfaction was better in the ketorolac group. Conclusion Overall, 20 mg of ketorolac is more effective than 300 mg of paracetamol when added to lidocaine for IVRA, with faster onset and slower recovery of both sensory and motor blockade, lower postoperative VAS scores, delayed timing of the first analgesic request, and decreased total analgesic requirements.
{"title":"Ketorolac versus paracetamol adjunct to lidocaine for intravenous regional anesthesia in patients undergoing hand and forearm surgeries","authors":"M. Abdelrady, Golnar Fathy, Omar Ali, K. Abdel-Rahman","doi":"10.4103/roaic.roaic_94_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_94_20","url":null,"abstract":"Background We aimed to compare the influence of adding ketorolac as an adjunct to lidocaine for intravenous regional anesthesia (IVRA) on postoperative analgesia and both motor and sensory blockade. Patients and methods A total of 51 patients undergoing operations under IVRA were randomly assigned to receive lidocaine 3 mg/kg (group 1), lidocaine 3 mg/kg plus ketorolac 30 mg (group 2), and lidocaine 3 mg/kg plus paracetamol 300 mg (group 3). Results There was rapid sensory and motor blockade onset and slower recovery in ketorolac group when compared with the other groups and also in paracetamol when compared with lidocaine (P≤0.05). The mean time to first request of intramuscular diclofenac was longer in the ketorolac group (5.6±0.8 h) compared with the lidocaine group (2.5±0.4 h) and paracetamol group (4.4±0.3 h, P=0.000). The total consumption of intramuscular diclofenac was 75 mg (75–150 mg) in the ketorolac group versus 75 mg (75–150 mg) in the paracetamol group and 150 mg (75–150 mg) in lidocaine group (P=0.001). The mean visual analog scale (VAS) scores were lesser in the ketorolac group when compared with the other groups at all time points (P≤0.05), except before tourniquet and immediately after tourniquet, with the highest VAS (P>0.05). Patient satisfaction was better in the ketorolac group. Conclusion Overall, 20 mg of ketorolac is more effective than 300 mg of paracetamol when added to lidocaine for IVRA, with faster onset and slower recovery of both sensory and motor blockade, lower postoperative VAS scores, delayed timing of the first analgesic request, and decreased total analgesic requirements.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132710979","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 : 2021-10-01DOI: 10.4103/roaic.roaic_64_20
F. Faris, A. Fattah, Marwa Ali, Sayed Ali
Introduction Nutritional support is a vital therapy of most surgical patients. Early initiation via the enteral route has a significant effect on postoperative recovery. The prognostic role of C-reactive protein (CRP) and albumin can be explained by their abilities to reflect inflammation in the acute phase in critical settings and assess the nutritional status of critically ill patients, respectively. This indicates the prognostic value of the CRP/albumin ratio in postoperative patients admitted to the ICU. Aim To determine the effect of early enteral versus parenteral nutrition on ICU outcome in postoperative abdominal surgical patients and the value of CRP/albumin ratio as an inflammatory marker for both groups. Patients and methods A prospective cohort nonrandomized study included 80 consecutive postoperative major abdominal surgical patients at the Critical Care Department, Cairo University, over 1-year duration. Forty (50%) patients received enteral nutrition 6 h after surgical procedures and 40 (50%) patients received parenteral nutrition 6 h after surgical procedures. Nutritional status and inflammatory markers were screened. All patients were followed up during the ICU stay and up to 3 months. Sepsis-related organ-failure assessment (SOFA) scoring was done every 48 h. Results The study included 57 (71.3%) males with mean age 48.5±18.4 years. Esophagogastrectomy was done in 29 (36.25%) patients, repair of intestinal obstruction in 26 (32.5%) patients, and pancreaticoduodenectomy in 25 (31.25%) patients. Mean ICU stay was 5.16±2.56 days. A statistically significant improvement in serum protein and albumin levels was found at postoperative day (POD)3 and POD5 in comparison with POD1 in the enteral group (P=0.001). There was a statistically significant improvement in serum calcium levels in the enteral group (P=0.001) at POD7. There was a significant decrease in the white-blood cell count at POD7 in comparison with POD1 in both enteral and parenteral groups (P=0.017, 0.041), respectively. There was a significant decrease in CRP levels at POD3, POD5, and POD7 in comparison with POD1 in both enteral and parenteral groups (P<0.001). There was a highly statistically significant decrease in CRP/albumin ratio at days 3, 5, and 7 postoperatively in both enteral and parenteral groups (P<0.001). There was a strong positive significant correlation between CRP/albumin ratio and SOFA score at POD3 in the whole study group (r=0.728, P>0.001). Conclusion Starting nutrition in early postoperative abdominal surgeries either enteral or parenteral had a significant decrease in the parameters of infection. Early enteral nutrition in postoperative abdominal surgeries had significantly improved nutritional status, ICU survival, and decreased in-hospital mortality. There was a strong positive correlation between CRP/albumin ratio and SOFA score in postoperative abdominal surgery patients who started early nutrition.
{"title":"Impact of early enteral and parenteral nutrition on postoperative outcome after abdominal surgery","authors":"F. Faris, A. Fattah, Marwa Ali, Sayed Ali","doi":"10.4103/roaic.roaic_64_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_64_20","url":null,"abstract":"Introduction Nutritional support is a vital therapy of most surgical patients. Early initiation via the enteral route has a significant effect on postoperative recovery. The prognostic role of C-reactive protein (CRP) and albumin can be explained by their abilities to reflect inflammation in the acute phase in critical settings and assess the nutritional status of critically ill patients, respectively. This indicates the prognostic value of the CRP/albumin ratio in postoperative patients admitted to the ICU. Aim To determine the effect of early enteral versus parenteral nutrition on ICU outcome in postoperative abdominal surgical patients and the value of CRP/albumin ratio as an inflammatory marker for both groups. Patients and methods A prospective cohort nonrandomized study included 80 consecutive postoperative major abdominal surgical patients at the Critical Care Department, Cairo University, over 1-year duration. Forty (50%) patients received enteral nutrition 6 h after surgical procedures and 40 (50%) patients received parenteral nutrition 6 h after surgical procedures. Nutritional status and inflammatory markers were screened. All patients were followed up during the ICU stay and up to 3 months. Sepsis-related organ-failure assessment (SOFA) scoring was done every 48 h. Results The study included 57 (71.3%) males with mean age 48.5±18.4 years. Esophagogastrectomy was done in 29 (36.25%) patients, repair of intestinal obstruction in 26 (32.5%) patients, and pancreaticoduodenectomy in 25 (31.25%) patients. Mean ICU stay was 5.16±2.56 days. A statistically significant improvement in serum protein and albumin levels was found at postoperative day (POD)3 and POD5 in comparison with POD1 in the enteral group (P=0.001). There was a statistically significant improvement in serum calcium levels in the enteral group (P=0.001) at POD7. There was a significant decrease in the white-blood cell count at POD7 in comparison with POD1 in both enteral and parenteral groups (P=0.017, 0.041), respectively. There was a significant decrease in CRP levels at POD3, POD5, and POD7 in comparison with POD1 in both enteral and parenteral groups (P<0.001). There was a highly statistically significant decrease in CRP/albumin ratio at days 3, 5, and 7 postoperatively in both enteral and parenteral groups (P<0.001). There was a strong positive significant correlation between CRP/albumin ratio and SOFA score at POD3 in the whole study group (r=0.728, P>0.001). Conclusion Starting nutrition in early postoperative abdominal surgeries either enteral or parenteral had a significant decrease in the parameters of infection. Early enteral nutrition in postoperative abdominal surgeries had significantly improved nutritional status, ICU survival, and decreased in-hospital mortality. There was a strong positive correlation between CRP/albumin ratio and SOFA score in postoperative abdominal surgery patients who started early nutrition.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130791349","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 : 2021-10-01DOI: 10.4103/roaic.roaic_96_20
M. Abdullah, A. Abdelhady, Elsayed E. Elsayed, A. Ibrahim, M. Soliman
Objective To highlight the role of late gadolinium-enhanced cardiac magnetic resonance (LGE-CMRI) examination in the detection of location and transmural extent of myocardial scarring in relatively short CMRI examination duration. Background It is important to identify viable myocardium in patients with known or suspected ischemic heart disease to improve their long-term survival and to allow patients to avoid the risks associated with revascularization therapy. Patients and methods A total of 30 consecutive patients with suspected or having previous attack of ischemic heart disease were examined by different sequences of CMRI. Morphological, functional, and viability evaluation for distinction of viable and nonviable myocardium had been done by two independent observers. Results Regarding the distribution of LGE myocardium, almost perfect interobserver agreement was observed on per patient basis (κ=1.0 and 95% confidence interval=1.0–1.0) (P=1.0) and on per segment basis(κ=0.98 and 95% confidence interval=0.97–1.0) (P=0.84). On evaluation of transmural extent of LGE on per-segment basis, a substantial interobserver agreement was noted regarding the detection of 1–25% myocardial wall enhancement (κ=1.0 and 95% confidence interval=1.0–1.0). Otherwise, an almost perfect interobserver agreement was noted on detection of other degrees of mural extent of LGE (P=0.94). On correlation of segments with abnormal wall motion abnormalities and LGE, it was noticed that segmental wall motion abnormality could predict myocardial scarring with 58.08% sensitivity and 99.7% specificity; however, normal wall motion cannot exclude myocardial scarring. The overall duration needed for complete CMRI examination was ±35–40 min, with mean duration of 37.5±1.92 min. Conclusion CMR examination is a robust technique that can provide functional, morphological, and viability information in a relatively short CMRI examination duration (±35–40 min), which allow risk stratification of patients and predicting their outcomes.
{"title":"Myocardial scaring in ischemic heart diseases: role of late gadolinium-enhanced cardiac MRI","authors":"M. Abdullah, A. Abdelhady, Elsayed E. Elsayed, A. Ibrahim, M. Soliman","doi":"10.4103/roaic.roaic_96_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_96_20","url":null,"abstract":"Objective To highlight the role of late gadolinium-enhanced cardiac magnetic resonance (LGE-CMRI) examination in the detection of location and transmural extent of myocardial scarring in relatively short CMRI examination duration. Background It is important to identify viable myocardium in patients with known or suspected ischemic heart disease to improve their long-term survival and to allow patients to avoid the risks associated with revascularization therapy. Patients and methods A total of 30 consecutive patients with suspected or having previous attack of ischemic heart disease were examined by different sequences of CMRI. Morphological, functional, and viability evaluation for distinction of viable and nonviable myocardium had been done by two independent observers. Results Regarding the distribution of LGE myocardium, almost perfect interobserver agreement was observed on per patient basis (κ=1.0 and 95% confidence interval=1.0–1.0) (P=1.0) and on per segment basis(κ=0.98 and 95% confidence interval=0.97–1.0) (P=0.84). On evaluation of transmural extent of LGE on per-segment basis, a substantial interobserver agreement was noted regarding the detection of 1–25% myocardial wall enhancement (κ=1.0 and 95% confidence interval=1.0–1.0). Otherwise, an almost perfect interobserver agreement was noted on detection of other degrees of mural extent of LGE (P=0.94). On correlation of segments with abnormal wall motion abnormalities and LGE, it was noticed that segmental wall motion abnormality could predict myocardial scarring with 58.08% sensitivity and 99.7% specificity; however, normal wall motion cannot exclude myocardial scarring. The overall duration needed for complete CMRI examination was ±35–40 min, with mean duration of 37.5±1.92 min. Conclusion CMR examination is a robust technique that can provide functional, morphological, and viability information in a relatively short CMRI examination duration (±35–40 min), which allow risk stratification of patients and predicting their outcomes.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124861338","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 : 2021-10-01DOI: 10.4103/roaic.roaic_30_21
Sherif Abdelmonem, T. Zaytoun, Mahmoud Elabd
Introduction ‘Stroke’ is the term commonly used to describe the sudden onset of a neurological deficit such as weakness or paralysis due to disturbance of the blood flow to the brain. The term is applied loosely to cover ischemic and hemorrhagic episodes. Objective The aim of this study was to evaluate the predictors of poor outcome after either acute ischemic or hemorrhagic stroke among patients throughout 30 days after their admission to ICUs at Alexandria Hospitals. Patients and methods In this prospective observational study, 817 patients were enrolled over a period of 6 months from critical care units at Alexandria University hospitals, ‘either free hospitals, insured hospitals or paid hospitals,’ as well as nongovernmental insurance hospitals. Cases included patients with acute stroke, either acute ischemic stroke or hemorrhagic stroke. Patients with Glasgow outcome scale (severe disability, vegetative, or dead) were considered to have poor prognosis. Results Poor prognosis occurred in 56.5% of patients (461/817 patients). Overall, 47.5% of patients had ventilator-associated pneumonia (VAP), 42.5% had seizures, 21.3% had deep vein thrombosis, and 25.7% of patients developed acute kidney injury (AKI). The most significant predictors of poor outcome included development of hospital-acquired pneumonia/VAP [odds ratio (OR) 128.871; 95% confidence interval (CI) 67.253–246.941; P<0.001], occurrence of bed sores (OR 10.287; 95% CI 5.865–18.045; P<0.001), occurrence of bloodstream infections (OR 4.463; 95% CI 2.445–8.147; P<0.001), occurrence of seizures (OR 4.005; 95% CI 2.35–6.826; P<0.001), and occurrence of AKI (OR 3.532; 95% CI 1.944–6.416; P=0.001), which were significantly associated with poor outcomes. Conclusion The poorest prognostic factors for patients with acute stroke are development of hospital-acquired pneumonia or VAP, followed by development of bed sores, occurrence of bloodstream infection, and occurrence of AKI.
“中风”是一个常用的术语，用来描述突然出现的神经功能缺陷，如由于大脑血液流动受阻而导致的虚弱或瘫痪。这个术语宽泛地适用于缺血性和出血性发作。目的本研究的目的是评估急性缺血性或出血性卒中患者在亚历山大医院重症监护室入院后30天内预后不良的预测因素。在这项前瞻性观察性研究中，817名患者在6个月的时间里被纳入亚历山大大学医院的重症监护室，“免费医院，参保医院或付费医院”，以及非政府参保医院。病例包括急性脑卒中患者，急性缺血性脑卒中或出血性脑卒中。具有格拉斯哥预后量表(严重残疾、植物人或死亡)的患者被认为预后不良。结果预后不良者占56.5%(461/817)。总体而言，47.5%的患者发生呼吸机相关性肺炎(VAP)， 42.5%发生癫痫发作，21.3%发生深静脉血栓形成，25.7%的患者发生急性肾损伤(AKI)。预后不良最显著的预测因子包括医院获得性肺炎/VAP的发生[优势比(OR) 128.871;95%置信区间(CI) 67.253 ~ 246.941;P<0.001]，褥疮发生率(OR 10.287;95% ci 5.865-18.045;P<0.001)，血流感染发生率(OR 4.463;95% ci 2.445-8.147;P<0.001)，癫痫发作的发生率(OR 4.005;95% ci 2.35-6.826;P<0.001)， AKI的发生率(OR 3.532;95% ci 1.944-6.416;P=0.001)，这与不良预后显著相关。结论急性脑卒中患者预后最差的因素是发生医院获得性肺炎或VAP，其次是发生褥疮、发生血流感染和发生AKI。
{"title":"Outcome predictors after acute stroke in Egyptian patients admitted to the ICU (OPASEP study)","authors":"Sherif Abdelmonem, T. Zaytoun, Mahmoud Elabd","doi":"10.4103/roaic.roaic_30_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_30_21","url":null,"abstract":"Introduction ‘Stroke’ is the term commonly used to describe the sudden onset of a neurological deficit such as weakness or paralysis due to disturbance of the blood flow to the brain. The term is applied loosely to cover ischemic and hemorrhagic episodes. Objective The aim of this study was to evaluate the predictors of poor outcome after either acute ischemic or hemorrhagic stroke among patients throughout 30 days after their admission to ICUs at Alexandria Hospitals. Patients and methods In this prospective observational study, 817 patients were enrolled over a period of 6 months from critical care units at Alexandria University hospitals, ‘either free hospitals, insured hospitals or paid hospitals,’ as well as nongovernmental insurance hospitals. Cases included patients with acute stroke, either acute ischemic stroke or hemorrhagic stroke. Patients with Glasgow outcome scale (severe disability, vegetative, or dead) were considered to have poor prognosis. Results Poor prognosis occurred in 56.5% of patients (461/817 patients). Overall, 47.5% of patients had ventilator-associated pneumonia (VAP), 42.5% had seizures, 21.3% had deep vein thrombosis, and 25.7% of patients developed acute kidney injury (AKI). The most significant predictors of poor outcome included development of hospital-acquired pneumonia/VAP [odds ratio (OR) 128.871; 95% confidence interval (CI) 67.253–246.941; P<0.001], occurrence of bed sores (OR 10.287; 95% CI 5.865–18.045; P<0.001), occurrence of bloodstream infections (OR 4.463; 95% CI 2.445–8.147; P<0.001), occurrence of seizures (OR 4.005; 95% CI 2.35–6.826; P<0.001), and occurrence of AKI (OR 3.532; 95% CI 1.944–6.416; P=0.001), which were significantly associated with poor outcomes. Conclusion The poorest prognostic factors for patients with acute stroke are development of hospital-acquired pneumonia or VAP, followed by development of bed sores, occurrence of bloodstream infection, and occurrence of AKI.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123357040","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 : 2021-10-01DOI: 10.4103/roaic.roaic_87_20
Ezzat Siam, D. Abo Alia, Rehab Fathy, Mohamed Elshahaly
Background Transversus abdominis plane block (TAPB) has proven to be an effective component of multimodal analgesic regimens for a variety of abdominal procedures. Magnesium sulfate (MgSO4) N-methyl-D-aspartate receptor antagonist has the potential to be an ideal adjuvant in TAPB. We studied the efficacy of MgSO4 as an adjuvant to bupivacaine in TAPB in patients scheduled for inguinal hernia repair. Patients and methods A total of 50 adult male patients aged 20–60 years, American Society of Anesthesiologists class I or II, and scheduled for elective primary unilateral open inguinal hernia repair were studied. Patients were randomly allocated into two groups: group 1 (n=25) included 18 ml of 0.25% bupivacaine with 2 ml 0.9% NaCl, and group 2 (n=25) included 18 ml of 0.25% bupivacaine with 2-ml MgSO4 10% (200 mg). They were evaluated for pain at 0, 1, 2, 3, 4, 8, 12, 16, 20, and 24 h. Time to first rescue analgesic and duration of postoperative analgesia were noted. Results Group 2 showed longer duration of postoperative analgesia (P<0.001); lower postoperative visual analog scale scores during rest, where P values at 4, 8, 12, 16, and 20 h postoperatively were less than 0.001, 0.038, 0.037, 0.015, and 0.006, respectively; and lower postoperative visual analog scale scores during movement, where P values at 4, 8, 12, 16, and 20 h postoperatively were less than 0.001, 0.001, 0.001, 0.009, and 0.037, respectively. Group 2 patients had longer time till rescue analgesia, less total dose of opioids, and more patient satisfaction. Conclusions MgSO4 (150 mg) as an adjuvant to bupivacaine in ultrasonographic‑guided TAPB prolongs the duration of analgesia, reduces postoperative pain scores, and decreases demands for rescue analgesics.
背景:经腹平面阻滞(TAPB)已被证明是多种腹部手术的多模式镇痛方案的有效组成部分。硫酸镁(MgSO4) n -甲基- d -天冬氨酸受体拮抗剂有潜力成为治疗TAPB的理想佐剂。我们研究了MgSO4作为布比卡因辅助治疗腹股沟疝修补术患者TAPB的疗效。患者与方法选择50例年龄20 ~ 60岁，美国麻醉医师学会I级或II级，择期行原发性单侧开放式腹股沟疝修补术的成年男性患者。将患者随机分为两组:1组(n=25) 18 ml 0.25%布比卡因加2 ml 0.9% NaCl; 2组(n=25) 18 ml 0.25%布比卡因加2 ml 10% MgSO4 (200 mg)。分别在0、1、2、3、4、8、12、16、20和24小时评估疼痛。记录首次抢救镇痛时间和术后镇痛持续时间。结果2组患者术后镇痛时间较长(P<0.001);术后休息时视觉模拟量表评分较低，其中术后4、8、12、16、20 h P值分别小于0.001、0.038、0.037、0.015、0.006;术后运动时视觉模拟评分较低，其中术后4、8、12、16、20 h的P值分别小于0.001、0.001、0.001、0.009、0.037。2组患者镇痛时间较长，阿片类药物总剂量较小，患者满意度较高。结论MgSO4 (150 mg)辅助布比卡因在超声引导下的TAPB中可延长镇痛时间，降低术后疼痛评分，减少对抢救性镇痛药物的需求。
{"title":"Efficacy of magnesium sulfate added to bupivacaine in transversus abdominis plane block for postoperative analgesia after inguinal herniorrhaphy","authors":"Ezzat Siam, D. Abo Alia, Rehab Fathy, Mohamed Elshahaly","doi":"10.4103/roaic.roaic_87_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_87_20","url":null,"abstract":"Background Transversus abdominis plane block (TAPB) has proven to be an effective component of multimodal analgesic regimens for a variety of abdominal procedures. Magnesium sulfate (MgSO4) N-methyl-D-aspartate receptor antagonist has the potential to be an ideal adjuvant in TAPB. We studied the efficacy of MgSO4 as an adjuvant to bupivacaine in TAPB in patients scheduled for inguinal hernia repair. Patients and methods A total of 50 adult male patients aged 20–60 years, American Society of Anesthesiologists class I or II, and scheduled for elective primary unilateral open inguinal hernia repair were studied. Patients were randomly allocated into two groups: group 1 (n=25) included 18 ml of 0.25% bupivacaine with 2 ml 0.9% NaCl, and group 2 (n=25) included 18 ml of 0.25% bupivacaine with 2-ml MgSO4 10% (200 mg). They were evaluated for pain at 0, 1, 2, 3, 4, 8, 12, 16, 20, and 24 h. Time to first rescue analgesic and duration of postoperative analgesia were noted. Results Group 2 showed longer duration of postoperative analgesia (P<0.001); lower postoperative visual analog scale scores during rest, where P values at 4, 8, 12, 16, and 20 h postoperatively were less than 0.001, 0.038, 0.037, 0.015, and 0.006, respectively; and lower postoperative visual analog scale scores during movement, where P values at 4, 8, 12, 16, and 20 h postoperatively were less than 0.001, 0.001, 0.001, 0.009, and 0.037, respectively. Group 2 patients had longer time till rescue analgesia, less total dose of opioids, and more patient satisfaction. Conclusions MgSO4 (150 mg) as an adjuvant to bupivacaine in ultrasonographic‑guided TAPB prolongs the duration of analgesia, reduces postoperative pain scores, and decreases demands for rescue analgesics.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132676927","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 : 2021-07-01DOI: 10.4103/roaic.roaic_15_21
Rachita Naik, S. Rajan, J. Paul, L. Kumar
{"title":"Adequacy and safety of inhalational anesthesia with supplemental transtracheal block in patients with myasthenia gravis","authors":"Rachita Naik, S. Rajan, J. Paul, L. Kumar","doi":"10.4103/roaic.roaic_15_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_15_21","url":null,"abstract":"","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124086600","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 : 2021-07-01DOI: 10.4103/roaic.roaic_97_20
M. Laimoud, F. Faris
Background Our case was acute ST-segment elevation myocardial infarction with multiple coronary thrombosis, despite aggressive anticoagulation and antiplatelet therapy in a young, relatively low-risk patient, on three abused drugs. Case summary A 38-year-old male smoker patient with a BMI of 31 kg/m2 and a background of multiple drug addiction, was admitted after an hour of severe retrosternal compressing chest pain. Upon admission, he had cardiac arrest in ventricular fibrillation. Resuscitation was done, including defibrillation shocks and invasive mechanical ventilation with a cardiopulmonary resuscitation (CPR) time of 17 min and the patient was transferred to the catheterization laboratory with extensive anterior and inferior myocardial infarctions. Coronary angiography showed an unusual thrombosis in multiple coronary branches with coronary spasms and total occlusion of left anterior descending artery for which primary percutaneous coronary intervention was done. Admission laboratory screening showed high blood levels of amphetamines, cannabinoids, and tramadol. The patient was kept under invasive ventilation for 10 days, with difficult weaning due to severe drug-withdrawal manifestations, ventilator-associated pneumonia, and hemodynamic instability that necessitated intravenous inotropic drip and intra-aortic balloon counter pulsation. The patient regained near-normal left ventricular function after baseline severe regional and global dysfunction. Conclusion The authors postulated a relationship between the use of amphetamines, potentiated by cannabinoids and tramadol, and occurrence of acute thrombosis of multiple major coronary arteries especially with concurrent cigarette smoking.
{"title":"Acute myocardial infarction with multiple coronary thrombosis in a young multidrug addict (amphetamines, cannabinoids, and tramadol): a case report","authors":"M. Laimoud, F. Faris","doi":"10.4103/roaic.roaic_97_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_97_20","url":null,"abstract":"Background Our case was acute ST-segment elevation myocardial infarction with multiple coronary thrombosis, despite aggressive anticoagulation and antiplatelet therapy in a young, relatively low-risk patient, on three abused drugs. Case summary A 38-year-old male smoker patient with a BMI of 31 kg/m2 and a background of multiple drug addiction, was admitted after an hour of severe retrosternal compressing chest pain. Upon admission, he had cardiac arrest in ventricular fibrillation. Resuscitation was done, including defibrillation shocks and invasive mechanical ventilation with a cardiopulmonary resuscitation (CPR) time of 17 min and the patient was transferred to the catheterization laboratory with extensive anterior and inferior myocardial infarctions. Coronary angiography showed an unusual thrombosis in multiple coronary branches with coronary spasms and total occlusion of left anterior descending artery for which primary percutaneous coronary intervention was done. Admission laboratory screening showed high blood levels of amphetamines, cannabinoids, and tramadol. The patient was kept under invasive ventilation for 10 days, with difficult weaning due to severe drug-withdrawal manifestations, ventilator-associated pneumonia, and hemodynamic instability that necessitated intravenous inotropic drip and intra-aortic balloon counter pulsation. The patient regained near-normal left ventricular function after baseline severe regional and global dysfunction. Conclusion The authors postulated a relationship between the use of amphetamines, potentiated by cannabinoids and tramadol, and occurrence of acute thrombosis of multiple major coronary arteries especially with concurrent cigarette smoking.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132123522","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 : 2021-07-01DOI: 10.4103/roaic.roaic_8_21
M. Laimoud, M. Alanazi
Background Vascular access can be challenging in patients with obesity, impalpable pulsations, hemodynamic instability, thrombocytopenia, and coagulopathy. Our aim was to study the clinical effectiveness of vascular ultrasound (US) in arterial and venous catheterizations in critically ill patients with nonpulsatile circulation admitted at cardiac critical care units and to compare with the landmark techniques. Patients and methods This retrospective study included adult patients from January 2015 to January 2019 who had been admitted to the adult cardiac critical care unit with left ventricular assist device or veno-arterial extracorporeal membrane oxygenation and required vascular access. Results In 152 critically ill patients, 292 vascular catheters were inserted. The first-attempt success was achieved in 77.9 versus 34.6% (P=0.001) and the whole procedural success was 100 versus 67.5% (P=0.001) in the US and landmark groups, respectively. The number of attempts was 1.7±0.6 versus 1.2±0.4 (P=0.001) and the complications occurred in 2.5 versus 21.2% (P=0.001) in the US and landmark groups, respectively. Jugular catheterization was done in 42.9 versus 19.3% (P=0.001), while subclavian cannulation was done in 5 versus 42.3% (P=0.001) in the US and landmark groups, respectively. Iatrogenic pneumothorax happened in 0 versus 3.1% (P=0.001), accidental puncture of the adjacent artery happened in 0 versus 14.7% (P=0.001), and hematoma formation happened in 2.5 versus 9% (P=0.03) in the US and landmark groups, respectively. Conclusion Arterial and venous catheterizations guided by US in critically ill patients with nonpulsatile circulation and unstable hemodynamics were associated with higher success and more safety compared with the landmark techniques.
{"title":"Ultrasound-guided vascular catheterization in critically ill patients with nonpulsatile continuous circulation veno-arterial extracorporeal membrane oxygenation or ventricular assist device support","authors":"M. Laimoud, M. Alanazi","doi":"10.4103/roaic.roaic_8_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_8_21","url":null,"abstract":"Background Vascular access can be challenging in patients with obesity, impalpable pulsations, hemodynamic instability, thrombocytopenia, and coagulopathy. Our aim was to study the clinical effectiveness of vascular ultrasound (US) in arterial and venous catheterizations in critically ill patients with nonpulsatile circulation admitted at cardiac critical care units and to compare with the landmark techniques. Patients and methods This retrospective study included adult patients from January 2015 to January 2019 who had been admitted to the adult cardiac critical care unit with left ventricular assist device or veno-arterial extracorporeal membrane oxygenation and required vascular access. Results In 152 critically ill patients, 292 vascular catheters were inserted. The first-attempt success was achieved in 77.9 versus 34.6% (P=0.001) and the whole procedural success was 100 versus 67.5% (P=0.001) in the US and landmark groups, respectively. The number of attempts was 1.7±0.6 versus 1.2±0.4 (P=0.001) and the complications occurred in 2.5 versus 21.2% (P=0.001) in the US and landmark groups, respectively. Jugular catheterization was done in 42.9 versus 19.3% (P=0.001), while subclavian cannulation was done in 5 versus 42.3% (P=0.001) in the US and landmark groups, respectively. Iatrogenic pneumothorax happened in 0 versus 3.1% (P=0.001), accidental puncture of the adjacent artery happened in 0 versus 14.7% (P=0.001), and hematoma formation happened in 2.5 versus 9% (P=0.03) in the US and landmark groups, respectively. Conclusion Arterial and venous catheterizations guided by US in critically ill patients with nonpulsatile circulation and unstable hemodynamics were associated with higher success and more safety compared with the landmark techniques.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133140931","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 : 2021-07-01DOI: 10.4103/roaic.roaic_4_21
O. Mohamed, Huda Abd El-Azim, S. Mohamed
Context The lateral transversus abdominus plane (TAP) block can provide sensory blockade of the T10–L1 abdominal dermatomes, which works well for lower abdominal surgery, but it is insufficient in extended upper incisions that may be needed in emergency laparotomies. So, concomitant use of the subcostal TAP block can extend the sensory blockade to the T7 abdominal dermatomes. Aims This clinical trial aimed to evaluate the efficacy and safety of ultrasound-guided four quadrants TAP block in emergency laparotomies and the effect of adding dexamethasone or magnesium sulfate as an adjuvant. Settings Minia University Hospital. Design This is a prospective double-blind, randomized, controlled study. Patients and methods After approval of the Faculty of Medicine Council and Research Ethics Committee − Minia University and clinical trial registration, this study was conducted on 90 adult patients with emergency laparotomies under general anesthesia who equally assigned into three groups that all received preincisional four quadrants TAP block using 38 ml of bupivacaine hydrochloride 0.25%, plus 2 ml of saline in group C, +2 ml of dexamethasone (8 mg) in group D, and +2 ml of magnesium sulfate (200 mg) in group M. Results The four-quadrants TAP block was effective in attenuating the hemodynamic stress response and providing intraoperative and postoperative analgesia [only two (6.7%) patients needed intraoperative fentanyl in the control group and the mean time of the first postoperative analgesia was 6.3±0.9 h] without notable complications. The mean time of the first analgesic request was significantly longer in group M (10.8±3.8 h) and group D (9.6±4.2 h) when compared with group C (6.3±0.9 h); consequently, the postoperative paracetamol doses were significantly lower in group M (1619.5±780.2) and group D (1942.5±969.9) than in group C (3638.8±1251) with no significant difference between D and M groups. Conclusions Four quadrants TAP block was safe and effective in intraoperative and postoperative analgesics in emergency laparotomies. Adding magnesium sulfate or dexamethasone as adjuvants prolonged the duration of analgesia. Magnesium sulfate was superior.
背景:侧腹横平面(TAP)阻滞可以提供对T10-L1腹部皮节的感觉阻滞，这在下腹手术中效果很好，但在急诊剖腹手术中可能需要的扩大的上切口中是不够的。因此，同时使用肋下TAP阻滞可以将感觉阻滞扩展到T7腹部皮节。目的本临床试验旨在评价超声引导四象限TAP阻滞在急诊剖腹手术中的有效性和安全性，以及添加地塞米松或硫酸镁作为辅助的效果。设置:明尼亚大学附属医院。本研究为前瞻性、双盲、随机对照研究。患者和方法经医学委员会和研究伦理委员会−Minia大学批准和临床试验注册后，本研究对90例全麻急诊剖腹手术的成年患者进行了研究，这些患者平均分为三组，均接受手术前四象限TAP阻滞，使用盐酸布比卡因0.25% 38 ml +生理盐水2 ml, D组+地塞米松2 ml (8 mg)。结果四象限TAP阻滞能有效减轻血流动力学应激反应，提供术中及术后镇痛[对照组术中仅2例(6.7%)患者需要芬太尼，术后首次镇痛平均时间为6.3±0.9 h]，无明显并发症。M组(10.8±3.8 h)和D组(9.6±4.2 h)的平均首次请求镇痛时间明显长于C组(6.3±0.9 h);因此，M组(1619.5±780.2)和D组(1942.5±969.9)术后对乙酰氨基酚剂量明显低于C组(3638.8±1251)，D组与M组间差异无统计学意义。结论四象限TAP阻滞用于急诊剖腹手术术中、术后镇痛安全有效。添加硫酸镁或地塞米松作为佐剂可延长镇痛时间。硫酸镁效果较好。
{"title":"Ultrasound-guided four quadrants transversus abdominis plane (TAP) block in emergency laparotomies and the effect of adding magnesium sulfate or dexamethasone as an adjuvant to bupivacaine: a randomized controlled trial","authors":"O. Mohamed, Huda Abd El-Azim, S. Mohamed","doi":"10.4103/roaic.roaic_4_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_4_21","url":null,"abstract":"Context The lateral transversus abdominus plane (TAP) block can provide sensory blockade of the T10–L1 abdominal dermatomes, which works well for lower abdominal surgery, but it is insufficient in extended upper incisions that may be needed in emergency laparotomies. So, concomitant use of the subcostal TAP block can extend the sensory blockade to the T7 abdominal dermatomes. Aims This clinical trial aimed to evaluate the efficacy and safety of ultrasound-guided four quadrants TAP block in emergency laparotomies and the effect of adding dexamethasone or magnesium sulfate as an adjuvant. Settings Minia University Hospital. Design This is a prospective double-blind, randomized, controlled study. Patients and methods After approval of the Faculty of Medicine Council and Research Ethics Committee − Minia University and clinical trial registration, this study was conducted on 90 adult patients with emergency laparotomies under general anesthesia who equally assigned into three groups that all received preincisional four quadrants TAP block using 38 ml of bupivacaine hydrochloride 0.25%, plus 2 ml of saline in group C, +2 ml of dexamethasone (8 mg) in group D, and +2 ml of magnesium sulfate (200 mg) in group M. Results The four-quadrants TAP block was effective in attenuating the hemodynamic stress response and providing intraoperative and postoperative analgesia [only two (6.7%) patients needed intraoperative fentanyl in the control group and the mean time of the first postoperative analgesia was 6.3±0.9 h] without notable complications. The mean time of the first analgesic request was significantly longer in group M (10.8±3.8 h) and group D (9.6±4.2 h) when compared with group C (6.3±0.9 h); consequently, the postoperative paracetamol doses were significantly lower in group M (1619.5±780.2) and group D (1942.5±969.9) than in group C (3638.8±1251) with no significant difference between D and M groups. Conclusions Four quadrants TAP block was safe and effective in intraoperative and postoperative analgesics in emergency laparotomies. Adding magnesium sulfate or dexamethasone as adjuvants prolonged the duration of analgesia. Magnesium sulfate was superior.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114665875","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 : 2021-07-01DOI: 10.4103/roaic.roaic_20_21
Nagwa Elkobbia, Hossam Rida, M. Moustafa, M. Shaat
Background Direct laryngoscopes have been developed for many optical fiberscopes to provide a better view of the glottis without alignment of the oral, pharyngeal, and tracheal axes. Recently, video laryngoscopes have become increasingly important devices in difficult airway management. Purpose This study aimed to compare between direct laryngoscopy, C-MAC, and the C-MAC D-blade for orotracheal intubation in patients with limited neck extension and to assess the hemodynamics and the possible complications of orotracheal intubation in patients with limited neck extension using the three different devices. Patients and methods Thirty adult patients subjected to general anesthesia were randomly categorized into three equal groups: in group I, endotracheal intubation was performed using direct laryngoscopy with a conventional Macintosh blade, in group II C-MAC video laryngoscopy was performed with a conventional Macintosh blade, and in group III C-MAC video laryngoscopy was performed with a D-blade. Then, an assessment of the laryngoscopic view and the whole procedure of laryngoscopy and intubation was carried out. Conclusion This study validates the efficacy of the C-MAC Macintosh blade and the D-blade when compared with a direct laryngoscope in patients with limited neck extension. The D-blade has been found to be more effective in reducing hemodynamic responses to laryngoscopy and intubation, resulting in improvement of the laryngoscopic view with a high success rate; it facilitates the smooth performance of laryngoscopy and intubation from the first attempt with the least use of assisting maneuvers while achieving the shortest endotracheal tube (ETT) insertion time, with no occurrence of complications.
背景:直接喉镜已经发展为许多光纤镜，以提供更好的声门视图，而无需对准口，咽和气管轴。近年来，视频喉镜已成为困难气道治疗中越来越重要的设备。目的本研究旨在比较直接喉镜、C-MAC和C-MAC d -刀片在有限颈部伸入患者经气管插管中的应用，并评估三种不同设备在有限颈部伸入患者经气管插管中的血流动力学和可能的并发症。患者和方法将30例全麻成人患者随机分为三组:I组气管插管采用直接喉镜直视常规Macintosh刀片，II组C-MAC视频喉镜直视常规Macintosh刀片，III组C-MAC视频喉镜直视d刀片。然后，对喉镜视野和喉镜插管的整个过程进行评估。结论本研究验证了C-MAC Macintosh刀片和d -刀片与直接喉镜相比在颈部伸展受限患者中的疗效。研究发现，d型刀片在减少喉镜和插管后的血流动力学反应方面更有效，从而改善了喉镜视野，成功率高;它有助于喉镜检查和插管从第一次尝试顺利进行，使用最少的辅助操作，同时实现最短的气管内管(ETT)插入时间，无并发症发生。
{"title":"Endotracheal intubation using three different devices in patients with limited neck extension","authors":"Nagwa Elkobbia, Hossam Rida, M. Moustafa, M. Shaat","doi":"10.4103/roaic.roaic_20_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_20_21","url":null,"abstract":"Background Direct laryngoscopes have been developed for many optical fiberscopes to provide a better view of the glottis without alignment of the oral, pharyngeal, and tracheal axes. Recently, video laryngoscopes have become increasingly important devices in difficult airway management. Purpose This study aimed to compare between direct laryngoscopy, C-MAC, and the C-MAC D-blade for orotracheal intubation in patients with limited neck extension and to assess the hemodynamics and the possible complications of orotracheal intubation in patients with limited neck extension using the three different devices. Patients and methods Thirty adult patients subjected to general anesthesia were randomly categorized into three equal groups: in group I, endotracheal intubation was performed using direct laryngoscopy with a conventional Macintosh blade, in group II C-MAC video laryngoscopy was performed with a conventional Macintosh blade, and in group III C-MAC video laryngoscopy was performed with a D-blade. Then, an assessment of the laryngoscopic view and the whole procedure of laryngoscopy and intubation was carried out. Conclusion This study validates the efficacy of the C-MAC Macintosh blade and the D-blade when compared with a direct laryngoscope in patients with limited neck extension. The D-blade has been found to be more effective in reducing hemodynamic responses to laryngoscopy and intubation, resulting in improvement of the laryngoscopic view with a high success rate; it facilitates the smooth performance of laryngoscopy and intubation from the first attempt with the least use of assisting maneuvers while achieving the shortest endotracheal tube (ETT) insertion time, with no occurrence of complications.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"292 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124197613","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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