Pub Date : 2023-07-01DOI: 10.4103/roaic.roaic_18_23
Tamer Habib, A. Fayed, Mohamed Marouf, Islam Ahmed
Introduction Although septic shock mortality has decreased lately due to better identification and timely application of therapies. Research has continued for 20 years, but no therapies have been discovered yet to change sepsis’s course once it is infected. Objective The aim of this study was to evaluate the effect of enteral metoprolol tartrate on hemodynamics and clinical outcomes in patients with septic shock grouped into various pretargeted heart rate (HR) groups. Methods Septic shock patients (n=90) were randomly assigned directly after the resuscitation into 3 groups (30 in each). Then, treatment with metoprolol tartrate was started. The dose of metoprolol was 25-150 mg every 12 h and increased gradually to reach the pretargeted HR group range; group A (HR = 60-70 beats/min), group B (HR = 71-80 beats/min), and group C (HR = 81-90 beats/min). Metoprolol was continued to maintain the targeted HR till either discharge form intensive care unit (ICU) or death. The primary outcomes measured were mean arterial pressure (MAP), mixed venous oxygen saturation (SvO2), serum lactate, and sequential organ failure assessment (SOFA) score. Results After 1 day, group A (60-70 beats/min) had a significantly higher MAP (61.73±6.39 mmHg) than group B (51.33±7.76 mmHg) and group C (52.0±7.14 mmHg) (P < 0.001). After 3 days, group A had a significantly improved SvO2, lower serum lactate, and lower SOFA score than the other groups (all P < 0.05). When compared with groups B and C, group A had decreased norepinephrine (NE) requirements (P < 0.001) and shorter ICU stay (P = 0.001). Conclusion Targeting HR between 60-70 beats/min using metoprolol tartrate, when compared with higher targets in septic shock after hemodynamic stabilization, was not associated with profound hypotension but also with earlier improved MAP, tissue perfusion measured as SvO2 and serum lactate, and organ failure measured as the SOFA score. It also showed decreased Norepinephrine requirements and a shorter ICU stay, but with no 28-day mortality benefit.
{"title":"Role of enteral metoprolol tartrate on hemodynamics and clinical outcomes of septic shock patients of various pretargeted heart rate groups","authors":"Tamer Habib, A. Fayed, Mohamed Marouf, Islam Ahmed","doi":"10.4103/roaic.roaic_18_23","DOIUrl":"https://doi.org/10.4103/roaic.roaic_18_23","url":null,"abstract":"Introduction Although septic shock mortality has decreased lately due to better identification and timely application of therapies. Research has continued for 20 years, but no therapies have been discovered yet to change sepsis’s course once it is infected. Objective The aim of this study was to evaluate the effect of enteral metoprolol tartrate on hemodynamics and clinical outcomes in patients with septic shock grouped into various pretargeted heart rate (HR) groups. Methods Septic shock patients (n=90) were randomly assigned directly after the resuscitation into 3 groups (30 in each). Then, treatment with metoprolol tartrate was started. The dose of metoprolol was 25-150 mg every 12 h and increased gradually to reach the pretargeted HR group range; group A (HR = 60-70 beats/min), group B (HR = 71-80 beats/min), and group C (HR = 81-90 beats/min). Metoprolol was continued to maintain the targeted HR till either discharge form intensive care unit (ICU) or death. The primary outcomes measured were mean arterial pressure (MAP), mixed venous oxygen saturation (SvO2), serum lactate, and sequential organ failure assessment (SOFA) score. Results After 1 day, group A (60-70 beats/min) had a significantly higher MAP (61.73±6.39 mmHg) than group B (51.33±7.76 mmHg) and group C (52.0±7.14 mmHg) (P < 0.001). After 3 days, group A had a significantly improved SvO2, lower serum lactate, and lower SOFA score than the other groups (all P < 0.05). When compared with groups B and C, group A had decreased norepinephrine (NE) requirements (P < 0.001) and shorter ICU stay (P = 0.001). Conclusion Targeting HR between 60-70 beats/min using metoprolol tartrate, when compared with higher targets in septic shock after hemodynamic stabilization, was not associated with profound hypotension but also with earlier improved MAP, tissue perfusion measured as SvO2 and serum lactate, and organ failure measured as the SOFA score. It also showed decreased Norepinephrine requirements and a shorter ICU stay, but with no 28-day mortality benefit.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139364896","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}
Context Propofol is the most commonly used intravenous (IV) anesthetic drug for induction of anaesthesia and for sedation, but pain which occur during its injection still remains a problem. Approximately 70 to 90% of patients who receive propofol for anaesthesia induction experience pain during injection and this pain can be quite severe. The most frequently used drug to alleviate pain in propofol injection is IV Lignocaine which acts through the local anesthetic effect on the veins. Administration of sodium bicarbonate with lidocaine was proved to reduce pain in propofol injection through increasing sodium ions concentration as well as increasing serum pH through its buffering effect. Aims To compare the effect of adding lignocaine vs sodium bicarbonate to propofol in reducing pain on propofol injection. Settings and design A randomized, controlled, double-blinded trial. Methods and material One hundred and eighty patients underwent conscious sedation during surgical procedures were randomly divided into three equal groups as follows: Group (L) 3 ml (60 mg) of lignocaine 2% premixed with propofol, group (B) 3 ml of sodium bicarbonate 8.5% premixed with propofol and group (S) 3 ml of normal saline premixed with propofol. The 3 groups were compared regarding pain intensity immediately after IV injection of propofol using the four-point verbal rating and BP. Results The incidence of pain and the pain score were significantly lower in the lignocaine group (43%) in comparison to both group (Saline 81% and bicarbonate 71%) P value < 0.001. However, no difference in pain score or the incidence of pain were found between Group S and Group B. Conclusions Our study demonstrated that mixing lignocaine with propofol appears to be effective in reducing both the incidence and severity of the pain during propofol injection when compared to mixing propofol with sodium bicarbonate or normal saline.
{"title":"Effect of lignocaine versus sodium bicarbonate on reducing pain due to intravenous injection of propofol: a prospective randomised double-blinded, controlled study","authors":"Karim Mourad, Sahar Marzouk, Aliaa Mohammed, Ayman Abougabal","doi":"10.4103/roaic.roaic_14_23","DOIUrl":"https://doi.org/10.4103/roaic.roaic_14_23","url":null,"abstract":"Context Propofol is the most commonly used intravenous (IV) anesthetic drug for induction of anaesthesia and for sedation, but pain which occur during its injection still remains a problem. Approximately 70 to 90% of patients who receive propofol for anaesthesia induction experience pain during injection and this pain can be quite severe. The most frequently used drug to alleviate pain in propofol injection is IV Lignocaine which acts through the local anesthetic effect on the veins. Administration of sodium bicarbonate with lidocaine was proved to reduce pain in propofol injection through increasing sodium ions concentration as well as increasing serum pH through its buffering effect. Aims To compare the effect of adding lignocaine vs sodium bicarbonate to propofol in reducing pain on propofol injection. Settings and design A randomized, controlled, double-blinded trial. Methods and material One hundred and eighty patients underwent conscious sedation during surgical procedures were randomly divided into three equal groups as follows: Group (L) 3 ml (60 mg) of lignocaine 2% premixed with propofol, group (B) 3 ml of sodium bicarbonate 8.5% premixed with propofol and group (S) 3 ml of normal saline premixed with propofol. The 3 groups were compared regarding pain intensity immediately after IV injection of propofol using the four-point verbal rating and BP. Results The incidence of pain and the pain score were significantly lower in the lignocaine group (43%) in comparison to both group (Saline 81% and bicarbonate 71%) P value < 0.001. However, no difference in pain score or the incidence of pain were found between Group S and Group B. Conclusions Our study demonstrated that mixing lignocaine with propofol appears to be effective in reducing both the incidence and severity of the pain during propofol injection when compared to mixing propofol with sodium bicarbonate or normal saline.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139366081","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 : 2023-07-01DOI: 10.4103/roaic.roaic_66_22
Sherif Omar, M. Afify, Mohamed Abd El-Hameed, Mohamed Abd El-Hady
Background Patients undergoing breast surgery require a multimodal postoperative pain treatment regimen that provides high-quality analgesia with minimal side effects. The aim of this study was to compare between the efficiency of serratus anterior plane block and thoracic epidural analgesia in terms of postoperative pain relief in the first 24 h determined by the visual analog scale (VAS) score. The second aim was to compare between the two methods as regards duration of the procedure in minutes, incidence of adverse effects, total analgesic consumption in the first 24 h, and patient satisfaction. Patients and methods Forty female patients aged 25–50 years, American Society of Anesthesiologists class II or III scheduled for elective unilateral modified radical mastectomy were studied. Patients were randomly allocated to two groups; group E (epidural group) (n=20) received 20 ml of 0.25% bupivacaine and group S (serratus anterior block group) (n=20) received 20 ml of 0.25% bupivacaine. Results There was no difference between both groups as regards demographic data, heart rate, systolic blood pressure, SpO2, and end-tidal CO2 and associated complications. Moreover, group E had a significant lower VAS score than group S. Group E took longer time to perform the analgesic technique. Group E required significantly less rescue analgesia in the first 24 h. Group S analgesic duration was significantly shorter than in group E. Conclusions Serratus anterior plane block is a good, simple alternative and a safe technique than thoracic epidural analgesia both providing effective intraoperative analgesia and prolonged postoperative pain relief after breast surgery with comparable postoperative VAS score in the first 24 h.
背景接受乳腺手术的患者需要一种能提供高质量镇痛且副作用最小的多模式术后疼痛治疗方案。本研究的目的是比较前锯肌平面阻滞和胸硬膜外镇痛在术后 24 小时内的疼痛缓解效果（以视觉模拟量表（VAS）评分为准）。第二个目的是比较两种方法在手术持续时间（分钟）、不良反应发生率、头 24 小时镇痛剂总用量和患者满意度方面的差异。患者和方法 研究对象为 40 名年龄在 25-50 岁之间、美国麻醉医师协会 II 级或 III 级、计划进行择期单侧改良根治性乳房切除术的女性患者。患者被随机分配到两组：E 组（硬膜外组）（20 人）接受 20 毫升 0.25% 布比卡因，S 组（前锯肌阻滞组）（20 人）接受 20 毫升 0.25% 布比卡因。结果 两组在人口统计学数据、心率、收缩压、SpO2、潮气末二氧化碳和相关并发症方面均无差异。此外，E 组的 VAS 评分明显低于 S 组。结论 与胸膜硬膜外镇痛相比，Serratus前平面阻滞是一种良好、简单、安全的替代技术，既能提供有效的术中镇痛，又能延长乳腺手术后的疼痛缓解时间，且术后 24 小时内的 VAS 评分相当。
{"title":"Comparison between ultrasound-guided serratus anterior plane block and thoracic epidural for postoperative analgesia after modified radical mastectomy","authors":"Sherif Omar, M. Afify, Mohamed Abd El-Hameed, Mohamed Abd El-Hady","doi":"10.4103/roaic.roaic_66_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_66_22","url":null,"abstract":"Background Patients undergoing breast surgery require a multimodal postoperative pain treatment regimen that provides high-quality analgesia with minimal side effects. The aim of this study was to compare between the efficiency of serratus anterior plane block and thoracic epidural analgesia in terms of postoperative pain relief in the first 24 h determined by the visual analog scale (VAS) score. The second aim was to compare between the two methods as regards duration of the procedure in minutes, incidence of adverse effects, total analgesic consumption in the first 24 h, and patient satisfaction. Patients and methods Forty female patients aged 25–50 years, American Society of Anesthesiologists class II or III scheduled for elective unilateral modified radical mastectomy were studied. Patients were randomly allocated to two groups; group E (epidural group) (n=20) received 20 ml of 0.25% bupivacaine and group S (serratus anterior block group) (n=20) received 20 ml of 0.25% bupivacaine. Results There was no difference between both groups as regards demographic data, heart rate, systolic blood pressure, SpO2, and end-tidal CO2 and associated complications. Moreover, group E had a significant lower VAS score than group S. Group E took longer time to perform the analgesic technique. Group E required significantly less rescue analgesia in the first 24 h. Group S analgesic duration was significantly shorter than in group E. Conclusions Serratus anterior plane block is a good, simple alternative and a safe technique than thoracic epidural analgesia both providing effective intraoperative analgesia and prolonged postoperative pain relief after breast surgery with comparable postoperative VAS score in the first 24 h.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139365814","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 : 2023-04-01DOI: 10.4103/roaic.roaic_63_22
F. Badawy, Abd El-Rahman Hassan El-Rahman, K. Hassan, Asmaa Farghaly Gad-Allah, K. Abdelfattah
Background Inadequate treatment of post-thoracotomy pain can lead to both acute impact on patient comfort and pulmonary function, and long-term pain interfering with patients’ regular activities for a long time. This study aimed to evaluate the analgesic effectiveness of serratus anterior plane block (SAPB) as a regional analgesic procedure in post-thoracotomy pain. Patients and methods In this randomized, prospective, interventional, single-center, and double-blind study, patients were randomly assigned into two groups of 30 patients each. Group A: patients were subjected to standard anesthesia and ultrasound-guided SAPB using 30 ml of 0.25% bupivacaine after induction of anesthesia. In addition, rescue postoperative intravenous opioid analgesia was used when needed to maintain the visual analog scale (VAS) at less than or equal to 3.Group B: standard anesthesia was done, and titrated postoperative intravenous opioid analgesia was used for post-thoracotomy pain relief to maintain the VAS at less than or equal to 3. Our primary outcome was to measure postoperative VAS at rest and on coughing up to 24 h postoperatively. Our secondary outcomes were to measure total intraoperative and postoperative opioid used, to record opioid use over time intervals, time to first postoperative opioid administration, and to assess opioid-related complications, all up to 24 h postoperatively. Results VAS at rest and on coughing up to 6 h postoperatively was significantly less in the SAPB group, and there was no significant difference between both groups from 6 h up to 24 h postoperatively. Total intravenous opioids used, total intraoperative fentanyl, total postoperative morphine, and time-related postoperative morphine up to 6 h postoperatively were significantly less in the SAPB group, and there was no significant difference between both groups from 6 up to 24 h postoperatively. The time to first postoperative opioid use was also significantly longer in the SAPB group. Conclusion Ultrasound-guided SAPB can be an effective technique for post-thoracotomy analgesia with probably better pain control compared with intravenous opioid analgesia alone, with less total opioid use.
{"title":"Serratus anterior plane block versus intravenous opioid use for acute post-thoracotomy pain","authors":"F. Badawy, Abd El-Rahman Hassan El-Rahman, K. Hassan, Asmaa Farghaly Gad-Allah, K. Abdelfattah","doi":"10.4103/roaic.roaic_63_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_63_22","url":null,"abstract":"Background Inadequate treatment of post-thoracotomy pain can lead to both acute impact on patient comfort and pulmonary function, and long-term pain interfering with patients’ regular activities for a long time. This study aimed to evaluate the analgesic effectiveness of serratus anterior plane block (SAPB) as a regional analgesic procedure in post-thoracotomy pain. Patients and methods In this randomized, prospective, interventional, single-center, and double-blind study, patients were randomly assigned into two groups of 30 patients each. Group A: patients were subjected to standard anesthesia and ultrasound-guided SAPB using 30 ml of 0.25% bupivacaine after induction of anesthesia. In addition, rescue postoperative intravenous opioid analgesia was used when needed to maintain the visual analog scale (VAS) at less than or equal to 3.Group B: standard anesthesia was done, and titrated postoperative intravenous opioid analgesia was used for post-thoracotomy pain relief to maintain the VAS at less than or equal to 3. Our primary outcome was to measure postoperative VAS at rest and on coughing up to 24 h postoperatively. Our secondary outcomes were to measure total intraoperative and postoperative opioid used, to record opioid use over time intervals, time to first postoperative opioid administration, and to assess opioid-related complications, all up to 24 h postoperatively. Results VAS at rest and on coughing up to 6 h postoperatively was significantly less in the SAPB group, and there was no significant difference between both groups from 6 h up to 24 h postoperatively. Total intravenous opioids used, total intraoperative fentanyl, total postoperative morphine, and time-related postoperative morphine up to 6 h postoperatively were significantly less in the SAPB group, and there was no significant difference between both groups from 6 up to 24 h postoperatively. The time to first postoperative opioid use was also significantly longer in the SAPB group. Conclusion Ultrasound-guided SAPB can be an effective technique for post-thoracotomy analgesia with probably better pain control compared with intravenous opioid analgesia alone, with less total opioid use.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121489769","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 : 2023-04-01DOI: 10.4103/roaic.roaic_71_22
H. ElHoshy, A. Khalifa
Background Although bone marrow aspiration (BMA) in children is a familiar short duration procedure, nearly 65% of patients develop sever anxiety that may extend more beyond, up to chronic postoperative behavioral changes. Consequently, the objectives of any related anesthetic technique is to afford smooth nontraumatic induction with safe maintenance and rapid recovery. The rational of the current study is to assess the outcomes of total intravenous anesthesia (TIVA) using propofol or dexmedetomidine versus sevoflurane for maintenance of anesthesia in children scheduled for BMA. Patients and methods A total of 60 children aged 3–12 years of American Society of Anesthesiologists physical status I and II, who planned to undergo elective BMA and biopsy were enrolled randomly to one of three groups (20 child each) receiving either sevoflurane inhalational anesthesia for induction, then sevoflurane and fentanyl infusion for maintenance (group S), propofol infusion for induction afterward propofol and fentanyl infusions for maintenance of anesthesia (group P) or dexmedetomidine infusion for induction after that dexmedetomidine and fentanyl infusions for maintenance (group D). The primary endpoint was postoperative sedation score on arriving the postanesthetic care unit after the procedure. Secondary outcomes included procedure duration, hemodynamic variables, parents and surgeons satisfaction and incidences of any adverse events. Results Hemodynamics revealed statistically comparable significant decrease in the three studied groups relative to the preoperative baseline levels. Values of oxygen saturation in group D showed significant increase relative to those of group P. Time for spontaneous eye open were significantly shorter in group P comparable to the other two groups (P<0.001). Members of group D were more sedated relative to the other two groups. Satisfaction of both parents and surgeons were significantly higher in the group D relative to the other two studied groups (P<0.05). Conclusion TIVA with dexmedetomidine can be a superior alternative to TIVA with propofol or sevoflurane for maintenance of anesthesia in children scheduled for BMA in consequence of favorable hemodynamic stability and smooth recovery profile.
{"title":"Comparison between total intravenous anesthesia using propofol or dexmedetomidine versus sevoflurane during anesthesia of children undergoing bone marrow aspiration","authors":"H. ElHoshy, A. Khalifa","doi":"10.4103/roaic.roaic_71_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_71_22","url":null,"abstract":"Background Although bone marrow aspiration (BMA) in children is a familiar short duration procedure, nearly 65% of patients develop sever anxiety that may extend more beyond, up to chronic postoperative behavioral changes. Consequently, the objectives of any related anesthetic technique is to afford smooth nontraumatic induction with safe maintenance and rapid recovery. The rational of the current study is to assess the outcomes of total intravenous anesthesia (TIVA) using propofol or dexmedetomidine versus sevoflurane for maintenance of anesthesia in children scheduled for BMA. Patients and methods A total of 60 children aged 3–12 years of American Society of Anesthesiologists physical status I and II, who planned to undergo elective BMA and biopsy were enrolled randomly to one of three groups (20 child each) receiving either sevoflurane inhalational anesthesia for induction, then sevoflurane and fentanyl infusion for maintenance (group S), propofol infusion for induction afterward propofol and fentanyl infusions for maintenance of anesthesia (group P) or dexmedetomidine infusion for induction after that dexmedetomidine and fentanyl infusions for maintenance (group D). The primary endpoint was postoperative sedation score on arriving the postanesthetic care unit after the procedure. Secondary outcomes included procedure duration, hemodynamic variables, parents and surgeons satisfaction and incidences of any adverse events. Results Hemodynamics revealed statistically comparable significant decrease in the three studied groups relative to the preoperative baseline levels. Values of oxygen saturation in group D showed significant increase relative to those of group P. Time for spontaneous eye open were significantly shorter in group P comparable to the other two groups (P<0.001). Members of group D were more sedated relative to the other two groups. Satisfaction of both parents and surgeons were significantly higher in the group D relative to the other two studied groups (P<0.05). Conclusion TIVA with dexmedetomidine can be a superior alternative to TIVA with propofol or sevoflurane for maintenance of anesthesia in children scheduled for BMA in consequence of favorable hemodynamic stability and smooth recovery profile.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130832006","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 : 2023-04-01DOI: 10.4103/roaic.roaic_62_21
Amr El-Morsy, A. Dahroug, Ahmed Elfaham
Intro duction Traumatic brain injury (TBI) is a major public health problem. It is considered to be one of the leading causes of death and disability worldwide. After TBI, cerebral blood flow (CBF) becomes extremely low approaching ischemic thresholds. Concurrently, CBF velocities become strongly correlated to CBF itself post injury. Identification of such hemodynamic disturbances can be used to predict outcome in severe TBI when measured immediately postinjury using transcranial Doppler (TCD). TCD permits noninvasive assessment of different CBF velocities as well as pulsatility index (PI). Abnormal measurement of such indices is believed to correlate to poor outcome. Objective The aim of this work was to assess the predictive value of early TCD in patients with severe TBI and to correlate different TCD measurements with full outline of unresponsiveness (FOUR) score. Patients and methods In total, 74 patients with severe TBI, according to Glasgow Coma Scale (GCS), underwent TCD within 24 h posttrauma. Middle cerebral artery (MCA) velocities and pulsatility index (PI), as well as other clinical and neuroimaging data, were recorded and accordingly patients were divided into three groups: patients with normal TCD measurements, patients with hypoperfusion, and patients with vasospasm. Hypoperfusion was defined by meeting two out of three criteria: mean flow velocity of MCA less than 35 cm/s, end-diastolic velocity of MCA less than 20 cm/s, and PI more than 1.4. Vasospasm was defined as mean flow velocity more than 120 cm/s. Outcome was evaluated using the Glasgow Outcome Scale Extended at 3 months, as well as in-hospital mortality. TCD measurements were also correlated to GCS and FOUR score. Results There was a significant correlation between PI and Glasgow Outcome Scale Extended at 3 months. There was also significant correlation between PI and mortality. Strong negative correlation was recognized between PI and FOUR scores. Patients with hypoperfusion showed worst GCS and FOUR score and patients with vasospasm group showed worst Acute Physiology and Chronic Health Evaluation II score between all groups. Conclusion PI, when measured within the first 24 h posttrauma, is considered a good predictor of mortality as well as functional outcome at 3 months. PI values were associated with moderate negative correlation with the severity of injury FOUR score.
{"title":"Role of transcranial Doppler ultrasound as a predictor of outcome in severe traumatic brain injury and its correlation with full outline of unresponsiveness score","authors":"Amr El-Morsy, A. Dahroug, Ahmed Elfaham","doi":"10.4103/roaic.roaic_62_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_62_21","url":null,"abstract":"Intro duction Traumatic brain injury (TBI) is a major public health problem. It is considered to be one of the leading causes of death and disability worldwide. After TBI, cerebral blood flow (CBF) becomes extremely low approaching ischemic thresholds. Concurrently, CBF velocities become strongly correlated to CBF itself post injury. Identification of such hemodynamic disturbances can be used to predict outcome in severe TBI when measured immediately postinjury using transcranial Doppler (TCD). TCD permits noninvasive assessment of different CBF velocities as well as pulsatility index (PI). Abnormal measurement of such indices is believed to correlate to poor outcome. Objective The aim of this work was to assess the predictive value of early TCD in patients with severe TBI and to correlate different TCD measurements with full outline of unresponsiveness (FOUR) score. Patients and methods In total, 74 patients with severe TBI, according to Glasgow Coma Scale (GCS), underwent TCD within 24 h posttrauma. Middle cerebral artery (MCA) velocities and pulsatility index (PI), as well as other clinical and neuroimaging data, were recorded and accordingly patients were divided into three groups: patients with normal TCD measurements, patients with hypoperfusion, and patients with vasospasm. Hypoperfusion was defined by meeting two out of three criteria: mean flow velocity of MCA less than 35 cm/s, end-diastolic velocity of MCA less than 20 cm/s, and PI more than 1.4. Vasospasm was defined as mean flow velocity more than 120 cm/s. Outcome was evaluated using the Glasgow Outcome Scale Extended at 3 months, as well as in-hospital mortality. TCD measurements were also correlated to GCS and FOUR score. Results There was a significant correlation between PI and Glasgow Outcome Scale Extended at 3 months. There was also significant correlation between PI and mortality. Strong negative correlation was recognized between PI and FOUR scores. Patients with hypoperfusion showed worst GCS and FOUR score and patients with vasospasm group showed worst Acute Physiology and Chronic Health Evaluation II score between all groups. Conclusion PI, when measured within the first 24 h posttrauma, is considered a good predictor of mortality as well as functional outcome at 3 months. PI values were associated with moderate negative correlation with the severity of injury FOUR score.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113986664","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 : 2023-04-01DOI: 10.4103/roaic.roaic_73_22
Rehab Abd El-Raof Abd El-Aziz, A. Morsy, Mervat Abdelmaksoud, Mariam Abdelhamid
Background This prospective study examined the influence of adding magnesium sulfate to bupivacaine in popliteal sciatic nerve block in diabetic foot surgeries. Patients and methods Patients were divided into two equal groups: patients in B group received 28 ml of 0.25% bupivacaine plus 2-ml normal saline, and patients in BM group received 28 ml of 0.25% bupivacaine plus 2-ml magnesium sulfate 10%. The primary end point was postoperative analgesic duration assessment. Secondary aims were to assess the sensory and motor block regarding the onset and the duration and assessment of analgesic requirements postoperatively. Results In B group, the range of analgesic duration was between 450 and 690 min, with a mean of 585.90±78.96 min, whereas in BM group, it ranged from 720 to 1080 min, with a mean of 870.0±100.6 min. A statistically significant higher prolongation in the duration of analgesia was found in the BM group than the B group. Conclusions Magnesium sulfate when added to bupivacaine produced prolongation of analgesic duration postoperatively with decreased analgesic requirements without significant complications.
本前瞻性研究探讨了在布比卡因中加入硫酸镁对糖尿病足手术中腘窝坐骨神经阻滞的影响。患者与方法将患者分为两组，B组患者给予0.25%布比卡因28 ml +生理盐水2 ml, BM组患者给予0.25%布比卡因28 ml + 10%硫酸镁2 ml。主要终点为术后镇痛持续时间评估。次要目的是评估感觉和运动阻滞的发生、持续时间和术后镇痛需求的评估。结果B组镇痛时间450 ~ 690 min，平均为585.90±78.96 min; BM组镇痛时间720 ~ 1080 min，平均为870.0±100.6 min。BM组镇痛持续时间延长明显高于B组。结论在布比卡因中加入硫酸镁可延长术后镇痛时间，降低镇痛需求，无明显并发症。
{"title":"Ultrasound-guided popliteal sciatic nerve block using bupivacaine alone or combined with magnesium sulfate for diabetic foot surgeries","authors":"Rehab Abd El-Raof Abd El-Aziz, A. Morsy, Mervat Abdelmaksoud, Mariam Abdelhamid","doi":"10.4103/roaic.roaic_73_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_73_22","url":null,"abstract":"Background This prospective study examined the influence of adding magnesium sulfate to bupivacaine in popliteal sciatic nerve block in diabetic foot surgeries. Patients and methods Patients were divided into two equal groups: patients in B group received 28 ml of 0.25% bupivacaine plus 2-ml normal saline, and patients in BM group received 28 ml of 0.25% bupivacaine plus 2-ml magnesium sulfate 10%. The primary end point was postoperative analgesic duration assessment. Secondary aims were to assess the sensory and motor block regarding the onset and the duration and assessment of analgesic requirements postoperatively. Results In B group, the range of analgesic duration was between 450 and 690 min, with a mean of 585.90±78.96 min, whereas in BM group, it ranged from 720 to 1080 min, with a mean of 870.0±100.6 min. A statistically significant higher prolongation in the duration of analgesia was found in the BM group than the B group. Conclusions Magnesium sulfate when added to bupivacaine produced prolongation of analgesic duration postoperatively with decreased analgesic requirements without significant complications.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115957715","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 : 2023-04-01DOI: 10.4103/roaic.roaic_1_23
Dina Mohamed, S. El-Sayeh, A. Salem, S. Mahmoud, Manal H. Abuelela, Marwa A Fouly, Marwa Ahmed El Mansour
Aim This study aimed to compare the efficacy and safety of the local anesthetic bupivacaine 0.5% and oxybuprocaine hydrochloride 0.4% used topically to provide surface anesthesia before intravitreal injection (IVI) procedures. Settings and design This double-blinded, randomized, controlled trial was carried out at the Research Institute of Ophthalmology, Egypt. Patients and methods This trial included diabetic patients with glycated hemoglobin less than 7.5 mmol/l of both sexes, aged from 30 to 70 years, American Society of Anesthesiologists I, II, or III, who had central retinal vein occlusion and choroidal neovascularization. A total of 110 eligible patients were randomly allocated into two groups. Patients in group A received bupivacaine 0.5%, while those in group B received oxybuprocaine hydrochloride 0.4%. Both drugs were topically applied, three times, at 5 min intervals, for 15 min, which was followed by the IVI. The primary outcome was pain during the injection and the secondary outcome was corneal adverse effects. Results The frequency of pain-free IVI was equal in both groups (83.6% each, P=0.100). The difference in the mean heart rate after injection between groups A (81.4±12.7) and B (82.5±15.6) was nonsignificant (P=0.678). The rate of corneal side effects in terms of opacity or allergy to the topically applied drugs was nonsignificantly lower in group A compared with group B (9.1 vs. 12.7%, P=0.541). Conclusions The topical use of bupivacaine 0.5% had anesthetic efficacy similar to that of oxybuprocaine hydrochloride 0.4% during the IVI. Both the topical anesthetics were well tolerated by patients.
{"title":"Topical anesthetics oxybuprocaine versus bupivacaine 0.5% in intravitreal injections","authors":"Dina Mohamed, S. El-Sayeh, A. Salem, S. Mahmoud, Manal H. Abuelela, Marwa A Fouly, Marwa Ahmed El Mansour","doi":"10.4103/roaic.roaic_1_23","DOIUrl":"https://doi.org/10.4103/roaic.roaic_1_23","url":null,"abstract":"Aim This study aimed to compare the efficacy and safety of the local anesthetic bupivacaine 0.5% and oxybuprocaine hydrochloride 0.4% used topically to provide surface anesthesia before intravitreal injection (IVI) procedures. Settings and design This double-blinded, randomized, controlled trial was carried out at the Research Institute of Ophthalmology, Egypt. Patients and methods This trial included diabetic patients with glycated hemoglobin less than 7.5 mmol/l of both sexes, aged from 30 to 70 years, American Society of Anesthesiologists I, II, or III, who had central retinal vein occlusion and choroidal neovascularization. A total of 110 eligible patients were randomly allocated into two groups. Patients in group A received bupivacaine 0.5%, while those in group B received oxybuprocaine hydrochloride 0.4%. Both drugs were topically applied, three times, at 5 min intervals, for 15 min, which was followed by the IVI. The primary outcome was pain during the injection and the secondary outcome was corneal adverse effects. Results The frequency of pain-free IVI was equal in both groups (83.6% each, P=0.100). The difference in the mean heart rate after injection between groups A (81.4±12.7) and B (82.5±15.6) was nonsignificant (P=0.678). The rate of corneal side effects in terms of opacity or allergy to the topically applied drugs was nonsignificantly lower in group A compared with group B (9.1 vs. 12.7%, P=0.541). Conclusions The topical use of bupivacaine 0.5% had anesthetic efficacy similar to that of oxybuprocaine hydrochloride 0.4% during the IVI. Both the topical anesthetics were well tolerated by patients.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126800635","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 : 2023-04-01DOI: 10.4103/roaic.roaic_42_22
N. Sasikumar, S. Rajan, Pulak Tosh, L. Kumar
{"title":"Combined use of Jackson Rees circuit with end-tidal carbon dioxide monitoring: an easy and safer technique during awake blind nasal intubation","authors":"N. Sasikumar, S. Rajan, Pulak Tosh, L. Kumar","doi":"10.4103/roaic.roaic_42_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_42_22","url":null,"abstract":"","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126638426","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 : 2023-04-01DOI: 10.4103/roaic.roaic_67_22
R. Wahdan, Shereen E. Abd Ellatif
Purpose The aim was to evaluate the effect of combination of recruitment maneuver (RM) or intraperitoneal saline infusion (IPS) to low-pressure pneumoperitoneum in reducing postlaparoscopic shoulder and abdominal pain in patients undergoing laparoscopic gynecologic surgeries. Patients and methods This prospective blinded randomized controlled study was conducted on 108 patients undergoing laparoscopic gynecologic surgery. Patients were randomly allocated to four groups: group C (control group) patients received standard pressure pneumoperitoneum, group L received low-pressure pneumoperitoneum, group LR received low-pressure pneumoperitoneum and intermittent five times RM at a pressure of 40 cmH2O, and group LS received low-pressure pneumoperitoneum and IPS (15–20 ml/kg). Primary outcome was visual analog scale score for shoulder pain and abdominal pain at 2, 6, 12, 24, 48, 72, and 96 h postoperatively. Results The visual analog scale values of shoulder pain and abdominal pain were statistically significantly higher in the control group at different timings postoperatively compared with the interventional groups. Moreover, the LR group had the lowest statistically significant values at all different timings except at 2, 48, 72, and 96 h, where it had no significant difference with the LS group regarding shoulder pain. However, regarding abdominal pain values, the LS group had the lowest statistically significant values at 72 and 96 h postoperatively. Conclusion Adding of RM or IPS to low-pressure insufflation could significantly decrease the intensity of postlaparoscopic shoulder and abdominal pain. However, RM seems to be more effective but it is a relatively short-acting maneuver, whereas IPS seems to be less effective but it has a longer lasting effect.
{"title":"Different maneuvers for reducing postlaparoscopic shoulder and abdominal pain: a randomized controlled trial","authors":"R. Wahdan, Shereen E. Abd Ellatif","doi":"10.4103/roaic.roaic_67_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_67_22","url":null,"abstract":"Purpose The aim was to evaluate the effect of combination of recruitment maneuver (RM) or intraperitoneal saline infusion (IPS) to low-pressure pneumoperitoneum in reducing postlaparoscopic shoulder and abdominal pain in patients undergoing laparoscopic gynecologic surgeries. Patients and methods This prospective blinded randomized controlled study was conducted on 108 patients undergoing laparoscopic gynecologic surgery. Patients were randomly allocated to four groups: group C (control group) patients received standard pressure pneumoperitoneum, group L received low-pressure pneumoperitoneum, group LR received low-pressure pneumoperitoneum and intermittent five times RM at a pressure of 40 cmH2O, and group LS received low-pressure pneumoperitoneum and IPS (15–20 ml/kg). Primary outcome was visual analog scale score for shoulder pain and abdominal pain at 2, 6, 12, 24, 48, 72, and 96 h postoperatively. Results The visual analog scale values of shoulder pain and abdominal pain were statistically significantly higher in the control group at different timings postoperatively compared with the interventional groups. Moreover, the LR group had the lowest statistically significant values at all different timings except at 2, 48, 72, and 96 h, where it had no significant difference with the LS group regarding shoulder pain. However, regarding abdominal pain values, the LS group had the lowest statistically significant values at 72 and 96 h postoperatively. Conclusion Adding of RM or IPS to low-pressure insufflation could significantly decrease the intensity of postlaparoscopic shoulder and abdominal pain. However, RM seems to be more effective but it is a relatively short-acting maneuver, whereas IPS seems to be less effective but it has a longer lasting effect.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120940542","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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