Pub Date : 2023-04-01DOI: 10.4103/roaic.roaic_86_21
H. Elatroush, D. Ragab, K. Mashhour, M. Afify, Ahmad Salah
Background Early outcome prediction in ischemic stroke is a crucial concern for clinicians for proper decisions to reduce morbidity and mortality. The present study aimed to compare between computed tomography (CT) perfusion, National Institutes of Health Stroke Scale (NIHSS), and S100β for early outcome prediction. Patients and methods The study was carried out on 50 adult patients with acute ischemic stroke, classified into two groups according to modified Rankin score into group I (favorable outcome) and group II (unfavorable outcome). CT-perfusion was done on admission, NIHSS was calculated on admission, and blood was withdrawn on admission and third day for S100β. Results Infarction core size and the penumbra size were larger significantly in unfavorable-outcome group (P<0.001). Also, S100β levels and NIHSS on admission were higher in group 2 than group 1 significantly (P<0.001, P=0.001, respectively). Area under the curves were 0.787 for NIHSS score, 0.877 for S100β level, and 0.844 for penumbra size. A combination between penumbra size, S100β, and NIHSS to predict outcome. The receiver operating characteristic curve yielded an area under the curve of 0.905 (P<0.001). Furthermore, the comparison between a combination of penumbra size, S100β, NIHSS on admission, and the final infarct in noncontrast CT on day 3 had a significant positive correlation coefficient (r=0.577, P<0.001). Conclusion We suggest that higher NIHSS score on admission, large core and penumbra size, and high S100β level are independent early predictors of the functional outcome for acute ischemic-stroke patients. Moreover, detecting cases with NIHSS score more than 19, S100β more than 241 pg/ml, core size more than 10.35 cm3, and penumbra size more than 17.9 cm3, can individually predict unfavorable functional outcome in acute ischemic-stroke patients. Hence, using these cutoffs in combination might predict the outcome in a more precise manner.
{"title":"Early prognostication of ischemic stroke using computed tomography perfusion and S100 beta level","authors":"H. Elatroush, D. Ragab, K. Mashhour, M. Afify, Ahmad Salah","doi":"10.4103/roaic.roaic_86_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_86_21","url":null,"abstract":"Background Early outcome prediction in ischemic stroke is a crucial concern for clinicians for proper decisions to reduce morbidity and mortality. The present study aimed to compare between computed tomography (CT) perfusion, National Institutes of Health Stroke Scale (NIHSS), and S100β for early outcome prediction. Patients and methods The study was carried out on 50 adult patients with acute ischemic stroke, classified into two groups according to modified Rankin score into group I (favorable outcome) and group II (unfavorable outcome). CT-perfusion was done on admission, NIHSS was calculated on admission, and blood was withdrawn on admission and third day for S100β. Results Infarction core size and the penumbra size were larger significantly in unfavorable-outcome group (P<0.001). Also, S100β levels and NIHSS on admission were higher in group 2 than group 1 significantly (P<0.001, P=0.001, respectively). Area under the curves were 0.787 for NIHSS score, 0.877 for S100β level, and 0.844 for penumbra size. A combination between penumbra size, S100β, and NIHSS to predict outcome. The receiver operating characteristic curve yielded an area under the curve of 0.905 (P<0.001). Furthermore, the comparison between a combination of penumbra size, S100β, NIHSS on admission, and the final infarct in noncontrast CT on day 3 had a significant positive correlation coefficient (r=0.577, P<0.001). Conclusion We suggest that higher NIHSS score on admission, large core and penumbra size, and high S100β level are independent early predictors of the functional outcome for acute ischemic-stroke patients. Moreover, detecting cases with NIHSS score more than 19, S100β more than 241 pg/ml, core size more than 10.35 cm3, and penumbra size more than 17.9 cm3, can individually predict unfavorable functional outcome in acute ischemic-stroke patients. Hence, using these cutoffs in combination might predict the outcome in a more precise manner.","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":"114607569","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_2_23
Z. Ersoy, A. Uslu, BegümNemika Gökdemir, N. Çekmen, S. Jafarov
Objective We aim to compare the effects of remifentanil and dexmedetomidine administered under general anesthesia in patients undergoing rhinoplasty. The primary outcomes were hemodynamics, postoperative pain, and recovery; the secondary outcomes were PONV, shivering, and patient and surgeon satisfaction. Methods In this randomized controlled, double-blind trial, 62 patients 18–65 years of age and ASA I-II class who underwent rhinoplasty under elective conditions were accepted to the study and divided into two groups. Group R (n = 31) received 0.25 μg/kg/min intravenously infusion during the operation without a loading dose. Group D (n = 31) was initiated with a bolus of 1 μg/kg over 10 min before induction of anesthesia and then received 0.5 μg/kg/h intravenously infusion during the operation. The patient’s pain level was assessed at 5 min, 30 min, and 12 h after surgery. Intraoperative hemodynamics, vital parameters, PONV, shivering, and patient and surgical satisfaction were evaluated. Results Remifentanil and dexmedetomidine had similar effects on hemodynamics and additional analgesic requirements. No postoperative complications, including PONV, occurred in either group. Recovery from anesthesia was faster, and pain scores were lower in the dexmedetomidine group. While patient satisfaction was similar, surgeon satisfaction was higher in the remifentanil group. Conclusion We think dexmedetomidine can be used safely and effectively as an adjuvant during general anesthesia for nasal surgery.
{"title":"Comparison of the effects of remifentanil and dexmedetomidine in patients under general anesthesia for rhinoplasty","authors":"Z. Ersoy, A. Uslu, BegümNemika Gökdemir, N. Çekmen, S. Jafarov","doi":"10.4103/roaic.roaic_2_23","DOIUrl":"https://doi.org/10.4103/roaic.roaic_2_23","url":null,"abstract":"Objective We aim to compare the effects of remifentanil and dexmedetomidine administered under general anesthesia in patients undergoing rhinoplasty. The primary outcomes were hemodynamics, postoperative pain, and recovery; the secondary outcomes were PONV, shivering, and patient and surgeon satisfaction. Methods In this randomized controlled, double-blind trial, 62 patients 18–65 years of age and ASA I-II class who underwent rhinoplasty under elective conditions were accepted to the study and divided into two groups. Group R (n = 31) received 0.25 μg/kg/min intravenously infusion during the operation without a loading dose. Group D (n = 31) was initiated with a bolus of 1 μg/kg over 10 min before induction of anesthesia and then received 0.5 μg/kg/h intravenously infusion during the operation. The patient’s pain level was assessed at 5 min, 30 min, and 12 h after surgery. Intraoperative hemodynamics, vital parameters, PONV, shivering, and patient and surgical satisfaction were evaluated. Results Remifentanil and dexmedetomidine had similar effects on hemodynamics and additional analgesic requirements. No postoperative complications, including PONV, occurred in either group. Recovery from anesthesia was faster, and pain scores were lower in the dexmedetomidine group. While patient satisfaction was similar, surgeon satisfaction was higher in the remifentanil group. Conclusion We think dexmedetomidine can be used safely and effectively as an adjuvant during general anesthesia for nasal surgery.","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":"116676169","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_74_22
A. Aly, M. Medhat
Purpose Open abdominal surgeries are associated with an increased risk of postoperative pulmonary complications, especially in obese patients, which seem to be related directly to intraoperative mechanical ventilation. The present study aimed to compare the effect of using conventional protective ventilation (CPV) [low tidal volume and fixed positive end expiratory pressure (PEEP)] with open lung approach (OLA) (recruitment maneuver followed by personalized PEEP) on postoperative pulmonary complications. Patients and methods A total of 56 obese patients undergoing open abdominal surgery under general anesthesia were enrolled and randomly assigned to either the CPV group in which they received a tidal volume of 7 ml/kg with fixed PEEP level of 5 cmH2O or the OLA group in which they had alveolar recruitment maneuver followed by individualized PEEP. The primary outcome was the early postoperative pulmonary complications during the first 5 days after surgery. Secondary outcomes included lung mechanics, gas exchange, and hemodynamics during the intraoperative period as well as length of hospital stay, postoperative extrapulmonary complications, and intrahospital mortality. Results Postoperative pulmonary complications in the first 5 days were significantly higher in the CPV than in the OLA group. During the intraoperative period, the static compliance, the PEEP, and plateau pressure were significantly higher in the OLA group than the CPV group. On the contrary, driving pressure was significantly lower in the OLA group. Better oxygenation was observed in the OLA group in the intraoperative period and postoperative days 1 and 3. Pulmonary function tests were significantly better among patients who received the OLA on the first and third postoperative days. Conclusion The OLA may be used as an acceptable alternative to CPV as it was associated with less postoperative pulmonary complications, better intraoperative and postoperative oxygenation, and better postoperative pulmonary functions.
{"title":"Open lung approach versus conventional protective ventilation in obese patients undergoing open abdominal surgery: a randomized controlled trial","authors":"A. Aly, M. Medhat","doi":"10.4103/roaic.roaic_74_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_74_22","url":null,"abstract":"Purpose Open abdominal surgeries are associated with an increased risk of postoperative pulmonary complications, especially in obese patients, which seem to be related directly to intraoperative mechanical ventilation. The present study aimed to compare the effect of using conventional protective ventilation (CPV) [low tidal volume and fixed positive end expiratory pressure (PEEP)] with open lung approach (OLA) (recruitment maneuver followed by personalized PEEP) on postoperative pulmonary complications. Patients and methods A total of 56 obese patients undergoing open abdominal surgery under general anesthesia were enrolled and randomly assigned to either the CPV group in which they received a tidal volume of 7 ml/kg with fixed PEEP level of 5 cmH2O or the OLA group in which they had alveolar recruitment maneuver followed by individualized PEEP. The primary outcome was the early postoperative pulmonary complications during the first 5 days after surgery. Secondary outcomes included lung mechanics, gas exchange, and hemodynamics during the intraoperative period as well as length of hospital stay, postoperative extrapulmonary complications, and intrahospital mortality. Results Postoperative pulmonary complications in the first 5 days were significantly higher in the CPV than in the OLA group. During the intraoperative period, the static compliance, the PEEP, and plateau pressure were significantly higher in the OLA group than the CPV group. On the contrary, driving pressure was significantly lower in the OLA group. Better oxygenation was observed in the OLA group in the intraoperative period and postoperative days 1 and 3. Pulmonary function tests were significantly better among patients who received the OLA on the first and third postoperative days. Conclusion The OLA may be used as an acceptable alternative to CPV as it was associated with less postoperative pulmonary complications, better intraoperative and postoperative oxygenation, and better postoperative pulmonary functions.","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":"114077105","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_55_22
Ahmed Abd Fatah, S. Wagdy, M. Alim, Mina Montasser
Background Early diagnosis and appropriate management of acute heart failure (AHF) is aimed at better hemodynamic balance, improved functional capacity, decreased mortality, and shorter length of hospital stay. However, this is often a challenge in the emergency department (ED), where diagnosis is mainly based on clinical signs and standard parameters. Early use of Brest score could reduce the diagnosis time and improve diagnostic accuracy. Purpose The aim of this study is to evaluate the validity of the Brest score in the prediction of AHF in undifferentiated dyspnea in ED. Patients and methods The study was conducted on 100 adult patients admitted to the ED of Alexandria Main University Hospital with acute dyspnea. The study was conducted to reach initial impression about AHF diagnosis, which was then compared with the final diagnosis to determine accuracy, agreement, sensitivity, and specificity. Results The data acquired from Brest score in the diagnosis of HF is compared with echocardiography as a gold standard. The area under the receiver-operating characteristic curve for the data received from Brest score was 0.84, 95% confidence interval: 0.667–1, with a P value lower than 0.001 being highly significant. Conclusion The Brest score showed high accuracy in identifying AHF in ED, so it is considered a bedside, reliable, rapid, and noninvasive technique.
{"title":"Diagnostic accuracy of the Brest score for prediction of acute heart failure in the emergency department","authors":"Ahmed Abd Fatah, S. Wagdy, M. Alim, Mina Montasser","doi":"10.4103/roaic.roaic_55_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_55_22","url":null,"abstract":"Background Early diagnosis and appropriate management of acute heart failure (AHF) is aimed at better hemodynamic balance, improved functional capacity, decreased mortality, and shorter length of hospital stay. However, this is often a challenge in the emergency department (ED), where diagnosis is mainly based on clinical signs and standard parameters. Early use of Brest score could reduce the diagnosis time and improve diagnostic accuracy. Purpose The aim of this study is to evaluate the validity of the Brest score in the prediction of AHF in undifferentiated dyspnea in ED. Patients and methods The study was conducted on 100 adult patients admitted to the ED of Alexandria Main University Hospital with acute dyspnea. The study was conducted to reach initial impression about AHF diagnosis, which was then compared with the final diagnosis to determine accuracy, agreement, sensitivity, and specificity. Results The data acquired from Brest score in the diagnosis of HF is compared with echocardiography as a gold standard. The area under the receiver-operating characteristic curve for the data received from Brest score was 0.84, 95% confidence interval: 0.667–1, with a P value lower than 0.001 being highly significant. Conclusion The Brest score showed high accuracy in identifying AHF in ED, so it is considered a bedside, reliable, rapid, and noninvasive technique.","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":"114682170","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_68_22
Harshavardhan Kuri, Ankur Sharma, R. Kanth
Creutzfeldt-Jakob disease (CJD) is a human prion, rare neurodegenerative disorder of unknown etiology that causes rapidly progressive dementia. Diagnosing CJD is difficult due to nonspecific clinical features and low suspicion. Rapidly progressive dementia accompanied with quick involuntary muscle jerking, visual disturbances, cerebellar and pyramidal/extrapyramidal signs are characteristic feature. Here we present a 62-year-old male with decreased appetite, appendicular rigidity and symmetrical progressive loss of vision since 1 month. EEG showed signs of 0.5–1.0 Hz periodic sharp wave complexes (PSWC) and MRI showed diffuse cerebral atrophy with ventriculomegaly. High level of suspicion and molecular diagnostic techniques forms the mainstay for its early identification.
{"title":"Creutzfeldt-Jakob disease: A rare disorder − a common malingerer","authors":"Harshavardhan Kuri, Ankur Sharma, R. Kanth","doi":"10.4103/roaic.roaic_68_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_68_22","url":null,"abstract":"Creutzfeldt-Jakob disease (CJD) is a human prion, rare neurodegenerative disorder of unknown etiology that causes rapidly progressive dementia. Diagnosing CJD is difficult due to nonspecific clinical features and low suspicion. Rapidly progressive dementia accompanied with quick involuntary muscle jerking, visual disturbances, cerebellar and pyramidal/extrapyramidal signs are characteristic feature. Here we present a 62-year-old male with decreased appetite, appendicular rigidity and symmetrical progressive loss of vision since 1 month. EEG showed signs of 0.5–1.0 Hz periodic sharp wave complexes (PSWC) and MRI showed diffuse cerebral atrophy with ventriculomegaly. High level of suspicion and molecular diagnostic techniques forms the mainstay for its early identification.","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":"132774528","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 : 2023-01-01DOI: 10.4103/roaic.roaic_45_22
M. Elshayeb, Wafaa Shafshak, Ola Zanati, H. Eldin
Background Many thyroidectomy patients suffer from pain after surgery that may delay early hospital discharge and place a significant burden on both the patient and the healthcare team. The aim of this study was to evaluate dexmedetomidine as adjuvant to bupivacaine in superficial and ultrasound-guided intermediate cervical plexus block for postoperative analgesia in patients undergoing total thyroidectomy. Patients and methods This prospective, randomized, double-blinded, and controlled study included 50 adult patients of either sex, aged 20–60 years, with American Society of Anathesiologists (ASA) class I or II, scheduled for elective total thyroidectomy under general anesthesia. Results Adding dexmedetomidine to bupivacaine significantly decreased the pain intensity as measured by the visual analog scale compared with group II. Heart rate levels in group I were significantly lower than that in group II in most periods of measurement. The duration of analgesia was prolonged in group I compared with group II, as the time to first dose of rescue analgesia ranged from 12 to 20 h in group I and from 4 to 12 h in group II. The total postoperative nalbuphine consumption was significantly lower in group I than group II. Postanesthesia recovery was significantly faster in group I than group II as measured by the modified Aldrete score 4 min postoperatively. Conclusion Adding dexmedetomidine to bupivacaine for bilateral superficial and ultrasound-guided intermediate cervical plexus block is considered to be an effective and safe method that efficiently managed acute postoperative pain, prolonged the time to first rescue analgesia, and reduced the needed for opioid consumption.
{"title":"Effect of adding dexmedetomidine to bupivacaine during superficial combined with ultrasound-guided intermediate cervical plexus block in total thyroidectomy","authors":"M. Elshayeb, Wafaa Shafshak, Ola Zanati, H. Eldin","doi":"10.4103/roaic.roaic_45_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_45_22","url":null,"abstract":"Background Many thyroidectomy patients suffer from pain after surgery that may delay early hospital discharge and place a significant burden on both the patient and the healthcare team. The aim of this study was to evaluate dexmedetomidine as adjuvant to bupivacaine in superficial and ultrasound-guided intermediate cervical plexus block for postoperative analgesia in patients undergoing total thyroidectomy. Patients and methods This prospective, randomized, double-blinded, and controlled study included 50 adult patients of either sex, aged 20–60 years, with American Society of Anathesiologists (ASA) class I or II, scheduled for elective total thyroidectomy under general anesthesia. Results Adding dexmedetomidine to bupivacaine significantly decreased the pain intensity as measured by the visual analog scale compared with group II. Heart rate levels in group I were significantly lower than that in group II in most periods of measurement. The duration of analgesia was prolonged in group I compared with group II, as the time to first dose of rescue analgesia ranged from 12 to 20 h in group I and from 4 to 12 h in group II. The total postoperative nalbuphine consumption was significantly lower in group I than group II. Postanesthesia recovery was significantly faster in group I than group II as measured by the modified Aldrete score 4 min postoperatively. Conclusion Adding dexmedetomidine to bupivacaine for bilateral superficial and ultrasound-guided intermediate cervical plexus block is considered to be an effective and safe method that efficiently managed acute postoperative pain, prolonged the time to first rescue analgesia, and reduced the needed for opioid consumption.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124053325","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 : 2023-01-01DOI: 10.4103/roaic.roaic_18_22
K. Poonam, Sinha Chandni, K. Amarjeet, K. Ajeet, Arun Shettru K., Kandrakonda Pavan K.
Objective We aimed to compare the effect of tocilizumab and itolizumab in terms of PaO2/FiO2 ratio (P/F ratio), interleukin 6 (IL-6) level, serum ferritin, C-reactive protein, and a reduction in mortality. Our primary objective was to compare P/F ratio at various time intervals: baseline (before administering the drug), 12 h after drug administration, once a day for the next 7 days, and on the 14th day. Our secondary objective was to evaluate serum level of biomarkers like IL-6, ferritin, and C-reactive protein before start of drug infusion and following drug infusion at 72 h and on 7th day. Patients and methods A total of 50 patients, age between 18 and 60 years, having moderate Acute Respiratory distress syndrome (ARDS) following coronavirus disease 2019 infection were recruited. Patients of group I received a single dose of injection of tocilizumab 8 mg/kg intravenously (i.v.) via infusion over 1–2 h. Group II patients received premedication with hydrocortisone 100 mg and pheniramine 30 mg and a single dose of injection itolizumab 1.6 mg/kg dissolved in 250 ml of 0.9% normal saline infusion over 5–6 h. Results We observed significantly higher P/F ratio in the itolizumab group (239.18±97.31) than in the tocilizumab group (104.87±75.25) on the 3rd day following drug administration (P<0.001). Similarly, the IL-6 level was lower in the itolizumab group (72±100) in comparison with the tocilizumab group (682±1360), and the differences were statistically significant (P<0.05). We identified adverse effects of the drugs in 10 patients who have received itolizumab. Conclusion We observed an increasing trend in P/F ratio on the 3rd day following itolizumab administration in comparison with tocilizumab, and the difference was statistically significant (P<0.001).
{"title":"Comparative study of tocilizumab versus itolizumab in coronavirus disease 2019-infected patients: a randomized controlled trial","authors":"K. Poonam, Sinha Chandni, K. Amarjeet, K. Ajeet, Arun Shettru K., Kandrakonda Pavan K.","doi":"10.4103/roaic.roaic_18_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_18_22","url":null,"abstract":"Objective We aimed to compare the effect of tocilizumab and itolizumab in terms of PaO2/FiO2 ratio (P/F ratio), interleukin 6 (IL-6) level, serum ferritin, C-reactive protein, and a reduction in mortality. Our primary objective was to compare P/F ratio at various time intervals: baseline (before administering the drug), 12 h after drug administration, once a day for the next 7 days, and on the 14th day. Our secondary objective was to evaluate serum level of biomarkers like IL-6, ferritin, and C-reactive protein before start of drug infusion and following drug infusion at 72 h and on 7th day. Patients and methods A total of 50 patients, age between 18 and 60 years, having moderate Acute Respiratory distress syndrome (ARDS) following coronavirus disease 2019 infection were recruited. Patients of group I received a single dose of injection of tocilizumab 8 mg/kg intravenously (i.v.) via infusion over 1–2 h. Group II patients received premedication with hydrocortisone 100 mg and pheniramine 30 mg and a single dose of injection itolizumab 1.6 mg/kg dissolved in 250 ml of 0.9% normal saline infusion over 5–6 h. Results We observed significantly higher P/F ratio in the itolizumab group (239.18±97.31) than in the tocilizumab group (104.87±75.25) on the 3rd day following drug administration (P<0.001). Similarly, the IL-6 level was lower in the itolizumab group (72±100) in comparison with the tocilizumab group (682±1360), and the differences were statistically significant (P<0.05). We identified adverse effects of the drugs in 10 patients who have received itolizumab. Conclusion We observed an increasing trend in P/F ratio on the 3rd day following itolizumab administration in comparison with tocilizumab, and the difference was statistically significant (P<0.001).","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124353661","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 : 2023-01-01DOI: 10.4103/roaic.roaic_19_22
Iman S. Aboul Fetouh, Rehab S Khattab, A. Salem, N. Naguib, Tamer Omar
Aims To evaluate the efficacy and safety of verapamil as an adjuvant to the local anesthetics xylocaine and bupivacaine for peribulbar block in vitreoretinal surgery. Settings and design This blinded, randomized, controlled trial was carried out at the Research Institute of Ophthalmology, Egypt. Patients and methods A total of 82 eligible patients were randomly allocated into two groups. The control group received xylocaine, bupivacaine, and normal saline. Verapamil group were treated the same way as the control group but received 5 mg of verapamil instead of normal saline. The primary outcomes included the onset of sensory block, motor block, lid akinesia, duration of the block, and patients’ hemodynamics. Secondary outcomes included postoperative pain, time to first analgesia, and patient’s and surgeon’s satisfaction. Results The onset of sensory block was significantly shorter in the verapamil group compared with the control group (42.6±10.1 vs. 52.2±23.6 s, respectively; P=0.020). A significant decrease in the mean rank of VAS score was recorded at two h in the verapamil group compared with the control group (30.72 vs. 47.50, respectively; P=0.001). Otherwise, the medians of motor block and lid akinesia and the mean duration of block did not show significant differences between the two groups. Conclusions Addition of 5 mg of verapamil to a mixture of 5 ml of xylocaine 2% and 5 ml of bupivacaine 0.5% in peribulbar block significantly shortened the onset of sensory block and reduced the postoperative pain but did not affect the onset of motor block or the duration of anesthesia.
{"title":"The effect of adding verapamil to local anesthetics in peribulbar block for intraoperative anesthesia and postoperative analgesia in vitreoretinal surgery: a randomized clinical trial","authors":"Iman S. Aboul Fetouh, Rehab S Khattab, A. Salem, N. Naguib, Tamer Omar","doi":"10.4103/roaic.roaic_19_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_19_22","url":null,"abstract":"Aims To evaluate the efficacy and safety of verapamil as an adjuvant to the local anesthetics xylocaine and bupivacaine for peribulbar block in vitreoretinal surgery. Settings and design This blinded, randomized, controlled trial was carried out at the Research Institute of Ophthalmology, Egypt. Patients and methods A total of 82 eligible patients were randomly allocated into two groups. The control group received xylocaine, bupivacaine, and normal saline. Verapamil group were treated the same way as the control group but received 5 mg of verapamil instead of normal saline. The primary outcomes included the onset of sensory block, motor block, lid akinesia, duration of the block, and patients’ hemodynamics. Secondary outcomes included postoperative pain, time to first analgesia, and patient’s and surgeon’s satisfaction. Results The onset of sensory block was significantly shorter in the verapamil group compared with the control group (42.6±10.1 vs. 52.2±23.6 s, respectively; P=0.020). A significant decrease in the mean rank of VAS score was recorded at two h in the verapamil group compared with the control group (30.72 vs. 47.50, respectively; P=0.001). Otherwise, the medians of motor block and lid akinesia and the mean duration of block did not show significant differences between the two groups. Conclusions Addition of 5 mg of verapamil to a mixture of 5 ml of xylocaine 2% and 5 ml of bupivacaine 0.5% in peribulbar block significantly shortened the onset of sensory block and reduced the postoperative pain but did not affect the onset of motor block or the duration of anesthesia.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132065675","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 : 2023-01-01DOI: 10.4103/roaic.roaic_39_22
N. Sasikumar, S. Rajan, Pulak Tosh, Kaushik Barua
{"title":"A case of an ischemic bulky free flap contributing to severe postoperative lactic acidosis following major head and neck reconstructive surgery","authors":"N. Sasikumar, S. Rajan, Pulak Tosh, Kaushik Barua","doi":"10.4103/roaic.roaic_39_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_39_22","url":null,"abstract":"","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126822738","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 : 2023-01-01DOI: 10.4103/roaic.roaic_18_20
Aliaa Faiter, Magdy Abd Mansour, A. Hozien
Aim To assess the efficacy of preemptive analgesia in the form of ultrasound-guided (IIN / IHN) block alone or with lidocaine (5%) patch on (US) acute, chronic post-herniorrhaphy pain and patient satisfaction. Patients and methods Preemptive US guided IIN / IHN block was performed on 60 patients (equally distributed into two groups) planned to undergo unilateral inguinal hernia operation under general anesthesia, 30 patients without lidocaine (5%) patch (group I) and 30 patients with lidocaine (5%) patch in the postoperative day 0 (group II). The groups were compared regarding patient satisfaction, intensity of postoperative pain, chronic post-herniorrhaphy pain, and its impact on daily activities. Results There were considerable differences between two groups as regards Douleur Neuropathique en 4 questions as it was higher in group I, P value less than 0.001. There was a significant increase in Brief Pain Inventory short form score postoperatively through 1, 3, and 6 months in group I, P value of 0.033. On the other hand, there were insignificant differences within each group as regards Brief Pain Inventory at 1, 3, and 6 months postoperatively with P values of 0.378, 0.931, and 0.934, respectively. There were insignificant differences regarding the patient’s satisfaction and postoperative visual analog scale. Conclusions US guided IIN / IHN block provides good perioperative pain control for inguinal hernia-repair surgeries. Addition of lidocaine (5%) patch may increase patient satisfaction and improve chronic postoperative pain outcome.
{"title":"Evaluation of chronic post-inguinal herniorrhaphy pain in patients receiving ultrasound-guided ilioinguinal and iliohypogastric nerve block with lidocaine (5%) patch","authors":"Aliaa Faiter, Magdy Abd Mansour, A. Hozien","doi":"10.4103/roaic.roaic_18_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_18_20","url":null,"abstract":"Aim To assess the efficacy of preemptive analgesia in the form of ultrasound-guided (IIN / IHN) block alone or with lidocaine (5%) patch on (US) acute, chronic post-herniorrhaphy pain and patient satisfaction. Patients and methods Preemptive US guided IIN / IHN block was performed on 60 patients (equally distributed into two groups) planned to undergo unilateral inguinal hernia operation under general anesthesia, 30 patients without lidocaine (5%) patch (group I) and 30 patients with lidocaine (5%) patch in the postoperative day 0 (group II). The groups were compared regarding patient satisfaction, intensity of postoperative pain, chronic post-herniorrhaphy pain, and its impact on daily activities. Results There were considerable differences between two groups as regards Douleur Neuropathique en 4 questions as it was higher in group I, P value less than 0.001. There was a significant increase in Brief Pain Inventory short form score postoperatively through 1, 3, and 6 months in group I, P value of 0.033. On the other hand, there were insignificant differences within each group as regards Brief Pain Inventory at 1, 3, and 6 months postoperatively with P values of 0.378, 0.931, and 0.934, respectively. There were insignificant differences regarding the patient’s satisfaction and postoperative visual analog scale. Conclusions US guided IIN / IHN block provides good perioperative pain control for inguinal hernia-repair surgeries. Addition of lidocaine (5%) patch may increase patient satisfaction and improve chronic postoperative pain outcome.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131375500","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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