Pub Date : 2023-01-01DOI: 10.4103/roaic.roaic_17_21
M. Khalifa, R. Ammar, A. Elshafie
Background In vertebral fixation surgeries, patients lose a lot of blood during the course of surgery. This could result in severe patient complications during and after surgery. This also makes surgical visualization in the bloody field difficult and the duration of surgery more prolonged. With the new anesthetic agents, drugs, and monitoring techniques, this problem has been addressed. Controlled hypotension is defined as a reduction in systolic blood pressure to 80–90 mmHg, a reduction of mean arterial pressure (MAP) to 60–70 mmHg or by 30% of the baseline. Controlled hypotension is a commonly used technique to limit blood loss and improve visualization of the operative field during vertebral fixation surgery. Objective To compare the effects of intravenous infusion of dexmedetomidine (DEX) and nitroglycerin (NTG) on intraoperative hemodynamics, amount of blood loss, speed of recovery from hypotension after cessation of infusion, and postoperative complications. Subjective This study was carried out on 50 adult patients of both sexes, American Society of Anesthesiologists I and II, admitted to Alexandria Main University Hospital, Department of Neurosurgery for elective spinal fixation surgeries (by the same surgical team) under general anesthesia. Results The results of the present study showed that arterial blood pressure in group I DEX at baseline (before induction of anesthesia) was 87.32±6.11 and increases significantly after 10 min from 20 to 80 min. The MAP was significantly decreased in group I at 90 min till the end of follow-up; there was no significant change in MAP from the baseline, while in group II ‘NTG.’ Comparing the two studied groups regarding MAP at different periods of follow-up, it was found that there was no significant difference between the two groups regarding MAP all over the period of follow-up. Conclusion NTG and DEX could induce hypotension, but DEX showed a more favorable hemodynamic profile as regards blood pressure and heart rate. DEX also showed a shorter duration of surgery with less blood loss and less blood transfusion.
背景在椎体固定手术中，患者在手术过程中会大量失血。这可能导致患者在手术期间和手术后出现严重的并发症。这也使得手术在血液区的可视化变得困难，并且延长了手术时间。随着新的麻醉剂、药物和监测技术的出现，这个问题已经得到了解决。控制性低血压的定义是收缩压降至80-90 mmHg，平均动脉压(MAP)降至60-70 mmHg或基线的30%。在椎体固定手术中，控制性低血压是一种常用的技术，以限制失血量和提高手术视野的可视性。目的比较右美托咪定(DEX)与硝酸甘油(NTG)静脉滴注对术中血流动力学、失血量、停注后低血压恢复速度及术后并发症的影响。本研究的对象是在亚历山大大学附属医院神经外科(同一手术组)接受全麻下择期脊柱固定手术的50例男女成年患者，均为美国麻醉师学会I、II分会会员。结果本研究结果显示，ⅰ组患者基线(麻醉前)动脉血压为87.32±6.11,20 ~ 80 min后10 min明显升高。1组在随访结束前90 min MAP明显降低;与基线相比，MAP没有显著变化，而在第二组的NTG中。比较两组在不同随访时期的MAP，发现两组在整个随访期间的MAP没有显著差异。结论NTG和DEX均可诱导低血压，但DEX在血压和心率方面表现出更有利的血流动力学特征。DEX还显示手术时间短，出血量少，输血量少。
{"title":"Comparison between intravenous dexmedetomidine and nitroglycerin infusions for induced hypotension in patients undergoing vertebral fixation surgeries","authors":"M. Khalifa, R. Ammar, A. Elshafie","doi":"10.4103/roaic.roaic_17_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_17_21","url":null,"abstract":"Background In vertebral fixation surgeries, patients lose a lot of blood during the course of surgery. This could result in severe patient complications during and after surgery. This also makes surgical visualization in the bloody field difficult and the duration of surgery more prolonged. With the new anesthetic agents, drugs, and monitoring techniques, this problem has been addressed. Controlled hypotension is defined as a reduction in systolic blood pressure to 80–90 mmHg, a reduction of mean arterial pressure (MAP) to 60–70 mmHg or by 30% of the baseline. Controlled hypotension is a commonly used technique to limit blood loss and improve visualization of the operative field during vertebral fixation surgery. Objective To compare the effects of intravenous infusion of dexmedetomidine (DEX) and nitroglycerin (NTG) on intraoperative hemodynamics, amount of blood loss, speed of recovery from hypotension after cessation of infusion, and postoperative complications. Subjective This study was carried out on 50 adult patients of both sexes, American Society of Anesthesiologists I and II, admitted to Alexandria Main University Hospital, Department of Neurosurgery for elective spinal fixation surgeries (by the same surgical team) under general anesthesia. Results The results of the present study showed that arterial blood pressure in group I DEX at baseline (before induction of anesthesia) was 87.32±6.11 and increases significantly after 10 min from 20 to 80 min. The MAP was significantly decreased in group I at 90 min till the end of follow-up; there was no significant change in MAP from the baseline, while in group II ‘NTG.’ Comparing the two studied groups regarding MAP at different periods of follow-up, it was found that there was no significant difference between the two groups regarding MAP all over the period of follow-up. Conclusion NTG and DEX could induce hypotension, but DEX showed a more favorable hemodynamic profile as regards blood pressure and heart rate. DEX also showed a shorter duration of surgery with less blood loss and less blood transfusion.","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":"132338950","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 : 2022-10-01DOI: 10.4103/roaic.roaic_74_21
Mohammed Mohammed, Ali El Said Rashad
Background Postoperative sore throat (POST) is commonly reported by patients after endotracheal intubation. This study was conducted to compare the efficacy of intravenous lidocaine and dexamethasone in the prevention of such problem. Patients and methods We included a total of 394 cases who were randomly divided using the closed-envelope method into two groups: group D that included 197 cases who received intravenous dexamethasone (8 mg), and group L that included the remaining 197 cases who received intravenous lidocaine (1.5 mg/kg). Both the incidence and risk factors for POST were assessed. Results Sore throat was reported by 115 (58.4%) cases in group L, whereas it was reported by 82 (41.6%) cases of cases in the other group. There was a marked reduction of sore-throat sensation in group D (P<0.001). Logistic regression revealed that the presence of blood on suction was a significant risk factor for developing sore throat after intubation. Conclusion Intravenous administration of dexamethasone appears to be more promising than lidocaine in decreasing the incidence of POST.
{"title":"Lidocaine versus dexamethasone for reduction of sore throat after general anesthesia: a comparative study","authors":"Mohammed Mohammed, Ali El Said Rashad","doi":"10.4103/roaic.roaic_74_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_74_21","url":null,"abstract":"Background Postoperative sore throat (POST) is commonly reported by patients after endotracheal intubation. This study was conducted to compare the efficacy of intravenous lidocaine and dexamethasone in the prevention of such problem. Patients and methods We included a total of 394 cases who were randomly divided using the closed-envelope method into two groups: group D that included 197 cases who received intravenous dexamethasone (8 mg), and group L that included the remaining 197 cases who received intravenous lidocaine (1.5 mg/kg). Both the incidence and risk factors for POST were assessed. Results Sore throat was reported by 115 (58.4%) cases in group L, whereas it was reported by 82 (41.6%) cases of cases in the other group. There was a marked reduction of sore-throat sensation in group D (P<0.001). Logistic regression revealed that the presence of blood on suction was a significant risk factor for developing sore throat after intubation. Conclusion Intravenous administration of dexamethasone appears to be more promising than lidocaine in decreasing the incidence of POST.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127903785","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 : 2022-10-01DOI: 10.4103/roaic.roaic_6_22
C. Sinha, P. Kumari, U. Bhadani, M. Anant, Arun Shettru Kotresh
Coronavirus disease 2019 (COVID-19) is a contagious pulmonary infectious disease with respiratory symptoms. The virus, SARS-CoV-2 has shown 85% resemblance to SARS coronavirus (SARS-CoV) and MERS coronavirus (MERS-CoV). The management of a COVID-19 positive mother is challenging as the virus is extremely contagious and can be life threatening to mothers and health-care personnel. Here, we describe the successful anesthetic management of 20 pregnant women with confirmed COVID-19 infection undergoing cesarean section in our hospital. A dedicated operating room was used for cesarean delivery of a parturient with COVID-19. This dedicated operating room was located in the secluded area of our hospital, away from the rest of the operating rooms. The first choice of anesthesia was a single-shot subarachnoid block with 0.5% heavy bupivacaine.
{"title":"Anesthetic management of cesarean sections in coronavirus disease 2019 patients at our coronavirus disease center: a case series","authors":"C. Sinha, P. Kumari, U. Bhadani, M. Anant, Arun Shettru Kotresh","doi":"10.4103/roaic.roaic_6_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_6_22","url":null,"abstract":"Coronavirus disease 2019 (COVID-19) is a contagious pulmonary infectious disease with respiratory symptoms. The virus, SARS-CoV-2 has shown 85% resemblance to SARS coronavirus (SARS-CoV) and MERS coronavirus (MERS-CoV). The management of a COVID-19 positive mother is challenging as the virus is extremely contagious and can be life threatening to mothers and health-care personnel. Here, we describe the successful anesthetic management of 20 pregnant women with confirmed COVID-19 infection undergoing cesarean section in our hospital. A dedicated operating room was used for cesarean delivery of a parturient with COVID-19. This dedicated operating room was located in the secluded area of our hospital, away from the rest of the operating rooms. The first choice of anesthesia was a single-shot subarachnoid block with 0.5% heavy bupivacaine.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134086448","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 : 2022-10-01DOI: 10.4103/roaic.roaic_23_22
E. Ismail, F. Askar, Asmaa Toni, Mohamed Elyounsi, O. Askar
Background Spinal anesthesia is acceptable in patients undergoing diabetic foot surgery. The duration of the spinal anesthesia has been improved by the addition of other drugs such as opioids, dexmedetomidine, clonidine, and dexamethasone. Dexamethasone may affect blood glucose levels. The primary outcome of the study was the effect of a single dose of intrathecal dexamethasone on blood glucose levels during the first 24 h postoperatively. Patients and methods After approval, 60 diabetic patients, American Society of Anesthesiologists grades 2 and 3 with ages ranging from 20 to 70 years were enrolled in this randomized, double-blinded, placebo-controlled trial. All patients who underwent diabetic foot surgery under spinal anesthesia have controlled type II diabetes. Patients were randomly allocated into two equal groups: the control group was given intrathecal 2.5 ml of hyperbaric bupivacaine 0.5% plus 1 ml of 0.9% sodium chloride. The dexamethasone group was given intrathecal 2.5 ml of hyperbaric bupivacaine 0.5% plus 4 mg of dexamethasone. Results The control group had significantly lower levels of blood sugar at different times compared with the dexamethasone group. However, at the end of 24 h, nonsignificant changes were present between the two groups. Also, using 200 mg/dl as a cutoff for high blood sugar, there were nonsignificant changes all through the 24 h in both groups. Moreover, dexamethasone prolongs the duration of analgesia and decreases paracetamol requirements during the first 24 h postoperatively. Conclusions Addition of intrathecal dexamethasone did not change postoperative glycemic evolution in controlled diabetic patients undergoing diabetic foot surgery. However, it significantly prolongs the duration of analgesia and decreases analgesic consumption during the first 24 h postoperatively.
背景:在接受糖尿病足手术的患者中，脊髓麻醉是可以接受的。加入阿片类药物、右美托咪定、可乐定、地塞米松等其他药物后，脊髓麻醉的持续时间得到改善。地塞米松可能影响血糖水平。该研究的主要结果是单剂量鞘内地塞米松对术后24小时内血糖水平的影响。患者和方法经批准后，60名年龄在20至70岁之间的美国麻醉学会2级和3级糖尿病患者被纳入这项随机、双盲、安慰剂对照试验。所有在脊柱麻醉下接受糖尿病足部手术的患者均控制了II型糖尿病。患者随机分为两组:对照组给予鞘内2.5 ml 0.5%高压布比卡因+ 1 ml 0.9%氯化钠。地塞米松组给予布比卡因0.5%高压压2.5 ml +地塞米松4mg的鞘内注射。结果与地塞米松组比较，对照组患者不同时间血糖水平均明显降低。然而，在24小时结束时，两组之间没有明显变化。同样，使用200 mg/dl作为高血糖的临界值，两组在24小时内都没有显著变化。此外，地塞米松延长了镇痛持续时间，减少了术后24小时对扑热息痛的需求。结论鞘内添加地塞米松不会改变接受糖尿病足手术的控制糖尿病患者的术后血糖演变。然而，它明显延长了镇痛持续时间，减少了术后24小时内的镇痛消耗。
{"title":"Effect of adding dexamethasone to intrathecal bupivacaine on blood sugar of controlled diabetic patients undergoing diabetic foot surgeries","authors":"E. Ismail, F. Askar, Asmaa Toni, Mohamed Elyounsi, O. Askar","doi":"10.4103/roaic.roaic_23_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_23_22","url":null,"abstract":"Background Spinal anesthesia is acceptable in patients undergoing diabetic foot surgery. The duration of the spinal anesthesia has been improved by the addition of other drugs such as opioids, dexmedetomidine, clonidine, and dexamethasone. Dexamethasone may affect blood glucose levels. The primary outcome of the study was the effect of a single dose of intrathecal dexamethasone on blood glucose levels during the first 24 h postoperatively. Patients and methods After approval, 60 diabetic patients, American Society of Anesthesiologists grades 2 and 3 with ages ranging from 20 to 70 years were enrolled in this randomized, double-blinded, placebo-controlled trial. All patients who underwent diabetic foot surgery under spinal anesthesia have controlled type II diabetes. Patients were randomly allocated into two equal groups: the control group was given intrathecal 2.5 ml of hyperbaric bupivacaine 0.5% plus 1 ml of 0.9% sodium chloride. The dexamethasone group was given intrathecal 2.5 ml of hyperbaric bupivacaine 0.5% plus 4 mg of dexamethasone. Results The control group had significantly lower levels of blood sugar at different times compared with the dexamethasone group. However, at the end of 24 h, nonsignificant changes were present between the two groups. Also, using 200 mg/dl as a cutoff for high blood sugar, there were nonsignificant changes all through the 24 h in both groups. Moreover, dexamethasone prolongs the duration of analgesia and decreases paracetamol requirements during the first 24 h postoperatively. Conclusions Addition of intrathecal dexamethasone did not change postoperative glycemic evolution in controlled diabetic patients undergoing diabetic foot surgery. However, it significantly prolongs the duration of analgesia and decreases analgesic consumption during the first 24 h postoperatively.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122773929","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 : 2022-10-01DOI: 10.4103/roaic.roaic_35_22
H. Ali, Naglaa A. Elnegeery
Background There has been an increasing trend toward performing inguinal repair surgeries under regional anesthetic techniques like paravertebral block (PVB). Neostigmine has been used as an adjuvant to local anesthetics, but the existing research studies are few. This study was conducted to evaluate the efficacy of neostigmine as an adjuvant to local anesthesia used for PVB in inguinal hernia repair procedures. Patients and methods This prospective randomized study included 72 patients prepared for elective inguinal hernia repair under PVB. They were allocated into two groups: the neostigmine group received a mixture of bupivacaine and neostigmine (5 μg/kg), whereas the control group received bupivacaine alone. During the postoperative period, pain score, hemodynamic parameters, first analgesic request, total analgesic consumption, and the incidence of adverse effects were noted and recorded. Results Both groups showed comparable findings regarding age and weight. However, the number of patients requiring rescue analgesia showed a significant increase in the control group. Moreover, controls reported significantly earlier first analgesic requests. Both diclofenac and fentanyl consumptions were increased without neostigmine administration. Pain score was significantly better with neostigmine at 4 and 6 h after surgery. Hemodynamic parameters were almost comparable between the two groups. Conclusion Neostigmine appears to be an efficient adjuvant to local anesthetics when administered during PVB as it significantly improves its analgesic profile. Its administration should be encouraged in clinical practice.
{"title":"Ultrasound-guided paravertebral block for inguinal herniorrhaphy: does neostigmine have a role?","authors":"H. Ali, Naglaa A. Elnegeery","doi":"10.4103/roaic.roaic_35_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_35_22","url":null,"abstract":"Background There has been an increasing trend toward performing inguinal repair surgeries under regional anesthetic techniques like paravertebral block (PVB). Neostigmine has been used as an adjuvant to local anesthetics, but the existing research studies are few. This study was conducted to evaluate the efficacy of neostigmine as an adjuvant to local anesthesia used for PVB in inguinal hernia repair procedures. Patients and methods This prospective randomized study included 72 patients prepared for elective inguinal hernia repair under PVB. They were allocated into two groups: the neostigmine group received a mixture of bupivacaine and neostigmine (5 μg/kg), whereas the control group received bupivacaine alone. During the postoperative period, pain score, hemodynamic parameters, first analgesic request, total analgesic consumption, and the incidence of adverse effects were noted and recorded. Results Both groups showed comparable findings regarding age and weight. However, the number of patients requiring rescue analgesia showed a significant increase in the control group. Moreover, controls reported significantly earlier first analgesic requests. Both diclofenac and fentanyl consumptions were increased without neostigmine administration. Pain score was significantly better with neostigmine at 4 and 6 h after surgery. Hemodynamic parameters were almost comparable between the two groups. Conclusion Neostigmine appears to be an efficient adjuvant to local anesthetics when administered during PVB as it significantly improves its analgesic profile. Its administration should be encouraged in clinical practice.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128990555","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 : 2022-10-01DOI: 10.4103/roaic.roaic_28_22
T. Mawla, Aliaa Elhameed, Areeg Abdallah, O. Momtaz
Background Acute circulatory collapse is one of the most familiar challenges in ICUs. It is considered that artefacts generated by lung ultrasound (LUS) can help in diagnosis and management. FALLS-protocol using LUS is a tool proposed for the management of unexplained shock. Objectives To investigate the role of LUS FALLS-protocol in differentiating types of shock in critically ill patients. Patients and methods A total of 50 patients presented with undiagnosed shock. Fast bedside echocardiography and LUS FALLS-protocol were applied along with inferior vena cava diameter and collapsibility measurement. Results A total of 19 patients with septic shock on presentation had A profile in all of them and AB profile in three of them, and after resuscitation, they were transformed to B profile with 100% sensitivity, 90.5% specificity, 90.5% positive predictive value (PPV), and 100% negative predictive value (NPV). Overall, 16 patients with hypovolemic shock had A profile in all of them on presentation and after resuscitation, with 100% sensitivity, 94.1% specificity, 88.9% PPV, and 100% NPV. Moreover, eight patients with cardiogenic shock had B profile in all of them on presentation with 100% sensitivity, 95.2% specificity, 80% PPV, and 100% NPV; three patients with obstructive shock had A profile in all of them on presentation, with 100% sensitivity, 25.5% specificity, 7.9% PPV, and 100% NPV; and two patients with anaphylactic shock had A profile in all of them on presentation and transformed to B profile after resuscitation with 100% sensitivity, 50% specificity, 9.5% PPV, and 100% NPV. Our findings showed preference of FALLS-protocol than inferior vena cava diameter and collapsibility in directing fluid therapy. Conclusion Bedside chest ultrasound FALLS-protocol should be considered in the resuscitation pathways with a possible significant effect on patient management.
{"title":"Validity of lung ultrasound FALLS-protocol in differentiating types of shock in critically ill patients","authors":"T. Mawla, Aliaa Elhameed, Areeg Abdallah, O. Momtaz","doi":"10.4103/roaic.roaic_28_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_28_22","url":null,"abstract":"Background Acute circulatory collapse is one of the most familiar challenges in ICUs. It is considered that artefacts generated by lung ultrasound (LUS) can help in diagnosis and management. FALLS-protocol using LUS is a tool proposed for the management of unexplained shock. Objectives To investigate the role of LUS FALLS-protocol in differentiating types of shock in critically ill patients. Patients and methods A total of 50 patients presented with undiagnosed shock. Fast bedside echocardiography and LUS FALLS-protocol were applied along with inferior vena cava diameter and collapsibility measurement. Results A total of 19 patients with septic shock on presentation had A profile in all of them and AB profile in three of them, and after resuscitation, they were transformed to B profile with 100% sensitivity, 90.5% specificity, 90.5% positive predictive value (PPV), and 100% negative predictive value (NPV). Overall, 16 patients with hypovolemic shock had A profile in all of them on presentation and after resuscitation, with 100% sensitivity, 94.1% specificity, 88.9% PPV, and 100% NPV. Moreover, eight patients with cardiogenic shock had B profile in all of them on presentation with 100% sensitivity, 95.2% specificity, 80% PPV, and 100% NPV; three patients with obstructive shock had A profile in all of them on presentation, with 100% sensitivity, 25.5% specificity, 7.9% PPV, and 100% NPV; and two patients with anaphylactic shock had A profile in all of them on presentation and transformed to B profile after resuscitation with 100% sensitivity, 50% specificity, 9.5% PPV, and 100% NPV. Our findings showed preference of FALLS-protocol than inferior vena cava diameter and collapsibility in directing fluid therapy. Conclusion Bedside chest ultrasound FALLS-protocol should be considered in the resuscitation pathways with a possible significant effect on patient management.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134049362","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 : 2022-10-01DOI: 10.4103/roaic.roaic_69_19
A. Fawzy, Omar Aleem, Ayman A Rayan, A. Aiad
Background Transversus abdominis plane (TAP) block is a newly effective peripheral block which involving mainly the nerves of the anterior abdominal wall in lower abdominal surgery. The present study aimed to evaluate the postoperative analgesic efficacy of right-sided ultrasound guided TAP block by using 20 millimeters of bupivacaine 0.25% in patients undergoing open appendicectomy. Patients and methods After taking informed consent, fifty patients (ASA I and II) undergoing open appendicectomy were randomized into 2 groups (25 each). After induction of general anesthesia; Group B received right side ultrasound guided TAP block using 20 ml bupivacaine 0.25%. Group S (standard group) received general anesthesia without TAP block. Postoperative analgesia by ketorolac and paracetamol was given as required. Postoperative VAS at rest and movement, intra and post operative hemodynamics, analgesic requirements and their side effects were recorded for 24 hours. Results A significant reduction of VAS up to twelve hours postoperatively detected in the TAP block group with bupivacaine 0.25%. There was also significant elongation of time to the first analgesia, significant reduction in number of rescue analgesics, as will as there were significant decrease in nausea, vomiting and pruritus between two groups. Conclusion Right-sided ultrasound guided TAP block using 20 ml of bupivacaine 0.25% had effective postoperative analgesia for twelve hours after the open appendicectomy.
{"title":"Pre-emptive ultrasound-guided transversus abdominis plane block in open appendicectomy","authors":"A. Fawzy, Omar Aleem, Ayman A Rayan, A. Aiad","doi":"10.4103/roaic.roaic_69_19","DOIUrl":"https://doi.org/10.4103/roaic.roaic_69_19","url":null,"abstract":"Background Transversus abdominis plane (TAP) block is a newly effective peripheral block which involving mainly the nerves of the anterior abdominal wall in lower abdominal surgery. The present study aimed to evaluate the postoperative analgesic efficacy of right-sided ultrasound guided TAP block by using 20 millimeters of bupivacaine 0.25% in patients undergoing open appendicectomy. Patients and methods After taking informed consent, fifty patients (ASA I and II) undergoing open appendicectomy were randomized into 2 groups (25 each). After induction of general anesthesia; Group B received right side ultrasound guided TAP block using 20 ml bupivacaine 0.25%. Group S (standard group) received general anesthesia without TAP block. Postoperative analgesia by ketorolac and paracetamol was given as required. Postoperative VAS at rest and movement, intra and post operative hemodynamics, analgesic requirements and their side effects were recorded for 24 hours. Results A significant reduction of VAS up to twelve hours postoperatively detected in the TAP block group with bupivacaine 0.25%. There was also significant elongation of time to the first analgesia, significant reduction in number of rescue analgesics, as will as there were significant decrease in nausea, vomiting and pruritus between two groups. Conclusion Right-sided ultrasound guided TAP block using 20 ml of bupivacaine 0.25% had effective postoperative analgesia for twelve hours after the open appendicectomy.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115498740","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}
Background and aims Cisatracurium has many advantages over other nondepolarizing muscle relaxants; however, for rapid intubation, rocuronium is the preferred drug in lieu of succinylcholine. The aim of this study was to compare the onset time and intubating conditions at 90 s using 0.3 mg/kg cisatracurium (6× ED95) versus 1.2 mg/kg rocuronium (4× ED95). Material and methods The study was conducted at a tertiary care hospital as a randomized double-blind prospective study after obtaining the ethical committee clearance. A total of 60 patients were randomly assigned to receive 1.2 mg/kg rocuronium (4× ED95) or 0.3 mg/kg cisatracurium (6× ED95) after premedication with fentanyl-midazolam and induction with propofol-sevoflurane. Laryngoscopy and intubation were done at 90 s. Primary outcomes assessed were laryngoscopy and intubation conditions and onset times. The Student t test was used to compare prospective, repeated measures. χ2 test was used to test the significance of difference for qualitative variables. Results The onset of action of the muscle relaxant was predicted by measuring train-of-four ratio and was found to be significantly longer in the cisatracurium group (149.50±25.064 s) than in the rocuronium group (101±s) (P<0.05). Although the intubating conditions were better in the rocuronium group, cisatracurium also provided good to excellent intubation conditions at 90 s. Conclusion Cisatracurium can be used to intubate the trachea at 90 s at a dose of 0.3 mg/kg in patients premedicated with fentanyl-midazolam and induced with propofol-sevoflurane, while maintaining hemodynamic stability, without increasing the incidence of adverse effects.
{"title":"Comparison of rapid intubating conditions between rocuronium and cisatracurium: a randomized double-blind study","authors":"Rohini Bhat Pai, Anisha Deulkar, Deependra Kambli, Bhagyashri Kanekar, Pragati Volvoikar, Hemant Parsekar, S. Kamat","doi":"10.4103/roaic.roaic_1_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_1_22","url":null,"abstract":"Background and aims Cisatracurium has many advantages over other nondepolarizing muscle relaxants; however, for rapid intubation, rocuronium is the preferred drug in lieu of succinylcholine. The aim of this study was to compare the onset time and intubating conditions at 90 s using 0.3 mg/kg cisatracurium (6× ED95) versus 1.2 mg/kg rocuronium (4× ED95). Material and methods The study was conducted at a tertiary care hospital as a randomized double-blind prospective study after obtaining the ethical committee clearance. A total of 60 patients were randomly assigned to receive 1.2 mg/kg rocuronium (4× ED95) or 0.3 mg/kg cisatracurium (6× ED95) after premedication with fentanyl-midazolam and induction with propofol-sevoflurane. Laryngoscopy and intubation were done at 90 s. Primary outcomes assessed were laryngoscopy and intubation conditions and onset times. The Student t test was used to compare prospective, repeated measures. χ2 test was used to test the significance of difference for qualitative variables. Results The onset of action of the muscle relaxant was predicted by measuring train-of-four ratio and was found to be significantly longer in the cisatracurium group (149.50±25.064 s) than in the rocuronium group (101±s) (P<0.05). Although the intubating conditions were better in the rocuronium group, cisatracurium also provided good to excellent intubation conditions at 90 s. Conclusion Cisatracurium can be used to intubate the trachea at 90 s at a dose of 0.3 mg/kg in patients premedicated with fentanyl-midazolam and induced with propofol-sevoflurane, while maintaining hemodynamic stability, without increasing the incidence of adverse effects.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114146132","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 : 2022-10-01DOI: 10.4103/roaic.roaic_21_22
W. Abu-Elwafa, Islam S. H. Ahmed, Salah-Eldin Abdul-Aziz, A. Hassan
Introduction Among all the regional blocks, the peribulbar block is one of the most popular for most ophthalmic procedures as it has few complications. Aim To study the effects of mixing local anesthetic with either dexmedetomidine or fentanyl in the peribulbar block for vitreoretinal surgery. Patients and methods The study included 40 adult patients (ASA II–IV) who had a peribulbar block for elective retinal surgery at Sohag University Hospital. All patients received the following combination: lidocaine 2%, bupivacaine 0.5%, hyaluronidase 15 IU/Ml, in addition to either 20 μg of fentanyl (group F) or 20 μg of dexmedetomidine (group D). The duration of postoperative analgesia, the onset, and duration of sensory and motor blocks, along with other complications, were recorded. Results The onset time of motor and sensory blocks was significantly longer in group F. For the duration of sensory and motor blocks, group D had a significantly greater duration than group F (P=0.05). Group D took substantially longer to request analgesia than group F (P=0.0002). Total paracetamol consumption was substantially higher in group F than in group D (P=0.001). The overall number of patients who required nalbuphine was substantially higher in group F (P=0.003) than in group D. At 2, 4, and 6 h postoperatively, the visual analog scale was statistically significantly greater in group F than in group D. Conclusion Dexmedetomidine-local anesthetic mixture in the peribulbar block for retinal surgery was superior to fentanyl-local anesthetic mixture regarding onset and duration of motor, sensory block, postoperative analgesia, and analgesic requirement.
{"title":"Peribulbar block for retinal surgery comparison among dexmedetomidine, fentanyl, and local anesthesia","authors":"W. Abu-Elwafa, Islam S. H. Ahmed, Salah-Eldin Abdul-Aziz, A. Hassan","doi":"10.4103/roaic.roaic_21_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_21_22","url":null,"abstract":"Introduction Among all the regional blocks, the peribulbar block is one of the most popular for most ophthalmic procedures as it has few complications. Aim To study the effects of mixing local anesthetic with either dexmedetomidine or fentanyl in the peribulbar block for vitreoretinal surgery. Patients and methods The study included 40 adult patients (ASA II–IV) who had a peribulbar block for elective retinal surgery at Sohag University Hospital. All patients received the following combination: lidocaine 2%, bupivacaine 0.5%, hyaluronidase 15 IU/Ml, in addition to either 20 μg of fentanyl (group F) or 20 μg of dexmedetomidine (group D). The duration of postoperative analgesia, the onset, and duration of sensory and motor blocks, along with other complications, were recorded. Results The onset time of motor and sensory blocks was significantly longer in group F. For the duration of sensory and motor blocks, group D had a significantly greater duration than group F (P=0.05). Group D took substantially longer to request analgesia than group F (P=0.0002). Total paracetamol consumption was substantially higher in group F than in group D (P=0.001). The overall number of patients who required nalbuphine was substantially higher in group F (P=0.003) than in group D. At 2, 4, and 6 h postoperatively, the visual analog scale was statistically significantly greater in group F than in group D. Conclusion Dexmedetomidine-local anesthetic mixture in the peribulbar block for retinal surgery was superior to fentanyl-local anesthetic mixture regarding onset and duration of motor, sensory block, postoperative analgesia, and analgesic requirement.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125901242","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 : 2022-10-01DOI: 10.4103/roaic.roaic_51_22
A. Salem, Dina Mohamed, Iman S. Aboul Fetouh, Rehab S Khattab, S. Mahmoud
Aims To assess the safety and efficacy of lidocaine gel 2% used in pediatric squint surgeries to prevent the oculocardiac reflex intraoperatively and reduce postoperative pain and agitation. Settings and design This single-blinded, randomized trial was carried out at the Research Institute of Ophthalmology, Egypt. Patients and methods Forty-eight children (2–13 years old) of both sexes scheduled for squint surgeries were randomly allocated into two groups (24 patients each): the lidocaine gel group and the control group. In the experimental group, we applied lidocaine gel 2% abundantly below both eyelids of the surgical eye for at least 3 min before surgical incision, while nothing was applied to patients in the control group. Patients were monitored intraoperatively and postoperatively, and the outcomes were recorded. Results There was a lower median postoperative face, leg, activity, cry, and consolability scale in the lidocaine gel group (3.0, interquartile range=2.5–5.0) than in the control group (4.0, interquartile range=1.5–7.0) with no significant difference (P=0.770). The incidence of bradycardia was lower with lidocaine gel 2% use (16.7%) compared with the control group (41.7%), but this difference was not statistically significant (P=0.057). We found no complications except for two patients in the control group who had fever and flushing due to atropine administration. Conclusion Application of lidocaine gel 2% below both lids of the surgical eye in pediatric squint surgery under general anesthesia is safe with no observed systemic side effects. However, it has no adjuvant effects in reducing postoperative pain and agitation or preventing intraoperative oculocardiac reflex.
{"title":"Preoperative topical lidocaine in pediatric squint surgeries: a randomized clinical trial","authors":"A. Salem, Dina Mohamed, Iman S. Aboul Fetouh, Rehab S Khattab, S. Mahmoud","doi":"10.4103/roaic.roaic_51_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_51_22","url":null,"abstract":"Aims To assess the safety and efficacy of lidocaine gel 2% used in pediatric squint surgeries to prevent the oculocardiac reflex intraoperatively and reduce postoperative pain and agitation. Settings and design This single-blinded, randomized trial was carried out at the Research Institute of Ophthalmology, Egypt. Patients and methods Forty-eight children (2–13 years old) of both sexes scheduled for squint surgeries were randomly allocated into two groups (24 patients each): the lidocaine gel group and the control group. In the experimental group, we applied lidocaine gel 2% abundantly below both eyelids of the surgical eye for at least 3 min before surgical incision, while nothing was applied to patients in the control group. Patients were monitored intraoperatively and postoperatively, and the outcomes were recorded. Results There was a lower median postoperative face, leg, activity, cry, and consolability scale in the lidocaine gel group (3.0, interquartile range=2.5–5.0) than in the control group (4.0, interquartile range=1.5–7.0) with no significant difference (P=0.770). The incidence of bradycardia was lower with lidocaine gel 2% use (16.7%) compared with the control group (41.7%), but this difference was not statistically significant (P=0.057). We found no complications except for two patients in the control group who had fever and flushing due to atropine administration. Conclusion Application of lidocaine gel 2% below both lids of the surgical eye in pediatric squint surgery under general anesthesia is safe with no observed systemic side effects. However, it has no adjuvant effects in reducing postoperative pain and agitation or preventing intraoperative oculocardiac reflex.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126858601","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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