Pub Date : 2022-01-01DOI: 10.4103/roaic.roaic_50_21
A. Abdelrazik, A. Ali, I. Youssef, Sohair A. Megalla
Background To evaluate whether dexamethasone as an adjuvant to bupivacaine–lidocaine mixture in supraclavicular brachial plexus block can enhance the block, prolong the duration of action, and improve postoperative analgesia than a mixture of bupivacaine–lidocaine only. Patients and methods In all, 60 patients were posted for elective and emergent upper limb orthopedic surgery (below shoulder joint), under supraclavicular brachial plexus block guided by a nerve stimulator. Patients were randomly divided into two equal groups: group C (the control group, n=30) received 40 ml solution containing local anesthetics only. Group D (the dexamethasone group, n=30) received a 40 ml solution containing local anesthetics plus 4 mg dexamethasone. Primary outcomes were onset time of sensory and motor block, and duration of sensory and motor block, which were assessed in minutes. Secondary outcomes were pain assessment using a scoring system based on the visual analog scale, time to first analgesic requirement, and total analgesic consumption. Results Duration of sensory and motor block in the dexamethasone group were significantly longer than the control group (753±68.04 vs. 565±30.85 min and 733.66±69.77 vs. 547.16±29.38 min, respectively). For visual analog scale, while comparing the two groups, the differences were significant at 9, 12, and 18 h after surgery in favor of the dexamethasone group. The time to first analgesic request was significantly longer in the dexamethasone group in comparison to the control group. The total analgesic requirement was also significantly lower in the dexamethasone group in comparison to the control group. Conclusion The use of dexamethasone at a dose of 4 mg as an adjuvant to local anesthetics provided effective prolongation in the duration of sensory and motor block, prolonged time to first analgesic request, and reduced the total analgesic consumption.
{"title":"Bupivacaine–lidocaine versus bupivacaine–lidocaine plus dexamethasone in supraclavicular brachial plexus block","authors":"A. Abdelrazik, A. Ali, I. Youssef, Sohair A. Megalla","doi":"10.4103/roaic.roaic_50_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_50_21","url":null,"abstract":"Background To evaluate whether dexamethasone as an adjuvant to bupivacaine–lidocaine mixture in supraclavicular brachial plexus block can enhance the block, prolong the duration of action, and improve postoperative analgesia than a mixture of bupivacaine–lidocaine only. Patients and methods In all, 60 patients were posted for elective and emergent upper limb orthopedic surgery (below shoulder joint), under supraclavicular brachial plexus block guided by a nerve stimulator. Patients were randomly divided into two equal groups: group C (the control group, n=30) received 40 ml solution containing local anesthetics only. Group D (the dexamethasone group, n=30) received a 40 ml solution containing local anesthetics plus 4 mg dexamethasone. Primary outcomes were onset time of sensory and motor block, and duration of sensory and motor block, which were assessed in minutes. Secondary outcomes were pain assessment using a scoring system based on the visual analog scale, time to first analgesic requirement, and total analgesic consumption. Results Duration of sensory and motor block in the dexamethasone group were significantly longer than the control group (753±68.04 vs. 565±30.85 min and 733.66±69.77 vs. 547.16±29.38 min, respectively). For visual analog scale, while comparing the two groups, the differences were significant at 9, 12, and 18 h after surgery in favor of the dexamethasone group. The time to first analgesic request was significantly longer in the dexamethasone group in comparison to the control group. The total analgesic requirement was also significantly lower in the dexamethasone group in comparison to the control group. Conclusion The use of dexamethasone at a dose of 4 mg as an adjuvant to local anesthetics provided effective prolongation in the duration of sensory and motor block, prolonged time to first analgesic request, and reduced the total analgesic consumption.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124989446","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 : 2022-01-01DOI: 10.4103/roaic.roaic_24_21
Yahya Morsi, R. Ammar, A. Elshafie
Background Pain was identified by the International Association for the Study of Pain as an unpleasant sensory or emotional experience associated with actual or potential tissue damage. The incidence of inadequate pain management seems to be high, even in the developed countries. Traumatic upper limbs injuries are accountable for a considerable number of patients, who require care by medical facilities (5–10% of emergency department visits). Regional anesthesia [e.g. brachial plexus block (BPB)] is increasingly taking place in patients with upper limb injuries as it is a logical choice avoiding the side effects of muscle relaxants, narcotics, and potent volatile anesthetics used in general anesthesia. Different additives have been used as an adjuvant with local anaesthetics to achieve dense and prolonged block and adequate postoperative analgesia. Objective To evaluate the effects of adding dexmedetomidine to bupivacaine versus bupivacaine alone in infraclavicular BPB with ultrasound guidance for plastic and reconstructive surgeries of the hand and forearm as regards the duration of postoperative analgesia, onset, and the duration of sensory and motor block and postoperative analgesic requirements. Patients and methods This randomized double-blind study carried out in Alexandria Main University Hospital on 70 adult patients of both sexes aged from 20 to 40 years, who were evaluated as American Society of Anesthesiologists I or II physical status and were scheduled for plastic and reconstructive surgeries of the hand and forearm. Results The results of our study show that the duration of analgesia ranged from 450 to 690 min with a mean value of 588.90±73.15 min in group C ‘control,’ while the duration of analgesia ranged from 990 to 1440 min with a mean value of 1295.10±121.60 min in group D ‘dexmedetomidine.’ Comparing the two groups, there was significant statistical difference in the duration of analgesia between the two groups, showing prolonged duration of analgesia in group D more than in group C. Conclusion Administration of bupivacaine with dexmedetomidine in infraclavicular BPB provides prolonged postoperative analgesia without causing a significant hemodynamic instability. Also, coadministration of dexmedetomidine leads to significantly decreased total analgesic doses required postoperatively with minimal side effects.
{"title":"Ultrasound-guided infraclavicular brachial plexus block using bupivacaine alone or combined with dexmedetomidine for hand and forearm surgeries","authors":"Yahya Morsi, R. Ammar, A. Elshafie","doi":"10.4103/roaic.roaic_24_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_24_21","url":null,"abstract":"Background Pain was identified by the International Association for the Study of Pain as an unpleasant sensory or emotional experience associated with actual or potential tissue damage. The incidence of inadequate pain management seems to be high, even in the developed countries. Traumatic upper limbs injuries are accountable for a considerable number of patients, who require care by medical facilities (5–10% of emergency department visits). Regional anesthesia [e.g. brachial plexus block (BPB)] is increasingly taking place in patients with upper limb injuries as it is a logical choice avoiding the side effects of muscle relaxants, narcotics, and potent volatile anesthetics used in general anesthesia. Different additives have been used as an adjuvant with local anaesthetics to achieve dense and prolonged block and adequate postoperative analgesia. Objective To evaluate the effects of adding dexmedetomidine to bupivacaine versus bupivacaine alone in infraclavicular BPB with ultrasound guidance for plastic and reconstructive surgeries of the hand and forearm as regards the duration of postoperative analgesia, onset, and the duration of sensory and motor block and postoperative analgesic requirements. Patients and methods This randomized double-blind study carried out in Alexandria Main University Hospital on 70 adult patients of both sexes aged from 20 to 40 years, who were evaluated as American Society of Anesthesiologists I or II physical status and were scheduled for plastic and reconstructive surgeries of the hand and forearm. Results The results of our study show that the duration of analgesia ranged from 450 to 690 min with a mean value of 588.90±73.15 min in group C ‘control,’ while the duration of analgesia ranged from 990 to 1440 min with a mean value of 1295.10±121.60 min in group D ‘dexmedetomidine.’ Comparing the two groups, there was significant statistical difference in the duration of analgesia between the two groups, showing prolonged duration of analgesia in group D more than in group C. Conclusion Administration of bupivacaine with dexmedetomidine in infraclavicular BPB provides prolonged postoperative analgesia without causing a significant hemodynamic instability. Also, coadministration of dexmedetomidine leads to significantly decreased total analgesic doses required postoperatively with minimal side effects.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115365140","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 Continuous positive airway pressure (CPAP) is increasingly used as a ward ceiling of care. Nevertheless, little is known about its effectiveness. Objective A retrospective study to explore whether CPAP therapy as a ceiling of care improves outcome in coronavirus disease 2019 (COVID-19)-infected patients with acute respiratory failure. Methods A retrospective cohort study was conducted on adult COVID-19-infected patients admitted to two UK hospitals from the March 1 to June 30, 2020. All patients experienced type 1 respiratory failure and were not suitable for intubation. They were divided into two groups: patients for CPAP versus conventional oxygen therapy (COT). Results A total of 39 patients received CPAP, whereas 247 received COT. CPAP group patients were more hypoxic (mean SpO2 86.5% vs. 91%, P=0.003), younger (mean±SD: 71.8±8.8 vs. 80.7±9.8 years, P<0.001), and less frail than the COT group [median (interquartile range) clinical frailty score 4 (3–5) vs. 6 (4–7), P<0.001]. Overall, 35 patients died in the CPAP group (89.7%) compared with 185 patients in the COT group (74.9%) (P=0.041). Propensity score matching of the two groups showed that CPAP was still associated with higher mortality (90.3 vs. 67.7%, P=0.029). Length of hospital stay was similar in both groups (mean±SD 9.2±7.3 vs. 9.7±8.6 days, P=0.719). Conclusion In COVID-19-infected patients presenting with type 1 respiratory failure and deemed not suitable for escalation to intubation, the use of CPAP therapy does not carry extra benefit than COT. In such patients, COT appears to be the appropriate measure. Further studies are required to corroborate these findings.
{"title":"A propensity score matching analysis for CPAP versus conventional oxygen therapy as a ceiling of care in COVID-19-associated type 1 respiratory failure","authors":"Noeman-Ahmed Yasser, Roshdy Ashraf, Bedir Abdulla, El Iman, Noeman Maryam, Koduri Gouri, Warrier Vinod, Gokaraju Sriya, Ayuen Patrice, Abualela Nour, Sharma Shashank, Powrie Duncan J.","doi":"10.4103/roaic.roaic_31_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_31_21","url":null,"abstract":"Background Continuous positive airway pressure (CPAP) is increasingly used as a ward ceiling of care. Nevertheless, little is known about its effectiveness. Objective A retrospective study to explore whether CPAP therapy as a ceiling of care improves outcome in coronavirus disease 2019 (COVID-19)-infected patients with acute respiratory failure. Methods A retrospective cohort study was conducted on adult COVID-19-infected patients admitted to two UK hospitals from the March 1 to June 30, 2020. All patients experienced type 1 respiratory failure and were not suitable for intubation. They were divided into two groups: patients for CPAP versus conventional oxygen therapy (COT). Results A total of 39 patients received CPAP, whereas 247 received COT. CPAP group patients were more hypoxic (mean SpO2 86.5% vs. 91%, P=0.003), younger (mean±SD: 71.8±8.8 vs. 80.7±9.8 years, P<0.001), and less frail than the COT group [median (interquartile range) clinical frailty score 4 (3–5) vs. 6 (4–7), P<0.001]. Overall, 35 patients died in the CPAP group (89.7%) compared with 185 patients in the COT group (74.9%) (P=0.041). Propensity score matching of the two groups showed that CPAP was still associated with higher mortality (90.3 vs. 67.7%, P=0.029). Length of hospital stay was similar in both groups (mean±SD 9.2±7.3 vs. 9.7±8.6 days, P=0.719). Conclusion In COVID-19-infected patients presenting with type 1 respiratory failure and deemed not suitable for escalation to intubation, the use of CPAP therapy does not carry extra benefit than COT. In such patients, COT appears to be the appropriate measure. Further studies are required to corroborate these findings.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134329296","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 : 2022-01-01DOI: 10.4103/roaic.roaic_9_20
M. Mohamed, R. Mohamed, Medhat Khali Mohamed, Hamed Khattab
Regardless of some preventive measures, postoperative sore throat (POST) and hoarseness of voice are most undesirable and most frequent complication in the post-operative period [1,2]. Postoperatively it seems reasonable that most of the signs and symptoms are the result of mucosal injury which leads to inflammation caused by the process of air way instrumentation, also its postulated etiology has been associated with mucosal dehydration or edema, tracheal ischemia secondary to the pressure of endotracheal tube cuffs, aggressive oropharyngeal suctioning and mucosal erosion from friction between delicate tissues and the endotracheal tube (ETT) [4,5]. Aim, the primary outcome was to compare between the effects of Dexamethasone alone versus its use with Clonidine on post-operative sore throat. The secondary outcome was to compare between the effects of Dexamethasone alone versus its use with Clonidine on post-operative hoarseness of voice. Method, this prospective controlled randomized double- blind study was carried on 126 patients divided into two groups the Dexa group 63 and Dexaclonidine group 63. Randomization were done by using closed envelop technique opened immediately before induction by an anaesthetist who was unaware of the study protocol and responsible for preparing the study drugs. Patient in Dexaclonidine group received oral 150 microgram Clonidine tablet one hour before induction, whereas patients in the Dexa group received placebo which is multivitamin tablet with the same shape and size of Clonidine. Both Clonidine and placebo were covered with nontransparent paper. Patients in both groups were received 5 ml of normal saline containing Dexamethasone (8 mg) iv at 30 min before anaesthetic induction. Sedation with midazolam was given (0.05 mg/kg) IV 15 minutes before surgery for the two groups. On arrival to operating room patients were cannulated and monitored with electrocardiography, non-invasive blood pressure, pulse oximetry and capnography. Anaesthesia was induced with intravenous propofol (2 mg/kg) and fentanyl (1–1.5 micro g/kg) after approximately 5 min of preoxygenation and face mask ventilation. Rocuronium (0.6–0.8 mg/ kg) was administered to facilitate endotracheal intubation after using of nerve stimulator (train of four) to ensure complete muscle relaxation before intubation, an endotracheal tube were inserted (ETTs) after Cormack-Lehane scoring (13) of internal diameter 7.0 and 7.5 were used for females and males, respectively by Direct laryngoscopy with either a Macintosh blade size 3 or 4. The ETTs were inserted so that the vocal cords were located between the two indicator marks on the proximal part of the tube shaft. Intubations were confirmed by capnography and chest auscultation for equality of air entry on both sides. None of the patients received topical lidocaine or lidocaine jelly during the intubation procedure. The lungs were ventilated with 50% air 50% oxygen; ventilation was adjusted to maintain an end ti
{"title":"A comparative study of the effect of dexamethasone versus its use with clonidine on postoperative sore throat and hoarseness of voice","authors":"M. Mohamed, R. Mohamed, Medhat Khali Mohamed, Hamed Khattab","doi":"10.4103/roaic.roaic_9_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_9_20","url":null,"abstract":"Regardless of some preventive measures, postoperative sore throat (POST) and hoarseness of voice are most undesirable and most frequent complication in the post-operative period [1,2]. Postoperatively it seems reasonable that most of the signs and symptoms are the result of mucosal injury which leads to inflammation caused by the process of air way instrumentation, also its postulated etiology has been associated with mucosal dehydration or edema, tracheal ischemia secondary to the pressure of endotracheal tube cuffs, aggressive oropharyngeal suctioning and mucosal erosion from friction between delicate tissues and the endotracheal tube (ETT) [4,5]. Aim, the primary outcome was to compare between the effects of Dexamethasone alone versus its use with Clonidine on post-operative sore throat. The secondary outcome was to compare between the effects of Dexamethasone alone versus its use with Clonidine on post-operative hoarseness of voice. Method, this prospective controlled randomized double- blind study was carried on 126 patients divided into two groups the Dexa group 63 and Dexaclonidine group 63. Randomization were done by using closed envelop technique opened immediately before induction by an anaesthetist who was unaware of the study protocol and responsible for preparing the study drugs. Patient in Dexaclonidine group received oral 150 microgram Clonidine tablet one hour before induction, whereas patients in the Dexa group received placebo which is multivitamin tablet with the same shape and size of Clonidine. Both Clonidine and placebo were covered with nontransparent paper. Patients in both groups were received 5 ml of normal saline containing Dexamethasone (8 mg) iv at 30 min before anaesthetic induction. Sedation with midazolam was given (0.05 mg/kg) IV 15 minutes before surgery for the two groups. On arrival to operating room patients were cannulated and monitored with electrocardiography, non-invasive blood pressure, pulse oximetry and capnography. Anaesthesia was induced with intravenous propofol (2 mg/kg) and fentanyl (1–1.5 micro g/kg) after approximately 5 min of preoxygenation and face mask ventilation. Rocuronium (0.6–0.8 mg/ kg) was administered to facilitate endotracheal intubation after using of nerve stimulator (train of four) to ensure complete muscle relaxation before intubation, an endotracheal tube were inserted (ETTs) after Cormack-Lehane scoring (13) of internal diameter 7.0 and 7.5 were used for females and males, respectively by Direct laryngoscopy with either a Macintosh blade size 3 or 4. The ETTs were inserted so that the vocal cords were located between the two indicator marks on the proximal part of the tube shaft. Intubations were confirmed by capnography and chest auscultation for equality of air entry on both sides. None of the patients received topical lidocaine or lidocaine jelly during the intubation procedure. The lungs were ventilated with 50% air 50% oxygen; ventilation was adjusted to maintain an end ti","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123957996","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 : 2022-01-01DOI: 10.4103/roaic.roaic_87_21
Mona Gad, M. Abdelkhalek, Khaled Gaballa, S. Elbalka, M. Hegazy
Background The thoracic epidural analgesia (TEA) is considered as a standard technique for postoperative pain relief in major abdominal surgeries, but sometimes, it is contraindicated or complicated. Rectus-sheath block (RSB) bilaterally has developed recently to offer analgesia in these operations. This study was designed to evaluate the promising RSB as a suitable alternative to TEA in major operations for abdominal cancers through a midline incision. Patients and methods The current clinical trial that had been performed on American Society of Anesthesiologists I, II, and III patients underwent major operations for abdominal cancers through a midline incision, and randomly allocated into either the TEA group: received TEA with bupivacaine+fentanyl or RSB group: received RSB with bupivacaine+fentanyl bilaterally. The primary outcome was the cumulative intravenous (IV) fentanyl doses consumed through the postoperative 24 h. The secondary outcomes were the patients’ number who needed analgesia, the duration spent till the first analgesic request, visual analog score with rest and cough, and any complications related to either the block techniques or drugs. Results Cumulative IV fentanyl consumed and the titration doses of IV fentanyl during the postoperative 24 h, the time to the first request of fentanyl, number of patients who needed analgesia, and visual analog score with rest and cough at the time points of the study, all did not show any statistical significant difference between both groups. The RSB group recorded significant shorter time to ambulation compared with the TEA group. Sedation scores were comparable in both groups at all time points of the trial. Both groups were comparable regarding the incidence of fentanyl-associated side effects, time to passing flatus, and patient-satisfaction score. Conclusion RSB could be used as an efficient alternative to TEA, especially whenever the latter is contraindicated in patients subjected to major abdominal surgeries with midline incision.
{"title":"Ultrasound-guided rectus-sheath block compared with thoracic epidural analgesia for major abdominal cancer surgeries with a midline incision","authors":"Mona Gad, M. Abdelkhalek, Khaled Gaballa, S. Elbalka, M. Hegazy","doi":"10.4103/roaic.roaic_87_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_87_21","url":null,"abstract":"Background The thoracic epidural analgesia (TEA) is considered as a standard technique for postoperative pain relief in major abdominal surgeries, but sometimes, it is contraindicated or complicated. Rectus-sheath block (RSB) bilaterally has developed recently to offer analgesia in these operations. This study was designed to evaluate the promising RSB as a suitable alternative to TEA in major operations for abdominal cancers through a midline incision. Patients and methods The current clinical trial that had been performed on American Society of Anesthesiologists I, II, and III patients underwent major operations for abdominal cancers through a midline incision, and randomly allocated into either the TEA group: received TEA with bupivacaine+fentanyl or RSB group: received RSB with bupivacaine+fentanyl bilaterally. The primary outcome was the cumulative intravenous (IV) fentanyl doses consumed through the postoperative 24 h. The secondary outcomes were the patients’ number who needed analgesia, the duration spent till the first analgesic request, visual analog score with rest and cough, and any complications related to either the block techniques or drugs. Results Cumulative IV fentanyl consumed and the titration doses of IV fentanyl during the postoperative 24 h, the time to the first request of fentanyl, number of patients who needed analgesia, and visual analog score with rest and cough at the time points of the study, all did not show any statistical significant difference between both groups. The RSB group recorded significant shorter time to ambulation compared with the TEA group. Sedation scores were comparable in both groups at all time points of the trial. Both groups were comparable regarding the incidence of fentanyl-associated side effects, time to passing flatus, and patient-satisfaction score. Conclusion RSB could be used as an efficient alternative to TEA, especially whenever the latter is contraindicated in patients subjected to major abdominal surgeries with midline incision.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123780758","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 : 2022-01-01DOI: 10.4103/roaic.roaic_38_21
V. Ravindran, S. Rajan, L. Kumar
{"title":"Anesthetic management of a patient with Gitelman syndrome for elective surgery","authors":"V. Ravindran, S. Rajan, L. Kumar","doi":"10.4103/roaic.roaic_38_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_38_21","url":null,"abstract":"","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122312164","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 : 2022-01-01DOI: 10.4103/roaic.roaic_32_21
Yasser Noeman Ahmed, N. Setty, A. Roshdy, D. Powrie, Dor Amran, A. Elsheikh, S. Gokaraju, A. Tear, Maryam Noeman, M. Darda, I. El Sayed, Vijayalakshmi Karunanithi, Aarani Mahalingam, Muhammad Shafiq, Iman Abdul-Khaliq, J. Samuel
Background Many coronavirus disease 2019 (COVID-19) patients suffering acute hypoxemic respiratory failure (AHRF), fail to respond to conventional oxygen therapy (COT). Subsequently, some centers escalate to continuous positive airway pressure (CPAP), while others resort directly to invasive mechanical ventilation (IMV). We conducted a study to compare the use of CPAP versus COT alone in COVID-19-related AHRF. Patients and methods It is a retrospective cohort study of laboratory-confirmed COVID-19 patients suffering AHRF and deemed eligible for IMV escalation at three university hospitals (United Kingdom) during a 3-month period. The primary endpoint was the need for intubation and the secondary endpoint was 60-day mortality. Results In total, 174 patients were included. In total, 84 patients received CPAP (group 1) and 90 received only COT (group 2). Both groups had comparable demographic criteria and disease severity. There was nonsignificant reduction in the need for IMV when using CPAP compared with COT alone (50 vs. 76.6%, P=0.866). Sixty-day mortality was significantly higher in group 2 (25 vs. 37.8%, P=0.02). COT as stand-alone therapy for COVID-19 patients (group 2) was associated with a significant increased relative risk of death (relative risk 2.14, 95% confidence interval 1.39–3.29) corresponding to a number needed to treat of 3.74 (95% confidence interval 2.47–7.73). Among patients who progressed to IMV, there was no difference in the risk of mortality between the two groups. Conclusion Introducing CPAP rather than escalating FiO2 or endotracheal intubation in COVID-19 cases refractory to COT is safe and associated with improved mortality. Clinical trials are needed to guide the optimum timing and selection of patients most likely to benefit.
许多新冠肺炎(COVID-19)患者患有急性低氧性呼吸衰竭(AHRF)，对常规氧疗(COT)无效。随后，一些中心升级为持续气道正压通气(CPAP)，而其他中心则直接采用有创机械通气(IMV)。我们进行了一项研究，比较了在covid -19相关的AHRF中使用CPAP和单独使用COT的情况。患者和方法这是一项回顾性队列研究，研究对象是实验室确诊的COVID-19患者，他们患有AHRF，并被认为有资格在3个月期间(英国)在三所大学医院进行IMV升级。主要终点是是否需要插管，次要终点是60天死亡率。结果共纳入174例患者。总共有84例患者接受了CPAP(第一组)，90例患者只接受了COT(第二组)。两组的人口统计学标准和疾病严重程度相当。与单独使用COT相比，使用CPAP时IMV的需求没有显著减少(50比76.6%，P=0.866)。第2组60天死亡率显著高于第2组(25 vs. 37.8%， P=0.02)。COT作为COVID-19患者(第二组)的独立治疗与相对死亡风险显著增加相关(相对风险2.14,95%置信区间1.39-3.29)，对应于治疗所需的数字3.74(95%置信区间2.47-7.73)。在进展为IMV的患者中，两组之间的死亡风险没有差异。结论在COVID-19难治性COT患者中引入CPAP而不是升级FiO2或气管插管是安全的，并可降低死亡率。需要临床试验来指导最佳时机和选择最有可能受益的患者。
{"title":"Continuous positive airway pressure as a useful tool in coronavirus disease 2019-related acute hypoxemic respiratory failure: experience from three UK hospitals","authors":"Yasser Noeman Ahmed, N. Setty, A. Roshdy, D. Powrie, Dor Amran, A. Elsheikh, S. Gokaraju, A. Tear, Maryam Noeman, M. Darda, I. El Sayed, Vijayalakshmi Karunanithi, Aarani Mahalingam, Muhammad Shafiq, Iman Abdul-Khaliq, J. Samuel","doi":"10.4103/roaic.roaic_32_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_32_21","url":null,"abstract":"Background Many coronavirus disease 2019 (COVID-19) patients suffering acute hypoxemic respiratory failure (AHRF), fail to respond to conventional oxygen therapy (COT). Subsequently, some centers escalate to continuous positive airway pressure (CPAP), while others resort directly to invasive mechanical ventilation (IMV). We conducted a study to compare the use of CPAP versus COT alone in COVID-19-related AHRF. Patients and methods It is a retrospective cohort study of laboratory-confirmed COVID-19 patients suffering AHRF and deemed eligible for IMV escalation at three university hospitals (United Kingdom) during a 3-month period. The primary endpoint was the need for intubation and the secondary endpoint was 60-day mortality. Results In total, 174 patients were included. In total, 84 patients received CPAP (group 1) and 90 received only COT (group 2). Both groups had comparable demographic criteria and disease severity. There was nonsignificant reduction in the need for IMV when using CPAP compared with COT alone (50 vs. 76.6%, P=0.866). Sixty-day mortality was significantly higher in group 2 (25 vs. 37.8%, P=0.02). COT as stand-alone therapy for COVID-19 patients (group 2) was associated with a significant increased relative risk of death (relative risk 2.14, 95% confidence interval 1.39–3.29) corresponding to a number needed to treat of 3.74 (95% confidence interval 2.47–7.73). Among patients who progressed to IMV, there was no difference in the risk of mortality between the two groups. Conclusion Introducing CPAP rather than escalating FiO2 or endotracheal intubation in COVID-19 cases refractory to COT is safe and associated with improved mortality. Clinical trials are needed to guide the optimum timing and selection of patients most likely to benefit.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131409017","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 : 2022-01-01DOI: 10.4103/roaic.roaic_10_21
M. Medhat, Sara Abd Elnaby
Background The preoperative time is traumatic for young children undergoing surgery. Parental separation and needle injection increase preoperative anxiety. Preoperative sedation in children is usually administered via the rectal, oral sublingual, and intranasal routes with different degrees of patient acceptance. Nebulized drug is an alternative method of sedation that is relatively easy to set up. Materials and Methods Thirty nine pediatric patients (2–6) years old scheduled for outpatient dental surgeries were randomly allocated in three groups (13 patients each); group (F) received nebulized fentanyl 2 μg/kg 30 min before surgery, group (M) received nebulized midazolam 0.2 mg/kg 30 min before surgery and group (D) received nebulized dexmedetomidine 2 μg/kg 30 min before surgery. The outcome measures included onset of sedation, parental separation, tolerance to mask induction, reaction to intravenous cannulation and preoperative hemodynamic changes (systolic blood pressure, diastolic blood pressure and heart rate). Results Children who received nebulized fentanyl and nebulized midazolam had early onset of sedation as compared to dexmedetomidine. In child-parent separation, quality of induction was better with fentanyl and dexmedetomidine as compared to midazolam. Intravenous cannulation score was best achieved with fentanyl as premedication. Conclusion Nebulized fentanyl in a dose of 2 μg/kg is better than nebulized midazolam 0.2 mg/kg and nebulized dexmedetomidine 2 μg/kg as far as premedication is concerned because of its early onset of action, deeper levels of sedation, easy child-parent separation and shorter duration of action.
{"title":"Comparison of nebulized fentanyl, midazolam, and dexmedetomidine as a sedative premedication in outpatient pediatric dental surgeries: a randomized double-blind study","authors":"M. Medhat, Sara Abd Elnaby","doi":"10.4103/roaic.roaic_10_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_10_21","url":null,"abstract":"Background The preoperative time is traumatic for young children undergoing surgery. Parental separation and needle injection increase preoperative anxiety. Preoperative sedation in children is usually administered via the rectal, oral sublingual, and intranasal routes with different degrees of patient acceptance. Nebulized drug is an alternative method of sedation that is relatively easy to set up. Materials and Methods Thirty nine pediatric patients (2–6) years old scheduled for outpatient dental surgeries were randomly allocated in three groups (13 patients each); group (F) received nebulized fentanyl 2 μg/kg 30 min before surgery, group (M) received nebulized midazolam 0.2 mg/kg 30 min before surgery and group (D) received nebulized dexmedetomidine 2 μg/kg 30 min before surgery. The outcome measures included onset of sedation, parental separation, tolerance to mask induction, reaction to intravenous cannulation and preoperative hemodynamic changes (systolic blood pressure, diastolic blood pressure and heart rate). Results Children who received nebulized fentanyl and nebulized midazolam had early onset of sedation as compared to dexmedetomidine. In child-parent separation, quality of induction was better with fentanyl and dexmedetomidine as compared to midazolam. Intravenous cannulation score was best achieved with fentanyl as premedication. Conclusion Nebulized fentanyl in a dose of 2 μg/kg is better than nebulized midazolam 0.2 mg/kg and nebulized dexmedetomidine 2 μg/kg as far as premedication is concerned because of its early onset of action, deeper levels of sedation, easy child-parent separation and shorter duration of action.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130327253","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 : 2022-01-01DOI: 10.4103/roaic.roaic_35_21
Sherif M Sabry, Nael Samer, Khaled Ibrahim, Mohammed A. Mahmoud
Objective To assess the predictive utility of serum copeptin concerning the 30-day mortality among patients presenting with ischemic stroke (IS) or hemorrhagic stroke (HS) acute cerebrovascular stroke. Besides, we aimed to evaluate whether serum copeptin has a role in discriminating between HS and IS. Background Since its discovery in early 1970s, copeptin has emerged as an effective predictive marker with high potentials of wide clinical applications due to its stability and robust measure. Serum copeptin can reflect the vasopressogenics in a practical way. Patients and methods We performed this prospective study on patients with either IS or HS, as indicated by clinical signs and computed tomography. The serum copeptin level was assessed by sandwich immunoassay at admission. All patients were followed up for 30 days after admission. Results Nonsurvivors with acute cerebrovascular stroke exhibited a significantly higher copeptin level than the survivors’ group (P=0.038). Besides, patients with HS exhibited a significantly higher copeptin level than the patients with IS (P=0.042). Copeptin showed good sensitivity (70.6%) and specificity (56.5%) at a cutoff value of 48.8 pmol/l to predict mortality in the whole studied population. Conclusions Serum copeptin is a promising prognostic tool for the prediction of short-term mortality in patients with acute cerebrovascular stroke. Besides, the serum copeptin has a fair diagnostic accuracy for the differentiation of IS and HS.
{"title":"Serum copeptin level as a prognostic marker for acute ischemic cerebrovascular stroke and cerebral hemorrhage","authors":"Sherif M Sabry, Nael Samer, Khaled Ibrahim, Mohammed A. Mahmoud","doi":"10.4103/roaic.roaic_35_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_35_21","url":null,"abstract":"Objective To assess the predictive utility of serum copeptin concerning the 30-day mortality among patients presenting with ischemic stroke (IS) or hemorrhagic stroke (HS) acute cerebrovascular stroke. Besides, we aimed to evaluate whether serum copeptin has a role in discriminating between HS and IS. Background Since its discovery in early 1970s, copeptin has emerged as an effective predictive marker with high potentials of wide clinical applications due to its stability and robust measure. Serum copeptin can reflect the vasopressogenics in a practical way. Patients and methods We performed this prospective study on patients with either IS or HS, as indicated by clinical signs and computed tomography. The serum copeptin level was assessed by sandwich immunoassay at admission. All patients were followed up for 30 days after admission. Results Nonsurvivors with acute cerebrovascular stroke exhibited a significantly higher copeptin level than the survivors’ group (P=0.038). Besides, patients with HS exhibited a significantly higher copeptin level than the patients with IS (P=0.042). Copeptin showed good sensitivity (70.6%) and specificity (56.5%) at a cutoff value of 48.8 pmol/l to predict mortality in the whole studied population. Conclusions Serum copeptin is a promising prognostic tool for the prediction of short-term mortality in patients with acute cerebrovascular stroke. Besides, the serum copeptin has a fair diagnostic accuracy for the differentiation of IS and HS.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129658604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.4103/roaic.roaic_29_21
Sherif Abdelmonem, T. Zaytoun, R. Elsayed
Introduction Stroke is a devastating and costly disease. That is the second leading cause of death worldwide and the first leading cause of long-term disability, making the prevention of stroke a global health priority. Stroke is preventable to a large extent due to modifiable risk factors. Although risk factors are well known, recent studies showed regional variations in the prevalence of risk factors. Objective The aim of the study was to evaluate the risk factors for occurrence of acute stroke, either hemorrhagic or ischemic, that required admission at critical care units among Egyptian population at Alexandria Hospitals. Patients and methods In this retrospective observational study, 1202 participants were recruited from critical care units, comprising 535 (44.5%) cases of acute stroke, 282 (23.5%) cases of hemorrhagic stroke, and 385 controls of different diagnoses. Data from all the patients were collected retrospectively by revising the medical record and patients’ available medical data and then administered through a structured online questionnaire. Results Out of the studied cases, 817 cases of stroke were distributed: 60% of cases were males, 43% of cases were above 65 years old, 24% have family history of stroke, 83% were hypertensive, 60% were diabetic, 62% have ischemic heart disease, 51% have dyslipidemia, 60% were smokers, 35% have atrial fibrillation, 12% have renal disease, 18% have hepatic disease, 4% have vasculitis, 40% were obese, and 10% have psychiatric problems. Conclusion Hypertension is the most independent factor for occurrence of stroke followed by atrial fibrillation and then smoking among Egyptian population.
{"title":"Risk factors for occurrence of acute stroke that required critical care unit admission in Egyptian population (RASEP study)","authors":"Sherif Abdelmonem, T. Zaytoun, R. Elsayed","doi":"10.4103/roaic.roaic_29_21","DOIUrl":"https://doi.org/10.4103/roaic.roaic_29_21","url":null,"abstract":"Introduction Stroke is a devastating and costly disease. That is the second leading cause of death worldwide and the first leading cause of long-term disability, making the prevention of stroke a global health priority. Stroke is preventable to a large extent due to modifiable risk factors. Although risk factors are well known, recent studies showed regional variations in the prevalence of risk factors. Objective The aim of the study was to evaluate the risk factors for occurrence of acute stroke, either hemorrhagic or ischemic, that required admission at critical care units among Egyptian population at Alexandria Hospitals. Patients and methods In this retrospective observational study, 1202 participants were recruited from critical care units, comprising 535 (44.5%) cases of acute stroke, 282 (23.5%) cases of hemorrhagic stroke, and 385 controls of different diagnoses. Data from all the patients were collected retrospectively by revising the medical record and patients’ available medical data and then administered through a structured online questionnaire. Results Out of the studied cases, 817 cases of stroke were distributed: 60% of cases were males, 43% of cases were above 65 years old, 24% have family history of stroke, 83% were hypertensive, 60% were diabetic, 62% have ischemic heart disease, 51% have dyslipidemia, 60% were smokers, 35% have atrial fibrillation, 12% have renal disease, 18% have hepatic disease, 4% have vasculitis, 40% were obese, and 10% have psychiatric problems. Conclusion Hypertension is the most independent factor for occurrence of stroke followed by atrial fibrillation and then smoking among Egyptian population.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130117556","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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