Pub Date : 2024-08-08DOI: 10.2174/0125896458294513240710071442
Erwin Mulyawan, C. Aurelia
Achieving adequate analgesia after total knee arthroplasty (TKA) can be a challenging task. This study investigates the efficacy and adverse effects of continuous femoral nerve block using a patient-controlled analgesia machine (FNB-PCA) in comparison to intrathecal morphine (ITM) with patient-controlled epidural analgesia (PCEA) using bupivacaine in patients undergoing unilateral TKA under spinal anesthesia. Forty patients with ASA I-II scheduled for unilateral TKA were randomized into two groups. Group ITBM+Ep received 250 mcg of intrathecal morphine and 15 mg of hyperbaric bupivacaine, and group ITB-FNB received FNB with 30 ml of 0.375% Bupivacaine with 5 mcg/ml of epinephrine with 15 mg bupivacaine administered intrathecally. Post-operative analgesia for group ITBM+Ep was maintained by PCEA with bupivacaine, while group ITB-FNB used PCA. Visual analogue scales (VAS) on rest and movement, hemodynamics, and side effects were recorded post-operatively. A decrease in VAS at rest between group ITBM+Ep and ITB-FNB from the 24th - 48th hour was statistically significant (P<0.05). VAS on movement showed no statistical difference between both groups from the 1st until the 6th hour (P >0.05), but VAS was significantly different starting the 12th hour (P <0.05). Group FNB was associated with less hypotension, nausea, vomiting, and pruritus (P <0.05). This study concludes that ITB-FNB-PCA provides superior analgesia on rest and movement with a significant reduction in side effects in comparison to ITBM+Ep with PCEA for patients who underwent TKA. Further trials comparing different anesthetic techniques with larger sample sizes are necessary to establish “gold standard” management after TKA. 194/K-LKJ/ETIK/VI/2022
{"title":"Efficacy and Adverse Effect of Continuous Femoral Nerve Block and Intrathecal Morphine with Patient-Controlled Epidural Analgesia Post-total Knee Arthroplasty: A Randomised Controlled Trial","authors":"Erwin Mulyawan, C. Aurelia","doi":"10.2174/0125896458294513240710071442","DOIUrl":"https://doi.org/10.2174/0125896458294513240710071442","url":null,"abstract":"\u0000 \u0000 Achieving adequate analgesia after total knee arthroplasty (TKA) can be a challenging task. This study investigates the efficacy and adverse effects of continuous femoral nerve block using a patient-controlled analgesia machine (FNB-PCA) in comparison to intrathecal morphine (ITM) with patient-controlled epidural analgesia (PCEA) using bupivacaine in patients undergoing unilateral TKA under spinal anesthesia.\u0000 \u0000 \u0000 \u0000 Forty patients with ASA I-II scheduled for unilateral TKA were randomized into two groups. Group ITBM+Ep received 250 mcg of intrathecal morphine and 15 mg of hyperbaric bupivacaine, and group ITB-FNB received FNB with 30 ml of 0.375% Bupivacaine with 5 mcg/ml of epinephrine with 15 mg bupivacaine administered intrathecally. Post-operative analgesia for group ITBM+Ep was maintained by PCEA with bupivacaine, while group ITB-FNB used PCA. Visual analogue scales (VAS) on rest and movement, hemodynamics, and side effects were recorded post-operatively.\u0000 \u0000 \u0000 \u0000 A decrease in VAS at rest between group ITBM+Ep and ITB-FNB from the 24th - 48th hour was statistically significant (P<0.05). VAS on movement showed no statistical difference between both groups from the 1st until the 6th hour (P >0.05), but VAS was significantly different starting the 12th hour (P <0.05). Group FNB was associated with less hypotension, nausea, vomiting, and pruritus (P <0.05).\u0000 \u0000 \u0000 \u0000 This study concludes that ITB-FNB-PCA provides superior analgesia on rest and movement with a significant reduction in side effects in comparison to ITBM+Ep with PCEA for patients who underwent TKA. Further trials comparing different anesthetic techniques with larger sample sizes are necessary to establish “gold standard” management after TKA.\u0000 \u0000 \u0000 \u0000 194/K-LKJ/ETIK/VI/2022\u0000","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"116 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141926355","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 : 2024-07-02DOI: 10.2174/0125896458274787231124060251
R. Syukur, Arie Utariani, Muh R. Achmad, Lucky Andriyanto, Ezra Octaliansah, Windhu Purnomo, M. Adhi
Pediatric patients with COVID-19 who undergo surgery have two actual problems, both the presence of a viral inflammatory response and an inflammatory response to surgery, which can affect the outcome of surgery and therapy. NLR is considered a fairly accurate predictor of surgery and COVID-19 infection. This study aims to investigate the effect of changes in neutrophil-lymphocyte (NLR) on post-surgery outcomes in pediatric patients with COVID-19 infection. It is a retrospective cohort study with an observational analysis. This research is a multi-center study on COVID-19 patients using a data bank of pediatric patients with COVID-19 and control patients non COVID-19 children undergoing surgery in three hospitals. Data recorded were age, gender, nutritional status, anesthetic status before surgery, length of stay, repeat surgery, sepsis, septic shock, and mortality. Statistical analysis was performed by the U-mann Whitney test. The study sample consisted of 87 total samples consisting of 2 groups, namely the group of pediatric patients with 29 samples with COVID-19 and 58 non-COVID-19 samples. Gender, nutritional status, length of stay, the incidence of reoperation, sepsis, septic shock, and mortality were not significantly different between the two groups with a p<0.05. Risk analysis by looking at the incidence of sepsis and septic shock obtained an intersection point of 2.175 and 2.225, respectively. Analysis of changes in the NLR (delta-NLR) in the mortality events of the COVID-19 group and non-COVID-19 found that the NLR of the COVID-19 group was two times greater than the cut-off NLR of 2,175. There is no difference in the outcome of surgery for children with COVID-19 and non-COVID-19 based on the NLR change analysis.
{"title":"Comparison of Changes in the Neutrophil-lymphocyte Ratio (NLR) and Post-surgery Outcomes in Child Patients with COVID-19 and Non-COVID-19","authors":"R. Syukur, Arie Utariani, Muh R. Achmad, Lucky Andriyanto, Ezra Octaliansah, Windhu Purnomo, M. Adhi","doi":"10.2174/0125896458274787231124060251","DOIUrl":"https://doi.org/10.2174/0125896458274787231124060251","url":null,"abstract":"\u0000 \u0000 Pediatric patients with COVID-19 who undergo surgery have two actual problems, both the presence of a viral inflammatory response and an inflammatory response to surgery, which can affect the outcome of surgery and therapy. NLR is considered a fairly accurate predictor of surgery and COVID-19 infection.\u0000 \u0000 \u0000 \u0000 This study aims to investigate the effect of changes in neutrophil-lymphocyte (NLR) on post-surgery outcomes in pediatric patients with COVID-19 infection.\u0000 \u0000 \u0000 \u0000 It is a retrospective cohort study with an observational analysis. This research is a multi-center study on COVID-19 patients using a data bank of pediatric patients with COVID-19 and control patients non COVID-19 children undergoing surgery in three hospitals. Data recorded were age, gender, nutritional status, anesthetic status before surgery, length of stay, repeat surgery, sepsis, septic shock, and mortality. Statistical analysis was performed by the U-mann Whitney test.\u0000 \u0000 \u0000 \u0000 The study sample consisted of 87 total samples consisting of 2 groups, namely the group of pediatric patients with 29 samples with COVID-19 and 58 non-COVID-19 samples. Gender, nutritional status, length of stay, the incidence of reoperation, sepsis, septic shock, and mortality were not significantly different between the two groups with a p<0.05. Risk analysis by looking at the incidence of sepsis and septic shock obtained an intersection point of 2.175 and 2.225, respectively. Analysis of changes in the NLR (delta-NLR) in the mortality events of the COVID-19 group and non-COVID-19 found that the NLR of the COVID-19 group was two times greater than the cut-off NLR of 2,175.\u0000 \u0000 \u0000 \u0000 There is no difference in the outcome of surgery for children with COVID-19 and non-COVID-19 based on the NLR change analysis.\u0000","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"142 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141687354","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 : 2024-05-06DOI: 10.2174/0125896458296522240404043901
A. Dmitriev, N. Trembach
The problem of perioperative pain relief has not lost its relevance over the years. Studies have shown that patients report moderate to severe pain after surgery, even after laparoscopy. In recent years, specialists have focused on the role of baroreflex sensitivity in the functional state of the nociceptive and antinociceptive systems. Studies have shown that a test with maximum breath-holding during inspiration allows for a non-invasive and accurate assessment of the functional state of the cardiorespiratory system, making it possible to identify a cohort of patients with reduced baroreflex sensitivity The aim of the study was to assess the relationship between the breath-holding test and postoperative pain and to develop a model for predicting pain after laparoscopic gynecological surgery. Data from 489 patients undergoing gynecological laparoscopy at the Clinic of the Kuban State Medical University from August 2019 to September 2023 were analyzed. Severe postoperative pain was reported in 146 patients (29.9%). The duration of breath-holding was statistically significantly correlated with NRS upon admission to the PACU at all time points of the study (from -0,15 to -0,21). Logistic regression showed that the Generalized Anxiety Disorder scale score, Pain Catastrophizing Scale score, duration of surgery, Breath-holding duration, and endometriosis surgery influenced the risk of severe postoperative pain (NRS 7-10) (AUROC 0,809). The breath-holding test, along with other factors, may be useful in assessing the risk of severe postoperative pain after laparoscopic gynecology.
{"title":"Breath-holding Test in the Prognosis of Postoperative Pain in Laparoscopic Gynecology: Observational Cohort Study","authors":"A. Dmitriev, N. Trembach","doi":"10.2174/0125896458296522240404043901","DOIUrl":"https://doi.org/10.2174/0125896458296522240404043901","url":null,"abstract":"\u0000 \u0000 The problem of perioperative pain relief has not lost its relevance over the years. Studies have shown that patients report moderate to severe pain after surgery, even after laparoscopy. In recent years, specialists have focused on the role of baroreflex sensitivity in the functional state of the nociceptive and antinociceptive systems. Studies have shown that a test with maximum breath-holding during inspiration allows for a non-invasive and accurate assessment of the functional state of the cardiorespiratory system, making it possible to identify a cohort of patients with reduced baroreflex sensitivity\u0000 \u0000 \u0000 \u0000 The aim of the study was to assess the relationship between the breath-holding test and postoperative pain and to develop a model for predicting pain after laparoscopic gynecological surgery.\u0000 \u0000 \u0000 \u0000 Data from 489 patients undergoing gynecological laparoscopy at the Clinic of the Kuban State Medical University from August 2019 to September 2023 were analyzed.\u0000 \u0000 \u0000 \u0000 Severe postoperative pain was reported in 146 patients (29.9%). The duration of breath-holding was statistically significantly correlated with NRS upon admission to the PACU at all time points of the study (from -0,15 to -0,21). Logistic regression showed that the Generalized Anxiety Disorder scale score, Pain Catastrophizing Scale score, duration of surgery, Breath-holding duration, and endometriosis surgery influenced the risk of severe postoperative pain (NRS 7-10) (AUROC 0,809).\u0000 \u0000 \u0000 \u0000 The breath-holding test, along with other factors, may be useful in assessing the risk of severe postoperative pain after laparoscopic gynecology.\u0000","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"5 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141006546","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 : 2024-05-02DOI: 10.2174/0125896458291304240328081800
M. Chalil, Mual Kristian Sinaga, Muhammad Ramli Ahmad
Post-herpetic Neuralgia (PHN) is a neuropathic pain syndrome resulting from the sequelae of Herpes Zoster (HZ). Therefore, this study aimed to report a case of a 66-year-old male who presented with chronic pain characterized by a burning sensation in the right chest region, specifically at the areola level. The patient had been experiencing these symptoms for a year, which progressed to the severe stage over the past few months. To mitigate pain, a Thoracic Paravertebral Block (TPVB) procedure was proposed and conducted 3 times, with a solution containing levobupivacaine 0.25% and dexamethasone 10 mg in 5 ml. The procedure was replicated three times. After two weeks, the pain had almost subsided, showing less need for further analgesia.
{"title":"Repeated Thoracic Paravertebral Blocking to Alleviate Pain Symptoms in 66-years-old Man with Post-herpetic Neuralgia: A Case Report","authors":"M. Chalil, Mual Kristian Sinaga, Muhammad Ramli Ahmad","doi":"10.2174/0125896458291304240328081800","DOIUrl":"https://doi.org/10.2174/0125896458291304240328081800","url":null,"abstract":"\u0000 \u0000 Post-herpetic Neuralgia (PHN) is a neuropathic pain syndrome resulting from the sequelae of Herpes Zoster (HZ).\u0000 \u0000 \u0000 \u0000 Therefore, this study aimed to report a case of a 66-year-old male who presented with chronic pain characterized by a burning sensation in the right chest region, specifically at the areola level. The patient had been experiencing these symptoms for a year, which progressed to the severe stage over the past few months. To mitigate pain, a Thoracic Paravertebral Block (TPVB) procedure was proposed and conducted 3 times, with a solution containing levobupivacaine 0.25% and dexamethasone 10 mg in 5 ml.\u0000 \u0000 \u0000 \u0000 The procedure was replicated three times. After two weeks, the pain had almost subsided, showing less need for further analgesia.\u0000","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"15 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141020937","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 : 2024-01-10DOI: 10.2174/0125896458278196231229121146
Mona Raafat Elghamry, T. Naguib, Taysser Mahmoud AbdAlraheem, L. Dawood
Surgery and anesthesia are sources of patients' stress and release of inflammatory mediators that have adverse effects on wound healing and remote organs. To compare the effects of dexmedetomidine and ketamine on perioperative serum levels of inflammatory biomarkers (interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP). We included 75 patients aged 30-60, ASA I and II, and scheduled for laparoscopic hysterectomy. Randomized patients received either intraoperative ketamine (bolus dose 0.25mg/kg then continuous infusion of 250µg/kg/h), dexmedetomidine (1µg/kg bolus dose then continuous infusion of 0.5µg/kg/h), or placebo. The primary outcome was to measure perioperative inflammatory biomarkers. Hemodynamic parameters, Recovery time, and complications were secondary outcomes. At 6 and 24 hours, IL-6 significantly increased in the control group versus ketamine and dexmedetomidine groups (113.4±14.1,107.4±13.7;50.1± 8.1,48.2± 8.1;47.7±7.1, 46.01±7.1;p<0.001). Similarly, At 6 and 24 hours, TNF-α significantly increased in the control group versus ketamine and dexmedetomidine groups (81.8±18.6,72.7±16.4; 40.6±7.1, 39.2±6.9;41.6± 7.6,39.9±7.6;p<0.001).The same for CRP (17.4±3.6,40.0±6.0;10.2±1.3,16.2± 1.2;10.9±1.8,16.3±1.9;p<0.001). Regarding hemodynamic parameters, there were significant increases in the ketamine group and decreases in the dexmedetomidine group compared to baseline. Recovery time was significantly longer in the ketamine group than in the control and dexmedetomidine group (24.3±6.4,12.6±2.0,13.5±3.3 min, respectively; P<0.001). There were no significant differences between the three groups regarding agitation, nausea, and vomiting (P=1,0.126,0.776, respectively). Both dexmedetomidine and ketamine could attenuate the inflammatory response. However, dexmedetomidine has a shorter recovery time. Trial registry at Pan African Clinical Trials Registry. The number is (PACTR201910617459894: date of registration 10/24/2019). https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9479).
{"title":"Effect of Ketamine versus Dexmedetomidine on Release of Inflammatory Mediators in Laparoscopic Hysterectomy. A Randomized Trial","authors":"Mona Raafat Elghamry, T. Naguib, Taysser Mahmoud AbdAlraheem, L. Dawood","doi":"10.2174/0125896458278196231229121146","DOIUrl":"https://doi.org/10.2174/0125896458278196231229121146","url":null,"abstract":"\u0000 \u0000 Surgery and anesthesia are sources of patients' stress and release of inflammatory mediators that have adverse effects on wound healing and remote organs.\u0000 \u0000 \u0000 \u0000 To compare the effects of dexmedetomidine and ketamine on perioperative serum levels of inflammatory biomarkers (interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP).\u0000 \u0000 \u0000 \u0000 We included 75 patients aged 30-60, ASA I and II, and scheduled for laparoscopic hysterectomy. Randomized patients received either intraoperative ketamine (bolus dose 0.25mg/kg then continuous infusion of 250µg/kg/h), dexmedetomidine (1µg/kg bolus dose then continuous infusion of 0.5µg/kg/h), or placebo. The primary outcome was to measure perioperative inflammatory biomarkers. Hemodynamic parameters, Recovery time, and complications were secondary outcomes.\u0000 \u0000 \u0000 \u0000 At 6 and 24 hours, IL-6 significantly increased in the control group versus ketamine and dexmedetomidine groups (113.4±14.1,107.4±13.7;50.1± 8.1,48.2± 8.1;47.7±7.1, 46.01±7.1;p<0.001). Similarly, At 6 and 24 hours, TNF-α significantly increased in the control group versus ketamine and dexmedetomidine groups (81.8±18.6,72.7±16.4; 40.6±7.1, 39.2±6.9;41.6± 7.6,39.9±7.6;p<0.001).The same for CRP (17.4±3.6,40.0±6.0;10.2±1.3,16.2± 1.2;10.9±1.8,16.3±1.9;p<0.001). Regarding hemodynamic parameters, there were significant increases in the ketamine group and decreases in the dexmedetomidine group compared to baseline. Recovery time was significantly longer in the ketamine group than in the control and dexmedetomidine group (24.3±6.4,12.6±2.0,13.5±3.3 min, respectively; P<0.001). There were no significant differences between the three groups regarding agitation, nausea, and vomiting (P=1,0.126,0.776, respectively).\u0000 \u0000 \u0000 \u0000 Both dexmedetomidine and ketamine could attenuate the inflammatory response. However, dexmedetomidine has a shorter recovery time.\u0000 \u0000 \u0000 \u0000 Trial registry at Pan African Clinical Trials Registry.\u0000 The number is (PACTR201910617459894: date of registration 10/24/2019).\u0000 \u0000 \u0000 \u0000 https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9479).\u0000","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"44 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140510817","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 : 2023-10-30DOI: 10.2174/0125896458247890230921045721
Dini Aprilia, Ririn Sumiyani, Niniek Tripuspitasari, Ade MWD Pambudi, Christina Avanti
Background: Lidocaine injection with 2% HCl as an anesthetic drug must guarantee its sterility to avoid microbial contamination. In efforts to maintain the sterile preparation of Lidocaine HCl 2% before use in hospitals, some anesthesiologists opt for re-sterilization. Objective: This study aimed to evaluate the impact of plasma sterilization using hydrogen peroxide on Lidocaine HCl levels employing a validated Ultra Performance Liquid Chromatography (UPLC) assay. Methods: The 2% Lidocaine HCl samples were separated into two groups, one undergoing re-sterilization with hydrogen peroxide and the other handled only with aseptic techniques. The chromatographic assay was performed using a Waters Corp Acquity UPLC® H-Class system and a Waters Corp Acquity UPLC ® BEH C18 column, with a mobile phase of 20% Acetonitrile and 80% Acetate Buffer pH 3.4, flow rate of 0.3 mL/min, and total duration of 4.5 minutes. Results: The results showed a decrease in Lidocaine HCl levels to 1.88% after re-sterilization and 2.01% without re-sterilization. Conclusion: These findings suggest that re-sterilization with hydrogen peroxide plasma sterilization leads to a significant decrease in Lidocaine HCl levels, causing non-compliance with pharmacopoeia standards.
{"title":"Hydrogen Peroxide Plasma Sterilization Sabotages the Efficacy of Lidocaine HCl Injection","authors":"Dini Aprilia, Ririn Sumiyani, Niniek Tripuspitasari, Ade MWD Pambudi, Christina Avanti","doi":"10.2174/0125896458247890230921045721","DOIUrl":"https://doi.org/10.2174/0125896458247890230921045721","url":null,"abstract":"Background: Lidocaine injection with 2% HCl as an anesthetic drug must guarantee its sterility to avoid microbial contamination. In efforts to maintain the sterile preparation of Lidocaine HCl 2% before use in hospitals, some anesthesiologists opt for re-sterilization. Objective: This study aimed to evaluate the impact of plasma sterilization using hydrogen peroxide on Lidocaine HCl levels employing a validated Ultra Performance Liquid Chromatography (UPLC) assay. Methods: The 2% Lidocaine HCl samples were separated into two groups, one undergoing re-sterilization with hydrogen peroxide and the other handled only with aseptic techniques. The chromatographic assay was performed using a Waters Corp Acquity UPLC® H-Class system and a Waters Corp Acquity UPLC ® BEH C18 column, with a mobile phase of 20% Acetonitrile and 80% Acetate Buffer pH 3.4, flow rate of 0.3 mL/min, and total duration of 4.5 minutes. Results: The results showed a decrease in Lidocaine HCl levels to 1.88% after re-sterilization and 2.01% without re-sterilization. Conclusion: These findings suggest that re-sterilization with hydrogen peroxide plasma sterilization leads to a significant decrease in Lidocaine HCl levels, causing non-compliance with pharmacopoeia standards.","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"36 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136132496","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 : 2023-10-12DOI: 10.2174/18743218-v17-e230913-2023-12
Mohamed Gaber Ibrahim Mostafa Allam
Introduction: Failure to wean and re-ventilation is a major problem in the intensive care unit (ICU). Thirty percent of ventilated patients experience weaning failure and are re-ventilated, especially patients who are ventilated for long durations. Ultrasound provides reliable data on lung parenchyma inflammation resolution and diaphragmatic contraction power, thereby assisting in deciding if the patient should be weaned and consequently reducing the percentage of weaning failure. Aim of the Work: To compare the ultrasonic criteria for weaning with the conventional criteria of weaning in patients with post-traumatic acute respiratory distress syndrome (ARDS) who were ventilated for a long time and assess their effect on the ICU stay duration. Materials and Methods: This was a prospective, double-blind study performed on 200 participants who were weaned from the ventilator after being ventilated for > 1 week due to respiratory failure. Respiratory failure in the patients was either due to severe lung contusion or post-traumatic ARDS. The patients were randomly and equally allocated in two groups of 100 patients each. Groups A and B comprised patients who were weaned from the ventilator using the conventional and ultrasound weaning criteria, respectively. All patients weaned from both groups were followed up for 6 days for signs of weaning failure and post-extubation respiratory failure. The number of patients who were re-ventilated and discharged from the ICU was recorded and compared in both groups. Results: Group A had a significantly higher number of patients who experienced deterioration in consciousness, tachypnea, desaturation, tachycardia, and hypertension in addition to showing chest X-ray infiltration and being re-ventilated than group B. Moreover, group A patients had a significantly longer ICU duration than group B patients. Conclusion: The use of the ultrasonic criteria for weaning reduces re-intubation, re-ventilation, and post-extubation respiratory failure. Additionally, its use also decreases the ICU stay in patients with post-traumatic ARDS who were ventilated for a long time.
{"title":"Comparative Study between the use of Ultrasonic Criteria of Weaning versus the Conventional Criteria of Weaning in Post-traumatic Acute Respiratory Distress Syndrome Patients who were Ventilated for a long Time","authors":"Mohamed Gaber Ibrahim Mostafa Allam","doi":"10.2174/18743218-v17-e230913-2023-12","DOIUrl":"https://doi.org/10.2174/18743218-v17-e230913-2023-12","url":null,"abstract":"Introduction: Failure to wean and re-ventilation is a major problem in the intensive care unit (ICU). Thirty percent of ventilated patients experience weaning failure and are re-ventilated, especially patients who are ventilated for long durations. Ultrasound provides reliable data on lung parenchyma inflammation resolution and diaphragmatic contraction power, thereby assisting in deciding if the patient should be weaned and consequently reducing the percentage of weaning failure. Aim of the Work: To compare the ultrasonic criteria for weaning with the conventional criteria of weaning in patients with post-traumatic acute respiratory distress syndrome (ARDS) who were ventilated for a long time and assess their effect on the ICU stay duration. Materials and Methods: This was a prospective, double-blind study performed on 200 participants who were weaned from the ventilator after being ventilated for > 1 week due to respiratory failure. Respiratory failure in the patients was either due to severe lung contusion or post-traumatic ARDS. The patients were randomly and equally allocated in two groups of 100 patients each. Groups A and B comprised patients who were weaned from the ventilator using the conventional and ultrasound weaning criteria, respectively. All patients weaned from both groups were followed up for 6 days for signs of weaning failure and post-extubation respiratory failure. The number of patients who were re-ventilated and discharged from the ICU was recorded and compared in both groups. Results: Group A had a significantly higher number of patients who experienced deterioration in consciousness, tachypnea, desaturation, tachycardia, and hypertension in addition to showing chest X-ray infiltration and being re-ventilated than group B. Moreover, group A patients had a significantly longer ICU duration than group B patients. Conclusion: The use of the ultrasonic criteria for weaning reduces re-intubation, re-ventilation, and post-extubation respiratory failure. Additionally, its use also decreases the ICU stay in patients with post-traumatic ARDS who were ventilated for a long time.","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136058049","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 : 2023-04-19DOI: 10.2174/25896458-v17-e230419-2022-17
Mohamed Gaber Ibrahim Mostafa Allam
The utilization of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for immunoadsorption has proven efficacious in reducing mortality rates among neonatal and pediatric patients afflicted with severe sepsis and septic shock. However, the effectiveness of this treatment in adult patients with septic shock remains controversial. This study was designed to assess the potential of VA-ECMO as an immunoadsorption therapy in patients with severe sepsis and septic shock. The primary objective of this study is to evaluate the efficacy of VA-ECMO in improving clinical outcomes, including acute respiratory distress syndrome (ARDS) and ventilator-associated pneumonia (VAP), weaning from mechanical ventilation, the length of intensive care unit (ICU) stay, and mortality rates in patients with concurrent severe pulmonary contusions, septic shock, and respiratory failure resulting from ARDS and VAP. This study enrolled a cohort of 100 adult patients with severe pulmonary contusions resulting in persistent respiratory failure despite ten days of mechanical ventilation. These patients subsequently developed severe sepsis, VAP with ARDS presentation, and high Murray score (>3 points), Sequential Organ Failure Assessment (SOFA) score (> 12 points), and Clinical Pulmonary Infection Score (CPIS) (> 6 points). The patients were then divided into two groups: group A (n = 50) received conventional management, while group B (n = 50) underwent VA-ECMO. Moreover, the outcomes, including improvement in ARDS and VAP, successful weaning from mechanical ventilation, length of ICU stay, improvement of one or all parameters of Murray, SOFA, and CPIS scores, morbidity rate, and mortality rate were compared between the two groups and recorded after 14 days of treatment. This study revealed that patients in group B showed significant improvement in Murray, SOFA, and CPIS scores. Furthermore, a large percentage of patients in group B were successfully weaned from both inotropic support and mechanical ventilation and were discharged from ICU. However, no significant difference in the mortality rate was observed between the two groups. VA-ECMO notably impedes the progression of sepsis, shortens ICU stay, and expedites the weaning from inotropic support and mechanical ventilation. However, it has no impact on the mortality rate of adult patients with septic shock.
{"title":"The Immunoadsorption Effect of Veno-arterial Extracorporeal Membrane Oxygenation in Refractory Septic Shock, Ventilator-associated Pneumonia, and Acute Respiratory Distress Syndrome Following Severe Pulmonary Contusions","authors":"Mohamed Gaber Ibrahim Mostafa Allam","doi":"10.2174/25896458-v17-e230419-2022-17","DOIUrl":"https://doi.org/10.2174/25896458-v17-e230419-2022-17","url":null,"abstract":"\u0000 \u0000 The utilization of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for immunoadsorption has proven efficacious in reducing mortality rates among neonatal and pediatric patients afflicted with severe sepsis and septic shock. However, the effectiveness of this treatment in adult patients with septic shock remains controversial.\u0000 \u0000 \u0000 \u0000 This study was designed to assess the potential of VA-ECMO as an immunoadsorption therapy in patients with severe sepsis and septic shock. The primary objective of this study is to evaluate the efficacy of VA-ECMO in improving clinical outcomes, including acute respiratory distress syndrome (ARDS) and ventilator-associated pneumonia (VAP), weaning from mechanical ventilation, the length of intensive care unit (ICU) stay, and mortality rates in patients with concurrent severe pulmonary contusions, septic shock, and respiratory failure resulting from ARDS and VAP.\u0000 \u0000 \u0000 \u0000 This study enrolled a cohort of 100 adult patients with severe pulmonary contusions resulting in persistent respiratory failure despite ten days of mechanical ventilation. These patients subsequently developed severe sepsis, VAP with ARDS presentation, and high Murray score (>3 points), Sequential Organ Failure Assessment (SOFA) score (> 12 points), and Clinical Pulmonary Infection Score (CPIS) (> 6 points). The patients were then divided into two groups: group A (n = 50) received conventional management, while group B (n = 50) underwent VA-ECMO. Moreover, the outcomes, including improvement in ARDS and VAP, successful weaning from mechanical ventilation, length of ICU stay, improvement of one or all parameters of Murray, SOFA, and CPIS scores, morbidity rate, and mortality rate were compared between the two groups and recorded after 14 days of treatment.\u0000 \u0000 \u0000 \u0000 This study revealed that patients in group B showed significant improvement in Murray, SOFA, and CPIS scores. Furthermore, a large percentage of patients in group B were successfully weaned from both inotropic support and mechanical ventilation and were discharged from ICU. However, no significant difference in the mortality rate was observed between the two groups.\u0000 \u0000 \u0000 \u0000 VA-ECMO notably impedes the progression of sepsis, shortens ICU stay, and expedites the weaning from inotropic support and mechanical ventilation. However, it has no impact on the mortality rate of adult patients with septic shock.\u0000","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73280701","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 : 2023-04-19DOI: 10.2174/25896458-v17-e230403-2022-26
A. Sobhy, Lobna A Saleh, Marwa Abdelatty, S. Refaat, M. Kamal
Critically ill COVID-19 patients undergoing cytokine storm are believed to have a worse prognosis and increased fatality rate. Ibuprofen is a non-steroidal anti-inflammatory drug (NSAIDs) that might prove beneficial for the early management of COVID-19 due to its immunomodulatory effects. This study aimed to assess the efficacy and safety of the early use of ibuprofen to attenuate the severity of the course of COVID-19 and improve outcomes in patients diagnosed with a moderate case of COVID-19 disease. This randomized, double-blinded prospective study was conducted from January, 2022 to May, 2022, which included a total sample size of 180 patients with moderate cases of COVID-19. The number of patients transferred to intensive care was used as a primary outcome with a proposed large effect size (0.8), alfa =0.05, and power=0.80, so 90 cases were included in each group. Secondary outcomes were inflammatory markers: C-Reactive Protein (CRP), serum ferritin, and interleukin-6 (IL-6), duration of hospital stay, and need for ICU admission. One hundred eighty patients with moderate case of COVID-19 disease were divided in a 1: 1 ratio to receive ibuprofen (IG) or paracetamol (CG). The average age of the included patients was almost 41 years. Statistically significant differences were reported between both groups in terms of improvement in cough symptoms and lymphopenia in IG compared to CG (p= 0.034 and p= 0.044, respectively). Regarding secondary outcomes, statistically, significant differences were reported between the study’s groups in terms of the mean number of patients transferred to the ICU in IG compared to the CG (p =0.0.047) and duration of hospitalization (p =0.013), with no significant differences (p > 0.9999) in the occurrence of side effects. Concerning the follow-up of the cytokine storm marker, there was a statistically significant reduction in serum cytokine marker compared to the baseline value (P < 0.05) in the same group. No statistically significant differences were observed when comparing both groups together in terms of serum ferritin level (p =0.570), serum IL-6 level (p =0.580), and CRP level (p =0.401). It can be concluded that early use of ibuprofen as adjuvant therapy in COVID-19 management is effective and safe to attenuate the severity of diseases and improve outcomes. Project manager for the Pan African Clinical Trial Registry PACTR202202880140319. Registered 9th February, 2022 - Retrospectively registered, (https://pactr.samrc.ac.za/)
{"title":"Early Use of Ibuprofen in Moderate Cases of COVID-19 Might be a Promising Agent to Attenuate the Severity of Disease: A Randomized Controlled Trial","authors":"A. Sobhy, Lobna A Saleh, Marwa Abdelatty, S. Refaat, M. Kamal","doi":"10.2174/25896458-v17-e230403-2022-26","DOIUrl":"https://doi.org/10.2174/25896458-v17-e230403-2022-26","url":null,"abstract":"\u0000 \u0000 Critically ill COVID-19 patients undergoing cytokine storm are believed to have a worse prognosis and increased fatality rate. Ibuprofen is a non-steroidal anti-inflammatory drug (NSAIDs) that might prove beneficial for the early management of COVID-19 due to its immunomodulatory effects. This study aimed to assess the efficacy and safety of the early use of ibuprofen to attenuate the severity of the course of COVID-19 and improve outcomes in patients diagnosed with a moderate case of COVID-19 disease.\u0000 \u0000 \u0000 \u0000 This randomized, double-blinded prospective study was conducted from January, 2022 to May, 2022, which included a total sample size of 180 patients with moderate cases of COVID-19. The number of patients transferred to intensive care was used as a primary outcome with a proposed large effect size (0.8), alfa =0.05, and power=0.80, so 90 cases were included in each group. Secondary outcomes were inflammatory markers: C-Reactive Protein (CRP), serum ferritin, and interleukin-6 (IL-6), duration of hospital stay, and need for ICU admission.\u0000 \u0000 \u0000 \u0000 One hundred eighty patients with moderate case of COVID-19 disease were divided in a 1: 1 ratio to receive ibuprofen (IG) or paracetamol (CG). The average age of the included patients was almost 41 years. Statistically significant differences were reported between both groups in terms of improvement in cough symptoms and lymphopenia in IG compared to CG (p= 0.034 and p= 0.044, respectively). Regarding secondary outcomes, statistically, significant differences were reported between the study’s groups in terms of the mean number of patients transferred to the ICU in IG compared to the CG (p =0.0.047) and duration of hospitalization (p =0.013), with no significant differences (p > 0.9999) in the occurrence of side effects.\u0000 Concerning the follow-up of the cytokine storm marker, there was a statistically significant reduction in serum cytokine marker compared to the baseline value (P < 0.05) in the same group. No statistically significant differences were observed when comparing both groups together in terms of serum ferritin level (p =0.570), serum IL-6 level (p =0.580), and CRP level (p =0.401).\u0000 \u0000 \u0000 \u0000 It can be concluded that early use of ibuprofen as adjuvant therapy in COVID-19 management is effective and safe to attenuate the severity of diseases and improve outcomes.\u0000 \u0000 \u0000 \u0000 Project manager for the Pan African Clinical Trial Registry PACTR202202880140319. Registered 9th February, 2022 - Retrospectively registered, (https://pactr.samrc.ac.za/)\u0000","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82680140","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 : 2023-02-23DOI: 10.2174/25896458-v17-230223-2022-24
N. Elshalakany
Analgesic effects can be further augmented with the addition of clonidine and ketamine to the TIVA propofol, providing an even more effective anesthetic without compromising patient safety. This study aims to determine whether propofol infusion combined with clonidine and ketamine is more efficient in lowering the level of IL-8, preserving operation stability, and dropping post-operative pain and morphine intake. We conducted a study in which two groups of 60 patients were scheduled for colorectal cancer surgery. The treated group, (group T), received premedication with clonidine, intraoperative ketamine, and propofol for sedation. As a control group, a normal saline solution was administered to the group (Group C). Group T reported lower levels of post-operative pain than the control group (P<0.05). This suggests that group T was more effective at reducing pain than the control group. A significant difference in mean arterial blood pressure was observed between groups (P<0.05). It is worth noting that there was no statistically significant difference in IL-8 levels between the two groups postoperatively (P=0.47). There was also a lower consumption of morphine (4.09±1.78) in group T postoperatively. It was found that TIVA using propofol with clonidine and ketamine was more effective than propofol infusion alone in maintaining hemodynamic stability, reducing postoperative pain, and decreasing morphine consumption over conventional propofol infusion. As a combination, propofol, clonidine, and ketamine provide sedation and manage the pain of patients in a synergistic manner.
{"title":"Consequences of Co-Administration of Propofol with Clonidine and Ketamine throughout Colon Cancer Surgery: A Randomized Trial","authors":"N. Elshalakany","doi":"10.2174/25896458-v17-230223-2022-24","DOIUrl":"https://doi.org/10.2174/25896458-v17-230223-2022-24","url":null,"abstract":"Analgesic effects can be further augmented with the addition of clonidine and ketamine to the TIVA propofol, providing an even more effective anesthetic without compromising patient safety. This study aims to determine whether propofol infusion combined with clonidine and ketamine is more efficient in lowering the level of IL-8, preserving operation stability, and dropping post-operative pain and morphine intake. We conducted a study in which two groups of 60 patients were scheduled for colorectal cancer surgery. The treated group, (group T), received premedication with clonidine, intraoperative ketamine, and propofol for sedation. As a control group, a normal saline solution was administered to the group (Group C). Group T reported lower levels of post-operative pain than the control group (P<0.05). This suggests that group T was more effective at reducing pain than the control group. A significant difference in mean arterial blood pressure was observed between groups (P<0.05). It is worth noting that there was no statistically significant difference in IL-8 levels between the two groups postoperatively (P=0.47). There was also a lower consumption of morphine (4.09±1.78) in group T postoperatively. It was found that TIVA using propofol with clonidine and ketamine was more effective than propofol infusion alone in maintaining hemodynamic stability, reducing postoperative pain, and decreasing morphine consumption over conventional propofol infusion. As a combination, propofol, clonidine, and ketamine provide sedation and manage the pain of patients in a synergistic manner.","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73292594","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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