Pub Date : 2022-10-31DOI: 10.2174/25896458-v16-e2208180
Aksana Aliakseyeva, Dante Villarreal, N. Pawlowicz
Local anesthetic resistance is a clinical entity characterized by inadequate analgesia despite technically well-performed procedures. The exact etiology and pathogenesis of this condition are not yet fully understood. A 36-year-old Caucasian female presented to labor and delivery for induction of labor. On admission, the patient reported failure of epidural anesthesia during the previous delivery. An epidural catheter was placed, and analgesia was reported only at high doses of local anesthetic. The patient’s maximum pain level during delivery never reached a score of 2 out of 10. The most common causes of regional anesthetic failure are technical or placement failure, failure related to the local anesthetic itself, or localized infection. This patient appeared to have a true local anesthetic resistance, which was overcome by doubling the customary concentration of local anesthetic. Atypical responses to local anesthetics observed in the patient may be due to incomplete penetrance mutations in sodium channels since local anesthetics work through blocking nerve conduction by acting on these channels.
{"title":"Pain Management During Labor and Delivery in a Patient with Possible Local Anesthetic Resistance: A Case Report","authors":"Aksana Aliakseyeva, Dante Villarreal, N. Pawlowicz","doi":"10.2174/25896458-v16-e2208180","DOIUrl":"https://doi.org/10.2174/25896458-v16-e2208180","url":null,"abstract":"\u0000 \u0000 Local anesthetic resistance is a clinical entity characterized by inadequate analgesia despite technically well-performed procedures. The exact etiology and pathogenesis of this condition are not yet fully understood.\u0000 \u0000 \u0000 \u0000 A 36-year-old Caucasian female presented to labor and delivery for induction of labor. On admission, the patient reported failure of epidural anesthesia during the previous delivery. An epidural catheter was placed, and analgesia was reported only at high doses of local anesthetic. The patient’s maximum pain level during delivery never reached a score of 2 out of 10.\u0000 \u0000 \u0000 \u0000 The most common causes of regional anesthetic failure are technical or placement failure, failure related to the local anesthetic itself, or localized infection. This patient appeared to have a true local anesthetic resistance, which was overcome by doubling the customary concentration of local anesthetic. Atypical responses to local anesthetics observed in the patient may be due to incomplete penetrance mutations in sodium channels since local anesthetics work through blocking nerve conduction by acting on these channels.\u0000","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85753857","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 : 2022-09-30DOI: 10.2174/25896458-v16-e2208110
Juliana Thomaz Menck, S. Tenório, R. D. de Oliveira, R. Strobel, Bruna Bastiani dos Santos, Armando Ferreira Fonseca Junior, M. D. de Cesaro
Opioid-free anesthesia (OFA) has gained popularity in recent years due to concerns about the abusive use of this drug but also due to the potential benefits of OFA for pain control and decreased side effects. This trial aimed to study whether opioid-free anesthesia (OFA) benefits patients submitted to laparoscopic gastroplasty compared to anesthesia with fentanyl. The primary objective was to measure pain score and morphine use for rescue analgesia. The secondary objective was to evaluate the incidence of postoperative nausea and vomiting (PONV) and oxygen desaturation. Patients undergoing gastroplasty were randomized to receive general anesthesia with fentanyl (n = 30) or OFA (n = 30) according to a predefined protocol. They were assessed for pain using a verbal numerical scale (VNS), morphine consumption and PONV in the post-anesthesia care unit and on the first day after surgery. Besides, oxygen desaturation during the immediate postoperative period was also recorded. The study was blinded to the surgeon and postoperative evaluators. The groups were comparable for all demographic data analyzed. A significance level of 5% was used, and no differences were found in the variables studied. The specific OFA protocol presented in this trial was safe and effective. However, this study did not find any benefit in using it compared with fentanyl anesthesia in videolaparoscopic gastroplasties.
{"title":"Opioid-free Anesthesia for Laparoscopic Gastroplasty. A Prospective and Randomized Trial","authors":"Juliana Thomaz Menck, S. Tenório, R. D. de Oliveira, R. Strobel, Bruna Bastiani dos Santos, Armando Ferreira Fonseca Junior, M. D. de Cesaro","doi":"10.2174/25896458-v16-e2208110","DOIUrl":"https://doi.org/10.2174/25896458-v16-e2208110","url":null,"abstract":"\u0000 \u0000 Opioid-free anesthesia (OFA) has gained popularity in recent years due to concerns about the abusive use of this drug but also due to the potential benefits of OFA for pain control and decreased side effects.\u0000 \u0000 \u0000 \u0000 This trial aimed to study whether opioid-free anesthesia (OFA) benefits patients submitted to laparoscopic gastroplasty compared to anesthesia with fentanyl. The primary objective was to measure pain score and morphine use for rescue analgesia. The secondary objective was to evaluate the incidence of postoperative nausea and vomiting (PONV) and oxygen desaturation.\u0000 \u0000 \u0000 \u0000 Patients undergoing gastroplasty were randomized to receive general anesthesia with fentanyl (n = 30) or OFA (n = 30) according to a predefined protocol. They were assessed for pain using a verbal numerical scale (VNS), morphine consumption and PONV in the post-anesthesia care unit and on the first day after surgery. Besides, oxygen desaturation during the immediate postoperative period was also recorded. The study was blinded to the surgeon and postoperative evaluators.\u0000 \u0000 \u0000 \u0000 The groups were comparable for all demographic data analyzed. A significance level of 5% was used, and no differences were found in the variables studied.\u0000 \u0000 \u0000 \u0000 The specific OFA protocol presented in this trial was safe and effective. However, this study did not find any benefit in using it compared with fentanyl anesthesia in videolaparoscopic gastroplasties.\u0000","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81173988","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 : 2022-09-27DOI: 10.2174/25896458-v16-e2208010
Xueqin Ding
The sensory innervation of the clavicle remains controversial. It might come from both the cervical plexus and brachial plexus. Peripheral nerve blocks used to anesthetize the clavicle include cervical plexus blocks, brachial plexus blocks, and combined cervical and brachial plexus blocks. The review was to determine whether there is a difference in pain scores and pain medication consumption intraoperatively and postoperatively among these blocks. Secondary endpoints were block success and serious adverse events. A comprehensive literature search of PubMed and Web of Science was performed. Only English-written randomized controlled studies were included. Compared with patients with general anesthesia, patients with combined ultrasound-guided superficial cervical and interscalene brachial plexus block spent a shorter time in PACU (35.60 ± 5.59 min vs. 53.13 ± 6.95 min, P < 0.001), had a more extended pain-free period (324.67 ± 41.82 min vs. 185.27 ± 40.04 min, P < 0.001), and received less opioid consumption (Tramadol 213.33 ± 57.13 mg vs. 386.67 ± 34.57 mg, P < 0.001) in first 24 h postoperatively. Compared with patients with ultrasound-guided superficial cervical and interscalene brachial plexus block, patients with ultrasound-guided intermediate cervical and interscalene brachial plexus block had a higher success rate (100% vs. 80%) and longer duration of post-operative analgesia (7.5±0.8 h vs. 5.7± 0.4 h, P<0.001). Without ultrasound guidance, patients with combined superficial, deep cervical, and interscalene brachial plexus block had a higher success rate (96% vs. 60%), lower pain score at two h postoperatively (1.96±0.17 vs. 3.22±0.88, p=0.000), and a more extended pain-free period (1h vs 6h) compared to combined superficial cervical and interscalene brachial plexus block. There were no regional anesthesia-related complications reported in all studies. Patients with regional anesthesia have a more significant pain-free period and less intraoperative and postoperative opioid consumption than patients with general anesthesia. Combined intermediate or deep cervical plexus and Interscalene brachial plexus blocks provide better analgesia than combined superficial cervical plexus and Interscalene brachial plexus blocks. Ultrasound guidance improved the success rate of regional anesthesia. Combined cervical plexus and brachial plexus block can be used as sole anesthesia for clavicle fracture surgery.
锁骨的感觉神经支配仍有争议。它可能来自颈神经丛和臂丛。用于锁骨麻醉的周围神经阻滞包括颈丛阻滞、臂丛阻滞和颈、臂丛联合阻滞。本综述的目的是确定这些手术块在疼痛评分和术中、术后止痛药使用方面是否存在差异。次要终点为阻滞成功和严重不良事件。对PubMed和Web of Science进行了全面的文献检索。只纳入了英语写作的随机对照研究。与全麻患者相比，超声引导下颈浅肌-斜角肌间联合阻滞患者PACU时间更短(35.60±5.59 min vs. 53.13±6.95 min, P < 0.001)，无痛时间更长(324.67±41.82 min vs. 185.27±40.04 min, P < 0.001)，术后24 h阿片类药物用量更少(曲马多213.33±57.13 mg vs. 386.67±34.57 mg, P < 0.001)。与超声引导下的浅表颈肌和斜角肌间臂丛阻滞相比，超声引导下的中级颈肌和斜角肌间臂丛阻滞的成功率更高(100%比80%)，术后镇痛时间更长(7.5±0.8 h比5.7±0.4 h, P<0.001)。在无超声引导的情况下，颈浅、颈深、斜角间联合臂丛阻滞患者成功率更高(96% vs 60%)，术后2 h疼痛评分较低(1.96±0.17 vs 3.22±0.88,p=0.000)，无痛时间较长(1h vs 6h)。所有研究均未发现与区域麻醉相关的并发症。与全麻患者相比，区域麻醉患者的无痛期更明显，术中和术后阿片类药物消耗更少。颈浅神经丛和斜角肌间神经丛联合阻滞镇痛效果好于斜角肌间神经丛联合阻滞镇痛。超声引导提高了区域麻醉成功率。颈丛、臂丛联合阻滞可作为锁骨骨折手术的单一麻醉。
{"title":"Regional Anesthesia for Clavicle Fracture Surgery- What is the Current Evidence: A Systematic Review","authors":"Xueqin Ding","doi":"10.2174/25896458-v16-e2208010","DOIUrl":"https://doi.org/10.2174/25896458-v16-e2208010","url":null,"abstract":"\u0000 \u0000 The sensory innervation of the clavicle remains controversial. It might come from both the cervical plexus and brachial plexus. Peripheral nerve blocks used to anesthetize the clavicle include cervical plexus blocks, brachial plexus blocks, and combined cervical and brachial plexus blocks.\u0000 \u0000 \u0000 \u0000 The review was to determine whether there is a difference in pain scores and pain medication consumption intraoperatively and postoperatively among these blocks. Secondary endpoints were block success and serious adverse events.\u0000 \u0000 \u0000 \u0000 A comprehensive literature search of PubMed and Web of Science was performed. Only English-written randomized controlled studies were included.\u0000 \u0000 \u0000 \u0000 Compared with patients with general anesthesia, patients with combined ultrasound-guided superficial cervical and interscalene brachial plexus block spent a shorter time in PACU (35.60 ± 5.59 min vs. 53.13 ± 6.95 min, P < 0.001), had a more extended pain-free period (324.67 ± 41.82 min vs. 185.27 ± 40.04 min, P < 0.001), and received less opioid consumption (Tramadol 213.33 ± 57.13 mg vs. 386.67 ± 34.57 mg, P < 0.001) in first 24 h postoperatively. Compared with patients with ultrasound-guided superficial cervical and interscalene brachial plexus block, patients with ultrasound-guided intermediate cervical and interscalene brachial plexus block had a higher success rate (100% vs. 80%) and longer duration of post-operative analgesia (7.5±0.8 h vs. 5.7± 0.4 h, P<0.001). Without ultrasound guidance, patients with combined superficial, deep cervical, and interscalene brachial plexus block had a higher success rate (96% vs. 60%), lower pain score at two h postoperatively (1.96±0.17 vs. 3.22±0.88, p=0.000), and a more extended pain-free period (1h vs 6h) compared to combined superficial cervical and interscalene brachial plexus block. There were no regional anesthesia-related complications reported in all studies.\u0000 \u0000 \u0000 \u0000 Patients with regional anesthesia have a more significant pain-free period and less intraoperative and postoperative opioid consumption than patients with general anesthesia. Combined intermediate or deep cervical plexus and Interscalene brachial plexus blocks provide better analgesia than combined superficial cervical plexus and Interscalene brachial plexus blocks. Ultrasound guidance improved the success rate of regional anesthesia. Combined cervical plexus and brachial plexus block can be used as sole anesthesia for clavicle fracture surgery.\u0000","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82181554","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 : 2022-09-19DOI: 10.2174/25896458-v16-e2207130
Leta Melaku
While providing anaesthetic treatments during emergency surgical procedures, the safety of both the mother and the foetus in utero is the primary goal. Cardiac output, heart rate, and stroke volume decrease to pre-labor values. Maternal blood volume increases during pregnancy, and this involves an increase in plasma volume as well as in red cell and white cell volumes. Oxygen consumption and carbon dioxide production also increases. The respiratory mucous membranes also become vascular, edematous, and friable. Gastric emptying time is significantly slower during labor and hence gastric volume is increased. Furthermore, hepatic transaminases, bilirubin, and LDH are increased slightly in pregnancy. Renal blood flow, glomerular filtration rate and tubular reabsorption of sodium are increased. Hence glycosuria and aminoaciduria may develop in normal gestation. The size of thyroid gland and total T3 and T4 levels are also increased. Hyperplasia of the β-cells occurs. Adrenal cortical hyperplasia leads to increases in both free and total cortisol in pregnancy. Permeability of the blood-brain barrier increases. Altered anatomy and responses to pain and pharmacotherapy occur as pregnancy progresses. The basic aims during the first trimester revolve around avoidance of any drug or technique, which can interfere with proper embryological development. By second trimester, most of the physiological changes have achieved a plateau level and management of anaesthesia becomes relatively safer than in the first or the third trimester. Decision-making in the third trimester becomes a little easier as one can proceed for caesarean section before the major surgery. It is the technical advancements in regional anaesthesia, which has propelled labour analgesia to newer horizons. The provision of a prolonged post-operative pain-free period makes this technique a first choice of many parturients. Eclampsia is one of the most common emergencies encountered by anesthesiologists in our day to day anaesthesia practice.
{"title":"Physiological Changes in the Pregnancy and Anesthetic Implication during Labor, Delivery, and Postpartum","authors":"Leta Melaku","doi":"10.2174/25896458-v16-e2207130","DOIUrl":"https://doi.org/10.2174/25896458-v16-e2207130","url":null,"abstract":"While providing anaesthetic treatments during emergency surgical procedures, the safety of both the mother and the foetus in utero is the primary goal. Cardiac output, heart rate, and stroke volume decrease to pre-labor values. Maternal blood volume increases during pregnancy, and this involves an increase in plasma volume as well as in red cell and white cell volumes. Oxygen consumption and carbon dioxide production also increases. The respiratory mucous membranes also become vascular, edematous, and friable. Gastric emptying time is significantly slower during labor and hence gastric volume is increased. Furthermore, hepatic transaminases, bilirubin, and LDH are increased slightly in pregnancy. Renal blood flow, glomerular filtration rate and tubular reabsorption of sodium are increased. Hence glycosuria and aminoaciduria may develop in normal gestation. The size of thyroid gland and total T3 and T4 levels are also increased. Hyperplasia of the β-cells occurs. Adrenal cortical hyperplasia leads to increases in both free and total cortisol in pregnancy. Permeability of the blood-brain barrier increases. Altered anatomy and responses to pain and pharmacotherapy occur as pregnancy progresses. The basic aims during the first trimester revolve around avoidance of any drug or technique, which can interfere with proper embryological development. By second trimester, most of the physiological changes have achieved a plateau level and management of anaesthesia becomes relatively safer than in the first or the third trimester. Decision-making in the third trimester becomes a little easier as one can proceed for caesarean section before the major surgery. It is the technical advancements in regional anaesthesia, which has propelled labour analgesia to newer horizons. The provision of a prolonged post-operative pain-free period makes this technique a first choice of many parturients. Eclampsia is one of the most common emergencies encountered by anesthesiologists in our day to day anaesthesia practice.","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89750373","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 : 2022-03-29DOI: 10.2174/25896458-v16-e2202280
V. Pota, G. Nigro, G. Limongelli, C. Esposito, M. Pace
Fortunately, early diagnosis, the discovery of new therapies, and the use of a multidisciplinary approach have led to an extension of the life expectancy of patients suffering from rare neuromuscular diseases (NMD). In this group of diseases, both prejudicial and post-judicial pathologies are included [1, 2]. The presence of a neuromuscular pathology is a challenge for the anaesthesiologists and intensivists who have to manage anaesthesia and a perioperative care course in a patient suffering from such characteristic comorbidities. The main focus in the management of the perioperative care of a patient suffering from NMD is the risk of postoperative respiratory failure [3]. These patients could be affected by weakness of the respiratory muscles associated or not with a restrictive respiratory failure due to anatomical alteration of the rib cage. They could also present a poor management of secretions with ineffective cough and/or poor control of the airways, especially in bulbar forms of Amyotrophic Lateral Sclerosis (ALS). It is, therefore, very important to correctly evaluate preoperative respiratory function not only through blood gas analysis but, above all, through the study of vital capacity (VC) and cough peak flow (PCF), the study of sleep apnea-hypopnea with sleep polygraphy possibly related to electroencephalography, as well as maximum inspiratory and exhaling pressure (MIP and MEP) [4]. The evaluation and the management of the airways are also not to be underestimated. These patients could be affected by anatomical alterations (progeny, macroglossia) or by poor control of tongue movement and swallowing. This could lead not only to a problem of ventilation/intubation during general anaesthesia but also to acute respiratory failure due to obstructive effect of the tongue or inhalation during procedural sedation. The latter aspect is easy to be efforted in a center specialized in the treatment of neuromuscular diseases in patients who are required to receive procedural sedation, for
{"title":"Anaesthesia and Rare Neuromuscular Diseases","authors":"V. Pota, G. Nigro, G. Limongelli, C. Esposito, M. Pace","doi":"10.2174/25896458-v16-e2202280","DOIUrl":"https://doi.org/10.2174/25896458-v16-e2202280","url":null,"abstract":"Fortunately, early diagnosis, the discovery of new therapies, and the use of a multidisciplinary approach have led to an extension of the life expectancy of patients suffering from rare neuromuscular diseases (NMD). In this group of diseases, both prejudicial and post-judicial pathologies are included [1, 2]. The presence of a neuromuscular pathology is a challenge for the anaesthesiologists and intensivists who have to manage anaesthesia and a perioperative care course in a patient suffering from such characteristic comorbidities. The main focus in the management of the perioperative care of a patient suffering from NMD is the risk of postoperative respiratory failure [3]. These patients could be affected by weakness of the respiratory muscles associated or not with a restrictive respiratory failure due to anatomical alteration of the rib cage. They could also present a poor management of secretions with ineffective cough and/or poor control of the airways, especially in bulbar forms of Amyotrophic Lateral Sclerosis (ALS). It is, therefore, very important to correctly evaluate preoperative respiratory function not only through blood gas analysis but, above all, through the study of vital capacity (VC) and cough peak flow (PCF), the study of sleep apnea-hypopnea with sleep polygraphy possibly related to electroencephalography, as well as maximum inspiratory and exhaling pressure (MIP and MEP) [4]. The evaluation and the management of the airways are also not to be underestimated. These patients could be affected by anatomical alterations (progeny, macroglossia) or by poor control of tongue movement and swallowing. This could lead not only to a problem of ventilation/intubation during general anaesthesia but also to acute respiratory failure due to obstructive effect of the tongue or inhalation during procedural sedation. The latter aspect is easy to be efforted in a center specialized in the treatment of neuromuscular diseases in patients who are required to receive procedural sedation, for","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82648700","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 : 2021-12-16DOI: 10.2174/2589645802115010040
Haruko Hasegawa, M. Ozaki, Sumire Yokokawa, Y. Kotera, H. Egawa
We reviewed the intraoperative management of previous liver transplantation (LT) cases to identify an optimal anesthetic method, which may affect patient outcomes and lead to faster postoperative recovery for future recipients. This single-center retrospective study reviewed 63 patients who underwent LT, including 51 living donor LT (LDLT), seven deceased donor LT (DDLT), and five simultaneous liver-kidney transplantation patients. We examined the patients’ backgrounds, intraoperative management (anesthetic method, water balance, and catecholamine dosage), and postoperative courses (hospitalization period, length of intensive care unit stay, renal function). All patients received general anesthesia using inhalational anesthetics, either sevoflurane or desflurane, and both drugs were administered similarly. Rocuronium was administered at its usual dose despite liver failure. All patients undergoing preoperative dialysis due to acute kidney injury were successfully withdrawn from dialysis after surgery. The albumin infusion volume was 32% of the total infusion and transfusion volume. The five-year survival rate was 88% and graft failure occurred in one case. The anesthetic management of LT is currently conducted empirically in our institution, and we could not identify an optimal anesthetic method. However, we drew some conclusions. First, the use of human atrial natriuretic peptide as a drug infusion and appropriate transfusion management was expected to restore renal function. Second, the infusion volume of albumin was high. Third, the usual dose of rocuronium was required because excessive bleeding may cause unstable plasma drug concentration. Our results will be useful in future multi-institutional studies or meta-analyses and further improving the outcomes of future transplant recipients.
{"title":"Experience Verification of 63 Cases of Liver Transplantation Anesthesia Management","authors":"Haruko Hasegawa, M. Ozaki, Sumire Yokokawa, Y. Kotera, H. Egawa","doi":"10.2174/2589645802115010040","DOIUrl":"https://doi.org/10.2174/2589645802115010040","url":null,"abstract":"\u0000 \u0000 We reviewed the intraoperative management of previous liver transplantation (LT) cases to identify an optimal anesthetic method, which may affect patient outcomes and lead to faster postoperative recovery for future recipients.\u0000 \u0000 \u0000 \u0000 This single-center retrospective study reviewed 63 patients who underwent LT, including 51 living donor LT (LDLT), seven deceased donor LT (DDLT), and five simultaneous liver-kidney transplantation patients. We examined the patients’ backgrounds, intraoperative management (anesthetic method, water balance, and catecholamine dosage), and postoperative courses (hospitalization period, length of intensive care unit stay, renal function).\u0000 \u0000 \u0000 \u0000 All patients received general anesthesia using inhalational anesthetics, either sevoflurane or desflurane, and both drugs were administered similarly. Rocuronium was administered at its usual dose despite liver failure. All patients undergoing preoperative dialysis due to acute kidney injury were successfully withdrawn from dialysis after surgery. The albumin infusion volume was 32% of the total infusion and transfusion volume. The five-year survival rate was 88% and graft failure occurred in one case.\u0000 \u0000 \u0000 \u0000 The anesthetic management of LT is currently conducted empirically in our institution, and we could not identify an optimal anesthetic method. However, we drew some conclusions. First, the use of human atrial natriuretic peptide as a drug infusion and appropriate transfusion management was expected to restore renal function. Second, the infusion volume of albumin was high. Third, the usual dose of rocuronium was required because excessive bleeding may cause unstable plasma drug concentration. Our results will be useful in future multi-institutional studies or meta-analyses and further improving the outcomes of future transplant recipients.\u0000","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80478221","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 : 2021-03-10DOI: 10.2174/2589645802115010020
Lachlan Gan, G. Sullivan
The environmental superiority of Total Intravenous Anaesthesia (TIVA) compared to inhaled agents has been recognised by ANZCA in a 2019 statement. Yet what about cost? Little current data has been published on this topic. We conducted a cost analysis and audit of propofol use in 71 endoscopy cases (colonoscopy/gastroscopy), taking into account the cost of adjuncts (syringes, tubing, and discarded propofol). We then compared these to calculated costs of the same cases performed with sevoflurane anaesthesia. In terms of the agent, propofol was 35% cheaper, costing $1.60 for an average endoscopy compared to a sevoflurane cost of $2.46. Including the cost of adjuncts (including a laryngeal mask airway for sevoflurane anaesthesia), endoscopy cases with propofol infusions were 80% cheaper than the same case performed under sevoflurane general anaesthesia ($3.08 vs $15.48). Although pricing may vary from hospital to hospital, our data suggests choosing propofol costs less in endoscopy.
{"title":"If the Price is Right? Cost Analysis of Propofol Infusions and Sevoflurane Anaesthesia in Endoscopic Cases","authors":"Lachlan Gan, G. Sullivan","doi":"10.2174/2589645802115010020","DOIUrl":"https://doi.org/10.2174/2589645802115010020","url":null,"abstract":"The environmental superiority of Total Intravenous Anaesthesia (TIVA) compared to inhaled agents has been recognised by ANZCA in a 2019 statement. Yet what about cost? Little current data has been published on this topic. We conducted a cost analysis and audit of propofol use in 71 endoscopy cases (colonoscopy/gastroscopy), taking into account the cost of adjuncts (syringes, tubing, and discarded propofol). We then compared these to calculated costs of the same cases performed with sevoflurane anaesthesia. In terms of the agent, propofol was 35% cheaper, costing $1.60 for an average endoscopy compared to a sevoflurane cost of $2.46. Including the cost of adjuncts (including a laryngeal mask airway for sevoflurane anaesthesia), endoscopy cases with propofol infusions were 80% cheaper than the same case performed under sevoflurane general anaesthesia ($3.08 vs $15.48). Although pricing may vary from hospital to hospital, our data suggests choosing propofol costs less in endoscopy.","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86082657","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 : 2021-01-01DOI: 10.2174/2589645802115010034
S. Vahabi, S. Beiranvand, A. Karimi, Bagher Jafari-Takab
Post-anesthesia shivering is one of the most common problems after surgery and may lead to multiple complications such as hypoxemia, lactate acidosis and catecholamine release. The purpose of this study was to compare the effects of intravenous meperidine and ondansetron on postoperative shivering in patients having an elective cesarean section under spinal anesthesia. Cross-sectional study In this cross-sectional study, 105 patients with the age of 18-45 years and ASA class I-II undergoing elective cesarean section were randomly assigned into three groups. Group O was administered 8mg ondansetron, group M patients were given 0.4mg/kg meperidine and group P was placebo that was administered with 2cc of saline intravenously after the delivery. The incidence and intensity of shivering and postoperative nausea was monitored and recorded by the trained nurse. The data obtained was analyzed using SPSS v18. All three groups (n=35) had no significant difference in terms of age, weight and time of spinal anesthesia. Postoperative shivering was reported in 4 patients (11.4%) in group A and 3 patients (8.6%) in group B and in 14 patients (40%) in group C. The incidence of postoperative shivering was significantly less in groups A and B as compared to the placebo, p=0.03. The intensity of shivering was greater in group C as compared to groups A and B, p=0.01. The incidence and intensity of postoperative nausea was significantly less in group A, p=0.03, p<0.001, respectively, while no difference was reported in groups B and C, p<0.05. 8mg ondansetron and 0.4 mg/kg of meperidine are equally effective in managing postoperative shivering; however, ondansetron has an additional effect of reducing the incidence of postoperative nausea among patients undergoing caesarean section with spinal anesthesia.
{"title":"Cross-sectional Study on Effects of Ondansetron and Meperidine in the Prevention of Postoperative Shivering after Spinal Anesthesia","authors":"S. Vahabi, S. Beiranvand, A. Karimi, Bagher Jafari-Takab","doi":"10.2174/2589645802115010034","DOIUrl":"https://doi.org/10.2174/2589645802115010034","url":null,"abstract":"Post-anesthesia shivering is one of the most common problems after surgery and may lead to multiple complications such as hypoxemia, lactate acidosis and catecholamine release. The purpose of this study was to compare the effects of intravenous meperidine and ondansetron on postoperative shivering in patients having an elective cesarean section under spinal anesthesia. Cross-sectional study In this cross-sectional study, 105 patients with the age of 18-45 years and ASA class I-II undergoing elective cesarean section were randomly assigned into three groups. Group O was administered 8mg ondansetron, group M patients were given 0.4mg/kg meperidine and group P was placebo that was administered with 2cc of saline intravenously after the delivery. The incidence and intensity of shivering and postoperative nausea was monitored and recorded by the trained nurse. The data obtained was analyzed using SPSS v18. All three groups (n=35) had no significant difference in terms of age, weight and time of spinal anesthesia. Postoperative shivering was reported in 4 patients (11.4%) in group A and 3 patients (8.6%) in group B and in 14 patients (40%) in group C. The incidence of postoperative shivering was significantly less in groups A and B as compared to the placebo, p=0.03. The intensity of shivering was greater in group C as compared to groups A and B, p=0.01. The incidence and intensity of postoperative nausea was significantly less in group A, p=0.03, p<0.001, respectively, while no difference was reported in groups B and C, p<0.05. 8mg ondansetron and 0.4 mg/kg of meperidine are equally effective in managing postoperative shivering; however, ondansetron has an additional effect of reducing the incidence of postoperative nausea among patients undergoing caesarean section with spinal anesthesia.","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85433312","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 : 2020-12-31DOI: 10.2174/2589645802014010115
Jung-A. Lim, In-Young Kim, S. Byun
The accurate placement of the double-lumen endotracheal tube is imperative for effective one-lung ventilation in thoracic surgery. Malpositioning and repositioning of a misplaced tube may cause excessive trauma. We hypothesized that the fiberoptic bronchoscope-guided method for double-lumen endotracheal tube placement would reduce the incidence of malpositioning as compared to the conventional method using the Macintosh laryngoscope. Fifty patients scheduled to undergo elective thoracic surgery were recruited and randomly assigned to the fiberoptic bronchoscope-guided [n=25; Group F] and conventional [n=25; Group C] method groups, according to the method of double-lumen endotracheal tube placement. The primary outcome was the incidence of double-lumen endotracheal tube malpositioning observed under the fiberoptic bronchoscope after initial placement. Secondary outcomes included the times for placement, confirmation, and total procedure of double-lumen endotracheal tube intubation. The incidence of malpositioning after initial double-lumen endotracheal tube placement was significantly lower in Group F than in Group C (20.0% vs 68.0%). In addition, the time for placement was significantly higher in Group F than in Group C, and that for confirmation was significantly lower in Group F than in Group C. The fiberoptic bronchoscope-guided method for double-lumen endotracheal tube placement can reduce the incidence of malpositioning after initial placement and expedite the intubation process with a double-lumen endotracheal tube in thoracic surgery.
在胸外科手术中，双腔气管插管的准确放置是有效的单肺通气的必要条件。放错位置的管子的错位和重新定位可能会造成过度的创伤。我们假设在纤维支气管镜引导下放置双腔气管内管的方法与使用Macintosh喉镜的传统方法相比，可以减少定位错误的发生率。50例计划接受择期胸外科手术的患者被随机分配到纤维支气管镜引导下[n=25;F组和常规组[n=25;C组]方法组，按双腔法置管。主要观察结果为初次置入后纤维支气管镜下观察到的双腔气管内管错位发生率。次要结果包括放置次数、确认次数和双腔气管插管总过程。初始双腔气管内置管后，F组的位错发生率明显低于C组(20.0% vs 68.0%)。此外，F组置入时间明显高于C组，F组确认时间明显低于C组。纤维支气管镜引导下双腔气管插管方法可减少初次置入后的错位发生率，加快胸外科双腔气管插管过程。
{"title":"The Effect of Fiberoptic Bronchoscopy-guided Technique for Placement of a Left-sided Double-lumen Tube on the Intubation Performance Compared with the Conventional Method Using a Macintosh Laryngoscope","authors":"Jung-A. Lim, In-Young Kim, S. Byun","doi":"10.2174/2589645802014010115","DOIUrl":"https://doi.org/10.2174/2589645802014010115","url":null,"abstract":"\u0000 \u0000 The accurate placement of the double-lumen endotracheal tube is imperative for effective one-lung ventilation in thoracic surgery. Malpositioning and repositioning of a misplaced tube may cause excessive trauma.\u0000 \u0000 \u0000 \u0000 We hypothesized that the fiberoptic bronchoscope-guided method for double-lumen endotracheal tube placement would reduce the incidence of malpositioning as compared to the conventional method using the Macintosh laryngoscope.\u0000 \u0000 \u0000 \u0000 Fifty patients scheduled to undergo elective thoracic surgery were recruited and randomly assigned to the fiberoptic bronchoscope-guided [n=25; Group F] and conventional [n=25; Group C] method groups, according to the method of double-lumen endotracheal tube placement. The primary outcome was the incidence of double-lumen endotracheal tube malpositioning observed under the fiberoptic bronchoscope after initial placement. Secondary outcomes included the times for placement, confirmation, and total procedure of double-lumen endotracheal tube intubation.\u0000 \u0000 \u0000 \u0000 The incidence of malpositioning after initial double-lumen endotracheal tube placement was significantly lower in Group F than in Group C (20.0% vs 68.0%). In addition, the time for placement was significantly higher in Group F than in Group C, and that for confirmation was significantly lower in Group F than in Group C.\u0000 \u0000 \u0000 \u0000 The fiberoptic bronchoscope-guided method for double-lumen endotracheal tube placement can reduce the incidence of malpositioning after initial placement and expedite the intubation process with a double-lumen endotracheal tube in thoracic surgery.\u0000","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90708267","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 : 2020-03-01DOI: 10.1093/qjmed/hcaa039.076
B. Hasan, H. Elgendy, A. S. Abdelkawe, H. M. Ibrahim
Sepsis and infection are among the leading causes of death world-wide. The annual burden of sepsis in high-income countries is rising with a mortality rate of 40% and 90% of the worldwide deaths from pneumonia, meningitis or other infections occur in less developed countries. This study was performed to evaluate the therapeutic efficacy of pentoxifylline as an adjuvant therapy in septic patients and its effect on multiple organ dysfunction and mortality in septic patients. This randomized, double-blinded prospective study was conducted from October 2017 to November 2018, which included a total sample size of 52 cases of septic patients. Organ dysfunction was used as a primary outcome with proposed large effect size ((0.8) and alfa =0.05 and power=0.80, so, 26 cases were needed in each group). Secondary outcomes were inflammatory markers C-Reactive Protein (CRP) and pro-calcitonin, duration of hospital stay, need for hemodialysis, need for vasopressor & inotropes, need for mechanical ventilation and 28 days survival. Fifty-two patients with sepsis were divided in 1: 1 ratio to receive pentoxifylline or not. The average age of the included patients was almost 53 years, chest disorders were the main cause of sepsis in both groups. There were no statistically significant differences between both groups in terms of Sequential Organ Failure Assessment (SOFA) score, lactate level, CRP level and pro-calcitonin level. As regards secondary outcomes, there were no statistically significant differences between study’s groups in terms of length of hospital stay (p =0.707), need for hemodialysis (p =0.541), need for vasopressor & inotropes (p =0.249), need for mechanical ventilation (p =0.703), and 28 days survival (p =0.5). We concluded that pentoxifylline as an adjuvant therapy in septic patients had no significant influence on multiple organ dysfunction and mortality.
{"title":"Effect of Pentoxifylline on Organ Dysfunction and Mortality in Severe Sepsis","authors":"B. Hasan, H. Elgendy, A. S. Abdelkawe, H. M. Ibrahim","doi":"10.1093/qjmed/hcaa039.076","DOIUrl":"https://doi.org/10.1093/qjmed/hcaa039.076","url":null,"abstract":"\u0000 \u0000 Sepsis and infection are among the leading causes of death world-wide. The annual burden of sepsis in high-income countries is rising with a mortality rate of 40% and 90% of the worldwide deaths from pneumonia, meningitis or other infections occur in less developed countries. This study was performed to evaluate the therapeutic efficacy of pentoxifylline as an adjuvant therapy in septic patients and its effect on multiple organ dysfunction and mortality in septic patients.\u0000 \u0000 \u0000 \u0000 This randomized, double-blinded prospective study was conducted from October 2017 to November 2018, which included a total sample size of 52 cases of septic patients. Organ dysfunction was used as a primary outcome with proposed large effect size ((0.8) and alfa =0.05 and power=0.80, so, 26 cases were needed in each group). Secondary outcomes were inflammatory markers C-Reactive Protein (CRP) and pro-calcitonin, duration of hospital stay, need for hemodialysis, need for vasopressor & inotropes, need for mechanical ventilation and 28 days survival.\u0000 \u0000 \u0000 \u0000 Fifty-two patients with sepsis were divided in 1: 1 ratio to receive pentoxifylline or not. The average age of the included patients was almost 53 years, chest disorders were the main cause of sepsis in both groups. There were no statistically significant differences between both groups in terms of Sequential Organ Failure Assessment (SOFA) score, lactate level, CRP level and pro-calcitonin level. As regards secondary outcomes, there were no statistically significant differences between study’s groups in terms of length of hospital stay (p =0.707), need for hemodialysis (p =0.541), need for vasopressor & inotropes (p =0.249), need for mechanical ventilation (p =0.703), and 28 days survival (p =0.5).\u0000 \u0000 \u0000 \u0000 We concluded that pentoxifylline as an adjuvant therapy in septic patients had no significant influence on multiple organ dysfunction and mortality.\u0000","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87196838","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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