Pub Date : 2019-10-24DOI: 10.2174/2589645801913010100
N. Sherif, M. Mohamad, S. Taher, A. A. Hannon, H. Salem
Peribulbar anesthesia in ophthalmic surgeries is limited by delayed and/or incomplete orbital akinesia and inadequate operative and postoperative analgesia. The aim of this study was to assess the safety and effectiveness of a single percutaneous peribulbar block technique with 100 mg magnesium sulphate added to the local anesthetics used compared with the standard peribulbar block technique in adult strabismus surgery. A total of 54 consecutive patients undergoing strabismus surgery were included in the study. They were divided into two equal groups (27 patients each). In group I, 1 ml (100 mg/ml) magnesium sulphate added to a mixture of 2 ml lidocaine 2%, 2 ml bupivacaine 0.5% and 1 ml hyaluronidase (150 units/ml) was administered through a single percutaneous peribulbar injection with a short (1 inch) needle, while in group II, a mixture of 1 ml saline added to 2 ml lidocaine 2%, 2 ml bupivacaine 0.5% and 1 ml hyaluronidase (150 units/ml) was administered using the standard peribulbar block technique. The collected data included patient's baseline characteristics, perioperative and early postoperative outcomes and follow-up data. The elapsed time before the onset of anesthesia and akinesia of the globe was significantly shorter in group I compared with group II (1.9 ± 0.7 vs. 3.9 ± 1.0 min, p < 0.001; 2.3 ± 0.7 vs. 4.4 ± 1.2 min, p < 0.001 respectively), and the duration of anesthesia was significantly longer in group I compared with group II (180.0 ± 0.0 vs. 43.0 ± 8.5 min, p < 0.001). The median VAS pain score was significantly lower in group I compared with group II (1.0 vs. 4.0, p < 0.001), and the patient's satisfaction was significantly higher in group I compared with group II (100.0% vs. 25.9%, p < 0.001). Co-administration of 100 mg magnesium sulphate with the local anesthetics was effective and safe. It achieved suitable conditions to start surgery rapidly. Further, it improved the quality of operative conditions and patient satisfaction.
眼球手术中的球周麻醉受到延迟和/或不完全眼窝运动障碍以及手术和术后镇痛不足的限制。本研究的目的是评估单次经皮球周阻滞技术与标准球周阻滞技术在成人斜视手术中的安全性和有效性，该技术在局部麻醉剂中添加100 mg硫酸镁。共有54名连续接受斜视手术的患者被纳入研究。他们被分为两组(每组27例)。在第一组中，将1ml (100mg /ml)硫酸镁加入2ml利多卡因2%、2ml布比卡因0.5%和1ml透明质酸酶(150单位/ml)的混合物中，用短(1英寸)针单次经皮球周注射给药，而在第二组中，将1ml生理盐水加入2ml利多卡因2%、2ml布比卡因0.5%和1ml透明质酸酶(150单位/ml)的混合物中，采用标准球周阻滞技术给药。收集的数据包括患者的基线特征、围手术期和术后早期结局以及随访数据。I组麻醉和眼球运动障碍发生前的时间明显短于II组(1.9±0.7 vs 3.9±1.0 min, p < 0.001;麻醉时间(2.3±0.7 min vs. 4.4±1.2 min, p < 0.001)，麻醉时间(180.0±0.0 min vs. 43.0±8.5 min, p < 0.001)明显长于麻醉时间(p < 0.001)。I组VAS疼痛评分中位数明显低于II组(1.0比4.0,p < 0.001)， I组患者满意度明显高于II组(100.0%比25.9%，p < 0.001)。100mg硫酸镁与局麻药合用是安全有效的。达到了快速开刀的适宜条件。进一步提高了手术条件质量和患者满意度。
{"title":"Effectiveness and Safety of Single Percutaneous Peribulbar Block Using Magnesium Sulphate as an Adjuvant to Local Anesthetics Versus the Standard Peribulbar Block for Strabismus Surgery in Adults","authors":"N. Sherif, M. Mohamad, S. Taher, A. A. Hannon, H. Salem","doi":"10.2174/2589645801913010100","DOIUrl":"https://doi.org/10.2174/2589645801913010100","url":null,"abstract":"\u0000 \u0000 Peribulbar anesthesia in ophthalmic surgeries is limited by delayed and/or incomplete orbital akinesia and inadequate operative and postoperative analgesia.\u0000 \u0000 \u0000 \u0000 The aim of this study was to assess the safety and effectiveness of a single percutaneous peribulbar block technique with 100 mg magnesium sulphate added to the local anesthetics used compared with the standard peribulbar block technique in adult strabismus surgery.\u0000 \u0000 \u0000 \u0000 A total of 54 consecutive patients undergoing strabismus surgery were included in the study. They were divided into two equal groups (27 patients each). In group I, 1 ml (100 mg/ml) magnesium sulphate added to a mixture of 2 ml lidocaine 2%, 2 ml bupivacaine 0.5% and 1 ml hyaluronidase (150 units/ml) was administered through a single percutaneous peribulbar injection with a short (1 inch) needle, while in group II, a mixture of 1 ml saline added to 2 ml lidocaine 2%, 2 ml bupivacaine 0.5% and 1 ml hyaluronidase (150 units/ml) was administered using the standard peribulbar block technique. The collected data included patient's baseline characteristics, perioperative and early postoperative outcomes and follow-up data.\u0000 \u0000 \u0000 \u0000 The elapsed time before the onset of anesthesia and akinesia of the globe was significantly shorter in group I compared with group II (1.9 ± 0.7 vs. 3.9 ± 1.0 min, p < 0.001; 2.3 ± 0.7 vs. 4.4 ± 1.2 min, p < 0.001 respectively), and the duration of anesthesia was significantly longer in group I compared with group II (180.0 ± 0.0 vs. 43.0 ± 8.5 min, p < 0.001). The median VAS pain score was significantly lower in group I compared with group II (1.0 vs. 4.0, p < 0.001), and the patient's satisfaction was significantly higher in group I compared with group II (100.0% vs. 25.9%, p < 0.001).\u0000 \u0000 \u0000 \u0000 Co-administration of 100 mg magnesium sulphate with the local anesthetics was effective and safe. It achieved suitable conditions to start surgery rapidly. Further, it improved the quality of operative conditions and patient satisfaction.\u0000","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84147223","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 : 2019-10-24DOI: 10.2174/2589645801913010106
E. Çetin, Alper Iynem, Celal Selçuk Ünal, Ertan Demirdaş
To investigate the effect of high thoracic epidural analgesia combined with general anesthesia on pain management and postoperative outcomes in patients undergoing off-pump Coronary Artery Bypass Grafting (CABG). Patients were divided into two groups; Group 1 received general anesthesia and high thoracic epidural anesthesia whereas Group 2 received general anesthesia alone during off-pump coronary artery bypass grafting. Epidural catheters were placed at least 6 hours before transfer to the operating room. An epidural analgesic solution of 0.25% bupivacaine and 10 µg/ml fentanyl was started as continuous infusion at 5 ml/hour and maintained for at least 12 hours after completion of surgery. A 10-cm visual analog scale was used to measure pain at 4th, 6th, 9th and 12th postoperative hours. Mean time to extubation was similar between two groups (2.45±0.88 vs. 2.59±1.31 for Groups 1 and 2, respectively, p=0.90). In all measurements, mean Visual Analogue Scale VAS scores were significantly lower in Group 1 compared to Group 2 (6.50±1.53 vs. 4.09±1.83 at 4th hour, 6.62±1.55 vs. 3.71±1.85 at 6th hour, 5.83±1.40 vs. 2.93±1.54 at 9th hour and 4.41±1.97 vs. 2.50±1.19 at 12th hour, p<0.001 in each comparison). Continuous high thoracic epidural analgesia seems to be a good adjunct to general anesthesia, as its pain relief effect becomes obvious at 4th postoperative hour and lasts at least 12th postoperative hour.
{"title":"High Thoracic Epidural Analgesia as an Adjunct to General Anesthesia in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting","authors":"E. Çetin, Alper Iynem, Celal Selçuk Ünal, Ertan Demirdaş","doi":"10.2174/2589645801913010106","DOIUrl":"https://doi.org/10.2174/2589645801913010106","url":null,"abstract":"\u0000 \u0000 To investigate the effect of high thoracic epidural analgesia combined with general anesthesia on pain management and postoperative outcomes in patients undergoing off-pump Coronary Artery Bypass Grafting (CABG).\u0000 \u0000 \u0000 \u0000 Patients were divided into two groups; Group 1 received general anesthesia and high thoracic epidural anesthesia whereas Group 2 received general anesthesia alone during off-pump coronary artery bypass grafting. Epidural catheters were placed at least 6 hours before transfer to the operating room. An epidural analgesic solution of 0.25% bupivacaine and 10 µg/ml fentanyl was started as continuous infusion at 5 ml/hour and maintained for at least 12 hours after completion of surgery. A 10-cm visual analog scale was used to measure pain at 4th, 6th, 9th and 12th postoperative hours.\u0000 \u0000 \u0000 \u0000 Mean time to extubation was similar between two groups (2.45±0.88 vs. 2.59±1.31 for Groups 1 and 2, respectively, p=0.90). In all measurements, mean Visual Analogue Scale VAS scores were significantly lower in Group 1 compared to Group 2 (6.50±1.53 vs. 4.09±1.83 at 4th hour, 6.62±1.55 vs. 3.71±1.85 at 6th hour, 5.83±1.40 vs. 2.93±1.54 at 9th hour and 4.41±1.97 vs. 2.50±1.19 at 12th hour, p<0.001 in each comparison).\u0000 \u0000 \u0000 \u0000 Continuous high thoracic epidural analgesia seems to be a good adjunct to general anesthesia, as its pain relief effect becomes obvious at 4th postoperative hour and lasts at least 12th postoperative hour.\u0000","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"111 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80639329","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 : 2019-09-30DOI: 10.2174/2589645801913010093
Seunghyuk Lee, S. Yoon, G. Choi, Yong‐Hee Park, Hyun Kang, C. Baek, Y. Jung, Y. Woo
Glycopyrrolate is often used as a premedication for anesthesia as it has anti-sialogogue and vagolytic effect. Patients undergoing laparoscopic gynecologic surgery have high-risk of Post-Operative Nausea and Vomiting (PONV).This retrospective study investigates the effect of glycopyrrolate as a premedication for PONV in patients receiving fentanyl-based Intravenous (IV) Patient-Controlled Analgesia (PCA) after laparoscopic gynecological surgery.We reviewed the medical records of adult patients who received fentanyl-based IV-PCA after laparoscopic gynecological surgery at Chung-Ang University Hospital between January 1, 2010, and June 30, 2016. We classified patients into two groups on the basis of glycopyrrolate premedication: non-premedicated group (Group N; n = 316) and glycopyrrolate premedicated group (Group P; n = 434). The Propensity Score Matching Method (PSM) was used to select 157 subjects in Group N and P, on the basis of their covariates which were matched with a counterpart in the other group.Prior to PSM, the necessities for rescue anti-emetics were lower on Postoperative Day (POD) 0 (58[18.4%]vs.45[10.4%],P= 0.002) and POD1 (60[19.0%]vs.59[13.6%],P= 0.046), and Visual Analogue Scale (VAS) of pain on POD 1 (2.86 ± 1.49vs.3.13 ± 1.53,P= 0.017) was higher in group P. After PSM, the Numerical Rating Scale (NRS) score for nausea (0.38 ± 0.75vs. 0.21 ± 0.62,P= 0.027) and rescue anti-emetics (27 [17.2%]vs. 15 [9.6%],P= 0.047) on POD 0 were both lower in the group P.In patients receiving fentanyl-based IV-PCA after laparoscopic gynecological surgery, the severity of nausea and necessity for rescue ant-emetic was lower in the glycopyrrolate premedication group.
{"title":"The Effects of Glycopyrrolate as Premedication on Post-Operative Nausea and Vomiting: A Propensity Score Matching Analysis","authors":"Seunghyuk Lee, S. Yoon, G. Choi, Yong‐Hee Park, Hyun Kang, C. Baek, Y. Jung, Y. Woo","doi":"10.2174/2589645801913010093","DOIUrl":"https://doi.org/10.2174/2589645801913010093","url":null,"abstract":"Glycopyrrolate is often used as a premedication for anesthesia as it has anti-sialogogue and vagolytic effect. Patients undergoing laparoscopic gynecologic surgery have high-risk of Post-Operative Nausea and Vomiting (PONV).This retrospective study investigates the effect of glycopyrrolate as a premedication for PONV in patients receiving fentanyl-based Intravenous (IV) Patient-Controlled Analgesia (PCA) after laparoscopic gynecological surgery.We reviewed the medical records of adult patients who received fentanyl-based IV-PCA after laparoscopic gynecological surgery at Chung-Ang University Hospital between January 1, 2010, and June 30, 2016. We classified patients into two groups on the basis of glycopyrrolate premedication: non-premedicated group (Group N; n = 316) and glycopyrrolate premedicated group (Group P; n = 434). The Propensity Score Matching Method (PSM) was used to select 157 subjects in Group N and P, on the basis of their covariates which were matched with a counterpart in the other group.Prior to PSM, the necessities for rescue anti-emetics were lower on Postoperative Day (POD) 0 (58[18.4%]vs.45[10.4%],P= 0.002) and POD1 (60[19.0%]vs.59[13.6%],P= 0.046), and Visual Analogue Scale (VAS) of pain on POD 1 (2.86 ± 1.49vs.3.13 ± 1.53,P= 0.017) was higher in group P. After PSM, the Numerical Rating Scale (NRS) score for nausea (0.38 ± 0.75vs. 0.21 ± 0.62,P= 0.027) and rescue anti-emetics (27 [17.2%]vs. 15 [9.6%],P= 0.047) on POD 0 were both lower in the group P.In patients receiving fentanyl-based IV-PCA after laparoscopic gynecological surgery, the severity of nausea and necessity for rescue ant-emetic was lower in the glycopyrrolate premedication group.","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82598200","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 : 2019-09-30DOI: 10.2174/2589645801913010086
D. Salah, A. M. Alansary
Spinal anesthesia is the commonest technique used in Cesarean Section (CS) and most frequently associated with maternal hypotension, for which a lot of techniques have been described to prevent but an effective method is yet to be found. The aim was to study the effect of using a sub-anesthetic dose of ketamine to prevent post-spinal hypotension in CS delivery. This double-blinded randomized controlled study was conducted on 80 participating parturients who were ASA І, П term pregnant. All the parturients received spinal anesthesia. The parturients were then randomly divided into two equal groups (n= 40 in each); ketamine group received a sub-anesthetic dose of ketamine of 0.5 mg/kg IV bolus in 3 ml saline and control group received the same volume of normal saline IV bolus. Heart Rate (HR) and Mean Arterial blood Pressure (MAP) were recorded at baseline (5 minutes prior to the intrathecal injection), at 5, 10, 15 and 20 minutes after the injection and then every 15 minutes till the end of the operation. Incidences of hypotension and severe hypotension were recorded. The total dose of ephedrine was recorded. Ramsay sedation score was recorded at baseline then 5, 10, 15, 30, 45 minutes after injection and then at the end of the operation. Compared to the control group, sedation score was significantly higher among ketamine group at 5, 10 and 15 minutes. MAP and HR were significantly higher among ketamine group at 5, 10, 15, and 20 minutes. Total ephedrine dose was significantly lower among the ketamine group. Mild hypotension and severe hypotension were significantly less frequent among the ketamine group, as all the patients in the control group had an attack of mild hypotension and 55% of this group had an attack of severe hypotension. No significant difference between both the groups regarding diplopia, nystagmus, hallucination, nausea and vomiting. It is concluded that ketamine in a sub-anesthetic dose is an effective agent that can be used in preventing post-spinal hypotension in parturients undergoing CS delivery.
{"title":"Impact of Sub-Anesthetic Dose of Ketamine on Post Spinal Hypotension in Cesarean Delivery","authors":"D. Salah, A. M. Alansary","doi":"10.2174/2589645801913010086","DOIUrl":"https://doi.org/10.2174/2589645801913010086","url":null,"abstract":"\u0000 \u0000 Spinal anesthesia is the commonest technique used in Cesarean Section (CS) and most frequently associated with maternal hypotension, for which a lot of techniques have been described to prevent but an effective method is yet to be found.\u0000 \u0000 \u0000 \u0000 The aim was to study the effect of using a sub-anesthetic dose of ketamine to prevent post-spinal hypotension in CS delivery.\u0000 \u0000 \u0000 \u0000 This double-blinded randomized controlled study was conducted on 80 participating parturients who were ASA І, П term pregnant. All the parturients received spinal anesthesia. The parturients were then randomly divided into two equal groups (n= 40 in each); ketamine group received a sub-anesthetic dose of ketamine of 0.5 mg/kg IV bolus in 3 ml saline and control group received the same volume of normal saline IV bolus. Heart Rate (HR) and Mean Arterial blood Pressure (MAP) were recorded at baseline (5 minutes prior to the intrathecal injection), at 5, 10, 15 and 20 minutes after the injection and then every 15 minutes till the end of the operation. Incidences of hypotension and severe hypotension were recorded. The total dose of ephedrine was recorded. Ramsay sedation score was recorded at baseline then 5, 10, 15, 30, 45 minutes after injection and then at the end of the operation.\u0000 \u0000 \u0000 \u0000 Compared to the control group, sedation score was significantly higher among ketamine group at 5, 10 and 15 minutes. MAP and HR were significantly higher among ketamine group at 5, 10, 15, and 20 minutes. Total ephedrine dose was significantly lower among the ketamine group. Mild hypotension and severe hypotension were significantly less frequent among the ketamine group, as all the patients in the control group had an attack of mild hypotension and 55% of this group had an attack of severe hypotension. No significant difference between both the groups regarding diplopia, nystagmus, hallucination, nausea and vomiting.\u0000 \u0000 \u0000 \u0000 It is concluded that ketamine in a sub-anesthetic dose is an effective agent that can be used in preventing post-spinal hypotension in parturients undergoing CS delivery.\u0000","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"361-362 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75421880","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 : 2019-08-30DOI: 10.2174/2589645801913010068
A. Moharram, R. Mostafa
Dexmedetomidine on the basis of the previous literature can be considered a safe agent for controlled hypotension through its central and peripheral sympatholytic action. Its easy administration and absence of fatal side effect make it a near-ideal hypotensive agent. This study was intended to evaluate the efficacy of dexmedetomidine infusion “without loading dose” as an effective hypotensive agent in lumbar fixation surgery.In a double-blind study, a total of 60 patients aged 18-65 years, of both genders, belonging to the American Society of Anesthesiologist (ASA) class I - II scheduled for elective lumbar spine instrumentation were included and divided into: Control group (Group C) who received placebo and Dexmedetomidine group (Group D) who received Intravenous (IV) dexmedetomidine. The patients were compared primarily for intraoperative hemodynamics.The study results showed that dexmedetomidine had successfully maintained target mean blood pressure of 65-70 mmHg and only 2 patients out of 30 required rescue therapy (both of propofol and NG). Also, dexmedetomidine had maintained heart rate stability than the control group from the 15thminute after positioning till the end of surgery (P-value < 0.001). Intraoperative fentanyl consumption was significantly low in Dexmedetomidine group 75 ± 25.43 µgversus169.64 ± 34.26 µg in Control group (P-value < 0.001). Finally, more post-operative sedation was noticed during the 1stpostoperative hour in dexmedetomidine group when compared to the control group (P-value < 0.001).Dexmedetomidine infusion without loading dose could be an effective and safe agent in achieving controlled hypotension in adults undergoing elective lumbar spine instrumentation surgery with limited side effects together with intraoperative opioid-sparing effect.
根据先前的文献，右美托咪定可以通过其中枢和外周交感神经溶解作用被认为是一种安全的控制性低血压药物。它易于管理，没有致命的副作用，使其成为一种近乎理想的降压药。本研究旨在评估右美托咪定输液“无负荷剂量”作为腰椎固定手术中有效的降压药的疗效。在一项双盲研究中，共纳入60名年龄在18-65岁的男女患者，属于美国麻醉师学会(ASA) I - II类，计划进行选择性腰椎内固定，并分为:对照组(C组)接受安慰剂，右美托咪定组(D组)接受静脉注射(IV)右美托咪定。主要比较两组患者的术中血流动力学。研究结果显示右美托咪定成功地维持了65-70 mmHg的目标平均血压，30例患者中只有2例需要抢救治疗(异丙酚和NG)。右美托咪定组从体位后15分钟至手术结束均比对照组保持心率稳定(p值< 0.001)。右美托咪定组术中芬太尼用量(75±25.43µg)明显低于对照组(169.64±34.26µg) (p值< 0.001)。最后，与对照组相比，右美托咪定组术后1小时的镇静发生率更高(p值< 0.001)。无负荷剂量右美托咪定输注可作为一种安全有效的降压药物用于成人择期腰椎内固定手术，其副作用有限且术中阿片类药物节省。
{"title":"Efficacy of Dexmedetomidine Infusion Without Loading Dose as a Potent Hypotensive Agent in Lumbar Fixation Surgery","authors":"A. Moharram, R. Mostafa","doi":"10.2174/2589645801913010068","DOIUrl":"https://doi.org/10.2174/2589645801913010068","url":null,"abstract":"Dexmedetomidine on the basis of the previous literature can be considered a safe agent for controlled hypotension through its central and peripheral sympatholytic action. Its easy administration and absence of fatal side effect make it a near-ideal hypotensive agent. This study was intended to evaluate the efficacy of dexmedetomidine infusion “without loading dose” as an effective hypotensive agent in lumbar fixation surgery.In a double-blind study, a total of 60 patients aged 18-65 years, of both genders, belonging to the American Society of Anesthesiologist (ASA) class I - II scheduled for elective lumbar spine instrumentation were included and divided into: Control group (Group C) who received placebo and Dexmedetomidine group (Group D) who received Intravenous (IV) dexmedetomidine. The patients were compared primarily for intraoperative hemodynamics.The study results showed that dexmedetomidine had successfully maintained target mean blood pressure of 65-70 mmHg and only 2 patients out of 30 required rescue therapy (both of propofol and NG). Also, dexmedetomidine had maintained heart rate stability than the control group from the 15thminute after positioning till the end of surgery (P-value < 0.001). Intraoperative fentanyl consumption was significantly low in Dexmedetomidine group 75 ± 25.43 µgversus169.64 ± 34.26 µg in Control group (P-value < 0.001). Finally, more post-operative sedation was noticed during the 1stpostoperative hour in dexmedetomidine group when compared to the control group (P-value < 0.001).Dexmedetomidine infusion without loading dose could be an effective and safe agent in achieving controlled hypotension in adults undergoing elective lumbar spine instrumentation surgery with limited side effects together with intraoperative opioid-sparing effect.","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80990518","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 : 2019-08-30DOI: 10.2174/2589645801913010078
A. Saleh, D. Emam, M. Kamal
Although PONV is usually self-limiting or is treated without sequelae, the incidence of PONV could be as high as 70% to 80% in high-risk populations such as female sex, obese patients, age younger than 40 years, nonsmoker patients, history of PONV or motion sickness. The study aimed to investigate whether dextrose 10% decreases the incidence of postoperative nausea and vomiting in female patients undergoing laparoscopic cholecystectomy This prospective, double-blind randomized placebo-controlled study comprised 130 ASA physical status I and II nonsmoker female patients, 20-40 years of age, scheduled for laparoscopic cholecystectomy at Ain Sham University – Assembled operating theater from August 2018 to October 2018. Patients were arbitrarily divided into two study groups of 65 patients each. Group LR received lactated Ringer’s solution and group D received 10% dextrose. The primary objective of this study was to compare the incidence of PONV in the study treatment groups. The secondary outcomes included measurement of antiemetic medication consumption as well as blood glucose changes between groups. 50 from a total of 65 participants (76.9%) in Lactated Ringer (LR) group experienced nausea. On the other hand, 30 participants only (46.2%) in dextrose (D) group were nauseated. This dissimilarity was statistically highly significant (P= 0.0003). In this study, dextrose 10% administration resulted in improved postoperative emesis management as explained by the lower incidence of nausea and rescue antiemetic consumption.
{"title":"Evaluating the Effect of Intraoperative Dextrose 10% Administration on Reducing Postoperative Nausea and Vomiting after Laparoscopic Surgery","authors":"A. Saleh, D. Emam, M. Kamal","doi":"10.2174/2589645801913010078","DOIUrl":"https://doi.org/10.2174/2589645801913010078","url":null,"abstract":"\u0000 \u0000 Although PONV is usually self-limiting or is treated without sequelae, the incidence of PONV could be as high as 70% to 80% in high-risk populations such as female sex, obese patients, age younger than 40 years, nonsmoker patients, history of PONV or motion sickness.\u0000 \u0000 \u0000 \u0000 The study aimed to investigate whether dextrose 10% decreases the incidence of postoperative nausea and vomiting in female patients undergoing laparoscopic cholecystectomy\u0000 \u0000 \u0000 \u0000 This prospective, double-blind randomized placebo-controlled study comprised 130 ASA physical status I and II nonsmoker female patients, 20-40 years of age, scheduled for laparoscopic cholecystectomy at Ain Sham University – Assembled operating theater from August 2018 to October 2018.\u0000 Patients were arbitrarily divided into two study groups of 65 patients each. Group LR received lactated Ringer’s solution and group D received 10% dextrose. \u0000 The primary objective of this study was to compare the incidence of PONV in the study treatment groups. \u0000 The secondary outcomes included measurement of antiemetic medication consumption as well as blood glucose changes between groups.\u0000 \u0000 \u0000 \u0000 50 from a total of 65 participants (76.9%) in Lactated Ringer (LR) group experienced nausea. On the other hand, 30 participants only (46.2%) in dextrose (D) group were nauseated. This dissimilarity was statistically highly significant (P= 0.0003).\u0000 \u0000 \u0000 \u0000 In this study, dextrose 10% administration resulted in improved postoperative emesis management as explained by the lower incidence of nausea and rescue antiemetic consumption.\u0000","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78975460","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 : 2019-08-30DOI: 10.2174/2589645801913010059
S. Amin, Sallam M. Abd-Elgalil, S. Mohamed, M.M. Ahmed, T. Hamawy, Lotfy M. Fathi
Patients undergoing cardiac surgery are at risk of postcardiotomy myocardial dysfunction. This condition causes delayed recovery, organ failure, prolonged intensive care unit and hospital stays, and an increased risk of mortality; these patients often require inotropic agent support. Levosimendan is a calcium sensitizer with a unique mechanism of action, binding to cardiac troponin C and enhancing myofilament responsiveness to calcium, increasing myocardial contraction without increasing myocardial oxygen consumption. Phosphodiesterase III inhibitors such as milrinone provide an alternative means of inotropic support by increasing the concentration of cyclic AMP and intracellular calcium. They also have vasodilatory effects. The aim of this study was the comparison between levosimendan versus milrinone regarding their effects on the hemodynamics, need for additional mechanical (intra aortic balloon pump) or pharmacological support to the heart, weaning from mechanical ventilation and duration of intensive care unit stay for patients after Off-Pump Coronary Artery Bypass Graft (OPCABG) surgery suffering from impaired left ventricular function (preoperative ejection fraction ≤ 40%). 60 patients between 40 and 70 years of both sexes with impaired left ventricular function (ejection fraction ≤ 40%), New York Heart Association (NYHA III & IV), undergoing elective Off-Pump Coronary Artery Bypass Graft (OPCABG) surgery were selected for this study. After induction of anesthesia, patients were randomly assigned to one of two equal groups each containing 30 patients: Group L (Levosimendan group) included patients who received levosimendan 0.1- 0.2 µg/kg/min. Started immediately with the induction of anesthesia. Group M (Milrinone group) included patients who received milrinone 0.4-0.6 µg/kg/min. Started immediately with the induction of anesthesia. In both groups, norepinephrine was titrated (8 mg norepinephrine in 50 ml saline) to keep mean arterial pressure MAP ≥ 70 mmHg. Hemodynamic findings included Preoperative and post ICU discharge ejection fraction, systemic and pulmonary artery pressures, systemic and pulmonary vascular resistance, cardiac output and stroke volume. Also laboratory findings included Serum lactate and Troponin I., in addition, to post operative findings were: Need for intra aortic balloon pump, time of weaning from the ventilator, days of ICU stay and appearance of drug allergy compared in both groups. There was a significant increase in the ejection fraction in both groups that was greater in the levosimendan group. The decrease in pulmonary pressure in the levosimendan group was more significant than milrinone group. There was a gradual decrease in pulmonary and systemic vascular resistance in both groups with a more significant decrease in the levosimendan group. There was a gradual increase in cardiac output and stroke volume in both groups that was greater in the levosimendan group. Serum lactate g
{"title":"Levosimendan Versus Milrinone in the Management of Impaired Left Ventricular Function in Patients Undergoing Coronary Artery Bypass Graft Surgery","authors":"S. Amin, Sallam M. Abd-Elgalil, S. Mohamed, M.M. Ahmed, T. Hamawy, Lotfy M. Fathi","doi":"10.2174/2589645801913010059","DOIUrl":"https://doi.org/10.2174/2589645801913010059","url":null,"abstract":"\u0000 \u0000 Patients undergoing cardiac surgery are at risk of postcardiotomy myocardial dysfunction. This condition causes delayed recovery, organ failure, prolonged intensive care unit and hospital stays, and an increased risk of mortality; these patients often require inotropic agent support. Levosimendan is a calcium sensitizer with a unique mechanism of action, binding to cardiac troponin C and enhancing myofilament responsiveness to calcium, increasing myocardial contraction without increasing myocardial oxygen consumption. Phosphodiesterase III inhibitors such as milrinone provide an alternative means of inotropic support by increasing the concentration of cyclic AMP and intracellular calcium. They also have vasodilatory effects.\u0000 \u0000 \u0000 \u0000 The aim of this study was the comparison between levosimendan versus milrinone regarding their effects on the hemodynamics, need for additional mechanical (intra aortic balloon pump) or pharmacological support to the heart, weaning from mechanical ventilation and duration of intensive care unit stay for patients after Off-Pump Coronary Artery Bypass Graft (OPCABG) surgery suffering from impaired left ventricular function (preoperative ejection fraction ≤ 40%).\u0000 \u0000 \u0000 \u0000 60 patients between 40 and 70 years of both sexes with impaired left ventricular function (ejection fraction ≤ 40%), New York Heart Association (NYHA III & IV), undergoing elective Off-Pump Coronary Artery Bypass Graft (OPCABG) surgery were selected for this study. After induction of anesthesia, patients were randomly assigned to one of two equal groups each containing 30 patients:\u0000 Group L (Levosimendan group) included patients who received levosimendan 0.1- 0.2 µg/kg/min. Started immediately with the induction of anesthesia.\u0000 Group M (Milrinone group) included patients who received milrinone 0.4-0.6 µg/kg/min. Started immediately with the induction of anesthesia.\u0000 In both groups, norepinephrine was titrated (8 mg norepinephrine in 50 ml saline) to keep mean arterial pressure MAP ≥ 70 mmHg.\u0000 Hemodynamic findings included Preoperative and post ICU discharge ejection fraction, systemic and pulmonary artery pressures, systemic and pulmonary vascular resistance, cardiac output and stroke volume. Also laboratory findings included Serum lactate and Troponin I., in addition, to post operative findings were: Need for intra aortic balloon pump, time of weaning from the ventilator, days of ICU stay and appearance of drug allergy compared in both groups.\u0000 \u0000 \u0000 \u0000 There was a significant increase in the ejection fraction in both groups that was greater in the levosimendan group. The decrease in pulmonary pressure in the levosimendan group was more significant than milrinone group. There was a gradual decrease in pulmonary and systemic vascular resistance in both groups with a more significant decrease in the levosimendan group. There was a gradual increase in cardiac output and stroke volume in both groups that was greater in the levosimendan group. Serum lactate g","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84573089","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 : 2019-07-24DOI: 10.2174/2589645801913010047
M. Hosny, A. N. Saleh, W. Abdelaal, T. Rabie
Midazolam, given by varying routes, is widely used as a premedication. This study was performed to investigate the effect of IV midazolam premedication on the recovery characteristics from isoflurane anesthesia in pediatric patients undergoing cochlear implant surgery. In this double-blind randomized study, a total of 60 unilateral cochlear implants procedures were performed on 60 children aged 1 – 6 years. They were 29 males (48.3%) and 31 females (51.7%). Patients were randomly allocated in one of two groups (M and S). Each group included 30 participants. Patients in group M received 0.01 mg/kg IV midazolam in 2 ml of 0.9% saline, while patients in group S received equal volume of 0.9% saline, two minutes before induction. Recovery times from discontinuation of isoflurane were recorded. Postoperative pain was assessed using Objective Pain Discomfort Score (OPDS). Emergence Agitation (EA) was recorded based on Aono’s four-point scale. There were statistically significant differences between patients pre-medicated with IV midazolam and those of the normal saline group as regards all measured recovery parameters (p<0.001). Patients in group M scored higher than those in Group S on the OPDS. Yet, this difference didn't show statistical significance (p=0.438) Among patients pre-medicated with midazolam, 17 (56.6%) suffered from EA compared to 12 (40%) patients from the other group. This difference did not reach statistical significance (p=0.196). Premedication with IV midazolam delayed recovery in pediatric patients undergoing moderately-long procedures when isoflurane was used as the inhalation anesthetic, while its effect on EA remains uncertain.
咪达唑仑，通过不同的途径给予，被广泛用作前用药。本研究旨在探讨静脉咪达唑仑预用药对异氟醚麻醉后儿童人工耳蜗术后恢复的影响。在这项双盲随机研究中，对60名1 - 6岁的儿童进行了60例单侧人工耳蜗植入手术。男性29例(48.3%)，女性31例(51.7%)。患者随机分为两组(M组和S组)，每组30人。M组患者在诱导前2分钟给予0.01 mg/kg咪达唑仑静脉滴注于2 ml 0.9%生理盐水中，S组患者给予等体积0.9%生理盐水。记录停止使用异氟醚后的恢复时间。术后疼痛采用客观疼痛不适评分(OPDS)进行评估。根据Aono四分制记录涌现性躁动(EA)。静脉滴注咪达唑仑组与生理盐水组的各项恢复指标均有统计学差异(p<0.001)。M组患者OPDS评分高于S组。但差异无统计学意义(p=0.438)。在预先给予咪达唑仑的患者中，有17例(56.6%)发生EA，而另一组有12例(40%)发生EA。差异无统计学意义(p=0.196)。当使用异氟醚作为吸入麻醉剂时，静脉滴注咪达唑仑延迟了接受中等时间手术的儿科患者的恢复，而其对EA的影响仍不确定。
{"title":"Effect of IV Midazolam Premedication on the Recovery of Pediatric Patients after Isoflurane Anesthesia for Cochlear Implant Surgery","authors":"M. Hosny, A. N. Saleh, W. Abdelaal, T. Rabie","doi":"10.2174/2589645801913010047","DOIUrl":"https://doi.org/10.2174/2589645801913010047","url":null,"abstract":"\u0000 \u0000 Midazolam, given by varying routes, is widely used as a premedication. This study\u0000 was performed to investigate the effect of IV midazolam premedication on\u0000 the recovery characteristics from isoflurane anesthesia in pediatric patients\u0000 undergoing cochlear implant surgery.\u0000 \u0000 \u0000 \u0000 In this double-blind randomized study, a total of 60 unilateral cochlear implants procedures were performed on 60 children aged 1 – 6 years. They were 29 males (48.3%) and 31 females (51.7%). Patients were randomly allocated in one of two groups (M and S). Each group included 30 participants. Patients in group M received 0.01 mg/kg IV midazolam in 2 ml of 0.9% saline, while patients in group S received equal volume of 0.9% saline, two minutes before induction. Recovery times from discontinuation of isoflurane were recorded. Postoperative pain was assessed using Objective Pain Discomfort Score (OPDS). Emergence Agitation (EA) was recorded based on Aono’s four-point scale.\u0000 \u0000 \u0000 There were statistically significant differences between patients pre-medicated with IV midazolam and those of the normal saline group as regards all measured recovery parameters (p<0.001). Patients in group M scored higher than those in Group S on the OPDS. Yet, this difference didn't show statistical significance (p=0.438) Among patients pre-medicated with midazolam, 17 (56.6%) suffered from EA compared to 12 (40%) patients from the other group. This difference did not reach statistical significance (p=0.196).\u0000 \u0000 \u0000 \u0000 Premedication with IV midazolam delayed recovery in pediatric patients undergoing moderately-long procedures when isoflurane was used as the inhalation anesthetic, while its effect on EA remains uncertain.\u0000","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79318488","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 : 2019-07-24DOI: 10.2174/2589645801913010053
D. Doyle
This brief review introduces the reader to some of the various historical and modern methods that are available for the bio-acoustical assessment of patient breathing, with other bio-acoustical processes discussed peripherally. Some simple methods of respiratory assessment of historical interest are first discussed, along with more modern methods of patient acoustical monitoring based on advanced analytic methods.
{"title":"Acoustical Respiratory Monitoring: Historical and Modern Aspects","authors":"D. Doyle","doi":"10.2174/2589645801913010053","DOIUrl":"https://doi.org/10.2174/2589645801913010053","url":null,"abstract":"This brief review introduces the reader to some of the various historical and modern methods that are available for the bio-acoustical assessment of patient breathing, with other bio-acoustical processes discussed peripherally. Some simple methods of respiratory assessment of historical interest are first discussed, along with more modern methods of patient acoustical monitoring based on advanced analytic methods.","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86040802","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 : 2019-06-30DOI: 10.2174/2589645801913010044
V. R. Kadam
Anaesthetic management of upper airway surgery in paediatric is challenging. Total intravenous anaesthesia with opioid or inhalation technique with spontaneous respiration has been used but studies are limited on inhalation technique. This study aimed to use tubeless inhalation insufflation technique without opioids at a tertiary centre. All paediatric patients coming for elective upper airway surgery to the centre, were included. Mask induction was with 5-8% sevoflurane in O2 and maintenance with 2-3%, via a nasopharyngeally placed Endotracheal Tube (ETT) or catheter on spontaneous ventilation with flow between 8-10 l/min. Lidocaine up to 5 mg/kg was then sprayed to the mucosa of larynx and trachea. Once adequate depth was attained, suspension laryngoscope was placed by a surgeon for surgery. Some complications were observed i.e inadequate anaesthesia requiring rescue drugs like opioids or propofol, intubation, desaturation events from laryngospasm and delayed recovery. Surgical technique involved was diagnostic and therapeutic for the upper airway lesions. Fifteen paediatric patients (2 months to 7 yrs) were included in the study with tubeless anaesthesia. None of them required intubation during the procedure. The mean time from induction of anaesthesia to unconsciousness was 15 ± 3 s and attainment of necessary anaesthetic depth for surgery was 4.7 ± 0.90 min. None had desaturation events or required opioids. However, propofol was required in one and delayed anaesthetic recovery was observed in one patient. This study on tubeless anaesthesia with Local Anaesthetic (LA) spray with spontaneous inhalation insufflation technique provided an opioid-free, interference-free operative field without airway compromise, not requiring intubation, therefore, further studies are required.
{"title":"Inhalation Insufflation Technique with Local Anaesthetic Spray without Intubation and Opioids for Paediatric Upper Airway Surgery - Observational Case Series Study","authors":"V. R. Kadam","doi":"10.2174/2589645801913010044","DOIUrl":"https://doi.org/10.2174/2589645801913010044","url":null,"abstract":"\u0000 \u0000 Anaesthetic management of upper airway surgery in paediatric is challenging. Total intravenous anaesthesia with opioid or inhalation technique with spontaneous respiration has been used but studies are limited on inhalation technique. This study aimed to use tubeless inhalation insufflation technique without opioids at a tertiary centre.\u0000 \u0000 \u0000 \u0000 All paediatric patients coming for elective upper airway surgery to the centre, were included. Mask induction was with 5-8% sevoflurane in O2 and maintenance with 2-3%, via a nasopharyngeally placed Endotracheal Tube (ETT) or catheter on spontaneous ventilation with flow between 8-10 l/min. Lidocaine up to 5 mg/kg was then sprayed to the mucosa of larynx and trachea. Once adequate depth was attained, suspension laryngoscope was placed by a surgeon for surgery. Some complications were observed i.e inadequate anaesthesia requiring rescue drugs like opioids or propofol, intubation, desaturation events from laryngospasm and delayed recovery. Surgical technique involved was diagnostic and therapeutic for the upper airway lesions.\u0000 \u0000 \u0000 \u0000 Fifteen paediatric patients (2 months to 7 yrs) were included in the study with tubeless anaesthesia. None of them required intubation during the procedure. The mean time from induction of anaesthesia to unconsciousness was 15 ± 3 s and attainment of necessary anaesthetic depth for surgery was 4.7 ± 0.90 min. None had desaturation events or required opioids. However, propofol was required in one and delayed anaesthetic recovery was observed in one patient.\u0000 \u0000 \u0000 \u0000 This study on tubeless anaesthesia with Local Anaesthetic (LA) spray with spontaneous inhalation insufflation technique provided an opioid-free, interference-free operative field without airway compromise, not requiring intubation, therefore, further studies are required.\u0000","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77328986","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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