Pub Date : 2018-09-28DOI: 10.2174/2589645801812010061
A. Saleh, R. Mostafa
The inhibitory effect of Tranexamic Acid (TXA) on γ-aminobutyric acid and glycine receptors of spinal dorsal horn neurons which leads to pain arousal, has been highlighted recently in animal studies. Such findings would elicit concerns about adverse effects of TXA as a routine agent used to reduce perioperative blood loss.This study aimed to evaluate the effect of different doses of TXA on analgesic requirements in adolescent patients undergoing elective single-stage posterior spine fusion surgery for idiopathic scoliosis.This prospective, randomized, double-blinded study comprised 75 patients who were randomly allocated to one of three groups. Each group comprised 25 patients. In group C (Control), patients received normal saline. While in group HD (High Dose), patients received TXA with a loading dose of 50 mg/kg and maintenance dose of 20 mg/kg/h and patients in group LD (Low Dose) received TXA with a loading dose of 10 mg/kg and maintenance dose of 1 mg/kg/h. The total intraoperative fentanyl dose was calculated for each patient which we used as a measure of the patients’ nociception level.Group HD patients’ required the highest dose of fentanyl compared to those in LD group (mean of 60µgversus27µg). Patients in group C received no extra intraoperative narcotic doses and experienced the longest duration of surgical procedure. These results showed high statistically significant difference (p< 0.001).Intraoperative administration of TXA increases the analgesic requirement during elective single stage posterior spine fusion surgery which likely reflects an increase in patients’ intraoperative nociception.
{"title":"Increased Nociception Following Administration of Different Doses of Tranexamic Acid in Adolescent Idiopathic Scoliosis Surgery","authors":"A. Saleh, R. Mostafa","doi":"10.2174/2589645801812010061","DOIUrl":"https://doi.org/10.2174/2589645801812010061","url":null,"abstract":"The inhibitory effect of Tranexamic Acid (TXA) on γ-aminobutyric acid and glycine receptors of spinal dorsal horn neurons which leads to pain arousal, has been highlighted recently in animal studies. Such findings would elicit concerns about adverse effects of TXA as a routine agent used to reduce perioperative blood loss.This study aimed to evaluate the effect of different doses of TXA on analgesic requirements in adolescent patients undergoing elective single-stage posterior spine fusion surgery for idiopathic scoliosis.This prospective, randomized, double-blinded study comprised 75 patients who were randomly allocated to one of three groups. Each group comprised 25 patients. In group C (Control), patients received normal saline. While in group HD (High Dose), patients received TXA with a loading dose of 50 mg/kg and maintenance dose of 20 mg/kg/h and patients in group LD (Low Dose) received TXA with a loading dose of 10 mg/kg and maintenance dose of 1 mg/kg/h. The total intraoperative fentanyl dose was calculated for each patient which we used as a measure of the patients’ nociception level.Group HD patients’ required the highest dose of fentanyl compared to those in LD group (mean of 60µgversus27µg). Patients in group C received no extra intraoperative narcotic doses and experienced the longest duration of surgical procedure. These results showed high statistically significant difference (p< 0.001).Intraoperative administration of TXA increases the analgesic requirement during elective single stage posterior spine fusion surgery which likely reflects an increase in patients’ intraoperative nociception.","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86220433","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 : 2018-09-27DOI: 10.2174/2589645801812010049
D. Doyle
This brief review of the Ventrain ventilation system summarizes the main clinical and technical aspects of the device, with special emphasis on its role in the “Cannot Intubate, Cannot Oxygenate“ situation and in surgery involving the airway. Animal and bench studies characterizing the performance of the device, which is based on Bernoulli's Principle, are also discussed. It is concluded that as clinical experience is accumulated that this new device will play a special role in clinical airway management.
{"title":"Ventilation via Narrow-Bore Catheters: Clinical and Technical Perspectives on the Ventrain Ventilation System","authors":"D. Doyle","doi":"10.2174/2589645801812010049","DOIUrl":"https://doi.org/10.2174/2589645801812010049","url":null,"abstract":"This brief review of the Ventrain ventilation system summarizes the main clinical and technical aspects of the device, with special emphasis on its role in the “Cannot Intubate, Cannot Oxygenate“ situation and in surgery involving the airway. Animal and bench studies characterizing the performance of the device, which is based on Bernoulli's Principle, are also discussed. It is concluded that as clinical experience is accumulated that this new device will play a special role in clinical airway management.","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88672063","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 : 2018-08-29DOI: 10.2174/2589645801812010034
R. Hussien, D. Ibrahim
The current study focusses on ultrasound guided Brachial Plexus Block (BPB) which plays an important role in patients with hand trauma either in pain control or for surgical intervention. The brachial plexus can be blocked by several techniques but the most commonly used are the Supraclavicular (SCB) and Axillary (AXB) blocks. To compare the two techniques with regards to the performance time, needling time, anesthesia-related time, block-related complications, number of needle pass and block related pain. After approval of the ethical committee and obtaining a written informed consent from patients, this prospective, randomized, interventional double-blinded study was done to patients undergoing emergency crushed hand surgery. 80 patients were allocated randomly into two equal groups. Under ultrasound guidance, the SCB and AXB were done for the two groups, respectively. The needling time, performance time, anesthesia-related time, onset time, number of 1st needle pass in each group and block related complications were noted. Data were analysed using the Statistical Package for Social Science (IBM SPSS) version 23 SPSS. Longer needling, performance, anesthesia-related time in the AXB group than SCB and less complications have occurred with AXB than SCB group. Axillary block of brachial plexus is a good alternative to Supraclavicular block in emergency crushed hand surgery and the choice is made according to the requirement of each case.
{"title":"Ultrasound Guided Axillary Brachial Plexus Block Versus Supraclavicular Block In Emergency Crushed Hand Patients : A Comparative Study","authors":"R. Hussien, D. Ibrahim","doi":"10.2174/2589645801812010034","DOIUrl":"https://doi.org/10.2174/2589645801812010034","url":null,"abstract":"\u0000 \u0000 The current study focusses on ultrasound guided Brachial Plexus Block (BPB) which plays an important role in patients with hand trauma either in pain control or for surgical intervention. The brachial plexus can be blocked by several techniques but the most commonly used are the Supraclavicular (SCB) and Axillary (AXB) blocks.\u0000 \u0000 \u0000 \u0000 To compare the two techniques with regards to the performance time, needling time, anesthesia-related time, block-related complications, number of needle pass and block related pain.\u0000 \u0000 \u0000 \u0000 After approval of the ethical committee and obtaining a written informed consent from patients, this prospective, randomized, interventional double-blinded study was done to patients undergoing emergency crushed hand surgery. 80 patients were allocated randomly into two equal groups. Under ultrasound guidance, the SCB and AXB were done for the two groups, respectively. The needling time, performance time, anesthesia-related time, onset time, number of 1st needle pass in each group and block related complications were noted.\u0000 \u0000 \u0000 \u0000 Data were analysed using the Statistical Package for Social Science (IBM SPSS) version 23 SPSS.\u0000 \u0000 \u0000 \u0000 Longer needling, performance, anesthesia-related time in the AXB group than SCB and less complications have occurred with AXB than SCB group.\u0000 \u0000 \u0000 \u0000 Axillary block of brachial plexus is a good alternative to Supraclavicular block in emergency crushed hand surgery and the choice is made according to the requirement of each case.\u0000","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86137859","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 : 2018-07-31DOI: 10.2174/2589645801812010026
D. Doyle
Clinical Early Warning Scores are tools intended to alert clinical staff to possible future clinical deterioration, often related to the onset of sepsis. Since their introduction, they have increased greatly in popularity. Their operation is conceptually simple: an elevated early warning score triggers a formal assessment by the responsible clinician. While the best-known system is the Royal College of Physicians National Early Warning Score (NEWS), a number of other scores are in use, such as an adaptation known as the Modified Early Warning System (MEWS) or warning systems for pediatric patients (PEWS). However, while promising, such instruments need to be studied in more detail to better characterize their eventual role in monitoring hospital patients. In particular, a central question concerns the identification of the best system (NEWS, MEWS, PEWS etc.) for a given clinical population (pediatric, trauma, prehospital etc.).
{"title":"Clinical Early Warning Scores: New Clinical Tools in Evolution","authors":"D. Doyle","doi":"10.2174/2589645801812010026","DOIUrl":"https://doi.org/10.2174/2589645801812010026","url":null,"abstract":"Clinical Early Warning Scores are tools intended to alert clinical staff to possible future clinical deterioration, often related to the onset of sepsis. Since their introduction, they have increased greatly in popularity. Their operation is conceptually simple: an elevated early warning score triggers a formal assessment by the responsible clinician. While the best-known system is the Royal College of Physicians National Early Warning Score (NEWS), a number of other scores are in use, such as an adaptation known as the Modified Early Warning System (MEWS) or warning systems for pediatric patients (PEWS). However, while promising, such instruments need to be studied in more detail to better characterize their eventual role in monitoring hospital patients. In particular, a central question concerns the identification of the best system (NEWS, MEWS, PEWS etc.) for a given clinical population (pediatric, trauma, prehospital etc.).","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87415254","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 : 2018-07-16DOI: 10.2174/2589645801812010019
R. Hussien, D. Ibrahim, Islam Gamal Hamed Abdelnaby
Ultrasound guided sciatic nerve block has been proved to be effective in pain control for lower limb surgeries, fortunately, it can be performed at different levels via different approaches. To compare the effectiveness of the sub-gluteal and the popliteal approaches of blocking the sciatic nerve as well as their success rate. After approval of the ethical committee and obtaining a written informed consent from 56 ASA II, III patients aged 45–75 year, this prospective, randomized, interventional double blinded study was done to patients undergoing elective below knee amputation. Patients were randomly assigned to receive either sciatic nerve block using a popliteal approach (group P, n 28) or a sub gluteal approach (group G, n 28). femoral nerve block done for sensory block of the medial side of the leg. Time to complete sensory and motor block, time taken to perform the block, block-related complications, block duration, time for asking for rescue analgesia in the first 24 h and both patients′ and surgeons′ level of satisfaction were recorded. Success of the block was considered when the block is solid and doesn’t require shifting to GA. Patients in the P group had a 100% success rate, shorter time to perform the block, less overall complications, required no postoperative rescue analgesia. Yet, more surgeons preferred the sub-gluteal approach. Popliteal approach is as effective as the sub-gluteal approach block providing adequate analgesia with a 100% success rate
{"title":"Ultrasound-Guided Sciatic Nerve Block in Below Knee Amputation Surgery: Sub Gluteal Versus Popliteal Approach","authors":"R. Hussien, D. Ibrahim, Islam Gamal Hamed Abdelnaby","doi":"10.2174/2589645801812010019","DOIUrl":"https://doi.org/10.2174/2589645801812010019","url":null,"abstract":"\u0000 \u0000 Ultrasound guided sciatic nerve block has been proved to be effective in pain control for lower limb surgeries, fortunately, it can be performed at different levels via different approaches.\u0000 \u0000 \u0000 \u0000 To compare the effectiveness of the sub-gluteal and the popliteal approaches of blocking the sciatic nerve as well as their success rate.\u0000 \u0000 \u0000 \u0000 After approval of the ethical committee and obtaining a written informed consent from 56 ASA II, III patients aged 45–75 year, this prospective, randomized, interventional double blinded study was done to patients undergoing elective below knee amputation.\u0000 \u0000 \u0000 \u0000 Patients were randomly assigned to receive either sciatic nerve block using a popliteal approach (group P, n 28) or a sub gluteal approach (group G, n 28). femoral nerve block done for sensory block of the medial side of the leg. Time to complete sensory and motor block, time taken to perform the block, block-related complications, block duration, time for asking for rescue analgesia in the first 24 h and both patients′ and surgeons′ level of satisfaction were recorded. Success of the block was considered when the block is solid and doesn’t require shifting to GA.\u0000 \u0000 \u0000 \u0000 Patients in the P group had a 100% success rate, shorter time to perform the block, less overall complications, required no postoperative rescue analgesia. Yet, more surgeons preferred the sub-gluteal approach.\u0000 \u0000 \u0000 \u0000 Popliteal approach is as effective as the sub-gluteal approach block providing adequate analgesia with a 100% success rate\u0000","PeriodicalId":22862,"journal":{"name":"The Open Anesthesia Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87851127","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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