Background Caesarean sections are usually performed under spinal anaesthesia. It provides effective postoperative pain control over a limited period of time. As a result, various intrathecal additives have been used. Recently, dexamethasone and dexmedetomidine have been used as adjuncts for different types of regional anaesthesia without increasing the risk of neurological complications. Objectives: We compared the analgesic effects of intrathecal dexamethasone and dexmedetomidine in elective caesarean sections. Design: A single-blind randomized trial. Setting: Benha University Hospital, between February 2021 and July 2021. Patients: We randomly enrolled 633 pregnant women in this study. Only 580 patients met all the inclusion and exclusion criteria. The inclusion criteria were age of 18 to 40 years old, an ASA class ІІ - III, gestational age > 37 weeks, BMI less than 30 kg/m2 who were electively scheduled for. The exclusion criteria included patient refusal, age < 18 or > 40 years, known allergy to medications used in the study, BMI more than 30 kg/m2, coagulopathies or anticoagulant use, cerebrovascular insufficiency, neuromuscular diseases and diabetic neuropathy. Intervention: The dexmedetomidine group (A) received 10 μg of dexmedetomidine with 12.5 mg hyperbaric bupivacaine 0.5%intrathecally(n=290). The dexamethasone group (B) received 4 mg of dexamethasone with 12.5 mg hyperbaric bupivacaine 0.5%intrathecally(n=290). Main outcome: The time to initial analgesic rescue (pethidine 0.5 mg/kg) and the duration of motor blockage were assessed. Results: The time to the first rescue analgesia and motor blockade were significantly higher in the dexmedetomidine group. (418 min vs 190 min), P<0.001, (324 min vs 144 min), P <0.001 respectively. Conclusion: According to this study, both drugs could be safely added to bupivacaine intrathecally. Dexmedetomidine provides significantly longer postoperative analgesia and motor blockade times than dexamethasone. Further dose-response studies are needed to determine the optimum dosage of dexamethasone and dexmedetomidine and the safety of the intrathecal route.
背景:剖宫产通常在脊髓麻醉下进行。它在有限的时间内提供了有效的术后疼痛控制。因此，使用了各种鞘内添加剂。最近，地塞米松和右美托咪定被用作不同类型的局部麻醉的辅助药物，而不会增加神经系统并发症的风险。目的:比较地塞米松和右美托咪定在择期剖宫产术中的镇痛效果。设计:单盲随机试验。地点:本哈大学医院，2021年2月至2021年7月。患者:我们随机招募了633名孕妇。只有580例患者符合所有纳入和排除标准。入选标准为年龄18 ~ 40岁，ASA分级ІІ - III级，胎龄> 37周，BMI小于30 kg/m2。排除标准包括患者拒绝、年龄< 18岁或> 40岁、已知对研究中使用的药物过敏、BMI大于30 kg/m2、凝血功能障碍或抗凝剂使用、脑血管功能不全、神经肌肉疾病和糖尿病性神经病变。干预:右美托咪定组(A组)给予右美托咪定10 μg，同时给予12.5 mg 0.5%布比卡因鞘内注射(n=290)。地塞米松组(B组)给予地塞米松4 mg，布比卡因12.5 mg，浓度为0.5%。主要观察指标:评估初始镇痛救援时间(哌啶0.5 mg/kg)和运动阻滞持续时间。结果:右美托咪定组到第一次抢救镇痛和运动阻滞的时间明显高于右美托咪定组。(418 min vs 190 min)， P<0.001， (324 min vs 144 min)， P<0.001。结论:两种药物均可安全加入布比卡因鞘内治疗。右美托咪定术后镇痛和运动阻滞时间明显长于地塞米松。需要进一步的剂量反应研究来确定地塞米松和右美托咪定的最佳剂量以及鞘内途径的安全性。
{"title":"Comparison Between Analgesic Effect of Dexamethasone and Dexmedetomidine as an Adjuvant to Bupivacaine for Spinal Anaesthesia for Elective Caesarean Sections","authors":"Baher Said Abdelhady","doi":"10.54289/jaad2200102","DOIUrl":"https://doi.org/10.54289/jaad2200102","url":null,"abstract":"Background Caesarean sections are usually performed under spinal anaesthesia. It provides effective postoperative pain control over a limited period of time. As a result, various intrathecal additives have been used. Recently, dexamethasone and dexmedetomidine have been used as adjuncts for different types of regional anaesthesia without increasing the risk of neurological complications. Objectives: We compared the analgesic effects of intrathecal dexamethasone and dexmedetomidine in elective caesarean sections. Design: A single-blind randomized trial. Setting: Benha University Hospital, between February 2021 and July 2021. Patients: We randomly enrolled 633 pregnant women in this study. Only 580 patients met all the inclusion and exclusion criteria. The inclusion criteria were age of 18 to 40 years old, an ASA class ІІ - III, gestational age > 37 weeks, BMI less than 30 kg/m2 who were electively scheduled for. The exclusion criteria included patient refusal, age < 18 or > 40 years, known allergy to medications used in the study, BMI more than 30 kg/m2, coagulopathies or anticoagulant use, cerebrovascular insufficiency, neuromuscular diseases and diabetic neuropathy. Intervention: The dexmedetomidine group (A) received 10 μg of dexmedetomidine with 12.5 mg hyperbaric bupivacaine 0.5%intrathecally(n=290). The dexamethasone group (B) received 4 mg of dexamethasone with 12.5 mg hyperbaric bupivacaine 0.5%intrathecally(n=290). Main outcome: The time to initial analgesic rescue (pethidine 0.5 mg/kg) and the duration of motor blockage were assessed. Results: The time to the first rescue analgesia and motor blockade were significantly higher in the dexmedetomidine group. (418 min vs 190 min), P<0.001, (324 min vs 144 min), P <0.001 respectively. Conclusion: According to this study, both drugs could be safely added to bupivacaine intrathecally. Dexmedetomidine provides significantly longer postoperative analgesia and motor blockade times than dexamethasone. Further dose-response studies are needed to determine the optimum dosage of dexamethasone and dexmedetomidine and the safety of the intrathecal route.","PeriodicalId":326444,"journal":{"name":"Journal of Anesthesia and Anesthetic Drugs","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128239368","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}
We give different characters to the pain. If a child is injured, he will cry and say, "I have a wound". The mother will ask: where does my love hurt? Consider that these are two different approaches to pain: 1. The emotional element of pain, which is phylogenetically primitive and deals with pain as something unpleasant, which must be avoided and the most recent: 2. the distinct element of pain, which is the ability to perceive exactly where the pain is and to respond appropriately.
{"title":"Physiology of Pain","authors":"Dalamagka Maria","doi":"10.54289/jaad2200101","DOIUrl":"https://doi.org/10.54289/jaad2200101","url":null,"abstract":"We give different characters to the pain. If a child is injured, he will cry and say, \"I have a wound\". The mother will ask: where does my love hurt? Consider that these are two different approaches to pain: 1. The emotional element of pain, which is phylogenetically primitive and deals with pain as something unpleasant, which must be avoided and the most recent: 2. the distinct element of pain, which is the ability to perceive exactly where the pain is and to respond appropriately.","PeriodicalId":326444,"journal":{"name":"Journal of Anesthesia and Anesthetic Drugs","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114664640","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}
Neurogenic pulmonary edema is a serious and life-threatening complication caused by central nervous system diseases, excluding cardiogenic pulmonary edema, other causes of pulmonary edema, lung injury, etc. The lack of specific diagnostic criteria for NPE and the lack of awareness among clinicians often lead to underdiagnosis and misdiagnosis. The disease progresses rapidly with poor prognosis and high mortality [1]. In this paper, we report a patient with a ruptured right middle cerebral artery aneurysm causing subarachnoid hemorrhage, who developed neurogenic pulmonary edema and underwent elective aneurysm clamping under general anesthesia. The relevant perioperative management is reported as follows, and the anesthesia management of patients with neurogenic pulmonary edema is analyzed in the context of the relevant literature.
{"title":"Neurogenic Pulmonary Edema Caused by Subarachnoid Hemorrhage: A Case Report","authors":"T. Zhu","doi":"10.54289/jaad2100106","DOIUrl":"https://doi.org/10.54289/jaad2100106","url":null,"abstract":"Neurogenic pulmonary edema is a serious and life-threatening complication caused by central nervous system diseases, excluding cardiogenic pulmonary edema, other causes of pulmonary edema, lung injury, etc. The lack of specific diagnostic criteria for NPE and the lack of awareness among clinicians often lead to underdiagnosis and misdiagnosis. The disease progresses rapidly with poor prognosis and high mortality [1]. In this paper, we report a patient with a ruptured right middle cerebral artery aneurysm causing subarachnoid hemorrhage, who developed neurogenic pulmonary edema and underwent elective aneurysm clamping under general anesthesia. The relevant perioperative management is reported as follows, and the anesthesia management of patients with neurogenic pulmonary edema is analyzed in the context of the relevant literature.","PeriodicalId":326444,"journal":{"name":"Journal of Anesthesia and Anesthetic Drugs","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129267542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Transcatheter aortic valve replacement is an important procedure with the aging US population presenting with more aortic stenosis and as many as 10 % of these patients presenting with an abdominal aortic aneurysm at the time of screening. This procedure has also been shown to be as safe as open aortic valve replacement with lower risks of death, stroke, and rehospitalization. Case Report: A 91-year-old female presents approximately one month after transcatheter aortic valve with an acute retroperitoneal rupture of a known abdominal aortic aneurysm. The patient was taken for an emergent endovascular aortic aneurysm repair and became suddenly unresponsive and apneic prior to any anesthetic drug administration, the patient was intubated, and rapid transfusion was started. The procedure was completed successfully with immediate improvement in the patient’s vitals after deployment of the stent. The patient was recovering well, but five days later had a sudden pulseless electrical activity arrest and after appropriate but unsuccessful advanced cardiac life support was declared deceased. Conclusion: While not standard of care, a simultaneous endovascular aneurysm repair during transcatheter aortic valve repair in select patients seems to be a safe procedure without increase in complications from either procedure completed separately. The aim of this manuscript is to review the recent success of simultaneous repair and to illustrate that this newer method may improve outcomes.
{"title":"Ruptured Abdominal Aortic Aneurysm After Successful Transcatheter Aortic Valve Replacement- A Case Report and Review of Management","authors":"Michael Trostler","doi":"10.54289/jaad2100102","DOIUrl":"https://doi.org/10.54289/jaad2100102","url":null,"abstract":"Background: Transcatheter aortic valve replacement is an important procedure with the aging US population presenting with more aortic stenosis and as many as 10 % of these patients presenting with an abdominal aortic aneurysm at the time of screening. This procedure has also been shown to be as safe as open aortic valve replacement with lower risks of death, stroke, and rehospitalization. Case Report: A 91-year-old female presents approximately one month after transcatheter aortic valve with an acute retroperitoneal rupture of a known abdominal aortic aneurysm. The patient was taken for an emergent endovascular aortic aneurysm repair and became suddenly unresponsive and apneic prior to any anesthetic drug administration, the patient was intubated, and rapid transfusion was started. The procedure was completed successfully with immediate improvement in the patient’s vitals after deployment of the stent. The patient was recovering well, but five days later had a sudden pulseless electrical activity arrest and after appropriate but unsuccessful advanced cardiac life support was declared deceased. Conclusion: While not standard of care, a simultaneous endovascular aneurysm repair during transcatheter aortic valve repair in select patients seems to be a safe procedure without increase in complications from either procedure completed separately. The aim of this manuscript is to review the recent success of simultaneous repair and to illustrate that this newer method may improve outcomes.","PeriodicalId":326444,"journal":{"name":"Journal of Anesthesia and Anesthetic Drugs","volume":"114 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117242098","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}
Introduction: Dural arteriovenous fistulas account for 10 to 15% of intracranial arteriovenous malformations. They are defined as malformations to short-circuits between dural and extracranial arteries with dural venous sinuses. Its presentation is in frequent and its management is a challenge in low- and middle-income countries where there are difficulties in accessing high quality technological tools. Case: We present the case of an unusual dural arteriovenous fistula involving the mastoid region and draining into the external jugular vein and through emissary veins into the superior longitudinal sinus, which was treated transarterially. Conclusion: Endovascular management of intracranial dural arteriovenous fistulas can be a challenge. Endovascular treatment includes a transarterial or transvenous approach from the femoral artery or vein. There is little evidence on this subject, so it is necessary to carry out more studies to determine risk factors, intervention effects and medium- and long-term outcomes.
{"title":"Extracranial Dural Arteriovenous Fistula as a Cause of Mastoid Mass: A Case Report","authors":"Md Moshiur Rahman","doi":"10.54289/jaad2100105","DOIUrl":"https://doi.org/10.54289/jaad2100105","url":null,"abstract":"Introduction: Dural arteriovenous fistulas account for 10 to 15% of intracranial arteriovenous malformations. They are defined as malformations to short-circuits between dural and extracranial arteries with dural venous sinuses. Its presentation is in frequent and its management is a challenge in low- and middle-income countries where there are difficulties in accessing high quality technological tools. Case: We present the case of an unusual dural arteriovenous fistula involving the mastoid region and draining into the external jugular vein and through emissary veins into the superior longitudinal sinus, which was treated transarterially. Conclusion: Endovascular management of intracranial dural arteriovenous fistulas can be a challenge. Endovascular treatment includes a transarterial or transvenous approach from the femoral artery or vein. There is little evidence on this subject, so it is necessary to carry out more studies to determine risk factors, intervention effects and medium- and long-term outcomes.","PeriodicalId":326444,"journal":{"name":"Journal of Anesthesia and Anesthetic Drugs","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123058779","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}
{"title":"Systemic Hemodynamic Atherothrombotic Syndrome: Expanding the Concept","authors":"M. Rahman","doi":"10.54289/jaad2100103","DOIUrl":"https://doi.org/10.54289/jaad2100103","url":null,"abstract":"","PeriodicalId":326444,"journal":{"name":"Journal of Anesthesia and Anesthetic Drugs","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114969391","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}
{"title":"Ascending Posterior Mediastinal Abscess from Vertebral Osteomyelitis - A Case Report and Review of Diagnosis and Management","authors":"Michael Trostler","doi":"10.54289/jaad2100101","DOIUrl":"https://doi.org/10.54289/jaad2100101","url":null,"abstract":"","PeriodicalId":326444,"journal":{"name":"Journal of Anesthesia and Anesthetic Drugs","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133426496","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}
{"title":"Ethical Issues to be Considered for the Neurosurgeons During the COVID-19 Pandemic","authors":"Md Moshiur Rahman","doi":"10.54289/jaad2100104","DOIUrl":"https://doi.org/10.54289/jaad2100104","url":null,"abstract":"","PeriodicalId":326444,"journal":{"name":"Journal of Anesthesia and Anesthetic Drugs","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123032303","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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