Background: Postoperative sore throat is a common postoperative complication of anesthesia. Complaints range from a minor self- limiting throat irritation to debilitating pain, inability to swallow for several days. Many factors can contribute to postoperative sore throat and the incidence has been found to vary with the method of airway management. Aim: The aim of this study was to determine magnitude and factors associated with post-operative sore throat among adult surgical patients who were operated under general anesthesia in a resource-limited setup at a tertiary care institution, Addis Ababa, Ethiopia. Materials and Methods: Hospital-based, cross-sectional study was conducted from August 1st to September 30th, 2021 in St. Paul's Hospital Millennium Medical Collage among 303 adult patients. Stratified random sampling technique was used to group surgical patients into departments then surgical patients were sampled from each department by using simple random sampling technique. For the study, data was collected using formatted questionnaire. Sore throat and it's severity was assessed and graded once patients were responsive, communicative and cooperative (within 2 hours) then at 6, 12, 24 and 48 hours of post operation. Severity was assessed using Numerical Rating Scale (NRS). Results: Out of 301 patients who had surgery with general anesthesia and completed 48 hours data collection, post-operative sore-throat was found in 48.5% of patients with variable severity. Approximately 71% of them developed post-operative sore-throat with in the first 2 hours of post-surgery. from the multivariate binary logistic regression analysis; Naso-gastric tube insertion , blood-stained tracheal tube on extubation , duration of anesthesia, for two to six hours and for greater than six hours, number of attempts at intubation for two attempts and no laryngoscopy were strongly associated and important predictors of post-operative sore-throat as compared to their counter-parts. Conclusion and Recommendations: Nearly half of surgical patients undergoing general anesthesia had post-operative sore-throat which is considerably high. It is recommended to give attention for patients undergoing long intubation hours (>2 hours), NG tube inserted patients, multiple attempts at intubation and choice of air way equipment during General anesthesia.
{"title":"Magnitude and Factors Associated with post-operative Sore Throat Among Adult Surgical Patients Undergoing General Anesthesia at a Tertiary Care Institution, Addis Ababa, Ethiopia","authors":"Yalew Hassen, Nura Nasser, Mebratu Abraha","doi":"10.52916/jcar224012","DOIUrl":"https://doi.org/10.52916/jcar224012","url":null,"abstract":"Background: Postoperative sore throat is a common postoperative complication of anesthesia. Complaints range from a minor self- limiting throat irritation to debilitating pain, inability to swallow for several days. Many factors can contribute to postoperative sore throat and the incidence has been found to vary with the method of airway management. Aim: The aim of this study was to determine magnitude and factors associated with post-operative sore throat among adult surgical patients who were operated under general anesthesia in a resource-limited setup at a tertiary care institution, Addis Ababa, Ethiopia. Materials and Methods: Hospital-based, cross-sectional study was conducted from August 1st to September 30th, 2021 in St. Paul's Hospital Millennium Medical Collage among 303 adult patients. Stratified random sampling technique was used to group surgical patients into departments then surgical patients were sampled from each department by using simple random sampling technique. For the study, data was collected using formatted questionnaire. Sore throat and it's severity was assessed and graded once patients were responsive, communicative and cooperative (within 2 hours) then at 6, 12, 24 and 48 hours of post operation. Severity was assessed using Numerical Rating Scale (NRS). Results: Out of 301 patients who had surgery with general anesthesia and completed 48 hours data collection, post-operative sore-throat was found in 48.5% of patients with variable severity. Approximately 71% of them developed post-operative sore-throat with in the first 2 hours of post-surgery. from the multivariate binary logistic regression analysis; Naso-gastric tube insertion , blood-stained tracheal tube on extubation , duration of anesthesia, for two to six hours and for greater than six hours, number of attempts at intubation for two attempts and no laryngoscopy were strongly associated and important predictors of post-operative sore-throat as compared to their counter-parts. Conclusion and Recommendations: Nearly half of surgical patients undergoing general anesthesia had post-operative sore-throat which is considerably high. It is recommended to give attention for patients undergoing long intubation hours (>2 hours), NG tube inserted patients, multiple attempts at intubation and choice of air way equipment during General anesthesia.","PeriodicalId":340605,"journal":{"name":"Journal of Clinical Anesthesiology Research","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129553971","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}
Ultrasound-Guided Popliteal Nerve Block has become a routine plan of anesthesia for below-knee Surgeries. It takes care of post-operative analgesia leading to the reduction of intravenous analgesia. In comparison to multiple pricks, single prick blocks are gaining importance since the success rate is the same, the duration of the procedure is less and patients cooperate better. Patients find to be in a prone position when compared to the lateral position and the ease of block is expected to be better in the lateral position. There are two approaches to block, commonest is the lateral approach which needs a change of needle direction and another prick to block both nerves.
{"title":"Ease of Single Prick Popliteal Sciatic Block in a Modified Lateral Position","authors":"K. Prasad T","doi":"10.52916/jcar224011","DOIUrl":"https://doi.org/10.52916/jcar224011","url":null,"abstract":"Ultrasound-Guided Popliteal Nerve Block has become a routine plan of anesthesia for below-knee Surgeries. It takes care of post-operative analgesia leading to the reduction of intravenous analgesia. In comparison to multiple pricks, single prick blocks are gaining importance since the success rate is the same, the duration of the procedure is less and patients cooperate better. Patients find to be in a prone position when compared to the lateral position and the ease of block is expected to be better in the lateral position. There are two approaches to block, commonest is the lateral approach which needs a change of needle direction and another prick to block both nerves.","PeriodicalId":340605,"journal":{"name":"Journal of Clinical Anesthesiology Research","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123685733","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}
Mohamed Gaber Ibrahim Mostafa Allam, Abdullah Abdulrahman Raddah Alharthi, Hamed Marzoog Masfer Alharthi
Introduction: Recent meta-analysis prove that vitamin C shorten the duration of mechanical ventilation and accelerate weaning from ventilator especially in prolonged ventilated patients. Nitric oxide considered a relatively old drug used for long time in this issue. Aim: To compare the effect of either vitamin C or nitric oxide on improvement of general condition of the patients, improvement lung mechanics, early weaning from prolonged ventilation and mortality rates. Material and Methods: This a prospective double-blind study done in King Abdul-Aziz specialist hospital between September 2020 and December 2021 in the intensive care unit on 60 patients had difficult weaning after ventilation for >10 days due to Acute Respiratory Distress Syndrome (ARDS) and still showing full criteria of ARDS. Allocated randomly in two groups 30 patients in each. All patients in both groups continued on the same protocol of ventilation. Group A received Nitric Oxide (NO) while group B received vitamin C intravenous. The duration of the study last 16 days. during this period, APCH II score, Hemodynamics, Chest X-ray, hypoxic index, lung compliance, Recruitment maneuver, arterial blood saturation, Lactic Acid Dehydrogenase (LDH), C-reactive protein used as indicator for improvement. Number of patients weaned from the ventilator and patients died also recorded. >Results: Showed significant improvement in the general condition between patients of group B compared to group A which monitored by number of patients had both APACH II score <10 and had normal core temperature. Significant improvement in lung condition between patients of group B compared to group A which monitored clinically by number of patients had arterial oxygen saturation >95, hypoxic index >300, better lung compliance, responder to recruitment maneuver. And monitored radiologically by significant higher number of patients in group B had parenchymatous lung infiltrate in chest X-ray less than one quadrant infiltration compared to group A. And monitored laboratory by significant higher number of patients had lower level of LDH from (100-200 U/L) and CRP (201-300) mg/L in group B compared to group A. There was significant higher number of patients weaned from the ventilator in group B compared to group A. There was significant lower morbidity between patients of group B compared to group A. No significant difference was found in mortality rates. Conclusion: Vitamin C significantly improve the general condition of the patients, improve all parameters of lung mechanics and accelerate weaning from ventilators in prolonged ventilated patients compared to nitric oxide.
{"title":"Comparative Study Between Action Vitamin C vs. Action of Nitric Oxide in Prolonged Ventilation in Respiratory Failure Patients Due to ARDS","authors":"Mohamed Gaber Ibrahim Mostafa Allam, Abdullah Abdulrahman Raddah Alharthi, Hamed Marzoog Masfer Alharthi","doi":"10.52916/jcar224010","DOIUrl":"https://doi.org/10.52916/jcar224010","url":null,"abstract":"Introduction: Recent meta-analysis prove that vitamin C shorten the duration of mechanical ventilation and accelerate weaning from ventilator especially in prolonged ventilated patients. Nitric oxide considered a relatively old drug used for long time in this issue. Aim: To compare the effect of either vitamin C or nitric oxide on improvement of general condition of the patients, improvement lung mechanics, early weaning from prolonged ventilation and mortality rates. Material and Methods: This a prospective double-blind study done in King Abdul-Aziz specialist hospital between September 2020 and December 2021 in the intensive care unit on 60 patients had difficult weaning after ventilation for >10 days due to Acute Respiratory Distress Syndrome (ARDS) and still showing full criteria of ARDS. Allocated randomly in two groups 30 patients in each. All patients in both groups continued on the same protocol of ventilation. Group A received Nitric Oxide (NO) while group B received vitamin C intravenous. The duration of the study last 16 days. during this period, APCH II score, Hemodynamics, Chest X-ray, hypoxic index, lung compliance, Recruitment maneuver, arterial blood saturation, Lactic Acid Dehydrogenase (LDH), C-reactive protein used as indicator for improvement. Number of patients weaned from the ventilator and patients died also recorded. >Results: Showed significant improvement in the general condition between patients of group B compared to group A which monitored by number of patients had both APACH II score <10 and had normal core temperature. Significant improvement in lung condition between patients of group B compared to group A which monitored clinically by number of patients had arterial oxygen saturation >95, hypoxic index >300, better lung compliance, responder to recruitment maneuver. And monitored radiologically by significant higher number of patients in group B had parenchymatous lung infiltrate in chest X-ray less than one quadrant infiltration compared to group A. And monitored laboratory by significant higher number of patients had lower level of LDH from (100-200 U/L) and CRP (201-300) mg/L in group B compared to group A. There was significant higher number of patients weaned from the ventilator in group B compared to group A. There was significant lower morbidity between patients of group B compared to group A. No significant difference was found in mortality rates. Conclusion: Vitamin C significantly improve the general condition of the patients, improve all parameters of lung mechanics and accelerate weaning from ventilators in prolonged ventilated patients compared to nitric oxide.","PeriodicalId":340605,"journal":{"name":"Journal of Clinical Anesthesiology Research","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116029289","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}
Endoscopic dacryocystorhinostomy is generally performed under general anaesthesia. However, elderly patients with multiple comorbidities can impose significant risk during conduction of general anesthesia. We report safe management of an elderly patient with hypothyroidism and severe left ventricular systolic dysfunction having implantable cardioverter defibrillator planned for endoscopic dacryocystorhinostomy using monitored anesthesia care. Emphasis is given to the specific drug choices and technique of oxygen supplementation along with assisted local anesthesia in this scenario.
{"title":"Endoscopic Dacryocystorhinostomy in an Elderly Patient With Severe Left Ventricular Dysfunction Under Individualized Monitored Anesthesia Care","authors":"S. Sethi","doi":"10.52916/jcar214009","DOIUrl":"https://doi.org/10.52916/jcar214009","url":null,"abstract":"Endoscopic dacryocystorhinostomy is generally performed under general anaesthesia. However, elderly patients with multiple comorbidities can impose significant risk during conduction of general anesthesia. We report safe management of an elderly patient with hypothyroidism and severe left ventricular systolic dysfunction having implantable cardioverter defibrillator planned for endoscopic dacryocystorhinostomy using monitored anesthesia care. Emphasis is given to the specific drug choices and technique of oxygen supplementation along with assisted local anesthesia in this scenario.","PeriodicalId":340605,"journal":{"name":"Journal of Clinical Anesthesiology Research","volume":"110 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133000147","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}
Propofol is an anesthetic agent commonly used for sedation and induction and/or maintenance of general anesthesia and presents an inhibitory effect on the excitatory neurotransmitters through GABA receptors. Although propofol is an agent that can be used to treat status epilepticus because of its anticonvulsant property, it may cause epileptiform convulsions, as reported in the literature. In this case report, a young patient’s epileptiform convulsions after administering a single dose of propofol injection for general anesthesia are presented. Due to uncontrolled epilepsy episodes following extubation, the patient was taken to intensive care. The patient regained consciousness, and epileptic attacks were controlled on the 4th day of intensive, was taken to the neurology service. We consider that this case is noteworthy concerning the association between propofol and epilepsy in anesthesia. Thus, this study aimed to draw attention to propofol in patients with a history of epilepsy.
{"title":"Status Epilepticus During Recovery from General Anesthesia","authors":"B. Dinç, İ. Aycan, A. Toylu","doi":"10.52916/jcar214008","DOIUrl":"https://doi.org/10.52916/jcar214008","url":null,"abstract":"Propofol is an anesthetic agent commonly used for sedation and induction and/or maintenance of general anesthesia and presents an inhibitory effect on the excitatory neurotransmitters through GABA receptors. Although propofol is an agent that can be used to treat status epilepticus because of its anticonvulsant property, it may cause epileptiform convulsions, as reported in the literature. In this case report, a young patient’s epileptiform convulsions after administering a single dose of propofol injection for general anesthesia are presented. Due to uncontrolled epilepsy episodes following extubation, the patient was taken to intensive care. The patient regained consciousness, and epileptic attacks were controlled on the 4th day of intensive, was taken to the neurology service. We consider that this case is noteworthy concerning the association between propofol and epilepsy in anesthesia. Thus, this study aimed to draw attention to propofol in patients with a history of epilepsy.","PeriodicalId":340605,"journal":{"name":"Journal of Clinical Anesthesiology Research","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122255556","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: Supraclavicular Brachial plexus block also described as the “spinal of arm”, provides a rapid onset, complete, predictable, and dense anesthesia for the mid humerus, forearm and hand surgery. Brachial plexus block also causes sympathetic block with resultant improvement in blood flow, reduction in vasospasm, and edema which is more favorable for an acute hand injury and reconstructive plastic surgery. In the present study, we compared the anesthetic quality with the addition of either clonidine, fentanyl, or dexmedetomidine to 0.5℅ ropivacaine for supraclavicular brachial plexus block in regard to the onset and duration of sensory/motor block and duration of analgesia at a tertiary hospital. Material and Methods: Present study was the prospective, interventional and comparative study carried out in the department of anaesthesiology, in patients 18-60 years, ASA grade1/2, Mallampati grades 1 and 2, posted for elective upper limb surgeries. 60 patients were randomly divided into three groups, each group includes 20 patients, (Group D- Dexmedetomidine, C- Clonidine, F- Fentanyl). Results: 60 patients scheduled to undergo elective upper limb surgeries were randomly divided into three groups (Group D, C, F), each group includes 20 patients. Age, gender, ASA status, weight, height and mean duration of surgery were comparable in three groups and the difference was statistically insignificant. The difference between the onset of sensory blockade, mean time of onset of complete sensory blockade, duration of complete sensory blockade was found to be statistically significant. Intergroup analysis in groups D, C and F for the onset of sensory blockade, onset of complete sensory blockade and duration of complete sensory blockade in three different groups noted a statistically significant difference. The difference for the onset of motor blockade, the onset of complete motor blockade and duration of motor blockade was found to be statistically significant as (p<0.05), there is a difference noted between Group D, C, and F. Intergroup statistical analysis of the onset of motor blockade, the onset of complete motor blockade and duration of motor blockade between group D vs C and group D vs F were statistically significant, whereas between group C vs F it was insignificant. The duration of analgesia was prolonged in Group D, C, F and was found to be statistically significant. Intergroup analysis of duration of analgesia between three different groups. The difference between group D vs C, between group D vs F, and between-group C vs F was statistically significant. The time of 1st rescue analgesia was prolonged in Group D, C, F and was statistically significant (p<0.05). Intergroup analysis of the time of 1st rescue analgesia between three different groups. The difference between group D vs C, between group D vs F, and between group C vs F were statistically significant. Conclusion: Dexmedetomidine, clonidine added to ropivacaine shortens the onset of s
{"title":"Comparative Study for Anaesthetic Quality with the Addition of Clonidine, Fentanyl or Dexmedetomidine to 0.5℅ Ropivacaine in Supraclavicular Brachial Plexus Block at a Tertiary Hospital","authors":"P. Naveen","doi":"10.26611/10151639","DOIUrl":"https://doi.org/10.26611/10151639","url":null,"abstract":"Background: Supraclavicular Brachial plexus block also described as the “spinal of arm”, provides a rapid onset, complete, predictable, and dense anesthesia for the mid humerus, forearm and hand surgery. Brachial plexus block also causes sympathetic block with resultant improvement in blood flow, reduction in vasospasm, and edema which is more favorable for an acute hand injury and reconstructive plastic surgery. In the present study, we compared the anesthetic quality with the addition of either clonidine, fentanyl, or dexmedetomidine to 0.5℅ ropivacaine for supraclavicular brachial plexus block in regard to the onset and duration of sensory/motor block and duration of analgesia at a tertiary hospital. Material and Methods: Present study was the prospective, interventional and comparative study carried out in the department of anaesthesiology, in patients 18-60 years, ASA grade1/2, Mallampati grades 1 and 2, posted for elective upper limb surgeries. 60 patients were randomly divided into three groups, each group includes 20 patients, (Group D- Dexmedetomidine, C- Clonidine, F- Fentanyl). Results: 60 patients scheduled to undergo elective upper limb surgeries were randomly divided into three groups (Group D, C, F), each group includes 20 patients. Age, gender, ASA status, weight, height and mean duration of surgery were comparable in three groups and the difference was statistically insignificant. The difference between the onset of sensory blockade, mean time of onset of complete sensory blockade, duration of complete sensory blockade was found to be statistically significant. Intergroup analysis in groups D, C and F for the onset of sensory blockade, onset of complete sensory blockade and duration of complete sensory blockade in three different groups noted a statistically significant difference. The difference for the onset of motor blockade, the onset of complete motor blockade and duration of motor blockade was found to be statistically significant as (p<0.05), there is a difference noted between Group D, C, and F. Intergroup statistical analysis of the onset of motor blockade, the onset of complete motor blockade and duration of motor blockade between group D vs C and group D vs F were statistically significant, whereas between group C vs F it was insignificant. The duration of analgesia was prolonged in Group D, C, F and was found to be statistically significant. Intergroup analysis of duration of analgesia between three different groups. The difference between group D vs C, between group D vs F, and between-group C vs F was statistically significant. The time of 1st rescue analgesia was prolonged in Group D, C, F and was statistically significant (p<0.05). Intergroup analysis of the time of 1st rescue analgesia between three different groups. The difference between group D vs C, between group D vs F, and between group C vs F were statistically significant. Conclusion: Dexmedetomidine, clonidine added to ropivacaine shortens the onset of s","PeriodicalId":340605,"journal":{"name":"Journal of Clinical Anesthesiology Research","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133894864","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}
Endometriosis is a category of lesions and fibroids which occur in the innermost lining of the uterus that is the endometrial layer and spreads to the other parts of the neighboring tissues. It is characterized by inflammation, pelvic pain, menstrual bleeding, and Dysmenorrhea. Endometriosis exists in 3 forms based on its spreadability. i.) superficial peritoneal lesions ii.) deep infiltrating lesion and iii.) cyst. Traditional treatments involve are NSAIDS, Oral contraceptives, Aromatase inhibitors, and GnRH agonists. Elagolix emerges out to be the latest potent drug that acts by inhibiting the GnRH receptor. Unlike other allopathy medicine, it is not an asymptomatic pain reliever but acts on the root cause of the disease. FDA has approved it for specific treatment of endometriosis in July 2018. It is believed that endometriosis occurs by an increase in the production of estrogen. Elagolix competitively binds to the GnRH receptors and prevents the binding of the Gonadotropin hormone flowing through blood capillaries from the Hypothalamus to the pituitary gland and thereby stops the formation of Oestrogen in the reproductive system which ultimately ceases in the proliferation of endometrial layers and tissue spread. In estrogen biosynthesis, the aromatase P450 enzyme plays a vital role. Elagolix belongs to BCS class III and available in the oral dosage form of 150, 200mg. It is rapidly absorbed and Cmax reaches within 1hour. The plasma protein binding is 80%. In this review, various aspects related to Elagolix sodium have been summarised, which include pathophysiology, Mode of Action, Structure-activity relationship, Pharmacokinetics, pharmacodynamics, and clinical studies with minimal side effects.
{"title":"Elagolix Sodium: Novel GnRH Antagonist for the Treatment of Endometriosis","authors":"R. Bhatia","doi":"10.52916/JCAR214007","DOIUrl":"https://doi.org/10.52916/JCAR214007","url":null,"abstract":"Endometriosis is a category of lesions and fibroids which occur in the innermost lining of the uterus that is the endometrial layer and spreads to the other parts of the neighboring tissues. It is characterized by inflammation, pelvic pain, menstrual bleeding, and Dysmenorrhea. Endometriosis exists in 3 forms based on its spreadability. i.) superficial peritoneal lesions ii.) deep infiltrating lesion and iii.) cyst. Traditional treatments involve are NSAIDS, Oral contraceptives, Aromatase inhibitors, and GnRH agonists. Elagolix emerges out to be the latest potent drug that acts by inhibiting the GnRH receptor. Unlike other allopathy medicine, it is not an asymptomatic pain reliever but acts on the root cause of the disease. FDA has approved it for specific treatment of endometriosis in July 2018. It is believed that endometriosis occurs by an increase in the production of estrogen. Elagolix competitively binds to the GnRH receptors and prevents the binding of the Gonadotropin hormone flowing through blood capillaries from the Hypothalamus to the pituitary gland and thereby stops the formation of Oestrogen in the reproductive system which ultimately ceases in the proliferation of endometrial layers and tissue spread. In estrogen biosynthesis, the aromatase P450 enzyme plays a vital role. Elagolix belongs to BCS class III and available in the oral dosage form of 150, 200mg. It is rapidly absorbed and Cmax reaches within 1hour. The plasma protein binding is 80%. In this review, various aspects related to Elagolix sodium have been summarised, which include pathophysiology, Mode of Action, Structure-activity relationship, Pharmacokinetics, pharmacodynamics, and clinical studies with minimal side effects.","PeriodicalId":340605,"journal":{"name":"Journal of Clinical Anesthesiology Research","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124694141","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}
Aim: This prospective comparative study aimed to investigate the effect of various body positions on changes of respiratory parameters mostly; the TV, oxygen saturation, airway pressure, and endotracheal tube cuff pressure in mechanically ventilated critical care patients. Background: Many patients who are admitted to the critical care unit require intubation and invasive mechanical ventilation for many reasons such as major trauma, medical causes, or post-operative major surgeries. Changing a patient’s position in the critical care unit is very important for the following benefits; to break through the routine monotonic delivery of mechanical ventilation, to favor the clearance of respiratory secretions, the prevention of pressure sores and ventilator acquired pneumonia, and finally the improvement in lung volume and oxygenation. Methods: A prospective, comparative study was carried out on 210 patients of both gender, aged between 21-70 years old admitted to ICU due to many reasons. After stabilization of patient condition and connection of monitors’ cables, supine position or semi setting position was chosen and this was documented in the patient’s chart. All patients were sedated to prevent them from breathing against the machine which causes the ETT cuff pressure and mean airway pressure to rise. Fentanyl sedation drug (Loading dose: 1–2 mic/kg/hour infused gradually. Maintenance dose: 1-4 mic/kg/hour) using continuous intravenous infusion typically in combination with Midazolam sedation (0.05-0.2 mg/kg/hour). The following parameters were recorded; tidal volume, mean airway pressure, PO2 /FIO2 , and ETT cuff pressure. Results: Our results show that about (58.1%) were male and (41.9%) were female. Concerning age, their mean was between (40.6 ± 8.9) years. Regarding diagnosis (50.5%) of patients were admitted with major trauma, (31.9%) due to medical causes, and (17.6%) admitted due to major chest and abdominal surgeries. The patient’s mean heart rate was (93.6 ± 7.5) b/m and the Mean Arterial Pressure was (67.7 ± 0.6)°C. Tables the Description, SOP2, Mean airway, and ETT cuff pressure of each body position in the study with the highest SPO2 98% and cuff pressure 19.2+41 in the prone position. The position checklist is illustrated in Table and Figure. The highest TV (520 ml) and PO2 /FIO2 ratio (410) were in prone poison and the lowest was in Lower Fowler position (460 ml and 320) respectively. Regarding outcome and ICU stay which were the best in both semi setting and prone position. Conclusion: Supine position (lying flat) or lateral position do not seem beneficial for critically ill patients in terms of respiratory mechanics. The semi-sitting position (with thorax angulation=30° from the horizontal plane) is associated with improvement of PO2/FIO2 , oxygenation, and tidal volume, and the effects of prone position on respiratory mechanics are very beneficial and this reflected on patient outcome and short ICU length of stay.
{"title":"Airway Pressure and Respiratory Mechanics Variability with Different Body Positions in Mechanically Ventilated Critical Care Patients: A Prospective Comparative Clinical Study","authors":"Alaa Ali M. Elzohry","doi":"10.52916/JCAR204001","DOIUrl":"https://doi.org/10.52916/JCAR204001","url":null,"abstract":"Aim: This prospective comparative study aimed to investigate the effect of various body positions on changes of respiratory parameters mostly; the TV, oxygen saturation, airway pressure, and endotracheal tube cuff pressure in mechanically ventilated critical care patients. Background: Many patients who are admitted to the critical care unit require intubation and invasive mechanical ventilation for many reasons such as major trauma, medical causes, or post-operative major surgeries. Changing a patient’s position in the critical care unit is very important for the following benefits; to break through the routine monotonic delivery of mechanical ventilation, to favor the clearance of respiratory secretions, the prevention of pressure sores and ventilator acquired pneumonia, and finally the improvement in lung volume and oxygenation. Methods: A prospective, comparative study was carried out on 210 patients of both gender, aged between 21-70 years old admitted to ICU due to many reasons. After stabilization of patient condition and connection of monitors’ cables, supine position or semi setting position was chosen and this was documented in the patient’s chart. All patients were sedated to prevent them from breathing against the machine which causes the ETT cuff pressure and mean airway pressure to rise. Fentanyl sedation drug (Loading dose: 1–2 mic/kg/hour infused gradually. Maintenance dose: 1-4 mic/kg/hour) using continuous intravenous infusion typically in combination with Midazolam sedation (0.05-0.2 mg/kg/hour). The following parameters were recorded; tidal volume, mean airway pressure, PO2 /FIO2 , and ETT cuff pressure. Results: Our results show that about (58.1%) were male and (41.9%) were female. Concerning age, their mean was between (40.6 ± 8.9) years. Regarding diagnosis (50.5%) of patients were admitted with major trauma, (31.9%) due to medical causes, and (17.6%) admitted due to major chest and abdominal surgeries. The patient’s mean heart rate was (93.6 ± 7.5) b/m and the Mean Arterial Pressure was (67.7 ± 0.6)°C. Tables the Description, SOP2, Mean airway, and ETT cuff pressure of each body position in the study with the highest SPO2 98% and cuff pressure 19.2+41 in the prone position. The position checklist is illustrated in Table and Figure. The highest TV (520 ml) and PO2 /FIO2 ratio (410) were in prone poison and the lowest was in Lower Fowler position (460 ml and 320) respectively. Regarding outcome and ICU stay which were the best in both semi setting and prone position. Conclusion: Supine position (lying flat) or lateral position do not seem beneficial for critically ill patients in terms of respiratory mechanics. The semi-sitting position (with thorax angulation=30° from the horizontal plane) is associated with improvement of PO2/FIO2 , oxygenation, and tidal volume, and the effects of prone position on respiratory mechanics are very beneficial and this reflected on patient outcome and short ICU length of stay.","PeriodicalId":340605,"journal":{"name":"Journal of Clinical Anesthesiology Research","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126288949","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：