Middle East Journal of Anesthesiology最新文献

Background: Acute renal failure following cardiac surgery is not uncommon and carries a high level of morbidity and mortality. The aim of our study was to determine whether perioperative sodium bicarbonate infusion (POSBI) would decrease acute kidney injury in cardiac surgery patients and improve post-operative outcomes.

Methods: A retrospective analysis of 318 cardiac surgery patients from 2008-2011 was performed. Clinical parameters were compared in patients receiving POSBI versus sodium chloride. Serum creatinine levels were measured in the first five post-operative days. The primary outcome measured was the number of patients developing post-operative renal injury. Secondary outcomes included three-month mortality, intensive care unit and hospital length of stay.

Results: Patients given POSBI showed no significant differences compared to the normal saline cohort in regards to increases in serum creatinine [< 25% rise in Cr: 93% vs 94%; > 25% rise in Cr: 6% vs 6%; > 50% rise in Cr: 1% vs 1%; > 100% rise in Cr: 1% vs 0%, all with p-value > 0.99]. There were fewer patients with AKIN stage 1 renal failure receiving POSBI [8% vs 28%, p = 0.02] however there was no difference between POSBI and sodium chloride cohorts in AKIN stages 2 and 3 renal failure. Mortality, duration of hospitalization and ICU stay were not statistically significant.

Conclusions: POSBI resulted in fewer patients developing AKIN stage 1 renal failure. Despite this, there appears to be little benefit in the prevention of acute kidney injury after 48 hours or mortality reduction in cardiac surgery patients.

Background: The etiology of delirium in intensive care units (ICU) is usually multi-factorial. There is common "myth" that lunar phases affect human body especially human brains (and minds).

Objective: In the absence of any pre-existing studies in ICU patients, the current retrospective study was planned to investigate whether lunar phases play any role in ICU delirium by assessing if lunar phases correlate with prevalence of ICU delirium as judged by the corresponding consumptions of rescue anti-psychotics used for delirium in ICU.

Materials and methods: After institutional review board approval with waived consent, the daily census of ICU patients from the administrative records was accessed at an academic university's Non-Cancer Hospital in a Metropolitan City of United States. Thereafter, the ICU pharmacy's electronic database was accessed to obtain data on the use of haloperidol and quetiapine over the two time periods for patients aged 18 years or above. Subsequently the data was analyzed for whether the consumption of haloperidol or quetiapine followed any trends corresponding to the lunar phase cycles.

Results: A total of 5382 pharmacy records of haloperidol equivalent administrations were analyzed for this study. The cumulative prevalence of incidents of haloperidol equivalent administrations peaked around the full moon period and troughed around the new moon period. As compared to male patients, female patients followed much more uniform trends of haloperidol equivalent administrations' incidents which peaked around the full moon period and troughed around the new moon period. Further sub-analysis of 70-lunar cycles across the various solar months of the total 68-month study period revealed that haloperidol equivalent administrations' incidents peaked around the full moon periods during the months of November-December and around the new moon periods during the month of July which all are interestingly the major holiday months (a potential confounding factor) in the United States.

Conclusion: Consumption trends of rescue anti-psychotics for ICU delirium revealed an influence by lunar phase cycles particularly that of full moon periods on female patients in the ICU.

Background: Although oral ketamine has been used in some cases to reduce pain in children, the use of this drug to reduce pain after tonsillectomy has not been studied yet.

Methods: This double-blind clinical trial was conducted in 2009 in 92 children who were aged three to nine years old, met ASA I or II criteria, and were candidate for tonsillectomy. Patients were divided randomly into two groups. Half an hour before general anesthesia, 5 mg/kg ketamine mixed in 2 cc/kg apple juice was given to the children in oral ketamine group and 2 cc/kg of apple juice alone was given to the children in the peritonsillar group. After general anesthesia and three minutes before surgery 1 cc of 0.9% normal saline in the oral group and 1cc of ketamine (0.5 mg/kg) in the peritonsillar group was injected to the tonsil bed of patients.

Results: There was no difference between the two groups in terms of sex, age, and weight. Duration of surgery was significantly shorter in the peritonsillar group (P < 0.001) and the severity of postoperative bleeding was significantly higher in peritonsillar group (P = 0.022). However, postoperative bleeding recurred in 25 patients (27%) and there was no statistically significant difference between the two groups. The level of pain in children six hours after surgery according to CHEOPS criteria was significantly lower in the peritonsillar group (0.9 ± 0.8) than in the oral group (2.6 ± 1) (P < 0.001).

Conclusions: The finding of this study showed that, compared with the peritonsillar infiltration of ketamine, the use of oral ketamine before general anesthesia was less effective in reducing postoperative pain of tonsillectomy in children.

Background: Ideal anesthetic technique for renal allograft recipients should provide hemodynamic stability, optimum graft reperfusion and adequate analgesia. Balanced anesthesia is preferred because renal nociception is conducted multi-segmentally and chronically ill ESRD patients have labile psychological profile. Present study compared the efficacy ofdexmedetomidine with fentanyl administered via intravenous and epidural route before induction of general anesthesia.

Methods: Prospective, double blind randomized study, recruited sixty hemo-dynamically stable ESRD adults, 18-55 years, scheduled for elective live related renal transplantation. Patients randomly received intravenous dexmedetomidine 0.5 μg/kg followed by epidural dexmedetomidine 0.5 μg/kg alongwith 5 ml; 0.25% ropivacaine or intravenous fentanyl 1 μg/kg followed by epiduralfentanyl 1 μg/kg alongwith 5 ml; 0.25% ropivacaine. All patients received standardized general anaesthesia and continuous epidural ropivacaine 0.25%; 4-8 ml/hr. Preoperative sedation, peri-operative haemodynamics, end tidal anaesthetic agent requirement, peri-operative fluid requirement, need for vasopressors, blood loss and early graft function was assessed.

Results: 80% patients receiving intravenous dexmedetomidine did not require rescue midazolam for achieving satisfactory sedation before induction of general anaesthesia. Dexmedetomidine significantly reduced propofol and end tidal inhalational agents requirement and need for rescue analgesics. Early renal graft function (onset time of diuresis after declamping, 24 hours urine output and serum creatinine levels) was comparable. There were no adverse sequelae.

Conclusion: Dexmedetomidine-based anaesthetic regimen versus fentanyl-based anaesthesia provided appropriate anxiolysis and analgesia for conducting invasive procedures and subsequent epidural administration of these agents reduced anaesthetic requirement and prolonged postoperative analgesia without compromising hemodynamics and respiratory parameters. Further dose finding studies can be conducted in kidney transplant recipients.

Background: The most common peripheral nerve blocks used in umbilical hernia repair are rectus sheath block and regional block (caudal block). Ultrasound guidance of peripheral nerve blocks has reduced the number of complications and improved the quality of blocks. The aim of this study is to assess the post rectus sheath block pain relief in pediatric patients coming for umbilical surgery, and to evaluate the easiness of soft tissue puncture and ultrasonic appearance of two different needle types.

Methods: Twenty two (22) pediatric patients (age range: 1.5-8 years) scheduled for umbilical hernia repair were included in the study. Following the induction of general anesthesia, the ultrasonographic anatomy of the umbilical region was studied with a 5-16 MHz linear probe. An ultrasound-guided rectus sheath block in the lateral edge of both rectus abdominis muscles (RMs) was performed (total of 44 punctures). A 22 gauge short beveled sharp cutting needle 1.1 x 30 mm needle A (BD Insyte--W, Vialon material. Spain) was used in one side, and a Stimuplex A insulated Needle 22G 50mm (needle B) was used on the other side. Surgical conditions, intraoperative hemodynamic parameters, and postoperative analgesia were evaluated.

Results: Ultrasonograghic visualization of the posterior sheath was possible in all patients. Needle A scored 72.7% of excellent needle tip and shaft view (16 out of 22) compared to 63.63% for needle B (14 out of 22). None of the needles scored poor view. The ultrasound guided rectus sheath blockade provided sufficient analgesia in all children with no need for additional analgesia except for one child who postoperatively requested morphine 0.1 mg/kg intravenously in recovery room. There were no complications.

Conclusions: Ultrasound guidance enables performances of an effective rectus sheath block for umbilical hernia in the lateral edge of the rectus muscle. Use of the sharp short beveled needle of 22 gauge intravenous (IV) cannula stylet provides easy, less traumatic skin and rectus muscle penetration and better needle visualization by the ultrasound.

Recent research has shown that cerebrovascular complications following shoulder surgery performed in the beach chair position under general anesthesia arise secondary to cerebral ischemia. Appropriate management of cerebral oxygenation is thus one of the primary goals of anesthetic management during such procedures. The present report describes the case of a 65-year-old male patient, in which both bispectral index (BIS) and near-infrared spectroscopy (NIRS) were used to monitor cerebral oxygenation. During the positioning, we observed an increased suppression ratio (SR) while BIS and regional cerebral oxygen saturation (rSO2) were at adequate level. In view of the difference in blood pressure between the heart and the base of the brain, blood pressure was maintained to ensure adequate cerebral perfusion. Although intraoperative rSO2 was at or around the cut-off point (a 12% relative decrease from baseline), no marked decrease in BIS or further increase in the SR was observed. Monitoring of cerebral perfusion using combined BIS and NIRS optimized anesthetic management during the performance of arthroscopic shoulder surgery in the beach chair position.

Purpose: Studies have suggested an association between the use of regional paravertebral or epidural anesthesia and a reduction in tumor recurrence following breast cancer surgery. To examine this relationship we performed a retrospective case-control study of patients undergoing breast cancer surgery receiving regional, regional and general, or general anesthesia.

Methods: A retrospective chart review was performed of patients undergoing surgery for stage 0 to III breast cancer. Patients identified as receiving regional anesthesia were then matched for age, stage, estrogen receptor (ER) status, progesterone receptor status, and HER-2 expression with patients who received no regional anesthesia. Univariate (Pearson's χ2 test and odds ratio) and multivariate logistic analyses with backward stepwise regression were performed to determine factors associated with cancer recurrence.

Results: Between 1998 and 2007, 816 women underwent surgery for stage 0-III breast cancer at our institution. Forty-five patients developed tumors. Univariate analysis showed the use of regional anesthesia trended towards reduced cancer recurrence, but it did not achieve statistical significance (p = 0.06). Higher recurrence rates were associated with ER positive status (p = 0.003) and higher tumor stage (p < 0.0001). Age and HER-2 status were not associated with increased cancer recurrence (both p > 0.11). Multivariate analysis confirmed ER status and stage as independently influential (p = 0.002 and p < 0.0001 respectively).

Conclusion: Although we found a trend towards reduced breast cancer recurrence with the use of regional anesthesia, univariate analysis did not reach statistical significance.

Background: General anesthesia in patients with comorbid conditions may affect their intermediate or long-term outcomes. In this study, we evaluated the effects of provision of anesthesia on mortality in critical patients with comorbid conditions by retrospectively investigating one-year mortality in patients with ASA physical status more than III who underwent minor surgery for relative indications and nonfatal reasons.

Methods: Data were collected during the period between January 2006 and December 2011. Eligible patients were those with ASA physical status more than III who underwent minor surgery under general anesthesia for relative indications and nonfatal reasons. Preoperative clinical information was collected from the patient's clinical charts. Comorbidity was quantified using the Charlson comorbidity index. All the patients were evaluated for in-hospital mortality and were followed-up for mortality at one-year.

Results: During the study period, 14, 979 patients underwent general anesthesia. Thirty six patients satisfied the eligibility for enrollment. Charlson comorbidity index of the patients ranged from one to five. No patients died during their hospital-stay; however, 4 patients were lost to follow up. Therefore, one-year mortality rates for each Charlson index category were 0%.

Conclusion: The postoperative one-year mortality in patients with ASA physical status more than III undergoing minor surgery under general anesthesia for relative indications and nonfatal reasons was expected to be considerably small regardless of the Charlson index category.