Middle East Journal of Anesthesiology最新文献

Long QT syndrome (LQTS) is a rare condition that in certain circumstances can lead to severe and potentially lethal cardiac arrhythmia known as Torsade de Pointes (TdP). Inhalational anesthetics are among many medications and conditions known to prolong QT and thus potentially predispose the patient to TdP. Although studies have shown that sevoflurane should be safe for the healthy patients, the situation is unclear in patients with LQTS. We present a case of 14-year-old Caucasian female with the diagnosis of LQTS who developed TdP during sevoflurane inhalational induction. At the end, an anesthetic plan for patients with LQTS will be suggested.

Context: Epidural anesthesia provides the advantage of segmental blockade and many adjuvants have been added to shorten the onset of action, improve the quality of analgesia and prolong the duration of analgesia. Magnesium sulphate(MgSO4) by virtue of its anti-iociceptive property has been administered by various routes.

Aim: To assess the effect of MgSO4 on the duration of onset of action of injection bupivacaine for epidural anesthesia in infraumbilical surgeries.

Materials and methods: A prospective, double-blind, randomized control study was conducted in 40 patients. Group M received 15 ml of bupivacaine 0.5% + 1 ml of 50 mg MgSO4 and Group C received 15 ml of bupivacaine 0.5% + 1 ml of normal saline via epidural route. Onset time of the sensory and motor blockade were the primary outcomes studied. Highest level of sensory block, time for two segment regression, hemodynamic parameters, side effects were the secondary parameters.

Results: There was a significant difference between the groups in the mean onset time of sensory blockade at T8, 12.85 ± 2.32 min in Group M and 16.75 ± 1.74 min in Group C. Median level of sensory blockade was comparable. Mean onset time of motor blockade was 13.85 ± 3.28 min in Group M and 23.25 ± 3.35 min in Group C which was clinically and statistically significant. Time for two segment regression of sensory blockade was 95.75 ± 11.84 min in Group M and 55.5 ± 8.57 min in Group C which was significant. Hemodynamic parameters and side effects were comparable.

Conclusion: Magnesium sulphate as an adjuvant provides rapid onset of epidural anesthesia and prolongs the duration of analgesia with minimal side effects.

We report a case of intraoperative severe bradycardia that resulted in asystole and cardiac arrest shortly after (<2 min) intravenous granisetron 1mg for postoperative nausea and vomiting prophylaxis, that occurred in a female patient who underwent an elective total thyroidectomy. After two cycles of cardiopulmonary resuscitation and defibrillation, spontaneous circulation and sinus rhythm returned successfully. Postoperatively, the patient was diagnosed with a drug-induced long QT syndrome. At the time of the event, granisetron was the only medication administered. Furthermore, there was no reason to suspect electrolyte abnormalities. We explore the association of the onset of severe sinus bradycardia with the intravenous administration of granisetron.

Background: Gaining proficiency with various airway management tools is an important goal for anesthesiology training. Indirect video laryngoscopes facilitate tracheal intubation in adults, but it is not clear whether these findings translate to children. This study evaluates the total time to successful intubation when performed by anesthesiology trainees using GlideScope Cobalt® video laryngoscopy (GlideScope), Storz DCI® video laryngoscopy (Storz), or direct laryngoscopy (Direct) in children <2 years old with normal airway anatomy.

Methods: Sixty-five children presenting for elective surgery were randomly assigned to undergo tracheal intubation using GlideScope, Storz, or Direct. Laryngoscopists were anesthesiology trainees in clinical anesthesia year ≥2 who had proven basic proficiency with each laryngoscope on an infant airway manikin. Total time to successful intubation (TTSI, seconds), rate of successful intubation on first laryngoscopy attempt, and the change in intubation time from manikin to clinical settings were recorded. An intubation time difference >10 seconds was defined as clinically significant.

Results: TTSI was longer for Storz (42.1; 34.0 to 59.0) than for Direct (21.5; 17.0 to 34.3; p=0.002). We were not able to demonstrate a difference >10 seconds between the GlideScope and the other laryngoscopes. Median manikin intubation time was <10 seconds and increased significantly in the clinical setting for all laryngoscopes (all p <0.0001).

Conclusions: Anesthesiology trainees completed manikin tracheal intubation rapidly with all laryngoscopes studied, but required a clinically significant longer time to tracheally intubate children <2 years. Our findings suggest in vivo training should be included to facilitate proficiency with device-specific intubation techniques.

Background: Low-dose ropivacaine combined with intrathecal fentanyl can provide adequate anaesthesia with minimal haemodynamic variation. Preemptive analgesia can enhance analgesic effect of spinal anaesthesia without obvious side effects.

Aims: To assess the efficacy of preoperative intravenous oxycodone on transurethral resection of prostate (TURP) under 10 mg ropivacaine spinal anaesthesia combined with intrathecal 25 pg fentanyl.

Methods: Sixty patients undergoing TURP were randomly divided into two groups: Group o (n=30), in which the patients were administered 0.1 mg.kg-1 oxycodone intravenously 10 min prior to the operation for 2 min, and Group C (n=30) in which the patients were administered intravenously a similar volume of 0.9% saline. The participants were injected with hyperbaric 10 mg ropivacaine and 25 µg fentanyl intrathecally. The block characteristics, hemodynamic values, the tramadol consumption and adverse effects were analyzed.

Results: The peak level of sensory block was lower in Group C. Time to the first analgesic request and time to two-segment regression of sensory block were shorter in Group C. Fewer patients in Group 0 were given postoperative analgesics.

Conclusion: Preoperative intravenous oxycodone can prolong analgesic effect of this method and postoperative analgesia.

Spinal stenosis is a potentially serious condition that can lead to myelopathies and autonomic instability, both of which, as a result, may complicate anesthetic management. Additionally, neuraxial anesthesia appears to increase the risk of worsened neurological outcomes in this population. A 56-year-old female with spinal stenosis, autonomic dysfunction, and known difficult airway who required anesthesia for repair of a femur fracture is presented. After pre-operative arterial line and femoral block placement, an ultrasound guided subarachnoid block was safely placed. This supports the notion that in the appropriate setting, a safe, successful neuraxial blockade can be performed when a general anesthetic may be fraught with more risk.

A 52 yearold female presented with a thoracic paravertebral tumour causing spinal nerve root compression and lower limbs neurologic symptoms. The patient was scheduled to undergo thoracic decompression laminectomy and instrumentation. Markedly severe hemodynamic fluctuations happened during the manipulation of the tumor and continued after the tumor was removed. After multimodal antihypertensive therapy the vital signs were adequately managed and the surgery was successfully performed without complications. The patient was discharged without any sequelae ten days later. The pathology report indicated the diagnosis of extra-adrenal pheochromocytoma. Unexpected pheochromocytoma may lead to a fatal hypertensive crisis during surgery. For anesthesiologists and surgeons who encounter an unexpected hypertensive crisis during surgery, undiagnosed pheochromocytoma should always be considered.

Simulation-based medical education (SBME) and simulation-based mastery learning (SBML) has become well-established in undergraduate and graduate medical, nursing and allied healthcare training programs. Although still in its relative infancy, the use of hi-fidelity simulation to train students in a variety of health-related professions is becoming a foundational cornerstone in program curriculum in the United States and, increasingly, in the international circle. The entire investment return resulting from the inclusion of simulation training labs in healthcare programs has just begun to be realized. The future is bright for this approach to education and healthcare to become an essential tool in the resource education box for colleges, universities, hospitals and research facilities as they serve the mission of training healthcare professionals to meet the growing needs of aging populations.

Background: Inadequate pain management of post-operative pain of patients undergoing hip surgery can result in morbidity and mortality complications. Anatomically, pain resulted from the incision site innervation (Lateral femoral cutaneous nerve) and the hip joint innervation mainly the femoral nerve. Adding femoral nerve blockade to the multimodal regimen for postoperative pain control after hip surgery has been described.

Methods: all 31 patients included in the study received preoperatively combined FN and LFCN block with Normal Saline 0, 9% (group I) or bupivacaine 0.5% (group II) randomly by using a previously generated continuous randomization list kept in a closed envelope. Pain control regimen consisted of Perfalgan 1g IV every 6 hours systematically and Dolosal 50 mg IM every 6 hours if needed (i.e. VAS > 4). Pain level was measured by using Visual Analogue Scale (VAS) for the first 24 hours.Time to the first request of analgesia and the total dose of dolosal were calculated.

Results: The number of patients who requested narcotics was significantly higher in group I (8) than group II (3), P=0,044; the total dose of dolosal used was significantly higher in group 1 (50 mg) than group II (9,375mg), P=0,0058. Time to the first request for analgesia was significantly lower in group I (6hrs ± 5,12) as compared to Group II (21.3 hrs ± [Arabic letters: see text]), P =0,043.

Conclusion: In conclusion, FN and LFCN block when added to the standard regimen for postoperative pain management after hip surgery had a benefit in decreasing pain scores as well as opioid consumption.