S. Masud, Deepak Hrh, A. Niazi, M. Attia, A. Haris
Ever since its introduction, LMA associated cranial nerve injuries have been reported on numerous occasions. There have been many factors attributed to this. High cuff volume/pressure and suboptimal use of LMA are the most important etiological factors associated with these complications. We present an unusual case of inferior alveolar nerve damage associated with LMA, with review of potential causative factors and prevention methods. This case highlights the importance of the correct use of LMA without which serious complications could occur even in routine cases without any risk factors
{"title":"Inferior Alveolar Nerve Injury With Laryngeal Mask Airway","authors":"S. Masud, Deepak Hrh, A. Niazi, M. Attia, A. Haris","doi":"10.5580/IJA.3500","DOIUrl":"https://doi.org/10.5580/IJA.3500","url":null,"abstract":"Ever since its introduction, LMA associated cranial nerve injuries have been reported on numerous occasions. There have been many factors attributed to this. High cuff volume/pressure and suboptimal use of LMA are the most important etiological factors associated with these complications. We present an unusual case of inferior alveolar nerve damage associated with LMA, with review of potential causative factors and prevention methods. This case highlights the importance of the correct use of LMA without which serious complications could occur even in routine cases without any risk factors","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114274559","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}
A. Naveena, T. Elamurugan, G. Sreenath, S. Jagdish
Metastatic tumours in the oral cavity are relatively uncommon and account for 1% of all oral malignancies. The breast, the lung and the kidney are the common primary origin of metastasis. Metastasis to the oral cavity from a thyroid malignancy is very rare and cases described in literature are very few. We report a case of 70 year old lady who presented with a soft tissue swelling in the oral cavity without any other significant clinical findings. Ultrasound of the neck showed a very small anechoic area in the left lobe of thyroid. Fine needle aspiration cytology from both lesions showed malignant cells with follicular pattern.
{"title":"Unusual Oral Cavity Metastasis From Follicular Carcinoma Of The Thyroid – A Case Report","authors":"A. Naveena, T. Elamurugan, G. Sreenath, S. Jagdish","doi":"10.5580/2cee","DOIUrl":"https://doi.org/10.5580/2cee","url":null,"abstract":"Metastatic tumours in the oral cavity are relatively uncommon and account for 1% of all oral malignancies. The breast, the lung and the kidney are the common primary origin of metastasis. Metastasis to the oral cavity from a thyroid malignancy is very rare and cases described in literature are very few. We report a case of 70 year old lady who presented with a soft tissue swelling in the oral cavity without any other significant clinical findings. Ultrasound of the neck showed a very small anechoic area in the left lobe of thyroid. Fine needle aspiration cytology from both lesions showed malignant cells with follicular pattern.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130382701","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}
Zia Arshad, Haider Abbas, L. Gupta, Jaishree Bogra
The Magill forceps are used for nasotracheal intubation, endotracheal suctioning, passing gastric tubes, placement of tampons in the nasopharynx and extraction of foreign material from the pharynx. On many occasions they used it for other anesthesia and extra-anesthesia purposes; e.g. removal of mucous plugs, solid food particles in case of vomiting on induction, fallen loose tooth in the mouth and impacted bolus of meat. Even Ascaris worm obstructing the airway and the list would not end.Although Magill forceps are being used as an aid for nasotracheal intubation since last so many years but its use as an aid to orotracheal intubation is not described. In cases with difficult airway, in which laryngoscopic view is Cormack Lehane Grading is II/III some time we require use of a stylet as an assistance. In such situation with the use of stylet we find some problems. Therefore the aim of this study is to find out whether we can use Magill forceps as an aid for difficult intubation in place of stylet. INTRODUCTION The Nasal tracheal intubation was first described in 1920 by Stanley Rowbotham and Ivan Magill. They developed a device to aid the insertion of the tip of the endotracheal tube into the glottis. Magill's forceps are still the instrument of choice for nasal tracheal intubation carried out under laryngoscopic visualization. This is a valuable instrument for Anesthesiologists to help introducing the endotracheal tube into the larynx. The Magill forceps are used for nasotracheal intubation, endotracheal suctioning, passing gastric tubes, placement of tampons in the nasopharynx and extraction of foreign material from the pharynx. On many occasions they used it for other anesthesia and extra-anesthesia purposes; e.g. removal of mucous plugs, solid food particles in case of vomiting on induction, fallen loose tooth in the mouth and impacted bolus of meat. Even Ascaris worm obstructing the airway and the list would not end. Although Magill forceps are being used as an aid for nasotracheal intubation since last so many years but its use as an aid to orotracheal intubation is not described. In cases with difficult airway, in which laryngoscopic view is Cormack Lehane Grading is II/III some time we require use of a stylet as an assistance. In such situation with the use of stylet we find the following problemsTherefore the aim of this study is to find out whether can we use Magill forceps as an aid for difficult intubation in place of stylet. MATERIALS AND METHODS We have studied 50 patients of either sex with no age limit. The only criteria was the laryngoscopic view CL II/III in which there is requirement of extra aid or manoeuvre to intubate the trachea (in the form of stylet or cricoid pressure). The patients were randomised equally to intubate either with the aid of Stylet or Magill forcep. In Magill forecp group, we putted Magill forcep and pushed endotracheal tube in the trachea. Then we hold the tube just above the cuff with the help of Magill
{"title":"Magill Forceps- An Aid For Difficult Intubation","authors":"Zia Arshad, Haider Abbas, L. Gupta, Jaishree Bogra","doi":"10.5580/2ccb","DOIUrl":"https://doi.org/10.5580/2ccb","url":null,"abstract":"The Magill forceps are used for nasotracheal intubation, endotracheal suctioning, passing gastric tubes, placement of tampons in the nasopharynx and extraction of foreign material from the pharynx. On many occasions they used it for other anesthesia and extra-anesthesia purposes; e.g. removal of mucous plugs, solid food particles in case of vomiting on induction, fallen loose tooth in the mouth and impacted bolus of meat. Even Ascaris worm obstructing the airway and the list would not end.Although Magill forceps are being used as an aid for nasotracheal intubation since last so many years but its use as an aid to orotracheal intubation is not described. In cases with difficult airway, in which laryngoscopic view is Cormack Lehane Grading is II/III some time we require use of a stylet as an assistance. In such situation with the use of stylet we find some problems. Therefore the aim of this study is to find out whether we can use Magill forceps as an aid for difficult intubation in place of stylet. INTRODUCTION The Nasal tracheal intubation was first described in 1920 by Stanley Rowbotham and Ivan Magill. They developed a device to aid the insertion of the tip of the endotracheal tube into the glottis. Magill's forceps are still the instrument of choice for nasal tracheal intubation carried out under laryngoscopic visualization. This is a valuable instrument for Anesthesiologists to help introducing the endotracheal tube into the larynx. The Magill forceps are used for nasotracheal intubation, endotracheal suctioning, passing gastric tubes, placement of tampons in the nasopharynx and extraction of foreign material from the pharynx. On many occasions they used it for other anesthesia and extra-anesthesia purposes; e.g. removal of mucous plugs, solid food particles in case of vomiting on induction, fallen loose tooth in the mouth and impacted bolus of meat. Even Ascaris worm obstructing the airway and the list would not end. Although Magill forceps are being used as an aid for nasotracheal intubation since last so many years but its use as an aid to orotracheal intubation is not described. In cases with difficult airway, in which laryngoscopic view is Cormack Lehane Grading is II/III some time we require use of a stylet as an assistance. In such situation with the use of stylet we find the following problemsTherefore the aim of this study is to find out whether can we use Magill forceps as an aid for difficult intubation in place of stylet. MATERIALS AND METHODS We have studied 50 patients of either sex with no age limit. The only criteria was the laryngoscopic view CL II/III in which there is requirement of extra aid or manoeuvre to intubate the trachea (in the form of stylet or cricoid pressure). The patients were randomised equally to intubate either with the aid of Stylet or Magill forcep. In Magill forecp group, we putted Magill forcep and pushed endotracheal tube in the trachea. Then we hold the tube just above the cuff with the help of Magill","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126346711","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}
Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant disease characterized by progressive ossification of tendons, ligaments, fascia, and skeletal muscle. Ossification can occur either spontaneously or as a result of tissue trauma beginning in childhood. Joints typically ankylose and patients frequently become immobile in their 20s. Patient’s frequently die before their 40s because of restrictive pulmonary failure as a result of intercostal muscle involvement.(1) The temporomandibular joint (TMJ) and cervical spine also often ossify resulting in mmobilization of the jaw and neck, making traditional airway management impossible.(2) Although there are case reports relating to anesthesia for dental procedures, there are no case reports related to the anesthesia care of a parturient with FOP. Our patient is a 24 y.o. G1P0 who presented at 22 weeks for a prenatal consultation. Initial evaluation revealed a 5’0” tall, 58 kg female with a fetus developing appropriately. The patient was successfully delivered at 25 3/7 weeks under GETA, with awake nasal intubation, due to preterm labor and vaginal bleeding. Particular attention was made to prevent further muscular trauma to avoid exacerbation of the disease.
{"title":"Cesarean Section of a 25 3/7 Week Parturient with Fibrodysplasia Ossificans Progressiva: A Case Report","authors":"G. Lynde, R. Guffey, R. Gershon","doi":"10.5580/2cc8","DOIUrl":"https://doi.org/10.5580/2cc8","url":null,"abstract":"Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant disease characterized by progressive ossification of tendons, ligaments, fascia, and skeletal muscle. Ossification can occur either spontaneously or as a result of tissue trauma beginning in childhood. Joints typically ankylose and patients frequently become immobile in their 20s. Patient’s frequently die before their 40s because of restrictive pulmonary failure as a result of intercostal muscle involvement.(1) The temporomandibular joint (TMJ) and cervical spine also often ossify resulting in mmobilization of the jaw and neck, making traditional airway management impossible.(2) Although there are case reports relating to anesthesia for dental procedures, there are no case reports related to the anesthesia care of a parturient with FOP. Our patient is a 24 y.o. G1P0 who presented at 22 weeks for a prenatal consultation. Initial evaluation revealed a 5’0” tall, 58 kg female with a fetus developing appropriately. The patient was successfully delivered at 25 3/7 weeks under GETA, with awake nasal intubation, due to preterm labor and vaginal bleeding. Particular attention was made to prevent further muscular trauma to avoid exacerbation of the disease.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124048011","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}
The study was done to compare the efficacy, duration, quality and side effects of intrathecal bupivacaine alone and bupivacaine plus clonidine. A prospective randomised double blind study was carried out in 60 ASA-1 paediatrics patients undergoing surgeries below T8 dermatome up to 2 hrs duration. Patients were randomly allocated in two groups. Group-A received bupivacaine .5% heavy (0.4mg/kg for 5-15kg or 0.3mg/kg for >15 kg) and Group-B received bupivacaine 0.5%heavy (0.4mg/kg for 5-15kg or 0.3mg/kg for >15kg) and preservative free clonidine (1 mcg/kg), comprising 30 patients each. Time of onset of sensory block, maximum level of sensory block, duration of sensory block, duration of post-op analgesia and side effects were observed. Data obtained was subjected to statistical computation and analysed using computer programme statistical package for social science (SPSS)ver-16.0 and tests performed were unpaired student-t test, nonparametric mann-whitney two samples test and Chi square test. Value of p<0.05 was considered significant and p<0.0000001 highly significant. Awake sedation score with clonidine was better than bupivacaine alone. The side effect profile: only one patient of Group-A had bradycardia and in Group-B two patients had bradycardia and two patients had hypotension. No patients in any group had nausea vomitting, post dural puncture headache, urinary retention or high spinal. Adding clonidine is providing early onset of sensory block, adequate sedation and prolonged postoperative analgesia.
{"title":"Intrathecal Bupivacaine Vs. Bupivacaine And Clonidine In Paediatrics Age Group: A Comparative Evaluation.","authors":"Nagesh Jambure","doi":"10.5580/2cc9","DOIUrl":"https://doi.org/10.5580/2cc9","url":null,"abstract":"The study was done to compare the efficacy, duration, quality and side effects of intrathecal bupivacaine alone and bupivacaine plus clonidine. A prospective randomised double blind study was carried out in 60 ASA-1 paediatrics patients undergoing surgeries below T8 dermatome up to 2 hrs duration. Patients were randomly allocated in two groups. Group-A received bupivacaine .5% heavy (0.4mg/kg for 5-15kg or 0.3mg/kg for >15 kg) and Group-B received bupivacaine 0.5%heavy (0.4mg/kg for 5-15kg or 0.3mg/kg for >15kg) and preservative free clonidine (1 mcg/kg), comprising 30 patients each. Time of onset of sensory block, maximum level of sensory block, duration of sensory block, duration of post-op analgesia and side effects were observed. Data obtained was subjected to statistical computation and analysed using computer programme statistical package for social science (SPSS)ver-16.0 and tests performed were unpaired student-t test, nonparametric mann-whitney two samples test and Chi square test. Value of p<0.05 was considered significant and p<0.0000001 highly significant. Awake sedation score with clonidine was better than bupivacaine alone. The side effect profile: only one patient of Group-A had bradycardia and in Group-B two patients had bradycardia and two patients had hypotension. No patients in any group had nausea vomitting, post dural puncture headache, urinary retention or high spinal. Adding clonidine is providing early onset of sensory block, adequate sedation and prolonged postoperative analgesia.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127820150","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}
S. Kinthala, P. Durga, S. Tirumala, G. Ramachandran, L. Kurnutala
Background: Injection pain and hypotension are the two main adverse effects of propofol. The commonly used lignocaine pretreatment for reducing injection pain has a failure rate between 1332 %. There are few studies in literature using ephedrine pretreatment for reduction of propofol injection pain and these studies have also looked at the effect of ephedrine in overcoming hypotension and hemodynamic stability, each with varying results. We studied the effect of ephedrine 50μg/kg pretreatment on prevention of propofol injection pain and hemodynamics.Methods: This prospective, randomized, double-blind, placebocontrolled study was conducted after obtaining institutional ethical committee approval. Patients (eighty one patients) were randomly allocated to one of three groups. Each group consisting 27 (n= 27) patients were to receive one of lignocaine (Group L, n = 27), normal saline (Group S, n = 27) or ephedrine (Group E, n = 27) as pretreatment. Group Lpretreatment with 2% lignocaine 2 ml. Group Spretreatment with 0.9% normal saline 2ml, Group Epretreatment with ephedrine 50 μg/kg body weight diluted in normal saline into a 2 ml normal saline solution. Propofol was injected 30 sec later. A blinded researcher assessed the patient's pain level using a four point verbal rating scale.Results: There was no significant difference with respect to patient's characteristics and hemodynamic changes during propofol induction among the three groups. There was a statistically significant difference in the incidence of pain between groups. Patients who received lignocaine pretreatment group had 51.8% pain. The Normal saline pretreatment group had 77.8% pain. Ephedrine pretreatment group had pain as high as 70.4 %.Conclusion: Ephedrine used as pretreatment in dose of 50 μg/kg is neither useful to decrease propofol injection pain nor to maintain better hemodynamic.
{"title":"Efficacy of Ephedrine Versus Lignocaine Pretreatment In Preventing Pain Following Propofol Injection: A Prospective, Randomized, Double-blind, Placebo-controlled Study.","authors":"S. Kinthala, P. Durga, S. Tirumala, G. Ramachandran, L. Kurnutala","doi":"10.5580/2cec","DOIUrl":"https://doi.org/10.5580/2cec","url":null,"abstract":"Background: Injection pain and hypotension are the two main adverse effects of propofol. The commonly used lignocaine pretreatment for reducing injection pain has a failure rate between 1332 %. There are few studies in literature using ephedrine pretreatment for reduction of propofol injection pain and these studies have also looked at the effect of ephedrine in overcoming hypotension and hemodynamic stability, each with varying results. We studied the effect of ephedrine 50μg/kg pretreatment on prevention of propofol injection pain and hemodynamics.Methods: This prospective, randomized, double-blind, placebocontrolled study was conducted after obtaining institutional ethical committee approval. Patients (eighty one patients) were randomly allocated to one of three groups. Each group consisting 27 (n= 27) patients were to receive one of lignocaine (Group L, n = 27), normal saline (Group S, n = 27) or ephedrine (Group E, n = 27) as pretreatment. Group Lpretreatment with 2% lignocaine 2 ml. Group Spretreatment with 0.9% normal saline 2ml, Group Epretreatment with ephedrine 50 μg/kg body weight diluted in normal saline into a 2 ml normal saline solution. Propofol was injected 30 sec later. A blinded researcher assessed the patient's pain level using a four point verbal rating scale.Results: There was no significant difference with respect to patient's characteristics and hemodynamic changes during propofol induction among the three groups. There was a statistically significant difference in the incidence of pain between groups. Patients who received lignocaine pretreatment group had 51.8% pain. The Normal saline pretreatment group had 77.8% pain. Ephedrine pretreatment group had pain as high as 70.4 %.Conclusion: Ephedrine used as pretreatment in dose of 50 μg/kg is neither useful to decrease propofol injection pain nor to maintain better hemodynamic.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116698059","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: Epidural volume extension with saline solution can contribute to enhancement of a small dose intrathecal local anaesthetic. The resultant substantial reduction in local anaesthetic dose produces a sufficient effective block, decreased side effect and less motor blockade. The aim of this study was to evaluate the sensory and motor block characteristics of 10ml epidural saline after intrathecal small dose local anaesthetic and opioid. Setting and Design: This prospective, randomized, double-blind study was conducted in a operation room setting of a university hospital. One hundred and five women (25-40 years) of ASA 1 and 11 physical status electively undergoing caesarean section under regional anaesthesia were investigated.Method and Material: After hospital Ethics Committee approval and written informed consent, 105 women were allocated randomly, into three groups (n=35), received 7mg of spinal hyperbaric 0.5% Bupivacaine (groupB7), 7mg of spinal hyperbaric 0.5% Bupivacaine followed by 10ml of Normal Saline through the epidural catheter, 5 minutes thereafter (group B7EVE) and 10mg of spinal hyperbaric 0.5% Bupivacaine without epidural volume extension (groupB10). All women also received 25mcg of Fentanyl intrathecally. The patients were assessed at 2.5 minutes interval for sensory block level to loss of pain from pin prick and for motor block using modified Bromage scale. We also recorded visual analogue scale, peak sensory block height, highest Modified Bromage scale, motor block recovery, incidences of side effects and ephedrine dose requirement.Result: Demographic data, duration of surgery, VAS, incidence of maternal side effects and ephedrine dose requirement were similar in all the groups. There was no difference in the peak sensory block heights between the groups during the study. The motor score was significantly lower in the group B7-EVE (grade-1 vs grade-3 in groupB7and groupB10, P=0.014). This was associated with a significantly faster motor recovery to Modified Bromage 0 in group B7-EVE (61-80mts vs 121-140mts in group B7 and 141-160mts in groupB10, P=0.0001).Conclusion: This study demonstrates a benefit in using epidural volume extension with 10ml normal saline, as a part of a combined spinal epidural technique by providing a more rapid motor recovery of the lower limbs after elective caesarean section.
背景:用生理盐水扩大硬膜外容量有助于增强小剂量鞘内局部麻醉。因此，局部麻醉剂量的大幅减少产生了足够有效的阻滞，减少了副作用，减少了运动阻滞。本研究的目的是评估鞘内小剂量局部麻醉和阿片类药物后10ml硬膜外生理盐水的感觉和运动阻滞特性。环境和设计:这项前瞻性、随机、双盲研究在一所大学医院的手术室环境中进行。研究了105例(25 ~ 40岁)ASA 1级和11级身体状态的女性在区域麻醉下选择性剖宫产术。方法与材料:经医院伦理委员会批准并书面知情同意后，将105名女性随机分为3组(n=35)，分别给予7mg脊髓高压0.5%布比卡因(b7组)、7mg脊髓高压0.5%布比卡因后经硬膜外导管加10ml生理盐水(B7EVE组)、10mg脊髓高压0.5%布比卡因不经硬膜外扩容量(b10组)。所有女性还接受了25微克的芬太尼鞘内注射。采用改良Bromage评分法，每隔2.5分钟评估患者针刺后疼痛消失的感觉阻滞程度和运动阻滞程度。同时记录视觉模拟评分、感觉阻滞峰值高度、最高修正Bromage评分、运动阻滞恢复情况、副反应发生率及麻黄素剂量要求。结果:两组患者的人口学资料、手术时间、VAS、产妇不良反应发生率、麻黄素需用量等差异无统计学意义。在研究过程中，两组之间的峰值感觉阻滞高度没有差异。B7-EVE组运动评分明显低于b7、b10组(1级vs 3级，P=0.014)。这与B7- eve组改良Bromage 0的运动恢复明显更快相关(61-80mts vs B7组121-140mts和b10组141-160mts, P=0.0001)。结论:本研究表明，使用10ml生理盐水进行硬膜外容量扩展，作为脊髓硬膜外联合技术的一部分，可以在选择性剖宫产后提供更快速的下肢运动恢复。
{"title":"Epidural Volume Extension In Combined Spinal Epidural Anaesthesia For Rapid Motor Recovery After Elective Caesarean SectionA Comparative Study","authors":"S. Kaur, Richa Jayant, S. Aggarwal","doi":"10.5580/2c7b","DOIUrl":"https://doi.org/10.5580/2c7b","url":null,"abstract":"Background: Epidural volume extension with saline solution can contribute to enhancement of a small dose intrathecal local anaesthetic. The resultant substantial reduction in local anaesthetic dose produces a sufficient effective block, decreased side effect and less motor blockade. The aim of this study was to evaluate the sensory and motor block characteristics of 10ml epidural saline after intrathecal small dose local anaesthetic and opioid. Setting and Design: This prospective, randomized, double-blind study was conducted in a operation room setting of a university hospital. One hundred and five women (25-40 years) of ASA 1 and 11 physical status electively undergoing caesarean section under regional anaesthesia were investigated.Method and Material: After hospital Ethics Committee approval and written informed consent, 105 women were allocated randomly, into three groups (n=35), received 7mg of spinal hyperbaric 0.5% Bupivacaine (groupB7), 7mg of spinal hyperbaric 0.5% Bupivacaine followed by 10ml of Normal Saline through the epidural catheter, 5 minutes thereafter (group B7EVE) and 10mg of spinal hyperbaric 0.5% Bupivacaine without epidural volume extension (groupB10). All women also received 25mcg of Fentanyl intrathecally. The patients were assessed at 2.5 minutes interval for sensory block level to loss of pain from pin prick and for motor block using modified Bromage scale. We also recorded visual analogue scale, peak sensory block height, highest Modified Bromage scale, motor block recovery, incidences of side effects and ephedrine dose requirement.Result: Demographic data, duration of surgery, VAS, incidence of maternal side effects and ephedrine dose requirement were similar in all the groups. There was no difference in the peak sensory block heights between the groups during the study. The motor score was significantly lower in the group B7-EVE (grade-1 vs grade-3 in groupB7and groupB10, P=0.014). This was associated with a significantly faster motor recovery to Modified Bromage 0 in group B7-EVE (61-80mts vs 121-140mts in group B7 and 141-160mts in groupB10, P=0.0001).Conclusion: This study demonstrates a benefit in using epidural volume extension with 10ml normal saline, as a part of a combined spinal epidural technique by providing a more rapid motor recovery of the lower limbs after elective caesarean section.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123127403","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}
S. Palmese, M. Manzi, Vincenzo Visciano, Andrea C. Scibilia, A. Natale
The purpose of this retrospective study was to estimate the frequency of hypotension and bradycardia in parturients undergoing caesarean section, after the introduction of a protocol providing for the administration of colloids (HydroxyEthylStarch, HES 6%) 500 ml for hypotension prevention after spinal anaesthesia and the administration of Ondansetron (8 mg) for nausea and vomiting prevention. We reviewed the anaesthesiology records of the patients who underwent to caesarean section in spinal anaesthesia, in Nocera Inferiore Hospital (Salerno), between January 2012 and May 2012. 54 patients were examined. Retrospective examination of the records showed a 16,6% incidence of systolic hypotension, and 25,9% of diastolic hypotension. The average consumption of Ephedrine was 5.91 mg. Only 4 (7,4%) patients had an episode of bradycardia, HR < 60, no < 58.The association HES 6% plus Ondansetron seems to reduce the incidence of arterial hypotension in parturients undergoing caesarean section, compared to the incidence of hypotension reported in literature.
{"title":"Reduced Hypotension After Subarachnoid Anaesthesia With Ondansetron Most Colloids In Parturients Undergoing Caesarean Section. A Retrospective Study.","authors":"S. Palmese, M. Manzi, Vincenzo Visciano, Andrea C. Scibilia, A. Natale","doi":"10.5580/2cc0","DOIUrl":"https://doi.org/10.5580/2cc0","url":null,"abstract":"The purpose of this retrospective study was to estimate the frequency of hypotension and bradycardia in parturients undergoing caesarean section, after the introduction of a protocol providing for the administration of colloids (HydroxyEthylStarch, HES 6%) 500 ml for hypotension prevention after spinal anaesthesia and the administration of Ondansetron (8 mg) for nausea and vomiting prevention. We reviewed the anaesthesiology records of the patients who underwent to caesarean section in spinal anaesthesia, in Nocera Inferiore Hospital (Salerno), between January 2012 and May 2012. 54 patients were examined. Retrospective examination of the records showed a 16,6% incidence of systolic hypotension, and 25,9% of diastolic hypotension. The average consumption of Ephedrine was 5.91 mg. Only 4 (7,4%) patients had an episode of bradycardia, HR < 60, no < 58.The association HES 6% plus Ondansetron seems to reduce the incidence of arterial hypotension in parturients undergoing caesarean section, compared to the incidence of hypotension reported in literature.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"119 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125166926","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}
Rekha Gupta, Mamta Dubey, B. Naithani, A. Bhargava
Background: Tracheal intubation produces transient hemodynamic pressor responses which may be unpredictable. Diltiazemlidocaine combination is hypothesized to attenuate these responses better that when they are used alone.Aims: To compare the clinical efficacy and safety of diltiazem-lidocaine combination in attenuating pressor response to tracheal intubation with lidocaine and diltiazem alone.Settings and Design : prospective double blind, randomised clinical trial of efficacy and safetyMethods and Materials: 120 ASA grade II B and C were thus unaware of the drug given.Statistical analysis used : Demographic profiles were evaluated statistically using CHI square test. Changes in haemodynamic parameters were compared using paired t test within the group. Inter group comparison were done by one way analysis of variance (ANOVA). Results: The attenuation of hemodynamic response occurred maximal in DL group followed by lidocaine and diltiazem group respectively ( P value< 0.001 till 5 minutes postintubation for BP and HR). Lidocaine controlled both heart rate and blood pressure better than Diltiazem as there was reflex tachycardia to some extent in D group due to reflex sympathoadrenal stimulation. Diltiazem-Lidocaine combination controlled both these parameter to optimal levels.Conclusions : The primary outcome of the study is that Diltiazem-Lidocaine combination is safe and effective in attenuating pressor response to tracheal intubation . We recommend its routine used before intubation
{"title":"Clinical Efficacy Of Combination Of Diltiazem And Lidocaine In Attenuating Hemodynamic Changes During Tracheal Intubation And Comparing The Response When They Are Used Alone.","authors":"Rekha Gupta, Mamta Dubey, B. Naithani, A. Bhargava","doi":"10.5580/2cbb","DOIUrl":"https://doi.org/10.5580/2cbb","url":null,"abstract":"Background: Tracheal intubation produces transient hemodynamic pressor responses which may be unpredictable. Diltiazemlidocaine combination is hypothesized to attenuate these responses better that when they are used alone.Aims: To compare the clinical efficacy and safety of diltiazem-lidocaine combination in attenuating pressor response to tracheal intubation with lidocaine and diltiazem alone.Settings and Design : prospective double blind, randomised clinical trial of efficacy and safetyMethods and Materials: 120 ASA grade II B and C were thus unaware of the drug given.Statistical analysis used : Demographic profiles were evaluated statistically using CHI square test. Changes in haemodynamic parameters were compared using paired t test within the group. Inter group comparison were done by one way analysis of variance (ANOVA). Results: The attenuation of hemodynamic response occurred maximal in DL group followed by lidocaine and diltiazem group respectively ( P value< 0.001 till 5 minutes postintubation for BP and HR). Lidocaine controlled both heart rate and blood pressure better than Diltiazem as there was reflex tachycardia to some extent in D group due to reflex sympathoadrenal stimulation. Diltiazem-Lidocaine combination controlled both these parameter to optimal levels.Conclusions : The primary outcome of the study is that Diltiazem-Lidocaine combination is safe and effective in attenuating pressor response to tracheal intubation . We recommend its routine used before intubation","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131411029","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}
O. Wellisch, Kenneth D. Eichenbaum, J. Choueka, Piyush Gupta
Study Objective: To evaluate the utility of multimodal pain management subsequent to general or neuraxial anesthesia following total knee arthroplasty. Design: Retrospective review. Setting: University-affiliated teaching hospital. Patients: 389 patients (ASA physical status I-IV) scheduled for elective total knee replacement surgery over 3 year period. Interventions and Measurements: A total of 218 patients met inclusion criteria: 1) status-post a total knee arthroplasty 2) femoral nerve block with a continuous infusion of 0.1% ropivacaine 3) femoral catheter discontinued on post-op day 3, and 4.) follow-up with acute pain service. The study group (S) (N=105) received multimodal pain management consisting of a continuous femoral nerve blockade, celecoxib 200mg PO Q24 hrs, oxycontin 10mg PO Q12, acetaminophen 1000mg PO TID, and Percocet 5/325 1-2 tabs PO Q4-6 hr PRN (≤3 tabs/24hrs). The control group (NS) (N=113) received a continuous femoral nerve block with a non-standardized pain management regimen as prescribed by the orthopedic service. Outcome measurements included: mode of anesthesia (neuraxial vs. GA); length of surgery; time to ambulation and 90 flexion; pain score, morphine equivalents and length of stay in hospital. Main Results: The study group demonstrated decreased pain scores on the third post-operative day as compared to the control group (S=2.43 vs. NS=3.38, p=0.003, SEM + 0.215). The study group also demonstrated reduced length of stay relative to controls (S=3.64 vs. NS=4.47, p<0.001, SEM + 0.114). Conclusion: Multimodal pain management following total knee arthroplasty improved postoperative outcomes irrespective of opioids requirements or mode of anesthesia. Our results are consistent with previous work demonstrating improved patient care, superior analgesia and reduced length of stay in hospital through implementation of standardized multimodal pain management with standardized discharge criteria.
研究目的:评价全膝关节置换术后全身或轴向麻醉后多模式疼痛管理的有效性。设计:回顾性审查。单位:学校附属教学医院。患者:389例患者(ASA身体状态I-IV)计划在3年内进行选择性全膝关节置换术。干预措施和测量:共有218例患者符合纳入标准:1)全膝关节置换术后状态;2)持续输注0.1%罗哌卡因进行股神经阻滞;3)术后第3天停用股导管;4)急性疼痛随访。研究组(N=105)接受多模式疼痛管理，包括连续股神经阻断，塞来昔布200mg PO Q24小时，奥施康定10mg PO Q12，对乙酰氨基酚1000mg PO TID, Percocet 5/325 1-2片PO Q4-6小时PRN(≤3片/24小时)。对照组(N=113)采用骨科规定的非标准化疼痛管理方案进行连续股神经阻滞治疗。结果测量包括:麻醉方式(神经轴向vs. GA);手术时长;活动和90度屈曲时间;疼痛评分，吗啡当量和住院时间。主要结果:研究组术后第3天疼痛评分较对照组降低(S=2.43 vs. NS=3.38, p=0.003, SEM + 0.215)。研究组的住院时间也比对照组短(S=3.64 vs. NS=4.47, p<0.001, SEM + 0.114)。结论:全膝关节置换术后的多模式疼痛管理改善了术后结果，与阿片类药物需求或麻醉方式无关。我们的研究结果与先前的研究结果一致，表明通过实施标准化的多模式疼痛管理和标准化的出院标准，改善了患者护理，改善了镇痛效果，缩短了住院时间。
{"title":"Standardized Multimodal Pain Management Reduces Post-Operative Pain and Length of Stay in Hospital for Total Knee Arthroplasty: A Retrospective Review","authors":"O. Wellisch, Kenneth D. Eichenbaum, J. Choueka, Piyush Gupta","doi":"10.5580/2cbf","DOIUrl":"https://doi.org/10.5580/2cbf","url":null,"abstract":"Study Objective: To evaluate the utility of multimodal pain management subsequent to general or neuraxial anesthesia following total knee arthroplasty. Design: Retrospective review. Setting: University-affiliated teaching hospital. Patients: 389 patients (ASA physical status I-IV) scheduled for elective total knee replacement surgery over 3 year period. Interventions and Measurements: A total of 218 patients met inclusion criteria: 1) status-post a total knee arthroplasty 2) femoral nerve block with a continuous infusion of 0.1% ropivacaine 3) femoral catheter discontinued on post-op day 3, and 4.) follow-up with acute pain service. The study group (S) (N=105) received multimodal pain management consisting of a continuous femoral nerve blockade, celecoxib 200mg PO Q24 hrs, oxycontin 10mg PO Q12, acetaminophen 1000mg PO TID, and Percocet 5/325 1-2 tabs PO Q4-6 hr PRN (≤3 tabs/24hrs). The control group (NS) (N=113) received a continuous femoral nerve block with a non-standardized pain management regimen as prescribed by the orthopedic service. Outcome measurements included: mode of anesthesia (neuraxial vs. GA); length of surgery; time to ambulation and 90 flexion; pain score, morphine equivalents and length of stay in hospital. Main Results: The study group demonstrated decreased pain scores on the third post-operative day as compared to the control group (S=2.43 vs. NS=3.38, p=0.003, SEM + 0.215). The study group also demonstrated reduced length of stay relative to controls (S=3.64 vs. NS=4.47, p<0.001, SEM + 0.114). Conclusion: Multimodal pain management following total knee arthroplasty improved postoperative outcomes irrespective of opioids requirements or mode of anesthesia. Our results are consistent with previous work demonstrating improved patient care, superior analgesia and reduced length of stay in hospital through implementation of standardized multimodal pain management with standardized discharge criteria.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"2140 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130004433","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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