T. Chand, Pankaj Bundela, K. Joshi, A. Agarwal, A. Dupargude
Aims: The aim of the study was to compare the analgesic efficacy and the safety profile of different concentrations of sufentanil and fentanyl as an adjuvant to bupivacaine for postoperative lumbar epidural analgesia.Settings and Design: Prospective double blind, randomized controlled ,single centre study.Material and Methods: 80 patients of ASA-I-II aged 40-55 years who underwent vaginal hysterectomy were randomly allocated in four groups. The PCEA pump was programmed to deliver a 2 ml bolus with a lockout interval of 12 min and background infusion of 4 ml/h. 0.125% bupivacaine with sufentanil 0.5 μg/mL ,0.75 μg /mL and 1 μg /mL was administered and compared with fentanyl 4μg/ml. Patients were observed for analgesic profile and side effects. Statistical analysis : Statistical analyses were performed by using SPSS 14. p< 0.05 was considered significant.Results: The quality of postoperative analgesia of all combinations of bupivacaine-sufentanil were equivalent to bupivacaine-fentanyl . Pruritus was significantly less with bupivacaine – sufentanil 0.5μg/ml (P < 0.05). Conclusion: Sufentanil 0.5 μg/ml is the recommended dose for PCEA
{"title":"Patient-Controlled Epidural Analgesia After Hysterectomy With Bupivacaine 0.125%: Comparison Of Different Concentrations Of Sufentanil And Fentanyl","authors":"T. Chand, Pankaj Bundela, K. Joshi, A. Agarwal, A. Dupargude","doi":"10.5580/2b98","DOIUrl":"https://doi.org/10.5580/2b98","url":null,"abstract":"Aims: The aim of the study was to compare the analgesic efficacy and the safety profile of different concentrations of sufentanil and fentanyl as an adjuvant to bupivacaine for postoperative lumbar epidural analgesia.Settings and Design: Prospective double blind, randomized controlled ,single centre study.Material and Methods: 80 patients of ASA-I-II aged 40-55 years who underwent vaginal hysterectomy were randomly allocated in four groups. The PCEA pump was programmed to deliver a 2 ml bolus with a lockout interval of 12 min and background infusion of 4 ml/h. 0.125% bupivacaine with sufentanil 0.5 μg/mL ,0.75 μg /mL and 1 μg /mL was administered and compared with fentanyl 4μg/ml. Patients were observed for analgesic profile and side effects. Statistical analysis : Statistical analyses were performed by using SPSS 14. p< 0.05 was considered significant.Results: The quality of postoperative analgesia of all combinations of bupivacaine-sufentanil were equivalent to bupivacaine-fentanyl . Pruritus was significantly less with bupivacaine – sufentanil 0.5μg/ml (P < 0.05). Conclusion: Sufentanil 0.5 μg/ml is the recommended dose for PCEA","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126635748","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}
Arvind Kumar, B. Shadangi, Jitendra Agarwal, V. M. Agnihotri
Purpose: Supraclavicular brachial plexus block technique, blocks the entire arm distally till mid arm level but risk of pneumothorax, phrenic nerve palsy and vascular puncture could be life threatening so to overcome these sequale we compared the lateral approach of supraclavicular brachial plexus block with conventional approach of supraclavicular block. Methods: Patients were randomly allocated in two groups; group 1 (n=50) received conventional approach of supraclavicular brachial plexus block and group 2 (n= 50) received lateral approach of supraclavicular brachial plexus block. Both the group received lignocaine with adrenaline (1:200000) 7 mg/kg and bupivacaine 2 mg.kg -1. The total volume of drug injected was 30 ml. Results: All the patients were assessed in terms of Time of onset of analgesia, Extent of sensory block, Quality of motor blocked, Tourniquet tolerance, Technical difficulty, Total duration of analgesia, Total duration of motor paralysis, and complications. Appropriate statistical analysis was done. Conclusion: We concluded that the Lateral Approach of Supraclavicular brachial plexus block justifies its own routine clinical uses because it has got better compliance of block in relation to onset, duration, extent and success rate. It is less traumatic and causes less adverse effects like puncture of vessels and pleura.
{"title":"Lateral Approach Of Supraclavicular Brachial Plexus As A Better Alternative To Conventional Supraclavicular Brachial Plexus Block","authors":"Arvind Kumar, B. Shadangi, Jitendra Agarwal, V. M. Agnihotri","doi":"10.5580/2b97","DOIUrl":"https://doi.org/10.5580/2b97","url":null,"abstract":"Purpose: Supraclavicular brachial plexus block technique, blocks the entire arm distally till mid arm level but risk of pneumothorax, phrenic nerve palsy and vascular puncture could be life threatening so to overcome these sequale we compared the lateral approach of supraclavicular brachial plexus block with conventional approach of supraclavicular block. Methods: Patients were randomly allocated in two groups; group 1 (n=50) received conventional approach of supraclavicular brachial plexus block and group 2 (n= 50) received lateral approach of supraclavicular brachial plexus block. Both the group received lignocaine with adrenaline (1:200000) 7 mg/kg and bupivacaine 2 mg.kg -1. The total volume of drug injected was 30 ml. Results: All the patients were assessed in terms of Time of onset of analgesia, Extent of sensory block, Quality of motor blocked, Tourniquet tolerance, Technical difficulty, Total duration of analgesia, Total duration of motor paralysis, and complications. Appropriate statistical analysis was done. Conclusion: We concluded that the Lateral Approach of Supraclavicular brachial plexus block justifies its own routine clinical uses because it has got better compliance of block in relation to onset, duration, extent and success rate. It is less traumatic and causes less adverse effects like puncture of vessels and pleura.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126330520","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}
Kenneth D. Eichenbaum, A. Bronstein, Kenneth Scope, D. Feierman, K. Tyagaraj
The introduction of modern optical airway devices permits a number of new options for safer management of the difficult airway. As the American Society of Anesthesiology Task Force endeavors to update the standardized Difficult Airway Algorithm of 2003 (1), we would like to offer a modular addition to the existing algorithm (Fig. 1). This module can prompt further discussion and provide an initiative for further review and update of the algorithm. In addition, there is opportunity to build on current concepts in the management of the difficult airway (2-5).
{"title":"New Building Blocks for the Airway Algorithm","authors":"Kenneth D. Eichenbaum, A. Bronstein, Kenneth Scope, D. Feierman, K. Tyagaraj","doi":"10.5580/2c36","DOIUrl":"https://doi.org/10.5580/2c36","url":null,"abstract":"The introduction of modern optical airway devices permits a number of new options for safer management of the difficult airway. As the American Society of Anesthesiology Task Force endeavors to update the standardized Difficult Airway Algorithm of 2003 (1), we would like to offer a modular addition to the existing algorithm (Fig. 1). This module can prompt further discussion and provide an initiative for further review and update of the algorithm. In addition, there is opportunity to build on current concepts in the management of the difficult airway (2-5).","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116622961","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 26-year-old pregnant female of 34 weeks gestation presented with swelling over the anterior aspect of the neck, trismus and a normal obstetrics history. Our approach included regional technique of superficial cervical plexus block, under which rapid decompression of the abscess in the submandibular region was done.
{"title":"Superficial Cervical Plexus Block For I and D Of Ludwig’s Angina In Pregnancy","authors":"A. Singam, S. Ghoshal","doi":"10.5580/2afc","DOIUrl":"https://doi.org/10.5580/2afc","url":null,"abstract":"A 26-year-old pregnant female of 34 weeks gestation presented with swelling over the anterior aspect of the neck, trismus and a normal obstetrics history. Our approach included regional technique of superficial cervical plexus block, under which rapid decompression of the abscess in the submandibular region was done.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"74 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121016840","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: Hemodynamic monitoring is a necessary priority in the perioperative setting. Invasive and noninvasive monitoring technologies have been used to improve patient care. Literature pertaining to a new hemodynamic monitoring system, the Vigileo!"/FloTrac!" system, was explored to ascertain the reliability of data obtained from patients in the perioperative setting. The objective was to assess cardiac output (CO), stroke volume variation (SVV), and data trends over time for reliability in perioperative hemodynamic management. Methods: A systematic review was conducted that focused on the reliability of hemodynamic data obtained from the Vigileo!"/FloTrac!" system. Google Scholar and FirstSearch: Medline database were utilized for this review. Results: The Vigileo!"/FloTrac!" system provides reliable SVV and data trends that may guide hemodynamic management of perioperative patients. Conclusion: The Vigileo!"/FloTrac!" system provides reliable data that may be used to manage perioperative patient
{"title":"Vigileo™/FloTrac™ System: Stroke Volume Variation and Hemodynamic Trends are Beneficial for Acute Care Management of Perioperative Patients.","authors":"Rhonda Walker, M. Welliver","doi":"10.5580/2a5e","DOIUrl":"https://doi.org/10.5580/2a5e","url":null,"abstract":"Background: Hemodynamic monitoring is a necessary priority in the perioperative setting. Invasive and noninvasive monitoring technologies have been used to improve patient care. Literature pertaining to a new hemodynamic monitoring system, the Vigileo!\"/FloTrac!\" system, was explored to ascertain the reliability of data obtained from patients in the perioperative setting. The objective was to assess cardiac output (CO), stroke volume variation (SVV), and data trends over time for reliability in perioperative hemodynamic management. Methods: A systematic review was conducted that focused on the reliability of hemodynamic data obtained from the Vigileo!\"/FloTrac!\" system. Google Scholar and FirstSearch: Medline database were utilized for this review. Results: The Vigileo!\"/FloTrac!\" system provides reliable SVV and data trends that may guide hemodynamic management of perioperative patients. Conclusion: The Vigileo!\"/FloTrac!\" system provides reliable data that may be used to manage perioperative patient","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126494088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report a 14-year-old, ASA grade I female who presented with a mouth opening of 5 mm. The patient complained of trismus since she was 2-years-old due to trauma to the mandible. She was diagnosed as a case of bilateral TMJ ankylosis and was posted for interpositional gap arthroplasty.Due to the unavailability of fiberoptic bronchoscope, retrograde intubation was planned. A modified technique of retrograde intubation was done, were ventilating bougie was used along with J tipped guide wire, which made the intubation easier and reduced the chances of trauma.
{"title":"Modified Technique Of Retrograde Intubation Using Ventilating Bougie","authors":"S. Ghoshal, A. Singam","doi":"10.5580/2af4","DOIUrl":"https://doi.org/10.5580/2af4","url":null,"abstract":"We report a 14-year-old, ASA grade I female who presented with a mouth opening of 5 mm. The patient complained of trismus since she was 2-years-old due to trauma to the mandible. She was diagnosed as a case of bilateral TMJ ankylosis and was posted for interpositional gap arthroplasty.Due to the unavailability of fiberoptic bronchoscope, retrograde intubation was planned. A modified technique of retrograde intubation was done, were ventilating bougie was used along with J tipped guide wire, which made the intubation easier and reduced the chances of trauma.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"128 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116450300","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}
Patient controlled analgesia (PCA) devices are a commonly used method of self-administered intravenous opioid titration postsurgery. Tramadol PCA has been shown to be a safe and effective modality of post-operative analgesia when compared with morphine. Reports of Tramadol toxicity are well documented in the literature; however there are no clear guidelines on maximal doses that should be administered by PCA. We report a case of seizure related to Tramadol and review the literature to determine a safe dosing range for Tramadol PCA.
{"title":"Is There A Ceiling Effect For Patient Controlled Analgesia Using Tramadol? A Case Report And Review Of The Literature.","authors":"A. Langley, M. Malan","doi":"10.5580/2b45","DOIUrl":"https://doi.org/10.5580/2b45","url":null,"abstract":"Patient controlled analgesia (PCA) devices are a commonly used method of self-administered intravenous opioid titration postsurgery. Tramadol PCA has been shown to be a safe and effective modality of post-operative analgesia when compared with morphine. Reports of Tramadol toxicity are well documented in the literature; however there are no clear guidelines on maximal doses that should be administered by PCA. We report a case of seizure related to Tramadol and review the literature to determine a safe dosing range for Tramadol PCA.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"114 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117207111","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. Dagal, A. Joffe, M. Treggiari, S. Sharar, J. Tansley, I. Moppett, B. Baxendale
Purpose: We aimed to survey the members of anesthesia departments in two large university hospitals, University of Washington (Seattle, USA) (UW-US) and University of Nottingham (Nottingham, UK) (UN-UK) to compare differences in their current approach to rapid sequence induction (RSI). Methods: The survey was distributed in electronic and paper format in 2009. Overall response rate was 48.6% (146/300). Participants were asked to indicate their practice for a RSI technique for emergency appendectomy in a previously healthy adult. Data were summarized descriptively using frequency distribution. Chi square statistic was used to compare frequency of responses. Results: There were several differences in the practice of RSI: 1. Aspiration prophylaxis was preferred in UW-US (40%) versus UN-UK (12%); 2. Preferred patient position was with a head support in UW-US versus 30 head of the bed elevation in UN-UK; 3. UWUS reported not to use mask ventilation prior to intubation (55%) versus UN-UK (78%); 4. The preferred opioid was fentanyl (93%) for UW-US and alfentanil (74%) for UN-UK; 5. Adjuvant drugs were used by 68% of UW-US versus 8% of UN-UK providers; 6. Commonly used induction agents were propofol in UW-US (94%) and thiopental in UN-UK (51%). Both centers preferred succinylcholine for muscle relaxation to rocuronium (UW-US 80% versus UN-UK 90%). Conclusions: RSI practice differed significantly across continents. Due to disagreement and a lack of scientific evidence regarding the standards of RSI, it appears that traditional RSI practice has already been abolished. Revised evidence based guidance statement is due and has the potential to reduce practice variability.
{"title":"Rapid Sequence Induction Practices In The United States And The United Kingdom: A Comparative Survey Study.","authors":"A. Dagal, A. Joffe, M. Treggiari, S. Sharar, J. Tansley, I. Moppett, B. Baxendale","doi":"10.5580/2a5c","DOIUrl":"https://doi.org/10.5580/2a5c","url":null,"abstract":"Purpose: We aimed to survey the members of anesthesia departments in two large university hospitals, University of Washington (Seattle, USA) (UW-US) and University of Nottingham (Nottingham, UK) (UN-UK) to compare differences in their current approach to rapid sequence induction (RSI). Methods: The survey was distributed in electronic and paper format in 2009. Overall response rate was 48.6% (146/300). Participants were asked to indicate their practice for a RSI technique for emergency appendectomy in a previously healthy adult. Data were summarized descriptively using frequency distribution. Chi square statistic was used to compare frequency of responses. Results: There were several differences in the practice of RSI: 1. Aspiration prophylaxis was preferred in UW-US (40%) versus UN-UK (12%); 2. Preferred patient position was with a head support in UW-US versus 30 head of the bed elevation in UN-UK; 3. UWUS reported not to use mask ventilation prior to intubation (55%) versus UN-UK (78%); 4. The preferred opioid was fentanyl (93%) for UW-US and alfentanil (74%) for UN-UK; 5. Adjuvant drugs were used by 68% of UW-US versus 8% of UN-UK providers; 6. Commonly used induction agents were propofol in UW-US (94%) and thiopental in UN-UK (51%). Both centers preferred succinylcholine for muscle relaxation to rocuronium (UW-US 80% versus UN-UK 90%). Conclusions: RSI practice differed significantly across continents. Due to disagreement and a lack of scientific evidence regarding the standards of RSI, it appears that traditional RSI practice has already been abolished. Revised evidence based guidance statement is due and has the potential to reduce practice variability.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129615708","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}
Objective: The aim of this study was to determine the accuracy of Fine needle aspiration cytology in detection of thyroid swellings in our ENT unit and to assess the correlation between preoperative cytodiagnosis and postoperative histopathological diagnosis.Study design: Cross sectional studyPlace & Duration of study: Department of ENT- Head & Neck Surgery, Charak hospital, Pokhara, Nepal, from January 2010 to December 2010.Method: Fifty patients with enlarged thyroid gland, of both sexes were selected. All patients had preoperative fine needle aspiration (FNAC), performed by pathologist at histopathology department and postoperative specimens were also examined after which histopathological diagnosis were made. All FNAC reports were correlated with histopathology diagnosis.Results:Out of 50 patients 46 were female and 4 male. FNAC was accurate in 94% patients. Over all sensitivity was 91.66% and specificity of 97.29%.Conclusions:FNAC is reliable, safe and accurate method as a first line of evaluation in thyroid gland nodulesbefore surgery. FNAC is more specific than sensitive in detecting thyroid gland malignancy andtherefore histopathological analysis still remains essential for the final diagnosis.
{"title":"Comparative Study Of FNAC And HistopathologyIn The Diagnosis Of Thyroid Swelling","authors":"R. Nepali, Banita, G. Thakur","doi":"10.5580/2a78","DOIUrl":"https://doi.org/10.5580/2a78","url":null,"abstract":"Objective: The aim of this study was to determine the accuracy of Fine needle aspiration cytology in detection of thyroid swellings in our ENT unit and to assess the correlation between preoperative cytodiagnosis and postoperative histopathological diagnosis.Study design: Cross sectional studyPlace & Duration of study: Department of ENT- Head & Neck Surgery, Charak hospital, Pokhara, Nepal, from January 2010 to December 2010.Method: Fifty patients with enlarged thyroid gland, of both sexes were selected. All patients had preoperative fine needle aspiration (FNAC), performed by pathologist at histopathology department and postoperative specimens were also examined after which histopathological diagnosis were made. All FNAC reports were correlated with histopathology diagnosis.Results:Out of 50 patients 46 were female and 4 male. FNAC was accurate in 94% patients. Over all sensitivity was 91.66% and specificity of 97.29%.Conclusions:FNAC is reliable, safe and accurate method as a first line of evaluation in thyroid gland nodulesbefore surgery. FNAC is more specific than sensitive in detecting thyroid gland malignancy andtherefore histopathological analysis still remains essential for the final diagnosis.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133133201","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 Plasma cholinesterase (butrylcholinesterase) is an enzyme of importance in the practise of anaesthesia due to its role in the metabolism of suxamethonium, and other anaesthetic related drugs. Deficiency of plasma cholinesterase has been associated with prolonged duration of suxamethonium apnoea. The study aimed to investigate the effect of varied levels of plasma cholinesterase on the duration of suxamethonium apnoea in anaesthetised patients and compare the effects in adults and children. Methods – One hundred healthy patients with the American Society of Anesthesiologists (ASA) physical status I and II scheduled for elective surgery under general anaesthesia requiring endotracheal intubation were studied. Pre-induction serum cholinesterase levels were estimated. Suxamethonium 2mg/kg was administered after induction of anaesthesia. After the administration of thiopentone, a Fisher and Paykel peripheral nerve stimulator (PNS) Model NS272 was applied to the ulnar nerve to determine onset and the duration of neuromuscular blockade. Results – Sixty-four adults and 36 children were studied. The mean cholinesterase level was 6573.29 ±2128.29 (ranged from 1227-14536) IU/L. The cholinesterase activity was similar in both children (7044.86 ±2448.81) IU/L and adults (6308.03 ±1894.19) IU/L p = 0.97. The mean onset time of suxamethonium was 37.83 ±9.49 seconds. This onset was similar in children and adults (p = 0.374). There was poor correlation between cholinesterase level and onset time (r = 0.031, p = 0.760). The mean clinical apnoea time was 5.88 ±2.00 minutes. Significant difference existed between adults (6.25 ±1.85 minutes) and children (5.22 ±2.06 minutes) p = 0.012. The mean PNS apnoea time was 8.17 ±3.14 minutes which was significantly shorter in children (6.73 ±3.59 minutes) than in adults (8.97 ±2.52 minutes) p<0.001. There was moderate inverse and significant correlation between cholinesterase level and PNS apnoea time (r = -0.423, p< 0.001), as well as clinical apnoea time (r = -0.461, p<0.001). There was a highly positive and significant correlation between clinical and PNS apnoea time (r = 0.876, p<0.001). The mean recovery time was 7.44 ±2.49 minutes which was significantly shorter in children (6.73 ±2.92 minutes) than in adults (7.86 ±2.13 minutes) p = 0.028. There was a moderate inverse and significant correlation between cholinesterase level and recovery time (r = -0.456, p<0.001). Conclusion – The duration of suxamethonium apnoea increased with low levels of plasma cholinesterase. Children exhibited significantly shorter apnoea and recovery times compared to adults.
{"title":"Comparison Of Plasma Cholinesterase Levels And The Duration Of Suxamethonium Apnoea In Nigerian Adult And Paediatric Patients","authors":"Adekola Oo, I. Desalu, Kushimo Ot","doi":"10.5580/2a5b","DOIUrl":"https://doi.org/10.5580/2a5b","url":null,"abstract":"Background Plasma cholinesterase (butrylcholinesterase) is an enzyme of importance in the practise of anaesthesia due to its role in the metabolism of suxamethonium, and other anaesthetic related drugs. Deficiency of plasma cholinesterase has been associated with prolonged duration of suxamethonium apnoea. The study aimed to investigate the effect of varied levels of plasma cholinesterase on the duration of suxamethonium apnoea in anaesthetised patients and compare the effects in adults and children. Methods – One hundred healthy patients with the American Society of Anesthesiologists (ASA) physical status I and II scheduled for elective surgery under general anaesthesia requiring endotracheal intubation were studied. Pre-induction serum cholinesterase levels were estimated. Suxamethonium 2mg/kg was administered after induction of anaesthesia. After the administration of thiopentone, a Fisher and Paykel peripheral nerve stimulator (PNS) Model NS272 was applied to the ulnar nerve to determine onset and the duration of neuromuscular blockade. Results – Sixty-four adults and 36 children were studied. The mean cholinesterase level was 6573.29 ±2128.29 (ranged from 1227-14536) IU/L. The cholinesterase activity was similar in both children (7044.86 ±2448.81) IU/L and adults (6308.03 ±1894.19) IU/L p = 0.97. The mean onset time of suxamethonium was 37.83 ±9.49 seconds. This onset was similar in children and adults (p = 0.374). There was poor correlation between cholinesterase level and onset time (r = 0.031, p = 0.760). The mean clinical apnoea time was 5.88 ±2.00 minutes. Significant difference existed between adults (6.25 ±1.85 minutes) and children (5.22 ±2.06 minutes) p = 0.012. The mean PNS apnoea time was 8.17 ±3.14 minutes which was significantly shorter in children (6.73 ±3.59 minutes) than in adults (8.97 ±2.52 minutes) p<0.001. There was moderate inverse and significant correlation between cholinesterase level and PNS apnoea time (r = -0.423, p< 0.001), as well as clinical apnoea time (r = -0.461, p<0.001). There was a highly positive and significant correlation between clinical and PNS apnoea time (r = 0.876, p<0.001). The mean recovery time was 7.44 ±2.49 minutes which was significantly shorter in children (6.73 ±2.92 minutes) than in adults (7.86 ±2.13 minutes) p = 0.028. There was a moderate inverse and significant correlation between cholinesterase level and recovery time (r = -0.456, p<0.001). Conclusion – The duration of suxamethonium apnoea increased with low levels of plasma cholinesterase. Children exhibited significantly shorter apnoea and recovery times compared to adults.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129620804","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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