Oya Ünsal, H. Türk, M. Açık, P. Sayın, N. Ediz, S. Oba
Colonoscopy-induced neurological complications are very rare, but they have high mortality and morbidity rates. Subarachnoid hemorrhage, which was the complication of colonoscopy, was reported in 1 case in literature and ended with death. We report this survived case to discuss this rare complication and emphasize the management of subarachnoid hemorrhage.
{"title":"A Rare Complication Of Colonoscopy: Subarachnoid Hemorrhage","authors":"Oya Ünsal, H. Türk, M. Açık, P. Sayın, N. Ediz, S. Oba","doi":"10.5580/2afd","DOIUrl":"https://doi.org/10.5580/2afd","url":null,"abstract":"Colonoscopy-induced neurological complications are very rare, but they have high mortality and morbidity rates. Subarachnoid hemorrhage, which was the complication of colonoscopy, was reported in 1 case in literature and ended with death. We report this survived case to discuss this rare complication and emphasize the management of subarachnoid hemorrhage.","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":"133223207","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, Tamara T Semei, Srikrishna B Nanduri, Rajashekar R. Mudaraddi
It is not uncommon to face difficulty or even failure in passing a nasogastric tube when in need. Many times we receive patients in the intensive care unit in whom an orogastric tube was placed intra operatively or in emergency department for management where nasogatric tube placement was difficult or not possible. Nasogastric tubes may be more desirable for management of the same patient after extubation of endotracheal tube.
{"title":"Technique To Convert An Orogastric Tube To A Nasogastric Tube","authors":"S. Kinthala, Tamara T Semei, Srikrishna B Nanduri, Rajashekar R. Mudaraddi","doi":"10.5580/2b46","DOIUrl":"https://doi.org/10.5580/2b46","url":null,"abstract":"It is not uncommon to face difficulty or even failure in passing a nasogastric tube when in need. Many times we receive patients in the intensive care unit in whom an orogastric tube was placed intra operatively or in emergency department for management where nasogatric tube placement was difficult or not possible. Nasogastric tubes may be more desirable for management of the same patient after extubation of endotracheal tube.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"60 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":"123882696","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}
Carcinoid syndrome is a rare systemic disorder attributed to the release of vasoactive amines and peptides into the systemic circulation. We present the case of a sick 47 year old lady with known metastatic carcinoid deposits who required urgent laparotomy for an intra-abdominal perforation. We explore the issues surrounding anaesthesia for this uncommon condition in the emergency setting.
{"title":"Emergency Anaesthesia For A Moribund Patient With Carcinoid Syndrome - A Case Report.","authors":"E. Gilbert, J. Price, Masood Ahmad","doi":"10.5580/2a59","DOIUrl":"https://doi.org/10.5580/2a59","url":null,"abstract":"Carcinoid syndrome is a rare systemic disorder attributed to the release of vasoactive amines and peptides into the systemic circulation. We present the case of a sick 47 year old lady with known metastatic carcinoid deposits who required urgent laparotomy for an intra-abdominal perforation. We explore the issues surrounding anaesthesia for this uncommon condition in the emergency setting.","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":"130311096","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}
BackgroundThis randomised, placebo-controlled, double-blind study designed to assess the efficacy of intravenous magnesium sulphate to reduce postoperative pain in upper limb orthopaedic surgery (duration of surgery≤120minutes) under general anaesthesia using thiopentone, fentanyl, vecuronium,N2O/O2 and isoflurane.MethodAfter obtaining written informed consent from 100 ASA I-II patients, they were divided randomly into two groups of 50 each. Group M received magnesium sulphate 30 mg/kg as a bolus before induction and 10 mg/kg/hour by infusion. Group S patients received same volume of normal saline. All the vital parameters were recorded at the time of start of administering drugs and at 10 minutes interval till the end of study. All patients received injection meperidine 0.5-1mg/kg intramuscular (IM) and diclofenac 75 mg IM as soon as they complained of pain or when the visual analogue scale (VAS) became >3cm. Pain by using VAS, during first hour and 3, 6, 12, 18 and 24 hours after surgery was noted. The timing and dosage of rescue analgesic during first 24hrs after operation was noted.ResultPain in the postoperative period was significantly lower in group M compared to in group S during first hour and 3,6,12 and 18 hrs postoperatively. Patients in group M were more sedated as compared to group S [sedation score 1.32 vs. 1.88 (p=0.000)]. Rescue analgesia requirement postoperatively was significantly lower in patients of group M than group S.ConclusionIntravenous Magnesium sulphate decreases postoperative pain and cumulative analgesic requirement without any clinically significant adverse reaction.
{"title":"Evaluation Of Intravenous Magnesium Sulphate For Postoperative Analgesia In Upper Limb Orthopaedic Surgery Under General Anaesthesia: A Comparative Study","authors":"S. Kaur, Naresh Baghla","doi":"10.5580/2ac9","DOIUrl":"https://doi.org/10.5580/2ac9","url":null,"abstract":"BackgroundThis randomised, placebo-controlled, double-blind study designed to assess the efficacy of intravenous magnesium sulphate to reduce postoperative pain in upper limb orthopaedic surgery (duration of surgery≤120minutes) under general anaesthesia using thiopentone, fentanyl, vecuronium,N2O/O2 and isoflurane.MethodAfter obtaining written informed consent from 100 ASA I-II patients, they were divided randomly into two groups of 50 each. Group M received magnesium sulphate 30 mg/kg as a bolus before induction and 10 mg/kg/hour by infusion. Group S patients received same volume of normal saline. All the vital parameters were recorded at the time of start of administering drugs and at 10 minutes interval till the end of study. All patients received injection meperidine 0.5-1mg/kg intramuscular (IM) and diclofenac 75 mg IM as soon as they complained of pain or when the visual analogue scale (VAS) became >3cm. Pain by using VAS, during first hour and 3, 6, 12, 18 and 24 hours after surgery was noted. The timing and dosage of rescue analgesic during first 24hrs after operation was noted.ResultPain in the postoperative period was significantly lower in group M compared to in group S during first hour and 3,6,12 and 18 hrs postoperatively. Patients in group M were more sedated as compared to group S [sedation score 1.32 vs. 1.88 (p=0.000)]. Rescue analgesia requirement postoperatively was significantly lower in patients of group M than group S.ConclusionIntravenous Magnesium sulphate decreases postoperative pain and cumulative analgesic requirement without any clinically significant adverse reaction.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"66 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":"121103252","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}
M. Roberts, M. Mani, A. Wilkes, E. Flavell, N. Goodwin
Study Objective: To compare performance of the LMA Supreme and LMA ProSeal in unparalysed adult patients.Design: A randomised crossover study, using a non-inferiority study design aiming to demonstrate that first time insertion success rate with the LMA Supreme is no more than 15% lower than with the LMA ProSeal.Setting: Operating theatre.Patients: 50 ASA 1 or 2 adult patients undergoing general anaesthesia for elective surgery, without neuromuscular blocking agents. Interventions: After a standardised induction of anaesthesia and adequate jaw relaxation, the initial airway was inserted, in a randomized order. Adequate placement was confirmed by a square wave form on the capnograph. A maximum of two attempts was allowed. Measurements were taken before the device was removed and replaced by the second and the measurements repeated. Measurements: Number of insertion attempts with each device was recorded. Insertion time (from picking up the device until one complete capnograph square wave seen), oropharyngeal leak pressure, fibreoptic laryngeal view and ease of insertion and removal were recorded. Blood pressure, heart rate and oxygen saturations were recorded before and after insertion of each device.Main Results: First time insertion success rates were 88% (44/50) and 94% (47/50) (95% CI -19 to 7%) for the LMA Supreme and LMA ProSeal respectively. The lower limit of the 95% CI (-19%) lies outside the -15% limit of non-inferiority. Overall success was 96% (48/50) and 98% (49/50), (95% CI -12% to 7%), mean leak pressures were 22cmH2O and 26cmH2O (p=0.005) and insertion times were 23 and 26 seconds (p=0.198) for the LMA Supreme and LMA ProSeal respectively. There was no significant difference in the fibreoptic view obtained (p=0.086).Conclusions: We failed to demonstrate that the LMA Supreme is non-inferior to the LMA ProSeal in terms of its first time insertion success rate in unparalysed patients, and must conclude our results to be equivocal. This work was supported by Intavent Orthofix Ltd who donated all Laryngeal Mask Airways, free of charge.
{"title":"A Randomised Crossover Study Comparing The Disposable Laryngeal Mask Airway Supreme With The Laryngeal Mask Airway Proseal In Unparalysed Anaesthetised Patients","authors":"M. Roberts, M. Mani, A. Wilkes, E. Flavell, N. Goodwin","doi":"10.5580/2b13","DOIUrl":"https://doi.org/10.5580/2b13","url":null,"abstract":"Study Objective: To compare performance of the LMA Supreme and LMA ProSeal in unparalysed adult patients.Design: A randomised crossover study, using a non-inferiority study design aiming to demonstrate that first time insertion success rate with the LMA Supreme is no more than 15% lower than with the LMA ProSeal.Setting: Operating theatre.Patients: 50 ASA 1 or 2 adult patients undergoing general anaesthesia for elective surgery, without neuromuscular blocking agents. Interventions: After a standardised induction of anaesthesia and adequate jaw relaxation, the initial airway was inserted, in a randomized order. Adequate placement was confirmed by a square wave form on the capnograph. A maximum of two attempts was allowed. Measurements were taken before the device was removed and replaced by the second and the measurements repeated. Measurements: Number of insertion attempts with each device was recorded. Insertion time (from picking up the device until one complete capnograph square wave seen), oropharyngeal leak pressure, fibreoptic laryngeal view and ease of insertion and removal were recorded. Blood pressure, heart rate and oxygen saturations were recorded before and after insertion of each device.Main Results: First time insertion success rates were 88% (44/50) and 94% (47/50) (95% CI -19 to 7%) for the LMA Supreme and LMA ProSeal respectively. The lower limit of the 95% CI (-19%) lies outside the -15% limit of non-inferiority. Overall success was 96% (48/50) and 98% (49/50), (95% CI -12% to 7%), mean leak pressures were 22cmH2O and 26cmH2O (p=0.005) and insertion times were 23 and 26 seconds (p=0.198) for the LMA Supreme and LMA ProSeal respectively. There was no significant difference in the fibreoptic view obtained (p=0.086).Conclusions: We failed to demonstrate that the LMA Supreme is non-inferior to the LMA ProSeal in terms of its first time insertion success rate in unparalysed patients, and must conclude our results to be equivocal. This work was supported by Intavent Orthofix Ltd who donated all Laryngeal Mask Airways, free of charge.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"61 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":"125884621","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}
G. Aydın, Asiye Süslü, O. Özlü, M. Aksoy, R. Polat
Background: The distrubition of spinal anesthesia is affected by many factors such as the density and viscosity and temperature of the local anesthetics. We aimed to compare the effects of 37 oC plain %0.5 levobupivacaine versus 24oC levobupivacaine in regards of intraoperative anesthetic and postoperative analgesic conditions for patients undergoing arthroscopic menisectomy. Methods: In this randomized, blind, prospective trial a total of fifty three patients aged 17-70 years (ASA I-II) scheduled to have elective ambulatory arthroscopic menisectomy of the knee were randomly allocated into two groups. All patients received intrathecal 3 mL of plain % 0.5 levobupivacaine. Group 1 received the solution that had been previously equilibrated to 37 oC and group 2 received at room temperature(24oC) . Sensory blockade was assessed by loss of pinprick sensation and motor block was assessed using a modified Bromage scale. Readiness of surgery was defined as presence of adequate motor blockade (Bromage ≥ 2) and loss of pinprick sensation at L1 at the operative side. Visual analog scale was used to define patients degree of pain.Results: The mean time required to achive readiness to surgery was 5.07±0.39 minutes in Group 1 and 10.37±1.13 minutes in Group 2 (p 0.05).Conclusions: We showed an increase in initial cephaled migration of block for the first 10 minutes by warming levobupivacaine % 0.5 from room temperature(24oC) to 37oC.
背景:脊髓麻醉的分布受局麻药的密度、粘度和温度等多种因素的影响。我们的目的是比较37℃普通%0.5左布比卡因与24℃左布比卡因对关节镜半月板切除术患者术中麻醉和术后镇痛的影响。方法:在这项随机、盲、前瞻性试验中，共有53名17-70岁(ASA I-II)的患者计划进行选择性关节镜下膝关节半月板切除术，随机分为两组。所有患者鞘内均给予3ml普通% 0.5左布比卡因。第一组接受之前平衡到37℃的溶液，第二组接受室温(24℃)的溶液。通过针刺感觉的丧失来评估感觉阻滞，使用改良的Bromage量表来评估运动阻滞。手术准备的定义是存在足够的运动阻断(Bromage≥2)和手术侧L1处针刺感觉的丧失。采用视觉模拟量表评定患者疼痛程度。结果:1组平均手术准备时间为5.07±0.39 min, 2组平均手术准备时间为10.37±1.13 min (p < 0.05)。结论:我们发现左旋布比卡因% 0.5从室温(24℃)加热到37℃，头10分钟内阻滞的初始头部迁移增加。
{"title":"The Influence Of Temperature On Spread Of Intrathecal Levobupıvacaıne","authors":"G. Aydın, Asiye Süslü, O. Özlü, M. Aksoy, R. Polat","doi":"10.5580/f22","DOIUrl":"https://doi.org/10.5580/f22","url":null,"abstract":"Background: The distrubition of spinal anesthesia is affected by many factors such as the density and viscosity and temperature of the local anesthetics. We aimed to compare the effects of 37 oC plain %0.5 levobupivacaine versus 24oC levobupivacaine in regards of intraoperative anesthetic and postoperative analgesic conditions for patients undergoing arthroscopic menisectomy. Methods: In this randomized, blind, prospective trial a total of fifty three patients aged 17-70 years (ASA I-II) scheduled to have elective ambulatory arthroscopic menisectomy of the knee were randomly allocated into two groups. All patients received intrathecal 3 mL of plain % 0.5 levobupivacaine. Group 1 received the solution that had been previously equilibrated to 37 oC and group 2 received at room temperature(24oC) . Sensory blockade was assessed by loss of pinprick sensation and motor block was assessed using a modified Bromage scale. Readiness of surgery was defined as presence of adequate motor blockade (Bromage ≥ 2) and loss of pinprick sensation at L1 at the operative side. Visual analog scale was used to define patients degree of pain.Results: The mean time required to achive readiness to surgery was 5.07±0.39 minutes in Group 1 and 10.37±1.13 minutes in Group 2 (p 0.05).Conclusions: We showed an increase in initial cephaled migration of block for the first 10 minutes by warming levobupivacaine % 0.5 from room temperature(24oC) to 37oC.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124822607","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}
M. Metin, D. Ornek, Gülay Erdo an, G. Erk, Oya K lc, Ahu Y lmaz, Seyhan Metin, Bayazit Dikmen, Nermin Gö üs
Aim: Investigation of working conditions and control, job satisfaction, burnout, and depression levels among anesthesiologyreanimation and internal medicine physicians.Material and Method: Resident and specialist physicians working in AR and IM branches in hospitals located at the central district of Ankara province, were included in the study. Maslach Burnout Inventory which analyzes emotional exhaustion, desensitization, and personal accomplishment; Minnesota Satisfaction Questionnaire which measures job satisfaction; Beck Depression Inventory which evaluates the level of depressive signs; adapted survey form of ‘Working Conditions and Control Questionnaire’ which examines the job conditions and control over those conditions; and the socio-demographic data collection form which assesses the individual characteristics, were delivered to the physicians along with the informed consent form. 412 forms received back from those physicians, were statistically evaluated with independent samples T, one-way variance analysis, Pearson chi-square, Yates chi-square, and Fischer exact tests. Results: In review of burnout in all the physicians, reduction in desensitization was found to occur with aging (p=0.001). Among residents, emotional exhaustion, desensitization and Beck Depression Inventory scores were high (p=0,020, p<0,001, p=0,013), whereas working conditions and control were low. In AR physicians, control was high, while desensitization was lower (p=0.006). Conclusion: We believe, working and personal conditions of physicians should be evaluated at certain intervals and amended when required to.
{"title":"Workıng Condıtıons And Control, Job Satısfactıon, Burnout, Depressıon Levels Among Anesthesıology-Reanımatıon And Internal Medıcıne Physıcıans","authors":"M. Metin, D. Ornek, Gülay Erdo an, G. Erk, Oya K lc, Ahu Y lmaz, Seyhan Metin, Bayazit Dikmen, Nermin Gö üs","doi":"10.5580/1e0d","DOIUrl":"https://doi.org/10.5580/1e0d","url":null,"abstract":"Aim: Investigation of working conditions and control, job satisfaction, burnout, and depression levels among anesthesiologyreanimation and internal medicine physicians.Material and Method: Resident and specialist physicians working in AR and IM branches in hospitals located at the central district of Ankara province, were included in the study. Maslach Burnout Inventory which analyzes emotional exhaustion, desensitization, and personal accomplishment; Minnesota Satisfaction Questionnaire which measures job satisfaction; Beck Depression Inventory which evaluates the level of depressive signs; adapted survey form of ‘Working Conditions and Control Questionnaire’ which examines the job conditions and control over those conditions; and the socio-demographic data collection form which assesses the individual characteristics, were delivered to the physicians along with the informed consent form. 412 forms received back from those physicians, were statistically evaluated with independent samples T, one-way variance analysis, Pearson chi-square, Yates chi-square, and Fischer exact tests. Results: In review of burnout in all the physicians, reduction in desensitization was found to occur with aging (p=0.001). Among residents, emotional exhaustion, desensitization and Beck Depression Inventory scores were high (p=0,020, p<0,001, p=0,013), whereas working conditions and control were low. In AR physicians, control was high, while desensitization was lower (p=0.006). Conclusion: We believe, working and personal conditions of physicians should be evaluated at certain intervals and amended when required to.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124940916","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}
Abstract: Purpose: This review evaluates the efficacy of furbiprofen axetil for preventing pain on injection of propofol. Methods: The following databases were searched including Medline (1966-2009), EMBASE (1990-2009), CINAHL, The Cochrane Central Register of Controlled Trials, and Scopus for randomized controlled trials assessing flurbiprofen axetil intervention for propofol induced injection pain. Trials were included where adults were randomized to receive flurbiprofen axetil or control including placebo, no treatment, or other pharmacologic intervention. Data were abstracted on the incidence and severity of pain at the propofol injection site. Adverse effects related to flurbiprofen axetil were also extracted. Combined data were analyzed using a random effects model. Results: Ten clinical trials were included. The incidence of patients without pain was significantly higher in flurbiprofen axetil group compared with no treatment control or placebo control (Risk Ratio [RR]: 3.46, 95% CI: 2.18, 5.49) with number needed to treat (NNT) of 2.6. The NNT for the incidence of patients without pain was 2.5, 2.1 and 5.0 in flurbiprofen axetil 50 mg pretreatment without venous occlusion, flurbirofen axetil 50 mg preceded by venous occlusion, and flubiprofen axetil 25mg preceded by venous occlusion group, respectively. The incidence of moderate or severe pain was also significantly lower in patients receiving flubiprofen axetil intervention compared with no treatment control (RR: 0.41, 95% CI: 0.31, 0.56).Conclusion: Flurbiprofen axetil reduces the incidence and severity of propofol induced injection pain. Purpose: This review evaluates the efficacy of furbiprofen axetil for preventing pain on injection of propofol. Methods: The following databases were searched including Medline (1966-2009), EMBASE (1990-2009), CINAHL, The Cochrane Central Register of Controlled Trials, and Scopus for randomized controlled trials assessing flurbiprofen axetil intervention for propofol induced injection pain. Trials were included where adults were randomized to receive flurbiprofen axetil or control including placebo, no treatment, or other pharmacologic intervention. Data were abstracted on the incidence and severity of pain at the propofol injection site. Adverse effects related to flurbiprofen axetil were also extracted. Combined data were analyzed using a random effects model. Results: Ten clinical trials were included. The incidence of patients without pain was significantly higher in flurbiprofen axetil group compared with no treatment control or placebo control (Risk Ratio [RR]: 3.46, 95% CI: 2.18, 5.49) with number needed to treat (NNT) of 2.6. The NNT for the incidence of patients without pain was 2.5, 2.1 and 5.0 in flurbiprofen axetil 50 mg pretreatment without venous occlusion, flurbirofen axetil 50 mg preceded by venous occlusion, and flubiprofen axetil 25mg preceded by venous occlusion group, respectively. The incidence of moderate or severe pain was also s
{"title":"Flurbiprofen Axetil For Prevention Of Propofol Injection Pain In Adult --- A Systematic Review","authors":"Yanxia Sun, Tianzuo Li, Fang Chai, T. Gan","doi":"10.5580/27b3","DOIUrl":"https://doi.org/10.5580/27b3","url":null,"abstract":"Abstract: Purpose: This review evaluates the efficacy of furbiprofen axetil for preventing pain on injection of propofol. Methods: The following databases were searched including Medline (1966-2009), EMBASE (1990-2009), CINAHL, The Cochrane Central Register of Controlled Trials, and Scopus for randomized controlled trials assessing flurbiprofen axetil intervention for propofol induced injection pain. Trials were included where adults were randomized to receive flurbiprofen axetil or control including placebo, no treatment, or other pharmacologic intervention. Data were abstracted on the incidence and severity of pain at the propofol injection site. Adverse effects related to flurbiprofen axetil were also extracted. Combined data were analyzed using a random effects model. Results: Ten clinical trials were included. The incidence of patients without pain was significantly higher in flurbiprofen axetil group compared with no treatment control or placebo control (Risk Ratio [RR]: 3.46, 95% CI: 2.18, 5.49) with number needed to treat (NNT) of 2.6. The NNT for the incidence of patients without pain was 2.5, 2.1 and 5.0 in flurbiprofen axetil 50 mg pretreatment without venous occlusion, flurbirofen axetil 50 mg preceded by venous occlusion, and flubiprofen axetil 25mg preceded by venous occlusion group, respectively. The incidence of moderate or severe pain was also significantly lower in patients receiving flubiprofen axetil intervention compared with no treatment control (RR: 0.41, 95% CI: 0.31, 0.56).Conclusion: Flurbiprofen axetil reduces the incidence and severity of propofol induced injection pain. Purpose: This review evaluates the efficacy of furbiprofen axetil for preventing pain on injection of propofol. Methods: The following databases were searched including Medline (1966-2009), EMBASE (1990-2009), CINAHL, The Cochrane Central Register of Controlled Trials, and Scopus for randomized controlled trials assessing flurbiprofen axetil intervention for propofol induced injection pain. Trials were included where adults were randomized to receive flurbiprofen axetil or control including placebo, no treatment, or other pharmacologic intervention. Data were abstracted on the incidence and severity of pain at the propofol injection site. Adverse effects related to flurbiprofen axetil were also extracted. Combined data were analyzed using a random effects model. Results: Ten clinical trials were included. The incidence of patients without pain was significantly higher in flurbiprofen axetil group compared with no treatment control or placebo control (Risk Ratio [RR]: 3.46, 95% CI: 2.18, 5.49) with number needed to treat (NNT) of 2.6. The NNT for the incidence of patients without pain was 2.5, 2.1 and 5.0 in flurbiprofen axetil 50 mg pretreatment without venous occlusion, flurbirofen axetil 50 mg preceded by venous occlusion, and flubiprofen axetil 25mg preceded by venous occlusion group, respectively. The incidence of moderate or severe pain was also s","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126187462","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}
R. Gorji, Robert Nastasi, S. Stuart, Richard A. Tallarico, Fenghua Li
Achondroplastic Dwarfism (AD) is a type of osteochondrodysplasia identifiable at birth caused by defects in the growth of tubular bone and/or spine. Anesthetic challenges include abnormalities of the airway, cervical spine, pulmonary, cardiac and neurologic systems. We describe the anesthetic management of an achondroplastic dwarf presenting for T6 thru S1 decompression laminectomies, instrumentation and spinal reconstruction with neurologic monitoring. The patient was a 50-year old, 66 kg, 127 cm tall male with spinal stenosis who suffered from severe back pain and thoraco-lumbar myelopathy. Past medical/surgical history included hypertension, thoracolumbar laminectomy, and shoulder arthroscopies. Airway exam showed macroglossia, short mandible with prognathism, large head, short neck & mallampati class III airway. Pulmonary and cardiac evaluations were unremarkable. Neurological exam revealed severe thoracolumbar kyphosis with lumbar lordosis. Standard ASA and bispectral monitors were applied. Spinal cord and lumbosacral roots were monitored via somatosensory evoked potentials (SSEP), electromyogram (EMG) and transcranial evoked potentials (tcMEP). Only upper extremity SSEPs responses were reliable. TcMEPs and SSEPs showed unreliable lower extremity responses. Continuous electromyogram yielded mixed results. Achondroplastic dwarfism poses significant anesthesia challenges. Airway challenges include sleep apnea resulting from brainstem compression and problems with mask ventilation and laryngoscopy, which we did not experience. Intravenous access can be difficult in AD and in our patient necessitated placement of central line. Through the careful titration of anesthetic infusions, we were able to extubate the patient at the conclusion of surgery to perform a neurologic examination. Intra-operative SSEP, EMG and tcMEP monitoring assisted us in avoiding spinal cord ischemia without resorting to a wake up test. Blood loss was minimized with meticulous surgical technique as well as the use of epsilon-aminocaproic acid which has been shown to reduce transfusion requirements in patients undergoing complex spine procedures. We conclude that with adequate anesthetic management, complex spine procedures can be performed on AD patient in a safe manner.
{"title":"Anesthesia And Neuromonitoring For Correction Of Thoracolumbar Deformity In An Achondroplastic Dwarf","authors":"R. Gorji, Robert Nastasi, S. Stuart, Richard A. Tallarico, Fenghua Li","doi":"10.5580/1346","DOIUrl":"https://doi.org/10.5580/1346","url":null,"abstract":"Achondroplastic Dwarfism (AD) is a type of osteochondrodysplasia identifiable at birth caused by defects in the growth of tubular bone and/or spine. Anesthetic challenges include abnormalities of the airway, cervical spine, pulmonary, cardiac and neurologic systems. We describe the anesthetic management of an achondroplastic dwarf presenting for T6 thru S1 decompression laminectomies, instrumentation and spinal reconstruction with neurologic monitoring. The patient was a 50-year old, 66 kg, 127 cm tall male with spinal stenosis who suffered from severe back pain and thoraco-lumbar myelopathy. Past medical/surgical history included hypertension, thoracolumbar laminectomy, and shoulder arthroscopies. Airway exam showed macroglossia, short mandible with prognathism, large head, short neck & mallampati class III airway. Pulmonary and cardiac evaluations were unremarkable. Neurological exam revealed severe thoracolumbar kyphosis with lumbar lordosis. Standard ASA and bispectral monitors were applied. Spinal cord and lumbosacral roots were monitored via somatosensory evoked potentials (SSEP), electromyogram (EMG) and transcranial evoked potentials (tcMEP). Only upper extremity SSEPs responses were reliable. TcMEPs and SSEPs showed unreliable lower extremity responses. Continuous electromyogram yielded mixed results. Achondroplastic dwarfism poses significant anesthesia challenges. Airway challenges include sleep apnea resulting from brainstem compression and problems with mask ventilation and laryngoscopy, which we did not experience. Intravenous access can be difficult in AD and in our patient necessitated placement of central line. Through the careful titration of anesthetic infusions, we were able to extubate the patient at the conclusion of surgery to perform a neurologic examination. Intra-operative SSEP, EMG and tcMEP monitoring assisted us in avoiding spinal cord ischemia without resorting to a wake up test. Blood loss was minimized with meticulous surgical technique as well as the use of epsilon-aminocaproic acid which has been shown to reduce transfusion requirements in patients undergoing complex spine procedures. We conclude that with adequate anesthetic management, complex spine procedures can be performed on AD patient in a safe manner.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122518779","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}
Tracheo-innominate fistula (TIF) is a rare complication of tracheostomy placement with mortality rates from 73% to 100%. Focusing on anesthetic management concerns, we report a case of TIF in a patient with cerebral palsy and review the current literature on diagnosis and management of TIF to direct our recommendations.
{"title":"Anesthetic Management of Tracheo-Innominate Fistula in a Patient with Cerebral Palsy: Case Report and Literature Review","authors":"Anna Woodbury, S. Helfman","doi":"10.5580/37e","DOIUrl":"https://doi.org/10.5580/37e","url":null,"abstract":"Tracheo-innominate fistula (TIF) is a rare complication of tracheostomy placement with mortality rates from 73% to 100%. Focusing on anesthetic management concerns, we report a case of TIF in a patient with cerebral palsy and review the current literature on diagnosis and management of TIF to direct our recommendations.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129816660","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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