A case of low pressure headache after an endoscopic third ventriculostomy treated with epidural blood patch is presented in this report.The patient presented with a severe debilitating headache that interfered with his daily activities. He was evaluated with an MRI cine study that showed free flow through the ventriculostomy, and a lumbar puncture with an opening pressure of 6cmH2O.Initial treatments were narcotics, hydration and caffeine without resolution of symptoms. The patient was then seen by anesthesia and an epidural blood patch was thought to be appropriate, due to the pathophysiology of her current debilitating symptom.An uneventful epidural blood patch was done, with immediate resolution of the present symptom.Epidural blood patch may be useful in the treatment of low pressure headaches of etiologies other than secondary to lumbar or thoracic punctures.Implication Statement: Anesthesiologists are sometimes called upon to perform epidural blood patches for patients who have had a dural tear after a procedure along the spinal column. This is a case in which a lumbar epidural blood patch helped a patient who had a hole put in his third ventricle.
{"title":"Epidural Blood Patch for Headaches after Endocopic Third Ventriculostomy.","authors":"K. Wagner, German Barbosa-Hernandez","doi":"10.5580/c2e","DOIUrl":"https://doi.org/10.5580/c2e","url":null,"abstract":"A case of low pressure headache after an endoscopic third ventriculostomy treated with epidural blood patch is presented in this report.The patient presented with a severe debilitating headache that interfered with his daily activities. He was evaluated with an MRI cine study that showed free flow through the ventriculostomy, and a lumbar puncture with an opening pressure of 6cmH2O.Initial treatments were narcotics, hydration and caffeine without resolution of symptoms. The patient was then seen by anesthesia and an epidural blood patch was thought to be appropriate, due to the pathophysiology of her current debilitating symptom.An uneventful epidural blood patch was done, with immediate resolution of the present symptom.Epidural blood patch may be useful in the treatment of low pressure headaches of etiologies other than secondary to lumbar or thoracic punctures.Implication Statement: Anesthesiologists are sometimes called upon to perform epidural blood patches for patients who have had a dural tear after a procedure along the spinal column. This is a case in which a lumbar epidural blood patch helped a patient who had a hole put in his third ventricle.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"80 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":"133580268","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}
Aquib Butt, K. Mohammad, Mohamad Ommid, Mubashir Ahmad, N. Jehan, Shigufta Qazi
: 50 patients each of ASA I –II were randomly allocated to two study groupsone group received gabapentin (1200mg) and other group received placebo 1 hour prior to surgery. Both groups received morphine (0.1mg/kg) as intraoperative analgesic at induction of anaesthesia. After the completion of mastectomy postoperative analgesia was assessed with visual analogue scale (VAS) method (0cmno pain and 10cmworst possible pain). Rescue analgesic was administered to patients whose VAS was above 3 (morphine 0.1mg/kg).Apart from VAS haemodynamic parameters and oxygen saturation were regularly recorded half hourly for first two hours, then hourly for next 4 hours and then 2 hourly till the patient requested for analgesia postoperatively.
:将 50 名 ASA I - II 级患者随机分配到两个研究组，一组在手术前 1 小时服用加巴喷丁（1200 毫克），另一组服用安慰剂。两组患者在麻醉诱导时均接受吗啡（0.1 毫克/千克）作为术中镇痛剂。乳房切除术结束后，采用视觉模拟量表（VAS）法评估术后镇痛效果（0 厘米无痛，10 厘米最痛）。除视觉模拟量表外，还定期记录血流动力学参数和血氧饱和度，头两小时每半小时记录一次，接下来的4小时每小时记录一次，然后每2小时记录一次，直到患者要求术后镇痛为止。
{"title":"A Randomized Double Blind Placebo Controlled Study Of Prophylactic Gabapentin For Prevention Of Postoperative Pain And Morphine Consumption In Patients Undergoing Mastectomy.","authors":"Aquib Butt, K. Mohammad, Mohamad Ommid, Mubashir Ahmad, N. Jehan, Shigufta Qazi","doi":"10.5580/1e5c","DOIUrl":"https://doi.org/10.5580/1e5c","url":null,"abstract":": 50 patients each of ASA I –II were randomly allocated to two study groupsone group received gabapentin (1200mg) and other group received placebo 1 hour prior to surgery. Both groups received morphine (0.1mg/kg) as intraoperative analgesic at induction of anaesthesia. After the completion of mastectomy postoperative analgesia was assessed with visual analogue scale (VAS) method (0cmno pain and 10cmworst possible pain). Rescue analgesic was administered to patients whose VAS was above 3 (morphine 0.1mg/kg).Apart from VAS haemodynamic parameters and oxygen saturation were regularly recorded half hourly for first two hours, then hourly for next 4 hours and then 2 hourly till the patient requested for analgesia postoperatively.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"26 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":"131126926","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}
AIM To evaluate the appropriateness of intubation depth marks on the pediatric tracheal tube as a method of achieving midtracheal tube placement.To review other methods used for correct depth placement of endotracheal tube (ETT). METHODS This is a prospective study carried out at Innova childrens heart hospital Hyderabad India between June 1st to September 30th 2010. One hundred patients with body weight of 10kg and below who had elective cardiac surgeries under general anesthesia were included in the study. Demographic data were obtained from patientscase file. Data concerning type of operation done, ETT (uncuffed polyvinyl chloride tube) size, position, adjustment, type of endotracheal intubation and level of carina were observed. The tube was placed with the recommended centimeter marking aligned with the vocal cords. Radiological examination was carried out in the surgical intensive care unit immediate post operation and after 24hrs with the head in neutral, flexed and extended positions. RESULT The patients were between the ages of 23 days and 4years. They were 58 males and 42 females. The mean body weight of patients was 6.2 ± 2.0kg and height 68.2 ± 10.6cm. The sizes of ETT used were 4.0 (n=37), 4.5 (n=44), and 5.0 (n=9). In 76% of cases the ETT was located at first thoracic vertebra (T1) and in 6% of patients ETT was adjusted to T1. No case of endobronchial intubation or accidental extubation was recorded. CONCLUSION Midtrachea ETT placement was achieved by using intubation depth marks on the pediatric tracheal tube.
{"title":"Appropriate Placement Of Endotracheal Tubes In Pediatric Cardiac Patients","authors":"F. Onyekwulu, T. Prasad, R. Nagarajan","doi":"10.5580/1905","DOIUrl":"https://doi.org/10.5580/1905","url":null,"abstract":"AIM To evaluate the appropriateness of intubation depth marks on the pediatric tracheal tube as a method of achieving midtracheal tube placement.To review other methods used for correct depth placement of endotracheal tube (ETT). METHODS This is a prospective study carried out at Innova childrens heart hospital Hyderabad India between June 1st to September 30th 2010. One hundred patients with body weight of 10kg and below who had elective cardiac surgeries under general anesthesia were included in the study. Demographic data were obtained from patientscase file. Data concerning type of operation done, ETT (uncuffed polyvinyl chloride tube) size, position, adjustment, type of endotracheal intubation and level of carina were observed. The tube was placed with the recommended centimeter marking aligned with the vocal cords. Radiological examination was carried out in the surgical intensive care unit immediate post operation and after 24hrs with the head in neutral, flexed and extended positions. RESULT The patients were between the ages of 23 days and 4years. They were 58 males and 42 females. The mean body weight of patients was 6.2 ± 2.0kg and height 68.2 ± 10.6cm. The sizes of ETT used were 4.0 (n=37), 4.5 (n=44), and 5.0 (n=9). In 76% of cases the ETT was located at first thoracic vertebra (T1) and in 6% of patients ETT was adjusted to T1. No case of endobronchial intubation or accidental extubation was recorded. CONCLUSION Midtrachea ETT placement was achieved by using intubation depth marks on the pediatric tracheal tube.","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":"130790249","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: The influence of gender on post operative complications following anaesthesia has been of interest. The incidence of the various complications among gender may vary due to the differing hormonal and psychological makeup. This was our interest in this study.METHOD: We studied 380 adult patients ASA 1 and ASA 2 undergoing elective inpatient surgery. Post operative complications were assessed from the recovery room until the third day after surgery. Data were analysed using paired student t test. Associations were described using risk ratios and 95% confidence intervals. RESULTS: The results showed that women were more likely to have postoperative nausea and vomiting while being slower to return to baseline health status.CONCLUSION: We conclude that though women have a poorer quality of recovery than men following general anaesthesia.
{"title":"Gender Difference And Quality Of Recovery After General Anaesthesia","authors":"V. Ajuzieogu, A. Amucheazi, Ezike H.A, N. Chinedu","doi":"10.5580/f28","DOIUrl":"https://doi.org/10.5580/f28","url":null,"abstract":"BACKGROUND: The influence of gender on post operative complications following anaesthesia has been of interest. The incidence of the various complications among gender may vary due to the differing hormonal and psychological makeup. This was our interest in this study.METHOD: We studied 380 adult patients ASA 1 and ASA 2 undergoing elective inpatient surgery. Post operative complications were assessed from the recovery room until the third day after surgery. Data were analysed using paired student t test. Associations were described using risk ratios and 95% confidence intervals. RESULTS: The results showed that women were more likely to have postoperative nausea and vomiting while being slower to return to baseline health status.CONCLUSION: We conclude that though women have a poorer quality of recovery than men following general anaesthesia.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"33 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":"123486287","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. Babashahi, A. Ghomeishi, L. Izadi, M. A. Mashari, I. Zaeem, S. Fallahpour, H. Safari, H. Mirzaei
We report a 25-year-old Iranian female who presented with progressive memory disturbance, headache, and personality change associated with loss of visual acuity since 3 months before admission; bilateral optic atrophy was also noted. Magnetic resonance imaging disclosed a large bifrontal lesion accompanied by prominent edema in both frontal lobes. Cerebral angiography demonstrated a rich-vessel tumor that drained through the diploic vein. A bifrontal craniotomy was performed. We encountered massive bleeding from the diploic vein and dura mater immediately after craniotomy. We were also faced with severe brain swelling at the dural incision. The tumor was solid, highly vascularized, and fairly well demarcated. We performed total removal of the tumor as quickly as possible to reduce intracranial hypertension and avoid impending brain herniation. The patient had an uneventful recovery, and no new neurologic deficits were noted at follow-up.
{"title":"A Huge Bifrontal Meningioma Associated With Intraoperative Massive Bleeding","authors":"A. Babashahi, A. Ghomeishi, L. Izadi, M. A. Mashari, I. Zaeem, S. Fallahpour, H. Safari, H. Mirzaei","doi":"10.5580/2399","DOIUrl":"https://doi.org/10.5580/2399","url":null,"abstract":"We report a 25-year-old Iranian female who presented with progressive memory disturbance, headache, and personality change associated with loss of visual acuity since 3 months before admission; bilateral optic atrophy was also noted. Magnetic resonance imaging disclosed a large bifrontal lesion accompanied by prominent edema in both frontal lobes. Cerebral angiography demonstrated a rich-vessel tumor that drained through the diploic vein. A bifrontal craniotomy was performed. We encountered massive bleeding from the diploic vein and dura mater immediately after craniotomy. We were also faced with severe brain swelling at the dural incision. The tumor was solid, highly vascularized, and fairly well demarcated. We performed total removal of the tumor as quickly as possible to reduce intracranial hypertension and avoid impending brain herniation. The patient had an uneventful recovery, and no new neurologic deficits were noted at follow-up.","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":"114978270","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}
Disruptive behaviors among healthcare members are a nationally recognized problem encountered frequently in healthcare institutions. Disruptive behaviors have a negative effect on concentration, communication, collaboration, and workplace relationships. Because of these negative effects, disruptive behaviors have been linked to compromised patient safety, adverse events, and patient mortality. To minimize the occurrence of these events, several strategies or policies have been mandated by some healthcare organizations. However, despite these mandates disruptive behaviors continue to be an escalating national patient safety concern. We aim 1) to describe the most common types of disruptive behaviors-their prevalence, frequency, and distribution in various sectors of healthcare; 2) to recognize the factors that drive disruptive behaviors and their consequences on patient safety; and 3) to illustrate the organizational processes used to address the general issue of disruptive practitioners. We believe that increasing the awareness of disruptive behaviors and understanding the organizational processes that healthcare institutions can have to minimize these behaviors has the potential to reduce the occurrence of disruptive behaviors and improve effective communication among the healthcare team. These efforts may eventually lead to improvements in patient care and safety, as well as improvements in organizational performance.
{"title":"Disruptive Behaviors in Healthcare","authors":"B. Jericho, D. Mayer, T. McDonald","doi":"10.5580/25bf","DOIUrl":"https://doi.org/10.5580/25bf","url":null,"abstract":"Disruptive behaviors among healthcare members are a nationally recognized problem encountered frequently in healthcare institutions. Disruptive behaviors have a negative effect on concentration, communication, collaboration, and workplace relationships. Because of these negative effects, disruptive behaviors have been linked to compromised patient safety, adverse events, and patient mortality. To minimize the occurrence of these events, several strategies or policies have been mandated by some healthcare organizations. However, despite these mandates disruptive behaviors continue to be an escalating national patient safety concern. We aim 1) to describe the most common types of disruptive behaviors-their prevalence, frequency, and distribution in various sectors of healthcare; 2) to recognize the factors that drive disruptive behaviors and their consequences on patient safety; and 3) to illustrate the organizational processes used to address the general issue of disruptive practitioners. We believe that increasing the awareness of disruptive behaviors and understanding the organizational processes that healthcare institutions can have to minimize these behaviors has the potential to reduce the occurrence of disruptive behaviors and improve effective communication among the healthcare team. These efforts may eventually lead to improvements in patient care and safety, as well as improvements in organizational performance.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"11 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":"128454896","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}
Varunee Wirasinghe, S. Grover, D. Ma, M. Vizcaychipi
Acute Spinal Injury (ASI) is relatively rare, presenting most frequently in young male adults. The commonest cause of spinal injury is road traffic accidents, followed by domestic, industrial and sporting injuries. Self-harm and assault count for less than 10% of the cases. A high index of suspicion of spinal injury and timely, safe intervention is important in multiple trauma patients and where the mechanism of injury is suggestive of ASI. The anaesthetist, in encountering these patients at several points in their hospital management, has an important role in optimal care of ASI. The choice of anaesthetic technique and intervention, together with the timing of intervention, must be carefully considered. The aim is to protect the spinal cord from further damage, avoid further disruption in alignment, and facilitate stability of the vertebral column to permit maximal neurological recovery and rehabilitation.
{"title":"Anaesthetic Management Of Patients With Acute Spinal Injury","authors":"Varunee Wirasinghe, S. Grover, D. Ma, M. Vizcaychipi","doi":"10.5580/762","DOIUrl":"https://doi.org/10.5580/762","url":null,"abstract":"Acute Spinal Injury (ASI) is relatively rare, presenting most frequently in young male adults. The commonest cause of spinal injury is road traffic accidents, followed by domestic, industrial and sporting injuries. Self-harm and assault count for less than 10% of the cases. A high index of suspicion of spinal injury and timely, safe intervention is important in multiple trauma patients and where the mechanism of injury is suggestive of ASI. The anaesthetist, in encountering these patients at several points in their hospital management, has an important role in optimal care of ASI. The choice of anaesthetic technique and intervention, together with the timing of intervention, must be carefully considered. The aim is to protect the spinal cord from further damage, avoid further disruption in alignment, and facilitate stability of the vertebral column to permit maximal neurological recovery and rehabilitation.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"1 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":"127338025","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}
In a prospective randomized double blind clinical study, 120 patients of either sex in the age group of 25-65 years with ASA I and II, who were scheduled to undergo elective laparoscopic cholecystectomy were allocated to two groups of 60 patients each with regard to postoperative analgesia. In Group-I (n=60) the patients received Bupivacaine (0.5%) 20ml, instilled in gallbladder bed and the undersurface of diaphragm and infiltration of port wounds. In Group-II (n=60) the patients were provided with postoperative analgesia with Tramadol (100mg) given intramuscularly (IM) at the completion of procedure. The postoperative analgesia was assessed using Visual Analogue Scale (VAS) at hourly intervals for first four hours and then 24 hours also. Vital signs like Spo2, HR, NIBP, RR were recorded six hourly for 24 hours postoperatively. There was statistically significant (p value<0.05) better analgesia in Group-II (Tramadol group) as compared to Group-I (Bupivacaine group).
{"title":"Postoperative Analgesia In Laparoscopic Cholecystectomy: A Comparative Study Using Bupivacaine Instillation And Infiltration Versus Parenteral Analgesia (Tramadol).","authors":"S. Shabir, B. Saleem, Abdul Hakim, A. Hashia","doi":"10.5580/1315","DOIUrl":"https://doi.org/10.5580/1315","url":null,"abstract":"In a prospective randomized double blind clinical study, 120 patients of either sex in the age group of 25-65 years with ASA I and II, who were scheduled to undergo elective laparoscopic cholecystectomy were allocated to two groups of 60 patients each with regard to postoperative analgesia. In Group-I (n=60) the patients received Bupivacaine (0.5%) 20ml, instilled in gallbladder bed and the undersurface of diaphragm and infiltration of port wounds. In Group-II (n=60) the patients were provided with postoperative analgesia with Tramadol (100mg) given intramuscularly (IM) at the completion of procedure. The postoperative analgesia was assessed using Visual Analogue Scale (VAS) at hourly intervals for first four hours and then 24 hours also. Vital signs like Spo2, HR, NIBP, RR were recorded six hourly for 24 hours postoperatively. There was statistically significant (p value<0.05) better analgesia in Group-II (Tramadol group) as compared to Group-I (Bupivacaine group).","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"305 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":"114396283","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}
Hypertension and tachycardia have been reported since 1950 during intubation under light anesthesia. Increase in blood pressure and heart rate occurs most commonly from reflex sympathetic discharge in response to laryngotracheal stimulation. Hypertensive response of normal subjects to laryngoscopy and intubation might be enhanced and prove dangerous to hypertensive subjects. Various agents have been used to attenuate hypertensive response. Seventy five patients fulfilling eligibility criteria were included in study. The patients were randomly assigned to one of three groups of twenty five each through a computer generated number. Group A = received 1mg/ kg of esmolol intravenously (n=25), Group B = received 1.5mg/ kg of lidocaine intravenously (n=25), Group C = received 0.2mg/ kg of diltiazem intravenously (n=25). These agents were administered three minutes prior laryngoscopy. Patients were premedicated with fixed dose of injection fortwin and phenergan according to body weight and anesthesia was induced with thiopentone, intubation facilitated by use of succinylcholine. No surgical stimulation, analgesics or inhalational anesthetics were allowed till five minutes after intubation and haemodynamic parameter noted. The results were statistically analyzed. We concluded that esmolol in dose of 1 mg/kg intravenously 3 min prior to laryngoscopy and intubation prevented the rise in heart rate effectively. Esmolol was also effective in attenuating systolic blood pressure increase, diastolic blood pressure increase and increase in mean blood pressure except at 1 min after intubation whereas in comparison lidocaine and diltiazem were not that effective.
自1950年以来，在轻度麻醉下插管时就有高血压和心动过速的报道。血压和心率升高最常见的原因是对喉气管刺激的反射性交感放电。正常人对喉镜检查和插管的高血压反应可能会增强，对高血压患者有危险。各种药物已被用于减轻高血压反应。75例符合资格标准的患者纳入研究。通过计算机生成的数字，患者被随机分为三组，每组25人。A组静脉滴注艾斯洛尔1mg/ kg (n=25)， B组静脉滴注利多卡因1.5mg/ kg (n=25)， C组静脉滴注地尔硫卓0.2mg/ kg (n=25)。这些药物在喉镜检查前三分钟使用。患者根据体重预先给予固定剂量的福尔双和非那根注射液，用硫喷妥酮诱导麻醉，琥珀胆碱辅助插管。在插管并记录血流动力学参数后5分钟，才允许使用手术刺激、镇痛或吸入性麻醉剂。对结果进行统计学分析。我们得出结论，在喉镜检查和插管前3分钟静脉注射剂量为1mg /kg的艾司洛尔可有效防止心率升高。除插管后1分钟外，艾司洛尔在降低收缩压升高、舒张压升高和平均血压升高方面也有效，而利多卡因和地尔硫卓则没有那么有效。
{"title":"To Study The Efficacy Of Intravenous Esmolol, Lidocaine And Diltiazem In Attenuating Haemodynamic Response To Laryngoscopy And Intubation","authors":"Pramendra Agrawal, Swaran Bhalla, I. Singh","doi":"10.5580/d6f","DOIUrl":"https://doi.org/10.5580/d6f","url":null,"abstract":"Hypertension and tachycardia have been reported since 1950 during intubation under light anesthesia. Increase in blood pressure and heart rate occurs most commonly from reflex sympathetic discharge in response to laryngotracheal stimulation. Hypertensive response of normal subjects to laryngoscopy and intubation might be enhanced and prove dangerous to hypertensive subjects. Various agents have been used to attenuate hypertensive response. Seventy five patients fulfilling eligibility criteria were included in study. The patients were randomly assigned to one of three groups of twenty five each through a computer generated number. Group A = received 1mg/ kg of esmolol intravenously (n=25), Group B = received 1.5mg/ kg of lidocaine intravenously (n=25), Group C = received 0.2mg/ kg of diltiazem intravenously (n=25). These agents were administered three minutes prior laryngoscopy. Patients were premedicated with fixed dose of injection fortwin and phenergan according to body weight and anesthesia was induced with thiopentone, intubation facilitated by use of succinylcholine. No surgical stimulation, analgesics or inhalational anesthetics were allowed till five minutes after intubation and haemodynamic parameter noted. The results were statistically analyzed. We concluded that esmolol in dose of 1 mg/kg intravenously 3 min prior to laryngoscopy and intubation prevented the rise in heart rate effectively. Esmolol was also effective in attenuating systolic blood pressure increase, diastolic blood pressure increase and increase in mean blood pressure except at 1 min after intubation whereas in comparison lidocaine and diltiazem were not that effective.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"54 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":"116458004","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}
“Remember this-that there is a proper dignity and proportion to be observed in the performance of every act of life.”Marcus Aurelius Antoninus (121AD-180AD) Regardless of race, culture and religion, every patient during his/her medical examination or treatment expect that his/her body would be treated decently. For the good quality care, provision of due respect is an essential component. Actions to circumvent unnecessary exposure of patient’s body is a display of kindness of care provider which is associated with greater patient satisfaction.[1].The use of regional anaesthesia for caesarean section has dramatically increased during recent decades [2]. It is performed in the lumber area with the patient either in sitting or lying in lateral position. This procedure requires exposure of the patient’s back and exposure of the rest of the body is not required and therefore should be considered as unnecessary exposure. However if proper attention is not given to avoid unnecessary exposure, then sitting position is likely to expose the upper half and lying position the lower half of the body. Sitting position is preferred by many anaesthetists as midline of the back and its side wise tilt is ascertained easily and in case of spinal anaesthesia, higher CSF hydrostatic pressure results in quick appearance and increase flow of CSF. The use of regional anesthesia requires considerable technical skills and demands good appreciation of regional anatomic relationships. Its technique includes; positioning of the patient, exposing her back, cleaning with antiseptic and except the lumbar area, covering the back with sterile drapes. However, covering the back may conceal the spinal tilt and thus may makes the spinal anaesthesia technically difficult. Before inserting the spinal/epidural needle, the anaesthetist decides about the site of insertion. After insertion, the needle is then advanced, targeting the lumbar inter-laminar space. This space is deep to the skin, subcutaneous tissue and spinal ligaments. The anaesthetist viewing the patient back like a roentgenogram, create an imaginary picture of her spine. This image is constructed with the help of the information gathered from the inspection and the palpation of patient’s back. The information regarding patient’s size and frame, spinal curve or tilt, dimension of her trunk is obtained from the inspection. Palpation is performed to feel for the bonny landmarks (lumbar spinous process, interspinous gap and iliac crest). In most patients bony landmarks are palpable, so required placement of the regional block needle is often not difficult. However, in obese pregnant woman, bony landmarks may not be palpable which makes the block difficult to perform [3,4] Clinically, inspection is then the only method which provide information on which spinal anatomy could be speculated. Additional difficulties are encountered in conditions like hydramnious, multiple pregnancies which exaggerate the lardosis, which further lim
{"title":"Technical And Ethical Considerations During Regional Anaesthesia For Cesarean Section: Achieving A Balance","authors":"J. Anwari","doi":"10.5580/233d","DOIUrl":"https://doi.org/10.5580/233d","url":null,"abstract":"“Remember this-that there is a proper dignity and proportion to be observed in the performance of every act of life.”Marcus Aurelius Antoninus (121AD-180AD) Regardless of race, culture and religion, every patient during his/her medical examination or treatment expect that his/her body would be treated decently. For the good quality care, provision of due respect is an essential component. Actions to circumvent unnecessary exposure of patient’s body is a display of kindness of care provider which is associated with greater patient satisfaction.[1].The use of regional anaesthesia for caesarean section has dramatically increased during recent decades [2]. It is performed in the lumber area with the patient either in sitting or lying in lateral position. This procedure requires exposure of the patient’s back and exposure of the rest of the body is not required and therefore should be considered as unnecessary exposure. However if proper attention is not given to avoid unnecessary exposure, then sitting position is likely to expose the upper half and lying position the lower half of the body. Sitting position is preferred by many anaesthetists as midline of the back and its side wise tilt is ascertained easily and in case of spinal anaesthesia, higher CSF hydrostatic pressure results in quick appearance and increase flow of CSF. The use of regional anesthesia requires considerable technical skills and demands good appreciation of regional anatomic relationships. Its technique includes; positioning of the patient, exposing her back, cleaning with antiseptic and except the lumbar area, covering the back with sterile drapes. However, covering the back may conceal the spinal tilt and thus may makes the spinal anaesthesia technically difficult. Before inserting the spinal/epidural needle, the anaesthetist decides about the site of insertion. After insertion, the needle is then advanced, targeting the lumbar inter-laminar space. This space is deep to the skin, subcutaneous tissue and spinal ligaments. The anaesthetist viewing the patient back like a roentgenogram, create an imaginary picture of her spine. This image is constructed with the help of the information gathered from the inspection and the palpation of patient’s back. The information regarding patient’s size and frame, spinal curve or tilt, dimension of her trunk is obtained from the inspection. Palpation is performed to feel for the bonny landmarks (lumbar spinous process, interspinous gap and iliac crest). In most patients bony landmarks are palpable, so required placement of the regional block needle is often not difficult. However, in obese pregnant woman, bony landmarks may not be palpable which makes the block difficult to perform [3,4] Clinically, inspection is then the only method which provide information on which spinal anatomy could be speculated. Additional difficulties are encountered in conditions like hydramnious, multiple pregnancies which exaggerate the lardosis, which further lim","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"29 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":"124483604","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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