This paper aimed at evaluating the effect of low-dose perioperative magnesium sulfate (MgSO4) on postoperative pain in lumbar surgery. Sixty adult patients were included in this randomized controlled double-blind study. After intubation, an infusion of MgSO4 (10 mg/kg/h) and isotonic saline 0.9% (10 mg/kg/h) were administered in groups M and C, respectively. Heart rate and mean arterial pressure were recorded before and during surgery. Serum magnesium levels were recorded before and after the surgery. Perioperative remifentanil consumption and extubation time were recorded. In the post-anesthesia care room (PACU), Agitation-sedation with Richmond Agitation-Sedation Scale (RASS), the pain was evaluated with Visual Analogue Scale (VAS) and recorded at the baseline, at 5th, 10th, 15th and 30th minutes. Patients were transferred to surgical ward with intravenous patient-controlled analgesia (PCA) for postoperative analgesia and received diclofenac sodium for rescue analgesia if VAS >4. Postoperative VAS scores at 2nd, 4th, 6th and 24th hours, opioid consumption after 4 and 24 hours and rescue analgesic consumption for postoperative 24 h were recorded. In the PACU, RASS scores were statistically lower in group M than in group C (p = 0.001), and VAS scores were statistically lower at all measurement times in group M than in group C. In the surgical ward, VAS Scores were statistically lower in Group M at the 6th and 24th hours than in group C (p = 0.015, p = 0.009, respectively). The need for post-operative rescue analgesic was statistically lower in Group M (p < 0.001). The side effect incidence of both groups was similar. Our findings suggest that perioperative low-dose (10 mg/kg/h) MgSO4 infusion reduces early post-op agitation, VAS scores and the need for analgesics up to 24 hours postoperatively. Low dose MgSO4 infusion can be effectively applied for pain management in patients undergoing lumbar surgery.
{"title":"The effects of perioperative low-dose magnesium sulfate infusion on postoperative pain in lumbar surgery","authors":"","doi":"10.22514/sv.2023.097","DOIUrl":"https://doi.org/10.22514/sv.2023.097","url":null,"abstract":"This paper aimed at evaluating the effect of low-dose perioperative magnesium sulfate (MgSO4) on postoperative pain in lumbar surgery. Sixty adult patients were included in this randomized controlled double-blind study. After intubation, an infusion of MgSO4 (10 mg/kg/h) and isotonic saline 0.9% (10 mg/kg/h) were administered in groups M and C, respectively. Heart rate and mean arterial pressure were recorded before and during surgery. Serum magnesium levels were recorded before and after the surgery. Perioperative remifentanil consumption and extubation time were recorded. In the post-anesthesia care room (PACU), Agitation-sedation with Richmond Agitation-Sedation Scale (RASS), the pain was evaluated with Visual Analogue Scale (VAS) and recorded at the baseline, at 5th, 10th, 15th and 30th minutes. Patients were transferred to surgical ward with intravenous patient-controlled analgesia (PCA) for postoperative analgesia and received diclofenac sodium for rescue analgesia if VAS >4. Postoperative VAS scores at 2nd, 4th, 6th and 24th hours, opioid consumption after 4 and 24 hours and rescue analgesic consumption for postoperative 24 h were recorded. In the PACU, RASS scores were statistically lower in group M than in group C (p = 0.001), and VAS scores were statistically lower at all measurement times in group M than in group C. In the surgical ward, VAS Scores were statistically lower in Group M at the 6th and 24th hours than in group C (p = 0.015, p = 0.009, respectively). The need for post-operative rescue analgesic was statistically lower in Group M (p < 0.001). The side effect incidence of both groups was similar. Our findings suggest that perioperative low-dose (10 mg/kg/h) MgSO4 infusion reduces early post-op agitation, VAS scores and the need for analgesics up to 24 hours postoperatively. Low dose MgSO4 infusion can be effectively applied for pain management in patients undergoing lumbar surgery.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135106285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to compare the effect of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) modes on cerebral oximetry during laparoscopic cholecystectomy using near-infrared spectroscopy (NIRS). Seventy patients who underwent elective laparoscopic cholecystectomy were randomized to receive either VCV (group V) or PCV (group P). Demographic and operative data (anesthesia, surgery and insufflation durations) were recorded. The primary outcome was the NIRS value, while the secondary outcomes were peripheral oxygen saturation (SpO2), blood gas parameters and peak and plateau pressures in mechanical ventilation. Measurements were conducted at the start of anesthesia (T0), end of intubation (T1), 5 min after insufflation (T2), just before desufflation (T3), and 5 min after desufflation (T4). Both groups were comparable in terms of age, sex, body mass index, intraoperative time, anesthesia and insufflation durations. The average NIRS right T1–T2–T3 and left T2–T3 values were significantly higher in group P than in group V (p = 0.030, p = 0.001, p = 0.001, p = 0.006 and p = 0.002 respectively). In contrast, the mean peak and mean plateau pressures in group P at T1, T2 and T4 were significantly lower than those in group V (p = 0.003, p = 0.001, p < 0.001, p = 0.011, p = 0.001 and p < 0.001 respectively).The PCV mode allows better cerebral oxygenation than VCV while maintaining lower peak pressure and plateau pressures.
本研究旨在利用近红外光谱(NIRS)比较容量控制通气(VCV)和压力控制通气(PCV)模式对腹腔镜胆囊切除术中脑血氧测定的影响。70例择期腹腔镜胆囊切除术患者随机分为VCV组(V组)和PCV组(P组)。记录人口学和手术数据(麻醉、手术和充气持续时间)。主要指标为近红外光谱(NIRS)值，次要指标为外周血氧饱和度(SpO2)、血气参数、机械通气时的峰值和平台压。测量分别在麻醉开始(T0)、插管结束(T1)、充气后5分钟(T2)、消肿前(T3)和消肿后5分钟(T4)进行。两组在年龄、性别、体重指数、术中时间、麻醉和充气时间方面具有可比性。P组右侧T1-T2-T3和左侧T2-T3平均NIRS值显著高于V组(P = 0.030, P = 0.001, P = 0.001, P = 0.006, P = 0.002)。相比之下，P组T1、T2和T4的平均峰值压力和平均平台压力显著低于V组(P = 0.003, P = 0.001, P <0.001, p = 0.011, p = 0.001, p <0.001分别)。与VCV相比，PCV模式能提供更好的脑氧合，同时维持较低的峰值压和平台压。
{"title":"Effect of volume-controlled and pressure-controlled ventilation modes on cerebral oximetry in laparoscopic cholecystectomy: a randomized controlled trial","authors":"","doi":"10.22514/sv.2023.098","DOIUrl":"https://doi.org/10.22514/sv.2023.098","url":null,"abstract":"This study aimed to compare the effect of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) modes on cerebral oximetry during laparoscopic cholecystectomy using near-infrared spectroscopy (NIRS). Seventy patients who underwent elective laparoscopic cholecystectomy were randomized to receive either VCV (group V) or PCV (group P). Demographic and operative data (anesthesia, surgery and insufflation durations) were recorded. The primary outcome was the NIRS value, while the secondary outcomes were peripheral oxygen saturation (SpO2), blood gas parameters and peak and plateau pressures in mechanical ventilation. Measurements were conducted at the start of anesthesia (T0), end of intubation (T1), 5 min after insufflation (T2), just before desufflation (T3), and 5 min after desufflation (T4). Both groups were comparable in terms of age, sex, body mass index, intraoperative time, anesthesia and insufflation durations. The average NIRS right T1–T2–T3 and left T2–T3 values were significantly higher in group P than in group V (p = 0.030, p = 0.001, p = 0.001, p = 0.006 and p = 0.002 respectively). In contrast, the mean peak and mean plateau pressures in group P at T1, T2 and T4 were significantly lower than those in group V (p = 0.003, p = 0.001, p < 0.001, p = 0.011, p = 0.001 and p < 0.001 respectively).The PCV mode allows better cerebral oxygenation than VCV while maintaining lower peak pressure and plateau pressures.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135107523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Subarachnoid hemorrhage (SAH) is a common occurrence among patients with altered mental status who arrive at the emergency department (ED), particularly for emergency physicians. However, the combination of neurogenic pulmonary edema (NPE) followed by SAH is generally considered a rare condition in the ED setting. Chest radiographs in these patients often reveal lung infiltrations, which are frequently misinterpreted by many emergency physicians as resulting from chest compression during cardiopulmonary resuscitation or aspiration due to altered mental status. This case report highlights a patient with SAH who developed NPE, with the aim to raise awareness among emergency department physicians about NPE and provide comprehensive insights regarding its management, as well as clinical, prognostic and diagnostic information.
{"title":"An early presentation of neurogenic pulmonary edema in acute subarachnoid hemorrhage","authors":"","doi":"10.22514/sv.2023.101","DOIUrl":"https://doi.org/10.22514/sv.2023.101","url":null,"abstract":"Subarachnoid hemorrhage (SAH) is a common occurrence among patients with altered mental status who arrive at the emergency department (ED), particularly for emergency physicians. However, the combination of neurogenic pulmonary edema (NPE) followed by SAH is generally considered a rare condition in the ED setting. Chest radiographs in these patients often reveal lung infiltrations, which are frequently misinterpreted by many emergency physicians as resulting from chest compression during cardiopulmonary resuscitation or aspiration due to altered mental status. This case report highlights a patient with SAH who developed NPE, with the aim to raise awareness among emergency department physicians about NPE and provide comprehensive insights regarding its management, as well as clinical, prognostic and diagnostic information.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135262755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To reduce the risk of pulmonary aspiration, fasting before general anesthesia is essential. Studies reported that despite that traditional “NPO (nothing by mouth) after midnight” regulations are being liberalized, noncompliance with NPO status is still a threat to patient safety and may result in delays of elective surgical procedures, reduce the efficiency of ambulatory surgery setting, and compromise patient safety. This study aimed to assess the community’s knowledge of preoperative fasting, as well as their attitudes toward preoperative fasting in Saudi Arabia.This is a cross-sectional study conducted among the Saudi general population. A self-administered questionnaire was distributed among the targeted population using an online surgery. The questionnaire includes socio-demographic data (i.e., age, gender, education, etc.) and a 12-item questionnaire to measure the knowledge and attitude toward preoperative fasting. The result of 4257 participants was recruited, 67.2% were females and 39.3% were aged between 18 to 24 years old. The prevalence of participants who had surgery that required anesthesia was 48.9%. The overall mean knowledge score was 4.80 (standard deviation (SD) 2.36) out of 12 points. 60.1% were considered poor knowledge, 38.3% were moderate and only 1.6% were considered good knowledge levels. Factors associated with increased knowledge were being older in age, female gender, living in Northern Region, and having undergone surgery that required anesthesia. The level of knowledge among the general population regarding the importance of fasting before the surgery was inadequate. Older females who were living in the Northern Region and who previously received general anesthesia during their previous operation were more likely to demonstrate better knowledge about preoperative fasting as compared to the rest of the groups. More research is needed to determine the level of und
{"title":"Community's knowledge and attitude of pre-operative fasting in kingdom of Saudi Arabia, 2022","authors":"","doi":"10.22514/sv.2023.106","DOIUrl":"https://doi.org/10.22514/sv.2023.106","url":null,"abstract":"To reduce the risk of pulmonary aspiration, fasting before general anesthesia is essential. Studies reported that despite that traditional “NPO (nothing by mouth) after midnight” regulations are being liberalized, noncompliance with NPO status is still a threat to patient safety and may result in delays of elective surgical procedures, reduce the efficiency of ambulatory surgery setting, and compromise patient safety. This study aimed to assess the community’s knowledge of preoperative fasting, as well as their attitudes toward preoperative fasting in Saudi Arabia.This is a cross-sectional study conducted among the Saudi general population. A self-administered questionnaire was distributed among the targeted population using an online surgery. The questionnaire includes socio-demographic data (i.e., age, gender, education, etc.) and a 12-item questionnaire to measure the knowledge and attitude toward preoperative fasting. The result of 4257 participants was recruited, 67.2% were females and 39.3% were aged between 18 to 24 years old. The prevalence of participants who had surgery that required anesthesia was 48.9%. The overall mean knowledge score was 4.80 (standard deviation (SD) 2.36) out of 12 points. 60.1% were considered poor knowledge, 38.3% were moderate and only 1.6% were considered good knowledge levels. Factors associated with increased knowledge were being older in age, female gender, living in Northern Region, and having undergone surgery that required anesthesia. The level of knowledge among the general population regarding the importance of fasting before the surgery was inadequate. Older females who were living in the Northern Region and who previously received general anesthesia during their previous operation were more likely to demonstrate better knowledge about preoperative fasting as compared to the rest of the groups. More research is needed to determine the level of und","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"183 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135509236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study analyzes the effectiveness of adding lactate levels to the Rapid Emergency Medicine Score (REMS) scoring system to better predict short-term mortality and outcomes in patients over 40 years of age who present to the emergency department (ED) with dyspnea. This prospective observational study recruited all consecutive patients with shortness of breath as their chief complaint. Patients were evaluated using REMS and categorized in the ED as low-, intermediate-, or high-risk. In-hospital outcomes and the survival rates of the patients were recorded. The patients’ REMS points and lactate levels were analyzed together to elicit the REMS+L scores used to predict mortality and outcomes. A total of 1044 patients were included in the study. The majority (64.8%, n = 677) of the patients received diagnoses related to the respiratory system, 9.9% (n = 103) with the cardiovascular system, and 25.3% (n = 264) with nonspecific diagnoses. A total of 31% (n = 324) of the patients were hospitalized, while the majority (78%, n = 253) were admitted to an intensive care unit. A total of 104 (10%) died within 28 days, with 23 of those deaths (2.2%) occurring within 2 days. The diagnostic accuracies of lactate, REMS, and REMS+L values were calculated using receiver operating characteristics (ROC) analysis and revealed that the REMS+L score (p < 0.001) was more accurate than the lactate measurements (p < 0.001) and REMS score (p < 0.001) in predicting short-term mortality. The REMS+L score (p < 0.001) was superior to the REMS (p < 0.001) and lactate values (p < 0.001) in predicting mortality. Adding lactate measurements to REMS in patients over 40 years of age who present to the ED with shortness of breath appeared to yield more accurate estimates than using REMS and lactate values alone when determining two-day mortality.
{"title":"Should lactate levels be combined with rapid emergency medicine scores (REMS) to predict outcomes of patients with dyspnea","authors":"","doi":"10.22514/sv.2023.024","DOIUrl":"https://doi.org/10.22514/sv.2023.024","url":null,"abstract":"This study analyzes the effectiveness of adding lactate levels to the Rapid Emergency Medicine Score (REMS) scoring system to better predict short-term mortality and outcomes in patients over 40 years of age who present to the emergency department (ED) with dyspnea. This prospective observational study recruited all consecutive patients with shortness of breath as their chief complaint. Patients were evaluated using REMS and categorized in the ED as low-, intermediate-, or high-risk. In-hospital outcomes and the survival rates of the patients were recorded. The patients’ REMS points and lactate levels were analyzed together to elicit the REMS+L scores used to predict mortality and outcomes. A total of 1044 patients were included in the study. The majority (64.8%, n = 677) of the patients received diagnoses related to the respiratory system, 9.9% (n = 103) with the cardiovascular system, and 25.3% (n = 264) with nonspecific diagnoses. A total of 31% (n = 324) of the patients were hospitalized, while the majority (78%, n = 253) were admitted to an intensive care unit. A total of 104 (10%) died within 28 days, with 23 of those deaths (2.2%) occurring within 2 days. The diagnostic accuracies of lactate, REMS, and REMS+L values were calculated using receiver operating characteristics (ROC) analysis and revealed that the REMS+L score (p < 0.001) was more accurate than the lactate measurements (p < 0.001) and REMS score (p < 0.001) in predicting short-term mortality. The REMS+L score (p < 0.001) was superior to the REMS (p < 0.001) and lactate values (p < 0.001) in predicting mortality. Adding lactate measurements to REMS in patients over 40 years of age who present to the ED with shortness of breath appeared to yield more accurate estimates than using REMS and lactate values alone when determining two-day mortality.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"178 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135585519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bystander cardiopulmonary resuscitation (BCPR) is a significant factor in the chain of survival; however, various potential barriers are observed. We aimed to identify the impact of the coronavirus disease 2019 (COVID-19) pandemic on BCPR. This retrospective observational study used Daegu out-of-hospital cardiac arrest (OHCA) registry data of patients aged over 18 years with cardiac etiology in Daegu, Korea from 18 February 2019 to 17 February 2021. We divided BCPR into self-led (SBCPR) and dispatcher-assisted BCPR (DACPR). To determine changes in the effect of BCPR on OHCA outcomes from the COVID-19 pandemic, we performed multivariable logistic regression analyses by BCPR type. Furthermore, we performed the Wald test to identify differences in logistic regression analysis results between the two periods. A total of 1680 OHCAs were included (before-pandemic, 804; during pandemic, 876). The BCPR rate was not different between the two periods (DACPR, 43.9% vs. 42.0%; SBCPR, 18.7% vs. 18.4; p = 0.643). SBCPR showed effectiveness for OHCA outcomes before the pandemic (adjusted odds ratio (aOR), 2.59; 95% confidence interval (CI), 1.09–6.18 for survival to hospital discharge; aOR, 2.58; 95% CI, 1.03–6.46 for favorable neurological outcomes); however, it disappeared after the pandemic (aOR, 1.88; 95% CI, 0.88–4.00 for survival to hospital discharge; aOR, 1.67; 95% CI, 0.69–4.05 for favorable neurological outcomes). However, no statistical difference was observed in the Wald test (survival to hospital discharge, p = 0.586; favorable neurologic outcomes, p = 0.504). A decreasing trend in the effect of SBCPR on OHCA outcomes was observed during the COVID-19 pandemic; however, no statistically significant difference was observed compared with that before the pandemic.
旁观者心肺复苏(BCPR)是生存链中的一个重要因素，然而，观察到各种潜在的障碍。我们旨在确定2019冠状病毒病(COVID-19)大流行对BCPR的影响。这项回顾性观察性研究使用了2019年2月18日至2021年2月17日韩国大邱18岁以上心脏病因患者的院外心脏骤停(OHCA)登记数据。我们将BCPR分为自主导型(SBCPR)和调度员辅助型(DACPR)。为了确定BCPR对COVID-19大流行后OHCA结局影响的变化，我们按BCPR类型进行了多变量logistic回归分析。此外，我们进行了Wald检验，以确定两个时期之间逻辑回归分析结果的差异。共纳入了1680个ohca(大流行前804个;大流行期间876个)。两期BCPR率无差异(DACPR 43.9% vs 42.0%; SBCPR 18.7% vs 18.4; p = 0.643)。SBCPR在大流行前显示了OHCA结局的有效性(调整优势比(aOR)， 2.59; 95%可信区间(CI)，生存至出院1.09-6.18;aOR, 2.58;神经系统良好结局95% CI, 1.03-6.46);然而，在大流行后消失(aOR, 1.88;生存至出院95% CI, 0.88-4.00; aOR, 1.67;神经系统良好结局95% CI, 0.69-4.05)。然而，Wald检验无统计学差异(生存至出院，p = 0.586;良好的神经系统预后，p = 0.504)。在2019冠状病毒病大流行期间，SBCPR对OHCA结果的影响呈下降趋势，但与大流行前相比无统计学差异。
{"title":"Impact of COVID-19 pandemic on bystander CPR in patient with OHCA: a registry-based before and after study in Daegu, Korea","authors":"","doi":"10.22514/sv.2023.116","DOIUrl":"https://doi.org/10.22514/sv.2023.116","url":null,"abstract":"Bystander cardiopulmonary resuscitation (BCPR) is a significant factor in the chain of survival; however, various potential barriers are observed. We aimed to identify the impact of the coronavirus disease 2019 (COVID-19) pandemic on BCPR. This retrospective observational study used Daegu out-of-hospital cardiac arrest (OHCA) registry data of patients aged over 18 years with cardiac etiology in Daegu, Korea from 18 February 2019 to 17 February 2021. We divided BCPR into self-led (SBCPR) and dispatcher-assisted BCPR (DACPR). To determine changes in the effect of BCPR on OHCA outcomes from the COVID-19 pandemic, we performed multivariable logistic regression analyses by BCPR type. Furthermore, we performed the Wald test to identify differences in logistic regression analysis results between the two periods. A total of 1680 OHCAs were included (before-pandemic, 804; during pandemic, 876). The BCPR rate was not different between the two periods (DACPR, 43.9% vs. 42.0%; SBCPR, 18.7% vs. 18.4; p = 0.643). SBCPR showed effectiveness for OHCA outcomes before the pandemic (adjusted odds ratio (aOR), 2.59; 95% confidence interval (CI), 1.09–6.18 for survival to hospital discharge; aOR, 2.58; 95% CI, 1.03–6.46 for favorable neurological outcomes); however, it disappeared after the pandemic (aOR, 1.88; 95% CI, 0.88–4.00 for survival to hospital discharge; aOR, 1.67; 95% CI, 0.69–4.05 for favorable neurological outcomes). However, no statistical difference was observed in the Wald test (survival to hospital discharge, p = 0.586; favorable neurologic outcomes, p = 0.504). A decreasing trend in the effect of SBCPR on OHCA outcomes was observed during the COVID-19 pandemic; however, no statistically significant difference was observed compared with that before the pandemic.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135705318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Since 15 November 2012, the South Korean government amended the law to make some medicines available at 24-hour convenient stores that had previously been sold at pharmacies only. The aim of this study was to evaluate the impact of this legislation on drug poisoning in youth patients, who may be affected by increased access. This study retrospectively analyzed data registered in the Emergency Department-based Injury In-depth Surveillance (EDIIS) database from January 2007 to December 2018. Patients aged 15 to 24 years old were selected to analyze the incidence and outcomes of acetaminophen (AAP) poisoning in youth patientsBefore the deregulation of over-the-counter (OTC) medication sales, 1994 youth patients visited the emergency department (ED) from 2007–2012. By contrast, 5440 youth visited the ED from 2013–2018 after deregulation. In particular, there were 263 (13.2%) and 820 (15.1%) cases of AAP poisoning intentionally before and after deregulation, respectively, which was not significantly different (p = 0.085). However, the number of patients who were admitted to the general ward (GW) due to AAP poisoning significantly increased from 93 (35.4%) to 339 (41.3%) (p = 0.041). Furthermore, the number of patients who were admitted to the intensive care unit (ICU) after ingesting AAP significantly increased from 9 (3.4%) to 93 (11.3%) (p < 0.001).There was no significant difference in intentional AAP poisoning ratios following the deregulation of OTC drug sales; however, GW and ICU admission rates significantly increased. This study demonstrated that there is positive relationship between intentional AAP poisoning and severity in youth patients after the deregulation legislation.
{"title":"Trends in drug poisoning of youth patients after the deregulation of over the counter drug sales","authors":"","doi":"10.22514/sv.2023.078","DOIUrl":"https://doi.org/10.22514/sv.2023.078","url":null,"abstract":"Since 15 November 2012, the South Korean government amended the law to make some medicines available at 24-hour convenient stores that had previously been sold at pharmacies only. The aim of this study was to evaluate the impact of this legislation on drug poisoning in youth patients, who may be affected by increased access. This study retrospectively analyzed data registered in the Emergency Department-based Injury In-depth Surveillance (EDIIS) database from January 2007 to December 2018. Patients aged 15 to 24 years old were selected to analyze the incidence and outcomes of acetaminophen (AAP) poisoning in youth patientsBefore the deregulation of over-the-counter (OTC) medication sales, 1994 youth patients visited the emergency department (ED) from 2007–2012. By contrast, 5440 youth visited the ED from 2013–2018 after deregulation. In particular, there were 263 (13.2%) and 820 (15.1%) cases of AAP poisoning intentionally before and after deregulation, respectively, which was not significantly different (p = 0.085). However, the number of patients who were admitted to the general ward (GW) due to AAP poisoning significantly increased from 93 (35.4%) to 339 (41.3%) (p = 0.041). Furthermore, the number of patients who were admitted to the intensive care unit (ICU) after ingesting AAP significantly increased from 9 (3.4%) to 93 (11.3%) (p < 0.001).There was no significant difference in intentional AAP poisoning ratios following the deregulation of OTC drug sales; however, GW and ICU admission rates significantly increased. This study demonstrated that there is positive relationship between intentional AAP poisoning and severity in youth patients after the deregulation legislation.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136218169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The ongoing coronavirus 2019 (COVID-19) pandemic has increased the need for healthcare professionals to perform emergency endotracheal intubation (ETI) in patients with COVID-19-related respiratory failure outside of the operating room. Difficult airways and severe airway-related adverse events occur much more frequently in such settings due to limited time and resources as well as the patient’s reduced physiological reserve. The gum elastic bougie (GEB) intubation tube is an inexpensive, simple, and readily transportable aid to intubation, but its effectiveness in emergency airway management has not been comprehensively evaluated in recent years. Here, we performed a literature review and have updated the available evidence on the utility of GEB in emergency airway management. After a systematic MEDLINE search, we identified 36 relevant reports that compared GEB with alternative airway management approaches in a variety of real-world and simulated settings. In most studies, GEB increased the first-pass ETI success rate and decreased the force applied on the tongue and incisors during laryngoscopy. GEB also increased the speed, safety, and reliability of emergency cricothyrotomy. Conflicting results were obtained in studies examining GEB use for ETI during cardiopulmonary resuscitation, and other special circumstances such as selective lung ventilation, the presence of vomitus, and the use of personal protective equipment. These results suggest that GEB use could be expanded beyond difficult airways and rescue after failed ETI attempts, but further studies will be necessary to determine the utility of GEB under special conditions. Because fatal airway-related adverse events can in part be attributed to limited accessibility of proper airway management equipment, devices such as GEB may increase successful outcomes, especially under the overwhelmingly challenging conditions imposed by the COVID-19 pandemic.
{"title":"Emergency airway management with the gum elastic bougie outside of the operating room: a narrative review","authors":"","doi":"10.22514/sv.2023.074","DOIUrl":"https://doi.org/10.22514/sv.2023.074","url":null,"abstract":"The ongoing coronavirus 2019 (COVID-19) pandemic has increased the need for healthcare professionals to perform emergency endotracheal intubation (ETI) in patients with COVID-19-related respiratory failure outside of the operating room. Difficult airways and severe airway-related adverse events occur much more frequently in such settings due to limited time and resources as well as the patient’s reduced physiological reserve. The gum elastic bougie (GEB) intubation tube is an inexpensive, simple, and readily transportable aid to intubation, but its effectiveness in emergency airway management has not been comprehensively evaluated in recent years. Here, we performed a literature review and have updated the available evidence on the utility of GEB in emergency airway management. After a systematic MEDLINE search, we identified 36 relevant reports that compared GEB with alternative airway management approaches in a variety of real-world and simulated settings. In most studies, GEB increased the first-pass ETI success rate and decreased the force applied on the tongue and incisors during laryngoscopy. GEB also increased the speed, safety, and reliability of emergency cricothyrotomy. Conflicting results were obtained in studies examining GEB use for ETI during cardiopulmonary resuscitation, and other special circumstances such as selective lung ventilation, the presence of vomitus, and the use of personal protective equipment. These results suggest that GEB use could be expanded beyond difficult airways and rescue after failed ETI attempts, but further studies will be necessary to determine the utility of GEB under special conditions. Because fatal airway-related adverse events can in part be attributed to limited accessibility of proper airway management equipment, devices such as GEB may increase successful outcomes, especially under the overwhelmingly challenging conditions imposed by the COVID-19 pandemic.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135949779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The traditional axillary perineural (PN) approach for brachial plexus block is frequently used, but separate musculocutaneous nerve (MCN) block is required and increases procedure time and patient discomfort. We hypothesized that a block using the proximal perivascular (PPV) method at the MCN branching from the lateral cord would obviate the need for an MCN block while ensuring a quality similar to that of the PN method. For the PN group (n = 25), a needle was placed on each nerve, and 8 mL local anesthetic was infiltrated around the radial, ulnar, and median nerves (total: 24 mL). We then injected 6 mL local anesthetic around the MCN. In the PPV group (n = 25), we moved the probe proximally until the branching junction of the the MCN in the lateral cord. The needle tips were placed in the 12-o’clock and 6-o’clock positions of the axillary artery, and 15 mL local anesthetic was injected (total: 30 mL). The procedure time, number of needle passes, procedure-related complications, sensory/motor block level, and onset time were recorded. The PPV group had a significantly shorter procedure time than the PN group (3.9 ± 1.0 vs. 7.5 ± 3.3 min, p < 0.001). Furthermore, the PPV group required fewer needle passes. The PN group showed a significantly faster onset time than the PPV group (6.4 ± 2.7 vs. 10.4 ± 2.9 min, p < 0.001). The induction time did not show significant intergroup difference. Sensory blockade in the PN group occurred significantly faster than that in the PPV group at 5 and 10 min. There were no significant differences in motor nerve paralysis. PPV axillary block under ultrasound guidance was as effective as the PN axillary block. Therefore, the PPV axillary block is a simple, safe and effective regional technique for upper limb surgery.
臂丛神经阻滞通常采用传统的腋窝周围神经(PN)入路，但需要单独的肌肉皮神经(MCN)阻滞，这增加了手术时间和患者的不适。我们假设使用近端血管周围(PPV)方法在侧索分支的MCN处进行阻滞，可以避免MCN阻滞的需要，同时确保与PN方法相似的质量。PN组(n = 25)，每根神经上放置一根针，在桡神经、尺神经和正中神经周围浸润局麻药8 mL(共24 mL)。然后在MCN周围注射6 mL局麻药。在PPV组(n = 25)中，我们将探针近端移动到MCN在外侧脊髓的分支连接处。针尖分别置于腋窝动脉12、6点钟位置，注射局麻15 mL(共30 mL)。记录手术时间、穿刺次数、手术相关并发症、感觉/运动阻滞水平和开始时间。PPV组手术时间明显短于PN组(3.9±1.0 vs. 7.5±3.3 min, p <0.001)。此外，PPV组需要更少的针道。PN组的发病时间明显快于PPV组(6.4±2.7 vs 10.4±2.9 min, p <0.001)。诱导时间组间差异不显著。PN组感觉阻滞发生时间在5和10 min明显快于PPV组，运动神经麻痹无显著性差异。超声引导下PPV腋窝阻滞与PN腋窝阻滞效果相同。因此，PPV腋窝阻滞术是一种简单、安全、有效的局部上肢手术技术。
{"title":"Comparison of perineural brachial plexus block and proximal perivascular block in ultrasound-guided axillary brachial plexus block","authors":"","doi":"10.22514/sv.2023.082/","DOIUrl":"https://doi.org/10.22514/sv.2023.082/","url":null,"abstract":"The traditional axillary perineural (PN) approach for brachial plexus block is frequently used, but separate musculocutaneous nerve (MCN) block is required and increases procedure time and patient discomfort. We hypothesized that a block using the proximal perivascular (PPV) method at the MCN branching from the lateral cord would obviate the need for an MCN block while ensuring a quality similar to that of the PN method. For the PN group (n = 25), a needle was placed on each nerve, and 8 mL local anesthetic was infiltrated around the radial, ulnar, and median nerves (total: 24 mL). We then injected 6 mL local anesthetic around the MCN. In the PPV group (n = 25), we moved the probe proximally until the branching junction of the the MCN in the lateral cord. The needle tips were placed in the 12-o’clock and 6-o’clock positions of the axillary artery, and 15 mL local anesthetic was injected (total: 30 mL). The procedure time, number of needle passes, procedure-related complications, sensory/motor block level, and onset time were recorded. The PPV group had a significantly shorter procedure time than the PN group (3.9 ± 1.0 vs. 7.5 ± 3.3 min, p < 0.001). Furthermore, the PPV group required fewer needle passes. The PN group showed a significantly faster onset time than the PPV group (6.4 ± 2.7 vs. 10.4 ± 2.9 min, p < 0.001). The induction time did not show significant intergroup difference. Sensory blockade in the PN group occurred significantly faster than that in the PPV group at 5 and 10 min. There were no significant differences in motor nerve paralysis. PPV axillary block under ultrasound guidance was as effective as the PN axillary block. Therefore, the PPV axillary block is a simple, safe and effective regional technique for upper limb surgery.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135358837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to investigate the association of characteristics and clinical outcomes of patients who presented with mushroom intoxication. We conducted a retrospective study of mushroom intoxication cases using national registry data (representative of the period 01 January 2011 to 31 December 2019). Specifically, we analyzed the demographics, vital signs, mental status, intoxication related factors, and clinical presentations of the patients. The outcomes were assessed based on general ward admission, intensive care unit (ICU) admission, length of hospitalization, and mortality. The t-test or chi-square test were used to compare the emergency department (ED) discharge group and admission group. Logistic regressions were used to predict patients that were high-risk with regards to being admitted. A total of 393 patients with mushroom intoxication were presented at the ED, and the highest number of visits occurred in the month of September. Overall, 277 (70.5%) patients were discharged from the ED and 116 (29.5%) patients were admitted. Of these, 25 (6.4%) patients were admitted to the ICU, and 3 (2.6%) patients died. Patients are more likely to be admitted to the general ward or ICU when symptoms presented after 6 h: 6 to 24 h (Odds ratio (OR) 2.158; 95% Confidence interval (CI), 1.218–3.816) or >24 h (OR: 3.382; 95% CI, 1.438–8.050). Additionally, when the patients presented with diarrhea, they were more likely to be discharged with favorable outcomes with a less likelihood for admission (OR: 0.237; 95% CI, 0.093–0.523). Most cases of mushroom intoxication presented with gastrointestinal symptoms and followed a benign course. The longer time to onset of symptoms increased the likelihood of hospitalization. Clinicians should evaluate more carefully, observe, or admit those with delayed symptom onset.
{"title":"Mushroom intoxications presented to emergency departments in South Korea: a 2011‐2019 national registry study","authors":"","doi":"10.22514/sv.2023.086","DOIUrl":"https://doi.org/10.22514/sv.2023.086","url":null,"abstract":"This study aimed to investigate the association of characteristics and clinical outcomes of patients who presented with mushroom intoxication. We conducted a retrospective study of mushroom intoxication cases using national registry data (representative of the period 01 January 2011 to 31 December 2019). Specifically, we analyzed the demographics, vital signs, mental status, intoxication related factors, and clinical presentations of the patients. The outcomes were assessed based on general ward admission, intensive care unit (ICU) admission, length of hospitalization, and mortality. The t-test or chi-square test were used to compare the emergency department (ED) discharge group and admission group. Logistic regressions were used to predict patients that were high-risk with regards to being admitted. A total of 393 patients with mushroom intoxication were presented at the ED, and the highest number of visits occurred in the month of September. Overall, 277 (70.5%) patients were discharged from the ED and 116 (29.5%) patients were admitted. Of these, 25 (6.4%) patients were admitted to the ICU, and 3 (2.6%) patients died. Patients are more likely to be admitted to the general ward or ICU when symptoms presented after 6 h: 6 to 24 h (Odds ratio (OR) 2.158; 95% Confidence interval (CI), 1.218–3.816) or >24 h (OR: 3.382; 95% CI, 1.438–8.050). Additionally, when the patients presented with diarrhea, they were more likely to be discharged with favorable outcomes with a less likelihood for admission (OR: 0.237; 95% CI, 0.093–0.523). Most cases of mushroom intoxication presented with gastrointestinal symptoms and followed a benign course. The longer time to onset of symptoms increased the likelihood of hospitalization. Clinicians should evaluate more carefully, observe, or admit those with delayed symptom onset.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135361335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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