Pub Date : 2017-01-01DOI: 10.4103/1687-7934.238470
M. Kamal, Dalia El-Fawy
{"title":"Intrathecal ketamine as an adjuvant in day-case surgeries: a reply for the comments on a previously published article","authors":"M. Kamal, Dalia El-Fawy","doi":"10.4103/1687-7934.238470","DOIUrl":"https://doi.org/10.4103/1687-7934.238470","url":null,"abstract":"","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81857658","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}
Pub Date : 2017-01-01DOI: 10.4103/1687-7934.238472
F. Ibrahim, Essam F. Abdelgalel
Background It had been suggested that the use of fluids containing albumin in critically ill patients may increase the absolute risk for death when compared with crystalloids. Objective The aim of this study was to compare the effect of albumin infusion versus conservative therapy on both serum albumin concentration (SAC) and patient outcome in case of postoperative hypoalbuminemia after exploration laparotomy for major abdominal trauma. Patients and methods Sixty-four patients with major abdominal trauma who had undergone exploration laparotomy were studied. In addition to patient’s demographic data, serial postoperative SAC and intra-abdominal pressure up to the seventh day were measured. Moreover, clinical, laboratory, and radiological follow-up was conducted to evaluate the morbidity until patient discharge from the hospital. The mortality rate was also recorded. Results There were no significant differences between patients who received albumin (group A) for the treatment of hypoalbuminemia and those who did not receive albumin (group B) as regards length of ICU stay (P=0.33), first postoperative day SAC (P=0.99), total complications (P=1), and individual postoperative complications [hemodynamic instability with vasopressor requirement (P=0.74), abdominal compartment syndrome (P=1), multiple organ dysfunction syndrome (P=1), and anastomotic leak (P=1), acute respiratory distress (P<0.6), and mortality (P=1)]. However, SAC was significantly higher on the third, fifth, and seventh day postoperatively in group A than in group B (P<0.001). Conclusion Postoperative treatment of hypoalbuminemia in major abdominal trauma had no benefit as regards morbidity and mortality.
{"title":"Postoperative outcome in major abdominal trauma: is the treatment of hypoalbuminemia beneficial?","authors":"F. Ibrahim, Essam F. Abdelgalel","doi":"10.4103/1687-7934.238472","DOIUrl":"https://doi.org/10.4103/1687-7934.238472","url":null,"abstract":"Background It had been suggested that the use of fluids containing albumin in critically ill patients may increase the absolute risk for death when compared with crystalloids. Objective The aim of this study was to compare the effect of albumin infusion versus conservative therapy on both serum albumin concentration (SAC) and patient outcome in case of postoperative hypoalbuminemia after exploration laparotomy for major abdominal trauma. Patients and methods Sixty-four patients with major abdominal trauma who had undergone exploration laparotomy were studied. In addition to patient’s demographic data, serial postoperative SAC and intra-abdominal pressure up to the seventh day were measured. Moreover, clinical, laboratory, and radiological follow-up was conducted to evaluate the morbidity until patient discharge from the hospital. The mortality rate was also recorded. Results There were no significant differences between patients who received albumin (group A) for the treatment of hypoalbuminemia and those who did not receive albumin (group B) as regards length of ICU stay (P=0.33), first postoperative day SAC (P=0.99), total complications (P=1), and individual postoperative complications [hemodynamic instability with vasopressor requirement (P=0.74), abdominal compartment syndrome (P=1), multiple organ dysfunction syndrome (P=1), and anastomotic leak (P=1), acute respiratory distress (P<0.6), and mortality (P=1)]. However, SAC was significantly higher on the third, fifth, and seventh day postoperatively in group A than in group B (P<0.001). Conclusion Postoperative treatment of hypoalbuminemia in major abdominal trauma had no benefit as regards morbidity and mortality.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77107873","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}
Pub Date : 2017-01-01DOI: 10.4103/1687-7934.238460
M. Shorbagy, D. Salah
Background and aim Various studies have questioned the efficacy of intraoperative acute normovolemic hemodilution (ANH) in reducing bleeding, the need for allogenic transfusion, and the incidence of re-exploration in cardiac surgery. The aim of the present study was to evaluate the effectiveness of the use of minimal ANH for blood transfusion requirements and re-opening in elective adult coronary artery bypass graft surgery using cardiopulmonary bypass. Patients and methods This prospective, randomized controlled study was conducted on 100 consecutive adult patients who underwent elective coronary artery bypass graft. Patients were randomly divided into two equal groups: the ANH group (n=50) and the control group (n=50). In the ANH group, 5–8 ml/kg of autologous blood was withdrawn after administering anesthesia and before systemic heparinization. Simultaneously, colloid solution (6% hydroxyethyl starch 130/0.4; Voluven) was infused in a ratio of 1:1, and then the blood was re-infused after bypass. Hemodilation was not carried out for the control group. Total amount of allogenic-packed red blood cell, fresh frozen plasma, platelet concentrate transfusion, and the number of patients undergoing re-opening because of excessive bleeding were calculated for the two groups. Results A significant decrease was observed in the number of red blood cell units and fresh frozen plasma transfusion per patient in the ANH group compared with the control group. Conversely, chest tube output, representing postoperative bleeding and platelet count, did not differ between the two groups. Conclusion In this study, the use of the minimal ANH technique reduced the consumption of allogenic red blood cells and fresh frozen plasma in adult cardiac surgery patients. However, this technique had no effect on postoperative bleeding, incidence of re-exploration, and platelet count.
{"title":"Effectiveness of minimal acute normovolemic hemodilution to minimize allogenic blood transfusion and re-exploration in elective adult coronary artery bypass graft surgery using colloid as a replacement solution","authors":"M. Shorbagy, D. Salah","doi":"10.4103/1687-7934.238460","DOIUrl":"https://doi.org/10.4103/1687-7934.238460","url":null,"abstract":"Background and aim Various studies have questioned the efficacy of intraoperative acute normovolemic hemodilution (ANH) in reducing bleeding, the need for allogenic transfusion, and the incidence of re-exploration in cardiac surgery. The aim of the present study was to evaluate the effectiveness of the use of minimal ANH for blood transfusion requirements and re-opening in elective adult coronary artery bypass graft surgery using cardiopulmonary bypass. Patients and methods This prospective, randomized controlled study was conducted on 100 consecutive adult patients who underwent elective coronary artery bypass graft. Patients were randomly divided into two equal groups: the ANH group (n=50) and the control group (n=50). In the ANH group, 5–8 ml/kg of autologous blood was withdrawn after administering anesthesia and before systemic heparinization. Simultaneously, colloid solution (6% hydroxyethyl starch 130/0.4; Voluven) was infused in a ratio of 1:1, and then the blood was re-infused after bypass. Hemodilation was not carried out for the control group. Total amount of allogenic-packed red blood cell, fresh frozen plasma, platelet concentrate transfusion, and the number of patients undergoing re-opening because of excessive bleeding were calculated for the two groups. Results A significant decrease was observed in the number of red blood cell units and fresh frozen plasma transfusion per patient in the ANH group compared with the control group. Conversely, chest tube output, representing postoperative bleeding and platelet count, did not differ between the two groups. Conclusion In this study, the use of the minimal ANH technique reduced the consumption of allogenic red blood cells and fresh frozen plasma in adult cardiac surgery patients. However, this technique had no effect on postoperative bleeding, incidence of re-exploration, and platelet count.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83752779","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}
Pub Date : 2017-01-01DOI: 10.4103/1687-7934.238463
M. Younes, K. Gamil, A. Elgarhy
Objective The aim of the study was to assess single-dose intrathecal bupivacaine in combination with fentanyl as a safe and effective alternative to epidural for labor analgesia. Patients and methods Sixty women aged 20–30 years, of American Society of Anesthesiology I–II, and with a single uncomplicated pregnancy were included in this study. Patients were randomly allocated to two equal groups: the spinal group received hyperbaric bupivacaine 0.5% at a dose of 1 ml plus 25 μg fentanyl (0.5 ml), whereas the epidural group received bupivacaine 0.25% at a 14 ml bolus dose with a background epidural infusion of bupivacaine 0.125% at 10 ml/h. Pain intensity was recorded on a visual analogue scale. The quality of pain relief was also related to patient satisfaction after delivery. Side effects such as hypotension, motor block, pruritus, sedation, and nausea were noted. Obstetric parameters and Apgar score were noted, and all results were compared. Results Onset of sensory block was earlier (5.6 ± 1.27 vs. 8.8 ± 1.62 min, P < 0.001) and visual analogue scale at 5, 60, 90, 120, and 150 min was lower in the spinal group compared with the epidural group. All these results were statistically signifi cant. Ninety percent of the parturients in the spinal group versus 62% in the epidural group scored the analgesic quality as excellent. No significant hemodynamic changes were recorded in either group. There were no significant differences between the two groups in motor block, sedation, and nausea. No cesarean section or instrumental delivery was performed. Oxytocin augmentation was needed in 33.3 versus 50% of the parturients in the spinal and epidural groups, respectively. Fetal heart rate disturbances were seen in 10% in the epidural group versus 6.6% in the spinal group. Apgar scores were high and no neonate had Apgar score less than 7 in either group. The overall cost was lower in the spinal group compared with the epidural group. Conclusion Single-dose intrathecal local anesthetic with narcotics is shown to relieve pain safely in most laboring women, with rapid onset and prolonged duration of labor analgesia comparable to that of epidural analgesia while being more easily performed, less time-consuming, and less expensive, and providing similarly excellent analgesia.
目的评价单剂量布比卡因联合芬太尼作为硬膜外分娩镇痛的安全有效替代方案。患者和方法入选美国麻醉学学会I-II分会，年龄20-30岁，单次无并发症妊娠的女性60例。患者被随机分为两组:脊柱组接受0.5%布比卡因高压治疗，剂量为1 ml，加25 μg芬太尼(0.5 ml)，而硬膜外组接受0.25%布比卡因，剂量为14 ml，硬膜外背景输注0.125%布比卡因，剂量为10 ml/h。用视觉模拟量表记录疼痛强度。分娩后疼痛缓解的质量也与患者满意度有关。副作用如低血压、运动阻滞、瘙痒、镇静和恶心。记录产科参数和Apgar评分，并对所有结果进行比较。结果脊髓组感觉阻滞发生时间较硬膜外组早(5.6±1.27 vs 8.8±1.62 min, P < 0.001)， 5、60、90、120、150 min的视觉模拟评分较硬膜外组低。这些结果均有统计学意义。脊髓组90%的产妇和硬膜外组62%的产妇认为镇痛质量优良。两组均未见明显血流动力学变化。两组在运动阻滞、镇静和恶心方面无显著差异。未进行剖宫产或器械分娩。脊髓组和硬膜外组分别有33.3%和50%的产妇需要催产素增强。硬膜外麻醉组胎儿心率紊乱发生率为10%，脊髓麻醉组为6.6%。两组新生儿Apgar评分均较高，均未低于7分。与硬膜外组相比，脊髓组的总成本较低。结论单剂量鞘内局麻加麻醉品可安全缓解大多数产妇的疼痛，与硬膜外镇痛相比，分娩镇痛起效快、持续时间长，且操作简单、耗时短、费用低，镇痛效果同样优异。
{"title":"Intrathecal hyperbaric bupivacaine with fentanyl for labor pain control: a comparative study with continuous epidural analgesia with bupivacaine","authors":"M. Younes, K. Gamil, A. Elgarhy","doi":"10.4103/1687-7934.238463","DOIUrl":"https://doi.org/10.4103/1687-7934.238463","url":null,"abstract":"Objective The aim of the study was to assess single-dose intrathecal bupivacaine in combination with fentanyl as a safe and effective alternative to epidural for labor analgesia. Patients and methods Sixty women aged 20–30 years, of American Society of Anesthesiology I–II, and with a single uncomplicated pregnancy were included in this study. Patients were randomly allocated to two equal groups: the spinal group received hyperbaric bupivacaine 0.5% at a dose of 1 ml plus 25 μg fentanyl (0.5 ml), whereas the epidural group received bupivacaine 0.25% at a 14 ml bolus dose with a background epidural infusion of bupivacaine 0.125% at 10 ml/h. Pain intensity was recorded on a visual analogue scale. The quality of pain relief was also related to patient satisfaction after delivery. Side effects such as hypotension, motor block, pruritus, sedation, and nausea were noted. Obstetric parameters and Apgar score were noted, and all results were compared. Results Onset of sensory block was earlier (5.6 ± 1.27 vs. 8.8 ± 1.62 min, P < 0.001) and visual analogue scale at 5, 60, 90, 120, and 150 min was lower in the spinal group compared with the epidural group. All these results were statistically signifi cant. Ninety percent of the parturients in the spinal group versus 62% in the epidural group scored the analgesic quality as excellent. No significant hemodynamic changes were recorded in either group. There were no significant differences between the two groups in motor block, sedation, and nausea. No cesarean section or instrumental delivery was performed. Oxytocin augmentation was needed in 33.3 versus 50% of the parturients in the spinal and epidural groups, respectively. Fetal heart rate disturbances were seen in 10% in the epidural group versus 6.6% in the spinal group. Apgar scores were high and no neonate had Apgar score less than 7 in either group. The overall cost was lower in the spinal group compared with the epidural group. Conclusion Single-dose intrathecal local anesthetic with narcotics is shown to relieve pain safely in most laboring women, with rapid onset and prolonged duration of labor analgesia comparable to that of epidural analgesia while being more easily performed, less time-consuming, and less expensive, and providing similarly excellent analgesia.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81048696","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 Intraoperative bleeding during functional endoscopic sinus surgery (FESS) leads to poor visibility of the surgical field, and is of major concern. Controlled hypotension, using a variety of pharmacological agents, during general anesthesia reduces blood loss and helps clear visibility of the surgical field during FESS. The aim of this study was to compare the surgical conditions for FESS during controlled hypotension provided by nitroglycerin (NTG) versus magnesium sulfate (MGS) under general anesthesia. Patients and methods Fifty adult patients of both sexes requiring FESS under general anesthesia were randomly divided to receive either NTG infusion of 3–5 µg/kg/min (group NTG, n=25) or MGS (group MGS, n=25) 30 mg/kg, administered as a slow intravenous bolus and 10 mg/kg/h by continuous infusion during the operation, to provide controlled hypotension. In both the groups, the mean arterial blood pressure was reduced until the targeted mean arterial blood pressure (55–65 mmHg) was achieved. Results Both drugs produced the desired hypotension, in the magnesium group there were better operative conditions, reduction in the duration of surgery (85.3±13.1 vs. 92.9±10.3 min) and reduced anesthetic requirements [average end-tidal sevoflurane concentration (vol %) and fentanyl consumption (μg); P<0.0001]. However, there was longer extubation time (10.0±2.9 vs. 5.5±2.3 min) and recovery time (16.7±4.4 vs. 9.8±2.3 min) in comparison with the NTG group. Heart rate values were significantly higher in the NTG group compared with the magnesium group (P<0.0004). Conclusion Both NTG and MGS can be used safely to provide controlled hypotension during FESS. However, MGS was better as it provided optimum surgical condition and less tachycardia. In addition, it led to decreased anesthetic requirements.
背景:功能性内窥镜鼻窦手术(FESS)术中出血导致手术视野不清晰，是一个主要的问题。在全身麻醉期间，使用多种药物控制低血压，减少失血，并有助于在FESS期间清晰手术视野。本研究的目的是比较全身麻醉下硝酸甘油(NTG)和硫酸镁(MGS)提供的控制性低血压期间FESS的手术条件。患者和方法50例需要全麻FESS的成年患者，随机分为两组，分别给予3-5µg/kg/min的NTG (NTG组，n=25)和30 mg/kg的MGS (MGS组，n=25)，术中缓慢静脉滴注，10 mg/kg/h，持续滴注，以控制低血压。在两组中，平均动脉血压都有所降低，直到达到目标平均动脉血压(55-65 mmHg)。结果两种药物均达到预期降压效果，镁组手术条件较好，手术时间缩短(85.3±13.1 vs 92.9±10.3 min)，麻醉需用量[平均潮末七氟醚浓度(vol %)和芬太尼用量(μg)]减少;P < 0.0001)。但拔管时间(10.0±2.9 vs. 5.5±2.3 min)和恢复时间(16.7±4.4 vs. 9.8±2.3 min)较NTG组明显延长。NTG组心率值显著高于镁组(P<0.0004)。结论NTG和MGS均可安全用于FESS术中控制性降压。然而，MGS的效果更好，因为它提供了最佳的手术条件和较少的心动过速。此外，它还减少了麻醉需求。
{"title":"Controlled hypotension for functional endoscopic sinus surgery: a Comparative study between magnesium sulfate and nitroglycerin","authors":"R. Shoukry, A. Mahmoud","doi":"10.4103/asja.asja_46_16","DOIUrl":"https://doi.org/10.4103/asja.asja_46_16","url":null,"abstract":"Background Intraoperative bleeding during functional endoscopic sinus surgery (FESS) leads to poor visibility of the surgical field, and is of major concern. Controlled hypotension, using a variety of pharmacological agents, during general anesthesia reduces blood loss and helps clear visibility of the surgical field during FESS. The aim of this study was to compare the surgical conditions for FESS during controlled hypotension provided by nitroglycerin (NTG) versus magnesium sulfate (MGS) under general anesthesia. Patients and methods Fifty adult patients of both sexes requiring FESS under general anesthesia were randomly divided to receive either NTG infusion of 3–5 µg/kg/min (group NTG, n=25) or MGS (group MGS, n=25) 30 mg/kg, administered as a slow intravenous bolus and 10 mg/kg/h by continuous infusion during the operation, to provide controlled hypotension. In both the groups, the mean arterial blood pressure was reduced until the targeted mean arterial blood pressure (55–65 mmHg) was achieved. Results Both drugs produced the desired hypotension, in the magnesium group there were better operative conditions, reduction in the duration of surgery (85.3±13.1 vs. 92.9±10.3 min) and reduced anesthetic requirements [average end-tidal sevoflurane concentration (vol %) and fentanyl consumption (μg); P<0.0001]. However, there was longer extubation time (10.0±2.9 vs. 5.5±2.3 min) and recovery time (16.7±4.4 vs. 9.8±2.3 min) in comparison with the NTG group. Heart rate values were significantly higher in the NTG group compared with the magnesium group (P<0.0004). Conclusion Both NTG and MGS can be used safely to provide controlled hypotension during FESS. However, MGS was better as it provided optimum surgical condition and less tachycardia. In addition, it led to decreased anesthetic requirements.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89443314","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}
Pub Date : 2017-01-01DOI: 10.4103/1687-7934.238459
Hoda Shokri
Background Ultrasound (U/S)-guided rectus sheath block is an effective analgesic technique in elective pediatric laparoscopic surgical procedures. The aim of the study was to evaluate the efficacy of rectus sheath block for pain management following laparoscopic orchiopexy surgery. Patients and methods A total of 50 patients undergoing elective laparoscopic orchiopexy were allocated randomly into two groups: the U/S-guided rectus sheath block group (the REC group) and the general anesthesia-only group (the GA group), in which no rectus sheath block was performed. All patients received the same general anesthetic technique. In the REC group, patients received bilateral U/S-guided rectus sheath block, using 0.4 ml/kg of 0.25% bupivacaine, and morphine (0.1 mg/kg) was administered for rescue analgesia postoperatively and its total dose was recorded. Pain was measured by means of Children’s Hospital of Eastern Ontario Pain Scale score. Hospital stay and the incidence of respiratory depression or vomiting were recorded. Results In all, 50 patients completed the study. The total dose of morphine used over 24 h was significantly lower in the REC group. Children’s Hospital of Eastern Ontario Pain Scale scores were significantly lower in the REC group during the first 3 h postoperatively, and the incidence of vomiting, respiratory depression, and oxygen saturation in the postanesthesia care unit showed no significant difference between the study groups. Hospital stay was significantly shorter in the REC group compared with the GA group. Conclusion U/S-guided rectus sheath block is an effective analgesic technique with morphine-sparing effect after laparoscopic orchiopexy surgery.
{"title":"The efficacy of rectus sheath block for pain management following laparoscopic orchiopexy surgery","authors":"Hoda Shokri","doi":"10.4103/1687-7934.238459","DOIUrl":"https://doi.org/10.4103/1687-7934.238459","url":null,"abstract":"Background Ultrasound (U/S)-guided rectus sheath block is an effective analgesic technique in elective pediatric laparoscopic surgical procedures. The aim of the study was to evaluate the efficacy of rectus sheath block for pain management following laparoscopic orchiopexy surgery. Patients and methods A total of 50 patients undergoing elective laparoscopic orchiopexy were allocated randomly into two groups: the U/S-guided rectus sheath block group (the REC group) and the general anesthesia-only group (the GA group), in which no rectus sheath block was performed. All patients received the same general anesthetic technique. In the REC group, patients received bilateral U/S-guided rectus sheath block, using 0.4 ml/kg of 0.25% bupivacaine, and morphine (0.1 mg/kg) was administered for rescue analgesia postoperatively and its total dose was recorded. Pain was measured by means of Children’s Hospital of Eastern Ontario Pain Scale score. Hospital stay and the incidence of respiratory depression or vomiting were recorded. Results In all, 50 patients completed the study. The total dose of morphine used over 24 h was significantly lower in the REC group. Children’s Hospital of Eastern Ontario Pain Scale scores were significantly lower in the REC group during the first 3 h postoperatively, and the incidence of vomiting, respiratory depression, and oxygen saturation in the postanesthesia care unit showed no significant difference between the study groups. Hospital stay was significantly shorter in the REC group compared with the GA group. Conclusion U/S-guided rectus sheath block is an effective analgesic technique with morphine-sparing effect after laparoscopic orchiopexy surgery.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79520987","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}
Pub Date : 2017-01-01DOI: 10.4103/asja.asja_126_16
Asmaa Abdellah, Fatma Ashour, Enas Elshanawany
Background Thoracic paravertebral block (TPVB) is an effective technique in controlling pain after lower thoracic and upper abdominal surgery, and ultrasound guidance is a recent technique that may offer several advantages. Intraperitoneal injections of local anesthetics have been proposed to minimize postoperative pain after laparoscopic surgery. Patients and methods A total of 60 patients with American Society of Anesthesiologists status I and II aged 30–50 years undergoing elective laparoscopic cholecystectomy were divided into three equal groups (20 patients each): ultrasound-guided thoracic paravertebral block (UG-TPVB group) with 20 ml 0.25% bupivacaine bilaterally, intraperitoneal instillation of local anesthetics with 50 ml 0.25% bupivacaine after inflation of the abdomen with gas (IP group), and general anesthesia alone without any local anesthetics (GA group) (control group). General anesthesia was induced for all patients. Intraoperative and postoperative hemodynamic data (mean arterial blood pressure and heart rate) were recorded. Intraoperative anesthetic and analgesic consumption, pain intensity using visual analog scale, pethidine consumption, serum cortisol, blood glucose level, and complications were estimated. Results Hemodynamic data were significantly lower in IP and UG-TPVB groups compared with GA group (P<0.05), and on comparing UG-TPVB group with IP group, with no significant difference was seen regarding postanaesthesia care unit admission and discharge (P1>0.05). End-tidal sevoflurane % (UG-TPVB: 1.1±0.21, IP: 1.8±0.22, GA: 2±0.23) and volume of consumption (UG-TPVB: 12.0±0.9, IP: 15.1±0.7, GA: 18.2±2) showed significant decrease when comparing UG-TPVB and IP groups with GA group (P<0.05). The mean dose of intraoperative fentanyl, mean dose of postoperative pethidine consumption, and the number of patients who received pethidine were significantly lower in IP and UG-TPVB groups compared with GA group (P<0.05). Postoperative serum cortisol and blood glucose level showed significant decrease in UG-TPVB and IP groups compared with GA group at 6 and 24 h postoperative (P<0.05). Pain score using visual analog scale and number of patients who experienced postoperative nausea and vomiting were significantly decreased in both groups in comparison with GA group. Conclusion UG-TPVB and IP bupivacaine instillation as pre-emptive analgesia in laparoscopic cholecystectomy provided good intraoperative and postoperative analgesia and decreased the dose of anesthetics used with great safety, and the incidence of complications was less.
{"title":"Comparative study between ultrasound-guided thoracic paravertebral nerve block and intraperitoneal instillation of local anesthetic as pre-emptive analgesia in laparoscopic cholecystectomy surgery","authors":"Asmaa Abdellah, Fatma Ashour, Enas Elshanawany","doi":"10.4103/asja.asja_126_16","DOIUrl":"https://doi.org/10.4103/asja.asja_126_16","url":null,"abstract":"Background Thoracic paravertebral block (TPVB) is an effective technique in controlling pain after lower thoracic and upper abdominal surgery, and ultrasound guidance is a recent technique that may offer several advantages. Intraperitoneal injections of local anesthetics have been proposed to minimize postoperative pain after laparoscopic surgery. Patients and methods A total of 60 patients with American Society of Anesthesiologists status I and II aged 30–50 years undergoing elective laparoscopic cholecystectomy were divided into three equal groups (20 patients each): ultrasound-guided thoracic paravertebral block (UG-TPVB group) with 20 ml 0.25% bupivacaine bilaterally, intraperitoneal instillation of local anesthetics with 50 ml 0.25% bupivacaine after inflation of the abdomen with gas (IP group), and general anesthesia alone without any local anesthetics (GA group) (control group). General anesthesia was induced for all patients. Intraoperative and postoperative hemodynamic data (mean arterial blood pressure and heart rate) were recorded. Intraoperative anesthetic and analgesic consumption, pain intensity using visual analog scale, pethidine consumption, serum cortisol, blood glucose level, and complications were estimated. Results Hemodynamic data were significantly lower in IP and UG-TPVB groups compared with GA group (P<0.05), and on comparing UG-TPVB group with IP group, with no significant difference was seen regarding postanaesthesia care unit admission and discharge (P1>0.05). End-tidal sevoflurane % (UG-TPVB: 1.1±0.21, IP: 1.8±0.22, GA: 2±0.23) and volume of consumption (UG-TPVB: 12.0±0.9, IP: 15.1±0.7, GA: 18.2±2) showed significant decrease when comparing UG-TPVB and IP groups with GA group (P<0.05). The mean dose of intraoperative fentanyl, mean dose of postoperative pethidine consumption, and the number of patients who received pethidine were significantly lower in IP and UG-TPVB groups compared with GA group (P<0.05). Postoperative serum cortisol and blood glucose level showed significant decrease in UG-TPVB and IP groups compared with GA group at 6 and 24 h postoperative (P<0.05). Pain score using visual analog scale and number of patients who experienced postoperative nausea and vomiting were significantly decreased in both groups in comparison with GA group. Conclusion UG-TPVB and IP bupivacaine instillation as pre-emptive analgesia in laparoscopic cholecystectomy provided good intraoperative and postoperative analgesia and decreased the dose of anesthetics used with great safety, and the incidence of complications was less.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80411072","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}
Pub Date : 2017-01-01DOI: 10.4103/1687-7934.238452
A. Kasem, F. Elbokl, H. Elzahaby, Hisham Elazzazy, A. Elsayed
Objective The aim of this study was to compare the use of remifentanil and propofol infusion plus low-dose atracurium besylate technique with the commonly used inhalational technique using sevoflurane with fentanyl for children undergoing bronchoscopy for foreign body (FB) removal. Patients and methods This prospective randomized-controlled trial was conducted at Ain Shams University Hospitals. Sixty children aged 1–5 years planned for elective or emergency FB removal by bronchoscopy were included in the current study. The recruited children were assigned randomly into two groups: group I: total intravenous anesthesia (TIVA group) (remifentanil, propofol, and low-dose atracurium besylate); group II: volatile induction and maintenance of anesthesia (VIMA) (sevoflurane and fentanyl). Intraoperative and postoperative measurements and complications were recorded. Results There was no statistically significant difference between both groups in induction time, bronchoscopy time, time for discharge from the recovery room, and emergence time between both groups. The number of bronchoscopy attempts, interruptions of bronchoscopy, and body movements were significantly higher in the VIMA group than the TIVA group; satisfaction with surgery was greater in the TIVA group than the VIMA group. There was no difference between groups in the incidence of complications, except for postoperative agitation, with a higher incidence in the VIMA group compared with the TIVA group. Conclusion The use of 0.1 µg/kg/min remifentanil-propofol TIVA, plus a small dose (0.25 mg/kg) of atracurium besylate at induction, provided stable hemodynamics, better surgeon satisfaction, and less postoperative agitation compared with sevoflurane 2% in 100% oxygen plus fentanyl 1 µg/kg in children undergoing tracheobronchial FB removal during rigid bronchoscopy.
{"title":"Propofol, remifentanil, and low-dose atracurium besylate versus sevoflurane and fentanyl for bronchoscopy in children: a randomized-controlled trial","authors":"A. Kasem, F. Elbokl, H. Elzahaby, Hisham Elazzazy, A. Elsayed","doi":"10.4103/1687-7934.238452","DOIUrl":"https://doi.org/10.4103/1687-7934.238452","url":null,"abstract":"Objective The aim of this study was to compare the use of remifentanil and propofol infusion plus low-dose atracurium besylate technique with the commonly used inhalational technique using sevoflurane with fentanyl for children undergoing bronchoscopy for foreign body (FB) removal. Patients and methods This prospective randomized-controlled trial was conducted at Ain Shams University Hospitals. Sixty children aged 1–5 years planned for elective or emergency FB removal by bronchoscopy were included in the current study. The recruited children were assigned randomly into two groups: group I: total intravenous anesthesia (TIVA group) (remifentanil, propofol, and low-dose atracurium besylate); group II: volatile induction and maintenance of anesthesia (VIMA) (sevoflurane and fentanyl). Intraoperative and postoperative measurements and complications were recorded. Results There was no statistically significant difference between both groups in induction time, bronchoscopy time, time for discharge from the recovery room, and emergence time between both groups. The number of bronchoscopy attempts, interruptions of bronchoscopy, and body movements were significantly higher in the VIMA group than the TIVA group; satisfaction with surgery was greater in the TIVA group than the VIMA group. There was no difference between groups in the incidence of complications, except for postoperative agitation, with a higher incidence in the VIMA group compared with the TIVA group. Conclusion The use of 0.1 µg/kg/min remifentanil-propofol TIVA, plus a small dose (0.25 mg/kg) of atracurium besylate at induction, provided stable hemodynamics, better surgeon satisfaction, and less postoperative agitation compared with sevoflurane 2% in 100% oxygen plus fentanyl 1 µg/kg in children undergoing tracheobronchial FB removal during rigid bronchoscopy.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90730150","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 With the advent of opioid receptors, a variety of opioid agents are added to local anesthetic mixtures used in peripheral blocks to improve the quality and duration of block. In this study, we compared the effect of butorphanol and tramadol as adjuvant agents for orthopedic upper extremity surgery. Patients and methods This study was carried out on 50 patients aged between 18 and 60 years, of American Society of Anesthesiologists grades I and II, of either sexes in each group, undergoing orthopedic upper limb surgeries through axillary brachial plexus block. An injection of butorphanol 2 mg (group B) and that of tramadol 100 mg (group T) were added to local anesthetic mixture. Onset of sensory and motor blockade, extent of blockade, and occurrence of any complications were studied in both groups. All patients were observed for analgesia postoperatively by visual analog scale pain score. Results In our study, the onset time (minutes) of sensory and motor blockade was delayed in group B (8.76±1.0 and 5.86±0.71, respectively) as compared with group T (7.54±0.88 and 4.6±0.73, respectively). In group B, the duration of sensory block (291.24±48.51 min) was longer than group T (160.42±12.66 min). Duration of analgesia postoperatively (first rescue analgesic) was 619.96±26.96 min in group B, whereas it was 290.2±20.38 min in group T. Conclusion Butorphanol is more potent and produces longer duration of postoperative analgesia than tramadol, with an extra advantage of sedation and calmness.
{"title":"Comparison of butorphanol and tramadol as an adjuvant to local anesthetic drug in axillary brachial plexus block","authors":"U. Bhatia, Gauri. M Panjabi, Atisha Patel","doi":"10.4103/asja.asja_51_16","DOIUrl":"https://doi.org/10.4103/asja.asja_51_16","url":null,"abstract":"Background With the advent of opioid receptors, a variety of opioid agents are added to local anesthetic mixtures used in peripheral blocks to improve the quality and duration of block. In this study, we compared the effect of butorphanol and tramadol as adjuvant agents for orthopedic upper extremity surgery. Patients and methods This study was carried out on 50 patients aged between 18 and 60 years, of American Society of Anesthesiologists grades I and II, of either sexes in each group, undergoing orthopedic upper limb surgeries through axillary brachial plexus block. An injection of butorphanol 2 mg (group B) and that of tramadol 100 mg (group T) were added to local anesthetic mixture. Onset of sensory and motor blockade, extent of blockade, and occurrence of any complications were studied in both groups. All patients were observed for analgesia postoperatively by visual analog scale pain score. Results In our study, the onset time (minutes) of sensory and motor blockade was delayed in group B (8.76±1.0 and 5.86±0.71, respectively) as compared with group T (7.54±0.88 and 4.6±0.73, respectively). In group B, the duration of sensory block (291.24±48.51 min) was longer than group T (160.42±12.66 min). Duration of analgesia postoperatively (first rescue analgesic) was 619.96±26.96 min in group B, whereas it was 290.2±20.38 min in group T. Conclusion Butorphanol is more potent and produces longer duration of postoperative analgesia than tramadol, with an extra advantage of sedation and calmness.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77598621","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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