Pub Date : 2016-07-01DOI: 10.4103/1687-7934.189568
Tanuj Kumawat, Varsha Kothari, S. Priyadarshi, Tuhin Mistry, S. Morwal
Background Percutaneous nephrolithotomy (PCNL) is the preferred surgical technique for large renal stones (>2 cm in diameter), which involves keyhole surgery through a 1 cm incision on the skin overlying the kidney. It can be performed under local, regional, as well as general anesthesia (GA). We have compared the efficacy and safety of regional epidural anesthesia (EA) and GA in patients undergoing PCNL. Patients and methods In this prospective study, a total of 112 patients of American Society of Anesthesiologists physical status I and II undergoing PCNL were randomized into two groups. Patients in group A (n=56) received regional EA (with lignocaine and bupivacaine), and group B (n=56) patients received standard GA. The postoperative visual analog scale (VAS) score, amount of postoperative analgesic use, adverse effects, operative time, and blood loss were evaluated and compared between the two groups. Results The mean VAS score at 1 h was 1.25 in group A and 5.21 in group B (P<0.001), at 3 h it was 3.05 in group A and 5.04 in group B (P<0.001), and at 6 h it was 3.04 in group A and 4.79 in group B (P<0.001). Less analgesia was required in the EA group compared with the GA group (P<0.001). Five (8.92%) patients in group A and 21 (37.50%) patients in group B had postoperative nausea (P<0.05). Pain score at 18 and 24 h, operative time, postoperative hemoglobin level, and adverse effects were not significantly different between the two groups. Conclusion EA is a good alternative anesthetic technique for PCNL with less analgesic consumption and fewer complications as compared to GA.
背景:经皮肾镜取石术(PCNL)是治疗大肾结石(直径> 2cm)的首选手术技术，它需要在肾上皮肤上开一个1cm的锁孔手术。它可以在局部、区域和全身麻醉(GA)下进行。我们比较了局部硬膜外麻醉(EA)和局部硬膜外麻醉(GA)在PCNL患者中的疗效和安全性。患者与方法在本前瞻性研究中，将112例美国麻醉医师学会物理状态I和II的PCNL患者随机分为两组。A组(n=56)患者接受局部EA(联合利多卡因和布比卡因)，B组(n=56)患者接受标准GA。比较两组患者术后视觉模拟评分(VAS)、术后镇痛药用量、不良反应、手术时间、出血量。结果A组患者1 h VAS平均评分为1.25,B组评分为5.21 (P<0.001); A组患者3 h VAS平均评分为3.05,B组评分为5.04 (P<0.001); A组患者6 h VAS平均评分为3.04,B组评分为4.79 (P<0.001)。与GA组相比，EA组需要较少的镇痛(P<0.001)。A组术后恶心发生率为5例(8.92%)，B组为21例(37.50%)(P<0.05)。两组患者18、24 h疼痛评分、手术时间、术后血红蛋白水平、不良反应等差异无统计学意义。结论与GA相比，EA是一种较好的PCNL替代麻醉技术，镇痛消耗少，并发症少。
{"title":"A randomized study comparing the efficacy and safety of epidural anesthesia versus general anesthesia in patients undergoing percutaneous nephrolithotomy","authors":"Tanuj Kumawat, Varsha Kothari, S. Priyadarshi, Tuhin Mistry, S. Morwal","doi":"10.4103/1687-7934.189568","DOIUrl":"https://doi.org/10.4103/1687-7934.189568","url":null,"abstract":"Background Percutaneous nephrolithotomy (PCNL) is the preferred surgical technique for large renal stones (>2 cm in diameter), which involves keyhole surgery through a 1 cm incision on the skin overlying the kidney. It can be performed under local, regional, as well as general anesthesia (GA). We have compared the efficacy and safety of regional epidural anesthesia (EA) and GA in patients undergoing PCNL. Patients and methods In this prospective study, a total of 112 patients of American Society of Anesthesiologists physical status I and II undergoing PCNL were randomized into two groups. Patients in group A (n=56) received regional EA (with lignocaine and bupivacaine), and group B (n=56) patients received standard GA. The postoperative visual analog scale (VAS) score, amount of postoperative analgesic use, adverse effects, operative time, and blood loss were evaluated and compared between the two groups. Results The mean VAS score at 1 h was 1.25 in group A and 5.21 in group B (P<0.001), at 3 h it was 3.05 in group A and 5.04 in group B (P<0.001), and at 6 h it was 3.04 in group A and 4.79 in group B (P<0.001). Less analgesia was required in the EA group compared with the GA group (P<0.001). Five (8.92%) patients in group A and 21 (37.50%) patients in group B had postoperative nausea (P<0.05). Pain score at 18 and 24 h, operative time, postoperative hemoglobin level, and adverse effects were not significantly different between the two groups. Conclusion EA is a good alternative anesthetic technique for PCNL with less analgesic consumption and fewer complications as compared to GA.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"16 1","pages":"353 - 357"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82933977","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 : 2016-07-01DOI: 10.4103/1687-7934.189096
A. Shoukry, W. Nofal, S. Elfawal
Background Laparoscopic surgeries are being widely conducted nowadays for its well-known advantages such as less postoperative pain, shorter length of hospital stay, decreased morbidity and mortality, and reduced healthcare costs. Many analgesic modalities have been applied for this type of surgery, of which we have chosen the intraperitoneal injection (IP) of local anesthetics and the transversus abdominis plane (TAP) block. We studied the effect of both techniques on postoperative pain scores and their effect on abdominal and shoulder pain after laparoscopic colectomy. Patients and methods Fifty patients were enrolled in the study. All of them were of American Society of Anesthesiology (ASA) physical status I or II and scheduled for elective laparoscopic colectomy surgery. Patients were randomly allocated into one of two groups (25 patients each): the TAP block group (TAP group) and the IP of local anesthetics group (IP group). Pain score using the numerical rating scale (NRS), hemodynamic parameters, amount of consumption of rescue analgesia, shoulder pain, and adverse reactions were recorded. Results The main outcome variable was the pain score in the immediate postoperative period and the next 3 h; the mean NRS scores were lower in the TAP group than in the IP group in the previously mentioned time periods, with a highly significant difference. Also, there was a significant difference in the NRS score at the fourth hour postoperatively; however, the subsequent NRS scores at the different time intervals showed no significant difference until the end of the 24th hour postoperatively. In the TAP group, 20 patients (80%) complained of abdominal pain at least once in the first 24 h after surgery, whereas all the patients in the IP group experienced abdominal pain, with a significant difference between the two groups. The overall analgesic consumption in milligrams and the total number of analgesic doses were found to be less in the TAP group, with a highly significant difference. Conclusion The results of this study demonstrated that the TAP block is a more effective analgesic modality for abdominal pain than the IP local anesthetic during the early postoperative period after laparoscopic colectomy but IP is more effective in relieving postoperative shoulder pain.
{"title":"Comparative study evaluating the efficacy of ultrasound-guided transversus abdominis plain block versus intraperitoneal injection of local anesthetics in pain control following laparoscopic colectomy","authors":"A. Shoukry, W. Nofal, S. Elfawal","doi":"10.4103/1687-7934.189096","DOIUrl":"https://doi.org/10.4103/1687-7934.189096","url":null,"abstract":"Background Laparoscopic surgeries are being widely conducted nowadays for its well-known advantages such as less postoperative pain, shorter length of hospital stay, decreased morbidity and mortality, and reduced healthcare costs. Many analgesic modalities have been applied for this type of surgery, of which we have chosen the intraperitoneal injection (IP) of local anesthetics and the transversus abdominis plane (TAP) block. We studied the effect of both techniques on postoperative pain scores and their effect on abdominal and shoulder pain after laparoscopic colectomy. Patients and methods Fifty patients were enrolled in the study. All of them were of American Society of Anesthesiology (ASA) physical status I or II and scheduled for elective laparoscopic colectomy surgery. Patients were randomly allocated into one of two groups (25 patients each): the TAP block group (TAP group) and the IP of local anesthetics group (IP group). Pain score using the numerical rating scale (NRS), hemodynamic parameters, amount of consumption of rescue analgesia, shoulder pain, and adverse reactions were recorded. Results The main outcome variable was the pain score in the immediate postoperative period and the next 3 h; the mean NRS scores were lower in the TAP group than in the IP group in the previously mentioned time periods, with a highly significant difference. Also, there was a significant difference in the NRS score at the fourth hour postoperatively; however, the subsequent NRS scores at the different time intervals showed no significant difference until the end of the 24th hour postoperatively. In the TAP group, 20 patients (80%) complained of abdominal pain at least once in the first 24 h after surgery, whereas all the patients in the IP group experienced abdominal pain, with a significant difference between the two groups. The overall analgesic consumption in milligrams and the total number of analgesic doses were found to be less in the TAP group, with a highly significant difference. Conclusion The results of this study demonstrated that the TAP block is a more effective analgesic modality for abdominal pain than the IP local anesthetic during the early postoperative period after laparoscopic colectomy but IP is more effective in relieving postoperative shoulder pain.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"19 1","pages":"358 - 365"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82183351","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 : 2016-07-01DOI: 10.4103/1687-7934.189567
Lobna A Saleh, A. Hassan, A. Sobhy
Increased bleeding tendency is associated with the use of selective serotonin reuptake inhibitors. In this study, we report a case of perioperative bleeding in patient on selective serotonin reuptake inhibitors. The management options for such cases are discussed.
{"title":"Management of perioperative bleeding associated with the use of selective serotonin reuptake inhibitors","authors":"Lobna A Saleh, A. Hassan, A. Sobhy","doi":"10.4103/1687-7934.189567","DOIUrl":"https://doi.org/10.4103/1687-7934.189567","url":null,"abstract":"Increased bleeding tendency is associated with the use of selective serotonin reuptake inhibitors. In this study, we report a case of perioperative bleeding in patient on selective serotonin reuptake inhibitors. The management options for such cases are discussed.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"6 1","pages":"449 - 451"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79656282","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 : 2016-07-01DOI: 10.4103/1687-7934.189090
G. Gad
Background Although a high fraction of inspired oxygen (FiO2) could reduce surgical site infection, there is a concern that it could increase postoperative pulmonary complications, including hypoxemia. However, there is an advantage for preoperative high FiO2 before induction of anesthesia as it decreases the incidences of desaturation and wound infection. Our aim was to assess whether different levels of FiO2 affect pulmonary function tests. Patients and methods Ninety patients scheduled for elective abdominal hysterectomy were randomized to receive either preoxygenation with 1.0 FiO2 for 3 min, then continued on 1.0 FiO2 till the end of surgery (group A), or preoxygenation with 1.0 FiO2 for 3 min, then continued on 0.4 FiO2 till the end of surgery (group B), or preoxygenation with 0.4 FiO2 then continued on 0.4 FiO2 till the end of surgery (group C). The oxygenation index (PaO2/FiO2) was measured every 30 min during anesthesia and 2 h after extubation. Pulmonary function test was measured on the morning of surgery and 2 h after extubation. Results Five minutes after intubation, the median PaO2/FiO2 was 483 (371–490) mmHg in group A, 420 (336–490) mmHg in group B, and 450 (350–485) mmHg in group C (P = 0.24). Two hours after extubation, the PaO2/FiO2 was reduced to 333 (314–342) mmHg in group A, 328 (311–357) mmHg in group B, and 342 (303–316) mmHg in group C (P = 0.55). The median functional vital capacity were 1950 (1600–2120), 1850 (1570–2250), and 1900 (1490–2020) ml at baseline and 1650 (1370–1953), 1670 (1340–2350), and 1711 (1412–2410) ml 2 h after extubation in groups A, B, and C, respectively (P = 0.66). Conclusion We found no significant difference in the oxygenation index or pulmonary function tests between patients administered different levels of FiO2.
{"title":"Effect of high fractional inspiratory oxygen on postoperative pulmonary function: a randomized–controlled study","authors":"G. Gad","doi":"10.4103/1687-7934.189090","DOIUrl":"https://doi.org/10.4103/1687-7934.189090","url":null,"abstract":"Background Although a high fraction of inspired oxygen (FiO2) could reduce surgical site infection, there is a concern that it could increase postoperative pulmonary complications, including hypoxemia. However, there is an advantage for preoperative high FiO2 before induction of anesthesia as it decreases the incidences of desaturation and wound infection. Our aim was to assess whether different levels of FiO2 affect pulmonary function tests. Patients and methods Ninety patients scheduled for elective abdominal hysterectomy were randomized to receive either preoxygenation with 1.0 FiO2 for 3 min, then continued on 1.0 FiO2 till the end of surgery (group A), or preoxygenation with 1.0 FiO2 for 3 min, then continued on 0.4 FiO2 till the end of surgery (group B), or preoxygenation with 0.4 FiO2 then continued on 0.4 FiO2 till the end of surgery (group C). The oxygenation index (PaO2/FiO2) was measured every 30 min during anesthesia and 2 h after extubation. Pulmonary function test was measured on the morning of surgery and 2 h after extubation. Results Five minutes after intubation, the median PaO2/FiO2 was 483 (371–490) mmHg in group A, 420 (336–490) mmHg in group B, and 450 (350–485) mmHg in group C (P = 0.24). Two hours after extubation, the PaO2/FiO2 was reduced to 333 (314–342) mmHg in group A, 328 (311–357) mmHg in group B, and 342 (303–316) mmHg in group C (P = 0.55). The median functional vital capacity were 1950 (1600–2120), 1850 (1570–2250), and 1900 (1490–2020) ml at baseline and 1650 (1370–1953), 1670 (1340–2350), and 1711 (1412–2410) ml 2 h after extubation in groups A, B, and C, respectively (P = 0.66). Conclusion We found no significant difference in the oxygenation index or pulmonary function tests between patients administered different levels of FiO2.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"22 1","pages":"337 - 342"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89373206","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 : 2016-07-01DOI: 10.4103/1687-7934.189102
Abd-Elazeem El Bakry, E. Ibrahim
Background Shivering is a common complication in elderly patients undergoing urologic operations under spinal anesthesia. The present study compares the effect of prophylactic dexamethasone and pethidine on shivering during transurethral resection of the prostate (TURP) under spinal anesthesia. Patients and methods This random prospective double-blinded controlled study was conducted on 90 patients scheduled for TURP operations under spinal anesthesia. Patients were allocated into three groups: in the C group, patients were administered intravenous 10 ml normal saline before spinal anesthesia. In the P group, patients were administered 25 mg pethidine in 10 ml normal saline. In the D group, patients were administered 0.1 mg/kg dexamethasone in 10 ml normal saline. Core body temperature, mean arterial blood pressure, respiratory rate, oxygen saturation, incidence and severity of shivering, nausea, vomiting, and pruritus were recorded. Results The incidence and severity of shivering were low in the pethidine and dexamethasone groups compared with the control group (P < 0.05), with no significant difference between the pethidine and dexamethasone groups (P > 0.05). Conclusion Prophylactic dexamethasone is as effective as pethidine in reducing the incidence and severity of shivering in TURP patients under spinal anesthesia.
{"title":"Prophylactic dexamethasone or pethidine for the prevention of postoperative shivering during transurethral resection of the prostate under spinal anesthesia","authors":"Abd-Elazeem El Bakry, E. Ibrahim","doi":"10.4103/1687-7934.189102","DOIUrl":"https://doi.org/10.4103/1687-7934.189102","url":null,"abstract":"Background Shivering is a common complication in elderly patients undergoing urologic operations under spinal anesthesia. The present study compares the effect of prophylactic dexamethasone and pethidine on shivering during transurethral resection of the prostate (TURP) under spinal anesthesia. Patients and methods This random prospective double-blinded controlled study was conducted on 90 patients scheduled for TURP operations under spinal anesthesia. Patients were allocated into three groups: in the C group, patients were administered intravenous 10 ml normal saline before spinal anesthesia. In the P group, patients were administered 25 mg pethidine in 10 ml normal saline. In the D group, patients were administered 0.1 mg/kg dexamethasone in 10 ml normal saline. Core body temperature, mean arterial blood pressure, respiratory rate, oxygen saturation, incidence and severity of shivering, nausea, vomiting, and pruritus were recorded. Results The incidence and severity of shivering were low in the pethidine and dexamethasone groups compared with the control group (P < 0.05), with no significant difference between the pethidine and dexamethasone groups (P > 0.05). Conclusion Prophylactic dexamethasone is as effective as pethidine in reducing the incidence and severity of shivering in TURP patients under spinal anesthesia.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"16 1","pages":"349 - 352"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91344482","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 : 2016-07-01DOI: 10.4103/1687-7934.189569
P. Bhalerao, K. Kelkar, Anandlkumar Pande, Bapu P.G. Kakade
A 28-year-old female presented with complaints of fever with chills and dizziness on and off for the last 3 months. On admission, she was investigated and found to have anemia and thrombocytopenia. On examination, the patient was pale and had a palpable huge spleen. Past history revealed a diagnosis of Wilson’s disease 15 years ago. This disease, due to altered copper metabolism, may influence the conduct and outcome of anesthesia secondary to abnormalities in hemopoietic, cardiovascular, connective tissue, immune, and nervous systems. In this study, we present a patient, a diagnosed case of Wilson’s disease, with massive splenomegaly posted for splenectomy under general anesthesia and the concerns involved therein.
{"title":"Copper and anesthesia − a surprising connection","authors":"P. Bhalerao, K. Kelkar, Anandlkumar Pande, Bapu P.G. Kakade","doi":"10.4103/1687-7934.189569","DOIUrl":"https://doi.org/10.4103/1687-7934.189569","url":null,"abstract":"A 28-year-old female presented with complaints of fever with chills and dizziness on and off for the last 3 months. On admission, she was investigated and found to have anemia and thrombocytopenia. On examination, the patient was pale and had a palpable huge spleen. Past history revealed a diagnosis of Wilson’s disease 15 years ago. This disease, due to altered copper metabolism, may influence the conduct and outcome of anesthesia secondary to abnormalities in hemopoietic, cardiovascular, connective tissue, immune, and nervous systems. In this study, we present a patient, a diagnosed case of Wilson’s disease, with massive splenomegaly posted for splenectomy under general anesthesia and the concerns involved therein.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"3 1","pages":"455 - 457"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79028167","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 : 2016-07-01DOI: 10.4103/1687-7934.189094
S. Kaliannan, K. Sherfudeen, P. Dammalapati
Flexible fiberoptic bronchoscope is a delicate instrument that can get damaged due to improper handling. Once damaged, this costly instrument becomes useless. We reported a case in which we used a damaged flexible fiberoptic bronchoscope in overcoming a difficulty in advancing the endotracheal tube after visualization of the vocal cord with TruviewPCD in a patient with cervical spine injury.
{"title":"Innovative use of damaged fiberoptic bronchoscope","authors":"S. Kaliannan, K. Sherfudeen, P. Dammalapati","doi":"10.4103/1687-7934.189094","DOIUrl":"https://doi.org/10.4103/1687-7934.189094","url":null,"abstract":"Flexible fiberoptic bronchoscope is a delicate instrument that can get damaged due to improper handling. Once damaged, this costly instrument becomes useless. We reported a case in which we used a damaged flexible fiberoptic bronchoscope in overcoming a difficulty in advancing the endotracheal tube after visualization of the vocal cord with TruviewPCD in a patient with cervical spine injury.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"30 1","pages":"463 - 464"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87239518","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 : 2016-07-01DOI: 10.4103/1687-7934.189565
Waleed Abdalla, F. Kamel, N. Ali, T. Shabana
Background The use of terlipressin, a long-acting synthetic analog of vasopressin, is associated with reduction in cardiac output and oxygen delivery. The present study was designed to determine whether dobutamine may reverse the terlipressin-induced depression in central venous oxygen saturation (SvO2) in patients with catecholamine-dependent septic shock. Patients and methods This clinical trial was conducted in Ain Shams University hospital’s surgical ICU. In total, 90 septic shock patients requiring a continuous infusion of norepinephrine reaching 0.6 µg/kg/min to maintain mean arterial pressure at greater than or equal to 65 mmHg were randomly allocated to three groups be treated as follows: (i): group I, treated with norepinephrine infusion (control); (ii) group II, treated with a single bolus of terlipressin 1 mg, intravenous; (iii) and group III, treated with a single bolus of terlipressin 1 mg, followed by a dobutamine infusion. Results The use of terlipressin (with and without dobutamine) resulted in maintaining mean arterial pressure above 65 mmHg with reduction in norepinephrine requirements to 0.2 (0.1) µg/kg/min in group II and 0.15 (0.1) µg/kg/min in group III (P in each <0.001 vs. control at 2, 4, and 6 h). The use of terlipressin alone in group II resulted in a drop in central SvO2 to 58 (3)% (P<0.001 vs. control at 2, 4, and 6 h) and a decrease in heart rate to 105 beat/minute (7) (P vs. control=0.013 at 2 h, 0.001 at 4 h, and 0.01 at 6 h). The addition of dobutamine in group III resulted in an increase in central SvO2 to 70 (3)% (P<0.001 vs. group II at 2, 4, and 6 h). Conclusion Administration of terlipressin bolus was effective in increasing mean arterial blood pressure and reducing norepinephrine requirements in catecholamine-dependant septic shock patients. Its use was associated with significant reductions in central SvO2, which was reversed by using dobutamine.
{"title":"A comparative study between terlipressin alone and dobutamine and terlipressin in septic shock patients","authors":"Waleed Abdalla, F. Kamel, N. Ali, T. Shabana","doi":"10.4103/1687-7934.189565","DOIUrl":"https://doi.org/10.4103/1687-7934.189565","url":null,"abstract":"Background The use of terlipressin, a long-acting synthetic analog of vasopressin, is associated with reduction in cardiac output and oxygen delivery. The present study was designed to determine whether dobutamine may reverse the terlipressin-induced depression in central venous oxygen saturation (SvO2) in patients with catecholamine-dependent septic shock. Patients and methods This clinical trial was conducted in Ain Shams University hospital’s surgical ICU. In total, 90 septic shock patients requiring a continuous infusion of norepinephrine reaching 0.6 µg/kg/min to maintain mean arterial pressure at greater than or equal to 65 mmHg were randomly allocated to three groups be treated as follows: (i): group I, treated with norepinephrine infusion (control); (ii) group II, treated with a single bolus of terlipressin 1 mg, intravenous; (iii) and group III, treated with a single bolus of terlipressin 1 mg, followed by a dobutamine infusion. Results The use of terlipressin (with and without dobutamine) resulted in maintaining mean arterial pressure above 65 mmHg with reduction in norepinephrine requirements to 0.2 (0.1) µg/kg/min in group II and 0.15 (0.1) µg/kg/min in group III (P in each <0.001 vs. control at 2, 4, and 6 h). The use of terlipressin alone in group II resulted in a drop in central SvO2 to 58 (3)% (P<0.001 vs. control at 2, 4, and 6 h) and a decrease in heart rate to 105 beat/minute (7) (P vs. control=0.013 at 2 h, 0.001 at 4 h, and 0.01 at 6 h). The addition of dobutamine in group III resulted in an increase in central SvO2 to 70 (3)% (P<0.001 vs. group II at 2, 4, and 6 h). Conclusion Administration of terlipressin bolus was effective in increasing mean arterial blood pressure and reducing norepinephrine requirements in catecholamine-dependant septic shock patients. Its use was associated with significant reductions in central SvO2, which was reversed by using dobutamine.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"119 1","pages":"330 - 336"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77585890","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 : 2016-07-01DOI: 10.4103/1687-7934.189101
S. Elfawal, A. Shoukry, Walid H. Nofal
Background The current prospective randomized double-blind study was designed to compare the clinical efficacy of intrathecal midazolam versus fentanyl when added to hyperbaric ropivacaine, evaluating the effect of each on the duration and quality of spinal blockade produced by hyperbaric ropivacaine. Patients and methods The study was conducted on 90 patients of both sexes, aged 20-60 years, of class I or II of the American Society of Anesthesiologists classification, who were undergoing elective lower-limb surgery. Patients were randomly assigned to three groups (30 patients each): group R (control group) received 3 ml (15 mg) of hyperbaric ropivacaine plus 0.5 ml of normal saline (0.9%) at a total volume of 3.5 ml intrathecally, whereas group RF received 3 ml (15 mg) of hyperbaric ropivacaine plus 0.5 ml of 25 μg fentanyl (50 μg/ml) at a total volume of 3.5 ml intrathecally and group RM received 3 ml (15 mg) of hyperbaric ropivacaine plus 0.5 ml of 1 mg midazolam (2 mg/ml) at a total volume of 3.5 ml intrathecally. The onset and duration of sensory and motor blockade, postoperative pain, and the time to first rescue analgesia request were noted. Patients were observed for hypotension, bradycardia, sedation, respiratory depression, pruritus, and postoperative nausea and vomiting. Results The onset times and the duration of motor blockade were comparable among groups, whereas the time to sensory block regression was longer in group RM and group RF as compared with group R (P < 0.001). The duration of postoperative analgesia was significantly longer in group RM and group RF as compared with group R (P < 0.001), whereas there was no difference between group RM and group RF. The incidence of pruritus and vomiting was higher in group RF. Conclusion Adding midazolam to hyperbaric ropivacaine in spinal anesthesia for lower-limb surgeries is considered a good alternative for improving the duration of sensory block and decreasing the analgesic requirement in the early postoperative period with minimal side effects compared with hyperbaric ropivacaine alone or fentanyl combined with hyperbaric ropivacaine.
{"title":"Comparative study of intrathecal midazolam versus fentanyl as adjuvants to ropivacaine for lower-limb surgery","authors":"S. Elfawal, A. Shoukry, Walid H. Nofal","doi":"10.4103/1687-7934.189101","DOIUrl":"https://doi.org/10.4103/1687-7934.189101","url":null,"abstract":"Background The current prospective randomized double-blind study was designed to compare the clinical efficacy of intrathecal midazolam versus fentanyl when added to hyperbaric ropivacaine, evaluating the effect of each on the duration and quality of spinal blockade produced by hyperbaric ropivacaine. Patients and methods The study was conducted on 90 patients of both sexes, aged 20-60 years, of class I or II of the American Society of Anesthesiologists classification, who were undergoing elective lower-limb surgery. Patients were randomly assigned to three groups (30 patients each): group R (control group) received 3 ml (15 mg) of hyperbaric ropivacaine plus 0.5 ml of normal saline (0.9%) at a total volume of 3.5 ml intrathecally, whereas group RF received 3 ml (15 mg) of hyperbaric ropivacaine plus 0.5 ml of 25 μg fentanyl (50 μg/ml) at a total volume of 3.5 ml intrathecally and group RM received 3 ml (15 mg) of hyperbaric ropivacaine plus 0.5 ml of 1 mg midazolam (2 mg/ml) at a total volume of 3.5 ml intrathecally. The onset and duration of sensory and motor blockade, postoperative pain, and the time to first rescue analgesia request were noted. Patients were observed for hypotension, bradycardia, sedation, respiratory depression, pruritus, and postoperative nausea and vomiting. Results The onset times and the duration of motor blockade were comparable among groups, whereas the time to sensory block regression was longer in group RM and group RF as compared with group R (P < 0.001). The duration of postoperative analgesia was significantly longer in group RM and group RF as compared with group R (P < 0.001), whereas there was no difference between group RM and group RF. The incidence of pruritus and vomiting was higher in group RF. Conclusion Adding midazolam to hyperbaric ropivacaine in spinal anesthesia for lower-limb surgeries is considered a good alternative for improving the duration of sensory block and decreasing the analgesic requirement in the early postoperative period with minimal side effects compared with hyperbaric ropivacaine alone or fentanyl combined with hyperbaric ropivacaine.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"18 1","pages":"432 - 439"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73030159","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 : 2016-07-01DOI: 10.4103/1687-7934.189088
S. Bajwa, S. Kalra, M. Baruah
Introduction The Lancet recently reported on the Global Burden of Disease 2010 (GBD) in a series of landmark epidemiological articles that discuss the causes of morbidity and mortality in people of both sexes, of all age groups, based on data from 187 countries. This seminal treatise has major significance for anesthesia, as it gives us a bird’s eye view of the comorbid conditions one can expect in critical care and anesthesia practice. The increasing prevalence of diabetes mellitus (DM) has significant impact on anesthesiology practice as it can directly and indirectly impact the outcome in surgical patients. A strong need is felt among endocrinologists and anesthesiologists to work in unison so as to manage the increasing number of surgical patients with DM. A universal consensus on therapeutic management strategies in surgical diabetic patients is mandatory between these two specialties to counter this ever‐increasing burden of DM. As such, a strong need is felt to highlight the impact of the DM epidemic in the practice of diabeto‐anesthesia [1]. This communication highlights the global burden of diabetes, as reported by GBD 2010, while emphasizing the surgical and medical aspects of the disease that may impact anesthesia care in times to come [2–4]. (http://www. healthmetricsandevaluation.org/gbd/visualizations/ gbd‐2010‐leading‐causes‐and‐risks‐region‐heat‐map? metric = YLL).
{"title":"Global burden of diabetes: action for anesthesia","authors":"S. Bajwa, S. Kalra, M. Baruah","doi":"10.4103/1687-7934.189088","DOIUrl":"https://doi.org/10.4103/1687-7934.189088","url":null,"abstract":"Introduction The Lancet recently reported on the Global Burden of Disease 2010 (GBD) in a series of landmark epidemiological articles that discuss the causes of morbidity and mortality in people of both sexes, of all age groups, based on data from 187 countries. This seminal treatise has major significance for anesthesia, as it gives us a bird’s eye view of the comorbid conditions one can expect in critical care and anesthesia practice. The increasing prevalence of diabetes mellitus (DM) has significant impact on anesthesiology practice as it can directly and indirectly impact the outcome in surgical patients. A strong need is felt among endocrinologists and anesthesiologists to work in unison so as to manage the increasing number of surgical patients with DM. A universal consensus on therapeutic management strategies in surgical diabetic patients is mandatory between these two specialties to counter this ever‐increasing burden of DM. As such, a strong need is felt to highlight the impact of the DM epidemic in the practice of diabeto‐anesthesia [1]. This communication highlights the global burden of diabetes, as reported by GBD 2010, while emphasizing the surgical and medical aspects of the disease that may impact anesthesia care in times to come [2–4]. (http://www. healthmetricsandevaluation.org/gbd/visualizations/ gbd‐2010‐leading‐causes‐and‐risks‐region‐heat‐map? metric = YLL).","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":"115 1","pages":"317 - 318"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83841951","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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