Pub Date : 2016-07-01DOI: 10.4103/1687-7934.189564
A. A. Abd El-Hamid, Hatem El-Moutaz, A. A. Abdel Moneim
Background and objectives Postoperative pain after laparoscopic cholecystectomy (LC) is unpredictable, which explains the need for systematic prevention of pain before the patient wakes up from anesthesia. The study was conducted to evaluate the effect of intraperitoneal levobupivacaine with or without sufentanil for postoperative analgesia after LC. Patients and methods Ninety patients who underwent elective LC completed the study. Group C (n=29) received 50 ml of intraperitoneal normal saline, group L (n=31) received 50 ml of intraperitoneal levobupivacaine 0.25%, and group LS (n=30) received 50 ml of intraperitoneal levobupivacaine 0.25% plus 20 μg sufentanil. Visual analog score was recorded immediately postoperatively, and at 4, 8, and 12 h postoperatively. In addition, time to first rescue analgesia (diclofenac), total diclofenac consumption in 12 h, and complications (pruritus, emesis, shoulder pain, bradycardia, and hypotension) were recorded. Results Visual analog score until 8 h postoperatively was significantly higher in group C compared with groups L and LS. However, the difference was nonsignificant between groups L and LS, except at 8 and 12 h postoperatively. Time to first rescue analgesia was significantly longer in group LS (134.16±36.5) compared with group C (11.96±5.92) and group L (114.83±35.49) (P<0.001). Total diclofenac consumption in the first 12 h postoperatively was significantly lower in group L (92.5±32.26) and group LS (82.5±22.88) compared with group C (152.5±13.69). Conclusion Intraperitoneal instillation of levobupivacaine with sufentanil reduces not only the intensity of postoperative pain but also the total rescue analgesic dose consumption after LC.
{"title":"Evaluation of intraperitoneal levobupivacaine with and without sufentanil for postoperative analgesia after laparoscopic cholecystectomy","authors":"A. A. Abd El-Hamid, Hatem El-Moutaz, A. A. Abdel Moneim","doi":"10.4103/1687-7934.189564","DOIUrl":"https://doi.org/10.4103/1687-7934.189564","url":null,"abstract":"Background and objectives Postoperative pain after laparoscopic cholecystectomy (LC) is unpredictable, which explains the need for systematic prevention of pain before the patient wakes up from anesthesia. The study was conducted to evaluate the effect of intraperitoneal levobupivacaine with or without sufentanil for postoperative analgesia after LC. Patients and methods Ninety patients who underwent elective LC completed the study. Group C (n=29) received 50 ml of intraperitoneal normal saline, group L (n=31) received 50 ml of intraperitoneal levobupivacaine 0.25%, and group LS (n=30) received 50 ml of intraperitoneal levobupivacaine 0.25% plus 20 μg sufentanil. Visual analog score was recorded immediately postoperatively, and at 4, 8, and 12 h postoperatively. In addition, time to first rescue analgesia (diclofenac), total diclofenac consumption in 12 h, and complications (pruritus, emesis, shoulder pain, bradycardia, and hypotension) were recorded. Results Visual analog score until 8 h postoperatively was significantly higher in group C compared with groups L and LS. However, the difference was nonsignificant between groups L and LS, except at 8 and 12 h postoperatively. Time to first rescue analgesia was significantly longer in group LS (134.16±36.5) compared with group C (11.96±5.92) and group L (114.83±35.49) (P<0.001). Total diclofenac consumption in the first 12 h postoperatively was significantly lower in group L (92.5±32.26) and group LS (82.5±22.88) compared with group C (152.5±13.69). Conclusion Intraperitoneal instillation of levobupivacaine with sufentanil reduces not only the intensity of postoperative pain but also the total rescue analgesic dose consumption after LC.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78030162","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: 10.4103/1687-7934.189562
Elsayed Kamel, Ahmed F. Elsaid, Eid A Gumaa, Abd Elhafez El Sheweal
Background Available medications for the treatment of neuropathic pain, such as steroidal anti-inflammatory drugs and NSAIDs, were shown to be of limited therapeutic benefit. Objectives This study aimed to evaluate the analgesic and anti-inflammatory effects of atorvastatin and pravastatin in acute and neuropathic pain in rats. Materials and methods Acute and neuropathic pains were induced in rat models by means of subplantar carrageenan injection and partial sciatic nerve ligation (PSNL), respectively. The anti-inflammatory effect of statins was assessed by the reduction in plantar edema (at 0, 1, 2, and 3 h) and prolongation of paw withdrawal reaction time in response to thermal stimulation (at 0, 0.5, 1, 2, 3, and 4 h) after carrageenan injection. Atorvastatin (2, 4, or 8 mg/kg) and pravastatin (4, 8, or 12 mg/kg) were administered intraperitoneally 30 min before carrageenan injection. The effect of statins on neuropathic pain was assessed by prolongation of paw withdrawal reaction time in response to thermal stimulation evaluated at 0, 3, 6, 9, 12, 15, and 18 days after PSNL. Atorvastatin (2, 4, or 8 mg/kg) and pravastatin (4, 8, or 12 mg/kg) were administered orally for 18 consecutive days after PSNL. In addition, the effect of atorvastatin and pravastatin on total cholesterol and tumor necrosis factor-α levels was also assessed. Results Both atorvastatin and pravastatin ameliorated carrageenan-induced rat paw edema and prolonged withdrawal time in response to thermal-induced pain. Both statins were also effective in ameliorating neuropathic pain induced by PSNL. These effects were independent of statin-induced hypolipidemic action but were concomitant with reduction of serum tumor necrosis factor-α levels. Conclusion Atorvastatin and pravastatin demonstrated effective therapeutic potentials to reduce acute and chronic pain together with the associated inflammation and hyperalgesia independent of their hypolipidemic effect.
{"title":"Statins attenuate hyperalgesia and inflammation in experimentally induced acute and neuropathic pain in rats","authors":"Elsayed Kamel, Ahmed F. Elsaid, Eid A Gumaa, Abd Elhafez El Sheweal","doi":"10.4103/1687-7934.189562","DOIUrl":"https://doi.org/10.4103/1687-7934.189562","url":null,"abstract":"Background Available medications for the treatment of neuropathic pain, such as steroidal anti-inflammatory drugs and NSAIDs, were shown to be of limited therapeutic benefit. Objectives This study aimed to evaluate the analgesic and anti-inflammatory effects of atorvastatin and pravastatin in acute and neuropathic pain in rats. Materials and methods Acute and neuropathic pains were induced in rat models by means of subplantar carrageenan injection and partial sciatic nerve ligation (PSNL), respectively. The anti-inflammatory effect of statins was assessed by the reduction in plantar edema (at 0, 1, 2, and 3 h) and prolongation of paw withdrawal reaction time in response to thermal stimulation (at 0, 0.5, 1, 2, 3, and 4 h) after carrageenan injection. Atorvastatin (2, 4, or 8 mg/kg) and pravastatin (4, 8, or 12 mg/kg) were administered intraperitoneally 30 min before carrageenan injection. The effect of statins on neuropathic pain was assessed by prolongation of paw withdrawal reaction time in response to thermal stimulation evaluated at 0, 3, 6, 9, 12, 15, and 18 days after PSNL. Atorvastatin (2, 4, or 8 mg/kg) and pravastatin (4, 8, or 12 mg/kg) were administered orally for 18 consecutive days after PSNL. In addition, the effect of atorvastatin and pravastatin on total cholesterol and tumor necrosis factor-α levels was also assessed. Results Both atorvastatin and pravastatin ameliorated carrageenan-induced rat paw edema and prolonged withdrawal time in response to thermal-induced pain. Both statins were also effective in ameliorating neuropathic pain induced by PSNL. These effects were independent of statin-induced hypolipidemic action but were concomitant with reduction of serum tumor necrosis factor-α levels. Conclusion Atorvastatin and pravastatin demonstrated effective therapeutic potentials to reduce acute and chronic pain together with the associated inflammation and hyperalgesia independent of their hypolipidemic effect.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86289349","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: 10.4103/1687-7934.189095
Rania M. Ali, M. Khairy
Background Radiofrequency ablation (RFA) is a minimally invasive and effective method for local tumor destruction in nonsurgical patients with early-stage hepatocellular carcinoma (HCC). General anesthesia (GA) has been used for RFA. GA can decrease the hepatic blood flow and cause more hepatic dysfunction. This study aimed to compare the hemodynamic response, recovery characteristics, and postprocedural analgesia after induction of GA with either sevoflurane–propofol or sevoflurane–ketofol in liver patients undergoing RFA of HCC. Patients and methods Eighty patients with hepatic cirrhosis scheduled for RFA of HCC were randomly allocated into two groups. In group PS, induction of anesthesia was achieved using sevoflurane with propofol (1%). In group KPS, induction of anesthesia was achieved using sevoflurane with ketofol (prepared at a ratio of 1: 2). Results Regarding the induction time, the laryngeal mask airway (LMA) insertion time, the percentage of LMA insertions from the first attempt, time to removal of LMA, and time to emergence were comparable between the two groups. However, the rescue analgesia time was longer in group KPS compared with group PS (P < 0.001). The number of episodes during which blood pressure was below 20% of baseline blood pressure, as well as the highest and the lowest mean arterial pressure, was comparable between the two groups. Postoperative levels of liver enzymes were comparable between the two groups. In the recovery unit, only one patient (2.5%) in group KPS suffered from postoperative emergence agitation, and three patients (7.5%) suffered from nausea. Conclusion Either sevoflurane–propofol or sevoflurane–ketofol may be used as alternatives in liver patients undergoing RFA of HCC as both techniques have favorable anesthetic profiles and provide hemodynamic stability. However, when choosing sevoflurane–ketofol, the advantage of its enhanced analgesic effect must be weighed against the increased risk for postoperative nausea and vomiting.
{"title":"The effects of coinduction with sevoflurane–propofol and sevoflurane–ketofol in patients undergoing radiofrequency ablation of hepatocellular carcinoma","authors":"Rania M. Ali, M. Khairy","doi":"10.4103/1687-7934.189095","DOIUrl":"https://doi.org/10.4103/1687-7934.189095","url":null,"abstract":"Background Radiofrequency ablation (RFA) is a minimally invasive and effective method for local tumor destruction in nonsurgical patients with early-stage hepatocellular carcinoma (HCC). General anesthesia (GA) has been used for RFA. GA can decrease the hepatic blood flow and cause more hepatic dysfunction. This study aimed to compare the hemodynamic response, recovery characteristics, and postprocedural analgesia after induction of GA with either sevoflurane–propofol or sevoflurane–ketofol in liver patients undergoing RFA of HCC. Patients and methods Eighty patients with hepatic cirrhosis scheduled for RFA of HCC were randomly allocated into two groups. In group PS, induction of anesthesia was achieved using sevoflurane with propofol (1%). In group KPS, induction of anesthesia was achieved using sevoflurane with ketofol (prepared at a ratio of 1: 2). Results Regarding the induction time, the laryngeal mask airway (LMA) insertion time, the percentage of LMA insertions from the first attempt, time to removal of LMA, and time to emergence were comparable between the two groups. However, the rescue analgesia time was longer in group KPS compared with group PS (P < 0.001). The number of episodes during which blood pressure was below 20% of baseline blood pressure, as well as the highest and the lowest mean arterial pressure, was comparable between the two groups. Postoperative levels of liver enzymes were comparable between the two groups. In the recovery unit, only one patient (2.5%) in group KPS suffered from postoperative emergence agitation, and three patients (7.5%) suffered from nausea. Conclusion Either sevoflurane–propofol or sevoflurane–ketofol may be used as alternatives in liver patients undergoing RFA of HCC as both techniques have favorable anesthetic profiles and provide hemodynamic stability. However, when choosing sevoflurane–ketofol, the advantage of its enhanced analgesic effect must be weighed against the increased risk for postoperative nausea and vomiting.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82241658","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: 10.4103/1687-7934.189566
Ayman El Sayed, M. Soltan, M. Nabil
Objectives The aim of this study was to compare the effect of sevoflurane general anesthesia (GA) and sciatic–femoral–obturator blockade as regards analgesia and incidence of postoperative cognitive dysfunction (POCD) in elderly patients undergoing unilateral total knee replacement. Patients and methods The patients were divided in a randomized manner into two groups: the GA group (n=40) received maintenance of anesthesia with inhalational sevoflurane, and the peripheral nerve block (PNB) group (n=40) underwent sciatic nerve block (40 ml), femoral nerve block (20 ml), and obturator nerve block (10 ml) with 0.25% bupivacaine. The following time points were considered: baseline, immediately before induction of anesthesia (T-baseline), immediately after induction of anesthesia (T-induction), at the end of the operation (T-end) and then at 6, 12, 18, and 24 h postoperatively and were represented as T6, T12, T18, and T24, respectively. Results A total of 15 of 40 patients from the GA group developed POCD, whereas six of 38 patients in the PNB group developed POCD at T24. This difference was significant. Moreover, there was a significant decrease in Mini-Mental State Examination score in the GA group after 24 h in comparison with the preoperative value. There was a significantly higher value of Aβ (β-amyloid protein) in the GA group compared with the PNB group 24 h postoperatively. Visual analogue score was significantly lower at T-end, T6, T12, T18, and T24 in the PNB group compared with the GA group. Hemodynamics was significantly lower in the PNB group than in the GA group at T-end, T6, T12, T18, and T24. They were significantly higher in the PNB group than in the GA group at T-induction. Total opioid consumption within 24 h postoperatively and the incidence of nausea were lower in the PNB group compared with the GA group. Induction time was significantly longer in the PNB group than in the GA group. Conclusion The current study demonstrated that PNB with sciatic–femoral–obturator for total knee replacement was accompanied by less POCD, less pain, less nausea, and less opioid consumption within 24 h postoperatively compared with GA with sevoflurane.
目的:比较七氟醚全麻(GA)和坐骨-股-闭孔阻滞对老年单侧全膝关节置换术患者镇痛和术后认知功能障碍(POCD)发生率的影响。患者和方法将患者随机分为两组:GA组(n=40)采用吸入性七氟醚维持麻醉，周围神经阻滞(PNB)组(n=40)采用0.25%布比卡因坐骨神经阻滞(40 ml)、股神经阻滞(20 ml)和闭孔神经阻滞(10 ml)。考虑以下时间点:基线、麻醉诱导前(T-baseline)、麻醉诱导后(T-induction)、手术结束(T-end)和术后6、12、18、24 h，分别用T6、T12、T18、T24表示。结果GA组40例患者中有15例发生POCD，而PNB组38例患者中有6例在T24发生POCD。这种差异是显著的。此外，GA组24 h后精神状态检查评分较术前有显著下降。术后24 h GA组β-淀粉样蛋白含量明显高于PNB组。PNB组t端、T6、T12、T18、T24的视觉模拟评分明显低于GA组。PNB组在t端、T6、T12、T18、T24的血流动力学明显低于GA组。t诱导时，PNB组明显高于GA组。与GA组相比，PNB组术后24 h内阿片类药物总消耗量和恶心发生率均较低。PNB组诱导时间明显长于GA组。结论目前的研究表明，与加七氟醚的全膝关节置换术相比，经坐骨-股-闭孔的PNB术后24 h内POCD、疼痛、恶心和阿片类药物消耗更少。
{"title":"Comparative study between general anesthesia and sciatic–femoral–obturator blockade as regards analgesia and incidence of postoperative cognitive dysfunction in elderly patients undergoing unilateral total knee replacement","authors":"Ayman El Sayed, M. Soltan, M. Nabil","doi":"10.4103/1687-7934.189566","DOIUrl":"https://doi.org/10.4103/1687-7934.189566","url":null,"abstract":"Objectives The aim of this study was to compare the effect of sevoflurane general anesthesia (GA) and sciatic–femoral–obturator blockade as regards analgesia and incidence of postoperative cognitive dysfunction (POCD) in elderly patients undergoing unilateral total knee replacement. Patients and methods The patients were divided in a randomized manner into two groups: the GA group (n=40) received maintenance of anesthesia with inhalational sevoflurane, and the peripheral nerve block (PNB) group (n=40) underwent sciatic nerve block (40 ml), femoral nerve block (20 ml), and obturator nerve block (10 ml) with 0.25% bupivacaine. The following time points were considered: baseline, immediately before induction of anesthesia (T-baseline), immediately after induction of anesthesia (T-induction), at the end of the operation (T-end) and then at 6, 12, 18, and 24 h postoperatively and were represented as T6, T12, T18, and T24, respectively. Results A total of 15 of 40 patients from the GA group developed POCD, whereas six of 38 patients in the PNB group developed POCD at T24. This difference was significant. Moreover, there was a significant decrease in Mini-Mental State Examination score in the GA group after 24 h in comparison with the preoperative value. There was a significantly higher value of Aβ (β-amyloid protein) in the GA group compared with the PNB group 24 h postoperatively. Visual analogue score was significantly lower at T-end, T6, T12, T18, and T24 in the PNB group compared with the GA group. Hemodynamics was significantly lower in the PNB group than in the GA group at T-end, T6, T12, T18, and T24. They were significantly higher in the PNB group than in the GA group at T-induction. Total opioid consumption within 24 h postoperatively and the incidence of nausea were lower in the PNB group compared with the GA group. Induction time was significantly longer in the PNB group than in the GA group. Conclusion The current study demonstrated that PNB with sciatic–femoral–obturator for total knee replacement was accompanied by less POCD, less pain, less nausea, and less opioid consumption within 24 h postoperatively compared with GA with sevoflurane.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76045381","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: 10.4103/1687-7934.189092
K. Gupta, P. Gupta, Bhawana Rastogi, Manish Jain, D. Sharma, M. Pandey
Background Regional anesthesia is the technique of choice for patients undergoing transurethral resection of the prostate (TURP), but anesthetic management of elderly patients is challenging due to compromised organ function. The present study aimed to evaluate the relative efficacy and safety of dexmedetomidine versus fentanyl in the enhancement of the quality and duration of epidural anesthesia with 0.5% levobupivacaine and hemodynamic stability during TURP in elderly patients. Patients and methods Sixty elderly consented patients were randomized into two equal groups of 30 patients each in a double-blind manner. They were given 15 ml of 0.5% levobupivacaine (75 mg) either with 1 ml (50 μg) dexmedetomidine (group LD) or with 1 ml (50 μg) fentanyl (group LF) using an epidural catheter. The primary endpoints were the onset and duration of sensory and motor blockade, duration of sensory analgesia, hemodynamic variability, respiratory adequacy, and any adverse effect. Results Demographic data were comparable in both groups. Onset of sensory and motor blockade was faster in patients of group LD than in patients of group LF, with a statistically significant difference (P < 0.05). Duration of motor blockade and sensory analgesia was longer in patients of group LD than in patients of group LF (P < 0.05). Intraoperative heart rate and mean arterial blood pressure were significantly lower in patients of group LD, but no intervention was required. Surgical bleeding was reduced in patients of group LD. Conclusion Dexmedetomidine as an adjuvant to epidural levobupivacaine for TURP has shortened onset time of anesthesia and prolonged duration of sensory analgesia. The surgical field vision was improved due to reduced bleeding.
背景区域麻醉是经尿道前列腺切除术(TURP)患者的首选技术，但由于器官功能受损，老年患者的麻醉管理具有挑战性。本研究旨在评价右美托咪定与芬太尼在提高0.5%左布比卡因硬膜外麻醉质量和持续时间以及老年患者TURP期间血流动力学稳定性方面的相对有效性和安全性。患者与方法采用双盲方法，将60例老年患者随机分为两组，每组30例。经硬膜外导管给予15 ml 0.5%左布比卡因(75 mg)与1 ml (50 μg)右美托咪定(LD组)或1 ml (50 μg)芬太尼(LF组)。主要终点是感觉和运动阻断的开始和持续时间，感觉镇痛的持续时间，血流动力学变异性，呼吸充分性和任何不良反应。结果两组人口统计学数据具有可比性。LD组感觉及运动阻滞发作速度快于LF组，差异有统计学意义(P < 0.05)。LD组运动阻滞和感觉镇痛持续时间明显长于LF组(P < 0.05)。LD组患者术中心率和平均动脉血压明显降低，但不需要干预。结论右美托咪定辅助硬膜外左布比卡因治疗TURP可缩短麻醉起效时间，延长感觉镇痛时间。手术视野因出血减少而改善。
{"title":"Dexmedetomidine versus fentanyl as adjuvant to epidural 0.5% levobupivacaine for transurethral prostate resection in elderly patients: a comparative evaluation","authors":"K. Gupta, P. Gupta, Bhawana Rastogi, Manish Jain, D. Sharma, M. Pandey","doi":"10.4103/1687-7934.189092","DOIUrl":"https://doi.org/10.4103/1687-7934.189092","url":null,"abstract":"Background Regional anesthesia is the technique of choice for patients undergoing transurethral resection of the prostate (TURP), but anesthetic management of elderly patients is challenging due to compromised organ function. The present study aimed to evaluate the relative efficacy and safety of dexmedetomidine versus fentanyl in the enhancement of the quality and duration of epidural anesthesia with 0.5% levobupivacaine and hemodynamic stability during TURP in elderly patients. Patients and methods Sixty elderly consented patients were randomized into two equal groups of 30 patients each in a double-blind manner. They were given 15 ml of 0.5% levobupivacaine (75 mg) either with 1 ml (50 μg) dexmedetomidine (group LD) or with 1 ml (50 μg) fentanyl (group LF) using an epidural catheter. The primary endpoints were the onset and duration of sensory and motor blockade, duration of sensory analgesia, hemodynamic variability, respiratory adequacy, and any adverse effect. Results Demographic data were comparable in both groups. Onset of sensory and motor blockade was faster in patients of group LD than in patients of group LF, with a statistically significant difference (P < 0.05). Duration of motor blockade and sensory analgesia was longer in patients of group LD than in patients of group LF (P < 0.05). Intraoperative heart rate and mean arterial blood pressure were significantly lower in patients of group LD, but no intervention was required. Surgical bleeding was reduced in patients of group LD. Conclusion Dexmedetomidine as an adjuvant to epidural levobupivacaine for TURP has shortened onset time of anesthesia and prolonged duration of sensory analgesia. The surgical field vision was improved due to reduced bleeding.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87032312","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: 10.4103/1687-7934.189103
Ramaligam Sripriya, S. Parthasarathy, M. Ravishankar
Analysis of ventilator graphics is useful in a few situations for detecting ventilator dysfunction. However, there is a paucity of literature as to what sort of dysfunctions can be detected. We report two cases in which the graphics enabled us to identify ventilator dysfunction in patients who were on mechanical ventilation. Analysing the graphics and not looking at numbers alone enabled us to take timely corrective actions, thereby preventing morbidity. Both patients ultimately achieved a complete recovery.
{"title":"Ventilator dysfunction: role of graphics in detection","authors":"Ramaligam Sripriya, S. Parthasarathy, M. Ravishankar","doi":"10.4103/1687-7934.189103","DOIUrl":"https://doi.org/10.4103/1687-7934.189103","url":null,"abstract":"Analysis of ventilator graphics is useful in a few situations for detecting ventilator dysfunction. However, there is a paucity of literature as to what sort of dysfunctions can be detected. We report two cases in which the graphics enabled us to identify ventilator dysfunction in patients who were on mechanical ventilation. Analysing the graphics and not looking at numbers alone enabled us to take timely corrective actions, thereby preventing morbidity. Both patients ultimately achieved a complete recovery.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80833579","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: 10.4103/1687-7934.189091
M. Eladawy, A. Omran
Background Septic shock is one of the biggest causes of mortality in intensive care settings, and, despite all the recent advances in pharmacological and mechanical support therapies, is the second leading cause of death among ICU patients. Although vasopressors have been widely used in these situations, where keeping the hemodynamic stability is of utmost importance, a detailed study of their effects is undoubtedly needed. Objective Our study compared the effect of methylene blue (MB) in the vasoplegic situation associated with sepsis with that of vasopressin. Patients and methods We randomized 40 patients into two groups (20 patients each); patients in the first group received MB, whereas patients in the second group received vasopressin as a hemodynamic support. Results In the present study, mean arterial blood pressure was found to be significantly higher in the MB group compared with the vasopressin group, whereas within the MB group, it was significantly higher after 6 h compared with the baseline level. The systemic vascular resistance showed no difference between the two groups at the start but a marked difference only after 2 h, being higher for the MB group — that is, there was a significant decrease in the vasopressors and inotropes needed in the MB group. There was no significant difference between the two groups regarding the ICU length of stay, the central venous pressure, pulmonary artery pressure, and oxygen extraction ratio. Conclusion The use of MB in sepsis-induced refractory vasoplegic situations remains one of the salvage management strategies; however, the practice of its routine use is yet to be established and needs further investigation.
{"title":"Methylene blue versus vasopressin in sepsis-induced vasoplegia","authors":"M. Eladawy, A. Omran","doi":"10.4103/1687-7934.189091","DOIUrl":"https://doi.org/10.4103/1687-7934.189091","url":null,"abstract":"Background Septic shock is one of the biggest causes of mortality in intensive care settings, and, despite all the recent advances in pharmacological and mechanical support therapies, is the second leading cause of death among ICU patients. Although vasopressors have been widely used in these situations, where keeping the hemodynamic stability is of utmost importance, a detailed study of their effects is undoubtedly needed. Objective Our study compared the effect of methylene blue (MB) in the vasoplegic situation associated with sepsis with that of vasopressin. Patients and methods We randomized 40 patients into two groups (20 patients each); patients in the first group received MB, whereas patients in the second group received vasopressin as a hemodynamic support. Results In the present study, mean arterial blood pressure was found to be significantly higher in the MB group compared with the vasopressin group, whereas within the MB group, it was significantly higher after 6 h compared with the baseline level. The systemic vascular resistance showed no difference between the two groups at the start but a marked difference only after 2 h, being higher for the MB group — that is, there was a significant decrease in the vasopressors and inotropes needed in the MB group. There was no significant difference between the two groups regarding the ICU length of stay, the central venous pressure, pulmonary artery pressure, and oxygen extraction ratio. Conclusion The use of MB in sepsis-induced refractory vasoplegic situations remains one of the salvage management strategies; however, the practice of its routine use is yet to be established and needs further investigation.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91173007","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: 10.4103/1687-7934.189087
Hany Mickhael, Josef Zekry, M. Elrazek
Objective The aim of the present study was to detect the efficacy of early postoperative calf muscle exercise to decrease the risk of deep venous thrombosis achieved by intrathecal 3 ml bupivacaine 0.25% and fentanyl 25 μg instead of 3 ml bupivacaine 0.5%. In total, 40 patients of either sex, aged between 18 and 60 years, with American Society of Anesthesiologists (ASA) I and II were included in the study. Patients and methods A total of 40 ASA I and II patients undergoing elective total hip replacement surgery were randomly assigned to two equal groups of 20 patients each (group A and B). Group A received bupivacaine 0.5% (3 ml) and group B received bupivacaine 0.25% (3 ml)+fentanyl 25 μg. Patients were instructed on how to do cuff muscle exercise once they regained the full strength of the lower limbs muscles postoperatively. Five venous blood samples were taken from each patient for the D-dimer assessment as an indicator for the occurrence of venous thromboembolism. The first sample was taken preoperatively at the time of induction of anesthesia; the rest of samples were then taken at 12, 24, 48 h, and 7 days postoperatively. Results Group B, in which patients received intrathecal bupivacaine 0.25% plus fentanyl, had an earlier recovery of motor power; patients in this group started doing calf muscle exercise earlier than did those in group A, and this group had significantly lower postoperative D-dimer level, denoting less susceptibility to deep venous thrombosis. Conclusion Early postoperative calf muscle exercise decreased the incidence of venous thromboembolism risk as indicated by the results of the D-dimer assessment.
{"title":"Selective spinal anesthesia using low concentration bupivacaine and fentanyl versus ordinary bupivacaine as a prophylaxis against deep venous thrombosis in total hip replacement surgery","authors":"Hany Mickhael, Josef Zekry, M. Elrazek","doi":"10.4103/1687-7934.189087","DOIUrl":"https://doi.org/10.4103/1687-7934.189087","url":null,"abstract":"Objective The aim of the present study was to detect the efficacy of early postoperative calf muscle exercise to decrease the risk of deep venous thrombosis achieved by intrathecal 3 ml bupivacaine 0.25% and fentanyl 25 μg instead of 3 ml bupivacaine 0.5%. In total, 40 patients of either sex, aged between 18 and 60 years, with American Society of Anesthesiologists (ASA) I and II were included in the study. Patients and methods A total of 40 ASA I and II patients undergoing elective total hip replacement surgery were randomly assigned to two equal groups of 20 patients each (group A and B). Group A received bupivacaine 0.5% (3 ml) and group B received bupivacaine 0.25% (3 ml)+fentanyl 25 μg. Patients were instructed on how to do cuff muscle exercise once they regained the full strength of the lower limbs muscles postoperatively. Five venous blood samples were taken from each patient for the D-dimer assessment as an indicator for the occurrence of venous thromboembolism. The first sample was taken preoperatively at the time of induction of anesthesia; the rest of samples were then taken at 12, 24, 48 h, and 7 days postoperatively. Results Group B, in which patients received intrathecal bupivacaine 0.25% plus fentanyl, had an earlier recovery of motor power; patients in this group started doing calf muscle exercise earlier than did those in group A, and this group had significantly lower postoperative D-dimer level, denoting less susceptibility to deep venous thrombosis. Conclusion Early postoperative calf muscle exercise decreased the incidence of venous thromboembolism risk as indicated by the results of the D-dimer assessment.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79551416","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: 10.4103/1687-7934.189089
G. Chilkoti, M. Mohta, S. Nath, A. Saxena, P. Khurana
Vasopressin, a potent vasoconstrictor, has often been used intramyometrially to prevent blood loss during surgical management of uterine myomas. Various lethal complications reported with its use include bradycardia, unmeasurable blood pressure, loss of palpable peripheral pulse, marked pallor, arrhythmia, pulmonary oedema and cardiac arrest. We herein report a case of uterine myomas in which intramyometrial vasopressin-induced complications such as bradycardia, absent pulse and marked pallor were observed with very low dose and concentration (i.e. 1.5 U and 0.1 U/ml). This could be attributed to the coexistence of hypertension in our patient. Here, we discuss the anaesthetic concerns with the use of intramyometrial vasopressin and reinforce the need for dogmatic guidelines envisaging the recommended safe dose and concentrations of intramyometrial vasopressin and proper patient selection.
{"title":"Anaesthetic concerns with intramyometrial vasopressin during myomectomy","authors":"G. Chilkoti, M. Mohta, S. Nath, A. Saxena, P. Khurana","doi":"10.4103/1687-7934.189089","DOIUrl":"https://doi.org/10.4103/1687-7934.189089","url":null,"abstract":"Vasopressin, a potent vasoconstrictor, has often been used intramyometrially to prevent blood loss during surgical management of uterine myomas. Various lethal complications reported with its use include bradycardia, unmeasurable blood pressure, loss of palpable peripheral pulse, marked pallor, arrhythmia, pulmonary oedema and cardiac arrest. We herein report a case of uterine myomas in which intramyometrial vasopressin-induced complications such as bradycardia, absent pulse and marked pallor were observed with very low dose and concentration (i.e. 1.5 U and 0.1 U/ml). This could be attributed to the coexistence of hypertension in our patient. Here, we discuss the anaesthetic concerns with the use of intramyometrial vasopressin and reinforce the need for dogmatic guidelines envisaging the recommended safe dose and concentrations of intramyometrial vasopressin and proper patient selection.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89296075","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: 10.4103/1687-7934.189098
S. Chaudhary, R. Verma, S. Rana, Jai P Singh, A. Danesh
Background The use of magnesium sulfate as an adjuvant in neuraxial block has gained popularity, with the aim of improving and enhancing the quality and duration of anesthesia, delaying the onset of postoperative pain, and thus reducing the demand for postoperative rescue analgesics. However, until today, there has been no consensus as regards the ideal dose of magnesium sulfate as an adjuvant in the subarachnoid block. The present study was designed to examine whether the addition of intrathecal magnesium sulfate (50 and 100 mg) would enhance the analgesic efficacy of intrathecal bupivacaine. We hypothesized that the additive effect of magnesium sulfate as an adjuvant to bupivacaine in subarachnoid block is dose dependent. Materials and methods This study was carried out on 90 American Society of Anesthesiology I and II patients of both sexes in the age group of 20–60 years scheduled for below knee surgeries under subarachnoid block. Group 1 (n = 30) patients received intrathecal 0.5% heavy bupivacaine (2.8 ml) +0.2 ml normal saline; group 2 (n = 30) received intrathecal 0.5% heavy bupivacaine (2.8 ml) +50 mg (0.1 ml) magnesium sulfate +0.1 ml normal saline; and group 3 (n = 30) received intrathecal 0.5% heavy bupivacaine (2.8 ml)+100 mg (0.2 ml) magnesium sulfate. The primary outcome measure was the duration of postoperative analgesia, and secondary outcomes included the number of supplemental analgesic requirements, block characteristics, and hemodynamic stability. Results The onset of sensory and motor block was delayed in the magnesium group (100 mg>50 mg). There was a significant prolongation of postoperative analgesia in the magnesium group in a dose-dependent manner, and total dose of rescue analgesic requirement was found to be significantly delayed in the 100 mg group. Patients in all groups remained hemodynamically stable without any adverse effects. Conclusion Magnesium sulfate (100 mg) as an adjuvant to bupivacaine in subarachnoid block prolongs the duration of analgesia and decreases the demand for rescue analgesics compared with the control and the magnesium sulfate 50 mg group.
{"title":"Magnesium sulfate at two different doses as an adjuvant to bupivacaine in infraumblical (below knee) orthopedic surgeries under spinal anesthesia","authors":"S. Chaudhary, R. Verma, S. Rana, Jai P Singh, A. Danesh","doi":"10.4103/1687-7934.189098","DOIUrl":"https://doi.org/10.4103/1687-7934.189098","url":null,"abstract":"Background The use of magnesium sulfate as an adjuvant in neuraxial block has gained popularity, with the aim of improving and enhancing the quality and duration of anesthesia, delaying the onset of postoperative pain, and thus reducing the demand for postoperative rescue analgesics. However, until today, there has been no consensus as regards the ideal dose of magnesium sulfate as an adjuvant in the subarachnoid block. The present study was designed to examine whether the addition of intrathecal magnesium sulfate (50 and 100 mg) would enhance the analgesic efficacy of intrathecal bupivacaine. We hypothesized that the additive effect of magnesium sulfate as an adjuvant to bupivacaine in subarachnoid block is dose dependent. Materials and methods This study was carried out on 90 American Society of Anesthesiology I and II patients of both sexes in the age group of 20–60 years scheduled for below knee surgeries under subarachnoid block. Group 1 (n = 30) patients received intrathecal 0.5% heavy bupivacaine (2.8 ml) +0.2 ml normal saline; group 2 (n = 30) received intrathecal 0.5% heavy bupivacaine (2.8 ml) +50 mg (0.1 ml) magnesium sulfate +0.1 ml normal saline; and group 3 (n = 30) received intrathecal 0.5% heavy bupivacaine (2.8 ml)+100 mg (0.2 ml) magnesium sulfate. The primary outcome measure was the duration of postoperative analgesia, and secondary outcomes included the number of supplemental analgesic requirements, block characteristics, and hemodynamic stability. Results The onset of sensory and motor block was delayed in the magnesium group (100 mg>50 mg). There was a significant prolongation of postoperative analgesia in the magnesium group in a dose-dependent manner, and total dose of rescue analgesic requirement was found to be significantly delayed in the 100 mg group. Patients in all groups remained hemodynamically stable without any adverse effects. Conclusion Magnesium sulfate (100 mg) as an adjuvant to bupivacaine in subarachnoid block prolongs the duration of analgesia and decreases the demand for rescue analgesics compared with the control and the magnesium sulfate 50 mg group.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85947330","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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