Ain-Shams Journal of Anesthesiology最新文献

英文中文

The efficacy of pregabalin on the duration of the spinal anesthesia and the early postoperative pain after total knee arthroplasty 普瑞巴林对脊髓麻醉持续时间和全膝关节置换术后早期疼痛的疗效

IF 0.5

Ain-Shams Journal of Anesthesiology

Pub Date : 2024-01-22 DOI: 10.21608/asja.2024.250437.1009

T. Abdelaziz, W. Abdelwahab, Ismail Ibrahim

引用次数: 0

Anesthetic management of diphallia with anorectal malformation posted for colostomy: a rare association 对因结肠造口术导致肛门直肠畸形的双足畸形患者的麻醉管理：一种罕见的联系

IF 0.5

Ain-Shams Journal of Anesthesiology

Pub Date : 2023-12-13 DOI: 10.1186/s42077-023-00399-3

Aakriti Sharma, Neelam Dogra, Rama Chatterjee, Pratibha Rathore, Hardika Mangal

Duplication of the penis or Diphallia is a rare abnormality of the urogenital tract present once in every 5–6 million live births with varied presentations and associated systemic anomalies. We present the anesthetic management of a neonate presenting with duplication of penis, urethra, and anorectal malformation. With this rare case, we aim to shed light on the various perioperative anesthetic concerns of such neonates presenting with surgical emergencies and their successful management.

阴茎或双阴茎畸形是一种罕见的泌尿生殖道畸形，每 500-600 万活产婴儿中就会出现一次，其表现各不相同，并伴有全身畸形。我们介绍了对一名阴茎、尿道和肛门直肠畸形重复的新生儿的麻醉处理。通过这一罕见病例，我们旨在阐明此类新生儿手术急症围手术期的各种麻醉问题及其成功处理方法。

引用次数: 0

APACHE IV, SAPS III, and SOFA scores for outcome prediction in a surgical/trauma critical care unit: an analytical cross-sectional study APACHE IV、SAPS III和SOFA评分用于外科/创伤重症监护病房的预后预测:一项分析性横断面研究

IF 0.5

Ain-Shams Journal of Anesthesiology

Pub Date : 2023-12-05 DOI: 10.1186/s42077-023-00383-x

Huda F. Ghazaly, Ahmed Alsaied A. Aly, Marwa H. Sayed, Mahmoud M. Hassan

Patients’ outcomes in surgical/trauma intensive care units (ICUs) are still challenging to predict. There has been a lack of consensus over the efficacy of Acute Physiology and Chronic Health Evaluation IV (APACHE IV), Simplified Acute Physiology Score III (SAPS III), and Sequential Organ Failure Assessment (SOFA) scores in predicting patient outcomes. This analytical cross-sectional study was designed to determine how well APACHE IV, SAPS III, and SOFA scores predict ICU mortality and the length of stay in a surgical ICU. APACHE IV, SAPS III, and SOFA scores were calculated on admission. The effectiveness of these scores in predicting mortality was determined using logistic regression models. The accuracy of these discriminative abilities was measured using the area under the receiver operating characteristic curve (AUC). The Hosmer and Lemeshow calibration test was calculated to test the model fit. The agreement between APACHE IV, SAPS III, and SOFA scores in the prediction of mortality was examined using the Bland–Altman curve. A total of 148 patients met the study criteria. APACHE IV was the only significant predictor of mortality, with a 1-point increase in the APACHE IV score resulting in a 5% increase in death probability (AOR = 1.049, 95% CI 1.028–1.069) (P-value < 0.001). The APACHE IV score was superior to the SAPS III and SOFA scores regarding accuracy, with an AUC of 0.766 (95% CI, 0.670–0.862) (P-value < 0.001). Furthermore, there was a significant positive correlation between APACHE IV score and ICU length of stay (r = 0.22, P = 0.004). APACHE IV outperformed SAPS III and SOFA scores in predicting mortality in a surgical/trauma critical care unit and showed a significant positive correlation with the ICU length of stay.

手术/创伤重症监护病房(icu)患者的预后仍然难以预测。急性生理和慢性健康评估IV (APACHE IV)、简化急性生理评分III (SAPS III)和顺序器官衰竭评估(SOFA)评分在预测患者预后方面的有效性缺乏共识。本分析性横断面研究旨在确定APACHE IV、SAPS III和SOFA评分对ICU死亡率和外科ICU住院时间的预测效果。入院时计算APACHE IV、SAPS III和SOFA评分。使用逻辑回归模型确定这些评分在预测死亡率方面的有效性。这些鉴别能力的准确性用受试者工作特征曲线下面积(AUC)来衡量。计算Hosmer和Lemeshow校准检验来检验模型的拟合性。使用Bland-Altman曲线检验APACHE IV、SAPS III和SOFA评分在预测死亡率方面的一致性。共有148名患者符合研究标准。APACHE IV是死亡率的唯一显著预测因子，APACHE IV评分每增加1分，死亡概率增加5% (AOR = 1.049, 95% CI 1.028-1.069) (p值< 0.001)。APACHE IV评分在准确性方面优于SAPS III和SOFA评分，AUC为0.766 (95% CI, 0.670-0.862) (p值< 0.001)。APACHE IV评分与患者在ICU的住院时间呈正相关(r = 0.22, P = 0.004)。APACHE IV在预测外科/创伤重症监护病房死亡率方面优于SAPS III和SOFA评分，并与ICU住院时间呈显著正相关。

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引用次数: 0

Broken epidural catheter: individualize your management 硬膜外导管破裂:个体化处理

IF 0.5

Ain-Shams Journal of Anesthesiology

Pub Date : 2023-11-24 DOI: 10.1186/s42077-023-00381-z

Sanjay Kumar, Shalvi Mahajan, Vishal Kumar, Komal Anil Gandhi

Epidural anaesthesia is one of the most used neuraxial anaesthesia techniques. It has been utilized as the principal anaesthesia modality involving lower limb surgery. Breakage of epidural catheters is an unusual occurrence whose subsequent therapy lacks uniformity due to the absence of a consensus and defined standards. A 39-year-old male with no comorbidities was scheduled for right lower limb reconstruction surgery due to non-union of the tibia. Combined spinal-epidural anaesthesia was planned. During epidural catheter insertion, there was difficulty threading the catheter, and upon its removal, a long segment of catheter (8 cm) was left inside the body. Following informed consent from the patient, the retained fragment was surgically extracted in the same sitting under general anaesthesia. Even when faced with such a circumstance, it is best to explore surgically and remove a long segment broken catheter to allay patient anxiety.

硬膜外麻醉是最常用的神经轴麻醉技术之一。它已被用作主要麻醉方式涉及下肢手术。硬膜外导管断裂是一种罕见的现象，由于缺乏共识和明确的标准，其后续治疗缺乏一致性。一名39岁男性，无合并症，因胫骨不愈合，计划进行右下肢重建手术。计划脊髓-硬膜外联合麻醉。在硬膜外置管过程中，导管穿线困难，取出导管后，在体内留下一长段(8cm)导管。经患者知情同意后，保留的碎片在全身麻醉下手术取出。即使遇到这样的情况，最好还是手术探查，取出长段断裂导管，以减轻患者的焦虑。

引用次数: 0

Abiraterone, a rare cause of severe perioperative hypokalemia with unusual presentation as aphonia and quadriparesis: a case report 阿比特龙，一个罕见的原因严重围手术期低钾血症不寻常的表现为失音和四肢瘫痪:1例报告

IF 0.5

Ain-Shams Journal of Anesthesiology

Pub Date : 2023-11-20 DOI: 10.1186/s42077-023-00392-w

Sakshi Thakore, Ankita Kaasat, Nirdesh Thakore, Yatendra Singh Chundawat

Oral Abiraterone acetate is a novel antineoplastic agent approved by the FDA for the treatment of metastatic prostate cancer. Abiraterone is an irreversible inhibitor of the 17α-hydroxylase (CYP17) enzyme complex resulting in a reduction of androgens and corticosteroids. It may cause mineralocorticoid excess syndrome; hence, it is prescribed with steroids. Here we describe a case of postoperative severe hypokalemia with unusual presentation in a patient after spine surgery in which abiraterone with prednisolone was continued preoperatively. Anesthetic concerns about the perioperative administration of abiraterone have not been reported in the literature. An 80-year-old male with a known case of metastatic prostate cancer was posted for spine surgery under general anesthesia. Surgery was uneventful and the patient was extubated after ensuring adequate muscle power and respiratory parameters. Postoperatively, the patient developed aphonia, quadriparesis, and respiratory distress leading to reintubation. After evaluation, severe grade 4 hypokalemia was found to be the causative factor. The patient recovered well after potassium and steroid supplementation. Low potassium and cortisol levels indicate a diagnosis of abiraterone-induced hypokalemia. Patients on abiraterone require more stringent and vigilant monitoring of potassium and cortisol levels. In such circumstances, it might be advantageous to add additional steroids or substitute alternative steroids.

口服醋酸阿比特龙是一种被FDA批准用于治疗转移性前列腺癌的新型抗肿瘤药物。阿比特龙是17α-羟化酶(CYP17)酶复合物的不可逆抑制剂，导致雄激素和皮质类固醇的减少。它可能导致矿物皮质激素过量综合征;因此，它与类固醇一起开处方。在这里，我们描述了一个病例术后严重低钾血症与不寻常的表现在病人脊柱手术后，阿比特龙与泼尼松龙继续术前。关于阿比特龙围手术期给药的麻醉问题尚未在文献中报道。一名80岁男性转移性前列腺癌病例在全身麻醉下接受脊柱手术。手术顺利，患者在确保足够的肌肉力量和呼吸参数后拔管。术后，患者出现失音、四肢瘫和呼吸窘迫，导致再次插管。经评估，发现严重的4级低钾血症是致病因素。患者在补充钾和类固醇后恢复良好。低钾和皮质醇水平提示诊断为阿比特龙引起的低钾血症。服用阿比特龙的患者需要更严格和警惕地监测钾和皮质醇水平。在这种情况下，添加额外的类固醇或替代类固醇可能是有利的。

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引用次数: 0

An incidental finding of xanthochromia during spinal anaesthesia in a patient posted for lower limb surgery 一例下肢手术病人在脊髓麻醉期间偶然发现黄色症

IF 0.5

Ain-Shams Journal of Anesthesiology

Pub Date : 2023-11-19 DOI: 10.1186/s42077-023-00398-4

Sumedha Mehta, Kavita Adate, Kiran Valake

Xanthochromia is the yellowish discoloration of cerebrospinal fluid associated with serious conditions like subarachnoid haemorrhage and spinal cord tumour which raises concerns regarding safety when presented during spinal anaesthesia. There is limited literature regarding the clinical implications of spinal anaesthesia in xanthochromia. We report a case of a 31-year-old male patient with an incidental finding of xanthochromia cerebrospinal fluid during spinal anaesthesia. The patient with a history of fall was posted for lower limb orthopaedic surgery under subarachnoid block. In the process of administering the block, the pale yellow coloured cerebrospinal fluid was encountered. We conclude that proceeding with spinal anaesthesia in xanthochromia should be at the discretion of the anaesthesiologist and further investigations for the diagnosis can be considered for the management in such cases.

黄色症是与蛛网膜下腔出血和脊髓肿瘤等严重疾病相关的脑脊液变黄，在脊髓麻醉期间出现时引起对安全性的担忧。有有限的文献关于脊髓麻醉在黄色症的临床意义。我们报告一个病例31岁的男性患者偶然发现黄色脑脊液在脊髓麻醉期间。有跌倒史的患者在蛛网膜下腔阻滞下进行下肢矫形手术。在给药过程中，遇到了淡黄色的脑脊液。我们的结论是，在黄色症中进行脊髓麻醉应该由麻醉师决定，并且可以考虑在这种情况下进行进一步的诊断调查。

引用次数: 0

Obesity and postoperative pulmonary complications: other potential factors carrying “weight” 肥胖与术后肺部并发症:其他携带“体重”的潜在因素

IF 0.5

Ain-Shams Journal of Anesthesiology

Pub Date : 2023-11-17 DOI: 10.1186/s42077-023-00393-9

Rohan Magoon, Varun Suresh

A recent study concluded that body mass index (BMI) was not significantly associated with postoperative pulmonary complications (PPCs) in a retrospective evaluation of 231 patients undergoing elective upper abdominal surgery (Shiramoto et al. 2023). The authors notably assessed a pertinent complication in a homogenous surgical cohort, nonetheless their analysis being limited by a rather “slim” cohort of obese when defined by the World Health Organization (WHO) criterion. Herein, we are concerned that the research results could have been influenced by factors other than those discussed in the index article.

Cross-sectional population-based surveys (Vold et al. 2012) exist outlining pivotal links between an increasing BMI and low arterial oxygen saturation (SpO₂). The same becomes especially relevant when researchers delineate almost ten times elevated risk of PPCs following abdominal surgery in background of a preoperative SpO₂ < 94% (adjusted odds ratio; 95% confidence interval: 10.67; 3.79–30.02, p-value < 0.001) (Gebeyehu et al. 2022). The fact however remains that Gebeyehu et al. prospectively included 287 elective-emergency abdominal surgical subset with 33% incidence of PPCs when compared to 11.69% patients with PPCs in the Shiramoto et al. retrospective study staged in an elective surgical setting. Having said that, the importance of accounting for respiratory infections within the month prior to surgical intervention cannot be overemphasized while assessing PPCs as an outcome of interest. Indeed, the PPC predictive risk indices, such as the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT score, inculcating preoperative SpO₂ and respiratory infections in the last month, in addition to factors like preoperative anemia), have demonstrated encouraging results, as depicted in a large external risk-predictive validation endeavor (Mazo et al. 2014).

Furthermore, retrospective surgical literature highlights the concurrent role of nutritional status and perioperative inflammation in determining the propensity to developing PPCs. Thus, amidst independent studies assigning significant PPC “weight” to serum albumin cholesterol, platelets (Xue et al. 2021), and prognostic nutritional index (Yu et al. 2021), the former could also have been potential players, particularly in the context of a predisposed surgical cohort of obese patients.

Not applicable.

ARISCAT:: Assess Respiratory Risk in Surgical Patients in Catalonia
BMI:: Body mass index
PPC:: Postoperative pulmonary complications
SpO₂ :: Arterial oxygen saturation
WHO:: World Health Organization

通讯作者:Varun Suresh对参与者的伦理批准和同意不适用。发表同意不适用。竞争利益作者声明他们没有竞争利益。出版商声明:对于已出版的地图和机构关系中的管辖权要求，普林格·自然保持中立。开放获取本文遵循知识共享署名4.0国际许可协议，该协议允许以任何媒介或格式使用、共享、改编、分发和复制，只要您适当地注明原作者和来源，提供知识共享许可协议的链接，并注明是否进行了更改。本文中的图像或其他第三方材料包含在文章的知识共享许可协议中，除非在材料的署名中另有说明。如果材料未包含在文章的知识共享许可中，并且您的预期用途不被法律法规允许或超过允许的用途，您将需要直接获得版权所有者的许可。要查看该许可证的副本，请访问http://creativecommons.org/licenses/by/4.0/.Reprints和PermissionsCite这篇文章magoon, R.， Suresh, V.肥胖和术后肺部并发症:其他携带“体重”的潜在因素。中华麻醉学杂志，2015(5):357 - 357。https://doi.org/10.1186/s42077-023-00393-9Download citation:收稿日期:2023年6月6日收稿日期:2023年11月7日发布日期:2023年11月17日doi: https://doi.org/10.1186/s42077-023-00393-9Share这篇文章任何你分享以下链接的人都可以阅读到这篇文章:获取可共享链接对不起，本文目前没有可共享链接。复制到剪贴板由Springer Nature shareit内容共享计划提供

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引用次数: 0

Prevalence and outcome of chronic hepatitis C patients admitted with COVID-19 to intensive care units: a blessing in disguise 重症监护病房收治的COVID-19慢性丙型肝炎患者的患病率和结局:因祸得福

IF 0.5

Ain-Shams Journal of Anesthesiology

Pub Date : 2023-11-16 DOI: 10.1186/s42077-023-00396-6

Essamedin M. Negm, Rehab H. El-Sokkary, Mai M. Malek, Heba M. Ezzat, Ahmed E. Tawfik, Heba Ali Abed, Seham Mahmoud ELdeeb, Mohamed Sorour Mohamed, Hamdy M. Kassem, Ahmed Mosallem, Sherif M. S. Mowafy

Managing COVID-19 pneumonia is, in reality, one of the biggest challenges in the history of intensive care medicine. The link between comorbidity and COVID-19 remains unclear. Worldwide, Egypt has the highest prevalence of hepatitis C virus (HCV). The study’s objectives were to assess the prevalence of chronic hepatitis C as a risk factor among COVID-19 patients and to investigate the impact of it and the prior exposure to different HCV management protocols on the clinical characteristics and outcome of COVID-19 patients. Of 2106 confirmed cases of COVID-19, CLD, malignancy, and chronic kidney disease were significant risk factors for death [OR (95% CI) = 2.78 (1.29–5.98), 2.72 (1.14–6.46) and 3.79 (1.39–10.36) respectively]. The mortality rate was 24.3%. A total of 99 cases (4.7%) with CLD were investigated during the study period; 69 patients (3.3%) were categorized as HCV-positive. Among the positive HCV cases, 49 patients (2.3%) received anti-hepatitis C medications. The mortality rate was 46.4% and 73.3% between HCV and non-HCV hepatic patients, respectively. Triple therapy showed a statistically significant association with a better outcome (p value = 0.009). In the present report, chronic liver diseases, chronic kidney disease, and malignancy were significant risk factors for mortality among COVID-19 patients. The Egyptian mass management of chronic hepatitis C may explain the favorable outcome of COVID-19 among these patients. Intervention trials are required to prove that direct-acting antivirals are effective in preventing COVID-19.

实际上，管理COVID-19肺炎是重症监护医学史上最大的挑战之一。合并症与COVID-19之间的联系尚不清楚。在世界范围内，埃及是丙型肝炎病毒(HCV)患病率最高的国家。该研究的目的是评估慢性丙型肝炎在COVID-19患者中作为一个危险因素的流行程度，并调查慢性丙型肝炎以及之前接触过不同HCV管理方案对COVID-19患者临床特征和预后的影响。在2106例COVID-19确诊病例中，CLD、恶性肿瘤和慢性肾脏疾病是导致死亡的显著危险因素[OR (95% CI)分别为2.78(1.29-5.98)、2.72(1.14-6.46)和3.79(1.39-10.36)]。死亡率为24.3%。研究期间共调查CLD 99例(4.7%);hcv阳性69例(3.3%)。在HCV阳性病例中，49例(2.3%)患者接受了抗丙型肝炎药物治疗。丙型肝炎和非丙型肝炎患者的死亡率分别为46.4%和73.3%。三联治疗与较好的预后有统计学意义(p值= 0.009)。在本报告中，慢性肝病、慢性肾病和恶性肿瘤是COVID-19患者死亡的重要危险因素。埃及对慢性丙型肝炎的大规模管理可能解释了COVID-19在这些患者中的有利结果。需要进行干预试验，以证明直接作用的抗病毒药物对预防COVID-19有效。

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引用次数: 0

i-gel as an interface before intubation to buy safe apnea time in a patient with anticipated difficult airway due to multiple facial fractures I-gel作为气管插管前的界面，为预期因多处面部骨折导致气道困难的患者获得安全的呼吸暂停时间

IF 0.5

Ain-Shams Journal of Anesthesiology

Pub Date : 2023-11-16 DOI: 10.1186/s42077-023-00397-5

Sony Sony, Manasmita Dalai, Boney John, Abhilash D. Sadhankar

Any traumatic injury to the face can be uniquely challenging to the anesthesiologist. A difficult airway in a chronic obstructive pulmonary disease patient, non-consenting for awake intubation can pose quite a conundrum. Our patient had multiple facial fractures with limited mouth opening, making mask ventilation difficult. We found that i-gel® was easy to insert in a lighter plane of anesthesia maintaining spontaneous ventilation, without much manipulation. The benefits were twofold, it confirmed the ability to ventilate and secondly bought us safe apnea time before attempts of intubation were made. Supra-glottic devices are an integral part of difficult airways but i-gel® is uniquely simple and easy to use.

任何脸部外伤对麻醉师来说都是一个独特的挑战。慢性阻塞性肺疾病患者气道困难，不同意清醒插管可能会造成相当大的难题。我们的病人有多处面部骨折，张嘴受限，使面罩通气困难。我们发现i-gel®很容易插入较轻的麻醉平面，保持自发通气，无需太多操作。好处是双重的，它证实了通气的能力，其次，在尝试插管之前，我们获得了安全的呼吸时间。声门上设备是困难气道的一个组成部分，但i-gel®是独特的简单易用。

引用次数: 0

ESPB and post cardiac surgery recovery: reading between the lines ESPB和心脏手术后恢复:字里行间的阅读

Ain-Shams Journal of Anesthesiology

Pub Date : 2023-11-14 DOI: 10.1186/s42077-023-00394-8

Sunaakshi Puri, Anjishnujit Bandyopadhyay, Rohan Magoon

引用次数: 0

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