Pub Date : 2023-11-10DOI: 10.1186/s42077-023-00388-6
Bassem N. Beshay, Islam M. Elbardan, Moustafa A. Moustafa, Ahmed S. Shehab
Abstract Background Griggs’ technique with assisting tools for bedside percutaneous tracheotomy (PDT) is safe and fast and carries few complications in expert hands. Assisting tools are not routinely available in many ICUs. The study aims to evaluate the impact of a novel technique for blind percutaneous tracheotomy on success rate, duration of the procedure, and rate of complications. This retrospective case-series study was conducted in the different intensive care units in Alexandria University Hospitals. Three hundred eighty-six patients were recruited from 1 January 2018 to 31 December 2021. After skin incision and blunt pre-tracheal dissection, a needle was inserted to access the airway, transfixing the endotracheal tube (ETT). A change in the alignment of the needle tip inside the trachea from caudal to cranial accompanied the withdrawal of the ETT off the trachea. In situ caudal needle redirection for subsequent guidewire passage distally into the trachea was done. The rest of the procedure was continued as Griggs’ technique. Results The success rate was 100%. The procedure duration (in seconds) was 125.73±19.52. No procedure-related deaths or major intra-operative complications were encountered. Only three patients developed pneumothorax and subcutaneous emphysema, managed by intercostal tube insertion. Conclusions The novel technique for blind percutaneous tracheotomy was successful with no significant procedure-related complications. The duration of the procedure was comparable to the literature.
{"title":"A novel technique for safe blind percutaneous tracheotomy: retrospective case-series study on three hundred eighty-six patients","authors":"Bassem N. Beshay, Islam M. Elbardan, Moustafa A. Moustafa, Ahmed S. Shehab","doi":"10.1186/s42077-023-00388-6","DOIUrl":"https://doi.org/10.1186/s42077-023-00388-6","url":null,"abstract":"Abstract Background Griggs’ technique with assisting tools for bedside percutaneous tracheotomy (PDT) is safe and fast and carries few complications in expert hands. Assisting tools are not routinely available in many ICUs. The study aims to evaluate the impact of a novel technique for blind percutaneous tracheotomy on success rate, duration of the procedure, and rate of complications. This retrospective case-series study was conducted in the different intensive care units in Alexandria University Hospitals. Three hundred eighty-six patients were recruited from 1 January 2018 to 31 December 2021. After skin incision and blunt pre-tracheal dissection, a needle was inserted to access the airway, transfixing the endotracheal tube (ETT). A change in the alignment of the needle tip inside the trachea from caudal to cranial accompanied the withdrawal of the ETT off the trachea. In situ caudal needle redirection for subsequent guidewire passage distally into the trachea was done. The rest of the procedure was continued as Griggs’ technique. Results The success rate was 100%. The procedure duration (in seconds) was 125.73±19.52. No procedure-related deaths or major intra-operative complications were encountered. Only three patients developed pneumothorax and subcutaneous emphysema, managed by intercostal tube insertion. Conclusions The novel technique for blind percutaneous tracheotomy was successful with no significant procedure-related complications. The duration of the procedure was comparable to the literature.","PeriodicalId":7686,"journal":{"name":"Ain-Shams Journal of Anesthesiology","volume":"5 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135141875","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}
Abstract Background Anesthetic techniques are designed to minimize intraoperative surgical bed bleeding which is a major problem that may interfere with precision, surgery duration, or postoperative wound healing. The main reason for reoperation and/or mortality in children who have had tonsillectomies is post-tonsillectomy hemorrhage. We evaluate the local application effect of tranexamic acid and lidocaine local infiltration in the tonsillar bed during tonsillectomy surgery on postoperative analgesia and bleeding. Results FLACC scores showed a statistically significant reduction in the first 24 h in group T ( P < 0.05). Post-tonsillectomy hemorrhage was significantly minimized in group T. No complications were recorded following the local application of tranexamic acid and local lidocaine infiltration inside the tonsil bed. Conclusions Local infiltration of lidocaine provides adequate postoperative analgesia, and tranexamic acid application during tonsillectomy surgery minimizes postoperative bleeding and shortens surgery duration. Trial registration This study was preregistered with the Clinical Trials Registry (NCT05817474).
{"title":"Clinical efficacy of local infiltration of lidocaine and tranexamic acid application in tonsillar region on postoperative pain and bleeding during tonsillectomy: prospective, randomized, double-blind controlled study","authors":"Mohamed Abdelgawad Abdelhalim Aboelsuod, Abdalla Mohamed Abdalla, Ismail Mohamed Abdelgawad Ahmed, Sameh Hamdy Seyam, Ahmed Mohamed Hassan","doi":"10.1186/s42077-023-00391-x","DOIUrl":"https://doi.org/10.1186/s42077-023-00391-x","url":null,"abstract":"Abstract Background Anesthetic techniques are designed to minimize intraoperative surgical bed bleeding which is a major problem that may interfere with precision, surgery duration, or postoperative wound healing. The main reason for reoperation and/or mortality in children who have had tonsillectomies is post-tonsillectomy hemorrhage. We evaluate the local application effect of tranexamic acid and lidocaine local infiltration in the tonsillar bed during tonsillectomy surgery on postoperative analgesia and bleeding. Results FLACC scores showed a statistically significant reduction in the first 24 h in group T ( P < 0.05). Post-tonsillectomy hemorrhage was significantly minimized in group T. No complications were recorded following the local application of tranexamic acid and local lidocaine infiltration inside the tonsil bed. Conclusions Local infiltration of lidocaine provides adequate postoperative analgesia, and tranexamic acid application during tonsillectomy surgery minimizes postoperative bleeding and shortens surgery duration. Trial registration This study was preregistered with the Clinical Trials Registry (NCT05817474).","PeriodicalId":7686,"journal":{"name":"Ain-Shams Journal of Anesthesiology","volume":" 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135191995","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 : 2023-11-09DOI: 10.1186/s42077-023-00389-5
Nilesh M. Solanki, Maulik P. Bhimani, Nirmal S. Mistry, Diya Rajan
Abstract Background A subarachnoid block is the cheaper and widely used regional block for lower limb surgery. Postoperative pain occurs after lower limb orthopedic surgery from moderate to severe. We conducted a prospective, randomized, double-blind controlled trial. All patients were assessed for onset and duration of sensory and motor block, total duration of analgesia, and postoperative pain relief. This study was conducted to evaluate the efficacy of intrathecal bupivacaine with magnesium undergoing lower limb orthopedic surgery. Results One hundred patients were randomly divided into two equal groups. Group M: Intrathecal 3 ml (15 mg) of 0.5% bupivacaine + 0.2 ml (50 mg) of preservative-free 25% of magnesium sulphate. Group B: Intrathecal 3 ml (15 mg) of 0.5% bupivacaine + 0.2 ml preservative-free 0.9% normal saline. The mean time that occurred for the sensory blockade at T10 was 2.49 ± 0.49 min in group B, while it was 4.13 ± 0.74 min in group BM ( p value < 0.0001). The mean of the total duration of the sensory block in group B was 139.5 ± 32.01 min, while it was 366.4 ± 30.12 min in group BM ( p value < 0.0001). The time taken for the onset of motor block in group B was 5.28 ± 1.31 min, while it was 7.86 ± 1.19 min in group BM ( p value < 0.0001). The mean total duration of the motor block in group B was 136.3 ± 8.19 min, while it was 336.5 ± 37.08 min in group BM ( p value < 0.0001). The total duration of analgesia in group B was 141.4 ± 14.85 min, while it was 365.9 ± 44.91 min in group BM ( p value < 0.0001). The mean dose required for rescue analgesia in group B was 2.2 ± 1.14, while in group BM was 1.28 ± 0.96 ( p value < 0.0001). Conclusions The addition of 50 mg magnesium sulphate in intrathecal hyperbaric bupivacaine significantly prolongs the extended duration of sensory, motor blockade, and total duration of analgesia for patients undergoing lower limb orthopedic surgery.
摘要背景:蛛网膜下腔阻滞是一种廉价且广泛应用于下肢手术的区域阻滞。下肢骨科手术后疼痛由中度到重度不等。我们进行了一项前瞻性、随机、双盲对照试验。评估所有患者感觉和运动阻滞的发生和持续时间，镇痛总持续时间和术后疼痛缓解。本研究旨在评估布比卡因加镁鞘内注射在下肢骨科手术中的疗效。结果100例患者随机分为两组。M组:鞘内注射0.5%布比卡因3ml (15mg) +不含防腐剂的25%硫酸镁0.2 ml (50mg)。B组:鞘内注射0.5%布比卡因3 ml (15 mg) +不含防腐剂的0.9%生理盐水0.2 ml。T10时感觉阻滞发生的平均时间B组为2.49±0.49 min, BM组为4.13±0.74 min (p值<0.0001)。B组感觉阻滞总持续时间平均为139.5±32.01 min, BM组为366.4±30.12 min (p值<0.0001)。B组运动阻滞发生时间为5.28±1.31 min, BM组为7.86±1.19 min (p值<0.0001)。B组运动阻滞的平均总持续时间为136.3±8.19 min, BM组为336.5±37.08 min (p值<0.0001)。B组总镇痛时间为141.4±14.85 min, BM组总镇痛时间为365.9±44.91 min (p值<0.0001)。B组抢救镇痛所需平均剂量为2.2±1.14,BM组为1.28±0.96 (p值<0.0001)。结论布比卡因鞘内高压注入硫酸镁50 mg可显著延长下肢骨科手术患者的感觉、运动阻滞时间和总镇痛时间。
{"title":"Evaluation of adding magnesium sulphate to intrathecal bupivacaine in lower limb orthopedic surgery","authors":"Nilesh M. Solanki, Maulik P. Bhimani, Nirmal S. Mistry, Diya Rajan","doi":"10.1186/s42077-023-00389-5","DOIUrl":"https://doi.org/10.1186/s42077-023-00389-5","url":null,"abstract":"Abstract Background A subarachnoid block is the cheaper and widely used regional block for lower limb surgery. Postoperative pain occurs after lower limb orthopedic surgery from moderate to severe. We conducted a prospective, randomized, double-blind controlled trial. All patients were assessed for onset and duration of sensory and motor block, total duration of analgesia, and postoperative pain relief. This study was conducted to evaluate the efficacy of intrathecal bupivacaine with magnesium undergoing lower limb orthopedic surgery. Results One hundred patients were randomly divided into two equal groups. Group M: Intrathecal 3 ml (15 mg) of 0.5% bupivacaine + 0.2 ml (50 mg) of preservative-free 25% of magnesium sulphate. Group B: Intrathecal 3 ml (15 mg) of 0.5% bupivacaine + 0.2 ml preservative-free 0.9% normal saline. The mean time that occurred for the sensory blockade at T10 was 2.49 ± 0.49 min in group B, while it was 4.13 ± 0.74 min in group BM ( p value < 0.0001). The mean of the total duration of the sensory block in group B was 139.5 ± 32.01 min, while it was 366.4 ± 30.12 min in group BM ( p value < 0.0001). The time taken for the onset of motor block in group B was 5.28 ± 1.31 min, while it was 7.86 ± 1.19 min in group BM ( p value < 0.0001). The mean total duration of the motor block in group B was 136.3 ± 8.19 min, while it was 336.5 ± 37.08 min in group BM ( p value < 0.0001). The total duration of analgesia in group B was 141.4 ± 14.85 min, while it was 365.9 ± 44.91 min in group BM ( p value < 0.0001). The mean dose required for rescue analgesia in group B was 2.2 ± 1.14, while in group BM was 1.28 ± 0.96 ( p value < 0.0001). Conclusions The addition of 50 mg magnesium sulphate in intrathecal hyperbaric bupivacaine significantly prolongs the extended duration of sensory, motor blockade, and total duration of analgesia for patients undergoing lower limb orthopedic surgery.","PeriodicalId":7686,"journal":{"name":"Ain-Shams Journal of Anesthesiology","volume":" 41","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135241746","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}
Abstract Background Various studies have demonstrated the analgesic benefit of systemic lidocaine in the perioperative setting, especially during laparoscopic abdominal surgery. However, the best appropriate dose for an administered bolus and continuous infusion of lignocaine is unclear. Our aim is to compare the effect of two different doses of intravenous lidocaine for analgesia in patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Fifty-four patients of ASA PS I or II, aged between 18 and 65 years undergoing elective laparoscopic cholecystectomy under general anesthesia were randomly divided into two groups of 26 patients each. Patients in group A received an intravenous bolus injection of lidocaine 1.5 mg/kg slowly over 10 min, prior to induction and then followed by a continuous infusion at the rate of 1.5 mg/kg/h via infusion pump whereas group B patients received intravenous lidocaine bolus of 1.5 mg/kg slowly over 10 min followed by infusion at the rate of 2 mg/kg/h. Postoperative analgesia was assessed by VAS score, time to first analgesic dose, and total consumption of rescue analgesic in 24 h. Results There was a statistically significant difference in mean VAS Scores between the two groups at different time intervals postoperatively. Time to first rescue analgesia was earlier in group A (30.65 min) compared to group B (49.42 min) and the difference was statistically significant. Total consumption of rescue analgesic was higher in group A with a mean of 178.85 mg compared to 126.92 mg in group B. Conclusion Both the infusion doses of Lidocaine provided clinically adequate analgesia postoperatively but the infusion dose of 2 mg/kg/h had a mean VAS score significantly lower than 1.5 mg/kg/h.
{"title":"Comparison of dose–response to two different doses of intravenous lidocaine for analgesia in patients undergoing elective laparoscopic cholecystectomy under general anesthesia","authors":"Sunana Gupta, Prerna Attal, Nandita Mehta, Heena Saini, Sitikantha Banerjee","doi":"10.1186/s42077-023-00390-y","DOIUrl":"https://doi.org/10.1186/s42077-023-00390-y","url":null,"abstract":"Abstract Background Various studies have demonstrated the analgesic benefit of systemic lidocaine in the perioperative setting, especially during laparoscopic abdominal surgery. However, the best appropriate dose for an administered bolus and continuous infusion of lignocaine is unclear. Our aim is to compare the effect of two different doses of intravenous lidocaine for analgesia in patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Fifty-four patients of ASA PS I or II, aged between 18 and 65 years undergoing elective laparoscopic cholecystectomy under general anesthesia were randomly divided into two groups of 26 patients each. Patients in group A received an intravenous bolus injection of lidocaine 1.5 mg/kg slowly over 10 min, prior to induction and then followed by a continuous infusion at the rate of 1.5 mg/kg/h via infusion pump whereas group B patients received intravenous lidocaine bolus of 1.5 mg/kg slowly over 10 min followed by infusion at the rate of 2 mg/kg/h. Postoperative analgesia was assessed by VAS score, time to first analgesic dose, and total consumption of rescue analgesic in 24 h. Results There was a statistically significant difference in mean VAS Scores between the two groups at different time intervals postoperatively. Time to first rescue analgesia was earlier in group A (30.65 min) compared to group B (49.42 min) and the difference was statistically significant. Total consumption of rescue analgesic was higher in group A with a mean of 178.85 mg compared to 126.92 mg in group B. Conclusion Both the infusion doses of Lidocaine provided clinically adequate analgesia postoperatively but the infusion dose of 2 mg/kg/h had a mean VAS score significantly lower than 1.5 mg/kg/h.","PeriodicalId":7686,"journal":{"name":"Ain-Shams Journal of Anesthesiology","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135342361","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 : 2023-11-07DOI: 10.1186/s42077-023-00386-8
G. Sanjeev, D. Subha, D. Divya
{"title":"Malposition of right internal jugular vein cannulation into left brachiocephalic vein","authors":"G. Sanjeev, D. Subha, D. Divya","doi":"10.1186/s42077-023-00386-8","DOIUrl":"https://doi.org/10.1186/s42077-023-00386-8","url":null,"abstract":"","PeriodicalId":7686,"journal":{"name":"Ain-Shams Journal of Anesthesiology","volume":"302 7","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135475322","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}
Abstract Background COVID-19 patients with respiratory failure may need intensive care unit (ICU) admission. Prone positioning in mechanically ventilated patients improves oxygenation and reduces mortality in moderate to severe acute respiratory distress syndrome. For better oxygenation and outcomes, awake proning is being tried in non-intubated patients also. Our aim was to investigate advantage of awake self-prone positioning with oxygen therapy using non-rebreathing mask (NRBM) in COVID-19 ICU patients. Results This prospective observational study was conducted in ICU from 18th November 2020 to 28th February 2021. Sixty COVID-19 cooperative patients with hypoxemia on arrival with hemodynamic stability were included. Patients on NRBM were advised to turn prone for 12–14 h per day. Oxygen saturation (SpO 2 ) was recorded in supine position and 30 min after initiation of prone positioning. Ratio of arterial partial pressure of oxygen and fractional concentration of inspired oxygen (P/F) was recorded in supine and 24 h after initiation of prone position. Primary outcome was improvement in SpO 2 > 94%. Secondary outcome was incidence of intubation. Sixty patients were received in ICU with supplemental oxygen, and median SpO 2 was 80% ( IQR 70–88%). Patients were put on NRBM with median SpO 2 in supine position 86% ( IQR 76–90). Thirty minutes of proning increased SpO 2 to 94% ( IQR 89 to 97%). Wilcoxon rank-sum test was used ( P = 0.001). Forty-three patients did not require intubation, and seventeen patients needed intubation. Conclusions Awake self-proning in COVID-19 patients on NRBM improved oxygenation with reduced intubation rate.
{"title":"Awake self-proning for COVID-19 non-intubated patients—a single-centered experience","authors":"Rekha Nileshbhai Solanki, Jayshree Mahendra Thakkar","doi":"10.1186/s42077-023-00387-7","DOIUrl":"https://doi.org/10.1186/s42077-023-00387-7","url":null,"abstract":"Abstract Background COVID-19 patients with respiratory failure may need intensive care unit (ICU) admission. Prone positioning in mechanically ventilated patients improves oxygenation and reduces mortality in moderate to severe acute respiratory distress syndrome. For better oxygenation and outcomes, awake proning is being tried in non-intubated patients also. Our aim was to investigate advantage of awake self-prone positioning with oxygen therapy using non-rebreathing mask (NRBM) in COVID-19 ICU patients. Results This prospective observational study was conducted in ICU from 18th November 2020 to 28th February 2021. Sixty COVID-19 cooperative patients with hypoxemia on arrival with hemodynamic stability were included. Patients on NRBM were advised to turn prone for 12–14 h per day. Oxygen saturation (SpO 2 ) was recorded in supine position and 30 min after initiation of prone positioning. Ratio of arterial partial pressure of oxygen and fractional concentration of inspired oxygen (P/F) was recorded in supine and 24 h after initiation of prone position. Primary outcome was improvement in SpO 2 > 94%. Secondary outcome was incidence of intubation. Sixty patients were received in ICU with supplemental oxygen, and median SpO 2 was 80% ( IQR 70–88%). Patients were put on NRBM with median SpO 2 in supine position 86% ( IQR 76–90). Thirty minutes of proning increased SpO 2 to 94% ( IQR 89 to 97%). Wilcoxon rank-sum test was used ( P = 0.001). Forty-three patients did not require intubation, and seventeen patients needed intubation. Conclusions Awake self-proning in COVID-19 patients on NRBM improved oxygenation with reduced intubation rate.","PeriodicalId":7686,"journal":{"name":"Ain-Shams Journal of Anesthesiology","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135635236","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 : 2023-11-03DOI: 10.1186/s42077-023-00384-w
Beshoy Gamal Nazeem Saad, Basem Boles Gabriale Saad, Ashraf EL Said Abd EL Rahman EL Agamy, Mona Ahmed Abd Elmotalb Ammar, Khaled Moustafa Ali Khalaf
Abstract Background Preoperative time is a very stressful time for most patients undergoing surgery, particularly young patients. The primary goal of an anaesthesiologist is to reduce patients’ anxiety before surgery. To lessen this stress response, many anaesthetic pre-medications are used. Magnesium chloride and dexmedetomidine are two of these pre-medications that work well as sedatives. This study examined dexmedetomidine and magnesium sulphate as a pre-anaesthetic medication for kids. Dexmedetomidine and magnesium will be compared for their efficacy and safety in treating children who experience emerging anxiety after having their tonsils removed in this trial. Forty-five children between the ages of 4 and 12 years who were having elective adenotonsillectomy surgery in this comparative prospective, double-blind, randomised controlled clinical research. Children were split up into three groups: group A was given dexmedetomidine, group B was given magnesium infusion, and group C was given normal saline 0.9% infusion. Results Ramsay and Cravero scores revealed that children who got dexmedetomidine infusion were less agitated than those who received magnesium sulphate or normal saline infusion ( p value 0.01). Conclusions When comparing dexmedetomidine to magnesium sulphate, there are a few advantages to its use. It can be administered as an anaesthetic medication to minors undergoing adenotonsillectomy under general anaesthesia in order to lessen postoperative agitation.
{"title":"Dexmedetomidine or magnesium to control agitations in patients undergoing tonsillectomy: randomised controlled study","authors":"Beshoy Gamal Nazeem Saad, Basem Boles Gabriale Saad, Ashraf EL Said Abd EL Rahman EL Agamy, Mona Ahmed Abd Elmotalb Ammar, Khaled Moustafa Ali Khalaf","doi":"10.1186/s42077-023-00384-w","DOIUrl":"https://doi.org/10.1186/s42077-023-00384-w","url":null,"abstract":"Abstract Background Preoperative time is a very stressful time for most patients undergoing surgery, particularly young patients. The primary goal of an anaesthesiologist is to reduce patients’ anxiety before surgery. To lessen this stress response, many anaesthetic pre-medications are used. Magnesium chloride and dexmedetomidine are two of these pre-medications that work well as sedatives. This study examined dexmedetomidine and magnesium sulphate as a pre-anaesthetic medication for kids. Dexmedetomidine and magnesium will be compared for their efficacy and safety in treating children who experience emerging anxiety after having their tonsils removed in this trial. Forty-five children between the ages of 4 and 12 years who were having elective adenotonsillectomy surgery in this comparative prospective, double-blind, randomised controlled clinical research. Children were split up into three groups: group A was given dexmedetomidine, group B was given magnesium infusion, and group C was given normal saline 0.9% infusion. Results Ramsay and Cravero scores revealed that children who got dexmedetomidine infusion were less agitated than those who received magnesium sulphate or normal saline infusion ( p value 0.01). Conclusions When comparing dexmedetomidine to magnesium sulphate, there are a few advantages to its use. It can be administered as an anaesthetic medication to minors undergoing adenotonsillectomy under general anaesthesia in order to lessen postoperative agitation.","PeriodicalId":7686,"journal":{"name":"Ain-Shams Journal of Anesthesiology","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135868260","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 : 2023-11-03DOI: 10.1186/s42077-023-00385-9
Ravi Murmu, A. Aditya, P. K. Tiwary, Ladhu Lakra, Tushar Kumar
Abstract Background Local anesthetic agents are widely used drugs across the globe. Within their dosage range and appropriate location of administration, they are quite safe and effective. Rarely when given via intravascular route, local anesthetics can lead to life-threatening consequences. Case presentation Here, we present a case of a young male with an epidural catheter for femur surgery. The catheter was functioning quite well initially but later migrated in the intravascular route. When top-up was given with local anesthetics, the patient developed seizures which were managed promptly. Conclusions Inadvertent migration of catheter may occur during patient positioning or unwanted movements during surgery, but careful aspiration before every top-up and aspiration during every aliquot of top-up must be practiced.
{"title":"Epidural catheter migration: is aspiration enough? A case report","authors":"Ravi Murmu, A. Aditya, P. K. Tiwary, Ladhu Lakra, Tushar Kumar","doi":"10.1186/s42077-023-00385-9","DOIUrl":"https://doi.org/10.1186/s42077-023-00385-9","url":null,"abstract":"Abstract Background Local anesthetic agents are widely used drugs across the globe. Within their dosage range and appropriate location of administration, they are quite safe and effective. Rarely when given via intravascular route, local anesthetics can lead to life-threatening consequences. Case presentation Here, we present a case of a young male with an epidural catheter for femur surgery. The catheter was functioning quite well initially but later migrated in the intravascular route. When top-up was given with local anesthetics, the patient developed seizures which were managed promptly. Conclusions Inadvertent migration of catheter may occur during patient positioning or unwanted movements during surgery, but careful aspiration before every top-up and aspiration during every aliquot of top-up must be practiced.","PeriodicalId":7686,"journal":{"name":"Ain-Shams Journal of Anesthesiology","volume":"129 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135818962","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}
Abstract Background Multiple myeloma (MM) patients are prone to pathological fractures due to osteolytic bone lesions. With improved perioperative care, outcome of patients with vertebral compression fractures presenting for surgical interventions has become better. However, perioperative care of such patients is challenging for the anesthesiologist. Case presentation Herein, we report the successful perioperative management of a 55-year-old multiple myeloma patient with the compression fracture of lumbar vertebrae 2nd to 5th, for which balloon kyphoplasty was planned in prone position. Conclusions Multiple myeloma patients are at high risk of developing postoperative complications like acute kidney injury (AKI), pneumonia, and infections. In the present case report, we discuss and provide recommendations for better perioperative care to prevent perioperative complications.
{"title":"Perioperative management of a morbidly obese patient with multiple myeloma for spine surgery—when the problem doubles up!","authors":"Shankey Garg, Shalvi Mahajan, Ankit Kansal, Swati Taneja","doi":"10.1186/s42077-023-00375-x","DOIUrl":"https://doi.org/10.1186/s42077-023-00375-x","url":null,"abstract":"Abstract Background Multiple myeloma (MM) patients are prone to pathological fractures due to osteolytic bone lesions. With improved perioperative care, outcome of patients with vertebral compression fractures presenting for surgical interventions has become better. However, perioperative care of such patients is challenging for the anesthesiologist. Case presentation Herein, we report the successful perioperative management of a 55-year-old multiple myeloma patient with the compression fracture of lumbar vertebrae 2nd to 5th, for which balloon kyphoplasty was planned in prone position. Conclusions Multiple myeloma patients are at high risk of developing postoperative complications like acute kidney injury (AKI), pneumonia, and infections. In the present case report, we discuss and provide recommendations for better perioperative care to prevent perioperative complications.","PeriodicalId":7686,"journal":{"name":"Ain-Shams Journal of Anesthesiology","volume":"174 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136376225","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 : 2023-10-26DOI: 10.1186/s42077-023-00382-y
Kamal Chandra Deori, Mrinal Kanti Taye, Babita Lahkar
Abstract Background The study was done to observe the effectiveness of nalbuphine as an adjuvant to intrathecal bupivacaine heavy, and hence, it was compared in terms of regression time of sensory and motor block and adverse effects with that of fentanyl as an adjuvant. The study design was a prospective randomized double-blind study. Total number of patients were 100. They were randomly allocated into two groups. Group N ( n = 50) received 3.2 ml of 0.5% heavy bupivacaine and 0.5 ml (0.8 mg) of nalbuphine, a total of 3.7 ml. Group F ( n = 50) received 3.2 ml of 0.5% heavy bupivacaine and 0.5 ml (25 µg) of fentanyl, a total of 3.7 ml. Assessment of sensory and motor blockade and analgesia was done by visual analogue scale and modified Bromage scale. Results On comparing the spinal block characteristics among two groups to reach, Bromage-3 motor block was found to be significantly shorter in group F ( p = 0.03777). The regression time of both sensory and motor block was significantly prolonged in group N ( P < 0.0001). No patients required additional analgesic intraoperatively, and intraoperative VAS scores and adverse effects were comparable in the two groups. Conclusions On comparing nalbuphine 0.8 mg and fentanyl 25 µg as an adjuvant to intrathecal bupivacaine, it has been observed that nalbuphine significantly prolongs regression time of sensory and motor block indicating the effectiveness of nalbuphine as an alternative to fentanyl and for prolong surgeries. The incidence of adverse effects was similar in both groups.
{"title":"Comparative study on regression time of block and adverse effects of nalbuphine and fentanyl as an adjuvant to intrathecal bupivacaine: a prospective randomized double-blind study","authors":"Kamal Chandra Deori, Mrinal Kanti Taye, Babita Lahkar","doi":"10.1186/s42077-023-00382-y","DOIUrl":"https://doi.org/10.1186/s42077-023-00382-y","url":null,"abstract":"Abstract Background The study was done to observe the effectiveness of nalbuphine as an adjuvant to intrathecal bupivacaine heavy, and hence, it was compared in terms of regression time of sensory and motor block and adverse effects with that of fentanyl as an adjuvant. The study design was a prospective randomized double-blind study. Total number of patients were 100. They were randomly allocated into two groups. Group N ( n = 50) received 3.2 ml of 0.5% heavy bupivacaine and 0.5 ml (0.8 mg) of nalbuphine, a total of 3.7 ml. Group F ( n = 50) received 3.2 ml of 0.5% heavy bupivacaine and 0.5 ml (25 µg) of fentanyl, a total of 3.7 ml. Assessment of sensory and motor blockade and analgesia was done by visual analogue scale and modified Bromage scale. Results On comparing the spinal block characteristics among two groups to reach, Bromage-3 motor block was found to be significantly shorter in group F ( p = 0.03777). The regression time of both sensory and motor block was significantly prolonged in group N ( P < 0.0001). No patients required additional analgesic intraoperatively, and intraoperative VAS scores and adverse effects were comparable in the two groups. Conclusions On comparing nalbuphine 0.8 mg and fentanyl 25 µg as an adjuvant to intrathecal bupivacaine, it has been observed that nalbuphine significantly prolongs regression time of sensory and motor block indicating the effectiveness of nalbuphine as an alternative to fentanyl and for prolong surgeries. The incidence of adverse effects was similar in both groups.","PeriodicalId":7686,"journal":{"name":"Ain-Shams Journal of Anesthesiology","volume":"194 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136377205","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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