Abstract Background The anaesthetic agents can affect the quality of motor-evoked potential intraoperatively as they inhibit synaptic transmission. Intravenous anaesthetics suppress motor-evoked potential lesser than inhalational agents, so total intravenous anaesthesia or a combination of intravenous with minimal inhalational anaesthetic supplementation is used when motor-evoked potential is monitored. Motor-evoked potential can get depressed at high doses of propofol required to maintain surgical depth, hence, adjuvant agents like dexmedetomidine that maintain anaesthetic depth without affecting the motor-evoked potential are often required. This study was a prospective non-randomized and comparative study (quasi-experimental) assigned into two groups of 64 each, labelled as the propofol group (group P) and Propofol + dexmedetomidine group (group PD). The primary objective of our study was to compare the total dose reduction of propofol with the addition of dexmedetomidine and their interference with motor-evoked potential readings. The secondary objective was to assess the hemodynamic changes, changes in amplitude and latency of motor-evoked potential, and complications if any. Results The mean total dose of propofol consumed in our study was 502.81 ± 71.01 mg in group propofol( P) and 392.18 ± 59.00 mg in group propofol + dexmedetomidine (PD). Moreover, the mean total dose of propofol (mg) was significantly less used in group PD. Intraoperative hemodynamic stability, no difference in amplitude and latency for motor-evoked potential, and only significant bradycardia in group propofol + dexmedetomidine (PD). Conclusions Dexmedetomidine can be successfully used in propofol-based total intravenous anaesthesia for motor-evoked potential monitoring in spine surgeries, but it is better to maintain stable hemodynamics with a significant reduction of the mean dose of propofol.
{"title":"A bispectral index guided comparative evaluation of dexmedetomidine as an adjuvant to propofol-based total intravenous anaesthesia in spine surgeries done under motor-evoked potential monitoring","authors":"Anshuman Anand, Suraj Kumar, Virendra Kumar, Manoj Kumar Giri, Praveen Kumar Das, Deepti Sharma","doi":"10.1186/s42077-023-00379-7","DOIUrl":"https://doi.org/10.1186/s42077-023-00379-7","url":null,"abstract":"Abstract Background The anaesthetic agents can affect the quality of motor-evoked potential intraoperatively as they inhibit synaptic transmission. Intravenous anaesthetics suppress motor-evoked potential lesser than inhalational agents, so total intravenous anaesthesia or a combination of intravenous with minimal inhalational anaesthetic supplementation is used when motor-evoked potential is monitored. Motor-evoked potential can get depressed at high doses of propofol required to maintain surgical depth, hence, adjuvant agents like dexmedetomidine that maintain anaesthetic depth without affecting the motor-evoked potential are often required. This study was a prospective non-randomized and comparative study (quasi-experimental) assigned into two groups of 64 each, labelled as the propofol group (group P) and Propofol + dexmedetomidine group (group PD). The primary objective of our study was to compare the total dose reduction of propofol with the addition of dexmedetomidine and their interference with motor-evoked potential readings. The secondary objective was to assess the hemodynamic changes, changes in amplitude and latency of motor-evoked potential, and complications if any. Results The mean total dose of propofol consumed in our study was 502.81 ± 71.01 mg in group propofol( P) and 392.18 ± 59.00 mg in group propofol + dexmedetomidine (PD). Moreover, the mean total dose of propofol (mg) was significantly less used in group PD. Intraoperative hemodynamic stability, no difference in amplitude and latency for motor-evoked potential, and only significant bradycardia in group propofol + dexmedetomidine (PD). Conclusions Dexmedetomidine can be successfully used in propofol-based total intravenous anaesthesia for motor-evoked potential monitoring in spine surgeries, but it is better to maintain stable hemodynamics with a significant reduction of the mean dose of propofol.","PeriodicalId":7686,"journal":{"name":"Ain-Shams Journal of Anesthesiology","volume":"116 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135510797","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 Patients with polytrauma (fractures of the humerus and the femur) require concurrent operative fixation. Pain originating from multiple operative sites leads to increasing doses of opioid-based analgesia, which has detrimental effects in the form of longer hospital stays, higher costs, and increased mortality. Case presentation In twelve patients with humerus and femur fractures, a cervical erector spinae plane block (ESPB) at the level of T1 and a lumbar ESPB at the level of L2 were administered with a catheter and continuous infusion technique for postoperative analgesia. None of these patients required opioids in the postoperative period. The catheters were removed after 48 h. Conclusions A dual ESPB can be used successfully in patients with multiple injuries by appropriately selecting the level of intervention, and opioid-sparing analgesia can be effectively delivered to these patients.
{"title":"Dual erector spinae plane block for complex traumas of upper and lower limb: an opioid reduction strategy—a case series","authors":"Sandeep Diwan, Abhijit Nair, Bharati Adhye, Ganesh Bhong, Parag Sancheti","doi":"10.1186/s42077-023-00380-0","DOIUrl":"https://doi.org/10.1186/s42077-023-00380-0","url":null,"abstract":"Abstract Background Patients with polytrauma (fractures of the humerus and the femur) require concurrent operative fixation. Pain originating from multiple operative sites leads to increasing doses of opioid-based analgesia, which has detrimental effects in the form of longer hospital stays, higher costs, and increased mortality. Case presentation In twelve patients with humerus and femur fractures, a cervical erector spinae plane block (ESPB) at the level of T1 and a lumbar ESPB at the level of L2 were administered with a catheter and continuous infusion technique for postoperative analgesia. None of these patients required opioids in the postoperative period. The catheters were removed after 48 h. Conclusions A dual ESPB can be used successfully in patients with multiple injuries by appropriately selecting the level of intervention, and opioid-sparing analgesia can be effectively delivered to these patients.","PeriodicalId":7686,"journal":{"name":"Ain-Shams Journal of Anesthesiology","volume":"38 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135512896","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 : 2023-10-04DOI: 10.1186/s42077-023-00377-9
Heena Garg, Debesh Bhoi, Kapil Sikka
{"title":"Combined greater auricular and lesser occipital nerve block in cochlear implant for an ear-to-ear smile","authors":"Heena Garg, Debesh Bhoi, Kapil Sikka","doi":"10.1186/s42077-023-00377-9","DOIUrl":"https://doi.org/10.1186/s42077-023-00377-9","url":null,"abstract":"","PeriodicalId":7686,"journal":{"name":"Ain-Shams Journal of Anesthesiology","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135592792","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 Perioperative prophylactic dexamethasone is commonly administered to reduce postoperative nausea and vomiting (PONV) and pain after surgery. In this study, we aimed to systematically review the efficacy and adverse effects of perioperative dexamethasone administration. Methods We conducted a systematic search until January 2023 in scientific databases, including PubMed, Scopus, Embase, Web of Science, and Google Scholar. After assessing the methodological quality of relevant studies, we synthesized those focusing on PONV, oral food intake tolerance, impaired wound healing, major postoperative complications, and postoperative infections following the perioperative administration of dexamethasone. Results A total of 27 studies were included in this systematic review and meta-analysis. The dexamethasone group showed decreased PONV (OR = 0.19; 95% CI 0.06–0.55), increased oral food intake tolerance (OR = 7.38; 95% CI 1.07–51.11), increased risk of impaired wound healing (OR = .48; 95% CI 0.52–4.21), decreased probability of postoperative infection (OR = 0.61; 95% CI 0.51–0.72), and increased risk of major postoperative complications (OR = 1.27; 95% CI 0.68–2.39) compared to the controls. Conclusions The results of our pooled data analysis showed that dexamethasone was superior to the control in terms of PONV, oral food intake tolerance, and postoperative infections.
背景围手术期预防性地塞米松用于减少术后恶心呕吐(PONV)和术后疼痛。在本研究中，我们旨在系统地回顾围手术期给药地塞米松的疗效和不良反应。方法系统检索PubMed、Scopus、Embase、Web of Science、Google Scholar等科学数据库，检索截止至2023年1月。在评估相关研究的方学质量后，我们综合了那些关注PONV、口服食物摄入耐受性、伤口愈合受损、术后主要并发症和围手术期给药地塞米松术后感染的研究。结果本系统综述和荟萃分析共纳入27项研究。地塞米松组PONV降低(OR = 0.19;95% CI 0.06-0.55)，增加口服食物摄入耐受性(OR = 7.38;95% CI 1.07-51.11)，伤口愈合受损的风险增加(OR = 0.48;95% CI 0.52-4.21)，术后感染概率降低(OR = 0.61;95% CI 0.51-0.72)，术后主要并发症的风险增加(OR = 1.27;95% CI 0.68-2.39)。结论综合数据分析结果显示，在PONV、口服食物摄入耐受性和术后感染方面，地塞米松优于对照组。
{"title":"The efficacy and safety of perioperative administration of dexamethasone: a systematic review and meta-analysis","authors":"Mohammad Javad Najafzadeh, Mohadeseh Shafiei, Meraj Sharifi, Parvaneh Nazari, Naser Nasiri, Morteza Hashemian","doi":"10.1186/s42077-023-00376-w","DOIUrl":"https://doi.org/10.1186/s42077-023-00376-w","url":null,"abstract":"Abstract Background Perioperative prophylactic dexamethasone is commonly administered to reduce postoperative nausea and vomiting (PONV) and pain after surgery. In this study, we aimed to systematically review the efficacy and adverse effects of perioperative dexamethasone administration. Methods We conducted a systematic search until January 2023 in scientific databases, including PubMed, Scopus, Embase, Web of Science, and Google Scholar. After assessing the methodological quality of relevant studies, we synthesized those focusing on PONV, oral food intake tolerance, impaired wound healing, major postoperative complications, and postoperative infections following the perioperative administration of dexamethasone. Results A total of 27 studies were included in this systematic review and meta-analysis. The dexamethasone group showed decreased PONV (OR = 0.19; 95% CI 0.06–0.55), increased oral food intake tolerance (OR = 7.38; 95% CI 1.07–51.11), increased risk of impaired wound healing (OR = .48; 95% CI 0.52–4.21), decreased probability of postoperative infection (OR = 0.61; 95% CI 0.51–0.72), and increased risk of major postoperative complications (OR = 1.27; 95% CI 0.68–2.39) compared to the controls. Conclusions The results of our pooled data analysis showed that dexamethasone was superior to the control in terms of PONV, oral food intake tolerance, and postoperative infections.","PeriodicalId":7686,"journal":{"name":"Ain-Shams Journal of Anesthesiology","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135895799","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 : 2023-09-27DOI: 10.1186/s42077-023-00378-8
Imran Ahmed Khan, Habib Md R. Karim
<p>Letter to Editor</p><p>We appreciate the work by Chaudhary et al. (Choudhary et al. 2023) for throwing light on the enigma regarding suitable additives for intrathecal bupivacaine in gynecological surgery. The article is relevant in the current anesthesia practice and has pointed out the conundrum of choosing between dexmedetomidine and clonidine. However, certain salient points still need dialogue, especially before accepting the suggestions.</p><p>The authors’ conclusion and suggestion to choose clonidine over dexmedetomidine must be argued. The authors found the onset of sensory and motor effects as early in the dexmedetomidine group than in the clonidine group (Choudhary et al. 2023). Also, the duration of motor block and total duration of analgesia was more in the dexmedetomidine group. These findings were statistically significant, suggesting a more effective adjuvant property of dexmedetomidine. The authors’ findings also correlate with the study by Mahendru et al., who found better quality of analgesia for dexmedetomidine in their comparative study among groups receiving fentanyl, clonidine, and dexmedetomidine as an adjuvant and bupivacaine alone (Mahendru et al. 2013).</p><p>While comparing the side effects of the two groups, authors found more need for rescue analgesia, pressor agents, bradycardia, and nausea and vomiting in the clonidine group compared to the dexmedetomidine group. Although these differences were not statistically significant, which might be due to the small sample size, clinical significance cannot be guaranteed or refuted based on statistical significance. While clonidine costs less than dexmedetomidine, such adverse events also impact the quality of recovery, length of stay, and cost (Ludbrook 2022).</p><p>Contemporary research and pharmacological profile also show some advantages of Dexmedetomidine over Clonidine. A meta-analysis also suggested that when used with local anesthetic as an adjuvant for blocks, dexmedetomidine provides better clinical efficacy than clonidine (Bajpai et al. 2022). Therefore, because dexmedetomidine, when used intrathecally, is more potent, provides early onset of sensory and motor effects, provides a longer duration of analgesia, a lesser need for rescue analgesia, and lesser side effects, clonidine cannot be recommended only weighing on the cost difference of 1–2 US dollar. Until we get better quality evidence from meta-analysis or randomized, multi-center studies with larger samples, the enigma of better adjuvant for intrathecal bupivacaine among the alpha-2 agonists continues. We would appreciate the author’s valuable comment on this aspect.</p><p>Not applicable.</p><ul data-track-component="outbound reference"><li><p>Bajpai V, Patel TK, Dwivedi P, Bajpai A, Gupta A, Gangwar P et al (2023) Dexmedetomidine versus clonidine as an adjuvant to local anaesthetic in brachial plexus blocks: a meta-analysis of randomised controlled trials. Braz J Anesthesiol 73(5):665–675. https://doi.or
致编辑的信我们感谢Chaudhary等人(Choudhary et al. 2023)的工作，因为它揭示了关于妇科手术中鞘内布比卡因合适添加剂的谜团。本文结合目前的麻醉实践，指出了在右美托咪定和可乐定之间选择的难题。然而，某些突出问题仍然需要对话，特别是在接受建议之前。作者的结论和建议选择可乐定而不是右美托咪定，必须加以论证。作者发现右美托咪定组出现感觉和运动效应的时间比可乐定组早(Choudhary et al. 2023)。右美托咪定组运动阻滞持续时间和总镇痛持续时间更长。这些发现具有统计学意义，表明右美托咪定具有更有效的辅助特性。作者的发现也与Mahendru等人的研究相关联，他们在芬太尼、clonidine和右美托咪定辅助组与单独布比卡因组的比较研究中发现右美托咪定镇痛质量更好(Mahendru et al. 2013)。在比较两组的副作用时，作者发现与右美托咪定组相比，可乐定组更需要抢救止痛、加压剂、心动过缓、恶心和呕吐。虽然这些差异不具有统计学意义，可能是样本量小的原因，但不能根据统计学意义来保证或反驳临床意义。虽然可乐定的成本低于右美托咪定，但此类不良事件也会影响恢复质量、住院时间和成本(Ludbrook 2022)。当代研究和药理学资料也显示右美托咪定优于可乐定。一项荟萃分析还表明，当与局麻药一起作为阻滞辅助使用时，右美托咪定比可乐定具有更好的临床疗效(Bajpai et al. 2022)。因此，由于右美托咪定在鞘内使用时更有效，提供早期的感觉和运动效应，提供更长的镇痛持续时间，更少需要救援镇痛，副作用更小，因此仅考虑1-2美元的成本差异，不能推荐可乐定。直到我们从荟萃分析或随机、多中心、更大样本的研究中获得更高质量的证据，在α -2激动剂中鞘内布比卡因更好的辅助剂的谜题仍在继续。我们将感谢作者在这方面的宝贵意见。不适用。Bajpai V, Patel TK, Dwivedi P, Bajpai A, Gupta A, Gangwar P等(2023)右美托咪定与克拉定作为臂丛阻滞局部麻醉的辅助:一项随机对照试验的荟萃分析。中华麻醉学杂志，21(5):665-675。https://doi.org/10.1016/j.bjane.2022.07.005Choudhary R, Pathania J, Sharma A, Sharma A, Sharma R(2023)鞘内布比卡因与克拉定或右美托咪定辅助妇科手术:一个谜。吕德布鲁克GL(2022)隐性流行病:术后并发症的成本。Mahendru V, Tewari A, Katyal S, Grewal A, Singh MR, Katyal R(2013):一项双盲对照研究:右美托咪定、克拉定和芬太尼作为高压布比卡因在下肢手术中的辅助剂的比较。作者及联系作者及联系单位BRD医学院社区医学系，Gorakhpur, UP, India, 273013Imran Ahmed khan, Deogarh, Jharkhand，全印度医学科学研究所麻醉与重症监护系您也可以在PubMed Google ScholarHabib Md R. KarimView作者出版物中搜索该作者。您也可以在PubMed Google scholarcontributions中搜索该作者。两位作者的贡献相同。两位作者都阅读并批准了最终的手稿。通讯作者:Imran Ahmed Khan对参与者的伦理批准和同意不适用。发表同意不适用。竞争利益两位作者都宣称他们没有竞争利益。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。要查看该许可的副本，请访问http://creativecommons.org/licenses/by/4.0/.Reprints和PermissionsCite这篇文章khan, I.A, Karim, H.M.R.致编辑的信:对α -2激动剂作为鞘内布比卡因更好辅助剂的研究。中华麻醉学杂志，2015(5)。https://doi.org/10.1186/s42077-023-00378-8Download citation:收稿日期:2023年4月13日接受日期:2023年9月17日发布日期:2023年9月27日doi: https://doi.org/10.1186/s42077-023-00378-8Share本文任何与您共享以下链接的人都可以阅读此内容: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
{"title":"Letter to Editor: An inquest into alpha-2 agonists as a better adjuvant to intrathecal bupivacaine","authors":"Imran Ahmed Khan, Habib Md R. Karim","doi":"10.1186/s42077-023-00378-8","DOIUrl":"https://doi.org/10.1186/s42077-023-00378-8","url":null,"abstract":"<p>Letter to Editor</p><p>We appreciate the work by Chaudhary et al. (Choudhary et al. 2023) for throwing light on the enigma regarding suitable additives for intrathecal bupivacaine in gynecological surgery. The article is relevant in the current anesthesia practice and has pointed out the conundrum of choosing between dexmedetomidine and clonidine. However, certain salient points still need dialogue, especially before accepting the suggestions.</p><p>The authors’ conclusion and suggestion to choose clonidine over dexmedetomidine must be argued. The authors found the onset of sensory and motor effects as early in the dexmedetomidine group than in the clonidine group (Choudhary et al. 2023). Also, the duration of motor block and total duration of analgesia was more in the dexmedetomidine group. These findings were statistically significant, suggesting a more effective adjuvant property of dexmedetomidine. The authors’ findings also correlate with the study by Mahendru et al., who found better quality of analgesia for dexmedetomidine in their comparative study among groups receiving fentanyl, clonidine, and dexmedetomidine as an adjuvant and bupivacaine alone (Mahendru et al. 2013).</p><p>While comparing the side effects of the two groups, authors found more need for rescue analgesia, pressor agents, bradycardia, and nausea and vomiting in the clonidine group compared to the dexmedetomidine group. Although these differences were not statistically significant, which might be due to the small sample size, clinical significance cannot be guaranteed or refuted based on statistical significance. While clonidine costs less than dexmedetomidine, such adverse events also impact the quality of recovery, length of stay, and cost (Ludbrook 2022).</p><p>Contemporary research and pharmacological profile also show some advantages of Dexmedetomidine over Clonidine. A meta-analysis also suggested that when used with local anesthetic as an adjuvant for blocks, dexmedetomidine provides better clinical efficacy than clonidine (Bajpai et al. 2022). Therefore, because dexmedetomidine, when used intrathecally, is more potent, provides early onset of sensory and motor effects, provides a longer duration of analgesia, a lesser need for rescue analgesia, and lesser side effects, clonidine cannot be recommended only weighing on the cost difference of 1–2 US dollar. Until we get better quality evidence from meta-analysis or randomized, multi-center studies with larger samples, the enigma of better adjuvant for intrathecal bupivacaine among the alpha-2 agonists continues. We would appreciate the author’s valuable comment on this aspect.</p><p>Not applicable.</p><ul data-track-component=\"outbound reference\"><li><p>Bajpai V, Patel TK, Dwivedi P, Bajpai A, Gupta A, Gangwar P et al (2023) Dexmedetomidine versus clonidine as an adjuvant to local anaesthetic in brachial plexus blocks: a meta-analysis of randomised controlled trials. Braz J Anesthesiol 73(5):665–675. https://doi.or","PeriodicalId":7686,"journal":{"name":"Ain-Shams Journal of Anesthesiology","volume":"12 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138526616","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 : 2023-09-21DOI: 10.1186/s42077-023-00374-y
Essam Mahran, Mohamed A. Wadod
Abstract Background Superior hypogastric plexus is a retroperitoneal plexus that receives visceral sensation from pelvic viscera. Superior hypogastric plexus block (SHPB) was used for chronic pelvic pain and recently studied for postoperative pain. We examined the safety and efficacy of preemptive anterior US-guided SHPB to reduce postoperative morphine consumption. Thirty-six patients undergoing pelvic cancer surgery were randomly divided into two equal groups; group S in which patients received anterior US-guided SHPB immediately after induction of general anesthesia and before skin incision using 20 ml bubivacaine 0.5%, group C control group in which 20 ml normal saline was given by the same technique. Patients of both groups received morphine via PCA postoperative and followed for 24 h. In both groups, we measured the total morphine consumption, VAS, vital signs, and side effects. Results Demographic data, duration, and type of surgery were comparable in both groups. Total 24 h morphine consumption in mg was significantly lower in group S (43.8 ± 2) than in group C (54.83 ± 2) with P value < 0.001. VAS was significantly lower in group S in all time intervals from 2 till 24 h postoperative. Side effects were minimal with no significant difference between both groups. Conclusion Preemptive US-guided SHPB is a relatively safe and effective method to reduce postoperative opioid demands after pelvic cancer surgeries. Trial registration ClinicalTrials.gov NCT04732234 in 1–2-2021.
{"title":"Pre-emptive ultrasound-guided superior hypogastric plexus block in pelvic cancer surgeries: a randomized double-blinded study","authors":"Essam Mahran, Mohamed A. Wadod","doi":"10.1186/s42077-023-00374-y","DOIUrl":"https://doi.org/10.1186/s42077-023-00374-y","url":null,"abstract":"Abstract Background Superior hypogastric plexus is a retroperitoneal plexus that receives visceral sensation from pelvic viscera. Superior hypogastric plexus block (SHPB) was used for chronic pelvic pain and recently studied for postoperative pain. We examined the safety and efficacy of preemptive anterior US-guided SHPB to reduce postoperative morphine consumption. Thirty-six patients undergoing pelvic cancer surgery were randomly divided into two equal groups; group S in which patients received anterior US-guided SHPB immediately after induction of general anesthesia and before skin incision using 20 ml bubivacaine 0.5%, group C control group in which 20 ml normal saline was given by the same technique. Patients of both groups received morphine via PCA postoperative and followed for 24 h. In both groups, we measured the total morphine consumption, VAS, vital signs, and side effects. Results Demographic data, duration, and type of surgery were comparable in both groups. Total 24 h morphine consumption in mg was significantly lower in group S (43.8 ± 2) than in group C (54.83 ± 2) with P value < 0.001. VAS was significantly lower in group S in all time intervals from 2 till 24 h postoperative. Side effects were minimal with no significant difference between both groups. Conclusion Preemptive US-guided SHPB is a relatively safe and effective method to reduce postoperative opioid demands after pelvic cancer surgeries. Trial registration ClinicalTrials.gov NCT04732234 in 1–2-2021.","PeriodicalId":7686,"journal":{"name":"Ain-Shams Journal of Anesthesiology","volume":"91 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136235886","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 : 2023-09-18DOI: 10.1186/s42077-023-00371-1
Amr Shaaban Elshafei, Sherif M. S. Mowafy
Abstract Background Conservative treatments of post-dural puncture headache (PDPH) may be unsuccessful, and the relief that is provided is frequently insufficient. This study aimed to meticulously explore the analgesic efficacy of the sphenopalatine ganglion (SPG) block when administered alone or in conjunction with the greater occipital nerve block (GONB) for the purpose of treating PDPH and with the aid of transcranial Doppler (TCD) to evaluate the cerebral hemodynamics before and after the block. This study was conducted on 63 women with post-partum PDPH randomized into the following: control group (Group C = 21 participants), received conservative management; SPG block group (Group S = 21 participants), received conservative management with SPG block; and combined nerve and ganglion block group (Group NAG = 21 participants), received conservative management with SPG block and ultrasound guided GONB. Visual analog score (VAS), modified Lybecker score, and transcranial Doppler (TCD) measures were used to determine PDPH severity at 0 (baseline), 1, 6, and 24 h. Additionally, the three groups’ needs for EBP were noted. Results VAS and modified Lybecker scores at 1, 6, and 24 h were statistically significantly lower in S and NAG groups compared to the control group with no statistically significant difference between S and NAG groups. With TCD, the mean velocity (MV) was significantly lower at 1, 6, and 24 h compared to baseline reading in both S and NAG groups. Also, the pulsatility index (PI) was statistically higher at 1, 6, and 24 h compared to baseline readings in S and NAG groups. There was no statistically significant difference regarding the need for EBP. Conclusions In terms of headache relief or the need for EBP, there is no difference between individual SPG block or combined SPG block and GONB in the treatment of PDPH.
{"title":"Sphenopalatine ganglion block with or without greater occipital nerve block for treatment of obstetric post-dural puncture headache after spinal anesthesia: randomized controlled trial","authors":"Amr Shaaban Elshafei, Sherif M. S. Mowafy","doi":"10.1186/s42077-023-00371-1","DOIUrl":"https://doi.org/10.1186/s42077-023-00371-1","url":null,"abstract":"Abstract Background Conservative treatments of post-dural puncture headache (PDPH) may be unsuccessful, and the relief that is provided is frequently insufficient. This study aimed to meticulously explore the analgesic efficacy of the sphenopalatine ganglion (SPG) block when administered alone or in conjunction with the greater occipital nerve block (GONB) for the purpose of treating PDPH and with the aid of transcranial Doppler (TCD) to evaluate the cerebral hemodynamics before and after the block. This study was conducted on 63 women with post-partum PDPH randomized into the following: control group (Group C = 21 participants), received conservative management; SPG block group (Group S = 21 participants), received conservative management with SPG block; and combined nerve and ganglion block group (Group NAG = 21 participants), received conservative management with SPG block and ultrasound guided GONB. Visual analog score (VAS), modified Lybecker score, and transcranial Doppler (TCD) measures were used to determine PDPH severity at 0 (baseline), 1, 6, and 24 h. Additionally, the three groups’ needs for EBP were noted. Results VAS and modified Lybecker scores at 1, 6, and 24 h were statistically significantly lower in S and NAG groups compared to the control group with no statistically significant difference between S and NAG groups. With TCD, the mean velocity (MV) was significantly lower at 1, 6, and 24 h compared to baseline reading in both S and NAG groups. Also, the pulsatility index (PI) was statistically higher at 1, 6, and 24 h compared to baseline readings in S and NAG groups. There was no statistically significant difference regarding the need for EBP. Conclusions In terms of headache relief or the need for EBP, there is no difference between individual SPG block or combined SPG block and GONB in the treatment of PDPH.","PeriodicalId":7686,"journal":{"name":"Ain-Shams Journal of Anesthesiology","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135153585","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 Preoperative airway assessment is essential to predict difficult airway so that adequate planning could be made to secure the airway. Various airway tests have been devised to improve diagnostic accuracy but none of the tests individually have proven to be adequate. Recently, a new airway predictor thyromental height test (TMHT) appears to be a more accurate predictor of difficult laryngoscopy than the existing anatomical measurements. The aim of this study is to evaluate the accuracy of the TMHT and compare it with various screening tests to determine whether TMHT can prove to be a more comprehensive and accurate test for predicting difficult laryngoscopy. Total 150 patients aged > 18 years of either sex with American Society of Anaesthesiologist physical status I—III scheduled for elective surgery under general anaesthesia requiring tracheal intubation were included in this prospective observational study. All patients were subjected to a preoperative airway assessment test including TMHT, modified Mallampati test, upper lip bite test, interincisior gap, thyromental distance and sternomental distance. Intraoperatively direct laryngoscopy was done and the grading of laryngoscopic view was done according to CL. Results The preoperative data and CL grading were used to evaluate the accuracy of TMHT and compared the sensitivity, specificity, positive and negative predictive value with other tests. Twenty six (17.33%) patients had difficult laryngoscopy and 18 patients (12%) required bougie/stylet to facilitate intubation. TMHT had the highest sensitivity (76.92%), specificity (98.38%), PPV (90.90%), NPV (95.31%) and accuracy (94.67%) when compared to other tests. Conclusions TMHT is a simple bedside test with higher sensitivity and specificity for predicting difficult laryngoscopy as compared to other screening tests.Future study should be done to define ethinicity, race, age groups and gender specific cut off values of TMHT for accurate validation of prediction in difficult laryngoscopy.
{"title":"Evaluation of thyromental height test as a single anatomical measure for prediction of difficult laryngoscopy: a prospective observational study","authors":"Anil Kumar Bhiwal, Charu Sharma, Anuj Tripathi, Aakansha BK, Vidhu Choudhary, Sunanda Gupta","doi":"10.1186/s42077-023-00372-0","DOIUrl":"https://doi.org/10.1186/s42077-023-00372-0","url":null,"abstract":"Abstract Background Preoperative airway assessment is essential to predict difficult airway so that adequate planning could be made to secure the airway. Various airway tests have been devised to improve diagnostic accuracy but none of the tests individually have proven to be adequate. Recently, a new airway predictor thyromental height test (TMHT) appears to be a more accurate predictor of difficult laryngoscopy than the existing anatomical measurements. The aim of this study is to evaluate the accuracy of the TMHT and compare it with various screening tests to determine whether TMHT can prove to be a more comprehensive and accurate test for predicting difficult laryngoscopy. Total 150 patients aged > 18 years of either sex with American Society of Anaesthesiologist physical status I—III scheduled for elective surgery under general anaesthesia requiring tracheal intubation were included in this prospective observational study. All patients were subjected to a preoperative airway assessment test including TMHT, modified Mallampati test, upper lip bite test, interincisior gap, thyromental distance and sternomental distance. Intraoperatively direct laryngoscopy was done and the grading of laryngoscopic view was done according to CL. Results The preoperative data and CL grading were used to evaluate the accuracy of TMHT and compared the sensitivity, specificity, positive and negative predictive value with other tests. Twenty six (17.33%) patients had difficult laryngoscopy and 18 patients (12%) required bougie/stylet to facilitate intubation. TMHT had the highest sensitivity (76.92%), specificity (98.38%), PPV (90.90%), NPV (95.31%) and accuracy (94.67%) when compared to other tests. Conclusions TMHT is a simple bedside test with higher sensitivity and specificity for predicting difficult laryngoscopy as compared to other screening tests.Future study should be done to define ethinicity, race, age groups and gender specific cut off values of TMHT for accurate validation of prediction in difficult laryngoscopy.","PeriodicalId":7686,"journal":{"name":"Ain-Shams Journal of Anesthesiology","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135306772","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 : 2023-09-15DOI: 10.1186/s42077-023-00373-z
Hemlata Kapoor, Bipan Chander Sarin, Milin Raju Shah
Abstract Background Left ventricular diastolic dysfunction is frequently noticed in patients with multiple co-morbidities. Echocardiography is used to determine the presence of diastolic dysfunction and to grade its severity. In left ventricular diastolic dysfunction, the ventricular diastolic distensibility, filling, or relaxation is abnormal; however, the left ventricular ejection fraction may be normal or decreased. Case presentation We present anesthetic management of two patients with diastolic dysfunction grade III for renal transplant. During declamping in renal transplant, high central venous pressures are required for adequate perfusion of the transplanted kidney. In the operation theater standard monitors including NIBP, SpO 2 and five lead ECG were attached. An arterial line (radial) and central line (right internal jugular) were established for IBP and CVP monitoring. Infusions of furosemide and dopamine were started. Nitrogycerine and milrinone infusions were prepared but were not required intraoperatively. Both the patients were extubated at the end of surgery. Conclusions Increased incidence of major adverse cardiovascular events has been reported in surgical patients having grade III diastolic dysfunction. Hemodynamic instability and fluid overload in this set of patients are known to generate pulmonary edema.
{"title":"Anesthetic management for renal transplant in patients with grade III diastolic dysfunction: case reports","authors":"Hemlata Kapoor, Bipan Chander Sarin, Milin Raju Shah","doi":"10.1186/s42077-023-00373-z","DOIUrl":"https://doi.org/10.1186/s42077-023-00373-z","url":null,"abstract":"Abstract Background Left ventricular diastolic dysfunction is frequently noticed in patients with multiple co-morbidities. Echocardiography is used to determine the presence of diastolic dysfunction and to grade its severity. In left ventricular diastolic dysfunction, the ventricular diastolic distensibility, filling, or relaxation is abnormal; however, the left ventricular ejection fraction may be normal or decreased. Case presentation We present anesthetic management of two patients with diastolic dysfunction grade III for renal transplant. During declamping in renal transplant, high central venous pressures are required for adequate perfusion of the transplanted kidney. In the operation theater standard monitors including NIBP, SpO 2 and five lead ECG were attached. An arterial line (radial) and central line (right internal jugular) were established for IBP and CVP monitoring. Infusions of furosemide and dopamine were started. Nitrogycerine and milrinone infusions were prepared but were not required intraoperatively. Both the patients were extubated at the end of surgery. Conclusions Increased incidence of major adverse cardiovascular events has been reported in surgical patients having grade III diastolic dysfunction. Hemodynamic instability and fluid overload in this set of patients are known to generate pulmonary edema.","PeriodicalId":7686,"journal":{"name":"Ain-Shams Journal of Anesthesiology","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135438202","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 : 2023-09-12DOI: 10.1186/s42077-023-00370-2
Sapna Annaji Nikhar, Rajasekhar Metta, Raja Nimmagadda, R. Gopinath
Abstract Background Head and neck reconstructive surgeries needs free tissue transfer but it fails sometimes. As most of the flap failure occurs in first 24 h. Local rise in lactate level or glucose lactate ratio provides clear indicator of tissue ischemia and further recovery. The question is about systemic rise in lactate levels with failing flap. Hence, we aimed to use systemic lactate levels to indicate free flap failure. To correlate the systemic rise in serum lactate levels to free flap failure in head and neck reconstructive surgeries. The series of cases were targeted undergoing free fibular graft, posted electively for head and reconstructive surgery operated by same surgeon. Record of blood loss, need of blood transfusion and use of microspan was also done. Monitoring of arterial blood gas values mainly lactate and vitals were done. Results Out of 15 patients studied, only 2(13.3%) patients had flap re-exploration (group F). Twelve (80%) patients were of ASA class I. Lactate, pH, blood sugars, base deficits and hemoglobin and vitals studied over 24 h in two groups had no statistically significant difference in the two groups. Lactate rise was noted in all cases for first few hours after starting surgery but elevated values were not observed during hours of flap re-exploration. Conclusions We could not establish relation between systemic rise in lactate levels and flap re-exploration or flap failure but continuous acidosis can impact outcome. We need to be vigilant and need to have individualized approach for management.
{"title":"Does the systemic rise in serum lactate levels correlate to free flap failure in head and neck reconstructive surgeries—series of cases","authors":"Sapna Annaji Nikhar, Rajasekhar Metta, Raja Nimmagadda, R. Gopinath","doi":"10.1186/s42077-023-00370-2","DOIUrl":"https://doi.org/10.1186/s42077-023-00370-2","url":null,"abstract":"Abstract Background Head and neck reconstructive surgeries needs free tissue transfer but it fails sometimes. As most of the flap failure occurs in first 24 h. Local rise in lactate level or glucose lactate ratio provides clear indicator of tissue ischemia and further recovery. The question is about systemic rise in lactate levels with failing flap. Hence, we aimed to use systemic lactate levels to indicate free flap failure. To correlate the systemic rise in serum lactate levels to free flap failure in head and neck reconstructive surgeries. The series of cases were targeted undergoing free fibular graft, posted electively for head and reconstructive surgery operated by same surgeon. Record of blood loss, need of blood transfusion and use of microspan was also done. Monitoring of arterial blood gas values mainly lactate and vitals were done. Results Out of 15 patients studied, only 2(13.3%) patients had flap re-exploration (group F). Twelve (80%) patients were of ASA class I. Lactate, pH, blood sugars, base deficits and hemoglobin and vitals studied over 24 h in two groups had no statistically significant difference in the two groups. Lactate rise was noted in all cases for first few hours after starting surgery but elevated values were not observed during hours of flap re-exploration. Conclusions We could not establish relation between systemic rise in lactate levels and flap re-exploration or flap failure but continuous acidosis can impact outcome. We need to be vigilant and need to have individualized approach for management.","PeriodicalId":7686,"journal":{"name":"Ain-Shams Journal of Anesthesiology","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135826526","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：