Ain-Shams Journal of Anesthesiology最新文献

{"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":null,"pages":null},"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}

{"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":null,"pages":null},"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}

{"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":null,"pages":null},"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}

{"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":null,"pages":null},"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}

{"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":null,"pages":null},"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}

{"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":null,"pages":null},"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}

{"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":null,"pages":null},"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}

{"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":null,"pages":null},"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}

{"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 &gt; 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":null,"pages":null},"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}

{"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":null,"pages":null},"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}