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The Underreported Postoperative Suffering after Thyroid Surgery: Dysphagia, Dysphonia, and Neck Pain-A Cross-Sectional Study. 甲状腺手术后未被报道的术后痛苦:吞咽困难,发音困难和颈部疼痛-横断面研究。
IF 1.4 Q2 ANESTHESIOLOGY Pub Date : 2023-01-01 DOI: 10.1155/2023/1312980
Hunduma Jisha Chawaka, Zenebe Bekele Teshome

Background and aims: Postoperative voice change, difficulty of swallowing, throat pain, and neck pain are the most commonly complaint after thyroid surgery. However, little emphasis is given to the problem, especially a place where the surgical and anesthesia services' unmet need is highly observed, i.e., the problem gets little attention especially in the countries where the gaps of surgery and anesthesia services are observed. Hence, this study aims to determine the magnitude and associated factors of voice change and related complaints after thyroid surgery.

Methods: A cross-sectional study was conducted on 151 patients who had had thyroid surgery from June 1 to December 30, 2021. Data were retrieved during the postoperative period after the patient regains consciousness.

Result: Out of 151 participants, 98 (64.9%) patients complained of either voice change or difficulty of swallowing and neck pain after thyroid surgery within 24 hours. Majority (58.3%) of the participants aged more than 30 years with a mean age of 33.7 ± 8.3 years and females 102 (67.5%). Neck pain is the most (52.3%) complained suffering after thyroid surgery, followed by voice change 38.4% and difficulty in swallowing 37.7%. Difficulty in swallowing after thyroid surgery significantly associated with a patient who frequently experience intraoperative hypotension (AOR = 23.24, 95% CI 4.6-116.7, and p = 0.01), type of surgical procedure (total thyroidectomy) (AOR = 8.62, 95% CI 1.21-61.50, and p = 0.03), and larger ETT size (AOR = 4.92, 95% CI 1.34-18.01, and p = 0.02). Postoperative voice change is associated with larger endotracheal tube (AOR = 15.47, 95% CI 3.4-69.5, and p ≤ 0.001), surgery lasting more than 2 hours (AOR = 7.34, 95% CI 1.5-35.1, and p = 0.01), and intraoperative hypotension (AOR = 23.24, 95% CI 4.6-116.7, and p ≤ 0.001).

Conclusion: The complaint of postthyroidectomy neck pain and throat discomfort is higher than 64.9%. Intraoperative hypotension, blood loss, higher ETT size utilization, and duration of surgical procedure are the identified possible risk factors and have to be minimized as much as possible. Patient reassurance has to be considered during the postoperative time.

背景和目的:术后声音改变、吞咽困难、咽喉疼痛和颈部疼痛是甲状腺手术后最常见的主诉。然而,很少重视这一问题,特别是在高度观察到手术和麻醉服务未满足需求的地方,即,这个问题很少得到关注,特别是在观察到手术和麻醉服务差距的国家。因此,本研究旨在确定甲状腺手术后声音变化和相关投诉的大小和相关因素。方法:对2021年6月1日至12月30日行甲状腺手术的151例患者进行横断面研究。在患者恢复意识后的术后期间检索数据。结果:在151名参与者中,98名(64.9%)患者在甲状腺手术后24小时内抱怨声音改变或吞咽困难和颈部疼痛。年龄≥30岁者占58.3%,平均年龄33.7±8.3岁,女性102岁(67.5%)。甲状腺手术后颈部疼痛最多(52.3%),其次是声音改变(38.4%)和吞咽困难(37.7%)。甲状腺手术后吞咽困难与患者术中频繁出现低血压(AOR = 23.24, 95% CI 4.6-116.7, p = 0.01)、手术类型(全甲状腺切除术)(AOR = 8.62, 95% CI 1.21-61.50, p = 0.03)和ETT较大(AOR = 4.92, 95% CI 1.34-18.01, p = 0.02)显著相关。术后嗓音改变与气管内管较大(AOR = 15.47, 95% CI 3.4 ~ 69.5, p≤0.001)、手术时间超过2小时(AOR = 7.34, 95% CI 1.5 ~ 35.1, p = 0.01)、术中低血压(AOR = 23.24, 95% CI 4.6 ~ 116.7, p≤0.001)相关。结论:甲状腺切除术后颈部疼痛、咽喉不适主诉高于64.9%。术中低血压、失血、ETT体积利用率高和手术时间是确定的可能的危险因素,必须尽可能减少。术后必须考虑病人的放心。
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引用次数: 0
ICU-Managed Patients' Epidemiology, Characteristics, and Outcomes: A Retrospective Single-Center Study. icu管理患者的流行病学、特征和结果:一项回顾性单中心研究。
IF 1.4 Q2 ANESTHESIOLOGY Pub Date : 2023-01-01 DOI: 10.1155/2023/9388449
Ahmed Muhammad Bashir, Marian Muse Osman, Hawa Nuradin Mohamed, Ifrah Adan Hilowle, Halima Abdulkadir Ahmed, Abdirahman Abdikadir Osman, Osman Abubakar Fiidow

Background: Resources are limited, and it is exceedingly difficult to provide intensive care in developing nations. In Somalia, intensive care unit (ICU) care was introduced only a few years ago.

Purpose: In this study, we aimed to determine the epidemiology, characteristics, and outcome of ICU-managed patients in a tertiary hospital in Mogadishu.

Methods: We retrospectively evaluated the files of 1082 patients admitted to our ICU during the year 2021.

Results: The majority (39.7%) of the patients were adults (aged between 20 and 39 years), and 67.8% were male patients. The median ICU length of stay was three days (IQR = 5 days), and nonsurvivors had shorter stays, one day. The mortality rate was 45.1%. The demand for critical care services in low-income countries is high.

Conclusion: The country has a very low ICU bed capacity. Critical care remains a neglected area of health service delivery in this setting, with large numbers of patients with potentially treatable conditions not having access to such services.

背景:资源有限,在发展中国家提供重症监护极其困难。在索马里,重症监护病房(ICU)护理几年前才开始实行。目的:在本研究中,我们旨在确定摩加迪沙一家三级医院icu管理患者的流行病学、特征和预后。方法:回顾性分析2021年我院ICU收治的1082例患者的资料。结果:20 ~ 39岁的成人占绝大多数(39.7%),男性占67.8%。ICU的中位住院时间为3天(IQR = 5天),非幸存者的住院时间更短,为1天。死亡率为45.1%。低收入国家对重症监护服务的需求很高。结论:我国ICU病床容量很低。在这种情况下,重症监护仍然是卫生服务提供的一个被忽视的领域,大量患有潜在可治疗疾病的患者无法获得此类服务。
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引用次数: 0
Anticipated vs. Experienced Pain at Site of Spinal Needle Insertion in Patients Undergoing Elective Lower Segment Caesarean Section: Perspective from Resource-Limited Region. 选择性下节段剖宫产患者脊髓针插入部位的预期疼痛与经历疼痛:来自资源有限地区的视角。
IF 1.4 Q2 ANESTHESIOLOGY Pub Date : 2023-01-01 DOI: 10.1155/2023/5516346
Waleed Bin Ghaffar, Fauzia Minai

Background: Despite significant advantages, approximately 20% of pregnant patients refuse spinal anaesthesia in caesarean section due to fear of spinal needle prick. Studies have shown that the patient's expectation of pain is higher than what they experience in real. The objective was to evaluate the difference between anticipated and actually experienced pain at the spinal needle insertion site in spinal anaesthesia for pregnant women undergoing elective lower segment caesarean section (ELSCS).

Method: The cross-sectional study was conducted in a labour room suite of a tertiary care hospital.

Results: A total of 50 patients scheduled for ELSCS were included. The median experienced pain at the site of spinal needle insertion was significantly low as compared to anticipated pain (P value < 0.01). For the identification of predictors impacting the anticipated and experienced pain, univariate and multivariate regression models were applied. Amsterdam Preoperative Anxiety and Information Scale ≥11 for anticipated pain showed a statistically significant positive correlation in univariate (coefficient: 2.59; 95% CI: 1.49 to 3.68; P value < 0.001) and multivariable analyses (coefficient: 2.51; 95% CI: 1.36 to 3.67; P value < 0.001). Thus, anxiety was associated with statistically significant higher anticipated pain.

Conclusion: In conclusion, there is a remarkable difference in the obstetric population between anticipated and actually experienced pain at the site of spinal needle insertion in ELSCS.

背景:尽管有明显的优势,但约20%的孕妇因害怕脊髓针刺痛而拒绝剖腹产。研究表明,病人对疼痛的预期高于他们在现实中所经历的。目的是评估孕妇择期下段剖宫产(ELSCS)脊髓麻醉时预期和实际经历的脊髓针插入部位疼痛的差异。方法:横断面研究在某三级医院产房套房进行。结果:共纳入50例计划进行ELSCS的患者。结论:综上所述,在ELSCS中,产科人群中预期与实际经历的脊髓针插入部位疼痛存在显著差异。
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引用次数: 0
Intramuscular Ketamine Effect on Postnasal Surgery Agitation: A Prospective Double-Blinded Randomized Controlled Trial. 肌注氯胺酮对鼻术后躁动的影响:一项前瞻性双盲随机对照试验。
IF 1.4 Q2 ANESTHESIOLOGY Pub Date : 2023-01-01 DOI: 10.1155/2023/2286451
Husam A Almajali, Ali M Abu Dalo, Nidal M Al-Soud, Ali Almajali, Abdelrazzaq Alrfooh, Thani Alawamreh, Hamza Al-Wreikat

This study investigates the effect of intramuscular ketamine on emergence agitation (EA) following septoplasty and open septorhinoplasty (OSRP) when administered at subanesthetic doses at the end of surgery. A random sample of 160 ASA I-II adult patients who underwent septoplasty or OSRP between May and October, 2022, was divided into two groups of eighty patients each: ketamine (Group K) and saline (Group S) with the latter serving as the control group. At the end of surgery immediately after turning off the inhalational agent, Group K was administered with intramuscular 2 ml of normal saline containing 0.7 mg/kg ketamine and Group S with 2 ml of intramuscular normal saline. Sedation and agitation scores at emergence from anesthesia were recorded after extubation using the Richmond Agitation-Sedation Scale (RASS). The incidence of EA was higher in the saline group than in the ketamine group (56.3% vs. 5%; odds ratio (OR): 0.033; 95% confidence interval (CI): 0.010-0.103; p < 0.001). Variables associated with a higher incidence of agitation were ASA II classification (OR: 3.286; 95% (CI): 1.359-7.944; p=0.008), longer duration of surgery (OR: 1.010; 95% CI: 1.001-1.020; p=0.031), and OSRP surgery (OR: 2.157; CI: 1.056-5.999; p=0.037). The study concluded that the administration of intramuscular ketamine at a dose of 0.7 mg/kg at the end of surgery effectively reduced the incidence of EA in septoplasty and OSRP surgery.

本研究探讨在手术结束时以亚麻醉剂量给予肌内氯胺酮对中隔成形术和开放式中隔成形术(OSRP)后出现躁动(EA)的影响。随机选取在2022年5月至10月间接受鼻中隔成形术或OSRP的160例ASA I-II成年患者,分为两组,每组80例:氯胺酮(K组)和生理盐水(S组),S组为对照组。手术结束后立即关闭吸入剂,K组肌注含氯胺酮0.7 mg/kg的生理盐水2 ml, S组肌注生理盐水2 ml。拔管后使用Richmond躁动-镇静量表(RASS)记录麻醉苏醒时的镇静和躁动评分。生理盐水组EA的发生率高于氯胺酮组(56.3% vs. 5%;优势比(OR): 0.033;95%置信区间(CI): 0.010-0.103;P < 0.001)。与躁动发生率较高相关的变量为ASA II分类(OR: 3.286;95% (ci): 1.359-7.944;p=0.008),手术时间较长(OR: 1.010;95% ci: 1.001-1.020;p=0.031), OSRP手术(OR: 2.157;置信区间:1.056—-5.999;p = 0.037)。研究得出结论,手术结束时肌注氯胺酮剂量为0.7 mg/kg,可有效降低鼻中隔成形术和OSRP手术中EA的发生率。
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引用次数: 0
A Randomized Controlled Trial for Prevention of Postoperative Nausea and Vomiting after Laparoscopic Sleeve Gastrectomy: Aprepitant/Dexamethasone vs. Mirtazapine/Dexamethasone. 预防腹腔镜袖胃切除术后恶心呕吐的随机对照试验:阿瑞吡坦/地塞米松vs米氮平/地塞米松
IF 1.6 Q2 ANESTHESIOLOGY Pub Date : 2022-04-30 eCollection Date: 2022-01-01 DOI: 10.1155/2022/3541073
Tarek M Ashoor, Dina Y Kassim, Ibrahim M Esmat

Background: Coadministration of different antiemetics proved to decrease postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG). This trial compared aprepitant/dexamethasone (A/D) combination vs mirtazapine/dexamethasone (M/D) combination vs dexamethasone (D) alone for prevention of PONV in morbidly obese patients undergoing LSG.

Methods: Ninety patients scheduled for LSG were randomly allocated to receive 8 mg dexamethasone intravenous infusion (IVI) only in the D group or in addition to 80 mg aprepitant capsule in the A/D group or in addition to 30 mg mirtazapine tablet in the M/D group. Assessment of PONV was carried out at 0-2 h (early) and 2-24 h (late). The primary outcome was the complete response 0-24 h after surgery. Collective PONV, postoperative pain, side effects and patient satisfaction score were considered as secondary outcomes.

Results: The A/D and M/D groups were superior to the D group for a complete response within 0-24 h after surgery (79.3% for the A/D group, 78.6% for the M/D group, and 20.7% for the D group). The D group was inferior to the A/D and M/D groups regarding collective PONV and use of rescue antiemetic 0-24 h after surgery (P < 0.001, P < 0.001, respectively). The peak nausea scores (2-24 h) were significantly reduced in the M/D group in comparison to the D group (P=0.005). Patients in the M/D group showed high sedation scores, while those in the A/D group showed low pain scores (2-24 h) and less analgesic requirements (P < 0.001, P < 0.001, P < 0.001, respectively). The A/D and M/D groups were superior to the D group with regard to the patient satisfaction score (P < 0.001).

Conclusion: Aprepitant/dexamethasone combination and mirtazapine/dexamethasone combination were superior to dexamethasone alone in alleviating postoperative nausea and vomiting in morbidly obese patients scheduled to undergo laparoscopic sleeve gastrectomy. Trial Registration: ClinicalTrials.gov identifier: NCT04013386.

背景不同止吐药联合应用可减少腹腔镜袖胃切除术后恶心呕吐(PONV)。该试验比较了阿瑞吡坦/地塞米松(A/D)联合用药与米氮平/地塞米松(M/D)联合用药与单独地塞米松(D)治疗对行LSG的病态肥胖患者PONV的预防作用。方法90例LSG患者随机分为两组,D组仅静脉输注地塞米松8mg, A/D组加80mg阿瑞吡坦胶囊,M/D组加30mg米氮平片。在0-2 h(早期)和2-24 h(晚期)进行PONV评估。主要终点是手术后0 - 24小时的完全缓解。综合PONV、术后疼痛、副作用和患者满意度评分作为次要结局。结果A/D组和M/D组术后0 ~ 24 h内完全缓解率均优于D组(A/D组为79.3%,M/D组为78.6%,D组为20.7%)。D组在术后0 ~ 24 h的集体PONV和抢救止吐药使用方面均低于A/D组和M/D组(P < 0.001, P < 0.001)。与D组相比,M/D组的恶心高峰评分(2-24 h)显著降低(P=0.005)。M/D组患者镇静评分较高,而A/D组患者疼痛评分较低(2-24 h),镇痛需求较少(P < 0.001, P < 0.001, P < 0.001)。A/D组和M/D组患者满意度评分优于D组(P < 0.001)。结论阿瑞吡坦/地塞米松联合用药及米氮平/地塞米松联合用药对缓解病态性肥胖患者腹腔镜袖胃切除术后恶心呕吐的效果优于单用地塞米松。试验注册:ClinicalTrials.gov标识符:NCT04013386。
{"title":"A Randomized Controlled Trial for Prevention of Postoperative Nausea and Vomiting after Laparoscopic Sleeve Gastrectomy: Aprepitant/Dexamethasone vs. Mirtazapine/Dexamethasone.","authors":"Tarek M Ashoor, Dina Y Kassim, Ibrahim M Esmat","doi":"10.1155/2022/3541073","DOIUrl":"10.1155/2022/3541073","url":null,"abstract":"<p><strong>Background: </strong>Coadministration of different antiemetics proved to decrease postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG). This trial compared aprepitant/dexamethasone (A/D) combination vs mirtazapine/dexamethasone (M/D) combination vs dexamethasone (<i>D</i>) alone for prevention of PONV in morbidly obese patients undergoing LSG.</p><p><strong>Methods: </strong>Ninety patients scheduled for LSG were randomly allocated to receive 8 mg dexamethasone intravenous infusion (IVI) only in the <i>D</i> group or in addition to 80 mg aprepitant capsule in the A/D group or in addition to 30 mg mirtazapine tablet in the M/D group. Assessment of PONV was carried out at 0-2 h (early) and 2-24 h (late). The primary outcome was the complete response 0-24 h after surgery. Collective PONV, postoperative pain, side effects and patient satisfaction score were considered as secondary outcomes.</p><p><strong>Results: </strong>The A/D and M/D groups were superior to the <i>D</i> group for a complete response within 0-24 h after surgery (79.3% for the A/D group, 78.6% for the M/D group, and 20.7% for the <i>D</i> group). The <i>D</i> group was inferior to the A/D and M/D groups regarding collective PONV and use of rescue antiemetic 0-24 h after surgery (<i>P</i> < 0.001, <i>P</i> < 0.001, respectively). The peak nausea scores (2-24 h) were significantly reduced in the M/D group in comparison to the <i>D</i> group (<i>P</i>=0.005). Patients in the M/D group showed high sedation scores, while those in the A/D group showed low pain scores (2-24 h) and less analgesic requirements (<i>P</i> < 0.001, <i>P</i> < 0.001, <i>P</i> < 0.001, respectively). The A/D and M/D groups were superior to the <i>D</i> group with regard to the patient satisfaction score (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Aprepitant/dexamethasone combination and mirtazapine/dexamethasone combination were superior to dexamethasone alone in alleviating postoperative nausea and vomiting in morbidly obese patients scheduled to undergo laparoscopic sleeve gastrectomy. Trial Registration: ClinicalTrials.gov identifier: NCT04013386.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2022 1","pages":"3541073"},"PeriodicalIF":1.6,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9078838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44534915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Anesthetic Approach in Ambulatory Vitrectomy: Peribulbar Block vs. Balanced General Anesthesia 动态玻璃体切除术的麻醉方法:球周阻滞与平衡全麻
IF 1.4 Q2 ANESTHESIOLOGY Pub Date : 2022-03-28 DOI: 10.1155/2022/3838222
Bárbara Gouveia, L. Ferreira, P. Maia
Background Vitrectomy is one of the most common outpatient ophthalmic surgeries. The anesthetic technique used in outpatient surgery should contribute to a faster functional recovery, better pain control, and fewer complications. The aim of this study was to compare peribulbar block and balanced general anesthesia, in patients undergoing outpatient vitrectomy. Methods A prospective cohort study was carried out, including adult patients undergoing ambulatory vitrectomy, between January and February 2018. Peribulbar block or balanced general anesthesia was the independent variable analyzed. Clinical and perioperative variables were evaluated, namely, postoperative pain, nausea, and vomiting in the postoperative period, intraoperative hypotension, patient satisfaction with the anesthetic technique, time to oral diet introduction and to hospital discharge, operating room occupancy time, and pharmacological costs. SPSS® 27 was used for statistical analyses. Results Twenty-one patients were evaluated, 11 of whom underwent peribulbar block and 10 underwent balanced general anesthesia. Patients undergoing peribulbar block did not experience postoperative pain when compared to patients undergoing balanced general anesthesia (p=0.001). Intraoperative hypotension occurred in 18.2% of patients undergoing peribulbar block and in 70% of those undergoing balanced general anesthesia (p=0.03). Time to oral diet introduction (<1 hour vs. > 2 hours; p < 0.05), operating room occupancy time (70 vs. 90 minutes; p=0.027), time to hospital discharge (17 vs. 22.5 hours; p=0.004), and pharmacological costs (4.65 vs. 12.09 euros; p < 0.05) were lower in patients undergoing peribulbar block versus balanced general. Conclusions Peribulbar block seems to meet the criteria of an ideal anesthetic technique in outpatient vitrectomy surgery.
背景玻璃体切除术是最常见的门诊眼科手术之一。门诊手术中使用的麻醉技术应有助于更快的功能恢复、更好的疼痛控制和更少的并发症。本研究的目的是比较球周阻滞和平衡全麻在门诊接受玻璃体切除术的患者中的作用。方法对2018年1月至2月期间接受门诊玻璃体切除术的成年患者进行前瞻性队列研究。球周阻滞或平衡全麻是分析的自变量。评估了临床和围手术期的变量,即术后疼痛、术后恶心和呕吐、术中低血压、患者对麻醉技术的满意度、口服饮食介绍和出院时间、手术室占用时间和药物成本。SPSS®27用于统计分析。结果21例患者接受了评估,其中11例接受了球周阻滞,10例接受了平衡全麻。与接受平衡全身麻醉的患者相比,接受球周阻滞的患者没有术后疼痛(p=0.001)。18.2%的球周阻滞患者和70%的平衡全身麻醉患者发生术中低血压(p=0.03)( 2小时;p<0.05)、手术室占用时间(70 vs.90分钟;p=0.027)、出院时间(17 vs.22.5小时;p=0.004)和药物成本(4.65 vs.12.09欧元;p<0.05)在接受球周阻滞的患者中低于平衡型普通型。结论球周阻滞符合门诊玻璃体切除术的理想麻醉技术标准。
{"title":"Anesthetic Approach in Ambulatory Vitrectomy: Peribulbar Block vs. Balanced General Anesthesia","authors":"Bárbara Gouveia, L. Ferreira, P. Maia","doi":"10.1155/2022/3838222","DOIUrl":"https://doi.org/10.1155/2022/3838222","url":null,"abstract":"Background Vitrectomy is one of the most common outpatient ophthalmic surgeries. The anesthetic technique used in outpatient surgery should contribute to a faster functional recovery, better pain control, and fewer complications. The aim of this study was to compare peribulbar block and balanced general anesthesia, in patients undergoing outpatient vitrectomy. Methods A prospective cohort study was carried out, including adult patients undergoing ambulatory vitrectomy, between January and February 2018. Peribulbar block or balanced general anesthesia was the independent variable analyzed. Clinical and perioperative variables were evaluated, namely, postoperative pain, nausea, and vomiting in the postoperative period, intraoperative hypotension, patient satisfaction with the anesthetic technique, time to oral diet introduction and to hospital discharge, operating room occupancy time, and pharmacological costs. SPSS® 27 was used for statistical analyses. Results Twenty-one patients were evaluated, 11 of whom underwent peribulbar block and 10 underwent balanced general anesthesia. Patients undergoing peribulbar block did not experience postoperative pain when compared to patients undergoing balanced general anesthesia (p=0.001). Intraoperative hypotension occurred in 18.2% of patients undergoing peribulbar block and in 70% of those undergoing balanced general anesthesia (p=0.03). Time to oral diet introduction (<1 hour vs. > 2 hours; p < 0.05), operating room occupancy time (70 vs. 90 minutes; p=0.027), time to hospital discharge (17 vs. 22.5 hours; p=0.004), and pharmacological costs (4.65 vs. 12.09 euros; p < 0.05) were lower in patients undergoing peribulbar block versus balanced general. Conclusions Peribulbar block seems to meet the criteria of an ideal anesthetic technique in outpatient vitrectomy surgery.","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49364364","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}
引用次数: 2
Lateral Quadratus Lumborum Block versus Transversus Abdominis Plane Block in Laparoscopic Surgery: A Randomized Controlled Study 腰方形外侧阻滞与经腹平面阻滞在腹腔镜手术中的比较:一项随机对照研究
IF 1.4 Q2 ANESTHESIOLOGY Pub Date : 2022-03-28 DOI: 10.1155/2022/9201795
Omar Sayed Fargaly, M. Boules, M. Hamed, Mohammed Abdel Aleem Abbas, M. Shawky
Background After laparoscopic abdominal surgery, we aim to evaluate the analgesic efficiency of US-directed bilateral transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB). Methods 50 patients aged 18–60 years listed for elective laparoscopic abdomen operation were registered in this study. Cases were randomly allocated into two similar groups: TAPB and QLB groups. The first outcome was the growing morphine consumption on the 1st day postoperatively. The second outcome involved VAS score, first analgesic necessities, and any postoperative complications. Statistical analysis was done with the 2-sample t-test, and Mann–Whitney U testing was utilized to compare medians for skewed end points. Qualitative data were introduced as numbers and percentages, and chi-squared testing was utilized to determine the significance. Results The median cumulative morphine consumptions on the 1st day were high significantly in the TAPB group than in the QLB group (6 mg [6, 9] vs. 3 mg [3, 6], p value ≤0.0001]). The QLB group showed an increase in the median of the time to the first analgesic request in comparison with the TAPB group (17 hours [12, 24] vs. 8 hours [6, 24], p ≤ 0.001). In addition, on the 1st day, the mean VAS scoring at rest was lower in the QLB group. Conclusion In comparison to the TAPB, the QL block delivers more successful pain relief, has an extended period of analgesic actions, extends interval to the 1st analgesic necessity, is accompanied with lesser morphine consumptions, and may be utilized in multimodal analgesia and opioid-sparing regimens after that laparoscopic operation. This trial is registered with NCT04553991.
背景腹腔镜腹部手术后,我们的目的是评估美国指导的双侧腹横肌平面阻滞(TAPB)和腰方肌阻滞(QLB)的镇痛效果。方法本研究登记了50例年龄在18-60岁之间的择期腹腔镜腹部手术患者。病例被随机分为两组:TAPB组和QLB组。第一个结果是术后第1天吗啡用量增加。第二个结果涉及VAS评分、第一次镇痛的必要性和任何术后并发症。统计分析采用2样本t检验,Mann–Whitney U检验用于比较偏斜终点的中位数。定性数据以数字和百分比的形式引入,卡方检验用于确定显著性。结果TAPB组第1天的吗啡累积消耗量中位数显著高于QLB组(6 mg[6,9]vs.3 mg[3,6],p值≤0.0001])。QLB组与TAPB组相比,首次镇痛请求的时间中位数增加(17小时[12,24]vs.8小时[6,24]p≤0.001)。此外,第1天,QLB组静息时的平均VAS评分较低。结论与TAPB相比,QL阻滞能更成功地缓解疼痛,镇痛作用时间延长,间隔延长至第一次镇痛需要,吗啡消耗较少,可用于腹腔镜手术后的多模式镇痛和阿片类药物保留方案。本试验注册号为NCT04553991。
{"title":"Lateral Quadratus Lumborum Block versus Transversus Abdominis Plane Block in Laparoscopic Surgery: A Randomized Controlled Study","authors":"Omar Sayed Fargaly, M. Boules, M. Hamed, Mohammed Abdel Aleem Abbas, M. Shawky","doi":"10.1155/2022/9201795","DOIUrl":"https://doi.org/10.1155/2022/9201795","url":null,"abstract":"Background After laparoscopic abdominal surgery, we aim to evaluate the analgesic efficiency of US-directed bilateral transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB). Methods 50 patients aged 18–60 years listed for elective laparoscopic abdomen operation were registered in this study. Cases were randomly allocated into two similar groups: TAPB and QLB groups. The first outcome was the growing morphine consumption on the 1st day postoperatively. The second outcome involved VAS score, first analgesic necessities, and any postoperative complications. Statistical analysis was done with the 2-sample t-test, and Mann–Whitney U testing was utilized to compare medians for skewed end points. Qualitative data were introduced as numbers and percentages, and chi-squared testing was utilized to determine the significance. Results The median cumulative morphine consumptions on the 1st day were high significantly in the TAPB group than in the QLB group (6 mg [6, 9] vs. 3 mg [3, 6], p value ≤0.0001]). The QLB group showed an increase in the median of the time to the first analgesic request in comparison with the TAPB group (17 hours [12, 24] vs. 8 hours [6, 24], p ≤ 0.001). In addition, on the 1st day, the mean VAS scoring at rest was lower in the QLB group. Conclusion In comparison to the TAPB, the QL block delivers more successful pain relief, has an extended period of analgesic actions, extends interval to the 1st analgesic necessity, is accompanied with lesser morphine consumptions, and may be utilized in multimodal analgesia and opioid-sparing regimens after that laparoscopic operation. This trial is registered with NCT04553991.","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49585657","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}
引用次数: 1
Hemodynamic Effects of Methamphetamine and General Anesthesia 甲基苯丙胺和全身麻醉对血液动力学的影响
IF 1.4 Q2 ANESTHESIOLOGY Pub Date : 2022-02-17 DOI: 10.1155/2022/7542311
Keyvan M. Safdari, Curtis Converse, F. Dong, Nickolas MacDougall, K. Hyer, Alec C. Runyon, Haley Ahlering, M. Comunale
Design A retrospective analysis of all anesthetic records at our institution over a two-year period was performed. Setting. Operating room cases under balanced anesthesia. Patients. All patients with ASA class I or II, who did not have trauma or were initially admitted to ICU, aged 18–65, without preexisting cardiac, renal, or pulmonary disease. Patients were divided into three groups: those acutely positive for methamphetamine within 48 hours of surgery (n = 137), those positive for methamphetamine between 48 hours and 7 days of surgery (n = 69), and randomly selected controls who were negative for methamphetamine within 7 days of surgery (n = 159). Measurements. Intraoperative hemodynamic instability was defined as either a drop of more than 40% in MAP for greater than 5 minutes or requirement for significant amount of vasopressors. Main Results. Among the patients who were acutely positive for methamphetamine within 24 hours, 31.4% met the criteria for hemodynamic instability within the first hour of general anesthesia, compared to 26.1% of the subacutely positive patients and 6.3% of controls (p < 0.0001). This was despite lower doses of anesthetic medications in the acutely and subacutely positive groups. Conclusion Patients who present to the operating room with a positive urine drug screen for amphetamines within 2 days of surgery are at increased risk of hemodynamic instability. Postponing surgery up to 7 days somewhat decreases this risk, but not to the levels of patients who do not use methamphetamines.
设计对我们机构两年来的所有麻醉记录进行回顾性分析。背景手术室病例在平衡麻醉下。病人。所有ASA I级或II级患者,没有创伤或最初入住ICU,年龄在18-65岁,之前没有心脏、肾脏或肺部疾病。患者被分为三组:在手术后48小时内甲基苯丙胺呈急性阳性的患者(n = 137),手术后48小时至7天内甲基苯丙胺呈阳性者(n = 69),以及随机选择的在手术后7天内甲基苯丙胺呈阴性的对照组(n = 159)。测量。术中血液动力学不稳定被定义为MAP下降超过40%,持续时间超过5 分钟或需要大量的血管升压药。主要结果。在24小时内甲基苯丙胺急性阳性的患者中,31.4%的患者在全身麻醉的第一个小时内符合血液动力学不稳定的标准,而亚急性阳性患者和对照组的这一比例分别为26.1%和6.3%(p<0.0001)。尽管急性和亚急性阳性组的麻醉药物剂量较低。结论手术后2天内尿苯丙胺药物筛查呈阳性的患者出现血液动力学不稳定的风险增加。将手术推迟7天在一定程度上降低了这种风险,但没有达到不使用甲基苯丙胺的患者的水平。
{"title":"Hemodynamic Effects of Methamphetamine and General Anesthesia","authors":"Keyvan M. Safdari, Curtis Converse, F. Dong, Nickolas MacDougall, K. Hyer, Alec C. Runyon, Haley Ahlering, M. Comunale","doi":"10.1155/2022/7542311","DOIUrl":"https://doi.org/10.1155/2022/7542311","url":null,"abstract":"Design A retrospective analysis of all anesthetic records at our institution over a two-year period was performed. Setting. Operating room cases under balanced anesthesia. Patients. All patients with ASA class I or II, who did not have trauma or were initially admitted to ICU, aged 18–65, without preexisting cardiac, renal, or pulmonary disease. Patients were divided into three groups: those acutely positive for methamphetamine within 48 hours of surgery (n = 137), those positive for methamphetamine between 48 hours and 7 days of surgery (n = 69), and randomly selected controls who were negative for methamphetamine within 7 days of surgery (n = 159). Measurements. Intraoperative hemodynamic instability was defined as either a drop of more than 40% in MAP for greater than 5 minutes or requirement for significant amount of vasopressors. Main Results. Among the patients who were acutely positive for methamphetamine within 24 hours, 31.4% met the criteria for hemodynamic instability within the first hour of general anesthesia, compared to 26.1% of the subacutely positive patients and 6.3% of controls (p < 0.0001). This was despite lower doses of anesthetic medications in the acutely and subacutely positive groups. Conclusion Patients who present to the operating room with a positive urine drug screen for amphetamines within 2 days of surgery are at increased risk of hemodynamic instability. Postponing surgery up to 7 days somewhat decreases this risk, but not to the levels of patients who do not use methamphetamines.","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2022-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49535762","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}
引用次数: 2
A Comparative Study between Postoperative Analgesia of Fascia Iliaca Compartment Block and Anterior Quadratus Lumborum Block in Proximal Femur Fracture. 股骨近端骨折髂筋膜腔室阻滞与腰前方肌阻滞术后镇痛的比较研究。
IF 1.4 Q2 ANESTHESIOLOGY Pub Date : 2022-01-01 DOI: 10.1155/2022/3465537
O S M Abd Elmaksoud, S E M Elansary, N G Fahmy, R M Hussien

Elderly patients with various comorbidities are more likely to suffer from proximal femur fractures. It is also a painful fracture, and poor pain management can have serious physiological and psychological consequences, such as acute delirium. Purpose. The aim of this study is to compare the efficacy of ultrasound-guided transmuscular (anterior) quadratus lumborum block (QLB) versus infrainguinal fascia iliaca compartment block (FICB) in proximal femur fractures for postoperative analgesia. Patient-reported pain on the visual analogue scale (VAS), analgesic demand, and ambulation were the key factors. Patients and Methods. This prospective, randomised trial was done after receiving approval from the institute' study ethical committee. In this study, ultrasound-guided infrainguinal fascia iliaca compartment block was compared to ultrasound-guided anterior quadratus lumborum block using 50 ml of bupivacaine 0.25%, with a maximum dose of 2.5 mg/kg at the end of surgery after spinal anaesthesia in 128 patients (64 patients in each group). Nalbuphine was given as rescue analgesia if VAS >3. Our 1st outcome was the first rescue analgesia and total analgesic consumption in the 1st 24 hours; the 2nd outcome was the time patients started to ambulate. Results. Postoperative pain perception was substantially greater in the FICB group starting from 30 min (P value 0.022) till 24 hours (P value <0.001), and they received a considerably larger total narcotic dose (14.1 ± 3.5) than patients in the QLB group (7.9 ± 3.4), P value (<0.001 ). The time required to achieve first rescue analgesia was much less in the FICB group (8.5 ± 2.2) compared to the QLB group (14.1 ± 4.5), P value (<0.001 ), and they took much longer to ambulate (22.3 ± 4.8) when compared to the QLB group (20.1 ± 4.6), P value (0.011 ). Hypotension (1.6%) was detected mainly in the QLB group, whereas poor fascial separation (1.6%) was observed only in the FICB group. There were no significant differences in complications between both the FICB and QLB groups. Conclusion. Patients receiving postoperative anterior QL block for proximal femur fracture demonstrated delayed first rescue analgesia and lower total nalbuphine consumption with early ambulation than patients who received FICB.

有各种合并症的老年患者更容易发生股骨近端骨折。这也是一种痛苦的骨折,疼痛管理不善会造成严重的生理和心理后果,如急性谵妄。目的。本研究的目的是比较超声引导下经肌肉(前)腰方肌阻滞(QLB)与腹股沟下筋膜髂隔室阻滞(FICB)在股骨近端骨折术后镇痛的效果。患者报告的视觉模拟量表(VAS)疼痛、镇痛需求和活动是关键因素。患者和方法。这项前瞻性随机试验是在获得研究所研究伦理委员会的批准后进行的。在本研究中,128例患者(每组64例)在脊髓麻醉后手术结束时,超声引导下腹股沟下筋膜髂腔室阻滞与超声引导下腰前方肌阻滞相比,使用0.25%布比卡因50 ml,最大剂量为2.5 mg/kg。VAS >3者给予纳布啡作为救助性镇痛。我们的第一个结局是第一次抢救镇痛和第24小时的总镇痛用量;第二个结果是病人开始走动的时间。结果。FICB组从30min (P值0.022)到24h (P值P值(∗))术后疼痛感明显增强。FICB组实现首次抢救镇痛所需的时间(8.5±2.2)远少于QLB组(14.1±4.5),P值(∗),与QLB组(20.1±4.6)相比,他们需要更长的时间(22.3±4.8),P值(0.011∗)。低血压(1.6%)主要见于QLB组,而筋膜分离不良(1.6%)仅见于FICB组。FICB组和QLB组的并发症无显著差异。结论。股骨近端骨折术后接受前路QL阻滞的患者比接受FICB的患者表现出延迟的首次救援镇痛和较低的早期下床总纳布啡消耗。
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引用次数: 2
Effects of Benson Relaxation Technique and Music Therapy on the Anxiety of Primiparous Women Prior to Cesarean Section: A Randomized Controlled Trial. Benson放松技术和音乐治疗对剖宫产前初产妇焦虑的影响:一项随机对照试验。
IF 1.4 Q2 ANESTHESIOLOGY Pub Date : 2022-01-01 DOI: 10.1155/2022/9986587
Sedigheh Nosrati Abarghoee, Abbas Mardani, Robabe Baha, Nasrin Fadaee Aghdam, Mahboobeh Khajeh, Fatemeh Eskandari, Mojtaba Vaismoradi

Background and aims: Primiparous women experience high levels of anxiety before cesarean section. Therefore, this research aimed to investigate the effects of the Benson Relaxation Technique (BRT) and Music Therapy (MT) on the anxiety of primiparous women prior to cesarean section.

Methods: A randomized controlled trial was carried out on 105 women scheduled for cesarean section. They were randomly assigned into three groups: BRT, MT, and control (n = 35 per group). The women in the BRT and MT groups performed exercises and listened to music, respectively, for 20 minutes prior to cesarean section. The State Anxiety Inventory was used to measure the women's anxiety in the groups before and after the intervention.

Results: Within-group comparisons showed that the women in the BRT (t = 5.61, p < 0.001, effect size (Cohen's d) = 0.94) and MT (t = 3.83, p = 0.001, d = 0.64) groups had significantly lower anxiety after the interventions compared to before the interventions. Also, between-group comparisons revealed that anxiety after the intervention was significantly lower in the BRT and MT groups compared to the control group (p = 0.007).

Conclusions: Although both of the BRT and MT helped with the reduction of anxiety among primiparous women before cesarean section, the BRT was shown more effective. These nonpharmacologic methods are safe and cost-effective and can improve well-being among women undergoing this invasive procedure. They can be used along with pharmacologic methods for reducing overreliance on medications.

背景和目的:初产妇女在剖宫产前经历高度焦虑。因此,本研究旨在探讨Benson放松技术(BRT)和音乐疗法(MT)对剖宫产术前初产妇焦虑的影响。方法:对105例剖宫产孕妇进行随机对照试验。他们被随机分为三组:BRT, MT和对照组(每组n = 35)。BRT组和MT组的妇女在剖宫产前分别进行了20分钟的锻炼和听音乐。采用状态焦虑量表测量干预前后各组妇女的焦虑程度。结果:组内比较显示,BRT组(t = 5.61, p d) = 0.94)和MT组(t = 3.83, p = 0.001, d = 0.64)的女性在干预后的焦虑水平明显低于干预前。此外,组间比较显示,与对照组相比,BRT组和MT组干预后的焦虑显著降低(p = 0.007)。结论:虽然BRT和MT都有助于减少剖宫产前初产妇的焦虑,但BRT显示出更有效的效果。这些非药物方法是安全的,具有成本效益,可以改善妇女的福祉进行这种侵入性手术。它们可以与药理学方法一起使用,以减少对药物的过度依赖。
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引用次数: 3
期刊
Anesthesiology Research and Practice
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