Anesthesiology and Pain Medicine最新文献

Background: During the COVID-19 pandemic, severe respiratory failure is a life-threatening condition, and life-saving tracheal intubation is a high-risk aerosol- and droplet-generating procedure. It is crucial to protect healthcare workers without compromising patient safety during intubation. The use of personal protective equipment (PPE) and different types of laryngoscopes are measures to reduce the risk of infectious transmission that might impact the intubation process.

Objectives: This study aimed to evaluate the effects of different levels of PPE and types of laryngoscopes on the duration of the intubation process and its success rate.

Methods: We conducted an open, randomized, parallel clinical trial on non-COVID-19 adult patients scheduled for elective and emergency surgeries under general anesthesia from November 2021 to May 2022. Patients were divided into three groups: Group 1 was intubated using a video-guided laryngoscope with operators wearing level three PPE; group 2 was intubated using a direct laryngoscope with operators wearing level three PPE; and group 3 was intubated using a direct laryngoscope with operators wearing level two PPE. Intubation was performed by 2nd- and 3rd-year anesthesia residents.

Results: The duration of intubation varied significantly among the groups, with Group 1 taking the longest time (P = 0.046). Group 3 had a higher success rate for first-attempt intubation (P = 0.056).

Conclusions: The use of PPE and video-guided laryngoscopy had varying effects on the intubation procedure, with the most notable impact being on the overall length of intubation. Further research with a larger sample size is needed to validate these findings.

Introduction: Frank ter Haar syndrome (FTHS) is a rare and complex multisystem congenital genetic disorder that leads to craniofacial, cardiac, and skeletal abnormalities. We report the anesthesia and airway management of a child with FTHS who was referred for repair of atrial septal defect (ASD) and ventricular septal defect (VSD).

Case presentation: The patient exhibited craniofacial and skeletal abnormalities, including craniosynostosis, micrognathia, a prominent forehead, hypertelorism, and anteverted nostrils. These features raised the possibility of a difficult airway.

Conclusions: For patients with potential difficult airways undergoing elective surgery, the procedure should be postponed until all necessary equipment for managing a difficult airway is available.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a primary diagnostic and therapeutic option for pancreaticobiliary pathologies.

Objectives: This study aimed to investigate the efficacy and safety of dexmedetomidine versus propofol during ERCP in cancer patients.

Methods: This randomized controlled single-blinded trial was conducted with 202 cancer patients aged 21 to 60 years, of both sexes, with a body mass index of 18.5 to 30 kg/m², and classified as American Society of Anesthesiologists (ASA) class II - III, who were undergoing ERCP. The patients were randomly assigned to two equal groups. The Propofol Group (n = 101) received a loading dose of propofol (1 - 2 mg/kg over 30 seconds) followed by an infusion (0.05 - 0.1 mg/kg/hour). The Dexmedetomidine Group (n = 101) received a loading dose of dexmedetomidine (1 μg/kg over 10 minutes) followed by an infusion (0.2 - 0.7 μg/kg/hour). The maintenance dose was adjusted during the procedure based on vital signs, Bispectral Index (BIS), and oxygen saturation.

Results: The Dexmedetomidine group showed a significantly lower incidence of intra-procedural hypoxemic events (14.9% vs. 26.7%, P = 0.037) and a comparable incidence of hypotension (17.8% vs. 13.9%, P = 0.441). Dexmedetomidine also demonstrated significantly lower intraoperative pain scores according to the Facial Pain Score (P < 0.05), significantly lower postoperative Visual Analog Scale (VAS) scores (P < 0.05), and a lower frequency of postoperative nausea and vomiting (PONV) compared to the Propofol group. Additionally, there was a significantly higher frequency of endoscopist satisfaction in the Dexmedetomidine group compared to the Propofol group (P < 0.05).

Conclusions: Dexmedetomidine can be used as a safe and effective alternative to propofol for deep sedation of cancer patients undergoing ERCP. It is associated with a lower incidence of hypoxemic events, effective intraoperative sedation, quicker recovery, and superior analgesic effects both intraoperatively and postoperatively compared to propofol.

Introduction: Post-dural puncture headache (PDPH) is a well-known consequence of neuraxial anesthesia that can impede patient recovery and delay early discharge. Traditional remedies include hydration and the administration of simple analgesics for symptom relief. When symptoms persist despite conservative interventions, an epidural blood patch (EBP) is typically recommended. However, this invasive procedure carries risks and complications. Our case report aims to explore a potential alternative treatment for PDPH.

Case presentation: We present the case of a 22-year-old female who experienced PDPH following spinal anesthesia. Despite initial attempts at conservative management, her symptoms persisted. She then opted for a trans-nasal sphenopalatine ganglion (SPG) block, which resulted in remarkable pain relief and eliminated the need for an EBP.

Conclusions: The SPG block emerges as a minimally invasive option for treating PDPH. Multiple studies have demonstrated that patients undergoing SPG block therapy did not require EBP.

Background: This study compares the effects of transforaminal magnesium sulfate injection versus other methods for managing radicular back pain, highlighting its potential for improved pain relief and functional outcomes.

Methods: This randomized, double-blind clinical trial involved 30 patients with radicular back pain who were randomly assigned to receive either transforaminal magnesium sulfate or triamcinolone injection. Primary outcomes were pain intensity and functional disability, assessed using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI), respectively. These were evaluated at five time points: Before the injection, 2 weeks, 1 month, 3 months, and 6 months after the injection. Secondary outcomes included drug-related adverse events within the six-month follow-up period.

Results: Baseline characteristics were not significantly different between the two study groups. Compared to pre-injection measures, post-injection pain intensity and functional disability were significantly reduced in both groups at all time points (P < 0.001). At all postoperative evaluations, pain intensity and functional disability were lower in the magnesium sulfate group compared to the steroid group (P < 0.001). No drug-related side effects were recorded in either group.

Conclusions: For patients with radicular back pain, transforaminal magnesium sulfate injection appears to be an effective and safe alternative to transforaminal steroid injection.

Background: Lumbar disc herniation (LDH) can cause pain in the lower back and leg, as well as numbness or weakness in the affected area. Various steroids, including methylprednisolone, are currently used for treatment.

Objectives: This study aimed to compare the effectiveness of pulse intravenous infusion of 500 mg methylprednisolone with common non-steroidal anti-inflammatory drugs (NSAIDs) in relieving pain and improving the clinical condition of patients with lumbar disc herniation.

Methods: This clinical trial, registered under code IRCT20211116053077N1, included an experimental group (37 patients) and a control group (35 patients). Pain assessments were conducted before treatment, and at one, two, and three weeks, as well as one and six months after treatment. The control group received common painkillers (diclofenac sodium tablets 100 mg), while the experimental group received a single dose of 500 mg methylprednisolone sodium succinate (intravenous injection in 500 cc normal saline). Pain scores were analyzed using SPSS 16 and statistical tests such as ANOVA, independent t-tests, and repeated measures ANOVA.

Results: Prior to intervention, the mean (SD) pain score was 8.7 (3.57) in the experimental group and 8.17 (0.66) in the control group (P > 0.76). Six months after methylprednisolone injection, the mean (SD) pain score in the experimental group was 1.56 (0.83), compared to 6.48 (0.91) in the control group (P = 0.000). Analysis of variance indicated that methylprednisolone significantly reduced pain in patients with LDH (P = 0.000, F = 660.668).

Conclusions: Given the effectiveness of intravenous pulse infusion of 500 mg methylprednisolone compared to common NSAIDs in relieving pain and improving clinical outcomes for patients with lumbar disc herniation, the use of this drug is recommended for pain reduction in these patients.

Background: One of the most prevalent causes of anterior knee pain is chondromalacia patella (CMP), particularly among young populations, including soldiers. Although various treatments have been suggested to relieve the symptoms and improve the functioning of patients with CMP, none have proven to be adequately effective.

Objectives: This study assessed the effectiveness of electroacupuncture as a complementary treatment for CMP, noting its minimal complications.

Methods: In this randomized clinical trial, soldiers diagnosed with CMP who met the inclusion criteria and referred to Imam Reza Hospital in Tehran in 2023 were assigned to one of two treatment groups. The electroacupuncture group received treatment at specific acupuncture points combined with an electrical current. The physical therapy group underwent treatment consisting of 10 sessions of routine physical therapy modalities. The Visual Analog Scale (VAS) for pain and disability and the knee injury and osteoarthritis outcome score (KOOS) questionnaire were used to assess the outcomes before the intervention and three months after the intervention.

Results: Twenty participants were analyzed in each group. The VAS for pain and disability reduced in both groups during the study; however, the difference between the two groups was not significant (P = 0.999 for pain and P = 0.873 for disability). No significant difference was observed in the KOOS symptom score either during the study or between the two groups (P = 0.423). The changes in the "pain" scores of the KOOS questionnaire were significant both in the electroacupuncture group (P = 0.003) and in the physical therapy group (P = 0.038); however, the difference was not significant between the two groups. The "activities of daily living" scores of the patients were significant both during the study and between the two groups (P = 0.042), with a steeper improvement in the electroacupuncture group. The patients' "sports and recreational activities" scores were significant in the electroacupuncture group (P = 0.001) and between the two groups (P = 0.023). The "knee-related quality-of-life" scores were significant in both groups, and the comparison of the two groups indicated that the slope of the changes was higher in the electroacupuncture group than in the physical therapy group (P = 0.001).

Conclusions: According to the results of the current research, electroacupuncture can improve the symptoms and function of patients with CMP, and its efficacy is equivalent to that of physical therapy.

Background: Non-invasive treatment options are preferred for managing upper extremity pain due to osteoarthritis (OA). Transcutaneous pulsed radiofrequency (TcPRF) is a promising technique and appears effective in managing knee and shoulder pain.

Objectives: To investigate whether TcPRF treatment is effective in reducing pain and safe to use among patients with OA of the upper extremity.

Methods: In this retrospective study, patients with painful OA of the upper extremity who underwent TcPRF treatment from February 2021 to February 2022 were included. The primary outcome measure was the change in NRS pain scores between baseline and 1, 2, and 6 weeks of follow-up. Secondary outcome measures included adverse events. Data were extracted from electronic medical records and via telephone consultation after the 6-week follow-up.

Results: A total of 41 initial TcPRF treatments were performed among 37 patients. The NRS score at rest showed a statistically significant improvement at 6 weeks [median = 5 [interquartile range (IQR) 2 - 8)] compared with baseline [median = 6 (IQR 4 - 8)], P = 0.023, with a moderate effect size, r = -0.44. For NRS scores during activity, all follow-up moments had lower NRS scores [median = 7 (IQR 5 - 8)] than before TcPRF [median = 8 (IQR 7 - 9)], P = 0.002 - 0.006, with moderate to large effect sizes, r = -0.45 to r = -0.51. No adverse events were reported.

Conclusions: Transcutaneous pulsed radiofrequency treatment is effective in reducing pain and is safe to use among patients with upper extremity pain due to OA.

Background: The success of epidural analgesia hinges on the precise insertion of the needle within the epidural space; failure rates have been reported to reach 32%.

Objectives: We report a new method using color Doppler to help verify the accurate location of the epidural needle tip.

Methods: This is a randomized prospective study. Sixty patients undergoing hysterectomy were enrolled, with 30 patients in each group. Color flow Doppler (CFD) ultrasonography was employed to guide epidural catheter placement. The ultrasound-guided epidural technique was used for patients where challenges in identifying traditional landmarks for epidural space localization were anticipated. The procedure commenced with a spinal epidural technique. After sterile preparation and draping of the area, a curvilinear ultrasound transducer, encased in a sterile sheath, was used to locate the interspinous space. The primary outcome measure focused on flow visualization at different insertion levels. Secondary outcome measures included the duration of catheter implantation, intervertebral level of insertion, and dermatome sensory levels. The study also assessed the quality of epidural analgesia and patients' assessment of analgesic quality using a Verbal Numerical Rating Scale.

Results: The study reported a successful and predominantly safe outcome, with high success rates in flow visualization and effective anesthesia coverage. Flow visualization at the insertion and surrounding levels demonstrated a 100% success rate at all observed points. The Visual Numeric Rating Scale (VNRS) results indicated a median pain score of 2 with an interquartile range (IQR) of 2 - 3, showcasing a generally low level of post-procedural pain among the subjects, reflecting good quality post-operative analgesia. Regarding dermatome sensory levels after 2 hours, the distribution across various levels, including T4, T6, T7, T8, T10, and T12, exhibited a favorable outcome. The highest proportion was observed at T10 (68.3%), suggesting effective anesthesia coverage in the targeted areas. The study demonstrated comparable efficiency between the CFD-guided and blind techniques in terms of procedural aspects. However, notable distinctions were observed in patients' reported pain levels, with the CFD group experiencing lower pain compared to the blind technique group. Additionally, the study highlighted the association between CFD and improved procedural accuracy and safety.

Conclusions: This study advocates for the integration of CFD into routine clinical practice to enhance procedural outcomes and patient safety during hysterectomy surgeries.

Progeria syndrome is a rare genetic disorder resulting in premature aging. General anesthesia is very challenging in these patients due to difficult intubation and age-related comorbidities. We describe spinal anesthesia management in a 30-year-old man with progeria syndrome. To our knowledge, this is the first report on using spinal anesthesia in this group of patients.