Pub Date : 2023-09-01DOI: 10.1136/rapm-2023-esra.426
Marco Mazzocchi, Benedetta Mascia, Eleonora Pariani, Giacomo Bruschi, Pietro Quaretti, Alessandro Locatelli
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)
Background and Aims
PAD induces severe and disabling pain with gradual functional impairment and progressive circulation disorder leading to gangrene. Affection of microcirculation rarely develops an effective compensatory mechanism and can’t be treated surgically. RA reduces pain and induces vasodilation, acting on sympathetic and sensitive nerve fibers. O3 therapy promotes nitric oxide release resulting in vasodilation, improves O2 delivery and activates mediators involved in endothelial regeneration. We hypothesized that the combination of RA and O3 could be effective for pain relief and reactivation of microcirculation.
Methods
We treated 1 male patient(68y), with a critical, bilateral upper extremities PAD not amenable to revascularization surgery and with severe pain(NRS=10), poor responsive to drugs. Signs of chronic ischemia, including gangrene, were present. The last chance treatment was the amputation of both hands. We performed autohemotherapy(30 ml of blood + 30 ml of O2O3 blend at 40 mcg/ml of concentration) twice a week + digital nerve block with levobupivacaine 0,15% + subcutaneous infiltration of O2O3 at 10 mcg/ml.
Results
Following one week of treatment pain disappeared completely. After 2 months hands were warmer and well-perfused, areas of dry necrosis were delimited, granulation tissue appeared and eschars fell off from healthier skin. Doppler showed arterial flows. No collateral effects occurred. Maintenance therapy was once a week for 2 months.
Conclusions
The combination between RA and O3 therapy has shown to be a safe and an effective conservative treatment in managing pain and in the reactivation of microcirculation in this severe case of PAD, avoiding demolitive amputation surgery of both hands.
{"title":"#36337 Severe hand pain in iv-stage leriche-fontaine peripheral artery disease(pad): combination between regional anesthesia(RA) and ozone(O3) therapy for recovery of microcirculation. A case report","authors":"Marco Mazzocchi, Benedetta Mascia, Eleonora Pariani, Giacomo Bruschi, Pietro Quaretti, Alessandro Locatelli","doi":"10.1136/rapm-2023-esra.426","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.426","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <b>Application for ESRA Abstract Prizes:</b> I apply as an Anesthesiologist (Aged 35 years old or less) <h3>Background and Aims</h3> PAD induces severe and disabling pain with gradual functional impairment and progressive circulation disorder leading to gangrene. Affection of microcirculation rarely develops an effective compensatory mechanism and can’t be treated surgically. RA reduces pain and induces vasodilation, acting on sympathetic and sensitive nerve fibers. O3 therapy promotes nitric oxide release resulting in vasodilation, improves O2 delivery and activates mediators involved in endothelial regeneration. We hypothesized that the combination of RA and O3 could be effective for pain relief and reactivation of microcirculation. <h3>Methods</h3> We treated 1 male patient(68y), with a critical, bilateral upper extremities PAD not amenable to revascularization surgery and with severe pain(NRS=10), poor responsive to drugs. Signs of chronic ischemia, including gangrene, were present. The last chance treatment was the amputation of both hands. We performed autohemotherapy(30 ml of blood + 30 ml of O2O3 blend at 40 mcg/ml of concentration) twice a week + digital nerve block with levobupivacaine 0,15% + subcutaneous infiltration of O2O3 at 10 mcg/ml. <h3>Results</h3> Following one week of treatment pain disappeared completely. After 2 months hands were warmer and well-perfused, areas of dry necrosis were delimited, granulation tissue appeared and eschars fell off from healthier skin. Doppler showed arterial flows. No collateral effects occurred. Maintenance therapy was once a week for 2 months. <h3>Conclusions</h3> The combination between RA and O3 therapy has shown to be a safe and an effective conservative treatment in managing pain and in the reactivation of microcirculation in this severe case of PAD, avoiding demolitive amputation surgery of both hands.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686394","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.404
Rita Dinis, Bárbara Sousa, Andreia Puga
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes
Background and Aims
Peritonsillar abscess is a frequent otolaryngology emergency. Surgical drainage may be necessary and is poorly tolerated by the awake patient. In some cases is necessary to proceed with awake intubation in order to safely secure the airway.
Methods
Patient: 32-year-old male, with previous history of drug addiction. Procedure: surgical drainage of tonsilar abcess. Anesthetic plan: because a difficult airway was predictable, an awake intubation with videolaringoscopy (C-MAC® D-blade) was decided. Topicalization of the airway was performed with xylocaine 10% and supplemental oxygen was delivered via a nasal catheter. For sedation a bolus of dexmedetomidine (1mcg/kg) and ketamine (1mg/kg) was administered followed by an infusion with dexmedetomidine (1mcg/kg/h) and ketamine (1mg/kg/h).
Results
Videolaringoscopy was possible 10 minutes after the initiation of the infusion. After confirmation of good visualization of both abcess and vocal cords rapid sequence intubation was initiated, with administration of propofol (1mg/kg) and rocuronium (1,2mg/kg). After 1 minute, a new videolaringoscopy and sucessful orotraqueal was performed. The procedure as well as the emergence went uneventful.
Conclusions
The combination of dexmedetomidine and ketamine, not the most common in awake intubation, is a valuable one, as both drugs induce sedation and analgesia without depressing respiratory function or airway protection reflexes. When it comes to airway management in awake intubation, fibreoptic intubation has been considered the technique of choice, but intubation with videolaryngoscope should be considered since it yields high sucess rates in difficult airways.
{"title":"#35833 Paradigm shift in awake intubation","authors":"Rita Dinis, Bárbara Sousa, Andreia Puga","doi":"10.1136/rapm-2023-esra.404","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.404","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <b>Application for ESRA Abstract Prizes:</b> I don’t wish to apply for the ESRA Prizes <h3>Background and Aims</h3> Peritonsillar abscess is a frequent otolaryngology emergency. Surgical drainage may be necessary and is poorly tolerated by the awake patient. In some cases is necessary to proceed with awake intubation in order to safely secure the airway. <h3>Methods</h3> Patient: 32-year-old male, with previous history of drug addiction. Procedure: surgical drainage of tonsilar abcess. Anesthetic plan: because a difficult airway was predictable, an awake intubation with videolaringoscopy (C-MAC® D-blade) was decided. Topicalization of the airway was performed with xylocaine 10% and supplemental oxygen was delivered via a nasal catheter. For sedation a bolus of dexmedetomidine (1mcg/kg) and ketamine (1mg/kg) was administered followed by an infusion with dexmedetomidine (1mcg/kg/h) and ketamine (1mg/kg/h). <h3>Results</h3> Videolaringoscopy was possible 10 minutes after the initiation of the infusion. After confirmation of good visualization of both abcess and vocal cords rapid sequence intubation was initiated, with administration of propofol (1mg/kg) and rocuronium (1,2mg/kg). After 1 minute, a new videolaringoscopy and sucessful orotraqueal was performed. The procedure as well as the emergence went uneventful. <h3>Conclusions</h3> The combination of dexmedetomidine and ketamine, not the most common in awake intubation, is a valuable one, as both drugs induce sedation and analgesia without depressing respiratory function or airway protection reflexes. When it comes to airway management in awake intubation, fibreoptic intubation has been considered the technique of choice, but intubation with videolaryngoscope should be considered since it yields high sucess rates in difficult airways. <h3>Attachment</h3> Consentimento informado sem dados do doente.pdf","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"92 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686395","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.396
Silvia De Miguel Manso, Rocío Gutiérrez Bustillo, Carlota Gordaliza Pastor, Pilar Olmedo Olmedo
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)
Background and Aims
Medication errors are a common source of iatrogenicity. Intrathecal administration of wrong drugs can be life-threatening. A patient suffered an anaphylactic shock after accidental intradural administration of atropine. The aim of this work is to find out if these two facts were related.
Methods
Performing spinal anesthesia for postoperative pain treatment, inadvertent intrathecal inyection of 0.2 mg of atropine instead of morphic chloride occurred to a patient. General anesthesia was induced and then the error was discovered. Surgery was performed without incidents until intravenous administration of metamizole, when severe hypotension underwent. It was resolved with norepinephrine and epinephrine and he recovered without sequelae. Investigating about this episode, authors carried out a bibliographic search in Pubmed, without limiting dates, for studies in which intrathecal administration of atropine was described, in order to find similar cases, consequences and its management.
Results
We found that intrathecal atropine is described by several studies as prevention of postoperative nausea and vomiting after caesarean section with spinal anesthesia. As far as the patient was concern, subsequent allergy testing showed that he was allergic to metamizole, concluding that the episode of hypotension had been consequence of an anaphylactic shock due to this drug, and no related with the medication error.
Conclusions
It has been shown that anticholinergics can be used for prevention of postoperative nausea and vomiting in different routes of administration, including intrathecal route at small doses. Regarding medication errors, a good practice protocol is necessary to avoid serious consequences that, fortunately in this case, did not occur.
{"title":"#35955 Inadverted intrathecal injection of atropine and anaphylactic shock","authors":"Silvia De Miguel Manso, Rocío Gutiérrez Bustillo, Carlota Gordaliza Pastor, Pilar Olmedo Olmedo","doi":"10.1136/rapm-2023-esra.396","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.396","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <h3>Background and Aims</h3> Medication errors are a common source of iatrogenicity. Intrathecal administration of wrong drugs can be life-threatening. A patient suffered an anaphylactic shock after accidental intradural administration of atropine. The aim of this work is to find out if these two facts were related. <h3>Methods</h3> Performing spinal anesthesia for postoperative pain treatment, inadvertent intrathecal inyection of 0.2 mg of atropine instead of morphic chloride occurred to a patient. General anesthesia was induced and then the error was discovered. Surgery was performed without incidents until intravenous administration of metamizole, when severe hypotension underwent. It was resolved with norepinephrine and epinephrine and he recovered without sequelae. Investigating about this episode, authors carried out a bibliographic search in Pubmed, without limiting dates, for studies in which intrathecal administration of atropine was described, in order to find similar cases, consequences and its management. <h3>Results</h3> We found that intrathecal atropine is described by several studies as prevention of postoperative nausea and vomiting after caesarean section with spinal anesthesia. As far as the patient was concern, subsequent allergy testing showed that he was allergic to metamizole, concluding that the episode of hypotension had been consequence of an anaphylactic shock due to this drug, and no related with the medication error. <h3>Conclusions</h3> It has been shown that anticholinergics can be used for prevention of postoperative nausea and vomiting in different routes of administration, including intrathecal route at small doses. Regarding medication errors, a good practice protocol is necessary to avoid serious consequences that, fortunately in this case, did not occur.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686525","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.431
Jesto Kurian, Olivia Biju Johny
Department of Anaesthesia, Rajagiri Hospital, Cochin, India Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes
Background and Aims
This is a case report of a rare incident of possible LAST after a femoral nerve block in an 80-year-old female with intertrochanteric fracture of femur.
Methods
The patient was on dual antiplatelets and CRF patient requiring dialysis 3 days a week. A rt femoral nerve block was planned with 20 ml 0.25% bupivacaine for pain relief. After scanning the inguinal region and identifying femoral nerve an 8 cm echogenic 22 G needle was directed near the femoral near after piercing the fascia, aspiration was done to see any blood .20 ml of 0.25% bupivacaine was injected in aliquots of 5 ml and aspiration was done after every 5 ml.
Results
After 10 minutes patient started having abnormal involuntary movements and patient complained of perioral distaste and earache. The patient was hemodynamically stable but intermittent VPCs were noted in EKG. A clinical diagnosis of LAST was made and 1 mg of midazolam was given initially to control the involuntary movements. An initial bolus of 50 ml of 20% intralipid was given as a bolus intravenously in 10 minutes considering her age and comorbidities though the presentation was not mandating administration of intralipid. The involuntary movements decreased gradually and in 15 minutes patient became completely conscious and EKG became normal.
Conclusions
A high degree of suspicion is required to anticipate LAST as it can present in different ways .20% intralipid has to made available in all areas where a regional anesthesia technique is used.
请确认已申请或批准伦理委员会批准:不相关(见本页底部信息)申请ESRA摘要奖项:我不希望申请ESRA奖项背景和目的本文报告一例80岁女性股骨粗隆间骨折股骨神经阻滞后可能发生LAST的罕见事件。方法患者采用双抗血小板治疗，CRF患者每周透析3天。计划用20 ml 0.25%布比卡因进行rt股神经阻滞以缓解疼痛。扫描腹股沟区，识别股神经后，用8厘米高回声22g针穿刺股筋膜附近，抽吸见血，每5毫升注射0.25%布比卡因20毫升，每5毫升抽吸一次。结果10分钟后患者出现不自主运动异常，患者主叫口周厌恶和耳痛。患者血流动力学稳定，但心电图显示间歇性室性早搏。临床诊断为LAST，最初给予1mg咪达唑仑控制不自主运动。考虑到她的年龄和合并症，在10分钟内静脉注射50毫升20%的脂内注射，尽管没有强制使用脂内注射。不自主运动逐渐减少，15分钟后患者完全清醒，心电图恢复正常。由于LAST可能以不同的方式出现，因此需要高度的怀疑来预测。在使用区域麻醉技术的所有区域都必须提供20%的脂肪内脂。
{"title":"#35956 A rare case of LAST after femoral nerve block under USG guidance -A case report","authors":"Jesto Kurian, Olivia Biju Johny","doi":"10.1136/rapm-2023-esra.431","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.431","url":null,"abstract":"<h3></h3> Department of Anaesthesia, Rajagiri Hospital, Cochin, India <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <b>Application for ESRA Abstract Prizes:</b> I don’t wish to apply for the ESRA Prizes <h3>Background and Aims</h3> This is a case report of a rare incident of possible LAST after a femoral nerve block in an 80-year-old female with intertrochanteric fracture of femur. <h3>Methods</h3> The patient was on dual antiplatelets and CRF patient requiring dialysis 3 days a week. A rt femoral nerve block was planned with 20 ml 0.25% bupivacaine for pain relief. After scanning the inguinal region and identifying femoral nerve an 8 cm echogenic 22 G needle was directed near the femoral near after piercing the fascia, aspiration was done to see any blood .20 ml of 0.25% bupivacaine was injected in aliquots of 5 ml and aspiration was done after every 5 ml. <h3>Results</h3> After 10 minutes patient started having abnormal involuntary movements and patient complained of perioral distaste and earache. The patient was hemodynamically stable but intermittent VPCs were noted in EKG. A clinical diagnosis of LAST was made and 1 mg of midazolam was given initially to control the involuntary movements. An initial bolus of 50 ml of 20% intralipid was given as a bolus intravenously in 10 minutes considering her age and comorbidities though the presentation was not mandating administration of intralipid. The involuntary movements decreased gradually and in 15 minutes patient became completely conscious and EKG became normal. <h3>Conclusions</h3> A high degree of suspicion is required to anticipate LAST as it can present in different ways .20% intralipid has to made available in all areas where a regional anesthesia technique is used.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686735","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.428
Catarina Tiago, Ana Marques, Nuno Oliveira, Joana Barros Silva, Ribeiro Carolina, Ana Panzina, Coimbra Luísa
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)
Background and Aims
Rett syndrome is a rare genetic neurodevelopmental disorder caused by mutations on MECP2 gene on chromosome X, which encodes a protein essential for the normal function of nerve cells. Hence, females are primarily affected. It is characterized by normal early growth and development followed by loss of previously acquired skills at about 6-18 months of life. Symptoms may include: loss of speech, mobility and muscle tone, involuntary hand movements, seizures, breathing and sleep disturbances and slowed rate of growth for head, hands and feet. This is the first case report of a patient with Rett syndrome who underwent surgery under regional anesthesia.
Methods
A 38 year old woman, ASA physical status III, presented for elective equinovarus foot surgery. She was diagnosed with Rett syndrome at 2 years of age. Spinal anesthesia with 0.5% hyperbaric bupivacaine was combined with femural and sciatic nerve blocks with 0.375% ropivacaine.
Results
The surgery lasted about 2,5 hours and went out uneventfully. No complications were reported in postoperative visit, no need of rescue analgesics registered, and the patient was discharged home on postoperative day 2.
Conclusions
Rett syndrome is a rare genetic disorder and therefore recommendations regarding anesthetic management are scarce and there are no reports of regional anesthesia. Anesthetic considerations should include: possibility of a difficult airway; risk of prolonged QT interval and T wave changes; increased sensitivity to sedative drugs; and anatomical malposition of vessels. In this case report we show that regional anesthesia can be an effective and safe approach in patients with Rett syndrome.
{"title":"#36471 Regional anesthesia in a patient with rett syndrome: a case report","authors":"Catarina Tiago, Ana Marques, Nuno Oliveira, Joana Barros Silva, Ribeiro Carolina, Ana Panzina, Coimbra Luísa","doi":"10.1136/rapm-2023-esra.428","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.428","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <h3>Background and Aims</h3> Rett syndrome is a rare genetic neurodevelopmental disorder caused by mutations on MECP2 gene on chromosome X, which encodes a protein essential for the normal function of nerve cells. Hence, females are primarily affected. It is characterized by normal early growth and development followed by loss of previously acquired skills at about 6-18 months of life. Symptoms may include: loss of speech, mobility and muscle tone, involuntary hand movements, seizures, breathing and sleep disturbances and slowed rate of growth for head, hands and feet. This is the first case report of a patient with Rett syndrome who underwent surgery under regional anesthesia. <h3>Methods</h3> A 38 year old woman, ASA physical status III, presented for elective equinovarus foot surgery. She was diagnosed with Rett syndrome at 2 years of age. Spinal anesthesia with 0.5% hyperbaric bupivacaine was combined with femural and sciatic nerve blocks with 0.375% ropivacaine. <h3>Results</h3> The surgery lasted about 2,5 hours and went out uneventfully. No complications were reported in postoperative visit, no need of rescue analgesics registered, and the patient was discharged home on postoperative day 2. <h3>Conclusions</h3> Rett syndrome is a rare genetic disorder and therefore recommendations regarding anesthetic management are scarce and there are no reports of regional anesthesia. Anesthetic considerations should include: possibility of a difficult airway; risk of prolonged QT interval and T wave changes; increased sensitivity to sedative drugs; and anatomical malposition of vessels. In this case report we show that regional anesthesia can be an effective and safe approach in patients with Rett syndrome.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686775","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.394
Jason Kalyvas, Diamanto Dimitroula, Dimitris Iason Kalyvas, Amalia Douma, Christina Chantzi, Antonia Dimakopoulou
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes
Background and Aims
The perioperative pain management of patients in a drug rehabilitation program is a challenge, as trying to meet their needs in analgesia without bypassing the rehabilitation program. The opioid free anesthesia is gaining ground for these patients lately. The recent entry of the NOL index (Nociception Level Index) may constitute valuable aid in the intraoperative assessment of analgesia.
Methods
A 60-year-old man, with history of IV heroin dependence, in a methadone(70mg daily) rehabilitation program, ASA II, attended our hospital for cholecystectomy and bile duct exploration. Opioid free anesthesia was administered (according to Mulier protocol-Mullimix: 50μg dexmedetomidine, 500mg lidocaine, 50mg ketamine diluted in 100ml NS). Loading was done with 1μg/kg dexdemetomidine in 15 min and MgSO4 40mg/kg. Also parecoxib and dexamethasone were administered. Induction in anesthesia was carried out with Mullimix 0.2 ml/kg, propofol 2 mg/kg and rocuronium 0.6 mg/kg. The maintenance was done with desflurane and mullimix 0.2ml/kg/h initially, and the dose was titrated with maintaining the NOL ratio at values of 10-25. 2g of paracetamol were administered 30 min before the end of the operation and the wound was infiltrated with 40 ml of ropivacaine 0.375%. Methadone intake was continued throughout the perioperative period. Postoperative analgesia included paracetamol 4g and parecoxib 80mg daily.
Results
Pain assessment was performed in the PACU, and every 4 hours for the first 48 hours with NRS values (numerical rate scale) < 4. The patient received no other opioids.
Conclusions
Guided by analgesia monitoring, opioid free anesthesia can be an efficient method for patients in rehabilitation programs.
{"title":"#36447 Opioid free anesthesia to a patient in a drug rehabilitation program guided by the NOL index (Nociception Level Index)","authors":"Jason Kalyvas, Diamanto Dimitroula, Dimitris Iason Kalyvas, Amalia Douma, Christina Chantzi, Antonia Dimakopoulou","doi":"10.1136/rapm-2023-esra.394","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.394","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <b>Application for ESRA Abstract Prizes:</b> I don’t wish to apply for the ESRA Prizes <h3>Background and Aims</h3> The perioperative pain management of patients in a drug rehabilitation program is a challenge, as trying to meet their needs in analgesia without bypassing the rehabilitation program. The opioid free anesthesia is gaining ground for these patients lately. The recent entry of the NOL index (Nociception Level Index) may constitute valuable aid in the intraoperative assessment of analgesia. <h3>Methods</h3> A 60-year-old man, with history of IV heroin dependence, in a methadone(70mg daily) rehabilitation program, ASA II, attended our hospital for cholecystectomy and bile duct exploration. Opioid free anesthesia was administered (according to Mulier protocol-Mullimix: 50μg dexmedetomidine, 500mg lidocaine, 50mg ketamine diluted in 100ml NS). Loading was done with 1μg/kg dexdemetomidine in 15 min and MgSO4 40mg/kg. Also parecoxib and dexamethasone were administered. Induction in anesthesia was carried out with Mullimix 0.2 ml/kg, propofol 2 mg/kg and rocuronium 0.6 mg/kg. The maintenance was done with desflurane and mullimix 0.2ml/kg/h initially, and the dose was titrated with maintaining the NOL ratio at values of 10-25. 2g of paracetamol were administered 30 min before the end of the operation and the wound was infiltrated with 40 ml of ropivacaine 0.375%. Methadone intake was continued throughout the perioperative period. Postoperative analgesia included paracetamol 4g and parecoxib 80mg daily. <h3>Results</h3> Pain assessment was performed in the PACU, and every 4 hours for the first 48 hours with NRS values (numerical rate scale) < 4. The patient received no other opioids. <h3>Conclusions</h3> Guided by analgesia monitoring, opioid free anesthesia can be an efficient method for patients in rehabilitation programs.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686791","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.390
Ana Maria Suarez, Vanessa Lopez, Jorge Rojas, Maria Santoyo, Jairo Moyano
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)
Background and Aims
We humans do not have a planet B to spare, but anesthesiologists can adopt a plan to reduce carbon footprint. One example are regional techniques that reduce the use of plastic (breathing circuits, masks, endotracheal tubes), anesthetic gases, one of which is desfluorane with a 20- year warming potential, generating a greenhouse effect.
Methods
The following are 3 successful surgeries (shoulder replacements) performed under regional anesthesia and sedation, proposing a plan that is friendlier to our planet (plan A). Patients were operated on in the beach chair position under sedation, with an ultrasound-guided superior trunk and superficial cervical plexus block, (15mL of a 0.5% lidocaine plus 0.375% levobupivacaine solution was administered). Bispectral Index Scale and vital signs monitoring, verbal communication, were performed.
Results
Patients‘ characteristics: Peter: 83-year-old male, 82 kg, 176 cm, hypertensive, pacemaker user due to atrial fibrillation. Denisse: 74-year-old female, 70 kg, 165 cm, hypertensive and diabetic. Jacqueline: 91-year-old female, 65 kg, 165 cm, hypertensive, generalized arthrosis. After surgery, a discharge assessment showed they were able to go home, without analgesic requirements.
Conclusions
Anesthesiologists can be leaders within the medical community when it comes to eco-friendly measures, which in these cases were: • Plan A: choosing wisely (regional vs. general) • Plan B: reducing gas flows, syringes, medications, circuits, gloves, extension sets, connectors. In summary, among those selected patients who require anesthesia for upper arm, brachial plexus block plus sedation maybe considered as the sole option. In addition to clinical outcomes, there is an environmental responsibility in the context of health care.
{"title":"#35777 What can anesthesiologists do to mitigate climate change?","authors":"Ana Maria Suarez, Vanessa Lopez, Jorge Rojas, Maria Santoyo, Jairo Moyano","doi":"10.1136/rapm-2023-esra.390","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.390","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <b>Application for ESRA Abstract Prizes:</b> I apply as an Anesthesiologist (Aged 35 years old or less) <h3>Background and Aims</h3> We humans do not have a planet B to spare, but anesthesiologists can adopt a plan to reduce carbon footprint. One example are regional techniques that reduce the use of plastic (breathing circuits, masks, endotracheal tubes), anesthetic gases, one of which is desfluorane with a 20- year warming potential, generating a greenhouse effect. <h3>Methods</h3> The following are 3 successful surgeries (shoulder replacements) performed under regional anesthesia and sedation, proposing a plan that is friendlier to our planet (plan A). Patients were operated on in the beach chair position under sedation, with an ultrasound-guided superior trunk and superficial cervical plexus block, (15mL of a 0.5% lidocaine plus 0.375% levobupivacaine solution was administered). Bispectral Index Scale and vital signs monitoring, verbal communication, were performed. <h3>Results</h3> Patients‘ characteristics: Peter: 83-year-old male, 82 kg, 176 cm, hypertensive, pacemaker user due to atrial fibrillation. Denisse: 74-year-old female, 70 kg, 165 cm, hypertensive and diabetic. Jacqueline: 91-year-old female, 65 kg, 165 cm, hypertensive, generalized arthrosis. After surgery, a discharge assessment showed they were able to go home, without analgesic requirements. <h3>Conclusions</h3> Anesthesiologists can be leaders within the medical community when it comes to eco-friendly measures, which in these cases were: • Plan A: choosing wisely (regional vs. general) • Plan B: reducing gas flows, syringes, medications, circuits, gloves, extension sets, connectors. In summary, among those selected patients who require anesthesia for upper arm, brachial plexus block plus sedation maybe considered as the sole option. In addition to clinical outcomes, there is an environmental responsibility in the context of health care.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135687169","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.439
Lucia Alvarez, Graziella Alexandra Galvez, Carla Romo, Carlos Daniel Higuera, Maria del Carmen Ojeda
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)
Background and Aims
VV-ECMO is used for the temporary support of patients with respiratory failure most commonly due to Acute Respiratory Distress Syndrome (ARDS). Use in near fatal asthma (NFA) is found only in case reports. We intend to present a case of NFA that received support with VV-ECMO.
Methods
A 21-yo man, asthmatic, with medication nonadherance developed a status asthmaticus that failed to respond to non-invasive therapy requiring intubation and mechanical ventilation (MV). After 24 hours on MV he developed pneumomediastinum, continued with severe respiratory acidosis and developed increased intracranial pressure (ICP). He was commenced on VV-ECMO therapy, his CO2 was normalized within 48 hours. MV was continued, still with high peak pressures, he received Sevofluorane for 24 hours. After 48 hours with ECMO he developed midriasis due to ICP and intracranial hemorrhage was seen in the CT scan. He was treated with hiperosmolar therapy. Diagnosis of acute hemorrhagic leukoencephalitis (AHL) is done after finding Herpes Virus type 1 in CSF. 6 days after cannulation the bronchospasm solved and 48 hours after ECMO was discontinued. A tracheostomy was done the day after the discontinuation of ECMO and the next day the patient woke up and followed commands. He was discharged home 8 days after ECMO weaning.
Results
Support for NFA is not commonly performed with ECMO. The finding of AHL is not a common complication seen in these cases nor a favorable outcomes.
Conclusions
VV-ECMO should be considered to be part of support in NFA but thus should be addressed in future trials.
{"title":"#35938 Venovenous ECMO in near fatal ashtma: case report","authors":"Lucia Alvarez, Graziella Alexandra Galvez, Carla Romo, Carlos Daniel Higuera, Maria del Carmen Ojeda","doi":"10.1136/rapm-2023-esra.439","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.439","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <b>Application for ESRA Abstract Prizes:</b> I apply as an Anesthesiologist (Aged 35 years old or less) <h3>Background and Aims</h3> VV-ECMO is used for the temporary support of patients with respiratory failure most commonly due to Acute Respiratory Distress Syndrome (ARDS). Use in near fatal asthma (NFA) is found only in case reports. We intend to present a case of NFA that received support with VV-ECMO. <h3>Methods</h3> A 21-yo man, asthmatic, with medication nonadherance developed a status asthmaticus that failed to respond to non-invasive therapy requiring intubation and mechanical ventilation (MV). After 24 hours on MV he developed pneumomediastinum, continued with severe respiratory acidosis and developed increased intracranial pressure (ICP). He was commenced on VV-ECMO therapy, his CO2 was normalized within 48 hours. MV was continued, still with high peak pressures, he received Sevofluorane for 24 hours. After 48 hours with ECMO he developed midriasis due to ICP and intracranial hemorrhage was seen in the CT scan. He was treated with hiperosmolar therapy. Diagnosis of acute hemorrhagic leukoencephalitis (AHL) is done after finding Herpes Virus type 1 in CSF. 6 days after cannulation the bronchospasm solved and 48 hours after ECMO was discontinued. A tracheostomy was done the day after the discontinuation of ECMO and the next day the patient woke up and followed commands. He was discharged home 8 days after ECMO weaning. <h3>Results</h3> Support for NFA is not commonly performed with ECMO. The finding of AHL is not a common complication seen in these cases nor a favorable outcomes. <h3>Conclusions</h3> VV-ECMO should be considered to be part of support in NFA but thus should be addressed in future trials.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135685784","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.425
Apoorva Ballal
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)
Background and Aims
Peri-operative pain is mostly managed pharmacologically. Evidence suggests 75% of patients feel anxious pre surgery, and 40-65% moderate to severe pain post-operatively, leading onto distress, dissatisfaction and prolonged hospital stay. Alternative cost effective modalities including music may help, with beneficial effects on stress responses and reduced medication requirements.
Methods
PubMed, MBase, GoogleScholar searches
Results
A recent meta-analysis evaluated RCT’s on effects of music intervention on anxiety and pain levels before and after surgery. Of the 92 RCT’s identified, 81 were included and found a significant reduction in all these measures. Individual preferences for certain music types and rhythm and harmony were noted. While evidence was compelling publication bias and heterogeneity.were noted. Future study The IMPROVE study (Netherlands) aims to be the first study actively implementing music intervention in a colorectal surgical cohort. Qualitative methods assessing patients and professionals attitudes towards musical interventions, and a multifaceted strategy to optimise delivery of music, followed by evaluation of effects and experiences of the intervention, and adjustments that may need to be made is planned. The intervention includes pre, intra and post- operative targeted music with at two 30 minute sessions daily during the whole hospital stay and surgical procedure. Aims include providing a systematic framework on the implementation of music intervention in real clinical settings.
Conclusions
A willingness to seek alternative, holistic, patient centred approaches to care and acknowledging the impact of calming distraction strategies, such as music in peri-operative care, that are also low in cost and harm is seen with both published and planned research.
{"title":"#36104 Music in peri operative care","authors":"Apoorva Ballal","doi":"10.1136/rapm-2023-esra.425","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.425","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <h3>Background and Aims</h3> Peri-operative pain is mostly managed pharmacologically. Evidence suggests 75% of patients feel anxious pre surgery, and 40-65% moderate to severe pain post-operatively, leading onto distress, dissatisfaction and prolonged hospital stay. Alternative cost effective modalities including music may help, with beneficial effects on stress responses and reduced medication requirements. <h3>Methods</h3> PubMed, MBase, GoogleScholar searches <h3>Results</h3> A recent meta-analysis evaluated RCT’s on effects of music intervention on anxiety and pain levels before and after surgery. Of the 92 RCT’s identified, 81 were included and found a significant reduction in all these measures. Individual preferences for certain music types and rhythm and harmony were noted. While evidence was compelling publication bias and heterogeneity.were noted. Future study The IMPROVE study (Netherlands) aims to be the first study actively implementing music intervention in a colorectal surgical cohort. Qualitative methods assessing patients and professionals attitudes towards musical interventions, and a multifaceted strategy to optimise delivery of music, followed by evaluation of effects and experiences of the intervention, and adjustments that may need to be made is planned. The intervention includes pre, intra and post- operative targeted music with at two 30 minute sessions daily during the whole hospital stay and surgical procedure. Aims include providing a systematic framework on the implementation of music intervention in real clinical settings. <h3>Conclusions</h3> A willingness to seek alternative, holistic, patient centred approaches to care and acknowledging the impact of calming distraction strategies, such as music in peri-operative care, that are also low in cost and harm is seen with both published and planned research.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"92 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686167","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}
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes
Background and Aims
Pain from sickle cell crises can be challenging to manage when patients experience intractable pain with high opioid requirements. We aim to decrease average hourly pain score by 20% over first four days of admission and decrease average length of stay by 20% for sickle cell admissions to UTMB by implementing an acute pain protocol for hospitalists and the Acute Pain Service to standardize pain management.
Methods
Being devoid of patient identifiable information, this study is exempt from IRB review requirements as per UTMB policy. We conducted a cohort study with a retrospective review of a control group (18 inpatient sickle cell patients) and a protocol group (18 patients) with the acute pain protocol implemented.
Results
The protocol group’s average hourly pain score for day 1 (5.6/10), day 2 (3.7/10), day 3 (3.4/10) and day 4 (3.8/10) were lower compared to the control group for day 1 (6.2/10), day 2 (4.2/10), day 3 (5.2/10) and day 4 (5.6/10). Average hourly pain scores for days 1-4 were lower by 24% (difference averaged over 4 days) in protocol group vs control group. The protocol group’s average days of admission was lower (5.9) than the control group (7.5) with a 21% difference.
Conclusions
We achieved our aim with faster pain control and shorter hospital stays. Next steps include creating a protocol for emergency physicians for earlier pain control. Overall, protocol-based pain management facilitated faster pain control, leading to more effective medical management – an approach that can be applied to hospital-wide admissions involving pain.
{"title":"#35788 Acute pain protocol for sickle cell crisis – quality improvement project","authors":"Siyun Xie, Elizabeth Nguyen, Jameson Dowell, Esteban Esquivel, Moe Ameri, Melissa Victory Brodman, Adebukola Owolabi","doi":"10.1136/rapm-2023-esra.411","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.411","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <b>Application for ESRA Abstract Prizes:</b> I don’t wish to apply for the ESRA Prizes <h3>Background and Aims</h3> Pain from sickle cell crises can be challenging to manage when patients experience intractable pain with high opioid requirements. We aim to decrease average hourly pain score by 20% over first four days of admission and decrease average length of stay by 20% for sickle cell admissions to UTMB by implementing an acute pain protocol for hospitalists and the Acute Pain Service to standardize pain management. <h3>Methods</h3> Being devoid of patient identifiable information, this study is exempt from IRB review requirements as per UTMB policy. We conducted a cohort study with a retrospective review of a control group (18 inpatient sickle cell patients) and a protocol group (18 patients) with the acute pain protocol implemented. <h3>Results</h3> The protocol group’s average hourly pain score for day 1 (5.6/10), day 2 (3.7/10), day 3 (3.4/10) and day 4 (3.8/10) were lower compared to the control group for day 1 (6.2/10), day 2 (4.2/10), day 3 (5.2/10) and day 4 (5.6/10). Average hourly pain scores for days 1-4 were lower by 24% (difference averaged over 4 days) in protocol group vs control group. The protocol group’s average days of admission was lower (5.9) than the control group (7.5) with a 21% difference. <h3>Conclusions</h3> We achieved our aim with faster pain control and shorter hospital stays. Next steps include creating a protocol for emergency physicians for earlier pain control. Overall, protocol-based pain management facilitated faster pain control, leading to more effective medical management – an approach that can be applied to hospital-wide admissions involving pain.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"374 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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