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#36509 Spinal anesthesia for transurethral resection in a patient with severe asymptomatic aortic stenosis after balloon aortic valvuloplasty #36509脊髓麻醉经尿道切除严重无症状主动脉瓣球囊成形术后狭窄的病人
Pub Date : 2023-09-01 DOI: 10.1136/rapm-2023-esra.438
Magdalena Palian, Linda Perica, Mateja Ulamec, Nataša Margaretić Piljek, Eleonora Goluža, Slobodan Mihaljević

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

One of the most prevalent serious valve disease problems is aortic stenosis. Patients with significant AS are often advised against receiving neuraxial anesthesia because they won’t be able to handle the crucial decrease in coronary perfusion pressure. We present a case of a successful transurethral resection under spinal anesthesia in a patient with severe asymptomatic AS which has been managed with balloon aortic valvuloplasty prior to the procedure.

Methods

An 81-year-old male, with a history of prostate cancer and a condition after prostatectomy, new-onset deep vein thrombosis of the left iliac vein, and newly detected severe asymptomatic aortic stenosis, was admitted to the hospital for a planned TUR due to tumor process of the urinary bladder. Echocardiography revealed preserved systolic function of the left ventricle, with severe aortic stenosis. In this case, TAVI was not indicated, so it was concluded that BAV would be performed to reduce the anesthetic risk. Balloon dilatation of the aortic valve was successfully performed. After a month from BAV, the patient was again admitted to the hospital for a planned surgical procedure. For TUR, a mixture of 0.5% bupivacaine, 40% glucose, and fentanyl was applied intrathecally at the L4-L5 level with a 27G needle.

Results

During the procedure the patient was stable, and TUR was done without any adverse effects. The patient was discharged home three days after surgery in good general condition.

Conclusions

In conclusion, our case report is evidence of successful outcome with spinal anesthesia in patient with adequately managed severe AS.
背景和目的主动脉瓣狭窄是最常见的严重瓣膜疾病之一。严重的AS患者通常被建议不要接受轴向麻醉,因为他们将无法处理冠状动脉灌注压的关键下降。我们提出了一个病例成功经尿道切除脊髓麻醉下的病人有严重的无症状的AS已处理与球囊主动脉瓣成形术之前。方法1例81岁男性,前列腺癌病史及前列腺切除术后病情,新发左髂静脉深静脉血栓形成,新发现严重无症状主动脉瓣狭窄,因膀胱肿瘤进展而住院,计划行TUR。超声心动图显示左心室收缩功能保留,主动脉狭窄严重。本例患者未行TAVI,因此认为应行BAV以降低麻醉风险。主动脉瓣球囊扩张术成功。BAV一个月后,患者再次入院接受计划的外科手术。对于TUR,使用27G针头在L4-L5水平鞘内施用0.5%布比卡因,40%葡萄糖和芬太尼的混合物。结果术中患者病情稳定,术后无不良反应。患者术后3天出院,总体情况良好。总之,我们的病例报告证明了脊髓麻醉治疗严重AS患者的成功结果。
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引用次数: 0
#34666 Case report: Ablation of renal tumour in high bmi patient under single shot paravertebral and remifentanil #34666病例报告:单次椎旁注射瑞芬太尼治疗高bmi患者肾肿瘤
Pub Date : 2023-09-01 DOI: 10.1136/rapm-2023-esra.410
David Lorigan, Suresh Kuthanur-Natarajan

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

Managing patients with multiple comorbidities is an increasingly common requirement of anaesthesiologists. This is compounded by the increasing demand for anaesthesia to be provided outside of the operating theatre. The role of regional anaesthesia and its use in avoiding the general physiological changes associated with general anaesthesia is becoming increasingly apparent.

Methods

Our patient is a 60 year old male presenting for radiofrequency ablation of a renal tumour. His medical history was relevant for tuberculosis involving his lungs and pericardium for which he had undergone a right lower lobectomy and pericardiectomy, and Ulcerative Colitis for which he had undergone a subtotal colectomy. His comorbidities included Chronic Obstructive Pulmonary Disease for which he was on 6 litres/minute of portable oxygen, obstructive sleep apnoea requiring CPAP, recurrent chest infections, Atrial fibrillation on Rivaroxaban, Liver Cirrhosis Childs Pugh A, Grade 1 Obesity, Type 2 diabetes, Gout, steroid induced myopathy.

Results

We report the use of an ultrasound guided paravertebral block in conjunction with monitored sedation using remifentanil to facilitate radiofrequency ablation of a low grade clear cell renal tumour. The procedure was tolerated well with satisfactory ablation of the tumor. Mr. EL was discharged the day after his procedure for follow up imaging in 4 months.

Conclusions

The use of a regional technique allowed us to avoid the complications of general anaesthesia in this high-risk gentleman, while facilitating the ablation of his renal tumor. Paravertebral blocks serve an increasingly important role in facilitating ablation of solid organ tumours, including lung, liver and kidney, in our institution.
背景和目的管理有多种合并症的患者是麻醉师越来越普遍的要求。这种情况由于对在手术室外提供麻醉的需求不断增加而变得更加复杂。区域麻醉的作用及其在避免全身麻醉引起的全身生理变化方面的应用正变得越来越明显。方法我们的病人是一位60岁的男性,以射频消融术治疗肾脏肿瘤。他的病史与涉及肺和心包的肺结核和溃疡性结肠炎有关,他为此接受了右下肺叶切除术和心包切除术,他还因溃疡性结肠炎接受了结肠大部切除术。他的合并症包括慢性阻塞性肺疾病(需要6升/分钟的便携式氧气)、阻塞性睡眠呼吸暂停(需要CPAP)、复发性胸部感染、利伐沙班治疗的心房颤动、肝硬化儿童Pugh A、1级肥胖、2型糖尿病、痛风、类固醇性肌病。结果我们报告使用超声引导椎旁阻滞结合瑞芬太尼监测镇静,以促进低级别透明细胞肾肿瘤的射频消融。手术耐受良好,肿瘤消融效果满意。EL先生于术后第二天出院,4个月后随访。结论:局部技术的使用使我们避免了该高危患者全身麻醉的并发症,同时促进了肾肿瘤的消融。在我们的机构中,椎旁阻滞在促进实体器官肿瘤(包括肺、肝和肾)消融方面发挥着越来越重要的作用。
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引用次数: 0
#36092 Dexmedetomidine in palliative care #36092右美托咪定在姑息治疗中的应用
Pub Date : 2023-09-01 DOI: 10.1136/rapm-2023-esra.422
Iztok Potocnik

Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission

Background and Aims

Delirium is common in the terminal patient. It increases discomfort for the patient and relatives. The agents used totreat delirium are various antipsychotics, which are not always effective. Dexmedetomidine intranazal application was effective.

Methods

A case report of a palliative patient who developed a severe dellirium well treated by the dexmedetomidine.

Results

A 42-year-old cancer patient was developed a severe dellirium. Delirium did not subside with the antipsychotics. Dexmedetomidine intranazal application 1 mcg/kg. The patient became completely calm and his previous neuroleptic and sedation therapy could be withdrawn. In the following days, he reacted sensibly and responded to instructions, his day-night rhythm was restored.

Conclusions

Palliative care is becoming an important area of medicine in where also anaesthesiologists participate. With our knowledge and experience, we can contribute a lot to better treatment of pain, as well as other conditions such as delirium and the need for patient sedation. In order to treat patients well, it is important to be familiar with medications and techniques, soit is important to apply our knowledge from operating theatres and ICUs to palliative care. Dexmedetomidine is a potentially useful drug for the targeted treatment of pain and delirium inthe tertiary palliative care setting. When used for sedation and delirium treatment, dexmedetomidine fits with the patient’s, family’s and physician’s goals of care when patient alertness and participation in conversations with loved ones and healhealth care personnel are important at the end of life.
请确认伦理委员会的批准是否已经申请或批准:是的:我正在上传伦理委员会的批准,并将其作为PDF文件与本文摘要一起上传。背景和目的谵妄在晚期患者中很常见。这会增加病人和家属的不适。用于治疗谵妄的药物是各种抗精神病药物,它们并不总是有效的。右美托咪定鼻内应用有效。方法报告1例右美托咪定治疗后发生严重谵妄的姑息性患者。结果1例42岁癌症患者出现严重谵妄。谵妄并未随抗精神病药物而消退。右美托咪定滴注1微克/公斤。患者完全平静下来,可以停止先前的抗精神病药和镇静治疗。在接下来的日子里,他反应灵敏,对指示作出反应,他的昼夜节律恢复了。结论姑息治疗正在成为麻醉医师参与的重要医学领域。凭借我们的知识和经验,我们可以为更好地治疗疼痛做出很大贡献,以及其他情况,如谵妄和患者镇静的需要。为了更好地治疗病人,熟悉药物和技术是很重要的,因此将我们在手术室和icu的知识应用到姑息治疗中是很重要的。右美托咪定在三级姑息治疗中是一种潜在的治疗疼痛和谵妄的有效药物。当用于镇静和谵妄治疗时,右美托咪定符合患者、家属和医生的护理目标,因为患者的警惕性和参与与亲人和卫生保健人员的对话在生命结束时很重要。
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引用次数: 0
#36084 Satisfaction with epidural analgesia in labour: analysis of questionnary 分娩时硬膜外镇痛满意度调查分析
Pub Date : 2023-09-01 DOI: 10.1136/rapm-2023-esra.414
Kata Sakic, Livija Sakic, Dinko Bagatin

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

Epidural analgesia is one of the most common methods of relieving pain in labour. The objective of this study was to examine the effectiveness of epidural analgesia, maternal satisfaction, and the relationship between the effectiveness of epidural analgesia and various factors.

Methods

The data were analysed prospectively, collected during 2022. A total of 60 parturients of single hospital centre in Croatia participated in the study. Data were collected through a questionnaire before the parturient was discharged from the hospital.

Results

The mean assessment of pain on a 1-10 numeric rating scale before epidural analgesia was 7,7 and 3,4 after administration of epidural analgesia. The median assessment of pain before epidural analgesia was 8 (7 – 8), and the median assessment of pain after epidural analgesia was 3 (2 ¬– 5). The average satisfaction with epidural analgesia on a 1-10 scale is 8,11, the median satisfaction is 10 (7 – 10). 35 (58,3%) parturients rated satisfaction with 10.

Conclusions

Statistically significant association between the effectiveness of epidural analgesia and parity, dilution of administered levobupivacaine, fentanyl administration, and level of education was not found. Childbirth pain is significantly alleviated by the application of epidural analgesia and the satisfaction of parturients is very high.
申请ESRA摘要奖项:我不希望申请ESRA奖项背景和目的硬膜外镇痛是缓解分娩疼痛最常用的方法之一。本研究的目的是探讨硬膜外镇痛的有效性,产妇满意度,以及硬膜外镇痛的有效性与各种因素的关系。方法采用前瞻性分析方法,于2022年收集。克罗地亚一家医院中心共有60名产妇参加了这项研究。数据在产妇出院前通过问卷收集。结果患者在硬膜外镇痛前的平均疼痛评分为7、7分,硬膜外镇痛后的平均疼痛评分为3、4分。硬膜外镇痛前疼痛的中位评分为8分(7 ~ 8分),硬膜外镇痛后疼痛的中位评分为3分(2 ~ 5分)。在1 ~ 10分量表中,硬膜外镇痛的平均满意度为8,11分,中位满意度为10分(7 ~ 10分)。35名(58.3%)产妇满意度为10。结论硬膜外镇痛的有效性与胎次、左旋布比卡因稀释度、芬太尼给药量和文化程度无统计学意义。应用硬膜外镇痛可明显减轻分娩疼痛,患者满意度高。
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引用次数: 0
#36277 Case series of patient satisfaction levels with loco-regional anaesthesia & immersive virtual reality (VR) sedation #36277病例系列患者对局部区域麻醉的满意度&;沉浸式虚拟现实(VR)镇静
Pub Date : 2023-09-01 DOI: 10.1136/rapm-2023-esra.430
Vikas Gulia, Dominic Goold, Mahul Gorecha, Kausik Dasgupta

Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes

Background and Aims

Immersive Virtual Reality(VR) simulator used in anaesthesia for relaxing images, videos and sounds, to engage the patient from the distraction of surgery.3-D environment puts patient in hypnotic state and reduces Phobias and stress levels. Virtual reality distraction decreases routine intravenous sedation and procedure-related pain during preoperative blocks(1).’VR for Peripheral Regional Anaesthesia (VR-PERLA Study)’, demonstrated benefit in improved patient satisfaction levels . Aim – 1. Primary outcomes are to study patient self reported satisfaction levels with and without VR . 2.Secondary outcomes were patient anxiety levels monitored with or without VR and reduced sedation requirements.

Methods

1. 15 Patients for elective orthopaedic surgery were consented for VR under Loco-regional anaesthesia ( Adductor canal , axillary , interscalene blocks). VR initiated on arrival to Anaesthesia room. Comparison were made with 15 similar patients undergoing similar procedures without VR. 2. Self-reporting patient‘s satisfaction on five-point Likert scale ((1 = very dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied, and 5 = very satisfied. 1. Modified Observer’s Assessment of Alertness and Sedation (MOAA/S) scale 6-point scale .

Results

2. MOAA/S scales were 5 in all patients having VR, with appropriate response to verbal stimuli . 3.Likert scale- all VR patients were satisfied.

Conclusions

1. Both Primary and secondary outcomes met through VR use. 2. Onset of peripheral nerve block, administration of systemic analgesics, Pre-op anxiety & analgesic history pre-op were significant determinant factors for patients’ level of satisfaction. 3.VR reduces anxiety & sedation requirement levels in Loco-Regional anaesthesia and improves satisfaction with more Haemodynamic stability.

Attachment

Likerts Questionnaire used.pdf
请确认已申请或授予伦理委员会批准:是的:我正在将伦理委员会批准作为PDF文件与此摘要提交一起上传ESRA摘要奖项申请:我不希望申请ESRA奖项背景和目的沉浸式虚拟现实(VR)模拟器用于麻醉,用于放松图像,视频和声音,以使患者免于手术的分心。三维环境使患者处于催眠状态,减少恐惧和压力水平。虚拟现实分心减少常规静脉镇静和手术相关的疼痛在术前阻滞(1)。“VR用于周围区域麻醉(VR- perla研究)”,证明了在提高患者满意度方面的益处。目标- 1。主要结果是研究患者自我报告的满意度水平,有无VR。2.次要结果是在有无VR的情况下监测患者的焦虑水平,并减少镇静需求。方法1。15例择期骨科手术患者同意在局部区域麻醉(内收管、腋窝、斜角肌间阻滞)下进行VR。到达麻醉室后开始虚拟现实。与15例类似的患者进行了类似的手术,但没有进行VR。2. 5点李克特量表自我报告患者满意度(1 =非常不满意,2 =不满意,3 =一般,4 =满意,5 =非常满意)。1. 修正观察者警觉与镇静评估(MOAA/S)量表6分制。结果2。所有VR患者的MOAA/S评分均为5分,对言语刺激反应适当。3.李克特量表-所有VR患者均满意。结论1。通过虚拟现实的使用,主要和次要的结果都得到了满足。2. 周围神经阻滞的发生,全身性镇痛药的使用,术前焦虑和amp;术前镇痛史是影响患者满意度的重要因素。3.VR减少焦虑& &;局部-区域麻醉的镇静需求水平,并提高对血流动力学稳定性的满意度。附件喜欢问卷使用。pdf
{"title":"#36277 Case series of patient satisfaction levels with loco-regional anaesthesia &amp; immersive virtual reality (VR) sedation","authors":"Vikas Gulia, Dominic Goold, Mahul Gorecha, Kausik Dasgupta","doi":"10.1136/rapm-2023-esra.430","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.430","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission <b>Application for ESRA Abstract Prizes:</b> I don’t wish to apply for the ESRA Prizes <h3>Background and Aims</h3> Immersive Virtual Reality(VR) simulator used in anaesthesia for relaxing images, videos and sounds, to engage the patient from the distraction of surgery.3-D environment puts patient in hypnotic state and reduces Phobias and stress levels. Virtual reality distraction decreases routine intravenous sedation and procedure-related pain during preoperative blocks(1).’VR for Peripheral Regional Anaesthesia (VR-PERLA Study)’, demonstrated benefit in improved patient satisfaction levels . Aim – 1. Primary outcomes are to study patient self reported satisfaction levels with and without VR . 2.Secondary outcomes were patient anxiety levels monitored with or without VR and reduced sedation requirements. <h3>Methods</h3> 1. 15 Patients for elective orthopaedic surgery were consented for VR under Loco-regional anaesthesia ( Adductor canal , axillary , interscalene blocks). VR initiated on arrival to Anaesthesia room. Comparison were made with 15 similar patients undergoing similar procedures without VR. 2. Self-reporting patient‘s satisfaction on five-point Likert scale ((1 = very dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied, and 5 = very satisfied. 1. Modified Observer’s Assessment of Alertness and Sedation (MOAA/S) scale 6-point scale . <h3>Results</h3> 2. MOAA/S scales were 5 in all patients having VR, with appropriate response to verbal stimuli . 3.Likert scale- all VR patients were satisfied. <h3>Conclusions</h3> 1. Both Primary and secondary outcomes met through VR use. 2. Onset of peripheral nerve block, administration of systemic analgesics, Pre-op anxiety &amp; analgesic history pre-op were significant determinant factors for patients’ level of satisfaction. 3.VR reduces anxiety &amp; sedation requirement levels in Loco-Regional anaesthesia and improves satisfaction with more Haemodynamic stability. <h3>Attachment</h3> Likerts Questionnaire used.pdf","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"141 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":"135686282","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: 0
#35920 The association between preoperative frailty and hypotension during the beach-chair position in patients undergoing total shoulder arthroplasty under general anesthesia with interscalene brachial plexus block #35920全麻斜角肌间臂丛神经阻滞行全肩关节置换术患者在沙滩椅体位时术前虚弱和低血压的关系
Pub Date : 2023-09-01 DOI: 10.1136/rapm-2023-esra.441
Hyun Jung Lee, Youn Jin Kim, Jae Hee Woo, Hye-Won Oh, Ji Seon Chae, Sang-Mee An, Youn Young Lee

Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)

Background and Aims

The beach-chair position (BCP) is commonly used for shoulder surgery but is known to increase hypotension incidence. Older age and interscalene brachial plexus block (ISB) have also been identified as risk factors for hypotension during BCP. As altered blood pressure control mechanisms and autonomic dysfunction, which cause hypotension, are more likely to occur in frail older patients, we investigated the association between preoperative frailty and hypotension during BCP in older patients.

Methods

Patients aged ≥ 65 years who underwent elective total shoulder arthroplasty in BCP under general anesthesia with preoperative ISB were included. The frailty of participants was assessed before surgery using the Reported Edmonton Frail Scale. Quadriceps depth was measured by ultrasound preoperatively, and values < 2.3cm were considered significant. Hypotension was defined as a mean blood pressure < 65mmHg or a decrease of ≥ 20% from baseline.

Results

Data were analyzed from 46 patients (mean age: 72.8 yrs). The incidence of hypotension during BCP was 71.7% (non-frail/prefrail/frail; 70.3%, 80% and 100%). A decreased quadriceps depth < 2.3cm was an independent risk factor for hypotension during BCP (odds ratio, 8.49, 95% confidence interval [CI], 1.38 – 51.90). The predictive power of hypotension during BCP was higher when both frailty and quadriceps depth were considered together, compared to considering frailty alone (AUC [95% CI], 0.766 [0.60-0.89] vs 0.51 [0.35-068], p=0.01).

Conclusions

A reduced quadriceps depth is associated with hypotension during BCP. Assessing both frailty and quadriceps depth may enhance the screening tool for identifying older patients at risk of developing hypotension during BCP.

Attachment

CRIS.pdf
请确认伦理委员会的批准已经申请或批准:是的:我正在将伦理委员会的批准以PDF文件的形式上传此摘要提交申请ESRA摘要奖励:我以麻醉师(年龄35岁或以下)的身份申请背景和目的沙滩椅体位(BCP)通常用于肩部手术,但已知会增加低血压的发生率。老年和斜角肌间臂丛阻滞(ISB)也被确定为BCP期间低血压的危险因素。由于血压控制机制的改变和引起低血压的自主神经功能障碍更容易发生在体弱多病的老年患者身上,我们研究了老年患者BCP期间术前虚弱和低血压之间的关系。方法选取年龄≥65岁、全麻下术前行选择性全肩关节置换术的BCP患者。术前使用报告埃德蒙顿虚弱量表评估参与者的虚弱程度。术前超声测量股四头肌深度,值<2.3cm认为显著。低血压定义为平均血压<65mmHg或较基线降低≥20%。结果分析46例患者的资料,平均年龄72.8岁。BCP期间低血压的发生率为71.7%(非虚弱/虚弱前期/虚弱;70.3%, 80%和100%)。股四头肌深度减小<2.3cm是BCP期间低血压的独立危险因素(优势比,8.49,95%可信区间[CI], 1.38 - 51.90)。与单独考虑虚弱相比,同时考虑虚弱和股四头肌深度时,BCP期间低血压的预测能力更高(AUC [95% CI], 0.766 [0.60-0.89] vs 0.51 [0.35-068], p=0.01)。结论:股四头肌深度减小与BCP期间的低血压有关。评估虚弱和股四头肌深度可以增强识别老年患者在BCP期间发生低血压风险的筛查工具。附件CRIS.pdf
{"title":"#35920 The association between preoperative frailty and hypotension during the beach-chair position in patients undergoing total shoulder arthroplasty under general anesthesia with interscalene brachial plexus block","authors":"Hyun Jung Lee, Youn Jin Kim, Jae Hee Woo, Hye-Won Oh, Ji Seon Chae, Sang-Mee An, Youn Young Lee","doi":"10.1136/rapm-2023-esra.441","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.441","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission <b>Application for ESRA Abstract Prizes:</b> I apply as an Anesthesiologist (Aged 35 years old or less) <h3>Background and Aims</h3> The beach-chair position (BCP) is commonly used for shoulder surgery but is known to increase hypotension incidence. Older age and interscalene brachial plexus block (ISB) have also been identified as risk factors for hypotension during BCP. As altered blood pressure control mechanisms and autonomic dysfunction, which cause hypotension, are more likely to occur in frail older patients, we investigated the association between preoperative frailty and hypotension during BCP in older patients. <h3>Methods</h3> Patients aged ≥ 65 years who underwent elective total shoulder arthroplasty in BCP under general anesthesia with preoperative ISB were included. The frailty of participants was assessed before surgery using the Reported Edmonton Frail Scale. Quadriceps depth was measured by ultrasound preoperatively, and values < 2.3cm were considered significant. Hypotension was defined as a mean blood pressure < 65mmHg or a decrease of ≥ 20% from baseline. <h3>Results</h3> Data were analyzed from 46 patients (mean age: 72.8 yrs). The incidence of hypotension during BCP was 71.7% (non-frail/prefrail/frail; 70.3%, 80% and 100%). A decreased quadriceps depth < 2.3cm was an independent risk factor for hypotension during BCP (odds ratio, 8.49, 95% confidence interval [CI], 1.38 – 51.90). The predictive power of hypotension during BCP was higher when both frailty and quadriceps depth were considered together, compared to considering frailty alone (AUC [95% CI], 0.766 [0.60-0.89] vs 0.51 [0.35-068], p=0.01). <h3>Conclusions</h3> A reduced quadriceps depth is associated with hypotension during BCP. Assessing both frailty and quadriceps depth may enhance the screening tool for identifying older patients at risk of developing hypotension during BCP. <h3>Attachment</h3> CRIS.pdf","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"48 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":"135686404","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: 0
#35904 Mitochondrial dysfunction as triggering in complex regional pain syndrome 线粒体功能障碍是复杂局部疼痛综合征的触发因素
Pub Date : 2023-09-01 DOI: 10.1136/rapm-2023-esra.415
Paola María Robert Vélez, Lucia Elizabeth Alvarez Palazuelos, Andrea Virginia Ruiz-Ramírez, Carlos Francisco Rivera Quiles, Miguel Alejandro Dávalos Benítez, Moctezuma Ilhuicamina Cabrera Salaiza

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

Complex regional pain syndrome (CRPS) is characterized by being disproportionate to the triggering event; the associated characteristics are autonomic dysfunction, swelling of the zone of affection, and even changes in the skin, such as dystrophy and rigidity. The pathophysiology is still unknown; it has been mentioned as a multifactorial disorder, with an exaggerated immune response to the triggering event, abnormal vasomotor function, and even maladaptive neuroplasticity. This study aimed to evaluate the differently expressed genes (DEG) between 4 patients with complex regional pain syndrome vs. healthy controls and analyze the pathways intervening.

Methods

Material/Methods: The gene expression dataset GSE47603 was downloaded from the GEO database, and DEG obtained. The highest up-regulated genes were examined in the String platform for the protein-protein interaction (PPI) network.

Results

Results: 60 primary genes up-regulated were identified according to the Log2-fold change statistics. The network for the 60 genes was sub-selected in clusters in STRING, obtaining a network of 20 nodes, 24 edges, and a PPI enrichment p-value of 3.73e-11. The principal intervening pathways were mitochondrial ATP synthesis, the electron transport chain, and lysosome vesicle biogenesis.

Conclusions

We found a relevant participation of mitochondrial metabolism in the PPI network that has not been mentioned before as a pain onset in CRPS, but at the same time presence of pain has been reported in patients with mitochondrial disease, the essential role that it could play in the sudden development of pain in CRPS needs to be further analyzed.
背景和目的:复杂区域性疼痛综合征(CRPS)的特点是与触发事件不成比例;相关特征是自主神经功能障碍,情感区肿胀,甚至皮肤变化,如营养不良和僵硬。病理生理机制尚不清楚;它被认为是一种多因素疾病,对触发事件的免疫反应过度,血管舒缩功能异常,甚至神经可塑性不良。本研究旨在评估4例复杂局部疼痛综合征患者与健康对照者的差异表达基因(DEG),并分析其干预途径。方法材料/方法:从GEO数据库下载基因表达数据集GSE47603,获取DEG。在蛋白-蛋白相互作用(PPI)网络的String平台上检测了上调最高的基因。结果:经log2倍变化统计,共鉴定出60个上调的原代基因。在STRING中对60个基因的网络进行分组选择,得到一个20节点、24边的网络,PPI富集p值为3.73e-11。主要的干预途径是线粒体ATP合成、电子传递链和溶酶体囊泡的生物发生。结论我们发现线粒体代谢相关参与PPI网络,与CRPS疼痛发病相关,但在线粒体疾病患者中存在疼痛的同时,其在CRPS疼痛突然发生中可能发挥的重要作用有待进一步分析。
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引用次数: 0
#35900 POMAHR – perioperative management of patient with hip fracture in centro hospitalar universitário lisboa norte (CHULN) #35900 POMAHR -中心医院髋部骨折患者的围手术期管理universitário北里斯本(CHULN)
Pub Date : 2023-09-01 DOI: 10.1136/rapm-2023-esra.419
Jorge Carteiro, Marco Dinis, João Valente, Alexandra Resende

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

Proximal femoral fractures (PFF) are an important public health problem in industrialized societies, affecting older, mainly female, patients who are more likely to suffer from osteoporosis. PFF are associated with increased morbidity and functional impairment with a negative impact on patient’s quality of life. Nearly always, PFF requires hospitalisation, permanently disables 50% of patients and a 26% one-year mortality rate, in elderly patients, has been described. The National Institute for Health and Care Excellence (NICE) recommends that patients with a hip fracture should have surgery within 36 hours of admission to hospital. In CHULN, we elaborated a protocol that allows patients to have surgical intervention within 36-48 hours, creating a multidisciplinary patient-centered approach, optimizing their clinical status and enhancing their recovery.

Methods

POMAHR has the following principles

1-preoperative patient medical optimization according to clinical protocols 2-early pain control with regional anesthesia 3-nutritional protocols with liquid intake up to 2h before surgery and protein reinforcement 4-surgical intervention within 36-48h 5- perform chemical neurolysis to control pain in patients who lack surgical indication 6-early rehabilitation since day1

Results

Patients with PFF are mainly elderly, often with several comorbidities, needing a multidisciplinary approach in addition to surgery within 48 hours. We hope to reduce perioperative complications, reducing time of hospitalisation and mortality thus enhancing recovery and previous functional status.

Conclusions

The implementation of this protocol in our center, promotes a multidisciplinary approach, a prompt intervention and a continuous clinical monitoring of patients with PFF, from admission to hospital discharge. These factors are key to successful patients’ treatment.
背景和目的股骨近端骨折(PFF)是工业化社会中一个重要的公共卫生问题,影响到更容易患骨质疏松症的老年人,主要是女性患者。PFF与发病率增加和功能损害相关,并对患者的生活质量产生负面影响。据报道,PFF几乎总是需要住院治疗,50%的患者永久残疾,老年患者的1年死亡率为26%。国家健康和护理卓越研究所(NICE)建议髋部骨折患者应在入院36小时内进行手术。在CHULN,我们制定了一个方案,允许患者在36-48小时内进行手术干预,创造了一个以患者为中心的多学科方法,优化了他们的临床状态,促进了他们的康复。方法POMAHR有以下原则:1 .术前根据临床方案对患者进行医疗优化2 .早期采用区域麻醉控制疼痛3 .术前2h营养方案并补充蛋白质4 .手术干预36-48h 5 .对缺乏手术指征的患者行化学神经松解术控制疼痛6 .术后早期康复1 .结果PFF患者以老年人为主,常伴有多种合并症。需要在48小时内除手术外进行多学科综合治疗。我们希望减少围手术期并发症,减少住院时间和死亡率,从而提高康复和既往功能状态。结论本方案在我中心的实施,促进了PFF患者从入院到出院的多学科方法、及时干预和持续的临床监测。这些因素是患者治疗成功的关键。
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引用次数: 0
#36206 Post operative seizure: a dilemma to anesthesia #36206术后癫痫:麻醉的两难选择
Pub Date : 2023-09-01 DOI: 10.1136/rapm-2023-esra.442
Ray Carlo Escollar, Jacky Corpuz, Samantha Claire Braganza, Iris Concepcion

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

Psychogenic nonepileptic seizures are unusual events that may occur in the perioperative period. It can mimic other complications causing confusions and misdiagnosis to regional anesthesiologist

Methods

Case of a 24 yo female for Open Reduction Internal Fixation of Ankle for Closed Distal Fibular Fracture Right. General Anesthesia with Ankle Block was done after consent. Intraoperatively, after induction and regional block performed, patient was stable all throughout the procedure. Surgery lasted for 3 hours. Patient was transported to the recovery room, uneventful.

Results

30 minutes postoperatively, patient developed signs of irregular uncontrolled movements, upward rolling of the eyes with no verbal response. Shivering and Seizure after local anesthetic toxicity were immediately considered with benzodiazepine and Lipid Emulsion initiated. Repeated attacks were recorded until 72 hours post operatively with an interval in between of intact sensorium and orientation. Attacks were noted to be triggered by severe pain. The longest duration noted to be was 25 minutes. However resistance to anticonvulsants, benzodiazepines were eventually noted. A 12 hour video Electroencephalogram was done with 2 attacks captured during the procedure and revealed a normal result. A psychogenic nonepileptic seizure was then considered until discharged.

Conclusions

Psychogenic nonepileptic seizures are rare with 1.4 per 100 000 and an estimated prevalence of 2-3 per 10000. Knowledge and correct diagnosis is of tantamount importance to anesthesiologists to prevent morbidity and mortality brought about by anticonvulsive therapy such as respiratory depression, risk and injury brought by tracheal intubation, with prolonged hospital stay and added costs especially in this third world country.
背景和目的心因性非癫痫性发作是围手术期可能发生的不寻常事件。方法24岁女性右腓骨远端闭合性骨折行切开复位内固定治疗一例。经同意后进行踝部阻滞全身麻醉。术中,经过诱导和局部阻滞,患者在整个过程中稳定。手术持续3小时。病人被送到了恢复室,平安无事。结果术后30分钟,患者出现不规则不受控制的运动体征,眼球向上翻动,无言语反应。局部麻醉毒性后立即考虑寒颤和癫痫发作,开始使用苯二氮卓类药物和脂质乳剂。反复发作的记录,直到术后72小时,感觉和定向之间的间隔完好。发作是由剧烈的疼痛引起的。最长的记录是25分钟。然而,抗惊厥药和苯二氮卓类药物的耐药性最终被注意到。在12小时的视频脑电图中记录了2次发作,结果显示正常。在出院前,我们一直认为是一种心因性非癫痫性发作。结论心因性非癫痫性发作罕见,每10万人中有1.4例,估计患病率为2-3 / 10000。知识和正确的诊断对麻醉师来说同样重要,以防止抗惊厥治疗带来的发病率和死亡率,如呼吸抑制,气管插管带来的风险和伤害,延长住院时间和增加费用,特别是在这个第三世界国家。
{"title":"#36206 Post operative seizure: a dilemma to anesthesia","authors":"Ray Carlo Escollar, Jacky Corpuz, Samantha Claire Braganza, Iris Concepcion","doi":"10.1136/rapm-2023-esra.442","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.442","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> Psychogenic nonepileptic seizures are unusual events that may occur in the perioperative period. It can mimic other complications causing confusions and misdiagnosis to regional anesthesiologist <h3>Methods</h3> Case of a 24 yo female for Open Reduction Internal Fixation of Ankle for Closed Distal Fibular Fracture Right. General Anesthesia with Ankle Block was done after consent. Intraoperatively, after induction and regional block performed, patient was stable all throughout the procedure. Surgery lasted for 3 hours. Patient was transported to the recovery room, uneventful. <h3>Results</h3> 30 minutes postoperatively, patient developed signs of irregular uncontrolled movements, upward rolling of the eyes with no verbal response. Shivering and Seizure after local anesthetic toxicity were immediately considered with benzodiazepine and Lipid Emulsion initiated. Repeated attacks were recorded until 72 hours post operatively with an interval in between of intact sensorium and orientation. Attacks were noted to be triggered by severe pain. The longest duration noted to be was 25 minutes. However resistance to anticonvulsants, benzodiazepines were eventually noted. A 12 hour video Electroencephalogram was done with 2 attacks captured during the procedure and revealed a normal result. A psychogenic nonepileptic seizure was then considered until discharged. <h3>Conclusions</h3> Psychogenic nonepileptic seizures are rare with 1.4 per 100 000 and an estimated prevalence of 2-3 per 10000. Knowledge and correct diagnosis is of tantamount importance to anesthesiologists to prevent morbidity and mortality brought about by anticonvulsive therapy such as respiratory depression, risk and injury brought by tracheal intubation, with prolonged hospital stay and added costs especially in this third world country.","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":"135686281","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: 0
#35908 Cerebrospinal fluid lavage for inadvertent intrathecal inyections. An option to be considered #35908因意外鞘内注射而进行脑脊液灌洗。一个可以考虑的选择
Pub Date : 2023-09-01 DOI: 10.1136/rapm-2023-esra.443
Silvia De Miguel Manso, Carlota Gordaliza Pastor, Rocío Gutiérrez Bustillo, Beatriz Martínez Rafael

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

Intrathecal administration of wrong drugs (IAWD) can have catastrophic consequences. Reported IAWD in literature are mainly individual cases or small case-series reports. In most of them cerebral spinal fluid lavage (CSFL) seems to be a choice of management, added to support measures. The aim of this work is to know if CSFL could be considered as a safe and effective treatment in case of IAWD.

Methods

The author searched published reports of IAWD using Pubmed database from January 2017 to January 2023. Those in which CSFL was used as a treatment were selected. The main study founded was a review article that identifyed potential sources of IAWD and its appropriate management. Other studies described individual cases of IAWD managed with CSFL.

Results

Immediate CSFL is related to good outcomes in many of the studies reviewed. It involves CSF aspiration with a spinal catheter or a needle at the volume of 10–20 ml each time and replaced with an equal volume of normal saline, so the drug is diluted and removed. It´s usually make in emergency situations so it´s difficult to perform a propper randomized clinical trial evaluation. Maybe that’s why it is not considered as a standard treatment for IAWD.

Conclusions

Despite of the lack of studies published, early CSFL should be considered, in addition to supportive and symptomatic treatment, especially if life- threatening consecuences are anticipated. It is needed to balance the risks and benefits case-by-case before using CSFL, but does not seem to have major complications in an emergency situation.
请确认已申请或批准伦理委员会批准:不相关(见本页底部的信息)背景和目的鞘内给药错误(IAWD)可能会造成灾难性后果。文献报道的IAWD主要是个案或小病例系列报道。在大多数情况下,脑脊液灌洗(CSFL)似乎是一种选择的管理,加上支持措施。这项工作的目的是了解CSFL是否可以被认为是一种安全有效的治疗IAWD的方法。方法利用Pubmed数据库检索2017年1月至2023年1月已发表的IAWD报告。选择使用CSFL作为治疗的病例。建立的主要研究是一篇综述文章,该文章确定了IAWD的潜在来源及其适当管理。其他研究描述了用CSFL治疗IAWD的个别病例。结果在许多研究中,即时CSFL与良好的结果有关。每次用脊髓导管或针抽吸10 - 20ml的脑脊液,用等量生理盐水代替,将药物稀释后取出。它通常是在紧急情况下进行的,因此很难进行适当的随机临床试验评估。也许这就是为什么它不被认为是IAWD的标准治疗方法。结论:尽管缺乏相关研究发表,但除了支持和对症治疗外,早期CSFL应该被考虑,特别是如果预期会发生危及生命的后果。在使用CSFL之前,需要逐个权衡风险和益处,但在紧急情况下似乎不会产生重大并发症。
{"title":"#35908 Cerebrospinal fluid lavage for inadvertent intrathecal inyections. An option to be considered","authors":"Silvia De Miguel Manso, Carlota Gordaliza Pastor, Rocío Gutiérrez Bustillo, Beatriz Martínez Rafael","doi":"10.1136/rapm-2023-esra.443","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.443","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> Intrathecal administration of wrong drugs (IAWD) can have catastrophic consequences. Reported IAWD in literature are mainly individual cases or small case-series reports. In most of them cerebral spinal fluid lavage (CSFL) seems to be a choice of management, added to support measures. The aim of this work is to know if CSFL could be considered as a safe and effective treatment in case of IAWD. <h3>Methods</h3> The author searched published reports of IAWD using Pubmed database from January 2017 to January 2023. Those in which CSFL was used as a treatment were selected. The main study founded was a review article that identifyed potential sources of IAWD and its appropriate management. Other studies described individual cases of IAWD managed with CSFL. <h3>Results</h3> Immediate CSFL is related to good outcomes in many of the studies reviewed. It involves CSF aspiration with a spinal catheter or a needle at the volume of 10–20 ml each time and replaced with an equal volume of normal saline, so the drug is diluted and removed. It´s usually make in emergency situations so it´s difficult to perform a propper randomized clinical trial evaluation. Maybe that’s why it is not considered as a standard treatment for IAWD. <h3>Conclusions</h3> Despite of the lack of studies published, early CSFL should be considered, in addition to supportive and symptomatic treatment, especially if life- threatening consecuences are anticipated. It is needed to balance the risks and benefits case-by-case before using CSFL, but does not seem to have major complications in an emergency situation.","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":"135686396","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: 0
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Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity
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