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.
{"title":"#36509 Spinal anesthesia for transurethral resection in a patient with severe asymptomatic aortic stenosis after balloon aortic valvuloplasty","authors":"Magdalena Palian, Linda Perica, Mateja Ulamec, Nataša Margaretić Piljek, Eleonora Goluža, Slobodan Mihaljević","doi":"10.1136/rapm-2023-esra.438","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.438","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> 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. <h3>Methods</h3> 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. <h3>Results</h3> 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. <h3>Conclusions</h3> In conclusion, our case report is evidence of successful outcome with spinal anesthesia in patient with adequately managed severe AS.","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":"135686770","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.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.
{"title":"#34666 Case report: Ablation of renal tumour in high bmi patient under single shot paravertebral and remifentanil","authors":"David Lorigan, Suresh Kuthanur-Natarajan","doi":"10.1136/rapm-2023-esra.410","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.410","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> 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. <h3>Methods</h3> 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. <h3>Results</h3> 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. <h3>Conclusions</h3> 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.","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":"135685780","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.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.
{"title":"#36092 Dexmedetomidine in palliative care","authors":"Iztok Potocnik","doi":"10.1136/rapm-2023-esra.422","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.422","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 <h3>Background and Aims</h3> 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. <h3>Methods</h3> A case report of a palliative patient who developed a severe dellirium well treated by the dexmedetomidine. <h3>Results</h3> 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. <h3>Conclusions</h3> 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.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"28 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":"135686008","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.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.
{"title":"#36084 Satisfaction with epidural analgesia in labour: analysis of questionnary","authors":"Kata Sakic, Livija Sakic, Dinko Bagatin","doi":"10.1136/rapm-2023-esra.414","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.414","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> 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. <h3>Methods</h3> 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. <h3>Results</h3> 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. <h3>Conclusions</h3> 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.","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":"135686125","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: 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.
{"title":"#36277 Case series of patient satisfaction levels with loco-regional anaesthesia & 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 & 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. <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}
Pub Date : 2023-09-01DOI: 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.
{"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}
Pub Date : 2023-09-01DOI: 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.
{"title":"#35904 Mitochondrial dysfunction as triggering in complex regional pain syndrome","authors":"Paola María Robert Vélez, Lucia Elizabeth Alvarez Palazuelos, Andrea Virginia Ruiz-Ramírez, Carlos Francisco Rivera Quiles, Miguel Alejandro Dávalos Benítez, Moctezuma Ilhuicamina Cabrera Salaiza","doi":"10.1136/rapm-2023-esra.415","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.415","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> 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. <h3>Methods</h3> 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. <h3>Results</h3> 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. <h3>Conclusions</h3> 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.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"49 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":"135686051","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.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.
{"title":"#35900 POMAHR – perioperative management of patient with hip fracture in centro hospitalar universitário lisboa norte (CHULN)","authors":"Jorge Carteiro, Marco Dinis, João Valente, Alexandra Resende","doi":"10.1136/rapm-2023-esra.419","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.419","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> 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. <h3>Methods</h3> <h3>POMAHR has the following principles</h3> 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 <h3>Results</h3> 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. <h3>Conclusions</h3> 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.","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":"135686277","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.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.
{"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}
Pub Date : 2023-09-01DOI: 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.
{"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}
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