Asian journal of anesthesiology最新文献

In critically ill patients undergoing laparotomy, both general anesthesia (GA) and central neuraxial block (CNB) may pose significant risks. Peripheral truncal blocks have been reported to provide effective postoperative analgesia following laparotomy. However, there are a limited number of reports describing this technique as surgical anesthesia for laparotomy. An 86-year-old man with non-specific interstitial pneumonia under home oxygen therapy and aortic valve stenosis was diagnosed with an incarcerated inguinal hernia. Because of these comorbidities, both GA and CNB were considered relatively contraindicated. Thus, we chose an ultrasound-guided transverse abdominis plane block and ilioinguinal/iliohypogastric block supplemented with neuroleptanesthesia as surgical anesthesia for emergency laparotomy. The surgery was uneventful using this technique. Truncal blocks supplemented with titrated intravenous sedatives/analgesics could be an alternative in high-risk patients undergoing laparotomy in whom both GA and CNB are considered relatively contraindicated.

Background: The NALDEBAIN® has been available since 2017, and high incidence of injection reactions in the phase 3 study has been reported. Since the first year in the market, the injection site reactions were still the majority of adverse drug reactions (ADRs) in pharmacovigilance reports. The new intramuscular (IM) instruction and package was introduced in the middle of 2018. In this retrospective study, we analyzed the pharmacovigilance data and published postmarketing studies to investigate the impact of IM injection-related reactions in Taiwan between the period of 2017-2022.

Methods: Individual case safety reports (ICSRs) and ADRs were classified by system organ class and preferred term. The reporting rate of ICSRs was used to evaluate the impact of the new IM instruction and package.

Results: A total of 37 ICSRs were identified from pharmacovigilance reports. Among them, 51% of IM injection-related reactions were reported after one single dose of NALDEBAIN administration. The reporting rate of IM injection-related reactions in pharmacovigilance data dropped from 125.00 to 3.56 per ten thousand exposures after IM instruction and package revision in 2018. In addition, the percentage of IM injection-related reactions also reduced in postmarketing studies from 27.5% to 4.5%. There were no serious IM injection-related reactions found in the pharmacovigilance and postmarketing dataset.

Conclusion: Injection site reactions were common after intramuscularly administered oil-based agents during the first year which is later markedly reduced by changing the length of the needle and injection education.

The proportion of women taking up anesthesiology and critical care as their careers has increased considerably in the last decade. Currently, women constitute 35%-40% of the total anesthesia workforce in some countries. Most resident doctors and a significant proportion of practicing physicians in anesthesia are in the reproductive age group. They are or will become pregnant at some point in their training program or career. This review focuses on all work-related exposure risks for anesthesia professionals during pregnancy, like risks of infectious diseases, radiation, stress, violence against doctors, and even peer support that can have deleterious effects on the health of pregnant physicians and the health of their unborn fetus. An occupational work environment more compatible with pregnancy is the need of the hour.

Background: Liver surgery is a major abdominal operation associated with a dramatic change in intraoperative hemodynamics; thus, the infusion strategy is challenging for anesthesiologists. Studies have demonstrated that stroke volume variation (SVV) can be used to predict fluid responsiveness during major abdominal surgery. SVV can be used as a guide for the administration of intraoperative fluids to improve postoperative prognosis. In the present study, we planned to investigate whether high- or low-SVV in liver surgery is associated with fewer postoperative complications.

Methods: This study was a prospective randomized trial of 74 patients who underwent hepatectomy. The patients were divided into two groups for SVV-guided infusion during tumor resection surgery using a low-SVV (≤ 10%, n = 37) or high-SVV (> 10%, n = 37) strategy. The primary outcome was postoperative complications, namely infection, pleural effusion, and atelectasis. The secondary outcomes were differences in perioperative physiological variables and postoperative pain.

Results: No differences in postoperative complications within 30 days of surgery were observed between the low-SVV and high-SVV groups. However, we observed lower estimated glomerular filtration rates (eGFRs) and higher alanine transaminase (ALT) levels in the high-SVV group after surgery.

Conclusion: Patients who underwent major liver tumor resection with the low-SVV or high-SVV strategy exhibited no differences in postoperative complications (48.6% vs. 45.9%; P > 0.999). However, in the high-SVV group, postoperative eGFRs were lower and ALT levels were higher.

Background: Shivering is one of the most common complications of spinal anesthesia because of inhibition of the thermoregulatory control. Dexmedetomidine and nalbuphine are the two commonly used drugs for treatment of perioperative shivering, but owing to paucity of their comparative data, we planned this study to compare the efficacy of these two drugs for treatment of post spinal shivering.

Methods: This study was conducted on 80 American Society of Anesthesiologists physical status I or II patients aged from 18 to 60 years who developed post-spinal shivering of grade III or IV during elective surgeries. These patients were randomly allocated into two groups (40 each). In group D, dexmedetomidine 0.50 μg/kg, and in group N, nalbuphine 0.08 mg/kg was given intravenously for treatment of shivering. Data regarding response time, recurrence rate and success rate along with their adverse effects were noted, and statistical analysis was performed using SPSS software version 17.0 (SPSS Inc., Chicago, IL, USA).

Results: The mean response time was significantly shorter in group D as compared to Group N (1.9 ± 0.6 min and 4.7 ± 1.1 min, respectively; P ＜ 0.001), but the success rate in both groups was 100%. Recurrence of shivering was greater in group N as compared to group D, but this difference was statistically insignificant. Although hypotension and bradycardia were observed more in group D and nausea was observed more in group N, the difference among both the groups was statistically insignificant.

Conclusions: Dexmedetomidine is a better alternative than nalbuphine for treatment of post spinal shivering with quicker response time and comparable side effects.