Pub Date : 2021-12-31DOI: 10.23937/2377-4630/1410130
D. Karantoula, E. Stamatakis, Sofia Hadzilia, P. Antsaklis, D. Valsamidis
Thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening thrombotic microangiopathy (TMA) characterized by microangiopathic hemolytic anemia, severe thrombocytopenia, and organ ischemia linked to disseminated microvascular platelet rich-thrombi. TTP is specifically related to a severe deficiency of ADAMTS13, a cleaving protease for von Willebrand (vWF). TTP is occurring in between 1 and 13 cases per million people depending on geographic location, and 1 in 25,000 pregnancies. We present 40-yr-old parturient with TTP who underwent spinal anesthesia for cesarean delivery at 37 weeks of gestation. Treatment for our case included acetylsalicylic acid, methylprednisolone and administration of fresh frozen plasma (FFP). We emphasize the importance of a multidisciplinary team approach to succeed the best outcome for this patient. Literature is discussed.
{"title":"Anesthetic Management in a Parturient with Thrombotic Thrombocytopenic Purpura for Cesarean Section: A Case Report and Literature Review","authors":"D. Karantoula, E. Stamatakis, Sofia Hadzilia, P. Antsaklis, D. Valsamidis","doi":"10.23937/2377-4630/1410130","DOIUrl":"https://doi.org/10.23937/2377-4630/1410130","url":null,"abstract":"Thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening thrombotic microangiopathy (TMA) characterized by microangiopathic hemolytic anemia, severe thrombocytopenia, and organ ischemia linked to disseminated microvascular platelet rich-thrombi. TTP is specifically related to a severe deficiency of ADAMTS13, a cleaving protease for von Willebrand (vWF). TTP is occurring in between 1 and 13 cases per million people depending on geographic location, and 1 in 25,000 pregnancies. We present 40-yr-old parturient with TTP who underwent spinal anesthesia for cesarean delivery at 37 weeks of gestation. Treatment for our case included acetylsalicylic acid, methylprednisolone and administration of fresh frozen plasma (FFP). We emphasize the importance of a multidisciplinary team approach to succeed the best outcome for this patient. Literature is discussed.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44571376","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 : 2021-12-31DOI: 10.23937/2377-4630/1410128
Sadiq Adamu A, A. Ballah, Panda Shehu U, Mohamed Hassan, GB Buma, Longji Dakum, Mufutau Jimoh L, Ndakotsu Alfa
{"title":"Consensus Reached on How to Recognise and Manage Sepsis and Septic Shock by Intensivists in Northeast Nigeria Held at the University of Maiduguri Teaching Hospital, Borno State Nigeria","authors":"Sadiq Adamu A, A. Ballah, Panda Shehu U, Mohamed Hassan, GB Buma, Longji Dakum, Mufutau Jimoh L, Ndakotsu Alfa","doi":"10.23937/2377-4630/1410128","DOIUrl":"https://doi.org/10.23937/2377-4630/1410128","url":null,"abstract":"","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43857462","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 : 2021-12-31DOI: 10.23937/2377-4630/1410127
Doi Yumi, Nishijima Eiji
{"title":"Rapid Progression of Neonatal Respiratory Distress from Laryngeal Cleft Type I: A Case Report","authors":"Doi Yumi, Nishijima Eiji","doi":"10.23937/2377-4630/1410127","DOIUrl":"https://doi.org/10.23937/2377-4630/1410127","url":null,"abstract":"","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42682023","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 : 2021-12-31DOI: 10.23937/2377-4630/1410129
Martínez Diego Escarramán, Gutiérrez Manuel Alberto Guerrero, Aguilar José Antonio Meade, Rojas Miguel Ángel Martínez, Nieto Orlando Rubén Pérez, Sánchez Bertha M Córdova, Lopez Eder Ivan Zamarrón, Diaz Jesús Salvador Sánchez
{"title":"Acute Kidney Injury in the Perioperative Period: Beyond the Obvious","authors":"Martínez Diego Escarramán, Gutiérrez Manuel Alberto Guerrero, Aguilar José Antonio Meade, Rojas Miguel Ángel Martínez, Nieto Orlando Rubén Pérez, Sánchez Bertha M Córdova, Lopez Eder Ivan Zamarrón, Diaz Jesús Salvador Sánchez","doi":"10.23937/2377-4630/1410129","DOIUrl":"https://doi.org/10.23937/2377-4630/1410129","url":null,"abstract":"","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48944963","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 : 2021-09-05DOI: 10.23937/2377-4630/1410126
L. Lydia, Lim Yiqi Ofelia, Chan Lijuan Jasmine, A. Joseph
Background: Spontaneous intracranial hypotension (SIH) is uncommon and postulated to occur due to spontaneous cerebrospinal fluid (CSF) leak. Subdural hemorrhage is a rare but serious complication of intracranial hypotension. With a paucity of high-level evidence to guide treatment, its management remains challenging. Case presentation: We report a case of spontaneous intracranial hypotension which was successfully treated with an epidural blood patch. The patient is a 59-year-old man with poorly controlled diabetes and hyperlipidemia who presented with left trochlear nerve palsy and bilateral acute subdural haemorrhage (SDH) secondary to SIH. He underwent bilateral burr hole drainage of acute SDH under general anaesthesia. Post-extubation, an epidural blood patch was performed which resulted in resolution of his symptoms. Conclusion: We highlight an interesting case of SIH presenting atypically with cranial nerve IV palsy and its successful management with epidural blood patch.
{"title":"Epidural Blood Patch for Spontaneous Intracranial Hypotension","authors":"L. Lydia, Lim Yiqi Ofelia, Chan Lijuan Jasmine, A. Joseph","doi":"10.23937/2377-4630/1410126","DOIUrl":"https://doi.org/10.23937/2377-4630/1410126","url":null,"abstract":"Background: Spontaneous intracranial hypotension (SIH) is uncommon and postulated to occur due to spontaneous cerebrospinal fluid (CSF) leak. Subdural hemorrhage is a rare but serious complication of intracranial hypotension. With a paucity of high-level evidence to guide treatment, its management remains challenging. Case presentation: We report a case of spontaneous intracranial hypotension which was successfully treated with an epidural blood patch. The patient is a 59-year-old man with poorly controlled diabetes and hyperlipidemia who presented with left trochlear nerve palsy and bilateral acute subdural haemorrhage (SDH) secondary to SIH. He underwent bilateral burr hole drainage of acute SDH under general anaesthesia. Post-extubation, an epidural blood patch was performed which resulted in resolution of his symptoms. Conclusion: We highlight an interesting case of SIH presenting atypically with cranial nerve IV palsy and its successful management with epidural blood patch.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42903889","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 : 2020-12-31DOI: 10.23937/2377-4630/1410118
Sezen Ozlem, Çevik E. Banu, Saracoglu Kemal Tolga
Background/aims: The aim of this study was to investigate the effects of the preemptive administration of a single dose of intravenous (IV) ibuprofen on the intraoperative hemodynamic parameters, recovery characteristics, and postoperative pain management in patients undergoing laparoscopic cholecystectomy. The time to first analgesic requirement during postoperative period was the main goal of this study. Material and methods: Following ethical committee approval, sixty patients scheduled for laparoscopic cholecystectomy with American Society of Anesthesiologists (ASA) physical status I-II and aged 30-65 years of either genders were included in this prospective, randomized, placebo-controlled double blinded study. Patients were randomly divided into two groups. The study group (group I) received 400 mg ibuprofen in 100 ml IV saline 15 min before anesthesia induction, whereas the placebo group (group C) received IV 100 ml saline only. The study drug and the saline were administered by an anesthesia nurse blinded to the study. The same general anesthesia protocol was applied in both groups. Hemodynamic parameters (non-invasive systolic (SAP), diastolic (DAP) and mean (MAP) arterial pressure, heart rate (HR), bispectral index (BIS) values and SpO2 values were recorded before induction (baseline) and after induction, peroperative 10, 20, 30, minutes., before extubation. The time to achieve a modified Aldrete score of ≥ 9 was recorded as the recovery time. During postoperative period, the time to first analgesic requirement and the total amount of analgesics within 24 hours was recorded. Patients were asked to give a number between from 1 to 5 for the satisfaction assessment for the anesthesia management. Results: There was no difference between the groups in terms of hemodynamic findings before anesthesia induction and in the peroperative period. The time until Aldrete score of 9 was statistically significantly shorter in Group I (Group I 3.8 ± 1.4 min, and Group C 6.3 ± 1.9 min, p < 0.001). Sevoflurane consumption was lower in the group given preemptive single dose IV ibuprofen, but the time to first postoperative analgesic requirement was longer (p < 0.001). Total analgesic consumption was highest in Group C (p < 0.001). Conclusion: Preemptive single dose i.v. ibuprofen (400 mg) can be used in laparoscopic cholecystectomy with the advantages of reducing the consumption of peroperative sevoflurane, providing better VAS scores, shortening the time to the first postoperative analgesic requirement and reducing analgesic consumption.
{"title":"The Effect of Single-Dose Preemptive Intravenous Ibuprofen on the Intraoperative Hemodynamic Parameters, Recovery Characteristics, and Acute Pain after Laparoscopic Cholecystectomy: A Randomized Double-Blind, Placebo-Controlled Clinical Trial","authors":"Sezen Ozlem, Çevik E. Banu, Saracoglu Kemal Tolga","doi":"10.23937/2377-4630/1410118","DOIUrl":"https://doi.org/10.23937/2377-4630/1410118","url":null,"abstract":"Background/aims: The aim of this study was to investigate the effects of the preemptive administration of a single dose of intravenous (IV) ibuprofen on the intraoperative hemodynamic parameters, recovery characteristics, and postoperative pain management in patients undergoing laparoscopic cholecystectomy. The time to first analgesic requirement during postoperative period was the main goal of this study. Material and methods: Following ethical committee approval, sixty patients scheduled for laparoscopic cholecystectomy with American Society of Anesthesiologists (ASA) physical status I-II and aged 30-65 years of either genders were included in this prospective, randomized, placebo-controlled double blinded study. Patients were randomly divided into two groups. The study group (group I) received 400 mg ibuprofen in 100 ml IV saline 15 min before anesthesia induction, whereas the placebo group (group C) received IV 100 ml saline only. The study drug and the saline were administered by an anesthesia nurse blinded to the study. The same general anesthesia protocol was applied in both groups. Hemodynamic parameters (non-invasive systolic (SAP), diastolic (DAP) and mean (MAP) arterial pressure, heart rate (HR), bispectral index (BIS) values and SpO2 values were recorded before induction (baseline) and after induction, peroperative 10, 20, 30, minutes., before extubation. The time to achieve a modified Aldrete score of ≥ 9 was recorded as the recovery time. During postoperative period, the time to first analgesic requirement and the total amount of analgesics within 24 hours was recorded. Patients were asked to give a number between from 1 to 5 for the satisfaction assessment for the anesthesia management. Results: There was no difference between the groups in terms of hemodynamic findings before anesthesia induction and in the peroperative period. The time until Aldrete score of 9 was statistically significantly shorter in Group I (Group I 3.8 ± 1.4 min, and Group C 6.3 ± 1.9 min, p < 0.001). Sevoflurane consumption was lower in the group given preemptive single dose IV ibuprofen, but the time to first postoperative analgesic requirement was longer (p < 0.001). Total analgesic consumption was highest in Group C (p < 0.001). Conclusion: Preemptive single dose i.v. ibuprofen (400 mg) can be used in laparoscopic cholecystectomy with the advantages of reducing the consumption of peroperative sevoflurane, providing better VAS scores, shortening the time to the first postoperative analgesic requirement and reducing analgesic consumption.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48568609","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 : 2020-04-20DOI: 10.23937/2377-4630/1410104
Basto Tatiana, S. MachadoHumberto
Introduction: Balanced anaesthesia relies on the administration of opioids in the perioperative period as antinociceptive agents. There is no clear evidence that intraoperative opioids result in reduction of postoperative pain scores. Opioid-free anaesthesia (OFA), combination of various opioids-sparing techniques leading to no administration of intraoperative systemic, neuraxial or intracavitary opioids, arises from the attempt to develop anti-hyperalgesic techniques to improve postoperative pain control. Therefore, the aim of this review is to understand to which extend is opioid free beneficial in the perioperative period, more specifically the analgesic impact of this technique. Methods: The electronic databases Medline and PubMed were searched until November 2019. We included meta-analyses, randomized controlled trials and prospective studies investigating pain outcomes comparing any type of intra-operative opioid general anaesthesia with opioid-free general anaesthesia. The primary outcome was first measure of pain score at rest and at 24 postoperative hours. Secondary outcomes included rescue analgesia, intravenous (i.v.) morphine consumption equivalents at 24h postoperatively, rates of postoperative nausea and vomiting (PONV) within the first 24 postoperative hours, rates of rescue antiemetic drugs, length of stay in post-anaesthesia care unit (PACU) and total hospital length of stay. Eleven studies were identified, three of which are meta-analysis. Results: Mean pain scores at rest in the first measure as well as at 24 postoperative hours were lower in the opioid free anaesthesia (OFA) group than in opioid based anaesthesia (OBA). Use of rescue postoperative analgesia and i.v. morphine consumption equivalents were lower in the OFA group. A statistically significant trend toward a decrease in PONV and use of antiemetic drugs among patients who did not received opioids was observed. Length of stay PACU was longer in the opioid free group, but only three of six trials reported a statistically significant difference. Finally, total length of stay in the hospital was investigated by two trials and was similar between groups. Conclusion: OFA, when compared with OBA, does not present inferior results regarding pain scores or opioid consumption in the postoperative period. It is also associated with reduced postoperative nausea and vomiting. The OFA technique presents as future challenges an objective documentation of both its short-term and long-term benefits and inconveniencies. Further research with robust methodological trials with large sample sizes are required to better determine the efficacy and safety of opioid-free anaesthetic strategy.
{"title":"Effect of Opioid-Free Anaesthesia on Perioperative Period: A Review","authors":"Basto Tatiana, S. MachadoHumberto","doi":"10.23937/2377-4630/1410104","DOIUrl":"https://doi.org/10.23937/2377-4630/1410104","url":null,"abstract":"Introduction: Balanced anaesthesia relies on the administration of opioids in the perioperative period as antinociceptive agents. There is no clear evidence that intraoperative opioids result in reduction of postoperative pain scores. Opioid-free anaesthesia (OFA), combination of various opioids-sparing techniques leading to no administration of intraoperative systemic, neuraxial or intracavitary opioids, arises from the attempt to develop anti-hyperalgesic techniques to improve postoperative pain control. Therefore, the aim of this review is to understand to which extend is opioid free beneficial in the perioperative period, more specifically the analgesic impact of this technique. Methods: The electronic databases Medline and PubMed were searched until November 2019. We included meta-analyses, randomized controlled trials and prospective studies investigating pain outcomes comparing any type of intra-operative opioid general anaesthesia with opioid-free general anaesthesia. The primary outcome was first measure of pain score at rest and at 24 postoperative hours. Secondary outcomes included rescue analgesia, intravenous (i.v.) morphine consumption equivalents at 24h postoperatively, rates of postoperative nausea and vomiting (PONV) within the first 24 postoperative hours, rates of rescue antiemetic drugs, length of stay in post-anaesthesia care unit (PACU) and total hospital length of stay. Eleven studies were identified, three of which are meta-analysis. Results: Mean pain scores at rest in the first measure as well as at 24 postoperative hours were lower in the opioid free anaesthesia (OFA) group than in opioid based anaesthesia (OBA). Use of rescue postoperative analgesia and i.v. morphine consumption equivalents were lower in the OFA group. A statistically significant trend toward a decrease in PONV and use of antiemetic drugs among patients who did not received opioids was observed. Length of stay PACU was longer in the opioid free group, but only three of six trials reported a statistically significant difference. Finally, total length of stay in the hospital was investigated by two trials and was similar between groups. Conclusion: OFA, when compared with OBA, does not present inferior results regarding pain scores or opioid consumption in the postoperative period. It is also associated with reduced postoperative nausea and vomiting. The OFA technique presents as future challenges an objective documentation of both its short-term and long-term benefits and inconveniencies. Further research with robust methodological trials with large sample sizes are required to better determine the efficacy and safety of opioid-free anaesthetic strategy.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44939779","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 : 2020-01-04DOI: 10.23937/2377-4630/1410101
Xinyue Liu, J. Jing, Guo-Qing Zhao
As the recent update of General Anaesthesia compared to Spinal anaesthesia (GAS) studies has been published in 2019, together with other clinical evidence, the human studies provided an overwhelming mixed evidence of an association between anaesthesia exposure in early childhood and later neurodevelopment changes in children. Pre-clinical studies in animals provided strong evidence on how anaesthetic and sedative agents (ASAs) causing neurotoxicity in developing brain and deficits in long-term cognitive functions. However pre-clinical results cannot translate to clinical practice directly. Three well designed large population-based human studies strongly indicated that a single brief exposure to general anesthesia (GAs) is not associated with any long-term neurodevelopment deficits in children’s brain. Multiple exposure might cause decrease in processing speed and motor skills of children. However, the association between GAs and neurodevelopment in children is still inconclusive. More clinical studies with larger scale observations, randomized trials with longer duration exposure of GAs and follow-ups, more sensitive outcome measurements, and strict confounder controls are needed in the future to provide more conclusive and informative data. New research area has been developed to contribute in finding solutions for clinical practice as attenuating the neurotoxic effect of ASAs. Xenon and Dexmedetomidine are already used in clinical setting as neuroprotection and anaesthetic sparing-effect, but more research is still needed.
{"title":"General Anesthesia Affecting on Developing Brain: Evidence from Animal to Clinical Research","authors":"Xinyue Liu, J. Jing, Guo-Qing Zhao","doi":"10.23937/2377-4630/1410101","DOIUrl":"https://doi.org/10.23937/2377-4630/1410101","url":null,"abstract":"As the recent update of General Anaesthesia compared to Spinal anaesthesia (GAS) studies has been published in 2019, together with other clinical evidence, the human studies provided an overwhelming mixed evidence of an association between anaesthesia exposure in early childhood and later neurodevelopment changes in children. Pre-clinical studies in animals provided strong evidence on how anaesthetic and sedative agents (ASAs) causing neurotoxicity in developing brain and deficits in long-term cognitive functions. However pre-clinical results cannot translate to clinical practice directly. Three well designed large population-based human studies strongly indicated that a single brief exposure to general anesthesia (GAs) is not associated with any long-term neurodevelopment deficits in children’s brain. Multiple exposure might cause decrease in processing speed and motor skills of children. However, the association between GAs and neurodevelopment in children is still inconclusive. More clinical studies with larger scale observations, randomized trials with longer duration exposure of GAs and follow-ups, more sensitive outcome measurements, and strict confounder controls are needed in the future to provide more conclusive and informative data. New research area has been developed to contribute in finding solutions for clinical practice as attenuating the neurotoxic effect of ASAs. Xenon and Dexmedetomidine are already used in clinical setting as neuroprotection and anaesthetic sparing-effect, but more research is still needed.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42105005","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 : 2019-10-26DOI: 10.23937/2377-4630/1410097
S. Thiruselvi, Jee Tan Ann
Introduction: Pain in the immediate postoperative period is found to be less after laparoscopic than after conventional surgical techniques. Ropivacaine is often in favour of Bupivacaine to avoid the risks of toxicity. Levo-bupivacaine, a safer version of bupivacaine is a contender to Ropivacaine. We compare the pain relief provided by Ropivacaine and Levo-bupivacaine instilled intra-abdominally during laparoscopic surgery for acute appendicitis. Methods and material: This is a double blinded randomized placebocontrolled study conducted on 120 patients in a public hospital over a period of 10 months. Using patient control analgesia (PCA), amount of morphine utilized to attain pain scores of 0-1, measured using visual analog score (VAS) was compared among placebo, Ropivacaine and Levo-bupivacanie group. Results: Data was analysed using analysis of variance with post-hoc multiple comparisons using Bonferroni test and statistical significance was set at p < 0.05. No significant difference was noted between the Ropivacaine and Levo-bupivacaine groups (p = 1); utilization of morphine was similar for both drugs. However, significant difference was noted between placebo and local anaesthetics (p = 0). Conclusions: There appear to be no difference between Ropivacaine and Levo-bupivacaine in terms of pain relief though Ropivacaine has been indicated to be less potent than Bupivacaine in some studies. Pre-emptive instillation of local anaesthetic for laparoscopic surgery is beneficial for post-operative pain relief. OriginAl ArTicle
{"title":"Levo-Bupivacaine vs. Ropivacaine for Post-Operative Pain Relief after Pre-Emptive Intraperitoneal Instillation in Laparoscopic Appendicectomy","authors":"S. Thiruselvi, Jee Tan Ann","doi":"10.23937/2377-4630/1410097","DOIUrl":"https://doi.org/10.23937/2377-4630/1410097","url":null,"abstract":"Introduction: Pain in the immediate postoperative period is found to be less after laparoscopic than after conventional surgical techniques. Ropivacaine is often in favour of Bupivacaine to avoid the risks of toxicity. Levo-bupivacaine, a safer version of bupivacaine is a contender to Ropivacaine. We compare the pain relief provided by Ropivacaine and Levo-bupivacaine instilled intra-abdominally during laparoscopic surgery for acute appendicitis. Methods and material: This is a double blinded randomized placebocontrolled study conducted on 120 patients in a public hospital over a period of 10 months. Using patient control analgesia (PCA), amount of morphine utilized to attain pain scores of 0-1, measured using visual analog score (VAS) was compared among placebo, Ropivacaine and Levo-bupivacanie group. Results: Data was analysed using analysis of variance with post-hoc multiple comparisons using Bonferroni test and statistical significance was set at p < 0.05. No significant difference was noted between the Ropivacaine and Levo-bupivacaine groups (p = 1); utilization of morphine was similar for both drugs. However, significant difference was noted between placebo and local anaesthetics (p = 0). Conclusions: There appear to be no difference between Ropivacaine and Levo-bupivacaine in terms of pain relief though Ropivacaine has been indicated to be less potent than Bupivacaine in some studies. Pre-emptive instillation of local anaesthetic for laparoscopic surgery is beneficial for post-operative pain relief. OriginAl ArTicle","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41703154","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 : 2019-09-23DOI: 10.23937/2377-4630/1410096
Barros Fernanda Rondon Pirangy, Cardoso de Melo, Pimentel Ivandete Coelho Pereira, Ramos e Mewryane Câmara Brandão, Marques Jamilly Rebouças Demosthenes
The present research project aims to evaluate the incidence of residual neuromuscular block in the post-anesthetic recovery room in patients who underwent general anesthesia with mechanical ventilation. It is known that neuromuscular blockers are drugs that interrupt the transmission of nerve impulses at the neuromuscular junction causing muscle paralysis. In addition, they facilitate endotracheal intubation during anesthetic induction and allow for adequate surgical management. There are several adverse effects resulting from their use, among them: The occurrence of vagolytic and sympatholytic activities that cause cardiovascular alterations or autonomic stimulation. Monitoring the levels of these blockers is of paramount importance because it allows the titration of the drug. By relaxing and paralyzing the muscles, postoperative weakness due to the absence or incomplete performance of the antagonists of this drug is frequent. This situation is known as postoperative residual neuromuscular block. When it comes to the anesthetic practice to evaluate such situation, the patient’s clinic is often the only alternative. The safe use of neuromuscular blockers requires monitoring to qualify muscle relaxation by being measured from a known monitor of four stimuli or Train of Four (TOF). The residual neuromuscular blocker influences possible clinical complications that may lead to increased morbidity and mortality in the postoperative period. Thus, this project aims to identify the incidence of residual neuromuscular block in the postanesthetic recovery room in order to reduce the cardiorespiratory complications resulting from the use of the adenos polarizing neuromuscular blockers.
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