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 : 2019-08-08DOI: 10.23937/2377-4630/1410092
F. TirottaChristopher, G. LagueruelaRichard, M. Danielle, Irizarry Marysory, McBride John, Ramsingh Davinder, H. Jonathan
Background/Aims: The purpose of this investigation was to identify causes and triggers of air entrainment related to intravenous (IV) access in a setting of clinical, operative or interventional procedure. Methods: An observational prospective trial was conducted in operating room settings across multiple study sites. A total of 120 surgical patients undergoing a variety of interventional and surgical procedures were included, representing multiple patient populations, case types and anesthesia setups. The ClearLine IV, a device that detects and removes air from IV tubing, was inserted into the IV circuit. Clinicians followed standard protocols. Blood warmers were used at the practitioner’s discretion. IV fluid was administered at a constant flow rate or through a bolus given over 30-60 seconds per standard of care. The volume and duration of fluid administration was recorded, along with the frequency, duration and amount of air captured by ClearLine IV. Results: Data confirmed a 52% probability of having air in the IV tubing, 79% when using a fluid warmer or bolus, and for every 10 mL of blood products administered, the risk increased by 0.5%. The baseline probability of dense air (defined as greater than 1000 μL per L of fluid) increased from 0% to 20% with the inclusion of a syringe setup, and up to 50% with a warmer or bolus. Conclusion: Air entrainment occurs in the presence of an IV in the hospital setting, and air burden, the amount of air captured, is increased by use of a fluid warmer, administration of medication by bolus, delivery of blood products, and inclusion of IV syringe setups. CLInICaL STuDy SuMMaRy
背景/目的：本研究的目的是确定临床、手术或介入程序中与静脉（IV）入路相关的空气夹带的原因和触发因素。方法：在多个研究地点的手术室环境中进行观察性前瞻性试验。共有120名手术患者接受了各种介入和手术，代表了多种患者群体、病例类型和麻醉设置。ClearLine IV是一种检测和清除IV管道中空气的设备，被插入IV回路。临床医生遵循标准方案。暖血器的使用由医生自行决定。静脉输液以恒定流速给药或通过每次标准护理30-60秒的推注给药。记录液体给药的体积和持续时间，以及ClearLine IV捕获的空气的频率、持续时间和量。结果：数据证实，静脉导管中有空气的概率为52%，使用液体加温器或推注时为79%，每给药10mL血液制品，风险增加了0.5%。在包括注射器设置的情况下，浓空气（定义为每升液体大于1000μL）的基线概率从0%增加到20%，在加热器或推注的情况下增加到50%。结论：在医院环境中，当静脉注射时会发生空气夹带，通过使用液体加温器、推注给药、输送血液制品和静脉注射注射器，空气负荷（即捕获的空气量）会增加。CLInICaL STuDy SuMMaRy
{"title":"A Prospective Observational Study of Air Burden in Intravenous Tubing: Factors that Increase Patient Exposure","authors":"F. TirottaChristopher, G. LagueruelaRichard, M. Danielle, Irizarry Marysory, McBride John, Ramsingh Davinder, H. Jonathan","doi":"10.23937/2377-4630/1410092","DOIUrl":"https://doi.org/10.23937/2377-4630/1410092","url":null,"abstract":"Background/Aims: The purpose of this investigation was to identify causes and triggers of air entrainment related to intravenous (IV) access in a setting of clinical, operative or interventional procedure. Methods: An observational prospective trial was conducted in operating room settings across multiple study sites. A total of 120 surgical patients undergoing a variety of interventional and surgical procedures were included, representing multiple patient populations, case types and anesthesia setups. The ClearLine IV, a device that detects and removes air from IV tubing, was inserted into the IV circuit. Clinicians followed standard protocols. Blood warmers were used at the practitioner’s discretion. IV fluid was administered at a constant flow rate or through a bolus given over 30-60 seconds per standard of care. The volume and duration of fluid administration was recorded, along with the frequency, duration and amount of air captured by ClearLine IV. Results: Data confirmed a 52% probability of having air in the IV tubing, 79% when using a fluid warmer or bolus, and for every 10 mL of blood products administered, the risk increased by 0.5%. The baseline probability of dense air (defined as greater than 1000 μL per L of fluid) increased from 0% to 20% with the inclusion of a syringe setup, and up to 50% with a warmer or bolus. Conclusion: Air entrainment occurs in the presence of an IV in the hospital setting, and air burden, the amount of air captured, is increased by use of a fluid warmer, administration of medication by bolus, delivery of blood products, and inclusion of IV syringe setups. CLInICaL STuDy SuMMaRy","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43821080","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 : 2019-08-08DOI: 10.23937/2377-4630/1410093
Weheba Hazem El Sayed Moawad, A. Tamer, G. Sameh, Makharita Mohamed Younis
Background and objectives: Effective perioperative analgesia with laparoscopic cholecystectomy enhances early recovery, ambulation, and discharge. Subcostal TAP block has been shown to reduce perioperative opioid use and provide effective perioperative analgesia. Currently, the QLB is performed as one of the perioperative pain management procedures for patients undergoing abdominal surgery. In the current study, we hypothesized that the analgesic efficacy of posterior QLB would be equal to or better than the subcostal TAP block in laparoscopic cholecystectomy. Methods: 106 patients were randomized for elective laparoscopic cholecystectomy. They were randomly allocated to 2 equal groups, 53 patients each. First group, patients received posterior QLB. Second group, patients received subcostal TAP block. The study was registered at ClinicalTrials.gov (NCT03323684). Results: Data from 98 patients were analyzed (48 patients in QLB group and 50 patients in the TAP group). The cumulative postoperative fentanyl consumption at 24 hours in patients required postoperative opioids shows no significant difference between the two groups but with less number of patients needing postoperative opioids in QLB group (17/48) than in the TAP group (28/50). The time to the first postoperative request for rescue analgesia was significantly longer in QLB group than in the TAP group. There was no significant difference between the two groups as regard PONV, and pain scores at 1, 6, 12, and 24 hours postoperatively. Conclusion: Posterior quadratus lumborum block can provide better effective postoperative analgesia in patients undergoing laparoscopic cholecystectomy than subcostal transversus abdominis plane block does. RESEARcH ARTiclE
{"title":"Posterior Quadratus Lumborum Block versus Subcostal Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy","authors":"Weheba Hazem El Sayed Moawad, A. Tamer, G. Sameh, Makharita Mohamed Younis","doi":"10.23937/2377-4630/1410093","DOIUrl":"https://doi.org/10.23937/2377-4630/1410093","url":null,"abstract":"Background and objectives: Effective perioperative analgesia with laparoscopic cholecystectomy enhances early recovery, ambulation, and discharge. Subcostal TAP block has been shown to reduce perioperative opioid use and provide effective perioperative analgesia. Currently, the QLB is performed as one of the perioperative pain management procedures for patients undergoing abdominal surgery. In the current study, we hypothesized that the analgesic efficacy of posterior QLB would be equal to or better than the subcostal TAP block in laparoscopic cholecystectomy. Methods: 106 patients were randomized for elective laparoscopic cholecystectomy. They were randomly allocated to 2 equal groups, 53 patients each. First group, patients received posterior QLB. Second group, patients received subcostal TAP block. The study was registered at ClinicalTrials.gov (NCT03323684). Results: Data from 98 patients were analyzed (48 patients in QLB group and 50 patients in the TAP group). The cumulative postoperative fentanyl consumption at 24 hours in patients required postoperative opioids shows no significant difference between the two groups but with less number of patients needing postoperative opioids in QLB group (17/48) than in the TAP group (28/50). The time to the first postoperative request for rescue analgesia was significantly longer in QLB group than in the TAP group. There was no significant difference between the two groups as regard PONV, and pain scores at 1, 6, 12, and 24 hours postoperatively. Conclusion: Posterior quadratus lumborum block can provide better effective postoperative analgesia in patients undergoing laparoscopic cholecystectomy than subcostal transversus abdominis plane block does. RESEARcH ARTiclE","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42983152","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 : 2019-05-10DOI: 10.23937/2377-4630/1410089
E. Kerem, Erkalp Nuran Kalekoglu, E. Veysel, Korkut Arzu Yasemin, Abut Yesim Cokay
Background: Inhalation induction (II) of anesthesia is a commonly used method in difficult airway management, pediatric anesthesia and also tracheostomized patients’ surgical practices. Sevoflurane and desflurane are the most common inhalation agents for II in these procedures of patients. We demonstrated that II with sevoflurane or desflurane in tracheostomized patients who are not studied up until now and their outcomes. Cardiorespiratory changes in II should be the same in tracheostomized patients with desflurane compared to sevoflurane. Methods: We studied 60 adult tracheostomized patients (ASA physical status 2 or 3), scheduled for elective surgery under general anesthesia. Patients were allocated randomly to receive either desflurane (Group D) or sevoflurane (Group S) for II. Following 1 mg midazolam and 1 μg/kg fentanyl, all patients were intubated via tracheostomy with a montandon tracheostomy tube. In the Group D, patients were firstly instructed to breath and then they immediately started using desflurane and 50% nitrous oxide in oxygen (3/3 L). Desflurane was introduced at an inspired concentration of 3% and increased by 1% every 4-6 breaths as tolerated, up to a maximum of 12%. In the Group S, patients were also instructed to breathe firstly and then they immediately started using sevoflurane and 50% nitrous oxide in oxygen (3/3 L). Sevoflurane was introduced at an inspired concentration of 1% and increased by 0.3% every 4-6 breaths as tolerated, up to a maximum of 6%. Hemodynamic values [(SpO2, heart rate (HR) and arterial pressure (MAP)], respiratory complications (coughing, bronchospasm, desaturation, breath-holding), purposeful movement of limbs, secretions requiring removal by suction, time to loss of response to command and concentration of expired inhalation agent (desflurane or sevoflurane) were recorded for 10 minutes of II. Mean, standard deviation, frequency and percentage were used for descriptive statistics with SSPS 20.0. Results: Couching, bronchospasm, desaturation, breathholding and purposeful movements distributions did not show any differences in Group D and Group S. Requirement of secretion removal was higher in Group D. Hemodynamic values were more stable in Group S. Conclusion: In tracheostomized patients’ II; desflurane has similar airway irritation with sevoflurane but II is more stable with sevoflurane than desflurane.
{"title":"Inhalation Induction in Tracheostomized Patients: Comparison of Desflurane and Sevoflurane","authors":"E. Kerem, Erkalp Nuran Kalekoglu, E. Veysel, Korkut Arzu Yasemin, Abut Yesim Cokay","doi":"10.23937/2377-4630/1410089","DOIUrl":"https://doi.org/10.23937/2377-4630/1410089","url":null,"abstract":"Background: Inhalation induction (II) of anesthesia is a commonly used method in difficult airway management, pediatric anesthesia and also tracheostomized patients’ surgical practices. Sevoflurane and desflurane are the most common inhalation agents for II in these procedures of patients. We demonstrated that II with sevoflurane or desflurane in tracheostomized patients who are not studied up until now and their outcomes. Cardiorespiratory changes in II should be the same in tracheostomized patients with desflurane compared to sevoflurane. Methods: We studied 60 adult tracheostomized patients (ASA physical status 2 or 3), scheduled for elective surgery under general anesthesia. Patients were allocated randomly to receive either desflurane (Group D) or sevoflurane (Group S) for II. Following 1 mg midazolam and 1 μg/kg fentanyl, all patients were intubated via tracheostomy with a montandon tracheostomy tube. In the Group D, patients were firstly instructed to breath and then they immediately started using desflurane and 50% nitrous oxide in oxygen (3/3 L). Desflurane was introduced at an inspired concentration of 3% and increased by 1% every 4-6 breaths as tolerated, up to a maximum of 12%. In the Group S, patients were also instructed to breathe firstly and then they immediately started using sevoflurane and 50% nitrous oxide in oxygen (3/3 L). Sevoflurane was introduced at an inspired concentration of 1% and increased by 0.3% every 4-6 breaths as tolerated, up to a maximum of 6%. Hemodynamic values [(SpO2, heart rate (HR) and arterial pressure (MAP)], respiratory complications (coughing, bronchospasm, desaturation, breath-holding), purposeful movement of limbs, secretions requiring removal by suction, time to loss of response to command and concentration of expired inhalation agent (desflurane or sevoflurane) were recorded for 10 minutes of II. Mean, standard deviation, frequency and percentage were used for descriptive statistics with SSPS 20.0. Results: Couching, bronchospasm, desaturation, breathholding and purposeful movements distributions did not show any differences in Group D and Group S. Requirement of secretion removal was higher in Group D. Hemodynamic values were more stable in Group S. Conclusion: In tracheostomized patients’ II; desflurane has similar airway irritation with sevoflurane but II is more stable with sevoflurane than desflurane.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43809639","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 : 2019-04-17DOI: 10.23937/2377-4630/1410088
D. Şeyda, A. Yeşim, E. Veysel, Seven Seda
The purpose of this study was to evaluate adding an obturator nerve block to adductor canal block may reduce tramadol consumption (primary endpoint), improve pain relief, enhance early ambulation ability, and reduce side effects (secondary endpoints) after TKA compared with single adductor canal block. This study was carried out retrospectively in order to compare the effect of the single injection adductor nerve block, which was applied to the patients undergoing total knee arthroplasty (TKA) under spinal anesthesia by the Anesthesiology and Reanimation Clinic for the postoperative analgesia, and the single injection obturator block added to this on postoperative analgesia and participation in physiotherapy in relation to analgesia. The sample of this study was comprised of 60 patients who underwent knee arthroplasty under spinal anesthesia and peripheral nerve block for postoperative analgesia at the end of the operation by the Orthopedics and Traumatology clinic between January 2015 and January 2016. The patients were between 45-80 years old and in ASA I-II-III group. For the purpose of this study, patient records, pain follow-up forms and physiotherapy follow-up forms were retrospectively examined. The data related to patients’ demographic characteristics, postoperative VAS scores, tramadol consumption, and tramadol related side effects, satisfaction levels and compliance with postoperative physical therapy were evaluated from printed data. The data of 30 out of the 60 patients to whom receiving only adductor canal block for analgesia were referred to as Group I and the data of the remaining 30 patients to whom receiving adductor canal block and obturator nerve block together for analgesia were defined as Group II were compared. The data of 3 patients in Group II were not included in the study because of the lack of records and a total of 57 patients were examined. No significant difference was identified between the groups in terms of age, gender, height, weight, ASA distribution and tourniquet duration. The rate of diabetes mellitus (DM) in Group I was significantly higher than in Group II and the mean surgical time was significantly lower (p = 0.005, p = 0.030). Patients’ VAS scores at 12th hour were significantly higher in group I and no significant difference was found at 1st, 4th and 24th hours. No significant difference was found between the groups in terms of tramadol consumption levels, nausea, vomiting, additional analgesic demand rates, satisfaction level distribution, maximum flexion to which the knee evaluated in physical therapy was able to reach and VAS score during that time, walking distance and chair test results (p = 0.506, p = 0.390, p = 0.656, p = 0.217, p = 0.240, p = 0.364, p = 0.571, p = 0.183, p = 0.386). In conclusion, combination of obturator nerve block to adductor canal block did not provide a statistically significant contribution over single adductor canal block in terms of total tramadol consumptions, postopera
{"title":"Postoperative Analgesia after Combined Obturator Nerve and Adductor Canal Block in Total Knee Arthroplasty","authors":"D. Şeyda, A. Yeşim, E. Veysel, Seven Seda","doi":"10.23937/2377-4630/1410088","DOIUrl":"https://doi.org/10.23937/2377-4630/1410088","url":null,"abstract":"The purpose of this study was to evaluate adding an obturator nerve block to adductor canal block may reduce tramadol consumption (primary endpoint), improve pain relief, enhance early ambulation ability, and reduce side effects (secondary endpoints) after TKA compared with single adductor canal block. This study was carried out retrospectively in order to compare the effect of the single injection adductor nerve block, which was applied to the patients undergoing total knee arthroplasty (TKA) under spinal anesthesia by the Anesthesiology and Reanimation Clinic for the postoperative analgesia, and the single injection obturator block added to this on postoperative analgesia and participation in physiotherapy in relation to analgesia. The sample of this study was comprised of 60 patients who underwent knee arthroplasty under spinal anesthesia and peripheral nerve block for postoperative analgesia at the end of the operation by the Orthopedics and Traumatology clinic between January 2015 and January 2016. The patients were between 45-80 years old and in ASA I-II-III group. For the purpose of this study, patient records, pain follow-up forms and physiotherapy follow-up forms were retrospectively examined. The data related to patients’ demographic characteristics, postoperative VAS scores, tramadol consumption, and tramadol related side effects, satisfaction levels and compliance with postoperative physical therapy were evaluated from printed data. The data of 30 out of the 60 patients to whom receiving only adductor canal block for analgesia were referred to as Group I and the data of the remaining 30 patients to whom receiving adductor canal block and obturator nerve block together for analgesia were defined as Group II were compared. The data of 3 patients in Group II were not included in the study because of the lack of records and a total of 57 patients were examined. No significant difference was identified between the groups in terms of age, gender, height, weight, ASA distribution and tourniquet duration. The rate of diabetes mellitus (DM) in Group I was significantly higher than in Group II and the mean surgical time was significantly lower (p = 0.005, p = 0.030). Patients’ VAS scores at 12th hour were significantly higher in group I and no significant difference was found at 1st, 4th and 24th hours. No significant difference was found between the groups in terms of tramadol consumption levels, nausea, vomiting, additional analgesic demand rates, satisfaction level distribution, maximum flexion to which the knee evaluated in physical therapy was able to reach and VAS score during that time, walking distance and chair test results (p = 0.506, p = 0.390, p = 0.656, p = 0.217, p = 0.240, p = 0.364, p = 0.571, p = 0.183, p = 0.386). In conclusion, combination of obturator nerve block to adductor canal block did not provide a statistically significant contribution over single adductor canal block in terms of total tramadol consumptions, postopera","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48987752","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 : 2019-03-13DOI: 10.23937/2377-4630/1410086
L. Antoine, Bouquerel Remi, S. Antoine, Gaillard Benjamin Le, P. Christophe, Houadec Mireille, Neto Edmundo Pereira de Souza
{"title":"Perioperative Management in Patients with Factor XI Deficiency","authors":"L. Antoine, Bouquerel Remi, S. Antoine, Gaillard Benjamin Le, P. Christophe, Houadec Mireille, Neto Edmundo Pereira de Souza","doi":"10.23937/2377-4630/1410086","DOIUrl":"https://doi.org/10.23937/2377-4630/1410086","url":null,"abstract":"","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42036624","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 : 2018-12-31DOI: 10.23937/2377-4630/1410080
Saracoglu Ayten, Tetik Sermin
Trauma is still a leading cause of death in the 21st Century mainly due to uncontrolled hemorrhage. Trauma has also an increasing cost of treatment in patients. Recently we have been aware of the importance of complex hemostatic and immunoinflammatory responses in pathogenesis of “Trauma Induced Coagulopathy”. As a result of understanding of changes on coagulation pathway in trauma, different hypotheses put forward explaining the trauma induced coagulopathy. New treatment algorithms also take place in early coagulation management of patients with traumatic coagulopathy. In this review, we aimed to explain pathophysiological determinant of trauma induced coagulopathy and recent evidence-based hemostatic treatment approach for patients with trauma.
{"title":"Hemostatic Coagulation Management in Trauma","authors":"Saracoglu Ayten, Tetik Sermin","doi":"10.23937/2377-4630/1410080","DOIUrl":"https://doi.org/10.23937/2377-4630/1410080","url":null,"abstract":"Trauma is still a leading cause of death in the 21st Century mainly due to uncontrolled hemorrhage. Trauma has also an increasing cost of treatment in patients. Recently we have been aware of the importance of complex hemostatic and immunoinflammatory responses in pathogenesis of “Trauma Induced Coagulopathy”. As a result of understanding of changes on coagulation pathway in trauma, different hypotheses put forward explaining the trauma induced coagulopathy. New treatment algorithms also take place in early coagulation management of patients with traumatic coagulopathy. In this review, we aimed to explain pathophysiological determinant of trauma induced coagulopathy and recent evidence-based hemostatic treatment approach for patients with trauma.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43172463","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 : 2018-12-31DOI: 10.23937/2377-4630/1410079
J. Budzinski
A pneumothorax can arise in a variety of clinical settings in the operating room, from bleb rupture to iatrogenic injury. Should it expand in size and cause increase in intrapleural pressures with resultant diminished venous return, it becomes referred to as a tension pneumothorax. We report a case of a premature infant presenting for repair of congenital pulmonary airway malformation who suffered an iatrogenic tension pneumothorax during lung isolation with fogarty embolectomy catheter used for single lung ventilation in a neonate. via c-section was noticed to have respiratory difficulty shortly after birth. Radiologic investigations revealed a right-sided chest mass with slight mediastinal shift (Figure 1). A diagnosis of CPAM was made, and the child was scheduled for right upper lobectomy. He was otherwise healthy with no abnormal laboratory or clinical findings. The case was discussed with the surgical team, and it was decided to proceed with lung isolation and single-lung ventilation (SLV). Atropine was administered intravenously, and anesthesia was induced with propofol and rocuronium. Mask ventilation was instituted using minimal pressures with 2% sevoflurane and 100% oxygen. Direct laryngoscopy (DL) was performed and a 4 Fr Fogarty embolectomy catheter (FC) easily inserted until resistance was met. An initial attempt with Case RepoRt
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Pub Date : 2018-12-31DOI: 10.23937/2377-4630/1410075
A. Abbas, M. Omid, H. Hossein, Shadnia Shahin, Zamani Nasim
Background: Respiratory failure is the most common cause of morbidity and mortality in organophosphate (OP)-intoxicated patients. We aimed to assess and compare the need for re-intubation and outcome between patients with self-extubation (SE) and planned extubation (PE). Methods: All OP-poisoned endotracheally intubated patients admitted to poisoning ICU were included. The frequency and time of SE, need for re-intubation, and its impact on hospital stay and outcome were assessed. Results: In fifteen patients (48.4%) SE was reported. Need for re-intubation in these patients was more than those who underwent PE (60.0% vs. 37.5%; P = 0.2). Early unplanned SE significantly correlated with occurrence of pulmonary complications (P = 0.04). The rate of aspiration pneumonia was high (80%) in SE cases. Hospital stay was also significantly prolonged in these patients (14.6 vs. 5.4 days, P = 0.04). Conclusion: Planning for on-time weaning/extubation in OP-poisoned patients can prevent unplanned SE and decrease the occurrence of lung complications.
背景:呼吸衰竭是有机磷中毒患者发病和死亡的最常见原因。我们的目的是评估和比较自我拔管(SE)和计划拔管(PE)患者再次插管的需要和结果。方法:纳入所有经气管插管的op中毒ICU患者。评估SE的频率和时间、再次插管的必要性及其对住院时间和结果的影响。结果:15例患者出现SE，占48.4%。这些患者再次插管的需求高于PE患者(60.0% vs 37.5%;P = 0.2)。早期非计划性SE与肺部并发症的发生有显著相关性(P = 0.04)。SE病例吸入性肺炎发生率高(80%)。住院时间也显著延长(14.6天比5.4天，P = 0.04)。结论:对op中毒患者实施及时脱机拔管计划可预防意外SE的发生，减少肺部并发症的发生。
{"title":"Outcome of Self- and Planned Extubation in Organophosphate-Poisoned Patients","authors":"A. Abbas, M. Omid, H. Hossein, Shadnia Shahin, Zamani Nasim","doi":"10.23937/2377-4630/1410075","DOIUrl":"https://doi.org/10.23937/2377-4630/1410075","url":null,"abstract":"Background: Respiratory failure is the most common cause of morbidity and mortality in organophosphate (OP)-intoxicated patients. We aimed to assess and compare the need for re-intubation and outcome between patients with self-extubation (SE) and planned extubation (PE). Methods: All OP-poisoned endotracheally intubated patients admitted to poisoning ICU were included. The frequency and time of SE, need for re-intubation, and its impact on hospital stay and outcome were assessed. Results: In fifteen patients (48.4%) SE was reported. Need for re-intubation in these patients was more than those who underwent PE (60.0% vs. 37.5%; P = 0.2). Early unplanned SE significantly correlated with occurrence of pulmonary complications (P = 0.04). The rate of aspiration pneumonia was high (80%) in SE cases. Hospital stay was also significantly prolonged in these patients (14.6 vs. 5.4 days, P = 0.04). Conclusion: Planning for on-time weaning/extubation in OP-poisoned patients can prevent unplanned SE and decrease the occurrence of lung complications.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48091556","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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