Pub Date : 2018-06-30DOI: 10.23937/2377-4630/1410068
Veiras Sonia, G. R. Rodríguez, S. Tomás, R. Javier, Baluja Aurora, A. Julian
Background: Volatile anaesthetics, most of all sevoflurane, have been described as providers of myocardial preconditioning, but few articles are focused on immunomodulatory effects of these agents. We aimed to study the effects of different anaesthetic procotols with sevoflurane and propofol on immunomodulation in patients undergoing cardiopulmonary bypass (CBP). Methods: Twenty-five patients scheduled for aortic valve replacement undergoing CBP were studied and divided in three groups depending on anaesthetic protocol: sevoflurane for induction, maintenance and CBP period (group 1); propofol for induction, maintenance and CBP period (group 2); propofol for induction and CBP period and sevoflurane for maintenance before and after CBP (group 3). Blood samples were obtained at baseline, immediately after sternal closure, 24 hours, 72 hours and 7 days after surgery. TLR2 and TLR4 expression were measured in monocytes and lymphocytes, and serum levels of tumoral necrosis factor α (TNFα), Cystatin C, Reactive C Protein (PCR), Propeptide Brain Natriuretic Protein (Pro-BNP) and Interleukin (IL) 6, IL-2R and IL-8 were analyzed. Conclusions: Compared with propofol, sevoflurane anaesthesia was associated to lower expression of TLR2 in monocytes and lower serum levels of inflammatory mediators.
{"title":"Sevoflurane but not Propofol Induces Immunomodulatory Effects in Patients Undergoing Aortic Valve Replacement and Cardiopulmonary Bypass","authors":"Veiras Sonia, G. R. Rodríguez, S. Tomás, R. Javier, Baluja Aurora, A. Julian","doi":"10.23937/2377-4630/1410068","DOIUrl":"https://doi.org/10.23937/2377-4630/1410068","url":null,"abstract":"Background: Volatile anaesthetics, most of all sevoflurane, have been described as providers of myocardial preconditioning, but few articles are focused on immunomodulatory effects of these agents. We aimed to study the effects of different anaesthetic procotols with sevoflurane and propofol on immunomodulation in patients undergoing cardiopulmonary bypass (CBP). Methods: Twenty-five patients scheduled for aortic valve replacement undergoing CBP were studied and divided in three groups depending on anaesthetic protocol: sevoflurane for induction, maintenance and CBP period (group 1); propofol for induction, maintenance and CBP period (group 2); propofol for induction and CBP period and sevoflurane for maintenance before and after CBP (group 3). Blood samples were obtained at baseline, immediately after sternal closure, 24 hours, 72 hours and 7 days after surgery. TLR2 and TLR4 expression were measured in monocytes and lymphocytes, and serum levels of tumoral necrosis factor α (TNFα), Cystatin C, Reactive C Protein (PCR), Propeptide Brain Natriuretic Protein (Pro-BNP) and Interleukin (IL) 6, IL-2R and IL-8 were analyzed. Conclusions: Compared with propofol, sevoflurane anaesthesia was associated to lower expression of TLR2 in monocytes and lower serum levels of inflammatory mediators.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42863984","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 : 2018-06-30DOI: 10.23937/2377-4630/1410063
Laurent Hertz, C. Sola, P. D. L. Arena, C. Dadure
Background: The use of perineural catheter for more than 72 hours is rare in perioperative practice, but was especially reported for chronic pain, oncologic related pain or palliative care. The main concern remains the risk of neurological or infectious complication. No guideline clearly specifies the maximum duration of perineural catheter maintenance and the safety of long-term catheters is discussed. Case report: We described the case of an 11-year-old boy who suffered a serious injury on his foot. An ultrasound guided sciatic nerve block was performed, with placement of a non-tunneled perineural catheter. The catheter could be used for 46 days with an excellent efficiency both for analgesia (continuous infusion) and anesthesia (additional bolus for surgical procedure). No infectious or neurological related complication to regional anesthesia was notified. Conclusion: This case demonstrates all the benefits that can be expected by long-term perineural catheter, even if it should be managed with great caution and after careful assessment of the risk-benefit balance. number of days before removal of the catheter with an increased risk after 3 days of catheter maintenance [2]. But only few transient and no major neurologic complications were reported [2]. In pediatric, PNBC are often used for postoperative analgesia after orthopedic or general surgery and are typically removed after only 2-3 days. Long term used of PNBC have yet been described for control of chronic pain, oncologic related pain or palliative care in young adults and children [3-5]. We present the case of a child who required the use of a PNBC over a long period of 46 days for perioperative pain management. The child and his family consented to the anonymous publication of this case. Description of the Case An 11-years-old boy, weighting 38 kg, without medical or surgical history, was admitted to our unit after a motor vehicle-pedestrian trauma. The child presented a faciocranial trauma with an initial loss of consciousness but a Glasgow score of 14 at the arrival of medical assistance. A fracture of the right horizontal branch of the mandibular corpus was diagnosed and treated by surgical osteosynthesis. Moreover, there was a severe injury with a large soft tissue defect extending from the internal malleolus to the second phalangeal of the right hallux and musculotendinous and osseous exposure. No vascular compromise was noted and the limited initial neurological exam was not able to objectify significant nerve injury or deficit. The patient complained of diffuse pain. However, shocked by the accident, it was not possible to assess the level of his pain. It was decided to treat him by sedation-analgesia with ketamine. Surgical CASe RePoRt
{"title":"Acute Pain Management in a Child: A Case Report of 46-Days of Popliteal Sciatic Nerve Catheter","authors":"Laurent Hertz, C. Sola, P. D. L. Arena, C. Dadure","doi":"10.23937/2377-4630/1410063","DOIUrl":"https://doi.org/10.23937/2377-4630/1410063","url":null,"abstract":"Background: The use of perineural catheter for more than 72 hours is rare in perioperative practice, but was especially reported for chronic pain, oncologic related pain or palliative care. The main concern remains the risk of neurological or infectious complication. No guideline clearly specifies the maximum duration of perineural catheter maintenance and the safety of long-term catheters is discussed. Case report: We described the case of an 11-year-old boy who suffered a serious injury on his foot. An ultrasound guided sciatic nerve block was performed, with placement of a non-tunneled perineural catheter. The catheter could be used for 46 days with an excellent efficiency both for analgesia (continuous infusion) and anesthesia (additional bolus for surgical procedure). No infectious or neurological related complication to regional anesthesia was notified. Conclusion: This case demonstrates all the benefits that can be expected by long-term perineural catheter, even if it should be managed with great caution and after careful assessment of the risk-benefit balance. number of days before removal of the catheter with an increased risk after 3 days of catheter maintenance [2]. But only few transient and no major neurologic complications were reported [2]. In pediatric, PNBC are often used for postoperative analgesia after orthopedic or general surgery and are typically removed after only 2-3 days. Long term used of PNBC have yet been described for control of chronic pain, oncologic related pain or palliative care in young adults and children [3-5]. We present the case of a child who required the use of a PNBC over a long period of 46 days for perioperative pain management. The child and his family consented to the anonymous publication of this case. Description of the Case An 11-years-old boy, weighting 38 kg, without medical or surgical history, was admitted to our unit after a motor vehicle-pedestrian trauma. The child presented a faciocranial trauma with an initial loss of consciousness but a Glasgow score of 14 at the arrival of medical assistance. A fracture of the right horizontal branch of the mandibular corpus was diagnosed and treated by surgical osteosynthesis. Moreover, there was a severe injury with a large soft tissue defect extending from the internal malleolus to the second phalangeal of the right hallux and musculotendinous and osseous exposure. No vascular compromise was noted and the limited initial neurological exam was not able to objectify significant nerve injury or deficit. The patient complained of diffuse pain. However, shocked by the accident, it was not possible to assess the level of his pain. It was decided to treat him by sedation-analgesia with ketamine. Surgical CASe RePoRt","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48866688","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 : 2015-01-01DOI: 10.23937/2377-4630/2/2/1028
Zachary L McCormick, Benjamin Marshall, Jeremy Walker, Robert McCarthy, David R Walega
Objective: Radiofrequency ablation (RFA) of the medial branch nerves for facet-mediated low back pain demonstrates clinical benefit for 6-12 months and possibly up to 2 years. This study investigated function, pain, and medication use outcomes of RFA for lumbar facet syndrome in a cohort with long-term follow-up.
Methods: Individuals evaluated in a tertiary academic pain practice between January, 2007-December, 2013, 18-60 years of age, with a clinical and radiologic diagnosis of lumbar facet syndrome, who underwent ≥1set of diagnostic medial branch blocks with resultant >75% pain relief and subsequent RFA were included. Outcomes measured were the proportion of individuals who reported ≥50% improvement in function, ≥50% improvement in pain; change in median NRS pain score, daily morphine equivalent consumption (DME), Medication Quantification Scale III (MSQ III) score and procedure complications.
Results: Sixty-two consecutive individuals with a median age and 25%-75% interquartile range (IQR) of 34 years (35, 52) met inclusion criteria. Seven individuals were lost to follow-up. Duration of pain was <2 years in 42%, 2-5 years in 40%, >5 years in 18% of individuals. Median duration of follow-up was 39 months (16, 60). Function and pain improved by ≥50% in 58% (CI 45%, 71%) and 53% (CI 40%, 66%) of individuals, respectively. The median reduction in MQS III score was 3.4 points (0, 8.8). No complications occurred in this cohort.
Conclusions: This study demonstrates a durable treatment effect of RFA for lumbar facet syndrome at long-term follow-up, as measured by improvement in function, pain, and analgesic use.
{"title":"Long-Term Function, Pain and Medication Use Outcomes of Radiofrequency Ablation for Lumbar Facet Syndrome.","authors":"Zachary L McCormick, Benjamin Marshall, Jeremy Walker, Robert McCarthy, David R Walega","doi":"10.23937/2377-4630/2/2/1028","DOIUrl":"https://doi.org/10.23937/2377-4630/2/2/1028","url":null,"abstract":"<p><strong>Objective: </strong>Radiofrequency ablation (RFA) of the medial branch nerves for facet-mediated low back pain demonstrates clinical benefit for 6-12 months and possibly up to 2 years. This study investigated function, pain, and medication use outcomes of RFA for lumbar facet syndrome in a cohort with long-term follow-up.</p><p><strong>Methods: </strong>Individuals evaluated in a tertiary academic pain practice between January, 2007-December, 2013, 18-60 years of age, with a clinical and radiologic diagnosis of lumbar facet syndrome, who underwent ≥1set of diagnostic medial branch blocks with resultant >75% pain relief and subsequent RFA were included. Outcomes measured were the proportion of individuals who reported ≥50% improvement in function, ≥50% improvement in pain; change in median NRS pain score, daily morphine equivalent consumption (DME), Medication Quantification Scale III (MSQ III) score and procedure complications.</p><p><strong>Results: </strong>Sixty-two consecutive individuals with a median age and 25%-75% interquartile range (IQR) of 34 years (35, 52) met inclusion criteria. Seven individuals were lost to follow-up. Duration of pain was <2 years in 42%, 2-5 years in 40%, >5 years in 18% of individuals. Median duration of follow-up was 39 months (16, 60). Function and pain improved by ≥50% in 58% (CI 45%, 71%) and 53% (CI 40%, 66%) of individuals, respectively. The median reduction in MQS III score was 3.4 points (0, 8.8). No complications occurred in this cohort.</p><p><strong>Conclusions: </strong>This study demonstrates a durable treatment effect of RFA for lumbar facet syndrome at long-term follow-up, as measured by improvement in function, pain, and analgesic use.</p>","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":"2 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33332471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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