Pub Date : 2018-12-31DOI: 10.23937/2377-4630/1410081
Saracoglu Ayten, Pence Halime Hanim, Yılmaz Mehmet, Saracoglu Kemal Tolga
Prevention and minimizing serious complications during difficult airway management is an important goal for anesthesia providers. Using the high flow cannula oxygenation systems it is possible to improve the clinical outcomes, increase patient safety and reduce the rate of complications. A possible mechanism of this method can be explain by ‘Aventilatory Mass Flow’ which is a physilogical phenomenon. Several methods can be used to implement apneic oxygenation such as nasopharyngeal catheter, nasal cannula, face mask, Venturi mask, transtracheal endobronchial catheters, dual blade laryngoscopes and High Flow Nasal Cannula Oxygenation (HFNCO) systems. However each method has some restrictions. In this review we aim to focus on the important features of HFNCO systems including the indications, contraindications and possible complications.
{"title":"Apneic Oxygenation and High Flow","authors":"Saracoglu Ayten, Pence Halime Hanim, Yılmaz Mehmet, Saracoglu Kemal Tolga","doi":"10.23937/2377-4630/1410081","DOIUrl":"https://doi.org/10.23937/2377-4630/1410081","url":null,"abstract":"Prevention and minimizing serious complications during difficult airway management is an important goal for anesthesia providers. Using the high flow cannula oxygenation systems it is possible to improve the clinical outcomes, increase patient safety and reduce the rate of complications. A possible mechanism of this method can be explain by ‘Aventilatory Mass Flow’ which is a physilogical phenomenon. Several methods can be used to implement apneic oxygenation such as nasopharyngeal catheter, nasal cannula, face mask, Venturi mask, transtracheal endobronchial catheters, dual blade laryngoscopes and High Flow Nasal Cannula Oxygenation (HFNCO) systems. However each method has some restrictions. In this review we aim to focus on the important features of HFNCO systems including the indications, contraindications and possible 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":"41661797","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: 10.23937/2377-4630/1410070
F. Fadi, Kalaydjian Antranig, C. Yuen, S. Pascal, A. Martín
Objective: Lower extremities nerves damage is a known complication of prostatectomies. Lumbar sympathetic block is a well-established treatment for sympathetically-mediated lower extremity pain. We report a case of bilateral lower extremity pain in a femoral distribution that developed after a robotic assisted prostatectomy and resolved after a lumbar sympathetic block. Case Report: A 69-year-old male patient presented with bilateral thigh pain one month after an uneventful robotic-assisted laparoscopic prostatectomy in the femoral nerve distribution. CT scan was unremarkable save for expected postsurgical changes. The patient failed conservative treatment. Considering a possible sympathetically-mediated pain, we performed a right lumbar sympathetic block that improved his pain. Conclusions: A lumbar sympathetic block can be used a salvage therapy when conservative management fails. Materials and Methods Patient informed consent was obtained for submission of the case report.
{"title":"Lumbar Sympathetic Block for Bilateral Post-Prostatectomy Lower Extremity Pain in the Femoral Nerve Distribution","authors":"F. Fadi, Kalaydjian Antranig, C. Yuen, S. Pascal, A. Martín","doi":"10.23937/2377-4630/1410070","DOIUrl":"https://doi.org/10.23937/2377-4630/1410070","url":null,"abstract":"Objective: Lower extremities nerves damage is a known complication of prostatectomies. Lumbar sympathetic block is a well-established treatment for sympathetically-mediated lower extremity pain. We report a case of bilateral lower extremity pain in a femoral distribution that developed after a robotic assisted prostatectomy and resolved after a lumbar sympathetic block. Case Report: A 69-year-old male patient presented with bilateral thigh pain one month after an uneventful robotic-assisted laparoscopic prostatectomy in the femoral nerve distribution. CT scan was unremarkable save for expected postsurgical changes. The patient failed conservative treatment. Considering a possible sympathetically-mediated pain, we performed a right lumbar sympathetic block that improved his pain. Conclusions: A lumbar sympathetic block can be used a salvage therapy when conservative management fails. Materials and Methods Patient informed consent was obtained for submission of the case report.","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":"42671066","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: 10.23937/2377-4630/1410069
R. Kurt, H. Till, P. Tobias, H. Alkadhi, R SpahnDonat
Central Venous Catheterization is a common procedure in daily clinical practice. The internal jugular, subclavian and the femoral veins are the most frequently catheterized central veins. Pneumothorax, hematothorax, arterial puncture, hematoma, nerve lesions, damage to the left thoracic duct, and air embolism are among the main mechanical complications. Nowadays, there are two techniques in daily clinical use: the traditional technique and the ultrasound guided technique. The traditional technique relies on the use of anatomical landmarks, but the failure rate is higheven in experienced hands. Furthermore, several different complications range from mechanical problems (5-19% of cases) to infections and thrombotic events (2-26%). There is compelling evidence that ultrasound-guided CVC insertion via the internal jugular veins is associated with higher success rates and fewer mechanical complications compared with the traditional techniques based on external anatomical landmarks. We report a clinical case of 76-years-old female patient requiring urgent placement of a central venous catheter and unrecognized arterial puncture and subsequent heparin overdose with nearly fatal outcome. eral venous access, administration of parenteral nutrition, vascular access in patients whose peripheral veins are difficult to catheterize, and procedures that require access to large-caliber vessels [1]. The central vessels that are most frequently catheterized are the internal jugular, subclavian, and femoral veins. The traditional CVC insertion technique relies on the use of anatomical landmarks rather than ultrasound guidance. But even in experienced hands, the traditional technique is associated with a high failure rate and several complications ranging from mechanical problems (5-19% of cases) to infections and thrombotic events (2-26%) [1-4]. Pneumothorax, hematothorax, arterial puncture, hematoma, nerve lesions, damage to the left thoracic duct, and air embolism are among the main mechanical complications [5]. The incidence of complications increase 6-fold after the third insertion attempt [1]. Other risk factors that are known to increase the incidence of complications are an inexperienced operator, the presence of anatomical variants as well as co-existing medical conditions such as clotting disorders, pulmonary emphysema, hypovolemia, or difficulties related to conditions under which the procedure is performed (i.e. an emergency) [5]. CASe RePoRT
{"title":"An Accidental Arterial Puncture and Anticoagulation after Internal Jugular Vein Catheterization Resulting in Massive Hematoma and Airway Compromise","authors":"R. Kurt, H. Till, P. Tobias, H. Alkadhi, R SpahnDonat","doi":"10.23937/2377-4630/1410069","DOIUrl":"https://doi.org/10.23937/2377-4630/1410069","url":null,"abstract":"Central Venous Catheterization is a common procedure in daily clinical practice. The internal jugular, subclavian and the femoral veins are the most frequently catheterized central veins. Pneumothorax, hematothorax, arterial puncture, hematoma, nerve lesions, damage to the left thoracic duct, and air embolism are among the main mechanical complications. Nowadays, there are two techniques in daily clinical use: the traditional technique and the ultrasound guided technique. The traditional technique relies on the use of anatomical landmarks, but the failure rate is higheven in experienced hands. Furthermore, several different complications range from mechanical problems (5-19% of cases) to infections and thrombotic events (2-26%). There is compelling evidence that ultrasound-guided CVC insertion via the internal jugular veins is associated with higher success rates and fewer mechanical complications compared with the traditional techniques based on external anatomical landmarks. We report a clinical case of 76-years-old female patient requiring urgent placement of a central venous catheter and unrecognized arterial puncture and subsequent heparin overdose with nearly fatal outcome. eral venous access, administration of parenteral nutrition, vascular access in patients whose peripheral veins are difficult to catheterize, and procedures that require access to large-caliber vessels [1]. The central vessels that are most frequently catheterized are the internal jugular, subclavian, and femoral veins. The traditional CVC insertion technique relies on the use of anatomical landmarks rather than ultrasound guidance. But even in experienced hands, the traditional technique is associated with a high failure rate and several complications ranging from mechanical problems (5-19% of cases) to infections and thrombotic events (2-26%) [1-4]. Pneumothorax, hematothorax, arterial puncture, hematoma, nerve lesions, damage to the left thoracic duct, and air embolism are among the main mechanical complications [5]. The incidence of complications increase 6-fold after the third insertion attempt [1]. Other risk factors that are known to increase the incidence of complications are an inexperienced operator, the presence of anatomical variants as well as co-existing medical conditions such as clotting disorders, pulmonary emphysema, hypovolemia, or difficulties related to conditions under which the procedure is performed (i.e. an emergency) [5]. CASe RePoRT","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":"48780001","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: 10.23937/2377-4630/1410083
Jan Summaira, A. Tawheed, R. Saima
Background: Laparoscopic surgeries involves creation of pneumo-peritoneum with insufflation of gas usually CO2 thereby increasing intra-abdominal pressure. The Intra-abdominal pressure above 10 mmHg causes adverse hemodynamic changes. Various agents have been used to attenuate these adverse effects. Dexmedetomidine alpha-2 agonist has sedative, sympatholytic, analgesic and anxiolytic properties and used in laparoscopic cholecystectomies for attenuation of adverse hemodynamic changes and to maintain hemodynamic stability. Material and methods: 60 patients of ASA 1-2 undergoing elective laparoscopic cholecystectomy were randomly allotted to two groups. Each group consists of 30 patients. Group 1 patients received dexmedetomidine infusion @0.2 microgram/kg/hour and group 2 patients received normal saline @0.2 microgram/kg/hour after intubation. The medication was stopped at the end of peritoneal deflation. Intraoperative hemodynamic stability was assessed by monitoring heart rate and Mean arterial pressure. Results: In Dexmedetomidine group, the haemodynamic response was significantly attenuated. Conclusion: Dexmedetomidine infusion in the dose of 0.2 μg/kg/hour effectively attenuates haemodynamic stress response to pneumo-peritoneum during laparoscopic surgery.
{"title":"Dexmedetomidine Infusion an Effective Intra-Operative Medication for Patients Undergoing Laparoscopic Cholecystectomy","authors":"Jan Summaira, A. Tawheed, R. Saima","doi":"10.23937/2377-4630/1410083","DOIUrl":"https://doi.org/10.23937/2377-4630/1410083","url":null,"abstract":"Background: Laparoscopic surgeries involves creation of pneumo-peritoneum with insufflation of gas usually CO2 thereby increasing intra-abdominal pressure. The Intra-abdominal pressure above 10 mmHg causes adverse hemodynamic changes. Various agents have been used to attenuate these adverse effects. Dexmedetomidine alpha-2 agonist has sedative, sympatholytic, analgesic and anxiolytic properties and used in laparoscopic cholecystectomies for attenuation of adverse hemodynamic changes and to maintain hemodynamic stability. Material and methods: 60 patients of ASA 1-2 undergoing elective laparoscopic cholecystectomy were randomly allotted to two groups. Each group consists of 30 patients. Group 1 patients received dexmedetomidine infusion @0.2 microgram/kg/hour and group 2 patients received normal saline @0.2 microgram/kg/hour after intubation. The medication was stopped at the end of peritoneal deflation. Intraoperative hemodynamic stability was assessed by monitoring heart rate and Mean arterial pressure. Results: In Dexmedetomidine group, the haemodynamic response was significantly attenuated. Conclusion: Dexmedetomidine infusion in the dose of 0.2 μg/kg/hour effectively attenuates haemodynamic stress response to pneumo-peritoneum during laparoscopic surgery.","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":"47882099","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: 10.23937/2377-4630/1410067
Kl Smith, C. Sharp, E. Smith, M. Currie, K. Hall, T. Vu, M. Lee, R. L. Cooper
Background: Medication errors cause an estimated 100,000 to 400,000 patient deaths in the United States annually (IOM). Previous reviews on this alarming statistic consistently identify human error as the most common etiology. The potential for medication errors is especially high risk in the operating suite, where the provider simultaneously selects, doses and verifies medications to be administered to patients. Additionally, a lack of standardization and error reduction strategies in this setting creates the environment for medication administration errors, prompting multiple recommendations for interventions to minimize human error. Methods: This project took place in three phases. In the Evaluation phase, evidence-based literature on anesthesia medication safety practices were evaluated, and high-risk/ look-alike, sound-alike medications on anesthesia medication trays were identified. In the Standardization phase, the interdisciplinary team developed strategies to organize the medication trays to improve safety. These standardized strategies were executed throughout the anesthesia mediation trays in the final Implementation phase. Results: A total of eight-three changes were made to the anesthesia medication trays. Sixty medications were removed, with an average of ten removals per tray. High risk medications were replaced with unit-of-use or ready-to-use syringes when possible, with an average of four replacements per tray. The greatest number of medication tray changes was in the trauma operating suite with a total of twenty-eight. Conclusions: Numerous opportunities were identified to decrease the potential for human error by standardizing anesthesia medication trays with a focus on optimizing medication safety. Organization and standardization of anesthesia medication trays is an economical strategy to decrease opportunity for human error in the operating suite that requires minimal capital outlay. Although previous studies have recommended strategies and technologies to improve medication safety in the operating suites; these interventions have yet to be implemented. Our unique study demonstrates successful intervention implementation.
{"title":"Interdisciplinary Anesthesia Tray Revision Project: Reducing the Opportunity for Human Error","authors":"Kl Smith, C. Sharp, E. Smith, M. Currie, K. Hall, T. Vu, M. Lee, R. L. Cooper","doi":"10.23937/2377-4630/1410067","DOIUrl":"https://doi.org/10.23937/2377-4630/1410067","url":null,"abstract":"Background: Medication errors cause an estimated 100,000 to 400,000 patient deaths in the United States annually (IOM). Previous reviews on this alarming statistic consistently identify human error as the most common etiology. The potential for medication errors is especially high risk in the operating suite, where the provider simultaneously selects, doses and verifies medications to be administered to patients. Additionally, a lack of standardization and error reduction strategies in this setting creates the environment for medication administration errors, prompting multiple recommendations for interventions to minimize human error. Methods: This project took place in three phases. In the Evaluation phase, evidence-based literature on anesthesia medication safety practices were evaluated, and high-risk/ look-alike, sound-alike medications on anesthesia medication trays were identified. In the Standardization phase, the interdisciplinary team developed strategies to organize the medication trays to improve safety. These standardized strategies were executed throughout the anesthesia mediation trays in the final Implementation phase. Results: A total of eight-three changes were made to the anesthesia medication trays. Sixty medications were removed, with an average of ten removals per tray. High risk medications were replaced with unit-of-use or ready-to-use syringes when possible, with an average of four replacements per tray. The greatest number of medication tray changes was in the trauma operating suite with a total of twenty-eight. Conclusions: Numerous opportunities were identified to decrease the potential for human error by standardizing anesthesia medication trays with a focus on optimizing medication safety. Organization and standardization of anesthesia medication trays is an economical strategy to decrease opportunity for human error in the operating suite that requires minimal capital outlay. Although previous studies have recommended strategies and technologies to improve medication safety in the operating suites; these interventions have yet to be implemented. Our unique study demonstrates successful intervention implementation.","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":"46856130","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: 10.23937/2377-4630/1410068
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 : 2018-06-30DOI: 10.23937/2377-4630/1410066
Corazzi Francesco, Brusa Stefania, G. Enrico, Civilini Efrem, Poletto Luca, R. Ferdinando
Paraplegia is one of the most devastating complication after Thoraco-abdominal Aorta (TAA) repair both in open surgery and in endovascular procedure, caused by critical obstruction to blood perfusion of the Spinal Cord. Spinal Cord Ischemia (SCI) may be due to hemodynamic impairment and/or to segmental artery occlusion during aortic clamping [1,2]. We report a case of chronically dissected Thoraco-abdominal Aortic Aneurysm (TAAA) which showed unilateral transient neurological impairment of the left lower limb, postoperatively.
{"title":"Transient Unilateral Lower Limb Palsy after Open Surgery Thoraco-Abdominal Aorta Repair","authors":"Corazzi Francesco, Brusa Stefania, G. Enrico, Civilini Efrem, Poletto Luca, R. Ferdinando","doi":"10.23937/2377-4630/1410066","DOIUrl":"https://doi.org/10.23937/2377-4630/1410066","url":null,"abstract":"Paraplegia is one of the most devastating complication after Thoraco-abdominal Aorta (TAA) repair both in open surgery and in endovascular procedure, caused by critical obstruction to blood perfusion of the Spinal Cord. Spinal Cord Ischemia (SCI) may be due to hemodynamic impairment and/or to segmental artery occlusion during aortic clamping [1,2]. We report a case of chronically dissected Thoraco-abdominal Aortic Aneurysm (TAAA) which showed unilateral transient neurological impairment of the left lower limb, postoperatively.","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":"48667678","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 : 2018-01-01Epub Date: 2018-04-26DOI: 10.23937/2377-4630/1410064
Luis Tollinche, KaySee Tan, Austin Han, Leslie Ojea, Cindy Yeoh
Background: In a climate of cost containment, it is critical to analyze and optimize all perioperative variable costs. Fresh gas flow is one important variable that determines utilization of inhalational agents and can be tightly controlled by the anesthesia provider. Manufacturers of inhalational agents have recommendations for minimum gas flow for their respective agents. Any gas flow above these recommendations is considered misuse and leads to unnecessary expense. The purpose of this study was to characterize and quantify the excess use of inhalational agents by analyzing fresh gas flow rates for long duration cases.
Methods: Over a span of three months, operating room records were analyzed for all procedures lasting greater than 4 hours. End tidal inhalation agent percentage for Sevoflurane and Isoflurane and fresh gas flows were analyzed. 303 unique patients with at least 4 hours of anesthesia time were included. Analysis excluded the first and last 30 minutes of all anesthetics to account for need for higher gas flows during induction/emergence of anesthesia. 152 patients received sevoflurane alone. 33 patients received isoflurane alone. 107 patients received both isoflurane and sevoflurane and were included in sevoflurane group given the higher gas flow needs of sevoflurane. 11 patients received neither agent and were excluded from analysis. We proceed with n = 292 unique patients. (259 in Sevo, 33 in iso) We used the two-sided one sample t-test setting 2 ml/min as the null for sevo and 1 ml/min as the null for iso; we ran analysis using a nonparametric test that didn't require the fresh gas flow to be normally distributed - the two-sided one-sample Wilcoxon rank-sum test: p value = < 0.0001.
Results: The results of our study revealed a sevoflurane (n = 259) mean fresh gas flow (L/min) 2.55 (95% CI, 2.45-2.66) - significantly different from null of 2 ml/min (p < 0.0001). Isoflurane (n = 33) mean fresh gas flows (L/min) 2.33 (95% CI, 2.00-2.66) - significantly different from null of 1 l/min (p < 0.0001).
Conclusion: Manufacturer recommendation for sevoflurane is to maintain gas flows 1-2 l/min and Isoflurane at above 1 l/min. Given these recommendations, the anesthesia providers delivered fresh gas flows at least 28% higher than necessary for sevoflurane and at least 130% greater than necessary for isoflurane anesthetics that lasted greater than 4 hours. This is an area where cost reduction can be readily achieved. Future plans to realize a reduction in inhalational agent utilization include education of the benefits of fresh gas flow and instituting a low fresh gas flow policy.
{"title":"Analyzing Volatile Anesthetic Consumption by Auditing Fresh Gas Flow: An Observational Study at an Academic Hospital.","authors":"Luis Tollinche, KaySee Tan, Austin Han, Leslie Ojea, Cindy Yeoh","doi":"10.23937/2377-4630/1410064","DOIUrl":"https://doi.org/10.23937/2377-4630/1410064","url":null,"abstract":"<p><strong>Background: </strong>In a climate of cost containment, it is critical to analyze and optimize all perioperative variable costs. Fresh gas flow is one important variable that determines utilization of inhalational agents and can be tightly controlled by the anesthesia provider. Manufacturers of inhalational agents have recommendations for minimum gas flow for their respective agents. Any gas flow above these recommendations is considered misuse and leads to unnecessary expense. The purpose of this study was to characterize and quantify the excess use of inhalational agents by analyzing fresh gas flow rates for long duration cases.</p><p><strong>Methods: </strong>Over a span of three months, operating room records were analyzed for all procedures lasting greater than 4 hours. End tidal inhalation agent percentage for Sevoflurane and Isoflurane and fresh gas flows were analyzed. 303 unique patients with at least 4 hours of anesthesia time were included. Analysis excluded the first and last 30 minutes of all anesthetics to account for need for higher gas flows during induction/emergence of anesthesia. 152 patients received sevoflurane alone. 33 patients received isoflurane alone. 107 patients received both isoflurane and sevoflurane and were included in sevoflurane group given the higher gas flow needs of sevoflurane. 11 patients received neither agent and were excluded from analysis. We proceed with n = 292 unique patients. (259 in Sevo, 33 in iso) We used the two-sided one sample t-test setting 2 ml/min as the null for sevo and 1 ml/min as the null for iso; we ran analysis using a nonparametric test that didn't require the fresh gas flow to be normally distributed - the two-sided one-sample Wilcoxon rank-sum test: p value = < 0.0001.</p><p><strong>Results: </strong>The results of our study revealed a sevoflurane (n = 259) mean fresh gas flow (L/min) 2.55 (95% CI, 2.45-2.66) - significantly different from null of 2 ml/min (p < 0.0001). Isoflurane (n = 33) mean fresh gas flows (L/min) 2.33 (95% CI, 2.00-2.66) - significantly different from null of 1 l/min (p < 0.0001).</p><p><strong>Conclusion: </strong>Manufacturer recommendation for sevoflurane is to maintain gas flows 1-2 l/min and Isoflurane at above 1 l/min. Given these recommendations, the anesthesia providers delivered fresh gas flows at least 28% higher than necessary for sevoflurane and at least 130% greater than necessary for isoflurane anesthetics that lasted greater than 4 hours. This is an area where cost reduction can be readily achieved. Future plans to realize a reduction in inhalational agent utilization include education of the benefits of fresh gas flow and instituting a low fresh gas flow policy.</p>","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2d/d6/nihms969072.PMC6020703.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36276013","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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