Background: The occurrence of femoral fractures is quite high. The quality of life gets affected to a large extent due to pain and post-operative delirium. Various regional block techniques like Fascia illiaca compartment block, lumbar epidural analgesia, femoral nerve block, etc. have been described for femoral fractures. In this study, we compared the efficacy of post-operative pain relief FICB and Epidural block on quality of recovery (QOR-15) in patients undergoing femoral surgery. Methods: This study included 40 patients wherein 20 patients were given FICB and 20 patients were given Epidural block. The patients were followed up for post-operative pain relief, Quality of Recovery, occurrence of delirium, disability and fraility. Results: Quality of recovery QOR-15 was similar for both the groups preoperatively as well as at 24 hour and 48 hours post-operatively. Additionally, there was no difference in the time taken to administer the block, postoperative VAS score on movement and rest, requirement of additional analgesia and opioid consumption. Moreover, there were no significant differences in WHO disability assessment, modified frailty score, prevalence of delirium, mortality, morbidity and side effects of techniques. However, the total duration of hospital stay (in days) was found to be significantly more in the epidural group as compared with the FICB group (5.75±1.61 vs 4.75±1.16; P=0.38). Conclusion: Ultrasound guided fascia iliaca compartment block is a tangible alternative to epidural block in patients undergoing femoral fracture repair.
{"title":"Comparison of the Efficacy of Postoperative Pain Relief in Ultrasound Guided Fascia Illiaca Compartment Block versus Epidural Block on Quality of Recovery (QOR-15) in Patients Undergoing Femoral Surgery","authors":"Sukanya Mitra, Jasveer Singh, Kompal Jain, Harjit Sharma, Prateek Upadhyay","doi":"10.26420/austinjanesthesiaandanalgesia.2023.1112","DOIUrl":"https://doi.org/10.26420/austinjanesthesiaandanalgesia.2023.1112","url":null,"abstract":"Background: The occurrence of femoral fractures is quite high. The quality of life gets affected to a large extent due to pain and post-operative delirium. Various regional block techniques like Fascia illiaca compartment block, lumbar epidural analgesia, femoral nerve block, etc. have been described for femoral fractures. In this study, we compared the efficacy of post-operative pain relief FICB and Epidural block on quality of recovery (QOR-15) in patients undergoing femoral surgery. Methods: This study included 40 patients wherein 20 patients were given FICB and 20 patients were given Epidural block. The patients were followed up for post-operative pain relief, Quality of Recovery, occurrence of delirium, disability and fraility. Results: Quality of recovery QOR-15 was similar for both the groups preoperatively as well as at 24 hour and 48 hours post-operatively. Additionally, there was no difference in the time taken to administer the block, postoperative VAS score on movement and rest, requirement of additional analgesia and opioid consumption. Moreover, there were no significant differences in WHO disability assessment, modified frailty score, prevalence of delirium, mortality, morbidity and side effects of techniques. However, the total duration of hospital stay (in days) was found to be significantly more in the epidural group as compared with the FICB group (5.75±1.61 vs 4.75±1.16; P=0.38). Conclusion: Ultrasound guided fascia iliaca compartment block is a tangible alternative to epidural block in patients undergoing femoral fracture repair.","PeriodicalId":92989,"journal":{"name":"Austin journal of anesthesia and analgesia","volume":" 40","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141368134","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 : 2023-04-01DOI: 10.26420/austinjanesthesiaandanalgesia.2023.1110
Hicham Bennani, W. Atmani, Y. Arjouni, Abdelouahed Houba, N. Doghmi
Objective: Describe the epidemiological characteristics of COVID-19 patients admitted to the intensive care unit. Methods: This was a prospective observational study of 6 months (August 2020 to February 2021) carried out at the COVID-19 resuscitation service of the Mohammed V military hospital. Results: During the study period, all patients tested positive for SARS-CoV-2; 300 were admitted to intensive care. The average age of patients was 67±11 years, with 217 male (72.3%) of cases, with a sex ratio (M/F) of 2.61. The majority of patients with at least one medical comorbidity 54%, including diabetes (35.7%), high blood pressure (31.8%), and obesity (29.7%). The mortality rate was 53.3% of all patients admitted to intensive care. Conclusion: During this period all patients declared COVID-19 a small proportion of patients were admitted to intensive care. These patients were mainly elderly and male, with at least one comorbidity.
{"title":"Epidemiological Profiles of COVID-19 Patients Admitted to Intensive Care","authors":"Hicham Bennani, W. Atmani, Y. Arjouni, Abdelouahed Houba, N. Doghmi","doi":"10.26420/austinjanesthesiaandanalgesia.2023.1110","DOIUrl":"https://doi.org/10.26420/austinjanesthesiaandanalgesia.2023.1110","url":null,"abstract":"Objective: Describe the epidemiological characteristics of COVID-19 patients admitted to the intensive care unit. Methods: This was a prospective observational study of 6 months (August 2020 to February 2021) carried out at the COVID-19 resuscitation service of the Mohammed V military hospital. Results: During the study period, all patients tested positive for SARS-CoV-2; 300 were admitted to intensive care. The average age of patients was 67±11 years, with 217 male (72.3%) of cases, with a sex ratio (M/F) of 2.61. The majority of patients with at least one medical comorbidity 54%, including diabetes (35.7%), high blood pressure (31.8%), and obesity (29.7%). The mortality rate was 53.3% of all patients admitted to intensive care. Conclusion: During this period all patients declared COVID-19 a small proportion of patients were admitted to intensive care. These patients were mainly elderly and male, with at least one comorbidity.","PeriodicalId":92989,"journal":{"name":"Austin journal of anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49530107","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 : 2023-01-27DOI: 10.26420/austinjanesthesiaandanalgesia.2023.1109
Masad Ilyass, Abouelalaa Kh, Elbouti An, Fakri Ah, Elwali Ab, Bensghir Mu
Neurogenic bradycardia which can lead to cardiac arrest is a rare, but well-recognized complication of anesthesia. we report the cases of two patients admitted for craniotomy who presented intraoperative bradycardia due to TrigeminoCardiac Reflex and Hypothalamic stimulation immediately reversible after cessation of stimulation. The importance of having the knowledge, vigilance, equipment and skills to quickly deal with such a case will be critical to the survival of the patient.
{"title":"Neurogenic Bradycardia in Perioperative of Neurosurgery: A Dreadful Complication 2 Cases and Literature Review","authors":"Masad Ilyass, Abouelalaa Kh, Elbouti An, Fakri Ah, Elwali Ab, Bensghir Mu","doi":"10.26420/austinjanesthesiaandanalgesia.2023.1109","DOIUrl":"https://doi.org/10.26420/austinjanesthesiaandanalgesia.2023.1109","url":null,"abstract":"Neurogenic bradycardia which can lead to cardiac arrest is a rare, but well-recognized complication of anesthesia. we report the cases of two patients admitted for craniotomy who presented intraoperative bradycardia due to TrigeminoCardiac Reflex and Hypothalamic stimulation immediately reversible after cessation of stimulation. The importance of having the knowledge, vigilance, equipment and skills to quickly deal with such a case will be critical to the survival of the patient.","PeriodicalId":92989,"journal":{"name":"Austin journal of anesthesia and analgesia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43823548","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 : 2022-11-14DOI: 10.26420/austinjanesthesiaandanalgesia.2022.1108
Nehme Pw, Maalouli Jm, Merheb Mt, Gharios Em
Background: The Baricity of bupivacaine is one of the most important factors to influence the characteristics of distribution of the local anaesthetic and spread of the blockade. Bupivacaine is rendered hyperbaric by adding glucose. The effect of differing degrees of hyperbaricity remains to be evaluated in term of spinal anesthesia blockade. Methods: Hundred patients who underwent lower abdominal, hips, and lower extremity surgeries were randomized into two groups in a double-blind, randomised, parallel group, prospective study. Group I received 0.5% isobaric bupivacaine with 80 mg/ml of glucose, while Group II received 0.5% isobaric bupivacaine with 40 mg/ml of glucose. Injection was made intrathecally in midline position at L3-4 and L4-L5 interspace in sitting position. The measured sensory blockade and motor blockade are the onset and duration. Duration of sensory block was the time measured from the time of the highest block for the regression to the S2 dermatome. Results: Success rate, spread and duration of sensory block were similar in both groups. The highest median level of sensory block was T3 (T2-T7) (median (10th/90th percentiles)) in both groups. Time to reach T10 did not differ between the groups. Power analysis suggested that a total number of 100 adults were required in both groups for a 90% chance at the 0.05 level of significance of detecting a10% difference in success between groups. Categorical data were tested using the chi square test. For continuous data the Mann–Whitney test was used. Results are presented as median (10–90th percentiles), number (%) of cases, the significance was set as P<0.05. Conclusion: These results demonstrate that bupivacaine in 80mg/ml glucose provides reliable spinal anaesthesia of shorter duration and with less hypotension than bupivacaine in 40 mg/ml glucose. The recovery profile for ropivacaine may be of interest given that more surgery is being performed in the day-case setting.
{"title":"Hyperbaric Bupivacaine for Spinal Anaesthesia in Adults Patients: Comparison of Isobaric Bupivacaine 0.5% in 80mg/Ml and 40 Mg/Ml Glucose Solutions","authors":"Nehme Pw, Maalouli Jm, Merheb Mt, Gharios Em","doi":"10.26420/austinjanesthesiaandanalgesia.2022.1108","DOIUrl":"https://doi.org/10.26420/austinjanesthesiaandanalgesia.2022.1108","url":null,"abstract":"Background: The Baricity of bupivacaine is one of the most important factors to influence the characteristics of distribution of the local anaesthetic and spread of the blockade. Bupivacaine is rendered hyperbaric by adding glucose. The effect of differing degrees of hyperbaricity remains to be evaluated in term of spinal anesthesia blockade. Methods: Hundred patients who underwent lower abdominal, hips, and lower extremity surgeries were randomized into two groups in a double-blind, randomised, parallel group, prospective study. Group I received 0.5% isobaric bupivacaine with 80 mg/ml of glucose, while Group II received 0.5% isobaric bupivacaine with 40 mg/ml of glucose. Injection was made intrathecally in midline position at L3-4 and L4-L5 interspace in sitting position. The measured sensory blockade and motor blockade are the onset and duration. Duration of sensory block was the time measured from the time of the highest block for the regression to the S2 dermatome. Results: Success rate, spread and duration of sensory block were similar in both groups. The highest median level of sensory block was T3 (T2-T7) (median (10th/90th percentiles)) in both groups. Time to reach T10 did not differ between the groups. Power analysis suggested that a total number of 100 adults were required in both groups for a 90% chance at the 0.05 level of significance of detecting a10% difference in success between groups. Categorical data were tested using the chi square test. For continuous data the Mann–Whitney test was used. Results are presented as median (10–90th percentiles), number (%) of cases, the significance was set as P<0.05. Conclusion: These results demonstrate that bupivacaine in 80mg/ml glucose provides reliable spinal anaesthesia of shorter duration and with less hypotension than bupivacaine in 40 mg/ml glucose. The recovery profile for ropivacaine may be of interest given that more surgery is being performed in the day-case setting.","PeriodicalId":92989,"journal":{"name":"Austin journal of anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47632856","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 : 2022-07-21DOI: 10.26420/austinjanesthesiaandanalgesia.2022.1107
Moutaoukil Md, Najout H, E. A, B. M
Introduction: The use of neuromuscular relaxants is needed in electroconvulsive therapy (ECT) to minimize the convulsive motor activity. Succinylcholine is the most useful and commonly available neuromuscular relaxant agent for ECT. However, rocuronium with subsequent use of sugammadex was proposed for ECT as an alternative to succinylcholine. Methods: A small case series of four patients with major depressive disorder recruited as part of a preliminary study is presented. The purpose of this study was to investigate the effect of a small dose succinylcholine (0.5 mg/ kg) and rocuronium (0.3 mg/kg)-sugammadex (4 mg/kg) complex on clinical recovery during ECT as well as ECT quality and the incidence of side effects. Results: Forty-eight ECT sessions were conducted in total in the post anesthesia care unit. The mean extent of motor seizure modification score was significantly higher in the group rocuronium-sugammadex (p=0.003). The mean time to resume spontaneous respiration and time to eye opening to verbal command were shorter following rocuronium blockade with 4 mg/ kg of sugammadex compared with succinylcholine (p=0.011 and p=0.028 respectively). Agitation and myalgia were significantly lower in rocuroniumsugammadex group (p=0.043 and p=0.01 respectively). Conclusion: This small case series study demonstrates the efficacy of rocuronium (0.3 mg/kg)–sugammadex (4 mg/kg) as an alternative to succinylcholine (0.5 mg/kg).
{"title":"Comparison of Rocuronium-Sugammadex and Succinylcholine during Electroconvulsive Therapy: A Small Observational Case Series Study","authors":"Moutaoukil Md, Najout H, E. A, B. M","doi":"10.26420/austinjanesthesiaandanalgesia.2022.1107","DOIUrl":"https://doi.org/10.26420/austinjanesthesiaandanalgesia.2022.1107","url":null,"abstract":"Introduction: The use of neuromuscular relaxants is needed in electroconvulsive therapy (ECT) to minimize the convulsive motor activity. Succinylcholine is the most useful and commonly available neuromuscular relaxant agent for ECT. However, rocuronium with subsequent use of sugammadex was proposed for ECT as an alternative to succinylcholine. Methods: A small case series of four patients with major depressive disorder recruited as part of a preliminary study is presented. The purpose of this study was to investigate the effect of a small dose succinylcholine (0.5 mg/ kg) and rocuronium (0.3 mg/kg)-sugammadex (4 mg/kg) complex on clinical recovery during ECT as well as ECT quality and the incidence of side effects. Results: Forty-eight ECT sessions were conducted in total in the post anesthesia care unit. The mean extent of motor seizure modification score was significantly higher in the group rocuronium-sugammadex (p=0.003). The mean time to resume spontaneous respiration and time to eye opening to verbal command were shorter following rocuronium blockade with 4 mg/ kg of sugammadex compared with succinylcholine (p=0.011 and p=0.028 respectively). Agitation and myalgia were significantly lower in rocuroniumsugammadex group (p=0.043 and p=0.01 respectively). Conclusion: This small case series study demonstrates the efficacy of rocuronium (0.3 mg/kg)–sugammadex (4 mg/kg) as an alternative to succinylcholine (0.5 mg/kg).","PeriodicalId":92989,"journal":{"name":"Austin journal of anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46177499","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 : 2022-05-05DOI: 10.26420/austinjanesthesiaandanalgesia.2022.1106
Prusak M, Liu Dt, E. P., König Sl, Windpassinger M
Background and Objectives: Topically applied epinephrine is used routinely in ear surgery to stop bleeding in the operating field. The data on its effect on postoperative pain perception has been missing so far. Materials and Methods: We carried out a single center retrospective cohort study of patients undergoing ear surgery over a period of 12 months. Epinephrine given intraoperatively was compared to piritramide dose given postoperatively. Patients receiving no piritramide intraoperatively were additionally compared to postoperative VAS score. Results: There was no difference in piritramid dose required for pain therapy as well as in VAS score in 230 patients included in the analysis. Conclusions: Epinephrine used in ear surgery has no effect on pain perception and thus may not be taken in consideration in postoperative pain management.
{"title":"Effect of Topic Epinephrine on Opioid Consumption in Ear Surgery","authors":"Prusak M, Liu Dt, E. P., König Sl, Windpassinger M","doi":"10.26420/austinjanesthesiaandanalgesia.2022.1106","DOIUrl":"https://doi.org/10.26420/austinjanesthesiaandanalgesia.2022.1106","url":null,"abstract":"Background and Objectives: Topically applied epinephrine is used routinely in ear surgery to stop bleeding in the operating field. The data on its effect on postoperative pain perception has been missing so far. Materials and Methods: We carried out a single center retrospective cohort study of patients undergoing ear surgery over a period of 12 months. Epinephrine given intraoperatively was compared to piritramide dose given postoperatively. Patients receiving no piritramide intraoperatively were additionally compared to postoperative VAS score. Results: There was no difference in piritramid dose required for pain therapy as well as in VAS score in 230 patients included in the analysis. Conclusions: Epinephrine used in ear surgery has no effect on pain perception and thus may not be taken in consideration in postoperative pain management.","PeriodicalId":92989,"journal":{"name":"Austin journal of anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47454198","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 : 2022-02-28DOI: 10.26420/austinjanesthesiaandanalgesia.2022.1104
Grossmann B, Nilsson A
Background: Patient-controlled sedation (PCS) is an efficient and costsaving method for sedation during flexible bronchoscopy (FB) in the presence of anaesthetic staff, but no data is available for PCS in a non-anaesthesiologist environment. Methods: This descriptive study describes PCS with propofol in a non-anaesthesiologist setup during outpatient FB procedures, including transbronchial biopsy, transbronchial needle aspiration, cryotherapy/biopsy and/or multistation endobronchial ultrasound, and endoscopic ultrasound with bronchoscope. Results: 287 procedures were completed. The median (range) duration for the procedures was 45 (10-105) minutes. The median (range) total propofol dose administered was 201 (55-570) mg, and 61 procedures (21%) required bolus doses of alfentanil. Desaturation occurred during 21% of the procedures and was resolved spontaneously (59%) or by using a jaw thrust (41%). No evidence was found that alfentanil contributed to desaturation (p=0.081). Inconsistent results were shown regarding the impact of alfentanil on the reduction of cough. The post-procedural assessment revealed high score of satisfaction and feasibility. 3 (1%) procedures were cancelled due to insufficient sedation. No prolonged recovery with need of overnight stay was reported. The direct costs for sedation were 180 USD/procedure. Conclusion: PCS with propofol and the presence of trained nonanaesthesiologists during outpatient FB has shown to result in high procedure feasibility and satisfaction without compromising patient safety or increasing the risk for unhandled respiratory adverse events. The method reduces costs for sedation and offers the possibility to increase patient turn over due to no prolonged recovery.
{"title":"Patient-Controlled Sedation by Non-Anaesthesiologists during Flexible Bronchoscopy: A One-Year Experience Regarding Safety, Feasibility and Costs","authors":"Grossmann B, Nilsson A","doi":"10.26420/austinjanesthesiaandanalgesia.2022.1104","DOIUrl":"https://doi.org/10.26420/austinjanesthesiaandanalgesia.2022.1104","url":null,"abstract":"Background: Patient-controlled sedation (PCS) is an efficient and costsaving method for sedation during flexible bronchoscopy (FB) in the presence of anaesthetic staff, but no data is available for PCS in a non-anaesthesiologist environment. Methods: This descriptive study describes PCS with propofol in a non-anaesthesiologist setup during outpatient FB procedures, including transbronchial biopsy, transbronchial needle aspiration, cryotherapy/biopsy and/or multistation endobronchial ultrasound, and endoscopic ultrasound with bronchoscope. Results: 287 procedures were completed. The median (range) duration for the procedures was 45 (10-105) minutes. The median (range) total propofol dose administered was 201 (55-570) mg, and 61 procedures (21%) required bolus doses of alfentanil. Desaturation occurred during 21% of the procedures and was resolved spontaneously (59%) or by using a jaw thrust (41%). No evidence was found that alfentanil contributed to desaturation (p=0.081). Inconsistent results were shown regarding the impact of alfentanil on the reduction of cough. The post-procedural assessment revealed high score of satisfaction and feasibility. 3 (1%) procedures were cancelled due to insufficient sedation. No prolonged recovery with need of overnight stay was reported. The direct costs for sedation were 180 USD/procedure. Conclusion: PCS with propofol and the presence of trained nonanaesthesiologists during outpatient FB has shown to result in high procedure feasibility and satisfaction without compromising patient safety or increasing the risk for unhandled respiratory adverse events. The method reduces costs for sedation and offers the possibility to increase patient turn over due to no prolonged recovery.","PeriodicalId":92989,"journal":{"name":"Austin journal of anesthesia and analgesia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41389206","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 : 2022-02-01DOI: 10.26420/austinjanesthesiaandanalgesia.2022.1103
A. W., A. B., E. A, M. M., Jaafari A, E. A, B. A, B. M
In Morocco, the Ministry of Health announces the registration of the first confirmed case of the new Coronavirus, by the Institut Pasteur in Morocco, during the evening of Monday March 02, 2020, at a Moroccan national residing in Italy, Morocco has declared a state of health emergency and confinement as of Friday March 20 at 6 p.m., in order to contain the spread of Covid-19. Aims: The study aimed to study the impact of COVID-19 on general surgical practice during three months compared to previous years and the future implications of the pandemic. Methods: Observational descriptive study being carried out in the central operating room of the military hospital in Rabat, evaluating the impact of Covid-19 on the planned surgery by thus comparing the activity of the unit during the three months of confinement March April May between 2018, 2019 and 2020. Results: The total number of surgeries has decreased to 497 in 12 weeks compared to 2073 at 2018 and 1900 at 2019. Cancer surgery has seen a decrease of 40% compared to the previous years, this reduction mainly concerns neurosurgery; ENT, and stomatology as for other specialties the number was almost the same. Benign surgery has seen a decrease of 70% compared to the previous years; all surgery combined has seen a reduction in the number of patients; this reduction is mainly due to the socio-demographic factor, the difficulty of traveling due to confinement.
{"title":"Impact of COVID-19 on Elective Surgery: HMIMV Rabat Experience between 15/03 and 15/06 (2018-2019-2020)","authors":"A. W., A. B., E. A, M. M., Jaafari A, E. A, B. A, B. M","doi":"10.26420/austinjanesthesiaandanalgesia.2022.1103","DOIUrl":"https://doi.org/10.26420/austinjanesthesiaandanalgesia.2022.1103","url":null,"abstract":"In Morocco, the Ministry of Health announces the registration of the first confirmed case of the new Coronavirus, by the Institut Pasteur in Morocco, during the evening of Monday March 02, 2020, at a Moroccan national residing in Italy, Morocco has declared a state of health emergency and confinement as of Friday March 20 at 6 p.m., in order to contain the spread of Covid-19. Aims: The study aimed to study the impact of COVID-19 on general surgical practice during three months compared to previous years and the future implications of the pandemic. Methods: Observational descriptive study being carried out in the central operating room of the military hospital in Rabat, evaluating the impact of Covid-19 on the planned surgery by thus comparing the activity of the unit during the three months of confinement March April May between 2018, 2019 and 2020. Results: The total number of surgeries has decreased to 497 in 12 weeks compared to 2073 at 2018 and 1900 at 2019. Cancer surgery has seen a decrease of 40% compared to the previous years, this reduction mainly concerns neurosurgery; ENT, and stomatology as for other specialties the number was almost the same. Benign surgery has seen a decrease of 70% compared to the previous years; all surgery combined has seen a reduction in the number of patients; this reduction is mainly due to the socio-demographic factor, the difficulty of traveling due to confinement.","PeriodicalId":92989,"journal":{"name":"Austin journal of anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49079840","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 : 2021-11-02DOI: 10.26420/austinjanesthesiaandanalgesia.2021.1102
Vaibhav Taneja, S. Mitra, Jasveer Singh, S. Jindal, Ravi Gupta
Background: Ultrasound-Guided Continuous Interscalene Block (USGCISB) decreases postoperative morbidity following arthroscopic shoulder surgery. Both dexamethasone and clonidine have been shown to prolong the duration of analgesia when added with ropivacaine in peripheral nerve blocks. However, there is no head-to-head comparison between dexamethasone and clonidine as an adjuvant using USG-CISB. Methods: In this randomized double-blinded controlled trial, 60 ASA grade 1-2 patients, 18-65 years, scheduled for arthroscopic shoulder surgery under general Anaesthesia following USG-CISB with perineural catheter using 30 ml of 0.5% ropivacaine were randomly allocated to Group 1 (adjunct dexamethasone 8 mg) or Group 2 (adjunct clonidine 150 μg). Primary outcome was duration of postoperative analgesia, as measured (in min) from the achievement of adequate sensory block till the first bolus of 0.2% ropivacaine by patient controlled regional analgesia. Secondary outcomes were measures of the pain ratings, total postoperative analgesic consumption, patient satisfaction, and adverse effects over 48h postoperatively. Results: The median duration of analgesia in Group 1 was significantly longer than Group 2 (1432 min vs. 751 min; P < 0.001). Median total postoperative analgesic consumption in Group 1 was significantly less than Group 2 (84 ml vs. 120 ml; P < 0.001). Median patient satisfaction score in Group 1 was significantly more than Group 2 (90 vs. 84; P = 0.001). Postoperative adverse effects were few and comparable. Conclusion: Compared to clonidine, dexamethasone significantly prolonged the duration of analgesia, decreased postoperative analgesic consumption, and increased patient satisfaction following USG-CISB when used as an adjunct to ropivacaine for arthroscopic shoulder surgery.
背景:超声引导的连续斜角肌间阻滞(USGCISB)降低肩关节镜手术后的术后发病率。当周围神经阻滞中加入罗哌卡因时，地塞米松和可乐定均可延长镇痛持续时间。然而，在USG-CISB的辅助治疗中，地塞米松和可乐定没有正面比较。方法:随机双盲对照试验，60例ASA级1-2级患者，年龄18-65岁，USG-CISB术后全身麻醉行关节镜肩关节手术，经神经周导管置入0.5%罗哌卡因30 ml，随机分为1组(辅助地塞米松8 mg)和2组(辅助克拉定150 μg)。主要终点是术后镇痛的持续时间，从达到足够的感觉阻滞到通过患者控制的局部镇痛第一次注射0.2%罗哌卡因(以分钟为单位)。次要结局是测量疼痛评分、术后总止痛药用量、患者满意度和术后48小时的不良反应。结果:组1中位镇痛时间明显长于组2 (1432 min vs. 751 min;P < 0.001)。组1术后镇痛总用量中位数显著低于组2 (84 ml vs 120 ml;P < 0.001)。组1患者满意度中位数明显高于组2(90分vs. 84分;P = 0.001)。术后不良反应少且具有可比性。结论:与克拉定相比，地塞米松作为罗哌卡因关节镜肩关节手术的辅助用药，显著延长了镇痛持续时间，减少了术后镇痛消耗，提高了USG-CISB术后患者满意度。
{"title":"A Randomized Double-Blind Trial Comparing the Efficacy of Dexamethasone vs. Clonidine as an Adjunct to Ropivacaine in Ultrasound Guided Continuous Interscalene Block for Arthroscopic Shoulder Surgery","authors":"Vaibhav Taneja, S. Mitra, Jasveer Singh, S. Jindal, Ravi Gupta","doi":"10.26420/austinjanesthesiaandanalgesia.2021.1102","DOIUrl":"https://doi.org/10.26420/austinjanesthesiaandanalgesia.2021.1102","url":null,"abstract":"Background: Ultrasound-Guided Continuous Interscalene Block (USGCISB) decreases postoperative morbidity following arthroscopic shoulder surgery. Both dexamethasone and clonidine have been shown to prolong the duration of analgesia when added with ropivacaine in peripheral nerve blocks. However, there is no head-to-head comparison between dexamethasone and clonidine as an adjuvant using USG-CISB. Methods: In this randomized double-blinded controlled trial, 60 ASA grade 1-2 patients, 18-65 years, scheduled for arthroscopic shoulder surgery under general Anaesthesia following USG-CISB with perineural catheter using 30 ml of 0.5% ropivacaine were randomly allocated to Group 1 (adjunct dexamethasone 8 mg) or Group 2 (adjunct clonidine 150 μg). Primary outcome was duration of postoperative analgesia, as measured (in min) from the achievement of adequate sensory block till the first bolus of 0.2% ropivacaine by patient controlled regional analgesia. Secondary outcomes were measures of the pain ratings, total postoperative analgesic consumption, patient satisfaction, and adverse effects over 48h postoperatively. Results: The median duration of analgesia in Group 1 was significantly longer than Group 2 (1432 min vs. 751 min; P < 0.001). Median total postoperative analgesic consumption in Group 1 was significantly less than Group 2 (84 ml vs. 120 ml; P < 0.001). Median patient satisfaction score in Group 1 was significantly more than Group 2 (90 vs. 84; P = 0.001). Postoperative adverse effects were few and comparable. Conclusion: Compared to clonidine, dexamethasone significantly prolonged the duration of analgesia, decreased postoperative analgesic consumption, and increased patient satisfaction following USG-CISB when used as an adjunct to ropivacaine for arthroscopic shoulder surgery.","PeriodicalId":92989,"journal":{"name":"Austin journal of anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46376534","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 : 2021-10-28DOI: 10.26420/austinjanesthesiaandanalgesia.2021.1101
Soghomonyan S, K. S., L. l, Soghomonyan G, Grossbach Aj
Spinal surgery carries the risk of significant intraoperative blood loss requiring blood transfusions. In patients with coexisting coagulopathy the risk is substantially higher, and proper correction of coagulation deficiency is mandatory to avoid major and uncontrolled blood loss and hematoma formation with spinal cord compression. We present a clinical case of successful cervical tumor removal in a patient with coexisting hemophilia A and Ehlers-Danlos syndrome. Coordination of the treatment plan between anesthesia providers, surgeons, and the hematological service helped to uneventfully remove the tumor and avoid perioperative complications.
{"title":"Cervical Spinal Surgery of a Patient with Hemophilia and Ehlers-Danlos Syndrome: Anesthetic Considerations","authors":"Soghomonyan S, K. S., L. l, Soghomonyan G, Grossbach Aj","doi":"10.26420/austinjanesthesiaandanalgesia.2021.1101","DOIUrl":"https://doi.org/10.26420/austinjanesthesiaandanalgesia.2021.1101","url":null,"abstract":"Spinal surgery carries the risk of significant intraoperative blood loss requiring blood transfusions. In patients with coexisting coagulopathy the risk is substantially higher, and proper correction of coagulation deficiency is mandatory to avoid major and uncontrolled blood loss and hematoma formation with spinal cord compression. We present a clinical case of successful cervical tumor removal in a patient with coexisting hemophilia A and Ehlers-Danlos syndrome. Coordination of the treatment plan between anesthesia providers, surgeons, and the hematological service helped to uneventfully remove the tumor and avoid perioperative complications.","PeriodicalId":92989,"journal":{"name":"Austin journal of anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42766535","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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