In recent years careful research has allowed us to identify that it was the Bologna surgeon Benedetto Schiassi who performed the first spinal anesthesia in Italy. The day was December 27, 1899 and the location was the Umberto and Margherita hospital in Budrio, his birthplace. There are four of his publications that, combined with the documentation retrieved from the archive of the Budrio hospital, attest to the first execution of a surgical operation with spinal anesthesia. The patient, a 70-year-old man, needed to undergo urgent leg amputation, as he was suffering from progressive and worsening gangrene of the right foot. His general clinical condition, characterized by dangerous toxic and infectious state, left ventricle dilatation and arrhythmia, was so compromised that Schiassi considered general anesthesia extremely risky, which at the time was performed with ether or chloroform. The drug used was cocaine, universally recognized as the forefather of all local anesthetics.
Background and aims: The study aimed was to assess the effect of magnesium on the incidence of atrial fibrillation undergoing coronary artery surgery. Materials and Methods: A double-blinded randomized study included 276 patients classified into two groups (each=138): Group M–the patients received magnesium sulphate infusion (15 mg/kg/h). The infusion was started 20 min before induction, during surgery and the first postoperative 24 hours. Group C–the patients received an equal amount of normal saline. The variables included incidence of atrial fibrillation, amiodarone level of magnesium, potassium, troponin I and creatinine kinase-MB, ECG changes. Results: The incidence of atrial fibrillation was 17(12.31%) patients in group M compared to 38(27.53%) patients in group C(P=0.002). The highest incidence was through the second day and it was 8(12.31%) patients in group M compared to 19(12.31%) patients in group C(P=0.042). The requirement for amiodarone was 17(12.31%) patients in group M compared to 38(27.53%) patients in group C(P=0.002). The blood level of magnesium and potassium was significantly higher in group M compared to group C(P<0.05). The troponin I level, CK-MB and ECG changes were lower in group M than group C(P<0.05). The magnesium sulphate decreases the incidence of atrial fibrillation in patients with ischemic heart diseases undergoing CABG. It decreases the requirement for amiodarone, incidence of perioperative myocardial infarction, the requirement of pharmacological and mechanical support. Keywords: Magnesium Sulfate, Coronary Artery Bypass Grafting, Atrial Fibrillation, Amiodarone, Troponin I, Creatinine Kinase-Mb Isoenzyme. Impact of Employee Compensation and Benefits on Operating Performance This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. Copyright © Author(s) retain the copyright of this article.
What is already known?• Steroids have been widely used in patients when severe inflammation needs to be rapidly attenuated.• Steroids may cause adverse effects.• Dexamethasone has been occasionally reported as causing hiccups in cancer patients.• The classification of hiccups is based on their duration.• Several central neurotransmitters are implicated in hiccups.• The hiccups are generated by a reflex arc with afferent, central, and efferent components.• There are reports of hiccups after dental implants using dexamethasone.What this article adds.• Three implants were performed only with antibiotic prevention.• Due to the loss of the implant in tooth 35, a new attempt was made with dexamethasone associated with the antibiotic.• Two 8 mg doses of dexamethasone were administered, and hiccups occurred after the second dose.
Introduction: Upper gastrointestinal hemorrhage is a common health problem worldwide and one of the emergencies determining a huge number of admissions into general surgery services in our scenario, it is therefore of great clinical and sanitary importance. Objective: To determine the usefulness of the modified Rockall and Baylor scores in predicting rebleeding in patients with upper gastrointestinal hemorrhage.
Background: Anesthesia for postoperative peritonitis is associated with significant mortality due to the risk of multiorgan failure.This study was conducted to find predictors of this mortality.Methods: This is a multicenter documentary analytical study conducted from 01/01/2017 to 12/31/2021 in patients anesthetized for postoperative peritonitis.Sociodemographic, clinical, and evolutionary data were collected and analyzed with SPSS 23.0 using, depending on the type of data; t Student, chi-square and Fischer's exact tests, logistic regression and Kaplan Meir curves for p˂0.05. Results: Two hundred and one patients were included in the study, the average age was 30 years (SD: 19); there were more or less as many men as women (sex ratio 0.97); 28.4% had comorbidities; 62.7% were transferred from peripheral structures, of which 57.7% were operated on urgently with appendicitis as the main indication (30.8%); surgery performed by a junior in 59.2%.The mean recovery time was 10.25 days; consciousness was altered perioperatively in 30.3%; 58.2% were classified as ASA III; 33.8% ASA IV; all the patients were operated under general anesthesia with tracheal intubation using the association propofolketamine, suxamethonium, halogenated and fentanyl.Antibiotic therapy was empirical using the combination of C 3 G-Metronidazole (44.3%) and Piperacillin/tazobactam-aminoside (30.3%), complications were present intraoperatively in 55.2% and postoperatively in 41.8%; 5.5% irreversible cardiorespiratory arrest on induction.The overall mortality was 37.7%.Age > 65 years, ASA class > 3, impaired consciousness and the occurrence of intraoperative complications have proven to be predictors of mortality. Conclusion:Mortality in this series, although significant, is low compared to previous studies and its predictors depend more on the patient's condition and are relatively independent of anesthesia.
Background: Malignant hyperthermia (MH) is a rare pharmacogenetic syndrome characterized by a severe hypermetabolic reaction after the administration of several halogenated inhalational anesthetics or depolarizing muscle relaxants such as succinylcholine, or both. MH is related to the exacerbated release of calcium in the myoplasm causing rhabdomyolysis. This case describes a rapid onset MH (15 minutes) after induction and intubation of general anesthesia. Case Report: Male, 30 years old, 85 kg, 76 cm tall and 119 kg, admitted with pancreatitis, to undergo endoscopic retrograde cholangiopancreatography and passage of a biliary prosthesis. Anesthetic induction with 200 μg of fentanyl, 80 mg of lidocaine without vasoconstrictor, 200 mg of propofol, 100 mg of succinylcholine and sevoflurane. Fifteen minutes tachycardia, hypoxemia, increased EtCO2, muscle stiffness. MH diagnostic hypothesis, arterial blood was collected, the entire respiratory system was changed, dantrolene and an ice pack were started. Gradual improvement, he was sent to the ICU where he remained for three days, being extubated on the 2nd day, discharged to the 4th to the ICU, and hospital discharge on the 5th day. Conclusion: This case showed the MH with rapid diagnosis and despite being a potentially fatal disease, the rapid administration of dantrolene, together with maintenance doses, clinical control of symptoms, allowed a favorable outcome, with hospital discharge on 5th postoperative day. The patient refused to undergo genetic testing and that of family members. Keywords: Inhalational Anesthetics, Malignant Hyperthermia, Dantrolene, Anesthetic Complications.
Ultrasound-guided supraclavicular block has been associated with a high rate of successful surgical
Background: Laparoscopic cholecystectomy has rapidly become the procedure of choice for routine gallbladder removal and is currently the most commonly performed major abdominal procedure in Western countries.Paracetamol is a medication used to treat pain and fever.It is typically used for mild to moderate pain relief.Also it is used for severe pain, such as cancer pain and pain after surgery, in combination with opioid pain medication. Objectives:The aim of the present study was to evaluate the effects of intravenous paracetamol treatment on early postoperative period analgesia after laparoscopic cholecystectomy. Subjects and Methods:Those patients were attending the general surgical unit in Sabratha Hospital.We conducted a case-control study of 20 patients underwent laparoscopic cholecystectomy as control group (aged 25 to 55 years; 13 males, 7 females) and their nearest-aged paracetamol group (aged 24 to 55 years; 14 males, 6 females).was used to assess severity of pain in all cases and controls.Pain evaluation was performed every 15 minutes after pain control was obtained.Results: There was a significant difference between cases and controls regarding all scores of Verbal Rating Scales.The verbal evaluation scores of the paracetamol group were significantly lower than the control group. Conclusion:It can be concluded that paracetamol is effective postoperative analgesia.It is the drug of choice in patients that cannot be treated with non-steroidal anti-inflammatory drugs.Pre-operative administration of paracetamol supports effective and faster recovery.Anticipatory guidance should be provided to encourage to use paracetamol as postoperative analgesia.Further studies are needed to clarify the postoperative recovery characteristics by Modified Aldrete's Scoring System.
The use of Dorsal Root Ganglion (DRG) stimulation has been an important piece of the algorithm in treating pain related to complex regional pain syndrome (CRPS) types 1 and 2, chronic post-surgical pain, nerve injury, peripheral neuropathies, amputation and other causes of nerve injury.Since its first approval in late 2011 in Europe, this technology has evolved and is currently the best evidence driven therapy for many of the conditions noted in this review.The proper use of the device based on patient selection, spinal anatomy, and physician training is important to capture optimal outcomes that are consistent with the peer-reviewed literature.This publication reviews the key points to offering this therapy to appropriate candidates.
The last decade has seen significant advances in the treatment of coronary artery disease (CAD). Drug eluting stent and off pump CABG (OPCAB) are emerged as the alternative methods of coronary revascularization that avoids the use of cardiopulmonary bypass (CPB). The avoidance of CPB during OPCAB has made the operation equivalent to any other major non cardiac surgical procedure. This has led the cardiac anaesthesiologist to believe elective post operative ventilation may not always be necessary in these patients.
Background: Large proportion patients believe that pre-anesthetic checkup is unnecessary and a waste of time and money.Patients in some cases shows a lack of interest during the pre-anesthesia check or attempts to rush through, which may results to an incomplete case history, general physical examination and laboratory investigations.These compromise patient care and may affect health state. Objectives:The aims of the present study was to evaluate the knowledge and perception of adult patients presenting for elective surgery in Sabratha and Surman public hospitals regarding the value and importance of pre-anesthesia checkup, and to investigate the effect of patients' variables on patient's Knowledge and perception for pre anesthesia checkup.Methodology: This study was conducted in Sabratha and Surman public hospitals in western Libya, over a period of 4 month.Forty Patients were asked to fill a questionnaire consisting of 15 questions before start of pre anesthesia assessment.Each question was provided with multiple possible choices, out of which patient had to choose the most appropriate in his or her opinion.Scoring was done by awarded 1 mark for correct answer while incorrect answer was given 0 marks.Statistical Analysis for data were stated as frequencies, percentages, means and standard deviations. Results:Our results revealed that around 62.5 % of patients had overall percentage for positive responses ≥ 50 %, while the rest had <50%.The total score of positive responses for all patients were 257 represented (58.4%) of overall percentage while the total score of negative responses for all patients were 183 represented (41.6 %) of overall percentage.Patients' variables included ages, educational levels, and previous visit for anesthesia assessment had significant effect on patient's knowledge and perception regarding pre anesthesia checkup.While gender had not significant effect on them. Conclusion:Large ratio of patients had insufficient knowledge and inadequate perception about preanesthesia checkup and its role in improving the patient care and the outcome of surgery.Also, we assumption that whenever patient in urban area increase in age, education level and previous experience for pre-anesthesia assessment, that will increase patient's knowledge and perception for the value and the importance of pre anesthesia check-up.
Background and Objectives: Although intra-articular injection is considered one of the therapeutic options for temporomandibular joint (TMJ) pain, it is not well understood whether in combination with local anesthetics, it is effective for TMJ pain.The objective of this study is to determine the efficacy of intra-articular injections of corticosteroids combined with local anesthetics in patients with TMJ pain and identify predictors for pain improvement. Methods: Charts of patients with persistent TMJ pain and a diagnosis of TMJ disorders who underwent intraarticular injections of 1.5 ml containing 20 mg triamcinolone and 10 or 20 mg lidocaine were retrospectively analyzed. The TMJ pain intensity on palpation before treatment, immediately after injection, and at follow-up was assessed using a verbal Numerical Rating Scale (NRS).Results: Thirty-seven injections of 31 patients were identified.The pre-treatment pain NRS score (median=7, interquartile range: 5-8) was significantly reduced immediately after injection (median=0, interquartile range: 0-0, p<0.001) and at follow-up (median=3, interquartile range: 0-6, p<0.001).Although transient facial palsy (2 cases) and bite change (1 case) were found after injection, no significant complications were reported.Greater pain improvement at follow-up was associated with cases without osteoarthritis (p=0.004).In addition, pain improvement was modestly correlated with the pre-treatment pain score (Spearman's rho=0.328,p=0.048) and immediate pain relief after injection (Spearman's rho=0.375,p=0.022). Conclusion: Intra-articular injections of corticosteroids in combination with local anesthetics may contributeto favorable prognosis of TMJ pain, with the absence of osteoarthritis serving as one of the predictors of TMJ pain improvement.The results highlight that pre-treatment conditions and diagnoses play a relevant role in the prognosis of TMJ pain after intra-articular injection.
Statement of the Problem:Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease, which affects approximately 1% of the world's adult population.It is characterized by the inflammation of synovial tissue from multiple articulations.According to traditional Chinese medicine (TCM) theory, RA is categorized under the "Bi" or impediment disease, a group of diseases caused by the invasion of Wind, Cold, Dampness, or Heat pathogen on the meridians involving muscles, sinews, bones, and joints. Purpose: To demonstrate that patient with rheumatoid arthritis can be treated without the use of corticosteroids and immunosuppressive medications.Methods: One case report of a 26-year-old male, with rheumatoid arthritis since 2015, and was using immunosuppressive medications and corticosteroids to control the pains in all joints.He began to treat his pains with a Chinese medicine doctor who advise him to avoid all dairy products and other foods that could imbalance the internal energy.He also was submitted to auricular acupuncture, apex ear bloodletting and radiesthesia procedure.All his seven chakras' energies centers were in the lowest level of energy (rated 1 out of 8) and he was medicated with homeopathies according to the theory Constitutional Homeopathy of the Five Elements based on Traditional Chinese Medicine and crystal-based medications for a period of one year or more. Results:The patient improved from his symptoms after the oriental medicine tools and avoiding all dairy products and after less one month of treatment he was able to withdrawn corticosteroids and immune suppressant medications. Conclusion:rheumatoid arthritis patients can be treated without using corticosteroids or immunosuppressive medications.To this end, the physician need to understand the factors involving the formation of disease in the energy point of view.Protections against the invasion of external pathogenic factors, orientations regarding the type of foods recommended to eat and replenishment the chakras´ energies centers with homeopathies and crystal-based medications are important to fortify the immune system of the patient and rebalance all the internal energies of the patient.
Ehlers Danlos Syndrome (EDS) is a group of collagen-related connective tissue disorders that is thought to affect 1 in 5000 individuals.EDS is divided into six main subtypes based on clinical picture, severity, pattern of inheritance, and specific genetic defect.The most common subtypes [type I, II (classical), and III (hypermobile)] make up about 90% of all cases of EDS while type IV (vascular) makes up about 3-10%.The remainder of subtypes [type VI (kyphoscoliosis), type VIIA/VIIB (arthrochalasis), type VIIC (dermatosparaxis)] are quite rare.Each subtype of EDS involves a specific mutation in genes coding for collagens or collagen-related proteins (collagen modifying enzymes, tenascin) that lead to connective tissue instability resulting in defects in cell attachment, platelet aggregation, organogenesis, and tensile strength in skin, bones, muscles, ligaments and tendons.These defects then lead to presentations that often go undetected with unknown clinical implications.(1) The purpose of this article is to review the current literature on the airway of EDS patients and discuss the challenges presented to the anesthesiologist.Although the manifestations of this disease are variable, there are several clinical features that are important for perioperative airway management.
