Introduction Ultrasound-guided truncal blocks such as quadratus lumborum (QLB) and erector spinae plane block (ESPB) are increasingly used for opioid-sparing analgesia. We aimed to evaluate the postoperative analgesic outcome of ultrasound-guided unilateral QLB (lateral approach) and ESPB for use in adult patients undergoing unilateral lower abdominal surgery. Methods In this randomized comparative clinical trial, 48 adult patients scheduled for unilateral lower abdominal surgery were randomized to receive QLB (n = 24) and ESPB (n = 24) following induction of general anesthesia. The primary outcome was total morphine consumption in the first 24 postoperative hours. Results There was no statistical difference for total morphine consumption between the QLB and ESPB groups (5.26 ± 2.17 mg vs. 5.88 ± 2.51 mg; p = 0.376). The median time to first rescue analgesia was greater in the QLB (2 hours [0–18]) vs. the ESPB group (1 hour [0–21]; p = 0.251). Pain scores were not different between groups at 2, 4, 8, 12, and 24 hours post-op (median Visual Analogue Scale (VAS) at 24h: 3 [3–5] QLB, 3 [2–3] ESPB; p = 0.08). There were no differences between groups with respect to hemodynamic parameters, adverse events (nausea and vomiting: 4 in the QLB group, 6 in the ESPB group; p > 0.05) or block performance times (median time: 10min for both). Discussion We consider the clinical role of QLB and ESPB as an effective component of multimodal analgesia in unilateral lower abdominal surgeries. They have a similar safety profile considering the technique and the opioid sparing effects, similar performance characteristics and complication rates, which together suggest both blocks are safe and well-tolerated anesthetic procedures that can be daily practices. Conclusion Both QLB and ESPB provide significant, safe, and comparable postoperative analgesia for patients undergoing unilateral lower abdomen surgery. QLB may provide a slight time benefit to analgesia onset. Trial Registration This study was prospectively registered on ClinicalTrials.gov (NCT05524038; principal investigator: Rana Ahmed Abdelghaffar), registration date: 1/9/ 2022.
Preoperative anxiety is a common concern among surgical patients and a key focus for anesthesiologists. Premedication, such as melatonin—an emerging option for sedation before cataract surgery—and midazolam, a routinely used benzodiazepine, play a vital role in managing anxiety and ensuring effective anesthetic care. This study aimed to compare the effects of melatonin and midazolam on the anxiety of cataract surgery candidates under general anesthesia. This study included 40 patients scheduled for cataract surgery under general anesthesia at a surgical center in Birjand, Iran. Participants were randomly divided into two groups: one received 0.1 mg/kg oral melatonin, and the other received 70–80 µg/kg IV midazolam as premedication. Anesthesia was induced uniformly with fentanyl (1 µg/kg), propofol (2 mg/kg), and atracurium (0.5 mg/kg). Anxiety levels were assessed using the Beck Anxiety Inventory at two-time points: before premedication (baseline) and 1.5 hours after administration (30 minutes pre-surgery). There was no significant difference in the comparison of the average anxiety score after and before the premedication in the two investigated groups. The average anxiety score after the premedication in the midazolam group was not significantly different compared to before the premedication (P=0.817), but the average anxiety score in the melatonin group after the premedication was significantly reduced compared to before the premedication (P<0.001). Both melatonin and midazolam similarly reduced preoperative anxiety in cataract surgery patients, with melatonin potentially offering a safer profile. Further studies could explore its wider use as an alternative to benzodiazepines. Melatonin may serve as a suitable alternative to midazolam for reducing preoperative anxiety. Given its better safety profile, further investigation of its broader applications is recommended. IRCT 20190618043934N15
Background Following a sleeve gastrectomy, post-operative nausea and vomiting (PONV) is a typical issue. Furthermore, several prophylactic techniques have been developed, such as preventive antiemetic and accelerated recovery after surgery (ERAS). However, PONV has not entirely disappeared, and clinicians are still working to lower PONV incidence. Aim Our goal was to evaluate how adopting Enhanced Recovery Protocols (ERAS) affects postoperative nausea and vomiting (PONV) in comparison to standard care protocol after laparoscopic sleeve gastrectomy (LSG) while receiving triple antiemetic prophylaxis. Objective The objective of this study was to verify that the ERAS procedure is crucial for lowering PONV despite the use of an efficient and effective antiemetic. Methods This is a computer-generated randomized clinical trial. Haloperidol, dexamethasone, and ondansetron were administered to all patients undergoing elective LSG, 29 patients within an ERAS protocol, and 29 within a standard care protocol. The primary finding was the incidence of PONV within 36 hours following LSG. The time to initially administer rescue antiemetic medication, number of rescue antiemetic medication administrations, postoperative opioid consumption, oral fluid tolerance, complications, and QoR-15 questionnaire for quality of recovery were the secondary outcomes. Results Within the first 36 hours following LSG, the incidence of PONV in the ERAS group was 17.20%, while in the non-ERAS group, it was 51.7%, with P<0.012 and higher PONV severity (P<0.021) in the non-ERAS group. The ERAS group took a longer time (6 hours) for the first rescue antiemetic medicine than the Non-ERAS group (2 hours), with P<0.001 and significantly less number of patients (20.7%) needing rescue antiemetic, compared to the Non-ERAS group (65.5%), with P<0.001. The dosage of nalbuphine needed by the ERAS group was lower (2.7±2.8) than the non-ERAS group (19.9±6.0). Regarding the QoR-15 scores, there was a significant difference in the two groups' overall performance (P <0.001). Between the two groups, there were no significant complications following surgery. Conclusion This study reveals that even though triple antiemetic prophylaxis was used, the ERAS protocol had a beneficial effect on PONV when compared to the standard care approach.
Background: The utilization of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for immunoadsorption has proven efficacious in reducing mortality rates among neonatal and pediatric patients afflicted with severe sepsis and septic shock. However, the effectiveness of this treatment in adult patients with septic shock remains controversial. Objective: This study was designed to assess the potential of VA-ECMO as an immunoadsorption therapy in patients with severe sepsis and septic shock. The primary objective of this study is to evaluate the efficacy of VA-ECMO in improving clinical outcomes, including acute respiratory distress syndrome (ARDS) and ventilator-associated pneumonia (VAP), weaning from mechanical ventilation, the length of intensive care unit (ICU) stay, and mortality rates in patients with concurrent severe pulmonary contusions, septic shock, and respiratory failure resulting from ARDS and VAP. Methods: This study enrolled a cohort of 100 adult patients with severe pulmonary contusions resulting in persistent respiratory failure despite ten days of mechanical ventilation. These patients subsequently developed severe sepsis, VAP with ARDS presentation, and high Murray score (>3 points), Sequential Organ Failure Assessment (SOFA) score (> 12 points), and Clinical Pulmonary Infection Score (CPIS) (> 6 points). The patients were then divided into two groups: group A (n = 50) received conventional management, while group B (n = 50) underwent VA-ECMO. Moreover, the outcomes, including improvement in ARDS and VAP, successful weaning from mechanical ventilation, length of ICU stay, improvement of one or all parameters of Murray, SOFA, and CPIS scores, morbidity rate, and mortality rate were compared between the two groups and recorded after 14 days of treatment. Results: This study revealed that patients in group B showed significant improvement in Murray, SOFA, and CPIS scores. Furthermore, a large percentage of patients in group B were successfully weaned from both inotropic support and mechanical ventilation and were discharged from ICU. However, no significant difference in the mortality rate was observed between the two groups. Conclusion: VA-ECMO notably impedes the progression of sepsis, shortens ICU stay, and expedites the weaning from inotropic support and mechanical ventilation. However, it has no impact on the mortality rate of adult patients with septic shock.
Introduction: Post Dural Puncture Headache is (PDPH) a relatively common complication of spinal anesthesia. This study aimed to compare the effect of oral administration of ergotamine and theophylline on PDPH in patients undergoing a cesarean section. Materials and Methods: This clinical trial was performed on 60 parturients undergoing cesarean section with PDPH. A tablet of theophylline (100 mg) or methyl ergotamine C (1 mg plus 100 mg caffeine) every 8 hours for 24 hours was administered randomly to patients referred to the hospital with PDPH. Using a checklist, demographic information, history of previous PDPH, number of punctures and intensity, location, and onset time of headache were collected. Intensity and duration of PDPH in the first 24 hours after surgery were the primary outcomes and nausea, vomiting, and vertigo were considered secondary outcomes. The intensity of the headache was assessed using Visual Analog Scale (VAS) before and within the first 24 hours after drug administration. Results and Discussion: In both groups, the VAS of headache significantly decreased at 2, 8, and 24 hours after administration of theophylline and ergotamine compared to pre-intervention time (theophylline from 8.6 ± 1.1 to 0.2 ± 0.1 and ergotamine from 8.6 ± 1.5 to 0.4 ± 0.2). However, the intensity of headaches was not different between the two groups at 2, 8, and 24 hours after the intervention. Duration of headache was similar in both groups (15.7 ± 5.9 in the theophylline group versus 17.5 ± 14.2 ergotamine group). In terms of secondary outcomes of nausea, vomiting, and vertigo, both groups were comparable. Conclusion: Oral administration of theophylline and ergotamine are similarly effective in reducing PDPH in cesarean sections. Clinical Trial Registration Number: IRCT20120915010841N14.
Background: Gastrointestinal (GI) bleeding after GI cancer surgery is not very common, but the use of NSAIDs such as Ketorolac can aggravate it, and if not controlled properly, it may be life-threatening. Therefore, an NSAID/PPI combination (ketorolac and Pantoprazole) that reduces the adverse effect of ketorolac on GI bleeding can be very important. Aim: The aim of this observational study is to compare the frequency of GI bleeding complications resulting from the use of Ketorolac after GI cancer surgery with or without gastric ulcer prophylaxis (Pantoprazole). Methods: In this retrospective case-control study, the medical files of adult patients aged 18-60 years undergoing GI cancer surgery referred to 3 hospitals in Iran in 2022 were reviewed. The case group consisted of patients who received ketorolac (30 mg every 8 hours, intravenously) with preventive Pantoprazole (40 mg daily). The control group consisted of patients who only received ketorolac (30 mg every 8 hours, intravenously). Patients were matched in groups based on demographic and clinical variables. Outcomes, including GI bleeding (melena, ...), length of hospital and ICU stay, receiving packed cells, intubation, hematocrit and hemoglobin, were compared between the groups. Results: Two groups were matched in terms of age, gender, comorbidities, type of surgery, duration of surgery (hours), and surgical bleeding (ml) (P>0.05). Examination of clinical outcomes showed that GI bleeding complications were not significantly different in the two groups. Although in the case group that received ketorolac and Pantoprazole combination, GI bleeding complications were reported in a smaller number of people. The hospital stay (days) was significantly lower in the case group than in the control group. The ICU stay (hours), packed cells, intubation, hematocrit, and hemoglobin were not significantly different between the two groups. Conclusion: The findings of the current study showed that the administration of Pantoprazole plus ketorolac might be effective in controlling bleeding in GI cancer surgery patients, which, of course, requires detailed and multicenter interventional studies.
Background: Classical nasal fiberoptic bronchoscope intubation may be a challenging and lengthy procedure with a 1-10% failure rate. Objectives: This study aimed to compare among patients with difficult airway intubation undergoing general anesthesia, the safety, and efficacy of Tube-First (TF) nasal fiberoptic bronchoscope intubation against the Classic (CL) procedure. Methods: This single-blinded, parallel-group, randomized trial enrolled 40 adult patients with known difficult airways and scheduled for surgery under general anesthesia. The patients were randomly allocated into two (n=20 each) patient groups. In the CL group, the endotracheal tube and fiberoptic bronchoscope were inserted together through the nostril; in the TF group, the endotracheal tube insertion preceded the fiberoptic bronchoscope. In both groups, the bronchoscope was used to visualize the vocal cords and removed after ensuring the endotracheal tube position. The primary (efficacy) outcomes were the time elapsing from the bronchoscope insertion and visualizing the vocal cords (T1) and the time elapsing from the bronchoscope advancing initiation to its removal (T2). The secondary (safety) outcomes included oxygen saturation and hemodynamic parameters during the procedure. Results: The TF group showed a significant T1 and T2 mean reduction compared to those of the CL group (37.15 ± 3.87 and 64.25 ± 8.28 vs. 55.05±4.52 and 88.25±5.49 seconds, respectively; p < 0.0001). The oxygen saturation was comparable in both groups with no desaturation (SpO2 < 90%) cases. The heart rate and mean arterial blood pressure changes were significantly lower in the TF group compared to the CL group. Conclusion: Among patients with difficult airway intubation undergoing general anesthesia, we found the Tube-First intubation approach was quicker and safer compared to the classical intubation technique.
Introduction: Studies point to the potential advantages of a combined technique using video laryngoscopes (VL) and dynamic stylets for difficult intubations. This study compares the outcomes of three advanced intubation techniques: combined technique (video laryngoscope + dynamic stylet), awake fiberoptic bronchoscope (FOB), and asleep FOB when used as the primary intubation technique. Methods: Airway notes of 138,387 consecutive anesthesia cases at a single academic medical center were filtered for the use of awake FOB, asleep FOB, or combined technique as the primary approach for potentially difficult intubations. The combined technique was defined as VL + dynamic stylet. The dynamic stylets available were FOB or TCITM (Total Control Introducer). The primary endpoint was the first pass success rate. Secondary endpoints included: failure to intubate with the primary technique, anesthesia “in room to intubation” time, “traumatic” intubation rate, and ease of intubation. Results: The first pass success rate was highest for combined techniques (88.7%) followed by awake FOB (74.2%, P<0.001) and asleep FOB (80.7%, P=0.06). “Failure to intubate” was lowest in the combined technique (1.8%), compared to awake FOB (9.2%, P=0.002). “In room to intubation” time was fastest for the combined techniques (13.0 minutes) followed by asleep FOB (15.1 minutes, P=0.002) and awake FOB (21.2 minutes, P<0.001). Combined techniques were recorded as “easy” significantly more often (72%) than awake FOB (38.2%, P<0.001). Combined techniques were recorded as “atraumatic” significantly more often (91.1%) than awake FOB (75.8%, P<0.001). Subgroup analysis of the combined techniques, VL + FOB vs. VL + TCITM, revealed that VL + TCITM was rated as “easy” and “atraumatic” significantly more often. It also achieved higher first pass success, lower “failure to intubate” rate, and faster “in room to intubated” time when compared with VL + FOB, although none reached significance. Conclusion: In this retrospective single-center comparative analysis, the combined techniques outperformed FOB techniques in effectiveness, speed, ease of use, and trauma.
Introduction: 65% of patients in Intensive Care Units (ICU) with severe sepsis and/or severe traumatic lung contusion are complicated with pneumonia and respiratory failure, which need long-term ventilation. Sepsis is a common finding in such patients; it is either a cause of ventilator associated pneumonia (VAP) or a complication of VAP. VAP is one of the most common complications of prolonged ventilation. Both diagnostic and therapeutic bronchoscopies could be used to improve the outcome in those patients by controlling septic reactions and improve lung mechanics through the clearing of the small airways from purulent discharge. Aims of Work: To evaluate the effect of the use of bronchoscopy in patients with Acute respiratory distress syndrome (ARDS), severe sepsis and complicated by VAP as regards, improve the general condition of those patients, improve lung mechanics, control all signs of both VAP and sepsis, accelerate weaning from the ventilator, shorten the duration of ICU stays and its effect on mortality rate in those patients. Materials and Methods: 200 patients were selected after 4 days of ventilation because of ARDS due to either severe traumatic lung contusion or a severe lung infection. Those who still showed unresolved ARDS (diagnosed by hypoxic index less than 200, bilateral parenchymatous lung infiltration on the chest X ray, ABG showed PH > 7.30), Severe sepsis diagnosed by >12 SOFA score (Sequential Organ Failure Assessment) and developed VAP diagnosed by >6 CPIS score (clinical pulmonary infection score) were included in two groups of 100 patients in each. Only patients of group B did three bronchoscopies and BAL was sent for culture, while patients of group A continued on the traditional way of management and sputum was sent for culture. Improvement of ARDS & VAP, weaning from ventilation, duration of ICU stay, improvement of one/all parameters of both SOFA & CPIS scores, morbidity, and mortality were recorded and compared within 14 days. Results: Patients of group B showed significant improvement in APACHII score (acute physiological assessment and chronic health evaluation score), GCS (Glasgow coma scale), parameters of both SOFA score and CPIS score, hemodynamics parameters, LDH (lactate dehydrogenase), and C-Reactive protein levels. A significantly higher number of patients were weaned from the ventilator and discharged from ICU. There was no significant difference between the two groups regarding the mortality rate. Conclusion: The use of bronchoscopy can improve general conditions, control all signs of severe sepsis, VAP, improve lung mechanics, improve ARDS, accelerate weaning from the ventilator, and shorten the ICU stay but has no effect on mortality rate in those patients with severe sepsis with ARDS and complicated by VAP from prolonged ventilation. Clinical Trial Registration Number: My study is already registered in the clinical trial, and all the information is present in this study. The clinical trial number is NCT04553367, and is registered by my name.
Background: There is limited information about adolescents' Basic-Life-Support (BLS) training. Objectives: In this study, adolescents' BLS training proficiency and knowledge retention of the Mixed Reality (MR), Mass-Training (MT), and Self-Directed Learning (SDL) methods were prospectively compared, following the training-outcomes levels-model classification. Methods: First-year secondary-school students were randomized into the MR, MT, and SDL groups, and after baseline evaluation, at T0, they received congruent BLS theoretical and Cardiopulmonary-Resuscitation (CPR) training. Knowledge, skills retention, and trainees' training-activity self-evaluation were evaluated utilizing ten (knowledge) and five-items (self-evaluation) questionnaires, a BLS-sequence checklist, and chest compressions recording mannequin one and three months after T0. We used the Kruskal-Wallis test for median comparison. Results: At all times, the MR group knowledge answers' median (≥6/10) was significantly higher (p<0.05) than groups MT and SDL (≤6/10), with no significant differences between the latter. The MR CPR skills and BLS checklist acquisition and retention were significantly superior (p<0.05) to the other groups; the SDL group showed limited results. Hands position and chest recoil showed excellent outcomes in all groups and at all times. At all times, trainees positively evaluated the BLS-training importance. Pre-training low self-confidence in BLS practice improved over time, yet not significantly, in group MT. The trainees' majority (62%) preferred the MR method. Conclusion: In an adolescent cohort, MR methods' BLS/CPR knowledge and skills acquisition and retention were comparable, if not better, than the MT method and superior to the SDL one. Future multicenter randomized and controlled studies with larger sample sizes and more limited instructor-to-participant ratios are warranted to generalize findings.
Objective: Analgesic effects can be further augmented with the addition of clonidine and ketamine to the TIVA propofol, providing an even more effective anesthetic without compromising patient safety. This study aims to determine whether propofol infusion combined with clonidine and ketamine is more efficient in lowering the level of IL-8, preserving operation stability, and dropping post-operative pain and morphine intake. Methods: We conducted a study in which two groups of 60 patients were scheduled for colorectal cancer surgery. The treated group, (group T), received premedication with clonidine, intraoperative ketamine, and propofol for sedation. As a control group, a normal saline solution was administered to the group (Group C). Results: Group T reported lower levels of post-operative pain than the control group (P<0.05). This suggests that group T was more effective at reducing pain than the control group. A significant difference in mean arterial blood pressure was observed between groups (P<0.05). It is worth noting that there was no statistically significant difference in IL-8 levels between the two groups postoperatively (P>0.05). There was also a lower consumption of morphine (4.09±1.78) in group T postoperatively. Conclusion: It was found that TIVA using propofol with clonidine and ketamine was more effective than propofol infusion alone in maintaining hemodynamic stability, reducing postoperative pain, and decreasing morphine consumption over conventional propofol infusion. As a combination, propofol, clonidine, and ketamine provide and manage the pain of patients in a synergistic manner. Clinical Trial: Registration no.: The trial was registered under the clinical trials registery NCTU5536362 at ClinicalTrials.gov.
Introduction: As one of the top ranks in the pain-producing procedure, spinal surgery requires adequate perioperative pain management to improve outcomes. Likewise, perioperative pain management in cirrhotic hepatic thrombocytopenia patients is challenging. Modified TLIP block can be an option for perioperative pain management in the lumbar decompression surgery for a cirrhotic hepatic patient with thrombocytopenia. Case Presentation: A man, 67 years old, who suffered from cirrhosis hepatic with thrombocytopenia underwent endoscopic spinal decompression with laminotomy and flavectomy of L4-L5. After induction of general anesthesia with midazolam 1,5 mg, fentanyl 150 mcg, propofol 100 mg, and rocuronium 1mg/kg, the patient was intubated. The lungs were ventilated with a pressure control mode with tidal volume 8 ml/kg BW, respiratory rate 12/min, and PEEP 5 cm H2O with FiO2 50%. and 1% sevoflurane. Modified TLIP block was performed at the L3 level. Twenty ml of bupivacaine 0,5% was administered between the longissimus and iliocostalis muscles on both sides. Results: Intraoperative, modified TLIP block provide adequate analgesia with stable hemodynamics. The visual Analog Scale (VAS) of pain was 1-2 in 24h postoperative. No additional opioid was required within 24 hours postoperatively. There were no neurological complications or bleeding due to the modified TLIP block found in this patient. Conclusion: Modified TLIP block can be an effective and safe analgesic technique for hepatic cirrhosis patients with thrombocytopenia. However, further research is needed to determine the safety limits of modified TLIP block in patients with coagulation disorder or anticoagulant use.
Background: Peripheral nerve injury during regional anaesthesia may result from accidental intraneural placement of the needle, or forceful needle nerve contact. Intraneural injections are associated with increased resistance to injection, typically >15 psi. The BBraun BSmart™ is an inline mechanical manometer, offering a visual display of injection pressures. Objective: The primary objective of this study was to determine if using the BBraun BSmartTM manometer successfully prevents 90% of anaesthetists and anaesthetic assistants from injecting at pressures > 15 psi during simulated nerve block. Methods: This was a prospective observational study involving anaesthetists and anaesthetic assistants. Two 20 ml injections were performed by each participant, once when the BBraun BSmartTM manometer was obscured from view, and once with the manometer visible. A PendoTech PressureMATTMS recorded injection pressures. Results: 39 participants completed the study, with a total of 78 injections recorded. During the study, 32 peak pressures during the 78 procedures were recorded above the recommended upper limit of 15 psi, 41% of the total injections. The peak pressure rose above 15 psi in 24/39 (62%) injections when the BBraun Bsmart™ manometer was obscured, but only in 8/39 (21%) injections when the manometer was visible. Conclusion: The BBraun Bsmart™ manometer did not successfully prevent 90% of anaesthetists or anaesthetic assistants from injecting at unsafe pressures. However, using the BBraun BSmart™ did reduce the number of unsafe injection pressures generated by participants. When utilised in conjunction with PNS and ultrasound guidance, this may offer additional safety during peripheral nerve blockade.
Bupivacaine with opioid is commonly used for labour epidural analgesia. Ropivacaine is considered as an alternative to bupivacaine due to its lower cardiovascular complications. However, there is a controversy regarding the efficacy of these drugs as some studies suggest equivalent action, whereas others report that ropivacaine produces less motor blockade. The study aimed to compare the effect of ropivacaine-fentanyl and bupivacaine-fentanyl for labour analgesia. The prospective randomized study was performed on 60 parturients, divided into two groups of 30 subjects each. Group I received 10ml of bupivacaine 0.1% + fentanyl 2µg/ml and Group II received 10ml of ropivacaine 0.1% + fentanyl 2µg/ml by epidural catheter. Pre-anaesthetic evaluation was performed on all the participants and all were administered metoclopramide 0.25mg/kg and ondansetron 0.08-0.1mg/kg intravenously as premedication. The baseline and post anaesthesia systolic, diastolic blood pressure, heart rate, VAS score, degree of motor block, sedation and APGAR score of the baby were recorded. The data were tabulated and statistically analyzed. When compared, there was no significant difference in systolic/diastolic blood pressure in two groups except at 360 min where diastolic pressure was low in group II. Significantly higher heart rate at 30 min (P=0.0003), 120 min (0.006), and 300 min (P=0.001) was observed in group I subjects. VAS score was significantly less at 180 min (P=0.019) and 300 min (P=0.019) in group II. Adverse effects such as fetal bradycardia, nausea/vomiting and hypotension observed were clinically insignificance when compared in two groups. Bupivacaine and ropivacaine produce an equal degree of analgesia and hemodynamic stability in 0.1% of concentration when added with 2µg/ml fentanyl . However, heart rate was well maintained with lower VAS scores in group II receiving ropivacaine. No significant difference in the side effects between the two groups. Hence, Ropivacaine can be used as a safe alternative to bupivacaine for labour epidural analgesia.
Background: The need for reliable respiratory monitoring has increased in recent years with the frequent use of opioids for perioperative pain management as well as a high prevalence of patients suffering from respiratory comorbidities. Objective: Motivated by the success of acoustical color spectrographic techniques in other knowledge domains, we sought to build proof-of-concept systems for the computer-based color spectrographic analysis of respiratory sounds, recorded from various sites. Methods: We used a USB miniature electret microphone and a Windows-based color spectrographic analysis package to obtain color spectrograms for breath sound recordings from the neck, from an oxygen mask, from the ear canal, and from a leak-free microphone pneumatically connected to the cuff of a laryngeal mask airway. Results: Potentially useful color spectrographic displays were obtained from all four recording sites, although the spectrograms obtained varied in their characteristics. It was also found that obtaining high-quality color spectrograms requires attention to a number of technical details. Conclusion: Color spectrographic analysis of respiratory sounds is a promising future technology for respiratory monitoring.
Objectives: To evaluate efficacy and side effects of free opioid anesthesia for laparoscopic cholecystectomy. Methods: A prospective study was performed on 94 patients undergoing laparoscopic cholecystectomy in Military Hospital 103 from May 2018 to February 2019. These patients were randomly allocated into two groups: patients in FOA (free - opioid anesthesia) group were administered lidocaine (2 mg/kg before induction and 1.5 mg/kg/h for maintenance), magnesium (30 mg/kg before induction and 1.5 g infusion for maintenance) combined with Intravenous (IV) injection of ketamine (0.5 mg/kg), and ketorolac (30 mg); while patients in OA group (opioid anesthesia) were provided with IV fentanyl (5 mcg/kg for induction and 1.5 mcg/kg every 30 minutes for maintenance of anesthesia). Both groups received total intravenous anesthesia by propofol. The depth of anesthesia was monitored by the entropy module during surgery. Neuromuscular blockade was reversed by sugammadex 2 mg/kg at the end of surgery. The postoperative analgesia was delivered using IV fentanyl for 48 to 72 hours. Visual Analog Scale (VAS) score was measured 10 mins, 20 mins, 1 hour, 2 hours and 3 hours after surgery. Results: All patients had an excellent quality of anesthesia with RE (Respond Entropy), SE (State Entropy) always under 60 from induction to abdominal closure without intraoperative awareness and postoperative recall of the operation; 100% of the patients were extubated immediately after surgery. In the first three postoperative hours fentanyl consumption in Group FOA was significantly lower than in Group OA (31.91 ± 3.98 mcg versus 34.47 ± 7.17 mcg, p=0,035). In the OA group, the rate of intraoperative hypotension was higher compared to its counterpart. Despite the higher risk of hypersalivation, group FOA had a significantly lower incidence of nausea and vomiting. Conclusion: Free opioid anesthesia provided adequate sedation and amnesia and may be an alternative approach to opioid anesthesia for laparoscopic cholecystectomy. Patients under free opioid anesthesia experienced a lower incidence of intraoperative hypotension, lower rate of nausea, vomiting and lower demand for analgesia in the early postoperative period (0 - 3 h) compared to those receiving opioid anesthesia.
Background:Piriformis Syndrome (PS) is an underdiagnosed cause of buttock, thigh and leg pain, most probably because it is thought to be a rare cause of sciatica. PS is widely believed to be myofascial in origin.Materials and Methods:This prospective, randomized, controlled, double-blind study was conducted at the pain management department. 50 patients aged from 20 to 60 years old were included in this study. The selected patients were randomly allocated into 2 groups containing 25 patients each; Group D received a total of 5 mL which included 2mL lidocaine 2%, 2mL (8 mg) dexamethasone and 1mL normal saline 0.9%, and Group M received a total of 5mL which included 2mL lidocaine 2%, 3mL magnesium sulphate (MgSO4) (2.5%) . Patients demographic characteristics, baseline physical examination findings of the patients as well as the duration of pain were all recorded. Patients were re-assessed immediately after injection, 1 week, 1 month, and 3 months after the injection. Numeric Rating Scale (NRS) values were used at each evaluation time to assess the pain, while patients were in sitting, standing, and lying positions. All patients were assessed immediately and for 4 hours post-injection for any side effects related to the drugs used.Results:In the pre-injection time, immediately after and 1 week after injection, there were no statistically significant differences between groups D and M in pain values. While, on comparison between both groups, group M, was significantly better than group D, in NRS values 1 month and 3 months after injection. In group D, pain score values were significantly better immediately, 1 week, and 1 month after injection compared to the pre-injection values, while these values were not significantly different 3 months after injection compared with the pre-injection values. In group M, pain score values were significantly better immediately, 1 week, 1 month, and 3 months after injection compared to the pre-injection values.Conclusion:Magnesium sulfate was more effective, especially for long term pain relief (3 months) when compared to dexamethasone as they were used as adjuvants to lidocaine, if injected into the piriformis muscle (PM) guided by ultrasound in the management of PS refractory as initial conservative treatment.
To date, the use of multimodal techniques can allow substantial opioid-sparing and can reduce pain by using the local and systemic effects of different types of analgesics. Aims: This case report describes a modified ERAS protocol specific for cardiac surgery with the ultrasound-guided block of the deep plane of the serratus muscle (SAP deep block) in a multimodal opioid-sparing approach. \ Two male patients, aged 62 and 67, undergoing elective mini-invasive off-pump Cardiopulmonary Bypass Grafting (CPB), were treated with an opioid-sparing multimodal anesthesiological approach based on the continuous ultrasound-guided SAP deep block. The continuous ultrasound-guided SAP deep block alone can be used in the case of mini-left thoracotomy off-pump cardiopulmonary bypass grafting implementing a multi-modal opioid-sparing strategy. It seems effective in obtaining good (2 hours) weaning from mechanical ventilation, quick (36 hours) discharge from post-operative intensive care, and good post-operative pain control (NRS < 5) even in elderly and frail patients.
Background: Bupivacaine with opioid is commonly used for labour epidural analgesia. Ropivacaine is considered as an alternative to bupivacaine due to its lower cardiovascular complications. However, there is a controversy regarding the efficacy of these drugs as some studies suggest equivalent action, whereas others report that ropivacaine produces less motor blockade. The study aimed to compare the effect of ropivacaine-fentanyl and bupivacaine-fentanyl for labour analgesia. Materials and Methods: The prospective randomized study was performed on 60 parturients, divided into two groups of 30 subjects each. Group I received 10ml of bupivacaine 0.1% + fentanyl 2µg/ml and Group II received 10ml of ropivacaine 0.1% + fentanyl 2µg/ml by epidural catheter. Pre-anaesthetic evaluation was performed on all the participants and all were administered metoclopramide 0.25mg/kg and ondansetron 0.08-0.1mg/kg intravenously as premedication. The baseline and post anaesthesia systolic, diastolic blood pressure, heart rate, VAS score, degree of motor block, sedation and APGAR score of the baby were recorded. The data were tabulated and statistically analyzed. Results: When compared, there was no significant difference in systolic/diastolic blood pressure in two groups except at 360 min where diastolic pressure was low in group II. Significantly higher heart rate at 30 min (P=0.0003), 120 min (0.006), and 300 min (P=0.001) was observed in group I subjects. VAS score was significantly less at 180 min (P=0.019) and 300 min (P=0.019) in group II. Adverse effects such as fetal bradycardia, nausea/vomiting and hypotension observed were clinically insignificance when compared in two groups. Conclusion: Bupivacaine and ropivacaine produce an equal degree of analgesia and hemodynamic stability in 0.1% of concentration when added with 2µg/ml fentanyl . However, heart rate was well maintained with lower VAS scores in group II receiving ropivacaine. No significant difference in the side effects between the two groups. Hence, Ropivacaine can be used as a safe alternative to bupivacaine for labour epidural analgesia.
Background: Pediatric fibreoptic diagnostic bronchoscope under general anesthesia using Supraglottic devices as Laryngeal Mask Airway (LMA) and nasopharyngeal airway (NPA) are one of the variable techniques used for patient’s ventilation during this procedure. Objective: We studied the effect of both devices on hypoxemia, the duration of the procedure, recovery time and the overall propofol consumption. Methods: Ninety patients of both sexes, aged 5-10 years, American society of Anesthesiology class I & II scheduled for diagnostic fibreoptic bronchoscope under general anesthesia were divided randomly into two equal groups; LMA group & NPA group, during the procedure: heart rate, non invasive blood pressure, peripheral arterial oxygen saturation (SpO2), arterial partial pressure of carbon dioxide(PaCO2), time of procedure, recovery time and total dose of propofol were measured and compared for each patient in both groups. Results: Hypoxemia & desaturation incidence was more in LMA group than NPA group with high significant difference (p-value 0.005). Also the duration of procedure, recovery time in PACU, and total dose of propofol consumed were significantly less in the NPA group (p< 0.001). With no difference in hemodynamic status and PaCO2. Conclusion: The use of NPA as supraglottic ventilating device for children undergoing diagnostic flexible fibreoptic bronchoscopy is considered a good alternative for shortening the bronchoscopy time with less incidence of hypoxemia and better recovery time compared to LMA.
