Current Issue : April - June Volume : 2015 Issue Number : 2 Articles : 7 Articles
Background. We propose a 1-1-12 wash-in scheme for desflurane-nitrous oxide (N2O) low-flow anesthesia. The objective of our\nstudy was to determine the time to achieve alveolar concentration of desflurane (FAD) at 1, 2, 3, 4, 5, and 6%. Methods.We enrolled\n106 patients scheduled for elective surgery under general anesthesia. After induction and intubation, wash-in was started with a\nfresh gas flow (FGF) of N2O:O2 1 : 1 L min?1 and vaporizer concentration of desflurane (FD) of 12%. Ventilation was controlled to\nmaintain PACO2 at 30ââ?¬â??35mmHg. Results. The FAD rose rapidly from 0 to 4% in 2 min in a linear manner in 0.5 min increments.\nAn FAD of 6% was achieved in 4 min in a linear fashion from FAD of 4% but in 1 min increments. An FAD of 1 to 6% occurred at\n0.6, 1, 1.5, 2, 3, and 4 min. Heart rate during wash-in showed a statistically, albeit not clinically, significant pattern of increase. By\ncontrast, blood pressure slightly decreased during this period. Conclusions.We developed a 1-1-12 wash-in scheme using a FGF of\nN2O:O2 1 : 1 L min?1 and FD of 12% for desflurane-nitrous oxide low-flow anesthesia. A respective FAD of 1, 2, 3, 4, 5, and 6?n\nbe expected at 0.6, 1, 1.5, 2, 3, and 4 min....
Aim. Comparing the effectivity of prilocaine and prilocaine alkalinized with 8.4% NaHCO3 in terms of sensory and motor block\nonset and termination durations in RIVA technique considering patients� satisfaction and tolerance with application of tourniquet\nundergoing hand-wrist surgery. Materials and Methods. 64 patients were randomised into two groups. First group (Group P) was\nadministered prilocaine and second group (Group PN) was administered prilocaine + %8.4 NaHCO3. Sensory and motor block\nonset and termination times and onset of tourniquet pain were recorded. Results. No significant difference was found between the\ntwo groups in terms of onset and termination of sensory block and the onset ofmotor block. The duration of the motor block was\nlonger inGroupPNthan inGroup P(???? < 0.05). Tourniquet pain was more intense in Group P (???? = 0.036). InGroupPN, the use of\nadditional drugs was recorded at a lower rate and patients� satisfaction was higher than Group P. Conclusion. In the present study,\nit was established that alkalinization of prilocaine had no effect on the duration of sensory block and it prolonged the duration\nof motor block, increased patients� satisfaction, and decreased tourniquet pain. It is our suggestion that future studies should be\ncarried out on the issue by using different volumes....
To prevent hypotension during spinal anesthesia for caesarean section, we assessed IV ondansetron of invasive maternal\nhemodynamic and fetal gazometric parameters....
Objective. To evaluate leukocyte gene expression for 9 selected genes (mRNAs) as biological markers in patients with medication\nrefractory depression before and after treatment with ECT or isoflurane anesthesia (ISO). Methods. In a substudy of a\nnonrandomized open-label trial comparing effects of ECT to ISO therapy, blood samples were obtained before and after treatment\nfrom 22 patients with refractory depression, and leukocyte mRNA was assessed by quantitative PCR. Patients� mRNAs were also\ncompared to 17 healthy controls. Results. Relative to controls, patients before treatment showed significantly higher IL10 and DBI\nand lower ADRA2A and ASIC3 mRNA (P < 0.025). Both ECT and ISO induced significant decreases after treatment in 4 genes:\nIL10, NR3C1, DRD4, and Sult1A1. After treatment, patients� DBI, ASIC3, and ADRA2A mRNA remained dysregulated. Conclusion.\nSignificant differences from controls and/or significant changes after ECT or ISO treatment were observed for 7 of the 9 mRNAs\nstudied. Decreased expression of 4 genes after effective treatment with either ECT or ISO suggests possible overlap of underlying\nmechanisms. Three genes showing dysregulation before and after treatment may be trait-like biomarkers of medication refractory\ndepression.Gene expression for these patients has the potential to facilitate diagnosis, clarify pathophysiology, and identify potential\nbiomarkers for treatment effects....
Background. This study was conducted to compare and evaluate the effect of adding lornoxicam or nitroglycerine as adjuncts to\nlidocaine in intravenous regional anesthesia (IVRA). Methods. 60 patients were randomly separated into three groups, lidocaine\ngroup (group L), lidocaine + lornoxicamgroup (group LL), and lidocaine + lornoxicam+ transdermal nitroglycerine group (group\nLL-N). Hemodynamic parameters, sensory and motor blocks onset, and recovery times were recorded. Analgesic consumption\nfor tourniquet pain and postoperative period were recorded. Results. Sensory block onset times andmotor block onset times were\nshorter in the LL-N and LL groups compared with L group. Sensory block recovery time and motor block recovery time were\nprolonged in the LL and LL-N groups compared with group L. The amount of fentanyl required for tourniquet pain was less in\ngroup LL and group LL-N when compared with group L. VAS scores of tourniquet pain were higher in group L compared with the\nother study groups. Postoperative VAS scores were higher for the first 4 hours in group L compared with the other study groups.\nConclusion. The adjuvant drugs (lornoxicam or TNG) when added to lidocaine in IVRA were effective in improving the overall\nquality of anesthesia, reducing tourniquet pain, increasing tourniquet tolerance, and improving the postoperative analgesia....
Introduction. Properly performing a subarachnoid block (SAB) is a competency expected of anesthesiology residents. We aimed\nto determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB. Methods. 21\nanesthesia residentswere enrolled.After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum.\nResidents were then randomized so that half received additional deliberate practice including repetition and expert-guided, realtime\nfeedback. All residents were then retested for technique. SABs on all residents� next three patients were evaluated in the\noperating room (OR). Results. Before completing the base curriculum, the control group completed 81% of a 16-item performance\nchecklist on the task-trainer and this increased to 91% after finishing the base curriculum (P < 0.02). The intervention group also\nincreased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed\nin the control group (P < 0.03). The OR time required to perform SAB was not different between groups. Conclusions. The\nbase curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent,\nincremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear...
Introduction. The aim of the study was to compare the sensory, motor, and neuroophthalmological effects of isobaric\nlevobupivacaine and bupivacaine when intrathecally administered. Materials and Methods. A prospective, double-blind, randomized\nstudy with 60 ASA grade I-II patients aged 18ââ?¬â??65 years awaiting knee arthroscopy under spinal anesthesia. Patients\nreceived 12.5 mg of isobaric bupivacaine or levobupivacaine. Several features were recorded. Results. No significant intergroup\ndifferences were observed for ASA classification, time to micturate, demographic data, surgery duration, and patient/surgeon\nsatisfaction. Similar hemodynamic parameters and sensory/motor blockade duration were found for both groups. There were no\nneuroophthalmological effects in either group. Sensory (P = 0.018) and motor blockade onset (P = 0.003) was faster in the\nbupivacaine group. T6 (T2ââ?¬â??T12) and T3 (T2ââ?¬â??T12) were the highest sensory block levels for the levobupivacaine and bupivacaine\ngroups, respectively (P = 0.008). It took less time to regain maximum motor blockade in the bupivacaine group (P = 0.014), and\nthe levobupivacaine group required use of analgesia earlier (P = 0.025). Conclusions. Isobaric bupivacaine and levobupivacaine are\nanalogous and well-tolerated anesthetics for knee arthroscopy. However, for bupivacaine, sensory and motor blockade onset was\nfaster, and greater sensory blockade with a longer postoperative painless period was achieved....
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