Current Issue : April - June Volume : 2016 Issue Number : 2 Articles : 8 Articles
Background. There are a few papers that compared the lateral transversus abdominis plane (TAP) block with the posterior TAP\nblock. Our study aimed to compare retrospectively the quality of analgesia after laparoscopic gynecologic surgery using the lateral\nTAP block with general anesthesia versus the posterior TAP block with general anesthesia. Method. Sixty-seven adult female\npatients were included in this retrospective study. Of these patients, thirty-four patients received the lateral TAP block with general\nanesthesia (lat. TAP group), and the rest of thirty-three patients received the posterior TAP block with general anesthesia (pos.\nTAP group). Pain scores both at rest and at movement and the use of additional analgesic drugs were recorded in the postoperative\ncare unit within twenty-four hours after the operation. Postoperative complications were noted. Results. Patients who received pos.\nTAP reported lower visual analog scale (VAS) pain scores in all points, within twenty-four hours after the operation, than patients\nwho received lat. TAP. Moreover, with the use of additional analgesic drugs, the incidence of nausea and vomiting during the first\ntwenty-four hours after surgery was lower in the pos. TAP group than in the lat. TAP group. Conclusion.The posterior TAP block\nprovided more effective analgesia than the lateral TAP block in patients undergoing laparoscopic gynecologic surgery....
Thyrotoxicosis is a hypermetabolic condition caused by an elevation in thyroid hormone levels. The disorder has a variety of\ncauses, manifestations, and therapies. Several clinical features of thyrotoxicosis are due to sympathetic stimulation with increased\nbeta-adrenoreceptor upregulation and sensitization to catecholamine. Anaesthetic management of thyrotoxicosis patients using\nneuraxial block has been described in literature; however, to our knowledge, there are no reports of peripheral nerve block\nutilization. Here, we report on the anaesthetic management of a patient with thyroiditis-associated thyrotoxicosis undergoing\nemergency surgery via a femoral and sciatic nerve block....
Introduction.This study compared streamlined liner of the pharynx airway (SLIPA) and I-gel noninflatable, single-use, supraglottic\nairway device (SAD) performance in anesthetized, paralyzed adults. Methods. Eighty adults (ASA physical statuses Iââ?¬â??III) who were\nundergoing elective procedures under general anesthesia with an SAD were enrolled in this prospective, randomized, single-blind\nstudy. Subjects were randomly and evenly assigned to the SLIPA or I-gel group for intraoperative airway management. Ease and\nnumber of insertions, insertion time, oropharyngeal sealing pressure, hemodynamic response, oxygen saturation (SpO2), end-tidal\nCO2 (EtCO2), and peri- and postoperative complications were examined. Results. The SLIPA and I-gel devices were successfully\ninserted in 100% and 95% of subjects, respectively. In two I-gel subjects (5%), ventilation was not possible after two attempts, but\na size 55 SLIPA was successfully inserted in both cases. Forty-two and 38 patients were ultimately included in the SLIPA and I-gel\ngroups, respectively. Insertion time was significantly shorter with the SLIPA (11.19 Ã?± 3.03 s) than with the I-gel (15.05 Ã?± 6.37 s,...
The perioperative management of patients suffering from extensive superior vena cava (SVC) thrombus complicated by SVC\nsyndrome presents unique challenges. The anesthesiologist needs to be prepared for possible thrombus dislodgement resulting\nin pulmonary embolism and also has to assess the need for fluid resuscitation given the dangers of massive intravenous fluid\napplication via the upper extremities. We present our perioperative approach in management of a patient scheduled for right\nhepatectomy who was previously diagnosed with extensive SVC and right atrial (RA) thrombus complicated by SVC syndrome....
Competency-based medical education is gaining traction as a solution to address the challenges associated with the current\ntime-based models of physician training. Competency-based medical education is an outcomes-based approach that involves\nidentifying the abilities required of physicians and then designing the curriculum to support the achievement and assessment\nof these competencies. This paradigm defies the assumption that competence is achieved based on time spent on rotations and\ninstead requires residents to demonstrate competence. The Royal College of Physicians and Surgeons of Canada (RCPSC) has\nlaunched Competence by Design (CBD), a competency-based approach for residency training and specialty practice. The first\nresidents to be trained within this model will be those in medical oncology and otolaryngology-head and neck surgery in July,\n2016. However, with approval from the RCPSC, the Department of Anesthesiology, University of Ottawa, launched an innovative\ncompetency-based residency training program July 1, 2015. The purpose of this paper is to provide an overview of the program and\noffer a blueprint for other programs planning similar curricular reform. The program is structured according to the RCPSC CBD\nstages and addresses all CanMEDS roles. While our program retains some aspects of the traditional design, we have made many\ntransformational changes....
There have been colossal technological advances in the use of simulation in anesthesiology in the past 2 decades. Over the years, the\nuse of simulation has gone from low fidelity to high fidelity models that mimic human responses in a startlingly realistic manner,\nextremely life-like mannequin that breathes, generates E.K.G, and has pulses, heart sounds, and an airway that can be programmed\nfor different degrees of obstruction. Simulation in anesthesiology is no longer a research fascination but an integral part of resident\neducation and one of ACGME requirements for resident graduation. Simulation training has been objectively shown to increase\nthe skill-set of anesthesiologists. Anesthesiology is leading the movement in patient safety. It is rational to assume a relationship\nbetween simulation training and patient safety. Nevertheless there has not been a demonstrable improvement in patient outcomes\nwith simulation training. Larger prospective studies that evaluate the improvement in patient outcomes are needed to justify the\nintegration of simulation training in resident education but ample number of studies in the past 5 years do show a definite benefit\nof using simulation in anesthesiology training. This paper gives a brief overview of the history and evolution of use of simulation\nin anesthesiology and highlights some of the more recent studies that have advanced simulation-based training....
Propofol is a widely used general anaesthetic with muscle relaxant properties. Similarly as\npropofol, the new general anaesthetic AZD3043 targets the GABAA receptor for its anaesthetic effects,\nbut the interaction with nicotinic acetylcholine receptors (nAChRs) has not been investigated. Notably,\nthere is a gap of knowledge about the interaction between propofol and the nAChRs found in the adult\nneuromuscular junction. The objective was to evaluate whether propofol or AZD3043 interact with\nthe �±1�²1�´�µ, �±3�²2, or �±7 nAChR subtypes that can be found in the neuromuscular junction and if there\nare any differences in affinity for those subtypes between propofol and AZD3043. Human nAChR\nsubtypes �±1�²1�´�µ, �±3�²2, and �±7 were expressed into Xenopus oocytes and studied with an automated\nvoltage-clamp. Propofol and AZD3043 inhibited ACh-induced currents in all of the nAChRs studied\nwith inhibitory concentrations higher than those needed for general anaesthesia. AZD3043 was\na more potent inhibitor at the adult muscle nAChR subtype compared to propofol. Propofol and\nAZD3043 inhibit nAChR subtypes that can be found in the adult NMJ in concentrations higher\nthan needed for general anaesthesia. This finding needs to be evaluated in an in vitro nerve-muscle\npreparation and suggests one possible explanation for the muscle relaxant effect of propofol seen\nduring higher doses....
Background. Propofol is a popular intravenous anesthetic and varieties of formulations were produced from different laboratories.\nThe present study compared efficacy of propofol of different laboratories and different concentrations (1 and 2%) during induction\nof anesthesia. Methods. Seventy-five scheduled surgical patients were randomly allocated into three groups. The patients of group\nD1 received AstraZeneca Diprivan 1% (Osaka, Japan) at a rate of 40mg kgâË?â??1 hâË?â??1. Group M1 was given 1% Maruishi (Maruishi\nPharmaceutical, Osaka, Japan) and group M2 was given 2% formulation at the same rate of propofol. Achieving hypnosis was\ndefined as failure to open their eyes in response to a verbal command and the venous blood sample was withdrawn. Results. The\nhypnotic doses ofM2were significantly larger (D1: 91.4Ã?±30.9, M1: 90.7Ã?±26.7, andM2: 118.4Ã?±40.2mg, resp. (mean Ã?± SD). ...
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