Current Issue : January - March Volume : 2017 Issue Number : 1 Articles : 7 Articles
Esophageal atresia is a disorder of the esophageal continuity with or without a connection\nwith the trachea or the under-development esophagus. Most babies who suffer\nfrom esophageal atresia also have tracheoesophageal fistula (an abnormal connection\nbetween the esophagus and the trachea/windpipe). The possibility of these two\nconditions is accompanied by other anomalies such as congenital heart disease and\nanorectal malformations. Esophageal atresia can also be interpreted as malformations\ncaused by the failure of the esophagus to develop a continual passage that may\nor may not establish a connection to the trachea (tracheoesophageal fistula) or it can\nbe said that the esophageal atresia is the failure of the esophagus to form a channel\nfrom the pharynx to the stomach during embryonic development. Another understanding\nof esophageal atresia is an interruption in the growth of a segment of the\nesophagus and remains as thin sections without continual channels. Tracheal esophageal\nfistula is an abnormal connection between the trachea and esophagus. Miscellaneous\ntypes of esophageal atresia include: Type A. The incidence of Type A\nesophageal atresia was about 5% - 8%. Type A esophageal atresia occurs at each end\nof the esophageal sac, and is apart without fistula to the trachea. Type B incident is\nrare. Type B esophageal atresia occurs at each end of the esophagus, and there is fistula\nfrom the trachea to the upper segment of esophagus. Incidence of Type C esophageal\natresia occurs about 80% - 95%. Type C esophageal atresia occurs at the\nproximal esophageal segment and ends at a dead-end sac, and distal segments are connected\nto the trachea or primary bronchus. Type D esophageal atresia is rare. In this\ntype, upper and lower segment of the esophagus is connected to the trachea. Type E\nesophageal atresia is rare when compared with Types A and C esophageal atresia. In\nthis type the esophagus and trachea are normal but they are connected with fistula....
Background: Cerebral oxygen saturation (rSO2c) decrease from baseline greater than 20 % during infant cardiac surgery\nwas associated with postoperative neurologic changes and neurodevelopmental impairment at 1 year of age. So far,\nthere is no sufficient evidence to support the routinemonitoring of rSO2c during general surgical procedures in children.\nWe aimed to find out the frequency of cerebral desaturation 20 % or more from baseline and to identify possible\npredictors of change in cerebral oxygen saturation during neonatal and infant general surgery.\nMethods: Forty-four infants up to 3 months of age were recruited. Before induction of anesthesia, two pediatric\ncerebral sensors were placed bilaterally to the forehead region and monitoring of regional cerebral saturation of\noxygen was started and continued throughout the surgery. Simultaneously, mean arterial blood pressure (MAP),\npulse oximetry (SpO2), heart rate (HR), endtidal CO2, expired fraction of sevoflurane and rectal temperature were\nrecorded. The main outcome measure was rSO2c value drop-off ââ?°Â¥20 % from baseline. Mann-Whitney U-test,\nchi-squared test, simple and multiple linear regression models were used for statistical analysis.\nResults: Forty-three infants were analyzed. Drop-off ââ?°Â¥20 % in rSO2c from baseline occurred in 8 (18.6 %)\npatients. There were no differences in basal rSO2c, SpO2, HR, endtidal CO2, expired fraction of sevoflurane and\nrectal temperature between patients with and without desaturation 20 % or more from baseline. But the two\ngroups differed with regard to gestation, preoperative mechanical ventilation and the use of vasoactive medications and\nred blood cell transfusions during surgery. Simple linear regression model showed, that gestation, age, preoperative\nmechanical ventilation and mean arterial pressure corresponding to minimal rSO2c value during anesthesia (MAPminrSO2c)\nwere associated with a change in rSO2c values. Multiple regression model including all above mentioned\nvariables, revealed that only MAPminrSO2c was predictive for a change in rSO2c values (Ã?² (95 % confidence interval) -0.28\n(âË?â??0.52ââ?¬â??(âË?â??0.04)) p = 0.02).\nConclusions: Cerebral oxygen desaturation ââ?°Â¥20 % from baseline occurred in almost one fifth of patients. Although\ndifferent perioperative factors can predispose to cerebral oxygenation changes, arterial blood pressure seems to be the\nmost important. Gestation as another possible risk factor needs further investigation...
Introduction. This survey aimed to investigate the attitudes/practice pertaining the use, management, and monitoring of\nneuromuscular blockade amongst Singaporean anaesthetists. Methods. All specialist accredited anaesthetists registered with\nthe Singapore Medical Council were invited to complete an anonymous online survey. Results. The response rate was 39.5%.\nNeuromuscular monitoring (NM) was used routinely by only 13.1% despite the widespread availability of monitors. 82% stated\nresidual NMB (RNMB) was a significant risk factor for patient outcome, but only 24% believed NMB monitoring should be\ncompulsory in all paralyzed patients. 63.6% of anaesthetists estimated the risk of RNMB in their own institutions to be <5%.\n63.1% always gave reversal. Neostigmine was predominantly used (85.1%), with 28.2% using sugammadex at least sometimes, citing\nunavailability and high costs. However, 83.8% believed in sugammadex�s benefits for patients� safety and >50% said such benefits\nmay be able to offset the associated costs. Conclusions. There is a significant need for reeducation about RNMB, studies on local\nRNMB incidences, and strengthening of current monitoring practices and guidelines. Strategies are discussed. As NM monitors\nappear widely available and reversal of NMB standard practice, it is hopeful that Singaporean anaesthetists will change and strive\nfor evidence-based best clinical practice to enhance patient safety....
Background: Sugammadex reverses neuromuscular block (NMB) through binding aminosteroid neuromuscular\nblocking agents. Although sugammadex appears to be highly selective, it can interact with other drugs, like\ncorticosteroids. A prospective single-blinded randomized clinical trial was designed to explore the significance\nof interactions between dexamethasone and sugammadex.\nMethods: Sixty-five patients who were anesthetized for elective abdominal or urological surgery were included.\nNMB was assessed using train-of-four stimulation (TOF), with rocuronium used to maintain the desired NMB depth.\nNMB reversal at the end of anaesthesia was achieved using sugammadex. According to their received antiemetics,\nthe patients were randomized to either the granisetron or dexamethasone group. Blood samples were taken before\nand after NMB reversal, for plasma dexamethasone and rocuronium determination. Primary endpoint was time from\nsugammadex administration to NMB reversal. Secondary endpoints included the ratios of the dexamethasone and\nrocuronium concentrations after NMB reversal versus before sugammadex administration.\nResults: There were no differences for time to NMB reversal between the control (mean 121 Ã?± 61 s) and the\ndexamethasone group (mean 125 Ã?± 57 s; P = 0.760). Time to NMB reversal to a TOF ratio ââ?°Â¥0.9 was significantly\nlonger in patients with lower TOF prior to sugammadex administration (Beta = âË?â??0.268; P = 0.038). The ratio between\nthe rocuronium concentrations after NMB reversal versus before sugammadex administration was significantly\naffected by sugammadex dose (Beta = âË?â??0.375; P = 0.004), as was rocuronium dose per hour of operation (Beta = âË?â??0.\n366; p = 0.007), while it was not affected by NMB depth before administration of sugammadex (Beta = âË?â??0.089; p = 0.\n483) and dexamethasone (Beta = âË?â??0.186; p = 0.131). There was significant drop in plasma dexamethasone after\nsugammadex administration and NMB reversal (p < 0.001).\nConclusions: Administration of dexamethasone to anesthetized patients did not delay NMB reversal by sugammadex...
Background: Dexmedetomidine as a sole agent showed limited use for painful procedures due to its insufficient\nsedative/analgesic effect, pronounced hemodynamic instability and prolonged recovery. The aim of this study was\nto compare the effects of dexmedetomidine-ketamine (DK) versus dexmedetomidine-midazolam-fentanyl (DMF)\ncombination on the quality of sedation/analgesia and recovery profiles for monitored anesthesia care (MAC).\nMethods: Fifty six patients undergoing chemoport insertion were randomly assigned to group DK or DMF. All patients\nreceived 1 Ã?¼g.kgâË?â??1 dexmedetomidine over 10 min followed by 0.2ââ?¬â??1.0 Ã?¼g.kgâË?â??1hâË?â??1 in order to maintain 3 or 4 of\nmodified Observer's Assessment of Analgesia and Sedation score checked every 3 min. At the start of dexmedetomidine\ninfusion, patients in group DK or DMF received 0.5 mg.kgâË?â??1 ketamine or 0.05 mg.kgâË?â??1 midazolam+ 0.5 Ã?¼g.kgâË?â??1 fentanyl\nintravenously, respectively. When required, rescue sedatives (0.5 mg.kg-1 of ketamine or 0.05 mg.kg-1 of midazolam)\nand analgesics (0.5 mg.kg-1 of ketamine or 0.5 Ã?¼g.kg-1 of fentanyl) were given to the patients in DK or DMF group,\nrespectively. The primary outcome of this study was the recovery parameters (time to spontaneous eye opening and\nthe length of the recovery room stay). The secondary outcomes were parameters indicating quality of sedation/\nanalgesia, cardiorespiratory variables, and satisfaction scores.\nResults: There were no significant differences in the onset time, time to spontaneous eye opening, recovery room\nstay, the incidences of inadequate analgesia, hypotension and bradycardia between the two groups. Despite lower\ninfusion rate of dexmedetomidine, more patients in the DMF group had bispectral index (BIS) < 60 than in the DK\ngroup and vice versa for need of rescue sedatives. The satisfaction scores of patients, surgeon, and anesthesiologist in\nthe DMF group were significantly better than the DK group.\nConclusions: The DK and DMF groups showed comparable recovery time, onset time, cardiorespiratory variables, and\nanalgesia. However, the DMF group showed a better sedation quality and satisfaction scores despite the lower infusion\nrate of dexmedetomidine, and a higher incidence of BIS < 60 than the DK group....
Background: Ramosetron is a relatively new 5-hydroxytryptamine three receptor antagonist with higher binding\naffinity and more prolonged duration of action compared to ondansetron. The present study was performed to\nevaluate the effects of ramosetron on QTc interval and possible cardiovascular adverse effects in patients\nundergoing cardiac surgery.\nMethod: A total of 114 patients who underwent off-pump coronary artery bypass surgery were enrolled in this\nrandomised placebo-controlled trial. Patients were allocated into two groups that received intravenous injection of\n0.3 mg ramosetron or normal saline during induction of anaesthesia. QTc intervals were measured before the\noperation, intraoperatively (0, 1, 2, 3, 5, 10, 15, 30, 45, 60, 90, 120, and 240 min after injection of ramosetron or\nnormal saline), at the end of the operation, and on postoperative day 1.\nResults: There were no differences in mean QTc interval between groups at every time point. However, maximal change\nin QTc interval during surgery was higher in the ramosetron group than the placebo group (25.1 Ã?± 22.0 vs. 17.5 Ã?± 14.5 ms,\n95 % CI 0.34ââ?¬â??14.78, P = 0.040). Also, there were more patients with a QTc interval increase of > 60 ms in the ramosetron\ngroup (5 vs. 0, 95 % CI 1.6ââ?¬â??18.0, P = 0.021). There were no significant differences in cardiovascular complications.\nConclusions: Ramosetron administered during induction of anaesthesia may affect maximal change in QTc interval\nduring off-pump coronary artery bypass surgery. Ramosetron should be used with caution in high risk patients for\ndeveloping Torsades de Pointes....
Background. Distal arm surgery is widely performed under regional anesthesia with brachial plexus block. The preponderance\nof evidence for the efficacy relies upon injection of local anesthetic in excess of 30 mL. We aimed to compare three different\nultrasound-guided brachial plexus block techniques restricting the total volume to 20 mL. Methods. 120 patients were prospectively\nrandomized to ultrasound-guided brachial plexus block with 20mL ropivacaine 0.75% at either the supraclavicular, infraclavicular,\nor axillary level. Multiinjection technique was performed with all three approaches. Primary outcome measure was performance\ntime. Results. Performance time and procedural pain were similar between groups. Needle passes and injection numbers were\nsignificantly reduced in the infraclavicular group (P < 0.01). Nerve visibility was significantly reduced in the axillary group\n(P = 0.01). Success-rate was significantly increased in the supraclavicular versus the axillary group (P < 0.025). Total anesthesiarelated\ntime was significantly reduced in the supraclavicular compared to the infraclavicular group (P < 0.01). Block duration\nwas significantly increased in the infraclavicular group (P < 0.05). No early adverse effects occurred. Conclusion. Supraclavicular\nand infraclavicular blocks exhibited favorable characteristics compared to the axillary block. Supraclavicular brachial plexus block\nwith the multiinjection intracluster technique exhibited significantly reduced total anesthesia-related time and higher success rate\nwithout any early adverse events....
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