Current Issue : October - December Volume : 2018 Issue Number : 4 Articles : 6 Articles
Background: The SpineNav3DTM technology was recently incorporated in\nthe Accuro device for the automatic detection of spinal bone landmarks. The\ngoal of our study was to validate the ability of the Accuro ultrasound scanner\nto detect the distance from skin to epidural space by comparing it to the golden\nstandard (the standard ultrasound). The secondary end-point was the inter-\nrater agreement between an expert anesthesiologist and a novice trainee in\ndetermining the epidural space depth with the Accuro device. Methods: 96\nconsecutive healthy volunteer parturients at term had their lumbar area\nscanned for the measurements of the depth of the epidural space (recorded in\ncm) by two anesthesiologists. The expert investigator made the measurements\nwith both the standard ultrasound and the Accuro devices, and the trainee\nmade the measurements with the Accuro device only. Results: There were no\ndifferences in the mean depth of the epidural space as measured by the expert\nor the novice investigator with both the devices (standard ultrasound and\nAccuro) in both positions (sitting and lateral) at any intervertebral level with a\ndifference less than 0.25 cm. Conclusion: We have demonstrated that this\nhandheld ultrasound system with 3D spine navigation technology can automatically\nidentify the key neuraxial landmarks within ultrasound images of\nthe lumbar spine acquired in the transverse plane and measure the epidural\ndepth with the same accuracy as the standard ultrasounds. We have also\ndemonstrated that the measurements may be rapidly and adequately obtained\nby a novice who had never previously used ultrasounds....
Introduction: Eclampsia is a common cause of maternal mortality in developing\ncountries. The objective of this study is to evaluate the practice of anesthesia\nfor eclampsia in tropical Africa. Patients and Methods: Retrospective\ndescriptive study on the parturients who benefited from eclampsia anesthesia\nin the operating theaters of the gynecology and obstetrics department, the\nUniversity Hospital Center (CHU) of Bouake over a two-year period (January\n2015 to December 2016). The parameters studied were: anesthetic risk assessment,\nanesthetic management, immediate anesthetic and post-anesthetic\naccidents and incidents. Results: Out of a total of 3831 emergency cesarean\nsections, 65 were for eclampsia, or 1.69% of obstetrical surgical activity. The\nmean age of the patients was 20.30 �± 3.34 years (range: 14 years and 39 years).\nPrenatal consultation was not performed in 70% of cases and 85% of patients\nwere primiparous. Patients classified as ASA IIIU accounted for 75% of the\npopulation and in 62% of cases, the Glasgow score was between 9 and 12. Induction\nwas achieved with thiopental in 98% of patients and vecuronium was\nthe only muscle relaxant used. The most common fetal complications were\nhypotrophy (50%), prematurity (30%) and respiratory distress (40%). Postoperative\nanesthetic complications were agitation (70%) and wake delay\n(15%). Maternal mortality was 5% and the neonatal death rate was around\n7.69%. The elements of poor maternal prognosis were the ASA IVU class (P =\n0.015) and the Aldrete awakening score between 3 and 5 awakening (P =\n0.001). Conclusion: Anesthesia for eclampsia at CHU of Bouake is difficult. It\nneeds to be improved thanks to better equipment of the health structures....
Background: Pneumatic arterial tourniquet is a utilized strategy in limb surgeries\nto provide bloodless field to facilitate surgical procedure. Be that as it\nmay, arterial tourniquet has numerous injurious impacts including hemodynamic\nchanges and tourniquet-induced pain which sometimes can be severe\nand intolerable. Objectives: Our primary aim was to assess the impact of\nperforming ââ?¬Å?Lumbar Plexus Block and sciatic nerve blockââ?¬Â with General Anesthesia\n(GA) on the degree of arterial tourniquet-induced hemodynamic effects.\nOn the other hand, our secondary aims were: amount of postoperative\nanalgesic prerequisites, patient satisfactory score and documented side effects.\nSettings and Design: Ain Shams University, Orthopedic operating theatre; a\nprospective, randomized, double-blind study. Methods and Material: The\nphysical status of 50 patients (both sexes) including I and II patients from\nAmerican Society of Anesthesiologists, whose ages are from 20 - 40 years, is not\nso ideal when they are undergoing elective knee Arthroscopy. The duration lasts\nno more than ninety minutes under GA with application of tourniquet. Patients\nwere allotted haphazardly to one of two groups. In Group C (Control group):\nOnly GA. In Group B: LPB and sciatic nerve block were performed just before\nGA administration. Intraoperative hemodynamics was recorded at specific timings.\nResults: Incidence of tourniquet induced hypertension (TIH) was markedly\nless with Group B at: forty five, sixty, seventy five mins after tourniquet inflation\nand just before tourniquet deflation. Also, the total ketorolac consumption\nduring first 24 hours of postoperative period was significantly less with\nGroup B (p < 0.001). Finally, patient satisfaction was significantly higher in\nGroup B. Conclusions: Combined Sciatic-Lumbar plexus blocks when combined\nwith general anesthesia were very effective in attenuating TIH....
Objectives. Recent advances in the treatment of postoperative pain (POP) have increased the quality of life in surgical patients. The\naim of this study was to examine the quality of POP management in patients after CS in comparison with patients after\ncomparable surgical procedures. Methods. This was a prospective observational analysis in patients after CS in comparison with\nthe patients of the same age, who underwent comparable abdominal gynaecological surgeries (GS group) at the university\nhospital. A standardised questionnaire including pain intensity on the Verbal Rating Scale (VRS-11), incidence of analgesiarelated\nside effects, and incidence of pain interference with the items of quality of life and patients� satisfaction with the treatment\nof POP was used. Results. Sixty-four patients after CS reported more pain on movement than the patients after GS (N 63): mean\n6.1 versus 3.6 (VRS-11; P < 0.001).Thepatients after CS reported less nausea (8 versus 41%) and vomiting (3 versus 21%; P < 0.001)\nand demonstrated better satisfaction with POP treatment than the patients after GS: 1.4 (0.7) versus 1.7 (0.7) (mean (SD); VRS-5;\nP 0.02). Conclusion.The disparity between the high level of pain and excellent satisfaction with POP treatment raises the ethical\nand biomedical considerations of restrictive pharmacological therapy of post-CS pain....
Background. The middle ear is an air-filled lacuna in the temporal bone. Inhaled anesthetic agents increase the pressure of this\nlacuna. Therefore, attention must be paid in choosing not only anesthetic agents but also anesthetic method. Aim. This study\ncompared the effects of high-flow total intravenous anesthesia (TIVA) and low- and high-flow desflurane anesthesia on middle ear\npressure. Study Design. Randomized prospective double-blind study. Methods. In this retrospective double-blind study, 90 patients\n(20ââ?¬â??65 years old) scheduled to undergo elective thyroidectomies were divided into three randomized anesthesia groups: high-flow\ndesflurane (Group I), low-flow desflurane (Group II), and high-flow TIVA (propofol, remifentanil) (Group III). The hemodynamic\nand respiratory parameters and tympanometry were measured before induction (...
Background. Transient neurologic symptoms (TNSs) can be distressing for patients and providers following uneventful spinal\nanesthesia. Spinal mepivacaine may be less commonly associated with TNS than lidocaine; however, reported rates of TNS with\nintrathecal mepivacaine vary considerably. Materials and Methods. We conducted a retrospective cohort study reviewing the\ninternal medical records of surgical patients who underwent mepivacaine spinal anesthesia at Toronto Western Hospital over the\nlast decade to determine the rate of TNS. We defined TNS as new onset back pain that radiated to the buttocks or legs bilaterally.\nResults. We found one documented occurrence of TNS among a total of 679 mepivacaine spinal anesthetics (0.14%; CI:\n0.02ââ?¬â??1.04%) that were performed in 654 patients. Conclusion. Our retrospective data suggest that the rate of TNS associated with\nmepivacaine spinal anesthesia is lower than that previously reported in the literature....
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