Current Issue : January - March Volume : 2019 Issue Number : 1 Articles : 6 Articles
Objective: We recorded the data of patients performing Percutaneous Nephrolithotomy\n(PCNL) under combined spinal anesthesia with sedative mixtures\nof Ketamine-Propofol (KP) or Fentanyl-Propofol (FP). Background: The\nPCNL is usually done under General anesthesia (GA); combining spinal\nanesthesia with a mixture of sedative drugs has shown to provide an optimum\nintra and post-operative analgesic and sedative response without side effects.\nPatients and Methods: 100 healthy patients were enrolled for PCNL, after\nstabilization of the sensory block of spinal anesthesia patients were randomized\ninto two groups; Group KP received 1 mg/Kg Ketamine and 1 mg/Kg\nPropofol diluted in 20 ml syringe given over 30 seconds and Group FP received\n1 mic/Kg Fentanyl and 1 mg/Kg Propofol diluted in 20 ml syringe over\n30 seconds; both groups will receive increment doses if the patient suffers\nfrom anxiety, pain or discomfort. Perioperative Hemodynamic data (HR, SBP,\nDBP, RR, and SpO2) were recorded; PACU stay time and post operative\nanalgesia time were analyzed. Results: Sedative mixtures of FP and KP provided\nremarkably deep sedation levels for PCNL procedures under spinal\nanesthesia. Respiratory depression, hypotension and bradycardia were the\nmajor side effects reported in FP group which had mean decrease in RR of\n4.63 breath/min (27.49%) with mean 3.77% drop in SpO2 levels. KP group\nproduced significant increase in HR about 7 beats/min without reported side\neffects. Conclusion: Various sedation techniques may be applicable for PCNL\nprocedures with routine premedication, mixtures of fentanyl-Propofol or Ketamine-\nPropofol could be used, and KP has advantages of stable hemodynamics,\nprolonged analgesic response intra and post-operatively with no appreciable\nside effects and more effective method of sedative mixture....
Background. Eutectic mixture of local anesthetics (EMLA) cream is often used for local anesthesia during spinal injections.\nHowever, this agent has delayed onset of action while vapocoolant spray serves more advantages. The vapocoolant spray\ncontaining ethyl chloride has fast onset and is safe, low cost, and widely available. This study aimed at comparing the effectiveness\nof vapocoolant spray and EMLA cream in reducing pain for spinal injections. Methods. This was an experimental study on 94\nsubjects with 47 subjects treated with EMLA cream and 47 subjects treated with vapocoolant spray. The effectiveness of anesthesia\nwas assessed by using Numeric Pain Rating Scale (NPRS) and patient movement during the surgery. Results. This study found that\nthe pain scale was NPRS 0 (0â??3) for the EMLA group and NPRS 0 (0â??4) for the vapocoolant spray group. There was no significant\ndifference between two groups for pain scale according to the Mannâ??Whitney U test. For patient movement, the movement was\nreported only in one (2.1%) patient in the EMLA group and one (2.1%) patient in the vapocoolant spray group. Based on Fisherâ??s\ntest, there was no significant difference between the two groups for patient movement. Conclusions. Both EMLA cream and\nvapocoolant spray were equally effective in reducing pain during spinal injection. There was no difference in degree of pain\nreduction and patient movement between the EMLA cream group and the vapocoolant spray group during spinal injection....
Human epidemiologic studies and laboratory investigations in animal models suggest\nthat exposure to general anesthetic agents (GAs) have harmful effects on brain development.\nThe mechanism underlying this putative iatrogenic condition is not clear and there are currently\nno accepted strategies for prophylaxis or treatment. Recent evidence suggests that anesthetics\nmight cause persistent deficits in synaptogenesis by disrupting key events in neurodevelopment.\nUsing an in vitro model consisting of dissociated primary cultured mouse neurons, we demonstrate\nabnormal pre- and post-synaptic marker expression after a clinically-relevant isoflurane anesthesia\nexposure is conducted during neuron development. We find that pharmacologic inhibition\nof the mechanistic target of rapamycin (mTOR) pathway can reverse the observed changes.\nIsoflurane exposure increases expression of phospho-S6, a marker of mTOR pathway activity,\nin a concentration-dependent fashion and this effect occurs throughout neuronal development.\nThe mTOR 1 complex (mTORC1) and the mTOR 2 complex (mTORC2) branches of the pathway\nare both activated by isoflurane exposure and this is reversible with branch-specific inhibitors.\nUpregulation of mTOR is also seen with sevoflurane and propofol exposure, suggesting that this\nmechanism of developmental anesthetic neurotoxicity may occur with all the commonly used GAs in\npediatric practice. We conclude that GAs disrupt the development of neurons during development\nby activating a well-defined neurodevelopmental disease pathway and that this phenotype can be\nreversed by pharmacologic inhibition....
Since the original publication on the erector spinae plane (ESP) block in 2016,\nthe technique of the ESP block has evolved significantly in the last few years.\nThis review highlights recent developments in the technique for administering\nthe ESP block and proposes directions for future research. Continuous efforts\nare being aimed at improving understanding regarding the administration of\nthe ESP block. Current reports suggest that the ESP block provides effective\nanalgesia in thoracic and abdominal sites in patients of all ages. However, no\ncohort studies or randomized controlled trials were performed in 2016 and\n2017. The ESP block is an effective analgesic tool in a wide range of sites.\nHowever. We are uncertain how effective the ESP block is compared to other\ntypes of regional anesthesia. Therefore, more research on ESP blocks is required....
The use of gamification in healthcare has been gaining popularity. This prospective,\nrandomized, clinical trial was designed to evaluate whether gamification of the preoperative\nprocessâ??via virtual reality (VR) gaming that provides a vivid, immersive and realistic\nexperienceâ??could reduce preoperative anxiety in children. Seventy children scheduled for elective\nsurgery under general anesthesia were randomly divided into either the control or gamification group.\nChildren in the control group received conventional education regarding the preoperative process,\nwhereas those in the gamification group played a 5 min VR game experiencing the preoperative\nexperience. Preoperative anxiety, induction compliance checklist (ICC), and procedural behavior\nrating scale (PBRS) were measured. Sixty-nine children were included in the final analysis (control group = 35, gamificati Preoperative anxiety (28.3 [23.3â??36.7] vs. 46.7 [31.7â??51.7]; p < 0.001)\nand intraoperative compliance measured using ICC (p = 0.038) were lower in the gamification group\nthan in the control group. However, PBRS (p = 0.092) and parent/guardian satisfaction (p = 0.268)\nwere comparable between the two groups. VR experience of the preoperative process could reduce\npreoperative anxiety and improve compliance during anesthetic induction in children undergoing\nelective surgery and general anesthesia....
McGrath® MAC video laryngoscope (McG) has been used for orotracheal intubation\nin both normal patients and patients for whom intubation was expected\nto be difficult, and has been reported to provide improved visibility of\nthe glottis during tracheal intubation. There are some reports that normal nasotracheal\nintubation is easier with McG than with macintosh laryngoscope\n(ML). The usefulness of McG for nasotracheal intubation is beginning to be\nrecognised. We experienced three cases using McG in patients for whom intubation\nwas expected to be difficult due to the limited mouth opening and\nusing McG for those patients enabled smooth nasotracheal intubation. McG\nprovides good visual field during nasotracheal intubation, and is less invasive\nto the patient....
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