Current Issue : April - June Volume : 2019 Issue Number : 2 Articles : 8 Articles
The aim of this study is to compare the efficacy and safety of propofol with dexmedetomidine in patients with obstructive sleep\napnea hypopnea syndrome (SAHS) undergoing drug-induced sleep endoscopy (DISE). The 88 patients diagnosed with SAHS\nin the Affiliated Hospital of Xuzhou Medical University were randomly allocated into 2 groups (n = 44). Patients in the group\ndexmedetomidine (group D) received continuous intravenous infusion of dexmedetomidine 1----g/kg over 15 minutes before the\nendoscopy, and propofol 2 mg/kg was intravenously administrated in the group propofol (group P). Cardiopulmonary parameters\nof patients were recorded.The time to fall asleep, duration of endoscopic examination, the wakeup time of patients, the number of\nmask ventilations for patients, the satisfaction of patients and endoscopic performers, and false positive cases of SAHS of patients\nwere compared between the two groups. Compared with group D, mean arterial pressure (MAP) and blood oxygen saturation\n(SPO2) of patients in the P group were lower at the time point of T1 (P < 0.05), the duration of endoscopic examination and wakeup\ntime of patientswere obviously prolonged, the incidence of mask ventilation for patients and false positive cases of SAHS of patients\nwas observably higher, and the satisfaction of endoscopic performerswasmarkedly lower, but the time to fall asleep was significantly\nshortened (P < 0.05). Dexmedetomidine served as a novel sleep induced drug and can provide satisfactory conditions and be safely\nand effectively applied for endoscopy in patients with SAHS, without adverse hemodynamic effects....
Abstract\nBackground: Regional anesthesia could affect the homeostatic system functions resulting frequently in\nperioperative hypothermia and consequently shivering. The objective of this trial was to evaluate the efficacy of\ndexmedetomidine and ondansetron to reduce the incidence and severity of shivering after intrathecal blocks.\nMethods: This randomized placebo-controlled trial included 120 patients allocated equally in three groups. All\npatients were anesthetized by standard intrathecal blocks for surgical procedure at lower half of the body and\nreceived one of the study drugs intravenously (IV) according to the group assignments. Group S patients (placebo)\nwere administered saline, Group O (ondansetron) were given 8 mg ondansetron, and Group D (dexmedetomidine)\nwere given 1 ----g/kg of dexmedetomidine. Shivering incidence and scores, sedation scores, core body temperature,\nhemodynamic variables, and incidence of complications (nausea, vomiting, hypotension, bradycardia, over-sedation,\nand desaturation) were recorded.\nResults: The incidence and 95 confidence interval (95% CI) of shivering in group S 57.5% (42.18â??72.82%) was\nsignificantly higher than that of both group O 17.5% (5.73â??29.27%), P < 0.001 and group D 27.5% (13.66â??41.34%),\nP = 0.012. However, the difference in the incidence of shivering between group O and group D was comparable,\nP = 0.425. The sedation scores were significantly higher in group D than those of both group S and group O, P < 0.\n001. Sedation scores between group S and group O were comparable, P = 0.19. Incidences of adverse effects were\ncomparable between the three groups.\nConclusion: Prophylactic administrations of dexmedetomidine or ondansetron efficiently decrease the incidence\nand severity of shivering after spinal anesthesia as compared to placebo without significant difference between\ntheir efficacies when compared to each other.\nTrial registration: Pan African Clinical Trial Registry (PACTR) under trial number (PACTR201710002706318). 18-10-2017.\nâ??retrospectively registeredâ??....
Background: The study was done to assess the postoperative analgesic efficacy\nof ultrasound-guided continuous transverses abdominis plane block,\ncontinuous lumbar paravertebral block and a continuous lumbar epidural\nblock in patients undergoing lower abdominal surgeries (unilateral inguinal\nhernia repair). We compared their analgesic efficacy over the first 48 hour\npostoperative, in a randomized, single-blind study in 120 patients divided into\nfour equal groups, 30 patients in each group. Methods: 120 patients randomly\nassigned into four equal groups, with 30 patients in each group. Group\nT received ultrasound-guided transverses abdominis plane block with 20 ml\nof bupivacaine 0.25% followed by continuous infusion of bupivacaine 0.125%\n(0.1 ml/kg/hr) and group P received ultrasound-guided continuous lumbar\nparavertebral block with bupivacaine 0.25% bolus dose 20 ml, followed by\ncontinuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr). Group E received\ncontinuous lumbar epidural infusion of bupivacaine 0.25% bolus dose 20 ml,\nfollowed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr) and\ngroup C received normal saline bolus dose 20 ml, followed by continuous infusion\nof normal saline (0.1 ml/kg/hr). General anesthesia induced with fentanyl\n1 - 2 ---g/kg and propofol 1 - 3 mg/kg followed by atracurium 0.5 mg/kg.\nAt the end of the surgical procedure, we activated the regional block with recording\nof parameters in the postoperative period each patient was assessed\nfor visual analog scale (VAS) at rest and on movement, analgesic consumption,\nvital signs and presence of complications (nausea, vomiting, sedation),\nand postoperative patient satisfaction all data collected postoperatively by a\nblinded investigator at one, two, 6, 12, 24 and 48 hours postoperatively. Results:\nPostoperative analgesic efficacy is more in group E than group P and group T, the latter is least effective in pain control. Also in group E the postoperative\nanalgesic consumption is lower than in group P and group T, regarding\ncomplications as nausea and vomiting more recorded in epidural\nthan the other two groups. Conclusion: Regarding postoperative analgesic\nefficacy, the continuous lumbar epidural block is more effective than continuous\nparavertebral and continuous transverses abdominis plane block, but\nregarding complications, there was a higher incidence in epidural group than\nother two groups....
Background: Epidural catheter re-siting in parturients receiving labour epidural analgesia is distressing to the\nparturient and places them at increased complications from a repeat procedure. The aim of this study was to\ndevelop and validate a clinical risk factor model to predict the incidence of epidural catheter re-siting in labour\nanalgesia.\nMethods: The data from parturients that received labour epidural analgesia in our centre during 2014â??2015 was\nused to develop a predictive model for epidural catheter re-siting during labour analgesia. Multivariate logistic\nregression analysis was used to identify factors that were predictive of epidural catheter re-siting. The forward,\nbackward and stepwise variable selection methods were applied to build a predictive model, which was internally\nvalidated. The final multivariate model was externally validated with the data collected from 10,170 parturients\nduring 2012â??2013 in our centre.\nResults: Ninety-three (0.88%) parturients in 2014â??2015 required re-siting of their epidural catheter. The training\ndata set included 7439 paturients in 2014â??2015. A higher incidence of breakthrough pain (OR = 4.42), increasing\nage (OR = 1.07), an increased pain score post-epidural catheter insertion (OR = 1.35) and problems such as\ninability to obtain cerebrospinal fluid in combined spinal epidural technique (OR = 2.06) and venous puncture\n(OR = 1.70) were found to be significantly predictive of epidural catheter re-siting, while spontaneous onset of\nlabour (OR = 0.31) was found to be protective. The predictive model was validated internally on a further 3189\npaturients from the data of 2014â??2015 and externally on 10,170 paturients from the data of 2012â??2013. Predictive\naccuracy of the model based on C-statistic were 0.89 (0.86, 0.93) and 0.92 (0.88, 0.97) for training and internal\nvalidation data respectively. Similarly, predictive accuracy in terms of C-statistic was 0.89 (0.86, 0.92) based on\n2012â??2013 data.\nConclusion: Our predictive model of epidural re-siting in parturients receiving labour epidural analgesia could\nprovide timely identification of high-risk paturients required epidural re-siting....
Background and purpose. Local infiltration analgesia (LIA) supports early mobilization after hip and knee arthroplasty. Inspired by\nthis, we studied the effectiveness of wound infiltration with the long acting local anesthetic ropivacaine in an effort to decrease the\nneed for postoperative opioids after osteosynthesis of extracapsular hip fracture. Methods. Forty-nine patients undergoing\nosteosynthesis with a sliding hip screw were randomized into two groups in a double-blind study (ClinicalTrials.gov:\nNCT01119209). The patients received intraoperative infiltration followed by 6 postoperative injections through a wound catheter\nin eight-hour intervals. 23 patients received ropivacaine and 26 received saline. The intervention period was 2 days, and the\nobservation period was 5 days. In both groups, there were no restrictions on the total daily dose of opioids. Pain was assessed at\nspecific postoperative time points, and the daily opioid usage was registered. Results. Intraoperative infiltration with 200 mg\nropivacaine and postoperative repeated infiltration with 100 mg ropivacaine did not result in statistically significant difference\nbetween the groups regarding postoperative opioid consumption or pain. Interpretation. Ropivacaine as single component in\npostoperative treatment of pain after hip fracture is not effective. In our setup, wound infiltration with ropivacaine is not\nstatistically significantly better than placebo....
Paraplegia after non-cervical spine surgery under general anesthesia is a rare\ndevastating postoperative complication [1]. A patient with shoulder pain was\nscheduled for shoulder arthroscopy due to rotator cuff repair. Arthroscopic\nshoulder surgery was performed with the patient in the beach-chair. Postoperatively,\npatients complained the weakness of both lower leg and marked\nnumbness and tingling in the both arms. MRI showed a herniated intervertebral\ndisc between C6 and C7 with spinal cord compression. Despite urgent\ndiscectomy, the patient remained dysesthesia of both upper extremities for 6\nmonths. The purpose of this report is to introduce our case with a paraplegia\nobserved after arthroscopic shoulder surgery in beach-chair position because\nof acute cervical herniation....
Chronic pain is an important public health issue. Moreover, its adequate management is still considered a major clinical problem,\nmainly due to its incredible complexity and still poorly understood pathophysiology. Recent scientific evidence coming from\nneuroimaging research, particularly functional magnetic resonance (fMRI) and positron emission tomography (PET) studies,\nindicates that chronic pain is associated with structural and functional changes in several brain structures that integrate\nantinociceptive pathways and endogenous modulatory systems. Furthermore, the last two decades have witnessed a huge increase\nin the number of studies evaluating the clinical effects of noninvasive neuromodulatory methods, especially transcranial magnetic\nstimulation (TMS) and transcranial direct current stimulation (tDCS), which have been proved to effectively modulate the cortical\nexcitability, resulting in satisfactory analgesic effects with minimal adverse events. Nevertheless, the precise neuromechanisms\nwhereby such methods provide pain control are still largely unexplored. Recent studies have brought valuable information\nregarding the recruitment of different modulatory systems and related neurotransmitters, including glutamate, dopamine, and\nendogenous opioids. However, the specific neurocircuits involved in the analgesia produced by those therapies have not been fully\nelucidated. This review focuses on the current literature correlating the clinical effects of noninvasive methods of brain stimulation\nto the changes in the activity of endogenous modulatory systems....
Background. Percutaneous radiofrequency ablation (PRFA) is a useful and safe treatment for hepatocellular carcinoma (HCC).\nPain management, during and after PRFA, is a critical component of patient care. Objectives. This study reviewed the efficacy of\nthoracic epidural analgesia, during and after PRFA, for patients with HCC. Study Design. A retrospective, observational chart\nreview. Setting. Tertiary medical center/teaching hospital. Methods. Patients who had undergone PRFA for HCC in the past 5 years\nwere divided into two groups, based on the type of anesthesia administered: thoracic epidural anesthesia group (Group E) and\nlocal anesthesia with monitored anesthesia care group (Group C). We retrospectively reviewed changes in the numeric rating scale\n(NRS) score during and after PRFA, opioid consumption, length of the procedure, length of hospital stay, changes in blood\npressure during PRFA, and the incidence of adverse events. Results. The NRS score in Group E was significantly lower than that in\nGroup C (P < 0.05). The opioid consumption in Group E was lower than that in Group C after PRFA (P <0.05). The procedure\ntime was shorter in Group E (P<0.05). Neither of the groups showed significant difference with respect to the length of hospital\nstay and the incidence of respiratory depression, fever, and blood pressure elevation. The incidence of nausea, vomiting, and\nvoiding difficulty was higher in Group E. Limitations. This study is limited by its retrospective design. Conclusions. Thoracic\nepidural analgesia was associated with shorter procedure times, lower postprocedural pain, and lower opioid consumption during\nand after PRFA for HCC....
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