Current Issue : July - September Volume : 2019 Issue Number : 3 Articles : 7 Articles
Background: There are several recent reports that left upper lobe lung resection is a risk factor for the development of\npostoperative thromboembolism. Although administering epidural analgesia is common in thoracic surgery,\nanesthesiologists should be alert when administering epidural analgesia to a patient undergoing left upper\nlobectomy, considering the increased risk of postoperative thromboembolism and the potential need for\nanticoagulation or fibrinolytic therapy in the immediate postoperative period.\nCase presentation: A seventy-one-year-old female with a metastatic lung lesion developed a cerebral infarction\napproximately 30 h after video-assisted thoracoscopic left upper lobectomy. Cerebral intravascular therapy was\nindicated and the epidural catheter was removed immediately to avoid formation of an epidural hematoma.\nApproximately four hours after onset, reperfusion was successfully established by aspiration of endovascular thrombi.\nShe recovered with mild residual paralysis of the left upper extremity and was transferred to a rehabilitation facility.\nConclusions: We present a patient with a cerebral infarction after left upper lobectomy. Left upper lobectomy is\nassociated with an increased risk of postoperative thromboembolism. Although the exact mechanism of thrombosis\nafter left upper lobectomy is unclear, a judicious decision should be made regarding epidural catheter placement for\npostoperative analgesia....
Background: Poor perioperative pain management during pneumothorax\nsurgery leads to respiratory complications in the post-operative period. The\nerector spinae plane (ESP) block technique has been shown to be able to\nblock the thoracic spinal nerves. Therefore,the ESP block may provide effective\nanalgesic during thoracic surgery. We have retrospectively investigated\nthe effectiveness of the ESP block for postoperative pain management in\npneumothorax surgery. Patients and Methods: Patients who underwent\npneumothorax surgery in 2017 were selected for the study. The primary outcome\nwas assessed using the numeric pain rating (NRS) scales until the\nmorning of the second post-operative day. The secondary outcomes were the\ncumulative amount of additional intravenous fentanyl administration until\nthe morning of the second post-operative day. Results: This retrospective\nstudy included 29 patients who underwent pneumothorax surgery. Of these\npatients, 13 patients received only general anaesthesia (control group), while\nthe other 16 patients received the ESP block in addition to general anaesthesia\n(study group). Compared to the control group, the study group did not show\nlower NRS scores at 1, 2, 4, 6, 12, and 24 hours post-surgery (P= 0.09, 0.17,\n0.06, 0.36, 0.47, and 0.71). As for the cumulative amount of additional fentanyl,\nthere were also no significant differences between the both groups.\nConclusions: The ESP block could not provide effective analgesia for the 24\nhours post-surgery period in patients undergoing pneumothorax surgery....
Background. The occurrence of false losses of resistance may be one of the reasons for inadequate or failed epidural block. A\nCompuFlo® epidural instrument has been introduced to measure the pressure of human tissues in real time at the orifice of a\nneedle and has been used as a tool to identify the epidural space. The aim of this study was to investigate the sensitivity and the\nspecificity of the ability of CompuFlo® to differentiate the false loss of resistance from the true loss of resistance encountered\nduring the epidural space identification procedure. Method. We performed epidural block with the CompuFlo® epidural instrument\nin 120 healthy women who requested labor epidural analgesia. The epidural needle was considered to have reached the\nepidural space when an increase in pressure (accompanied by an increase in the pitch of the audible tone) was followed by a\nsudden and sustained drop in pressure for more than 5 seconds accompanied by a sudden decrease in the pitch of the audible tone,\nresulting in the formation of a low and stable pressure plateau. We evaluate the sensitivity, specificity, and positive and negative\npredictive values of the ability of CompuFlo® recordings to correctly identify the true LOR from the false LOR. Results. The drop\nin pressure associated with the epidural space identification was significantly greater than that recorded after the false loss of\nresistance (73% vs 33%) (P =0.000001). The sensitivity was 0.83, and the AUC was 0.82. Discussion. We have confirmed the ability\nof CompuFlo® to differentiate the false loss of resistance from the true loss of resistance and established its specificity and\nsensitivity. Conclusion. An easier identification of dubious losses of resistance during the epidural procedure is essential to reduce\nthe number of epidural attempts and/or needle reinsertions with the potential of a reduced risk of accidental dural puncture\nespecially in difficult cases or when the procedure is performed by trainees....
Background: Postoperative delirium may manifest in the immediate post-anaesthesia care period. Such episodes\nappear to be predictive of further episodes of inpatient delirium and associated adverse outcomes. Frontal\nelectroencephalogram (EEG) findings of suppression patterns and low proprietary index values have been\nassociated with postoperative delirium and poor outcomes. However, the efficacy of titrating anaesthesia to\nproprietary index targets for preventing delirium remains contentious. We aim to assess the efficacy of two\nstrategies which we hypothesise could prevent post-anaesthesia care unit (PACU) delirium by maximising the alpha\noscillation observed in frontal EEG channels during the maintenance and emergence phases of anaesthesia.\nMethods: This is a 2 * 2 factorial, double-blind, stratified, randomised control trial of 600 patients. Eligible patients\nare those aged 60 years or over who are undergoing non-cardiac, non-intracranial, volatile-based anaesthesia of\nexpected duration of more than 2 h. Patients will be stratified by pre-operative cognitive status, surgery type and\nsite. For the maintenance phase of anaesthesia, patients will be randomised (1:1) to an alpha power-maximisation\nanaesthesia titration strategy versus standard care avoiding suppression patterns in the EEG. For the emergence\nphase of anaesthesia, patients will be randomised (1:1) to early cessation of volatile anaesthesia and emergence\nfrom an intravenous infusion of propofol versus standard emergence from volatile anaesthesia only. The primary\nstudy outcomes are the power of the frontal alpha oscillation during the maintenance and emergence phases of\nanaesthesia. Our main clinical outcome of interest is PACU delirium....
Background: Surveys of pediatric endotracheal tube (ETT) management\npreviously reported that specialists in pediatric anesthesia and intensive\ncare medicine preferred to use uncuffed ETTs for children younger than 8\nto 10 years of age. The aim of this study was to reveal the most recent attitudes\nand clinical practices of pediatric ETT management in Japan.\nMethods: The attitudes and clinical practices of pediatric ETT management\nwere investigated using the data sheets of each institution and each patient.\nThe data sheets contained information on patient characteristics and\ntype of hospital, surgical procedures, devices used for intubation, and ETT\ninformation including types, size, depth, intracuff pressure (ICP), interval\nof ICP measurement, laryngeal packing, ETT exchange, airway complications,\nand reintubations.Results: The response rate of this survey was\n66.7%. More than half of children older than 2 years of age were intubated\nwith cuffed ETTs; 83.5% of cuffed ETTs were used with the cuffs inflated,\nand ICP was measured in 80.7% of cuffed ETTs. More than half of ICP\nmeasurements were only taken at the time of intubation. Post-extubation\nstridor was rarely observed in cuffed (0.4%) or uncuffed ETTs (1.2%). The\npediatric ETT management questionnaire revealed age-based size selection,\ndifferences in pressure of air leakage between cuffed (15 - 20 cmH2O)\nand uncuffed ETTs (20 - 30 cmH2O) of different sizes, the depth-marking\nmethod of insertion length. Continuous measurement of ICP was not\ncommon. Conclusion: This study revealed widespread use of cuffed ETTs in\nchildren older than 2 years of age, rarely occurrence of post-extubation\nstridor, inflation of cuffs, and practice of ICP measurement....
Background: Pain is the common experience among post operative patients\nadmitted to the intensive care unit. Inadequate management can lead to undesired\ncomplications which can increase risk for morbidity and mortality.\nObjective: The aim of this study was to assess pain management and factors\nassociated with its severity among post surgical patients admitted in intensive\ncare unit at MNH.Method: A prospective study was conducted from October\n2017 to February 2018 involving a total of 123 post operative patients\naged 18 years and above admitted to the surgical and obstetric intensive care\nunits. Structured questionnaires were used to obtain the required perioperative\ninformation. Severity of pain was assessed by using the Numerical Rating\nScale (NRS). Data was analyzed using SPSS version 23.0. Frequency, percentages,\ntables and charts were used to summarize the study findings. Bivariate\nanalysis and multivariate logistic regression were done. P-value of <0.05 was\nconsidered significant. Results: The prevalence of severe post operative pain\nwithin 24 and 72 hours was 32.1% and 41.5% respectively. Pre operative use\nof analgesia (OR: 2.66, CI: 1.15 - 6.12, P value = 0.02), abdominal surgery\n(OR: 4.12 CI: 1.12 - 15.88, P value = 0.03) and thoracic surgeries (OR; 7.42,\nCI: 1.54 - 35.88, P value = 0.01) was significantly associated with severe pain.\nAge, sex, ASA class, duration of surgery, and level of education did not show\nsignificant association with pain severity. Opioids prescribed postoperatively\nwere pethidine (70.7%), morphine (11.4%) and fentanyl (11.4%). Other analgesics\nused were paracetamol (60.2%) and diclofenac (22%). Conclusion: The\nmagnitude of post operative pain was high. Pre operative uses of analgesia,\nabdominal and thoracic surgery were the factors associated with severe pain....
Recently, the interventional therapies are used more often in clinical practice for hepatocellular carcinoma. The most commonly\nused methodologies include radiofrequency ablation, microwave ablation, laser ablation, and cryotherapy. Most of the\ninterventional operations need local anesthesia combined with intravenous sedation. Also, some interventional therapy centers\napply general anesthesia. However, different anesthesia methods can cause diverse effects on patientsâ?? pain management,\nrecovery time, and hospitalization time. For the better understanding of the current anesthesia application status, we summarize\nand analyze multiple anesthesia methods while being applied in interventional therapy for hepatocellular carcinoma; in\naddition, their characters are also compared in this paper....
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