Current Issue : January - March Volume : 2012 Issue Number : 1 Articles : 8 Articles
We describe the anesthetic management of a patient with severe myasthenia gravis and tracheal stenosis; the patient was\r\nscheduled for direct laryngoscopy and dilatation. The combination of myasthenia gravis and tracheal obstruction presents several\r\ndifficulties for anesthetic management. The airway is shared; therefore, any complications are also shared by the anesthesiologist\r\nand bronchoscopists. The potential for respiratory compromise in patients undergoing the two procedures requires that\r\nanesthesiologists be familiar with the underlying disease state, as well as the interaction of anesthetic and nonanesthetic drugs in\r\na case involving myasthenia gravis. We reviewed the literature and report our experience in this case. There is no strong evidence\r\nfor choosing one approach to general anesthesia over another for bronchoscopy. Careful preoperative planning and experience in\r\nairway management and jet ventilation are crucial to prevent an adverse outcome and obtain favorable results....
We hypothesized that combined peripheral nerve block (CPNB) technique might reduce mortality in hip fracture patients with\r\nthe advantage of preserved cardiovascular stability. We retrospectively analyzed 257 hip fracture patients for mortality rates\r\nand affecting factors according to general anesthesia (GA), neuraxial block (NB), and CPNB techniques. Patients� gender, age\r\nat admission, trauma date, ASA status, delay in surgery, followup period, and Barthel Activities of Daily Living Index were\r\ndetermined. There were no differences between three anesthesia groups regarding to sex, followup, delay in surgery, and Barthel\r\nscore. NB patients was significantly younger and CPNB patients� ASA status were significantly worse than other groups. Mortality\r\nwas lower for regional group (NB + CPNB) than GA group. Mortality was increased with age, delay in surgery, and ASA and\r\ndecreased with CPNB choice; however, it was not correlated with NB choice. Since the patients� age and ASA status cannot be\r\nchanged, they must be operated immediately. We recommend CPNB technique in high-risk patients to operate them earlier....
The last 10 years has seen the increased use of enhanced recovery pathways across several surgical specialities. A prerequisite of\r\nenhanced recovery is the ability to mobilise patients early. This is dependent upon good postoperative pain control. A number of\r\ndifferent techniques have been employed in joint replacement surgery to address this issue. This paper focuses upon the current\r\nevidence for local infiltration anaesthesia....
Obesity is a worldwide health problem affecting 34% of the American population. As a result, more patients requiring anesthesia\r\nfor thoracic surgery will be overweight or obese. Changes in static and dynamic respiratory mechanics, upper airway anatomy,\r\nas well as multiple preoperative comorbidities and altered drug metabolism, characterize obese patients and affect the anesthetic\r\nplan at multiple levels. During the preoperative evaluation, patients should be assessed to identify who is at risk for difficult\r\nventilation and intubation, and postoperative complications. The analgesia plan should be executed starting in the preoperative\r\narea, to increase the success of extubation at the end of the case and prevent reintubation. Intraoperative ventilatory settings should\r\nbe customized to the changes in respiratory mechanics for the specific patient and procedure, to minimize the risk of lung damage.\r\nSeveral non invasive ventilatory modalities are available to increase the success rate of extubation at the end of the case and to\r\nprevent reintubation. The goal of this review is to evaluate the physiological and anatomical changes associated with obesity and\r\nhow they affect the multiple components of the anesthetic management for thoracic procedures....
There is much literature on the toxic effects of anesthetics. This paper deals with both the volatiles and locals. Adverse effects\r\nappear to be multifaceted, with the focus on radicals, oxidative stress (OS), and electron transfer (ET). ET functionalities involved\r\nare quinone, iminoquinone, conjugated iminium, and nitrone. The non-ET routes involving radicals and OS apparently pertain\r\nto haloalkanes and ethers. Beneficial effects of antioxidants, evidently countering OS, are reported. Knowledge at the molecular\r\nlevel should aid in devising strategies to combat the adverse effects....
The sympathetic nervous system has been implicated in pain associated with painful diabetic neuropathy. However, therapeutic\r\nintervention targeted at the sympathetic nervous system has not been established. We thus tested the hypothesis that sympathetic\r\nnerve blocks significantly reduce pain in a patient with painful diabetic neuropathy who has failed multiple pharmacological\r\ntreatments. The diagnosis of small fiber sensory neuropathy was based on clinical presentations and confirmed by skin biopsies.\r\nA series of 9 lumbar sympathetic blocks over a 26-month period provided sustained pain relief in his legs. Additional thoracic\r\nparavertebral blocks further provided control of the pain in the trunk which can occasionally be seen in severe diabetic neuropathy\r\ncases, consequent to extensive involvement of the intercostal nerves. These blocks provided sustained and significant pain relief\r\nand improvement of quality of life over a period of more than two years. We thus provided the first clinical evidence supporting\r\nthe notion that sympathetic nervous system plays a critical role in painful diabetic neuropathy and sympathetic blocks can be an\r\neffective management modality of painful diabetic neuropathy. We concluded that the sympathetic nervous system is a valuable\r\ntherapeutic target of pharmacological and interventional modalities of treatments in painful diabetic neuropathy patients....
Under normal conditions, acute pain processing consists of well-characterized neuronal signaling events.When dysfunctional pain\r\nsignaling occurs, pathological pain ensues. Glial activation and their released factors participate in the mediation of pathological\r\npain. The use of cannabinoid compounds for pain relief is currently an area of great interest for both basic scientists and physicians.\r\nThese compounds, bind mainly either the cannabinoid receptor subtype 1 (CB1R) or cannabinoid receptor subtype 2 (CB2R) and\r\nare able to modulate pain. Although cannabinoids were initially only thought to modulate pain via neuronal mechanisms within\r\nthe central nervous system, strong evidence now supports that CB2R cannabinoid compounds are capable of modulating glia,\r\n(e.g. astrocytes and microglia) for pain relief. However, the mechanisms underlying cannabinoid receptor-mediated pain relief\r\nremain largely unknown. An emerging body of evidence supports that CB2R agonist compounds may prove to be powerful novel\r\ntherapeutic candidates for the treatment of chronic pain....
Background\r\nPost-herpetic neuralgia (PHN) is a common type of neuropathic pain that can severely affect quality of life. NGX-4010, a capsaicin 8% dermal patch, is a localized treatment that can provide patients with significant pain relief for up to 3 months following a single 60-minute application. The NGX-4010 application can be associated with application-site pain and in previous clinical trials pretreatment with a topical 4% lidocaine anesthetic was used to enhance tolerability. The aim of the current investigation was to evaluate tolerability of NGX-4010 after pretreatment with lidocaine 2.5%/prilocaine 2.5% anesthetic cream.\r\nMethods\r\nTwenty-four patients with PHN were pretreated with lidocaine 2.5%/prilocaine 2.5% cream for 60 minutes before receiving a single 60-minute application of NGX-4010. Tolerability was assessed by measuring patch application duration, the proportion of patients completing over 90% of the intended treatment duration, application site-related pain using the Numeric Pain Rating Scale (NPRS), and analgesic medication use to relieve such pain. Safety was assessed by monitoring adverse events (AEs) and dermal irritation using dermal assessment scores.\r\n\r\nResults\r\nThe mean treatment duration of NGX-4010 was 60.2 minutes and all patients completed over 90% of the intended patch application duration. Pain during application was transient. A maximum mean change in NPRS score of +3.0 was observed at 55 minutes post-patch application; pain scores gradually declined to near pre-anesthetic levels (+0.71) within 85 minutes of patch removal. Half of the patients received analgesic medication on the day of treatment; by Day 7, no patients required medication. The most common AEs were application site-related pain, erythema, edema, and pruritus. All patients experienced mild dermal irritation 5 minutes after patch removal, which subsequently decreased; at Day 7, no irritation was evident. The maximum recorded dermal assessment score was 2.\r\nConclusion\r\nNGX-4010 was well tolerated following pretreatment with lidocaine 2.5%/prilocaine 2.5% cream in patients with PHN. The tolerability of the patch application appeared comparable with that seen in other studies that used 4% lidocaine cream as the pretreatment anesthetic....
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