Current Issue : January - March Volume : 2020 Issue Number : 1 Articles : 6 Articles
Background: Quadratus lumborum block (QLB) is an effective analgesia that lowers opioid consumption after\nlower abdominal and hip surgeries. The subcostal approach to transmuscular QLB is a novel technique that can\nprovide postoperative analgesia by blocking more dermatomes. The aim of this study is to evaluate the efficacy\nand viability of subcostal approach to QLB after laparoscopic nephrectomy.\nMethods: Sixty patients who underwent laparoscopic nephrectomy were randomly divided into the subcostal\napproach to QLB group (QLB group, n = 30) and the control group (C group, n = 30). All patients underwent\nultrasound-guided subcostal approach to QLB in an ipsilateral parasagittal oblique plane at the L1â??L2 level. The QLB\ngroup received 0.4 cc/kg of 0.3% ropivacaine, and the C group received 0.4 cc/kg of 0.9% saline. Postoperatively, a\npatient-controlled intravenous analgesic pump with sufentanil was attached to all the patients. The primary outcome\nwas sufentanil consumption within the first 24 h after surgery. The secondary outcomes included the Ramsey\nsedation scale (RSS) scores and Bruggemann comfort scale (BCS) scores 6 h (T1), 12 h (T2), and 24 h (T3) after surgery,\nintraoperative remifentanil consumption, number of patients requiring rescue analgesia, time to recovery of intestinal\nfunction, mobilization time after surgery, and presence of side effects.\nResults: Sufentanil consumption within the first 24 h after surgery was significantly lower in the QLB group than in the\nC group (mean [standard deviation]: 34.1 [9.9] microg vs 42.1 [11.6] microg, P = .006). The RSS scores did not differ between the\ntwo groups, and the BCS scores of the QLB group at T1 and T2 time points was significantly higher than those of the C\ngroup(P<0.05). The consumption of remifentanil intraoperatively and the number of patients requiring rescue analgesia\nwere significantly lower in the QLB group (P<0.05). Time to recovery of intestinal function and mobilization time after\nsurgery were significantly earlier in the QLB group (P<0.05). The incidence of postoperative nausea and vomiting was\nsignificantly lower in the QLB group (P<0.05).\nConclusions: The ultrasound-guided subcostal approach to QLB is an effective analgesic technique in patients\nundergoing laparoscopic nephrectomy as it reduces the consumption of sufentanil postoperatively....
Background: Limb-girdle muscular dystrophies (LGMDs) belong to few neuromuscular disorders mainly involving\npelvic and shoulder girdle muscles. Also, cardiac or pulmonary complications, increased rhabdomyolysis risk when\nexposed to volatile anesthetics and succinylcholine may increase anesthesia related risks. However, current reports\nabout the anesthesia management of these patients are limited.\nCase presentation: We described our anesthetic management of a 36 years old woman with LGMD 2B receiving\narthroscopic knee surgery. In consideration of the high risk of rhabdomyolysis, total intravenous anesthesia (TIVA)\nwas selected for her surgery. Considering the unpredictable respiratory depression, opioid based patient-controlled\nintravenous analgesia was replaced with an intra-articular cocktail therapy consisting of 20 ml of 0.2% ropivacaine.\nAlso, we reviewed the literatures on anesthetic management of LGMD through searching PubMed, in order to\nprovide a comprehensive and safe guidance for the surgery.\nConclusions: Carefully conducted general anesthesia with TIVA technique is a good choice for LGMD patients.\nNeuraxial anesthesia may be used if general anesthesia needs to be avoided. To warrant safe anesthesia for surgery,\nany decision must be well thought out during perioperative period....
Background: The monitoring of regional cerebral oxygen saturation (SrO2) using near-infrared spectroscopy is useful\nmethod to detect cerebral ischemia during. Sevoflurane and propofol decrease cerebral metabolic rate (CMRO2) in a\nsimilar manner, but the effects on the cerebral blood flow (CBF) are different. We hypothesized that the effects of\nsevoflurane and propofol on SrO2 were different in patients with deficits of CBF. This study compared the effect of\nsevoflurane and propofol on SrO2 of patients undergoing cerebral endarterectomy (CEA).\nMethod: Patients undergoing CEA were randomly assigned to the sevoflurane or propofol group (n = 74). The\nexperiment was preceded in 2 stages based on carotid artery clamping. The first stage was from induction of\nanaesthesia to immediately before clamping of the carotid artery, and the second stage was until the end of the\noperation after clamping of the carotid artery. Oxygen saturation (SrO2, SpO2), haemodynamic variables (blood\npressure, heart rate), respiratory parameters (end-tidal carbon dioxide tension, inspired oxygen tension), concentration\nof anesthetics, and anesthesia depth (bispectral index score) were recorded.\nResults: During stage 1 period (before carotid artery clamping), the mean value of the relative changes in SrO2 was\nhigher (P = 0.033) and the maximal decrease in SrO2 was lower in the sevoflurane group compared with the propofol\ngroup (P = 0.019) in the contralateral (normal) site. However, there is no difference in ipsilateral site (affected site). SrO2\ndecreased after carotid artery clamping and increased after declamping, but the difference was not significant between\ntwo groups. Changes in mean arterial blood pressure was lower in sevoflurane group than propofol group after the\ncarotid artery declamping (P = 0.048).\nConclusion: Propofol-remifentanil anesthesia was comparable with sevoflurane-remifentanil anesthesia in an aspect of\npreserving the SrO2 in patients undergoing carotid endarterectomy....
Background: Clinicians sometimes encounter resistance in advancing a tracheal tube, which is inserted via a nostril,\nfrom the nasal cavity into the oropharynx during nasotracheal intubation. The purpose of this study was to\ninvestigate the effect of neck extension on the advancement of tracheal tubes from the nasal cavity into the\noropharynx during nasotracheal intubation.\nMethods: Patients were randomized to the â??neck extension group (E group)â?? or â??neutral position group (N group)â??\nfor this randomized controlled trial. After induction of anesthesia, a nasal RAE tube was inserted via a nostril. For the\nE group, an anesthesiologist advanced the tube from the nasal cavity into the oropharynx with the patientâ??s neck\nextended. For the N group, an anesthesiologist advanced the tube without neck extension. If the tube was\nsuccessfully advanced into the oropharynx within two attempts by the same maneuver according to the assigned\ngroup, the case was defined as â??success.â?? We compared the success rate of tube advancement between the two\ngroups.\nResults: Thirty-two patients in the E group and 33 in the N group completed the trial. The success rate of tube\npassage during the first two attempts was significantly higher in the E group than in the N group (93.8% vs. 60.6%;\nodds ratio = 9.75, 95% CI = [1.98, 47.94], p = 0.002).\nConclusion: Neck extension during tube advancement from the nasal cavity to the oropharynx before\nlaryngoscopy could be helpful in nasotracheal intubation....
Background: Myasthenia gravis (MG) is a challenge for anesthesia management. This report shows that the use of\nrocuronium-sugammadex is not free from flaws and highlights the importance of cholinesterase inhibitors management\nand neuromuscular block monitoring in the perioperative period of myasthenic patients.\nCase presentation: Myasthenic female patient submitted to general balanced anesthesia using 25 mg of rocuronium.\nUnder train-of-four (TOF) monitoring, repeated doses of sugammadex was used in a total of 800 mg without recovery of\nneuromuscular blockade, but TOF ratio (TOFR) was stabilized at 60%. Neostigmine administration led to the improvement\nof TOFR.\nConclusions: Although the use of rocuronium-sugammadex seems safe, we should consider their unpredictability in\nmyasthenic patients. This report supports the monitoring of neuromuscular blockade as mandatory in every patient,\nespecially the myasthenic ones....
Background: Hysterectomy is a widely performed surgery and neuraxial anesthesia with intrathecal morphine\nprovides superior quality of recovery. Postoperative nausea and vomiting (PONV) is a frequent problem with\nintrathecal morphine use. Although palonosetron is effective for prevention of PONV after general anesthesia, its\nefficacy after neuraxial anesthesia has not been established. This study was conducted to compare the use of\npalonosetron with ondansetron for PONV prophylaxis in patients at a high risk of PONV during total abdominal\nhysterectomy (TAH) under spinal anesthesia with intrathecal morphine.\nMethods: This prospective, randomized double-blind study conducted at São Rafael Hospital involved 140\nAmerican Society of Anesthesiologists physical status I or II women who underwent TAH under spinal anesthesia\nwith intrathecal morphine and who had at least 3 risk factors for PONV based on Apfelâ??s simplified score. The\npatients were randomized into two groups: one received palonosetron whereas the other received ondansetron. All\npatients received spinal anesthesia with intrathecal morphine, as well as dexamethasone plus palonosetron or\nondansetron for PONV prophylaxis. The overall incidence of PONV, incidence of early- and late-onset nausea and\nvomiting, severity of nausea, and use of rescue antiemetics were recorded.\nResults: The overall incidence of PONV was 42.9% in the palonosetron group and 52.9% in the ondansetron group\n(p > 0.05). No significant differences existed in the incidence of early- and late-onset nausea or early-onset vomiting\nbetween the two groups. The incidence of late-onset vomiting was significantly lower in the palonosetron group.\nConclusions: Palonosetron exhibited efficacy similar to that of ondansetron for reducing the overall incidence of\nPONV after TAH under spinal anesthesia with intrathecal morphine; however, palonosetron reduced the incidence\nof late-onset vomiting significantly better than ondansetron....
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