Current Issue : April - June Volume : 2020 Issue Number : 2 Articles : 5 Articles
Background: Patient outcomes are influenced by intraoperative temperature management. Oesophageal/\npharyngeal temperature monitoring is the standard of care at our institute but is not well tolerated in awake\npatients. Many non-invasive temperature monitors have been studied. Only the TraxIt® Wearable Childrenâ??s\nUnderarm Thermometer which contains liquid crystals that undergo phase changes according to temperature is\navailable at our institution. We tested these non-invasive monitors against our standard of care which is the\noesophageal/pharyngeal temperature monitor.\nMethods: We conducted a prospective observational study of 100 patients receiving general anaesthesia for\nelective surgery. .......................................
Background: We aimed to evaluate a modified endotracheal tube containing upper and lower balloons for\nanesthetic administration among patients undergoing laparoscopic cholecystectomy.\nMethods: Ninety patients scheduled to undergo laparoscopic cholecystectomy were randomly allocated to 3 equal\ngroups: group A (conventional tracheal intubation without endotracheal anesthesia); B (conventional tracheal\nintubation with endotracheal anesthesia); and C (tracheal intubation using a modified catheter under study). Blood\npressure, heart rate, angiotensin II level, blood glucose level, airway pressure before anesthesia (T1) were measured\nimmediately after intubation (T2), 5 min after intubation (T3), and immediately after extubation (T4). The postextubation\npain experienced was evaluated using the Wong-Baker Face Pain scale. Adverse reactions within 30 min\nafter extubation were recorded.\nResults: Systolic blood pressure, diastolic blood pressure, angiotensin II, and blood sugar level in group C at T2, T3\nand T4, and heart rate at T2 and T4 were significantly lower than those in group A (P < 0.05); systolic blood pressure\nand blood sugar at T4, and angiotensin II levels at T2, T3, and T4 were significantly lower than those in group B\n(P < 0.05). Patients in group C reported the lowest post-extubation pain (P < 0.05 vs. Group A), and the lowest\nincidence of adverse events such as nausea, vomiting, and sore throat than that in groups A and B (P < 0.05).\nConclusion: The modified endotracheal anesthesia tube under study is effective in reducing cardiovascular and\ntracheal stress response, and increasing patient comfort, without inducing an increase in airway resistance....
Background: Spinal anesthesia using the midline approach might be technically difficult in geriatric population. We\nhypothesized that pre-procedural ultrasound (US)-guided paramedian technique and pre-procedural US-guided\nmidline technique would result in a different spinal anesthesia success rate at first attempt when compared with\nthe conventional landmark-guided midline technique in elderly patients.\nMethods: In this prospective, randomized, controlled study, one hundred-eighty consenting patients scheduled for\nelective surgery were randomized into the conventional surface landmark-guided midline technique (group LM),\nthe pre-procedural US-guided paramedian technique (group UP), or the pre-procedural US-guided midline technique\n(group UM) with 60 patients in each group. All spinal anesthesia were performed by a novice resident.\nResults: The successful dural puncture rate on first attempt (primary outcome) was higher in groups LM and UM (77\nand 73% respectively) than in group UP (42%; P < 0.001). The median number of attempts was lower in groups LM and\nUM (1 [1] and 1 [1â??1.75] respectively) than in group UP (2 [1, 2]; P < 0.001). The median number of passes was lower in\ngroups LM and UM (2 [0.25â??3] and 2 [0â??4]; respectively) than in group UP (4 [2â??7.75]; P < 0.001). The time taken to\nperform the spinal anesthesia was not different between groups LM and UM (87.24 ± 79.51 s and 116.32 ± 98.12 s,\nrespectively) but shorter than in group UP (154.58 ± 91.51 s; P < 0.001).\nConclusions: A pre-procedural US scan did not improve the ease of midline and paramedian spinal anesthesia as\ncompared to the conventional landmark midline technique when performed by junior residents in elderly population....
Background: We studied the influence of ephedrine or phenylephrine infusion administered immediately after\nspinal anesthesia (SA) on hemodynamics in elderly orthopedic patients.\nMethods: A prospective, randomized, double-blind, placebo-controlled study.\nAfter a subarachnoid injection of 15 mg of levobupivacaine, the participants received an infusion of either\nephedrine 20 mg (E group), phenylephrine 250 mcg (P group) or saline (C group) within 30 min. We measured\nblood pressure, cardiac index (CI) and heart rate (HR) from 15 min before to 30 min after SA.\nResults: Seventy patients were included in the final analysis. At the end of measurements, mean arterial pressure\n(MAP) decreased significantly after SA in comparison to the baseline value in the C group but was maintained in\nthe P and E group, with no significant differences between the groups. CI decreased after SA in the C group, was\nmaintained in the P group, and increased significantly in the E group with significant differences between the C\nand E group (p = 0.049) also between the P and E (p = 0.01) group at the end of measurements. HR decreased\nsignificantly after SA in the C and P group but was maintained in the E group, with significant differences between\nthe P and E group (p = 0.033) at the end of measurements.\nConclusions: Hemodynamic changes after SA in elderly orthopedic patients can be prevented by an immediate\ninfusion of phenylephrine or ephedrine. In addition to maintaining blood pressure, the ephedrine infusion also\nmaintains HR and increases CI after SA....
Neuraxial anaesthesia is widely used in surgical procedures; overall, epidural\nand intrathecal techniques. Nevertheless, several outcomes should be considered.\nThe incidence of neurologic complications after neuraxial anaesthesia\nis not perfectly clear (0% - 0.08%), although there are several described cases\nof spinal cord ischemia. We present a case of thoracic unilateral spinal cord\nsyndrome following lumbar spinal anaesthesia for periprosthetic knee fracture.\nOur patient suffered monoparesis in her left lower limb as well as decreasing\nof muscle strength and loss of tendon reflexes. The MNR showed left\nhyperintense intra-cord images from T7 to T12 attributed to spinal cord\noedema and a lineal hypointensity related to minimal haematic component.\nWhat made this case surprising was the fact that spinal anaesthesia was performed\nbetween L3 and L4 and the patient did not suffer paraesthesia associated\nwith local anaesthetic injection. She was treated with glucocorticoids,\ngabapentin and amitriptyline. She also was checked by physical rehabilitators,\nneurologists and Pain Unit physicians. We have found another case reported\nin the literature about thoracic cord injury after lumbar spinal puncture. In\nthis paper, we report possible aetiologies according to a review and neurological\nevolution of the patient seven months later....
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