Anaesthesia, Pain & Intensive Care最新文献

{"title":"Dialysis disequilibrium syndrome: A case report","authors":"Yahya, H. Hidayati, Alexander Tikara Sugondo, Vania Ayu Puspamaniar, Fajar Sena Firdausa","doi":"10.35975/apic.v28i1.2388","DOIUrl":"https://doi.org/10.35975/apic.v28i1.2388","url":null,"abstract":"Dialysis disequilibrium syndrome (DDS) is a rare syndrome that can occur in patients with severe azotemia undergoing an initial hemodialysis (HD) session. DDS is associated with a more rapid decrease in urea concentration in the blood than in the brain during dialysis. Although severe DDS is less common, the milder forms of DDS may be missed by doctors. A 53-year-old male patient had the main complaint of severe dizziness in the last 10 months accompanied by a sensation of a wobbling head and tinnitus in his right ear. The patient had previously been diagnosed with polycystic kidney disease in 2018 and underwent regular hemodialysis two times a week since June 2019. In the patient's neurological status, cerebellar examination was positive for left dysmetria, left positive past pointing, Romberg test (open eye) fell to the right, and Romberg test (closed eye) fell to the right. There was no nystagmus on the patient's neuro-ophthalmological examination. Patients with kidney failure are at risk of developing DDS, so that appropriate precautions are needed. Due to the variability of symptoms, DDS often goes undiagnosed. Thus, it is important to be aware of the risk factors for DDS so that preventive steps can be taken appropriately. Continuous case reporting will raise awareness and the opportunity for further research to improve outcome in severe cases of DDS. \u0000Keywords: Dialysis; Disequilibrium; Dizziness; Polycystic Kidney. \u0000Citation: Yahya, Hidayati HB, Sugondo AT, Puspamaniar VA, Firdausa FS. Dialysis disequilibrium syndrome: A case report. Anaesth. pain intensive care 2024;28(1):191−195; DOI: 10.35975/apic.v28i1.2388 \u0000Received: October 10, 2023; Reviewed: December 20, 2023; Accepted: January 02, 2024","PeriodicalId":108815,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"5 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141018638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurological manifestations of hypokalemia: a case report","authors":"Vania Ayu Puspamaniar, A. Firdha, Nurul Azizah, H. Hidayati","doi":"10.35975/apic.v28i1.2387","DOIUrl":"https://doi.org/10.35975/apic.v28i1.2387","url":null,"abstract":"Hypokalemic Periodic Paralysis (HPP) is a neurological manifestation of hypokalemia, with a prevalence of 1 in 100,000. HPP is recognized by the sudden onset of muscle paralysis and low serum potassium. Due to its various causes, it may be misdiagnosed and neglected. \u0000We present a case of 42-year-old Asian female with weakness of both legs and cramps. The weakness was felt upon awakening from sleep. She also complained of palpitation, tiredness, sweating, heat intolerance, and hand tremors. In the recent weeks, her appetite increased. \u0000Periodic paralysis (PP) is characterized by bursts of painless muscle weakening. A possible cause of periodic paralysis is hypokalemia which was found in our case. Hyperthyroid is classified into potassium depletion by extra renal route which was found in this case. Management \u0000When managing a patient with sudden onset weakness or paralysis, it is crucial to consider the possibility of periodic paralysis. HPP is a rare but serious medical emergency. This should be suspected in any patient presenting with sudden muscle weakness. Prompt correction of any abnormalities in potassium levels can lead to rapid and complete symptom resolution. To avoid persistent or recurrent paralysis, any underlying causes should be effectively managed wherever possible. \u0000Keywords: Hypokalemia; Paralysis; Hyperthyroid; Hypokalemic Periodic Paralysis \u0000Citation: Puspamaniar VA, Firdha AA, Azizah N, Hidayati HB. Neurological manifestations of hypokalemia: a case report. Anaesth. pain intensive care 2024;28(1):187−190; DOI: 10.35975/apic.v28i1.2387 \u0000Received: September 03, 2023; Reviewed: September 16, 2023; Accepted: September 19, 2023","PeriodicalId":108815,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"5 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141021153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of prothrombin complex concentrate to control critical bleeding after splenectomy for blunt abdominal trauma; A case report","authors":"Aditia Pria Laksana, S. Manggala, Vera Irawany","doi":"10.35975/apic.v28i1.2289","DOIUrl":"https://doi.org/10.35975/apic.v28i1.2289","url":null,"abstract":"Blunt abdominal trauma is an event that can cause massive internal bleeding and can be life-threatening. Splenectomy is often performed to treat organ injuries in patients with blunt abdominal trauma. However, splenectomy can cause hemostasis problems, which can cause more bleeding and risk complications such as Acute Kidney Injury (AKI). \u0000This case report aims to discuss the role of prothrombin complex concentrate (PCC) in treating bleeding and preventing AKI in blunt abdominal trauma patients after splenectomy at Fatmawati Hospital, Jakarta, Indonesia. \u0000A 15-year-old woman experienced blunt abdominal trauma due to a sports accident and sustained internal bleeding. After a thorough evaluation, she underwent an emergency splenectomy to stop the bleeding. However, patients developed hemostasis problem which made the control of postoperative bleeding difficult. To overcome this problem, patient was administered PCC intravenously, which resulted in significant improvement in controlling postoperative bleeding. The hematocrit level and red blood cell count steadily increased, indicating the effectiveness of PCC in improving the patient's hemostasis. \u0000PCC can play an important role in treating post-splenectomy bleeding in patients with blunt abdominal trauma. Apart from that, the use of PCC can also help prevent AKI, which is a serious and life-threatening complication. Further research and clinical trials are needed to confirm the benefits of using PCC in a broader patient population with similar conditions. \u0000Abbreviations: AKI- Acute Kidney Injury; PCC- Prothrombin Complex Concentrate \u0000Keywords: Acute Kidney Injury; Bleeding; Blunt Abdominal Trauma; Prothrombin Complex Concentrate; Splenectomy \u0000Citation: Laksana AP, Manggala SK, Irawany V. The role of prothrombin complex concentrate to control critical bleeding after splenectomy for blunt abdominal trauma; A case report. Anaesth. pain intensive care 2024;28(1):177−181; DOI: 10.35975/apic.v28i1.2289 \u0000Received: September 13, 2023; Reviewed: October 29, 2023; Accepted: December 19, 2023","PeriodicalId":108815,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"9 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141020605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect on emergence from anesthesia following induction with diazepam and its association with CYP2C9, CYP2C19 and CYP3A4 gene polymorphisms","authors":"T. Mittal, VK Badhe, DS Divekar Badhe, P. Ahluwalia, Balraj Mittal, Rama Mittal","doi":"10.35975/apic.v28i1.2380","DOIUrl":"https://doi.org/10.35975/apic.v28i1.2380","url":null,"abstract":"Introduction & Objectives: Benzodiazepines are commonly used as adjuvants to IV anesthetic agents. Diazepam dosage varies widely depending on the desired endpoints. The rationale behind such inter-individual variability in drug responses has been attributed to genetically determined alterations in the enzyme activities. We assessed the emergence time in patients after induction of anesthesia with two different doses of diazepam and evaluated if any correlation exists between the emergence time and genetic polymorphism in drug metabolizers CYP2C19, CYP2C9, and CYP3A4 genes. \u0000Methodology: The study was conducted on randomly selected adult patients scheduled for elective surgery between 40-60 y of age with predefined inclusion and exclusion criteria. The patients were distributed into 2 groups, with group 1 receiving 0.2 mg/kg and group 2 given 0.3 mg/kg diazepam. Wake-up time after surgery was determined after a standardized verbal command played by a tape-recorder. Three ml blood in Ethylenediaminetetraacetic acid (EDTA) was collected before administering anesthesia. \u0000Results: Wake-up time between 8-18 min did not vary between the two groups. Comparatively persons having 2C19 2 took longer time to wake-up but this association was not statistically significant. However, CYP2C9 2 and 2 C9 3 and CYP3A4 genotypes had no influence on wake-up time. \u0000Conclusion: The pilot study suggests the emergence time from diazepam is longer in patients having 2C19 2 which confers slow-metabolizer phenotype. However, this study needs to be replicated in larger sample size to arrive at definitive conclusions before clinical applications. \u0000Abbreviations: BDZ- benzodiazepine; EDTA- Ethylenediaminetetraacetic acid; GA-General Anesthesia \u0000Key words: Diazepam; Emergence; Gene Polymorphism; Pharmacogenetics \u0000Citation: Mittal T, Badhe VK, Badhe DSD, Ahluwalia P, Mitta Bl, Mittal R. Effect on emergence from anesthesia following induction with diazepam and its association with CYP2C9, CYP2C19 and CYP3A4 gene polymorphisms.  Anaesth. pain intensive care 2024;28(1):126-138. DOI: 10.35975/apic.v28i1.2380 \u0000Received: July 20, 2023; Reviewed: December 07, 2023; Accepted: December 07, 2023","PeriodicalId":108815,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"11 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141020585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided third occipital nerve (TON) blocks","authors":"H. Hidayati, Vania Ayu Puspamaniar, Alexander Tikara Sugondo, Fajar Sena Firdausa","doi":"10.35975/apic.v28i1.2390","DOIUrl":"https://doi.org/10.35975/apic.v28i1.2390","url":null,"abstract":"Peripheral nerve blocks, including occipital nerve blocks (ONBs), have received increased attention and support as pain management tools during the previous few decades. Researchers have documented usefulness of ONBs particularly for acute headache management in the outpatient setting. The blocks also play a role in other healthcare settings, such as in the emergency department. The potential role of ONBs for the management of acute headache episodes in primary and emergency care settings is not yet fully practiced. In this paper, we will review block techniques of third occipital nerve (TON): indication, medication selection, complications and measures that can help improve safety in this procedure of headache management. \u0000Key word: Analgesia, Regional; Headache; Occipital Nerve Block; Occipital Neuralgia; Third Occipital Nerve; Ultrasound-Guide. \u0000Citation: Hidayati HB, Puspamaniar VA, Sugondo AT, Firdausa FS. Ultrasound-guided third occipital nerve (TON) blocks. Anaesth. pain intensive care 2024;28(1):166−170; DOI: 10.35975/apic.v28i1.2390 \u0000Received: October 13, 2023; Reviewed: October 18, 2023; Accepted: January 02, 2024","PeriodicalId":108815,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"34 36","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140081742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing airway management for enhanced patient outcomes: a narrative review","authors":"Nobuyasu Komasawa","doi":"10.35975/apic.v28i1.2391","DOIUrl":"https://doi.org/10.35975/apic.v28i1.2391","url":null,"abstract":"Airway management evidence has primarily been gathered within the operating room, particularly during the induction of anesthesia. The introduction of newly developed supraglottic devices and videolaryngoscopes have significantly impacted the guidelines for managing difficult airways, prompting the need for new evaluation criteria. Moreover, airway complications such as accidental extubation may occur during surgery, while aspiration or respiratory suppression can manifest during the recovery period following extubation. In this review, I will explore the potential future standards for airway management and potential indications for its application. Additionally, I will underscore the significance of emergency airway management during both the surgical procedure and the recovery phase. It is imperative that we not only accumulate knowledge related to managing difficult airways but also focus on emergency airway management in the future. This calls for interprofessional airway management training for all members of the perioperative team. \u0000Key words: Airway Management; Videolaryngoscope; Supraglottic Device; Future Direction \u0000Abbreviations: DAM - Difficult Airway Management; DAS - Difficult Airway Society; OR - operating room; SGD - Supraglottic Device; VLS – videolaryngoscope \u0000Citation: Komasawa N. Advancing airway management for enhanced patient outcomes: a narrative review. Anaesth. pain intensive care 2024;28(1):171−176; DOI: 10.35975/apic.v28i1.2391 \u0000Received: December 12, 2023; Reviewed: December 16, 2023; Accepted: December 16, 2023","PeriodicalId":108815,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"46 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140082311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic post-ICU pain: A review of the mechanism and the rehabilitation management","authors":"Arnengsih Nazir","doi":"10.35975/apic.v28i1.2389","DOIUrl":"https://doi.org/10.35975/apic.v28i1.2389","url":null,"abstract":"Objectives: This review aimed to explore the pain mechanism and rehabilitation management of functional impairments due to chronic post-ICU pain (CPIP). \u0000Methodology: Articles were searched using PubMed and Google Scholar databases with keywords chronic pain, chronic post-ICU pain, persistent pain, ICU-related pain, ICU survivor, and rehabilitation. All types of articles that were written in English and available in full-text format were considered for analysis. \u0000Results: The cause of CPIP is not certainly known, but several factors associated with the incidence of CPIP have been identified including genetic, premorbid conditions, medical intervention, and ICU care, as well as psychological or social factors. CPIP management aims to prevent disabilities due to chronic pain and improve functional abilities. The rehabilitation program of CPIP begins with a prevention program from the acute phase to the follow-up phase. The rehabilitation program consists of physical modalities, exercise, occupational therapy, and psychological or social counseling, as well as cognitive behavioral therapy (CBT). The CBT program has been shown to be effective in improving long-term outcomes, preventing the incidence of PICS, and improving the functional status of ICU survivors. \u0000Abbreviations: ADL- Activities of Daily Living; ARDS- Acute Respiratory Distress Syndrome; CBT- Cognitive Behavioral Therapy; CPIP- Chronic Post-ICU Pain; ICU- Intensive Care Unit; PTSD- Post-Traumatic Stress Disorder; QoL- Quality of Life \u0000Conclusion: CPIP caused functional impairments in ICU survivors and rehabilitation management has been proven beneficial in improving functional outcomes. \u0000Keywords: Chronic Pain; Counseling; Intensive Care Unit; Survivors \u0000Citation: Nazir A. Chronic post-ICU pain: A review of the mechanism and the rehabilitation management. Anaesth. pain intensive care 2024;28(1):159−165; DOI: 10.35975/apic.v28i1.2389 \u0000Received: September 06, 2023; Reviewed: October 30, 2023; Accepted: December 09, 2023","PeriodicalId":108815,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"182 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139862734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between morphological electrocardiographic characteristics and survival in critical COVID-19 patients","authors":"Mihrican Sayan, H. B. Altinişik","doi":"10.35975/apic.v28i1.2385","DOIUrl":"https://doi.org/10.35975/apic.v28i1.2385","url":null,"abstract":"Background: Myocardial damage is a sign of poor prognosis in coronavirus disease 2019 (COVID-19). Electrocardiography (ECG) would be useful to evaluate the effects of ECG findings on survival in severe COVID-19. We studied the relationship of pathological ECG findings in patients of COVID-19 admitted in ICU with other adverse physiological parameters as well as the mortality. \u0000Methodology: The study population comprised critical COVID-19 patients in the intensive care unit (ICU). Patients with findings other than normal sinus rhythm, atrial extra beat, and ventricular extra beat were defined as patients with pathological ECG findings. Two groups were formed: patients with pathological ECG findings (n = 109) and patients without pathological ECG findings (n = 84). Data were compared and analysed between the groups.  The relationship among the risk factors, and ECG findings with mortality was investigated. \u0000Results: The presence of hypertension (69% vs. 40%, OR 5.49, CI 1.71-17.66, P = 0.004), peripheral oxygen saturation (SpO2) (88 vs. 95, OR 0.8, CI 0.7-0.9, P < 0.001) were found to be related to mortality in multivariable analyses. Patients with pathological ECG finding were older [74 (27-98) vs. 61 (22-89); P < 0.001], and more likely to have hypertension (68% vs. 44%, P = 0.001). Pathological ECG findings (66% vs. 51%, P = 0.02), atrial fibrillation (AF) (37% vs. 20%, P = 0.01), right branch bundle block (RBBB) (10% vs. 3%, P = 0.048) were associated with higher mortality in univariable analyses. \u0000Conclusion: Although abnormal findings on ECG, especially AF and RBBB, are associated with a poor prognosis, they are not primary effective in increasing the mortality of critical COVID-19 patients. \u0000Abbreviations: AF- Atrial Fibrillation; CRP- C-reactive protein; ICU- intensive care unit; RBBB- Right Bundle-Branch Block; RT-PCR- reverse-transcription polymerase chain reaction; VTE- venous thromboembolism \u0000Key words: Atrial Fibrillation; Biomarkers; COVID-19; ECG; Mortality; Right Bundle-Branch Block \u0000Citation: Sayan M, Altinisik HB. The relationship between morphological electrocardiographic characteristics and survival in critical COVID-19 patients. Anaesth. pain intensive care 2024;28(1):139−150. \u0000DOI: 10.35975/apic.v28i1.2385 \u0000Received: November 21, 2023; Reviewed: November 30, 2023; Accepted: December 21, 2023","PeriodicalId":108815,"journal":{"name":"Anaesthesia, Pain &amp; Intensive Care","volume":"28 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139864983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic post-ICU pain: A review of the mechanism and the rehabilitation management","authors":"Arnengsih Nazir","doi":"10.35975/apic.v28i1.2389","DOIUrl":"https://doi.org/10.35975/apic.v28i1.2389","url":null,"abstract":"Objectives: This review aimed to explore the pain mechanism and rehabilitation management of functional impairments due to chronic post-ICU pain (CPIP). \u0000Methodology: Articles were searched using PubMed and Google Scholar databases with keywords chronic pain, chronic post-ICU pain, persistent pain, ICU-related pain, ICU survivor, and rehabilitation. All types of articles that were written in English and available in full-text format were considered for analysis. \u0000Results: The cause of CPIP is not certainly known, but several factors associated with the incidence of CPIP have been identified including genetic, premorbid conditions, medical intervention, and ICU care, as well as psychological or social factors. CPIP management aims to prevent disabilities due to chronic pain and improve functional abilities. The rehabilitation program of CPIP begins with a prevention program from the acute phase to the follow-up phase. The rehabilitation program consists of physical modalities, exercise, occupational therapy, and psychological or social counseling, as well as cognitive behavioral therapy (CBT). The CBT program has been shown to be effective in improving long-term outcomes, preventing the incidence of PICS, and improving the functional status of ICU survivors. \u0000Abbreviations: ADL- Activities of Daily Living; ARDS- Acute Respiratory Distress Syndrome; CBT- Cognitive Behavioral Therapy; CPIP- Chronic Post-ICU Pain; ICU- Intensive Care Unit; PTSD- Post-Traumatic Stress Disorder; QoL- Quality of Life \u0000Conclusion: CPIP caused functional impairments in ICU survivors and rehabilitation management has been proven beneficial in improving functional outcomes. \u0000Keywords: Chronic Pain; Counseling; Intensive Care Unit; Survivors \u0000Citation: Nazir A. Chronic post-ICU pain: A review of the mechanism and the rehabilitation management. Anaesth. pain intensive care 2024;28(1):159−165; DOI: 10.35975/apic.v28i1.2389 \u0000Received: September 06, 2023; Reviewed: October 30, 2023; Accepted: December 09, 2023","PeriodicalId":108815,"journal":{"name":"Anaesthesia, Pain &amp; Intensive Care","volume":"11 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139802733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the effects of the local anesthetics on immunity during mastectomy","authors":"Darko Angjushev, M. Sholjakova, A. Kartalov, B. Kuzmanovska, Aleksandar Kishman, Vasko Demjanski, M. Srceva, Anita Kokareva, M. K. Angjushev","doi":"10.35975/apic.v28i1.2383","DOIUrl":"https://doi.org/10.35975/apic.v28i1.2383","url":null,"abstract":"Background & objective: Surgery and some anesthetic techniques can contribute to tumor cells dissemination. It is known that the use of local anesthetics and regional blocks during mastectomy preserved the immune function. We evaluated and compared, the levels of some cytokines (IFNγ, TNFα, IL2, IL12) responsible for immune function, as well as the level of leukocytes before and after breast carcinoma surgery; and to find out and compare the effects of local anesthetics on blood pressure (BP) and on postoperative complications, e.g., pain, vomiting, headache, the need for analgesia and surgical complications. \u0000Methodology: In this randomized prospective study, 45 patients were allocated in 3 equal groups: Group GA (n = 15) for standard general anesthesia; Group LA (n = 15) for general anesthesia and infusion of lidocaine; Group PECS (n = 15) for pectoralis I/II block with bupivacaine and general anesthesia. Blood samples were taken to ascertain cytokines and leukocytes levels before surgery and 24 h after surgery. \u0000Results: Lidocaine caused fall of BP (P = 0.002t), but bupivacaine (PECS I/II block) produced stable BP during mastectomy (P = 0.1). A significant increase of leucocytes after surgery was seen in Group PECS compared to Group GA (P = 0.033). In 24-h intervals after surgery, lidocaine and bupivacaine produced an increase of TNFα (P < 0.05). Bupivacaine showed a significantly low intensity of postoperative pain compared to other techniques and zero postoperative complications. \u0000Conclusion: Local anesthetics lidocaine and bupivacaine enhance the immune response and produce more stable hemodynamics compared to general anesthesia alone during mastectomy in patients with breast carcinoma. \u0000Abbreviations: CTL- Cytotoxic T Lymphocytes; IFNγ- Interferon Gamma; TNFα- Tumour Necrosis Factor α, IL2- Interleukin-2; NKCs- Natural Killer Cells; Th1- Type 1 T Helper Cells; VAS- Visual Analog Scale \u0000Keywords: Breast Carcinoma; Lidocaine; Bupivacaine; PECS I/II block; Cytokines \u0000Citation: Angjushev DL, Sholjakova MV, Kartalov A, Kuzmanovska B, Kishman A, Demjanski V, Srceva MJ, Kokareva A, Angjushev MK. Evaluation of the effects of the local anesthetics on immunity during mastectomy. Anaesth. pain intensive care 2024;28(1):108−114; DOI: 10.35975/apic.v28i1.2383 \u0000Received: November 14, 2023; Reviewed: November 17, 2023; Accepted: December 09, 2023","PeriodicalId":108815,"journal":{"name":"Anaesthesia, Pain &amp; Intensive Care","volume":"8 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139804134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}