Research and Opinion in Anesthesia and Intensive Care最新文献

{"title":"Caudal versus intravenous ketamine for supplementation of analgesia in children undergoing hypospadias repair: a randomized controlled trial","authors":"Ayman A Rayan","doi":"10.4103/roaic.roaic_42_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_42_20","url":null,"abstract":"Background Different additives have been reported to prolong the duration of caudal anesthesia in pediatrics. Although these drugs successfully increased the duration of the block, ketamine has been found to effectively increase the duration of caudal block in pediatrics. Aim This study aimed to assess the clinical effectiveness of ketamine after caudal or intravenous administration in pediatric patients who underwent hypospadias repair to distinguish between local and systemic analgesia. Patients and methods After induction of general anesthesia, 48 patients, aged 1–6 years, assigned to undergo hypospadias repair, received a caudal injection of bupivacaine and were randomly blinded into two groups: K1 group received 1 mg/kg S-ketamine as the caudal group, and K2 group received 1 mg/kg S-ketamine as the intravenous group. Postsurgical measurements included the effectiveness of postsurgical analgesia, which was assessed by using observational pain scale, duration of analgesia, sedation score, and hemodynamic and complications. Results The caudal block was successful in all the patients included in the study. None of the patients in either groups required intraoperative rescue analgesia. All patients remained vitally stable during the procedure, and intraoperative hemodynamic parameters were comparable in the two groups. The time to the administration of first analgesia was statistically longer in K1 group (11.5±4.6 h) than in the K2 group (8.7±3.1 h). Time to spontaneous leg movement and time to first micturition were statistically nonsignificant between both groups. The number of patients requested for additional analgesic drugs (acetaminophen and ibuprofen) was statistically significant, being higher in the K2 group than the K1 group. Conclusion This study demonstrates that ketamine if added to caudal epidural in a dose of 1 mg/kg provided prolonged postoperative analgesia with improved quality, had longer duration of analgesia, decreased the supplemental acetaminophen analgesia during the first 24 h postoperatively, had stable hemodynamic changes, and had comparable adverse effects and complications in comparison with systemic ketamine in a dose of 1 mg/kg.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"142 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114508922","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":"Maternal hypotension and fetal outcome: effect of height-adjusted and weight-adjusted dose versus fixed dose of 0.5% intrathecal hyperbaric bupivacaine","authors":"Adekunle Durodola, O. Adekola, P. Agbamu, Olusolape Akinwilliams, J. Olatosi","doi":"10.4103/roaic.roaic_52_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_52_20","url":null,"abstract":"Background Profound hypotension during cesarean section can compromise fetal circulation and cause cardiac arrest in the parturients. We compared the incidence of hypotension, adequacy of anesthesia, and neonatal outcome using a height-adjusted and weight-adjusted dose and a fixed dose of 0.5% intrathecal hyperbaric bupivacaine. Patients and methods This was a randomized controlled double-blind trial involving 80 parturients aged 18–40 years scheduled for elective cesarean section under spinal anesthesia. They were randomly allocated by blind balloting into one of two groups: group FD received 12 mg of 0.5% hyperbaric bupivacaine, whereas group AD received a height-adjusted and weight-adjusted dose of 0.5% hyperbaric bupivacaine according to Harten’s chart. Parturients were preloaded with 10 ml/kg of 0.9% sodium chloride. Results The median dose of bupivacaine was significantly higher in group FD (12 mg) than group AD (9.5 mg) (P=0.001). The incidence of hypotension was significantly higher in group FD (60%) than in group AD (32.5%) (P=0.014). The median time to attain the maximal level of sensory block (T5) was significantly faster in group FD (10 min) than group AD (13 min) (P=0.021). The Apgar score and incidences of other complications were comparable between both groups (P>0.05). Conclusion It is concluded that a lower dose of bupivacaine was required to provide comparable sensory and motor block, with less incidence of hypotension when the bupivacaine dose was adjusted to the height and weight of parturients than when a fixed dose was used.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"88 12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116255982","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":"Two safe techniques for intubation using Macintosh laryngoscope in Covid 19 suspected patients","authors":"S. Rajan, Dilesh Kadapamannil, Karthik C. Babu, S. Yoosaf","doi":"10.4103/roaic.roaic_46_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_46_20","url":null,"abstract":"","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"146 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122281173","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":"Erratum: Ultrasound-guided quadratus lumborum block versus transversus abdominis plane block in children undergoing laparoscopic","authors":"","doi":"10.4103/2356-9115.305203","DOIUrl":"https://doi.org/10.4103/2356-9115.305203","url":null,"abstract":"","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"89 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134430359","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 internal jugular vein and inferior vena cava distensibility indices as parameters of fluid responsiveness in mechanically ventilated septic shock patients","authors":"M. Megahed, H. Elsayed, Alaa Mostafa","doi":"10.4103/roaic.roaic_49_19","DOIUrl":"https://doi.org/10.4103/roaic.roaic_49_19","url":null,"abstract":"Context The use of dynamic parameters for the assessment of fluid responsiveness in septic shock patients has increased in recent years. Aims In this study, we examined the ability of internal jugular vein distensibility index (ΔDIJV) and inferior vena cava distensibility index (ΔDIVC) to predict volume responsiveness in the management of mechanically ventilated septic shock patients. Settings and design Prospective interventional cohort study. Patients and methods This study enrolled 34 septic shock patients. Hemodynamic data coupled with echocardiographic assessment of cardiac index (ΔCI), ΔDIVC, and ΔDIJV were assessed before and after 7 ml/kg fluid challenge. Patients were considered as fluid responders if a rise in ΔCI more than or equal to 15% took place after volume expansion, and if ΔCI was less than 15%, the patients were considered nonresponders. Results The area under the curve of ΔDIVC was 0.940 with the best cut off value of less than or equal to 13.6% with sensitivity, specificity, positive predictive value, and negative predictive value of 94.74, 80.00, 85.7, and 92.3%, respectively. While the area under the curve for ΔDIJV was 0.900 with the best cutoff value of less than or equal to 11.6% with sensitivity, specificity, positive predictive value, and negative predictive value of 84.21, 80.00, 84.2, and 80.0%, respectively. Conclusions Ultrasonic evaluation of respirophasic changes of internal jugular vein is a simple, easy, and readily accessible bedside measure of fluid responsiveness in mechanically ventilated, sedated septic shock patients. ΔDIJV can predict fluid responsiveness with good sensitivity, specificity, and overall accuracy. Meanwhile, ΔDIVC is still more sensitive with better overall accuracy.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"114 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116561054","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":"Role of early progressive mobilization protocol on outcomes of mechanically ventilated patients with pneumonia","authors":"Amr M Elsayed, A. Dahroug, A. Halawa","doi":"10.4103/roaic.roaic_106_19","DOIUrl":"https://doi.org/10.4103/roaic.roaic_106_19","url":null,"abstract":"Introduction Mobilization targets include upgrading respiratory function by improving ventilation/perfusion matching, increasing lung capacity, improving secretion clearance, reducing the hazards of immobility, improving levels of consciousness, improving functional independence, improving cardiovascular status, and improving psychological well-being. Objectives The aim of the study was to determine the effect of early mobilization of mechanically ventilated patients with pneumonia on morbidity (facilitating weaning, hospital stay, incidence of muscle weakness, and incidence of delirium) and mortality. Patients and methods This comparative randomized single-blinded study enrolled 70 adult mechanically ventilated patients of both sexes having pneumonia. They were categorized into two groups according to applying the mobilization protocol: mobilization group and control group. Before starting the protocol, the participants were subjected to history taking, complete physical examination, neurological examination (Glasgow Coma Scale and muscle power), full laboratory and radiological investigations. Initiation of stepwise progressive mobilization protocol after 24 h of intubation was done, and respiratory and hemodynamic stability were assessed. Results The first group (mobilization group) included 35 patients, in whom mobilization protocol was applied, and second group (control group) included 35 patients, in whom no protocol was applied. The mobilization group showed less ventilator days, ICU stay, and hospital stay. Moreover, they showed improvement in the static compliance, hypoxic index, and Sequential Organ Failure Assessment score (SOFA score) values in comparison between the first and last day of the study in each group. They showed less incidence of delirium and less mortality at days 7 and 28 in comparison with the control group. Conclusions The mobilization intervention is a feasible and safe intervention and offers improvement in multiple outcomes for patients with pneumonia such as reduction of the duration of mechanical ventilation, ICU stay, hospital stay, delirium, and mortality and improvement of muscle power and lung compliance.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132174195","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 effect of tidal volume on fluid responsiveness assessment using pulse pressure variations and velocity time integral variations in patients with septic shock","authors":"Mario Todary, A. Nabil, Ehab El Reweny","doi":"10.4103/roaic.roaic_124_19","DOIUrl":"https://doi.org/10.4103/roaic.roaic_124_19","url":null,"abstract":"Introduction Expanding volume in septic shock can be a source of therapeutic dilemma. On one hand, the severity of the disease necessitates administration of fluids. On the other hand, it has now been clearly demonstrated that fluid overload has bad consequences. Many parameters were introduced to assess fluid responsiveness in patients with septic shock such as pulse pressure variations (PP%) and velocity time integral variations (VTI%). Objective The aim of this study was to determine whether the change in tidal volume introduced to patients with septic shock on mechanical ventilation would affect the values of PP% and VTI% of fluid responsiveness. Patients and methods In this prospective observational study, 60 mechanically ventilated patients with septic shock were enrolled. On admission, all patients received sedation and muscle relaxant to avoid any spontaneous breath. A fluid challenge in the form of 400 ml of normal saline 0.9% was given to all patients. However, before giving the normal saline to the patient, PP% and VTI% were measured when patient was given tidal volume 6 ml/kg and then when patient was given tidal volume 10 ml/kg. The same measures were repeated with the same tidal volumes, 1 min after giving the normal saline. Results A total of 31 patients were identified as fluid responders, whereas 29 patients were fluid nonresponders. In responders, the mean value of change of PP% with fluid challenge decreased significantly when increasing tidal volume from 6 to10 ml/kg, whereas the mean value of change of VTI% decreased insignificantly with tidal volume change. Conclusion PP% could be a reliable predictor of fluid responsiveness in patients with septic shock on a higher tidal volume ventilation, unlike VTI% which could be reliable at low tidal volume.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"147 Pt 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126311562","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 paravertebral block in patients undergoing maxillofacial rotational flap reconstruction","authors":"Wafaa Shafshak, O. Zanaty, A. El-Nagar, Sarah El-Gamal","doi":"10.4103/roaic.roaic_79_19","DOIUrl":"https://doi.org/10.4103/roaic.roaic_79_19","url":null,"abstract":"Background Regional anesthesia plays an important role in improving the success rate of rotational flap surgery through the control of regional blood flow. Paravertebral block at levels T1 and T2 improves the survival of rotational flap in maxillofacial reconstruction. It is associated with a better outcome and fewer flap complications. Aim This study aimed to evaluate the effect of single-shot paravertebral block on the survival of maxillofacial rotational flap. Patients and methods A total of 32 patients scheduled for elective maxillofacial rotational flap reconstruction were included in the study. All patients received general anesthesia and randomly allocated to one of two groups: patients in group I received single-shot paravertebral block at levels T1 and T2, whereas patients in group II served as controls. Skin temperature was measure on both the reconstructive and the nonsurgical sides. Flap perfusion was assessed by analysis of skin color, turgor, and capillary refill. Flap survival was recorded. Results The surface temperature of pectoralis major myocutaneous (PMMC) flap was significantly higher in group I patients than in group II patients at 0, 4, 8, 12, 16, 20, and 24 h postoperatively (P=0.002, 0.009, 0.001, 0.001, 0.001, 0.001, and 0.029, respectively). The skin turgor and capillary refill scores were significantly higher in group I than in group II. Total perfusion score was significantly higher in group I patients than in group II patients at 16 and 20 h postoperatively (P<0.001). Flap reoperation was reported in five cases in group II (31.3%), and this was statistically significant (P=0.04). Conclusion Single-shot paravertebral block at T1 and T2 levels increases skin temperature and improves skin turgor and capillary refill, which are indicators of appropriate tissue perfusion and indicate maxillofacial PMMC flap survival.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129911642","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":"Hypothermia in prehospital polytrauma victims: an overlooked companion","authors":"Dilesh Kadapamannil, S. Rajan","doi":"10.4103/roaic.roaic_32_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_32_20","url":null,"abstract":"Introduction Hypothermia is a common companion of polytrauma and poses a serious threat and significantly affects the outcome in terms of morbidity and mortality. The initial approach to trauma victims was based on aggressive fluid resuscitation to maintain adequate tissue perfusion. This was highly inadequate and in most circumstances quite harmful. The lethal triad eventually results in a predictable and irreversible progression toward death. Many polytrauma victims presenting to the emergency department are hypothermic. Hypothermia is defined as core body temperature less than 35°C. Heat loss typically occurs at a rate of 60–75 kcal/h by four different methods: radiation, conduction, evaporation, and convection. Hypothermia in patients with trauma is caused by a multitude of factors. It affects almost all organs and also the coagulation system. It is crucial to alleviate the possibility of the setting in of the lethal triad, which includes acidosis, hypothermia, and coagulopathy. Resuscitating a patient with trauma in a prehospital environment is a much difficult task, which requires knowledge that the recognition and prevention of the lethal triad is critical. Hemorrhage in trauma leads to acidosis, hypothermia, and coagulopathy. Hypothermia worsens acidosis, which in turn contributes to further coagulopathy. This causes further hemorrhage, setting off the deadly vicious cycle. Thus, frontline responders are an essential part of the trauma management system, and recognition and prevention of the hypothermia arm in the lethal triad is of utmost importance.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127544790","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":"Ultrasonographic measurement of inferior vena cava collapsibility index and its correlation to central venous pressure in adult critically ill patients","authors":"Khadeja M. Elhossieny, Samia ElWakil, Mona ElHarissi, Sameh Hegab, H. Mohammed","doi":"10.4103/roaic.roaic_1_18","DOIUrl":"https://doi.org/10.4103/roaic.roaic_1_18","url":null,"abstract":"Background Central venous pressure (CVP) is currently one of the most widely used parameters for the determination of volume status in critically ill patients. To measure CVP, a central venous catheter must be inserted. This process is invasive, requires complex training, and has many complications such as bleeding, traumatic pneumothorax, and infection. Also it may be contraindicated in the presence of coagulation abnormalities which are not a rare finding in critically ill patients. Transabdominal ultrasonographic determination of inferior vena cava (IVC) collapsibility index (CI) can provide a rapid, noninvasive, easy, and reproducible method of determination of volume status in critically ill patients, which avoids the risk and complications of invasive central venous catheterization. Patients and methods The prospective study was carried out in Zagazig University Hospital. A total of 86 patients who were admitted to trauma and surgical emergency ICU at Zagazig University Hospitals were eligible for enrollment in this study over the period of 2 years (October 2015–October 2017). Each patient had simultaneous measurement of CVP and IVC-CI on four different sessions; the first was on admission, the second was 6 h after admission, the third was 12 h after admission, and the fourth was 24 h after admission. The patient sample was divided into two subgroups based on the mode of ventilation and CVP value to compare the strength of correlation between caval index and CVP value in the two groups. Results Our study showed that IVC-CI has significant negative correlation with CVP value (r=−85, P˂0.001 at 95% confidence interval) and it is better correlated with mean arterial blood pressure and lactate clearance as compared with CVP. However, it correlated better in spontaneously breathing patients (r=−0.86, P˂0.001) than in mechanically ventilated patients (r=−0.84, P˂0.001). IVC-CI has shown to correlate better with CVP value in lower values (˂10 cmH2O) (r=−0.8, P˂0.001) than in higher values (≥10 cmH2O) (r=−0.6, P˂0.001). We also concluded an IVC-CI cutoff value of 29% to discriminate between CVP values less than 10 cmH2O and values more than or equal to 10 cmH2O with high sensitivity (88.6%) and specificity (80.4%). Conclusion IVC-CI has a strong inverse relationship with CVP which is more pronounced at low CVP values. Point-of-care ultrasonographically measured IVC-CI is very likely to be a good alternative to CVP measurement with a high degree of precision and reproducibility","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128347433","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}