Research and Opinion in Anesthesia and Intensive Care最新文献

{"title":"Comparing the efficacy of preoperative nebulized ketamine, magnesium sulfate, and lidocaine in attenuating postoperative sore throat after endotracheal intubation","authors":"A. Kamel, M. Nasrallah","doi":"10.4103/roaic.roaic_95_19","DOIUrl":"https://doi.org/10.4103/roaic.roaic_95_19","url":null,"abstract":"Background and objectives Postoperative sore throat is a common complication after endotracheal intubation, and different methods have been proposed to attenuate it. The aims were to compare the intensity of sore throat and the sedation level of preoperative nebulized ketamine, magnesium sulfate, and lidocaine in attenuating postoperative sore throat after endotracheal intubation. Patients and methods A prospective comparative double-blind randomized study was conducted on 100 patients who were divided into four groups: group K (n=25) included patients who received nebulized ketamine 50 mg (1 ml) plus 4-ml normal saline; group M (n=25) included patients who received nebulized magnesium sulfate 250 mg (2.5 ml) plus 2.5-ml normal saline, group L (n=25) included patients who received nebulized lidocaine 2% 100 mg (5 ml), and group C (n=25) included patients who received nebulized normal saline 5 ml (control group). So, total volume used was 5 ml. Patients were preoperatively nebulized by compressor nebulizing for 15 min. Results Sore throat scores were statistically significant lower (0 and 1 point) in group L and group K at 0, 2, and 4 h compared with group C and group M (P<0.05). Group K showed statistically significant lower sore throat scores at 8, 12, and 24 h compared with group L, but statistically significant high sore throat scores (2, 3, and 4 points) compared with group M (P<0.05). The level of sedation assessed using A=alertness, V=response to verbal, P=response to painful stimulus, and U=unresponsive (AVPU) was statistically insignificant among groups (P>0.05). Conclusions Preoperative nebulized 100-mg lidocaine and 50-mg ketamine relieves throat pain earlier in the first 24 h after endotracheal intubation, but it persists for shorter duration than 250-mg magnesium sulfate, without any changes in sedation level.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134245592","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 intramuscular glycopyrrolate in preventing hypotension after subarachnoid block in elderly patients","authors":"Aseem Gargava, M. Arya, J. Dali, K. Sharma","doi":"10.4103/roaic.roaic_55_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_55_20","url":null,"abstract":"Background Hypotension is one of the most frequent complications during spinal anaesthesia. It is more common in elderly with a reported incidence of 65–75%. While keeping in mind that the hypotension induced by subarachnoid block is related to sympathetic blockade accompanied with bradycardia, the administration of glycopyrrolate could affect hemodynamic during spinal anaesthesia. Thus, we aimed at evaluating the role of intramuscular glycopyrrolate in preventing hypotension after subarachnoid block in elderly patients. Patients and methods It’s a randomized double blind study. Forty four patients (60–80 years of age, ASA I and II) posted for lower abdominal surgery or lower limb surgery were given subarachnoid block using standard anaesthesia technique. They were administered either 1 ml of normal saline (group N) or 0.2 mg glycopyrrolate (group G) intramuscularly 15 minutes before subarachnoid block. Parameters like blood pressure and heart rate (at preset time intervals), total requirement of ephedrine, time to first rescue vasopressor i.e. ephedrine, incidence of nausea and vomiting and requirement of Ondansetron, incidence of bradycardia and requirement of atropine, presence of dry mouth etc was recorded. Results Eleven of 22 (50%) patients in group N experienced hypotension compared with two of 22(9.09%) patients in group G (difference=40.91% ; P=0.001). The mean ephedrine requirement in group G is 0.45±1.47 mg while, in group N is 3.63±4.41 mg (P=0.001). There was no case of bradycardia reported in group G although, two out of 22 patients (9.09%) in group N reported bradycardia (P=0.55). There is no incidence of nausea and vomiting in group G while, 3 patients in group N complained about nausea and vomiting (P=0.03). Conclusion The intramuscular administration of 0.2 mg glycopyrrolate in elderly patients undergoing subarachnoid block significantly reduces the incidence and degree of hypotension; and reduces the total consumption of rescue vasopressor without any clinically significant side effect.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"6 7","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120860545","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":"Anosmia of unknown origin: an anesthesiologist’s experience in the coronavirus disease 2019 pandemic","authors":"S. Shah, U. Hariharan","doi":"10.4103/roaic.roaic_54_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_54_20","url":null,"abstract":"","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123000651","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 use of USB endoscope (Borescope) as an educational tool and a guide for tracheal intubation − a preliminary report","authors":"Mohammad Hazem Ahmad Sabry, A. Aboughazy","doi":"10.4103/roaic.roaic_67_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_67_20","url":null,"abstract":"Background In spite of the presence of multiple video laryngoscopes in the market, financial restrains are present that prevent its routine use in many practices. Methods The endoscope USB camera was inserted alongside with a stylet in a conventional endotracheal tube which could be inserted orally keeping it in midline (7 or 7.5 cuffed oral endotracheal tube), and sterile k-y gel was used to facilitate the insertion of the stylet and/or the borescope. This was used for 25 oral intubations in manikin and oral intubation in 10 patients. Results Oral intubation trials on manikin were done by 25 physicians after their completion of airway course as its last session. All were anesthesiologists except one emergency room physician. A total of 14 (56%) physicians were successful to orally intubate the manikin in the first attempt. Moreover, 10 (40%) physicians were successful to orally intubate the manikin in the second attempt with verbal guidance, except one who needed manual assistance, and one physician was successful to orally intubate the manikin in the third attempt with verbal assistance. The intubated 10 patients were all of Mallampati 1 or 2, where seven were intubated on the first attempt, two on the second attempt, and one failed. Conclusion Borescope can be used as a cheap option for airway management and its training. Randomized studies need to be done for its evaluation compared with other video laryngoscopy devices.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116216809","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":"Dexmedetomidine versus fentanyl as adjunct to ropivacaine-dexamethasone for labor analgesia: a randomized control study","authors":"A. Hassan","doi":"10.4103/roaic.roaic_47_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_47_20","url":null,"abstract":"Background and aims Although intrathecal analgesia is an effective option during labor, there is a need to establish sustainable and assured analgesia during the entire labor process. We aimed to compare the effect of dexmedetomidine versus fentanyl as an adjuvant to low-dose ropivacaine-dexamethasone for intrathecal labor analgesia in primigravida women. Patients and methods The study was conducted after approval of ethical committee of Al Azhar University Hospital. A total of 60 primiparous women classified in American Society of Anesthesiologists classes II with a singleton pregnancy in active labor were given combined spinal epidural analgesia. This was a double-blind randomized controlled trial that allocated them in two groups of 30 patients each. Group I received intrathecal 2.5 mg of 0.1% ropivacaine (diluted to 2.5 ml with normal saline)+5 μg dexmedetomidine+4 mg dexamethasone. Occurrence of any adverse reaction was observed for ten min. Group II received 25 μg of fentanyl instead of 5 μg dexmedetomidine. For both groups, epidural top-ups of 10 ml of 1% ropivacaine were given when parturients complained of two painful contractions (visual analog scale ≥4), after epidural test dose of 3 ml of 0.5% ropivacaine was slowly injected via epidural catheter and no occurrence of adverse reaction was observed 10 min later. Data collected were demographic profile of the patients, intrathecal block characteristics, needs for epidural activation before delivery, and maternal and fetal adverse effects. The primary study goal was to prove the analgesic efficacy and safety of intrathecal selective sensory block on both mother and fetus, whereas the study secondary goal was to prove that intrathecal single dose injection could be used as an effective alternative option in labor analgesia as well as epidural analgesia. Catecholamine level (epinephrine and norepinephrine) was measured using enzyme-linked immunosorbent assay technique. Results The mean age (years), weight (kg), height (cm), and BMI (kg/m2) in group I were 24.3±3.30, 65.4±16.2, 161.3±4.6, and 22.3±3.4, respectively, whereas in group II were 25.23±4.44, 66.3±15.6, 160.4±4.3, and 22.2±3.1, respectively, with insignificant difference (P>0.05). Mean visual analog scale score before onset of analgesia in group I and group II was 8.59±1.22 and 8.7±1.14, respectively. The time to full cervical dilatation was 120.14±10.2 in group I and 120.0±10.6 in group II, and the mean duration of second stage of labor was 12.02±1.37 min in group I and 11.83±0.93 min in group II. The mean duration of analgesia was statistically significant (lower) in group II (221.83±22.26) as compared with group I (296.33±44.83) (P<0.001). The mean analgesia in group I (12.3±1.8) and group II (12.1±1.7) was statistically insignificant (P>0.05). The mean highest sensory levels in group I and group II were statistically insignificant, that is, T5 (T4–T8) versus T6 (T4–T7) (P>0.05). The sensory region time in group II was greater (","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114908192","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":"Analgesic efficacy of ultrasound-guided continuous quadratus lumborum block versus continuous paravertebral block in radical cystectomy: a randomized study","authors":"Mohammad Hazem Ahmad Sabry, A. Hieba, R. Ammar","doi":"10.4103/roaic.roaic_117_18","DOIUrl":"https://doi.org/10.4103/roaic.roaic_117_18","url":null,"abstract":"Background Various techniques of regional anesthesia have been used in abdominal surgery including thoracic epidural, thoracic paravertebral block (TPVB), and transversus abdominis plane block. However, new techniques such as quadratus lumborum (QL) block are tested to detect its efficacy. Purpose To compare between intraoperative and postoperative analgesic effects of ultrasound-guided continuous QL block and continuous TPVB in patients operated for radical cystectomy (primary outcome). Side effects, length of hospital stay, and patient satisfaction are the secondary outcome. Patients and methods Sixty patients admitted to the Urosurgery Department at Alexandria Main University Hospital for radical cystectomy were randomly assigned into two groups, 30 patients for each group: group I received ultrasound-guided QL block with 0.3 ml/kg bupivacaine 0.25% on each side with catheter insertion for maintenance doses of 0.1 ml/kg/h on each side while group II received ultrasound-guided TPVB with 0.3 ml/kg bupivacaine 0.25% on each side with catheter insertion for maintenance doses of 0.1 ml/kg/h on each side. Results There was no statistically significant difference between the two groups regarding postoperative visual analog scale score, first request of analgesia, and length of hospital stay; however, there was statistically significant difference between the two groups as regards heart rate and mean blood pressure at the 1st, 4th, 6th, and 7th hours during the intraoperative periods. Conclusion It can be concluded that there is no difference in analgesic efficacy, opioid consumption, and hospital stay between continuous bilateral QL block and continuous bilateral TPVB after radical cystectomy. These data suggest that QL block is a viable alternative for delivering multimodal analgesia in radical cystectomy.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122778302","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":"Anesthetic challenges in the management of a pediatric case of Crouzon syndrome posted for neurosurgery","authors":"Delma D’Cunha, A. P.S., P. Mitali, K. Shetty","doi":"10.4103/roaic.roaic_69_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_69_20","url":null,"abstract":"Crouzon syndrome (CS) is an autosomal dominant disorder seen in about 1 in 60000 live births. The affected individuals are found to have facial dysmorphism, cranial synostosis and exophthalmos among other systemic involvement involving the heart and lungs. The primary concern for an anesthesiologist during administration of general anaesthesia for a patient with CS is the airway management. We report the successful anesthetic management of a pediatric case of CS who underwent a neurosurgical procedure.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"222 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122399710","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":"Coronavirus disease 2019: is it a novel retribution to our moral health?","authors":"Iti Shri, Kavita Chaudhry, U. Hariharan, P. Ahuja","doi":"10.4103/roaic.roaic_53_20","DOIUrl":"https://doi.org/10.4103/roaic.roaic_53_20","url":null,"abstract":"","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131228546","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":"Ketamine versus dexmedetomidine as an adjuvant in ultrasound-guided supraclavicular brachial plexus block: a double-blind randomized clinical trial","authors":"A. Mohmed, Haidy Mansour, A. Hassanein, M. Ahmed","doi":"10.21203/RS.3.RS-128342/V1","DOIUrl":"https://doi.org/10.21203/RS.3.RS-128342/V1","url":null,"abstract":"Background Peripheral nerve block has gained increased popularity owing to less postoperative pain and reduced need for postoperative analgesic drugs. The aim of the study was to compare the effect of ketamine and dexmedetomidine on the supraclavicular nerve block. Patients and methods A total of 75 adult patients undergoing elective operations of the elbow, forearm, wrist, or hand were randomly allocated into three groups of 25 patients each. Group K (ketamine group) received 40 ml 0.25% bupivacaine contain 1 mg/kg ketamine, group D (dexmedetomidine group) received 40 ml 0.25% bupivacaine contain 1 μg/kg dexmedetomidine, and group C (control group) received 40 ml 0.25% bupivacaine. The outcome measures included visual analog scale (0=no pain and 10 cm=the most severe pain), time to first analgesic request, and total dose of diclofenac analgesia given postoperatively. Results Patients in D and K groups had reduced visual analog scale scores than the C group, at all time points after surgery during the first 24 h, with more reduction in group D than K group (P<0.05). The time of the first analgesic request in the D group was significantly more than in the K group, and both were more than the C group (9.48±1.417 h, 7.08±1.255 h, and 5.00±1.04 h, respectively). Conclusion The addition of ketamine or dexmedetomidine in the ultrasound-guided supraclavicular brachial plexus block could improve the postoperative pain and need for analgesia. Therefore, we can consider the low-price readily available ketamine as a comparable adjuvant in brachial plexus block to some extent as dexmedetomidine.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131179174","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":"A prospective comparison between bedside ultrasound versus chest radiograph and computed tomography scan for the diagnosis of traumatic hemothorax","authors":"Assem Abd Rabbih, T. Helmy, H. Fathy, A. Alkafafy, H. Zaki","doi":"10.4103/roaic.roaic_104_19","DOIUrl":"https://doi.org/10.4103/roaic.roaic_104_19","url":null,"abstract":"Introduction Injuries to the chest are responsible for most of deaths occurring at the scene of trauma or within 1 h from arriving to hospital (immediate deaths) and many of those within few hours up to 24 h from arriving to hospital (early deaths). Hemothorax often develops after blunt or penetrating trauma. The most common cause of blunt trauma is traffic accidents, and hemothorax is associated with injures of the lung or intercostal vessels caused by broken rib ends as a result of rib fractures, frequently occurring in blunt trauma. Objectives The aim of this study is to evaluate the sensitivity and specificity of chest ultrasound (US) in the detection of traumatic hemothorax and quantification of its size in comparison with chest radiograph and the computed tomography (CT) chest as a gold standard diagnostic tool. Patients and methods This prospective observational study enrolled 80 patients who had hemothorax and admitted to Alexandria University Hospital, screened with chest radiograph, US, and CT scan to determine the accuracy and sensitivity of chest US imaging modality. Moreover, hemodynamic variations were assessed at the time of admission (0 h) and after 12 h. Results Overall, 71% of the patients were males, and 45% of the patients were between 20 and 30 years of age. The mode of trauma in 56% of cases was motor vehicle accidents, and in 33% of cases was falling from height. Moreover, 38% of the patients were intubated. Bedside US sensitivity in detection of traumatic hemothorax in comparison with the CT chest showed sensitivity of 93% on the right-side chest hemothorax and 100% on the left-side chest hemothorax and specificity of 100% on both sides. Conclusions US is a sensitive, specific, and accurate technique for detecting hemothorax in patients with thoracic trauma. CT does detect some hemothoraces not seen on US. However, it can permit early and precise definition of the location of bleeding in patients with trauma who cannot be moved. It is also more readily attainable than CT scan. Therefore, it can be used in patients who are not stable enough for transport and in resource-limited areas.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":"8 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":"131032289","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}