Journal of Anesthesia and Critical Care: Open access最新文献

{"title":"A great tool that resurfaced during the pandemic: Remifentanil","authors":"Miguel Angel Sosa Fragoso","doi":"10.15406/jaccoa.2023.15.00544","DOIUrl":"https://doi.org/10.15406/jaccoa.2023.15.00544","url":null,"abstract":"During anesthetic management, drugs such as fentanyl are required. This is a synthetic opioid used routinely. However, there are options derived from fentanyl, such as remifentanil, which has been referred to in the literature as an ideal opioid in anesthesiology due to its pharmacokinetic characteristics. Remifentanil is used in general or local anesthesia, as analgesic premedication for induction of anesthesia, and as an adjuvant in the maintenance of general anesthesia. In addition, it is suggested as a sedative in patients admitted to intensive care in patients undergoing mechanical ventilation, for analgesia and sedation in postoperative cardiac surgery and other types of surgeries, even in minor procedures. In this review, we focus on describing the use, properties, and anesthesiologic characteristics of remifentanil, as well as its repercussions of use.","PeriodicalId":228896,"journal":{"name":"Journal of Anesthesia and Critical Care: Open access","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114331543","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":"Comparison of goal-directed and standard therapy for hemodynamic management in heart transplantation surgery","authors":"Velasco-Villanueva Sergio, Trejo-Olguín Ana K","doi":"10.15406/jaccoa.2023.15.00545","DOIUrl":"https://doi.org/10.15406/jaccoa.2023.15.00545","url":null,"abstract":"Neuroblastoma is the most common solid extracranial tumor in childhood, that arises from neural crest cells. The cervical location is the least frequent and its clinical manifestations are diverse, from cervical mass, dyspnea, stridor, Horner's syndrome or dysphagia. In this case report, we present a male infant with an atypical clinical symptoms, with upper airway obstruction that can occur in multiple contexts, whether malformative or neoplastic masses; Simple and contrast-enhanced neck tomography revealed a lesion in the right posterior cervical triangle with involvement in the retropharyngeal region and significant displacement of the airway. The tumor was successfully excised. The histopathological diagnosis was mixed ganglioneuroblastoma, rich in Schwannian stroma, treatment was started with the COG protocol with 4 cycles of chemotherapy, at the end a control MRI was performed without evidence of tumor recurrence. The importance of recognizing primary tumors with atypical signs and symptoms is highlighted, given that the frequency of neuroblastomas, statistically speaking, is the second cause of childhood cancer, early diagnosis must be made in order to achieve successful treatment.","PeriodicalId":228896,"journal":{"name":"Journal of Anesthesia and Critical Care: Open access","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123811263","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":"Comparison of goal-directed and standard therapy for hemodynamic management in heart transplantation surgery","authors":"Ronak Benisy, K. Saberi, Hossein Saberi, Hasti Saberi, Shahnaz Sharifi","doi":"10.15406/jaccoa.2023.15.00543","DOIUrl":"https://doi.org/10.15406/jaccoa.2023.15.00543","url":null,"abstract":"Background: Significant numbers of patients who undergo major surgery experience postoperative problems, the majority of which are preventable. It has been demonstrated that goal-directed therapy, a method for guiding clinicians in administering fluids, vasopressors, and inotropes, reduces mortality and postoperative complications. However, heart transplant patients were not exclusively investigated. This study focused on patients having heart transplant surgery, which compared the effects of goal-directed versus traditional fluid management. Methods: Goal-directed and standard therapy were examined on 74 patients who had received heart transplantation and were randomly divided into two groups.Using Lidco's CO, CI, SVV, and SVR to track progress toward treatment goals, two groups were compared in terms of fluid repositioning and the use of vasoactive medications.We also compared secondary outcomes like AKI, Cardiac dysrhythmia, CVA, ICU length of stay, and 30-day survival. Results: Both groups had similar baseline characteristics. The goal-directed therapy group had less fluid repositioning. AKI, Cardiac dysrhythmia, CVA, ICU stay, and 30-day survival rates did not differ significantly between the groups; however, Conventional patients spent more time in the ICU. Conclusion: Our data showed that the time spent in the intensive care unit after a heart transplant can be cut in half using GDT. Adverse events occurred in both groups with no statistically significant difference. Preoperative goal-directed therapy needs further well-designed and adequately powered studies.","PeriodicalId":228896,"journal":{"name":"Journal of Anesthesia and Critical Care: Open access","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133533515","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 pleasure of being an anesthesiologist-intensivist","authors":"Víctor M. Whizar-Lugo MD","doi":"10.15406/jaccoa.2023.15.00542","DOIUrl":"https://doi.org/10.15406/jaccoa.2023.15.00542","url":null,"abstract":"","PeriodicalId":228896,"journal":{"name":"Journal of Anesthesia and Critical Care: Open access","volume":"12 44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121641446","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":"Tetralogy of Fallot","authors":"Aldy Heriwardito, Lara Aristya","doi":"10.15406/jaccoa.2022.14.00541","DOIUrl":"https://doi.org/10.15406/jaccoa.2022.14.00541","url":null,"abstract":"","PeriodicalId":228896,"journal":{"name":"Journal of Anesthesia and Critical Care: Open access","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131465250","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":"Aortic laceration during veress needle insertion: a laparoscopic disaster","authors":"M. Machado","doi":"10.15406/jaccoa.2022.14.00538","DOIUrl":"https://doi.org/10.15406/jaccoa.2022.14.00538","url":null,"abstract":"Introduction: More than 50% of all complications associated with laparoscopy occur during the entry phase for pneumoperitoneum and insertion of trocars. Major vascular injuries related to blind entry technique are infrequent, occurring in 0.04–0.1% of laparoscopic procedures. Nevertheless, 13%–50% of all vascular injuries are not detected immediately during the operation, resulting in correspondingly high morbidity and mortality rates. Major vascular injuries are the second most common cause of death during laparoscopy, after death from anesthesia, with a mortality rate of 6.37 %. The first reaction after vascular injury should not be conversion to laparotomy, but instead assessment and possible control of the injury. Obesity, previous abdominal surgeries, surgical experience, inflammatory bowel disease and pelvic inflammatory disease are known risk factors to injuries during the entry phase in laparoscopy. Clinical case: A 47 years old woman, BMI 42.2 kg/m2, without any previous abdominal surgery, was proposed to an elective left hemicolectomy after 2 diverticulitis episodes in a 6 months period, at a secondary hospital. As soon as the Veress needle was inserted, blood was seen. After the first trocar was placed, an median retroperitoneal inframesogastric hematoma was seen and the surgeon did an unsuccessful attempt to control the bleeding. Since there was hemodynamic instability, a conversion was made. An infrarrenal aortic laceration was seen and clamps were put in place to stop the bleeding. The patient was then transferred to a tertiary hospital to be intervened by vascular surgery. An aortoplasty with patch of the great safenous vein and trombectomy of the ilio-distal arteries was performed. The time occurred between the injury and the beginning of the vascular surgery was 2hours. The patient went to an Intensive Care Unit. A total of 15 red blood cells pool (first 2 without compatibility test), 12 plasma units, 3grams of fibrinogen and 1 pool of plaquelets were transfused. During the intensive care stay, the patient developed leg compartment syndrome, with the need of fasciectomy and a moderate ARDS, making it harder to manage the disease. Conclusion: Major Vascular lesions in laparoscopy surgery are rare but are associated with great morbidity and mortality. A close cooperation between laparoscopic surgeons, anesthesiologists, vascular surgeons and intensivists is needed to minimize the damage and the improve the result of the vascular repair. The existence of strict action protocols is necessary to minimize morbidity and mortality.","PeriodicalId":228896,"journal":{"name":"Journal of Anesthesia and Critical Care: Open access","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121194634","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":"Evaluating the outcomes of Sudanese septic patients who necessitated invasive mechanical ventilation","authors":"Gwahir Ebrahim Osman IbnIdriss, Abdelwahid Ali Abdelwahid Mohamed, Tarig Elhadi Elsideeg Mahmoud, Mohammed Ahmed Ibrahim Ahmed, N. Abdelrahman, S. Osman, Isam Eldeen Eltayeb Osman Ali, Abderrhman Ahmed Mohamed Ismaeil","doi":"10.15406/jaccoa.2022.14.00540","DOIUrl":"https://doi.org/10.15406/jaccoa.2022.14.00540","url":null,"abstract":"Background: Sepsis is a complicated disorder highlighted by the concurrent acceleration of coagulation and inflammation as a consequence of microbial assault. It has an important influence on hospitalized patients' need for mechanical ventilation and ICU admission. Objectives: The study's primary goal is to determine whether septic patients who require invasive mechanical ventilation fared well and whether their clinical condition improved or worsened after being connected to mechanical ventilation. The research also attempts to evaluate how additional medical interventions and other comorbidities affect the patient's prognosis. Material and methods: From November 2017 to May 2018, 160 patients with severe sepsis or septic shock were taken part in a prospective cross-sectional trial. The information was gathered using a straightforward, standardized questionnaire that included questions regarding the admission, progress, and outcome of septic patients who received mechanical ventilation in an intensive care unit. Results: 58 (36%) of the 160 patients were female, with 102 (64%) of the patients being male. In the age range of 60 to 70 years, 41 of them (or 25.6%) were detected. The majority of patients (59/369) had sepsis from a chest infection. Most of the patients, 87 (54.4%), got a combination of midazolam and fentanyl for sedation and analgesia. The majority of the patients, 85 (53%) had SIM/PS ventilation. Ultimately, 71 patients (44.4%) died, 80 patients (50%) were extubated, and 9 patients (5.6%) remained stationary and had a tracheostomy. Additionally, age, reasons, sedative type, and duration of stay were all substantially linked with the MV consequences (P 0.05). Conclusion: The better the outcome, the earlier septic patients who need IMV were identified and attached to IMV. It has been demonstrated that receiving IMV decreased mortality in septic patients by around 50%. The findings suggest that this intervention should be made more widely available and more reasonably priced by the authorities, along with the training of additional staff and the development of standard protocols for treating patients with such a condition. Focusing on health education awareness, establishing a focused outpatient department, and promptly screening patients who necessitate early referral to a tertiary care facility are the three most crucial aspects.","PeriodicalId":228896,"journal":{"name":"Journal of Anesthesia and Critical Care: Open access","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131712861","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":"Effectiveness of sphenopalatine ganglion block for V1 trigeminal neuralgia secondary to herpes zoster. case report","authors":"Del Rio-Parra Mariel Andrea, Velázquez- Ramos José Gerardo, DelRio-Parra Gerardo Francisco, Aréchiga-Ornelas Guillermo","doi":"10.15406/jaccoa.2022.14.00539","DOIUrl":"https://doi.org/10.15406/jaccoa.2022.14.00539","url":null,"abstract":"Introduction: Postherpetic V1 branch trigeminal neuralgia (TN) is a different neuralgia of the maxillary and mandibular divisions. This is usually refractory to conventional management since the involvement of the ophthalmic division can produce obvious autonomic symptoms. Few cases have been described, and conventional therapy is usually ineffective. Multimodal analgesic approaches are required in which regional anesthesia is considered an option, in order to optimize the response and improve the patient's quality of life. Methodology: A clinical case of a previously healthy 43-year-old female with a history of facial Herpes Zoster is reported. She presents TN of the left unilateral ophthalmic division for six months of evolution. The characteristic pain is accompanied by autonomic manifestations, refractory to pharmacological treatment. A sphenopalatine ganglion (SPG) block was performed in the pterygopalatine fossa with an infracygomatic approach. The evolution of pain was recorded on the Numerical Visual Analog Scale (VAS) and the quality of life was reported by the Headache Impact Test (HIT-6) scale on days 1, 15, 30, and 90 after the procedure. It was correlated with what was reported in the literature, finding only three cases related to autonomic trigeminal neuralgia (TN), which were treated with radiofrequency. The strongest evidence lies in the use of sphenopalatine ganglion block, radiofrequency ablation, and neurostimulation for cluster headaches. Results: A decrease in pain was reported on the VAS scale from 10/10 to 0/10 after the procedure, which was maintained during the first month without presenting autonomic symptoms. In the third month, VAS 2/10 is recorded, which is accompanied by tears. According to the HIT-6 scale, there was an improvement in quality of life from 69 points (very severe impact) to 36 points (little or no impact). Discussion: In recent studies, the connection of the ophthalmic nerve with the SPG has been found, in such a way that it is a possible explanation of why the SPG block is effective for pain relief in the ophthalmic nerve area in patients with TN. Conclusion: The present case of TN V1, with SPG blockade, showed analgesic efficacy and improvement in the quality of life reported by the patient. Further research with larger cohorts is required to standardize the procedure for such a diagnosis.","PeriodicalId":228896,"journal":{"name":"Journal of Anesthesia and Critical Care: Open access","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132965142","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":"Scale to evaluate the airway in pediatrics “EVAP”","authors":"Isabel Alemán Vargas","doi":"10.15406/jaccoa.2022.14.00536","DOIUrl":"https://doi.org/10.15406/jaccoa.2022.14.00536","url":null,"abstract":"The most feared catastrophe in Anesthetic practice is the management of the unanticipated Difficult Airway (VAD) in the Pediatric age where the Anesthesiologist does not have sufficient skills and abilities to face a clinical scenario of Emergency Surgery and due to the absence of a Training in the Sub-Specialty of Pediatrics and the Airway, hence the importance that during the training phase as resident physicians of the Specialty, training in the management of AV in pediatric patients and during professional life as an Anesthesiologist General is trained in basic and advanced courses on Pediatric Airway Management to develop technical skills and abilities in stressful and complex situations in the VA to provide efficient, effective and safe patient-centered medical care, due to these scenarios, this Pediatric Airway Clinical Scale is proposed based on Anatomical and Functional variables (EVAP), as well as the classification of Congenital Diseases and Clinical Entities that alter the Anatomy of the Upper Airway to identify an anticipated VAD, to be able to stratify the risk and plan an Efficient Medical Care of the Airway in Emergency and Elective Surgeries in the Pediatric age.","PeriodicalId":228896,"journal":{"name":"Journal of Anesthesia and Critical Care: Open access","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125006899","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":"Effectiveness of radiofrequency rhizotomies of genicular nerves for treating chronic pain in knee osteoarthritis","authors":"Dr. Shahzad Anwar, Dr. Muhammad Waseem Hassan, Dr. Syed Shahabud Din, Dr. Shoaib Ahmed, Fatima Tirmzi","doi":"10.15406/jaccoa.2022.14.00537","DOIUrl":"https://doi.org/10.15406/jaccoa.2022.14.00537","url":null,"abstract":"Background: Osteoarthritis (OA) is the most common cause of lower extremity disability in the elderly, primarily affecting lower extremity joints, such as the knee and hip. Elder patients with comorbidities may not be suitable candidates for surgery. For these difficult to treat cases, radiofrequency (RF) rhizotomies may be an effective alternative treatment. Likewise, it has been found that RF therapy can improve joint function and reduce pain by preventing the transmission of pain signals thus easing the patient. Objective: To evaluate the effectiveness of radiofrequency rhizotomies of genicular nerves in treating knee pain caused by knee osteoarthritis. Results: A total of 100 patients were enrolled in the current study. The mean age of patients was 62.7+9.7. Majority of the patients were female (69%), married (79%), and overweight (58.0%). Regarding affected knee sites, 39% had left, 34% right and 29% had both knees affected, respectively. There was a significant difference in mean scores among patients before and after treatment follow-up. The mean pain score before starting the treatment was 7.63+1.11, in the 1st week. The follow up mean pain score was 3.94+0.874, which further reduced in the 12th week to 1.51+1.12. The pain score, OKS and HADs significantly improved from baseline to 12th week follow up which shows that RFA was an effective treatment for OA knee pain (P-value <0.05) which shows that Radiofrequency rhizotomies of genicular nerves was an effective treatment for OA knee pain (P-value <0.05). Conclusion: Radiofrequency rhizotomies of genicular nerves is a safe and effective treatment option for patients suffering from chronic pain caused by knee OA.","PeriodicalId":228896,"journal":{"name":"Journal of Anesthesia and Critical Care: Open access","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125255804","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}