The Open Anesthesiology Journal最新文献

{"title":"Serum IL-6 Level in Breast Cancer Surgery: Evaluating the Addition ofHydrocortisone to Two Anesthetic Regimens","authors":"S. Abdelhamid, Ahmed Talha, S. Hamdy, A. Abdelhalim, Mohamed Hamdy Elakany","doi":"10.2174/1874321801509010029","DOIUrl":"https://doi.org/10.2174/1874321801509010029","url":null,"abstract":"Background: Interleukin (IL-6) and C-reactive protein (CRP) are found to be elevated in various inflammatory and malignant diseases and their levels are found to correlate with the extent of the disease. We evaluated the role of adding hydrocortisone to two different anesthetic regimens, on the level of IL-6, CRP and cortisol levels following breast cancer surgery. Patients and Methods: In this prospective, randomized, controlled trial, 124 ASA I-II, female patients, aged 30-50 years, undergoing conservative breast cancer surgery were randomly assigned to one of four equal groups receiving either standard general anesthesia and two doses of hydrocortisone (Group GH, n=31), thoracic paravertebral block and two doses of hydrocortisone (Group PH, n=31), standard general anesthesia with no hydrocortisone (Group G, n=31), or thoracic paravertebral block with no hydrocortisone (Group P, n=31). IL-6 was measured at three time points: before operation, 6 and 12 hours postoperatively. CRP and cortisol were measured preoperatively and 6 hours postoperatively. Results: On comparing group PH and GH, there was significant decrease in IL-6 level in group PH compared to group GH at 6 hour (122.1±21.2 vs 135.8±29.8pg/dl), but insignificant difference at 24 hours (107.9±21.6 vs 106.8±15.9pg/dl). CRP showed significant decrease in the postoperative reading in group PH compared to group GH (1.63±0.32 vs 1.91±0.43mg/l), and also group PH showed significant decrease compared to the control group P (1.63±0.32 vs 2.2±0.54). Conclusion: addition of hydrocortisone to general anesthesia or thoracic paravertebral block attenuated production of IL-6 and CRP levels significantly postoperatively compared to either anesthetic regimen alone, but not the serum cortisol level, highlighting its role in modifying the stress response to surgery. However, the effect was more pronounced when combined with thoracic paravertebral block.","PeriodicalId":272376,"journal":{"name":"The Open Anesthesiology Journal","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115243655","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":"Accuracy of an Automatic Infusion Controller (AutoClamp) for IntravenousFluid Administration","authors":"G. Choi, Il Jae Yoon, Oh Haeng Lee, Hyun Kang","doi":"10.2174/1874321801509010023","DOIUrl":"https://doi.org/10.2174/1874321801509010023","url":null,"abstract":"Background: This study was purposed to compare in vitro the volumetric accuracy of a newly introduced automatic infusion controller, AutoClamp with that of other commonly used infusion devices. Methods: Four different volumetric infusion devices were used to examine the accuracy: Terufusion TE-112; Volumed μVP7000; AutoClamp; and Infucon. Accuracy was determined for each flow rate (20, 40, 100, and 200 ml/h) by using infusate volumes collected af- ter 3 h of initiating the fluid administration. Accuracy was calculated as the percentage difference between set volume and actual volume delivered. The influences of fluid viscosity and flow resistance on infusion device accuracy were also evaluated. Results: There were no cases of a greater-than-10% difference between set volume and actual delivered vol- ume. The accuracy of the Infucon was significantly less than that of the other devices. Infusion devices proved to be con- sistent and unaffected by fluid viscosity or flow resistance except for the Infucon. Conclusion: The accuracy of the AutoClamp was comparable to that of other commonly used infusion pumps (Terufusion TE-112 and Volumed μVP7000) regardless of infusate viscosity and flow resistance.","PeriodicalId":272376,"journal":{"name":"The Open Anesthesiology Journal","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116326866","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":"Emergency Severity Index Scores Differ by Health Provider’s Gender andPatient’s Age","authors":"J. Vigil, Joe Alcock, Patrick Coulombe, Chance R. Strenth","doi":"10.2174/1874321801509010017","DOIUrl":"https://doi.org/10.2174/1874321801509010017","url":null,"abstract":"Background: Experimental research shows that laywomen express higher levels of empathy than men to pain suffering behaviors in others and female practitioners interact with and may prescribe different levels of pain medication to patients than male practitioners. Objectives: In this study we conduct a small medical records review to examine the possibility that female emergency department nurses assign lower levels (i.e., more urgent, serious, resource extensive) of emergency severity index (ESI) scores of patients presenting for care in the emergency department than male nurses, raising the possibility that patients receive disparate treatment during triage depending on the gender of medical staff. Methods: The patient-provided pain scores and the examiner-determined ESI scores of forty-eight male, emergency de- partment patients (21-89yrs, Mage = 57.2, SDage = 19.3) were examined across multiple visits, along with the gender of their triage examiner at each visit of (127 total patient/provider interactions). Results: A cross-classified mixed-effects model to analyze the influence of examiner gender on the triage scores that showed a significant Examiner Gender x Patient Age interaction. Further probing showed that female practitioners ascribed significantly lower ESI scores than male practitioners, although this effect was limited to patients younger than 55 years of age. Conclusion: These findings warrant larger-scale investigations of patient and examiner influences on patient treatment, which are necessary for creating more standardized protocols for reliably assessing emergency-care patients and for reducing health disparities in patient treatment quality.","PeriodicalId":272376,"journal":{"name":"The Open Anesthesiology Journal","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131385339","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 Programmatic Approach to Patient Blood Management - Reducing Transfusions and Improving Patient Outcomes","authors":"S. Farmer, K. Trentino, A. Hofmann, James B. Semmens, S. Mukhtar, G. Prosser, Jeffrey M. Hamdorf, Sudhakar Rao, Michael F. Leahy","doi":"10.2174/1874321801509010006","DOIUrl":"https://doi.org/10.2174/1874321801509010006","url":null,"abstract":"In July 2008, the Western Australia (WA) Department of Health embarked on a landmark 5-year project to implement a sustainable comprehensive health-system-wide Patient Blood Management Program. Fundamentally, it was a quality and safety initiative, which also had profound resource and economic implications. Unsustainable escalating direct and indirect costs of blood, potentially severe blood shortages due to changing population dynamics, donor deferrals, loss of altruism, wide variations in transfusion practice and growing knowledge of transfusion limitations and adverse outcomes necessitate a paradigm shift in the management of anemia and blood loss. The concept of patient-focused blood management is proving to be an effective force for change. This approach has now evolved to embrace comprehensive hospital-wide Patient Blood Management Programs. These programs show significant reductions in blood utilisation, and costs while achieving similar or improved patient outcomes. The WA Program is achieving these outcomes across a health jurisdiction in a sustained manner.","PeriodicalId":272376,"journal":{"name":"The Open Anesthesiology Journal","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133305216","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":"Continuous Versus Single-Injection Peripheral Nerve Blocks: A Prospective Cohort Study Comparing Procedural Time and Estimated Personnel Cost","authors":"B. Carvalho, Romy Yun, E. Mariano","doi":"10.2174/1874321801509010001","DOIUrl":"https://doi.org/10.2174/1874321801509010001","url":null,"abstract":"Background and Objectives: Continuous peripheral nerve blocks (CPNB) provide many additional benefits compared to single-injection peripheral nerve blocks (SPNB). However, the time and costs associated with CPNB provision have not been previously considered. The objective of this study was to compare the time required and estimated personnel costs associated with CPNB and SPNB. Methods: This IRB-exempt observational study involved provision of preoperative regional anesthesia procedures in a \"block room\" model by a dedicated team during routine clinical care. The primary outcome, the time to perform ultrasound-guided popliteal-sciatic blocks, was recorded prospectively. This time measurement was broken down into individual tasks: time to place monitors, prepare the equipment, scan and identify the target, perform the block, and clean up post-procedure. For peripheral nerve block catheters, time to insert, locate, and secure the catheter was also recorded. Cost estimates for physician time were determined using published national mean hourly wages. Results: Time measurements were recorded for 24 nerve block procedures (12 CPNB and 12 SPNB). The median (IQR; range) total time (seconds) taken to perform blocks was 1132 (1083-1290; 1060-1623) for CPNB versus 505 (409-589; 368-635) for SPNB (Table 1; p<0.001). The median (IQR) cost attributed to physician time during block performance was $35.20 ($33.66-$40.11) and $15.69 ($12.73-$18.32) for CPNB and SPNB, respectively. Conclusions: CPNB requires approximately 10 more minutes per procedure to perform when compared to SPNB. This additional time should be considered along with potential patient benefits and available resources when developing a regional anesthesia and acute pain medicine service.","PeriodicalId":272376,"journal":{"name":"The Open Anesthesiology Journal","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127108488","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":"Unexpected Difficult Intubation in a Patient with Prominent Mandibular Tori","authors":"J. Sarma","doi":"10.2174/1874321801408010001","DOIUrl":"https://doi.org/10.2174/1874321801408010001","url":null,"abstract":"Bony exostoses such as mandibular tori are fairly common. They are asymptomatic, benign cortical bony protuberances occurring along the lingular aspect of the mandible. Large tori may interfere with direct laryngoscopy resulting in difficult intubation. This is a case report about a 66 year old, Caucasian male with a Mallampati class I airway who was un-intubatable initially, due to the presence of bilateral mandibular tori that formed a plate of bone beneath his tongue. He was intubated subsequently with the help of an Eschmann bougie.","PeriodicalId":272376,"journal":{"name":"The Open Anesthesiology Journal","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114957866","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":"Acute Angioedema in a Patient on Long-term Angiotensin Converting Enzyme Inhibitor Following Oral Surgery: A Case Report","authors":"C. Awoniyi, Steven Yannaras, Julia M. Bauerfeind","doi":"10.2174/1874321801307010049","DOIUrl":"https://doi.org/10.2174/1874321801307010049","url":null,"abstract":"A relatively common side effect of angiotensin converting enzyme inhibitors (ACE-I), used for the treatment of high blood pressure, is angioedema. Whereas, angioedema due to ACE-I usually appear during the first few days or weeks of treatment, delayed onset, years after initiation of treatment is often unrecognized and can lead to life-threatening adverse events. We present a case report of rapidly progressive tongue swelling a few hours following oral surgery in a 62-year-old male who had been on ACE-I therapy for seven years. Prompt recognition and treatment prevented an impending respiratory compromise that could have been catastrophic.","PeriodicalId":272376,"journal":{"name":"The Open Anesthesiology Journal","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124781555","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":"Feasibility and Interest of Continuous Diaphragmatic Fatigue Monitoring Using Wavelet Denoising in ICU and Anesthesia","authors":"G. Morel, P. Mahul, M. Reche, J. Viale, C. Auboyer, A. Geyssant, F. Roche, J. Barthélémy, V. Pichot","doi":"10.2174/1874321801307010037","DOIUrl":"https://doi.org/10.2174/1874321801307010037","url":null,"abstract":"Measures of diaphragmatic electromyography (Edi), and respiratory mechanics, have demonstrated early changes before clinical complications. However, automatic Edi data collection is not adequate today due mainly to severe artefacts as well as to loss of signal. We thus intended to develop a new device with embedded artificial intelligence to optimize automatic Edi recordings independantly of artefacts and of probe displacement. We first chose the best mathematical tool to denoise Edi, using an established database, giving multiresolution wavelets as the best, resulting in the permanent availability of the H/L spectral index, a recognized representative of diaphragmatic fatigue. Fatigue was simultaneously measured using the classical mechanical f/Vt index (Rapid Shallow Breathing Index, RSBI), as well as the transdiaphragmatic pressure. We then performed a comparison of real-time H/L and RSBI in a group of seven healthy volunteers, before and during midazolam sedation infusion 0.1 mg.kg -1 , with a parallel CPAP administration (2.5, 5.0, and 10 cm H2O) intended to compensate for airways resistance due to midazolam. Procedure was ended by delivering the antagonistic flumazenil 0.2 to 0.5 mg.kg -1 . Progressive fatigue due to midazolam, the relief due to CPAP, as well as the answer to the anatgonist flu-","PeriodicalId":272376,"journal":{"name":"The Open Anesthesiology Journal","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131871478","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 Randomized, Double Blind Study to Evaluate the Efficacy of Palonosetron with Dexamethasone Versus Palonosetron Alone for Prevention of Post-Operative Nausea and Vomiting in Subjects Undergoing Bariatric Surgeries with High Emetogenic Risk","authors":"S. Didehvar, J. D. Viola-Blitz, M. Haile, Lola Franco, R. Kline, M. Kurian, G. Fielding, C. Ren, A. Bekker","doi":"10.2174/1874321801307010030","DOIUrl":"https://doi.org/10.2174/1874321801307010030","url":null,"abstract":"Introduction: Postoperative (PONV) and postdischarge (PDNV) nausea and vomiting are common (60-70%) after bariatric surgery. Palonosetron (Pal), a novel 5-HT3 antagonist, is an effective antiemetic with a prolonged duration of action in the setting of PDNV. We hypothesized that combination therapy with Palonosetron (Pal) and dexamethasone (Dex) would improve treatment in comparison to Palonosetron alone in patients at high risk for PONV. Methods: In this study, patients undergoing bariatric laparoscopic surgery under general anesthesia, a subgroup of a larger Phase IV clinical trial of patients who had laparoscopic surgery, were randomized to 8 mg Dex + 0.075mg Pal or saline + 0.075mg Pal. Data was collected postoperatively at 2, 6, 24 and 72 hrs. A Functional Living Index-Emesis (QOL-FLIE) test was administered at 96 hrs. Results: We enrolled 76 ASA 1-2 patients with at least 3 PONV risk factors. Both randomization groups had a low inci- dence of vomiting in the PACU (Pal, 0.0%; Pal + Dex, 5.4%) as well as at 72 hours (0.0% both groups). Complete re- sponse (no vomiting, no rescue medication) was not different between treatment groups at any time intervals. Cumulative success rates over the entire 72 hrs were 60.4% (Pal alone) vs. 60.0% (Pal + Dex). Nausea scores (4 point ordinal scale) were not different between groups for any time intervals. Cumulative success scores for nausea (score = \"none\"; 0-72 hrs) were 41.9% for the Pal group, and 55.2% for the Pal+ Dex group. The Pal + Dex group showed a trend toward greater sat- isfaction on the QOL-FLIE scores with the greatest differences in the \"nausea domain\". Discussion: The combination therapy (Pal + Dex) did not significantly reduce the incidence of PONV or PDNV when compared with Pal alone although a trend was observed indicating the possible increased efficacy of multi-drug therapy. There was no change in comparative efficacy over 72 hrs, possibly due to the low incidence of PDNV in both groups.","PeriodicalId":272376,"journal":{"name":"The Open Anesthesiology Journal","volume":"191 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127703182","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":"Acceleromyography at the Flexor Hallucis Brevis Muscle Underestimates Residual Neuromuscular Blockade","authors":"Y. Sugi, K. Nitahara, K. Katori, G. Kusumoto, K. Shigematsu, K. Higa","doi":"10.2174/1874321801307010026","DOIUrl":"https://doi.org/10.2174/1874321801307010026","url":null,"abstract":"Purpose: Recovery of the train-of-four ratio (TOFR) to > 0.9 in the upper limb is commonly used to determine that neuromuscular function has returned to the preoperative level. It is not known whether recovery of neuromuscular function can be determined in the same way using lower limb acceleromyography. We compared measurements of recov- ery from neuromuscular blockade using upper limb electromyography and lower limb acceleromyography. Methods: Twenty-nine patients who were scheduled for elective surgery were enrolled in this study. Patients were ex- cluded if they had neuromuscular disease or contraindications to neuromuscular blockade. General anesthesia was induced and maintained with propofol and fentanyl. Patients were monitored using electromyography at the first dorsal interosse- ous muscle of the upper limb and acceleromyography at the flexor hallucis brevis muscle of the lower limb. Vecuronium 0.1 mg/kg was administered for neuromuscular blockade, and the profile of the blockade was recorded, including onset time and recovery times to TOFR 0.7 and 0.9. Results were compared between the upper and lower limbs. Results: The first dorsal interosseous muscle of the upper limb was slower to recover to TOFR 0.7 and 0.9 than the flexor hallucis brevis muscle. When the TOFR at the flexor hallucis brevis muscle had recovered to 0.9, the TOFR at the first dorsal interosseous muscle was 0.44 ± 0.23. Conclusion: Monitoring the flexor hallucis brevis muscle using acceleromyography underestimates the residual neuro- muscular blockade.","PeriodicalId":272376,"journal":{"name":"The Open Anesthesiology Journal","volume":"413 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132107994","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}