Anesthesiology and Pain Medicine最新文献

{"title":"The Power of Color Flow Doppler Ultrasonography Versus Blind Technique in Localization of Epidural Catheter: A Randomized Prospective Study.","authors":"Atef Mohamed Mahmoud, Safaa Gaber Ragab, Taha Mohamed Agamy, Abeer Shaban Goda","doi":"10.5812/aapm-147828","DOIUrl":"https://doi.org/10.5812/aapm-147828","url":null,"abstract":"<p><strong>Background: </strong>The success of epidural analgesia hinges on the precise insertion of the needle within the epidural space; failure rates have been reported to reach 32%.</p><p><strong>Objectives: </strong>We report a new method using color Doppler to help verify the accurate location of the epidural needle tip.</p><p><strong>Methods: </strong>This is a randomized prospective study. Sixty patients undergoing hysterectomy were enrolled, with 30 patients in each group. Color flow Doppler (CFD) ultrasonography was employed to guide epidural catheter placement. The ultrasound-guided epidural technique was used for patients where challenges in identifying traditional landmarks for epidural space localization were anticipated. The procedure commenced with a spinal epidural technique. After sterile preparation and draping of the area, a curvilinear ultrasound transducer, encased in a sterile sheath, was used to locate the interspinous space. The primary outcome measure focused on flow visualization at different insertion levels. Secondary outcome measures included the duration of catheter implantation, intervertebral level of insertion, and dermatome sensory levels. The study also assessed the quality of epidural analgesia and patients' assessment of analgesic quality using a Verbal Numerical Rating Scale.</p><p><strong>Results: </strong>The study reported a successful and predominantly safe outcome, with high success rates in flow visualization and effective anesthesia coverage. Flow visualization at the insertion and surrounding levels demonstrated a 100% success rate at all observed points. The Visual Numeric Rating Scale (VNRS) results indicated a median pain score of 2 with an interquartile range (IQR) of 2 - 3, showcasing a generally low level of post-procedural pain among the subjects, reflecting good quality post-operative analgesia. Regarding dermatome sensory levels after 2 hours, the distribution across various levels, including T4, T6, T7, T8, T10, and T12, exhibited a favorable outcome. The highest proportion was observed at T10 (68.3%), suggesting effective anesthesia coverage in the targeted areas. The study demonstrated comparable efficiency between the CFD-guided and blind techniques in terms of procedural aspects. However, notable distinctions were observed in patients' reported pain levels, with the CFD group experiencing lower pain compared to the blind technique group. Additionally, the study highlighted the association between CFD and improved procedural accuracy and safety.</p><p><strong>Conclusions: </strong>This study advocates for the integration of CFD into routine clinical practice to enhance procedural outcomes and patient safety during hysterectomy surgeries.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"14 3","pages":"e147828"},"PeriodicalIF":0.0,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11480820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal Anesthesia Management in a 30-Year-Old Patient with Progeria Syndrome: A Case Report.","authors":"Maryam Vosoughian, Faramarz Mosaffa, Shide Dabir, Mastaneh Dahi Taleghani","doi":"10.5812/aapm-147344","DOIUrl":"https://doi.org/10.5812/aapm-147344","url":null,"abstract":"<p><p>Progeria syndrome is a rare genetic disorder resulting in premature aging. General anesthesia is very challenging in these patients due to difficult intubation and age-related comorbidities. We describe spinal anesthesia management in a 30-year-old man with progeria syndrome. To our knowledge, this is the first report on using spinal anesthesia in this group of patients.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"14 3","pages":"e147344"},"PeriodicalIF":0.0,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11480815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Pediatric Urologic Surgery-Clinical Anesthetic Considerations: A Comprehensive Review.","authors":"Nazih Khater, Seth Swinney, Joseph Fitz-Gerald, Ahmad S Abdelrazek, Natalie M Domingue, Sahar Shekoohi, Farnad Imani, Tahereh Chavoshi, Ali Moshki, Kimberly L Skidmore, Alan D Kaye","doi":"10.5812/aapm-146438","DOIUrl":"https://doi.org/10.5812/aapm-146438","url":null,"abstract":"<p><p>Minimally invasive robotic approaches have become standard in many institutions over the last decade for various pediatric urological procedures. The anesthetic considerations for common laparoscopic and robotic-assisted surgeries are similar since both require the insufflation of CO₂ to adequately visualize the operative area. However, few studies exist regarding anesthesia for robotic procedures in children. We hypothesized that pediatric patients undergoing robotic urologic surgeries would require specific anesthetic strategies, especially given the inherently longer durations of these procedures. This study aimed to evaluate anesthetic considerations, current robotic procedures, optimal patient positioning, and port placement for robotic-assisted surgery in pediatric patients. A comprehensive literature review of all published manuscripts from PubMed, EMBASE database, and Google Scholar was performed, focusing on robotic procedures involving pediatric patients, anesthesia for pediatric urology patients, and related topics from 1996 to 2023. Forty published manuscripts were identified and reviewed in depth. In pediatric cases, insufflation pressures and volumes are lower due to the laxity of the abdominal wall. However, the increase in intra-abdominal pressure and absorption of CO₂ may result in disproportionate changes in cardiopulmonary function. Specific patient positioning for robotic approaches may further compound these physiological changes. Correct patient positioning is essential to facilitate surgery optimally and safely. Understanding the physiological changes that can occur during a pediatric patient's robotic urologic surgery allows for safer anesthesia management.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"14 3","pages":"e146438"},"PeriodicalIF":0.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic Management Recommendations Using a Machine Learning Algorithm to Reduce the Risk of Acute Kidney Injury After Cardiac Surgeries","authors":"A. A. Abin, Ahmad Molla, Azar Ejmalian, Shahabedin Nabavi, Behnaz Memari, Kamal Fani, Ali Dabbagh","doi":"10.5812/aapm-143853","DOIUrl":"https://doi.org/10.5812/aapm-143853","url":null,"abstract":"Background: Open heart surgeries are a common surgical approach among patients with heart disease. Acute kidney injury (AKI) is one of the most common postoperative complications following cardiac surgeries, with an average incidence of 6 - 10%. Additionally, AKI has a mortality rate of 5 - 10%. One of the challenges of cardiac surgeries is selecting the appropriate anesthetic approaches to reduce the risk of AKI. Objectives: This study presents a machine learning-based method that consists of two regression models. These models can inform the anesthesiologist about the risk of AKI resulting from the improper selection of anesthetic parameters. Methods: In this cohort study, the medical records of 998 patients who underwent cardiac surgery were collected. The proposed method includes two regression models. The first regression model recommends optimal anesthesia parameters to minimize the risk of AKI. The second model provides the anesthesiologist with the safest margin for deciding on anesthetic parameters during surgery, including cardiopulmonary bypass (CPB) time, anesthesia time, crystalloid dose, diuretic dose, and transfusion of packed red cells (PC) and fresh frozen plasma (FFP). Using this method, the specialist can evaluate the anesthetic parameters and assess the potential AKI risk. Additionally, the proposed method can also provide the treatment team with anesthetic parameters that carry the lowest risk of AKI. Results: This method was evaluated using data from 526 patients who suffered from postoperative AKI (AKI+) and 472 who did not suffer any injury (AKI-). The accuracy of the proposed method is 80.6%. Additionally, the evaluation of the proposed method by three experienced cardiac anesthesiologists shows a high correlation between the results of the proposed method and the opinions of the anesthesiologists. Conclusions: The results indicated that the outputs of the proposed models and the designed software could help reduce the risk of postoperative AKI.","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"21 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141383685","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":"Retraction Note: The Effect of Dexmedetomidine and Esmolol on Early Postoperative Cognitive Dysfunction After Middle Ear Surgery Under Hypotensive Technique: A Comparative, Randomized, Double-blind Study.","authors":"Mahmood-Reza Alebouyeh","doi":"10.5812/aapm.149456","DOIUrl":"https://doi.org/10.5812/aapm.149456","url":null,"abstract":"<p><p>[This retracts the article DOI: 10.5812/aapm.107659.].</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"14 3","pages":"e149456"},"PeriodicalIF":0.0,"publicationDate":"2024-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11480816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Narrative Review on Pain Management in Head and Neck Cancer: Integrating Multimodal Analgesia and Interventional Procedures","authors":"F. Imani, Saleh Mohebbi, Masoud Mohseni, Behnaz Karimi, Saeid Rahimi, Gholamali Dikafraz Shokooh","doi":"10.5812/aapm-146825","DOIUrl":"https://doi.org/10.5812/aapm-146825","url":null,"abstract":": Surgical interventions and radiotherapy for head and neck cancer frequently result in substantial instances of acute and chronic discomfort. Optimizing pain management techniques stands as a pivotal factor in enhancing the well-being and overall quality of life for patients. This comprehensive review discusses various pain conditions encountered after head and neck cancer and explores a multidimensional approach to pain management. The review highlights the significance of incorporating multimodal analgesia, physical therapy, psychological support, palliative care, and emerging techniques including nerve blocks to achieve efficacious pain control. Such an endeavor necessitates cooperation among head and neck surgeons, radiotherapists, and pain specialists.","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141279080","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 on Time to Extubation in Patients with Morbid Obesity Undergoing Laparoscopic Sleeve Gastrectomy","authors":"Doha Mohammed Bakr, Rasha Behery Youssef, Maged Salah Mohamed, M. S. Khalil","doi":"10.5812/aapm-144776","DOIUrl":"https://doi.org/10.5812/aapm-144776","url":null,"abstract":"Background: Sleeve gastrectomy (SG) is an effective method for managing obesity. While opioids are used for their hemodynamic stability and their ability to reduce intraoperative stress, they also have reported side effects. Dexmedetomidine (DEX), an α2 adrenergic receptor agonist, is noted for its analgesic and anesthetic-sparing effects, leading to a higher quality of recovery. Objectives: The study aims to compare the effects of fentanyl and dexmedetomidine (DEX) on the recovery of morbidly obese patients following laparoscopic sleeve gastrectomy (SG). Methods: This randomized, double-blind study involved 64 patients, equally divided into two groups. The Dexmedetomidine group (Group D) received an intravenous (IV) loading dose of dexmedetomidine (1 μg/kg) over 15 minutes before anesthesia induction, followed by a 10 ml saline 0.9% infusion over 60 seconds during induction. Post-intubation, dexmedetomidine was administered at 0.5 μg/kg/h. The Fentanyl group (Group F) received a volume-matched saline 0.9% IV over 15 minutes pre-induction and fentanyl (1 μg/kg) diluted in 10 ml saline 0.9% IV over 60 seconds during induction. After intubation, a continuous fentanyl infusion was maintained at a rate of 1 μg/kg/hr. Results: Extubation time was significantly shorter in the Dexmedetomidine group (Group D) at 8.25 ± 2.7 minutes compared to the Fentanyl group (Group F) at 10.47 ± 2.17 minutes, with a P value of 0.001. Intraoperative heart rate and mean arterial blood pressure were also significantly lower in Group D than in Group F. Visual analogue scale (VAS) pain scores were significantly lower in Group D compared to Group F upon arrival at the post-anesthesia care unit and at 2 hours postoperatively (P-value < 0.05). Additionally, the morphine dose consumed in the first 12 hours after surgery was significantly lower in Group D (5.75 ± 2.20 mg) compared to Group F (8 ± 2.38 mg), with a P-value of 0.001. Conclusions: For morbidly obese patients undergoing laparoscopic sleeve gastrectomy, dexmedetomidine (DEX) proves to be an effective anesthetic choice. It not only reduces extubation time but also lowers early postoperative visual analogue scale (VAS) pain scores and opioid consumption within the first 12 hours following surgery.","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"45 25","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140975738","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":"Expression of Concern for The Effect of Dexmedetomidine and Esmolol on Early Postoperative Cognitive Dysfunction After Middle Ear Surgery Under Hypotensive Technique: A Comparative, Randomized, Double-blind Study [Anesth Pain Med. 2021;11(1): e107659]","authors":"M. Alebouyeh","doi":"10.5812/aapm.148635","DOIUrl":"https://doi.org/10.5812/aapm.148635","url":null,"abstract":"<jats:p/>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141003189","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":"Pain Management and Sociology Implications: The Sociomedical Problem of Pain Clinic Staff Harassment Caused by Chronic Pain Patients","authors":"Olumuyiwa Akinwumi Bamgbade, Monisola Temidayo Sonaike, Leili Adineh-Mehr, Daniel Olutosin Bamgbade, Zaina Samir Aloul, Cherith Boatametse Thanke, Thakgalo Thibela, Grace Gaceri Gitonga, Genet Tadesse Yimam, Aria Genaelle Mwizero, Fidelia Batombari Alawa, Lahja Omagano Kamati, Nolubabalo Patience Ralasi, Mwewa Chansa","doi":"10.5812/aapm-144263","DOIUrl":"https://doi.org/10.5812/aapm-144263","url":null,"abstract":"Background: Patients with chronic pain often experience psychological issues. They may also exhibit harassing behaviors toward healthcare staff. This complex sociomedical issue necessitates increased attention. Objectives: This study analyzed incidents of staff harassment caused by chronic pain patients. It examined the characteristics of chronic pain patients who harassed clinic staff, as well as the causative or associated factors. The study also explored the management and outcomes of these harassment incidents. Methods: This prospective observational study involved 1102 chronic pain patients who received treatment at a pain clinic. Data were prospectively collected on patients' gender, age, ethnicity, occupation, injury insurance claims, and incidents of staff harassment caused by patients. Results: Pain clinic staff were harassed by 121 patients (11 %). Among the harassers, females constituted 70.2 % and males 29.8 %. Additionally, 50.4 % of the harassers were unemployed, with unemployed patients causing more staff harassments (P = 0.001). A significant portion, 86 %, of the harassers had injury insurance claims and were associated with a higher incidence of staff harassments (P = 0.002). Patients making disability insurance claims also caused more staff harassments (P = 0.001). Among the harassers, 50.4 % demanded higher drug doses, and 50 % did not have regular primary healthcare providers. The types of harassment included insults (34.7 %), threats (19.8 %), retaliations (3.3 %), and sexual harassment (42.2 %). All cases of sexual harassment were addressed; the patients involved were counseled. Most harassment incidents were resolved through tactful communication. Of the harassers, 9.9 % were discharged from the clinic. Conclusions: Harassment of pain clinic staff by chronic pain patients is significant. This sociomedical issue may be worsening due to factors such as opioid misuse, racism, the pandemic, and socioeconomic challenges. While most chronic pain patients are reasonable, some can be challenging. This study confirmed that the majority of patients who harassed staff were female, unemployed, had made injury insurance claims, and demanded higher drug doses. Abusive patients should receive anxiolytic therapy, behavioral boundaries, counseling, distraction therapy, and empathy. Pain clinics should implement staff training and support programs to protect staff from harassment. Additionally, pain clinicians should establish peer support networks to mitigate the psychological impacts of patient aggression and maintain professional well-being.","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"271 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141012649","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 Modified Mallampati Classification in Supine and Sitting Positions to Predict Difficult Tracheal Intubation in Diabetic Patients.","authors":"Diya Sarah Jacob, Sonal Bhat, Sunil Vasudev Rao","doi":"10.5812/aapm-145034","DOIUrl":"10.5812/aapm-145034","url":null,"abstract":"<p><strong>Background: </strong>Airway management of patients with long-standing diabetes poses a major challenge for anaesthesiologists due to stiff joint syndrome affecting the atlanto-occipital joint. In certain cases requiring immobilization, the Mallampati test must often be performed in the supine position for obvious reasons.</p><p><strong>Objectives: </strong>Hence, we determined the diagnostic precision (sensitivity and specificity) of the modified Mallampati test in sitting and supine positions among the diabetic population in predicting difficult tracheal intubation.</p><p><strong>Methods: </strong>A single-center prospective observational study on adult diabetic patients undergoing general anesthesia and orotracheal intubation was carried out. An observer recorded the modified Mallampati in the sitting posture during the pre-anesthetic examination. The Mallampati in the supine position was determined while in the operating room, and the difficulty of intubation was noted, and diagnostic precision was calculated. The main objective was to predict a difficult airway by calculating the sensitivity, specificity, positive predictive value, and negative predictive value.</p><p><strong>Results: </strong>Out of the 150 participants, Mallampati grading in a sitting position was correctly able to identify 42.5% of difficult intubation cases, whereas it was 97.5% with Mallampati in the supine position. Mallampati grading in the sitting position was able to correctly identify 89.1% of easy intubation cases, which was 63.6% with Mallampati in the supine position. The correlation of Mallampati in the supine position with CL grading was statistically significant (P < 0.001).</p><p><strong>Conclusions: </strong>Among diabetic patients, the modified Mallampati test in the supine position can be considered a more accurate and sensitive predictor of difficult intubation than the sitting posture.</p>","PeriodicalId":7841,"journal":{"name":"Anesthesiology and Pain Medicine","volume":"14 2","pages":"e145034"},"PeriodicalIF":0.0,"publicationDate":"2024-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11088840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140915599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}