Asian journal of anesthesiology最新文献

{"title":"Reversal of Neuromuscular Blockade by Sugammadex for Stimulator-Guided Nerve Blocks After Tracheal Intubation: Is It Necessary?","authors":"Ming-Hui Hung, Yi-Ping Wang","doi":"10.6859/aja.202209_60(3).0005","DOIUrl":"https://doi.org/10.6859/aja.202209_60(3).0005","url":null,"abstract":"","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"60 3","pages":"119-120"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40563141","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 Different Doses of Dexmedetomidine as Adjuvant for Infraumbilical Surgery in Patients Receiving Bupivacaine Spinal Anesthesia: A Randomized Controlled Trial.","authors":"Amit Kumar Saha,&nbsp;Bani P M Hembrom,&nbsp;Baisakhi Laha,&nbsp;Tapobrata Mitra,&nbsp;Avijit Hazra","doi":"10.6859/aja.202209_60(3).0002","DOIUrl":"https://doi.org/10.6859/aja.202209_60(3).0002","url":null,"abstract":"<p><strong>Background: </strong>Infraumbilical surgery today is done preferentially under subarachnoid block. The relatively short duration of analgesia is a limiting factor which is overcome by adding an adjuvant to intrathecal bupivacaine. We aimed to determine optimum dose of intrathecal dexmedetomidine as adjuvant to 0.5% hyperbaric bupivacaine in infraumbilical surgery.</p><p><strong>Methods: </strong>A parallel group, double blind, randomized controlled trial was done with 105 adult patients posted for infraumbilical surgery under subarachnoid block. All subjects received 3.0 mL (15.0 mg) of 0.5% hyperbaric bupivacaine. Groups D5.0, D7.5, and D10.0 (n = 35 each) received additionally 5.0, 7.5, and 10.0 mcg intrathecal dexmedetomidine as adjuvant. The onset time of sensory block, its peak level and time to this level, maximum motor block and time to it, total duration of analgesia (time to first rescue), and vital parameters were recorded at intervals. Postoperative analgesia was assessed by visual analog scale score at 15 and 30 minutes, then every 30 minutes until 2 hours and then every hour until 6 hours. Treatment emergent adverse events (bradycardia, hypotension, and sedation) were documented.</p><p><strong>Results: </strong>Maximum sensory level achieved was higher in Group D10.0 than in the other two groups. There was significant and dose-dependent shortening of the mean time to peak sensory block (3.9, 3.3, and 2.9 min; P ＜ 0.001) and peak motor block (5.6, 5.3, and 4.8 min; P ＜ 0.001), and prolongation of postoperative analgesia duration (206.9, 220.8, and 244.0 min; P ＜ 0.001) with escalating doses (5.0, 7.5, and 10.0 mcg, respectively) of dexmedetomidine. Hemodynamic effects and adverse events were comparable in the three groups.</p><p><strong>Conclusions: </strong>Intrathecal dexmedetomidine (10.0 mcg), as adjuvant to 0.5% hyperbaric bupivacaine (15.0 mg), facilitates rapid onset sensory and motor block and prolongs duration of postoperative analgesia in spinal anesthesia without significant adverse effects. Although absolute differences are modest, the results are better compared to 5.0 and 7.5 mcg doses.</p>","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"60 3","pages":"101-108"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40563140","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 Importance of Skin Testing in Patients With History of Anesthesia-Related Anaphylaxis.","authors":"Yoriko Murase,&nbsp;Yukihide Koyama,&nbsp;Kunishige Ogasawara,&nbsp;Kei Morita,&nbsp;Koichi Tsuzaki","doi":"10.6859/aja.202209_60(3).0004","DOIUrl":"https://doi.org/10.6859/aja.202209_60(3).0004","url":null,"abstract":"","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"60 3","pages":"117-118"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40574267","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":"An Investigation Into Quality of Recovery After General Anesthesia With Isoflurane and Propofol in Patients Undergoing Abdominal Hysterectomy.","authors":"S. Seyfi, Hakimeh Alereza Amiri, N. Banihashem, Khadijeh Ezoji, Seyedeh Golnaz Ziaei","doi":"10.6859/aja.202208/PP.0001","DOIUrl":"https://doi.org/10.6859/aja.202208/PP.0001","url":null,"abstract":"BACKGROUND\u0000The quality of postanesthesia recovery is among the important issues of general anesthesia that affect the patient's ability to perform daily activities. This study hence aimed to investigate the effects of general anesthesia with isoflurane and propofol on the quality of recovery (QoR) in patients undergoing an abdominal hysterectomy.\u0000\u0000\u0000METHODS\u0000This clinical trial was conducted on 80 women aged 30-65 years who visited Ayatollah Rouhani Hospital of Babol for an elective abdominal hysterectomy in 2020. Based on a randomized block design (4 blocks of 20), the participants were equally assigned to two groups of propofol (P) and isoflurane (I). The QoR-15 scale was employed to measure the QoR in terms of physical and mental dimensions, as primary outcomes, and duration of anesthesia, duration of surgery, response time, quality of extubation, changes in blood pressure and heart rate, length of stay in the recovery unit, Aldrete score, pain score, and prevalence of postoperative nausea and vomiting (PONV), as secondary outcomes.\u0000\u0000\u0000RESULTS\u0000The results showed that there was no significant difference between the two groups in terms of postoperative physical and mental changes (P = 0.142), except for the second night after surgery (P = 0.001). The QoR, both physically and mentally, significantly changed in both groups over time (P ＜ 0.05). The results also indicated that response time (P ＜ 0.001), quality of extubation (P = 0.01), prevalence of PONV (P = 0.001), and increase in blood pressure (P = 0.02) were significantly lower in the propofol group (P) than in the isoflurane group (I). There was no significant difference between the two groups in the length of stay in the recovery unit (P = 0.44), pre-discharge Aldrete score (P = 0.31), pain score (P = 0.18), duration of anesthesia (P = 0.30), duration of surgery (P = 0.64), and heart rate (P = 0.30).\u0000\u0000\u0000CONCLUSIONS\u0000Propofol outperformed isoflurane in terms of response time, quality of extubation, prevalence of PONV, and increase in blood pressure. In addition, the physical and mental QoR on the second night after surgery was higher in patients anesthetized with propofol compared to those anesthetized with isoflurane.","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44798763","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":"Incidence of Neurotoxic Symptoms in Iranian Anesthesiology Staff: Psychometric Properties of Persian Version of the Euroquest Questionnaire.","authors":"Nasim Alipour, Hamid Saidnia, R. Heidarimoghadam, Seyed Ali Mahdiyoun, M. Babamiri, A. A. Fakhr","doi":"10.6859/aja.202208/PP.0004","DOIUrl":"https://doi.org/10.6859/aja.202208/PP.0004","url":null,"abstract":"BACKGROUND\u0000With the increase in the number of people exposed to anesthetic gases, there is a critical need to examine the prevalence of neurotoxic symptoms in these individuals using reliable tools. The aim of this study was to evaluate the psychometric characteristics of EUROQUEST questionnaire and to measure the rate of neurotoxic symptoms in the anesthesiology personnel.\u0000\u0000\u0000METHODS\u0000This research was a cross-sectional study. This study was a cross-sectional one. Participants included 404 personnel of the operating room in western Iran. EUROQUEST questionnaire was translated into Persian and used to measure the rate of neurotoxic symptoms. Reliability of the questionnaire was examined by Cronbach's alpha, while face and construct validities were evaluated using SPSS 16 (SPSS Inc., Chicago, IL, USA) and AMOS 18 (IBM, Chicago, IL, USA) software.\u0000\u0000\u0000RESULTS\u0000The results indicated that EUROQUEST questionnaire had acceptable reliability and validity. The most prevalent symptoms were observed in memory and concentration, fatigue, and sleepiness. The prevalence of fatigue was higher than other dimensions, with 28% of participants in the third and fourth quartiles. Also, there was no relationship between symptoms and work experience.\u0000\u0000\u0000CONCLUSIONS\u0000EUROQUEST questionnaire can be applied in studies of the neurotoxic symptoms. The study of the prevalence of symptoms also indicated that most participants complained about memory and concentration, fatigue, and sleepiness, and these symptoms were observed in all individuals regardless of their work experience.","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46976590","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":"Evaluation of Analgesic Efficacy of Ultrasound-Guided Adductor Canal Block With 20 mL of 0.5% Ropivacaine in Patients Undergoing Knee Surgeries-A Randomized Control Trial.","authors":"Pavithra Arumugam, Saravanan Ravi, Sundaram. Ln, Prasanna Manickam, Karthik Kanthan","doi":"10.6859/aja.202208/PP.0003","DOIUrl":"https://doi.org/10.6859/aja.202208/PP.0003","url":null,"abstract":"BACKGROUND\u0000Adductor canal block (ACB) is a motor sparing block providing analgesia for surgeries involving anterior part of the knee. The aim of our study was to evaluate the analgesic efficacy of ACB to reduce pain in arthroscopic knee surgeries done under spinal anesthesia. Our primary objective was to evaluate the 24 hours postoperative morphine consumption. The secondary objectives were to evaluate the visual analog scale (VAS) scores at rest and during knee flexion, hemodynamics and side effects of the block.\u0000\u0000\u0000METHODS\u0000In this prospective randomised controlled trial, 70 patients who underwent arthroscopic knee surgeries were randomly divided into two groups, A and C. Surgeries were done under spinal anesthesia. Group A patients received ACB with 20 mL of 0.5 % ropivacaine using ultrasound postoperatively. Block was not performed in group C. The amount of morphine consumption in PCA pump, duration of analgesia, mean VAS scores at rest and flexion, hemodynamics and adverse effects were monitored.\u0000\u0000\u0000RESULTS\u0000The average morphine consumption was significantly lesser with a P-value ＜ 0.001 in group A (8.628 ± 2.001 mg) when compared to group C (21.914 ± 5.118 mg). The duration of analgesia was longer in group A (365.71 ± 53.648 min vs. 150.429 ± 22.537 min) with highly significant P-value of ＜ 0.001. Group A patients had significantly decreased VAS scores at rest and knee flexion and better haemodynamic stability.\u0000\u0000\u0000CONCLUSIONS\u0000We conclude that ultrasound-guided ACB resulted in significantly lesser morphine consumption after arthroscopic knee surgeries. ACB prolonged the duration of analgesia with better hemodynamics, lesser VAS pain scores and with no complications.","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49102734","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":"Neostigmine Treats Postoperative Akinesia in a Restless Legs Syndrome Patient.","authors":"Ying-Tzu Chen, Tsai-Shan Wu, Wan-Jung Cheng, Zhi-Fu Wu","doi":"10.6859/aja.202208/PP.0002","DOIUrl":"https://doi.org/10.6859/aja.202208/PP.0002","url":null,"abstract":"","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48264839","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":"Propofol Backflow During Anesthesia Induction: Anesthesiologists Should Inspect for Preventing Awareness.","authors":"Chao-hsin Huang, Zhi-Fu Wu, Tin-Wei Hung, Chia-Heng Lin","doi":"10.6859/aja.202206/PP.0005","DOIUrl":"https://doi.org/10.6859/aja.202206/PP.0005","url":null,"abstract":"","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45531729","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 Different Doses of Dexmedetomidine as Adjuvant for Infraumbilical Surgery in Patients Receiving Bupivacaine Spinal Anesthesia: A Randomized Controlled Trial.","authors":"Amit Kumar Saha, Bani P M Hembrom, Baisakhi Laha, T. Mitra, A. Hazra","doi":"10.6859/aja.202206/PP.0003","DOIUrl":"https://doi.org/10.6859/aja.202206/PP.0003","url":null,"abstract":"BACKGROUND\u0000Infraumbilical surgery today is done preferentially under subarachnoid block. The relatively short duration of analgesia is a limiting factor which is overcome by adding an adjuvant to intrathecal bupivacaine. We aimed to determine optimum dose of intrathecal dexmedetomidine as adjuvant to 0.5% hyperbaric bupivacaine in infraumbilical surgery.\u0000\u0000\u0000METHODS\u0000A parallel group, double blind, randomized controlled trial was done with 105 adult patients posted for infraumbilical surgery under subarachnoid block. All subjects received 3.0 mL (15.0 mg) of 0.5% hyperbaric bupivacaine. Groups D5.0, D7.5, and D10.0 (n = 35 each) received additionally 5.0, 7.5, and 10.0 mcg intrathecal dexmedetomidine as adjuvant. The onset time of sensory block, its peak level and time to this level, maximum motor block and time to it, total duration of analgesia (time to first rescue), and vital parameters were recorded at intervals. Postoperative analgesia was assessed by visual analog scale score at 15 and 30 minutes, then every 30 minutes until 2 hours and then every hour until 6 hours. Treatment emergent adverse events (bradycardia, hypotension, and sedation) were documented.\u0000\u0000\u0000RESULTS\u0000Maximum sensory level achieved was higher in Group D10.0 than in the other two groups. There was significant and dose-dependent shortening of the mean time to peak sensory block (3.9, 3.3, and 2.9 min; P ＜ 0.001) and peak motor block (5.6, 5.3, and 4.8 min; P ＜ 0.001), and prolongation of postoperative analgesia duration (206.9, 220.8, and 244.0 min; P ＜ 0.001) with escalating doses (5.0, 7.5, and 10.0 mcg, respectively) of dexmedetomidine. Hemodynamic effects and adverse events were comparable in the three groups.\u0000\u0000\u0000CONCLUSIONS\u0000Intrathecal dexmedetomidine (10.0 mcg), as adjuvant to 0.5% hyperbaric bupivacaine (15.0 mg), facilitates rapid onset sensory and motor block and prolongs duration of postoperative analgesia in spinal anesthesia without significant adverse effects. Although absolute differences are modest, the results are better compared to 5.0 and 7.5 mcg doses.","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42351743","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":"Reversal of Neuromuscular Blockade by Sugammadex for Stimulator-Guided Nerve Blocks After Tracheal Intubation: Is It Necessary?","authors":"M. Hung, Yi-ping Wang","doi":"10.6859/aja.202206/PP.0004","DOIUrl":"https://doi.org/10.6859/aja.202206/PP.0004","url":null,"abstract":"Received: 28 September 2020; Received in revised form: 20 January 2022; Accepted: 1 March 2022. Corresponding Author: Ming-Hui Hung, MD, Department of Anesthesiology, National Taiwan University Hospital Hsin-Chu Branch, No. 25, Ln. 442, Sec. 1, Jingguo Rd., North Dist., Hsinchu City 300195, Taiwan (hung.minghui@gmail.com). To the Editor, We read the article by Dr. Moriwaki et al. with great interest in a recent issue of the journal. To facilitate early recovery of neuromuscular function for stimulator-guided nerve blocks, the authors administered sugammadex 2 mg/kg 10 minutes after rocuronium 0.6 mg/kg to obtain adequate responses from nerve stimulation. While their protocol is feasible and their results are satisfactory, we have concerns about the strategy. Sugammadex might be a game-changer in the practice of general anesthesia. It can reverse any depths of rocuronium-induced neuromuscular blockade within minutes and notably without cholinergic adverse effects. Nonetheless, anesthesiologists should be reminded that any drug is poison without considering why (indication), when (timing), and how (dose). First, for patients who desired general anesthesia and peripheral nerve block for pain control, we argue that using a supraglottic airway device without muscle relaxant during moderate-to-deep sedation or general anesthesia is sufficient to perform stimulator-guided nerve block. Even for long-hour procedures requiring a definite airway, general anesthesia with tracheal intubation can be performed after peripheral nerve blocks (block-before-intubation strategy). Second, the optimal depth of neuromuscular block without interfering with the use of a stimulator to guide nerve blocks is controversial. We did not know the specific depth of neuromuscular blockade 10 minutes after they gave rocuronium 0.6 mg/kg from their article. However, we found that all patients made a full recovery of neuromuscular function 7 minutes after sugammadex 2 mg/kg with a train-offour (TOF) ratio above 0.9 as shown in Figure 2 of the article done by Moriwaki et al. Unsurprisingly, many patients (72%) presented coughing and movement during surgery, most likely resulting from inadequate neuromuscular blockade hereafter. Anesthesiologists should be reminded that recommended doses of sugammadex from the package insert are relatively high for rapid and full reversal within 2–3 minutes in life-threatening scenarios. An excessive dose of sugammadex is not binding any rocuronium in the body. An unnecessary dose of sugammadex is associated with increasing drug cost and the occurrence of bradycardia and hypersensitivity reactions. Re-obtaining neuromuscular blockade after a high dose of sugammadex is another concern because rocuronium is not an option for muscle relaxation in the following hours. Therefore, it may be considered that anesthesiologists gave a low dose of sugammadex with TOF monitor to a targeted depth of neuromuscular blockade in such cases, instead of full recovery of","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44081112","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}