International journal of anesthetics and anesthesiology最新文献

{"title":"Epidural Anesthesia for a Caesarean Delivery in a Parturient with an Intrathecal Baclofen Pump and Sickle Cell Disease: A Case Report","authors":"J. Bastian, A. Bauer, C. Kern, M. Robertson-Baeriswyl","doi":"10.23937/2377-4630/1410095","DOIUrl":"https://doi.org/10.23937/2377-4630/1410095","url":null,"abstract":"A 32-year-old primigravida woman received an epidural anesthetic at 38 weeks of gestation for an elective caesarean delivery. She had for the past 10 years an intrathecal baclofen infusion pump to relieve spastic tetraparesis secondary to perinatal cerebral anoxia. She otherwise also suffered from sickle cell disease complicated by several vaso-occlusive crisis during pregnancy and a recent history of thromboembolic disease. A recent CT scan showed the intrathecal catheter entering the L3-L4 interspace and extending proximally to the thoracic region. For the caesarean delivery, an epidural catheter was sited using ultrasound in the L4-L5 interspace. Motor block and analgesia was obtained with a tested sensitive level never rising above T9. The patient was informed of the clinical situation and eventual risk of converting to general anesthesia if too uncomfortable during the caesarean section. Despite this she wished to forgo a general anesthesia if possible. It was decided to proceed with the caesarean delivery under epidural anesthesia. The caesarean section was uneventful, and no complications occurred in the post-natal period. Neuraxial anesthesia may be favored over general anesthesia for patients with sickle cell disease, but epidural local anesthetic spread may be unpredictable following interventions involving the epidural space as illustrated by this case report.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42412141","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":"Persistent Lactic Acidosis - Think beyond Sepsis","authors":"P. Emily, K. Thogulava","doi":"10.23937/2377-4630/1410094","DOIUrl":"https://doi.org/10.23937/2377-4630/1410094","url":null,"abstract":"Citation: Pallister E, Kannan T (2019) Persistent Lactic Acidosis Think beyond Sepsis. Int J Anesthetic Anesthesiol 6:094. doi.org/10.23937/2377-4630/1410094 Accepted: August 19, 2019: Published: August 21, 2019 Copyright: © 2019 Pallister E, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44222131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Prospective Observational Study of Air Burden in Intravenous Tubing: Factors that Increase Patient Exposure","authors":"F. TirottaChristopher, G. LagueruelaRichard, M. Danielle, Irizarry Marysory, McBride John, Ramsingh Davinder, H. Jonathan","doi":"10.23937/2377-4630/1410092","DOIUrl":"https://doi.org/10.23937/2377-4630/1410092","url":null,"abstract":"Background/Aims: The purpose of this investigation was to identify causes and triggers of air entrainment related to intravenous (IV) access in a setting of clinical, operative or interventional procedure. Methods: An observational prospective trial was conducted in operating room settings across multiple study sites. A total of 120 surgical patients undergoing a variety of interventional and surgical procedures were included, representing multiple patient populations, case types and anesthesia setups. The ClearLine IV, a device that detects and removes air from IV tubing, was inserted into the IV circuit. Clinicians followed standard protocols. Blood warmers were used at the practitioner’s discretion. IV fluid was administered at a constant flow rate or through a bolus given over 30-60 seconds per standard of care. The volume and duration of fluid administration was recorded, along with the frequency, duration and amount of air captured by ClearLine IV. Results: Data confirmed a 52% probability of having air in the IV tubing, 79% when using a fluid warmer or bolus, and for every 10 mL of blood products administered, the risk increased by 0.5%. The baseline probability of dense air (defined as greater than 1000 μL per L of fluid) increased from 0% to 20% with the inclusion of a syringe setup, and up to 50% with a warmer or bolus. Conclusion: Air entrainment occurs in the presence of an IV in the hospital setting, and air burden, the amount of air captured, is increased by use of a fluid warmer, administration of medication by bolus, delivery of blood products, and inclusion of IV syringe setups. CLInICaL STuDy SuMMaRy","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43821080","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":"Posterior Quadratus Lumborum Block versus Subcostal Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy","authors":"Weheba Hazem El Sayed Moawad, A. Tamer, G. Sameh, Makharita Mohamed Younis","doi":"10.23937/2377-4630/1410093","DOIUrl":"https://doi.org/10.23937/2377-4630/1410093","url":null,"abstract":"Background and objectives: Effective perioperative analgesia with laparoscopic cholecystectomy enhances early recovery, ambulation, and discharge. Subcostal TAP block has been shown to reduce perioperative opioid use and provide effective perioperative analgesia. Currently, the QLB is performed as one of the perioperative pain management procedures for patients undergoing abdominal surgery. In the current study, we hypothesized that the analgesic efficacy of posterior QLB would be equal to or better than the subcostal TAP block in laparoscopic cholecystectomy. Methods: 106 patients were randomized for elective laparoscopic cholecystectomy. They were randomly allocated to 2 equal groups, 53 patients each. First group, patients received posterior QLB. Second group, patients received subcostal TAP block. The study was registered at ClinicalTrials.gov (NCT03323684). Results: Data from 98 patients were analyzed (48 patients in QLB group and 50 patients in the TAP group). The cumulative postoperative fentanyl consumption at 24 hours in patients required postoperative opioids shows no significant difference between the two groups but with less number of patients needing postoperative opioids in QLB group (17/48) than in the TAP group (28/50). The time to the first postoperative request for rescue analgesia was significantly longer in QLB group than in the TAP group. There was no significant difference between the two groups as regard PONV, and pain scores at 1, 6, 12, and 24 hours postoperatively. Conclusion: Posterior quadratus lumborum block can provide better effective postoperative analgesia in patients undergoing laparoscopic cholecystectomy than subcostal transversus abdominis plane block does. RESEARcH ARTiclE","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42983152","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":"Transversus Abdominis Plane (TAP) Block as a Potential Diagnostic and Therapeutic Tool for Treatment of Chronic Post Herniorrhaphy Pain: A Case Report","authors":"P. Valentini, Petsas Dimosthenis, Efthymiou Evripidis, Drogouti Maria, Ntonas Athanasios, Ntonas Georgios","doi":"10.23937/2377-4630/1410091","DOIUrl":"https://doi.org/10.23937/2377-4630/1410091","url":null,"abstract":"Citation: Pogiatzi V, Petsas D, Efthymiou E, Drogouti M, Ntonas A, et al. (2019) Transversus Abdominis Plane (TAP) Block as a Potential Diagnostic and Therapeutic Tool for Treatment of Chronic Post Herniorrhaphy Pain: A Case Report. Int J Anesthetic Anesthesiol 6:091. doi.org/10.23937/2377-4630/1410091 Accepted: July 25, 2019: Published: July 27, 2019 Copyright: © 2019 Pogiatzi V, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48412568","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 illness, Co-morbidity and Mortality in a Norwegian Intensive Care Population","authors":"K. H. Tollisen, Marianne Bjerva, Dahl Gt, Meidell Nk, L. Sandvik, F. Heyerdahl, D. Jacobsen","doi":"10.23937/2377-4630/1410084","DOIUrl":"https://doi.org/10.23937/2377-4630/1410084","url":null,"abstract":"Background: The need for intensive care beds is high and expected to increase. Descriptive studies of the intensive care population may reveal differences in predisposing factors and outcome within subgroups and help identify areas in need of increased prevention efforts. Objective: To describe preadmission and clinical characteristics of an intensive care population in Oslo, and to compare the characteristics and outcomes of selected subgroups of this ICU-population. Method: Prospective observational cohort study of intensive care patients aged ≥ 18, admitted to two hospitals in Oslo during a one-year period. Acute illness characteristics, co-morbidity, limitations of life-sustaining treatment and hospital mortality were studied for the overall population and stratified for a) Gender and b) Medical and surgical patients within the age groups 18-59 years and 60 and above. Results: We included 861 patients, 567 (66%) males; median age 63 years (range 18-95); 537 (62%) medical admissions and 324 (38%) surgical admissions. 632 (73%) received mechanical ventilation. Trauma (n = 191, 21%) and cardiovascular disease (n = 180, 20%) were the most common causes of admission. In patients aged 18-59, poisoning caused 56/217 (26%) of the medical admissions and medical patients had a higher prevalence of pre-existing chronic disease (157/217, 72% vs. 69/160, 43%) and Charlson comorbidity index (mean 2.0 vs. 0.7, p < 0.001) than surgical patients. In patients aged 60 and above, comorbidity was similar, but medical patients had a higher hospital mortality (143/320, 45% vs. 58/164, 34%, p < 0.05). 205 (24%) died in the ICU, and limitations of life-sustaining treatment were made in 183 (89%) cases 279(32%) died during the hospital stay. Of the 582 surviving patients 455 (78%) were discharged to home or rehabilitation, 88 (15%) to nursing homes and 39 (7%) to other institutions. Conclusion: In patients younger than 60 years, trauma and poisoning were the most common causes of admission. Within this age group, medical patients had much higher prevalence of preexisting chronic disease than surgical patients, suggesting differences in predisposing factors. The majority of the surviving patients were discharged to home or to rehabilitation, indicating a low prevalence of futile intensive care.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43674931","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":"Inhalation Induction in Tracheostomized Patients: Comparison of Desflurane and Sevoflurane","authors":"E. Kerem, Erkalp Nuran Kalekoglu, E. Veysel, Korkut Arzu Yasemin, Abut Yesim Cokay","doi":"10.23937/2377-4630/1410089","DOIUrl":"https://doi.org/10.23937/2377-4630/1410089","url":null,"abstract":"Background: Inhalation induction (II) of anesthesia is a commonly used method in difficult airway management, pediatric anesthesia and also tracheostomized patients’ surgical practices. Sevoflurane and desflurane are the most common inhalation agents for II in these procedures of patients. We demonstrated that II with sevoflurane or desflurane in tracheostomized patients who are not studied up until now and their outcomes. Cardiorespiratory changes in II should be the same in tracheostomized patients with desflurane compared to sevoflurane. Methods: We studied 60 adult tracheostomized patients (ASA physical status 2 or 3), scheduled for elective surgery under general anesthesia. Patients were allocated randomly to receive either desflurane (Group D) or sevoflurane (Group S) for II. Following 1 mg midazolam and 1 μg/kg fentanyl, all patients were intubated via tracheostomy with a montandon tracheostomy tube. In the Group D, patients were firstly instructed to breath and then they immediately started using desflurane and 50% nitrous oxide in oxygen (3/3 L). Desflurane was introduced at an inspired concentration of 3% and increased by 1% every 4-6 breaths as tolerated, up to a maximum of 12%. In the Group S, patients were also instructed to breathe firstly and then they immediately started using sevoflurane and 50% nitrous oxide in oxygen (3/3 L). Sevoflurane was introduced at an inspired concentration of 1% and increased by 0.3% every 4-6 breaths as tolerated, up to a maximum of 6%. Hemodynamic values [(SpO2, heart rate (HR) and arterial pressure (MAP)], respiratory complications (coughing, bronchospasm, desaturation, breath-holding), purposeful movement of limbs, secretions requiring removal by suction, time to loss of response to command and concentration of expired inhalation agent (desflurane or sevoflurane) were recorded for 10 minutes of II. Mean, standard deviation, frequency and percentage were used for descriptive statistics with SSPS 20.0. Results: Couching, bronchospasm, desaturation, breathholding and purposeful movements distributions did not show any differences in Group D and Group S. Requirement of secretion removal was higher in Group D. Hemodynamic values were more stable in Group S. Conclusion: In tracheostomized patients’ II; desflurane has similar airway irritation with sevoflurane but II is more stable with sevoflurane than desflurane.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43809639","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":"Postoperative Analgesia after Combined Obturator Nerve and Adductor Canal Block in Total Knee Arthroplasty","authors":"D. Şeyda, A. Yeşim, E. Veysel, Seven Seda","doi":"10.23937/2377-4630/1410088","DOIUrl":"https://doi.org/10.23937/2377-4630/1410088","url":null,"abstract":"The purpose of this study was to evaluate adding an obturator nerve block to adductor canal block may reduce tramadol consumption (primary endpoint), improve pain relief, enhance early ambulation ability, and reduce side effects (secondary endpoints) after TKA compared with single adductor canal block. This study was carried out retrospectively in order to compare the effect of the single injection adductor nerve block, which was applied to the patients undergoing total knee arthroplasty (TKA) under spinal anesthesia by the Anesthesiology and Reanimation Clinic for the postoperative analgesia, and the single injection obturator block added to this on postoperative analgesia and participation in physiotherapy in relation to analgesia. The sample of this study was comprised of 60 patients who underwent knee arthroplasty under spinal anesthesia and peripheral nerve block for postoperative analgesia at the end of the operation by the Orthopedics and Traumatology clinic between January 2015 and January 2016. The patients were between 45-80 years old and in ASA I-II-III group. For the purpose of this study, patient records, pain follow-up forms and physiotherapy follow-up forms were retrospectively examined. The data related to patients’ demographic characteristics, postoperative VAS scores, tramadol consumption, and tramadol related side effects, satisfaction levels and compliance with postoperative physical therapy were evaluated from printed data. The data of 30 out of the 60 patients to whom receiving only adductor canal block for analgesia were referred to as Group I and the data of the remaining 30 patients to whom receiving adductor canal block and obturator nerve block together for analgesia were defined as Group II were compared. The data of 3 patients in Group II were not included in the study because of the lack of records and a total of 57 patients were examined. No significant difference was identified between the groups in terms of age, gender, height, weight, ASA distribution and tourniquet duration. The rate of diabetes mellitus (DM) in Group I was significantly higher than in Group II and the mean surgical time was significantly lower (p = 0.005, p = 0.030). Patients’ VAS scores at 12th hour were significantly higher in group I and no significant difference was found at 1st, 4th and 24th hours. No significant difference was found between the groups in terms of tramadol consumption levels, nausea, vomiting, additional analgesic demand rates, satisfaction level distribution, maximum flexion to which the knee evaluated in physical therapy was able to reach and VAS score during that time, walking distance and chair test results (p = 0.506, p = 0.390, p = 0.656, p = 0.217, p = 0.240, p = 0.364, p = 0.571, p = 0.183, p = 0.386). In conclusion, combination of obturator nerve block to adductor canal block did not provide a statistically significant contribution over single adductor canal block in terms of total tramadol consumptions, postopera","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48987752","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":"Spinal Anesthesia for Emergent Testicular Torsion Surgery in a Pediatric Patient with Spinal Muscular Atrophy Type-II","authors":"Aytuluk Hande Gurbuz, Topcu Hulya","doi":"10.23937/2377-4630/1410087","DOIUrl":"https://doi.org/10.23937/2377-4630/1410087","url":null,"abstract":"Spinal muscular atrophy (SMA) is one of the most common inherited diseases in children. The clinical symptoms of this neuromuscular disease vary widely from muscle weakness to death according to the onset of symptoms. There is no specific treatment for the disease. There are many risks for anesthesia, as these patients usually have skeletal deformities, increased sensitivity to opioids and neuromuscular blockers, and pulmonary disease secondary to respiratory muscle dysfunction. There is no evidence-based advice or guideline for the management of anesthesia in SMA patients and that most of the literature is based upon case reports. In this report, a 13-year-old pediatric patient who underwent an emergent surgery for testicular torsion under neuraxial anesthesia is presented.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44542364","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":"Perioperative Management in Patients with Factor XI Deficiency","authors":"L. Antoine, Bouquerel Remi, S. Antoine, Gaillard Benjamin Le, P. Christophe, Houadec Mireille, Neto Edmundo Pereira de Souza","doi":"10.23937/2377-4630/1410086","DOIUrl":"https://doi.org/10.23937/2377-4630/1410086","url":null,"abstract":"","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42036624","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}