Anesthesiology ,Critical Care, Pain management

Background: Cesarean section (CS) is considered a significant surgical intervention necessitating a high level of professional skill and a choice between general anesthesia (GA) and spinal anesthesia. Anesthesia type can significantly influence postoperative recovery patient satisfaction, and life activity. This study aims to compare the impacts of General Anesthesia and Spinal Anesthesia on life activity among women after Cesarean section. Methods: This study was carried out comparatively on 200 pregnant women who want to have a cesarean section with spinal anesthesia and general anesthesia preference to mothers or physicians were included in a purposive sample carried out in the operating room at Libya Teaching Hospital from January 2024 to July 2024, The selfadministered questionnaire was used by the participants to measure their health. Results: spinal anesthesia resulted in significantly better outcomes for mobility (70% vs. 44% no problems), self-care (8% vs. 11% no issues), and pain (83% vs. 75% moderate pain) (p<0.05). After one week, the advantages of spinal anesthesia remained for self-care (78% vs.44% no problems) and anxiety/ depression (66% vs. 47% not anxious) (p<0.05). After post-delivery, health outcomes were similar between anesthesia methods. Conclusions: The study found that spinal anesthesia offers better health-related life activity outcomes than general anesthesia for cesarean delivery. As a result, spinal anesthesia is commonly referred to as the anesthesia technique for cesarean delivery in many countries.

Background: Cesarean section (CS) is considered a significant surgical intervention necessitating a high level of professional skill and a choice between general anesthesia (GA) and spinal anesthesia. Anesthesia type can significantly influence postoperative recovery patient satisfaction, and life activity. This study aims to compare the impacts of General Anesthesia and Spinal Anesthesia on life activity among women after Cesarean section. Methods: This study was carried out comparatively on 200 pregnant women who want to have a cesarean section with spinal anesthesia and general anesthesia preference to mothers or physicians were included in a purposive sample carried out in the operating room at Libya Teaching Hospital from January 2024 to July 2024, The selfadministered questionnaire was used by the participants to measure their health. Results: spinal anesthesia resulted in significantly better outcomes for mobility (70% vs. 44% no problems), self-care (8% vs. 11% no issues), and pain (83% vs. 75% moderate pain) (p<0.05). After one week, the advantages of spinal anesthesia remained for self-care (78% vs.44% no problems) and anxiety/ depression (66% vs. 47% not anxious) (p<0.05). After post-delivery, health outcomes were similar between anesthesia methods. Conclusions: The study found that spinal anesthesia offers better health-related life activity outcomes than general anesthesia for cesarean delivery. As a result, spinal anesthesia is commonly referred to as the anesthesia technique for cesarean delivery in many countries.

Nalbuphine is a synthetic mixed agonist -antagonist opioid that has long been used for perioperative care. Yet, its use in critical and emergency medicine settings was still relatively low till recently. The current article provides an update of literature regarding nalbuphine in those two specific areas.

The geriatric population experiences significant changes of several organ systems. They also have several co-morbidities and are considerably vulnerable and especially sensitive to the stress of surgery and anesthesia. A high incidence of postprocedural complications in this population is observed. Appropriate perioperative care was required for geriatric patients. Generally, intravenous sedation has been utilized for geriatric patients undergoing gastrointestinal endoscopy (GIE). However, sedation-related complications in these patients are relatively high. All geriatric patients undergoing GIE procedures require a preprocedural evaluation and preparation, as well as appropriate monitoring during and after the procedure.

Background and Aims Total body hypothermia (cooling) improves outcome in hypoxic-ischaemic encephalopathy (HIE). This study tested the hypothesis that cooling affects the liver by examining whether cooling during HIE was associated with differences in clinically relevant biomarkers of hepatic metabolism. Methods Clinical records in 3 centres were searched for babies with HIE and umbilical artery pH at birth ≤ 7.0 born between 01/07/2006 and 30/06/2011. Each centre adopted routine cooling on a different date. The results of blood tests reflecting hepatic metabolism measured according to clinical practice within 7 days of birth were collected. ANOVA was used to assess the associations between extreme values of each analyte, HIE grade and the use of cooling and to calculate estimated marginal means for each condition. Results 127 babies were identified including 31 with Grade 1 (42% cooled), 65 with Grade 2 (80% cooled) and 31 babies with Grade 3 (90% cooled). Grade of HIE was associated with maximum AST [HIE1:

A 54-year-old male, recovering from dengue fever, presented with duodenal perforation and acute inferior wall myocardial infarction (IWMI). He had a history of fever, thrombocytopenia, and was being treated on an outpatient basis for dengue, which was confirmed by a positive Dengue IgM test. Upon admission for severe chest pain, ECG revealed ST segment elevation in leads II, III, and aVF, with elevated troponin I levels. Imaging revealed pneumo-peritoneum and duodenal perforation. The patient was monitored hemodynamically and managed conservatively with intravenous heparin, antiplatelets, and diuretics. After stabilization, he underwent a laparotomy for duodenal perforation. The Choice of Anaesthesia was General anesthesia with invasive monitoring. The surgery was uneventful, and the patient was extubated and transferred to critical care unit for further observation. Postoperative management included regional anesthesia for pain control, strict fluid management, and the continuation of anti-platelet therapy. The patient recovered well over 10 days.

Evaluation of loco-regional anesthesia procedure in the emergency department and prehospital care : a regional survey INTRODUCTION : l'anesthésie locorégionale (ALR), initialement réservée aux anesthésistes réanimateurs, n'est pas suffisamment utilisée dans les services d'urgence par crainte ou manque de formation.  But de l'étude : dix ans après les recommandations, une enquête régionale dans la région Poitou-Charentes a été réalisée dont l'objectif était d'évaluer les pratiques de l'ALR par les médecins urgentistes CONCLUSION : il existe une méconnaissance et un réel besoin de formation chez chez les médecins urgentistes, y compris chez les jeunes diplômés. → Le laboratoire de simulation semble une voie d'excellence.

Background: Ropivacaine also showed the advantage of lesser motor blockade making it preferable when early mobilization is suggested. This helps to hasten the postoperative recovery . Since its introduction into market in 1996, Ropivacaine has been put to extensive use in epidural, intrathecal and peripheral nerve blocks. OBJECTIVES: To measure, compare and analyse the below mentioned parameters at regular intervals among subjects undergoing lower abdominal and lower limb surgeries 1. Onset and duration of analgesia 2. Motor blockade 3. Hemodynamic parameters 4. Spo2 (oxygen saturation), respiratory rate 5. Postoperative period pain MATERIAL & METHODS: Study Design: A prospective, randomized, comparative study. Study area: The study was conducted in the Department of Anesthesiology, Malla Reddy Institute of Medical Sciences a tertiary care centre in Hyderabad. Study Period: Jan. 2021 -Dec. 2021. Study population: All the patients who were undergoing the elective lower abdominal and limb surgeries in the department of anesthesiology during the study period. Sample size: study consisted of 60 cases. Sampling method: Simple random method. Study tools and Data collection procedure: All the patients meeting the inclusion criteria were taken into the study. A pre-designed, pre-tested, semi structured and pre-coded proforma was used for recording all the findings. After obtaining Ethical clearance from the Institutional Ethical Committee, study was conducted. After taking informed consent, patients were posted for lower abdominal and lower limb surgeries and fulfilling the inclusion criteria were enrolled for the study. Documents providing information on the proposed study and form for obtaining consent (consent form) were provided to the patient in

Rasa nyeri merupakan pengalaman yang tidak menyenangkan bagi kehidupan
seseorang. Definisi nyeri terbaik datang dari Margo McCaffery, seorang perawat ahli nyeri
yang dikenal secara internasional. Definisi nyeri yang sering dikutip olehnya adalah "nyeri
adalah apa pun yang dikatakan seseorang, dan selalu ada kapan pun ia mengatakannya"
(Pasero & McCaffery, 2011, hal. 21).
Definisi ini tentunya menggambarkan betapa subjektifnya rasa sakit. Definisi nyeri
lain yang disepakati secara luas adalah “pengalaman sensorik dan emosional yang tidak
menyenangkan terkait dengan kerusakan jaringan aktual atau potensial, atau dijelaskan
dalam istilah kerusakan tersebut. Tiga aspek dari definisi ini mempunyai implikasi penting
bagi perawat. Pertama, rasa sakit adalah pengalaman fisik dan emosional, tidak semuanya
terjadi di tubuh atau di pikiran. Kedua, memang demikian sebagai respons terhadap
kerusakan jaringan aktual atau potensial, sehingga laporan laboratorium atau radiografi
mungkin tidak abnormal meskipun terdapat rasa sakit yang nyata. Terakhir, nyeri
dijelaskan dalam istilah kerusakan tersebut (misalnya nyeri neuropatik). ” (International
Association for the Study of Pain [IASP], 2012)

Background : Reversal agents given after completion of surgery have variations in neuromuscular recovery time. Few studies are published regarding the role of using calcium with reversal agents for faster recovery in adults only but not in pediatric group. Aim : Compare the duration of neuromuscular recovery after giving reversal drug with or without calcium gluconate in pediatric patients. Primary outcome was assessment of neuromuscular recovery time. Secondary outcome, train of four was measured at the end of surgery at 3, 5 and 10 minutes after giving reversal Results: Neuromuscular recovery time, Train of four ratio (TOFr) 5 min after neostigmine administration was significantly decreased in calcium group. Residual neuromuscular blockade 3 min after giving reversal was significantly higher in control group. In the calcium group, time for reversal administration to extubation as well as to end of anaesthesia was significantly shorter than in the control group.

Asiye Demırel1, Mevlut Comlekci2, Gokcen Basaranoglu3*, Haluk Ozdemir1, Nuriye Beril Bozkurt4, Mahmut Gokhan Teker5, Kerem Erkalp2, Nalan Muhammedoglu6 and Leyla Saidoglu7 1Vakif Gureba Training Hospital, Istanbul 2Bagcilar Training Hospital, Istanbul 3Bezmialem Vakif University, Istanbul 4Medical student Bezmialem Vakif University, Istanbul 5LIV Hospital, Istanbul 6Istanbul Training Hospital, Istanbul 7Kanuni Sultan Suleyman Training Hospital, Istanbul

Background: The use of gastric suction has been advocated while dexamethasone reduces postoperative vomiting and pain. The objective of the study was to compare effectiveness of gastric suction with an orogastric tube and the effect of a single dose of dexamethasone in reducing post tonsillectomy vomiting in children. Material and Methods: This was a Randomized control analytical study conducted at the ENT Department, Ayub Teaching Hospital, Abbottabad from January 2012 to June 2012. A total of 90 patients included in this study were randomized to three groups. Group 1 received dexamethasone 0.5 mg/kg intravenously (maximum dose 8mg) after the induction of anesthesia. Group 2 underwent gastric suction with an orogastric tube placed under direct visualization while the patients were still under general anesthesia and Group 3 received nothing. The frequency of vomiting, number of episodes of vomiting and the need for rescue antiemetics were noted. Results: The mean age of 90 patients ...

Minimal mandatory monitoring in the perioperative period recommended by Association of Anesthetists of Great Britain and Ireland and American Society of Anesthesiologists are universally acknowledged and has become an integral part of the anesthesia practice. The technologies in perioperative monitoring have advanced, and the availability and clinical applications have multiplied exponentially. Newer monitoring techniques include depth of anesthesia monitoring, goal-directed fluid therapy, transesophageal echocardiography, advanced neurological monitoring, improved alarm system and technological advancement in objective pain assessment. Various factors that need to be considered with the use of improved monitoring techniques are their validation data, patient outcome, safety profile, cost-effectiveness, awareness of the possible adverse events, knowledge of technical principle and ability of the convenient routine handling. In this review, we will discuss the new monitoring techniques in anesthesia, their advantages, deficiencies, limitations, their comparison to the conventional methods and their effect on patient outcome, if any.

Objective To evaluate current nutritional practices during and after therapeutic hypothermia (TH) for infants with hypoxic-ischaemic encephalopathy (HIE) in UK neonatal units. study design Email survey of neonatal clinicians. setting UK neonatal units providing active TH. Patients Neonates cooled for HIE. Methods Email survey including questions regarding the timing of starting enteral feeds, volumes, frequency and parenteral nutrition (PN) use and availability of guidelines. results Forty-nine responses were received (49/69, 71%). The rate of enteral feeding during TH and rewarming was 59% (29/49). There was a significant linear trend for the increase in the proportion of units starting enteral feeds (p=0.001) during TH. As compared with post-TH period, significantly lower milk volumes were started during TH (median (range): 7.5 mL/kg/day (1.5-24) vs 17.5 mL/kg/day (7.5-30), p=0.0004). During TH, breast milk was primarily used by 52% of units predominantly as 2-3 hourly feeds, and volumes were increased as tolerated in 55% of units. Only 29% (14/49) of units used PN, with 86% (12/14) of those offering enteral feeds during PN. Guidelines for feeding during TH were available in 31% (15/49) of units. conclusions Many neonatal clinicians offer enteral feeds predominantly using expressed breast milk, with or without PN, during TH, although with huge variability. The heterogeneity in the nutritional practice underscores the need for assessing the safety of both enteral and parenteral feeding during TH.

Objective To evaluate current nutritional practices during and after therapeutic hypothermia (TH) for infants with hypoxic-ischaemic encephalopathy (HIE) in UK neonatal units. study design Email survey of neonatal clinicians. setting UK neonatal units providing active TH. Patients Neonates cooled for HIE. Methods Email survey including questions regarding the timing of starting enteral feeds, volumes, frequency and parenteral nutrition (PN) use and availability of guidelines. results Forty-nine responses were received (49/69, 71%). The rate of enteral feeding during TH and rewarming was 59% (29/49). There was a significant linear trend for the increase in the proportion of units starting enteral feeds (p=0.001) during TH. As compared with post-TH period, significantly lower milk volumes were started during TH (median (range): 7.5 mL/kg/day (1.5-24) vs 17.5 mL/kg/day (7.5-30), p=0.0004). During TH, breast milk was primarily used by 52% of units predominantly as 2-3 hourly feeds, and volumes were increased as tolerated in 55% of units. Only 29% (14/49) of units used PN, with 86% (12/14) of those offering enteral feeds during PN. Guidelines for feeding during TH were available in 31% (15/49) of units. conclusions Many neonatal clinicians offer enteral feeds predominantly using expressed breast milk, with or without PN, during TH, although with huge variability. The heterogeneity in the nutritional practice underscores the need for assessing the safety of both enteral and parenteral feeding during TH.

The aim of the study was to evaluate the quality of sedation and analgesia produced by xylazine alone and in combination with tramadol or pentazocine in goats. Four male adult West African goats weighing 8.5 ± 0.2 kg (Means ± Standard Deviation) were sedated with each of three treatments in a randomized cross over design at one week interval between treatments. Treatments were Xylazine (0.1mg/kg) with normal saline (XYL-SAL); with tramadol (3mg/kg, XYL-TRA) and with pentazocine (2 mg/kg, XYL-PEN). Sedation scores, heart rate (HR), respiratory rate (RR) and rectal temperature (RT) were obtained before drug administration and subsequently at ten-minute intervals. Onset of sedation were 7.5 ± 0.7 min, 5.8± 1.3 min and 6.3 ± 1.7 min with the XYL-SAL, XYL-TRA and XYL-PEN treatments respectively. Duration of sedation was forty minutes with XYL-SAL and XYL-TRA and 50 minutes with XYL-PEN. Peak sedation occurred between thirty and forty minutes with the three treatments. At peak effect, sedation was mild with XYL-SAL, mild to moderate with XYL-TRA and intense with XYL-PEN but without analgesia. Heart and respiratory rates fell significantly from baseline values by 10 minutes post drug administration in the goats with the three treatments while rectal temperature remained unchanged. Side effects observed was drooling by all the goats with XYL-PEN and one goat with XYL-TRA. One goat had paraphimosis with XYL-TRA. It was concluded that addition of pentazocine to xylazine in goats enhanced sedation although without analgesia and provided better sedation quality than addition of tramadol.

Objective: This research aims to compare the effectiveness of intrathecal bupivacaine combined with dexmedetomidine to bupivacaine alone in patients having caesarian procedures. Methods: This randomized, controlled study was conducted at in operation theatre in Liaquat national hospital, with the agreement of the hospital&#39;s institutional review board. There were 272 patients total, and they were split evenly in two groups of 136 using non-probability consecutive sampling technique. Group A: Patients received subarachnoid block (2 ml of 0.5 % hyperbaric bupivacaine and 10 micrograms of normal saline). Group B: Patients received subarachnoid block (2 ml of 0.5 % hyperbaric bupivacaine and 10 micrograms of dexmedetomidine at L3-L4 or L4-L5 inter-vertebral space). Before the induction of anaesthesia, the patient&#39;s systolic blood pressure (BP), diastolic blood pressure (BP), mean arterial pressure (MAP), heart rate (HR), and peripheral capillary oxygen saturation (SPO2) will be m...

Conclusion: Our protocol produced a more easy anesthetic e ect and time-saving procedures with a highly successful rate in MI rats. Subcutaneous injection of Atipamezole e ciently counters the cardiopulmonary side e ect of MMB which is necessary for rapid recovery and subsequently enhancing the survival rate during the creation of the MI model in rats.

Background The administration of adequate analgesia post-operatively has been associated with fewer cardiopulmonary complications, lower morbidity and mortality, lower healthcare costs, and higher patient satisfaction. One of the most effective ways to raise the standard of healthcare would be standardization of multimodal analgesia with enhanced recovery after surgery. Adjuncts to spinal anesthetists can achieve a better post-operative pain relief with less doses of rescue analgesia. Methods This was a prospective, randomized trial conducted on 60 women undergoing abdominal hysterectomy under spinal anesthesia. We evaluated the impact of adding 0.5 mL (2.5 mg) of intrathecal midazolam versus 25 mcg of intrathecal fentanyl (0.5 mL) with 2.5 mL injection of 0.5% bupivacaine (hyperbaric) (12.5 mg). The outcomes were prolongation of analgesia in the post-operative period, onset and duration of sensory and motor blockade, stable hemodynamics, and any adverse reactions to the study drugs. Results The two groups, group M (midazolam + hyperbaric bupivacaine) and group F (fentanyl + hyperbaric bupivacaine), had similar distribution for age, weight, and type and duration of surgical procedure. Both groups had stable vital parameters and experienced a similar onset of sensory and motor blockade. Intraoperative modified Ramsay sedation score was better in group M in comparison to group F. However, mean of elapsed time of two-segment regression of sensory block, from T12 to L1 level, and mean time to regression, from Bromage score 3 to 2, were longer in group F. Group F also had a better visual analogue scale (VAS) score in the post-operative period than group M, and group F experienced a longer average postoperative analgesic duration (lasting for 367.73 minutes) as compared to group M (lasting for 254.9 minutes), having a difference that was of statistical significance (p < 0.001). No substantial adverse reactions were seen in either group. Conclusion The duration of post-operative analgesia is significantly prolonged when 25 mcg of adjuvant intrathecal fentanyl is used with 0.5% bupivacaine (hyperbaric) as compared to intrathecal midazolam 0.5 mL (2.5 mg) in women undergoing abdominal hysterectomy under spinal anesthesia. Both fentanyl and midazolam have minimal adverse reactions and are safe to use as adjuvants to 0.5% of bupivacaine (hyperbaric) in surgeries conducted in the lower abdomen.

Opioids are strong analgesics widely employed to treat various types of pain. In 2018, an estimated 168 million opioid prescriptions were dispensed in the United States. Opioids carry a number of side effects and up to 80% of patients treated with opioids experience a minimum of one adverse event. Although uncommon, hallucinosis is an effect experienced with opioids, which may be under-reported and attributed to underlying psychiatric disease rather than to the side effects of the opioid itself. Most of the opioidinduced hallucinoses reported are auditory and visual, and rarely tactile. Although opioid medication prescribing is decreasing in the United States, considering the continued opioid epidemic and deaths related to overdose, it is important for physicians to be aware of this potential adverse effect of opioids in isolation. We present a case of oral hydromorphone causing visual and tactile hallucinations. Discontinuing hydromorphone led to immediate cessation of the patient's psychotic signs and symptoms. To our knowledge, this is the first description of the use of hydromorphone resulting in tactile hallucinations.

Background: This study was designed to find out the effective antiemetic drug for prevention of postoperative nausea and vomiting in high risk emetogenic patients undergoing thyroid surgery. Patients and methods: One hundred twenty patients, ASA I, II, subjected to elective thyroid surgery were enrolled in this study. Patients were randomly assigned, according to antiemetic prophylaxis, into three groups, each consisted of 40 patients. Patients received 4 mg ondansetron plus 8 mg dexamethasone (Group II) i.v. or 2 mg midazolam plus 8 mg dexamethasone (Group III) i.v. or saline (Group I) just after induction of anesthesia. Frequency of nausea, vomiting, the use of antiemetics, the complete response (defined as no PONV and no administration of rescue antiemetic drug) were recorded at three time points (6 h, 12 h, 24 h) postoperatively. Results: We found that ondansetron/dexamethasone or midazolam/dexamethasone significantly increased the complete response, compared with placebo, with an incidence of 90%, 85%, and 22.5%, respectively at 6 h, 90%, 87.5%, 25%, respectively, at 12 h and 95%, 92.5%, 47.5%, respectively at 24 h postoperatively.

The tracheoesophageal fistula which occurred during oro-tracheal intubation of a patient in intensive care unit is a true challenge both in diagnostic and in therapeutic approach. The best treatment is prevention, by identifying risk factors but especially is important which the mechanism in the occurrence of tracheoesophageal fistula was. The occurrence of this complication in the evolution of hospitalized patients in ICU is accompanied by significant increase in mortality, contributing to negative prognostic. We have started a large multicentric study in April 2016 regarding all patients who required intubation longer than 7 days. The study will finish at the end of 2020. We are looking for a definite conclusion, in this moment we do not have enough data for a conclusion.[1, 2]

Study objective: To compare the incidence of postoperative nausea and vomiting (PONV) during perioperative administration of 5% dextrose and normal saline in laparoscopic cholecystectomy. Design: Prospective, randomized, double-blind trial. Setting: Operating rooms in a tertiary care hospital of Northern India. Patients: One hundred patients with American Society of Anesthesiologists status I to II undergoing laparoscopic cholecystectomy were enrolled in this study. Interventions: Patients were randomized into two groups [normal saline (NS) group and 5% dextrose (D) group]. Both the groups received Ringer acetate (Sterofundin ISO) intravenously as a maintenance fluid during intraoperative period. Besides this, patients of group NS received 250 ml of 0.9% normal saline and patients of group D received 5% dextrose @ 100 ml/h started at the time when gall bladder was taken out. It was continued in the postoperative period with the same rate till it gets finished. Measurements: Incidence of PONV, Apfel score, intraoperative opioids used and consumption of rescue antiemetics. Main results: Demographic data was statistically similar. Out of total 100 patients, 47 patients (47%) had PONV. In group D, 14 patients (28%) had PONV while in group NS, 33 patients (66%) had PONV within 24 h of surgery (p value 0.001). The incidence of PONV was reduced by 38% in group D which is significantly lower when compared with that of group NS (p value 0.001). The consumption of single dose of rescue antiemetics in group D was also reduced by 26% when compared to that of group NS (p value 0.002). Conclusions: Perioperative administration of 5% dextrose in patients undergoing laparoscopic surgery can reduce PONV significantly and even if PONV occurs, the quantity of rescue antiemetics to combat PONV is also reduced significantly.

Early detection of patients with a high risk of postoperative pulmonary complications (PPCs) could improve postoperative strategies. We investigated the role of monitoring systemic and lung inflammatory biomarkers during surgery and the early postoperative period to detect patients at high risk of PPCs after lung resection surgery (LRS). This is a substudy of a randomized control trial on the inflammatory effects of anaesthetic drugs during LRS. We classified patients into two groups, depending on whether or not they developed PPCs. We constructed three multivariate logistic regression models to analyse the power of the biomarkers to predict PPCs. Model 1 only included the usual clinical variables; Model 2 included lung and systemic inflammatory biomarkers; and Model 3 combined Models 1 and 2. Comparisons between mathematical models were based on the area under the receiver operating characteristic curve (AUROC) and tests of integrated discrimination improvement (IDI). Statistical significance was set at p < 0.05. PPCs were detected in 37 (21.3%) patients during admission. The AUROC for Models 1, 2, and 3 was 0.79 (95% CI 0.71-0.87), 0.80 (95% CI 0.72-0.88), and 0.93 (95% CI 0.88-0.97), respectively. Comparison of the AUROC between Models 1 and 2 did not reveal statistically significant values (p = 0.79). However, Model 3 was superior to Model 1 (p < 0.001). Model 3 had had an IDI of 0.29 (p < 0.001) and a net reclassification index of 0.28 (p = 0.007). A mathematical model combining inflammation biomarkers with clinical variables predicts PPCs after LRS better than a model that includes only clinical data. Clinical registration number Clinical Trial Registration NCT 02168751; EudraCT 2011-002294-29.

Le compte rendu fait partie intégrante de tout dossier médical. Les évaluations des dossiers médicaux ont montré que leur qualité avait un impact sur le parcours de soin des patients. En France, tout acte d'échographie remboursé par l'assurance maladie, doit faire l'objet d'un compte rendu détaillé. Il existe une grande disparité des comptes rendus d'échographie en anesthésie locorégionale. Les médecins anesthésistes estiment souvent que les informations colligées sur la « feuille d'anesthésie », font office de compte rendu. Il paraît nécessaire de rappeler sur ce sujet les dispositions réglementaires, les dispositions médicales, le contenu et l'utilité d'un compte rendu.

The high incidence of SA errors emphasizes the central role of adequate SA for decision-making and performance. Distribution of errors between the levels of perception, comprehension and projection was similar to other domains. An inherent limitation of our study is the subjective perspective of the reports in the CIRS which contributed to low inter-rater reliability. Conclusions: This pilot study assessed the incidence of SA errors and provides for the first time empirical evidence that SA is central for correct decision-making in anaesthesia and intensive care. Implementation of specific strategies for promoting SA is mandatory.

Background: Supraventricular cardiac arrhythmias are the most common rhythm disturbances in patients following thoracic surgery. The purpose of our study was to determine which of the clinical parameters are the most valuable in predicting postoperative atrial fibrillation (AF) after lung surgery.Methods: Retrospective analysis was carried out on 987 patients after noncardiac thoracic surgery to define the prevalence, associated risk factors, and clinical course of postoperative arrhythmias. There were 822 men and 165 women, age 34 to 78 years (mean age: 61 � 8 years). The patients were divided into two groups depending on the occurrence or absence of supraventricular arrhythmia. Group I consisted of 876 patients who were free from rhythm disturbances. The remaining 111 patients exhibited episodes of supraventricular arrhythmia (29 supraventricular tachycardia; 82 AF). These 111 patients were placed in Group II. Preoperative, operative, and postoperative data were reviewed. Statisti...

Study Objective: To evaluate the effects of oral, intramuscular (IM) and intravenous (rv) glycopyrrolate on oral and gastric secretions, and to assess how these routes of administration change intubating conditions. Design: Randomized, double-blinded study. Setting: University hospital operating room Patients: 37 ASA status I and II general anesthesia patients Interventions: Patients were randomized to receive glycopywolate or placebo just before surgery by three routes: oral, IM, and IF Glycopywolate was received once by one route and place8bo by the other two routes. A placebo group received three placebos and no glycopyrrolate. Measurements and Main Results: Mouth conditions and intubating conditions were qualitatively assessed by the patient and the intubating anesthesiologist. No difference between groups was noted. Oral and gastric volumes were measured and showed signij-cant<? less gastric volume for the IV group as compared with the other groups. Oral secretions were reduced in both the IV and IM groups when compared with placebo or glycopyrrolate administered orally. Conclusions: Preoperative glycopywolate is significantly more effective at reducing oral and gastric secretions ay administered intravenously immediately before induction.

Background The lack of a consensus definition of neonatal sepsis and a core outcome set (COS) proves a substantial impediment to research that influences policy and practice relevant to key stakeholders, patients and parents. Methods A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. In the included studies, the described outcomes were extracted in accordance with the provisions of the Core Outcome Measures in Effectiveness Trials (COMET) handbook and registered. Results Among 884 abstracts identified, 90 randomised controlled trials (RCTs) were included in this review. Only 30 manuscripts explicitly stated the primary and/or secondary outcomes. A total of 88 distinct outcomes were recorded across all 90 studies included. These were then assigned to seven different domains in line with the taxonomy for classification proposed by the COMET initiative. The most frequently reported...

Background: It has been contended the general anesthetic agents also may affect the psycho-social behavior of the patients, especially during the emergence from GA. This assumes much significance in day cases where, patients have to be roadworthy and mentally stable before discharge. Aims: We compared the psycho-behavioral effects of propofol, sevoflurane and their combination, while emerging from anesthesia. Settings and Design: The patients coming for short duration day care anesthesia were studied in a prospective randomized controlled comparison. Materials and Methods: The psycho-behavioral changes in early, intermediate and late recovery period were studied in 60 consenting patients undergoing Total Intra Venous Anesthesia (TIVA) using Propofol, Volatile Induction and Maintenance Anesthesia (VIMA) using Sevoflurane and the combination of these two agents. Statistical Analysis: Statistical Analysis of the data and application of various statistical tests was carried out with help of Statistical Package for Social Services (SPSS version 18). Data were compiled, analyzed and presented as frequency, proportions, mean and standard deviation. The tests of significance , like Chi-square test, percentages, independent sample t test, paired t test, and P value were used in the study. Results and Conclusions: Both the modalities of GA, viz; TIVA and VIMA, do produce significant psycho-behavioral changes in the patients after GA, though transiently. So it is imperative for the Clinicians to anticipate the entire aspect of Psycho-behavioral patterns before discharging the day cases from the Post anesthesia Care Unit (PACU).

Objective and design The effects of anesthetics on cytokine release in patients without comorbidities who undergo minor surgery are not well defined. We compared inflammatory cytokine profiles in adult patients undergoing minimally invasive surgery who received isoflurane or propofol anesthesia. Methods Thirty-four patients without comorbidities undergoing minor surgery were randomly assigned to receive an inhaled anesthetic (isoflurane; n = 16) or an intravenous anesthetic (propofol; n = 18). Blood samples were drawn before premedication and anesthesia (T1), 120 min after anesthesia induction (T2), and on the first post-operative day (T3). Plasma concentrations of interleukins (IL-) 1b, 6, 8, 10 and 12 and tumor necrosis factor (TNF)-a were measured using flow cytometry. Results The pro-inflammatory cytokine IL-6 was increased in the isoflurane group at T2 and T3 compared to T1 (P \ 0.01). In the propofol group, IL-6 and IL-8 were significantly increased at T3 compared to T1. However, there were no significant differences in cytokine concentrations between the isoflurane and propofol groups. Conclusion An inflammatory response occurred earlier in patients who received an inhaled agent compared with an intravenous anesthetic, but no differences in plasma cytokine profiles were evident between isoflurane and propofol anesthesia in patients without comorbidities undergoing minimally invasive surgeries.

s des travaux de recherche Congrès / CIFEPK 2018 Déclaration de liens d'intérêts L'auteur déclare ne pas avoir de liens d'intérêts. Références [1] Bénéfices de l'activité physique pendant et après cancer. Des connaissances scientifiques aux repères pratiques/Collection États des lieux et des connaissances. INCa; 2017. [2] Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise and physical fitness: definitions and distinctions for health-related research.

Introduction: Dexmedetomidine is a sedative and analgesic medication that is frequently used postoperatively in children after liver transplantation, hepatic dysfunction and liver failure. Objectives: The aim of this systematic review was to determine the role of dexmedetomidine in liver disease. Methods: We systematically reviewed the literature from PubMed, Embase, Scopus, ProQuest, Web of Science, and The Cochrane Library from January 1980 to June 2019. The search strategy included a combination of Mesh and free keywords such as liver transplantation, liver diseases, liver failure, and dexmedetomidine. Results: From a total of 741 articles, 7 studies were included in this systematic review. In the selected studies, a total of 218 patients in the control and treatment groups were studied. Based on the Fixed effect model, MAP changes in the intervention group were 1.89 units less than the control group, which was not statistically significant (pooled mean difference =-1.89, 95% CI:-6.28 to 2.5, P value = 0.39). Conclusions: DEX injection prior to anesthesia potentially had a protective effect on liver and intestinal function during hepatectomy with vascular occlusion.

Objective: The present study aims to determine the effect of time influence on rectal temperature, respiratory and pulse rate, onset and duration of action, duration of recumbency and recovery following ketamine and diazepam administration in cats. Methods: Experimental study design was used on 20 cats (males and females) randomly divided into two equal groups (A and B). Ketamine (10 mg/kg i. m.) was administered to group A in the morning. The same procedure was repeated using different dosages (15 mg/kg and 20 mg/kg i.m.) at intervals of 3 days each. A similar procedure was applied to group B in the evening. A week after, diazepam (1.5 mg/kg, 2.5 mg/kg and 3.5 mg/kg i. v.) were administered to group A and B using the same procedure used in ketamine administration. All baseline measurements were recorded after each drug administration and were repeated at 15, 30, 45, 60, 75, 90, 105, and 120 min intervals after induction of anesthesia with ketamine and diazepam. Results: It was found that the onset of action of ketamine following i. m. administration was slightly longer at evening (2-5 mins) while that of diazepam was instant after i. v. administration. The duration of recumbency was shorter in the morning using ketamine while longer following diazepam (7-19 mins) administration. The rectal temperature, respiratory and pulse rate were lower in the morning following ketamine and diazepam administration even though, the respiratory and pulse rate decreases as the dose was increased but not statistically significant. The duration of action and recovery was significantly longer in the morning after ketamine and diazepam administration. Conclusion: According to this study, there was not much difference between morning and evening administration using both drugs. However, it should be noted that influence of time of administration was evident in some of the parameters measured especially with diazepam.

The high incidence of SA errors emphasizes the central role of adequate SA for decision-making and performance. Distribution of errors between the levels of perception, comprehension and projection was similar to other domains. An inherent limitation of our study is the subjective perspective of the reports in the CIRS which contributed to low inter-rater reliability. Conclusions: This pilot study assessed the incidence of SA errors and provides for the first time empirical evidence that SA is central for correct decision-making in anaesthesia and intensive care. Implementation of specific strategies for promoting SA is mandatory.

affected neonates, end-organ involvement and outcome of neonates with candida sepsis. Methods King George's Medical University is a tertiary care referral centre in city of Lucknow in north India. A total 1356 neonates were admitted during 19 months period, sepsis was suspected in 596 neonates. Neonates in whom candida species grew in any one of the blood, CSF, or urine samples, were enrolled (n=62). Speciation was done using MALDI TOF and germ tube testing method. Data was analysed using SPSS version 26. Results Prevalence of candida sepsis was 4.57% of all NICU admissions. 85.9% of the isolates were non-albicans candida (NAC) and 14.1% isolates were C. albicans (figure 2). C.tropicalis (23.4%) was the most common species. Candida glabrata had 100% resistance to fluconazole. Candida auris was isolated from 4.7% neonates and had 66.6% resistance to fluconazole, voriconazole, amphotericin B. Resistance to fluconazole was seen in 37.5% isolates, 7.8% to voriconazole, 4.7% to amphotericin B, no resistance was seen against caspofungin (figure 1). Important clinical features were lethargy (75.8%), tachypnea (59.7%), decreased cry (35.5%), convulsion (41.9%), metabolic acidosis (67.7%), increased FiO2 requirement (46.8%), vomiting (46.8%), feed intolerance (66.1%), nasal flaring (50%), positive sepsis screen (100%), LOS (75.8%) and prior antibiotics 5 days (79%), concurrent blood culture-proven sepsis (27.4%). Three clinical features, namely metabolic acidosis, increased FiO2 requirement and feed intolerance were significantly associated with NAC infection, with Odd's ratio of 5.5, 8.9, and 5.07 respectively. Meningitis occurred in 12.9%, ventriculitis in 1.6%, UTI in 22.6%, renal fungal balls in 14.5%, endophthalmitis in 3.2%, pneumonia in 19.3%, endocarditis in 3.2%. Out of 62 neonates, 69.3% were discharged. The mortality was 14.5%. Crude mortality attributable to candidiasis (neonates dying within 72 hours of diagnosis of candidiasis) was 11.3%. 14.5% neonates expired of which 33.3% had multiple end-organ involvement and 22.2% had C. auris infection. Conclusion With advancing technology, critically sick neonates are surviving more. Candida sepsis is assuming an important role in nosocomial infections in neonates and is associated with high mortality and morbidity. Over time NAC species have gained more importance as reflected by high NAC prevalence, which makes it even more important to prevent candida sepsis in neonate as NAC species are more resistant to common antifungal agents and some of them are associated with increased morbidity and high mortality.

affected neonates, end-organ involvement and outcome of neonates with candida sepsis. Methods King George's Medical University is a tertiary care referral centre in city of Lucknow in north India. A total 1356 neonates were admitted during 19 months period, sepsis was suspected in 596 neonates. Neonates in whom candida species grew in any one of the blood, CSF, or urine samples, were enrolled (n=62). Speciation was done using MALDI TOF and germ tube testing method. Data was analysed using SPSS version 26. Results Prevalence of candida sepsis was 4.57% of all NICU admissions. 85.9% of the isolates were non-albicans candida (NAC) and 14.1% isolates were C. albicans (figure 2). C.tropicalis (23.4%) was the most common species. Candida glabrata had 100% resistance to fluconazole. Candida auris was isolated from 4.7% neonates and had 66.6% resistance to fluconazole, voriconazole, amphotericin B. Resistance to fluconazole was seen in 37.5% isolates, 7.8% to voriconazole, 4.7% to amphotericin B, no resistance was seen against caspofungin (figure 1). Important clinical features were lethargy (75.8%), tachypnea (59.7%), decreased cry (35.5%), convulsion (41.9%), metabolic acidosis (67.7%), increased FiO2 requirement (46.8%), vomiting (46.8%), feed intolerance (66.1%), nasal flaring (50%), positive sepsis screen (100%), LOS (75.8%) and prior antibiotics 5 days (79%), concurrent blood culture-proven sepsis (27.4%). Three clinical features, namely metabolic acidosis, increased FiO2 requirement and feed intolerance were significantly associated with NAC infection, with Odd's ratio of 5.5, 8.9, and 5.07 respectively. Meningitis occurred in 12.9%, ventriculitis in 1.6%, UTI in 22.6%, renal fungal balls in 14.5%, endophthalmitis in 3.2%, pneumonia in 19.3%, endocarditis in 3.2%. Out of 62 neonates, 69.3% were discharged. The mortality was 14.5%. Crude mortality attributable to candidiasis (neonates dying within 72 hours of diagnosis of candidiasis) was 11.3%. 14.5% neonates expired of which 33.3% had multiple end-organ involvement and 22.2% had C. auris infection. Conclusion With advancing technology, critically sick neonates are surviving more. Candida sepsis is assuming an important role in nosocomial infections in neonates and is associated with high mortality and morbidity. Over time NAC species have gained more importance as reflected by high NAC prevalence, which makes it even more important to prevent candida sepsis in neonate as NAC species are more resistant to common antifungal agents and some of them are associated with increased morbidity and high mortality.

Lymphocyte cell death contributes to sepsis-induced immunosuppression, leading to poor prognosis. This study examined whether sepsis severity and beta-blocker therapy could affect the degree of T-lymphocyte cell death in a mouse model of sepsis. In the first control study, 20 animals were allocated to 4 groups: control group with sham operation (group C, n = 5) and 3 groups with cecum ligation and puncture (CLP) performed at 3 different sites: proximal, middle, and distal cecum (groups CLP-P, CLP-M, and CLP-D, respectively; n = 5 in each group). Their spleens were resected under general anesthesia 24 hours after CLP, and the total number of normal splenic T lymphocytes per mouse and the percentage of apoptotic T lymphocytes were evaluated using flow cytometry. In the second experimental study, the effect of the beta-blocker esmolol was examined in CLP-P (group CLP-PE vs. CLP-P; n = 5 in each group). The total normal splenic T-lymphocyte numbers per mouse significantly decreased in p...

Anesthesia-related oropharyngeal injuries are known to occur. Risk factors for intraoperative dental injuries include difficult intubation, use of transesophageal echocardiography (TEE) probe, motor-evoked potential (MEP) monitoring, poor dental hygiene, etc. Our patient was a case of a thalamic cavernoma who underwent craniotomy in a sitting position with the neck flexed along with MEP and TEE monitoring. At the end of the surgery, the lower three incisors were found to be subluxated. The subluxated teeth were stabilized using a 2-0 Ethilon suture in the operation room. Immediate dental consultation was sought postoperatively. Sitting position surgeries with associated neck flexion, simultaneous, advanced monitoring techniques like TEE and MEP, poor dental condition, and the use of hard bite blocks can predispose patients to dental injury. Preoperative dental evaluation and explanation of neuromonitoring-associated injuries can be beneficial.

This article contains data on experimental endpoints of a randomized controlled animal trial. Fourteen healthy piglets underwent mechanical ventilation including injurious one-lung ventilation (OLV), seven of them experienced four cycles of remote ischemic preconditioning (RIP) on one hind limb immediately before OLV, seven of them did not receive RIP and served as controls, in a randomized manner. The two major endpoints were (1) pulmonary damage assessed with the diffuse alveolar damage (DAD) score and (2) the inflammatory response assessed by cytokine concentrations in serum and in bronchoalveolar lavage fluids (BAL). The cytokine levels in the homogenized lung tissue samples are presented in the original article. Further interpretation and discussion of these data can be found in Bergmann et al. (in press).

This article contains data on experimental endpoints of a randomized controlled animal trial. Fourteen healthy piglets underwent mechanical ventilation including injurious one-lung ventilation (OLV), seven of them experienced four cycles of remote ischemic preconditioning (RIP) on one hind limb immediately before OLV, seven of them did not receive RIP and served as controls, in a randomized manner. The two major endpoints were (1) pulmonary damage assessed with the diffuse alveolar damage (DAD) score and (2) the inflammatory response assessed by cytokine concentrations in serum and in bronchoalveolar lavage fluids (BAL). The cytokine levels in the homogenized lung tissue samples are presented in the original article. Further interpretation and discussion of these data can be found in Bergmann et al. (in press).

Transposition of the great arteries (TGA) is one of the most complicated congenital heart defects. In TGA, there is atrioventricular discordance, where pulmonary artery rises from left ventricle (LV) and aorta rises from right ventricle (RV). This discordance causes changes in blood circulation, where oxygenized blood flows to the pulmonary circulation and deoxygenized blood flows to the systemic circulation. TGA comprises of several types, each needs different approach and corrective surgery. Mainly, TGA is divided into two, congenitally-corrected TGA (cc-TGA) and dextro-TGA (d-TGA) which is further divided into two, TGA with intact ventricular septum (TGA-IVS) and TGA with ventricular septal defect (TGA-VSD). In cc-TGA, double switch procedure is needed. In d-TGA, arterial switch operation (ASO) is a procedure of choice. In TGA-IVS, the level of mixing is an important factor that needs to be maintained, while in TGA-VSD, pulmonary hypertension and heart failure happen more frequently. Anesthesia management is one of the most important factors to ensure the smoothness of corrective surgeries.

Background: Breast augmentation is the plastic surgery procedure associated with the greatest risk of postoperative nausea and vomiting (PONV). The purpose of this study is to evaluate the efficacy of a specific antiemetic protocol applied in breast augmentation in order to diminish the incidence of PONV Methods: A prospective-level of evidence II-study was performed in 247 patients that underwent breast augmentation from October 2010 to October 2014. General anesthesia was induced with propofol, fentanyl and rocuronium. Anesthetic maintenance was accomplished with total intravenous anesthesia and air with oxygen at 50%. All patients received metoclopramide 10 mg intravenously (iv) and 8 mg of ondasetron iv (2 mg at the induction and 6 mg over 30 minutes). Intergroup comparison of means was performed using unpaired t tests and analysis of variance, where applicable. Results: Nausea and emesis occurred with an overall frequency of 4.9% and 2.8% respectively. The 95.1 percent of the patient didn't complaint having nausea on the day of operation, and only 3 (1.2%) of them had this symptom remaining until the fifth post op day. Only 7 patients reported vomiting on the day of the operation. There is no significant difference in nausea between smokers and no smokers (p= 0.510). Conclusion: Τhe specific antiemetic protocol applied in breast augmentation operations seems to be highly effective. The fact that we observed no difference between smokers and nonsmokers regarding the incidence of PONV should be further investigated since till now a protective role for smoking against PONV was suggested.

Dekompresi mikrovaskular (microvascular decompression/MVD) adalah terapi definitif dari spasme hemifasial, yakni suatu gangguan gerakan neuromuskular wajah. Spasme ini ditandai dengan kontraksi involunter berulang pada otat yang diinervasi oleh N. fasialis (N.VII) akibat penekanan oleh arteri, tumor atau kelainan vaskular lainnya. Prevalensinya mencapai 9-11 kasus per 100.000 populasi sehat, dan paling sering terjadi pada usia 40-60 tahun. Meskipun bukaan operasi MVD kecil yaitu di sekitar retroaurikula tetapi teknik anestesi-nya menggunakan prinsip-prinsip pembedahan fossa posterior. Bukaan lapangan operasi yang baik, kewaspadaan terhadap rangsangan ke batang otak maupun nervus kranialis dan kewaspadaan terhadap penurunan perfusi otak merupakan pilar-pilar utama tatalaksana anestesia pada MVD. Disajikan empat kasus spasme hemifasial dengan keadaan khusus. Kasus pertama operasi dilakukan pada pasien geriatri, pasien kedua dengan riwayat hipertensi, pasien ketiga dengan leher pendek dan asma, pasien terakhir dengan diabetes mellitus serta hipertensi. Pemantauan kestabilan hemodinamik, kedalaman anestesia dan relaksasi otot merupakan aspek penting yang menyertai tata laksana anestesi pada kasus ini.

As we know, the volatile agent needs fresh gas flow to be carried out to the patient. It is very common in anesthesia practice, we use the fresh gas flow more than 2 liters per minute. In recent practice, the more flow we gave, the more volatile agent blew out to the patient. The present of APL (adjustable pressure limit) also leaks out of the circuit, we spend more gases, volatile agent, hence gave more pollutant to the operating theater. The consequences of those are an increase of anesthesia expenses and change the way of health care being delivered. ERAS (Enhanced Recovery After Surgery) is popular with its quick recovery after surgery, include quick emergence post anesthesia, that will reduce the time in the operating theater, recovery room, and as results, reduce the cost of anesthesia and surgery.

Inquiries were sent to practising Austrian anesthesiologists to ascertain their prernedication-prescribing habits and their assessment of premedicants that they received as patients. The 143 replies received showed meperidine/promethazine (M/P) as most used n = 8 3 and received (n = 54) drug (combination), followed by fentanyl/droperidol (F/D) n = 3 3 (n=21), benzodiazepines (BZ) n = 17 (n = 10) and several other drugs (combinations) n = 10 (n = 14). There was no significant difference in the prernedication habits of the 82 anesthesiologists who had received prernedication and those (61) who had no personal experience with premedicants. The former judged M/P to be significantly superior to F/D and other schemes; however thrre was no significant difference from the judgement of the BZ. Unpleasant side effects have been described in 9% of M/P, 10% of BZ, 24% of F/D and 21% of other prernedicants. O n future occasions lo?" of BL-, 13% of the M/P-, 24% F/D-and 21%-receivers of other combinations would reject the same drug. Srvrn F/D and five M/P users converted their prescription schemes after they had received the same drug for their own premedication. The prescription habits were not influenced by dependency on departmental or hospital orders. Of those who had received it 75% desired prernedication and 25% accepted prernedication, suggesting that anesthesiologists believe in the positive effects of premedication. However, the overall incidence of lo(;; unpleasant side effects, even in the better ranked drugs, shows that the available premedicants do not vet seem to be satisfactory.