Anesthesia Department Research Articles

Treatment quality with and without an electronic cognitive aid for emergencies in anaesthesia (eGENA) : The DANGER pilot study part 2 in randomized controlled in-situ emergency simulations

The electronic cognitive aid for emergencies in anesthesia (eGENA) is an app that offers digital support in anesthesiological emergency situations as a cognitive aid tool via checklists for memory and making decisions. The eGENA was published by the German Society of Anesthesiology and has been implemented in the emergency management of the anesthesiological team of the clinic in Potsdam, Germany. The primary endpoint was to observe the influence of eGENA on the anesthesiological emergency management on the subjective feeling of assurance as well as on quality of treatment and, therefore, patient safety. All employees in the anesthesia department (nursing staff and physicians) took part in the initial implementation of eGENA. The implementation phase covered crew resource management (CRM) principles and eGENA use as well as 10case studies that were discussed with help from eGENA. Afterwards in arandomized controlled simulation study, realistic case studies were processed and evaluated. In this, 18cases were handled by 9groups with 4persons in each group. Treatment during these simulations was assessed using apredetermined 20-point evaluation form and 10resuscitation-related and 10case-related points were awarded. Significance tests were carried out using the Wilcoxon-test (significance levelp < 0.05) and two evaluations were completed by the attendees at the beginning and the end of the eGENA implementation process. Scenarios1 and2 showed comparable overall scores (14.9vs. 16.3points out of 20, not significant). Higher case-associated scores (7.6 vs.5.6out of 10, p = 0.03) and higher total scores were achieved with the help of eGENA (16.9 vs. 14.3 out of 20, p = 0.02). Resuscitation-associated scores did not differ significantly (9.3vs.8.8 of 10, p = 0.1). During eGENA use for cases the execution of the algorithm-based resuscitation measures was not delayed or accelerated. With eGENA, however, differential diagnoses were discussed significantly more frequently and expanded treatment and diagnostic measures were implemented. During simulation cases eGENA was mainly used by physicians. The initially very positive responses of the evaluations toned down over time. Planned eGENA use for self-study was less frequent (p = 0.006) and there was less approval of the quality of treatment by eGENA than in the first survey (p = 0.002). The cooperation between doctors and nurses in emergency treatment showed an improvement (p < 0.001). The questions about self-assessed safety in emergency treatment on ascale from 0to 10showed higher values in all categories at the second survey (except only circulatory emergencies and 'other' emergencies). The respondents were more likely to be involved in emergency treatment at the second time of the survey (p = 0.03) after a median of 20months. The sense of security and emergency involvement increased significantly over the observation period. The initial need to use eGENA in everyday life has diminished over time; however, these results cannot be causally associated with eGENA. The use of eGENA does not improve resuscitation efforts but does not delay them either. With the use of eGENA better case-associated results are achieved and advanced diagnostics and treatment are implemented more frequently in complex emergency situations. This increases the quality of treatment. Further studies should be carried out with alarger number of cases to confirm the shown effects.

Incidence of Spinal-Induced Hypotension in Cesarean Section Patients in a Tertiary Hospital: A Retrospective Study

Introduction: Spinal anesthesia is anesthesia of choice for cesarean section, but it also has common side effects like hypotension, bradycardia, nausea, vomiting, shivering etc. This study aims to retrospectively assess the characteristics and outcome of spinal anesthesia in parturient undergoing cesarean section with specific objectives to determine the incidence of spinal induced hypotension and other side effects. Methods: This retrospective study was conducted in the Department of Anesthesia of HAMS Hospital. Data from January 2021 to December 2023 were retrieved from medical records department of the hospital and analyzed using Microsoft excel. Results: The results showed that out of the 1151 parturient, the incidence of spinal induced hypotension, shivering, nausea, vomiting, bradycardia, and high block in parturient undergoing cesarean section was 41.88%, 10.60%, 6.69%, 9.82%, 1.04% and 0.78% respectively. Conclusion: This study showed that the incidence of spinal induced hypotension in parturient undergoing cesarean section in this study was higher. We recommend considering using more preventive strategies to reduce spinal induced hypotension

Efficacy of Phenylephrine and Ephedrine for Treatment of Hypotension Encountered During Caesarean Section

Objective: To compare the efficacy of Phenylephrine and Ephedrine in treating hypotension encountered during spinal anaesthesia for caesarean section. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anaesthesia, Combined Military Hospital, Rawlakot Pakistan, from Sept 2020 to Aug 2021. Methodology: Hundred (50 in each Group) patients were observed. All patients were preloaded with 15ml/kg Hartmann’s solution ten minutes before giving spinal anaesthesia. Baseline blood pressure was recorded just before administration of spinal anaesthesia, at 1-minute intervals up to 5 minutes, and then every 5 minutes afterwards. When hypotension developed, vasopressors were administered, and blood pressure was noted every minute for three minutes following drug administration. The spinal block using 2ml of 0.75% hyperbaric bupivacaine was given at L3-L4 interspace with a 27G spinal needle (Quinke). Group-E patients were given 5mg bolus injection of Ephedrine if mean arterial pressure fell below 20% from baseline. Group-P patients were given a 50ug bolus of Phenylephrine if mean arterial pressure fell below 20% from baseline. Results: Demographic data was comparable in both groups. There was an insignificant difference between Phenylephrine and Ephedrine in terms of treating hypotension, with a p-value of 0.249. Ephedrine was effective in 41(82%) patients and was not effective in 9(18%) patients, whereas Phenylephrine was effective in 45(90%) patients and was not effective in 5(10%) patients. Conclusion: Our study concluded that Phenylephrine and Ephedrine are equally effective for treating hypotension encountered during spinal anaesthesia.

The Role of Oxygenation Index as an Outcome Predictor in Mechanically Ventilated Acute Respiratory Distress Syndrome Patients

Background: Acute respiratory distress syndrome (ARDS) is associated with a significant mortality rate and a high likelihood of failing to wean from mechanical ventilation. Predicting such outcomes in such patients is crucial for the modification of appropriate treatment approaches and for facilitating family communication. Several studies have found that the oxygenation index is an early predictor of outcomes. This study aimed to assess the role of OI assessed on day 1 for predicting weaning outcomes and mortality within 28 days. Methods: This prospective observational study was done at Dhaka Medical College Hospital (DMCH) over a year. A total of 122 patients with ARDS admitted to the non-COVID intensive care unit (ICU) at the Department of Anesthesia, Pain, Palliative &amp; Intensive Care were included in the study based on selection criteria, using a non-probability sampling technique after receiving informed written consent from the patient’s attendants. On day one, the oxygenation index (OI) was measured, and the outcomes were recorded. Results: An oxygenation index of ≥16.01 cm of H2O substantially increased the risk of mortality by 295.211 (95% confidence interval (CI): 28.163-3094.528) times and predicted mortality with 88.06% sensitivity and 87.27% specificity. The oxygenation index (≥11.11 cm of H2O) was found to independently and significantly increase the chance of weaning outcome (failure) by 35.094 (95% CI: 4.041-304.762) times and weaning failure was predicted with 95.45% sensitivity and 70.27% specificity. Conclusion: In ARDS patients on mechanical ventilation, the OI measure at day one can be used as a highly accurate, and independent predictor of death and weaning failure.

Premedication with Dexmedetomidine versus Midazolam for Prevention of Emergence Delirium in Children

Objective: To determine the effects of premedication with Dexmedetomidine vs. Midazolam to prevent the emergence of delirium in children operated at our hospital. Study Design: Quasi-experimental study. Place and Duration of Study: Anaesthesia and Pain Medicine Department, Combined Military Hospital, Okara Pakistan, from Apr 2021 to May 2022. Methodology: Children who operated in the main operation theatre of our hospital without any complications during the study period were recruited for this comparison of two medications to prevent the emergence of delirium. Study participants were allocated to two groups: Group-A received premedication with Dexmedetomidine, and Group-B received Midazolam in standard doses. An independent assessor assessed post-operative delirium using the Pediatric Anesthesia Emergence Delirium Scale. Results: A total of 130 children were included in the study, and they met the inclusion/exclusion criteria. The mean age of the children in the study was 5.66±3.55 years. 80(61.5%) patients were male, while 50(38.5%) were female. 29(22.3%) children showed the presence of emergence delirium, while 101(77.7%) did not show the presence of emergence delirium on the Pediatric Anesthesia Emergence Delirium Scale. It was revealed that children in Group-A had significantly fewer chances of having emergency delirium as compared to children in Group-B (p-value &lt;0.001). Conclusion: Emergence delirium was not uncommon in children undergoing surgeries under general anaesthesia at our unit. Children in which Dexmedetomidine was used as a premedication agent had less chance of having emergency delirium as compared to those who were pre-medicated with Midazolam.

COMPARISON OF THE EFFECT OF DEXMEDETOMIDINE AND TRAMADOL AS AN ADJUNCT WITH BUPIVACAINE ON THE DURATION OF SPINAL ANESTHESIA

Spinal anesthesia is a commonly employed technique for infra-umbilical surgeries, but its duration is often insufficient for prolonged procedures. Adjuvants such as dexmedetomidine and tramadol are used to enhance its efficacy. Objective: This study aimed to compare the effects of dexmedetomidine and tramadol as adjuvants to bupivacaine in spinal anesthesia. Methods: This randomized controlled trial was conducted at the Department of Anesthesia, AIMC, Jinnah Hospital, Lahore, over one year From 2021 to 2022. 68 patients undergoing elective infraumbilical surgeries were randomized into two groups. Group A received 7 µg dexmedetomidine with 12 mg bupivacaine, and Group B received 25 mg tramadol with 12 mg bupivacaine. Outcomes assessed included the onset of sensory block, total duration of analgesia, time to first rescue analgesia, and intraoperative and postoperative pain scores. Statistical analyses were performed using SPSS version 25, with a p-value &lt;0.05 considered significant. Results: The mean onset of sensory block was significantly shorter in the dexmedetomidine group (6.6 ± 0.603 minutes) compared to the tramadol group (7.2 ± 0.825 minutes; p = 0.002). The total duration of analgesia was significantly longer in the dexmedetomidine group (14.4 ± 1.16 hours) compared to the tramadol group (10.6 ± 1.02 hours; p &lt; 0.001). Similarly, the mean time to first rescue analgesia was significantly prolonged in the dexmedetomidine group (11.8 ± 0.967 hours) compared to the tramadol group (7.9 ± 0.924 hours; p &lt; 0.001). Intraoperative and postoperative pain scores were consistently lower in the dexmedetomidine group, with statistically significant differences at 2, 3, 5, and 6 hours. Conclusion: Dexmedetomidine is a more effective adjuvant than tramadol in spinal anesthesia, offering a shorter onset of sensory block, prolonged analgesic duration, and delayed rescue analgesia with better pain control. These results support the use of dexmedetomidine as a preferred adjuvant for extended surgical procedures under spinal anesthesia. Future studies with larger sample sizes are recommended to validate these findings further.

Exchange rates of second generation Microcuff® pediatric endotracheal tubes in children weighing more than 3 kg : A retrospective audit.

Cuffed endotracheal tubes (cETT) pose the potential advantage of an infrequent need for reintubation in pediatric patients compared to uncuffed tubes. The aim of this study was to investigate tube exchange rates using second generation Microcuff® pediatric endotracheal tubes (PET) with an adapted sizing recommendation in alarge single institution cohort of children and to identify potential variables associated with an elevated risk of tube exchange. Patient data obtained from the electronic patient data management system of the Department of Anesthesia, University Children's Hospital Zurich, Switzerland, were retrospectively assessed for demographic and anthropometric information, size of the internal tube diameter used for positive pressure ventilation and divergence from the size recommendation chart. Data from 14,188 children younger than 16years (median 5.3years) and weighing at least 3 kg who underwent oral or nasal tracheal intubation using second generation Microcuff® PET between 2009 and 2015 were included. Of 13,219 oral tracheal intubations 12,049 (84.9%) were performed according to the manufacturer's size recommendation and 1170 with divergent endotracheal tubes. The odds ratio (OR) of oral reintubation was 0.13% (95% confidence interval 0.08-0.22%) for cases using the manufacture's size recommendation correctly and 22.74% (95% confidence interval 20.42-25.23%) for patients intubated with anot recommended tube (p < 0.0001). These findings indicate that the second generation Microcuff® PETs can be reliably used with low tube exchange rates across the entire pediatric age range when the tube size is selected according to the manufacturer's size recommendation chart. Adherence to the manufacturer's tube size recommendation is urgently advised.

Knowledge, fear and acceptance rate of spinal anesthesia among pregnant women scheduled for cesarean section: a cross-sectional study from a tertiary care hospital in Karachi

BackgroundWorldwide, the cesarean section (c-section) rate is rising. Globally, regional anesthesia in the form of spinal anesthesia (SA) is considered the first choice in uncomplicated c-section cases for safe maternal and neonatal outcomes. This study aimed to ascertain knowledge, acceptance, and fears of SA among patients scheduled for c-section in a tertiary care hospital.MethodsThis cross-sectional study was performed in the Anesthesia Department, Hamdard University Hospital, Karachi, from April to September 2023. Knowledge was assessed using a self-designed questionnaire with a total of 7 questions. Data was entered in SPSS version 26 to perform statistical analysis.ResultsA total of 303 females were enrolled, with a mean age of 26.5 ± 4.5 years and a median gestational age of 37 (IQR = 36–37) weeks. 93.7% of women agreed to receive SA. 63% heard the term regional anesthesia before, 12.2% heard about general anesthesia, and 17.5% heard about SA. 23.4% of participants scored 7 out of 7, 39.9% had a score of 6 out of 7, and 36.6% had a score of ≤ 5. Among 129 (42.6%) females having fear, the commonest fear was limiting lower limb functions post-surgery (93.8%), followed by post-operative vaginal pain (91.5%), intra-operative pain (80.6%), post-operative backache (76.7%), having visuals of surgery (72.9%), back injury (56.6%), headache (46.5%), nausea/vomiting (31%), and being nude (24%).ConclusionThe present study analyzed that although the majority of female agreed to receive spinal anesthesia, they had a fear of it. Knowledge of spinal anesthesia was not remarkable among the study population. Proper education regarding anesthesia should be given to patients to overcome fears related to spinal anesthesia.Clinical trial numberNot applicable.

Assessment of Informatics Competency Among Nursing Faculty Members and Its Application in Educating Nursing Students at Abadan Nursing Faculty

Background: Nursing informatics in educational activities can serve as a strategy to bridge the gap between clinical practice and nursing education programs. Objectives: This study aimed to assess the informatics competency of nursing faculty members and its application in educating nursing students at Abadan Nursing Faculty. Methods: This descriptive-analytical research was conducted in 2023 at Abadan Nursing Faculty. The sample consisted of 73 faculty members from the nursing, operating room, and anesthesia departments, who were included in the study through census sampling. Data collection was performed using the standardized Nursing Informatics Competency Assessment Tool (NICAT) and an electronic teaching aids checklist. Data were analyzed using SPSS version 18, with independent t-tests, one-way analysis of variance (ANOVA), and Pearson’s correlation at a significance level of P &lt; 0.05. Results: The mean score of faculty members’ nursing informatics competency at the Nursing Faculty was 110 out of a maximum of 150, placing it within the proficient range. The highest score for nursing informatics competency was related to the informatics literacy dimension (47.65), while the lowest was related to the information management skills dimension (19.54). Information management skills (r = 0.881, P &lt; 0.001), computer literacy (r = 0.871, P &lt; 0.001), and informatics literacy (r = 0.976, P &lt; 0.001) were significantly correlated with nursing informatics competency. Faculty members reported the highest use of multimedia content development (mean score = 4.19) and the lowest use of robotic surgery (mean score = 1.71). Conclusions: Faculty members’ informatics competency was reported to be at a proficient level. However, due to advancements in technology and transformations in nursing care, it seems necessary to improve nursing faculty members’ abilities in all aspects, particularly in the information management skills dimension. It is recommended to hold faculty development programs regarding the integration of technology into the curriculum to elevate the quality of education.

Comparison of analgesic efficacy of transversus abdominis plane block with direct infiltration of local anesthetic into surgical incision in lower abdominal gynecological surgeries.

Objective: To compare the mean time for analgesic requirement of transversus abdominis plane block with direct infiltration of local anesthetic into surgical incision in lower abdominal gynecological surgeries. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesia, Combined Military Hospital, Kharian. Period: 1st July 2022 to 1st January 2023. Methods: A total of 60 patients with 30 patients in each group undergoing elective c section were included in the study. Patients were counselled about VAS scoring system before procedure. Time (in minutes) for first rescue analgesia and requirement in 24 hours was noted. Results: Mean time required for first analgesia was 143.966±8.15 minutes in group A as compare to 86.400±7.08 minutes in group B (p=0.000). Conclusion: Our study has concluded that TAP block is a promising technique in alleviating postoperative pain in patients undergoing lower abdominal gynecological surgeries.

Regional anaesthetic techniques in 14 Slovenian obstetric units between 2013 and 2021: where are we and where are we going?

Background: The use of regional anaesthetic techniques for caesarean section and labour analgesia is necessary for quality-driven obstetric anaesthesia as required by European minimum standards for obstetric analgesia and anaesthesia departments, which were issued by the European Society of Anaesthesiology and Intensive Therapy in 2020. The aim of this article is to evaluate the rate of caesarean sections performed using regional anaesthetic techniques and the rates of epidural, remifentanil-PCA, and meperidine analgesia for managing labour pain across the 14 Slovenian obstetric units, respectively. Methods: Data from the Slovenian National Perinatal Information System (NPIS) from 2013 to 2021 were analysed. Results: Spinal anaesthesia was used as a primary anaesthetic method (&gt; 50% of elective caesarean sections) in a half of Slovenian obstetric units. For emergency caesarean sections, regional anaesthetic methods (spinal and epidural) were used in &gt; 50% parturients in 3 obstetric units. Eight obstetric units had an epidural rate of &gt;10%. The use of epidural analgesia has progressively increased in 9 of 14 obstetric units. Remifentanil has been routinely used in 6 obstetric units. Accordingly, the consumption of meperidine has dropped in all but one obstetric unit in Slovenia. Conclusion: In the past decade, considerable progress has been observed in obstetric anaesthesia practice in Slovenia. This is evident from the increased use of regional anaesthesia for caesarean section and labour analgesia. However, there are considerable discrepancies in anaesthetic practices between different obstetric units in Slovenia, a situation the parturients should be informed of well in advance to be able to choose the obstetric unit according to their labour and delivery preferences. In order to avoid the differences in the quality and accessibility of anaesthetic practice between units, it is necessary to increase the number of anaesthesiologists involved in obstetric anaesthesia to ensure 24/7 service of labour analgesia to be able to fulfill minimum European standards for obstetric analgesia and anaesthesia departments.

Comparison of Awake Craniotomy with Craniotomy Under General Anesthesia for Resection of Tumors in Eloquent Areas of Brain

Objective: To compare awake craniotomy with craniotomy under general anesthesia for early post-operative parameters in patients undergoing resection of tumors in eloquent areas of brain. Study Design: Quasi experimental study. Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Rawalpindi Pakistan Apr 2021 to May 2022. Methodology: All the patients who underwent resection surgeries for brain tumors in eloquent areas of brain were included in the study. They were divided into two Groups via lottery method. Group A underwent awake craniotomy while Group B underwent craniotomy under general anesthesia. Relevant intraoperative and early post-operative parameters were compared in both the Groups. Results: A total of 60 patients who underwent resection of eloquent area brain tumors in our hospital during the study period were included in the final analysis. Out of these 40(66.7%) underwent craniotomy under general anesthesia while 20(33.3%) underwent awake craniotomies. Mean age of the study participants was 45.61±7.889 years. Frontal lobe tumors were the most encountered brain tumors in our study participants. Patients who underwent awake craniotomy had statistically significantly lower KORNAFSKY score, lesser days of post-operative admission days and lesser neurological deficits (p-value &lt;0.005) as compared to those who underwent craniotomy under general anesthesia. Conclusion: Awake craniotomy emerged as superior option as compared to craniotomy under general anesthesia in terms of early post-operative parameters. Lower KORNAFSKY score, lesser days of post-operative admission days and lesser neurological deficits were seen in patients undergoing awake craniotomy.

COMPARISON OF TWO DIFFERENT DOSES OF ORAL GABAPENTIN FOR POST OPERATIVE ANALGESIA IN LOWER LIMB SURGERY UNDER SPINAL ANAESTHESIA

Background: Pre-emptive analgesia is a technique of pain control where treatment is initiated before intervention and operational during the surgical procedure in order to reduce the physiological consequences of nociceptive transmission provoked by the procedure. Gabapentin has demonstrated analgesic effects in clinical trials as a preemptive analgesic in acute postoperative pain management with very few side effects. Owing to the protective effect of gabapentin on the nociceptive pathways, preemptive analgesia has the potential to be more effective and hence reduce postoperative pain and development of chronic pain. Objective: We therefore designed this study to compare two different doses of Oral Gabapentin (300mg and 600mg) given as pre-emptive analgesic for post-operative pain relief in lower limb surgeries under spinal anaesthesia. Method: After the approval from ethical committee this prospective randomized double blinded clinical study was conducted over a period of two years in department of anaesthesia in M.G.M.s medical college, Aurangabad. Randomly allocated two groups were given Oral Gabapentin 300mg and 600mg respectively, one hour prior to giving spinal anaesthesia for post operative analgesia in lower limb surgeries. Conclusion: There is no statistically significant difference between group G300 (gabapentin 300mg) and group G600 (gabapentin 600mg) regarding age, gender, duration of analgesia (i.e. demand for first rescue analgesic), total dose of analgesics in first twenty four hours after surgery, duration of sensory block (i.e. L1 regression), highest ramsay sedation score and VAS scores. No significant difference was seen in cases hemodynamic stability and incidence of side effects.

Evaluation of Bedside Lung Ultrasonography in Diagnosis of Acute Pulmonary Oedema

Background: Pulmonary oedema is one of the major causes of mortality and morbidity. Acute heart failure is the major cause of pulmonary oedema. NT-pro B-type natriuretic peptide has been found to be effective in distinguishing acute pulmonary oedema from other causes of dyspnea in the emergency care setting. But it is costly and time consuming. Bedside lung ultrasonography (LUS) is being considered as noninvasive, radiation-free and easy to perform tool to diagnosis pulmonary oedema. Objective: To determine the role of bedside LUS in diagnosis of patients with acute pulmonary oedema. Methods: This observational cross-sectional study was carried out in ICU, Department of Anaesthesia, Analgesia, Palliative &amp; Intensive Care Medicine, Dhaka Medical College Hospital, Dhaka from August 2018 to October 2019. Ethical approval was sought before conduction of the study. One hundred critically-ill patients with pulmonary oedema, detected by clinical examination &amp; chest X-ray, due to heart failure were included in the study. Routine labs including NT-pro B-type natriuretic peptide level were sent. Bedside LUS was done with a portable ultrasound machine. Data was collected by using a semi-structured data sheet. Observation and Results: The median age was 42 years (IQR 18-66). Among them, 67.71% were male. 90.0% of patients diagnosed as acute pulmonary oedema by NT-pro B-type natriuretic peptide levels findings and 88.5% of patients were diagnosed as acute pulmonary oedema by bedside lung ultrasonography. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of lung ultrasonography findings alone statistically significant as 94.2%, 66.7%, 96.4% &amp; 54.5% and 91.66% respectively in detection of pulmonary oedema. Conclusions: Bed side lung ultrasonography can be an effective adjunct tool for rapid and high diagnostic accuracy for diagnosis of acute pulmonary oedema along with NT pro BNP level in ICU. Bangladesh Crit Care J September 2024; 12 (2): 113-117

Conscientious Objection and the Anesthesiologist: An Ethical Dilemma.

Conscientious objection is a legally protected right of medical professionals to recuse themselves from patient care activities that conflict with their personal values. Anesthesiology is different from most specialties with respect to conscientious objection in that the focus is to facilitate safe, efficient, and successful performance of procedures by others, rather than to perform the treatment in question. This could give rise to a unique, somewhat indirect ethical tension between the application of conscientious objection and potential infringement upon patient autonomy and well-being. While some situations have clear grounds and precedent for conscientious objection (e.g., abortion, or futile procedures), newer procedures, such as gender-affirming surgery and xenotransplantation, may trigger conscientious objection for complex reasons. This review discusses ethical, legal, and practical aspects of conscientious objection; challenges to anesthesia groups, departments, and healthcare organizations when conscientious objection is invoked by anesthesiologists; and strategies to help mitigate the ethical dilemmas.

Comparison between Anterior Approach and Posterior Approach of Suprascapular Nerve Block for Postoperative Analgesia in Shoulder Arthroscopy

Abstract Background Severe intraoperative and postoperative pain associated with arthroscopic shoulder surgery has high incidence reaching up to 45%, it is often significant enough to interfere with initial recovery and rehabilitation. This pain is difficult to manage without large-dose opioids. Aim of the Work compare between anterior approach and posterior approach of suprascapular nerve block for postoperative analgesia in shoulder arthroscopy. Patients and Methods The study was conducted in Ain Shams University Eldemerdash Hospitals after approval from the ethics committee of anesthesia, intensive care and pain management department and written patients‟ consent. It included a total of 72 adult patients aged 18-60 years, Scheduled for shoulder arthroscopic surgeries. Patients were randomly divided into two equal groups, 36 each, according to the inclusion and exclusion criteria. Results no statistically significant differences in pain scores at 6, 12, and 24 hours postoperatively between the anterior SSNB and posterior SSNB groups. Postoperative First analgesia request time/hour early in posterior approach comparing to anterior approach (6.03±0.74, 5.64±0.68).opioid requirements were statistically different between the two groups, with a benefit in favour of the anterior route in the recovery area and during the first 24 postoperative hours. Conclusion the main finding is the anterior approach of SSNB provided superior analgesia compared with posterior approach of SSNB in postoperative opioid consumption.

Comparative Study between Ultrasound Guided Quadratus Lumborum Block vs Intraperitoneal and Perioportal Bupivacaine Infiltration as Post Operative Analgesia after Laparoscopic Cholecystectomy

Abstract Background Poorly controlled acute pain after abdominal surgery is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay and an increased likelihood of chronic pain. Objective To test the efficacy of QL block versus intraperitoneal and periportal infiltration with local anesthetic agent in providing postoperative analgesia after laparoscopic cholecystectomy. Patients and Methods Double-blinded randomized controlled clinical study [both the patient and the operator (the surgeon in intraperitoneal and periportal bupivacaine and the anesthetist in QL block) were blinded], After Approval was obtained from the research ethics committee of anesthesia and intensive care department, Ain Shams University. Results The results of the study revealed that the Patients receiving QLB had significantly longer time to first rescue analgesic and significantly lower total opioid consumption in first 24 h post operative compared with patients who received Intraperitoneal and periportal infiltration. Conclusion Bilateral QL block was effective in providing postoperative analgesia (significantly longer time to first rescue analgesia) and reduced postoperative opioid consumption in the first 24-h after laparoscopic cholecystectomy under general anesthesia, compared to intraperitoneal and periportal infiltration. This technique can be a promising mode of postoperative analgesia where epidural catheter insertion is contraindicated.

Inferior Vena Cava Collapsibility Index vs Central Venous Pressure for Assessment of Intravascular Volume Status in Patients with Ischemic Heart Diseases

Abstract Background Intravascular volume status assessment is one of the most challenging tasks for clinicians in intensive care unit so fluid therapy is considered as cornerstone in improving the outcome of the ischemic heart patients. Monitoring of intravascular volume status usually required to optimize blood flow and tissue oxygen delivery to organs to avoid any disturbance of fluid status of patient either excess fluid administration which lead to hypervolemia or insufficient fluid administration which lead to hypovolemia and Both conditions have negative effects on patient prognosis with increased risk of morbidity and mortality. Aim of the Work To assess inferior vena cava collapsibility index and central venous pressure to predict the intravascular volume status in ischemic heart patients. Patients and Methods This study was carried in intensive care unit of anesthesia department, Faculty of medicine, Ain Shams university hospitals with a duration of 6 months. Results At the first day (r = - 0.775, p value &amp;lt;0,001), in the 2nd day (r =-0.864, p value&amp;lt; 0,001) and in the 3rd day (r = -0,923, p value &amp;lt;0,001). The best cutoff of IVC in diagnosis of low CVP is ≥ 28.5% with area under curve 0.998, sensitivity 100%, specificity 94.7%, positive predictive value (PPV) 94.4%, negative predictive value (NPV) 100% and accuracy 97.2%. Conclusion This study is that IVC collapsibility index has a strong statically significant inverse correlation with central venous pressure which is more accurate at low central venous pressure values. Point-of-care in this study is to evaluate intravascular volume status non- invasively by using ultrasound through assessing inferior vena cava collapsibility index in ischemic heart patients. Although there is high sensitivity and specificity of ultrasonography to assess IVC collapsibility index as an indirect method of assessment of CVP.

HYGIENE DES DISPOSITIFS MEDICAUX REUTILISABLES DANS LA GESTION DES VOIES AERIENNES EN ANESTHESIE AU CHUD/ BORGOU-ALIBORI

Introduction :Nosocomial infection is a priority concern for hospitals. The aim of this study was to investigate the hygiene of reusable medical devices (DMR) used in anesthesia at CHUD-B/A. Methods :The study was observational, cross-sectional, descriptive and analytical. It surveyed nursing staff in the anesthesia department of CHUD Borgou/Alibori. Sampling was non-random, with a census of all staff. Data analysis was performed using IBM SPSS Statistics 21 software. Observations in the study were presented in proportions for qualitative variables and quantitative data using central tendency parameters such as mean with standard deviation, median as appropriate, mode and extremums. Results :A total of 14 caregivers were surveyed. Intermediate risks were related to semi-critical materials, according to 64.3% of subjects. Knowledge of DMR processing steps was affirmed by 92.2% of staff. Decontamination followed by cleaning and rinsing was confirmed by 84.6% of respondents. It was observed that equipment was immersed in a small jar containing a small volume of non-renewed decontamination solution, that there was no decontamination protocol, that hand hygiene was observed in 25 cases, and that gloves were worn in 30 cases. Conclusion:The absence of a DMR management protocol is apparent. Device hygiene needs to be improved. The development of a protocol for DMR treatment and the promotion of single-use equipment are necessary.

Prescription pattern of usage of analgesics in pain relief in cancer patients at a tertiary care teaching hospital - An observational prospective study

Objective The World Health Organization has developed guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents to provide evidence-based guidance to healthcare providers on the adequate relief of pain associated with cancer. This prospective study was done to evaluate the prescription pattern of analgesics for the treatment of cancer pain. Material and Methods This prospective observational study was conducted in cancer patients attending the pain clinic of the Anesthesia and Radiotherapy Outpatient Department. Approval was obtained from the Institutional Human Ethics Committee. Inclusion criteria were age ≥18 years of either gender, willing to provide written informed consent, and patients undergoing radiotherapy, chemotherapy, or palliative treatment. Exclusion criteria were patients having psychiatric illness, not willing to provide written informed consent, patients having renal and or hepatic dysfunction, patients with comorbidities with chronic pain, and patients who underwent surgical intervention. Results A total of 100 participants were recruited during the study period of July 2022–April 2024 whose data were assessed. Participants were prescribed different classes of analgesic drugs, which included 30% participants on opioid analgesics, 30% on non-opioid analgesics, and 40% on combination therapy. Among opioid analgesics, morphine was the most commonly prescribed. Among non-opioid, paracetamol was the most commonly prescribed. Among combination therapy, tramadol was the most commonly prescribed. Pregabalin was most commonly used as an adjuvant analgesic. Conclusion This study also emphasizes on need for adequate treatment of cancer pain and vigilant monitoring of patients on opioids to prevent drug abuse, drug dependence, and adverse drug reactions.