Anesthesia For Short Procedures Research Articles

INTRATHECAL 1% 2 CHLOROPROCAINE V/S 0.5% HYPERBARIC BUPIVACAINE IN AMBULATORY SURGERY

Background: Aims of the study to compare 2-CP with bupivacaine for spinal anesthesia in an elective ambulatory setting.
 Methods: Hospital based Randomized, Double Blind, Interventional study conducted on patients undergoing for ambulatory surgery under subarachnoid block.
 Results: The finding that shows the most significant advantage is the time for regression of the sensory block to S2, as 2-CP was faster than bupivacaine.
 Conclusion: 2-chloroprocaine provides adequate duration and depth of surgical anesthesia for short procedures with the advantages of faster block resolution and earlier hospital discharge compared with spinal bupivacaine
 Keywords: 2-chloroprocaine, Bupivacaine, Ambulatory surgery

Ocular surface disorders in dogs and cats submitted to dissociative anesthesia in elective orchiectomy procedure

The present study aims to verify whether dogs and cats submitted to dissociative anesthesia for elective orchiectomy may present alterations in the tear production and consequent lesions on the ocular surface. For this purpose, 40 animals, 22 cats and 18 dogs, underwent an ophthalmic semiotechnique composed of the evaluation of anterior and posterior chambers, fundscopy, Schirmer's tear test (TLS) and fluorescein test. Subsequently, they underwent dissociative anesthesia, associating ketamine with diazepam or midazolam. Immediately at the end of the procedure, the fluorescein and TLS test was repeated. After 24 hours, a new ophthalmic evaluation was performed to compare the results obtained. There were no ophthalmic changes. With the use of diazepam, TLS remained within the normal range with a median of 19 mm / min, with a mean and standard deviation of 19.27 ± 3.01 mm / min for dogs and a median of 18 mm / min, with a mean and standard deviation of 19.05 ± 2.81 mm / min for cats. When using midazolam, the TLS of the dogs had a median of 19 mm / min, with a mean and standard deviation of 18.84 ± 2.69 mm / min and of the cats, they had a median of 18 mm / min with a mean and standard deviation of 18.37 ± 2.32 mm / min. The results found suggest that the use of dissociative anesthesia for short procedures does not significantly alter the tear production, nor does it cause eye injuries.

Application of Dexemedetomidine as Monitored Anesthesia Care for Surgical Procedural Sedation

Background: Anesthesia for short procedures or ambulatory surgery as (awake fiber-optic bronchoscopy, ophthalmic procedures, back injections, awake craniotomy and other minor procedures) has several challenges to an anesthetist. Use of Dexemedetomidine (Precedex) medication for procedural sedation in non-intubated patients could be used prior to or during surgical procedures. Dexemedetomidine has some characters of ideal anesthetic for perioperative use as rapid start of action and termination with low lipid solubility, easy to give by infusion, achieve a well balanced sedation, can maintain airway reflexes, and less effect on respiration. Methodology: 41 patients of either sex, aged 18 to 60 yrs of ASA grade I and II were used as a sample; all adults over 18 years (most surgical patents coming at that time). All pediatrics, patients with multiple co morbidities, patient’s refusing; known or admitted alcohol or drug abusers, allergic to the drugs involved in the study and prisoners were excluded. Patients were randomized to receive a Loading dose of 0.5 to 1 mcg/kg IV over 10 minutes then maintenance IV infusion in dosage regimen of 0.2 to 0.4 mcg/kg/hour IV, titrate to effect. Results: 41 cases observed for vital signs, depth of sedation, patient response, and arousal effect. Results showed 30 cases got good smooth deep sedation without complications. 11 cases got low blood pressures with low heart rates needed stopping infusion, pressor support medications. Conclusion: Precedex dosing should be individualized and titrated to desired clinical response. It should be administered using a controlled infusion device with full monitoring devices and oxygen supplement.

Bier's block

Introduction: Intravenous Regional Anesthesia (IVRA) has been first described in 1908 by the German surgeon August KG Bier. Although the technique was convenient to perform and effective in giving surgical anesthesia, the recent plexus block techniques have largely replaced the "Bier’s block" instantly because of time limitations and safety considerations of IVRA. Throughout the years, modifications in procedure and new pharmacologic adjuvants have shown to prevent toxic reactions to anesthetics and mitigate limitations of IVRA, still IVRA can be preferred as choice of anesthesia for short procedures.
 Case Report: We present a case of 86 yr old male who was operated for radius fracture after a fall injury under Bier's Block or IVRA technique. Conclusion: IVRA can be the choice ofanesthesia for short procedures because of rapid onset of anesthesia, easy administration and cheaper cost with special considerations on its side effects, complications which can be the outcome of technical errors.

Why Do Bier Blocks Work for Hand Surgery … Most of the Time?

surgical procedures because it provides anesthesia for short procedures and a bloodless field under tourniquet control. It is a safe and cost-effective alternative to general anesthesia, with patients who undergo IVRA leaving the hospital one hour sooner and having less postoperative nausea than those undergoing general anesthesia. 2,3 The success of IVRA for hand surgery is contingent on careful patient selection, maintenance of a bloodless field, and tolerance of the tourniquet. We will discuss why Bier blocks work well for hand surgery, and review some of the recent literature on technical modifications to improve intraoperative hemostasis and tourniquet tolerance. TRADITIONAL METHOD OF IVRA Traditionally, IVRA is performed by first applying a single or double lumen tourniquet to the proximal arm. For surgery less than 20 minutes duration, a single lumen tourniquet is usually chosen, whereas for surgery up to 60 minutes, a double lumen tourniquet provides a more extended period before tourniquet pain occurs. A 20- or 22-gauge cannula is inserted preoperatively into a vein on the dorsum of the hand. The extremity is then elevated and exsanguinated using an Esmarch bandage. Incomplete exsanguination can reduce the quality of anesthesia and hemostasis within the surgical field. The proximal lumen of the tourniquet is then inflated. Local anesthetic (LA) is then injected slowly. A dose of 3 mg/kg 0.5% lidocaine is used frequently. Rapid infusion can exceed the tourniquet pressure and LA may enter the systemic circulation. Surgical-level anesthesia is commonly reached within 5 to 10 minutes. The tourniquet’s proximal lumen remains inflated until the patient becomes uncomfortable. The distal lumen, which is over an anesthetized area, is then inflated, followed by release of the proximal lumen. Gradual release of the distal lumen at the end of the procedure is recommended to prevent systemic LA toxicity for procedures lasting less than 20 minutes. 4

P0804 A PILOT STUDY OF PROPOFOL ANAESTHESIA FOR PAEDIATRIC ENDOSCOPY WITHOUT TRACHEAL INTUBATION

Introduction: Propofol is widely used in anaesthesia for short procedures but there is limited evidence for its use in children undergoing endoscopy. The aim of this pilot study was to investigate the efficacy and safety of propofol as a single agent anaesthetic agent for paediatric gastrointestinal endoscopy without endotracheal intubation. We compared this with our current practice of conscious sedation using low dose midazolam and pethidine Methods: A prospective randomised trial with two groups in parallel was performed on 49 children. Entry criteria were all children deemed to be safe for deep sedation endoscopy. 32 patients (age 1.1 -15 years median 6.4 yrs) were given midazolam (0.1–0.2mg/kg) /pethidine (1–2mg/kg). 17 children (1.5 to 14 yrs, median 7.2 yrs) were recruited to have propofol anaesthesia. A single observer carried out the observations in the table Results: 16 out of 17 children tolerated the procedure under Propofol of 3–6 mg/kg. 1 child needed a maximum of 9mg/kg. Airway support was unnecessary. See table 1.Table 1Conclusion: Our data shows that anaesthesia with Propofol without tracheal intubation is safe. It is well tolerated by patients and provides excellent sedation for efficient endoscopic evaluation with short recovery times.

ALFENTANIL-SUPPLEMENTED ANAESTHESIA FOR SHORT PROCEDURES

Eighty unpremedicated female patients undergoing short gynaecological procedures were randomly allocated to four groups and received either alfentanil or fentanyl (double-blind), together with Althesin-oxygen or methohexitone-nitrous oxide'-oxygen. Recovery from anaesthesia was assessed using the post-box test and the deletion of p. There was a significantly greater frequency of vomiting after operation (P less than 0.05) with methohexitone compared with Althesin and with fentanyl compared with alfentanil, and a significantly greater frequency of pain on injection (P less than 0.001) with methohexitone compared with Althesin. The alfentanil groups completed the post-box test significantly earlier after operation than the fentanyl groups (P less than 0.05). We conclude that alfentanil may offer a significant advantage over fentanyl as an analgesic supplement to i.v. anaesthesia for short procedures.