General Anesthesia For Management Research Articles

Ketamine versus pregabalin as an adjuvant to epidural analgesia for acute post-thoracotomy pain

Objective The aim was to compare analgesic effect of ketamine versus pregabalin as adjuvant to post-thoracotomy epidural analgesia in the National Cancer Institute. Patients and methods This randomized controlled trial involved 60 adults planned for thoracotomy under general anesthesia for management of lung cancer. They were randomly assigned into one of two groups. Group K (n=30) received three doses of ketamine 0.5 mg/kg intravenously, that is, after induction of anesthesia and at 6 and 30 h postoperatively. Group P (n=30) received oral pregabalin 150 mg 2 h before surgery and at 6 and 30 h postoperatively. The endpoints were pain reduction using visual analog score (VAS) score, frequency of rescue morphine doses, hemodynamic parameters, and adverse effects in the first 48 h. Results VAS score was significantly lower in ketamine group than that in the pregabalin group from 8 up to 48 h postoperatively. In group P, VAS score decreased after 16 h (P Conclusion Ketamine and pregabalin are good alternatives for augmentation of the efficacy of thoracic epidural analgesia following thoracotomy in patients with lung cancer. Ketamine has the advantage of more rapid action and higher efficacy in addition to less sedation in early postoperative period.

Vitamin D Insufficiency and Fracture Risk in Urban Children.

Investigation into the role of vitamin D in fractures in the pediatric population has been limited despite estimates that as many as 70% of American children have inadequate vitamin D levels (measured as 25-hydroxyvitamin D, 25(OH)D). The purpose of this study was to evaluate vitamin D's role in pediatric fracture risk by comparing 25(OH)D between fractured and nonfractured cohorts. A 12-month prospective case-control study was completed in children aged 2 to 14 years in an urban, academic hospital. Sixty fractured children requiring conscious sedation or general anesthesia for management were compared with 60 nonfractured controls. All participants and their guardians were surveyed for low bone density risk factors, and total serum 25(OH)D was measured. Statistical analysis was completed using Student t tests, χ tests, analysis of variance, and logistic regression models. After controlling for age and daily sun exposure, lower total serum 25(OH)D was associated with higher fracture risk (odds ratio=0.94; 95% confidence interval, 0.90-0.99; P=0.023). In the fractured cohort, 6 (10%) patients were deficient (25(OH)D<20 ng/mL) and 33 (55%) were insufficient (25(OH)D, 20 to 30 ng/mL). Of the nonfractured population, 8 (13%) were deficient and 19 (32%) were insufficient. There were more insufficient patients in the fractured than in the nonfractured cohort (odds ratio=2.99; 95% confidence interval, 1.27-7.0; P=0.037). Higher fracture incidence is associated with serum 25(OH)D insufficiency. Hypovitaminosis D may place the pediatric population at increased risk for fracture. Consideration should be given to routine assessment of vitamin D in fractured children. Prognostic level III-prospective case-control study.

Awake Fiberoptic Intubation for the Drainage of Ludwigs Angina in a Pregnant Patient; A Case Report

Ludwig’s angina is a potentially lethal, rapidly spreading cellulitis involving the sublingual and submandibular spaces leading to difficult airway. Associated pregnancy makes airway management and choice of anesthesia further difficult. There are previously reported cases of drainage of Ludwig’s angina in pregnant woman managed with superficial cervical plexus block and other regional techniques. We report a case of drainage of Ludwig’s angina in a pregnant woman, conducted under general anesthesia with awake fiberoptic intubation. The options of regional anesthesia vs. general anesthesia for management of Ludwig’s angina in pregnant patient are discussed.

321 POSTER Continuous high thoracic epidural anesthesia with 0.125% bupivacaine and fentanyl versus general anesthesia for management of oncologic mastectomy

321 POSTER Continuous high thoracic epidural anesthesia with 0.125% bupivacaine and fentanyl versus general anesthesia for management of oncologic mastectomy