Injection Of Anesthetic Agent Research Articles

PREVENTION OF PROPOFOL INJECTION PAIN-COMPARISON BETWEEN LIDOCAINE VS KETAMINE INFUSION

Pain during the injection of anaesthetic agents may be distressing to the patients and can reduce the acceptability of an otherwise useful agent such as propofol for short cases and day care surgeries. lidocaine and ketamine both are used as pre-treatment to decrease propofol related injection pain. In this study 108 patients were randomized into 2 groups of 54 each. Patients are undergoing elective surgery under general anaesthesia are assigned into two groups, group L and group K.Incidence and severrity of pain will be scored by McCrick and Hunter pain scale and results and hemodynamic changes will be recorded. we found that incidence of mild pain was 33.33% in group K in compare to 57.41% in group L, which was statistically signicant(p=0.01).

Fascia Iliaca Compartment Block for Hip Fractures: Improving Clinical Practice by Audit.

BackgroundHip fractures are the most frequently occurring serious injury in older people. They are the most common reason for people over the age of 65 to need emergency anaesthesia and surgery, and account for the most cause of death following an accident. A fascia iliaca compartment block (FICB) is the injection of anaesthetic agents into the fascia iliaca compartment with the effect of blocking the lumbar plexus via an anterior approach. FICB targets nerves that are in the fascia iliaca compartment that include the femoral nerve and the lateral femoral cutaneous nerve. A FICB is clinically safe and efficient providing consistent analgesic effects irrespective of the performing doctor's experience in managing hip fractures. Clinical audits and feedback are a veritable tool for quality improvement.MethodsData from the National Hip Fracture Database (NHFD) for all patients admitted with a hip fracture between October 2018 and May 2019 at a District hospital was interrogated and audited. Results of this audit were discussed in the department's and the Trust's mortality review meetings. In addition, teaching sessions on the safe administration of FICB using the Loss of Resistance (LOR) technique were held for junior doctors. A re-audit was carried out in May 2020 where a retrospective study of patients admitted with a hip fracture over six months from October 2019 to April 2020 was done to assess improvement in compliance rates in the administration of fascia iliaca blocks.ResultsThis study showed a statistically significant increase in the number of patients who got a fascia iliaca block on presentation with a fractured neck of the femur from after our second audit (p < 0.00001). There were no complications associated with the administration of FICB to patients with hip fractures.ConclusionsThe administration of FICB for patients with hip fractures by admitting junior doctors using the loss of resistance (LOR) technique is a safe, simple, and rapidly effective pain management method that reduces the need for excessive systemic analgesia and provides consistent simultaneous blockade of the lateral cutaneous femoral and femoral nerves. This study showed that clinical practices could be improved through audits, staff education and by enforcing the proper utilization of clinical proformas to ensure compliance.

A Comparative Study between Ketamine and Lidocaine ro Decrease Propofol Injection Pain During Induction of Anesthesia

Introduction: Pain during the injection of anesthetic agents may be distressing and can reduce the acceptability of an otherwise useful agent such as propofol during daycare surgeries. Lidocaine and ketamine both are used as pre-treatment to decrease propofol induced pain. This study aims to compare the effectiveness of ketamine injection to decrease propofol-induced pain in comparison to lidocaine injection.&#x0D; Methodology: This is a prospective cross-sectional comparative study. Eighty-nine cases were divided into two groups where group K received ketamine 2 ml (0.2 mg/kg) whereas group L received lidocaine 2% 2ml (0.5 mg/kg) after venous occlusion with rubber tourniquet. One-fourth dose of propofol was injected 1 min after release of tourniquet and pain accessed at 0, 1, and 2 minutes of propofol injection with a verbal response and behavioral signs. Chi-square test and paired T-test were used and a p-value less than 0.05 was considered significant.&#x0D; Result: Regarding hemodynamic, oxygenation, and adverse effects there was no significant difference. Immediately after propofol injection, only 1 patient of the ketamine group had mild pain (2.22%) while 12 patients from the lignocaine group had mild pain (27.27%) with a p-value of 0.009. Also after 2 minutes of propofol injection, only 12 cases had mild pain i.e. 13.48% (1 from ketamine group i.e. 2.22% and 11 from lidocaine group i.e. 25%) with p-value of 0.002. &#x0D; Conclusion: Our study helps prove low-dose ketamine is more effective in reducing the incidence and severity of pain on injection of propofol in comparison to Lidocaine with better hemodynamic stability.

Effect of dexmedetomidine anesthesia on respiratory function in pediatric patients undergoing retinoblastoma resection.

The aim of this study was to investigate the effect of dexmedetomidine (Dex) on the respiratory function during anesthesia induction in pediatric patients undergoing retinoblastoma (RB) resection. A total of 87 pediatric patients who underwent RB resection in Yidu Central Hospital of Weifang were recruited into this study. General anesthesia was first induced for all patients, of which 45 were randomly assigned to the experimental group and received Dex through an intravenous infusion pump to maintain general anesthesia. The remaining 42 patients were assigned to the control group and received saline through an intravenous infusion pump. Respiratory function and hemodynamic indexes at five time-points, i.e., before anesthesia induction (T0), 5 min after injection of anesthetic agents (T1), before intubation (T2), 15 min after intubation (T3), and 30 min after extubation (T4), were recorded and compared. Incidence of perioperative cardiac and respiratory adverse events was counted in both groups, and post-anesthesia resuscitation was evaluated and compared. Compared with T0, the respiratory rate (R) of the experimental group was lower at T1-T4, but there was no statistical difference (P<0.05). Compared with T0, the control group had a higher R at T2, lower R at T3 and T4 (P<0.05), and there was no significant difference in R between T0 and T1 (P>0.05). At the same time-point, compared with the experimental group, the R was higher at T2, and lower at T3 and T4 in the control group (P<0.05), and no significant difference was found at T1. Blood oxygen saturation (SpO2) of the experimental group was slightly lower than that of T0 at T1-T4 (P>0.05). In the control group, the levels of SpO2 were significantly lower at T1-T4 than those at T0 (P<0.05). Compared with the experimental group at the same time-point, SpO2 of the control group at T1-T4 decreased significantly (P<0.05). The heart rate (HR) of the experimental and control groups was lower at T1-T4 than that at T0 (P<0.05). The HR of the experimental group was higher than that of the control group at T1-T4 (P<0.05). Mean arterial pressure (MAP) of the experimental and control groups was lower at T1-T4 than that at T0 (P<0.05). MAP of the control group was higher than that of the experimental group at T2 but lower than that at T0 of the control group. MAP of the control group was lower than that of the experimental group at T1-T4. There was no significant difference in incidence of tachycardia, bradycardia, vomiting, hypoxia and laryngism between the two groups (P>0.05). There was no difference in resuscitation and extubation time between the two groups (P>0.05). Finally, agitation of the control group was more severe than that of the experimental group (P<0.05). Therefore, Dex can improve the respiratory function and hemodynamic stability during anesthesia induction in children with RB resection.

Diagnostic Injections About the Shoulder.

Injections about the shoulder serve diagnostic as well as therapeutic purposes. Diagnosis of shoulder conditions, such as rotator cuff tears, acromioclavicular joint pathology, subacromial impingement or anterolateral pain syndrome, glenohumeral joint pathology, suprascapular nerve entrapment, and biceps tendon pathologies, is often complicated by concomitant conditions with overlapping symptoms and by inconclusive physical examination and imaging results. Injections of anesthetic agents can often help clinicians locate the source of pain. However, technique and accuracy of needle placement can vary by route. Accuracy is often improved with the use of ultrasonography guidance, although studies differ on the benefits of guided versus unguided injection.

Regional anesthesia of the eye, orbit, and periocular skin

Advances in ophthalmic surgery, together with achieving greater patient safety, have changed the requirements of regional anaesthesia of the eye, orbit, and periocular skin. Patient comfort, safety, and low complication rates are essentials of regional anesthesia, which includes invasive procedures that generate intraoperative and postoperative analgesia, as well as akinesia. We present the currently used local anesthesia (topical and subcutaneous infiltration of local anesthetics) and regional anesthetic techniques in ophthalmic procedures, describing the techniques, advantages, disadvantages, and complications in ophthalmic regional blocks, as well as some educational measures to implement them to reduce the risk of ocular complications. Currently, there is no absolutely safe ophthalmic regional block, and the anesthetic modality should be assessed on a patient and surgeon basis.Local anesthesia is the reversible loss of sensation in certain area of the body to minimize pain and obtain patient comfort. It can be achieved through topical application or injection of anesthetic agents that block the nerve impulses to that tissue.

Post-frenotomy Methemoglobinemia Associated with Mepivacaine Use in a 3 Day Old

Background: With the increased numbers of babies breast-feeding over the last 10 years, there has been a higher incidence of frenotomies performed to increase the success of breast feeding. Frenotomies are often performed after administering topical or local injections of anesthetic agents. Objective: To report a case of methemoglobinemia after a procedure that has become more prevalent in the neonatal age group. Case report: We report a 3 day old male who presented with methemoglobinemia shortly after the amide anesthetic mepivacaine was used in performing a frenotomy. The infant had classic signs of methemoglobinemia and treatment was successfully administered with favourable outcomes. Summary: Neonates have lower amounts and activity of NADH-cytochrome b5 reductase (methemoglobin reductase) therefore putting them at more risk for methemoglobinemia when exposed to oxidizing chemicals such as topical or injectable anesthetics. After the use of local anesthetics for a minor procedure, clinicians should be aware of the risks for developing methemoglobinemia in this age group.

The influence of different anesthetic modes on intraocular pressure and ocular pulse amplitude

Objective To compare the influence of retrobulbar and sub-Tenon' s anesthesia on intraocular pressure (lOP) and ocular pulse amplitude (OPA). Methods Forty consecutive adult patients with monocular cataract were enrolled in this study and were divided into retrobulbar and sub-Tenon' s group. IOP and OPA were measured with dynamic contour tonometer (DCT) in the operated eye and in the contralateral eye as a control before and at Ⅰ minute and 10 minutes after administration of lidocaine anesthesia. Results With retrobulbar anesthesia, the IOP increased in the injected eyes while no significant change was observed in the control eyes; The lOP remained stable in both eyes with sub-Tenon' s anesthesia. The OPA significantly decreased in the injected eyes with both modes anesthesia after injection of anesthetic agents. The decrease of OPA in the sub - Tenon's group was detected after 10 minutes in the control eyes. In the retrobulbar anesthesia group,the OPA in the control eyes increased significantly at 1 minute after injection and returned to preinjection levels at 10 minutes after injection. Conclusion Retrobulbar anesthesia decreases OPA and increases (IOP). Sub-Tenon's anesthesia reduces OPA and has no obvious influence on IOP. Key words: retrobulbar anesthesia; sub-Tenon' s anesthesia; IOP; OPA; ocular blood flow

How I do it?: excision of neck lumps under local anaesthesia

Excisions of neck lesions under local anaesthesia are made technically more difficult by the injection of anaesthetic agent, causing the lesion to become less palpable. Pen marking the lesion can circumvent the problem; however, this marking often disappears after skin preparation. We describe a technique which abolishes this problem.

Possible mechanism of quadriceps femoris weakness in patients with ruptured anterior cruciate ligament.

The purpose of this study was to test the hypothesis that loss of afferent feedback due to rupture of anterior cruciate ligament (ACL) is the cause of quadriceps femoris (QF) weakness through gamma loop. Two experiments were designed to prove our hypothesis. In experiment 1, the maximal voluntary contraction (MVC) of knee extension and integrated electromyogram (I-EMG) of vastus medialis (VM), vastus lateralis (VL), and rectus femoris (RF) were measured in 13 patients with ruptured ACL and 7 healthy volunteers before and after injection of anesthetic agent into the knee. In experiment 2, MVC of knee extension and I-EMG of the VM, VL, and RF were measured in 13 patients with ruptured ACL, 7 knee-anesthetized healthy subjects, and 12 normal subjects, before and after 20-min vibration stimulation applied to the infrapatellar tendon. The results of experiment 1 revealed that injection of anesthetic agent into the knee capsule resulted in significant decrease of MVC and I-EMGs. In experiment 2, the mean percentage change of MVC in the control group was significantly lower than that in the other two groups. There was no significant difference between knee-anesthetized group and patients with ruptured ACL. The mean percentage change of I-EMG showed a pattern similar to that of MVC. Our results suggest that loss of feedback from mechanoreceptors in ACL is the underlying mechanism of weakness of QF in patients with ACL lesion. This conclusion is based on chronic suppression of recruitment of high-threshold motor units during voluntary contraction because ACL lesion leads to chronic reduction in Ia-feedback to muscles around the knee due to a lack of feedback from ACL to gamma motor neurons.

Dosage trials with transmucosal carfentanil citrate in non-human primates

The traditional method of immobilizing non-human primates involves remote-delivery injection of anesthetic agents. Orally delivered, transmucosally absorbed opioids have been shown to be a non-stressful alternative method of pre-anesthetic drug administration in children and adults [Stanley et al., 1989]. This report describes several cases using transmucosal carfentanil in non-human primates to determine whether orally delivered carfentanil can be a safe, less stressful, and reversible method of sedation in these species. Regimen 1: Transmucosal carfentanil alone. Three chimpanzees (Pan troglodytes), two capuchin monkeys (Cebus apella), and two gibbons (Hylobates lar) were given carfentanil citrate as their sole pre-medication agent. Doses ranged from 2.0 to 4.0 μg/kg. After a median time of 22 minutes, all chimpanzees were nearly or completely immobilized and showed signs of severe respiratory depression. In contrast, the gibbons and capuchins showed moderate to profound sedation and no signs of respiratory depression. Regimen 2: Oral droperidol followed by transmucosal carfentanil. Four chimpanzees and two bonobos (Pan paniscus) were given a dose of 2.5 mg droperidol orally 45 minutes before transmucosal carfentanil administration. Two chimpanzees received 1.0 μg/kg carfentanil, and all other animals in this trial received a dose of 2.0 μg/kg. All individuals were nearly or completely immobilized with this protocol, and respiratory depression was much less severe. Regimen 3: Oral droperidol followed by transmucosal carfentanil for euthanasia. Two western lowland gorillas (Gorilla gorilla) were electively euthanized using oral droperidol followed by transmucosal carfentanil. Droperidol was administered as in Regimen 2, and doses of carfentanil were 14 μg/kg in the case of a developmentally disabled young gorilla, and 2 μg/kg for a severely debilitated geriatric gorilla with severe respiratory and cardiac disease. Respiratory arrest occurred at 12 and 10 minutes, respectively after carfentanil administration, with subsequent cardiac arrest. Transmucosal carfentanil appears promising as an anesthetic agent when administered alone to gibbons and capuchin monkeys, when administered in combination with droperidol to chimpanzees and bonobos, and when administered for purposes of elective euthanasia in gorillas. Administration of transmucosal carfentanil alone for immobilization of chimpanzees is not recommended because of the severity of respiratory depression observed. Zoo Biol 18:397–402, 1999. © 1999 Wiley-Liss, Inc.

Respiratory arrest after local anesthesia for outpatient cataract surgery: a dramatic but transient complication

Retrobulbar injection of anesthetic agents is common practice before ophthalmologic procedures. Rare but life-threatening complications of this procedure include respiratory depression and coma. We present the case of a woman with complete respiratory arrest and unresponsiveness who was brought into our emergency department from a local freestanding surgical center after preoperative retrobulbar anesthetic injection. Subsequently, the pathogenesis, clinical features, and supportive treatment for this dramatic but transient complication are discussed.

Effect of Lidocaine on the Meninges in an Experimental Animal Model

Arachnoiditis has been reported in patients who had received previous epidural injections of anesthetic agents. The purpose of this study was to determine if epidural injections of lidocaine are sufficient to cause arachnoiditis. Four monkeys that received a single epidural injection of lidocaine hydrochloride 1% were compared to four controls that had epidural injections of 0.9% saline. Four dogs that had multiple epidural injections of lidocaine hydrochloride 1% were compared to four controls that had multiple injections of saline. All animals were killed on the eighty-fourth day of the experiment. The dural sac, containing nerve roots and spinal cord, was removed intact from the lumbar spinal canal, fixed, sectioned, stained, and examined microscopically for evidence of arachnoid inflammation and fibrosis. No significant changes were found in the treated animals. Lidocaine hydrochloride 1% injected singly or repeatedly in the epidural space does not appear to be a cause of significant chronic meningeal reaction.

New suction periosteal dissector.

The advantages of a dry field in surgery have long been appreciated by every surgeon. This is particularly desirable in nasal surgery. We usually rely on the production of partial hemostasis by the injection of anesthetic agents containing epinephrine and on the use of suction apparatus. In submucous resections particularly, it is important to separate the septal mucosa with its attached perichondrium and periosteum from the cartilaginous and bony septum by the use of a periosteal elevator such as the types designed by Freer, Joseph, McKenty, etc. This mucoperichondrial and mucoperiosteal dissection demands a dry field. Inasmuch as the area available is very limited, it is often difficult for an assistant to apply suction to the field while the operator manipulates both the nasal speculum and the periosteal elevator. Very often an assistant is not available and the operator must complete the dissection by himself. This he can do by