Intraoperative Adverse Effects Research Articles

Clinical study of acupuncture combined with surface anesthesia using proparacaine in geriatric cataract phacoemulsification.

During anesthesia administration for cataract surgery, low pH of proparacaine may induce pain or complications such as corneal damage and poor wound healing, with the use of additional drops intraoperatively increasing the risk of complications. Accordingly, there is a clinical need for adjuncts to local anesthesia needs to improve the efficiency of anesthesia and reduce the required amount of intraoperative proparacaine. To identify a method of anesthesia for geriatric cataract phacoemulsification that provides more efficient analgesia and improves clinical efficacy. A total of 130 geriatric patients with cataracts who attended Hebei Eye Hospital from December 2020 to December 2022 were included in the present study. Patients were divided into the proparacaine surface anesthesia (SA) group (65 cases) and the compound acupuncture-medicine anesthesia group (CAMA group, 65 cases). Patients in the CAMA group were provided acupuncture analgesia in addition to SA. Preoperative anxiety [Self-Rating Anxiety Scale (SAS) score and state anxiety inventory (SAI) score], intraoperative stress, vital signs, analgesia, and cooperation, as well as postoperative adverse events, were compared between groups. More marked reductions in anxiety were observed among patients in the CAMA group, with corresponding reductions in SAS and SAI scores. During the operation, no change in the secretion of E, NE, or Cor group compared to the preoperative period was observed in the CAMA, which was markedly lower than that in the SA group. Heart rate, blood pressure, and respiratory rate were more stable intraoperatively in the CAMA group. In addition, the incidence of intraoperative pain and the number of additional doses of anesthesia required in the CAMA group were markedly lower than in the SA group. Accordingly, patients in the CAMA group were able to avoid eye movements and eyelid closing leading to greater cooperation with surgeons during surgery. Furthermore, marked reductions in intraoperative adverse effects were observed in the CAMA group, indicating greater overall safety. Proparacaine SA combined with acupuncture as an analgesic provides improved analgesia with greater safety compared to surface anesthesia with proparacaine during geriatric cataract phacoemulsification.

Factors influencing USgHIFU ablation for adenomyosis with NPVR ≥ 50%

Objective To investigate the influencing factors of ultrasound-guided HIFU (USgHIFU) ablation for adenomyosis with a non-perfused volume ratio (NPVR)≥50%. Methods A total of 299 patients with adenomyosis who underwent USgHIFU ablation were enrolled. Quantitative signal intensity (SI) analysis was performed on T2WI and dynamic enhancement type. The energy efficiency factor (EEF) was defined as the ultrasound energy delivered for ablating 1 mm3 of tissue. NPVR ≥ 50% was used as the criterion for technical success. Adverse effects and complications were recorded. Logistic regression analyses of variables were conducted to identify the factors affecting NPVR ≥ 50%. Results The median NPVR was 53.5% (34.7%). There were 159 cases in the NPVR ≥ 50% group and 140 cases in the NPVR < 50% group. The EEF in NPVR < 50.0% group was significantly higher than that in NPVR ≥ 50% group (p < 0.05). The incidence of intraoperative adverse effects and postoperative adverse events in the NPVR < 50% group were higher than those in the NPVR ≥ 50% group (p < 0.05 for both). Logistic regression analysis showed that abdominal wall thickness, SI difference on T2WI between adenomyosis and rectus abdominis, and enhancement type on T1WI were protective factors for NPVR ≥ 50% (p < 0.05), while the history of childbirth was an independent risk factor (p < 0.001). Conclusions Compared with NPVR < 50%, NPVR ≥ 50% did not increase the intraprocedural and postprocedural adverse reactions. The possibility of NPVR ≥ 50% was higher in patients with thinner abdominal walls, showed slight enhancement of adenomyosis on T1WI, with a history of childbirth, or in whom the SI difference on T2WI between adenomyosis and rectus abdominis was more minor.

High intensity focused ultrasound treatment for adenomyosis: comparison of efficacy based on MRI features

Objective To compare the clinical efficacy of High intensity-focused ultrasound(HIFU) for different types of adenomyosis classified by magnetic resonance imaging (MRI). Methods A total of 227 patients with adenomyosis who underwent HIFU treatment in Suining Central Hospital from January 2014 to December 2019 were included. Based on the preoperative pelvic MRI examination and Kishi isometric classification method, the patients were divided into 4 types according to the location of lesions. There were 82 cases of type I (endogenous type), 75 cases of type II (exogenous type), 34 cases of type III (nodular type), and 36 cases of type IV (heterogeneous type). The results of HIFU treatment for four types of adenomyosis and intraoperative adverse effects were analyzed. The changes of lesion size, dysmenorrhea, and menstrual volume were analyzed at 3 and 6 months after the operation. Result (1) adverse effects: All patients successfully accepted HIFU treatment under sedation and analgesia. Grade A adverse effects occurred in 51 cases (22.47%) and grade B adverse effects in 3 cases (1.32%). The incidence of adverse effects in type I–IV patients was 21.95%, 22.66%, 23.53%, and 30.56%, respectively. There was no significant difference in the incidence of grade A and B adverse effects in all types, and no grade C–F adverse effects occurred. (2) Ablation effect: The ablation rate of type III(nodular type)patients was (74.7 ± 20.3) %, which was significantly higher than that of the other three types (p < .05). (3) Changes in lesion size: the lesion size of all patients decreased after treatment and the reduction rate gradually increased with time. At 6 months after the operation, the lesion reduction rate of type III patients was (70.8 ± 14.8) %, higher than that of the other three types patients (p < .05). There was no significant difference in the reduction rate of type I, type II and type IV. (4) Remission of menorrhagia: At 6 months after the operation, the total remission rate of type III patients was 100%, while the total remission rate of type IV patients (65.4%, 17/26) that was lower than that of type I, II and III patients(p < .05). (5) Dysmenorrhea relief: At 6 months after the operation, the total dysmenorrhea relief rate of type III patients was 100% and the complete relief rate (28.1%, 18/31) was higher than that of the other three types, which was significant differences (p < .05). Conclusions HIFU is safe and effective in the treatment of different types of adenomyosis, the therapeutic effect of HIFU in patients with type III adenomyosis is better than that of the other three types.

Effect of Perioperative Intravenous Lidocaine on Postoperative Recovery in Patients Undergoing Ileostomy Closure: Study Protocol for a Randomized Controlled Trial.

IntroductionOpioids have been widely used clinically as the first choice for pain management. Ileostomy closure usually leads to temporary intestinal paralysis, which manifests as abdominal distension and pain, delayed defecation, nausea, and vomiting. Intraoperative and postoperative use of opioids inhibit gastrointestinal function and aggravate intestinal paralysis, and are notoriously addictive. Thus, reducing perioperative opioid use is important for patients undergoing ileostomy closure to restore the continuity and integrity of the intestine. Intravenous lidocaine has been shown to have anti-inflammatory properties and analgesic effects. We consider minimizing the use of opioids for such patients, and perioperative intravenous injection of lidocaine may be beneficial to the recovery of intestinal function in patients with ileostomy closure.Methods and AnalysisThis is a randomized double-blind placebo-controlled trial to investigate the effectiveness and safety of intravenous lidocaine in patients undergoing ileostomy closure. The time of first postoperative anal venting, postoperative opioids use, postoperative recovery, intraoperative adverse effects and postoperative complications will be collected and analyzed.

Perbandingan Penggunaan Adjuvant Fentanyl 25µg Dan Klonidine 50µg Pada 10mg Bupivacain 0,5% Hiperbarik Terhadap Lama Kerja Blokade Sensorik Motorik Spinal Anestesi

Surgery still often causes various problems, one of which is pain, but the problem of pain during and after surgery can be overcome by anesthesia technique. One of them is spinal anesthesia technique. However, spinal anesthesia still has drawbacks where the duration of sensory and motor blockade is still very short. Various methods are used to prolong the duration of sensory and motor blockade of spinal anesthesia, one of which is the addition of adjuvants such as fentanyl and clonidine. This study was conducted to compare the speed of onset of action of sensory-motor blockade and the lengthening of duration of action of sensory-motor blockade between the addition of 25 g fentanyl compared to 50 g conidine in 10 mg hyperbaric 0.5% bipivacaine administered under spinal anesthesia. This study used a Randomized Control Trial (RCT) design with a double-blind randomized control trial and was conducted at Mitra Plumbon Hospital Cirebon from March-April 2021. There were 42 patients who met the inclusion criteria who underwent surgery with spinal anesthesia. Patients were divided into 2 groups, group 1 used 10mg hyperbaric 0.5% bupivacaine plus 25µg fentanyl, while group 2 used 10mg hyperbaric 0.5% bupivacaine plus 50µg clonidine. We investigated the onset of action and duration of action of sensory-motor blockade, the effect of hemodynamic shock, the effect of sedation levels and intraoperative adverse effects (side effects). Data analysis using SPSS 20.0. In the group of 10 mg bupivacaine 0.5% hyperbaric plus clonidine 50 g, the onset of action of sensory-motor blockade was faster and the duration of action was longer than in the group of 10 mg bupivacaine 0.5% hyperbaric plus 25 g fentanyl with a P value &lt;0.05. Likewise, the effect of hemodynamic fluctuations in the 10mg hyperbaric 0.5% bupivacaine group plus 50 g clnidine was more stable than the 10mg hyperbaric 0.5% bupivacaine group plus 25 g fentanyl. While the effect of the level of sedation and intraoperative side effects are comparable

Effects of Remimazolam Combined with Esketamine Anesthesia on Circulatory and Respiratory Function during Painless Gastroenteroscopy.

Objective To investigate the effect of applying remimazolam combined with esketamine for anesthesia in painless gastroenteroscopy on patients' circulatory and respiratory function. Method In this study, 106 patients who had undergone painless gastroenteroscopy in Xinjiang Production and Construction Corps (XPCC) Hospital between July 2021 and January 2022 were selected as study subjects, which were grouped according to the anesthetic drugs used in the surgery and divided into control group (n = 53 cases) and observation group (n = 53 cases), while those who were anesthetized with propofol + sufentanil during the operation were the control group and those who were anesthetized with remimazolam + esketamine were the observation group. To compare the induction time of anesthesia, patient awakening and recovery time of orientation, circulatory and respiratory function, intraoperative adverse effects, and postoperative complications in the two study groups. Results There was no statistical difference in induction of anesthesia, patient awakening, and recovery time of orientation between the two groups (P > 0.05) and no statistical difference in postoperative complications (P > 0.05). The observation group had a better occurrence of local pain at the injection site, circulatory and respiratory function of patients after anesthesia, and intraoperative adverse reactions than the control group (P < 0.05). Conclusion Remimazolam combined with esketamine anesthesia has the same advantages of rapid awakening compared with propofol anesthesia. Moreover, it has fewer side effects on patients' circulatory and respiratory functions with fewer adverse effects, as a suitable anesthetic method for painless gastroenteroscopy.

Comparison of single-stage and two-stage bilateral video-assisted thoracic surgery

ObjectiveSingle-stage sequential bilateral video-assisted thoracoscopic surgery (VATS) is a controversial procedure. In the present study, we retrospectively compared the outcomes of single-stage and two-stage VATS.MethodsThis study involved patients who underwent single-stage sequential bilateral VATS (SS-VATS group) or two-stage VATS at a 3-month interval (TS-VATS group) for treatment of non-small cell lung cancer from 2010 to 2018. The major outcome was the comparison of intraoperative changes.ResultsThe inspiratory peak pressure was higher, the incidences of intraoperative hypoxia and unstable hemodynamics were higher, the surgical time was longer, and the durations of the intensive care unit stay and postoperative hospitalization were longer in the SS-VATS group than in the TS-VATS group. However, the chest tube duration, incidence of postoperative mechanical ventilation, and clinical complications were not different between the two groups.ConclusionsCompared with two-stage VATS, single-stage sequential bilateral VATS can be performed for successful treatment of bilateral pulmonary lesions with a shorter total time and higher cost-effectiveness in terms of anesthesia and hospitalization but with a higher incidence of intraoperative adverse effects and a longer hospital stay.

Application of subretinal fluid to close refractory full thickness macular holes: treatment strategies and primary outcome: APOSTEL study.

Persisting macular holes (PMH) after surgical release of any epiretinal traction of the vitreous and adjacent membrane may rely on secondary firm adhesions between the retracted retina and adjacent retinal pigment epithelium. Secondary application of subretinal (SR)-fluid may release these adhesions followed by an anatomical closure. Twelve surgeons applied in a consecutive case series SR-fluid in 41 eyes with PMH and reported retrospectively their initial surgical, anatomical and functional experience with this approach. The mean duration of the MH prior to SR-fluid application was 17months (6-96months). The mean age of the patients at the time of surgery was 72years (54-88). The mean preoperative aperture diameter of the opening was 1212μm (239-4344μm), base diameter 649 μm (SD 320 μm). The mean preoperative BCVA prior to surgery was 0.1 (0.01-0.3). All patients (41/41) complained about reduced BCVA and a significant central scotoma (negative scotoma) in their central field of vision. The secondary closure rate for our PMH was 85.36% (35 out of 41 eyes) at 6weeks after surgery. The postoperative BCVA improved to 0.22 (0.02-0.5). The application of SR-fluid was not associated with major intraoperative adverse effects. Remaining SR-adhesions may inhibit PMH closure. Their release by application of SR-fluid will lead to a fast and immediate anatomical closure in many cases without serious adverse events.

Pseudophakic negative dysphotopsia and intraocular lens orientation: a prospective double-masked randomized controlled trial.

To determine whether horizontal orientation of the intraocular lens optic-haptic junctions has an effect on the incidence of pseudophakic negative dysphotopsia. Single-centre prospective double-masked randomized controlled trial. 220 eyes of 201 participants undergoing routine cataract surgery were randomized to receive their intraocular lens either orientated with the optic-haptic junctions at 180° ('horizontal') or without manipulation following implantation (control). Patients were excluded according to age (<19 and >99years), coexisting eye disease affecting visual function and insufficient cognitive function to complete the study. In the fourth postoperative week, a telephone interview was conducted to determine rates of negative dysphotopsia. The data were analysed to provide the relative risk of negative dysphotopsia with horizontal orientation of the intraocular lens (IOL) optic-haptic junctions compared with standard treatment. Orientating the IOL optic-haptic junctions horizontally halved the incidence of pseudophakic negative dysphotopsia in the fourth postoperative week (9/110 in the intervention group; 18/110 in the control group; RR: 0.50, 95% confidence interval: 0.235-1.064, p=0.072). The overall incidence of negative dysphotopsia was 12.2% (27/220 participating eyes). No intraoperative adverse effects of intraocular lens rotation were reported. The simple intraoperative manoeuvre of rotating the intraocular lens to orientate the optic-haptic junctions at 180° may be a safe and effective measure to reduce the risk of developing postoperative pseudophakic negative dysphotopsia in the first postoperative month. This is the first report that demonstrates the benefit of horizontal optic-haptic junction positioning to be sustained beyond the first postoperative day.

Value of robotic-assisted technique in redo gastrojejunostomy for severe stenosis after gastric bypass.

Development of gastrojejunal stricture following Roux-en-Y gastric bypass (RYGB) leads to an increase in morbidity and adverse effects, such as abdominal pain, vomiting, aspiration pneumonia, and malnutrition. Up to 38.5% of patients will require revisional surgery for late anastomotic strictures despite conservative treatment. However, no previous studies focused on revisional robotic bariatric surgery due to strictures after RYGB have been reported. To evaluate our outcomes and assess the advantages of the robotic platform with regard to laparoscopic and open revisional procedures. University Hospital. We performed a retrospective analysis of patients who underwent laparoscopic robotic-assisted redo gastrojejunostomy from 2016 to 2018. Demographics, surgical data, medical treatments, postoperative outcomes, and adverse effects were collected. Nine patients with symptomatic anastomotic strictures after primary RYGB underwent robotic revisional surgery. All patients received medical therapy as a first approach, and five patients (55.5%) underwent endoscopic balloon dilation. All procedures were successfully completed with robotic assistance, with a mean (standard deviation) operative time of 184.5 (49.1)min, and no intraoperative adverse effects were registered. Median (range) hospital stay was 2 (1-4)days. One patient presented with a postoperative intra-abdominal abscess and was treated with intravenous antibiotics and image-guided drainage. No anastomotic leak, hemorrhage, or mortality were reported. Robotic assistance seems to be safe and effective for redo gastrojejunostomy secondary to stricture. Even though the sample size is small, we believe that the application of robotic techniques may provide advantages and improve the outcomes in these complex revisional procedures.

Evaluation of the learning curve of transanal total mesorectal excision: single-centre experience.

IntroductionTransanal total mesorectal excision (TaTME) has been recently proposed to overcome the difficulties of the standard TME approach, allowing better visualization and dissection of the mesorectal fascia. Although TaTME seems very promising, the evidence and body of knowledge on achieving proficiency in performing it are still sparse.AimTo evaluate the learning curve of TaTME based on a single centre’s experience.Material and methodsConsecutive patients undergoing TaTME since 2014 in a tertiary referral department were included in the study. All procedures were performed by one experienced surgeon. CUSUM curve analyses were performed to evaluate learning curves.ResultsSixty-six patients underwent TaTME. After analysis of postoperative morbidity rate, intraoperative adverse effects and operative time, we estimated that 40 cases are needed to achieve TaTME proficiency. Subsequently, patients were divided into two groups: before (40 patients) and after overcoming the learning curve (26 patients). Group 1 had higher readmission (p = 0.041) and complication rates (p = 0.019). There were no statistically significant differences in terms of intraoperative adverse effects, length of stay or pathological quality of the specimen.ConclusionsTransanal total mesorectal excision is a promising yet technically demanding procedure and requires at least 40 cases to complete the learning curve. More data are needed to introduce it as a standard procedure for low rectal cancer treatment.

Salvage Transrectal High-Intensity Focused Ultrasound Therapy for Patients with Recurrence of Vesico-Urethral Anastomosis after Radical Prostatectomy

Background: Salvage radiotherapy has been used as the treatment for patients with local recurrence after radical prostatectomy. However, the therapy is time-consuming and it experiences adverse effects of some kind. Simple and less invasive treatment is highly anticipated. Objectives: To evaluate the outcomes of salvage transrectal high-intensity focused ultrasound (HIFU) therapy for patients with localized recurrence of a vesicourethral anastomosis (VUA) after radical prostatectomy. Material and methods: Sixteen patients with suspected local recurrence of a VUA after prostatectomy were treated with HIFU. All patients had prostate-specific antigen (PSA) failure (>0.2 ng/ml), positive findings of a VUA with biopsy and/or MRI, TRUS and CT, and no distant metastasis by CT, MRI and bone scintigraphy before HIFU. Recurrence after HIFU was determined by PSA failure (>0.2 ng/ml), histological findings, metastasis and start of systemic therapies. Results: HIFU treatments were performed in 16 patients, and followed-up for 7 - 159 months (median 46.5). The pre-HIFU PSA levels ranged from 0.318 to 3.1 ng/ml. Sonication time ranged from 9 - 42 min. All patients had a decline of PSA after HIFU, and 88% of the PSA nadir was <0.2 ng/ml. Recurrence free survival (RFS) rates of 5 year were 31.3%. Nadir PSA was significantly associated with recurrence, whereas initial PSA, pre-HIFU PSA, duration and risk group after prostatectomy were not. There were no intraoperative adverse effects. In the 1 - 3 months after HIFU, there was some difficulty voiding in 4 cases (grade 1), urgency incontinence in 3 cases (grade 1 or 2). Conclusion: HIFU therapy for local recurrence after prostatectomy may become a feasible salvage therapeutic option because of its ease and simple procedure. For salvage HIFU therapy, further research and additional follow-up are required to evaluate and correct the diagnosis of recurrence areas and to provide the sufficient sonication.

Addition of dexmedetomidine to bupivacaine in ultrasonography-guided paravertebral blockade potentiates postoperative pain relief among patients undergoing thoracotomy

Background and objectiveThoracic paravertebral blockade is an alternative regional technique for comforting post-thoracotomy pain, thereby decreasing opioid consumption, postoperative nausea and vomiting, dizziness, respiratory depression and health care costs. The objective of this study was to investigate the effects of bupivacaine and bupivacaine plus dexmedetomidine on postoperative pain score and analgesic consumption in thoracotomy patients who had undergone ultrasonography-guided paravertebral blockade. Material and method93 ASA I–II patients aged 18–65 years were included in the study and scheduled for thoracic surgery. Prior to anesthesia induction, the paravertebral blockade procedure was performed by an anesthetist with ultrasonography. Cases were randomly stratified into three groups. The paravertebral blockade procedure was performed with 20mL 0.5% bupivacaine injection in Group B (n=31) and 20mL 0.5% bupivacaine+1mL dexmedetomidine (100μg) injection in Group BD. Group C received postoperative i.v. morphine via patient-controlled analgesia without paravertebral blockade. Post-operative pain scores were recorded in the recovery room and post-operatively using a VAS. Hemodynamic parameters, adverse effects and morphine consumption were also recorded. ResultsNo significant difference was determined between Group B and Group C regarding intra-operative adverse effects such as bradicardia and hypotension, while these adverse effects were significantly higher in Group BD (p=0.04). VAS scores with rest and upon movement were significantly lower in Group BD compared to Group C (p<0.001). Total morphine consumption was significantly lower in both Group B and Group BD in comparison with Group C (p<0.001). In Group BD, HR and MAP were lower, but this was not clinically significant (p<0.05). ConclusionThe addition of dexmedetomidine to bupivacaine lowers postoperative pain scores and morphine consumption in thoracotomy patients who receive ultrasonography guided paravertebral blockade.

Comparison of Short-Term Clinical and Pathological Outcomes after Transanal versus Laparoscopic Total Mesorectal Excision for Low Anterior Rectal Resection Due to Rectal Cancer: A Systematic Review with Meta-Analysis

Background: Transanal total mesorectal excision (TaTME) is a new technique that is designed to overcome the limits of the open and laparoscopic approach for rectal resections. Objective: This study is designed to compare TaTME with standard laparoscopic TME (LaTME). Methods: We searched Medline, Embase, and Scopus databases covering a up to October 2018. Inclusion criteria for study enrolment: (1) study comparing laparoscopic resection of rectal cancer vs. TaTME for rectal malignancy, (2) reporting of overall morbidity, operative time, or major complications. Results: Eleven non-randomized studies were eligible with a total of 778 patients. We found statistical significant differences in regard to major complications in favour of TaTME (RR = 0.55; 95% CI 0.31–0.97; p = 0.04). We did not found significant differences regarding overall complications intraoperative adverse effects, operative time, anastomotic leakage, intra-abdominal abscess occurrence, Surgical Site Infection, reoperations, Length of stay, completeness of mesorectal excision, R0 resection rate, number of harvested lymph nodes, circumferential resection margin, and distal resection margin. Conclusions: This meta-analysis shows benefits of TaTME technique regarding major postoperative complications. Regarding clinicopathological features transanal approach is not superior to LaTME. Currently, the quality of the evidence on benefits of TaTME is low due to lack of randomized controlled trials, which needs to be taken into consideration in further evaluation of the technique. Further evaluation of TaTME require conducting large randomized control trials.

Factors associated with the presence of postoperative headache in elective surgery patients: a prospective single center cohort study.

Headache is an important cause of minor postoperative morbidity. In this study we evaluated the association of anesthesia and surgery with the occurrence of postoperative headache in elective surgery patients. After obtaining ethical approval, 446 patients were enrolled in this prospective, single-centre cohort study. Participants were interviewed preoperatively, and for five days postoperatively, regarding the appearance of headache, while demographics, lifestyle, type of anesthesia and surgery, the anesthetic drugs administered and intraoperative adverse effects were recorded. Multiple logistic regression analysis was conducted in order to identify independent factors associated with postoperative headache, both in the total sample and in patients without previous history of headache. The observed overall frequency of postoperative headache was 28.3% (N=126) in the total sample. In patients with previous history of headache, the frequency of postoperative headache was 41% (N=89), while in those with no history the frequency of postoperative headache was 16.2% (N=37). Female gender [p=0.024; odds ratio (OR)=2.1], sevoflurane administration (p<0.001; OR=3.66), intraoperative hypotension (p=0.008; OR=2.12) and smoking (p=0.006; OR=1.74) were independently associated with postoperative headache. In patients without previous history, female gender (p=0.005; OR=4.77), sevoflurane administration (p=0.001; OR=6.9), intraoperative hypotension (p=0.006; OR=6.7) and caffeine consumption (p=0.041; OR=5.28) presented greater likelihood for postoperative headache, while smoking revealed no association. Female gender, sevoflurane, smoking and intraoperative hypotension were documented as independent risk factors for postoperative headache. In patients with no previous history of headache, caffeine consumption was an additional independent factor for postoperative headache, while smoking revealed no association.

Comparison of hemodynamic response to tracheal intubation with laryngoscope versus intubating laryngeal mask airway in elderly hypertensive patients

Background Management of airways during intubation is a very stressful process that affects the hemodynamics, especially in elderly hypertensive patients. We aimed in this study to compare the hemodynamic response to tracheal intubation in elderly hypertensive patients using ILMA and Direct laryngoscopy. We aim in this study to prove that hemodynamic consequences with intubation using ILMA is that intubation with an ILMA has less hemodynamic consequences that last for a shorter period compared with DL in elderly hypertensive. Patients and methods A total of 70 patients of both sexes, ASA physical status II, above 60 years of age, undergoing elective abdominal surgery lasting less than 2 h were divided randomly using a regular sample method into two equal groups. Intubation was performed using a Macintosh laryngoscope in group (direct laryngoscopy), and in the second group [intubating laryngeal mask airway (ILMA)] intubation was performed with laryngeal mask airway. Hemodynamic data and oxygen saturation were recorded. Intraoperative adverse effects and postoperative complications such as sore throat, hoarseness of voice (during the first 24 h after surgery), and laryngospasm were recorded. Results There was a significant increase in heart rate and mean arterial blood pressure immediately after laryngoscopy and tracheal intubation until 3 min when compared with ILMA. Moreover, there was significant increase in heart rate, mean arterial blood pressure, and rate pressure product after tracheal extubation for 3 min, whereas it was for 1 min in the ILMA group. No significant difference was seen between the number of patients with or without symptoms after extubation in both groups. Conclusion Intubation with ILMA has less hemodynamic consequences for a shorter time compared with direct laryngoscopy in elderly hypertensive patients.

INTRATHECAL LOW DOSE OF HEAVY BUPIVACAINE WITH DEXMEDETOMIDINE FOR CESAREAN SECTION

Background: Different adjuvants have been used with local anesthetics to improve quality of regional anesthesia (sub-arachnoid, epidural or combined sub-arachnoid and epidural block) and to avoid intra-operative visceral and somatic pain and to provide prolonged post-operative analgesia. Dexmedetomidine is a highly selective α2-adrenergic agonist which has both analgesic and sedative properties when used as an adjuvant in regional anesthesia. Objective: Evaluation of the effect of intrathecal hyperbaric bupivacaine plus dexmedetomidine on the onset and duration of sensory and motor block, intra-operative hemodynamic stability (changes), surgeon's satisfaction, intraoperative adverse effects and postoperative analgesia. Patients and method: Sixty females in childbearing period (22-40 years old), ASA physical status I scheduled for elective cesarean section. Patients were randomly allocated to receive intrathecal either 12.5 mg of (0.5%) heavy bupivacaine [B control group], or 7.5mg of (0.5%) heavy bupivacaine plus 8 ug dexmedetomidine [BD study group]. Results: Patients in BD group had a significantly rapid onset and longer duration of sensory and motor block than control B group. Onset of postoperative pain significantly delayed in BD group. Moreover, abdominal muscle relaxation was excellent clinically, with marked reduction in side effects as nausea, vomiting, hypotension and bradycardia compared with control B group. No side effects were recorded on babies as regard the neonatal assessment in both groups. Conclusion: The low dose of intrathecal anesthetic agent (Bupivacaine 7.5 mg) with 8 ug Dexmedetomidine had a significantly rapid onset and associated with prolonged motor and sensory block, hemodynamic stability and decreased postoperative analgesic consumption compared with (Bupivacaine 12.5 mg) alone.

Resection of Intraocular Tumors (Partial Lamellar Sclerouvectomy) in the Pediatric Age Group

To describe the outcome of intraocular tumor resection by partial lamellar sclerouvectomy (PLSU) in the pediatric age group. Retrospective, interventional case series. We included 37 patients who underwent PLSU for intraocular tumors under age 21 years. Medical records were reviewed for clinical, operative, and histopathologic features. Globe salvage, visual acuity, surgical side effects, tumor control, and tumor-related metastasis and death. The mean patient age was 9 years (median, 10; range, 0.25-17) and there were 22 (59%) females and 15 (41%) males. The tumor involved mainly the iris (n = 27; 73%), ciliary body (n = 7; 19%), or choroid (n = 3; 8%). The mean tumor basal dimension was 7 mm (median, 6; range, 3-15) and thickness was 3.6 mm (median, 3; range, 0.2-9.6). The histopathologic diagnosis was melanoma (n = 19; 51%), cyst (n = 5; 14%), medulloepithelioma (n = 4; 10%), melanocytoma (n = 3; 8%), lacrimal gland choristoma (n = 2; 5%), gliosis (n = 1; 3%), nevus (n = 1; 3%), hemorrhage (n = 1; 3%), and leiomyoma (n = 1; 3%). Intraoperative adverse effects included vitreous loss in 19 (51%) and hyphema in 4 (11%). Postoperative side effects included early transient hyphema in 9 (24%) and late cataract in 12 (32%). Local tumor recurrence was detected in 5 cases (13%) at mean interval of 28 months, including melanoma (n = 3) and medulloepithelioma (n = 2). Enucleation was necessary in 9 (24%) cases for recurrence in 3 (8%), prophylactic in eyes with high-grade malignancy in 5 (13%), and for blind painful eye in 1 (3%). Of the 28 salvaged eyes, final visual acuity was ≥ 20/40 in 18 (64%), 20/50 to 20/100 in 5 (18%), and <20/200 in 5 (18%). There were no cases of metastasis or death at a mean of 51 months of follow-up. A surgically challenging procedure, PLSU can achieve control of selected intraocular tumors. Medulloepithelioma responds poorly to local resection and in most cases enucleation is required. If the globe is salvaged, visual acuity is ≥ 20/40 in 64% of children. The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Combined spinal epidural and epidural volume extension: Interaction of patient position and hyperbaric bupivacaine

Background:Previous trials have documented failure of block augmentation with epidural volume extension, when applied after the intrathecal injection of hyperbaric bupivacaine was made in sitting position. However, there is no study comparing the effect of change in patient position during block performance, on the results of epidural volume extension.Materials and Methods:The study was conducted in two parts in American Society of Anesthesiologists physical status I or II parturients scheduled for elective cesarean section under regional anesthesia. In the first part, 28 patients were randomized to one of the two groups, depending on whether epidural volume extension was applied following the block in sitting (group SE) or lateral position (group LE) (n=14 each). In the second part of the study another 28 patients were recruited and randomized to receive the block in sitting (group S) or lateral (group L) position (n=14 each), without epidural volume extension. All patients received combined spinal epidural block using needle-through-needle technique with intrathecal injection of 9 mg hyperbaric bupivacaine (0.5%) and 10 μg fentanyl. Epidural volume extension was performed using 5 ml normal saline in groups SE and LE.Results:In the first part of the study, the maximum sensory block level was higher in group LE vs. SE (P<0.05). In the second part of the study, no significant difference was seen in the maximum sensory level between group S and group L (P>0.05).Conclusions:If epidural volume extension is being applied with intention of rapid extension of sensory block when hyperbaric bupivacaine has been injected intrathecally, the combined spinal epidural block should be performed in lateral position rather than in the sitting position.

UNILATERAL SPINAL ANAESTHESIA

Objectives: To see the effects of adding pethidine to intrathecal bupivacaine on duration of post operative analgesia inpatients undergoing hip surgery. Design: A randomized placebo controlled observational study. Setting C M H Multan: Period: From March2006 to April 2007. Patient and Methods: A total of 90 male patients of age 60-75 years of comparable weight and height and ASAstatus II, III were selected. Patients were divided into two groups, group A and group B. Each group consisted of 45 patients. All patients wereassessed pre operatively a day before surgery and were briefed about the procedure. Results: All the patients were prepared before givingspinal anaesthesia. Patients in Group- A were given a mixture 01 ml of 0.75 bupivacaine and 0.2 ml of normal saline in lateral decubitus positionwith operating side down by using 23 G spinal needle. Patients in Group-B were given a mixture of 01 ml of 0.75 % bupivacaine and 0.2 mlof inj. pethidine 10mg in lateral decubitus position with operating side down by using 23 G spinal needle. All the patients were kept in lateraldecubitus position for 10 minutes to achieve unilateral block. Intra operative adverse effects like hypotension, nausea, vomiting, pruritis anddelayed respiratory depression and effective duration of post operative analgesia was recorded. Conclusion Addition of 10 mg pethidine tointrathecal hyperbaric bupivacaine is associated with prolonged postoperative analgesia and minimal side effects like hypotension, pruritis, anddelayed respiratory depression. However incidence of nausea and vomiting was much more