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An Easy Way for Percutaneous Nephrolithotomy Using Mixed Sedative Agents

Open Journal of Anesthesiology 2018年第7期8卷 205-213页

作者： Amr M. Hilal Abdou Walid Y. Kamel Eman K. Abo-Seif Department of Anesthesia Intensive Care and Pain Management Ain Shams University Cairo Egypt

Objective: We recorded the data of patients performing Percutaneous Nephro-lithotomy (PCNL) under combined spinal anesthesia with sedative mixtures of Ketamine-Propofol (KP) or Fentanyl-Propofol (FP). Background: The PCNL is usually done under General anesthesia (GA);combining spinal anesthesia with a mixture of sedative drugs has shown to provide an optimum intra and post-operative analgesic and sedative response without side effects. Patients and Methods: 100 healthy patients were enrolled for PCNL, after stabilization of the sensory block of spinal anesthesia patients were randomized into two groups;Group KP received 1 mg/Kg Ketamine and 1 mg/Kg Propofol diluted in 20 ml syringe given over 30 seconds and Group FP received 1 mic/Kg Fentanyl and 1 mg/Kg Propofol diluted in 20 ml syringe over 30 seconds;both groups will receive increment doses if the patient suffers from anxiety, pain or discomfort. Perioperative Hemodynamic data (HR, SBP, DBP, RR, and SpO2) were recorded;PACU stay time and post operative analgesia time were analyzed. Results: Sedative mixtures of FP and KP provided remarkably deep sedation levels for PCNL procedures under spinal anesthesia. Respiratory depression, hypotension and bradycardia were the major side effects reported in FP group which had mean decrease in RR of 4.63 breath/min (27.49%) with mean 3.77% drop in SpO2 levels. KP group produced significant increase in HR about 7 beats/min without reported side effects. Conclusion: Various sedation techniques may be applicable for PCNL procedures with routine premedication, mixtures of fentanyl-Propofol or Ketamine-Propofol could be used, and KP has advantages of stable hemodynamics, prolonged analgesic response intra and post-operatively with no appreciable side effects and more effective method of sedative mixture.

关键词： Nephrolithotomy Percutaneous sedation Propofol Ketamine

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A Comparative Study between Dexmedetomidine versus Fentanyl on Intubating Conditions and Side Effects during Awake Fiberoptic Nasal Intubation under Topical Anesthesia in Patients Underwent Elective Surgical Operation

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Open Journal of Anesthesiology 2017年第12期7卷 415-425页

作者： Ayman Eldemrdash Nagwa Gamaledeen Zaher Zaher Abdl Aal Salem Department of Anesthesia Faculty of Medicine Aswan University Aswan Egypt Department of General Surgery Faculty of Medicine Aswan University Aswan Egypt

Awake fiber optic intubation is the gold standard technique for management of anticipated difficult airway. In spite of availability of several sedatives, at higher doses these drugs cause respiratory depression and sensorium. This study was conducted to evaluate and compare the efficacy of Dexmedetomidine or Fentanyl for sedation during AFOI. Sixty patients, aged 20 - 40 years undergoing AFOI were made into two groups, group D Dexmedetomidine 1 mcg/kg, and group F Fentanyl 2 μg/kg, both drugs was diluted with 50 ml saline to be infused over 10 minutes). Demographic data, patient cough score, sedation score and post-intubation score were compared between two groups. Cough score ≤ 2 was 25 patients in group D compared with 2 patients in group F, post intubation score 1 in group D was 24 vs. 2 in group F, mean Ramsy sedation score in group D was 3 vs. 2.1 in group F, SpO2 ≥ 95% in group D was 28 vs. 5 patients in group F, insignificant rise in MAP from 93 to 96 mmhg in group D (P = 0.347), but there was significant rise from 92.3 to 118.18 (P ≤ 0.0001) in group F, there was significant decrease in HR from 77.4 to 71 (P = 0.005) vs. significant rise from 77 to 114 (P ≤ 0.0001) in group F. Thus, we can conclude that Dexmedetomidine provides better intubating condition, sedation, less respiratory depression and hemodynamic stability than fentanyl for AFOI, without adversely affecting airway.

关键词： Dexmedetomidine Fentanyl Intubation Awake Fiberoptic sedation Intravenous

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Dexmedetomidine vs propofol in intensive care unit patients

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World Journal of Anesthesiology 2014年第1期3卷 134-136页

作者： Valeria Fadda Dario Maratea Sabrina Trippoli Andrea Messori HTA Unit Area Vasta Centro Toscana Regional Health System 50100 Firenze Italy

Dexmedetomidine is indicated as a sedative agent in intensive care units(ICUs). While several clinical trials and two meta-analyses have compared this agent with propofol or midazolam, the results were variable depending on the specific end-point(e.g., duration of mechanical ventilation, ICU mortality, maintaining a target depth of sedation, incidence of delirium episodes, length of hospital stay). Hence, the effectiveness of this new agent vs the comparators seems to be controversial. Trial sequential analysis(TSA) is a statistical technique that can estimate the optimal, cumulative number of patients that would be needed to generate a conclusive result. We therefore applied a TSA model to the most recent meta-analysis evaluating dexmedetomidine. A total of 10 randomized controlled trials were included in our analysis. According to our results, the comparison of dexmedetomidine vs propofol showed no proof of incremental effectiveness for the end-points of length of ICUs stay and incidence of delirium episodes. In contrast, futility(i.e., proof of no incremental effectiveness) was demonstrated for the end-point of mechanical ventilation. Hence, the results for the comparison of dexmedetomidine vs propofol were inconclusive for the first two end-points; on the other hand, conclusiveness was reached for the third end-point. We conclude that the place of dexmedetomidine in therapy of critically ill patients is very uncertain and further controlled trials are still needed.

关键词： Dexmedetomidine Propofol Midazolam sedation Intensive care unit Mechanical ventilation Hospital stay Meta-analysis Trial sequential analysis

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Anesthesia and acupuncture

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World Journal of Anesthesiology 2015年第1期4卷 1-4页

作者： Gerhard Litscher Holger Simonis Wolfgang Kr?ll Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine and TCM Research Center Graz Medical University of Graz 8036 Graz Austria Division of General Anesthesiology and Intensive Care Medicine Department of Anesthesiology and Intensive Care Medicine Medical University of Graz 8036 Graz Austria

Using acupuncture instead of anesthetics to induce analgesia was performed in China many years ago in surgical anesthetization. Although many medical units in China's cities and rural areas are applying these techniques in operations, it should be pointed out that acupuncture anesthesia is still in the process of development and is of next to no practical and even less scientific value in the western world. However, acupuncture-assisted anesthesia can be useful also in countries other than China.

关键词： Anesthesia Acupuncture Anesthesiology Acupuncture-assisted-anesthesia sedation

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Improved Hemodynamics with the Use of Prophylactic Infusion of Epinephrine and/or Norepinephrine during Transcatheter Aortic Valve Replacement (TAVR)

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Open Journal of Anesthesiology 2015年第6期5卷 130-134页

作者： Walter Bethune Steven Konstadt Giuseppe Trunfio Lynn Belliveau Mark Kronenfeld Charles Keilin Dennis E. Feierman Department of Anesthesiology Maimonides Medical Center Brooklyn USA

Background: Transcatheter Aortic Valve Replacement (TAVR) is a new minimally-invasive surgical procedure in which a bioprosthetic aortic valve is placed via a small skin incision in the groin, over either the left or right iliac artery. TAVR was recently approved by the FDA as a treatment option for aortic stenosis in patients who may be too frail to undergo open heart surgery. Anesthetic management of TAVR is complicated by the fact that rapid left ventricular pacing (to at least 180 beats per minute) is required at multiple points throughout the procedure. Aim: This rapid pacing creates a profound pathophysiologic stress on the heart, sometimes leading to severe left ventricular dysfunction and resultant complete hemodynamic collapse. We report that the use of prophylactic infusion of epinephrine and/or norepinephrine in patients undergoing TAVR results in improved recovery from rapid pacing as reflected by intraoperative trends in systolic systemic blood pressure and systolic pulmonary arterial pressure. Cases: Here we report three cases. During the first of these, we reacted to intraoperative hemodynamic changes by administering boluses of vasoactive medications as needed. During the other two cases, we preemptively infused vasopressors to facilitate a more rapid recovery from some of the hemodynamic disturbance associated with either TAVR or rapid pacing. Conclusion: The two patients in this series who were managed with a preemptive strategy had higher ratios of systemic systolic blood pressure to pulmonary arterial systolic blood pressure at the end of the case than did the patient who was managed reactively. This suggests that the preemptive strategy may lead to decreased left ventricular impairment and improved overall cardiac function after TAVR.

关键词： Anaesthetics Intravenous Propofol Analgesics Opioids Alfentanil sedation

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Patient stress and satisfaction when allowed the presence of an accompanying person during endoscopy

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Open Journal of Gastroenterology 2013年第1期3卷 78-83页

作者： Jesse Lachter Benjamin Ephraim Bluen Bruce and Ruth Rappaport Faculty of Medicine Technion-Israel Institute of Technology Haifa Israel

Introduction: Patients undergoing esophagogastroduodenoscopy (EGD) have variable stress and anxiety and therefore commonly receive medications as sedative-anxiolytics. These medications have small but significant risks. To possibly make procedures safer and to increase patient satisfaction, this study aimed to measure the effects of allowing an accompanying person (AP) to be present in the endoscopy suite during EGD. Patients and Methods: Forty-two patients were randomly divided into two groups who would either be or not be offered to have an AP during endoscopy. Spielberger’s well-validated state and trait anxiety evaluations were administered to patients before and after EGD. APs also completed questionnaires as to their reactions after EGD. Results: 84.2% of the patients after EGD recommended accompaniment. Patients who underwent EGD with an AP tended (p < 0.06) to have decreased measurable anxiety compared to patients who were not offered an AP. The benefit was significant for persons with higher levels of anxiety prior to EGD (p < 0.04). Patients undergoing EGD for the first time had significantly more anxiety than those with previous EGD experience (p < 0.034). There was no significant reduction in sedative dosage when APs were present. Conclusions: Offering to permit the presence of an accompanying person during EGD was often shown to improve patient satisfaction and reduce anxiety.

关键词： Endoscopy Escort sedation Satisfaction

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