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World Journal of Clinical Cases 2021年第25期9卷 7588-7592页

作者： Giyoung Yun Eunsoo Kim Jiseok Baik Wangseok Do Young-Hoon Jung Chang-Min You Department of anesthesia and pain Medicine Biomedical Research InstitutePusan National University HospitalBusan 49241South Korea Department of anesthesia and pain Medicine Pusan National UniversitySchool of MedicineYangsan 50612South Korea

BACKGROUND Zoster sine herpete(ZSH)can be misdiagnosed because there are no typical vesicular eruptions characterized by a dermatomal ***,incorrect treatment due to a misdiagnosis can lead to severe pain and fatal *** SUMMARY A 75-year-old woman complained of sudden onset right shoulder pain and atypical *** 18 d,sudden hearing loss occurred in the left *** serology tests conducted after the onset of hearing loss,varicella-zoster virus IgM was *** had no history of a rash or *** the suspicion of ZSH,antiviral treatment and stellate ganglion block were administered four times,and the pain was effectively *** Early diagnosis and treatment of ZSH can help not only by reducing pain but also by preventing fatal complications.

关键词： Zoster sine herpete Ophthalmic pain Burning pain Ultrasound-guided stellate ganglion block Case report

Awareness during emergence from anesthesia: Features and future research directions

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World Journal of Clinical Cases 2020年第2期8卷 245-254页

作者： Marco Cascella Sabrina Bimonte Nagoth Joseph Amruthraj anesthesia Section Department of Anesthesia and Pain MedicineIstituto Nazionale Tumori-IRCCS-Fondazione PascaleNapoli 80100Italy Department of Translational Medicine University VanvitelliNaples 80100Italy

The anesthesia awareness with recall(AAWR) phenomenon represents a complication of general anesthesia consisting of memorization of intraoperative events reported by the patient immediately after the end of surgery or at a variable distance from it. Approximately 20% of AAWR cases occur during emergence from anesthesia. Clinically, these unexpected experiences are often associated with distress especially due to a sense of paralysis. Indeed, although AAWR at the emergence has multiple causes, in the majority of cases the complication develops when the anesthesia plan is too early lightened at the end of anesthesia and there is a lack of use, or misuse, of neuromuscular monitoring with improper management of the neuromuscular block. Because the distress caused by the sense of paralysis represents an important predictor for the development of severe psychological complications, the knowledge of the phenomenon, and the possible strategies for its prophylaxis are aspects of considerable importance. Nevertheless, a limited percentage of episodes of AAWR cannot be prevented. This paradox holds also during the emergence phase of anesthesia which represents a very complex neurophysiological process with many aspects yet to be clarified.

关键词： Intraoperative awareness anesthesia awareness with recall Explicit memory Emergence from anesthesia Neuromuscular monitoring Butyrylcholinesterase deficiency

Axonal regeneration after spinal cord injury in zebrafish and mammals: differences, similarities, translation

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Neuroscience Bulletin 2013年第4期29卷 402-410页

作者： Katarina Vajn Jeffery A Plunkett Alexis Tapanes-Castillo Martin oudega departments of Physical Medicine & Rehabilitation University of Pittsburgh School of Science Technology and Engineering Management St. Thomas University departments of Neurobiology University of Pittsburgh departments of Bioengineering University of Pittsburgh

Spinal cord injury （SCl） in mammals results in functional deficits that are mostly permanent due in part to the inability of severed axons to regenerate. Several types of growth-inhibitory molecules expressed at the injury site contribute to this regeneration failure. The responses of axons to these inhibitors vary greatly within and between organisms, reflecting axons＇ characteristic intrinsic propensity for regeneration. In the zebrafish （Danio rerio） many but not all axons exhibit successful regeneration after SCI. This review presents and compares the intrinsic and extrinsic determinants of axonal regeneration in the injured spinal cord in mammals and zebrafish. A better understanding of the molecules and molecular pathways underlying the remarkable individualism among neurons in mature zebrafish may support the development of therapies for SCI and their translation to the clinic.

关键词： spinal cord injury axonal regeneration growth inhibition functional recovery zebrafish

Massive haemorrhage in liver transplantation:Consequences,prediction and management

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World Journal of Transplantation 2016年第2期6卷 291-305页

作者： Stuart Cleland Carlos Corredor Jia Jia Ye Coimbatore Srinivas Stuart A Mc Cluskey Department of anesthesia and pain management Toronto General HospitalUniversity Health Network Department of anesthesia University of Toronto

From its inception the success of liver transplantation has been associated with massive blood loss. Massive transfusion is classically defined as > 10 units of red blood cells within 24 h, but describing transfusion rates over a shorter period of time may reduce the potential for survival bias. Both massive haemorrhage and transfusion are associated with increased risk of mortality and morbidity(need for dialysis/surgical site infection) following liver transplantation although causality is difficult to prove due to the observational design of most trials. The blood loss associated with liver transplantation is multifactorial. Portal hypertension secondary to cirrhosis results in extensive collateral circulation, which can bleed during hepatectomy particular if portal pressures are increased. Avoiding volume loading and maintenance of a low central venous pressure together with the use of vasopressors have been shown to reduce blood loss and transfusion during liver transplantation, but may increase the risk of renal impairment post-operatively. Coagulation defects may be present pre-transplant, but haemostasis is often re-balanced due to a deficit in both proand anti-coagulation factors. Further derangement of haemostasis may develop in the anhepatic and neohepatic phases due to absent hepatic metabolic function, hyperfibrinolysis and platelet sequestration in the donor liver. Point-of-care tests of coagulation such as the viscoelastic tests rotation thromboelastometry/thromboelastometry allow and more accurate and rapid assessment of these derangements in coagulation and guide the use of factor replacement and antifibrinolytics. Transfusion protocols guided by these tests have been shown to reduce transfusion rates compared with conventional coagulation tests, but have not shownimprovements in mortality or morbidity. Pre-operative factors associated with massive transfusion include previous surgery, re-do transplantation, the aetiology and severity of liver disea

关键词： Liver transplantation Massive transfusion Coagulopathy

Effect of Ketamine Instillation on Acute and Chronic Post Mastectomy pain, a Dose Finding Clinical Study

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Open Journal of Anesthesiology 2022年第4期12卷 146-159页

作者： Fatma El Sherif Hany Elmorabaa Khaled Mohamed Fares Sahar Abdel-Baky Mohamed Nourhan M. Elgalaly Khalid Rezk Moaaz Tohamy Department of anesthesia ICU and Pain Management South Egypt Cancer Institute Assiut University Assiut Egypt Department of anesthesia ICU and Pain Management Faculty of Medicine Assuit University Assiut Egypt

Background: Uncontrolled acute postoperative pain is considered a risk factor for the development of chronic pain afterward. Objectives: To explore the most effective dose of ketamine instillation (1 of 3 doses: 1, 2, or 3 mg/kg) for acute and chronic post mastectomy pain (PMP). Methods: Ninety female patients with cancer breast, aged (18 - 60 yrs), weighted (50 - 90 kg), scheduled for modified radical mastectomy, randomly allocated into 3 groups to receive ketamine instillation after surgical homeostasis before wound closure (1 of 3 doses;1, 2, or 3 mg/kg as A, B or C groups respectively) patients were followed up for 48 h for acute pain (total morphine consumption, the first request of analgesia and visual analog scale at rest and movement (VASR/M), chronic pain by Leeds assessment of neuropathic signs and symptoms (LANSS) for six-months, hemodynamics, and side effects. Results: Median total dose of morphine consumption was 8 mg (5 - 10) versus 6 mg (6 - 7) in A and B groups respectively in the first 48 h postoperatively. Lowest VASR/M was recorded in C then B and lastly A group (P = 0.037). No patients in the C group requested analgesia versus thirty (100%) and nine (30%) patients in the A and B groups respectively with the first request of analgesia was 12 h (5 - 36) in the A group versus 30 h (12 - 36) in the B group respectively (P Conclusion: Ketamine instillation effectively controlled acute post mastectomy pain (PMP) in a dose-dependent manner and reduced the incidence and severity of chronic pain in patients who undergoing a modified radical mastectomy.

关键词： Acute pain Breast Cancer Chronic pain Ketamine Instillation Modified Radical Mastectomy

An Easy Way for Percutaneous Nephrolithotomy Using Mixed Sedative Agents

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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

Effect of Head Position on the Success Rate of Blind Intubation through Air Q Laryngeal Mask in Morbidly Obese Patients

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Open Journal of Anesthesiology 2017年第8期7卷 240-252页

作者： Mona Hossam Eldin Abdelhamid Sahar Sayed Ismail Badawy Norhan Abdel Alim Ali Ramy Melad Ramzy Aziz Department of anesthesia Critical Care and Pain Management Faculty of Medicine Cairo University Cairo Egypt

Aim: To evaluate the effect of head positioning whether neutral or sniffing position on the conduct of intubation through air Q in morbidly obese patients. Patients and method: This study was conducted on 90 patients with body mass index equal or above 40 who were scheduled for surgery under GA and were randomly divided into 2 equal groups: Group N (Gn) in which blind intubation through air Q was done in neutral position. Group S (Gs) in which blind intubation was done in sniffing position. Proper airway assessment of the patients was done. Basic monitoring was attached;Induction of anaesthesia was achieved by Fentanyl 2 ug/kg, Propofol 1.5 - 2.5 mg/kg and Atracurium 0.5 mg/kg. Maintenance of anaesthesia was achieved by Sevoflurane, Atracurium, oxygen and air. When neuromuscular blockade was complete, the head of the patient was adjusted according to their group. The supraglottic device was inserted and connected to capnography, thereafter a well lubricated proper sized ETT was passed through the air Q. We recorded a baseline reading of HR, SBP, DBP, MBP, and oxygen saturation. A second reading was taken after induction of anesthesia, just before intubation. The third reading was recorded after intubation while further readings were measured 1, 3, 5, 10, 15 min after intubation. After ETT removal, we observed the patients in the recovery room at 0, 3 & 24 hours for possible postoperative complications. Results: There was no statistical difference between the two groups regarding the demographic data. Although the intubation in sniffing position has a higher success rate from the first time than the neutral position, the results were statistically insignificant, regarding the mean duration of blind intubation trials through the Air Q and postoperative complications. Conclusion: Although the sniffing position improves glottic visualization, the change of head position had no effect on the success rate of blind intubation through air Q in obese patients.

关键词： Air Q Head Position Obese Patient Intubation

The Impact of Total Intravenous Propofol Anaesthesia versus Sevoflurane Anaesthesia on Perioperative pain in Patients Undergoing Colonic Cancer Surgery

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Open Journal of Anesthesiology 2021年第1期11卷 1-11页

作者： Bahaa Gamal Saad Samy Abdelrahman Amr Ashraf Amin Mohammed Montaser Abdelfattah Mohammed Department of anesthesia Intensive Care and Pain Management South Egypt Cancer Institute Assuit University Assuit Egypt

Background: Cancer colon is one of the most common malignancies. After colon cancer surgery patients may experience severe pain. Several studies have reported that a significant decrease in postoperative pain with propofol while other studies have showed this effect was not significant. Aim: Our goal was to assess the effect of combined epidural anaesthesia either with propofol or sevoflurane on intraoperative fentanyl consumption and postoperative pain in patients undergoing open surgical resection of colon cancer. Patients and Methods: 48 adult patients suffering from cancer colon scheduled for open surgical resection randomly allocated either to receive epidural-propofol by total intra venous anaesthesia (TIVA) (n = 24) or epidural-sevoflurane

关键词： Cancer Colon Epidural anesthesia Propofol Sevoflurane Postoperative pain

Comparative study of caudal bupivacaine versus bupivacaine with tramadol for postoperative analgesia in paediatric cancer patients

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The Chinese-German Journal of Clinical Oncology 2013年第3期12卷 118-122页

作者： Mohammed Hegazy Ayman A.Ghoneim anesthesia & pain management Department National Cancer InstituteCairo UniversityCairoEgypt

Objective:Caudal epidural analgesia has become very common analgesic technique in paediatric *** tramadol to bupivacaine for caudal injection prolongs duration of analgesia with minimal side *** aim of the study was to investigate the different effects of caudal bupivacaine versus bupivacaine with thamadol for postoperative analgesia in paediatric cancer ***:A prospective randomized controlled trial was conducted over 40 paediatric cancer patients who were recruited from Children Cancer Hospital of Egypt(57357 Hospital).Patients were randomized into 2 groups:bupivacaine group(group B,20 patients) to receive single shot caudal block of 1 mL/kg 0.1875% bupivacaine;tramadol group(group T,20 patients) prepared as group B with the addition of 1 mg/kg caudal ***:The mean duration of analgesia was significantly longer among group T than group B [(24 ± 13.7) hours versus(7 ± 3.7) hours respectively with P = 0.001].Group T showed a significantly lower mean FLACC score than group B(2.2 ± 0.9 versus 3.6 ± 0.6 with P = 0.002).The difference in FLACC score was comparable on arrival,and after 2 and 4 *** 8 and 12 hours the group B recorded significantly higher scores(P = 0.002 and 0.0001 respectively).There were no significant differences between the groups as regards sedation score [the median in both groups was 1(0-1) with P value = o.8].No one developed facial flush or ***:Caudal injection of low dose tramadol 1 mg/kg with bupivacaine 0.1875% is proved to be effective,long standing technique for postoperative analgesia in major paediatric cancer surgery and almost devoid of side effect.

关键词： caudal bupivacaine tramadol paediatric analgesia

The analgesic effect of preoperative pregabalin in radical cystectomy for cancer bladder patients

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The Chinese-German Journal of Clinical Oncology 2013年第3期12卷 113-117页

作者： Ayman A.Ghoneim Mohammed M.Hegazy anesthesia and pain management Department National Cancer InstituteCairo UniversityCairoEgypt

Objective:After the pregabalin has been approved for the treatment of neuropathic pain,preliminary clinical studies suggested a possible role in the perioperative *** our knowledge,It has never been studied the perioperative analgesic effect of pregabalin in patients with cancer *** this study,we hypothesized that cancer bladder patients undergoing radical cystectomy and received oral pregabalin 75 mg twice daily for ten days preoperatively would get their postoperative pain ***:Sixty patients scheduled for elective radical cystectomy were randomly assigned to one of 2 groups(control group or pregabalin group).Patients in the pregabalin group received 75 mg pregabalin twice daily for ten days before *** anesthesia protocol was applied to all *** intensity,opioid consumption,level of sedation and other side effects were regularly assessed for 48h ***:Mean time for the first request of analgesia was statistically longer in pregabalin ***,mean morphine consumption,VAS scores at rest(in the first 32h postoperatively),VAS scores during movement(in the first 20h postoperatively) were statistically significant lower in the pregabalin group than those in the control *** in the pregabalin group were statistically more sedated in the first four hours postoperative than the control ***:Preoperative pregabalin 75 mg twice daily for ten days resulted in 60% reduction in 24h postoperative morphine requirements in patients undergoing radical cystectomy.

关键词： pregabalin lyrica cancer bladder acute postoperative pain