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Pressure of Local Anesthetic Solution While Performing Sciatic Nerve Blockade in Human Subgluteal Area

Open Journal of anesthesiology 2014年第11期4卷 276-280页

作者： Zakhar Kokhan Andrei Brukhnou Aliaksei Marochkov Valery Piacherski department of Anaesthesiology and Intensive Care Mogilev Regional Hospital Mogilev Republic of Belarus

Intraneural introduction of local anesthetic belongs to the existing complications of peripheral nerves blockades. The damage of peripheral nerves is associated with the damaging effect of the injection needle and with the pressure caused by the introduction of local anesthetic. Purpose: Determine the pressure of the local anesthetic in fascial compartment of the sciatic nerve during his administration in the blockade of the sciatic nerve subgluteal access. Materials and Methods: Submitted blockade of the sciatic nerve subgluteal access in 22 patients with peripheral nerve electrostimulation under ultrasound guidance. To measure interstitial pressure system was used with the inclusion of a probe invasive blood pressure. Results: During the introduction of 1 ml in the fascial compartment of the sciatic nerve, the pressure of 0.77 psi (40 mmHg) was registered. In the course of the further introduction of local anesthetic up to 13 ml, the pressure did not alter validly (p > 0.05) and its average was 40 (35;45) mmHg or 0.77 (0.68;0.87) psi. This is the first study that has allowed to determine the pressure of local anesthetic in the fascial compartment of the sciatic nerve at the time of its introduction, the blockade of the sciatic nerve subgluteal access for the first time determined the probable maximum pressure intraneural injection of local anesthetic. The disadvantage of this study is that it is impossible to measure the pressure of administration over 5.8 psi (300 mmHg), and the lack of opportunity to assess the intraneural blood flow in the sciatic nerve during the creation of such pressure.

关键词： Peripheral Blockade Sciatic Nerve Pressure of the Local Anestnetiс Ultrasound Guidance

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全胚冷冻周期患者不同冻融胚胎移植次数的临床妊娠结局分析

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中华妇幼临床医学杂志（电子版） 2017年第5期13卷 569-573页

作者：吕芳于鲁华王丽萍李雪丽许琳陈芳朱春辉刘凯峰张辰望王力张晓梅江苏省苏北人民医院/扬州大学临床医学院妇产科生殖医学中心 225001 江苏省苏北人民医院/扬州大学临床医学院妇产科生物样本库 225001 department of anesthesiology & Perioperative Medicine MD Anderson Cancer CenterUniversity of Texas

目的探讨同一促排卵周期全胚冷冻患者,冻融胚胎移植(FET)次数与临床妊娠率的关系。方法选择2012年1月至2016年9月在苏北人民医院生殖医学中心实施全胚冷冻后FET的807例患者为研究对象,按照FET累计次数不同,将FET累计1次者纳入A组(n=543)... 详细信息

目的探讨同一促排卵周期全胚冷冻患者,冻融胚胎移植(FET)次数与临床妊娠率的关系。方法选择2012年1月至2016年9月在苏北人民医院生殖医学中心实施全胚冷冻后FET的807例患者为研究对象,按照FET累计次数不同,将FET累计1次者纳入A组(n=543),FET累计2次者纳入B组(n=181),FET累计3次者纳入C组(n=63),FET累计4次者纳入D组(n=20)。回顾性分析807例患者的一般临床资料、移植周期资料以及累计临床妊娠率、临床妊娠率。结果 (1)4组患者的年龄、不孕年限、人体质量指数(BMI)、不孕类型构成比、不同因素全胚冷冻率构成比、基础卵泡刺激素(FSH)水平、基础黄体生成素(LH)水平、基础雌二醇水平、基础睾酮水平、基础窦卵泡数(AFC)、获卵数、减数第2次分裂中期(MⅡ)卵母细胞数、正常受精率、同一取卵周期可移植胚胎数等比较,差异均无统计学意义(P>0.05)。(2)各组患者胚胎移植日子宫内膜厚度、移植胚胎数、优质胚胎率及内膜准备方案中人工周期率比较,差异均无统计学意义(P>0.05)。(3)4组患者累计临床妊娠率分别为64.5%、60.0%、58.7%、60.0%,组间比较,差异无统计学意义(χ~2=1.67,P=0.64)。4组患者临床妊娠率依次为64.5%、36.5%、25.1%、18.8%,组间比较,差异有统计学意义(χ~2=143.02,P<0.01)。结论同一促排卵周期增加FET次数,全胚冷冻患者累计临床妊娠率无显著变化。同时首次进行FET未妊娠者,随着FET次数增加,临床妊娠率显著降低。

关键词：玻璃化冷冻胚胎移植卵母细胞妊娠率妇女

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Early immune response in post endoscopic retrograde cholangiopancreatography pancreatitis as a model for acute pancreatitis

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World Journal of Meta-Analysis 2019年第3期7卷 96-100页

作者： Ivana Plavsic Ivana Zitinic Vera Tulic Goran Poropat Marinko Marusic Goran Hauser department of anesthesiology and Critical care medicine Clinical Hospital CentreMedical FacultyUniversity of Rijeka department of Emergency Medicine Clinical Hospital Centre department of Internal Medicine Division of GastroenterologyClinical Hospital CentreMedical FacultyMedical Faculty RijekaUniversity of Rijeka department of Internal Medicine Division of GastroenterologyClinical Hospital Sv.DuhZagrebFaculty of Health StudiesUniversity of Rijeka department of Internal Medicine Division of GastroenterologyClinical Hospital CentreMedical FacultyFaculty of Health StudiesUniversity of Rijeka Medical Faculty Osijek University of J.J.Stossmayer

This opinion review summarizes comparison of clinical presentation and immunology of post-endoscopic pancreatitis and acute pancreatitis(AP) of other *** rationale for this topic was found in studies that mention differences in clinical presentation between these entities,stating that severe form of AP after endoscopic retrograde cholangiopancreatography was more severe than AP of other *** difference in clinical presentation may have a background in different immunology that needs to be further investigated.

关键词： Innate immunity Pancreatitis immunology Post endoscopic retrograde cholangiopancreatography pancreatitis

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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

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Adenosine or Magnesium Sulphate as Adjuvants for Pectoral Nerves Block in Modified Radical Mastectomy: A Randomized Controlled Trial

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Open Journal of anesthesiology 2018年第5期8卷 159-171页

作者： Ezzeldin Saleh Ibrahim Wesameldin Abdelrahman Sultan department of Anaesthesia and Intensive care Faculty of Medicine Menoufia University Shebeen El Kooom Egypt

Introduction: Magnesium sulphate can prolong the effect of local anaesthetics. Adenosine has not been compared to other local anaesthetics adjuvants. In the present study we aimed to compare the effect of adding magnesium sulphate and adenosine to bupivacaine for pectoral nerves block. Patients and Methods: In this randomized controlled trial, 90 females scheduled for breast surgery were included. Patients were divided into three groups. Patients received general anaesthesia with pectoral nerves block. Group C, A, and M had bupivacaine only, bupivacaine + adenosine, and bupivaciane + magnesium sulphate respectively. Post-operative visual analogue score, block duration, post-operative morphine consumption, sedation score, and peri-operative haemodynamic changes were recorded. Results: Visual analog score was lower in Group M compared to other groups. Group A and M showed significant longer duration of the block. Group M showed significant longer duration of action than Group A (p = 0.034). The total peri-operative morphine used was higher in Group C (p 0.05). Conclusions: Local anaesthetic adjuvants such as adenosine or magnesium sulphate can improve pectoral nerves block characteristics. Magnesium sulphate has an advantage over adenosine by increasing the block duration.

关键词： PECS Block Adenosine Magnesium Sulphate

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The Effect of Nitrous Oxide on the Intraocular Pressure in Patients Undergoing Abdominal Surgery under Sevoflurane and Remifentanil Anesthesia

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Open Journal of anesthesiology 2016年第6期6卷 85-90页

作者： Toru Goyagi Takehito Sato Takashi Horiguchi Toshiaki Nishikawa department of Anesthesia and Intensive Care Medicine Akita University Graduate School of Medicine Akita Japan

Introduction: Although inhalational anesthesia and nitrousoxide (N2O) are known to affect the intraocular pressure (IOP), little is known about the effect of nitrousoxide on the IOP during sevoflurane and remifentanil anesthesia. In the present study, we examined the effect of balanced anesthesia on the IOP. Materials and Methods: After obtaining informed consent, the patients undergoing abdominal surgery under general anesthesia were divided into two groups: N2O group (n = 10) and control group (n = 12). General anesthesia was maintained with remifentanil (0.05 - 0.3 μg/kg/min), 33% O2 and 1.2% sevoflurane to keep ETCO2 of 35 - 40 mmHg following tracheal intubation. After baseline measurement of IOP (T0, 20 minutes after injection of anesthesia), the patients in the N2O group received 67% nitrousoxide, and the patients in the control group received air, with O2 and 1.2% sevoflurane. Then, IOP was measured at 1 hour (T1), 2 hours (T2), and 3 hours (T3) after anesthesia induction in the supineposition. Blood pressure and heart rate were recorded at the same time interval. Results: There was no significant difference in the IOP at any period between the two groups. In both groups, the IOP at the T3 was significantly higher than that at T0. Conclusion: These results suggest that N2O does not affect the IOP in patients undergoing abdominal surgery under sevoflurane and remifentanil anesthesia.

关键词： Intraocular Pressure Nitrous Oxide Balanced Anesthesia

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Challenges of Improving Intensive Care Medicine in Eritrea: Impact of an Italian Cooperative Project of Educational and Clinical Support

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Open Journal of anesthesiology 2013年第7期3卷 315-319页

作者： Valentina Anichini Giovanni Zagli Hagos Goitom Giovanni Cianchi Andrea Cecchi Lucia Perretta Emanuele Bigazzi Barbara Gazzini Simone Proietti Alessandro Di Filippo Simone Toccafondi Gianfranco Gensini Giancarlo Berni Adriano Peris Anesthesia and Intensive Care Unit of Emergency department Careggi Teaching Hospital Florence Italy Anesthesia and Intensive Care Faculty of Medicine University of Florence Florence Italy department Intensive Care Unit Orotta National Referral Hospital Asmara Eritrea department of Critical Care Medicine and Surgery Careggi Teaching Hospital Florence Italy First Aid of Emergency department Careggi Teaching Hospital Florence Italy Tuscany Region Sanitary System Florence Italy.

Intensive care in Africa is available only in teaching or referral hospitals. Here we report the experience of a multidisciplinary collaboration between physicians and nurses of the Emergency department (First Aid and Intensive Care Unit) of a tertiary referral hospital (Careggi Teaching Hospital, Florence, IT) and physicians and nurses of Orotta National referral Hospital in Asmara, Eritrea. The project was aimed at performing clinical assistance and training on the job to the local staff to improve the standard of care in the local Emergency department. The duration of the project was initially planned to be 30 months, but unfortunately it was interrupted after 18 months because of lack of funds. The Italian staff was composed of two physicians and two nurses per period. To monitor local ICU activity, a retrospective survey of 36 months was performed. During the 36 months of data collection, 1169 patients were admitted to the ICU. Intra-ICU mortality rate resulted comparable before, during, and after Italian presence. On the contrary, the 28-day mortality resulted significantly lower bo th during and after the Italian stay. After project interruption, the Italian staff maintained contact with the Eritrean ICU personnel, who were invited to attend the Italian ICU for one month per year, and collected information about Orotta ICU activities.

关键词： Intensive Care Unit Developing Countries MEWS

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Preoperative Oral Sedation with Midazolam and Paracetamol vs Sedation Nasally with Midazolam and Ketamine for Children Scheduled for Dental Treatment

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Open Journal of anesthesiology 2017年第7期7卷 184-193页

作者： Walid Y. Kamel Aktham A. Shoukry department of Anaesthesia ICU and Pain Management Faculty of Medicine Ain Shams University Cairo Egypt

Background: Preoperative anxiety is common among children. It can result in adverse physiological and psychological outcomes. Pharmacological and non-pharmacologic techniques used preoperatively to decrease anxiety and improve cooperation in pediatric patients. The extent of an individual child’s risk for stress reflects genetics, personality, parenting, and previous life experience. Children 1 to 5 years of age are at the highest risk for extreme preoperative anxiety. Material and methods: The study is a double blinded clinical trial that conducted in Ain Sham University on 90 children for pulpotomy in the period from august 2015 to may 2017 after approval of the ethical committee and informed written consent from the guardians. The patients were divided randomly into two groups. Fifteen min. before the procedure, In group O, midazolam/paracetamol at a dose of 0.5 and 15 mg/kg respectively was given orally. In group N, midazolam/Ketamine 0.5 mg/kg and 10 mg/kg sprayed nasally. Ramsay sedation scale, child separation, mask acceptance, Aldrete’s scoring system, postanesthetic discharge criteria and parent satisfaction scores were recorded. Results: group N showed more smooth parenteral separation [88.9 vs 8.9%] and better tolerance to the face mask “scale 1” [73.3% vs 22.2%] meanwhile the PACU discharge [88.9% vs 66.7%] and the hospital discharge [77.8% vs 46.7%] were earlier in group O with a higher satisfaction score [77.7% vs 22.2%]. Conclusion: The combination of midazolam/paracetamol is orally comparable to the combination of midazolam/ket-amine nasally;however “midazolam/paracetamol” achieves a higher parents satisfaction and earlier postoperative discharge.

关键词： Sedation Children Discharge Dental Oral Nasal

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Comparison of Hemodynamic Responses Associated with Tracheal Intubation Under Various Induction Doses of Remifentanil and Propofol

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Open Journal of anesthesiology 2012年第4期2卷 154-160页

作者： Toru Goyagi Masashi Yoshimoto department of Anesthesia and Intensive Care Medicine Akita University Graduate School of Medicine Akita Japan

.Background: The optimal dose of propofol and remifentanil induction to minimize the cardiovascular response associated with tracheal intubation may exist. We investigated the cardiovascular response associated with tracheal intubation when various continuous induction doses of remifentanil in combination with propofol were used. Methods: Seventy- five patients were randomly allocated into 1 of 3 groups: the R-0.4 P-1 group (remifentanil 0.4 μg/kg/min and propofol 1 mg/kg);the R-0.5 P-1 group (remifentanil 0.5 μg/kg/min and propofol 1 mg/kg);and the R-0.4 P-2 group (remifentanil 0.4 μg/kg/min and propofol 2 mg/kg). One minute after remifentanil infusion commenced, a bolus of propofol was injected. Rocuronium 1 mg/kg was administered 1 min after propofol injection following loss of consciousness. Controlled ventilation was then performed for 2 min, and the trachea was intubated 4 min after the start of the remifentanil infusion. The infusion rate of remifentanil was decreased to 0.1 μg/kg/min after intubation. Blood pressure (BP) and heart rate (HR) were measured during this period until 5 min after tracheal intubation. Results: The changes in BP response due to tracheal intubation in the R-0.4 P-1 group were greater than those in the other 2 groups, whereas the HR responses to tracheal intubation were similar among the 3 groups. Conclusion: The combination of remifentanil 0.4 μg/kg/min and propofol 1 mg/kg led to an exaggerated cardiovascular response to tracheal intubation compared with the other combination groups.

关键词： Remifentanil Propofol Tracheal Intubation Presser Response

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Two surgical pathways for isolated hip fractures:A comparative study

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World Journal of Orthopedics 2023年第6期14卷 399-410页

作者： Alexander A Fokin Joanna Wycech Knight Maral Darya Ryan Stalder Ivan Puente Russell D Weisz Trauma and Critical Care Services Delray Medical CenterDelray BeachFL 33484United States department of Surgery Charles E.Schmidt College of MedicineFlorida Atlantic UniversityBoca RatonFL 33431United States Trauma and Critical Care Services Broward Health Medical CenterFort LauderdaleFL 33316United States Charles E.Schmidt College of Medicine Florida Atlantic UniversityBoca RatonFL 33431United States department of Surgery Herbert Wertheim College of MedicineFlorida International UniversityMiamiFL 33199United States department of Orthopedics South Palm OrthopedicsDelray BeachFL 33445United States

BACKGROUND Hip fractures(HF)are common among the aging population,and surgery within 48 h is *** can be hospitalized for surgery through different pathways,either trauma or medicine admitting *** To compare management and outcomes among patients admitted through the trauma pathway(TP)vs medical pathway(MP).METHODS This Institutional Review Board-approved retrospective study included 2094 patients with proximal femur fractures(AO/Orthopedic Trauma Association Type 31)who underwent surgery at a level 1 trauma center between *** were 69 patients admitted through the TP and 2025 admitted through the *** ensure comparability between groups,66 of the 2025 MP patients were propensity matched to 66 TP patients by age,sex,HF type,HF surgery,and American Society of anesthesiology *** statistical analyses included multivariable analysis,group characteristics,and bivariate correlation comparisons with theχ^(2)test and *** After propensity matching,the mean age in both groups was 75-years-old,62%of both groups were females,the main HF type was intertrochanteric(TP 52%vs MP 62%),open reduction internal fixation was the most common surgery(TP 68%vs MP 71%),and the mean American Society of anesthesiology score was 2.8 for TP and 2.7 for *** majority of patients in TP and MP(71%vs 74%)were geriatric(≥65-years-old).Falls were the main mechanism of injury in both groups(77%vs 97%,P=0.001).There were no significant differences in pre-surgery anticoagulation use(49%vs 41%),admission day of the week,or insurance *** incidence of comorbidities was equal(94%for both)with cardiac comorbidities being dominant in both groups(71%vs 73%).The number of preoperative consultations was similar for TP and MP,with the most common consultation being cardiology in both(44%and 36%).HF displacement occurred more among TP patients(76%vs 39%,P=0.000).Time to surgery was not statistically different(23 h in both),but length of surgery was sig

关键词： Isolated hip fractures Admitting service Trauma center Time to surgery American Society of Anesthesiologists score Preoperative consultations

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