Devalina GOSWAMI, Arijit SARDAR, Dalim Kumar BAIDYA, Rahul YADAV, Ongkila BHUTIA, Ajoy ROYCHOUDHURY
Devalina GOSWAMI, Arijit SARDAR, Dalim Kumar BAIDYA, Rahul YADAV, Ongkila BHUTIA, Ajoy ROYCHOUDHURY
Objective: This trial investigated the post operative analgesic efficacy of oarl etoricoxib 90 mg and 120 mg and a placebo in mandibular fracture
pain model.
Methods: A total of 63 adult patients with mandibular fractures who were scheduled to undergo maxillofacial surgery were randomly allocated
to receive etoricoxib 90 mg, etoricoxib 120 mg and a placebo 1 hour before the surgery. Patients were followed-up till 24 hours after the surgery.
Duration of analgesia, intra-operative and post-operative analgesic requirement, pain score, post-operative patient satisfaction and adverse
effects were measured.
Results: The baseline demographic parameters were similar in all the groups. Duration of analgesia was longer in both the E120 (6.00±0.816
hours) and E90 (4.37±1.008 hours) groups (p<0.05) as compared to the placebo group (2.60±0.821 hours). Mean difference of duration of
analgesia between E120 and E90 was 1.62 (95% confidence interval: 0.234–3.484; p>0.05). Post-operative pain intensity was significantly lower
in both the E120 and E90 groups as compared to the C group. Both the etoricoxib groups required less intra-operative (p=0.002) and post-operative (p=0.001) analgesic supplementation as compared to the placebo group. The patient satisfaction score and rate of occurrence of significant
adverse effects were similar among all the three groups.
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Alkin ÇOLAK, Ümit Nusret BAŞARAN, Elif ÇOPUROĞLU, Fatih SAĞ, Zafer ÇAKICI, Güven KIRAY
Alkin ÇOLAK, Ümit Nusret BAŞARAN, Elif ÇOPUROĞLU, Fatih SAĞ, Zafer ÇAKICI, Güven KIRAY
Although hepatoblastoma is rare, it is the most malignant tumour of childhood. Treatment is usually done by surgical resection and chemotherapy. The mortality and morbidity have decreased due to improvements in the treatments. In this process, hepatic resection has a risk of pulmonary embolism, and this condition could be fatal. In this case, a 9-month-old patient who was treated with chemotherapy and then underwent
hepatectomy was presented. We used non-invasive methods such as the perfusion index (PI), the plethysmographic variability index (PVI) (Massimo Radical 7) and non-invasive total haemoglobin measurement (SpHb) rather than invasive measurements. During closure of the surgical
skin incision, the end-tidal CO2
(ETCO2
) value dropped, after which arrhythmia and bradycardia resulted in cardiac arrest. Cardiopulmonary
resuscitation (CPR) was initiated. However, the patient did not respond to CPR. We concluded that heparin may be administered to reduce the
risk of thrombosis in patients undergoing liver surgery.
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Ibrahim Ibrahim Abd ELBASER, Ahmad Abd El Aleem EL DERIE
Ibrahim Ibrahim Abd ELBASER, Ahmad Abd El Aleem EL DERIE
Objective: The aim of the present study was to evaluate the efficacy of inhaled milrinone in controlling pulmonary arterial hypertension (PAH)
in paediatric cardiac surgery and its effect on weaning from cardiopulmonary bypass (CPB).
Methods: A total of 40 patients with congenital heart diseases complicated by PAH submitted to cardiac surgery requiring CPB were included
in the present study and were randomly classified into the control group (n=20) who received intravenous milrinone 0.5 μg kg-1 min-1 and the
inhaled group (n=20) who received inhaled milrinone 50 μg kg-1 before initiation and just before weaning off CPB. Mean pulmonary artery
pressure (mPAP), mean systemic arterial pressure (MAP), heart rate (HR), MAP/mPAP ratio, vasoactive drug requirements and time needed to
wean the patients from CPB were collected.
Results: mPAP and HR were significantly lower, and MAP and MAP/mPAP ratio were significantly higher in the inhaled group than in the
control group. Vasoactive drug requirements were significantly lesser, and the time needed to wean the patients was significantly shorter in the
inhaled group than in the control group.
Conclusion: Milrinone inhalation facilitated the weaning from CPB as it significantly reduced mPAP and maintained MAP with subsequently
less needs for vasoactive drugs.
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Devalina GOSWAMI, Neisevilie NİSA, Ankur SHARMA, Vatsala DADHWAL, Dalim Kumar BAIDYA, Mahesh ARORA
Devalina GOSWAMI, Neisevilie NİSA, Ankur SHARMA, Vatsala DADHWAL, Dalim Kumar BAIDYA, Mahesh ARORA
Objective: Outpatient hysteroscopy is often accompanied by pain and discomfort along with frequent occurrence of bradycardia and
hypotension. This study aimed to observe if intravenous low-dose ketamine reduces the pain scores along with lowering the incidence of
bradycardia and hypotension during hysteroscopy.
Methods: This prospective, randomised, double-blind trial was conducted in operating rooms in a tertiary care hospital. In this study, we
enrolled 72 patients with American Society of Anesthesiologists status I to II undergoing hysteroscopy. We randomised patients into two
groups, and both groups received paracervical block. The control group received intravenous pentazocine and promethazine along with
saline infusion. The ketamine group received ketamine infusion (0.75 mg kg−1 bolus followed by infusion at the rate of 10 mcg kg−1 min−1). We
analysed visual analogue scale (VAS), rescue analgesic consumption, hemodynamic parameters, lowest recorded heart rate, blood pressure,
level of sedation, patient’s comfort, surgeon’s satisfaction and nursing staff’s satisfaction.
Results: Analysis of the data revealed that the pain scores were similar in both the groups (p=0.493, p<0.001). Rescue analgesic was required
by 47% patients in control group, compared to only 5.6% patients in ketamine group. Episodes of bradycardia and hypotension were more
pronounced in the control group than in the ketamine group [77.4±10.9 vs. 78.4±5.5; 67.6±8 vs. 70.1±6 respectively] (p<0.001). Patient
comfort and surgeon’s satisfaction were higher in the ketamine group, but nursing satisfaction was higher in the control group. Disorientation
was present in 75% patients in the ketamine group as compared to none in the control group.
Conclusion: We concluded that low-dose ketamine in day-care hysteroscopy is an effective and safe agent.
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Khadija Al ALAYWA, Romain JOUFFROY, Christine Le BELLER, Jean-herlé RAPALEN, Lionel LAMHAUT, Agnes Lillo Le LOUET, Frederic BAUD
Khadija Al ALAYWA, Romain JOUFFROY, Christine Le BELLER, Jean-herlé RAPALEN, Lionel LAMHAUT, Agnes Lillo Le LOUET,
... Devamını oku
Objective: Toxicological analysis (TA) is advised when assessing the prognosis and the treatment of drug overdose patients. Apart from this use,
the value of TA has remained unclear. This study aimed at defining the value of TA regarding the toxicological diagnosis in severe overdose cases
that involved addictive or recreational drugs (ARDs) that were used either alone or in combination with medicinal drugs.
Methods: The patients who were enrolled in the study had been admitted to our intensive care unit for the treatment of poisoning. TA was performed using advanced technologies such as mass spectrometry of blood/urine on admission. An occurrence indicated the supposed ingestion
of a defined substance. Patients were included in a group depending on the combination of the occurrences of supposed ingested drugs (SID)
and the results of the 1) TA: SID+, TA+; 2) SID+, not searched by TA; 3) SID-, TA+.
Results: There were 224 occurrences of 90 substances in 70 patients. ARDs were present in 30 patients (43%). ARD accounted for 24 occurrences in the SID+, TA+ group, 10 occurrences in the SID+, not searched group and 196 occurrences in the SID-, TA+ group. In the SID+,
TA+ group, 9 occurrences (69%) of ethanol were confirmed by TA. Ingestion of ethanol was invalidated in 4 occurrences (31%). In the patients
who denied ethanol ingestion, TA confirmed the non-ingestion of ethanol using 30 blood measures (81%). Ethanol was involved in 57% of the
patients, being the lone substance in only 1 case.
Conclusion: In drug overdose instances that result in organ failure(s) and involve ARDs, self-reporting is of limited value in assessing the patients’ exposure to ARD. Multiple consumptions expose patients to unexpected drug interactions.
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Anju GUPTA, Nishkarsh GUPTA
Anju GUPTA, Nishkarsh GUPTA
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Mehmet CANTÜRK, Nazan KOCAOĞLU, Meltem HAKKI
Mehmet CANTÜRK, Nazan KOCAOĞLU, Meltem HAKKI
Objective: The aim of this study was to assess the accuracy and precision of the actual epidural depth (ND) and ultrasound (US) estimates
of the distance from the skin to the epidural space in the transverse median plane (ED/TM) and paramedian sagittal oblique plane (ED/
PSO) in patients who were not pregnant and who were undergoing unilateral inguinal hernia repair surgery under combined spinal epidural
anaesthesia.
Methods: A total of 100 patients with the American Society of Anaesthesiology status I–III of either gender were recruited. All epidurals were
inserted at the L3–4 intervertebral space, and the epidural needle was marked with a sterile marker. The ND was measured between the marker
and the tip of the needle. The ED/TM and ED/PSO were assessed with a 2–5 MHz curved array probe at the L3–4 intervertebral space. The
Pearson correlation coefficient and Lin’s concordance correlation coefficient were used to assess the precision and the Bland–Altman test was
used to assess the 95% limit of agreement.
Results: The ND was 48.98±6.91 mm, the ED/PSO was 48.92±6.91 mm and the ED/TM was 48.90±6.91 mm. The Pearson correlation
coefficient between ND and ED/PSO was 0.995 (p<0.001) and 0.994 (p<0.001) with ED/TM. Lin’s concordance correlation coefficient for ND
and ED/PSO was 0.995 (95%CI [confidence interval]: 0.992–0.997), and 0.993 for ND and ED/TM (95% CI: 0.990–0.996). The 95% limit of
agreement between ND and ED/PSO was 0.70–1.37, and for ND and ED/TM, it was 0.79–1.54.
Conclusion: Preprocedural ultrasound (US) scanning in both planes provides reliable estimates for actual epidural depth in non-pregnant
patient population.
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Merve SORAL, Gülbin TÖRE ALTUN, Pelin CORMAN DİNÇER, Mustafa Kemal ARSLANTAŞ, Zuhal AYKAÇ
Merve SORAL, Gülbin TÖRE ALTUN, Pelin CORMAN DİNÇER, Mustafa Kemal ARSLANTAŞ, Zuhal AYKAÇ
Objective: The objective of this study was to improve the patient comfort and safety during procedures done under anaesthesia and sedation. The analgesia nociception index (ANI) noninvasively provides information on the nociception-antinociception balance, and it can be
used to assess analgesia objectively. We aimed to compare the effects of analgesia management with conventional methods and with ANI
monitoring on total opioid consumption, sedation and analgesia levels in patients who underwent colonoscopy using sedo-analgesia.
Methods: Adult patients (n=102), scheduled for procedural sedation, were prospectively analysed. After the induction with propofol and
ketamine, infusions of propofol (2 mg kg−1 h−1) and remifentanil (0.05 mcg kg−1 min−1) were started. In Group A, remifentanil infusions were
titrated to maintain the ANI value between 50 and 70, whereas in Group C, analgesic requirements were met according to the attending
anaesthetist’s intention. The heart rate, blood pressure, respiratory rate, SpO2
, BIS, Numeric Rating Scale (NRS) and Ramsay Sedation
Scale were monitored. Complications, analgesics consumption, duration of the procedure, demographic information, NRS and the Modified
Aldrete Score were evaluated.
Results: A total remifentanil amount used in Group A was 66.51±47.87 mcg and 90.15±58.17 mcg in Group C (p=0.011); there was no
difference in total amounts of ketamine and propofol given. There was a negative correlation between ANI and NRS scores of Group A
patients at Minute 0 at the level of 0.402, which was significant statistically (p=0.003).
Conclusion: Opioid consumption was diminished when ANI monitoring was used, and thus the patient safety was improved. Further studies
with longer procedure times and with a greater number of patients are required to demonstrate whether there is a difference in side effects
and recovery times.
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Maize Cordeiro MELO, Walkiria Wingester Vilas BOAS, Marcos Daniel FARIA, Alyne Andrade LIMA, Rafaela Souto SOUZA
Maize Cordeiro MELO, Walkiria Wingester Vilas BOAS, Marcos Daniel FARIA, Alyne Andrade LIMA, Rafaela Souto SOUZA
Hereditary Angioedema (HEA), a disease caused by a mutation in the gene that encodes for the production of the fraction C1 in the complement
(C1-INH), is a rare pathology (1/50.000) that causes swelling of the skin and submucosa in various organs, either naturally triggered or provoked
by physical and psychological traumas, infections, or by the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and angiotensin-converting
enzyme inhibitors (ACEIs). Surgical trauma may spur the HEA crisis, leading to complications such as the swelling of the respiratory tracts and
hemodynamic instability. Thus, the pre-surgical approach to HEA patients requires a specific plan that ensures short term prophylaxis, careful
intra-operative management, rescue therapy and intensive post-surgery care. We present a report on a video-laparoscopic cholecystectomy approach for a 28-year-old woman diagnosed with asthma and HEA with symptomatic choledocholithiasis. We opted for short-term prophylaxis
and immunology with the intravenous application of C1-INH. Ultrasonography imaging showed arterial wall oedema, which could correspond
to a manifestation of C1-INH deficiency in the wall of the manipulated arteries during ultrasonography-guided puncture. Once the patient
recovered consciousness, she was transferred to the intensive care unit and was discharged on the 6th day of hospitalisation.
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Sandeep DIWAN, Abhijit NAIR
Sandeep DIWAN, Abhijit NAIR
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