We report two high risk patients undergoing inguinal herniorraphy and testicular biopsy under ultrasound-guided ilioinguinal/iliohypogastric and genitofemoral nerve blocks. The addition of the genitofemoral nerve bloc...We report two high risk patients undergoing inguinal herniorraphy and testicular biopsy under ultrasound-guided ilioinguinal/iliohypogastric and genitofemoral nerve blocks. The addition of the genitofemoral nerve block may enhance the ilioinguinal/iliohypogastric block to achieve complete anesthesia and thus avoid general and neuraxial anesthesia related hypotension that may be detrimental in patients with low cardiac reserve.展开更多
Objective: To investigate the effect of epidural block combined with intravenous anesthesia on stress response and T lymphocyte subsets in patients with breast cancer undergoing radical mastectomy. Methods: In our hos...Objective: To investigate the effect of epidural block combined with intravenous anesthesia on stress response and T lymphocyte subsets in patients with breast cancer undergoing radical mastectomy. Methods: In our hospital from July 2016 to June 2017 undergoing radical mastectomy for breast cancer of 88 patients were randomly divided into observation group and control group of 44 cases, 2 patients underwent routine preoperative preparation, and routine blood pressure, heart rate, pulse, oxygen saturation, ECG monitoring, control group with intravenous anesthesia. The observation group was treated with epidural block combined with intravenous anesthesia. 2 groups of patients before anesthesia, 30 MIM (T0), 1 h after skin incision (T1), 4 h after operation (T2), 24 h after operation (T3), 48 h after operation (T4) from peripheral venous blood were measured by interleukin-8 (IL-8) and interferon gamma (IFN-γ), cortisol (Cor), prolactin (PRL), growth hormone (GH) and T lymphocyte subsets (CD3+, CD4+, CD8+), the calculation of CD4+/CD8+ value. Results: the serum IL-8 level of T1, T2, T3and T4 decreased gradually, were lower than at T0, and the control group at each time point had no significant difference, T1, T2, T3group, T4IL-8 levels lower than the control group;the 2 groups of serum IFN-γ levels T1 and T2had no significant change, T3and T4increased gradually, was higher than that of T0, but no significant difference between the 2 groups of IFN-γ levels. 2 serum Cor levels peaked at T1, decreased at T2, was higher than that of T0, T3, T4returned to T0, the observation group T1, T2Cor level lower than the control group;the serum PRL levels of 2 groups reached a peak at T1, T2, T3at the time of T4decreased gradually, was higher than that of T0, T1, T2, T3of the observation group at the PRL level is lower than the control group;the serum level of GH 2 in group T1increased gradually, reached a peak at T2, T3and T4 decreased gradually, was higher than that of T0, the observation group T1, T2, T3, T4, GH levels lower than the control group. 2 groups of CD3+ decreased gradually in T1, T2, were lower than T0, T3, T4returned to T0, the observation group T1, T2CD3+ was higher than the control group;group CD4+ decreased gradually in T1, T2, T3and T4were lower than control, T0when, and the observation group CD4+ in T1, T2, T3, T4, no significant changes were observed in group T1, T2, T3, T4and CD4+ higher than that of the control group;the 2 group CD8+ had no obvious changes in T1, T2, T3, T4;observation group CD4+/CD8+ decreased gradually in T1, T2, were lower than T0, T3, T4returned to T0, the observation group T1, T2CD4+/CD8+ was higher than the control group. Conclusion: epidural block combined with intravenous anesthesia for breast cancer radical mastectomy can effectively relieve the stress and inflammatory reaction, alleviate the immunosuppression, and help to restore the postoperative immune function.展开更多
Background: Women who had caesarean section (CS) with spinal anaesthesia had more chances to develop low back pain. Controlled studies evaluating the prevention of back pain after neuraxial anaesthesia involved mostly...Background: Women who had caesarean section (CS) with spinal anaesthesia had more chances to develop low back pain. Controlled studies evaluating the prevention of back pain after neuraxial anaesthesia involved mostly the use of an anti-inflammatory medication or steroid, given epidurally or as part of the intradermal injectate. The purpose of this study is to determine the effect of topical Nonsteroidal Anti-inflammatory drugs (NSAIDS) patch on decreasing the incidence of post-operative backache following spinal anaesthesia for caesarean section. Patients and methods: One hundred thirty parturients aged 19 - 40 years, American society of Anaesthesiology class I & II scheduled for elective caesarean section with spinal anaesthesia were divided randomly into two equal Groups (65 patients each): ketoprofen group (TDK) received 30 mg ketoprofen transdermal patch at site of puncture for 24 hours and control group (TDC) received a placebo transdermal patch at site of puncture for 24 hours. In the Postoperative period 24 hours after the spinal procedure, the transdermal patch was removed in both groups then symptoms of back pain have been determined by visual numerical scale (VNS). Results: regard incidence of occurrence and severity of back pain (VNS > 3) the results showed that the back pain was less in the TDK group than in the TDC group at 24 hours post spinal interval (4.6% vs 15.4%) respectively. On the other hand there was no statistical significant difference at 48 hours and 2 weeks post spinal interval. Conclusion: Prophylactic application of topical NSAIDS patch may reduce the incidence and the severity of short term backache after spinal anaesthesia in CS with negligible complications.展开更多
<b><span>Background: </span></b><span>The ultrasound-guided axillary block is a block commonly used in upper limb surgery. Several local anaesthetics can be used to obtain an effective bl...<b><span>Background: </span></b><span>The ultrasound-guided axillary block is a block commonly used in upper limb surgery. Several local anaesthetics can be used to obtain an effective block. These include ropivacaine 0.5% and lidocaine 1.5% with adrenaline.</span><span> </span><b><span>Objective:</span></b><span> To evaluate lidocaine 1.5% with adrenaline as an alternative to ropivacaine 0.5% for ultrasound-guided axillary blocks.</span><span> </span><b><span>Methodology:</span></b><span> This was a 6</span><span>-</span><span>month prospective and randomized study (July 15, 2019 to January 15, 2020) conducted in the Department of Anesthesia at Ignace Deen National Hospital in Conakry, Guinea.</span><span> </span><b><span>Results:</span></b><span> A total of 38 patients were enrolled: 19 in each group. The mean age was 45.8 ± 16.9 years in the lidocaine with adrenaline group compared to 43.9 ± 20 years in the ropivacaine group. The mean onset time in the lidocaine group was 6.8 ± 2.1 minutes compared to 8.3 ± 2.4 minutes in the ropivacaine group (p = 0.04). The mean duration of axillary block was 233.3 ± 57.5 minutes in the lidocaine group versus 260.4 ± 74 minutes in the ropivacaine group (p = 0.21). The performance was identical in both groups with 89.5% of the effective blocks in the lidocaine group and in the ropivacaine group (p = 1). The cost of consumables for the ropivacaine group was 60 euros compared to 15 euros for the lidocaine group.</span><span> </span><b><span>Conclusion:</span></b><span> Lidocaine 1.5% with adrenaline is a good alternative to ropivacaine 0.5% for ultrasound-guided axillary blocks in resource-limited countries.</span>展开更多
Introduction: The practice of spinal anesthesia in pediatric surgery is declining, especially in countries with limited means. What about in our context? Objective: To evaluate the practice of spinal anesthesia in ped...Introduction: The practice of spinal anesthesia in pediatric surgery is declining, especially in countries with limited means. What about in our context? Objective: To evaluate the practice of spinal anesthesia in pediatric surgery in Togo. Framework and method of study: This was a prospective study from November 2017 to May 2018 in pediatric surgery at CHU SO de Lomé, in the operating room and hospital ward of CHU Kara. The surgical, anesthesiological and evolutionary aspects of the patients were analyzed. Results: Sixty children were selected for the study who had an indication for sub-umbilical surgery. The male sex was predominant (73.3%). 47 (78.30%) patients were operated on for scheduled surgery. Hernia repair was the most performed surgical intervention (43.30%). The mean duration of the surgery was 78 ± 35.9 minutes. Most of the patients were ASA 1 (98.30%). The local anesthetic used was 0.5% isobaric Bupivacaine. Fentanyl was the predominant adjuvant (55%). The most widely used lumbar puncture needle was 25 Gauge with 75 millimeters in length (63.30%). Diazepam was the most widely used sedative (50%). The predominant spinal anesthesia protocol was spinal anesthesia alone (60%). Only one patient had hypotension (1.70%). Conclusion: The fairly satisfactory pediatric spinal anesthesia in Togo remains poorly performed. Its promotion involves the training of anesthesia practitioners and the strengthening of the technical platform.展开更多
Neuraxial opioids,widely used in obstetric and perioperative pain management,often lead to unwanted itch,reducing patient satisfaction.While theμ-opioid receptor has been implicated in opioid-induced itch,the genetic...Neuraxial opioids,widely used in obstetric and perioperative pain management,often lead to unwanted itch,reducing patient satisfaction.While theμ-opioid receptor has been implicated in opioid-induced itch,the genetic basis for variable itch incidence remains unknown.This study examined 3616 patients receiving epidural opioids,revealing an itch occurrence of 26.55%,with variations among opioid types and gender.Analysis of the OPRM1 gene identified six single-nucleotide polymorphisms,notably rs1799971(A118G),that correlated with opioid-induced itch.Mouse models with an equivalent A112G mutation showed reduced neuraxial opioid-induced itch and light touch-evoked itch,mirroring human findings.The 118G allele demonstrated an anti-itch effect without impacting analgesia,addiction,or tolerance,offering insights for risk stratification and potential anti-itch pretreatment strategies.展开更多
AIM To analyze the incidence, risk factors, prevention, treatment and outcome of small for size syndrome(SFSS) after living donor liver transplantation(LDLT). METHODS Through-out more than 10 years: During the period ...AIM To analyze the incidence, risk factors, prevention, treatment and outcome of small for size syndrome(SFSS) after living donor liver transplantation(LDLT). METHODS Through-out more than 10 years: During the period from April 2003 to the end of 2013, 174 adult-to-adults LDLT(A-ALDLT) had been performed at National Liver Institute, Menoufiya University, Shibin Elkoom, Egypt. We collected the data of those patients to do this cohort study that is a single-institution retrospective analysis of a prospectively collected database analyzing the incidence, risk factors, prevention, treatment and outcome of SFSS in a period started from the end of 2013 to the end of 2015. The median period of follow-up reached 40.50 m, range(0-144 m). RESULTS SFSS was diagnosed in 20(11.5%) of our recipients. While extra-small graft [small for size graft(SFSG)], portal hypertension, steatosis and left lobe graft were significant predictors of SFSS in univariate analysis(P = 0.00, 0.04, 0.03, and 0.00 respectively); graft size was the only independent predictor of SFSS on multivariate analysis(P = 0.03). On the other hand, there was lower incidence of SFSS in patients with SFSG who underwent splenectomy [4/10(40%) SFSS vs 3/7(42.9%) no SFSS] but without statistical significance, However, there was none significant lower incidence of the syndrome in patients with right lobe(RL) graft when drainage of the right anterior and/or posterior liver sectors by middle hepatic vein, V5, V8, and/or right inferior vein was done [4/10(28.6%) SFSS vs 52/152(34.2%) no SFSS]. The 6-mo, 1-, 3-, 5-, 7-and 10-year survival in patients with SFSS were 30%, 30%, 25%, 25%, 25% and 25% respectively, while, the 6-mo, 1-, 3-, 5-, 7-and 10-year survival in patients without SFSS were 70.1%, 65.6%, 61.7%, 61%, 59.7%, and 59.7% respectively, with statistical significant difference(P = 0.00). CONCLUSION SFSG is the independent and main factor for occurrence of SFSS after A-ALDLT leading to poor outcome. However, the management of this catastrophe depends upon its prevention(i.e., selecting graft with proper size, splenectomy to decrease portal venous inflow, and improving hepatic vein outflow by reconstructing large draining veins of the graft).展开更多
There is a discrepancy between the information from clotting tests which have routinely been used in clinical practice and evidence regarding thrombotic and bleeding events in patients with liver disease. This discrep...There is a discrepancy between the information from clotting tests which have routinely been used in clinical practice and evidence regarding thrombotic and bleeding events in patients with liver disease. This discrepancy leads us to rely on other variables which have been shown to be involved in haemostasis in these patients and/or to extrapolate the behaviour of these patients to other settings in order to decide the best clinical approach. The aims of the present review are as follows:(1) to present the information provided by clotting tests in cirrhotic patients;(2) to present the factors that may influence clotting in these patients;(3) to review the clinical evidence; and(4) to put forward a clinical approach based on the first 3 points.展开更多
Ascites appearing in a previously healthy female patient is usually ascribed to a variety of causes,among which,is a cancerous process,especially if it comes with a raised CA-125 level.Although the CA-125 antigen is p...Ascites appearing in a previously healthy female patient is usually ascribed to a variety of causes,among which,is a cancerous process,especially if it comes with a raised CA-125 level.Although the CA-125 antigen is present on more than 80% of malignant epithelial ovarian tissue of non-mucinous type,it is also found on both healthy and malignant cells of mesothelial and non-mesothelial origin.Myxedema ascites which is caused by hypothyroidism is a rare entity,but on the other hand is easy to treat.It is one of the differential diagnoses when the ascites is refractory to treatment and no other obvious cause can be identified.If the diagnosis is delayed,patients will frequently receive unnecessary procedures,while treatment has very good response rates and ascites resolve with serum CA-125 normalization after adequate hormonal treatment.展开更多
The mechanisms of epidural-associated fever remain incompletely understood [1-3]. We propose that action of local anesthetic on TPRV1. The transient receptor potential cation channel subfamily V member 1 (TRPV1), also...The mechanisms of epidural-associated fever remain incompletely understood [1-3]. We propose that action of local anesthetic on TPRV1. The transient receptor potential cation channel subfamily V member 1 (TRPV1), also known as the capsaicin receptor and the vanilloid receptor can explain this effect and explain mechanism of burning sensation on local anesthetic injected subcutaneously or intramuscular. Role of TRPV1 receptor was not discussed previously in Obstetric Anesthesia literature. Based on available data, we propose that Local Anesthetics work as agonist/antagonist on TPRV1 receptors. Antagonist action may cause hyperthermia through modifying thermoregulation [4], agonist action may cause hyperthermia thru release of IL-6 and other mediators of inflammation [5-10]. Agonist action may explain burning sensation on injection of Local Anesthetics. Burning sensation can be diminished by increasing pH of Local Anesthetic solution, because vanillin receptors are stimulated by acidification through lower pH [11,12].展开更多
Objective:This study explored the timing of interventional treatment for acute intramural aortic hematoma(IMH)and the corresponding high-risk factors for its development into local aortic dissection(AD).Method:This re...Objective:This study explored the timing of interventional treatment for acute intramural aortic hematoma(IMH)and the corresponding high-risk factors for its development into local aortic dissection(AD).Method:This retrospective case study method examined clinical follow-up data of 42 patients with acute IMH between April 2013 and October 2016 from the First Affiliated Hospital of Xi?an Jiaotong University.SPSS 17.0 and PPMS1.5 were used to analyze follow-up data spanning 3–12 months(mean,7.5?3.7 months).Results:Patients were divided into the conversion group and the hematoma group according to whether they developed AD.Among them,16 patients(38.1%)developed AD and were treated with thoracic endovascular aortic repair(TEVAR).The remaining patients(61.89%)were treated conservatively.After 1 week,the mean aortic diameter of the conversion versus hematoma group was significantly widened.Hemodynamically unstable patients and those with hematoma to the abdominal aorta extension were more likely to develop AD.Patient outcomes after TEVAR were similar between groups.Conclusion:Our findings suggest that aortic isthmus diameter!3.0 cm,hematoma extending to the abdominal aorta,and hemodynamic instability are associated with AD development in acute IMH patents.TEVAR should be considered if hematoma thickening,calcification ingression,ulcer progression,or contrast enhancement within the intramural hematoma is noted beyond 2 weeks after IMH onset.展开更多
Ischemia-reperfusion plays a major role in the injury experienced by the liver during transplantation. Much work has been done recently investigating the role of redox species in hepatic ischemia-reperfusion. As anima...Ischemia-reperfusion plays a major role in the injury experienced by the liver during transplantation. Much work has been done recently investigating the role of redox species in hepatic ischemia-reperfusion. As animal models are better characterized and developed, and more insights are gained into the pathophysiology of hepatic ischemia reperfusion injury in humans the questions into exactly how oxidants participate in this injury are becoming more refined. These questions include effects of cellular location, timing of injury, and ability of therapeutics to access this site are increasing our appreciation of the complexity of ischemia reperfusion and improving attempts to ameliorate its effects. In this review, we aim to discuss the various methods to alter redox chemistry during ischemia reperfusion injury and future prospects for preventing organ injury during hepatic ischemia reperfusion.展开更多
Poisoning is the disruption of functions of a living organism by any agent. The aim of this study is to identify the clinical and demographic characteristics of intoxication cases admitted to the Numune Training and R...Poisoning is the disruption of functions of a living organism by any agent. The aim of this study is to identify the clinical and demographic characteristics of intoxication cases admitted to the Numune Training and Research Hospital emergency department. Characteristics such as age and gender of the patients, intoxication agents, and the results (discharge, forwarding, hospitalization, death etc.) were recorded to the prepared form. Data were assessed with the SPSS 15.0 software package and expressed. Quantitative variables were summarised as mean ± standard deviation. Frequency and percent distribution were used for the evaluation of data. The chi-squared test was used for comparison of the quailtative variables. p 0.05 was accepted significant. The mean age of the receiving 651 poisoned patients was 32.04 ± 12.24 years. Of them, 67.7% were female. The most causes of poisoning agents were a pharmaceuticals (79.4%), carbonmonoxide (8.9%) and alcohols (7.1%). Gastric lavage was performed in 76% patients. Activated charcoal was administered in 81% patients. Antidotes treatment was applied in 7.4% patients. Most patients were evaluated and then treated and discharged from the ED (91.9%).展开更多
BACKGROUND:Severe poisoning due to the overdosing of cardiac drugs can lead to cardiovascular failure.In order to decrease the mortality rate,the most severe patients should be transferred as quickly as possible to an...BACKGROUND:Severe poisoning due to the overdosing of cardiac drugs can lead to cardiovascular failure.In order to decrease the mortality rate,the most severe patients should be transferred as quickly as possible to an extracorporeal membrane oxygenation(ECMO)center.However,the predictive factors showing the need for venous-arterial ECMO(VA-ECMO)had never been evaluated.METHODS:A retrospective,descriptive,and single-center cohort study.All consecutive patients admitted in the largest ICU of Reunion Island(Indian Ocean)between January 2013 and September 2018 for beta-blockers(BB),calcium channel blockers(CCB),renin-angiotensin-aldosterone system blockers,digoxin or anti-arrythmic intentional poisonings were included.ECMO implementation was the primary outcome.RESULTS:A total of 49 consecutive admissions were included.Ten patients had ECMO,39 patients did not have ECMO.Three patients in ECMO group died,while no patients in the conventional group died.The most relevant ECMO-associated factors were pulse pressure and heart rate at first medical contact and pulse pressure,heart rate,arterial lactate concentration,liver enzymes and left ventricular ejection fraction(LVEF)at ICU-admission.Only pulse pressure at first medical contact and LVEF were significant after logistic regression.CONCLUSION:A transfer to an ECMO center should be considered for a pulse pressure<35 mmHg at first medical contact or LVEF<20%on admission to ICU.展开更多
Purpose: Levobupivacaine is thought to be a good alternative to bupivacaine for epidural labor analgesia because of its pharmacologic profile. However, the optimal concentration of levobupivacaine for labor analgesia ...Purpose: Levobupivacaine is thought to be a good alternative to bupivacaine for epidural labor analgesia because of its pharmacologic profile. However, the optimal concentration of levobupivacaine for labor analgesia has not been adequately studied. The objective of this retrospective study was to compare the analgesic effect of levobupivacaine between 0.06% and 0.1% both combined with 2 μg/mL of fentanyl. Methods: Primiparous women (ASA I, II) who delivered their babies to our hospital using combined spinal epidural analgesia and patient-controlled epidural analgesia between August 1, 2011 and September 30, 2011 were included into this retrospective study. The analgesic solution for epidural administration was 0.06% levobupivacaine with 2 μg/mL of fentanyl between August 1 and 31, and 0.1% levobupivacaine with 2 μg/mL of fentanyl between September 1 and 30. Their anesthetic and obstetric charts were reviewed to compare obstetric outcome, anesthetic intervention, and patients’ satisfaction. Results: There were 46 women fulfilling the inclusion criteria: 23 women in 0.06% group, and 23 women in 0.1% group. The number of patients who needed more than 3 requests for one actual bolus was significantly higher in the 0.06% group (P 0.05). Conclusion: Our results revealed that 0.06% levobupivacaine combined with 2 μg/mL fentanyl does not provide sufficient analgesic effects for epidural labor analgesia. It seems that levobupivacaine has not been adequately studied after its withdrawal from the US market. Further studies should be conducted to determine the optimal concentration of levobupivacaine for epidural labor analgesia.展开更多
BACKGROUND Fascia iliaca compartment blocks(FIBs) have been used to provide postoperative analgesia after total hip arthroplasty(THA). However, evidence of their efficacy remains limited. While pain control appears to...BACKGROUND Fascia iliaca compartment blocks(FIBs) have been used to provide postoperative analgesia after total hip arthroplasty(THA). However, evidence of their efficacy remains limited. While pain control appears to be satisfactory, quadriceps weakness may be an untoward consequence of the block. Prior studies have shown femoral nerve blocks and fascia iliaca blocks as being superior for pain control and ambulation following THA when compared to standard therapy of parenteral pain control. However, most studies allowed patients to ambulate on post-operative day(POD) 2-3, whereas new guidelines suggest ambulation on POD 0 is beneficial.AIM To determine the effect of FIB after THA in patients participating in an enhanced recovery after surgery(ERAS) program.METHODS We conducted a retrospective analysis of patients undergoing THA with or without FICBs and their ability to ambulate on POD 0 in accordance with ERAS protocol. Perioperative data was collected on 39 patients who underwent THA.Demographic data, anesthesia data, and ambulatory outcomes were compared.RESULTS Twenty patients had FIBs placed at the conclusion of the procedure, while 19 did not receive a block. Of the 20 patients with FIB, only 1 patient was able to ambulate. Of the 19 patients without FIB blocks, 17 were able to ambulate. All patients worked with physical therapy 2 h after arriving in the post-anesthesia care unit on POD 0.CONCLUSION Our data suggests an association between FIB and delayed ambulation in the immediate post-operative period.展开更多
<strong>Introduction: </strong>Tracheotomy is a commonly performed procedure, but with very large disparities according to the teams, both in terms of frequency and modality (percutaneous or surgical), tra...<strong>Introduction: </strong>Tracheotomy is a commonly performed procedure, but with very large disparities according to the teams, both in terms of frequency and modality (percutaneous or surgical), tracheotomy has been evolved with medical advances. The objective of this study was to clarify the indications and complications of emergency tracheotomies at the National hospital center (CHN) in Nouakchott Mauritania. <strong>Materials and Methods: </strong>It is a retrospective study of tracheotomies performed in the ENT department of the CHN during the period from January 1, 2010 to December 31, 2018. The indications and complications were noted, as well as the modalities and time of decannulation. <strong>Results:</strong> Tracheotomy was motivated by upper airway obstruction (UAO) in 139 (94%) cases (mean age 32.5 years), or the need for prolonged ventilation in 8 patients (median age 46 years). Sixteen (7%) early complications were noted with 5 untimely decannulations including one fatal and 5 obstructive plug responsible for another death. Six pneumothorax was observed. Fifteen (26%) late complications required additional surgery;7% (n = 11) of patients were decannulated with a mean duration of tracheotomy 26 months. In 19 (28%) cases of decannulations, the persistence of a tracheocutaneous fistula required surgery. <strong>Conclusion:</strong> Emergency tracheotomy is a survival gesture that is sure to be effective. A tracheotomy is not deprived of complications. Familiarity with the technique, the right choice of equipment, perfect knowledge of the anatomical relationships of the trachea, rigorous monitoring and postoperative care represent the main conditions for minimizing the risk of complications.展开更多
文摘We report two high risk patients undergoing inguinal herniorraphy and testicular biopsy under ultrasound-guided ilioinguinal/iliohypogastric and genitofemoral nerve blocks. The addition of the genitofemoral nerve block may enhance the ilioinguinal/iliohypogastric block to achieve complete anesthesia and thus avoid general and neuraxial anesthesia related hypotension that may be detrimental in patients with low cardiac reserve.
文摘Objective: To investigate the effect of epidural block combined with intravenous anesthesia on stress response and T lymphocyte subsets in patients with breast cancer undergoing radical mastectomy. Methods: In our hospital from July 2016 to June 2017 undergoing radical mastectomy for breast cancer of 88 patients were randomly divided into observation group and control group of 44 cases, 2 patients underwent routine preoperative preparation, and routine blood pressure, heart rate, pulse, oxygen saturation, ECG monitoring, control group with intravenous anesthesia. The observation group was treated with epidural block combined with intravenous anesthesia. 2 groups of patients before anesthesia, 30 MIM (T0), 1 h after skin incision (T1), 4 h after operation (T2), 24 h after operation (T3), 48 h after operation (T4) from peripheral venous blood were measured by interleukin-8 (IL-8) and interferon gamma (IFN-γ), cortisol (Cor), prolactin (PRL), growth hormone (GH) and T lymphocyte subsets (CD3+, CD4+, CD8+), the calculation of CD4+/CD8+ value. Results: the serum IL-8 level of T1, T2, T3and T4 decreased gradually, were lower than at T0, and the control group at each time point had no significant difference, T1, T2, T3group, T4IL-8 levels lower than the control group;the 2 groups of serum IFN-γ levels T1 and T2had no significant change, T3and T4increased gradually, was higher than that of T0, but no significant difference between the 2 groups of IFN-γ levels. 2 serum Cor levels peaked at T1, decreased at T2, was higher than that of T0, T3, T4returned to T0, the observation group T1, T2Cor level lower than the control group;the serum PRL levels of 2 groups reached a peak at T1, T2, T3at the time of T4decreased gradually, was higher than that of T0, T1, T2, T3of the observation group at the PRL level is lower than the control group;the serum level of GH 2 in group T1increased gradually, reached a peak at T2, T3and T4 decreased gradually, was higher than that of T0, the observation group T1, T2, T3, T4, GH levels lower than the control group. 2 groups of CD3+ decreased gradually in T1, T2, were lower than T0, T3, T4returned to T0, the observation group T1, T2CD3+ was higher than the control group;group CD4+ decreased gradually in T1, T2, T3and T4were lower than control, T0when, and the observation group CD4+ in T1, T2, T3, T4, no significant changes were observed in group T1, T2, T3, T4and CD4+ higher than that of the control group;the 2 group CD8+ had no obvious changes in T1, T2, T3, T4;observation group CD4+/CD8+ decreased gradually in T1, T2, were lower than T0, T3, T4returned to T0, the observation group T1, T2CD4+/CD8+ was higher than the control group. Conclusion: epidural block combined with intravenous anesthesia for breast cancer radical mastectomy can effectively relieve the stress and inflammatory reaction, alleviate the immunosuppression, and help to restore the postoperative immune function.
文摘Background: Women who had caesarean section (CS) with spinal anaesthesia had more chances to develop low back pain. Controlled studies evaluating the prevention of back pain after neuraxial anaesthesia involved mostly the use of an anti-inflammatory medication or steroid, given epidurally or as part of the intradermal injectate. The purpose of this study is to determine the effect of topical Nonsteroidal Anti-inflammatory drugs (NSAIDS) patch on decreasing the incidence of post-operative backache following spinal anaesthesia for caesarean section. Patients and methods: One hundred thirty parturients aged 19 - 40 years, American society of Anaesthesiology class I & II scheduled for elective caesarean section with spinal anaesthesia were divided randomly into two equal Groups (65 patients each): ketoprofen group (TDK) received 30 mg ketoprofen transdermal patch at site of puncture for 24 hours and control group (TDC) received a placebo transdermal patch at site of puncture for 24 hours. In the Postoperative period 24 hours after the spinal procedure, the transdermal patch was removed in both groups then symptoms of back pain have been determined by visual numerical scale (VNS). Results: regard incidence of occurrence and severity of back pain (VNS > 3) the results showed that the back pain was less in the TDK group than in the TDC group at 24 hours post spinal interval (4.6% vs 15.4%) respectively. On the other hand there was no statistical significant difference at 48 hours and 2 weeks post spinal interval. Conclusion: Prophylactic application of topical NSAIDS patch may reduce the incidence and the severity of short term backache after spinal anaesthesia in CS with negligible complications.
文摘<b><span>Background: </span></b><span>The ultrasound-guided axillary block is a block commonly used in upper limb surgery. Several local anaesthetics can be used to obtain an effective block. These include ropivacaine 0.5% and lidocaine 1.5% with adrenaline.</span><span> </span><b><span>Objective:</span></b><span> To evaluate lidocaine 1.5% with adrenaline as an alternative to ropivacaine 0.5% for ultrasound-guided axillary blocks.</span><span> </span><b><span>Methodology:</span></b><span> This was a 6</span><span>-</span><span>month prospective and randomized study (July 15, 2019 to January 15, 2020) conducted in the Department of Anesthesia at Ignace Deen National Hospital in Conakry, Guinea.</span><span> </span><b><span>Results:</span></b><span> A total of 38 patients were enrolled: 19 in each group. The mean age was 45.8 ± 16.9 years in the lidocaine with adrenaline group compared to 43.9 ± 20 years in the ropivacaine group. The mean onset time in the lidocaine group was 6.8 ± 2.1 minutes compared to 8.3 ± 2.4 minutes in the ropivacaine group (p = 0.04). The mean duration of axillary block was 233.3 ± 57.5 minutes in the lidocaine group versus 260.4 ± 74 minutes in the ropivacaine group (p = 0.21). The performance was identical in both groups with 89.5% of the effective blocks in the lidocaine group and in the ropivacaine group (p = 1). The cost of consumables for the ropivacaine group was 60 euros compared to 15 euros for the lidocaine group.</span><span> </span><b><span>Conclusion:</span></b><span> Lidocaine 1.5% with adrenaline is a good alternative to ropivacaine 0.5% for ultrasound-guided axillary blocks in resource-limited countries.</span>
文摘Introduction: The practice of spinal anesthesia in pediatric surgery is declining, especially in countries with limited means. What about in our context? Objective: To evaluate the practice of spinal anesthesia in pediatric surgery in Togo. Framework and method of study: This was a prospective study from November 2017 to May 2018 in pediatric surgery at CHU SO de Lomé, in the operating room and hospital ward of CHU Kara. The surgical, anesthesiological and evolutionary aspects of the patients were analyzed. Results: Sixty children were selected for the study who had an indication for sub-umbilical surgery. The male sex was predominant (73.3%). 47 (78.30%) patients were operated on for scheduled surgery. Hernia repair was the most performed surgical intervention (43.30%). The mean duration of the surgery was 78 ± 35.9 minutes. Most of the patients were ASA 1 (98.30%). The local anesthetic used was 0.5% isobaric Bupivacaine. Fentanyl was the predominant adjuvant (55%). The most widely used lumbar puncture needle was 25 Gauge with 75 millimeters in length (63.30%). Diazepam was the most widely used sedative (50%). The predominant spinal anesthesia protocol was spinal anesthesia alone (60%). Only one patient had hypotension (1.70%). Conclusion: The fairly satisfactory pediatric spinal anesthesia in Togo remains poorly performed. Its promotion involves the training of anesthesia practitioners and the strengthening of the technical platform.
基金supported by the National Natural Science Foundation of China(32271047)the National Key Research and Development Program of China(2020YFC2008405)+1 种基金The Innovative Research Team of High-level Local Universities in Shanghai,the Natural Science Foundation of Shanghai(22ZR1413800)Shanghai Municipal Science and Technology Major Project(2018SHZDZX01)。
文摘Neuraxial opioids,widely used in obstetric and perioperative pain management,often lead to unwanted itch,reducing patient satisfaction.While theμ-opioid receptor has been implicated in opioid-induced itch,the genetic basis for variable itch incidence remains unknown.This study examined 3616 patients receiving epidural opioids,revealing an itch occurrence of 26.55%,with variations among opioid types and gender.Analysis of the OPRM1 gene identified six single-nucleotide polymorphisms,notably rs1799971(A118G),that correlated with opioid-induced itch.Mouse models with an equivalent A112G mutation showed reduced neuraxial opioid-induced itch and light touch-evoked itch,mirroring human findings.The 118G allele demonstrated an anti-itch effect without impacting analgesia,addiction,or tolerance,offering insights for risk stratification and potential anti-itch pretreatment strategies.
文摘AIM To analyze the incidence, risk factors, prevention, treatment and outcome of small for size syndrome(SFSS) after living donor liver transplantation(LDLT). METHODS Through-out more than 10 years: During the period from April 2003 to the end of 2013, 174 adult-to-adults LDLT(A-ALDLT) had been performed at National Liver Institute, Menoufiya University, Shibin Elkoom, Egypt. We collected the data of those patients to do this cohort study that is a single-institution retrospective analysis of a prospectively collected database analyzing the incidence, risk factors, prevention, treatment and outcome of SFSS in a period started from the end of 2013 to the end of 2015. The median period of follow-up reached 40.50 m, range(0-144 m). RESULTS SFSS was diagnosed in 20(11.5%) of our recipients. While extra-small graft [small for size graft(SFSG)], portal hypertension, steatosis and left lobe graft were significant predictors of SFSS in univariate analysis(P = 0.00, 0.04, 0.03, and 0.00 respectively); graft size was the only independent predictor of SFSS on multivariate analysis(P = 0.03). On the other hand, there was lower incidence of SFSS in patients with SFSG who underwent splenectomy [4/10(40%) SFSS vs 3/7(42.9%) no SFSS] but without statistical significance, However, there was none significant lower incidence of the syndrome in patients with right lobe(RL) graft when drainage of the right anterior and/or posterior liver sectors by middle hepatic vein, V5, V8, and/or right inferior vein was done [4/10(28.6%) SFSS vs 52/152(34.2%) no SFSS]. The 6-mo, 1-, 3-, 5-, 7-and 10-year survival in patients with SFSS were 30%, 30%, 25%, 25%, 25% and 25% respectively, while, the 6-mo, 1-, 3-, 5-, 7-and 10-year survival in patients without SFSS were 70.1%, 65.6%, 61.7%, 61%, 59.7%, and 59.7% respectively, with statistical significant difference(P = 0.00). CONCLUSION SFSG is the independent and main factor for occurrence of SFSS after A-ALDLT leading to poor outcome. However, the management of this catastrophe depends upon its prevention(i.e., selecting graft with proper size, splenectomy to decrease portal venous inflow, and improving hepatic vein outflow by reconstructing large draining veins of the graft).
文摘There is a discrepancy between the information from clotting tests which have routinely been used in clinical practice and evidence regarding thrombotic and bleeding events in patients with liver disease. This discrepancy leads us to rely on other variables which have been shown to be involved in haemostasis in these patients and/or to extrapolate the behaviour of these patients to other settings in order to decide the best clinical approach. The aims of the present review are as follows:(1) to present the information provided by clotting tests in cirrhotic patients;(2) to present the factors that may influence clotting in these patients;(3) to review the clinical evidence; and(4) to put forward a clinical approach based on the first 3 points.
文摘Ascites appearing in a previously healthy female patient is usually ascribed to a variety of causes,among which,is a cancerous process,especially if it comes with a raised CA-125 level.Although the CA-125 antigen is present on more than 80% of malignant epithelial ovarian tissue of non-mucinous type,it is also found on both healthy and malignant cells of mesothelial and non-mesothelial origin.Myxedema ascites which is caused by hypothyroidism is a rare entity,but on the other hand is easy to treat.It is one of the differential diagnoses when the ascites is refractory to treatment and no other obvious cause can be identified.If the diagnosis is delayed,patients will frequently receive unnecessary procedures,while treatment has very good response rates and ascites resolve with serum CA-125 normalization after adequate hormonal treatment.
文摘The mechanisms of epidural-associated fever remain incompletely understood [1-3]. We propose that action of local anesthetic on TPRV1. The transient receptor potential cation channel subfamily V member 1 (TRPV1), also known as the capsaicin receptor and the vanilloid receptor can explain this effect and explain mechanism of burning sensation on local anesthetic injected subcutaneously or intramuscular. Role of TRPV1 receptor was not discussed previously in Obstetric Anesthesia literature. Based on available data, we propose that Local Anesthetics work as agonist/antagonist on TPRV1 receptors. Antagonist action may cause hyperthermia through modifying thermoregulation [4], agonist action may cause hyperthermia thru release of IL-6 and other mediators of inflammation [5-10]. Agonist action may explain burning sensation on injection of Local Anesthetics. Burning sensation can be diminished by increasing pH of Local Anesthetic solution, because vanillin receptors are stimulated by acidification through lower pH [11,12].
文摘Objective:This study explored the timing of interventional treatment for acute intramural aortic hematoma(IMH)and the corresponding high-risk factors for its development into local aortic dissection(AD).Method:This retrospective case study method examined clinical follow-up data of 42 patients with acute IMH between April 2013 and October 2016 from the First Affiliated Hospital of Xi?an Jiaotong University.SPSS 17.0 and PPMS1.5 were used to analyze follow-up data spanning 3–12 months(mean,7.5?3.7 months).Results:Patients were divided into the conversion group and the hematoma group according to whether they developed AD.Among them,16 patients(38.1%)developed AD and were treated with thoracic endovascular aortic repair(TEVAR).The remaining patients(61.89%)were treated conservatively.After 1 week,the mean aortic diameter of the conversion versus hematoma group was significantly widened.Hemodynamically unstable patients and those with hematoma to the abdominal aorta extension were more likely to develop AD.Patient outcomes after TEVAR were similar between groups.Conclusion:Our findings suggest that aortic isthmus diameter!3.0 cm,hematoma extending to the abdominal aorta,and hemodynamic instability are associated with AD development in acute IMH patents.TEVAR should be considered if hematoma thickening,calcification ingression,ulcer progression,or contrast enhancement within the intramural hematoma is noted beyond 2 weeks after IMH onset.
文摘Ischemia-reperfusion plays a major role in the injury experienced by the liver during transplantation. Much work has been done recently investigating the role of redox species in hepatic ischemia-reperfusion. As animal models are better characterized and developed, and more insights are gained into the pathophysiology of hepatic ischemia reperfusion injury in humans the questions into exactly how oxidants participate in this injury are becoming more refined. These questions include effects of cellular location, timing of injury, and ability of therapeutics to access this site are increasing our appreciation of the complexity of ischemia reperfusion and improving attempts to ameliorate its effects. In this review, we aim to discuss the various methods to alter redox chemistry during ischemia reperfusion injury and future prospects for preventing organ injury during hepatic ischemia reperfusion.
文摘Poisoning is the disruption of functions of a living organism by any agent. The aim of this study is to identify the clinical and demographic characteristics of intoxication cases admitted to the Numune Training and Research Hospital emergency department. Characteristics such as age and gender of the patients, intoxication agents, and the results (discharge, forwarding, hospitalization, death etc.) were recorded to the prepared form. Data were assessed with the SPSS 15.0 software package and expressed. Quantitative variables were summarised as mean ± standard deviation. Frequency and percent distribution were used for the evaluation of data. The chi-squared test was used for comparison of the quailtative variables. p 0.05 was accepted significant. The mean age of the receiving 651 poisoned patients was 32.04 ± 12.24 years. Of them, 67.7% were female. The most causes of poisoning agents were a pharmaceuticals (79.4%), carbonmonoxide (8.9%) and alcohols (7.1%). Gastric lavage was performed in 76% patients. Activated charcoal was administered in 81% patients. Antidotes treatment was applied in 7.4% patients. Most patients were evaluated and then treated and discharged from the ED (91.9%).
文摘BACKGROUND:Severe poisoning due to the overdosing of cardiac drugs can lead to cardiovascular failure.In order to decrease the mortality rate,the most severe patients should be transferred as quickly as possible to an extracorporeal membrane oxygenation(ECMO)center.However,the predictive factors showing the need for venous-arterial ECMO(VA-ECMO)had never been evaluated.METHODS:A retrospective,descriptive,and single-center cohort study.All consecutive patients admitted in the largest ICU of Reunion Island(Indian Ocean)between January 2013 and September 2018 for beta-blockers(BB),calcium channel blockers(CCB),renin-angiotensin-aldosterone system blockers,digoxin or anti-arrythmic intentional poisonings were included.ECMO implementation was the primary outcome.RESULTS:A total of 49 consecutive admissions were included.Ten patients had ECMO,39 patients did not have ECMO.Three patients in ECMO group died,while no patients in the conventional group died.The most relevant ECMO-associated factors were pulse pressure and heart rate at first medical contact and pulse pressure,heart rate,arterial lactate concentration,liver enzymes and left ventricular ejection fraction(LVEF)at ICU-admission.Only pulse pressure at first medical contact and LVEF were significant after logistic regression.CONCLUSION:A transfer to an ECMO center should be considered for a pulse pressure<35 mmHg at first medical contact or LVEF<20%on admission to ICU.
文摘Purpose: Levobupivacaine is thought to be a good alternative to bupivacaine for epidural labor analgesia because of its pharmacologic profile. However, the optimal concentration of levobupivacaine for labor analgesia has not been adequately studied. The objective of this retrospective study was to compare the analgesic effect of levobupivacaine between 0.06% and 0.1% both combined with 2 μg/mL of fentanyl. Methods: Primiparous women (ASA I, II) who delivered their babies to our hospital using combined spinal epidural analgesia and patient-controlled epidural analgesia between August 1, 2011 and September 30, 2011 were included into this retrospective study. The analgesic solution for epidural administration was 0.06% levobupivacaine with 2 μg/mL of fentanyl between August 1 and 31, and 0.1% levobupivacaine with 2 μg/mL of fentanyl between September 1 and 30. Their anesthetic and obstetric charts were reviewed to compare obstetric outcome, anesthetic intervention, and patients’ satisfaction. Results: There were 46 women fulfilling the inclusion criteria: 23 women in 0.06% group, and 23 women in 0.1% group. The number of patients who needed more than 3 requests for one actual bolus was significantly higher in the 0.06% group (P 0.05). Conclusion: Our results revealed that 0.06% levobupivacaine combined with 2 μg/mL fentanyl does not provide sufficient analgesic effects for epidural labor analgesia. It seems that levobupivacaine has not been adequately studied after its withdrawal from the US market. Further studies should be conducted to determine the optimal concentration of levobupivacaine for epidural labor analgesia.
基金supported by the National Key Natural Science Foundation of China(No.21135001)"973" National Key Basic Research Program(No.2011CB911000)+1 种基金Hunan Province Key Project of Scientific & Technical Programs(No.2010TP4013-1)the National Natural Science Foundation of China(Nos.21075032 and 21005026)
文摘Received 10 December 2012 Received in revised form 5 January 2013 Accepted 10 January 2013 Available online 8 February 2013
文摘BACKGROUND Fascia iliaca compartment blocks(FIBs) have been used to provide postoperative analgesia after total hip arthroplasty(THA). However, evidence of their efficacy remains limited. While pain control appears to be satisfactory, quadriceps weakness may be an untoward consequence of the block. Prior studies have shown femoral nerve blocks and fascia iliaca blocks as being superior for pain control and ambulation following THA when compared to standard therapy of parenteral pain control. However, most studies allowed patients to ambulate on post-operative day(POD) 2-3, whereas new guidelines suggest ambulation on POD 0 is beneficial.AIM To determine the effect of FIB after THA in patients participating in an enhanced recovery after surgery(ERAS) program.METHODS We conducted a retrospective analysis of patients undergoing THA with or without FICBs and their ability to ambulate on POD 0 in accordance with ERAS protocol. Perioperative data was collected on 39 patients who underwent THA.Demographic data, anesthesia data, and ambulatory outcomes were compared.RESULTS Twenty patients had FIBs placed at the conclusion of the procedure, while 19 did not receive a block. Of the 20 patients with FIB, only 1 patient was able to ambulate. Of the 19 patients without FIB blocks, 17 were able to ambulate. All patients worked with physical therapy 2 h after arriving in the post-anesthesia care unit on POD 0.CONCLUSION Our data suggests an association between FIB and delayed ambulation in the immediate post-operative period.
文摘<strong>Introduction: </strong>Tracheotomy is a commonly performed procedure, but with very large disparities according to the teams, both in terms of frequency and modality (percutaneous or surgical), tracheotomy has been evolved with medical advances. The objective of this study was to clarify the indications and complications of emergency tracheotomies at the National hospital center (CHN) in Nouakchott Mauritania. <strong>Materials and Methods: </strong>It is a retrospective study of tracheotomies performed in the ENT department of the CHN during the period from January 1, 2010 to December 31, 2018. The indications and complications were noted, as well as the modalities and time of decannulation. <strong>Results:</strong> Tracheotomy was motivated by upper airway obstruction (UAO) in 139 (94%) cases (mean age 32.5 years), or the need for prolonged ventilation in 8 patients (median age 46 years). Sixteen (7%) early complications were noted with 5 untimely decannulations including one fatal and 5 obstructive plug responsible for another death. Six pneumothorax was observed. Fifteen (26%) late complications required additional surgery;7% (n = 11) of patients were decannulated with a mean duration of tracheotomy 26 months. In 19 (28%) cases of decannulations, the persistence of a tracheocutaneous fistula required surgery. <strong>Conclusion:</strong> Emergency tracheotomy is a survival gesture that is sure to be effective. A tracheotomy is not deprived of complications. Familiarity with the technique, the right choice of equipment, perfect knowledge of the anatomical relationships of the trachea, rigorous monitoring and postoperative care represent the main conditions for minimizing the risk of complications.
