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Research Article
Analgesic and Opioid Sparing Effects of Tramadol, Ketamine, and Bupivacaine Following Wound Infiltration After Caesarean Section
Olayinka Olumide Ajiboye,
Adeyemi William Osebequin,
Agu Edith,
Olateju Simeon Olugbade,
Achi Joseph,
Oyewole Ezekiel
Issue:
Volume 12, Issue 1, June 2024
Pages:
1-6
Received:
16 December 2023
Accepted:
2 January 2024
Published:
18 January 2024
Abstract: Background: Adequate management of pain is considered a fundamental human right and social justice and this may be achieved for women who had caesarean section under subarachnoid block with multi modal means of analgesia. Wound infiltration with different agents may be part of the multi modal means of providing adequate analgesia. The study aimed to determine which of plain bupivacaine, ketamine or tramadol will give the best pain control post-operatively in terms of quality and duration of pain relief when used for wound infiltration following caesarean section under subarachnoid block. Methods: A prospective double blind randomized study of 132 patients, divided into three groups of A, B, and C with 44 patients in each group. Each group had wound infiltration with either 0.125% plain bupivacaine (Group A), 0.25% ketamine (Group B), or 0.25% tramadol (Group C) after caesarean section under subarachnoid block. Pain was assessed hourly in the first 4 hours then 4 hourly for 20hours. The duration of pain relief after subcutaneous infiltration, morphine consumption, and side effects were noted for all the three groups. Results: Time to first rescue analgesic was similar in all three groups, however duration of analgesia was longest in Group A (4 hours). ANOVA analysis of the time to first analgesic request across the three groups was not statistically significant (p=0.0862). Morphine consumption was highest in Group C with an average of 7mg in 24 hours, but was lower in Groups A and B which were 5.09mg and 5.63mg respectively in 24 hours. Using the 5 point Likert to test for patient satisfaction; group A recorded highest percentage of patients who strongly agreed to being satisfied, while the least percentage to satisfaction was found in Group C. Conclusion: This study demonstrated that of the three drugs tested, bupivacaine was the most effective analgesic with consequent reduction in opioid consumption and offered prolonged patient satisfaction.
Abstract: Background: Adequate management of pain is considered a fundamental human right and social justice and this may be achieved for women who had caesarean section under subarachnoid block with multi modal means of analgesia. Wound infiltration with different agents may be part of the multi modal means of providing adequate analgesia. The study aimed t...
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Case Report
Ultrasound-Guided Quadratus Lumborum Block as a Sole Anesthetic Method for Giant Inguinal Herniorrhaphy in an Elderly Patient with High Risk
Guangchao Zhang,
Min Xu,
Xiao Wang*
Issue:
Volume 12, Issue 1, June 2024
Pages:
7-10
Received:
14 January 2024
Accepted:
29 January 2024
Published:
5 February 2024
Abstract: Background: Quadratus lumborum (QL) block is a fascial plane block where local anesthetic is injected adjacent to the quadratus lumborum muscle to provide effective analgesia for abdominal procedures. We presented the feasibility of using this technique as the sole anesthetic technique for giant inguinal herniorrhaphy repair by observing intraoperative and postoperative analgesic effects in patients. Case: We present an elderly patient with complex comorbidities who was hospitalized for a left inguinal hernia that fell into the scrotum and formed a huge hernial sac. Comorbidities include hypertension, atrial fibrillation, and chronic obstructive pulmonary disease. After adequate preoperative evaluation, the anesthesiologist scheduled to perform QL block as the sole anesthetic technique to complete a giant inguinal herniorrhaphy with 30 mL of ropivacaine (0.33%). Intraoperative hemodynamics was stable, the patient did not complain discomfort and pain. And no additional analgesics or local infiltration anesthesia was required. The patient was able to move 6 hours after surgery and received the first analgesia 14 hours later. He was discharged one day later, without recurrence after one year of follow-up. Conclusions: Our experience suggests that QL block with 30 mL of ropivacaine (0.33%) may be an effective intraoperative anesthesia technique suitable for elderly patients with complex complications undergoing giant inguinal hernia repair surgery, and a represents a viable alternative approach to general and neuraxial anesthesia.
Abstract: Background: Quadratus lumborum (QL) block is a fascial plane block where local anesthetic is injected adjacent to the quadratus lumborum muscle to provide effective analgesia for abdominal procedures. We presented the feasibility of using this technique as the sole anesthetic technique for giant inguinal herniorrhaphy repair by observing intraopera...
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Case Report
Thrombosis of Prosthetic Tricuspid Valve During Veno-Arterial Extracorporeal Membrane Oxygenation Support: A Case Report
Issue:
Volume 12, Issue 1, June 2024
Pages:
11-14
Received:
17 January 2024
Accepted:
31 January 2024
Published:
20 February 2024
Abstract: Extracorporeal membrane oxygenation (ECMO) is frequently used for severe postcardiotomy cardiogenic shock in patients with bioprosthetic valves. Acute prosthetic valve thrombosis (PVT) is a rare complication after valve replacement surgery and significantly increases morbidity and mortality. Patients who develop PVT on ECMO could significantly influence the long-term durability of the bioprosthetic valves. However, previous studies only analyzed risk factor and treatment of the mitral valve thrombosis during ECMO support. The mechanism of thrombosis on the tricuspid valve was still unknown. Here we describe the symptoms and treatment of a valve replacement patient who developed bioprosthetic tricuspid valve thrombosis during veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Meanwhile, the patient’s mechanical prosthetic mitral valve functioned normally. An emergency re-do tricuspid prosthesis replacement was performed, and the patient finally developed the successful decannulation. At 6 months follow-up, the patient showed asymptomatic and had a reasonable quality of life. The pathophysiology of tricuspid valve thrombosis may be different from the left heart. Our case highlights that the risk of thrombosis associated with a prosthesis in the tricuspid position can be even higher in the setting of VA-ECMO support. In such patients, promoting forward blood flow across the prosthesis and improving levels of anticoagulation may be particularly important.
Abstract: Extracorporeal membrane oxygenation (ECMO) is frequently used for severe postcardiotomy cardiogenic shock in patients with bioprosthetic valves. Acute prosthetic valve thrombosis (PVT) is a rare complication after valve replacement surgery and significantly increases morbidity and mortality. Patients who develop PVT on ECMO could significantly infl...
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Case Report
Timely Surgical Intervention for Absent Pulmonary Valve Syndrome with an Intact Ventricular Septum in a Patient with a Long-Term Survival: A Case Report
Yunyi Zhang,
Shuhua Luo*,
Enping Wang
Issue:
Volume 12, Issue 1, June 2024
Pages:
15-19
Received:
31 January 2024
Accepted:
21 February 2024
Published:
29 February 2024
Abstract: Absent pulmonary valve syndrome with an intact ventricular septum (APVS with IVS) is a rare congenital heart defect that is associated with a high perinatal mortality. Most fetuses can hard to survive without inotropic support or heart transplantation due to the severe respiratory dysfunction, heart failure and serious infections resulting from tracheobronchial compression and right ventricular dilation. Almost one-third of the patients opted for a termination of pregnancy. The etiology of APVS patients is still unknown. Previous research only noted an enhancement in the long-term survival of APVS with tetralogy of Fallot patients over the past decade. However, the timeliness of surgical intervention and survival status in APVS with IVS patients remains unclear. In our case, we described a 27-year-old patient with a rare combination of the rudimentary pulmonary valve, intact ventricular septum and absent superior vena cava who successfully developed biventricular physiology without any medical intervene. And he received a timely pulmonary valve implantation in our centre to prevent further right ventricular dysfunction. Thus, we highlighted that biventricular circulation can be successfully achieved in this rare subtype of APVS with IVS patients. However, more multicentre studies and lifelong follow-up are required to determine the timeliness for pulmonary valve surgery to avoid over-dilatation of the right ventricle in APVS with IVS patients.
Abstract: Absent pulmonary valve syndrome with an intact ventricular septum (APVS with IVS) is a rare congenital heart defect that is associated with a high perinatal mortality. Most fetuses can hard to survive without inotropic support or heart transplantation due to the severe respiratory dysfunction, heart failure and serious infections resulting from tra...
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Research Article
A Study on Pre-clinical Anaesthesia Elective in Shaping Medical Students' Knowledge and Career Perspectives
Jeffrey Hauck*,
Ivan Angelov,
Kelli Silcox,
Ali Khalifa
Issue:
Volume 12, Issue 1, June 2024
Pages:
20-25
Received:
24 February 2024
Accepted:
7 March 2024
Published:
19 March 2024
DOI:
10.11648/j.ijacm.20241201.15
Downloads:
Views:
Abstract: Anesthesiology stands out as one of the rapidly growing and highly competitive medical specialties, necessitating students to cultivate an interest in anesthesia early and prepare extensively for clinical electives. Pre-clinical electives that introduce students to anesthesia and ready them for clinical settings in the early stages of their academic journey may confer benefits and enhance their competitiveness as residency applicants. This study implemented an eight-week pre-clinical elective titled "The History of Anesthesia" for first- and second-year students at Baylor College of Medicine. Eighty-eight students participated in the elective, with thirteen completing both pre-course and post-course surveys. The survey, consisting of thirteen questions related to anesthesia interest and relevant clinical knowledge, was analyzed, and statistical significance was calculated. The survey results demonstrated significantly elevated levels of self-assessed knowledge in the post-course survey compared to the pre-course survey (p < .05). Notably, topics considered more clinically relevant, such as modern anesthetic techniques, regional anesthesia, and obstetric anesthesia, exhibited significantly higher average survey results in the post-course compared to the pre-course results. The implementation of pre-clinical electives focusing on success in clinical settings appears beneficial for students aspiring to apply to an anesthesiology residency. Institutions should consider exposing students to anesthetic topics earlier in their academic journey to adequately prepare them for the competitive residency application process.
Abstract: Anesthesiology stands out as one of the rapidly growing and highly competitive medical specialties, necessitating students to cultivate an interest in anesthesia early and prepare extensively for clinical electives. Pre-clinical electives that introduce students to anesthesia and ready them for clinical settings in the early stages of their academi...
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Research Article
Effects of Dexmedetomidine on Oxidative Stress, Inflammatory Response, Coagulation Function and Hemodynamics in Patients Undergoing Hysterectomy
Issue:
Volume 12, Issue 1, June 2024
Pages:
26-32
Received:
11 March 2024
Accepted:
2 April 2024
Published:
28 April 2024
Abstract: Objective To investigate the effects of dexmedetomidine on oxidative stress, inflammatory response, coagulation function and hemodynamics in patients undergoing hysterectomy. Methods 92 patients who underwent hysterectomy in our hospital from January to September 2023 were selected as subjects. According to the difference in anesthesia, 46 patients were in the control group and 46 in the dexmedetomidine group. Patients in the control group received midazolam anesthesia, and patients in the dexmedetomidine group received dexmedetomidine anesthesia. The changes of oxidative stress, inflammatory response, coagulation function and hemodynamics were compared between T0 (before anesthesia), T1 (10 min after anesthesia), T2 (after extubation) and T3 (24 h after surgery). Results At T0, there was no significant difference in T-AOC, GSH-Px, MBP, MCP-1, AT III, FDP, MAP and SpO2 between the two groups (P>0.05). At the time of T1, T2 and T3, the two groups of patients T-AOC, GSH-Px were all lower than T0 (P<0.05), MBP and MCP-1 were all higher than T0 (P<0.05). The levels of T-AOC and GSH-Px in the dexmedetomidine group were significantly higher than those in the control group (P<0.05). The levels of MCP-1 was significantly lower than that of the control group (P<0.05). At the T1 and T2, ATIII levels was lower than T0 (P<0.05), and FDP levels was higher than T0 (P<0.05). At the time of T3, the levels of ATIII and FDP in the dexmedetomidine group recovered to the normal level of T0. There was no significant change in MAP and SpO2 at each time in the dexmedetomidine group (P>0.05). Conclusion Dexmedetomidine can more effectively alleviate the oxidative stress response in patients with hysterectomy, reduce the symptoms of inflammation in patients, improve the coagulation status of patients and have less influence on hemodynamics, and have high clinical value.
Abstract: Objective To investigate the effects of dexmedetomidine on oxidative stress, inflammatory response, coagulation function and hemodynamics in patients undergoing hysterectomy. Methods 92 patients who underwent hysterectomy in our hospital from January to September 2023 were selected as subjects. According to the difference in anesthesia, 46 patients...
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Case Report
Intraoperative Hypoxemia in the Right Lateral Decubitus Position: A Case Report
Guowei Wu,
Hongwei Xu*
Issue:
Volume 12, Issue 1, June 2024
Pages:
33-37
Received:
28 March 2024
Accepted:
11 April 2024
Published:
28 April 2024
Abstract: Platypnea-Orthodeoxia syndrome (POS), an exceptionally uncommon condition, is characterized by decreased oxygen saturation in an upright posture with corresponding improvement in the supine position. Recently, an 85-year-old female patient presented for surgery due to a left femoral neck fracture. Following successful tracheal intubation and anesthesia induction, the ventilator indicated an airway pressure of 15mmHg. While in the right lateral decubitus position, the patient developed hypoxia despite normal arterial blood pressure and symmetrical breath sounds. Attempts to alleviate the hypoxia through pure oxygen ventilation, tympanic lung ventilation, and high-frequency ventilation were unsuccessful. Subsequently, there was a notable decrease in both blood pressure and heart rate, prompting an immediate halt to the surgery and repositioning the patient to the supine position. This resulted in the normalization of the patient's heart rate, oxygen saturation, and blood pressure. To investigate the etiology, a TEE probe was inserted, revealing the presence of a patent foramen ovale (PFO) and a significant right-to-left shunt while the patient was in the lateral position. The procedure was performed in a specific right lateral decubitus position. This case may represent a unique manifestation of POS syndrome, expanding the differential diagnosis for intraoperative position-related hypoxemia. Given the severe hypoxemia observed with intraoperative positional changes, a strong suspicion of POS syndrome is warranted.
Abstract: Platypnea-Orthodeoxia syndrome (POS), an exceptionally uncommon condition, is characterized by decreased oxygen saturation in an upright posture with corresponding improvement in the supine position. Recently, an 85-year-old female patient presented for surgery due to a left femoral neck fracture. Following successful tracheal intubation and anesth...
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