Intravenous lidocaine as adjuvant to general anesthesia in renal surgery

The role of intraoperative intravenous lidocaine infusion has been previously evaluated for pain relief, inflammatory response, and post-operative recovery, particularly in abdominal surgery. The present study is a randomized double-blinded trial in which we evaluated whether IV lidocaine infusion reduces isoflurane requirement, intraoperative remifentanil consumption and time to post-operative recovery in non-laparoscopic renal surgery. Sixty patients scheduled to undergo elective non-laparoscopic renal surgery under general anesthesia were enrolled to receive either systemic lidocaine infusion (group L: bolus 1.5 mg/kg followed by a continuous infusion at the rate of 2 mg/kg/hr until skin closure) or normal saline (0.9% NaCl solution) (Group C). The depth of anesthesia was monitored using the Bispectral Index Scale (BIS), which is based on measurement of the patient’s cerebral electrical activity. Primary outcome of the study was End-tidal of isoflurane concentration (Et-Iso) at BIS values of 40–60. Secondary outcomes include remifentanil consumption during the operation and time to extubation. Et-Iso was significantly lower in group L than in group C (0.63% ± 0.10% vs 0.92% ± 0.11%, p < 10–3). Mean remifentanil consumption of was significantly lower in group L than in group C (0.13 ± 0.04 μg/kg/min vs 0.18 ± 0.04 μg/kg/ min, p < 10–3). Thus, IV lidocaine infusion permits a reduction of 31% in isoflurane concentration requirement and 27% in the intraoperative remifentanil need. In addition, recovery from anesthesia and extubation time was shorter in group L (5.8 ± 1.8 min vs 7.9 ± 2.0 min, p < 10–3). By reducing significantly isoflurane and remifentanil requirements during renal surgery, intravenous lidocaine could provide effective strategy to limit volatile agent and intraoperative opioids consumption especially in low and middle income countries.Keywords: intravenous lidocaine; isoflurane; remifentanil; consumption; Bispectral Index Scale (BIS); renal surger

Effects of music therapy under general anesthesia in patients undergoing abdominal surgery

Background: Music therapy, an innovative approach that has proven effectiveness in many medical conditions, seems beneficial also in managing surgical patients. The aim of this study is to evaluate its effects, under general anesthesia, on perioperative patient satisfaction, stress, pain, and awareness. Methods: This is a prospective, randomized, double-blind study conducted in the operating theatre of visceral surgery at Sahloul Teaching Hospital over a period of 4 months. Patients aged more than 18 undergoing a scheduled surgery under general anesthesia were included. Patients undergoing urgent surgery or presenting hearing or cognitive disorders were excluded. Before induction, patients wore headphones linked to an MP3 player. They were randomly allocated into 2 groups: Group M (with music during surgery) and group C (without music). Hemodynamic parameters, quality of arousal, pain experienced, patient’s satisfaction, and awareness incidence during anesthesia were recorded. Results: One hundred and forty patients were included and allocated into 2 groups that were comparable in demographic characteristics, surgical intervention type and anesthesia duration. Comparison of these two groups regarding the hemodynamic profile found more stability in group M for systolic arterial blood pressure. A calm recovery was more often noted in group M (77.1% versus 44%, p < 10–3). The average Visual Analog Scale (VAS) score was lower in the intervention group (33.8 ± 13.63 versus 45.1 ± 16.2; p < 10–3). The satisfaction rate was significantly higher among the experimental group (81.4% versus 51.4%; p < 10–3). The incidence of intraoperative awareness was higher in group C (8 cases versus 3 cases) but the difference was not statistically significant. Conclusion: Music therapy is a non-pharmacological, inexpensive, and non-invasive technique that can significantly enhance patient satisfaction and decrease patients’ embarrassing experiences related to perioperative stress, pain, and awareness

Prévalence du burnout en milieu d'anesthésie réanimation dans le centre tunisien

Introduction:&nbsp;l'épuisement professionnel serait particulièrement préoccupant en milieu d'anesthésie réanimation. En plus de ses répercussions socio-économiques, il altère la qualité des soins prodigués et le pronostic des malades. Notre but est d'évaluer sa prévalence chez le personnel d'anesthésie-réanimation dans le centre tunisien. Méthodes:&nbsp;il s'agit d'une enquête multicentrique transversale réalisée au sein des services d'anesthésie-réanimation dans les sept centres hospitalo-universitaires du centre tunisien et portant sur tout le personnel médical et paramédical consentant. L'instrument de mesure utilisé est le&nbsp;Maslach burnout Inventory. Résultats:&nbsp;deux cent quatre-vingt-trois personnes ont participé à l'étude (72,19%). L'âge moyen était de 40,2 ± 9,38 ans avec une prédominance féminine. L'analyse de l'échelle de Maslach a révélé que 94,71% des participants étaient concernés par le burnout. Les scores moyens d'épuisement émotionnel, de dépersonnalisation et d'accomplissement professionnel étaient respectivement de 28,65 ± 11,92; 8,62 ± 6.65 et 34,58 ± 8,07. Un niveau élevé à modéré de burnout a été trouvé respectivement dans 13,3% et 26,2% des cas. Un niveau bas a été trouvé dans 55,21% des cas. Les répercussions du burnout sont dominées par les conduites additives (52,65%) et les idées suicidaires (4,59%). Conclusion:&nbsp;le burnout apparaît de plus en plus comme une réalité palpable chez le personnel d'anesthésie réanimation. Ces conséquences sont graves aussi bien sur le plan individuel que social

Chronic Pain following Chest Trauma: Prevalence, Associated Factors, and Psychosocial Impact

Background. Chronic pain (CP) is a real public health concern. It is a common cause of poor quality of life and workplace absenteeism. It is well studied in many medical and surgical fields. However, only few data are available as regards to its occurrence in trauma patients. Purpose. To assess the prevalence, associated factors, and psychosocial impact of CP following chest trauma. Methods. This is an observational, descriptive, and analytic cross-sectional study performed in a Tunisian department of anesthesia and intensive care over a two-month period. Adult patients admitted one year ago for isolated chest trauma were enrolled. Data were collected by a phone interview. Studied variables were sociodemographic characteristics, traumatic injuries and their management, the occurrence of CP, and its psychosocial impact. CP was diagnosed by the Brief Pain Inventory (BPI) considering an evolution period of at least 3 months. Its impact was assessed by the BPI and the Posttraumatic stress disorder Checklist Scale (PCLS). Results. Fifty-four patients were included in the study. The prevalence of CP was 79.6%. The average CP intensity was 3.18 ± 1.4. It was neuropathic in 90.7%. Its main associated factors were pleural effusion (p=0.016), time to ICU admission (p=0.05), and posttraumatic stress disorders (p=0.017). After a multivaried analysis, only pleural effusion was associated with CP (p=0.01, OR = 6.9 CI 95% [1.2–37.3]). Probable or very likely PTSDs were noted, respectively, in 10 and 9 cases. Regarding the psychosocial impact of CP, the most commonly affected dimensions were general activity, work, sleep, and mood. Conclusion. CP following chest trauma is frequent and severe requiring preventive measures such as high risk patients screening, better management of acute pain, and a multidisciplinary approach for patients with diagnosed CP