Effect of sono-guided fascia iliaca block versus spinal anesthesia on tourniquet pain during foot and ankle orthopedic surgery

Introduction: The pneumatic thigh tourniquets are routinely used in below knee orthopedic surgeries to provide a bloodless operative field. Moderate to severe thigh pain following tourniquet inflation is a common patient complaint that can be so severe that necessitate general anesthesia. In the present study, we assessed the effectiveness of a single dose fascia iliaca block on thigh tourniquet pain during unilateral orthopedic foot and ankle surgery performed under popliteal sciatic nerve block. Materials and Methods: Seventy-two American Society of Anesthesiologists physical status 1 or 2 patients were randomly divided into two equal groups of spinal anesthesia and fascia iliaca block. Spinal anesthesia was provided with 15 mg of 0.5% hyperbaric bupivacaine. Fascia iliaca and popliteal blocks were performed under the guidance of ultrasound using 30 ml of 1.5% lidocaine and 20 ml of lidocaine 1.5% with epinephrine 1:200000, respectively. Results: Intraoperative tourniquet pain and the use of analgesics were significantly higher and patient satisfaction was significantly lower in the fascia iliaca block group than in the spinal anesthesia group. Conclusion: Fascia iliaca block alone was inadequate for relieving thigh tourniquet pain during surgery. However, for patients who are not suitable for spinal or general anesthesia, it can be used with supplementary intravenous analgesia for tolerance of thigh tourniquet in foot and ankle surgeries performing under popliteal sciatic nerve block

Relationship between Head and Neck Anthropometry in Sonographic Assessment of the Corner Pocket for Ultrasound – Guided Supraclavicular Plexus Blocks

Background: supraclavicular approach has steadily grown throughout various surgeries as a regional anesthesia technique. Ultrasound is suggested to increase the accuracy and safety. This study was aimed to assess the relationship between effectiveness of head and neck anthropometry and sonographic supraclavicular angle as a safety measure.Methods and Materials: 34 patients were evaluated using an ultrasonography device with a linear probe to assess angle of measurement. Besides, using metric measurements, head and neck anomalies were examined. Pearson coefficient analysis was used for data analysis.Results: Based on the results of this study (Table 2), except for age, gender and neck width of the patients, the results did not show a significant relationship. Also, regression calculation studies clearly indicated a higher correlation and alignment of factors such as width, length and circumference long distance in comparison with short distance.Conclusion: The result showed that there was a correlation between the studied angles and the factors of the study with more emphasis on the effective role of ultrasound in the process of anesthetizing the patient through supraclavicular

The Mortality Rate in COVID-19 Patients Undergoing Anesthesia for Surgical Procedures

Background: Planning anesthesia for coronavirus disease (COVID) positive patients remains a big dilemma for anesthesiologists. Aside associated harms of postponing surgeries, there is concern about the outcome of COVID after surgical stress, limitation of resources, and personal safety. Therefore, we aimed to investigate the effect of surgery and anesthesia on the course of coronavirus disease 2019 (COVID-19). Methods: A total of 179 patients (COVID-positive) who underwent surgery under anesthesia from March 2020 until March 2021 were retrospectively evaluated. The type of surgery, type of anesthesia, and outcome of patients were recorded. Renal and liver function tests as well as respiratory system function before and after surgery were compared. Results: Among them, 39 patients died (27%). Laboratory data including creatinine (Cr), Aspartate Transaminase (AST), Alanine Transaminase (ALT), Alkaline Phosphatase (ALK), and troponin were not significantly different preoperatively and post-operatively. 28 patients (15.6%) were intubated due to post-operative respiratory failure. In our study mortality rate for all types of surgery was 27% and the postoperative intubation rate was 15.6%. We did not have any organ failure after interventional procedures. Conclusion: The risk of infection progression must be weighed before scheduling invasive procedures. Moreover, regional anesthesia may be less harmful in case of urgent or emergent need for surgery in infected patients

The effects of Ropivacaine and its Combination with Dexmedetomidine and Dexamethasone on Neural Apoptosis

Background: Neurotoxicity effects of anesthetics in different age groups is a major concern regarding neural injuries. It is reasonable to recognize the neurotoxicity risks of anesthetic drugs and their combinations. Materials and Methods: A total of 16 mice (Mus musculus) weighing 22 to 30 gr were randomly divided into four drug groups (control, Ropivacaine, Ropivacaine + Dexmedetomidine, Ropivacaine + Dexamethasone). 24 hours after unilateral injection of drugs into the femoral nerve of mice, the mice were killed and their femoral nerve was removed. Hematoxylin-eosin tissue staining was used to evaluate changes in the effects of the drugs, and nerve samples were extracted to measure TLR4 and caspase 3 expressions. After Western blotting, the protein expression level was checked between different groups. Results: Ropivacaine in combination with dexamethasone caused less damage to the rat nerve cells. The combination of ropivacaine with dexamethasone (p=0.53 and p=0.46) compared to the combination of ropivacaine with dexmedetomidine relatively had better results in terms of cytotoxicity. Conclusion: A combination of ropivacaine with dexamethasone reduces neurotoxicity risk

Acquaintance of Patients with the Aims of Pre-Operative Anesthesia Evaluation Clinics

ABSTRACT Background: Anesthesia is peri-operative medicine. The role of anesthesiologist in the quality of care rendered to patient

Supplemental Oxygen therapy and Non-Invasive Ventilation in Corona Virus Disease (COVID-19)

The world has experienced a pandemic due to novel Severe Acute Respiratory Disease Corona Virus-2 (SARS-CoV2) since December 2019. The clinical spectrum of the disease known as Coronavirus Disease 2019 (COVID-19) is so much wide, starting from an asymptomatic state to paucisymptomatic clinical presentation, pneumonia, respiratory failure to even death. Supplemental oxygen therapy is essential in managing COVID-19. Also, there is sparse evidence regarding use of non-invasive ventilation (NIV) in pandemics like SARS-CoV-2. This study reviews the currently available methods for respiratory support in COVID-19 with a discussion about using these modalieties in the COVID-19 pandemic

The efficacy of axillary brachial plexus block plus axillary subcutaneous injection of local anesthetic versus axillary block alone for prevention of tourniquet pain in upper extremity surgery

Abstract Background and Objective: The ultrasound guided axillary block provides good anesthesia for orthopedic surgery below the elbow. However, an upper arm tourniquet may be painful because the block may not anesthetize the area under the inflated cuff. The aim of this study was to determine whether subcutaneous injection of a local anesthetic in the axilla decrease the incidence of tourniquet pain in orthopedic surgery performed under axillary block. Materials and Methods: 68 ASA I-III patients undergoing orthopedic surgery for forearm, wrist and hand under ultrasound guided axillary block entered into this prospective, randomized, double-blinded clinical trial. 34 axillary blocks in conjunction with a subcutaneous injection of lidocaine (study group) and 34 axillary blocks with subcutaneous saline injection (control group) were performed. The incidence and severity of tourniquet pain, tourniquet pain onset time, tourniquet inflation time, supplementary analgesia requirement for tourniquet pain and patient satisfaction were evaluated. Results: 16 women and 52 men, age of 17-70 years were included. The characteristics of the patients and operation and onset of tourniquet pain were similar in two groups. The incidence of tourniquet pain, pain scores at the tourniquet site, and the incidence of supplementary intravenous analgesia was significantly higher in the control group than in the study group. Conclusions: The incidence and severity of tourniquet pain with combining axillary brachial plexus block and a subcutaneous injection of lidocaine was significantly less than that associated with axillary block alone. It is an effective simple and safe method in prevention of tourniquet pain in the upper arm. &nbsp

Anesthesia Management in a Pregnant Woman with Severe Sub-glottic Stenosis

ABSTRAC

Regenerative Medicine And Perioperative Hypoxic Organ Damage: Targeting Hypoxia-Inducible Factors

Regenerative medicine is defined by utilizing body’s own repair mechanisms in order to restore normal function of tissues. An important perioperative cause of organ injury is hypoperfusion mostly due to hypoxia. Hypoxia can promote genomic pathway and increase the level of hypoxia-inducible factors (HIF). In this review we introduce HIF as a pioneer role of regenerative medicine for prevention of perioperative complications

Whole Lung Lavage of Nine Children with Pulmonary Alveolar Proteinosis: Experience in a Tertiary Lung Center

Background: Pulmonary alveolar proteinosis (PAP) is a rare disease in children, characterized by intraalveolar accumulation of large amounts of surfactant proteins, which severely reduce gas exchange. Whole lung lavage (WLL) is the preferred technique for the treatment of severe PAP. Case Presentation: This report presents nine pediatric cases with advanced PAP who underwent WLL under general anesthesia during a 9 year period. One patient was treated with multiple unilateral WLL without employing cardiopulmonary bypass (CPB) and eight cases were treated by simultaneous lavage of both lungs using partial CPB. Conclusion: Our experience suggested that partial CPB was useful to support oxygenation during WLL in small children with severe PAP in whom lung separation and selective lavaging of each lung were impracticable