Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section

BACKGROUND: Potentiating the effect of intrathecal local anesthetics by addition of intrathecal opiods for intra-abdominal surgeries is known. In this study by addition of fentanyl we tried to minimize the dose of bupivacaine, thereby reducing the side effects caused by higher doses of intrathecal bupivacaine in cesarean section. METHODS: Study was performed on 120 cesarean section parturients divided into six groups, identified as B(8), B(10 )and B (12.5 )8.10 and 12.5 mg of bupivacaine mg and FB(8), FB(10 )and FB (12.5 )received a combination of 12.5 μg intrathecal fentanyl respectively. The parameters taken into consideration were visceral pain, hemodynamic stability, intraoperative sedation, intraoperative and postoperative shivering, and postoperative pain. RESULTS: Onset of sensory block to T6 occurred faster with increasing bupivacaine doses in bupivacaine only groups and bupivacaine -fentanyl combination groups. Alone lower concentrations of bupivacaine could not complete removed the visceral pain. Blood pressure declined with the increasing concentration of Bupivacaine and Fentanyl. Incidence of nausea and shivering reduces significantly whereas, the postoperative pain relief and hemodynamics increased by adding fentanyl. Pruritis, maternal respiratory depression and changes in Apgar score of babies do not occur with fentanyl. CONCLUSION: Spinal anesthesia among the neuraxial blocks in obstetric patients needs strict dose calculations because minimal dose changes, complications and side effects arise, providing impetus for this study. Here the synergistic, potentiating effect of fentanyl (an opiod) on bupivacaine (a local anesthetic) in spinal anesthesia for cesarian section is presented, fentanyl is able to reduce the dose of bupivacaine and therefore its harmful effects

The anesthetizing sites supervised to anesthesiologist ratio is an invalid surrogate for group productivity in academic anesthesia departments when used without consideration of the corresponding managerial decisions

When the anesthesiologist does not individually perform the anesthesia care, then to make valid comparisons among US anesthesia departments, one must consider the staffing ratio (i.e., how many cases each anesthesiologist supervises when working with Certified Registered Nurse Anesthetists [CRNAs] or Certified Anesthesiologist Assistants [CAA]). The staffing ratio also must be considered when accurately measuring group productivity. In this narrative review, we consider anesthesia departments with non-physician anesthesia providers and anesthesiology residents. We investigate the validity of such departments assessing the overall ratio of anesthetizing sites supervised per anesthesiologist as a surrogate for group clinical productivity. The sites/anesthesiologist ratio can be estimated accurately using the arithmetic mean calculated by anesthesiologist, the harmonic mean calculated by case, or the harmonic mean calculated by CRNA or CAA, but not by the arithmetic mean ratio by case. However, there is lack of validity to benchmarking the percentage time that anesthesiologists are supervising the maximum possible number of CRNAs or CAAs when some of the anesthesiologists also are supervising resident physicians. Assignments can differ in the total number anesthesiologists needed while every anesthesiologist is supervising as many sites as possible. Similarly, there is lack of validity to limiting assessment to the anesthesiologists supervising only CRNAs or CAAs. There also is lack of validity to limiting assessment only to cases performed by supervised CRNAs or CAAs. When cases can be assigned to anesthesiology residents or CRNAs or CAAs, increasing sites/anesthesiologist while limiting consideration to the CRNAs or CAAs creates incentive for the CRNAs or CAAs to be assigned cases, even when lesser productivity is the outcome. Decisions also can increase sites/anesthesiologist without increasing productivity (e.g., when one anesthesiologist relieves another before the end of the regular workday). A suitable alternative approach to fallaciously treating the sites/anesthesiologist ratio as a surrogate for productivity is that, when a teaching hospital supplies financial support, a responsibility of the anesthesia department is to explain annually the principal factors affecting productivity at each facility it manages and to show annually that decisions were made that maximized productivity, subject to the facilities' constraints

Clay-Alginate Beads Loaded with Ionic Liquids: Potential Adsorbents for the Efficient Extraction of Oil from Produced Water

Produced water (PW) generated from the petroleum industry, during the extraction of oil and gas, has harmful impacts on human health and aquatic life, due to its complex nature. Therefore, it is necessary to treat it before discharging it into the environment in order to avoid serious environmental concerns. In this research, oil adsorption from PW was investigated using clay-alginate beads loaded with ionic liquids (ILs), as the adsorbent material. The effects of several process parameters, such as the initial concentration of oil, contact time, pH, and temperature on the removal efficiency of the beads, were analyzed and optimized. Different characterization methods, such as the Fourier transform infrared spectrophotometer (FTIR), scanning electron microscopy (SEM), energy dispersive X-ray (EDX), and thermal gravimetric analysis (TGA), were used to investigate the surface morphology, the chemical bond structure and functional group, and the thermal stability of the ILs-based beads. The results revealed that the clay-alginate-ILs beads indicated a removal efficiency of 71.8% at the optimum conditions (600 ppm initial oil concentration, 70 min contact time, 10 pH, and at room temperature) with an adsorption capacity of 431 mg/g. The FTIR analysis confirmed the successful chemical bond interaction of the oil with the beads. The SEM analysis verified that the beads have a porous and rough surface, which is appropriate for the adsorption of oil onto the bead’s surface. The TGA analysis provides the thermal degradation profile for the clay-alginate-ILs. The beads used in the adsorption process were regenerated and used for up to four cycles

Hydrophobic Ionic Liquids for Efficient Extraction of Oil from Produced Water

Produced water contaminated with oil has adverse effects on human health and aquatic life. Providing an efficient method for the removal of oil from produced water is a challenging task. In this study, the effects of carbon chain length and the cation nature of ionic liquids (ILs) on the removal efficiency of oil from produced water were investigated. For this purpose, seven ILs containing the bis (trifluoromethylsulfonyl) imide (NTf2) anion, and various cations such as imidazolium, pyridinium, phosphonium, and ammonium, were employed for the removal of oil from produced water via liquid–liquid extraction. The effects of process parameters such as the initial concentration of oil in produced water, contact time, pH, salinity, phase ratio, and temperature on the removal efficiency of oil were studied and optimized. 1-Decyl-3-methyl-imidazolium bis(trifluoromethylsulfonyl)imide ([C10mim][NTf2]) (IL4) was found to give the highest oil extraction efficiency of 92.8% under optimum conditions. The extraction efficiency was found to increase with increasing cation alkyl chain length from C2 to C10. The extraction efficiency of ILs based on cations follows the order imidazolium > ammonium > phosphonium > anpyridinium. Fourier Transform infrared spectroscopy (FTIR) was used to explore the ILs interaction with oil using [C10mim][NTf2] as a model. In addition, 1H and 13C NMR spectra were recorded to obtain a better understanding of the molecular structure of IL and to investigate the peak shifts in H and C atoms. Moreover, the cell viability of the most efficient IL, [C10mim][NTf2], in human cells was investigated. It has been concluded that this IL exhibited minimal cytotoxic effects at lower concentrations against human cell lines and is effective for the extraction of oil from aqueous media