Serum electrolytes disorders (K,Na,Cl,) after depolirizing drug administration to children

ΣΚΟΠΟΣ ΗΤΑΝ Η ΜΕΛΕΤΗ ΤΩΝ ΜΕΤΑΒΟΛΩΝ ΤΩΝ ΗΛΕΚΤΡΟΛΥΤΩΝ(Κ,ΝΑ,CL) ΤΟΥ ΠΛΑΣΜΑΤΟΣ ΩΣ ΚΑΙ ΤΗΣ ΚΡΕΑΤΙΝΙΚΗΣ ΚΙΝΑΣΗΣ ΚΑΙ ΤΗΣ ΜΥΟΣΦΑΙΡΙΝΗΣ, ΜΕΤΑ ΑΠΟ ΧΟΡΗΓΗΣΗ ΣΚΧ ΣΤΑ ΠΑΙΔΙΑ.ΜΕΛΕΤΗΘΗΚΑΝ 48 ΠΑΙΔΙΑ , ASA I,ΗΛΙΚΙΑΣ 1-14 ΕΤΩΝ ΧΩΡΙΣ ΠΡΟΝΑΡΚΩΣΗ.ΤΑ ΠΑΙΔΙΑ ΚΑΤΑΝΕΜΗΘΗΚΑΝ ΤΥΧΑΙΑ ΣΕ ΔΥΟ ΟΜΑΔΕΣ,ΑΠΟ 24 ΠΑΙΔΙΑ.ΟΜΑΔΑ Ο (ΕΛΕΓΧΟΥ):ΤΑ ΠΑΙΔΙΑ ΕΛΑΒΑΝ ΑΤΡΟΠΙΝΗ 0,1MG/KG ΚΑΙ ΘΕΙΟΠΕΝΤΑΛΗ 5MG/KG.Η ΔΙΑΤΗΡΗΣΗ ΤΗΣ ΑΝΑΙΣΘΗΣΙΑΣ ΓΙΝΟΤΑΝ ΜΕ ΧΟΡΗΓΗΣΗ ΔΙΑ ΜΑΣΚΑΣ ΙΣΟΦΛΟΥΡΑΝΙΟΥ ΣΕ ΜΙΓΜΑ Ο2/Ν2Ο. ΟΜΑΔΑ Ι(ΜΕΛΕΤΗΣ):ΤΑ ΠΑΙΔΙΑ ΕΛΑΒΑΝ ΑΤΡΟΠΙΝΗ 0,1MG/KG, ΘΕΙΟΠΕΝΤΑΛΗ 5MG/KG ΚΑΙ ΣΚΧ 1,2 MG/KG.ΑΚΟΛΟΥΘΗΣΕ ΔΙΑΣΩΛΗΝΩΣΗ ΤΗΣ ΤΡΑΧΕΙΑΣ ΚΑΙ ΔΙΑΤΗΡΗΣΗ ΤΗΣ ΑΝΑΙΣΘΗΣΙΑΣ ΜΕ ΠΑΡΟΧΗ ΙΣΟΦΛΟΥΡΑΝΙΟΥ ΣΕ ΜΙΓΜΑ Ο2/Ν2Ο.ΚΑΘΕ ΟΜΑΔΑ ΔΙΑΧΩΡΙΣΘΗΚΕ ΣΕ 3 ΗΛΙΚΙΑΚΕΣ ΥΠΟΟΜΑΔΕΣ ΑΠΟ 8 ΠΑΙΔΙΑ:ΤΗΝ 1-5,ΤΗΝ 6-10 ΚΑΙ ΤΗΝ 11-14 ΕΤΩΝ.ΜΕΛΕΤΗΘΗΚΑΝ ΟΙ ΤΙΜΕΣ ΤΩΝ ΗΛΕΚΤΡΟΛΥΤΩΝ ΣΤΙΣ ΑΙΜΟΛΗΨΙΕΣ ΤΩΝ 0,1,3,5,ΚΑΙ 15 ΧΡΟΝΙΚΩΝ ΣΤΙΓΜΩΝ ΩΣ ΚΑΙ ΤΗΣ CK ΚΑΙ ΤΗΣ ΜΥΟΣΦΑΙΡΙΝΗΣ ΣΤΙΣ ΧΡΟΝΙΚΕΣ ΣΤΙΓΜΕΣ 0,5 ΚΑΙ 15 ΚΑΙ Η ΚΙΝΗΤΙΚΗ ΑΠΑΝΤΗΣΗ ΤΩΝ ΠΑΙΔΙΩΝ ΒΑΣΕΙ ΚΛΙΜΑΚΑΣ ΠΕΝΤΕ ΒΑΘΜΙΔΩΝ.Η ΚΥΡΙΑ ΜΕΘΟΔΟΣ ΣΤΑΤΙΣΤΙΚΗΣ ΑΝΑΛΥΣΗΣ ΗΤΑΝ Η RM-ANOVA.ΚΑΙ ΣΤΙΣ ΔΥΟ ΟΜΑΔΕΣ ΠΑΡΑΤΗΡΗΘΗΚΕ ΣΤΑΤΙΣΤΙΚΑ ΣΗΜΑΝΤΙΚΗ ΠΤΩΣΗ ΤΩΝ ΗΛΕΚΤΡΟΛΥΤΩΝ (Κ,ΝΑ,CL) ΤΑ ΠΡΩΤΑ ΛΕΠΤΑ,ΠΟΥ ΑΚΟΛΟΥΘΕΙΤΑΙ ΑΠΟ ΑΝΑΚΑΜΨΗ ΑΥΤΩΝ ΣΤΟ 15ΛΕΠΤΟ.ΤΟ Κ ΕΜΦΑΝΙΣΕ ΠΤΩΣΗ ΚΑΙ ΓΙΑ ΤΙΣ ΔΥΟ ΟΜΑΔΕΣ (P<0.0001) ΜΕ ΤΗΝ ΟΜΑΔΑ ΜΕΛΕΤΗΣ ΝΑ ΠΑΡΟΥΣΙΑΖΕΙ ΜΕΓΑΛΥΤΕΡΗ ΑΝΑΚΑΜΨΗ ΤΟ 15'(P=0,0318).ΤΟ ΝΑ ΕΜΦΑΝΙΣΕ ΜΕΓΑΛΥΤΕΡΗ ΠΤΩΣΗ ΤΟ 1' ΚΑΙ ΤΟ 3'(p=0,0371 KAI 0,0490 ΑΝΤΙΣΤΟΙΧΑ) ΣΤΗΝ ΟΜΑΔΑ ΜΕΛΕΤΗΣ.ΤΟ CL ΕΜΦΑΝΙΣΕ ΜΕΓΑΛΥΤΕΡΗ ΠΤΩΣΗ ΤΟ 1'(P=0,0123)ΣΤΗΝ ΟΜΑΔΑ ΜΕΛΕΤΗΣ.Η ΧΟΡΗΓΗΣΗ ΣΚΧ ΠΡΟΚΑΛΕΣΕ ΔΙΑΦΟΡΑ ΣΤΗΝ ΚΙΝΗΤΙΚΗ ΑΠΑΝΤΗΣΗ ΤΩΝ ΠΑΙΔΙΩΝ (p=0,0000123, ΕΛΕΓΧΟΣ ΤΟΥ FISHER).Η ΧΟΡΗΓΗΣΗ ΣΚΧ ΣΤΑ ΠΑΙΔΙΑ ΠΡΟΚΑΛΕΣΕ ΜΙΚΡΗ ΑΝΟΔΟ ΤΗΣ CK ΣΤΟΝ ΧΡΟΝ

Anesthesia Related Toxic Effects on In Vitro Fertilization Outcome: Burden of Proof

Management of pain and anxiety during oocyte retrieval makes anesthesia an important part of the in vitro fertilization (IVF) procedures. There are many studies investigating the influence of anesthesia on IVF success. This review article provides an overview of published data regarding the potential toxic effects of different anesthetic techniques (Loco-regional, general anesthesia (GA), and monitored anesthesia care (MAC)), different anesthetic agents, and alternative medicine approach (principally acupuncture) on the IVF outcome. From our analysis, evidence of serious toxicity in humans is not well established. Trials regarding different anesthetic techniques ended up without clear conclusions. Studies about GA came up with conflicting results. A few trials relate GA with lower pregnancy rates, although some others failed to prove this conclusion. Furthermore, detectable amounts of some anesthetic agents are measurable in the follicular fluid but these findings are not strongly associated with toxicity. MAC and Loco-regional anesthesia appear as safe alternative choices and there is evidence of improved outcome. Whereas acupuncture may provide assistance increasing IVF success according to some trials, some others could not obtain these effects. Questions about the appropriate time of application and the underlying mechanism of action are not answered yet, so further investigation should be done

Prediction and Prevention of Intraoperative Hypotension with the Hypotension Prediction Index: A Narrative Review

Intraoperative hypotension is common and has been associated with adverse events. Although association does not imply causation, predicting and preventing hypotension may improve postoperative outcomes. This review summarizes current evidence on the development and validation of an artificial intelligence predictive algorithm, the Hypotension Prediction (HPI) (formerly known as the Hypotension Probability Indicator). This machine learning model can arguably predict hypotension up to 15 min before its occurrence. Several validation studies, retrospective cohorts, as well as a few prospective randomized trials, have been published in the last years, reporting promising results. Larger trials are needed to definitively assess the usefulness of this algorithm in optimizing postoperative outcomes

Epidural haematoma after epidural catheter removal under multiple anticoagulant therapy: report of two cases

We report two cases of epidural haematoma that probably developed after removal of the epidural catheter in patients receiving multiple anticoagulant and antiplatelet therapy. The first case is a 77-year-old male patient who underwent femoropopliteal artery bypass grafting surgery. The second case is a 77-year-old woman who underwent a semi-total replacement of the right hip, three days after she had a subtrochanteric fracture. Emergency laminectomy was performed in both patients but none experienced a full recovery

Sevoflurane impairs post-operative olfactory memory but preserves olfactory function

WOS: 000284869800013PubMed ID: 20962652Background and objective The effect of anaesthesia on olfaction has not been systematically studied. Our aim is to compare the effects of general and regional anaesthesia on olfactory acuity and memory in the immediate post-operative period. Methods Sixty adult patients with the American Society of Anesthesiologists I and II status scheduled for elective minor surgery were included. Exclusion criteria were smoking, alcoholism, psychiatric disease and recent or past airway infection with resulting hyposmia. Patients were randomly allocated to one of three groups (in the analysis, n = 16 in each group): epidural anaesthesia (group E), general anaesthesia with propofol (group P) and general anaesthesia with sevoflurane (group S) of 40-120 min duration. The evening before surgery, at 0.5 and at 3 h post-operatively olfactory acuity and memory were tested, along with blood sampling to measure plasma melatonin and oxytocin levels. Olfactory acuity was tested with successive dilutions of n-butyl-alcohol, and olfactory memory (interpretation of odours) with the University of Pennsylvania Smell Identification Test. Results Patient characteristics did not differ between groups. Olfactory acuity was intact in all patients, before and after anaesthesia. Olfactory memory deteriorated in group S compared to groups P and E at both post-operative time-points. This was accompanied by a significant post-operative reduction of plasma melatonin levels in group S. Oxytocin levels remained constant in all groups. Conclusion Our results manifest a specific effect of sevoflurane on olfactory memory, not observed with neuraxial or total intravenous anaesthesia. The misinterpretation of odours in the immediate post-operative period by sevoflurane could be mediated by the decreased levels of melatonin. Eur J Anaesthesiol 2011;28:63-68 Published online 19 October 2010University of Athens; Hellenic Navy; Department of Anaesthesiology, School of Medicine, University of Athens, 'Attikon' Hospital, Athens, GreeceThe present work was financially supported by the Special Account for Scientific Research of the University of Athens and the Hellenic Navy General Staff. No sponsorship was used.; The study was supported by the 2nd Department of Anaesthesiology, School of Medicine, University of Athens, 'Attikon' Hospital, Athens, Greece

The Use of the Hypotension Prediction Index Integrated in an Algorithm of Goal Directed Hemodynamic Treatment during Moderate and High-Risk Surgery

(1) Background: The Hypotension Prediction Index (HPI) is an algorithm that predicts hypotension, defined as mean arterial pressure (MAP) less than 65 mmHg for at least 1 min, based on arterial waveform features. We tested the hypothesis that the use of this index reduces the duration and severity of hypotension during noncardiac surgery. (2) Methods: We enrolled adults having moderate- or high-risk noncardiac surgery with invasive arterial pressure monitoring. Participating patients were randomized 1:1 to standard of care or hemodynamic management with HPI guidance with a goal directed hemodynamic treatment protocol. The trigger to initiate treatment (with fluids, vasopressors, or inotropes) was a value of HPI of 85 (range, 0–100) or higher in the intervention group. Primary outcome was the amount of hypotension, defined as time-weighted average (TWA) MAP less than 65 mmHg. Secondary outcomes were time spent in hypertension defined as MAP more than 100 mmHg for at least 1 min; medication and fluids administered and postoperative complications. (3) Results: We obtained data from 99 patients. The median (IQR) TWA of hypotension was 0.16 mmHg (IQR, 0.01–0.32 mmHg) in the intervention group versus 0.50 mmHg (IQR, 0.11–0.97 mmHg) in the control group, for a median difference of −0.28 (95% CI, −0.48 to −0.09 mmHg; p = 0.0003). We also observed an increase in hypertension in the intervention group as well as a higher weight-adjusted administration of phenylephrine in the intervention group. (4) Conclusions: In this single-center prospective study of patients undergoing elective noncardiac surgery, the use of this prediction model resulted in less intraoperative hypotension compared with standard care. An increase in the time spent in hypertension in the treatment group was also observed, probably as a result of overtreatment. This should provide an insight for refining the use of this prediction index in future studies to avoid excessive correction of blood pressure

Music’s Use for Anesthesia and Analgesia

This review article provides an overview of published data regarding the involvement of music in anesthesia practice. Music is an important topic for research in different fields of anesthesiology. The use of music preoperatively is aimed at reducing anxiety, stress, and fear. However, the effect of music on perception of pain intraoperatively is controversial, according to studies of both adults and children undergoing various surgical procedures under general and/or regional anesthesia. In postoperative pain management, postanesthesia care, and neonatal intensive care, music can be a complementary method for reducing pain, anxiety, and stress. Music is a mild anxiolytic, but it is relatively ineffective when a pain stimulus is severe. However, music is inexpensive, easily administered, and free of adverse effects, and as such, can serve as complementary method for treating perioperative stress and for acute and chronic pain management, even though music’s effectiveness depends on each individual patient’s disposition and severity of pain stimulus. (PsycINFO Database Record (c) 2016 APA, all rights reserved

Ketamine Versus Tramadol As an Adjunct To PCA Morphine for Postoperative Analgesia After Major Upper Abdominal Surgery: a Prospective, Comparative, Randomized Trial.

BACKGROUND AND AIMS: Patient-controlled analgesia (PCA) with morphine is commonly used to provide analgesia following major surgery, but is not sufficient as a monotherapy strategy. This study aimed to compare the adjunctive analgesic effect of ketamine versus tramadol on postoperative analgesia provided via PCA-morphine in patients undergoing major upper abdominal surgeries. METHODS: Forty-two patients undergoing elective major upper abdominal surgery under general anesthesia were allocated to receive either ketamine (load dose of 0.5 mg kg(-1) followed by a continuous infusion of 0.12 mg kg(-1) h(-1) up to 48 postoperative hours; ketamine group, n = 21) or tramadol (load dose of 1 mg kg(-1) followed by a continuous infusion of 0.2 mg kg(-1) h(-1) up to 48 postoperative hours; tramadol group, n = 21) in addition to their standard postoperative analgesia with PCA-morphine. Postoperative data included morphine consumption, visual analog scale (VAS) scores, and side effects during the first 48 postoperative hours after PCA-morphine initiation. RESULTS: There were no significant differences in patient demographic and intraoperative data between the two groups. Tramadol group had significantly less total morphine consumption during the first 48 postoperative hours (28.905 [16.504] vs 54.524 [20.846] mg [p &lt; 0.001]) and presented significantly lower VAS scores at rest and mobilization (p &lt; 0.05) than the ketamine group. No statistical difference was recorded between the two groups (p &gt; 0.05) regarding postoperative cough, sedation, hallucinations, pruritus, urine retention, and postoperative nausea and vomiting. However, patients in the ketamine group reported dry mouth more frequently than patients in the tramadol group (p = 0.032). CONCLUSIONS: Postoperative administration of tramadol was superior to ketamine due to significantly reduced opioid consumption and better pain scores in patients receiving PCA-morphine after major upper abdominal surgery