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

Comparison of two doses of hypobaric bupivacaine in unilateral spinal anesthesia for hip fracture surgery: 5 mg versus 7.5 mg

Introduction: Hip fracture is a frequent and severe disease. Its prognosis depends on the perioperative hemodynamic stability which can be preserved by the unilateral spinal anesthesia especially with low doses of local anesthetics. This study aims to compare the efficacy and hemodynamic stability of two doses of hypobaric bupivacaine (7.5 mg vs 5 mg) in unilateral spinal anesthesia. Methods: In this prospective, randomized, double-blind study, 108 patients scheduled for hip fracture surgery under unilateral spinal anesthesia were enrolled to receive either 5 mg (group 1) or 7.5 mg (group 2) of hypobaric bupivacaine. Spinal anesthesia was performed in lateral position. Patients’ socio-demographic characteristics, hemodynamic profile, sensory and motor blocks parameters were recorded. Results: Both groups were comparable regarding to demographic data. Two cases of failure occurred in group 1 and one case in group 2 corresponding to a comparable efficiency rates (96.29% and 98.14% respectively; p = 0.5). A higher mean onset and lower mean regression times of sensory block were significantly noted in group 1 (7.79±3.76 min vs 5.75±2.35 min, p < 0.001 and 91.29±31.55 min vs 112.77±18.77 min, p <0.001 respectively). Incidence of bilateralization (29.62% vs 87.03%, p < 0.001), incidence of hypotensive episodes (59.25% vs 92.59%, p < 0.001) and vascular loading (1481.48±411.65 ml vs 2111.11±596.10 ml, p < 0.001) were significantly higher in group 2. Conclusion: The dosage of 5mg of hypobaric bupivacaine in unilateral spinal anesthesia is as effective as the dosage of 7.5 mg with lower bilateralization incidence and better hemodynamic stability

Effet de la température frittage sur le comportement mécanique et tribologique de l’alliage TiNi poreux

La biocompatibilité des implants est une condition indispensable à leurs usages. Elle peut être définie par la compatibilité entre un système technique et un système biologique. On distingue deux types de biocompatibilité, structurale et celle de surface. Elle est caractéristique de l’endommagement provoqué par l’implant sur les tissus. Cet endommagement est lié aux propriétés mécaniques de l’implant et aux produits libérés par le frottement et par la corrosion qui se manifestent à l’interface du biomatériau et des tissus environnants. Ces derniers peuvent être à l’origine de nombreuses irritations. A cet effet l’objectif de ce travail est l’étude de l’effet de la température de frittage sur le comportement mécanique, électrochimique et tribologique de l’alliage TiNi poreux

Effet de la température de frittage sur le comportement mécanique et tribologique de l’alliage TiNi poreux

Le frittage en phase solide des poudres élémentaires de titane et de nickel a été utilisé pour élaborer l’alliage TiNi poreux. Dans ce travail, on a étudié l’effet de la température de frittage sur les comportements mécanique, tribologique et électrochimique de cet alliage. L’analyse par la diffraction des rayons X, la microscopie électronique à balayage (MEB) et l’analyse EDS révèlent la formation de la phase TiNi majoritaire pour tous les échantillons frittés aux différentes températures. L’échantillon fritté à 950 °C présente une dureté élevée, un module d’Young et un taux d’usure plus faibles que celui fritté à 850 °C. Les techniques : polarisation à circuit ouvert, potentiodynamique, et spectroscopie d’impédance électrochimique ont été utilisées pour vérifier l’influence de la température de frittage sur les paramètres électrochimiques de l’alliage dans des conditions physiologiques reproduisant celles rencontrées dans le corps humain (phosphate buffered saline solution). Les résultats des investigations montrent que l’alliage TiNi poreux présente un caractère passif et la cinétique de corrosion dépend dans une large mesure de la porosité ainsi que de la température de frittage

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

Magnesium Sulfate as Adjuvant in Prehospital Femoral Nerve Block for a Patient with Diaphysial Femoral Fracture: A Randomized Controlled Trial

Introduction. Prehospital management of traumatic pain is commonly based on morphine while locoregional analgesia techniques, especially the femoral nerve block (FNB), can be safely and efficiently used. Adjuvants uses can reduce local anesthetic doses and decrease their related risk. The aim of the study was to assess the analgesic effect of magnesium sulfate when used as an adjuvant in prehospital FNB. Methods. This is a randomized double-blinded trial conducted in a prehospital medical department of an academic hospital. Patients with isolated diaphysial femoral fracture and eligible to participate were randomized into 2 groups. Group C had a FNB with 15 ml of lidocaine with epinephrine (300 mg) and 3 ml of normal saline solution. Group I had a FNB with 15 ml of lidocaine with epinephrine (300 mg) and 3 ml of MgS 15% (450 mg). The FNB was performed according to the WINNIE technique. Primary endpoints were morphine consumption and pain intensity during the first 6 hours. Secondary endpoints were the duration of the sensory block, time to the first analgesic request, and side effects occurrence. Results. Twenty-four patients were enrolled in each group. Both groups were comparable according to demographic characteristics, initial pain scores, and vital constants. In group I, morphine requirements were significantly lower (2 ± 2 mg versus 5 ± 3 mg, p<10−3), analgesic onset was significantly faster, and the average time to the first analgesic request was longer (276 ± 139 min versus 160 ± 79 min, p<10−3). The average duration of sensory block was longer in group I (226 ± 64 min versus 116 ± 70 min p<10−3). No side effects were recorded. Conclusion. Magnesium sulfate should be considered as an efficient and safe adjuvant to lidocaine in prehospital FNB. This trial is registered with (NCT03597945)

Impact of Melatonin as a Premedication Agent in Caesarean Section on Blood Loss and Postoperative Pain Level

Background. Postpartum hemorrhage (PPH) is a serious postdelivery condition with a high incidence of morbidity and mortality for women who undergo childbirth with or without a caesarean section. Melatonin has been suggested to increase the contractility of myometrium and reduce the pain score postoperatively, therefore it is believed that the use of melatonin before surgery may decrease blood loss, reduce pain score, and decrease the need for postoperative opioids. Objectives. The main objectives of this study are focused on the investigation of melatonin as a premedication agent to reduce blood loss and decrease pain score postoperatively in patients undergoing cesarean section under spinal anesthesia. Methods. 80 patients were scheduled for spinal anesthesia-based cesarean sections and randomly assigned to two groups, melatonin group (M) 40 patients and placebo group (P) 40 patients to receive either 10 mg of sublingual melatonin or a placebo of 90 minutes preoperatively. Hemoglobin levels were been measured preoperative and 12 hrs. Postoperatively, blood loss volume was calculated by measuring both the weight of used materials before and after the surgery and the volume sucked in the suction bottle after placental delivery. Postoperative visual pain score and analgesic requirements were used to evaluate pain levels. Results. Analyzed collected data showed a significant decrease in blood loss in the melatonin group in comparison with the placebo group as measured by the hemoglobin level. On the other hand, there is a significant decrease in pain score and analgesia requirement with the melatonin group compared to the placebo group. Conclusion. Melatonin is a promising premedication drug that has a significant impact on postpartum hemorrhage by reducing blood loss and pain levels of mothers who have undergone C-sections

Portée pédagogique de Facebook à travers un programme de formation à base de caricatures

Contexte : Les technologies de l’information et de la communication (TIC) offrent des nouvelles avenues pédagogiques dont la portée demeure peu connue. Leur combinaison avec les caricatures, dotées d’une grande attractivité humoristique, pourrait favoriser la mémorisation et l’apprentissage. But : Évaluer la portée pédagogique de Facebook à travers un programme de formation basé sur les caricatures. Méthodes : Il s’agit d’une étude interventionnelle pré-expérimentale réalisée sur une période de 3 mois et incluant tous les internes et les résidents exerçant dans les services chirurgicaux et de réanimation. Après une évaluation initiale sur la transfusion sanguine, un groupe a été créé sur « Facebook » incluant tous les participants et via lequel 25 messages clés sous forme de caricatures ont été diffusés à raison de 3 messages par jour durant une période d’un mois. Finalement, l’évaluation initiale a été refaite. Le critère de jugement principal était le taux de bonne réponse (TBR) par participant. Résultats : Le taux de participation était de 84,6 % lors de la première évaluation et de 80,2 % lors de la deuxième. Au terme de notre intervention, le TBR par participant a augmenté de façon significative (de 52,3 à 66,5 % ; p < 0,001. Concernant les questions considérées comme dangereuses, le TBR a également significativement augmenté passant de 49,5 à 65,9 % avec p < 0,001. Conclusion : L’utilisation d’un moyen de communication tel que Facebook associé à un support d’information tel que les caricatures permettraient d’améliorer significativement les connaissances et constitueraient des outils pédagogiques intéressants et efficaces