Effect of intraoperative constant rate infusion of lidocaine on short-term survival of dogs with septic peritonitis: 75 cases (2007-2011)

OBJECTIVE To investigate whether intraoperative administration of a lidocaine infusion to dogs with septic peritonitis was associated with short-term (48 hours) survival after surgery. DESIGN Retrospective case series. ANIMALS 75 dogs with septic peritonitis. PROCEDURES Medical records of dogs with septic peritonitis that underwent laparotomy between January 2007 and December 2011 at the Royal Veterinary College were reviewed. Select variables during the preoperative, intraoperative, and postoperative periods and short-term survival after surgery were compared between dogs that received an opioid only (group O; n = 33) and dogs that received lidocaine (50 \u3bcg/kg/min [22.7 \u3bcg/kg/min], IV; group L; 42) in addition to an opioid during surgery. RESULTS The proportion of dogs that survived for 48 hours after surgery was significantly greater for group L (35/42) than for group O (20/33). Intraoperative infusion of lidocaine increased the odds of short-term survival (OR, 8.77; 95% CI, 1.94 to 39.57). No significant differences were observed between the 2 treatment groups for variables assessed during the preoperative and postoperative periods. During the intraoperative period, more dogs in group L received an IV bolus of a synthetic colloid than did dogs in group O, but the number of IV boluses administered was not associated with short-term survival. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that IV infusion of lidocaine might improve the short-term survival of dogs with septic peritonitis. Prospective clinical trials are necessary to determine the efficacy of lidocaine as a supportive treatment for dogs with septic peritonitis

Epidural Anesthesia with Lidocaine and Dexmedetomidine, Versus Lidocaine Alone on Plasma Levels of IL-6 in Patients with Proximal Femoral Fracture.

Interleukin-6 plays an important role in inflammatory responses and synthesis of acute hepatic phase proteins and its plasma level changes are used as a reliable prognostic factor for mortality in hospitalized patients. On the other hand, various methods for reducing inflammatory responses, including proper control of pain during and after surgery, and correction of hemodynamic disorders, can be monitored by monitoring of plasma levels of IL-6. Epidural anesthesia is an appropriate method for controlling pain in lower limb surgeries. The aim of this study was to evaluate the effect of adding Dexmedetomidine to lidocaine in the epidural injection for better control of post-surgical inflammatory responses by measuring interleukin-6 plasma levels.Patients referred to Taleghani Hospital in 1396 who suffered from lower limb fractures and requiring surgery were evaluated. 52 patients in two groups receiving Dexmedetomidine doses of media and controls for the quality of epidural anesthesia and IL-6 index. After obtaining written consent, the Dexmedetomidine treatment group and the normal saline control group were prescribed epidural with lidocaine. Finally, the level of IL-6 before surgery and 6 hours after surgery were evaluated.According to the results of statistical analysis, the two groups did not show a significant difference in age and level of interleukin prior to the operation. The mean age of patients in this study was 15.84639 ± 53.4038. The sex distribution of the study included 19 women (36.5%) and 33 men (63.5%). According to the U Mann Whitney test, the second injection time and total drug volume had a significant difference between the control and intervention groups and Dexmedetomidine reduced the volume of total drug needed and increase the time interval until the second injection (p <0.001). There was also a significant difference between the two groups in the level of interleukin 6 after 6 hours of operation and this was lower in the Dexmedetomidine group.keywords: Interleukin-6, Dexmedetomidine, lidocaine, Anesthesi

Ketamine

No AbstractKeywords: Ketamin

Внутривенная инфузия лидокаина в хирургии трахеи

ТРАХЕИ СТЕНОЗТРАХЕЯ /ХИРРЕЗЕКЦИЯ ТРАХЕИГРУДНАЯ ХИРУРГИЯТОРАКАЛЬНАЯ ХИРУРГИЯИНФУЗИИ ВНУТРИВЕННЫЕКАПЕЛЬНЫЕ ИНФУЗИИАНЕСТЕЗИРУЮЩИЕ СРЕДСТВА ВНУТРИВЕННЫЕВНУТРИВЕННЫЕ АНЕСТЕТИКИЛИДОКАИНПОСЛЕОПЕРАЦИОННОЕ ОБЕЗБОЛИВАНИЕПОСЛЕОПЕРАЦИОННАЯ ТОШНОТА И РВОТАЦель. Оценить возможность применения внутривенной инфузии лидокаина в хирургии трахеи. Материал и методы. Выполнен анализ 19 историй болезней пациентов, прооперированных по поводу стенозов трахеи. В зависимости от периоперационного обезболивания пациенты были разделены на две группы: 1-ая (n=9) – внутривенная инфузия лидокаина; 2-ая (n=10) – наркотические анальгетики. Резекция трахеи из шейного доступа. До пересечения трахеи и после наложения трахеального анастомоза проводилась протективная искусственная вентиляция легких. Этап резекции трахеи и создания анастомоза – струйная ВЧ-вентиляция. Поддержание анестезии – севофлураном, а после вскрытия просвета трахеи – пропофолом 6-8 мг/кг/ч. В первой группе в индукцию добавляли внутривенно болюсно лидокаин 1,5 мг/кг с последующей непрерывной инфузией 1,5 мг/кг/час во время операции. Концентрация лидокаина определялась через 15 минут после болюса и через сутки после операции. Оценивались гемодинамика, кислотно-щелочное состояние, гликемия, реакция на эндотрахеальную трубку, время экстубации, возникновение послеоперационной тошноты и рвоты. Болевой синдром оценивали по визуально-аналоговой шкале каждые 15 мин в течение часа, затем каждые 4 часа до истечения первых суток, фиксировали потребление опиоидов. Результаты. Пациенты 1-й группы экстубировались без ажитации, прессорная реакция на экстубацию менее выражена. Среднее артериальное давление, газовый состав крови и гликемия межгрупповых различий не имели. Признаков системной токсичности лидокаина не было обнаружено. Пациентам 1-й группы назначение промедола и трамадола не требовалось, а медиана и перцентили у пациентов 2-й группы, как для промедола, так и для трамадола составляли 60 [30; 60] и 400 [200; 400] мг соответственно. У четверых пациентов 2-й группы развилась послеоперационная тошнота и рвота. Заключение. Внутривенная инфузия лидокаина возможна как альтернатива периоперационной опиоидной анальгезии в хирургии трахеи, выполненной из шейного доступа.Objective. To evaluate the possibility of using intravenous infusion of lidocaine in tracheal surgery. Methods. The analysis of case histories of patients (n=19) operated on for tracheal stenosis was carried out. Depending on the perioperative analgesia, the patients were divided into two groups: the 1st group (n=9) – intravenous infusion of lidocaine; the 2nd – (n = 10) – narcotic analgesics. Tracheal resection was carried out using the cervical access. Before tracheal transection and after tracheal anastomosis was applied, protective mechanical ventilation of the lungs was performed. The stage of tracheal resection and formation of anastomosis is high-frequency jet ventilation (HFJV). Anesthesia was maintained with sevoflurane, and after opening the tracheal lumen – with propofol 6-8 mg/kg/h. In the first group, an intravenous bolus of lidocaine 1.5 mg / kg was added to the induction, followed by a continuous infusion of 1.5 mg / kg / h during surgery. The concentration of lidocaine was determined 15 minutes after the bolus and 24 h after surgery. Hemodynamics, acid-base state, glycemia, response to the endotracheal tube, time of extubation, occurrence of postoperative nausea and vomiting were assessed. Pain syndrome was assessed using a visual analogue scale every 15 minutes for an hour, and then every 4 hours until the end of the first day, the consumption of opioids was recorded. Results. Group 1 patients were extubated without agitation; the pressor response to extubation was less pronounced. Mean arterial pressure, blood gas composition and glycemia did not differ between these groups. There were no signs of systemic toxicity of lidocaine. Group 1 patients did not need promedol and tramadol, and the median and percentiles in group 2 patients, both for promedol and tramadol, were 60 [30; 60] and 400 [200; 400] mg, respectively. Four patients in group 2 had postoperative nausea and vomiting. Conclusion. Intravenous infusion of lidocaineis considered to be an alternative to perioperative opioid analgesia in tracheal surgery performed from the cervical approach

Septic shock in pediatrics II. Current concepts in diagnosis and treatment

Indexación: Web of Science; Scielo.Aunque los principios básicos para el diagnóstico y los pilares terapéuticos del niño con shock séptico se mantienen en el tiempo, es innegable que en las últimas décadas se han incorporado nuevos y trascendentes conceptos, siendo importante que el médico tratante en el Servicio de Urgencia tenga conocimiento a cabalidad de ellos. En la segunda parte de esta actualización se discuten las similitudes y diferencias entre la población infantil y adulta, la utilidad de las metas de reanimación metabólicas, como también el enfoque terapéutico inicial en el paciente séptico. Los conceptos más importantes revisados se refieren a las diferencias entre el niño y adulto con shock séptico, especialmente en la fisiopatología, clínica y tratamiento. Se recalca la importancia de expansión de la volemia y el uso de drogas vasoactivas si no hay respuesta a fluidos de reanimación. El manejo terapéutico debe estar orientado a la búsqueda de la normalización de metas macrohemodinámicas y de perfusión sistémica. Se deben evitar los errores más frecuentes de observar en el tratamiento inicial del paciente séptico. Esta entidad presenta una elevada incidencia y mortalidad, por lo cual el manejo precoz y agresivo es de máxima importancia en pediatría.Although the basic concepts of diagnosis and therapy of the child with septic shock have remained similar over time, it is undeniable that in recent decades, new and important concepts have been added, and any treating physician either at the Emergency Department or Intensive Care Unit should be fully aware of them. This second part discusses the similarities and differences between pediatric and adult populations, the utility of metabolic resuscitation goals, as well as the initial therapeutic approach in septic patients. The most important concepts of this work make reference to the differences between children and adults with septic shock, specifically regarding to pathophysiology, clinical presentation and treatment. Volume expansion and vasoactive drugs are crucial if there is no response to fluid resuscitation. The therapeutic management should focus on finding the normalization of macrohemodynamic and systemic perfusion targets. Common observation mistakes in the initial treatment of septic patients should be avoided. This condition has a high incidence and mortality rate; therefore an early and aggressive treatment is essential.http://ref.scielo.org/cc6t3

Dynamics of the ion beam induced nitridation of silicon

High-resolution Rutherford backscattering and channeling has been used to study the energy and angular dependence of the ion beam induced nitridation of Si in a secondary ion mass spectrometry system. The nitridation of Si is characterized by two critical angles θc1 and θc2, corresponding to the formation of stoichiometric and overstoichiometric Si-nitride layers, respectively. For the N₂⁺ bombardment in the 10 to 13.5 keV range, θc1 changes from 40° to 45°, while θc2 changes from 28° to 30°. Further, strong oscillations in the secondary ion signal, observed for angles of incidence below θc2, are directly related to charging of the Si-nitride surface. We demonstrate that the response of the Si-nitride layer under ion bombardment during the transient stage of nitridation can be described by a second order differential equation

Clinical and Immunomodulating Effects of Ketamine in Horses with Experimental Endotoxemia

Background:  Ketamine has immunomodulating effects both in vitro and in vivo during experimental endotoxemia in humans, rodents, and dogs. Hypothesis:  Subanesthetic doses of ketamine will attenuate the clinical and immunologic responses to experimental endotoxemia in horses. Animals:  Nineteen healthy mares of various breeds. Methods:  Experimental study. Horses were randomized into 2 groups: ketamine-treated horses (KET; n = 9) and saline-treated horses (SAL; n = 10). Both groups received 30 ng/kg of lipopolysaccharide (LPS, Escherichia coli, O55:B5) 1 hour after the start of a continuous rate infusion (CRI) of racemic ketamine (KET) or physiologic saline (SAL). Clinical and hematological responses were documented and plasma concentrations of tumor necrosis factor-α (TNF-α) and thromboxane B2 (TXB2) were quantified. Results:  All horses safely completed the study. The KET group exhibited transient excitation during the ketamine loading infusion (P \u3c .05) and 1 hour after discontinuation of administration (P \u3c .05). Neutrophilic leukocytosis was greater in the KET group 8 and 24 hours after administration of LPS (P \u3c .05). Minor perturbations of plasma biochemistry results were considered clinically insignificant. Plasma TNF-α and TXB2 production peaked 1.5 and 1 hours, respectively, after administration of LPS in both groups, but a significant difference between treatment groups was not demonstrated. Conclusions and Clinical Importance:  A subanesthetic ketamine CRI is well tolerated by horses. A significant effect on the clinical or immunologic response to LPS administration, as assessed by clinical observation, hematological parameters, and TNF-α and TXB2production, was not identified in healthy horses with the subanesthetic dose of racemic ketamine utilized in this study

Pediatric Sepsis: clinical Considerations

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