31 research outputs found
Low-concentration, continuous brachial plexus block in the management of Purple Glove Syndrome: a case report
<p>Abstract</p> <p>Introduction</p> <p>Purple Glove Syndrome is a devastating complication of intravenous phenytoin administration. Adequate analgesia and preservation of limb movement for physiotherapy are the two essential components of management.</p> <p>Case presentation</p> <p>A 26-year-old Tamil woman from India developed Purple Glove Syndrome after intravenous administration of phenytoin. She was managed conservatively by limb elevation, physiotherapy and oral antibiotics. A 20G intravenous cannula was inserted into the sheath of her brachial plexus and a continuous infusion of bupivacaine at a low concentration (0.1%) with fentanyl (2 μg/ml) at a rate of 1 to 2 ml/hr was given. She had adequate analgesia with preserved motor function which helped in physiotherapy and functional recovery of the hand in a month.</p> <p>Conclusion</p> <p>A continuous blockade of the brachial plexus with a low concentration of bupivacaine and fentanyl helps to alleviate the vasospasm and the pain while preserving the motor function for the patient to perform active movements of the finger and hand.</p
Interleukin 10-Mediated Response and Correlated Anemia in a Patient with Advanced Non-Small Cell Lung Carcinoma
Anemia in cancer patients is associated with poor quality of life, reduced response to therapy, and decreased overall survival. We describe a case of a 56-year old woman with advanced metastatic non-small cell lung carcinoma who demonstrated marked response to a novel combinational immunotherapy approach involving a long-acting PEGylated construct of recombinant human Interleukin-10 with Nivolumab, an anti-PD-L1 checkpoint inhibitor. While on treatment, the patient developed severe anemia and hyper-ferritinemia requiring RBC transfusion support. Here we discuss a possible novel immune mechanism of IL10-mediated anemia in correlation with tumor response
Screening for Lung Cancer Has Limited Effectiveness Globally and Distracts From Much Needed Efforts to Reduce the Critical Worldwide Prevalence of Smoking and Related Morbidity and Mortality
Lung cancer is the leading cause of cancer-related mortality worldwide in both men and women. Efforts to reduce lung cancer mortality using chest x-rays (CXRs) for early detection did not show improvements in mortality. More recently, results of the National Lung Screening Trial (NLST), which used low-dose computed tomography (LDCT) scans, appear to improve mortality outcomes. However, LDCT imaging comes at prohibitive costs because of the high number needed to screen as well as inadequate biopsy yields from screen-positive cases. Thus, it is imperative that attempts be made to either improve the efficiency of lung cancer screening or reduce the prevalence of smoking. The latter is especially important considering population increases and the consequently higher prevalence of active smokers. The 2015 WHO report on the global tobacco epidemic highlights that tobacco-related deaths continue to claim more lives than AIDS, malaria, and tuberculosis combined. Hence, continued attempts to reduce the prevalence of smoking are more likely to produce greater mortality reductions than lung cancer screening strategies. Primary preventive strategies have proven benefits but remain underused.
We describe the effectiveness of strategies for smoking control and tobacco-related diseases. We also explain why it is more relevant to increase implementation of these methods than the promotion of screening techniques for lung cancer, especially in low- and middle-income countries
Screening for Lung Cancer Has Limited Effectiveness Globally and Distracts From Much Needed Efforts to Reduce the Critical Worldwide Prevalence of Smoking and Related Morbidity and Mortality
Lung cancer is the leading cause of cancer-related mortality worldwide in both men and women. Efforts to reduce lung cancer mortality using chest x-rays (CXRs) for early detection did not show improvements in mortality. More recently, results of the National Lung Screening Trial (NLST), which used low-dose computed tomography (LDCT) scans, appear to improve mortality outcomes. However, LDCT imaging comes at prohibitive costs because of the high number needed to screen as well as inadequate biopsy yields from screen-positive cases. Thus, it is imperative that attempts be made to either improve the efficiency of lung cancer screening or reduce the prevalence of smoking. The latter is especially important considering population increases and the consequently higher prevalence of active smokers. The 2015 WHO report on the global tobacco epidemic highlights that tobacco-related deaths continue to claim more lives than AIDS, malaria, and tuberculosis combined. Hence, continued attempts to reduce the prevalence of smoking are more likely to produce greater mortality reductions than lung cancer screening strategies. Primary preventive strategies have proven benefits but remain underused.
We describe the effectiveness of strategies for smoking control and tobacco-related diseases. We also explain why it is more relevant to increase implementation of these methods than the promotion of screening techniques for lung cancer, especially in low- and middle-income countries
Sri Lankan Journal of Anaesthesiology 16(2) : 104 – 107 (2008) MONITORED ANAESTHESIA CARE
Key words: monitored anaesthesia care; pharmacology Monitored Anaesthesia Care (MAC) refers to a clinical service wherein an anaesthesiologist provides analgesia and sedation for a diagnostic or therapeutic procedure, and the patient is able to protect his airway for the majority of the procedure. 1 It involves the administration of medication that can potentially lead to loss of consciousness and normal protective reflexes. There is possibility of a deeper plane of sedation compared to ‘sedation/analgesia ’ which is provided by a non-anaesthesiologist. 2 Therefore, the ASA recommends that the standards of care be same as for general or regional anaesthesia, with regard to pre-operative evaluation, intra-operative monitoring of the cardio-respiratory system, the physical presence of an anaesthesiologist at all time, and the administration of oxygen and other medications to keep the patient safe and comfortable. 1 MAC should invoke less physiological disturbance and allow a more rapid recovery compared to a general anaesthetic. Therefore, it is not surprising to note that it is the technique of choice in up to 30 % of the surgical procedures. The three essential components of MAC are – safe sedation, anxiolysis and analgesia. 3 However, patient comfort, cardio-respiratory stability, good operating conditions and minimal side effects are equally important. Preoperative assessment The preoperative evaluation (history, examination and review of investigations) and optimization should be as for a general or regional anaesthetic. However, there are certain factors unique fo
Oral bisoprolol improves surgical field during functional endoscopic sinus surgery
Background: The success of functional endoscopic sinus surgery (FESS) depends on visual clarity of the surgical field, through the endoscope. The objective of this double-blind, randomized, controlled study was to determine if a pre-operative dose of bisoprolol (2.5 mg) would reduce the bleeding during FESS and improve the visualization of the operative field.
Materials and Methods: Thirty American Society of Anesthesiologists I or II patients, scheduled for FESS were randomized to receive either a placebo (Group A) or 2.5 mg of bisoprolol (Group B) 90 min prior to the surgery. All the patients received standard anesthesia and monitoring. The aim was to maintain the mean arterial pressure (MAP) of 60-70 mmHg, by titrating dose of isoflurane and fentanyl. The concentration of isoflurane used was recorded every 15 min. At the end of the surgery, the volume of blood loss was measured and the surgeon was asked to grade the operative field as per the Fromme-Boezaart Scale.
Result: The blood loss was significantly (P < 0.0001) more in the control group (398.67 ± 228.79 ml) as compared with that in the bisoprolol group (110.67 ± 45.35 ml). The surgical field was graded better in those who received bisoprolol as compared with those in the control group ( P − 0.0001). The volume percent of isoflurane and the dose of fentanyl used was significantly lower in those who received bisoprolol. During the operative period, the MAPs were 70.0 ± 2.7 (Group A) and 62.6 ± 3.6 mmHg (Group B) and the heart rate was 99.8 ± 5.0/min (Group A) and 69.2 ± 4.4/min (Group B). These differences were statistically significant ( P − 0.001).
Conclusion: This clinical trial has demonstrated that administration of a single pre-operative dose of bisoprolol (2.5 mg) can significantly reduce the blood loss during FESS and improve the visualization of the operating field
The effects of propofol and isoflurane on intraoperative motor evoked potentials during spinal cord tumour removal surgery - A prospective randomised trial
Background and Aims: Transcranial electrical stimulation (TES) elicited intraoperative motor evoked potentials (iMEPs), are suppressed by most anaesthetic agents. This prospective randomised study was carried out to compare the effects of Isoflurane and Propofol on iMEPs during surgery for spinal cord tumours. Methods: A total of 110 patients were randomly divided into two groups. In group P, anaesthesia was maintained with intravenous propofol (6.6 ± 1.5 mg/kg/hr) and in group I anaesthesia was maintained with isoflurane (0.8 ± 0.1% minimal alveolar concentration (MAC). An Oxygen- air mixture (FiO2-0.3) was used in both groups. TES-iMEPs were recorded from tibialis anterior, quadriceps, soleus and external anal sphincter muscles in 60 of 90 patients. Statistical analysis was performed with Pearson correlation and Paired 't' tests. Results: Successful baseline iMEPs were recorded in 74% of patients in Group P and in 50% of patients in Group I. Age and duration of symptoms influenced the elicitation of baseline iMEPs under isoflurane (r = −0.71, −0.66 respectively, P < 0.01) as compared to propofol (r = −0.60, −0.50 respectively, P < 0.01). The mean stimulus strength required to elicit the baseline iMEPs were lesser in propofol (205 ± 55Volts) as compared to isoflurane (274 ± 60 Volts). Suppression of the iMEP responses was less under propofol (7.3%) as compared to isoflurane anaesthesia (11.3%) in patients with no preoperative neurological deficits. Conclusion: iMEPs are better maintained under propofol anaesthesia (6-8 mg/kg/hr) when compared with isoflurane (0.7-0.9 MAC). in patients undergoing surgery for excision of spinal cord tumours
Physiology and clinical significance of natriuretic hormones
The natriuretic system consists of the atrial natriuretic peptide (ANP) and four other similar peptides including the wrongly named brain natriuretic peptide (BNP). Chemically they are small peptide hormones predominantly secreted by the cardiac myocytes in response to stretching forces. The peptide hormones have multiple renal, hemodynamic, and antiproliferative effects through three different kinds of natriuretic receptors. Clinical interest in these peptide hormones was initially stimulated by the use of these peptides as markers to differentiate cardiac versus noncardiac causes of breathlessness. Subsequently work has been done on using these peptides to prognosticate patients with acute and chronic heart failure and those with acute myocardial infraction. Synthetic forms of both atrial- and brain-natriuretic peptides have been studied and approved for use in acute heart failure with mixed results. This review focuses on the biochemistry and physiology of this fascinating hormone system and the clinical application of these hormones