High-Flow Nasal Cannula

Conventionally, oxygen is given at 4 to 6 L/min through nasal cannula for supplementation of oxygen. The FiO2 achieved through this can be up to 0.4. Flows more than this can cause dryness to the nasal mucosa without much increase in the FiO2. High-flow nasal cannula (HFNC) uses flow up to 60 L/min. Positive end-expiratory pressure is created in the nasopharynx and it is also conducted to the lower airways. Studies have shown HFNC improves washout of CO2 and decreases respiratory rate. Patient compliance also improves due to the comfort of the cannula compared to the non-invasive ventilation through a mask

Usporedba lidokaina i kombinacije lidokaina i ketamina primijenjenih za distalnu intravensku regionalnu anesteziju (DIVRA) u goveda

The hoof diseases of cattle can be managed surgically under intravenous regional anesthesia (IVRA). For routine induction of IVRA, a tourniquet is placed circumferentially at the metacarpus/metatarsus. In the present study, hoof diseases of cattle were corrected using a modified IVRA technique. The cattle with hoof ailments were randomly divided into two groups and a tourniquet was placed just distal to the dew claws instead of at the metacarpus/metatarsus in order to decrease the dose of anesthetic. In group I lidocaine (2mg/kg) and in group II a mixture of lidocaine and ketamine (2mg/kg+1.5mg/kg) was injected into the axial digital vein to induce distal intravenous regional anesthesia (DIVRA). The heart rate, respiration rate, systolic and diastolic pressure were unaffected in both groups. Oxygen saturation was significantly (P<0.05) lower between 5 and 60 minutes in group I and between 15 and 40 minutes in group II animals. The sensory and motor block onset time was shorter, and the sensory and motor block recovery time was longer in group II animals as compared to group I animals. It was concluded that the DIVRA technique using lidocaine alone and lidocaine admixed with ketamine are suitable for hoof examination and surgery.Bolesti papaka u goveda mogu se kirurški liječiti pod intravenskom regionalnom anestezijom (IVRA). Za rutinsko uvođenje u IVRA-u postavlja se kružno čvrsti zavoj na metakarpus/metatarzus. U ovom su istraživanju bolesti papaka u goveda liječene modificiranom IVRA metodom. Istražene životinje nasumično su podijeljene u dvije skupine a zavoj kojim se samnjuje doza anestetika postavljen je, umjesto na metakarpus/metatarzus, distalno od rudimentiranih papaka. U skupini I primijenjen je lidokain (2 mg/kg), a u skupini II kombinacija lidokaina i ketamina (2 mg/kg + 1,5 mg/kg). Za uvođenje u distalnu intravensku regionalnu anesteziju (DIVRA) anestetici su aplicirani u aksijalnu digitalnu venu. Srčana frekvencija, frekvencija disanja, sistolički i dijastolički tlak u obje su skupine bili nepromijenjeni. Zasićenost kisikom bila je znakovito niža (P<0,05) između 5. i 60. minute u skupini I te između 15. i 40. minute u skupini II. Vrijeme pojave senzornih i motoričkih blokova bilo je kraće, a vrijeme oporavka tih blokova dulje u životinja u skupini II u usporedbi sa skupinom I. Zaključeno je da je DIVRA, uz upotrebu i samog lidokaina i lidokaina u kombinaciji s ketaminom, prikladna metoda za pregled i obavljanje kiruških zahvata na papcima goveda

Role of Inferior Vena Cava (IVC) Recanalization in Patients with Back Pain, Secondary to IVC Obstruction in Budd–Chiari Syndrome

Purpose: To study the prevalence of back pain in patients of Budd–Chiari syndrome (BCS) with inferior vena cava (IVC) obstruction, and to evaluate the role of IVC recanalization in resolution of back pain. Methods: All patients with BCS and IVC obstruction who underwent IVC recanalization between January 2018 and October 2022 were included. Patients with degenerative spine disease or other identifiable causes for back pain were excluded; remaining patients were assessed for the presence of back pain. In patients with back pain, pain relief was assessed at 24 h following IVC recanalization. Results: Fifty-eight patients with BCS and IVC occlusion were identified, of which six with degenerative spine diseases were excluded. Of the remaining 52 patients, 34 (65.4%) had back pain, with pain score between 3 and 9. Engorged epidural venous plexus on preprocedural imaging (p = 0.002), and degree of luminal narrowing (p = 0.021) had a significant association with back pain. Twenty-nine of thirty-four patients (85.3%) with back pain had pain relief immediately following IVC recanalization, more so in patients with engorged epidural venous plexus on preprocedural imaging (p < 0.001). Conclusion: Back pain is one of the under-reported symptoms of IVC obstruction in BCS. IVC recanalization by IVC angioplasty with or without stenting relieves back pain due to the decompression of engorged epidural veins