Review of the effects of anesthetic agents used as premedication for patients undergoing electroconvulsive therapy with diagnoses of bipolar disorder or major depression on convulsion, recovery period, and hemodynamic parameters

Objective: The aim of this study was to examine the effects of anesthetic agents used as premedication in patients undergoing electroconvulsive therapy (ECT) for diagnoses of bipolar disorder or major depression in terms of convulsion, recovery period, and hemodynamic parameters. Materials and Method: This retrospective study was carried out by screening the anesthesia forms of patients in a psychiatry clinic in Turkey. Results: Researchers reviewed 104 patient files, of which 39 fit the inclusion criteria. 26 patients were given premedication; 13 patients were not given premedication. The study found a significant difference between the group to which dexmedetomidine was given and the non-premedication group in terms of mean arterial blood pressure and heart rate. A significant difference was also found between the group to which midazolam was given and the non-premedication group in terms of peripheral oxygen saturation. Conclusion: Premedication before ECT may be used to reduce the side effects after ECT without affecting convulsions and the recovery period

Effects of clown doctors on child and caregiver anxiety at the entrance to the surgery care unit and separation from caregivers

This study investigated the effects of hospital Clown Doctors intervention on child and caregiver preoperative anxiety at the entrance to the surgery care unit and separation from caregivers. A total of 88 children (aged 4-12 years) were assigned to one of the following two groups: Clown Doctors intervention or control group (standard care). Independent observational records using the modified Yale Preoperative Anxiety Scale instrument assessed children’s anxiety, while the State-Trait Anxiety Inventory measured caregiver’s state anxiety. In addition, caregivers assessed the children’s functional health problems by completing the Functional Status Questionnaire. Although no effects of Clown Doctors were found on children’s anxiety, results showed that both low functional health problems and Clown Doctors intervention were significant predictors of lower caregiver anxiety. Caregivers also reported being very satisfied with their intervention. Overall, this study demonstrated the positive role of Clown Doctors for caregivers at a specific pediatric hospital setting.peer-reviewe

The challenge of evaluating pain and a pre-incisional local anesthetic block.

Background. Our objective was to test the effectiveness of a local anesthetic line block administered before surgery in reducing postoperative pain scores in dogs undergoing ovariohysterectomy (OVHX). Methods. This study is a prospective, randomized, blinded, clinical trial involving 59 healthy female dogs. An algometric pressure-measuring device was used to determine nociceptive threshold, and compared to three subjective pain scales. Group L/B received a line block of lidocaine (4 mg/kg) and bupivacaine (1 mg/kg) subcutaneously in the area of the incision site and saline subcutaneously as premedication; group L/BM (positive control) received a similar block and morphine (0.5 mg/kg) subcutaneously for premedication; and group SS (negative control) received a saline line block and saline premedication. Criteria for rescue analgesia were defined before the study. Dogs were assessed prior to surgery, at extubation (time 0) and at 2, 4, 6, 8 and 24 h post-recovery. The data were analyzed with one-way ANOVA, and a Split Plot Repeated Measures ANOVA with one grouping factor and one repeat factor (time). P < 0.05 was considered statistically significant. Results. Approximately 33% of dogs required rescue analgesia at some point during the study, with no significant difference between groups. There was no significant difference between treatment groups with any assessment method. Conclusions. As there were no statistically significant differences between positive and negative controls, the outcome of this technique cannot be proven

Comparison of two ketamine/xylazine anesthesic protocols in pigs (Sus crofa domestica)

The pig (Sus scrofa domestica) is an animal used as an experimental model in surgical procedures. This makes the use of anaesthesia necessary. The present study constitutes a comparison between two different ketamine/xylazine concentration protocols. One protocol used ketamine 10% + xylazine 10% (high concentration), and the other ketamine 5% + xylazine 2% (low concentration). Concentrations were chosen since these are the most common presentations in the veterinary market. In the present experiments, twenty male and female pigs (Sus crofa domestica; 20 kg each), were assigned into two different groups. The first one was integrated by pigs treated with high concentration protocol (n = 10), and the second one, composed by pigs that received low concentration protocol (n = 10). Parameters measured were the time in which the animals were placed in sternal decubitus, and the heart rate. The effects of these drugs were considered not only specifically in its sedative effects, but also in the respiratory system. Based on these results, we conclude that the first protocol showed better results than the second one. The time in which the animals were placed in sternal decubitus was lower in the first one (p < 0.001). Differences between the effects on the respiratory system (p = 0.37) and sedative effects (p = 0.87) were not significant, even when focusing on the last measurement, higher concentration protocol was twenty percent (20%) more effective than lower.Fil: Guevara, Manuel Alejandro. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Lorenzo Aquaro, Sofía Ana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas; ArgentinaFil: Giai, Marcos. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Gargiulo, Pascual Angel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza; Argentina. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas; Argentina. Fundación Corporación Tecnológica Latinoamericana; Argentin

BUSM News and Notes

Monthly newsletter providing updates of interest to the Boston University School of Medicine community

Patient anxiety and modern elective surgery: a literature review

Medical advances have led to a considerable rise in the level of elective surgery undertaken as day-case surgery and with minimal hospital stay. However, amid such advances, preoperative psychological care has remained relatively static. A considerable number of patients are very anxious prior to elective surgery and little formal care is undertaken to address this major issue. A review of the literature from 1990 to 2002 was therefore undertaken in order to assess the present level of knowledge and interventions concerning patient anxiety when undergoing modern, intermediate surgical intervention. Thirty-four studies embracing data from 3754 patients undergoing both inpatient and day-case procedures were reviewed. Three main themes emerged -causes of anxiety, clinical concerns and measurement, and anxiety management. Each theme is discussed alongside details extracted from the relevant studies. Finally, the main issues arising are summarized and future research challenges identified

Quality of Postoperative Pain Management after Midfacial Fracture Repair—An Outcome-oriented Study

Objectives There is a lack of literature regarding the procedure-specific quality of acute postoperative pain management after midfacial fracture repair. The purpose of the presented prospective clinical study was to evaluate postoperative pain management after surgical repair of midfacial fractures. Materials and methods Eighty-five adults were evaluated on the first postoperative day following midfacial repair using the questionnaire of the Quality Improvement in Postoperative Pain Management (QUIPS) project. The main outcome measures were patients’ characteristics and clinical- and patient-reported outcome parameters. Results Overall, pain on the first postoperative day was moderate. A significant correlation between process and outcome parameters could be shown. Duration of surgery above the calculated median was significantly associated with higher maximum pain intensity (p = 0.017). Patients requiring opioids in the recovery room presented significantly higher pain on activity (p = 0.029) and maximum pain (p = 0.035). Sleeping impairment (p = 0.001) and mood disturbance (p = 0.008) were significantly more prevalent in patients undergoing repair of a centrolateral midfacial fracture. Conclusions QUIPS is a simple and qualified tool to evaluate the procedure specific quality of acute postoperative pain management. Pain on the first postoperative day following midfacial fracture repair seems overall to be moderate. Nearly a third of the patients showed inadequate postoperative pain management. To prevent inadequate postoperative pain management, it is necessary to establish a continued procedure-specific outcome measurement

Citrus aurantium Blossom and Preoperative Anxiety

Akhlaghi M, Shabanian G, Rafieian-Kopaei M, Parvin N, Saadat M, Akhlaghi M - Citrus aurantium Blossom and Preoperative Anxiety. Background and objectives: Reducing anxiety is very important before operation. Preoperative visit and use of premedication are popular methods to achieve this goal, but the role of anxiolytic premedication remains unclear and postoperative side-effects may result from routine premedication. Citrus aurantium is used as an alternative medicine in some countries to treat anxiety, and recently the anxiolytic role of this medicinal plant was established in an animal model study. The aim of this study was to assess the anxiolytic effect of Citrus aurantium blossom on preoperative anxiety. Methods: We studied 60 ASA I patients undergoing minor operation. In a randomized double-blind design, two groups of 30 patients received one of the following oral premedication two hours before induction of anesthesia: 1) Citrus aurantium blossom distillate 1 mL.kg(-1), (C-group); 2) Saline solution 1 mL.kg(-1) as placebo (P-group). Anxiety was measured before and after premedication using the Spielberger state-trait anxiety inventory (STAI-state) and the Amsterdam preoperative anxiety and information scale (APAIS) before operation. Results: After premedication, both the STAI-state and the APAIS scales were decreased in C-group (p < 0.05); while exhibiting no significant changes in P-group. Conclusions: Citrus aurantium blossom may be effective in terms of reduction in preoperative anxiety before minor operation

Orotracheal intubation in infants performed with a stylet versus without a stylet

Background: Neonatal endotracheal intubation is a common and potentially life-saving intervention. It is a mandatory skill for neonatal trainees, but one that is difficult to master and maintain. Intubation opportunities for trainees are decreasing and success rates are subsequently falling. Use of a stylet may aid intubation and improve success. However, the potential for associated harm must be considered. Objectives To compare the benefits and harms of neonatal orotracheal intubation with a stylet versus neonatal orotracheal intubation without a stylet. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; MEDLINE; Embase; the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and previous reviews. We also searched cross-references, contacted expert informants, handsearched journals, and looked at conference proceedings. We searched clinical trials registries for current and recently completed trials. We conducted our most recent search in April 2017. Selection criteria All randomised, quasi–randomised, and cluster-randomised controlled trials comparing use versus non-use of a stylet in neonatal orotracheal intubation. Data collection and analysis: Two review authors independently assessed results of searches against predetermined criteria for inclusion, assessed risk of bias, and extracted data. We used the standard methods of the Cochrane Collaboration, as documented in the Cochrane Handbook for Systemic Reviews of Interventions, and of the Cochrane Neonatal Review Group. Main results: We included a single-centre non-blinded randomised controlled trial that reported a total of 302 intubation attempts in 232 infants. The median gestational age of enrolled infants was 29 weeks. Paediatric residents and fellows performed the intubations. We judged the study to be at low risk of bias overall. Investigators compared success rates of first-attempt intubation with and without use of a stylet and reported success rates as similar between stylet and no-stylet groups (57% and 53%) (P = 0.47). Success rates did not differ between groups in subgroup analyses by provider level of training and infant weight. Results showed no differences in secondary review outcomes, including duration of intubation, number of attempts, participant instability during the procedure, and local airway trauma. Only 25% of all intubations took less than 30 seconds to perform. Study authors did not report neonatal morbidity nor mortality. We considered the quality of evidence as low on GRADE analysis, given that we identified only one unblinded study. Authors' conclusions: Current available evidence suggests that use of a stylet during neonatal orotracheal intubation does not significantly improve the success rate among paediatric trainees. However, only one brand of stylet and one brand of endotracheal tube have been tested, and researchers performed all intubations on infants in a hospital setting. Therefore, our results cannot be generalised beyond these limitations