Anesthesia, essays and researches
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Large numbers of patients are presenting for surgeries with aging-related pre-existing conditions that make them at higher risks of adverse outcomes. Hemodynamic instability due to high sympathetic nerve block largely limits the use of conventional dose spinal anesthesia in high risk elderly patients. ⋯ We concluded that the use of small dose of heavy bupivacaine 0.5% (5 mg) with immediate patient position changing to supine position provided good spinal block characteristics in elderly population without any hemodynamic side effects, also with better patient and surgeon satisfaction levels compared to higher doses of heavy bupivacaine (10 mg) even if we maintained patient position in the sitting position for 3 min after the block.
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Vitreoretinal surgery is associated with undesirable intraoperative and postoperative complications including pain, postoperative nausea and vomiting, and oculocardiac reflex (OCR). Systemic analgesics have side effects and are contraindicated in some cases. We hypothesized that the preoperative sub-Tenon's injection of levobupivacaine with general anesthesia would decrease postoperative pain and intraocular pressure as well as the incidence of complication. ⋯ The combination of general anesthesia with sub-Tenon's block using levobupivacaine in retinal surgery patients reduces pain scores after surgery; total analgesia requirement also decreases the incidence of OCR.
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Postoperative sore throat (POST) is a frequent and undesirable complication after general anesthesia with endotracheal intubation. Various pharmacological and non-pharmacological methods with variable success rate are used for attenuating POST. However, no single drug has been universally accepted. ⋯ Prophylactic betamethasone gel application and intravenous dexamethasone administration before induction of anaesthesia resulted in clinically important and statistically significant decreases in the incidence of POST only in early postoperative period.
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Carpal tunnel syndrome (CTS) is one of the most common focal entrapment neuropathies. Although the exact etiology remains unclear, high-pressure-related intracarpal tunnel compression of the median nerve (MN), progressing ischemia, and mechanical strangulation are common mechanisms. The therapeutic managements for CTS depend on the disease severity, varying from a conservative treatment to surgical interventions. Conservative treatment is helpful for most of the patients with mild-to-moderate CTS. Hydrodissection is a minimally invasive procedure of injecting solutions into some anatomical spaces to facilitate dissection and adhesiolysis. Steroids as an anti-inflammatory drugs are used to treat chronic pain conditions. Hyaluronidase as an adhesolysis agent can also be used for epidural injections with local anesthetics (LAs) and steroids for control of chronic back pain. ⋯ In this study, it was concluded that MN hydrodissction using hyaluronidase (as an adhesolysis agent) significantly improved patients with mild to moderate CTS compared to steroid (as an anti-inflammatory agents) hydrodissection of MN as regards BCTQ (SSS, FSS), electrophysiological studies (SNCV, DML), and sonographic data (CSA, echogenicity score, mobility score, and vascularity score) not only at 1 week, 1 month and 3 months follow up post-injection times but these parameters were also significantly improved at 6 months post-injection time in bupivacaine- hyaluronidase hydrodissection group compared to bupivacaine-steroid hydrodissection group.
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Self-extubation is a common clinical problem associated with mechanical ventilation in trauma patients worldwide. ⋯ More than one-tenth of patients with traumatic head injury develop self-extubation; this group of patients is more likely to have prescribed tramadol, develop agitation, and have longer hospital length of stay and less sedation use. Further prospective studies are needed to assess the predictors of self-extubation in TICU.