Saudi journal of anaesthesia
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Experimental studies both in vivo and in vitro show significantly increased survival rate in animals and in cortical neurons respectively exposed to acute hypoxia and pre-treated with opioids compared to non-treated counterparts. Thus, the main aim of the study was to examine survival rates in patients after sudden cardiac arrest (SCA) in the hospital who were or were not treated with opioids before and/or during cardiac pulmonary resuscitation (CPR). ⋯ Significantly higher 1, 2, 3 and 28 days survival rate and reduced duration of CPR were found in the patients additionally treated with opioids compared to ordinary resuscitation. Further prospective, randomized, controlled trials are needed to investigate the effects of early administration of opioids during CPR on survival and brain function in patients with witnessed in-hospital SCA.
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Aesthetic and functional complications caused by general anesthesia have been rarely described after aesthetic surgery. We report a case of unilateral right hypoglossal nerve paralysis following the use of a cuffed endotracheal airway in a 24-year-old woman undergoing aesthetic breast surgery. Neurological examination and magnetic resonance imaging of the head failed to provide additional insights into the cause of the nerve injury. ⋯ The transient hypoglossal nerve paralysis seemed to be due to neuropraxia. In this patient, we postulate that the right hypoglossal nerve was compressed between the endotracheal tube cuff and the hyoid bone, which was inflated with 30 cm H2O. Patients undergoing aesthetic surgery must be appropriately and adequately informed that postoperative aesthetic and functional deficits can occur due to anesthesia as well as the surgery.
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Various adjuncts have been used with lignocaine to decrease tourniquet pain and prolong post-operative analgesia during intravenous regional anesthesia (IVRA). Calcium-channel blockers potentiate the analgesic effect of local anesthetics. This study was designed to evaluate the efficacy of diltiazem as an adjunct to lignocaine in IVRA with respect to tourniquet tolerance, perioperative analgesia, and quality of anesthesia. ⋯ Diltiazem as an adjunct to lignocaine provided enhanced intraoperative and post-operative analgesia without any significant side effects.
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The pleth variability index (PVI), which is calculated from respiratory variations in the perfusion index (PI), has been shown to predict fluid responsiveness in mechanically ventilated patients; however, vasomotor tone changes induced by hypercapnia can affect PI and hence may slim down the accuracy of PVI. This study was designed to find out the impact of mild hypercapnia on PVI. ⋯ Hypercapnia retracts back PVI values compared with normocapnia. Precise judgment of fluid responsiveness as indicated by PVI necessitates its comparison against similar etCO2 levels.