Asian Journal of Anesthesiology
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台灣麻醉醫學會 & Ainosco Press,正常發行
選擇卷期
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Objective: Cardiac function analysis for Ailuropoda melanoleuca, also called giant panda, with transthoracic echocardiography has several limitations, such as limited probe position area and poor echo window. We want to determine the feasibility of transesophageal echocardiography (TEE) for cardiac examination in Ailuropoda melanoleuca. Methods: Eight-year-old male Ailuropoda melanoleuca was anesthetized by intramuscular ketamine and followed by inhalation isoflurane with spontaneous respiration. TEE probe was inserted through mouth. Comprehensive examinations were done by two-dimensional (2D), Doppler method, 3D zoom and 3D full volume mode for their cardiac evaluation. Results: The structure of heart was similar to human. We found mild mitral regurgitation. Right ventricle and pulmonary artery were free of any organic lesions. We did comprehensive multiplane examination by American Society of Echocardiography/Society of Cardiovascular Anesthesia guideline, but transgastric (TG) and deep TG view were not approachable. 3D reconstruction offered high quality image and quantitative calculations. Complete examinations took less than 30 minutes. There was no significant hemodynamic change during probe insertion, and no oropharyngeal trauma certified by dentist. Conclusion: TEE is a reasonable semi-invasive tool for cardiac function evaluation. Though some anatomical limitations prohibited comprehensive 2D views, improvements such as 3D images help to give detailed cardiac examination.
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Objective: To evaluate the analgesic efficacy of dexamethasone (DXA) vs. dexmedetomidine (DXM) as an adjunct to ropivacaine in ultrasound-guided interscalene block (USG-ISB) for arthroscopic shoulder surgery. Methods: In this randomized double-blinded controlled trial, 60 American Society of Anesthesiologists grade 1-2 patients, 18-65 years, scheduled for arthroscopic shoulder surgery were randomly allocated to either group 1 (USG-ISB given with 0.5% ropivacaine 20 mL with 2 mL of saline containing DXM 0.5 mcg/kg) or group 2 (same protocol but DXA 8 mg instead of DXM). ISB was performed with in-plane technique under USG. Following surgery under general anesthesia, the patients received intravenous patient-controlled analgesia with fentanyl. Data were collected at 2-hourly intervals up to 24 hours after USG-ISB. The primary outcome was the duration of analgesia. Secondary outcomes consisted of pain ratings, total cumulative postoperative fentanyl consumption, patient satisfaction, and adverse effects. Results: The groups were comparable regarding baseline demographic and clinical characteristics including onset of sensory and motor block. The duration of postoperative analgesia for group 2 was significantly longer than for group 1 (22.40 ± 2.16 h vs. 19.30 ± 3.80 h; p ＜ 0.001). Group 2 also required less total median number of boluses than group 1 (0 vs. 3; p ＜ 0.001), less total fentanyl consumption (10.00 mcg ± 24.20 vs. 40.33 mcg ± 38.70; p ＜ 0.001), less pain scores, and greater satisfaction (99.30 ± 2.53 vs. 93.30 ± 11.50; p = 0.007). Adverse effects were few and comparable in both groups. Conclusion: Greater postoperative analgesia and opioid sparing effect was observed in patients receiving 8 mg DXA as adjunct for USG-ISB.
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Objective: Organ changes during the aging are one of the significant events in old patients. Orthopedic surgeries are common operations in these patients that accompany with hemodynamic changes as blood pressure decrease, heart rate, and respiratory rate change. On the other hand, pain management of the ancient patients due to negative consequences as tachycardia, blood pressure increase, and myocardial ischemia is vital. Various types of opioid analgesics have been used in order to pain control in these patients. We decided to conduct the present study in order to compare the hemodynamic changes of the old patients who undergo lower limbs orthopedic surgeries by applying subarachnoid bupivacaine and meperidine (pethidine). Methods: Sixty-six patients older than 60 years included according to inclusion and exclusion criteria and randomly allocated into two same groups, Then in the first group in the sitting posture by Quincke spinal needle 24 gauge, 12.5 mg of bupivacaine 0.5% (2.5 mL) injected in the subarachnoid space between L_2- L_3 or L_3-L_4. In the second group, in a same posture by applying the same spinal needle 24 gauge, 1 mg/ kg of preservative-free pethidine injected in the subarachnoid space between L_2-L_3 or L_3-L_4. The patients evaluated for duration of anesthesia and analgesia, hemodynamic changes and complications such as headache, pruritus, shivering, urinary retention, and respiratory depression.. Results: Thirty-two patients were males (48.5%) and 34 females (51.5%). There was no statistically significant difference between groups in surgery types (p = 0.063). The duration of anesthesia was not different (p = 0.268) but the duration of analgesia was significantly longer in pethidine group (p = 0.000). No statistically significant difference observed in any time of first 15 min up to 180 min following intervention in heart rate (p = 0.867). No statistical significant difference observed in blood pressure change between two groups (p = 0.605). The experience of headache was more common in the group of bupivacaine during and after the operation (p = 0.004 and 0.000, respectively). The need for pruritus treatment was more in the pethidine group (p = 0.016). However, the frequency of shivering during the operation was not significant (p = 0.202), but after surgery was signifi cantly commoner in bupivacaine group (p = 0.001), but urinary retention and respiratory depression occurrence were not significant (p = 0.228 and 0.720, respectively). Conclusion: By regarding different aspects of opioids use, it seems pethidine is more efficient due to longer analgesic time, similar hemodynamic changes, fewer headache, and shivering occurrence in comparison to bupivacaine in old patients.
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The overall burden of chronic musculoskeletal pain in Asian countries will continue to increase as the population ages, as will the demand for safe and effective pain management. Currently available Asian guidelines are mostly outdated and targeted only to primary care. Implementation of international guidelines may be unsuitable for Asian patients due to cultural, local economic and regulatory factors. With the aim of developing Asian-specific consensus recommendations for the pharmacological management of osteoarthritis (OA) pain and chronic low back pain (cLBP), we convened to review and discuss recent available evidence for pharmacotherapy, clinical experiences, and current practice challenges they face in the region, including challenges in opioid use. Taking these into consideration, we provided general recommendations for the overall assessment and management of OA pain and cLBP. The strength of the recommendations regarding the use of pharmacological agents was assessed using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system. Where evidence is conflicting or limited, we made no recommendation pending the availability of further evidence. We recommend topical non-steroidal anti-inflammatory drugs (NSAIDs) as a first-line pharmacological treatment of OA pain, while oral NSAIDs should be considered as a first-line pharmacological treatment of cLBP. Acetaminophen has been commonly used as the first-line treatment for OA pain and cLBP, but its long-term use is not recommended based on recent evidence. These consensus recommendations are not prescriptive, and serve as a guide for decision-making in clinical practice. The optimal management of OA pain and cLBP should ultimately be individualized to each patient.
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Since the original description in 2011, the array of pectoral nerve blocks has evolved. The pectoral nerve (PECS) block in conjunction with general anesthesia can decrease an additional analgesic in perioperative period for breast cancer surgeries. Current literature on the PECS block has reported 3 several types (PECS I, PECS II, and serratus plane blocks). The PECS I block is the same as to the first injection in the PECS II block. The second injection in the PECS II block and the serratus plane block blocks intercostal nerves (Th2-6) and provides an analgesic for the breast cancer surgery. However, the PECS I block (or first injection in the PECS II block) has no analgesic, because both lateral and medial pectralis nerve blocks are motor nerves. PECS block in previous reports, when added to opioid-based general anesthesia, may improve analgesia and decrease narcotic use for breast cancer surgery. Moreover, PECS block compares favorably with other regional techniques for selected types of surgery. A major limitation of the PECS block is that it cannot block the internal mammary region. Therefore, some studies have reported its ability to block the anterior branches of the intercostal nerve. PECS block is an effective analgesic tool for the anterolateral chest. In particular, the PECS block can provide more effective analgesia for breast cancer surgery.
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