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Quarterly published in print and online "Inventi Impact: Anaesthesiology (Formerly Inventi Impact: Anesthesia & Analgesia)" publishes high quality unpublished as well as high impact pre-published research and reviews catering to the needs of researchers and professionals. This journal focuses on practice-oriented clinical research pertaining to perioperative medicine, critical care and pain management.
Background. We propose a 1-1-12 wash-in scheme for desflurane-nitrous oxide (N2O) low-flow anesthesia. The objective of our\nstudy was to determine the time to achieve alveolar concentration of desflurane (FAD) at 1, 2, 3, 4, 5, and 6%. Methods.We enrolled\n106 patients scheduled for elective surgery under general anesthesia. After induction and intubation, wash-in was started with a\nfresh gas flow (FGF) of N2O:O2 1 : 1 L min?1 and vaporizer concentration of desflurane (FD) of 12%. Ventilation was controlled to\nmaintain PACO2 at 30Ã¢â?¬â??35mmHg. Results. The FAD rose rapidly from 0 to 4% in 2 min in a linear manner in 0.5 min increments.\nAn FAD of 6% was achieved in 4 min in a linear fashion from FAD of 4% but in 1 min increments. An FAD of 1 to 6% occurred at\n0.6, 1, 1.5, 2, 3, and 4 min. Heart rate during wash-in showed a statistically, albeit not clinically, significant pattern of increase. By\ncontrast, blood pressure slightly decreased during this period. Conclusions.We developed a 1-1-12 wash-in scheme using a FGF of\nN2O:O2 1 : 1 L min?1 and FD of 12% for desflurane-nitrous oxide low-flow anesthesia. A respective FAD of 1, 2, 3, 4, 5, and 6?n\nbe expected at 0.6, 1, 1.5, 2, 3, and 4 min....
Background: Articles cited counts are catalogued and help identify landmark papers. This study provides a citation\r\nclassics of anesthesiology literature using the framework of subspecialties to provide a review of well-developed\r\nareas of research in anesthesiology.\r\nMethods: A comprehensive list of the most-cited articles in anesthesia was compiled using a bibliometric database\r\nand general search terms such as Ã¢â?¬Å?anesthesiaÃ¢â?¬Â as well as subspecialty-specific search terms. Queries were reviewed\r\nfor relevance to anesthesiology practice, categorized by subspecialty, and ranked according to their citation counts.\r\nResults: The database resulted in 2519 articles published between 1945 and 2008. The specialty areas most\r\nrepresented were chronic pain medicine (11%), pharmacology (9%), and pain sciences (9%).\r\nConclusions: This citations classic allows for advances in anesthesiology and its subspecialties to be highlighted as\r\nwell to provide useful manuscripts to guide patient care, direct future research, and serve as sources for future\r\nacademic pursuit....
Sciatica is a symptom rather than a specific diagnosis. It usually consists in a radiating leg pain from the buttock\r\ntoward the knee, ankle, foot and toes. Pain could be associated with neurological deficit, such as muscle weakness\r\nand reflex deficit.\r\nThe prevalence of sciatica in spine pathology is highly variable with values ranging from 1.6% to 43%. Between\r\n70%-90% of the cases of herniated disc with nerve-root compression caused sciatica. Other causes are lumbar\r\ncanal or foraminal stenosis, tumours or cysts.\r\nWe present a case evaluated in our Pain Unit with left-sided sciatic pain after an intense voluntary movement two\r\nmonths ago. He was previously pharmacologically treated for a non-specific low back pain with pseudo-sciatica. One\r\nweek later buttock soft tissues sarcoma was diagnosed. He deceased two weeks after the diagnosis....
The aim of this study is to compare the efficacy and safety of propofol with dexmedetomidine in patients with obstructive sleep\napnea hypopnea syndrome (SAHS) undergoing drug-induced sleep endoscopy (DISE). The 88 patients diagnosed with SAHS\nin the Affiliated Hospital of Xuzhou Medical University were randomly allocated into 2 groups (n = 44). Patients in the group\ndexmedetomidine (group D) received continuous intravenous infusion of dexmedetomidine 1----g/kg over 15 minutes before the\nendoscopy, and propofol 2 mg/kg was intravenously administrated in the group propofol (group P). Cardiopulmonary parameters\nof patients were recorded.The time to fall asleep, duration of endoscopic examination, the wakeup time of patients, the number of\nmask ventilations for patients, the satisfaction of patients and endoscopic performers, and false positive cases of SAHS of patients\nwere compared between the two groups. Compared with group D, mean arterial pressure (MAP) and blood oxygen saturation\n(SPO2) of patients in the P group were lower at the time point of T1 (P < 0.05), the duration of endoscopic examination and wakeup\ntime of patientswere obviously prolonged, the incidence of mask ventilation for patients and false positive cases of SAHS of patients\nwas observably higher, and the satisfaction of endoscopic performerswasmarkedly lower, but the time to fall asleep was significantly\nshortened (P < 0.05). Dexmedetomidine served as a novel sleep induced drug and can provide satisfactory conditions and be safely\nand effectively applied for endoscopy in patients with SAHS, without adverse hemodynamic effects....
Background: The purpose of this study was to compare the effects of scalp nerve block (SNB) and local anesthetic\ninfiltration (LA) with 0.75% ropivacaine on postoperative inflammatory response, intraoperative hemodynamic\nresponse, and postoperative pain control in patients undergoing craniotomy.\nMethods: Fifty-seven patients were admitted for elective craniotomy for surgical clipping of a cerebral aneurysm.\nThey were randomly divided into three groups: Group S (SNB with 15 mL of 0.75% ropivacaine), group I (LA with 15\nmL of 0.75% ropivacaine) and group C (that only received routine intravenous analgesia). Pro-inflammatory cytokine\nlevels in plasma for 72 h postoperatively, hemodynamic response to skin incision, and postoperative pain intensity\nwere measured.\nResults: The SNB with 0.75% ropivacaine not only decreased IL-6 levels in plasma 6 h after craniotomy but also\ndecreased plasma CRP levels and increased plasma IL-10 levels 12 and 24 h after surgery compared to LA and\nroutine analgesia. There were significant increases in mean arterial pressure 2 and 5 mins after the incision and\nduring dura opening in Groups I and C compared with Group S. Group S had lower postoperative pain intensity,\nlonger duration before the first dose of oxycodone, less consumption of oxycodone and lower incidence of PONV\nthrough 48 h postoperatively than Groups I and C.\nConclusion: Preoperative SNB attenuated inflammatory response to craniotomy for cerebral aneurysms, blunted\nthe hemodynamic response to scalp incision, and controlled postoperative pain better than LA or routine analgesia....
Objective: Various analgesic techniques can be used for a mastectomy with
axillary dissection with varying degrees of efficacy. In our institution, local
anaesthesia infiltration (LIA) is commonly performed by surgeons. In this
study, we hypothesise that the relatively novel PECS II block is equivalent to
the analgesic profile of LIA. Methodology: In this single center, prospective,
randomised control trial, 40 patients undergoing unilateral mastectomy with
axillary dissection were randomly assigned to receive either 30 ml 0.5% ropivacaine
before skin via LIA by a specialist breast surgeon during surgery or 30
ml 0.5% ropivacaine via PECS II block, before skin incision. Fentanyl was
used as rescue analgesia intraoperatively, and all patients received morphine
via patient-controlled analgesia (PCA) device postoperatively. The primary
outcome was the difference in total morphine consumption in 24 hours between
the 2 groups after surgery with equivalency set at ±1 mg. Secondary
outcomes included time to rescue analgesia after block administration,
post-operative pain score over 24 hours, adverse effects encountered, total
intraoperative opioid usage, effect on operative time, block performance time
as well as block and surgery related complications. Results: Unadjusted mean
PCA morphine consumption over 24 hours post-operatively comparing local
infiltration analgesia (LIA) to that of PECS II at 95% confidence interval was
−1.22 mg (95% CI: −3.77, 1.33). Total IV Fentanyl use comparing LIA to
PECS II was 2.53 ± 0.98 mcg/kg and 1.96 ± 0.57 mcg, P = 0.035. There were
no other significant differences in the secondary outcome. Conclusion: We conclude there is a lack of equivalence between that of LIA and PECS II
block, with the PECS II block providing superior analgesia....
Background: The effect of local infiltration after breast surgery is controversial. This prospective double blind\r\nrandomized study sought to document the analgesic effect of local anaesthetic infiltration after breast cancer\r\nsurgery.\r\nMethods: Patients scheduled for mastectomy or tumorectomy and axillary nodes dissection had immediate\r\npostoperative infiltration of the surgical wound with 20 ml of ropivacaine 7.5 mg.ml-1 or isotonic saline. Pain was\r\nassessed on a visual analogue scale at H2, H4, H6, H12, H24, H72, and at 2 month, at rest and on mobilization of\r\nthe arm. PatientÃ¢â?¬â?¢comfort was evaluated with numerical 0-3 scales for fatigue, quality of sleep, state of mood, social\r\nfunction and activity.\r\nResults: Twenty-two and 24 patients were included in the ropivacaine and saline groups respectively.\r\nPostoperative pain was lower at rest and on mobilization at 2, 4 and 6 hour after surgery in the ropivacaine group.\r\nNo other difference in pain intensity and patient Ã¢â?¬Ë?comfort scoring was documented during the first 3 postoperative\r\ndays. Patients did not differ at 2 month for pain and comfort scores.\r\nConclusion: Single shot infiltration with ropivacaine transiently improves postoperative pain control after breast\r\ncancer surgery....
Background. There are a few papers that compared the lateral transversus abdominis plane (TAP) block with the posterior TAP\nblock. Our study aimed to compare retrospectively the quality of analgesia after laparoscopic gynecologic surgery using the lateral\nTAP block with general anesthesia versus the posterior TAP block with general anesthesia. Method. Sixty-seven adult female\npatients were included in this retrospective study. Of these patients, thirty-four patients received the lateral TAP block with general\nanesthesia (lat. TAP group), and the rest of thirty-three patients received the posterior TAP block with general anesthesia (pos.\nTAP group). Pain scores both at rest and at movement and the use of additional analgesic drugs were recorded in the postoperative\ncare unit within twenty-four hours after the operation. Postoperative complications were noted. Results. Patients who received pos.\nTAP reported lower visual analog scale (VAS) pain scores in all points, within twenty-four hours after the operation, than patients\nwho received lat. TAP. Moreover, with the use of additional analgesic drugs, the incidence of nausea and vomiting during the first\ntwenty-four hours after surgery was lower in the pos. TAP group than in the lat. TAP group. Conclusion.The posterior TAP block\nprovided more effective analgesia than the lateral TAP block in patients undergoing laparoscopic gynecologic surgery....
We developed a Vital-signs-integrated Patient-assisted Intravenous opioid Analgesia (VPIA) analgesic\ninfusion pump, a closed-loop vital signs monitoring and drug delivery system which embodied in a novel\nalgorithm that took into account patientsâ?? vital signs (oxygen saturation, heart rate). The system aimed to allow\nresponsive titration of personalized pain relief to optimize pain relief and reduce the risk of respiratory depression.\nMoreover, the system would be important to enable continuous monitoring of patients during delivery of opioid\nanalgesia.\nMethods: Nineteen patients who underwent elective gynecological surgery with postoperative patient controlled\nanalgesia (PCA) with morphine were recruited. The subjects were followed up from their admission to the recovery\nroom/ ward for at least 24 h until assessment of patient satisfaction on the VPIA analgesic infusion pump.....................
Introduction. This study aimed to determine if preoperative psychological tests combined with simple pain prediction ratings\ncould predict pain intensity and analgesic usage following cesarean delivery (CD). Methods. 50 healthy women undergoing\nscheduled CD with spinal anesthesia comprised the prospective study cohort. Preoperative predictors included 4 validated\npsychological questionnaires (Anxiety Sensitivity Index (ASI), Fear of Pain (FPQ), Pain Catastrophizing Scale, and Eysenck\nPersonality Questionnaire) and 3 simple ratings: expected postoperative pain (0Ã¢â?¬â??10), anticipated analgesic threshold (0Ã¢â?¬â??10), and\nperceived analgesic needs (0Ã¢â?¬â??10). Postoperative outcome measures included post-CD pain (combined rest and movement) and\nopioid used for the 48-hour study period. Results. Bivariate correlations were significant with expected pain and opioid usage\n(...
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