Risk factors of inadequate emergence following general anesthesia with an emphasis on patients with substance dependence history / 대한마취과학회지

Background@#This study aims to define the incidence and risk factors of both emergence agitation and hypoactive emergence in adult patients and substance-dependent patients following general anesthesia to elaborate on the risk factors and precise management of them. @*Methods@#The study recruited 1,136 adult patients who received elective surgeries under general anesthesia for this prospective observational study. Inadequate emergence was determined according to the Richmond Agitation-Sedation Scale (RASS). Emergence agitation was defined as a RASS ≥ +1 point, and hypoactive emergence was defined as a RASS ≤ –2 points. Subgroup analyses were then conducted on patients with substance dependence. @*Results@#Inadequate emergence in the post-anesthesia care unit (PACU) occurred in 20.3% of patients, including 13.9% with emergence agitation and 6.4% with hypoactive emergence. Ninety-five patients had a history of substance dependence. Compared to divorced patients, never-married and presently married patients, who underwent gynecological and thoracic surgeries, had a lower risk of agitation. Neurologic disorders, intraoperative blood loss, intraoperative morphine, and PACU analgesic drug administration were associated with increased agitation risk. Hypertension and psychological disorders, intraoperative opioids, and PACU Foley catheter fixation were associated with increased hypoactive emergence risk. Substance-dependent patients had higher risk for agitation (21.1%, P = 0.019) and hypoactive emergence (10.5%, P = 0.044). @*Conclusions@#Inadequate emergence in PACU following general anesthesia is a significant problem correlated with several perioperative factors. Patients with a history of substance dependence appear to be more at risk of inadequate emergence than the general population.

Comparative clinical trial between ciaglia and griggs techniques during tracheostomy performed in patients admitted to intensive care unit

Percutaneous dilatation tracheostomy [PDT] is one of the most frequent interventions in ventilator dependant ICU patients. Ciaglia and Griggs are two common PDT techniques. Few studies are available comparing these two methods, but there is no data available to compare these two techniques in Iranian population. The aim of this study was to compare Ciaglia and Griggs technique in our population in order to recognize advantages and disadvantages of each technique in order to identify the most beneficial one. This study is a comparative clinical trial conducted on 100 consecutive ICU admitted patients who needed prolonged intubation; half of them underwent PDT with Ciaglia method and other half with Griggs method. Procedural time and short term complications including bleeding, vital signs instability and technical errors were compared in both two methods. Both groups were comparable in demographic characteristics. Griggs method performed significantly faster than Ciaglia method [P=0.001]. Complications such as high grade bleeding [P=0.01] and cardiac dysrhythmias [P=0.07] were less in Ciaglia technique than Griggs. Skin incision smaller than required was reported more with Griggs method than Ciaglia [P=0.03]. We conclude that PDT with Ciaglia method is safer with less complications than the Griggs method. We suggest use of Ciaglia for less experienced operators.

[ comparison between lateral spinal anesthesia and sitting positions in lower limb vascular surgery]

Patients who require surgery on the lower extremities are considered to be a high risk group from the point of anesthesia. This study was performed to compare sitting and lateral positions in spinal anesthesia method with hyperbaric bupivacaine 0.5% for hemodynamic status and analgesic period in patients under vascular surgery of the lower limbs in Imam-Khomeini Hospital Complex affiliated to Tehran University of Medical Sciences in 2009. In this study 40 patients were divided into two groups of 20 to undergo spinal anesthesia with 3 ml of hyperbaric bupivacaine 0.5% injected into the subarachnoid space in sitting or lateral positions. The anesthesia was performed at T10 level and the hemodynamic status and analgesic periods were compared in the two groups. The changes in mean arterial blood pressure and systolic and diastolic blood pressures were different between the two groups [P<0.05]. Except in the first and thirtieth minutes, the changes in heart rate [HR] were significantly different throughout the study between the two groups [P<0.04] and they were higher in sitting position. The duration of analgesia was significantly longer in lateral position [P<0.04] and the use of fluid was significantly larger in the sitting group [P<0.05]. According to the obtained results, the changes in hemodynamic variables were significantly lower in the group in lateral versus sitting position in patients undergoing spinal anesthesia with bupivacaine for vascular surgery of the lower limb

Tracheal cartilage fracture with the percutaneous dilatational tracheostomy, Ciaglia method

Surgical tracheostomy was first introduced by an ENT surgeon [Chevalier Jackson] in 1900. In 1955, Seldinger, a Swedish radiologist, introduced a way of insertion of a tube with the aid of a guidewire into the hollow spaces of body, such as blood vessels. In 1985 Pasquale Ciaglia performed percutaneous dilatational tracheostomy [PDA] with the Seldinger method. Tracheostomy nowadays is usually performed as PDT in the ICUs[1]. Most of the PDT methods are performed with the Seldinger method. The basic difference between the various PDT methods, however, is in both the way of dilation and the way of dilator entrance [antegrade vs retrograde]. In the Ciaglia method, several dilator tubes are used for tracheal dilation[2]

Complications and safety of percutaneous dilatational tracheostomy with Griggs method versus surgical tracheostomy a prospective trial with six months follow-up

Percutaneous Dilatational Tracheostomy has been developed all across the world during past two decades and is being performed with different methods in Intensive Care Units. The purpose of this study was to compare the complications of surgical tracheostomy versus pecutaneous dilatational traheostomy with Griggs method. In this prospective clinical trial, 100 cases of Percutaneous Dilatational Tracheostomy [PDT], was compared to surgical method. All PDTs were performed with Griggs method. The patients had been followed up for five months on a regular basis and potential complications were recorded. In surgical group we had three complications leading to death: Bleeding, Sever Emphysema and Pneumothorax. In five months of follow-up, we had no ventilatory complication in PDT group. Bleeding and infection rate in Tracheostomy place itself, Pneumothorax, Emphysema, duration of procedure, and required time for total closure of tracheostomy place in PDT were significantly less than surgical group. Percutaneous Dilatational Tracheostomy [PDT] with Griggs method has less complication in comparison to Surgical Tracheostomy. As such it should be recommended as a method of choice for tracheostomy in critically ill patients