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Peripheral neuropathy is very common in patients with chronic renal failure. The pain arising from hemodialysis can be caused by vascular problems (such as vascular stenosis and steal syndrome) and neuropathy. Hemodialysis patients who need to be dialyzed three times a week should not be told to endure worsening pain every time they are dialyzed. We report that the pain arising from hemodialysis in the lower arm was a concern due to the nerve entrapment in the axillary area, and it was successfully controlled with ultrasound-guided nerve hydrodissection.
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The number of patients with end-stage renal disease (ESRD) who are dependent on hemodialysis is increasing rapidly. As a result, more patients with ESRD need surgery. These patients have a significantly higher risk of postoperative death than those with normal kidney function. Therefore, this study analyzed the causes of postoperative mortality in ESRD patients undergoing surgery under general anesthesia and the risk factors for postoperative mortality. Methods: This retrospective analysis examined the mortality of ESRD patients, 20 to 80 years old, undergoing surgery under general anesthesia. We excluded patients who underwent cardiac, cancer, or emergency surgery or organ transplantation from the analysis. The primary outcome was the cause of postoperative 30-day mortality in ESRD patients. We also assessed the mortality rate and risk factors. Results: There were 2,459 eligible ESRD patients. When patients underwent multiple surgeries during the study period, only the last surgery was considered. In total, 167 patients died during the study period, including 65 within 30 days postoperatively. The cause of death was sepsis in 22 cases (33.8%) and a major cardiac event in 16 (24.6%). Atrial fibrillation, current angina, previous myocardial infarction, asthma, lower hemoglobin and albumin levels, and a larger intraoperative colloid volume were likely to increase mortality. Conclusions: Our study suggests that immunological issues have a significant role in the death of ESRD patients after general anesthesia.
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Background@#We compared upper- and lower-body forced-air blankets in terms of their ability to prevent perioperative hypothermia, defined as a reduction in body temperature to < 36.0°C, during the perioperative period in patients undergoing spine surgery in the prone position. @*Methods@#In total, 120 patients scheduled for elective spine surgery under general anesthesia were divided into an upper-warming group (n = 60) and a lower-warming group (n = 60). After inducing anesthesia and preparing the patient for surgery, including prone positioning, the upper and lower bodies of the patients in the upper- and lower-warming groups, respectively, were warmed using a forced-air warmer with specified upper and lower blankets. Body temperature was measured using a tympanic membrane thermometer during the pre- and post-operative periods and using a nasopharyngeal temperature probe during the intraoperative period. Patients were evaluated in terms of shivering, thermal comfort, and satisfaction in the post-anesthesia care unit (PACU). @*Results@#The incidence of intraoperative and postoperative hypothermia was lower in the upper-warming group than in the lower-warming group ([55.2% vs. 75.9%, P = 0.019] and [21.4% vs. 49.1%, P = 0.002]). Perioperative body temperature was higher in the upper-warming group (P < 0.001). However, intraoperative blood loss, postoperative thermal comfort scale and shivering scores, patient satisfaction, and PACU duration were similar in the two groups. @*Conclusions@#The upper-body blanket was more effective than the lower-body blanket for preventing perioperative hypothermia in patients who underwent spine surgery in the prone position.
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It has been reported that erector spinae plane block (ESPB), which was performed at the mid-thoracic level, can be effective for the visceral and somatic pain of the thoracic region. The magnetic resonance imaging (MRI) images showed the diffusion of the contrast medium into the transforaminal and epidural spaces after ESPB, and these MRI findings helped to understand the mechanism of the analgesic effect. There have also been reports that ESPB at the upper thoracic level can reduce the pain of the shoulder and upper extremities. However, no MRI images have been reported to support the mechanism of analgesic effect in the cervical region. We report for the first time the MRI images of local anesthetic spread after ESPB at the T2 level.
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Background@#Joubert syndrome and mitochondrial disease are rare congenital diseases in which a wide range of symptoms affects multiple organs. Patients with these diseases present characteristic symptoms related to the musculoskeletal, respiratory, and neurological systems, which make it difficult for anesthesiologists to manage the patient’s airway and choose appropriate anesthetic drugs. Case A 13-year-old male patient with Joubert syndrome and mitochondrial disease underwent elective surgery to insert a continuous ambulatory peritoneal dialysis catheter. Anesthesia was induced and maintained with propofol, remifentanil, and rocuronium. An I-gel was inserted to secure the airway; however, the fitting did not work properly, so the patient was intubated. The operation was completed without any major problems, and the intubated patient was transferred to the intensive care unit. @*Conclusions@#Anesthesiologists should determine the method of anesthesia and prepare for unintended complications based on a full understanding of these congenital diseases.
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It has been reported that erector spinae plane block (ESPB), which was performed at the mid-thoracic level, can be effective for the visceral and somatic pain of the thoracic region. The magnetic resonance imaging (MRI) images showed the diffusion of the contrast medium into the transforaminal and epidural spaces after ESPB, and these MRI findings helped to understand the mechanism of the analgesic effect. There have also been reports that ESPB at the upper thoracic level can reduce the pain of the shoulder and upper extremities. However, no MRI images have been reported to support the mechanism of analgesic effect in the cervical region. We report for the first time the MRI images of local anesthetic spread after ESPB at the T2 level.
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Background@#Joubert syndrome and mitochondrial disease are rare congenital diseases in which a wide range of symptoms affects multiple organs. Patients with these diseases present characteristic symptoms related to the musculoskeletal, respiratory, and neurological systems, which make it difficult for anesthesiologists to manage the patient’s airway and choose appropriate anesthetic drugs. Case A 13-year-old male patient with Joubert syndrome and mitochondrial disease underwent elective surgery to insert a continuous ambulatory peritoneal dialysis catheter. Anesthesia was induced and maintained with propofol, remifentanil, and rocuronium. An I-gel was inserted to secure the airway; however, the fitting did not work properly, so the patient was intubated. The operation was completed without any major problems, and the intubated patient was transferred to the intensive care unit. @*Conclusions@#Anesthesiologists should determine the method of anesthesia and prepare for unintended complications based on a full understanding of these congenital diseases.
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Herpes zoster is a disease that causes a skin rash with blisters and extreme pain along mainly the unilateral dermatome. It often occurs in the thoracic nerve area, but can also occur in the cranial, cervical, and lumbar nerve areas. It is not clear that the interventions such as nerve block or subcutaneous local anesthetics result in a lower incidence of postherpetic neuralgia than the natural course of herpes zoster. However, the severity of acute pain is known as a risk factor for postherpetic neuralgia. There have been many studies on the epidural block or paravertebral block for acute pain control of herpes zoster, but superficial cervical plexus block has not been widely applied. We performed a superficial cervical plexus block to alleviate the acute pain of herpes zoster in the neck and obtained the expected result, so we present it with a literature review.
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Erector spinae plane block (ESPB) has been performed as a method of postoperative analgesia for breast, thoracic, and abdominal surgery. Most of those cases were carried out at T4–7 level and the main targets for postoperative analgesia were the thoracic nerves. However, there are few studies on the effect of ESPB on the cervical nerves. We report that ESPB at the T2 level was effective for postoperative pain management of arm surgery due to the blocking effect of thoracic and cervical nerve.
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Herpes zoster is a disease that causes a skin rash with blisters and extreme pain along mainly the unilateral dermatome. It often occurs in the thoracic nerve area, but can also occur in the cranial, cervical, and lumbar nerve areas. It is not clear that the interventions such as nerve block or subcutaneous local anesthetics result in a lower incidence of postherpetic neuralgia than the natural course of herpes zoster. However, the severity of acute pain is known as a risk factor for postherpetic neuralgia. There have been many studies on the epidural block or paravertebral block for acute pain control of herpes zoster, but superficial cervical plexus block has not been widely applied. We performed a superficial cervical plexus block to alleviate the acute pain of herpes zoster in the neck and obtained the expected result, so we present it with a literature review.
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Erector spinae plane block (ESPB) has been performed as a method of postoperative analgesia for breast, thoracic, and abdominal surgery. Most of those cases were carried out at T4–7 level and the main targets for postoperative analgesia were the thoracic nerves. However, there are few studies on the effect of ESPB on the cervical nerves. We report that ESPB at the T2 level was effective for postoperative pain management of arm surgery due to the blocking effect of thoracic and cervical nerve.
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Background@#This study aimed to evaluate the efficacy of 10-min pre-warming in preventing inadvertent perioperative hypothermia, which is defined as a reduction in body temperature to less than 36.0℃ during the perioperative period in intraoperative warming patients. @*Methods@#In this prospective randomized study, 60 patients scheduled for elective surgery under general anesthesia lasting less than 120 min were divided into two groups: the 10-min pre-warming group (n = 30) and the control group (n = 30). Patients in the 10-min pre-warming group were pre-warmed for 10 min in the pre-anesthetic area using a forced-air warmer set at 47ºC. Intraoperatively, we warmed all patients with a forced-air warmer. Body temperature was measured using a tympanic membrane thermometer pre- or postoperatively and a nasopharyngeal temperature probe intraoperatively. Patients were evaluated on the shivering and thermal comfort scale in the pre-anesthetic area and post-anesthesia care unit. @*Results@#The incidences of intraoperative hypothermia and postoperative hypothermia were similar in both groups (10.7% vs. 28.6%, P = 0.177; 10.7% vs. 10.7%, P = 1.000 respectively). Body temperature was higher in the 10-min pre-warming group (P = 0.003). Thermal comfort during the pre-warming period was higher in the 10-min pre-warming group (P < 0.001). However, postoperative thermal comfort and shivering grades of both groups were similar. @*Conclusions@#Ten minutes of pre-warming has no additional effect on the prevention of inadvertent perioperative hypothermia in intraoperative warming patients.
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OBJECTIVE: Although the reference value of cardiac index (CI) is derived by pulmonary arterial pressure, the use of pulmonary arterial catheterization is limited by low cost effectiveness and many concerns regarding complications. Therefore, relatively noninvasive indirect measurement is used widely perioperatively. The goal of this study was to determine the accuracy of the CI derived by Mobil-O-Graph NG (cCI) noninvasively in patients undergoing general anesthesia by comparing that measured by FloTrac/Vigileo (fCI), the minimal invasive method. METHODS: The Bland-Altman method was used to quantify agreement. Bias (mean difference between fCI-cCI) represents the systematic error between methods and precision (standard deviation of the bias) represents the random error or variability between techniques. The percentage error was considered clinically acceptable, and the tested method (Mobil-O-Graph NG) was regarded as interchangeable with the reference method (FloTrac/Vigileo), if it was below 30%. RESULTS: One hundred and ninety-five patients were included in this study, and CI, measured in the 121 patients. The Bland-Altman analysis revealed a bias −0.01 and the percentage error of 32.4%. And the difference is inversely increased according the mean CI. CONCLUSION: Results showed that CI measured by Mobil-O-Graph NG had a wide limit of agreement with that measured by FloTrac/Vigileo, therefore regarded as not interchangeable.
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Humanos , Anestesia Geral , Pressão Arterial , Viés , Débito Cardíaco , Cateterismo , Catéteres , Análise Custo-Benefício , Métodos , Monitorização Fisiológica , Valores de ReferênciaRESUMO
Femoral nerve block with tumescent anesthesia is used to perform the radiofrequency ablation of varicose veins. The surgery can be done as day-case. But if recovery from motor block is delayed, it can make hospital discharge difficult. Prolonged femoral nerve blocks with motor blockade of the quadriceps have been noted after the use of bupivacaine. The motor blockade lasted up to 30–40 hours when 15–30 mL of 0.5% bupivacaine was used. However, it was rarely reported in ropivacaine. We report that femoral nerve block with 15 mL of 0.375% ropivacaine induced prolonged motor blockade up to 30 hours.
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Anestesia , Bupivacaína , Ablação por Cateter , Nervo Femoral , Bicarbonato de Sódio , VarizesRESUMO
BACKGROUND: Previous studies have shown that measuring the distance from the skin to the ligamentum flavum by ultrasound preceding cervical epidural block can be beneficial in excluding false loss of resistance. However, the measurement value using ultrasound may vary depending on the degree of operator experience. Therefore, we aimed to determine the depth from skin to cervical epidural space by using lateral cervical spine X-ray, which is a more intuitive method. METHODS: We enrolled 102 adult patients who were scheduled to undergo cervical epidural anesthesia for vascular bypass surgery of upper arm. After attaching a steel rod on the needle insertion site, lateral cervical spine X-ray was taken before the epidural procedure. We measured the distance from the steel rod to the midpoint of interlaminar space on the spinolaminar line. The X-ray depth was compared with needle depth. RESULTS: Of the 102 enrolled patients, 18 patients including 13 in whom we were unable to measure X-ray depth were excluded from the analysis. In total, 84 patients were included in the analysis. Concordance correlation coefficient between the X-ray-measured depth and needle depth was 0.925. Bland-Altman analysis indicated a mean difference of ± 1.96 SD with 0.06 ± 0.56 cm. CONCLUSIONS: Lateral cervical spine X-ray can be useful for prediction of the midline depth from skin to epidural space, particularly for operators who are not skilled at spine ultrasound or the use the C-arm fluoroscopy.
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Adulto , Feminino , Humanos , Anestesia , Anestesia Epidural , Braço , Vértebras Cervicais , Espaço Epidural , Fluoroscopia , Ligamento Amarelo , Métodos , Pescoço , Agulhas , Pele , Coluna Vertebral , Aço , UltrassonografiaRESUMO
OBJECTIVE: Many studies have demonstrated that carbon dioxide has direct depressive effects on the myocardium and dilates the vascular bed. However, it leads to an increase in arterial blood pressure and cardiac output because of sympathetic stimulating effect. Extensive epidural block may impair the sympathetic innervation to the heart as well as to the adrenal gland. The present study was set up in order to investigate how an extensive epidural block would affect the hemodynamic response to sympathetic stimulation induced by hypercapnia. METHODS: Twenty patients were mechanically ventilated under general anesthesia after epidural catheter insertion on T6–T7 intervertebral space. Hypercapnia was obtained by CO2 breathing. PaCO2 (partial pressure of CO2, arterial) was adjusted to 30, 45, and 60 mm Hg with each concentration being maintained for 10 minutes. In each period, hemodynamic variables were monitored by pulmonary artery catheter. After returning to normocarbia for 15 minutes, 20 mL of 0.375% ropivacaine was injected epidurally and PaCO2 was adjusted in the same manner, and then, the hemodynamic variables of each period were checked. RESULTS: There were no changes in mean arterial pressure and heart rate by hypercapnia after combined epidural anesthesia compared with general anesthesia only. Hypercapnia increased cardiac output and cardiac index. Systemic vascular resistance was decreased significantly. Pulmonary artery pressure was increased but not significantly. The degrees of hemodynamic changes were similar between in general anesthesia alone and in combined epidural anesthesia. CONCLUSION: In spite of an extensive epidural block, hemodynamic changes induced by hypercarbnia were not changed. There are some ‘escaped’ sympathetic nerve fibers.
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Humanos , Glândulas Suprarrenais , Anestesia , Anestesia Epidural , Anestesia Geral , Pressão Arterial , Dióxido de Carbono , Débito Cardíaco , Catéteres , Coração , Frequência Cardíaca , Hemodinâmica , Hipercapnia , Miocárdio , Fibras Nervosas , Artéria Pulmonar , Respiração , Resistência VascularRESUMO
OBJECTIVE: The aim of this study was to investigate the effects of intravenous magnesium sulfate on the prevention of pain during the injection of microemulsion propofol. Magnesium is a known calcium channel blocker and a physiological N-methyl-D-aspartate receptor antagonist. METHODS: American Society of Anesthesiologists I and II adults (n=114) undergoing general anesthesia for surgery were randomly assigned into two groups (n=57 per group). This study was designed in prospective and double-blind manner. Patients in the LM group (n=57) received pretreatment with 2% lidocaine (40 mg) and magnesium sulfate 10 mg/kg, while patients in group L (n=57) received pretreatment with 2% lidocaine (40 mg) and normal saline (2 mL) accompanied by venous occlusion. Induction with microemulsion propofol (Aquafol) 2 mg/kg was accomplished following the release of venous occlusion. Pain intensity was assessed on a four-point scale according to patient movement (grade 0, no movement; grade 1, movement in wrist only; grade 2, movement in the upper arm & shoulder of injected arm; grade 3, generalized movement). Systolic blood pressure, diastolic blood pressure, and heart rate were evaluated. RESULTS: A significant difference in pain intensity following injection of microemulsion propofol between the groups was found (P<0.05). In addition, the incidence of hypertension after injection was lower in the LM group than in the L group (P<0.05). CONCLUSION: The combination of magnesium and lidocaine are effective in attenuating the pain induced by microemulsion propofol injection when compared with lidocaine alone.
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Adulto , Humanos , Anestesia Geral , Braço , Pressão Sanguínea , Canais de Cálcio , Frequência Cardíaca , Hipertensão , Incidência , Lidocaína , Sulfato de Magnésio , Magnésio , N-Metilaspartato , Propofol , Estudos Prospectivos , Ombro , PunhoRESUMO
BACKGROUND: The purpose of this study was to evaluate the effect of palonosetron combined with dexamethasone for the prevention of PONV compared to dexamethasone alone in women who received intravenous patient-controlled analgesia (IV-PCA) using fentanyl. METHODS: In this randomized, double-blinded, placebo-controlled study, 204 healthy female patients who were scheduled to undergo elective surgery under general anesthesia followed by IV-PCA for postoperative pain control were enrolled. Patients were divided into two groups: the PD group (palonosetron 0.075 mg and dexamethasone 5 mg IV; n = 102) and the D group (dexamethasone 5 mg IV; n = 102). The treatments were given after the induction of anesthesia. The incidence of nausea, vomiting, severity of nausea, and the use of rescue anti-emetics during the first 48 hours after surgery were evaluated. RESULTS: The incidence of PONV was significantly lower in the PD group compared with the D group during the 0-24 hours (43 vs. 59%) and 0-48 hours after surgery (45 vs. 63%) (P < 0.05). The severity of nausea during the 6-24 hours after surgery was significantly less in the PD group compared with the D group (P < 0.05). The incidence of rescue antiemetic used was significantly lower in the PD group than in the D group during the 0-6 hours after surgery (13.1 vs. 24.5%) (P < 0.05). CONCLUSIONS: Palonosetron combined with dexamethasone was more effective in preventing PONV compared to dexamethasone alone in women receiving IV-PCA using fentanyl.
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Feminino , Humanos , Analgesia Controlada pelo Paciente , Anestesia , Anestesia Geral , Antieméticos , Dexametasona , Fentanila , Incidência , Náusea , Dor Pós-Operatória , Náusea e Vômito Pós-Operatórios , VômitoRESUMO
BACKGROUND: Neck and shoulder pain is fairly common among adolescents in Korea and results in significant health problem. The aims of this prospective study was to identify the effects of education, in terms of recognition of this issue and posture correction, on prevalence and severity of neck and shoulder pain in Korean adolescents. METHODS: A prospective, observational cohort design was used. The 912 students from two academic high schools in the city of Seoul were eligible for the current study and 887 completed this study. After a baseline cross-sectional survey, students listened to a lecture about cervical health, focusing on good posture, habits, and stretching exercises to protect the spine, and were encouraged by their teachers to keep the appropriate position. And follow-ups were conducted 3 months later, to evaluate the effect of education. RESULTS: The prevalence of neck and shoulder pain was decreased 19.5% (from 82.5 to 66.4%). The baseline mean usual and worst numeric rating scale were 19.9/100 (95% CI, 18.1-21.7) and 31.2/100 (95% CI, 28.7-33.2), respectively. On the follow-up survey, the mean usual and worst numeric rating scale were decreased significantly by 24.1 and 21.7%, respectively, compared with baseline (P < 0.01). Of the 570 students reporting neck and shoulder pain, 16.4% responded that they had experienced improvement during the 3 months. CONCLUSIONS: Education; recognition of this issue and posture correction, for cervical health appeared to be effective in decreasing the prevalence and severity of neck and shoulder pain at a 3 month follow-up.