Síndrome de Ramsay Hunt en paciente epiléptico en Santander, Colombia: Reporte de caso / Ramsay Hunt Syndrome in an epileptic patient in Santander, Colombia: Case report

El Síndrome de Ramsay Hunt es una entidad infrecuente, con una incidencia de 5 por cada 100.000 personas por año. Esta condición se caracteriza por una reactivación del virus de la varicela-zoster en el nervio facial. Su diagnóstico implica un reto para el médico puesto que suele ser netamente clínico, con la aparición de una triada consistente en: otalgia, parálisis facial ipsilateral y vesículas en el canal auditivo. El objetivo del artículo es presentar el caso de una mujer de 49 años de edad, con antecedente de epilepsia en tratamiento anticonvulsivante, quien ingresa con la triada clínica antes descrita, asociada a visión borrosa derecha y vértigo. La paciente fue tratada con antivirales y corticoides orales, presentando una resolución clínica favorable dado una reducción de más del 50% de las lesiones cutáneas. No se identificaron diferencias respecto a la presentación clínica de este síndrome al compararse con pacientes no epilépticos.

Ramsay Hunt Syndrome is a rare entity, with an incidence of 5 per 100,000 people per year. This condition is characterized by a reactivation of the varicella-zoster virus in the facial nerve. Its diagnosis implies a challenge for the physician since it is usually a clinical diagnosis, with the appearance of a clinical triad consisting of: otalgia, ipsilateral facial paralysis and vesicles in the ear canal. The objective of the article is to present the case of a 49-year-old woman, with a history of epilepsy receiving anticonvulsant treatment, who was admitted with the aforementioned clinical triad, associated with blurred right vision and vertigo. The patient was treated with oral antiviral management and oral corticosteroids, presenting a favorable clinical resolution given a reduction of more than 50% of the skin lesions. No differences were identified regarding the clinical presentation of this syndrome when compared with non-epileptic patients.

Continuous hemicrania as the initial manifestation of Ramsay Hunt syndrome: a case report / Hemicrania contínua como manifestação inicial da síndrome de Ramsay Hunt: relato de caso

Introduction:Ramsay-Hunt syndrome, also called otic zoster, is a rare complication of herpes zoster. The syndrome is characterized by peripheral facial nerve palsy and an erythematous vesicular eruption in the ear or mouth. Preceding the appearance of the vesicles, unilateral otalgia or neck pain may occur more commonly. However, persistent hemicrania is infrequent in the preeruptive phase. Objective:To present an atypical case of Ramsay Hunt syndrome with continuous unilateral headache preceding the onset of other symptoms and signs of the syndrome. Case report:Report of a 69-year-old woman who presented subacute onset of moderate to severe left hemicrania with no autonomic signs. Eight days after the start and continuous headache maintenance, she presented with peripheral facial paralysis. After four days, she noticed the presence of vesicles in the left ear and odynophagia. She developed nausea with several episodes of vomiting and severe imbalance that made it impossible for her to walk unassisted. On physical examination, she presented vesicles in the left ear and oropharynx, left peripheral facial palsy (House Brackmann grade IV), left hypoacusis, nystagmus, and vestibular gait. Diagnostic tests for screening several metabolic diseases and diagnosis of infection (including HIV) were unremarkable. Brain computed tomography and cerebrospinal fluid analysis showed no abnormalities. Conclusion:Ramsay-Hunt syndrome mainly involves the facial and vestibulocochlear nerves, causing peripheral facial palsy, otalgia, hypoacusis, and, less frequently, imbalance. Although pain is a frequent manifestation of the preeruptive phase of RHS, unilateral headache is not common in this scenario. On the other hand, it is a prevalent complaint in the emergency department and has several different etiologies. Hence, diagnosing RHS when patients present exclusively unilateral headaches is challenging for clinicians. Physicians must consider RHS a vital differential diagnosis of sided-locked headaches, avoiding diagnostic errors and treatment delays.

Introdução: A síndrome de Ramsay-Hunt, também chamada de ótico-zóster, é uma complicação rara do herpes-zóster. A síndrome é caracterizada por paralisia do nervo facial periférico e erupção vesicular eritematosa no ouvido ou na boca. Precedendo o aparecimento das vesículas, pode ocorrer mais comumente otalgia unilateral ou dor cervical. No entanto, a hemicrania persistente é pouco frequente na fase pré-eruptiva. Objetivo: Apresentar um caso atípico de síndrome de Ramsay Hunt com cefaleia unilateral contínua precedendo o aparecimento de outros sintomas e sinais da síndrome. Relato de caso: Relato de uma mulher de 69 anos que apresentou hemicrania esquerda de início subagudo, moderada a grave, sem sinais autonômicos. Oito dias após o início e manutenção contínua da cefaleia, apresentou paralisia facial periférica. Após quatro dias, notou presença de vesículas em orelha esquerda e odinofagia. Ela desenvolveu náuseas com vários episódios de vômitos e desequilíbrio grave que a impossibilitou de andar sem ajuda. Ao exame físico apresentava vesículas em orelha esquerda e orofaringe, paralisia facial periférica esquerda (grau IV de House Brackmann), hipoacusia esquerda, nistagmo e marcha vestibular. Os testes de diagnóstico para rastreio de diversas doenças metabólicas e diagnóstico de infeções (incluindo VIH) não apresentaram resultados dignos de nota. A tomografia computadorizada de cérebro e a análise do líquido cefalorraquidiano não mostraram alterações. Conclusão: A síndrome de Ramsay-Hunt envolve principalmente os nervos facial e vestibulococlear, causando paralisia facial periférica, otalgia, hipoacusia e, menos frequentemente, desequilíbrio. Embora a dor seja uma manifestação frequente da fase pré-eruptiva da SHI, a cefaleia unilateral não é comum neste cenário. Por outro lado, é uma queixa prevalente no serviço de urgência e tem diversas etiologias. Portanto, diagnosticar SHI quando os pacientes apresentam dores de cabeça exclusivamente unilaterais é um desafio para os médicos. Os médicos devem considerar a SHI um diagnóstico diferencial vital de cefaleias laterais, evitando erros de diagnóstico e atrasos no tratamento.

Estudio de líquido cerebroespinal en el síndrome de Ramsay-Hunt: controversia a raíz de un caso clínico / Study of cerebrospinal fluid in Ramsay-Hunt syndrome: controversy because of a clinical case

El Síndrome de Ramsay-Hunt (SRH), es la segunda causa de parálisis facial periférica (PFP). Causado por el virus Varicella zoster (VVZ), ipsilateral a la PFP,presenta unaerupción herpetiforme y cefalea en distribución del nervio facial. Presentamos el caso de una mujer, 54 años, con SRH y cefalea persistente cuyo líquido cerebroespinal (LCE) fue compatible con meningitis. Se indicó aciclovir endovenoso (EV). La literatura no recomienda estudio de LCE en PFP; y en SRH se sugiere en inmunosuprimidos y complicaciones del SRH como queratopatía, accidentes-cerebrovasculares, y meningitis. Un LCE alterado en SRH, indica modificar la conducta terapéutica.

Ramsay-Hunt Syndrome (RHS) is the second leading cause of peripheral facial palsy (PFP). Caused by the Varicella zoster virus (VZV), ipsilateral to the PFP, it presents a herpetiform rash and headache in the facial nerve distribution. We present the case of a 54-year-old woman with RHS and persistent headache whose cerebrospinal fluid (CSF) was compatible with meningitis. Intravenous acyclovir was indicated. The literature does not recommend an CSF study in PFP; in RHS it is suggested in immunosuppressed patients and complications of RHS such as keratopathy, cerebrovascular accidents, and meningitis. An altered CSF in RHS indicates modifying the therapeutic conduct.

Evaluation of the effect of non-intubation anesthesia with ketamine combined with dexmedetomidine for elective surgery after burns in children / 中国医师进修杂志

Objective:To investigate the clinical effect of non-intubation anesthesia with ketamine combined with dexmedetomidine for elective surgery after burns in children.Methods:From January 2018 to December 2019, 50 children with burns who underwent elective surgery and were admitted to the Hanchuan People′s Hospital were enrolled and they were divided into the control group and the observation group by random number table, with 25 cases in each group. Both groups were given ketamine 1-2 mg/kg for induction of anesthesia, the control group was given propofol 4 mg/(kg·h) constant-rate pump injection, and the observation group was given dexmedetomidine 1 μg/(kg·h) pump injection for 10 min and then 0.5 μg/(kg·h) to maintain pump injection. The number of basic anesthesia, operation time and intraoperative fluid infusion between the two groups were compared. The mean arterial pressure (MAP), heart rate (HR) and blood oxygen saturation (SpO 2) at enter the operating room (T 1), 1 min before operation (T 2), 3 min after operation (T 3), end of the operation (T 4), recovery (T 5) points in the two groups were recorded and compared. The occurrence of adverse anesthesia reactions in the two groups and postoperative recovery were compared. Results:There was no statistically significant difference in the number of basic anesthesia, operation time, and intraoperative fluid infusion between the two groups ( P>0.05). The levels of MAP and HR did not change significantly at different time points in the control group ( P>0.05); the level of SpO 2 at T 2 and T 3 was lower than that at T 1 and was lower than that in the observation group at the same time point ( P<0.05); the levels of MAP and HR in the observation group at T 2, T 3, T 4, and T 5 were significantly lower than that at T 1, and were lower than that in the control group at the same time point ( P<0.05). The incidence of adverse reactions in the control group was higher than that in the observation group: 24.0%(6/25) vs. 4.0%(1/25), and the difference was statistically significant ( P<0.05); the scores of sedation and restlessness scale in the control group was higher than that in the observation group: (3.14 ± 0.76) scores vs. (1.22 ± 0.41) scores, the scores of the Ramsay score in the control group was lower than that in the observation group: (1.53 ± 0.36) s cores vs.(3.27 ± 30.41) scores, and the differences were statistically significant ( P<0.05). Conclusions:It is safe and effective to use ketamine combined with dexmedetomidine for non-intubation anesthesia during elective surgery after burns in children. The clinical anesthesia effect is significantly better than that of ketamine combined with propofol.

Ramsey hunt syndrome after antimonial treatment for American Cutaneous Leishmaniasis

Abstract Ramsay Hunt Syndrome (RHS), also known as herpes zoster oticus, is caused by the reactivation of varicella zoster virus (VZV) in the geniculate ganglion of the facial nerve. Herein, we report a case of Ramsey Hunt Syndrome in a patient after antimonial treatment for Cutaneous Leishmaniasis. The patient presented with microvesicles grouped on an erythematous base, starting in the neck and ascending towards the scalp margin on the right side of the head. The patient also developed grade V peripheral facial palsy the day after initiating the herpes zoster treatment, this outcome corroborated the assumption of Ramsey Hunt Syndrome.

Síndrome de Ramsay Hunt. Informe de un caso y revisión de la literatura / Ramsay Hunt syndrome. Case report and literature review

RESUMEN Se presentó paciente masculino de 68 años de edad, con antecedentes de síndrome de Parkinson posinfarto cerebral isquémico antiguo e hipertensión arterial sistémica, con la intensión de describir la experiencia del diagnóstico y tratamiento del síndrome de Ramsay Hunt. El paciente acudió a consulta de Medicina Interna del Policlínico Universitario "Omar Ranedo Pubillones", Guantánamo, por presentar dolor en hemicara izquierda y otalgia homolateral, cefalea y febrícula. Luego, presentó lesiones vesiculosas de aspecto herpético. Se concluyó el diagnóstico definitivo de síndrome de Ramsay Hunt tipo II y se remitió a consulta de Otorrinolaringología, donde se confirmó el diagnóstico. Luego del tratamiento evolucionó satisfactoriamente. Aunque el síndrome de Ramsay Hunt no es un problema de salud, se revela la necesidad de que el médico del nivel primario de atención a la salud se familiarice con las bases teóricas para su diagnóstico y se connota la importancia de la evaluación interdisciplinaria para esta finalidad.

ABSTRACT It was reported a 68 year old male patient with a personal pathological history of post- ischemic stroke Parkinson's syndrome and systemic arterial hypertension and with the intention of describing the experience of diagnosis and treatment of Ramsay Hunt syndrome. Patient presented to his primary health physician at the Univirsity Clinic "Omar Ranedo Pubillones" in Guantanamo, presenting pain in right side of the face and earache, headache and fever. Then, he presented vesicular lesions with a herpetic appearance. It was concluded the definitive diagnosis of Ramsay Hunt syndrome type II and it was referred to Otolaryngology consultation, where the diagnosis was confirmed. After treatment patient's improvement was good. Although Ramsay Hunt syndrome is not a health problem, shows the need for primary care physicians to become familiar with the theoretical basis for its diagnosis and the importance of interdisciplinary evaluation for this purpose.

Propofol versus Fentanyl for Sedation in Pediatric Bronchoscopy: A Randomized Controlled Trial

Objectives: To compare propofol and fentanyl to induceconscious sedation in children undergoing flexiblebronchoscopy.Study design: Randomized controlled trial.Setting: Pediatric Pulmonology division at a tertiary care centerin Delhi, India.Participants: Children aged 3-15 years who underwentflexible bronchoscopy.Intervention: Children received either intravenous propofol 1mg/kg administered as a slow bolus over 1 minute followed by 2mg/kg/hour infusion, or intravenous Fentanyl 2 μg/kgadministered as a slow bolus over one minute.Outcomes: Primary outcome was time to achieve conscioussedation (Ramsay score 3). Secondary outcomes were need foradjuvant midazolam, physician satisfaction, level of cough,recovery features, and side-effects in the groups.Results: 53 children (propofol 27, fentanyl 26) were enrolled inthe study. The mean (SD) time taken to achieve Ramsay score 03was lower in propofol than fentanyl [15.7 (4.4) s vs 206 (55) s,P<0.001]. Propofol arm had significantly higher physiciansatisfaction, less requirement of adjuvant midazolam, lesscoughing and faster regain of full consciousness. There was nodifference in drug side-effects between the groups.Conclusion: Propofol has a shorter sedation induction time, lesscoughing during procedure, less recovery time, and betterphysician satisfaction compared to fentanyl for flexiblebronchoscopy in children.

Effect of nabuprofen and sufentanil on analgesia score and sedation score in patients with total hip arthroplasty / 中国基层医药

Objective@#To analyze the effects of nabuprofen combined with sufentanil on Ramsay sedation score, visual analogue scale (VAS) and analgesic effect in patients undergoing total hip arthroplasty (THA) for patient-controlled intravenous analgesia (PCIA).@*Methods@#From January 2017 to December 2017, 72 patients with THA in the Department of Orthopedics from the People's Hospital of Linfen were divided into three groups: A group was given nabuprofen, B group was given sufentanil, C group was given nabuprofen + sufentanil, with 24 cases in each group.Ramsay sedation score, VAS score and analgesic effect were compared among the three groups before and after operation.@*Results@#The Ramsay sedation scores of A group at 3, 12 and 24 hours after operation were (2.78±0.32)points, (2.59±0.40)points and (2.4±0.26)points, respectively, and the Ramsay sedation scores of C group at 3, 12 and 24 hours after operation were (2.37±0.24)points, (2.0±0.15)points, (1.89±0.22)points, respectively, which were decreased significantly compared with those of B group at the same time point [(3.07±0.58)points, (3.01±0.62)points and (2.73±0.47)points] (Fbetween group=6.83, Pbetween group=0.01; Ftime point=7.24, Ptime point<0.01; Fbetween group·time point=0.69, Pbetween group·time point=0.40). The VAS scores of group B at 3, 12 and 24 hours after operation were (2.40±0.72)points, (1.98±0.57)points and (1.24±0.38)points, respectively, and the VAS scores of C group at 3, 12 and 24 hours after operation were (2.35±0.75)points, (1.74±0.46)points and (1.18±0.26)points, respectively, which were decreased significantly compared with those of A group at the same time point [(3.35±0.59)points, (3.18±0.46)points and (3.01±0.33)points] (Fbetween group=7.02, Pbetween group<0.01; Ftime point=5.42, Ptime point=0.02; Fbetween group·time point=0.39, Pbetween group·time point=0.68). There was statistically significant difference among the three groups (χ2=7.66, P<0.05). The analgesic satisfaction of C group (91.67%) was significantly higher than that of A group (58.33%) and B group (62.50%) (χ2=5.44, 4.25, all P<0.05).@*Conclusion@#The sedative and analgesic effects of PCIA nabuprofen combined with sufentanil for patients with THA are definite and comfortable, which can effectively alleviate pain, so it has a definite clinical application value.

Anesthetic effect of dexmedetomidine in laparoscopic D2 radical gastrectomy and its influence on hemodynamics, visual analogue scale and Ramsay sedation score after operation / 肿瘤研究与临床

Objective@#To analyze the anesthetic effect of dexmedetomidine in laparoscopic D2 radical gastrectomy and its influence on hemodynamics, visual analogue scale (VAS) and Ramsay sedation score after operation.@*Methods@#A total of 86 patients who received laparoscopic D2 radical gastrectomy under general intravenous anesthesia in Shanxi Provincial Cancer Hospital from March 2017 to June 2017 were enrolled, and all the patients were divided into two groups by using random number table method. The observation group (43 cases) was intravenously injected with dexmedetomidine (0.6 μg/kg) before induction of general anesthesia, and the dose was changed to 0.4 μg/kg after 15 min with drug withdrawal till 30 minutes before surgery, the control group (43 cases) was given an equal volume of 0.9% normal saline. The mean arterial pressure (MAP) and heart rate change before anesthetic induction (T1), tracheal intubation time (T2), after intubation (T3), section time (T4) and the immediate time after intubation (T5) were compared between the two groups. The VAS and Ramsay scores at 1 h and 4 h after surgery and the intraoperative doses of anesthesia maintenance drugs were also compared between the two groups.@*Results@#The heart rate and MAP of the observation group were lower than those of the control group at the time of T1, T3-T5, the differences were statistically significant (all P < 0.05). The VAS and Ramsay scores of the observation group were better than those of the control group at 1 h and 4 h after operation, and the differences were statistically significant (all P < 0.05). The intraoperative doses of propofol and remifentanil in the observation group were (964±251) mg and (3.1±0.8) mg, respectively, which were less than those in the control group [(1 485±425) mg and (4.8±0.8) mg], the differences were statistically significant (t = 9.913, P < 0.01; t = 9.834, P < 0.01).@*Conclusion@#Dexmedetomidine can reduce the stress response of patients with laparoscopic D2 radical anesthesia, enhance the sedative effect, and reduce the dosage of propofol and remifentanil, therefore, it has high clinical application value.

Effect of nabuprofen and sufentanil on analgesia score and sedation score in patients with total hip arthroplasty / 中国基层医药

Objective To analyze the effects of nabuprofen combined with sufentanil on Ramsay sedation score,visual analogue scale (VAS) and analgesic effect in patients undergoing total hip arthroplasty (THA) for patient-controlled intravenous analgesia (PCIA).Methods From January 2017 to December 2017,72 patients with THA in the Department of Orthopedics from the People's Hospital of Linfen were divided into three groups:A group was given nabuprofen,B group was given sufentanil,C group was given nabuprofen + sufentanil,with 24 cases in each group.Ramsay sedation score,VAS score and analgesic effect were compared among the three groups before and after operation.Results The Ramsay sedation scores of A group at 3,12 and 24 hours after operation were (2.78 ±0.32) points,(2.59 ± 0.40) points and (2.4 ± 0.26) points,respectively,and the Ramsay sedation scores of C group at 3,12 and 24 hours after operation were (2.37 ± 0.24) points,(2.0 ± 0.15) points,(1.89 ± 0.22) points,respectively,which were decreased significantly compared with those of B group at the same time point [(3.07 ± 0.58) points,(3.01 ±0.62)points and (2.73 ±0.47)points] (Fbetween group =6.83,Pbetween group =0.01;Ftime point =7.24,Ptime point ＜0.01;Fbeyween group· time point =0.69,Pbetween group.timepoint =0.40).The VAS scores of group B at 3,12 and 24 hours after operation were (2.40 ± 0.72) points,(1.98 ± 0.57) points and (1.24 ± 0.38) points,respectively,and the VAS scores of C group at 3,12 and 24 hours after operation were (2.35 ± 0.75) points,(1.74 ± 0.46) points and (1.18 ±0.26) points,respectively,which were decreased significantly compared with those of A group at the same time point [(3.35 ± 0.59) points,(3.18 ± 0.46) points and (3.01 ± 0.33) points] (Fbetween group =7.02,Pbetween group ＜ 0.01;Ftime point =5.42,Ptime point =0.02;Fbetween group· time point =0.39,Pbetween gronp· time point =0.68).There was statistically significant difference among the three groups (x2 =7.66,P ＜0.05).The analgesic satisfaction of C group (91.67％) was significantly higher than that of A group (58.33％) and B group (62.50％) (x2 =5.44,4.25,all P ＜ 0.05).Conclusion The sedative and analgesic effects of PCIA nabuprofen combined with sufentanil for patients with THA are definite and comfortable,which can effectively alleviate pain,so it has a definite clinical application value.

Ramsay Hunt Syndrome Complicated by Meningoencephalitis and Radiologic findings: a Rare Case Report

Ramsay Hunt syndrome with the complication of encephalitis or meningoencephalitis is rarely reported and uncommon in immunocompetent patients. The radiological manifestations of such cases usually involve the cerebellum and brainstem or exhibit the absence of any abnormality. We report a case of a 78-year-old immunocompetent man hospitalized with Ramsay Hunt syndrome, who later developed meningoencephalitis. The cerebrospinal fluid-study excluded other causes of meningoencephalitis, and the clinical diagnosis indicated varicella zoster virus meningoencephalitis. Magnetic resonance imaging revealed increased signal intensities in the bilateral temporal lobe, midbrain, and pons on T2-weighted imaging, and T2 fluid attenuated inversion recovery and contralateral asymmetric pachymeningeal enhancement. Contrast-enhanced T1-weighted imaging revealed ipsilateral facial nerve enhancement.

Facial Herpes Zoster: A 15-year Retrospective Single-Center Study / 대한피부과학회지

BACKGROUND: Many studies about herpes zoster exist in the Korean dermatologic literature. However, few studies have reported about facial herpes zoster and its complications. OBJECTIVE: The purpose of this study was to investigate the epidemiology, clinical features, and complications of facial herpes zoster. METHODS: We analyzed the medical records of 977 patients who visited Sanggye Paik Hospital between January 2002 and December 2017. We categorized patients into 8 groups based on the dermatomal distribution of herpetic lesions. We investigated the correlations between clinical features, prognosis, and complications. RESULTS: We analyzed the medical records of 977 patients who visited Sanggye Paik Hospital between January 2002 and December 2017. We categorized patients into 8 groups based on the dermatomal distribution of herpetic lesions. We investigated the correlations between clinical features, prognosis, and complications. Results: The most common site of involvement of facial herpes zoster was the ophthalmic branch of the trigeminal nerve (59.2%). Herpes zoster involving the ophthalmic and the maxillary branches of the trigeminal nerves showed a significantly higher incidence rate of herpes zoster ophthalmicus than that observed with herpes zoster involving only the ophthalmic branch (odds ratio 7.373). Age and periorbital swelling were significantly correlated with herpes zoster ophthalmicus (p<0.001). Facial palsy was significantly correlated with otalgia and cutaneous ear involvement (p<0.001). Postherpetic neuralgia (PHN) occurred in 41% of patients with facial herpes zoster. Patients who received antiviral treatment within 3 days showed lower rates of PHN (35.8%) than patients who received treatment after 4 days (45.4%) (p=0.002). CONCLUSION: Facial herpes zoster is associated with several neurological complications. Variables including age, periorbital swelling, otalgia, and cutaneous ear involvement are useful predictors of complications and prognosis. Early institution of antiviral treatment and appropriate interdepartmental consultations are required for better treatment outcomes.

Anesthetic effect of dexmedetomidine in laparoscopic D2 radical gastrectomy and its influence on hemodynamics, visual analogue scale and Ramsay sedation score after operation / 肿瘤研究与临床

Objective To analyze the anesthetic effect of dexmedetomidine in laparoscopic D2 radical gastrectomy and its influence on hemodynamics, visual analogue scale (VAS) and Ramsay sedation score after operation. Methods A total of 86 patients who received laparoscopic D2 radical gastrectomy under general intravenous anesthesia in Shanxi Provincial Cancer Hospital from March 2017 to June 2017 were enrolled, and all the patients were divided into two groups by using random number table method. The observation group (43 cases) was intravenously injected with dexmedetomidine (0.6 μg/kg) before induction of general anesthesia, and the dose was changed to 0.4 μg/kg after 15 min with drug withdrawal till 30 minutes before surgery, the control group (43 cases) was given an equal volume of 0.9％normal saline. The mean arterial pressure (MAP) and heart rate change before anesthetic induction (T1), tracheal intubation time (T2), after intubation (T3), section time (T4) and the immediate time after intubation (T5) were compared between the two groups. The VAS and Ramsay scores at 1 h and 4 h after surgery and the intraoperative doses of anesthesia maintenance drugs were also compared between the two groups. Results The heart rate and MAP of the observation group were lower than those of the control group at the time of T1, T3-T5, the differences were statistically significant (all P< 0.05). The VAS and Ramsay scores of the observation group were better than those of the control group at 1 h and 4 h after operation, and the differences were statisticallysignificant (all P< 0.05). The intraoperative doses of propofol and remifentanil in the observation group were (964±251) mg and (3.1±0.8) mg, respectively, which were less than those in the control group [(1485±425) mg and (4.8 ±0.8) mg], the differences were statistically significant (t= 9.913, P< 0.01; t= 9.834, P< 0.01). Conclusion Dexmedetomidine can reduce the stress response of patients with laparoscopic D2 radical anesthesia, enhance the sedative effect, and reduce the dosage of propofol and remifentanil, therefore, it has high clinical application value.

Comparative study on sedative effects of midazolam and propofol in conscious, agitated, uncooperative patients those admitted in the Emergency Department of Rajah Muthiah Medical College and Hospital

Background: Sedation is the depression of a patient’s awareness of the environment and reduction of his or her responsiveness to external stimuli. Some decades ago, the emergency room procedures were conducted without adequate sedation of the patient, which landed upon various bitter events, like uncomfortableness for the patient, uncomfortableness for the doctor, failure of the procedure, high rate of complications. Aim of the study: To study the onset of action, duration of action, and necessity of additive doses of sedation requirement of midazolam and propofol, to compare the sedative effects of OD midazolam and propofol. Materials and methods: This observational study was conducted in the division of Emergency Medicine at Rajah Muthiah Medical College and Hospital, Chidambaram in the year October 2017 to August 2018. After formal approval from the Ethical committee, this study was conducted on 40 G. Balaji, C.R. Ramachandran. Comparative study on sedative effects of midazolam and propofol in conscious, agitated, uncooperative patients those admitted in the Emergency Department of Rajah Muthiah Medical College and Hospital. IAIM, 2019; 6(5): 154-159. Page 155 patients of either sex between age 20 – 50 years old. After proper IV access is acquired, calculated doses of Midazolam or Propofol were administered intravenously and data was collected. Selection of drug (either midazolam or propofol) was random. The patients were sorted into two groups namely, Group M – Midazolam received patients. Group P – Propofol received patients. Then the data were collected regarding the onset of action, duration of action, sedation scales, and vitals. Scales used to evaluate the effect of drugs were the Richmond Agitation Sedation Scale (RASS), and Ramsay scale. Results: 32.5% of patients belong to toxicology by diagnosis and 30% of patients were pure medical cases, 15% belongs to hanging, and 7.5% of patients are trauma cases. 50% of patients were sedated for securing the airway, and 37.5% of patients were sedated to do procedures. 7.5% of patients received sedation to control seizures and 5% for Cardioversion. In Group P only 15% of patients required top-up dose, whereas in Group M 25% of patients required top-up dose. In Group P, the mean score was 4.35 and in Group M is 3.9, and so there is a statistically significant difference in the Ramsay scale. The difference in fall in systolic BP and respiratory rate between Group P and Group M was statistically significant. Also, there is a significant rise in SpO2 in Group P compared to Group M. Conclusion: Propofol-induced sedation is quicker and effective than that of midazolam. The side effects produced by propofol are negligible and it is even safer when top-up doses are used. The recovery from propofol-induced sedation is faster, and it is even smoother than that of midazolam. So propofol can be safely used for effective sedation in ER.

Study on the application of dexmedetomidine combined with remifentanil in dressing change of conscious patients with non-intubation in burn intensive care unit / 中华烧伤杂志

Objective@#To observe the analgesic and sedative effect and safety of application of dexmedetomidine combined with remifentanil in dressing change of conscious patients with non-intubation in burn intensive care unit.@*Methods@#Forty patients conforming to the study criteria hospitalized in our burn intensive care unit from April 2015 to April 2017 were selected. Prospective, randomized, and double-blind method was used for the design. Patients were divided into dexmedetomidine group and dexmedetomidine+ remifentanil group according to the random number table, with 20 cases in each group. Patients in the two groups were respectively given corresponding drugs during dressing change. The frequency and time of dressing change, Verbal Rating Scale (VRS) score of patients during dressing change (at drug administration for 25 minutes) and after dressing change (25 min after dressing change), Ramsay Sedation Score (RSS) during dressing change, satisfaction level for anesthesia of the patients and physicians after dressing change, dosage of remifentanil, and various adverse effects during and after dressing change were recorded. The heart rate, mean arterial blood pressure (MAP), respiratory rate, and pulse oxygen saturation (SpO2) before drug administration and at 10, 15, and 25 minutes after drug administration were also recorded. Data were processed with analysis of variance for repeated measurement, t test, chi-square test, and Fisher′s exact probability test.@*Results@#(1) Totally 38 patients completed the trial. There were no statistically significant differences between patients in two groups in gender, American Association of Anesthesiologist Grading, age, weight, and total burn area (χ2=0.230, 0.146, t=0.224, 0.351, 0.367, P>0.05). (2) The frequency of dressing change of patients in two groups were both 48 times. The time of dressing change and VRS scores during dressing change of patients in two groups were similar (t=0.821, 1.522, P>0.05). The VRS score of patients in dexmedetomidine+ remifentanil group after dressing change was (3.1±0.4) points, obviously lower than (3.8±0.8) points in remifentanil group (t=2.213, P<0.05). The RSS, satisfaction level scores for anesthesia of the patients and physicians after dressing change in dexmedetomidine+ remifentanil group were (3.13±0.32), (3.44±0.41), and (3.13±0.25) points, respectively, obviously better than (1.82±0.24), (2.71±0.23), (2.53±0.41) points in remifentanil group (t=2.226, 2.684, 7.702, P<0.01). The dosage of remifentanil of patients in dexmedetomidine+ remifentanil group was (282±19) μg, obviously less than (340±31) μg in remifentanil group (t=9.896, P<0.01). There were no statistically significant differences between patients in two groups in rates of respiratory inhibition and hypotension (χ2=0.211, 0.154, P>0.05). Compared with those in remifentanil group, the rates of nausea, vomiting, and other gastrointestinal symptoms of patients in dexmedetomidine+ remifentanil group were obviously reduced (P<0.05), but the rate of bradycardia was obviously increased (χ2=6.008, P<0.05). (3) There were no statistically significant differences between patients in two groups in heart rate, MAP, respiratory frequency, and SpO2 before drug administration (t=0.444, 0.892, 1.059, 1.039, P>0.05). The heart rates of patients in dexmedetomidine+ remifentanil group at 10, 15, and 25 minutes after drug administration were (83±11), (78±10), and (82±14) times per minute, respectively, significantly lower than (95±10), (87±12), and (89±12) times per minute in remifentanil group (t=5.592, 3.992, 2.630, P<0.05 or P<0.01). The MAP of patients in dexmedetomidine+ remifentanil group at 15 and 25 minutes after drug administration were (69.4±3.1) and (73.8±2.2) mmHg (1 mmHg=0.133 kPa), respectively, significantly lower than (75.4±3.0) and (78.1±3.5) mmHg in remifentanil group (t=9.181, 7.206, P<0.01). There were no statistically significant differences between patients in two groups in respiratory frequency at each time point after drug administration (t=1.489, 1.862, 1.963, P>0.05). The SpO2 of patients in dexmedetomidine+ remifentanil group at 15 minutes after drug administration was 0.972±0.018, obviously lower than 0.979±0.015 in remifentanil group (t=2.070, P<0.05).@*Conclusions@#Application of remifentanil with small dosage has effective analgesia for conscious burn patients with non-intubation during dressing changes, however, adverse effects such as nausea and vomiting are likely to occur. Remifentanil combined with dexmedetomidine not only guarantee the analgesic effect, but also reduce the dosage of analgesics, improve the sedative effect and satisfaction of the patients for anesthesia, and reduce various adverse effects. However, it will increase the incidence of bradycardia and has some inhibition effect on circulation at the same time.

Clinical study of prophylactic propofol on the side effects of carboplatin and trometamol infusion at different plasma target concentrations in cesarean section / 中国基层医药

Objective To observe the effect of propofol infusion on the side effects of carboplatin and trometamol at different plasma target concentrations in cesarean section.Methods From January 2016 to October 2017,a total of 184 cases of cesarean section pregnant women in the People's Hospital of Quzhou were selected for prospective study.They were divided into A group ,B group,C group and control group (N group) according to random number table method,with 46 cases in each group.The A,B,C three groups were target -controlled infusion of propofol,the concentrations were 0.8μg/mL,1.2μg/mL,1.6μg/mL,respectively,while N group was infused 0.9%sodium chloride injection at the rate of 0.5mL· kg-1· h-1.The operative time,intraoperative blood loss,fluid replacement,elevated blood pressure,decreased blood pressure ,the incidence of tachycardia and adverse reactions were compared among the four groups.Results The operation time of the four groups were (46.65 ±5.32) min, (49.21 ±4.75)min,(48.74 ±4.28) min,(49.76 ±5.25) min,respectively,the differences were not statistically significant(F＝1.501,P ＞0.05).The volume of intraoperative blood loss in the four groups were (425.66 ± 39.54)mL,(428.71 ±41.03)mL,(427.96 ±41.55)mL,(431.56 ±42.35)mL,respectively,the differences were not statistically significant(F＝1.882,P＞0.05).The fluid replacement in the four groups were (884.59 ±51.22)mL, (879.20 ±47.63)mL,(883.59 ±50.14)mL,(896.33 ±50.23)mL,respectively,the differences were not statistically significant(F＝1.634,P＞0.05).The satisfaction rate of sedation in B group was 91.30%,which was significantly higher than 58.70%in A group and 30.43%in C group(Z＝91.428,P＜0.05).The incidence rates of cardiovascular events in B group and C group were significantly lower than those in A group (all P＜0.05),which in B group were lower than those in C group(all P＜0.05).There were no statistically significant differences in chest tightness ,head-ache,facial flushing incidence in the three groups (χ2＝3.450,4.816,5.396,all P＞0.05).The incidence rates of nausea and vomiting in B group were 8.70%and 4.35%,respectively.The incidence rates of nausea and vomiting in C group were 8.70%and 2.17%,respectively,which were significantly lower than those in A group (26.09% and 19.57%)(χ2＝7.485,10.405,all P＜0.05).Conclusion Targeted infusion of propofol at 1.2 μg/mL can effec-tively prevent the side effects of cesarean section carduvastatin trometamol with good sedative effect .

Clinical Characteristics of Dizziness Associated with Acute Peripheral Facial Palsy

BACKGROUND AND OBJECTIVES: We aimed to assess the clinical significance of dizziness associated with acute peripheral facial palsy (APFP). SUBJECTS AND METHODS: Medical records of patients who visited an otorhinolaryngology clinic at a university hospital and were admitted for treatment of APFP between 2014 and 2016 were thoroughly reviewed. RESULTS: In total, 15.3% (n=15) of patients had dizziness. Continuous, rotatory dizziness without exacerbating factors was most common and frequently accompanied by nausea/vomiting. Dizziness disappeared within 1 week during the hospitalization period. Patients with Ramsay Hunt syndrome (31.0%) had dizziness more frequently than those with Bell’s palsy (8.7%). In addition, higher hearing thresholds and pain around the ear was reported more often in dizzy patients (p < 0.05). Logistic regression analysis revealed that the initial House-Brackmann grade of facial paralysis was solely associated with final recovery, but dizziness was not associated with prognosis. CONCLUSIONS: Patients with APFP may have transient dizziness in the early stage, which may be more frequently accompanied by worse hearing thresholds and/or pain around the ear. However, these symptoms including dizziness seem to be unrelated to final prognosis.

Ramsay Hunt syndrome

Ramsay Hunt syndrome is a type of acute herpes zoster, which occurs by reactivation of the varicella-zoster virus at the geniculate ganglion. Clinical presentation of Ramsay Hunt syndrome includes a vesicular rash on the ear (herpes zoster oticus) or in the oral mucosa accompanied by acute peripheral facial nerve paralysis. Other cranial nerves such as V, IX, XI, and XII are often involved. Additional variability of the clinical picture of Ramsay Hunt syndrome is produced by varying patterns of skin involvement explained by individual anastomoses between cranial and cervical nerves. Combination treatment containing anti-viral agents and steroids is recommended for the treatment of Ramsay Hunt syndrome. Additionally, early diagnosis of Ramsay Hunt syndrome is a crucial factor to improve damaged nerves in Ramsay Hunt syndrome, which initiates treatment as soon as possible.

Abducens Nerve Palsy Associated with Ramsay-Hunt Syndrome / 대한평형의학회지

Ramsay-Hunt syndrome is an infectious disease caused by the varicella zoster virus. It is usually associated with facial and vestibulocochlear nerve palsy, but other cranial nerve dysfunction can be accompanied. We present a 68-year-old woman with abducens nerve palsy associated with Ramsay-Hunt syndrome. She showed abduction limitation of left eye with peripheral facial palsy and vestibulopathy of the left side. Varicella zoster virus polymerase chain reaction of cerebrospinal fluid was positive and internal auditory canal magnetic resonance imaging was revealed enhancement of labyrinthine segment of left facial nerve. Although abducens nerve palsy is uncommon feature of Ramsay-Hunt syndrome, but it can be developed by several different mechanisms.

Ramsay Hunt syndrome presenting with abducens nerve palsy followed by V, VII, VIII, IX, and X nerve palsies

@#Ramsay Hunt syndrome, associated with varicella zoster virus infection is characterized by herpes zoster oticus, facial nerve palsy, and cochleovestibular symptoms. Ramsay Hunt syndrome associated cranial polyneuropathy occasionally occurs with involvement beyond VII and VIII. We represent a patient of Ramsay Hunt syndrome who presented with only VI involvement at the first visit followed by cranial polyneuropathy. Varicella zoster virus infection was confirmed by the detection of varicella zoster virus-DNA in cerebrospinal fluid.