Latex allergy on anaesthesiologist and anaesthesia managements: are the health workers high risk patients?

Anaphylaxis is defined as a severe, life threating, generalized or systemic hypersensitivity reaction. The most common agent involved in intraoperative anaphylactic reactions is muscle relaxant (61-70%); natural rubber latex (NRL) is the second most implicated agent and the incidence of latex-related anaphylactic reactions is increasing despite increasing awareness and preventive measures taken. Latex is a ubiquitous part of life today. Medical products which contain latex are present in our environment, especially in the hospital setting. This study focuses on our experience with two different anaesthetic techniques performed on the same patient who had latex hypersensitivity reaction and underwent surgery for myomectomy twice in 5 years. This case report aims to point out to latex hypersensitivity on health workers. The patient described had latex allergy and strategy of management during perioperative period is detailed.

Intrathecal bupivacaine or levobupivacaine: which should be used for elderly patients?

OBJECTIVES: To compare two intrathecal anaesthetics, bupivacaine and levobupivacaine, for their effects on motor and sensory blockade and haemodynamics in patients aged ≥ 65 years undergoing transurethral resection of the prostate (TUR-P) or transurethral resection of the urinary bladder (TUR-M). METHODS: Patients scheduled to undergo TUR-P or TUR-M were randomized to receive either 3 ml (15 mg) 0.5% isobaric levobupivacaine (group L) or 3 ml (15 mg) of 0.5% hyperbaric bupivacaine (group B) for spinal anaesthesia. The onset time, maximum level and time to reach the maximum level of sensory and motor blockade were recorded. Changes to haemodynamic parameters were also recorded. RESULTS: The study randomized 100 patients: 57 to group L and 43 to group B. Levobupivacaine did not cause any significant changes in haemodynamic parameters, including systolic blood pressure, and showed a similar sensory block onset time compared with bupivacaine, but it had a significantly longer motor block onset time compared with bupivacaine. CONCLUSION: These current findings suggest that levobupivacaine can be used as a substitute for bupivacaine for spinal anaesthesia in elderly patients ≥ 65 years of age undergoing elective TUR-P or TUR-M operations.

Effect of nerve localization using a pen device on the success of axillary brachial plexus block.

OBJECTIVE: The effectiveness of axillary brachial plexus block (ABPB) performed using peripheral nerve stimulation (PNS) alone was compared with PNS preceded by nerve localization using a pen device, enabling nerve mapping without puncturing the skin. METHODS: Patients undergoing unilateral hand or forearm surgery suitable for ABPB were randomly assigned to receive either PNS alone (pen - group) or PNS preceded by nerve localization using a pen device (pen + group). Parameters related to the block procedure and patient comfort were assessed. RESULTS: Thirty patients were included in each group. The block performance time was longer in the pen + group than the pen - group despite a reduced number of needle insertions. The complete block rate was higher and intraoperative analgesic usage lower in the pen + group compared with the pen - group. Patient satisfaction and complication rates were similar in the two groups. CONCLUSION: The pen device seems to be a helpful addition to PNS for ABPB, with improved results in terms of block success and patient comfort, but further studies are needed to confirm these findings.

The incidence of postoperative residual curarization following the use of intermediate-acting muscle relaxants and related factors.

PURPOSE: To evaluate the incidence of residual curarization (RC) and related risk factors in the early and late postoperative periods in patients receiving general anesthesia with intermediate-acting muscle relaxants. METHODS: Two-hundred and eight American Society of Anesthesiologists class I and II patients, aged 18-70 years, who underwent general anesthesia with intermediate-acting muscle relaxants, were included. Heart rate, blood pressure, oxygen saturation, tympanic temperature were recorded for each patient who was transported to the recovery room, every 10 minutes by a trained nurse. To define the efficacy of residual muscle relaxants, neuromuscular monitoring was performed, and Train of Four (TOF) ratios < 90% were regarded as RC whereas ratios ≥ 90% were considered as adequate neuromuscular recovery in early and late recovery periods. Age, duration of anesthesia, repeated doses, reversal and types of intermediate-acting neuromuscular blockers were evaluated as risk factors for RC. Logistic Regression Analysis was performed to define the risk factors for RC in early and late periods. RESULTS: The RC rate was 10.6% in the early recovery period, and short duration of anesthesia, repeated doses and lack of reversal use were the risk factors for RC. However, RC rate was 2.9% in the late recovery period, and the only risk factor was repeated doses. CONCLUSION: Reversal use was shown to reduce residual effects of intermediate-acting muscle relaxants in early recovery period, whereas risk of RC in 30 min in PACU was shown to increase with repeated doses of muscle relaxants.

Combined spinal-epidural anesthesia with epidural volume extension causes a higher level of block than single-shot spinal anesthesia.

BACKGROUND AND OBJECTIVES: We evaluated the effects of epidural injection with levobupivacaine or serum physiologic, epidural volume extension (EVE), when using combined spinal-epidural anesthesia (CSEA) for cesarean delivery. METHODS: One-hundred and thirty-eight patients with a full-term pregnancy of 37-42 weeks that were scheduled for cesarean delivery were included. Group 1 (n=48) received single-shot spinal anesthesia (SSS), group 2 (n=45) received CSEA-EVE with saline, group 3 received CSEA-EVE with levobupivacaine. The characteristics of motor and sensory block, the effects on maternal hemodynamic changes and the effects on the newborn were compared. RESULTS: Time to reach maximum sensory block was significantly shorter in groups 3 than in group 1 and 2 (p<0.05). Two-segment regression time of sensory block was significantly shorter in group 1, whereas it was significantly longer in group 3 than in group 2 (p<0.05). Time to onset of motor block was significantly longer in group 1 than in groups 2 and 3 (p<0.05). Time to reach maximum motor block was significantly shorter in group 3 than in groups 1 and 2 (p<0.05). Time to recovery of motor block was significantly longer in group 3 than in groups 1 and 2 (p<0.05). The time to first analgesic was significantly longer in group 3 (p<0.05). CONCLUSIONS: Sufficient and rapid motor and sensory block was achieved in all the patients in the present study; however, motor and sensory block had faster onset, lasted longer, and was of a higher level in groups 2 and 3; these effects were more pronounced in the group 3.

An unusually prolonged duration of spinal anaesthesia following 0.5% levobupivacaine.

Spinal anaesthesia is the method of choice for elective caesarean delivery. Levobupivacaine may produce a sensory and motor block that is different from that produced by bupivacaine, the most popular local anaesthetic for parturients undergoing caesarean section (CS). We present a case of unexpectedly prolonged spinal anaesthesia following a successful spinal block with levobupivacaine. There was no evidence of any neurological injury in this patient during injection.

Uterine preservation and vaginal reconstruction in a patient with congenital vaginal agenesis presenting with cyclic menouria.

Herein we report the case of a patient with primary amenorrhea and cyclic menouria. The patient was a 20-year-old woman with primary amenorrhea and inability to achieve sexual intercourse. Clinical examination revealed normally developed labia majora and minora, clitoris, and external urethral orifice, but no vaginal opening. A mature female pubic hair pattern was present, and axillary hair development was normal. Breasts were normally developed. Abdominopelvic magnetic resonance imaging demonstrated a remnant upper vagina and unicornuate uterus filled with fluid, and left-sided renal agenesis. Intraoperatively, a congenital vesicouterine fistulous tract was observed. The fistulous tract was completely resected. Vaginal reconstruction using a sigmoid colon pedicled flap was performed. The proximal part of the neovagina was connected to the remnant cervix, and a Foley catheter was left in the uterine cavity for 7 days to prevent obstruction. The patient has been menstruating regularly since the operation. Menouria might be an early sign of congenital vesicouterine fistula. Resection of the fistulous tract with uterine preservation might be considered in patients with vaginal agenesis.

The comparative effect of single dose mivacurium during sevoflurane or propofol anesthesia in children.

BACKGROUND: We aimed to randomly compare intubating conditions, recovery characteristics and neuromuscular effects of single dose of mivacurium (0.2 mg.kg(-1)) during sevoflurane vs. propofol anesthesia in 60 healthy children, undergoing inguinal surgery. METHODS: All children were randomly allocated to receive 2 mg.kg(-1) propofol iv or sevoflurane 8% inspired concentration for induction of anesthesia. Anaesthesia was maintained with 66% nitrous oxide in oxygen and 100-120 microg.kg(-1) propofol or sevoflurane approximately 2-3% inspired concentration with controlled ventilation. The ulnar nerve was stimulated at the wrist by a train-of four (TOF) stimulus every 20 s and neuromuscular function was measured at the adductor pollicis. When the response to TOF was stable, 0.2 mg.kg(-1) mivacurium was given. The trachea was intubated successfully at the first attempt in all patients. RESULTS: Onset time following a single dose of mivacurium was shorter in the sevoflurane group (2.99 min), than in the propofol group (4.42 min). The times to 25, 50, 75, and 90% recovery were significantly longer in the sevoflurane group (13.1, 15.7, 18.6, and 21.2 min, respectively) than in the propofol group (11.4, 13.2, 14.4, and 17.2 min respectively). TOF ratios of 50, 70, and 90% were significantly occurred later in sevoflurane group than propofol group. CONCLUSIONS: Our results indicate that when compared with propofol group, the sevoflurane group had an accelerated onset and a delayed recovery of neuromuscular block induced by mivacurium in children.