Opioid-Free Anesthesia for Awake Neurosurgery in a Patient With Asthma and Von Willebrand Disease: A Case Report.

Anesthesia for awake neurosurgery requires meticulous planning. We report the case of a 44-year-old female with glioblastoma undergoing an awake craniotomy. Due to her asthma and von Willebrand disease, an opioid-free approach was chosen. Conscious sedation was attained using propofol and dexmedetomidine. The operation was successful after nine hours with patient comfort maintained. The patient was discharged from the intensive care unit in two days without sequelae. However, the use of desmopressin caused hyponatremia and cerebral edema. The scalp block was effective for pain management. This case highlights the importance of individualized anesthetic strategies in awake neurosurgeries.

Exploring the Potential of Lidocaine in a Bilateral Erector Spinae Plane Block for Multimodal Analgesia in Partial Hepatectomy: A Case Report.

The bilateral erector spinae plane block (ESP) has been effectively used for abdominal surgery, and the placement of catheters is known to extend the benefits of the block while allowing for the adjustment of local anesthetic doses as necessary. Since fascial plane blocks require high volumes of local anesthetic and a prolonged duration of effect, typically, long-acting local anesthetics are preferred. However, lidocaine is not commonly chosen for these types of blocks due to the large volumes required and the associated risk of local anesthetic systemic toxicity. Nonetheless, we present a case report of a patient who underwent a partial hepatectomy under general anesthesia, with perioperative placement of a bilateral ESP block. Bilateral catheters were inserted, and 1% lidocaine was selected as the local anesthetic due to resource limitations. The surgery proceeded without complications, and the patient reported effective analgesia and a high level of satisfaction. Our report suggests that the utilization of lidocaine in a continuous ESP block can be a successful alternative for partial hepatectomies.

A Comparison Between Saline and Balanced Solutions in Kidney Transplants: A Randomized Clinical Trial.

Objective This study aimed to investigate the impact of different types of intravenous fluids - normal saline (NS), lactated Ringer's solution (LR), and PlasmaLyte (PL) - on the acid-base balance and electrolyte concentration following kidney transplant, a common procedure for patients with end-stage renal disease (ESRD). Methodology A randomized controlled trial design was employed, wherein the primary parameters analyzed were postoperative pH and serum potassium levels. Postoperative concentrations of serum bicarbonate, sodium, chloride, and creatinine, as well as graft functionality, were assessed as secondary outcomes. These measurements were performed at the start and end of surgery, as well as 24 and 72 hours postoperatively. Results A total of 53 patients were included in the study and randomized into three cohorts: NS, LR, and PL, each of which showed comparability in terms of demographic and transplantation specifics. Notably, patients in the NS group exhibited a more significant decrease in pH (NS group: 7.285 ±0.098, LR group: 7.324 ±0.075, PL group: 7.7338 ±0.059) and bicarbonate levels (17.0 ±4.2, 20.9 ±2.8, 20.0 ±4.5) post 24 hours after the operation and displayed a similar pattern immediately after the surgery. However, there were no discernible differences in potassium (p=0.460), sodium (p=0.681), and chloride (p=0.321) levels across the groups. Furthermore, the study did not observe any significant differences in postoperative graft functionality. Conclusion The use of NS as the intraoperative fluid of choice led to lower pH and bicarbonate levels following kidney transplant, as compared to LR and PL. However, these results did not correlate with improvements in graft functionality.

Isokinetic Muscular Strength and Aerobic Physical Fitness in Recreational Long-Distance Runners: A Cross-Sectional Study.

ABSTRACT: Andrade, MS, Silva, WA, de Lira, CAB, Mascarin, NC, Vancini, RL, Nikolaidis, PT, and Knechtle, B. Isokinetic muscular strength and aerobic physical fitness in recreational long-distance runners: A cross-sectional study. J Strength Cond Res 36(3): e73-e80, 2022-Muscular strength, bilateral asymmetry, and imbalance between antagonist muscles have been considered as risk factors for knee injuries. Moreover, muscular strength has also been associated with aerobic performance. The aim of the study was to investigate bilateral muscular symmetry and muscular strength balance assessed by isokinetic dynamometry in recreational long-distance runners and to verify whether knee muscular strength would be associated with maximal oxygen uptake (V̇o2max), anaerobic threshold (AT), and running economy (RE). Thirty-nine runners (male [n = 24]: age, 30 ± 8 years; height, 176.0 ± 7.3 cm; body mass, 70.3 ± 8.0 kg; race pace below 4:30 min·km-1 and female [n = 15]: age, 31 ± 7 years; height, 163.0 ± 3.8 cm; body mass, 55.9 ± 4.7 kg; race pace below 5:00 min·km-1) participated in this study. Comparing the conventional knee balance ratio with the literature recommendation (60%), male runners presented significantly lower values for the nondominant side (55.5 ± 7.3%; p = 0.001; d = 0.85; confidence interval [CI] = 0.47 to 1.20) but not for the dominant side (58.1 ± 6.8%; p = 0.208; d = 0.37; CI = -0.12 to 0.86). Female runners presented lower values for both sides (52.1 ± 7.1%; p = 0.001; d = 1.55; CI = 0.86 to 2.20 and 50.7 ± 8.0%; p = 0.001; d = 1.62; CI = 0.90 to 2.30 for dominant and nondominant sides, respectively). Female and male runners presented nonfunctional ratio imbalance and asymmetry of bilateral strength. Strength outcomes were not associated with V̇o2max, AT, or RE. In conclusion, recreational runners were characterized by an imbalance in muscular strength between knee flexor and extensor muscles, which was more obvious in female runners, and by symmetrical thigh muscle strength values. Moreover, muscular isokinetic knee flexor and extensor muscle strength was not associated with aerobic fitness parameters.

Hip muscular strength balance is associated with running economy in recreationally-trained endurance runners.

BACKGROUND: The percentage of sustained maximal oxygen uptake and the running economy are important factors that determine the running success of endurance athletes. Running economy is defined as the oxygen uptake required to run at a given speed and depends on metabolic, cardiorespiratory, biomechanical, neuromuscular, and anthropometric factors. With regard to anthropometric characteristics, total body mass seems to be a crucial factor for the running economy. Moreover, neuromuscular components, especially knee muscular strength and the strength balance ratio, also seem to be critical for the running economy. In addition to knee muscle strength, hip muscle strength is also an important contributor to running performance on level or hilly ground. However, the relationship between running economy and the hip muscles is unknown. Thus the aim of the present study was to verify whether hip flexor and extensor isokinetic peak torque, the isokinetic strength balance ratio, total body mass and fat free mass were associated with running economy in both sexes and to compare sex differences in physical fitness and isokinetic strength characteristics. METHODS: A total of 24 male (31.0 ± 7.7 years, 176.2 ± 7.3 cm, and 70.4 ± 8.4 kg) and 15 female (31.3 ± 6.7 years, 162.9 ± 3.9 cm, and 56.0 ± 5.3 kg) recreationally-trained endurance runners were recruited. Maximal oxygen uptake, running economy, conventional (concentric flexors-to-concentric extensors) and functional (concentric flexors-to-eccentric extensors) hip isokinetic strength balance ratios, peak torque of the hip flexor and extensor muscles, total body mass, and fat-free mass were measured. Running economy was assessed on two separate days by means of the energy running cost (Ec) using a motorized treadmill at 10.0 and 12.0 km h-1 (3% gradient) and 11.0 and 14.0 km h-1 (1% gradient). RESULTS: The functional balance ratio was significantly and negatively associated with Ec at 11.0 (r =  - 0.43, P = 0.04) and 12.0 km h-1 (r =  - 0.65, P = 0.04) when using a 3% gradient in male runners. Considering muscular strength, male runners only showed a significant relationship between Ec (assessed at 12 km h-1 and a 3% gradient) and peak torque for extensor muscle eccentric action (r = 0.72, P = 0.04). For female runners, only peak torque relative to total body mass for extensor muscles (180° s-1) was positively associated with Ec when assessed at 10 km h-1 using a 3% gradient (r = 0.59, P = 0.03). No significant relationships were found between Ec and total body mass or fat-free mass. DISCUSSION: Given that the functional balance ratio was associated with a better Ec, coaches and athletes should consider implementing a specific strengthening program for hip flexor muscles to increase the functional ratio.