Low-Dose Ketamine and Diazepam: Use as an Adjunct to Local Anesthesia in an Office Operating Room

1982 ◽  
Vol 108 (7) ◽  
pp. 439-440 ◽  
Author(s):  
H. A. Tobin
Keyword(s):  
Operating Room ◽  
Local Anesthesia ◽  
Low Dose

Open Hemorrhoidectomy With Ligasure™ Under Local or Spinal Anesthesia: A Comparative Study

2021 ◽  
pp. 000313482110385
Author(s):  
Claudio F. Feo ◽  
Chiara Ninniri ◽  
Cinzia Tanda ◽  
Giulia Deiana ◽  
Alberto Porcu
Keyword(s):  
Spinal Anesthesia ◽  
Operating Room ◽  
Local Anesthesia ◽  
Outpatient Clinic ◽  
Perioperative Complications ◽  
Study Groups ◽  
Reoperation Rate ◽  
Hyperbaric Bupivacaine ◽  
Open Hemorrhoidectomy ◽  
American Society

Background There is increasing evidence that many anorectal surgical procedures may be performed under local anesthesia. The aim of the present study was to evaluate the safety and efficacy of local anesthesia in the outpatient clinic vs spinal anesthesia in the operating room for open hemorrhoidectomy. Methods Sixty-two patients with grade III or IV hemorrhoids underwent open hemorrhoidectomy with LigaSure™ between 2018 and 2020. Of them, 32 procedures were performed in the operating room under spinal anesthesia with hyperbaric bupivacaine and other 30 procedures were undertaken in the outpatient clinic under local anesthesia with ropivacaine. Results There were no significant differences regarding age, gender, American Society of Anesthesiologists class, and Goligher’s grade in between groups. No significant differences were observed in postoperative pain score (P = .85), perioperative complications (P = .51), and reoperation rate (P = .96). No recurrences and no differences in patients’ satisfaction degree (P = .76) were documented at long-term follow-up in both study groups. Discussion Our results suggest that open hemorrhoidectomy with LigaSure™ performed in selected patients under local anesthesia in the outpatient clinic is a well-tolerated, safe, and effective procedure.

Solid Organ Biopsies

2018 ◽  
pp. 246-249
Author(s):  
Jennifer Biber ◽  
Jenna Wheeler
Keyword(s):  
Adverse Events ◽  
General Anesthesia ◽  
Operating Room ◽  
Local Anesthesia ◽  
Deep Sedation ◽  
Recovery Period ◽  
Contingency Planning ◽  
Solid Organ ◽  
Sedation And Analgesia ◽  
Pediatric Sedation

While solid organ biopsies are routinely done on adults with only local anesthesia or minimal sedation, children frequently require deep sedation or general anesthesia to achieve acceptable conditions (stillness, anxiolysis, analgesia) to facilitate these procedures. This is more frequently being done with pediatric sedation/anesthesia outside the operating room. Issues unique to sedation for these procedures are pain, the need for relative patient immobility (both during the procedure and following it), and the nonstandard positioning required during the procedure. Regardless of the medications chosen, adequate monitoring should occur during the procedure as well as during the recovery period. With a good sedation plan for both sedation and analgesia, adequate monitoring, and contingency planning for adverse events, this can safely be performed in institutions with highly motivated and organized sedation services.

scholarly journals Methemoglobinemia Due to Local Anesthesia with Low-Dose Prilocaine

2009 ◽  
Vol 35 (1) ◽  
pp. 168-169 ◽  
Author(s):  
ZENO GAIGL ◽  
CORNELIA S. SEITZ ◽  
AXEL TRAUTMANN
Keyword(s):  
Local Anesthesia ◽  
Low Dose

scholarly journals Adding Dexmedetomidine to Articaine Increases the Latency of Thermal Antinociception in Rats

2020 ◽  
Vol 67 (2) ◽  
pp. 72-78
Author(s):  
Yukako Tsutsui ◽  
Katsuhisa Sunada
Keyword(s):  
Local Anesthesia ◽  
Local Anesthetic ◽  
Pain Perception ◽  
Low Dose ◽  
Cardiovascular Effects ◽  
Radiant Heat ◽  
Plantar Surface ◽  
Withdrawal Latency ◽  
Male Wistar Rats ◽  
Low Toxicity

Articaine is a low-toxicity local anesthetic that is widely used in dentistry. Typically, epinephrine is added to prolong the duration of articaine local anesthesia; however, epinephrine exhibits adverse effects. Low-dose dexmedetomidine (DEX), an α2-adrenoreceptor agonist, reportedly prolongs local anesthesia without notable adverse cardiovascular effects. The purpose of this study was to assess whether a combination of low-dose DEX and articaine would provide a low-toxicity local anesthetic option for dental procedures without adverse cardiovascular effects. Thus, this study investigated whether DEX could prolong the local anesthetic effect of articaine using a rat model of pain. Adult male Wistar rats (N = 44; 11 per group) received a 50-μL subcutaneous injection into the plantar surface of the hind paws; injections were composed of either normal saline, 4% articaine (2 mg articaine), combined 5 μg/kg DEX and 4% articaine (1.25 μg DEX + 2 mg articaine), or combined epinephrine (1:100,000) and 4% articaine (0.9 μg epinephrine + 2 mg articaine). Subsequent acute pain perception was determined by paw withdrawal movement in response to infrared radiant heat stimulation of the plantar region. Paw withdrawal latency was tested at 5-minute intervals. Paw withdrawal latency values at 35 and 40 minutes were 3.83 ± 1.76 and 3.29 ± 1.43 seconds for articaine alone, 7.89 ± 2.72 and 7.25 ± 3.37 seconds for DEX and articaine, and 8.95 ± 2.28 and 8.17 ± 3.01 seconds for epinephrine and articaine. DEX prolonged the paw withdrawal latency of articaine for up to 35 minutes (p = .015) but not 40 minutes after injection (p = .052) when compared to articaine alone. The combination of DEX and articaine can provide effective local anesthesia for up to 35 minutes after injection.

scholarly journals The Impact of Pain Control on Invasive Clinical Procedure on Children with Leukemia

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5827-5827
Author(s):  
Jiayi WANG ◽  
Yingyi He ◽  
Zhimin Liang ◽  
Tiezhen Ye ◽  
Hui Zhang
Keyword(s):  
Local Anesthesia ◽  
Pain Control ◽  
Adverse Reactions ◽  
Low Dose ◽  
Invasive Procedure ◽  
Anesthesia Group ◽  
Group A ◽  
Group B ◽  
The Impact ◽  
Group D

Abstract Background: Palliative care is becoming more and more important for systemic cancer treatment in developed countries, while this remains infamous topic in developing countries, such as in China. Contemporary treatment strategies have greatly contributed to the improved outcome in childhood cancer patients, survivorship comes at the cost of developing some treatment-related health condition, such as pain-related depression, chronic pain etc. Thus, developing a well-tolerated pain control methods is of great importance within the cancer treatment. Objective: To evaluate the impact and outcome of different pain control applications on invasive procedure in children with leukemia, and record the adverse reactions. Methods: The enrollment of childhood leukemia patients in our hospital from November 2011 to November 2016 were divided into four groups, that is successively midazolam + local anesthesia (group A), midazolam + ketamine +local anesthesia (group B), midazolam + fentanyl + local anesthesia (group C), and fentanyl + propofol + local anesthesia (group D). The efficacy and adverse reactions were systemically recorded. The inter-group diffferences were calculated using x2 test. Results: No significancewas observed in age, gender, and disease distribution in these four groups by ANOVA ONEWAY analysis. The sedation outcome is more pronunced in group D than others. Also, the quality of procedural pain control in group D was the best (P<0.01). In terms of the analgesic effect, group B and D were better than that group A and C. There was significant difference in Hallucination was more easily detected in group B and C. Systemic recovery was delayed in group B other than group A, C, and D. Basing on the survey, we did found that the family members were more willing to accept pain control treatment for their sick kids under the safety assurance. The compliance was significantly improved in group D. Conclusion: Upon adequate auxiliary breathing preparation and rigorous monitor, propofol combined with low-dose fentanyl was the best sedative/analgesic option for pain control within leukemia patients receiving invasive procedure.The outcome of propofol combined with low-dose fentanyl wasvery safe, satisfactory and compliable. Up to now, this study is the first pain control study for invasive procedure in China mainland, it deserves being paid attention. Disclosures No relevant conflicts of interest to declare.

Feasibility of Umbilical Hernia Repair Under Local Anesthesia and Monitored Anesthesia Care at a Veteran Affairs Hospital

2021 ◽  
pp. 000313482095145
Author(s):  
Lindsey Loss ◽  
Jennie Meier ◽  
Tri Phung ◽  
Javier Ordonez ◽  
Sergio Huerta
Keyword(s):  
Hernia Repair ◽  
Operating Room ◽  
Local Anesthesia ◽  
Umbilical Hernia ◽  
The United States ◽  
Postanesthesia Care Unit ◽  
Entire Cohort ◽  
Umbilical Hernia Repair ◽  
Hernia Size ◽  
To Receive

Background Local anesthesia (LA) for open umbilical hernia tissue repair (OUHTR) is not widely utilized in academic centers in the United States. We hypothesize that LA for OUHTR is feasible in a veteran patient population. Methods From 2015 to 2019, 449 umbilical hernias were repaired at our institution utilizing a standardized technique in veteran patients. OUHTR was included in this analysis (n = 283). Since 2017, 18.7% (n = 53) UH were repaired under LA. We compared outcomes and operative times between general anesthesia and LA in patients undergoing OUHTR. Univariable and multivariable analyses were performed to determine significance. Results The entire cohort was composed of older (56.3 ± 12.1 years), White (75.5%), obese (body mass index [BMI] = 32.3 ± 4.6 kg/m2) men (98.0%). The average hernia size for the entire cohort was 2.42 ± 1.2 cm. The groups were similar in age and BMI. Patients with higher American Society of Anesthesiologists (ASA) (Odds ratio [OR] 3.1; 95% CI 1.5-6.8) and cardiovascular disease (OR 2.7; 95% CI 1.0-7.2) were more likely to receive LA. Recurrence (0.0% vs 6.0%; P = .9) and 30-day complications (6.0% vs 13%; P = .9) were similar between LA and GA after correcting for hernia size. Operating room times were reduced in the LA group (17.7 minutes; P < .05). None of the patients with LA required postanesthesia care unit for recovery. The patients who received LA reported being comfortable (78.9% of patients), with the worst reported pain being 2.4 ± 2.4 (out of a scale of 10), and 94.7% would elect to receive LA if they had another hernia repair. Conclusion Patients who received LA had more cardiac disease and a higher ASA. Complications were similar between both groups. LA reduced operating room times. Patients were satisfied with LA.

Methemoglobinemia Due to Local Anesthesia with Low-Dose Prilocaine

2009 ◽  
Vol 35 (1) ◽  
pp. 168-169
Author(s):  
ZENO GAIGL ◽  
CORNELIA S. SEITZ ◽  
AXEL TRAUTMANN
Keyword(s):  
Local Anesthesia ◽  
Low Dose

Reduced radiation fluoroscopy technique for implantation of sacral neuromodulation

2021 ◽  
pp. 205141582110029
Author(s):  
Jason Groegler ◽  
Mohammad Hajiha ◽  
Hillary Wagner ◽  
Forrest Jellison ◽  
Akin S Amasyali ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Operating Room ◽  
Low Dose ◽  
Sacral Neuromodulation ◽  
Level Of Evidence ◽  
Lead Placement ◽  
Significant Difference ◽  
Fluoroscopic Imaging ◽  
Effects Of Radiation ◽  
Operating Room Staff

Introduction: Sacral neuromodulation (SNM) is a Food and Drug Administration–approved treatment option for urinary urgency and fecal incontinence. Fluoroscopic imaging is used at various steps during lead placement, which exposes the operating room staff and patient to the harmful effects of radiation. The aim of this study is to describe a reduced radiation technique during lead placement for treatment with SNM. Methods: A retrospective cohort of 51 consecutive patients who underwent lead insertion and SNM placement at a single academic institution were investigated. Reduced fluoroscopy (RF; n=11) involved C-arm settings to 1 pulse/second and an activated “low-dose” setting, while conventional fluoroscopy (CF; n=40) involved 30 pulses/second and a deactivated “low-dose” setting. The automatic brightness control and collimation were used optionally in both groups. Comparison of imaging quality, fluoroscopy settings, and radiation exposure during RF and CF was performed. Results: RF settings resulted in significant reduction of radiation compared to CF settings, including the fluoroscopy time (8.61 vs. 48.16 seconds; p<0.001), dose (2.66 vs. 26.25 mGy; p=0.001), and current (1.67 vs. 4.18 mAs; p<0.001). There was no significant difference in total operative time (59.18 vs. 61.33 minutes; p=0.77) and the rate of progression from stage 1 to stage 2 during follow-up (75% vs. 84%; p=0.55). Conclusions: Lead placement for treatment with SNM can be achieved using RF settings without compromising clinical outcomes. Applying the RF technique reduces overall radiation exposure to the patient and the operating room staff. Further validation of RF in a larger prospective cohort study is needed. Level of evidence: Level 4.

scholarly journals Transforming Anesthesia Data Into the Observational Medical Outcomes Partnership Common Data Model: Development and Usability Study (Preprint)

2021 ◽  
Author(s):  
Antoine Lamer ◽  
Osama Abou-Arab ◽  
Alexandre Bourgeois ◽  
Adrien Parrot ◽  
Benjamin Popoff ◽  
...  
Keyword(s):  
Data Warehouse ◽  
Operating Room ◽  
Local Anesthesia ◽  
Data Model ◽  
Large Scale ◽  
Longitudinal Research ◽  
Data Reuse ◽  
Common Data Model ◽  
Anesthesia Care ◽  
Medical Outcomes

BACKGROUND Electronic health records (EHRs, such as those created by an anesthesia management system) generate a large amount of data that can notably be reused for clinical audits and scientific research. The sharing of these data and tools is generally affected by the lack of system interoperability. To overcome these issues, Observational Health Data Sciences and Informatics (OHDSI) developed the Observational Medical Outcomes Partnership (OMOP) common data model (CDM) to standardize EHR data and promote large-scale observational and longitudinal research. Anesthesia data have not previously been mapped into the OMOP CDM. OBJECTIVE The primary objective was to transform anesthesia data into the OMOP CDM. The secondary objective was to provide vocabularies, queries, and dashboards that might promote the exploitation and sharing of anesthesia data through the CDM. METHODS Using our local anesthesia data warehouse, a group of 5 experts from 5 different medical centers identified local concepts related to anesthesia. The concepts were then matched with standard concepts in the OHDSI vocabularies. We performed structural mapping between the design of our local anesthesia data warehouse and the OMOP CDM tables and fields. To validate the implementation of anesthesia data into the OMOP CDM, we developed a set of queries and dashboards. RESULTS We identified 522 concepts related to anesthesia care. They were classified as demographics, units, measurements, operating room steps, drugs, periods of interest, and features. After semantic mapping, 353 (67.7%) of these anesthesia concepts were mapped to OHDSI concepts. Further, 169 (32.3%) concepts related to periods and features were added to the OHDSI vocabularies. Then, 8 OMOP CDM tables were implemented with anesthesia data and 2 new tables (EPISODE and FEATURE) were added to store secondarily computed data. We integrated data from 5,72,609 operations and provided the code for a set of 8 queries and 4 dashboards related to anesthesia care. CONCLUSIONS Generic data concerning demographics, drugs, units, measurements, and operating room steps were already available in OHDSI vocabularies. However, most of the intraoperative concepts (the duration of specific steps, an episode of hypotension, etc) were not present in OHDSI vocabularies. The OMOP mapping provided here enables anesthesia data reuse.

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