Spinal Anesthesia With Tetracaine in 0.75% Glucose: Influence of the Vertebral Interspace Used for Injection

1998 ◽  
Vol 23 (2) ◽  
pp. 170-175
Author(s):  
Shinichi Sakura ◽  
Mariko Sumi ◽  
Noriko Morimoto ◽  
Yuji Yamamori ◽  
Yoji Saito
Keyword(s):  
Spinal Anesthesia ◽  
Elective Surgery ◽  
Study Drug ◽  
Sensory Block ◽  
Lateral Position ◽  
Number Of Patients ◽  
Group 3 ◽  
Group 2 ◽  
Hyperbaric Solution ◽  
Hyperbaric Tetracaine

Background and ObjectivesThe anesthetic behavior and hemodynamic consequences of spinal anesthesia with marginally hyperbaric tetracaine containing a low concentration of glucose injected at two different interspaces were examined and compared with those of conventionally hyperbaric solution.MethodsOne-hundred twenty ASA Physical Status I or II patients scheduled for elective surgery to the lower limb were sequentially assigned to one of three equal groups to receive spinal anesthesia: Group 1 received 0.5% tetracaine in 0.75% glucose with 0.125% phenylephrine at the L2-L3 interspace; group 2 0.5% tetracaine in 0.75% glucose with 0.125% phenylephrine at the L3-L4 interspace; group 3 0.5% tetracaine in 7.5% glucose with 0.125% phenylephrine at the L3-L4 interspace. Neural block was assessed in a double-blinded manner by cold, pinprick, and touch sensation, and a modified Bromage scale after the injection of the study drug.ResultsInjection at the L2-L3 interspace produced significantly higher spread of analgesia [median T7 (10th, 90th percentiles T10, T4)] than injection at L3-L4 interspace [T10 (L1, T5)] when using the solution in 0.75% glucose. There were no significant differences in peak dermatomal levels between groups 1 and 3, but the number of patients who required ephedrine for the treatment of hypotension was larger in group 3.ConclusionsA marginally hyperbaric tetracaine solution injected at the L2-L3 interspace with the patient in the lateral position produced greater extent of cephalad spread than that at the L3-L4 interspace. When compared to a conventionally hyperbaric tetracaine solution injected at the L3-L4 interspace, the marginally hyperbaric solution injected at the L2-L3 interspace caused less hemodynamic variability despite similar levels of maximum sensory block.

scholarly journals Comparison of postoperative analgesic efficacy of preemptive USG-guided TAP block, USG-guided local infiltration and intravenous dexketoprofen in inguinal hernia repair

2020 ◽  
Author(s):  
Fikret Salık ◽  
Mustafa Bıçak ◽  
Hakan Akelma
Keyword(s):  
Inguinal Hernia ◽  
Postoperative Analgesia ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Number Of Patients ◽  
Vas Scores ◽  
Group 3 ◽  
Group 2 ◽  
Local Anesthetic Infiltration ◽  
Group 1

Abstract Background Although regional techniques have been suggested more in order to provide postoperative analgesia in inguinal hernia repairs, the ideal method is still controversial. The aim of this study was to evaluate the effect of preemptive transversus abdominis plane (TAP) block, local anesthetic infiltration (LAI) and intravenous dexketoprofen (IVD) on postoperative pain in inguinal hernia repairs. Methods This prospective study included 120 patients with American Society of Anesthesiologists status 1-3 between 18-75 years of age who undergoing elective inguinal hernia surgery under spinal anesthesia. The patients were allocated into three groups: USG-guided TAP block (Group 1, n = 40), USG-guided LAI (Group 2, n = 40) and IVD (Group 3, n = 40) before surgical incision. The mean of tramadol consumption, number of patients in requiring rescue analgesics, duration of postoperative analgesia and complications were recorded for 24 hours postoperatively. VAS scores were evaluated at the 30 minute, 1, 2, 4, 8, 12, 16 and 24th hours. Results There was no significant difference between the postoperative mean tramadol consumption [Group 1: 22.5 mg; Group 2: 20 mg; Group 3: 27.5 (p 0.833)]. The number of patients requiring rescue analgesics was statistically similar (p 0.787). VAS scores at 30. min, 1, 2, 4, 8 and 12 hours were statistically lower in Group 1 than in the other groups (p 0.003, 007, 0013, 0049, 0015, 0021). VAS scores at 30. min and 2. h were lower in Group 1 than Group 2 (p 0.049, 0.037). İn addition, VAS scores at 30 min, 1, 2, 8 and 12 hours were lower in Group 1 than in Group 3 (p 0.003, 0.006, 0.021, 0.017, 0.016). VAS scores at all hours were statistically similar between Group 2 and Group 3. Conclusion This study demonsrated that preemptive transversus abdominis plane block, local anesthetic infiltration or iv dexketoprofen for postoperative analgesia in inguinal hernia repairs had similar effects on postoperative tramadol consumption and number of requiring rescue analgesic patients. However, TAP block provides lower VAS values and excellent analgesia in more patients in the first 24 hours postoperatively.

scholarly journals The effect of hormonal disbalance on the aging rate change in the patients with arterial hypertension and comorbid endocrinopathies

2019 ◽  
Vol 23 (2) ◽  
pp. 277-282
Author(s):  
V. D. Nemtsova ◽  
I. A. Ilchenko ◽  
V. V. Zlatkina
Keyword(s):  
Arterial Hypertension ◽  
Premature Aging ◽  
Endocrine Disorders ◽  
Anthropometric Parameters ◽  
Aging Rate ◽  
Age Related ◽  
Number Of Patients ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Due to the growing number of patients with age-related diseases, the aim of the study was to investigate in the changes of aging rate (AR) in patients with comorbid course of arterial hypertension (H), type 2 diabetes mellitus (T2DM) and subclinical hypothyroidism (SH) and to study the features of these changes depending on hormonal imbalance. 118 patients (63 women and 55 men, average age — 53.6±4.3 years) were divided into 3 groups: group 1 (n=37) with isolated H; group 2 (n=42) — with H and T2DM; group 3 (n=39) — with H, T2DM and SH. The investigation program included: measurement of anthropometric parameters (blood pressure, height, body weight (BW), body mass index (BMI)), carbohydrate and thyroid metabolism using standard methods, biological age (BA) by V.P. Voitenko et al. Statistical processing was performed using the Statistica for Windows 8.0 software package. When evaluating AR, physiological aging was found in 8 patients (21.6%) of group 1, in 4 (9.5%) patients of group 2 and 3 (7.7%) of patients in group 3. In the overwhelming majority of the examined patients, premature aging (PA) was noted, however, the acceleration of PA between patients of groups 2 and 3 was not differ significantly (p>0.05). The increase in AR in group 2 patients was accompanied by an increase in BA by 7.2 years, in 3 group patients — by 7.3 years compared with their chronological age. A correlation analysis revealed a positive relationship between BMI and coefficient of aging rate (CAR) (r=0.679; p<0.05); BMI and BA (r=0.562; p<0.05) and CAR and the TSH level (r=0.050; p=0.388) in the 3rd group. Thus, the presence of hypertension and comorbid endocrinopathies — T2DM and SH significantly increases the AR and when assessing the effect of endocrine disorders, the presence of T2DM is more important than SH.

scholarly journals Single sitting multimodality management of hemorrhoid

2021 ◽  
Vol 8 (11) ◽  
pp. 3302
Author(s):  
Mahendra P. Singh
Keyword(s):  
Variable Number ◽  
Concomitant Treatment ◽  
Stage Management ◽  
Group 4 ◽  
Number Of Patients ◽  
Clinical Complexity ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: It is usual to face clinical complexity in piles patients. They usually present with variable number of pile masses and in different grades of progression. This led to the idea of offering concomitant single stage management in our hemorrhoid patients matching to our criteria. We conducted hospital based descriptive study among the patients coming to my clinical practice falling in grade-1-3.Methods: All the patients falling in grade-1-3 and matching to our criteria were included. The study was conducted   from January 2012 to December 2020. Place of study was basically at two centres: Karamdeep medical centre, Kanpur and Mayo health care, Mohali. Total number of patients were 581. Patients having grade-4 piles and with local co-morbidities were excluded from the study. Modalities of treatment used were sclerotherapy, band ligation and hemorrhoidectomy.Results: Patients managed were divided into four groups – group 1 included patients with piles in grade-1; group-2 included patients having piles in grade-1 and 2; group-3 included patients having piles in grade-1 and 3; and group-4 included patients having piles in grade-1, 2 and 3. Total 952 pile masses were treated in 581 patients. Sclerotherapy was required in 732 (77%) masses, banding in 99 (10.3%) masses and surgery in 122 (12.7%) masses.Conclusions: Concomitant treatment policy proved to be comprehensive way to tackle pile patients of grade-1-3. Mixed and matched method using surgical and non-surgical modalities in a single sitting proved to be beneficial. 86.4% cases were cured this way. Cost of the treatment was economical with lesser complications including local mutilation and better quality of life.

scholarly journals A comparative study of intravenous versus perineural administration of dexmedetomidine in supraclavicular brachial plexus block using 0.75% ropivacaine by ultrasound guided technique in upper limb surgeries

2018 ◽  
Vol 6 (7) ◽  
pp. 2407
Author(s):  
Fahad Khan ◽  
V. P. Singh
Keyword(s):  
Comparative Study ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Elective Surgery ◽  
Study Drug ◽  
Sensory Block ◽  
Ultrasound Guided ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

Background: Comparative study of intravenous versus perineural administration of dexmedetomidine in supraclavicular brachial plexus block using 0.75% ropivacaine by ultrasound guided technique in upper limb surgeries.Methods: Patients in the age group 18-58 years both male and female, having ASA 1 and ASA 2, scheduled for elective surgery of unilateral upper limb surgeries were included and randomly divided into three groups’ i.e. group RD, group RDI and group R and patients with chronic pain or taking any analgesics, ASA grade III and IV, bleeding disorders, history of brachial plexus injury, known allergy to the study drug, previous shoulder surgery, any psychiatric disorders, peripheral neuropathy, failed block, significant respiratory disease, hearing impairment, pregnant women, study were excluded.Results: Time to sensory onset in group RD was as compared to group RDI and group R was found statistically significant (p<0.001). Duration of sensory block (analgesia) in group RD, group RDI and Group R was also statistically significant (p<0.001). The level of sedation of Group RDI and Group RD had highly significant value till 30 mins (p<0.001).Conclusions: The central effects of dexmedetomidine also play some role in prolongation of sensory and motor block duration, as explained previously.

Does Upfront Therapy with Fludarabine Increase the Risk of Histological Transformation In Patients with Follicular Lymphoma?

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4885-4885
Author(s):  
Sobia Yaqub ◽  
Todd W. Gress ◽  
Oscar Ballester
Keyword(s):  
Follicular Lymphoma ◽  
Relapse Rate ◽  
Group 4 ◽  
Number Of Patients ◽  
Histological Transformation ◽  
Group 3 ◽  
Group 2 ◽  
Time To Relapse ◽  
Group 1

Abstract Abstract 4885 Introduction: Fludarabine has been reported to increase the incidence of relapse and histological transformation in chronic lymphocytic leukemia (Thornton PD, Leukemia research, 2005) and Waldenstrom macroglobulinemia (Leleu X, J Clincal Oncology, 2009). The purpose of our study was to investigate the role of Fludarabine and the risk of transformation and relapse in follicular lymphoma (FL). Patients and Methods: This is a retrospective single institution study. We included 50 patients consecutively diagnosed with FL Grade I and II based on WHO classification of lymphoid malignancies. Grade III patients were excluded from the study. Median follow up is 2.86 years. Patients were grouped according to the initial therapy chosen by their treating physicians: Group 1(n=14) included patients on observation and radiation therapy, Group 2 (n=6) included patients on Fludarabine based regimens, Group 3(n=13) included CVP-R and other rituximab regimens and Group 4(n=17) included R-CHOP. Data collected included time to the onset of biopsy proven transformation, time to relapse, mortality and overall survival. Level of significance was set at <0.05. Results: Median age of the patients was 56.5 and it was not significantly different for the various groups. High risk FLIPI score was seen in 66% of patients treated with Fludarabine regimens as compared to 61% of R-CHOP treated patients. Overall, relapse occurred in 38% patients and transformation occurred in 16% patients during the follow up period. Fludarabine treated patients had the highest relapse rate: 50% (p=0.03). R-CHOP group has lowest relapse rate: 11%. Transformation rate was highest in the Fludarabine group: 33%, as compared to 13% to 17% in other groups (p=0.10). Mortality rate was 7% in group 1, 16% in group 2, 23% for group 3 and 5% in group 4 (p=0.44). Time to relapse/progression in group 1 was 2.9 years; in group 2 was 2.1 years; in group 3 was 2.7 years and in group 4 was 5.8 years. Conclusions: In our study, Fludarabine treated patients appear to be at higher risk for relapse and transformation compared to patients treated with R-CHOP. The differences can not be explained on the basis of known prognostic factors such as age or FLIPI score. The retrospective nature of the study and the small numbers of patients preclude more definitive conclusions. Further research is needed with large number of patients. Disclosures: No relevant conflicts of interest to declare.

A COMPARATIVE STUDY OF TWO DIFFERENT DOSES OF DEXMEDETOMIDINE AS ADJUNCT TO LIDOCAINE IN INTRAVENOUS REGIONAL ANESTHESIA

2021 ◽  
Vol 74 (9) ◽  
pp. 2259-2264
Author(s):  
Diana Salam Sami ◽  
Ali Hadi Muslih
Keyword(s):  
Regional Anesthesia ◽  
Motor Block ◽  
Onset Time ◽  
Sensory Block ◽  
P Value ◽  
Intravenous Regional Anesthesia ◽  
Group 3 ◽  
Group 2 ◽  
Different Doses ◽  
Group 1

The aim: To compare the different doses of dexmedetomidine as adjuvant to lidocaine in intravenous regional anesthesia. Materials and methods: Ninety patients participated in this study in Al-Yarmook teaching hospital in period between January 1st 2016 – July 1st 2016, divided randomly in to 3 groups. Group 1: received lidocaine diluted with normal saline; Group 2 – lidocaine with dexmedetomidine 0.5 μg/kg; Group3 -lidocaine with dexmedetomidine 1 μg/kg. Statistical analysis was done by IBM SPSS program version 20 and Microsoft excel version 2010 , the means were compared by ANOVA methods and Dunnett t3, significancebetween groups were recorded if p value less than 0.05. Results: Dexmedetomidine was effective in decreasing the sensory block onset time and motor block onset time and prolongation of the motor and sensory recovery with no significant hemodynamic changes than is often shown by the lidocaine alone, it also prolongs the time interval for analgesic requirement after the operation. For the group 3 it was faster than in group 2 and faster than in group 1 significantly (p value < 0.001) to form a sensory block onset and motor block onset; and it took significantly more time to recover the sensation than in group 1 (p value <0.001) and 2 (p value <0.002) , and more time for motor recovery than in group 1 (p value < 0.001). Group 3 had the longest time to call for the analgesia after operation than group 2 and 3 (p value < 0.001); and group 2 also had longer time for the same process than group 1 (p value < 0.001). Conclusions: A variety of adjuvants have been used in IVRA to decrease tourniquet pain, improve block quality, and prolong analgesia after cuff deflation. Opioids are relatively ineffective and cause nausea, vomiting, and dizziness after tourniquet deflation, but several NSAIDs have been shown to be beneficial, dexmedetomidine improves block quality and postoperative analgesia.

Changes in Components of the Natural Coagulation Inhibitor System, in Patients with Antiphospholipid Antibodies and/or the Lupus Inhibitor.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4031-4031
Author(s):  
Yale S. Arkel ◽  
De-Hui W. Ku ◽  
Evelyn Y. Ku ◽  
Jeffrey Birnbaum ◽  
Xuam Lam
Keyword(s):  
Antiphospholipid Antibodies ◽  
Assay Method ◽  
Apparent Difference ◽  
Endothelial Protein C Receptor ◽  
Protein Z ◽  
Number Of Patients ◽  
Coagulation Assay ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract The cell surface glycoproteins thrombomodulin (TM) and endothelial protein C receptor (EPCR) are major intermediaries in the down-regulation of thrombin and are noted to be shed from endothelial cells (ECs) due to the actions of proinflammatory cytokines, thrombin and other agents. Antiphospholipid antibodies (APLA) have been described as perturbing ECs. The level of protein S (PS) and protein Z (PZ) have been reported to inconsistently relate to the presence of antibodies and clinical outcomes. We previously reported using a coagulation assay system to demonstrate that adverse pregnancy outcomes (APO) are associated with a greater incidence of resistance to the anticoagulant effects of TM. In the current study we measured the plasma levels of soluble TM (sTM), soluble EPCR (sEPCR) as a possible indicator of APLA-EC interaction. We measured levels of free PS, PZ, sTM and sEPCR in patients (pts) with APLA and/or lupus inhibitor (LI), and correlated the findings with a positive or negative history for thrombosis [THRM(+) or (−)]. APO were not assessed at this time. The study group consisted of 26 males and 60 females, ages ranging from 25 to 90 years; mean of 56. GROUP 1: 33 pts with increased (inc) APLA and 24 of them THRM(+), GROUP 2: 16 pts positive for LI and 7 of them THRM(+), GROUP 3: 37 pts positive for both APLA & LI and 21 of them THRM(+). The pts were compared to 49 normal APLA negative donors (CTR). Pts who have moderate to high levels of anticardiolipin and/or anti-β2 glycoprotein I are APLA positive. LI positive pts have prolonged LI sensitive PTT, and are positive for at least two of the confirmatory tests (Hexagonal phase assay, platelet neutralization procedure, and diluted Russel Viper Venom Time Ratio). GROUP 1 has statistically significant (SS) (p&lt;0.05) decreased (dec) sTM, sEPCR, and free PS when compared to CTR (sTM 1.0+/−1.4 vs 5.1+/−3.3ng/ml, sEPCR 43+/−53 vs 145+/−140ng/ml, free PS 63+/−25 vs 76+/−14%). Free PS is SS lower in the THRM(−) vs. THRM(+). PZ levels do not demonstrate SS differences in the subset comparisons. 8% of THRM(+) pts have PZ deficiency (PZ &lt;1.0ug/ml) with none noted in the THRM(−) pts. Free PS is dec in a majority of the THRM(−). This might be related to the much higher % of females in the THRM(−). Therefore issues such as use of OCP, estrogens, current or recent pregnancy might influence PS. The incidents of dec sTM levels (&lt;2.0ng/ml) are surprisingly higher in this group of patients (82%). This is strikingly higher than the CTR (4%). There is no apparent difference in the THRM(+) to THRM(−). The number of patients with dec sEPCR (&lt;5ng/ml) is much lower however; none of the THRM(−) has dec levels. Inc sTM (&gt;8.0ng/ml) nor inc sEPCR (&gt;284ng/ml) is noted in any of the Pts. In GROUP 2, there is SS dec sTM & sEPCR (sTM 1.6+/−1.8ng/ml, sEPCR 42+/−32ng/ml) vs. CTR with no SS difference in the THRM(+) vs. THRM(−). In GROUP 3, sEPCR is SS dec in pts (sEPCR 68+/−100ng/ml) vs. CTR and CTR vs THRM(+) (sEPCR 29+/−25ng/ml). sTM is SS dec in the CTR vs. THRM(+) (sTM 1.3+/11.4ng/ml). Our data shows low levels of sTM and sEPCR in the APLA patients. This might indicate that the levels are consumed by antibody interactions and could indicate that the APLA and associated other antibodies might interfere with their functions. Previous reports indicating a resistance to TM in a coagulation assay method in patients with THRM and APO raises the possibility of an inhibiting substance present in the APLA. Further work in larger patient groups is necessary to clarify these issues.

Incidence of Transient Neurologic Symptoms after Hyperbaric Subarachnoid Anesthesia with 5% Lidocaine and 5% Prilocaine 

1998 ◽  
Vol 88 (3) ◽  
pp. 624-628 ◽  
Author(s):  
Rafael Martinez-Bourio ◽  
Mikel Arzuaga ◽  
Jose M. Quintana ◽  
Luciano Aguilera ◽  
Javier Aguirre ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Elective Surgery ◽  
Demographic Data ◽  
Randomized Study ◽  
Lidocaine Group ◽  
Neurologic Symptoms ◽  
Group Assignment ◽  
Number Of Patients ◽  
Low Incidence ◽  
To Receive

Background Hyperbaric 5% lidocaine has been associated with transient neurologic symptoms (TNSs) after spinal anesthesia. A prospective, masked, randomized study was conducted to compare the incidence of TNSs after spinal anesthesia with hyperbaric 5% lidocaine or 5% prilocaine to assess the utility of prilocaine as an alternative to lidocaine in patients having short surgical procedures. Methods The number of patients to be enrolled (100 per group) was determined by power analysis (80%, P = 0.05) considering an incidence of TNSs after spinal anesthesia with lidocaine of at least 11% according to data reported in other studies. Two hundred patients scheduled for elective surgery expected to last &lt;60 min were allocated at random to receive spinal anesthesia with hyperbaric 5% lidocaine or hyperbaric 5% prilocaine. Three to 5 days after spinal anesthesia, all patients were interviewed by an anesthesiologist who was blinded to the group assignment and details of the anesthetic and surgical technique using a standardized symptom checklist. Patients with symptoms underwent neurologic examination. Results Both groups were comparable with regard to demographic data and details of the surgical and anesthetic procedures. The incidence of TNSs in both groups was low and differences were not found (4% in the lidocaine group and 1% in the prilocaine group). The mean age of patients with TNSs (58 yr) was higher than that of patients without TNSs (48 yr; P &lt; 0.05). No relation with any of the other variables was found. Conclusions The low incidence of TNSs among lidocaine-anesthetized patients (4%) may account for the lack of significant differences between hyperbaric 5% lidocaine and 5% prilocaine and to the insufficient power of the study to exclude the possibility of a type II error.

scholarly journals FRI0237 COMPARISON OF DIFFERENT PULMONARY HYPERTENSION SCREENING ALGORITHMS IN PATIENTS WITH SYSTEMIC SCLEROSIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 702.1-703
Author(s):  
M. Erdogan ◽  
B. Kilickiran Avci ◽  
C. Ebren ◽  
Y. Ersoy ◽  
Z. Ongen ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Systemic Sclerosis ◽  
Pulmonary Function Tests ◽  
Left Ventricular ◽  
Systolic Pulmonary Artery Pressure ◽  
Research Support ◽  
Severe Left Ventricular Dysfunction ◽  
Number Of Patients ◽  
Group 3 ◽  
Group 2

Background:Pulmonary hypertension (PH) is an important cause of morbidity and mortality in patients with systemic sclerosis (SSc). Different screening algorithms have been proposed for identifying patients who have a high probability of PH and require right heart catheterization (RHC), which is the gold standard for diagnosing PH.Objectives:To compare the performance of PH screening algorithms in our patients with SSc.Methods:Sixty-nine consecutive pts fulfilling ACR/EULAR 2013 SSc criteria have been screened for PH until now, using the 2015 ESC/ERS, DETECT and ASIG algorithms. Pulmonary function tests (PFT), diffusing capacity of the lung for carbon monoxide (DLCO), trans-thoracic echocardiography, serum NT-proBNP and uric acid assay and high-resolution computed tomography (HRCT) were performed as needed. Patients with known PH, severe interstitial lung disease and severe left ventricular dysfunction (LVD) were not included. RHC was performed in all patients with positive screening according to any one of the screening algorithms. Pts with PH were classified according to the updated PH classification criteria. Sensitivity and specificity of the 3 screening algorithms were evaluated according to the established cut-off value of 25 mmHg for mean systolic pulmonary artery pressure and for the recently proposed cut-off value of 20 mmHg.Results:Among the 69 SSc pts, 27 were excluded due to ILD(n=6), LVD(n=6), already diagnosed PH(n=4) no measurable TRV(n=5), lung cancer (n=2), pulmonary embolism (n=1) and nephrotic syndrome (n=1). Among the remaining 42 patients, 17 required RHC according to at least one of the screening algorithms (Table 1). Number of patients who had suspected pulmonary hypertension and required RHC according to ESC/ERS 2015, DETECT and ASIG were 7 (%17), 13 (%31), and 12 (%29) respectively (Figure 1). Among the 17 pts. who had RHC, PH was present in 3 pts according to the 25-mmHg cut-off (Group 2 in 2, Group 3 in 1) and in 9 pts according to the 20-mmHg cut-off (Group 1 in 5, Group 2 in 3, Group 3 in 1). The sensitivity and specificities were presented in Table 2. ASIG and DETECT had better sensitivity for 25-mmHg cut-off and was better with ASIG for 20 mmHg cut-off. The specificity was better with ESC/ERS for both cut-off values.Conclusion:The ASIG algorithm has a better sensitivity and ESC/ERS algorithm has a better specificity for detecting PH in patients with SSc. A limitation of this study was that RHC was not performed in patients who did not fulfill criteria according to any of the screening algorithms. The sensitivities may be lower than what we propose if there are patients with PH who are asymptomatic and not captured with any of the algorithms.Disclosure of Interests:Mustafa Erdogan: None declared, Burcak Kilickiran Avci: None declared, Cansu Ebren: None declared, Yagmur Ersoy: None declared, Zeki Ongen: None declared, Gul Ongen: None declared, Vedat Hamuryudan Speakers bureau: Pfizer, AbbVie, Amgen, MSD, Novartis, UCB, Gulen Hatemi Grant/research support from: BMS, Celgene Corporation, Silk Road Therapeutics – grant/research support, Consultant of: Bayer, Eli Lilly – consultant, Speakers bureau: AbbVie, Mustafa Nevzat, Novartis, UCB – speaker

scholarly journals The Efficacy and Safety of Low Dose Epidural Butorphanol on Postoperative Analgesia following Cesarean Delivery

2008 ◽  
Vol 47 (170) ◽  
Author(s):  
Krishna Pokharel ◽  
T R Rahman ◽  
S N Singh ◽  
B Bhattarai ◽  
N Basnet ◽  
...  
Keyword(s):  
Side Effects ◽  
Cesarean Delivery ◽  
Analgesic Efficacy ◽  
Study Drug ◽  
Group 3 ◽  
Group 2 ◽  
Spinal Epidural ◽  
Dose Dependent ◽  
Group 1

Butorphanol is considered an effective and safe analgesic after cesarean delivery but is associatedwith profound dose-dependent sedation. Somnolence may cause hindrance in early mother-babyinteraction. This study was designed to assess the analgesic efficacy and to monitor side-effects of low doses (0.5 mg and 0.75 mg) of epidural butorphanol with bupivacaine compared to bupivacainealone in parturients following cesarean delivery. One hundred and twenty parturients (AmericanSociety of Anesthesiologists physical status 1 and 2) undergoing cesarean delivery were allocatedinto three groups: group 1 received epidural 0.125% bupivacaine while group 2 and 3 received an additional 0.5 mg and 0.75 mg butorphanol respectively. A combined spinal, epidural techniquewas used. Spinal anaesthesia was used for surgery. The epidural route was used for postoperativeanalgesia with the study drug. Onset, duration and quality of analgesia, lowest visual analoguescales (VAS) score, and side effects were noted. The onset and duration of analgesia in group 2(4.1±2.6 min and 202.4±62.8 min) and group 3 (4.0±2.5 min and 192.3±69.1 min) were significantly different (P<0.01) from group 1 (6.6±2.7min and145.7±89.6 min). The quality of analgesia in terms of time to first independent movement and satisfactory VAS were statistically better (P<0.01) in group 2 (3.9±0.3 hour and 8.1±0.1 mm) and group 3 (3.8±0.4 hour and 8.1±0.9 mm) than in group 1 (5.2±0.4hour and 6.3±1.3 mm). The incidence of sedation was 5% in all the three groups. A lower dose of epidural butorphanol with bupivacaine produces a significantly earlier onset, longer duration and better quality of analgesia than bupivacaine does.Key words: analgesia, epidural, postcesarean, spinal

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