The Combination of General Anaesthesia and Epidural Block I: The Effects of Sequence of Induction on Haemodynamic Variables and Blood Gas Measurements in Healthy Patients

The haemodynamic effects of epidural block, administered before or after general anaesthesia, were investigated in twelve healthy women scheduled for elective gynaecological surgery. The effects of 10° head down tilt and administration of atropine 0.6 mg intravenously were also determined. Haemodynamic measurements included systolic (SAP), diastolic (DAP) and mean (MAP) arterial pressure, heart rate (HR), cardiac output (CO) and systemic vascular resistance (SVR). In those receiving general anaesthesia first (Group A) (thiopentone/suxamethonium/N2O/O2) significant changes occurred only at the time when epidural block and general anaesthesia were both present: SAP, DAP and MAP (-22%, p < 0.001) were reduced compared to awake control values, however changes in HR, CO and SVR were not significant. In those receiving epidural block first (Group B) (1.5% lignocaine, mean dose 270 mg), MAP was reduced by 20% (p < 0.01) from awake control values after epidural block and there was a further reduction to 35% below control (p < 0.001) when general anaesthesia was induced. These changes were accompanied by a significant reduction in SVR. Comparison of all variables between Group A and Group B showed no clinically significant differences, indicating that the order of performance of epidural block (before or after general anaesthesia) did not affect haemodynamic variables. Head down tilt resulted in no haemodynamic changes in the presence of general anaesthesia or epidural block alone and only minimal changes when the two were combined. In contrast, intravenous atropine (0.6 mg) resulted in a return of arterial pressures to essentially baseline values in both Group A and Group B (HR increased 84%, p < 0.001; MAP increased 37%, p < 0.001; CO increased 70%, p < 0.001).

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Coagulation effects of mannitol in combination with 0.9% normal saline or hydroxyethyl starch in patients undergoing supratentorial craniotomy: A preliminary report

Journal of Neuroanaesthesiology and Critical Care ◽

10.4103/2348-0548.124851 ◽

2014 ◽

Vol 01 (01) ◽

pp. 056-059 ◽

Cited By ~ 1

Author(s):

Hemanshu Prabhakar ◽

Gyaninder Singh ◽

Parmod Bithal ◽

Mani Kalaivani

Keyword(s):

General Anaesthesia ◽

Hydroxyethyl Starch ◽

Normal Saline ◽

In Vitro Study ◽

Coagulation Parameters ◽

Neurosurgical Patients ◽

Group A ◽

Clinically Significant ◽

Group B

Abstract Background: Neurosurgical patients often require administration of both, mannitol and hydroxyethyl starch (HES). A recent in vitro study demonstrated that HES in combination with mannitol could disturb coagulation parameters and should be avoided in neurosurgical practice. The aim of our study was to evaluate coagulation abnormalities due to mannitol when administered alone and in combination with HES in patients undergoing craniotomy for various intracranial brain tumours. Materials and Methods: We enrolled 30 adult patients undergoing craniotomy. Patients were randomised into two groups using a computer generated randomisation chart. Interventions: Group A: Patients received 10 ml/kg 0.9% normal saline and 1 g/kg mannitol and Group B: Patients received 10 ml/kg, HES 130/0.4, and 1 gm/kg mannitol; immediately after induction of general anaesthesia. Rotational thromboelastography was done immediately after induction of general anaesthesia and 5 min after administration of mannitol. Measured parameters of blood coagulation were clotting time (CT) and clot formation time (CFT) with EXTEM and maximum clot firmness (MCF) with EXTEM and (FIBTEM). Results: Fourteen patients in each group completed the study. Insignificant change was noted in CT; CFT altered significantly from the baseline in both the groups (P < 0.05). MCF with FIBTEM did not change significantly from baseline (P > 0.05), but significantly differed between groups (P = 0.001). However, all values were in normal range. Conclusion: Mannitol 1 g/kg and HES 10 ml/kg can be safely administered in patients undergoing craniotomy for supratentorial tumours, without clinically significant changes in coagulation parameters.

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A comparative study of various types of intravenous fluids on the changes during induction of general anaesthesia

International Surgery Journal ◽

10.18203/2349-2902.isj20195952 ◽

2019 ◽

Vol 7 (1) ◽

pp. 102

Author(s):

Surendra Kumar ◽

Desh Pal Singh ◽

Shailja Sharma ◽

Praveen Kumar

Keyword(s):

General Anaesthesia ◽

Tube Placement ◽

Intravenous Fluids ◽

Endotracheal Tube Placement ◽

Haemodynamic Changes ◽

Ringer’S Lactate ◽

Group A ◽

Group B ◽

Induction Of Anaesthesia ◽

Initial Process

Background: The induction and endotracheal intubation is the most risky and initial process of general anaesthesia. Without induction and endotracheal tube placement one cannot imagine the general anaesthesia. Propofol and fentanyl are the commonly used drugs for induction of general anaesthesia. These drugs produce hypotension and other cardiorespiratory disturbances. These hazardous and sometimes fatal effects can be reduced and eliminated by preloading the patients with colloid or crystalloid solutions.Methods: We selected 90 patients who visited our hospital in the last 2 years from June 2017 to May 2019. All the investigations and pre-anaesthetic check-up was done routinely. These patients had to undergo different surgical procedures under general anaesthesia. The induction of anaesthesia was done with propofol and fentanyl. These patients were divided in three groups A, B and C. Group A patients did not receive any preloading. Group B was given colloids (3.5% gelatins) and group C received crystalloids (Ringer’s lactate solution). The haemodynamic changes were noted and analysed statistically.Results: The study showed that IV fluids given before induction of general anaesthesia blunts the adverse cardiovascular response.Conclusions: We concluded that preload with fluids whether colloids or crystalloids are beneficial to counter the detrimental effects of propofol and fentanyl for induction of general anaesthesia. The preload fluids stabilise the patient haemodynamically. When compared the two, colloids were better to blunt the cardiovascular changes.

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Does Systematic Preliminar Colour Doppler Study Reduce Kidney Biopsy Complication Incidence?

International Journal of Nephrology ◽

10.4061/2011/419093 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5

Author(s):

Antonio Granata ◽

Fulvio Floccari ◽

Angelo Ferrantelli ◽

Ugo Rotolo ◽

Luca Di Lullo ◽

...

Keyword(s):

Kidney Biopsy ◽

Colour Doppler ◽

Doppler Examination ◽

Doppler Study ◽

Group A ◽

Clinically Significant ◽

Perinephric Hematoma ◽

Group B ◽

Biopsy Complications ◽

Optimal Site

While ultrasonography is widely performed prior to biopsy, colour Doppler examination is often used only to discover post-biopsy complications. Aim of this paper was to evaluate the usefulness of colour Doppler examination in planning the optimal site of puncture for renal biopsy. Present analysis includes 561 consecutive percutaneous renal biopsies performed from the same operator. Until August 2000 332 biopsies were performed after a preliminary ultrasonography (Group A). From September 2000, 229 patients underwent even a preliminary colour Doppler study (Group B). Postbioptic bleeding were categorized as minor (gross hematuria or subcapsular perinephric hematoma < 4 cmq of greater diameter) or major (hematoma >4 cmq of greater diameter; requiring blood transfusion or invasive procedures; leading to acute renal failure, urine tract obstruction, septicaemia, or death). Major complications were seen in 2.1% in Group A while in Group B only one case was reported (0.43%). Minor clinically significant complications occur in 7.8% in Group A and in 3.4% of cases of Group B. Colour Doppler reduced drastically the incidence of complications observed before the introduction of routine colour Doppler examination prior to biopsy. In our opinion, these data support the use of preliminary colour Doppler study when a biopsy is planned.

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Incidence of post-operative cardiac complications in cardiac patients undergoing urological procedures

International Journal of Advances in Scientific Research ◽

10.7439/ijasr.v1i2.1810 ◽

2015 ◽

Vol 1 (2) ◽

pp. 80

Author(s):

Mastan Saheb Shaik ◽

Venkata Rama Rao M ◽

Sailaja K

Keyword(s):

General Anaesthesia ◽

Regional Anaesthesia ◽

Cardiac Complications ◽

Anesthetic Techniques ◽

Ecg Changes ◽

Arterial Blood ◽

Group A ◽

Urological Procedures ◽

The Mean ◽

Group B

Context: There are limited studies indicating the incideance of post operative morbidity and mortality in high risk patients. Urological procedures constitute a major portion of geriatric surgeries where a cardiac obligation is almost inevitable and selected for this study purpose.Aims: To compare the incidence of post operative cardiovascular complications during regional and general anesthetic techniques in patients with known cardiac risk undergoing urological surgeriesSettings and Design: Prospective randomized double blind study.Methods and Material: 40 patients aged above 50 years posted for elective urological surgeries were enrolled in the study after obtaining approval from hospital ethics committee and written informed consent from the patients. Patients were divided into two groups A& B. Group A (n=20) received general and group B (n=20) received regional anaesthesia (spinal/ Epidural). All the patients received standard premedication and their basal vitals( BP, HR, ECG pattern) were recorded. The same parameters were monitored in the post operative period at regular intervals.Statistical analysis used: Student T test is used to test the significance of stastical difference in the variables between the two groups.Results: The mean heart rate and the mean arterial blood pressure were increased (P<0.01) in the general anaesthesia group. Group A showed 10% incidence of ECG changes and group B showed 35% incidence of ECG changes. But the changes in the hemodynamics were not significant.Conclusions: There is no difference between regional anaesthesia and general anaesthesia regarding the post operative outcome after urological procedures with respective hemodynamic changes.

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Penile nerve block at the base of penis in combination with intravenous ketamin plus midazolam versus general anaesthesia(GA) in children undergoing circumcision for post operative pain management in the Eastern Nepal

Journal of Chitwan Medical College ◽

10.3126/jcmc.v4i1.10846 ◽

2014 ◽

Vol 4 (1) ◽

pp. 33-36

Author(s):

NR Sharma ◽

P Timalsena ◽

U Rai

Keyword(s):

Pain Management ◽

General Anaesthesia ◽

Nerve Block ◽

Randomized Study ◽

Pain Scale ◽

Single Shot ◽

Post Operative Pain ◽

Analgesia Requirement ◽

Group A ◽

Group B

Adequate post operative analgesia in children provides satisfactory psychological objective of this study was to compare the post operative analgesia requirement and child satisfaction between two groups, general anaesthesia(GA) alone and GA in combination with penile nerve block. This prospective randomized study was conducted in 50 children aged 6 to 14 years, who underwent circumcision. The boys were randomly allocated into two groups. Group A (n = 25) received GA with Single shot ketamin 2mg/kg IV plus midazolam 0.1 mg/kg and dorsal penile nerve block at the base of penis prior to circumcision with and Group B (n = 25) received GA with ketamine 2mg/kg IV plus midazolam 0.1 mg/kg plus halothane by laryngeal mask. Severity of pain was assessed quantitatively by children’s hospital eastern Ontario pain scale (CHEOPS). The pain intensity was assessed at one hour A1 in group A and B1 for group B and at two hour A2 for group A and B2 for group B during postoperatively period for two hours. Statistical analysis was done by SPSS method. The post operative analgesia was satisfactory with CHEOPS score 6 or <6 in group A 1. In group A 2 twenty two out of twenty five cases had CHEOPS score <6.Where as in group B1 and B2 it was > 6 .Which was statistically 100% significant. In conclusion, combined penile nerve block in combination with intravenous ketamine plus midazolam is the satisfactory method of Post operative pain management in children undergoing circumcision. DOI: http://dx.doi.org/10.3126/jcmc.v4i1.10846 Journal of Chitwan Medical College 2014; 4(1): 33-36

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Effect of selective beta-blockade with bisoprolol in the treatment of recent-onset atrial fibrillation

Folia Medica ◽

10.2478/v10153-011-0085-7 ◽

2012 ◽

Vol 54 (2) ◽

pp. 27-31 ◽

Cited By ~ 2

Author(s):

Maria N. Negreva ◽

Atanas P. Penev

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Combined Therapy ◽

Beta Blockade ◽

Recent Onset ◽

Number Of Patients ◽

Group A ◽

Clinically Significant ◽

Group B ◽

Onset Atrial Fibrillation

ABSTRACT The incidence of atrial fibrillation has been rapidly increasing in recent years. The increased tonus of the sympathetic nervous system is related to the development of atrial fibrillation. OBJECTIVE: To study the effect of bisoprolol, a highly selective beta-blocker, on patients with recent-onset atrial fibrillation (< 48 hours) for regularization of the rhythm using propafenone. PATIENTS AND METHODS: The study includes 164 patients (81 women, 83 men, age 59.09 ± 10.81) with successfully restored sinus rhythm in recent-onset atrial fibrillation. The patients received either propafenone (group A, n = 82) or a combination of propafenone and bisoprolol (group B, n = 82). The studied patients were randomly allocated to the groups. Propafenone was administered intravenously as a 2 mg/kg bolus followed by infusion of 0.0078 mg/kg/min for 120 min and orally in dosage of 300 mg three times every 8 hours if arrhythmia persisted. Bisoprolol was administered in a single dose at the very beginning of propafenone treatment and only in patients from group B at a dose of 5 or 10 mg. Regularization of the rhythm was assessed at the 3rd, 6th, 12th and 24th hour. RESULTS: In the initial stages of regularization the combined therapy restored the sinus rhythm in a greater number of patients in comparison with the monotherapy (at the 6th hour 67.07% in group B versus 48.78% in group A, P < 0.05; at the 12th hour it was 87.80% versus 75.60%, respectively, P < 0.05). CONCLUSION: Early regularization of rhythm in patients with recent-onset atrial fibrillation reduces the likelihood of recurrent episodes of arrhythmia. This makes the application of selective beta-blockade clinically significant.

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Effect of Germanium-Embedded Knee Sleeve on Osteoarthritis of the Knee

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119879124 ◽

2019 ◽

Vol 7 (10) ◽

pp. 232596711987912 ◽

Cited By ~ 1

Author(s):

Katherine Marino ◽

Rachel Lee ◽

Paul Lee

Keyword(s):

United Kingdom ◽

Los Angeles ◽

Skin Irritation ◽

Oxford Knee Score ◽

Osteoarthritis Of The Knee ◽

Knee Oa ◽

The United Kingdom ◽

Group A ◽

Clinically Significant ◽

Group B

Background: Knee osteoarthritis (OA) affects an estimated 1 in 5 individuals older than 45 years of age in the United Kingdom. Previous studies have suggested that germanium-infused garments may provide improved clinical outcomes in OA. Germanium-embedded (GE) knee sleeves embrace this fabric technology. Purpose: To assess the outcomes of GE knee sleeves for patients with knee OA. Study Design: Cohort study; Level of evidence, 2. Methods: This study was undertaken at a hospital in the United Kingdom. Patients who had radiographic features of OA, experienced knee pain for at least 6 months, and opted for nonsurgical intervention were included. Patients were recruited over 3 months. The University of California, Los Angeles activity score, Lysholm score, visual analog scale (VAS) score, and Oxford Knee Score (OKS) were collected at monthly intervals for 6 months. Patients were followed to determine their compliance with wearing the knee sleeves at all times, as advised, and whether any adverse effects had occurred. Results: A total of 50 participants were recruited for the study; 4 participants were excluded due to pain and were converted to surgical management. Therefore, 46 patients were analyzed and placed into 2 groups according to severity of OA, as classified by the Kellgren-Lawrence system: group A had grade 1 or 2 OA, and group B had grade 3 or 4 OA. There were 25 patients in group A and 21 in group B. Improvements were seen in OKS, VAS, and Lysholm scores in both groups. Clinically significant improvements were seen in group A only for OKS (mean increase, 14), VAS (mean decrease, 4.1), and Lysholm (mean increase, 17.2) scores. These results were also statistically significant (OKS, P = 5.8 × 10-7; VAS, P = 7.7 × 10-12; Lysholm, P = 4.2 × 10-11). The data from this study demonstrated that GE knee sleeves gave better outcomes for patients with grades 1 and 2 OA compared with patients with more advanced disease, which is consistent with previous studies. A total of 3 patients reported skin irritation, which resolved with simple skin ointment application. No patients reported infection, deep vein thrombosis, or circulation problems. Conclusion: GE knee sleeves could play an important role in optimizing nonsurgical management of patients with knee OA, especially patients with grades 1 and 2 OA, as demonstrated by the clinically significant improvements.

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A Retrospective Audit of Clinically Significant Maternal Bacteraemia in a Specialist Maternity Hospital from 2001 to 2014

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2015/518562 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 12

Author(s):

Richard John Drew ◽

Zara Fonseca-Kelly ◽

Maeve Eogan

Keyword(s):

Blood Culture ◽

Positive Blood Culture ◽

Maternal Blood ◽

Maternity Hospital ◽

E Coli ◽

Live Births ◽

Retrospective Audit ◽

Group A ◽

Clinically Significant ◽

Group B

Maternal sepsis is a significant problem in obstetrics, with almost one in four maternal deaths related to severe sepsis. We carried out a retrospective review of clinically significant bacteraemia in obstetric patients attending Rotunda Hospital over 14 years. From 2001 to 2014, there were 252 clinically significant positive blood culture episodes in obstetric patients. There were 112,361 live births >500 g during the study period giving an overall rate of 2.24 clinically significant positive maternal blood culture episodes per 1000 live births >500 g. The median rate over the 14 years was 2.12 episodes per 1000 live births >500 g, with an interquartile range of 1.74–2.43 per 1000 live births >500 g. There was no discernable increasing or decreasing trend over the 14 years.E. coliwas the most commonly isolated organism (n= 92/252, 37%), followed by group BStreptococcus(n= 64/252, 25%),Staphylococcus aureus(n= 28/252, 11%), and anaerobes (n= 11/252, 4%). These top four organisms represented three-quarters of all positive blood culture episodes (n= 195/252, 77.3%). Of note, there were only five cases of listeriosis, representing a rate of 4.4 cases per 100,000 live births >500 g. The rate of invasive group A streptococcal infection was also very low at 5.3 cases per 100,000 live births >500 g.

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The Combination of General Anaesthesia and Epidural Block. I. The Effects of Sequence of Induction on Haemodynamic Variables and Blood Gas Measurements in Healthy Patients

Survey of Anesthesiology ◽

10.1097/00132586-198010000-00052 ◽

1980 ◽

Vol 24 (5) ◽

pp. 322

Author(s):

&NA;

Keyword(s):

General Anaesthesia ◽

Epidural Block ◽

Blood Gas ◽

Gas Measurements

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A comparative trial between the therapeutic efficacy of topical 2% sertaconazole cream and 1% terbinafine cream in the treatment of tinea cruris/tinea corporis

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20170082 ◽

2017 ◽

Vol 3 (1) ◽

pp. 59

Author(s):

Sumyuktha J. ◽

Murali Narasimhan ◽

Parveen Basher Ahamed

Keyword(s):

Comparative Trial ◽

Treated Group ◽

Tinea Corporis ◽

Fungal Culture ◽

Tinea Cruris ◽

Complete Cure ◽

Group A ◽

Clinically Significant ◽

Group B ◽

Cure Rates

Background: Skin infections caused by dermatophyte fungi account for 6% of dermatology consultations at our hospital and 3 to 4% worldwide. A variety of antifungal agents are available for topical use. Terbinafine 1% cream is considered the first line topical medication in the treatment of dermatophytosis. Sertaconazole 2% cream is a relatively new drug having antifungal as well as antiflammatory property. In this prospective study we sought to compare the safety and efficacy of topical 2% Sertaconazole and 1% Terbinafine creams in the treatment of localized tinea cruris and/or tinea corporis.Methods: In this study, 80 patients were randomized into two groups of 40 each. Group A received 2% Sertaconazole cream while group B received Terbinafine 1% cream topical application twice daily for 4 weeks. Patients were followed up at the end of 2nd and 4th weeks for clinical, mycological (KOH mount and fungal culture) and complete cure (both clinical and mycological).Results: The mean age of the patients studied was 27.97 years. Complete cure was achieved in 59.5% and 80% in group A and 71.4% and 90.9% in group B at the end of 2nd and 4th weeks respectively. Significant P values were observed if the results were compared within the group, between baseline and 2 weeks, baseline and 4th week and also 2nd and 4th week. Clinically significant side effects were not observed in both the groups. Conclusions: Although higher cure rates were observed in the Terbinafine treated group, the results were not statistically significant. It can be concluded from our study that Sertaconazole 2% cream is similar in efficacy to Terbinafine 1% cream in the treatment of localized tinea cruris and corporis.

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