Opioid-free anesthesia for patients with joint hypermobility syndrome undergoing craneo-cervical fixation: a case-series study focused on anti-hyperalgesic approach

Abstract Background Patients with Ehlers-Danlos Syndrome/Hypermobility Type (EDS-HT/JHS) and Craneo-Cervical Instability frequently suffer from severe widespread pain which is difficult to control. Chronic neuroinflammation, opioid-induced hyperalgesia, and central sensitization may explain this painful condition. The aim of this study was to determine if opioid-free anesthesia plus the postoperative administration of lidocaine, ketamine and dexmedetomidine can reduce postoperative pain and the need of methadone rescues in comparison with opioid-based management in these patients undergoing Craneo-Cervical Fixation (CCF). The secondary aim was to assess the needs of opioids at hospital-discharge, incidence of gastrointestinal complications and the requirement of anxiolytic. Methods A retrospective, consecutive case series study was designed. 42 patients with EDS-HT/JHS undergoing CCF were enrolled in two groups: an OFA-plus Group that received opioid-free anesthesia with propofol, lidocaine, ketamine and dexmedetomidine, and OP Group, opioid-based anesthesia-analgesia. The main variables: Preoperative Visual Analogue Score (VAS), postoperative VAS on the 1st, 2nd, 4th and 6th days, sufentanil or morphine requirements, need for methadone rescue, and VAS at hospital-discharge. Data was presented by mean ± SD, percentage, median or interquartile range. Chi-squared or Fisher’s test. 95% C.I and P values < 0.05. Results Nineteen patients in OFA-plus, and 23 patients in OP group. VAS was lower in OFA-plus on the postoperative days evaluated (p < 0.001).VAS at hospital-discharge was lower in OFA-plus: 4.96 (4.54–5.37) vs. OP 6.39 (6.07–6.71) (p < 0.001). Methadone requirement was lower in the OFA-plus (p < 0.001). 78% of patients in OFA-plus didn’t need methadone rescue. 95% in OP group needed methadone rescues at high doses(> 15 mg/day). No differences regarding equivalent doses of sufentanil or morphine consumption on the 2nd, 4th, and 6th postoperative days were found. OFA-plus decreased ileus, nausea and vomiting (p < 0.001). 60.9% in OFA-plus group decreased opioid requirements at hospital-discharge compared with preoperative values. A 77% reduction of anxiolytics requirements was shown. Conclusion OFA-plus management for patients undergoing CCF with EDS-HT/JHS shows significant reduction in postoperative pain and at hospital-discharge compared with opioid-based anesthesia. OFA-plus management decreases the total doses of methadone rescues, reduces anxiolytic requirements and gastrointestinal side-effects, except for constipation. OFA-plus management is a feasible option to improve postoperative pain control, reducing the opioids’ use and their postoperative side-effects in patients undergoing CCF with EDS-HT/JHS.

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Opioid-free Anesthesia for Patients With Joint Hypermobility Syndrome Undergoing Craneo-cervical Fixation: a Case-series Study Focused on Anti-hyperalgesic Approach

10.21203/rs.3.rs-93957/v1 ◽

2020 ◽

Author(s):

Carlos R Ramirez-Paesano ◽

Albert Juanola Galcerán ◽

Claudia Rodiera Clarens ◽

Vicenç Gilete García ◽

Bartolomé Oliver Abadal ◽

...

Keyword(s):

Side Effects ◽

Postoperative Pain ◽

Hospital Discharge ◽

Case Series ◽

Joint Hypermobility Syndrome ◽

Ehlers Danlos Syndrome ◽

Discharge Data ◽

Gastrointestinal Complications ◽

Case Series Study ◽

Series Study

Abstract Background. Patients with Ehlers-Danlos Syndrome/Hypermobility Type (EDS-HT/JHS) and Craneo-Cervical Instability frequently suffer from severe widespread pain which is difficult to control. Chronic neuroinflammation, opioid-induced hyperalgesia, and central sensitization may explain this painful condition.The aim of this study was to determine if opioid-free anesthesia plus the postoperative administration of lidocaine, ketamine and dexmedetomidine can reduce postoperative pain and the need of methadone rescues in comparison with opioid-based management in these patients undergoing Craneo-Cervical Fixation(CCF). The secondary aim was to assess the needs of opioids at hospital-discharge, incidence of gastrointestinal complications and the requirement of anxiolytic.Methods. A retrospective, consecutive case series study was designed. 42 patients with EDS-HT/JHS undergoing CCF were enrolled in two groups: an OFA-plus Group that received opioid-free anesthesia with propofol, lidocaine, ketamine and dexmedetomidine, and OP Group, opioid-based anesthesia-analgesia. The main variables: Preoperative Visual Analogue Score (VAS), postoperative VAS on the 1st, 2nd, 4th and 6th days, sufentanil or morphine requirements, need for methadone rescue, and VAS at hospital-discharge. Data was presented by mean ± SD, percentage, median or interquartile range. Chi-squared or Fisher’s test. 95% C.I and P values <0.05 . Results. Nineteen patients in OFA-plus, and 23 patients in OP group. VAS was lower in OFA-plus on the postoperative days evaluated (p<0.001).VAS at hospital-discharge was lower in OFA-plus: 4.96 (4.54-5.37) vs. OP 6.39 (6.07-6.71) (p<0.001). Methadone requirement was lower in the OFA-plus (p<0.001). 78% of patients in OFA-plus didn’t need methadone rescue. 95% in OP group needed methadone rescues at high doses(>15mg/day). No differences regarding equivalent doses of sufentanil or morphine consumption on the 2nd, 4th, and 6th postoperative days were found. OFA-plus decreased ileus, nausea and vomiting (p<0.001). 60.9% in OFA-plus group decreased opioid requirements at hospital-discharge compared with preoperative values. A 77% reduction of anxiolytics requirements was shown. Conclusion: OFA-plus management for patients undergoing CCF with EDS-HT/JHS shows significant reduction in postoperative pain and at hospital-discharge compared with opioid-based anesthesia. OFA-plus management decreases the total doses of methadone rescues, reduces anxiolytic requirements and gastrointestinal side-effects, except for constipation. OFA-plus management is a feasible option to improve postoperative pain control, reducing the opioids’ use and their postoperative side-effects in patients undergoing CCF with EDS-HT/JHS.

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P611 “An old and inexpensive drug to minimize the side effects of a new and expensive one”: Colchicine for the skin lesions induced by the tumor necrosis factor-alpha inhibitors, a case-series study

Journal of Crohn s and Colitis ◽

10.1016/s1873-9946(13)60632-7 ◽

2013 ◽

Vol 7 ◽

pp. S256 ◽

Cited By ~ 1

Author(s):

J.M. Mella ◽

R. Gonzalez ◽

B. Vizcaino ◽

G. Casas ◽

M. Larralde ◽

...

Keyword(s):

Side Effects ◽

Tumor Necrosis Factor ◽

Tumor Necrosis ◽

Case Series ◽

Skin Lesions ◽

Necrosis Factor Alpha ◽

Case Series Study ◽

Factor Alpha ◽

Series Study ◽

Necrosis Factor

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Use of remdesivir in the treatment of coronavirus disease 2019 (COVID-19) infection among Sudanese patients: a case series

F1000Research ◽

10.12688/f1000research.51375.1 ◽

2021 ◽

Vol 10 ◽

pp. 512

Author(s):

Maysoun Yousif ◽

Ghada Abd El-Raheem ◽

Doaa Mohamed

Keyword(s):

Side Effects ◽

Liver Enzymes ◽

Case Series ◽

Supportive Therapy ◽

First Case ◽

Case Series Study ◽

New Treatment ◽

Series Study

Introduction: The coronavirus disease 2019 (COVID-19) pandemic is affecting populations worldwide. Remdesivir is an anti-retroviral agent, with a broad spectrum of usage. Remdesivir usage against COVID-19 had been studied both in vitro and in vivo but is still considered a new treatment for COVID-19 and is not available in all countries. The aim of our study was to report several cases of the use of remdesivir in Sudanese patients and report the adverse events related to the course of treatment. Methods: A case series study was conducted in Imperial Hospital, Khartoum, Sudan reporting two cases who received remdesivir for treating COVID-19 besides other treatments such as steroids and supportive therapy in December 2020. Cases were males aged over 65 years. Cases presentation: Both patients were severe cases of COVID-19 admitted to the intensive care unit (ICU), who received remdesivir for treating COVID-19 infection. Several side effects were reported: the first case had increased liver enzymes and then unexpectedly died from severe resistant hypotension; and hypoalbuminemia was noticed in the second case. Conclusions: Remdesivir use among patients in Sudan must be studied extensively in order to determine the unexpected fatal event and assess the association of this event to remdesivir use, as well as to report the frequency of the side effects.

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Psychiatric Predisposition to Autonomic and Abnormal Perception Side-Effects of Ziconotide: A Case Series Study

Neuromodulation Technology at the Neural Interface ◽

10.1111/j.1525-1403.2011.00334.x ◽

2011 ◽

Vol 14 (3) ◽

pp. 219-224 ◽

Cited By ~ 5

Author(s):

Paolo Poli ◽

Antonella Ciaramella

Keyword(s):

Side Effects ◽

Case Series ◽

Case Series Study ◽

Series Study

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Systemic Minoxidil Accidental Exposure in a Paediatric Population: A Case Series Study of Cutaneous and Systemic Side Effects

Journal of Clinical Medicine ◽

10.3390/jcm10184257 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4257

Author(s):

Manuel Sánchez-Díaz ◽

David López-Delgado ◽

Trinidad Montero-Vílchez ◽

Luis Salvador-Rodríguez ◽

Alejandro Molina-Leyva ◽

...

Keyword(s):

Side Effects ◽

Treatment Time ◽

Case Series ◽

Paediatric Population ◽

High Dose ◽

Retrospective Case ◽

Case Series Study ◽

High Doses ◽

Initial Zone ◽

Series Study

Oral minoxidil is an approved treatment for high blood pressure which is also used as an off-label drug for alopecia. Knowledge about the effects of systemic minoxidil in the paediatric population is limited. A retrospective case series study of paediatric patients with history of systemic minoxidil intake due to contaminated sets of omeprazole was performed to describe side effects of high dose oral minoxidil intake in children. Twenty patients aged between 2 months and 13 years joined the study. They had received high doses of oral minoxidil (mean dose 0.90 mg/kg/day) during a mean time of 38.3 days. Hypertrichosis appeared in 65%, with a mean latency time of 24.31 days. Treatment time was associated with the appearance of hypertrichosis (p < 0.05). Most common initial zone of hypertrichosis was the face. Systemic effects developed in 15%, with no cases of severe disorders. The present study shows a novel insight into the side effects of high doses of oral minoxidil in children.

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Use of Remdesivir in The Treatment of COVID-19 Infection Among Sudanese Patients - Case Series

10.21203/rs.3.rs-153556/v1 ◽

2021 ◽

Author(s):

Maysoun Ahmed Awad Yousif ◽

Ghada Omer Hamad Abd El-Raheem ◽

Doaa Salih Ibrahim Mohamed

Keyword(s):

Side Effects ◽

Liver Enzymes ◽

Case Series ◽

The Other ◽

Elevated Liver Enzymes ◽

Case Series Study ◽

Profound Hypotension ◽

Series Study

Abstract Introduction: COVID-19 infection is a viral pandemic started in 2019, all societies have the susceptibility of getting infected. Remdesivir is an anti-retroviral agent, with a broad spectrum of activity. Remdesivir activity against COVID-19 had been studied in both in vitro and in vivo, but still considered new for COVID-19 treatment and not available in all countries. The aim of our study was to report the use of remdesivir among Sudanese population and report the adverse events related to the course of treatment. Methods: case series study was conducted in Imperial Hospital reporting the three cases who received Remdesivir for treating COVID-19 infection.Cases presentation: Three cases had received remdesivir for treating COVID-19 infection, side effects reported were elevated liver enzymes, profound hypotension and hypoalbuminemia. Discussion: All three patients were severe cases of COVID-19 admitted to the ICU. Unexpectedly, severe resistant hypotension was the cause of death in 2 cases who received remdesivir. Increased liver enzymes was noticed in one case. In the other hand, hypoalbuminemia was noticed in one case as well.

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Management and outcomes of caesarean scar pregnancy in medina maternity and children hospital

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212679 ◽

2021 ◽

Vol 10 (7) ◽

pp. 2848

Author(s):

Bahaa Eldin Salama ◽

Mohammed Mufti ◽

Rehab Alruwathi ◽

Tarig Yassin ◽

Roqayah Tuker ◽

...

Keyword(s):

Case Series ◽

Median Number ◽

Discharge Data ◽

Beta Human Chorionic Gonadotropin ◽

Case Series Study ◽

The Mean ◽

Magnetic Resonance Imaging Mri ◽

Β Hcg ◽

Operative Notes ◽

Series Study

Undergoing previous cesarean section (CS) can have the possibility for implantation of embryonic sac of any later gestation throughout its scar evolving what was known as a scar pregnancy (SP). The aim of this study to describe the diagnosis, treatment and outcomes of caesarean SP in Medina maternity and children hospital. This a case series study encompassed all patient diagnosed and managed as cesarean SP in Medina maternity and children hospital, Medina (MMCH), Saudi Arabia in the period from January 2020 to January 2021. Demographics, clinical and discharge data were attained from the previous hospital electronic records, nursing notes, anesthesia sheets, operative notes, discharge papers, and outpatient clinic documents. A total of 11 women detected by ultrasound (US) and magnetic resonance imaging (MRI) as SP. The mean age of women was 36±3.8 years. The median number of repeated CS was 2 while the mean gestational age was 50.6±7.8 days. The interval from diagnosis to management ranged from 2 to 9 days with a median of 4 days, and the interval between start treatment and negative Beta human chorionic gonadotropin β-hCG ranged from 21 to 135 days with a median of 62 days. The mean interval from last CS until this pregnancy is 39.7±19.2 months. Systemic methotrexate (MTX) given in a single dose for two patients while nine patients received multiple doses. Local MTX given for six cases. Bleeding as a complication occurred with two out of the eleven patients. MTX was actual treatment for SP, but bigger multicenter randomized-controlled trials involving more cases are essential to validate our conclusions.

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