scholarly journals PROLONGED SYSTEMIC SPINAL ANESTHESIA IN ORTHOPEDICS AND TRAUMATOLOGY (clinical study)

2021 ◽  
pp. 56-62
Author(s):  
O. M. Strogush
Keyword(s):  
Knee Joint ◽  
Spinal Anesthesia ◽  
Proximal Tibia ◽  
Total Duration ◽  
Hemodynamic Changes ◽  
Oral Clonidine ◽  
Knee Joint Surgery ◽  
The Mean ◽  
Prolonged Surgery

Introduction. The task of providing anesthesia for long-term operations on the lower extremities in the traumatology and orthopedics is resolved by different ways. Prolonged systemic spinal anesthesia (SA) using oral clonidine (clophelin) deserves a special attention. Aim is to study the duration of SA using oral clonidine (clophelin) in orthopedic and traumatic patients who were undergoing prolonged surgery on the knee joint and the proximal tibia epi-metaphysis. Materials and Methods: The study involved 43 patients who were divided into two groups - group without clophelin (22 patients) and group with clophelin (21 patients) use. Operations in both groups were performed under conditions of SA (0.5% solution of isobaric bupivacaine at a dose of 13 mg in combination with 40 mg of 2% solution of lidocaine). In group with clophelin the premedication included the addition appointment of oral clophelin at a dose of 4 μg / kg (approximately 300 μg) 60 minutes before surgery. There were determined the SA duration, the total duration of intraoperative anesthesia, the total duration of the pneumatic harness action, a state of hemodynamics during the operation and postoperative period. Results and Discussions. There were no statistically significant differences in duration of operations in the group without clophelin and in group with clophelin that amounted to 228.63 ± 51.59 minutes and 241.04 ± 48.46 minutes, respectively (p = 0.24). SA duration in the group with clophelin statistically significantly exceeded the duration in group without clophelin and consisted of 236.38 ± 39.76 minutes and 204.77 ± 38.92 minutes, respectively (p = 0.011). The pulse rate in the clophelin group, comparing to the group without clophelin was significantly lower during the operation, in 6 hours after surgery and did not reach the level of critical bradycardia. The mean arterial pressure in the group with clophelin, comparing with group without clophelin was significantly lower during the operation, in 24 hours after surgery and did not reach the level of critical hypotension.Conclusions. The duration of SA by bupivacaine in combination with lidocaine using oral clonidine (clophelin) before surgery at a dose of 4 μg / kg (about 300 μg) in orthopedic and traumatic patients undergoing the knee joint surgery was increased by an average of 32 minutes. Against the background of prolonged systemic SA with the use of oral clonidine (clophelin), these operations can be performed for up to 4 hours. The detected hemodynamic changes against the background of clonidine use were not critical and are not considered as complications.

17-Year Results following Transepiphyseal Anterior Cruciate Ligament Reconstruction in Children and Adolescents

2021 ◽  
Author(s):  
Alexander Zimmerer ◽  
Marco M. Schneider ◽  
Carina Semann ◽  
Wolfgang Schopf ◽  
Christian Sobau ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Lysholm Score ◽  
Long Term Results ◽  
Childhood And Adolescence ◽  
The Mean ◽  
Anterior Cruciate

Abstract Objective Rupture of the anterior cruciate ligament (ACL) in childhood and adolescence is a serious injury. It is now known that conservative therapy of an unstable knee joint in childhood or adolescence under can lead to poor subjective and objective results. The aim of this study is to record long-term results after transepiphyseal ACL reconstruction using autologous hamstring tendons and extracortical fixation in childhood and adolescence with open physes – at least 15 years after surgery. Methods Our internal registry was used to identify all patients who received surgical treatment of an acl tear during childhood and adolescence by transepiphyseal acl reconstruction more than 15 years previously. In these patients, the International Knee Documentation Committee for Subjective Knee Form (IKDCsubj.), Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Score (TAS) and Lysholm Score were collected, and clinical and magnetic resonance imaging (MRI) examinations were performed. Results A total of 22 patients were identified, 5 of whom could not be contacted. The mean age at the time of surgery was 13.1 years, and the mean follow-up time was 17.4 years. In 3 patients, a traumatic tear was observed with subsequent reconstruction of the ACL. None of the included patients showed a growth disorder during the course of the study. The IKDCsubj. was 92.4 ± 14.7 (48 – 100), the Lysholm score was 87.9 ± 16.9 (34 – 100), the TAS was 5.7 ± 2.3 (3 – 9) and the pain level based on VAS was 3.5 ± 2.6 (1 – 8) points. The values showed subjective and objective deterioration compared to the 10-year results, with no statistical significance. The following subscores were reported for the KOOS: KOOSpain 90.9 ± 17.6 (28 – 100); KOOSsymptom 82.9 ± 22.6 (11 – 100); KOOOSADL 94.3 ± 13.7 (44 – 100); KOOSSport 80.3 ± 26.4 (15 – 100); KOOSQOL 80.9 ± 25.8 (0 – 100). 13 of the 17 patients could also be clinically and radiologically examined. In 92% of patients, an intact acl reconstruction was found without evidence of cartilage or meniscus damage. The mean lateral difference in the KT-1000 measurement was 1.5 mm. Conclusion ACL reconstruction in childhood and adolescence provides good functionality and stability of the knee joint over the long term. Secondary signs of osteoarthritis can only be detected in isolated cases by MRI. ACL reconstruction using the transepiphyseal technique can be considered the method of choice for open growth plate knee joints.

scholarly journals An evaluation of hyperbaric ropivacaine with magnesium as an adjuvant in lower abdominal surgeries among the north Indian subjects: a double-blind randomized trial

2019 ◽  
Vol 7 (9) ◽  
pp. 3468
Author(s):  
Sulekha Saxena ◽  
Kuljit Kumar ◽  
Rajni Gupta ◽  
Avinash Agrawal
Keyword(s):  
Spinal Anesthesia ◽  
Muscle Relaxation ◽  
Double Blind Study ◽  
Lower Abdomen ◽  
Double Blind ◽  
The North ◽  
Significant Difference ◽  
The Mean ◽  
Basic Characteristics

Background: An evaluation of intrathecal hyperbaric ropivacaine without adjuvant and with adjuvant magnesium for lower abdominal surgeries.Methods: This was a prospective, randomized, double-blind study conducted among the patients aged 18 to 60 years planned for lower abdomen surgeries under spinal anaesthesia and ASA grade I or II. Patients were randomly allocated to two groups (30 in each): ropivacaine Group (R group): spinal anesthesia with 3ml of 0.6% hyperbaric ropivacaine (18mg )+ 0.5ml NS. hyperbaric ropivacaine + Magnesium Group (R+M group ):   spinal anesthesia with 3ml of 0.6% hyperbaric ropivacaine (18mg) + 0.5ml magnesium sulphate (50 mg).  All the patients scheduled for operation were given oral tablets ranitidine 150 mg and Alprazolam 0.25mg in the night before surgery.Results: There was no significant difference in the basic characteristics between the groups. The mean HR, MAP and SpO2 in both the groups decreased over the periods as compared to baseline. However, the trend of HR over the periods remains similar in both R and R+M groups. The bromage levels were significantly (p=0.0001) higher among the patients of Group R compared with R+M.  The 2 segment sensory regression (min), Sensory regression S2 (hr), motor recovery (hrs) and long term mobilization after spinal anesthesia were significantly (p=0.0001) lower among the patients of Group R compared with R+M. The complications were lower in Group R+M than R.Conclusions: Magnesium may be more suitable drug in surgeries in which muscle relaxation has greater value in lower abdominal surgeries.

Hemodynamic changes after spinal anesthesia in children below the age of four years

2021 ◽  
Vol 8 (2) ◽  
pp. 91-97
Author(s):  
Rikal Man Shrestha ◽  
Sunita Gurung ◽  
Sujan Surya Prajapati ◽  
Biplav Pokharel ◽  
Indra Kumar Shrestha ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Spinal Anesthesia ◽  
Cross Sectional Study ◽  
Sensory Level ◽  
Hemodynamic Changes ◽  
Cross Sectional ◽  
Small Children ◽  
Post Surgery ◽  
Balanced Anesthesia ◽  
The Mean

Introduction: Introduction: Spinal anesthesia has become the anesthesia of choice for most of the surgeries of the abdominal-pelvic region.  Cited with benefits such as lesser risks of apnea, minimal cardiopulmonary alteration, and abnormalities associated with neurocognitive development, it incorporates all components of balanced anesthesia, especially in pediatric surgeries. Encouraging results on the safety, efficacy, and feasibility of spinal anesthesia has increased its utility. The objective of our study was to assess the hemodynamic change occurring in children below four years undergoing lower abdominal and pelvic surgeries following spinal anesthesia. Method: This is a cross-sectional study conducted over 2 years and includes children undergoing surgery of the lower abdomen in Kathmandu Model Hospital. The information was data regarding patients' demography, hemodynamic status prior, during, and after the procedure of spinal anesthesia, measuring systolic blood pressure (SBP), diastolic blood pressure (SBP), mean arterial pressure (MAP), heart rate (HR), sensory and motor block characteristics (modified Bromage scale) and complications. Result: The intraoperative and postoperative hemodynamics did not show major differences. The mean peak sensory level was T4 (C7-T10) during the block. Recovery of sensory and motor blocks was complete in all patients. Modified Bromage scale was 1 in 57(98.27%), 2 h post-surgery.  The average duration of the block was 75 min (30-180). 1(1.72%) patient developed apnea during the surgery. Conclusion: Spinal anesthesia in small children showed minimal variation in intraoperative and postoperative hemodynamics and is a safer mode of anesthesia with sparing of respiratory alterations seen with general anesthesia.

Acute and Chronic Changes in Platelet Volume and Count After Cardiopulmonary Bypass Induced Thrombocytopenia in Man

1987 ◽  
Vol 57 (01) ◽  
pp. 55-58 ◽  
Author(s):  
J F Martin ◽  
T D Daniel ◽  
E A Trowbridge
Keyword(s):  
Platelet Count ◽  
Mean Platelet Volume ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Control Group ◽  
Artery Bypass Graft ◽  
Platelet Volume ◽  
Young Males ◽  
The Mean

SummaryPatients undergoing surgery for coronary artery bypass graft or heart valve replacement had their platelet count and mean volume measured pre-operatively, immediately post-operatively and serially for up to 48 days after the surgical procedure. The mean pre-operative platelet count of 1.95 ± 0.11 × 1011/1 (n = 26) fell significantly to 1.35 ± 0.09 × 1011/1 immediately post-operatively (p <0.001) (n = 22), without a significant alteration in the mean platelet volume. The average platelet count rose to a maximum of 5.07 ± 0.66 × 1011/1 between days 14 and 17 after surgery while the average mean platelet volume fell from preparative and post-operative values of 7.25 ± 0.14 and 7.20 ± 0.14 fl respectively to a minimum of 6.16 ± 0.16 fl by day 20. Seven patients were followed for 32 days or longer after the operation. By this time they had achieved steady state thrombopoiesis and their average platelet count was 2.44 ± 0.33 × 1011/1, significantly higher than the pre-operative value (p <0.05), while their average mean platelet volume was 6.63 ± 0.21 fl, significantly lower than before surgery (p <0.001). The pre-operative values for the platelet volume and counts of these patients were significantly different from a control group of 32 young males, while the chronic post-operative values were not. These long term changes in platelet volume and count may reflect changes in the thrombopoietic control system secondary to the corrective surgery.

Multi-Center Calibration of the Second Reference Material for Thromboplastin, Rabbit, Plain, Coded CRM 149R

1991 ◽  
Vol 65 (03) ◽  
pp. 263-267 ◽  
Author(s):  
A M H P van den Besselaar ◽  
R M Bertina
Keyword(s):  
Reference Material ◽  
Standard Error ◽  
Standard Errors ◽  
Sensitivity Index ◽  
Long Term Stability ◽  
Significant Bias ◽  
The Mean ◽  
The Relationship ◽  
International Sensitivity Index

SummaryIn a collaborative trial of eleven laboratories which was performed mainly within the framework of the European Community Bureau of Reference (BCR), a second reference material for thromboplastin, rabbit, plain, was calibrated against its predecessor RBT/79. This second reference material (coded CRM 149R) has a mean International Sensitivity Index (ISI) of 1.343 with a standard error of the mean of 0.035. The standard error of the ISI was determined by combination of the standard errors of the ISI of RBT/79 and the slope of the calibration line in this trial.The BCR reference material for thromboplastin, human, plain (coded BCT/099) was also included in this trial for assessment of the long-term stability of the relationship with RBT/79. The results indicated that this relationship has not changed over a period of 8 years. The interlaboratory variation of the slope of the relationship between CRM 149R and RBT/79 was significantly lower than the variation of the slope of the relationship between BCT/099 and RBT/79. In addition to the manual technique, a semi-automatic coagulometer according to Schnitger & Gross was used to determine prothrombin times with CRM 149R. The mean ISI of CRM 149R was not affected by replacement of the manual technique by this particular coagulometer.Two lyophilized plasmas were included in this trial. The mean slope of relationship between RBT/79 and CRM 149R based on the two lyophilized plasmas was the same as the corresponding slope based on fresh plasmas. Tlowever, the mean slope of relationship between RBT/79 and BCT/099 based on the two lyophilized plasmas was 4.9% higher than the mean slope based on fresh plasmas. Thus, the use of these lyophilized plasmas induced a small but significant bias in the slope of relationship between these thromboplastins of different species.

Comparative Study of effectiveness of mobilization with movement (MWM) and End range mobilization (ERM) techniques in frozen shoulder

2018 ◽  
Vol 4 (4) ◽  
pp. 519-522
Author(s):  
Jeyakumar S ◽  
Jagatheesan Alagesan ◽  
T.S. Muthukumar
Keyword(s):  
Range Of Motion ◽  
Frozen Shoulder ◽  
Type I ◽  
Mean Values ◽  
Functional Activities ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Frozen shoulder is disorder of the connective tissue that limits the normal Range of motion of the shoulder in diabetes, frozen shoulder is thought to be caused by changes to the collagen in the shoulder joint as a result of long term Hypoglycemia. Mobilization is a therapeutic movement of the joint. The goal is to restore normal joint motion and rhythm. The use of mobilization with movement for peripheral joints was developed by mulligan. This technique combines a sustained application of manual technique “gliding” force to the joint with concurrent physiologic motion of joint, either actively or passively. This study aims to find out the effects of mobilization with movement and end range mobilization in frozen shoulder in Type I diabetics. Materials and Methods: 30 subjects both male and female, suffering with shoulder pain and clinically diagnosed with frozen shoulder was recruited for the study and divided into two groups with 15 patients each based on convenient sampling method. Group A patients received mobilization with movement and Group B patients received end range mobilization for three weeks. The outcome measurements were SPADI, Functional hand to back scale, abduction range of motion using goniometer and VAS. Results: The mean values of all parameters showed significant differences in group A as compared to group B in terms of decreased pain, increased abduction range and other outcome measures. Conclusion: Based on the results it has been concluded that treating the type 1 diabetic patient with frozen shoulder, mobilization with movement exercise shows better results than end range mobilization in reducing pain and increase functional activities and mobility in frozen shoulder.

PITUITARY-ADRENAL RECOVERY FOLLOWING LONG-TERM CORTICOSTEROID THERAPY

1966 ◽  
Vol 51 (1) ◽  
pp. 63-70 ◽  
Author(s):  
P. F. Roe ◽  
D. M. Mitchell ◽  
G. W. Pennington
Keyword(s):  
Corticosteroid Therapy ◽  
Adrenocortical Function ◽  
Endocrine Disorders ◽  
Marked Rise ◽  
Underlying Condition ◽  
Normal Limits ◽  
Small Rise ◽  
The Mean ◽  
Corticosteroid Drugs

ABSTRACT Adrenocortical function was assessed in 20 patients receiving long-term corticosteroid drugs for a variety of non-endocrine disorders. In all cases plasma 17-hydroxycorticosteroids (17-OHCS) levels were within or above normal limits 48 hours after abruptly stopping their drugs and a further marked rise occurred in 7 patients given metyrapone for 24 h. Urinary 17-OHCS excretion did not show a parallel rise. Taking the group as a whole, a small rise in the mean output occurred 48 hours after stopping therapy, and a further slightly greater rise followed metyrapone. 3 patients had a relapse of their underlying condition during the test in spite of normal plasma and urinary 17-OHCS levels.

Long-term dynamics and destruction of marsh vegetation in the Kolokolkova Bay of the Barents Sea

2012 ◽  
pp. 66-77 ◽  
Author(s):  
I. A. Lavrinenko ◽  
O. V. Lavrinenko ◽  
D. V. Dobrynin
Keyword(s):  
Species Composition ◽  
Plant Communities ◽  
Barents Sea ◽  
Mean Value ◽  
Marsh Vegetation ◽  
Composition And Structure ◽  
The Mean ◽  
Species Composition And Structure

The satellite images show that the area of marshes in the Kolokolkova bay was notstable during the period from 1973 up to 2011. Until 2010 it varied from 357 to 636 ha. After a severe storm happened on July 24–25, 2010 the total area of marshes was reduced up to 43–50 ha. The mean value of NDVI for studied marshes, reflecting the green biomass, varied from 0.13 to 0.32 before the storm in 2010, after the storm the NDVI decreased to 0.10, in 2011 — 0.03. A comparative analysis of species composition and structure of plant communities described in 2002 and 2011, allowed to evaluate the vegetation changes of marshes of the different topographic levels. They are fol­lowing: a total destruction of plant communities of the ass. Puccinellietum phryganodis and ass. Caricetum subspathaceae on low and middle marches; increasing role of halophytic species in plant communities of the ass. Caricetum glareosae vic. Calamagrostis deschampsioides subass. typicum on middle marches; some changes in species composition and structure of plant communities of the ass. Caricetum glareosae vic. Calamagrostis deschampsioides subass. festucetosum rubrae on high marches and ass. Parnassio palustris–Salicetum reptantis in transition zone between marches and tundra without changes of their syntaxonomy; a death of moss cover in plant communities of the ass. Caricetum mackenziei var. Warnstorfia exannulata on brackish coastal bogs. The possible reasons of dramatic vegetation dynamics are discussed. The dating of the storm makes it possible to observe the directions and rates of the succession of marches vegetation.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

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