scholarly journals ROLE AND PROBLEMATICS OF THE EPIDURAL ANESTHESIA DURING EXTENSIVE LIVER RESECTIONS

2021 ◽  
pp. 76-82
Author(s):  
R. A. Zatsarynnyi ◽  
A. V. Biliaev ◽  
A. P. Mazur ◽  
O. Yu. Khomenko
Keyword(s):  
Pain Management ◽  
Epidural Anesthesia ◽  
Coagulation System ◽  
Extensive Resection ◽  
Vasoactive Substances ◽  
Post Operative Period ◽  
International Normalization Ratio ◽  
Intraoperative Period ◽  
Baseline Values ◽  
Clinically Significant

Abstract. In the following article it was evaluated the coagulopathy and/or hypotension incidence rate in patients with the liver extensive resection, who were treated with the thoracal epidural anesthesia and pain management (TEA). Materials and methods. There were enrolled 55 subjects whom the liver extensive resection with TEA both in the intraoperative, and post-operative period was performed at the following site: National Institute of Surgery and Transplantology of the NAMS of Ukraine named after A.A. Shalimov. Influence on the haemodynamics was evaluated on the basis of the mean blood pressure (MBP) decrease lower than 65 mm Hg and appearance of the necessity of vasoactive substances’ administration. We determined the coagulation system’s alteration on the basis of changes of the indicators related to the prothrombotic time (PTT), prothrombotic index (PTI) and international normalization ratio (INR). Vascular platelet hemostasis was evaluated on the basis of the platelets level dynamics. Result. 80% of the 55 subjects required administration of noradrenaline with the aim of the objective MBP control. Execution of the liver extensive resection was characterized by the verifiable decrease of the platelets in the early post-operative period, but this decrease was not clinically significant. It was observed the verifiable increase of the PTT starting from the intraoperative period at the 16,5% (р=0,0001) in comparison with the baseline values, which correlated with the change of PTI and INR.Execution of the liver extensive resection was characterized by the decrease of the blood coagulation properties in early post-operative period, and which led to the verifiable increase of the prothrombotic time, INR and decrease of PTI. Conclusion. Now therefore, the influence of the TEA on the systemic hemodynamics and coagulation system requires of the alternative safe pain management methods’ search for this subjects’ group.

A systematic review of the evidence supporting post-operative medication use in congenital heart disease

2021 ◽  
pp. 1-27
Author(s):  
Elizabeth J. Thompson ◽  
Henry P. Foote ◽  
Caitlin E. King ◽  
Sabarish Srinivasan ◽  
Elizabeth C. Ciociola ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Adverse Events ◽  
Drug Development ◽  
Drug Disposition ◽  
Controlled Vocabulary ◽  
Coagulation System ◽  
Future Research ◽  
Pulmonary Vasodilators ◽  
Post Operative Period ◽  
Operative Care

Abstract Background: Targeted drug development efforts in patients with CHD are needed to standardise care, improve outcomes, and limit adverse events in the post-operative period. To identify major gaps in knowledge that can be addressed by drug development efforts and provide a rationale for current clinical practice, this review evaluates the evidence behind the most common medication classes used in the post-operative care of children with CHD undergoing cardiac surgery with cardiopulmonary bypass. Methods: We systematically searched PubMed and EMBASE from 2000 to 2019 using a controlled vocabulary and keywords related to diuretics, vasoactives, sedatives, analgesics, pulmonary vasodilators, coagulation system medications, antiarrhythmics, steroids, and other endocrine drugs. We included studies of drugs given post-operatively to children with CHD undergoing repair or palliation with cardiopulmonary bypass. Results: We identified a total of 127 studies with 51,573 total children across medication classes. Most studies were retrospective cohorts at single centres. There is significant age- and disease-related variability in drug disposition, efficacy, and safety. Conclusion: In this study, we discovered major gaps in knowledge for each medication class and identified areas for future research. Advances in data collection through electronic health records, novel trial methods, and collaboration can aid drug development efforts in standardising care, improving outcomes, and limiting adverse events in the post-operative period.

scholarly journals Respiratory complications in the early post-operative period following elective craniotomies

2015 ◽  
Vol 02 (02) ◽  
pp. 114-120
Author(s):  
Sachidanand Bharati ◽  
Mihir Pandia ◽  
Girija Rath ◽  
Parmod Bithal ◽  
Hari Dash
Keyword(s):  
Risk Factors ◽  
Blood Transfusion ◽  
Ventilatory Support ◽  
Categorical Variables ◽  
Respiratory Complications ◽  
Chi Square ◽  
Post Operative Period ◽  
Intraoperative Period ◽  
Independent Risk Factors ◽  
Associated Risk Factors

Abstract Background and Aims: Respiratory complications are of major concern after intracranial procedures. The objective of the study was to assess the incidence of respiratory complications in the initial 72 hours after elective craniotomies and to identify the associated risk factors. Materials and Methods: Patients undergoing elective craniotomies were studied prospectively. Information pertinent to history, physical examinations, investigation reports, perioperative events and outcome at discharge of the patients were recorded. Occurrence of any sign or symptom of respiratory system, need for reintubation/increased ventilatory support within 72 hours of surgery were considered as post-operative respiratory complication. Relationships of numerical variables and categorical variables with post-operative respiratory complications (PRCs) were assessed via T test and Chi-square (or Fisher’s exact). Multivariate analysis using multiple logistic regression was performed for finding independent risk factors for respiratory complications. Results: Out of 961 patients, 137 (14.3%) patients developed PRC within 72 hours of surgery. Ninety-nine (10.3%) patients developed purulent tracheobronchitis. The patients who had PRC had longer hospital stays and poor Glasgow Outcome Scale at hospital discharge. The variables found as independent risk factors were tachycardia, blood transfusion in the intraoperative period and Glasgow Coma Scale (GCS) deterioration, hypokalemia and fever in the post-operative period. Conclusions: Respiratory complications within first 72 hours of elective craniotomies were common and were associated with prolonged hospital stay and poor neurological outcome. The variables which were found as independent risk factors were tachycardia, blood transfusion in the intraoperative period and GCS deterioration, hypokalemia and fever in the post-operative period.

scholarly journals Pharmacologic Therapy in Postpartum Pelvic Pain Management

2019 ◽  
Vol 69 (12) ◽  
pp. 3622-3625
Author(s):  
Alexandra Matei ◽  
Cringu Ionescu ◽  
Mihai Dimitriu ◽  
Corina Ilinca ◽  
Diana Gheorghiu ◽  
...  
Keyword(s):  
Pain Management ◽  
Cesarean Section ◽  
Vaginal Delivery ◽  
Pelvic Pain ◽  
Epidural Anesthesia ◽  
Confidence Level ◽  
Pearson Correlation ◽  
Descriptive Study ◽  
Pharmacologic Therapy ◽  
Childbirth Experience

Women�s perception on childbirth experience is frequently related to pain struggle, regardless the type of birth. We aimed to present our Department�s experience on pharmacologically treating postpartum related pain. We developed a 6 months retrospective, descriptive study which included a number of 305 patients. Two sample patients were formed depending on the type of birth. In the sample of vaginal delivery a correlation between episiotomy and Paracetamol consumption was found (Pearson correlation of 0.238). In the sample of cesarean section births, for Acupan, Ketoprofen and Algifen the correlations with epidural anesthesia are negative and statistically significant at the 99.9% confidence level.

scholarly journals Epidural Anesthesia to Effectively Manage Pain and Facilitate Rehabilitation in a Pediatric Case of Complex Regional Pain Syndrome

2018 ◽  
pp. 209-212
Author(s):  
Goran Tubic
Keyword(s):  
Pain Management ◽  
Physical Therapy ◽  
Epidural Catheter ◽  
Complex Regional Pain Syndrome ◽  
Epidural Anesthesia ◽  
Pain Syndrome ◽  
Epidural Infusion ◽  
Lumbar Catheter ◽  
Interventional Pain Management ◽  
And Function

There is a paucity of information related to treatment of pediatric CRPS. Treatment of CRPS in pediatric patients has been guided by adult recommendations, which consist of a multidisciplinary approach involving pharmacotherapy, physical therapy, and psychotherapy, as appropriate. Patients unable to tolerate physical therapy with traditional oral pharmacotherapy may require more invasive pain management techniques such as sympathetic blocks, epidural infusion of analgesics, or spinal cord stimulation to facilitate restoration of function. This case report describes the successful use of epidural infusion of fentanyl, clonidine, and bupivacaine through a tunneled epidural lumbar catheter for pain management in an 11-year-old girl who developed complex regional pain syndrome I (CRPS I) approximately 2 months after sustaining an injury to her right knee. Following short-lasting pain relief from 3 repeated blocks, she underwent an implant of a tunneled epidural catheter (TEC) and a 4-week infusion of fentanyl (2 mcg/mL), clonidine (1 mcg/mL), and bupivacaine (0.04%). At last follow-up, approximately 3.5 months after implant of the TEC, the patient’s pain and symptoms were completely resolved, her range of motion and function were completely restored, and her physical activity had returned to pre-injury levels. Key words: Complex regional pain syndrome (CRPS), tunneled epidural catheter, pediatric, continuous regional anesthesia, epidural analgesia, continuous epidural anesthesia, interventional pain management

scholarly journals Sex-appropriate pain management with epidural anesthesia in pancreaticoduodenectomy: a propensity score-matched analysis

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S648-S649
Author(s):  
J. Zarate Rodriguez ◽  
H. Cos ◽  
G. Williams ◽  
C. Woolsey ◽  
R. Fields ◽  
...  
Keyword(s):  
Pain Management ◽  
Propensity Score ◽  
Epidural Anesthesia

scholarly journals Effectiveness of Superior Hypogastric Plexus Block for Pain Control Compared to Epidural Anesthesia in Women Requiring Uterine Artery Embolization for the Treatment of Uterine Fibroids – A Retrospective Evaluation

2020 ◽  
Author(s):  
Amer Malouhi ◽  
Rene Aschenbach ◽  
Anna Erbe ◽  
Zbigniew Owsianowski ◽  
Stefan Rußwurm ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Score ◽  
Epidural Anesthesia ◽  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Uterine Fibroids ◽  
Artery Embolization ◽  
Hypogastric Plexus ◽  
Superior Hypogastric Plexus ◽  
Plexus Block

Purpose To assess the effectiveness of pain management with superior hypogastric plexus block (SHPB) compared to epidural anesthesia (EDA) in women requiring uterine artery embolization (UAE). Materials and Methods In this retrospective, single-center, non-randomized trial we included 79 women with symptomatic uterine fibroids who were scheduled for percutaneous, transcatheter UAE. According to their informed decision, the women were assigned to two different approaches of pain management including either SHPB or EDA. The effectiveness outcome measure was patient reported pain using a numeric rating scale ranging from 1 to 10. The pain score was assessed at UAE, 2 hours thereafter, and at subsequent intervals of 6 hours up to 36 hours after intervention. Results Treatment groups did not differ significantly regarding age, pain score for regular menstrual cramps, uterine fibroid size, location, and symptoms of uterine fibroids. During UAE and up to 6 hours thereafter, women who received SHPB experienced stronger pain than those who received EDA (mean pain score during UAE: 3.3 vs. 1.5, p < 0.001; at 2 hours: 4.4 vs. 2.8, p = 0.012; at 6 hours: 4.4 vs. 2.6, p = 0.021). The maximum pain level was 5.8 ± 2.9 with SHPB and 4.5 ± 2.9 with EDA (p = 0.086). Women with a history of severe menorrhagia tended to experience worse pain than those without (regression coefficient 2.5 [95 % confidence interval –0.3 to 5.3], p = 0.076). Conclusion Among women who underwent UAE, pain management including SHPB resulted in stronger pain during and after the procedure than pain treatment including EDA. Key Points: Citation Format

Evaluation of urine gamma-glutamyl transpeptidase-to-creatinine ratio as a diagnostic tool in an experimental model of aminoglycoside-induced acute renal failure in the dog

1996 ◽  
Vol 32 (4) ◽  
pp. 323-336 ◽  
Author(s):  
BJ Rivers ◽  
PA Walter ◽  
TD O'Brien ◽  
VL King ◽  
DJ Polzin
Keyword(s):  
Canine Model ◽  
Urine Specific Gravity ◽  
Creatinine Ratio ◽  
Gamma Glutamyl Transpeptidase ◽  
Gamma Glutamyl ◽  
Baseline Values ◽  
The Mean ◽  
Clinically Significant ◽  
Experimental Canine ◽  
Glutamyl Transpeptidase

The potential diagnostic utility of the urine gamma-glutamyl transpeptidase (GGT)-to-creatinine ratio was evaluated in an experimental canine model of aminoglycoside-induced nephrotoxicity. A therapeutic dosage of gentamicin resulted in a twofold increase in the mean urine GGT-to-creatinine ratio that was not associated with clinically significant nephrotoxicity. In dogs each given a nephrotoxic dosage of gentamicin, an increase in mean urine GGT-to-creatinine ratios approximately three times baseline values preceded clinically significant abnormalities in serum creatinine, urine specific gravity, and urine protein-to-creatinine ratio. The urine GGT-to-creatinine ratio appears superior as an early indicator of aminoglycoside-induced nephrotoxicity. Further studies in canine clinical cases are warranted.

Influence of different flow modi during extracorporeal circulation on endothelial-derived vasoactive substances

Perfusion ◽  
1995 ◽  
Vol 10 (4) ◽  
pp. 229-236 ◽  
Author(s):  
CH Knothe ◽  
J. Boldt ◽  
B. Zickmann ◽  
S. Konstantinov ◽  
P. Dick ◽  
...  
Keyword(s):  
Extracorporeal Circulation ◽  
Pulsatile Flow ◽  
Plasma Levels ◽  
Good Tool ◽  
Roller Pump ◽  
Constant Flow Rate ◽  
Vasoactive Substances ◽  
Baseline Values ◽  
Pulsatile Perfusion ◽  
Aortocoronary Bypass Operation

Influences of shear stress on endothelin (ET) as well as prostacyclin (PGF) levels are common findings in different experimental settings. Thus, plasma levels of both substances seem to be a good tool to verify if different flow modi can be produced in blood vessels by generating pulsatile flow with a roller pump. In the present study, 20 patients scheduled for elective aortocoronary bypass operation were divided into two groups at random. One group was perfused with nonpulsatile (CON-group) and the other with pulsatile flow (PULS-group) during extracorporeal circulation. ET and PGF plasma levels were monitored perioperatively together with parameters of renal function and haemodynamic data. ET values were only slightly elevated at the end of extracorporeal circulation (mean baseline value; CON 3.1 μg/ml and PULS 3.2 μg/ml; mean maximal values at the end of cardiopulmonary bypass (CPB) 4.0 μg/ml and 3.9 μg/ml respectively). Prostacylin values (median baseline values: CON 56.7 μg/ml and PULS 57.1 μg/ml) peaked at the end of operation (median CON 117.8 μg/ml and PULS 137.5 μg/ml respectively) with a subsequent small decrease. No differences between the groups could be observed at any time point with respect to vasoactive substances, urine output (CON 6.5 ml/min and PULS 6.2 ml/min) or haemodynamics during CPB. This confirms studies emphasizing that no effective microvascular pulsatile flow is generated by conventional pulsatile flow-generating devices. In the present study, normothermia and a constant flow rate were maintained during CPB. Aortic cannulae (body-surface-related not maximal large diameters) were inserted. Altering these procedures may have led to more pronounced differences between the groups. All patients had an uneventful course after the operation. Similar to other reports, the present study was not able to demonstrate any benefit of pulsatile perfusion during extracorporeal circulation.

scholarly journals Pulmonary Consequences of Upper Abdominal Surgery—Therapeutic Considerations

1974 ◽  
Vol 2 (3) ◽  
pp. 221-225 ◽  
Author(s):  
Albert Saady
Keyword(s):  
Pain Management ◽  
Abdominal Surgery ◽  
Clinical Features ◽  
Pulmonary Complications ◽  
Morbidity And Mortality ◽  
Ventilatory Function ◽  
Post Operative Period ◽  
Post Operative Pain ◽  
Upper Abdominal ◽  
Therapeutic Considerations

Pulmonary complications following abdominal surgery are the largest single cause of morbidity and mortality in the post-operative period. This paper discusses the predisposing factors and clinical features, including the changes in ventilatory function tests. Important concepts in post-operative pain management are outlined, with emphasis on extradural analgesia.

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