scholarly journals Caudal block analgesia for paediatric infra-umbilical surgery: A prospective observational study

2020 ◽  
Vol 8 (3) ◽  
pp. 122-130
Author(s):  
Binod Gautam ◽  
Manan Karki
Keyword(s):  
Observational Study ◽  
Large Scale ◽  
Prospective Observational Study ◽  
Anaesthetic Agent ◽  
Group Analysis ◽  
Control Group ◽  
Single Shot ◽  
Caudal Block ◽  
Perioperative Analgesia ◽  
Analgesic Regimen

Background: Caudal block is the most common regional anaesthesia technique used in children. It offers excellent perioperative analgesia in infra-umbilical surgeries. However, large-scale studies on caudal block in our paediatric population are not available.Objectives: We aimed to evaluate practice pattern, efficacy and safety of caudal block in paediatric infra-umbilical surgery.Methodology: Children (age less than 14 years) undergoing elective infra-umbilical surgery under general anaesthesia were included in this prospective observational study conducted over two years. Demographic characteristics, type of surgery, anaesthetic techniques and agents used, and details of caudal block were recorded. Perioperative events, complications and duration of analgesia were studied. Eligible children not receiving caudal block served as the control group. Analysis was performed using IBM Statistical Package for the Social Sciences version 20.Results: Caudal block was employed in 72 out of 183 children who completed the study. It was mostly preferred for children weighing less than 20 kilograms. Ketamine pre-medication was used in 123 children. Majority received Propofol induction and laryngeal mask. Halothane was preferred over Isoflurane for anaesthesia maintenance. Bupivacaine was the exclusively used local anaesthetic agent. Vascular puncture occurred in three children but no serious complication was observed. Need for supplement intraoperative analgesics was significantly lower, and duration of analgesia was significantly longer in caudal group. Intraoperative hypotension, laryngospasm during emergence and postoperative vomiting were the most frequent perioperative events.Conclusion: Pre-incisional single-shot caudal block is safe, effective and well accepted component of multi-modal perioperative analgesic regimen for younger children undergoing infra-umbilical surgery.

A prospective observational study of combinatorial abiraterone (AA) and radical radiotherapy (RT) in node-positive (N+) prostate cancer (PCa).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17555-e17555
Author(s):  
Mark Ting Le Tan ◽  
Wai Yee Woo ◽  
Adelene Sim Yen Ling ◽  
Jeffrey Tuan ◽  
Terence Wee Kiat Tan ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Treatment Protocol ◽  
Whole Body ◽  
Control Group ◽  
Genetic Profiling ◽  
Psma Pet ◽  
Psa Response ◽  
Secondary Endpoints

e17555 Background: The conventional treatment backbone of N+ PCa has been hormonal therapy (HT) alone. Nonetheless, evidence from the STAMPEDE trial suggests that there could be survival benefit with the addition of local RT or AA, and there may be synergy between RT and AA in these advanced patients. We therefore conducted a prospective observational study to evaluate the efficacy of combination AA+HT+RT in patients with N+ PCa. Here, we report the preliminary biochemical response and toxicity data. Methods: Patients with N+M0/N+M1a, biopsy-proven adenocarcinoma of the prostate were enrolled. Patients were staged by 68Ga-PSMA-PET or whole body MRI. Exclusion criteria were i) ECOG ≥2; ii) cardiac event of < 6 mo interval; iii) bone and visceral metastasis. Treatment protocol entailed 18 mo of combination AA (1000 mg plus 5 mg prednisolone once daily) and HT (LHRH agonist/antagonist); RT was delivered to the prostate (78 Gy) +/- pelvis (54 Gy with simultaneous boost of 60-66 Gy to grossly involved lymph nodes in M0 patients). This was matched against a control group that received long-term HT +/- RT (N = 38). Primary endpoint of this analysis was PSA ≤0.1 ng/ml at 6 mo; secondary endpoints were PSA ≤0.1 ng/ml, testosterone ≤0.7 nmol/l at 12 mo, and toxicity outcomes. Germline genetic profiling was performed in all patients. Results: From Feb 2017 to Aug 2019, 18 men were recruited to this study, with a median fu of 15 mo (range 6.0-35.0 mo). Median age was 66.0 y (IQR 62.0-71.0y); median baseline PSA was 18.2 ng/ml (range 3.0-272); 66.7% had GS 8-10 disease; and 22.2% had M1a disease. Combination AA+HT+RT achieved PSA of ≤0.1 ng/ml in 80.0% (N = 12) and 93.3% (N = 14) of patients at 6 mo and 12 mo, respectively, in contrast to 29.4% and 25.0% of patients who were treated with HT+RT and HT alone, respectively. We observed profound castration of 87.5% (N = 14) at 6 mo, and 91.7% (N = 11) at 12 mo. Four and 6 patients experienced acute G2 genitourinary and gastrointestinal toxicities during RT, respectively; 2 patients reported late G2 GU. One patient experienced G2 fatigue and G1 liver enzyme dysfunction, resulting in dose reduction of AA. Genetic testing revealed a patient with BRCA2 frameshift mutation; interestingly, this patient failed to achieve a PSA of ≤0.1 ng/ml at 12 mo. Conclusions: We demonstrate that combinatorial AA+HT and definitive RT is well tolerated, and yield a pronounced early PSA response in N+ PCa. Long-term data will inform if this early efficacy signal leads to improved survival in these patients.

The relationship between serum ammonia level and neurologic complications in patients with acute glufosinate ammonium poisoning: A prospective observational study

2017 ◽  
Vol 37 (6) ◽  
pp. 571-579 ◽  
Author(s):  
YS Cha ◽  
H Kim ◽  
Y Lee ◽  
EH Choi ◽  
HI Kim ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Latency Period ◽  
Ammonia Level ◽  
Control Group ◽  
Neurologic Complication ◽  
Neurologic Complications ◽  
Glufosinate Ammonium ◽  
Serum Ammonia Level ◽  
Serum Ammonia

Glufosinate ammonium poisoning can cause neurological complications even after a symptom-free period. We prospectively investigated the predictors of neurologic complications in acute glufosinate ammonium poisoning and the change of serum ammonia level as a predictor of patient’s presence and recovery of neurologic complication. This prospective observational study collected data from consecutive patients diagnosed with acute glufosinate ammonium poisoning between September 2014 and June 2016. Serum ammonia was serially measured. The patients were divided into two groups: the neurologic complication group and the nonneurologic complication group. We also defined 25 other insecticide- or herbicide-poisoned patients as controls. The neurologic complication group included 18 patients (72.0%). The latency period for neurologic complications was within 48-h postingestion. The peak ammonia level was statistically higher in the neurologic complication group than in the control group ( p < 0.001) and the nonneurologic complication groups ( p = 0.001). There was a statistical difference between the nonneurologic complication group and the neurologic complication group ( p = 0.0085) in terms of ingested amount. The peak ammonia was the only predictor for the development of neurologic complications (the optimal cutoff: 90 μg/dL). In patients with mental changes, the mean serum ammonia levels before and after recovery of the mental changes were statistically different ( p = 0.0019). In acute glufosinate ammonium poisoning, serial serum ammonia level measurements are needed and a serum peak ammonia level greater than 90 μg/dL is a predictor of neurologic complications. Also, it is important to treat the hyperammonemia in acute glufosinate ammonium poisoning.

scholarly journals Ivermectin as Pre-exposure Prophylaxis for COVID-19 among Healthcare Providers in a Selected Tertiary Hospital in Dhaka – An Observational Study

2020 ◽  
Vol 2 (6) ◽  
Author(s):  
Mohammed Tarek Alam ◽  
Rubaiul Murshed ◽  
Pauline Francisca Gomes ◽  
Zafor Md. Masud ◽  
Sadia Saber ◽  
...  
Keyword(s):  
Observational Study ◽  
Large Scale ◽  
Statistical Significance ◽  
Healthcare Providers ◽  
Tertiary Hospital ◽  
Control Group ◽  
P Value ◽  
Chi Square ◽  
Exposure Prophylaxis ◽  
Experimental Group

Introduction: While multiple vaccines are undergoing clinical trial across the globe, we yearn for an FDA approved drug to protect us from the devastating pandemic for the time being. This study aims to determine the effectiveness of Ivermectin when administered as pre-exposure prophylaxis for COVID-19. Method: An observational study, with 118 healthcare providers who were enrolled purposively, was conducted in a tertiary hospital in Dhaka from May 2020 to August 2020. The subjects were divided into experimental and control groups; and the experimental group received an oral monthly dose of Ivermectin 12mg for 4 months. Both groups were exposed to COVID-19 positive patients admitted in the hospital during the course of study. The symptomatic subjects were evaluated by physical examination, COVID-19 RT-PCR and/or HRCT of chest. Differences between the variables were determined using the Chi-square test and the level of statistical significance was reached when p<0.05. Result: 73.3% (44 out of 60) subjects in control group were positive for COVID-19, whereas only 6.9% (4 out of 58) of the experimental group were diagnosed with COVID-19 (p-value < 0.05). Conclusion: Ivermectin, an FDA-approved, safe, cheap and widely available drug, should be subjected to large-scale trials all over the world to ascertain its effectiveness as pre-exposure prophylaxis for COVID-19.

scholarly journals Single shot ultrasound-guided thoracic paravertebral block for opioid-free radical mastectomy: a prospective observational study

2019 ◽  
Vol Volume 12 ◽  
pp. 2701-2708 ◽  
Author(s):  
Domenico P Santonastaso ◽  
Annabella de Chiara ◽  
Emanuele Russo ◽  
Giovanni Musetti ◽  
Leonardo Lucchi ◽  
...  
Keyword(s):  
Free Radical ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Radical Mastectomy ◽  
Paravertebral Block ◽  
Single Shot ◽  
Ultrasound Guided ◽  
Thoracic Paravertebral Block

scholarly journals Protocol for a large-scale prospective observational study with alogliptin in patients with type 2 diabetes: J-BRAND Registry

BMJ Open ◽  
2014 ◽  
Vol 4 (9) ◽  
pp. e004760-e004760 ◽  
Author(s):  
N. Inagaki ◽  
K. Ueki ◽  
Y. Tanizawa ◽  
H. Watada ◽  
J. Nakamura ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Observational Study ◽  
Large Scale ◽  
Prospective Observational Study

scholarly journals Safety and efficacy of mini-percutaneous nephrolithotomy as daycare procedure: a prospective observational study

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
P. Aarthy ◽  
Mathisekaran Thangarasu ◽  
J. Sanjay Prakash ◽  
Deepak Raghavan ◽  
Nitesh Jain ◽  
...  
Keyword(s):  
Observational Study ◽  
Percutaneous Nephrolithotomy ◽  
Large Scale ◽  
Prospective Observational Study ◽  
Ambulatory Surgery ◽  
Preoperative Evaluation ◽  
Maximum Size ◽  
Stone Disease ◽  
Complication Rates ◽  
Hospital Resources

Abstract Background To evaluate the safety, feasibility of mini-percutaneous nephrolithotomy (mPCNL) being carried out as a daycare surgery and to study the re-admission, stone clearance rate and complication rates following mPCNL. We also sought to find out the rate of requirement of ancillary procedure, after mPCNL. Methods In this prospective observational study, easily accessible patients above 18 years of age with renal and/or upper ureteric calculi, who underwent mPCNL between September 2018 and February 2020, were included. Seventy patients were selected, as per statistical methods. Preoperative evaluation including history, blood and urine investigations and radiological images was collected. Intra-operative and post-operative events were analyzed. Written consent was obtained from the patients to participate in the study and to publish their data. Institutional Ethical and scientific committee clearance was obtained. Results Out of 70 patients who underwent mPCNL in the study, in the age group ranging from 24–68 years, most of the cases were partial staghorn with maximum size of stone up to about 3.5 cm. Inferior calyx was most frequently punctured. Six cases had multipuncture mPCNL, four patients had bilateral procedure, and two had supra-costal puncture. Eighteen patients had tubeless mPCNL, of which four were totally tubeless procedures. Four patients had hematuria, none requiring transfusion. Two patients had sepsis, managed with higher antibiotics. Limitation of the study was the sample size. To derive a sturdy conclusion, large scale studies are recommended. Conclusions We can conclude that mPCNL can be safely done as daycare or ambulatory surgery in properly selected patients. In centers with experienced urologists, bilateral and multipuncture mPCNL can be done as an ambulatory surgery. Thus, this addresses the stone disease as well as cost containment, without patient safety being compromised. Bed occupancy rate is reduced, helping effective utilization of hospital resources.

Effects of opioid-reduced anesthesia during scoliosis surgery in children: a prospective observational study

2021 ◽  
Author(s):  
Florence Julien-Marsollier ◽  
Rita Assaker ◽  
Daphné Michelet ◽  
Matthieu Camby ◽  
Anne Galland ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Adolescent Idiopathic Scoliosis ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Morphine Consumption ◽  
Control Group ◽  
Prospective Analysis ◽  
Scoliosis Surgery ◽  
Postoperative Morphine

Aims: Opioid-reduced anesthesia (ORA) was suggested to decrease morphine consumption after adolescent idiopathic scoliosis (AIS) surgery and incidence of chronic pain. Materials & methods: A prospective analysis using the ORA in AIS surgery was performed. Two cohorts were compared: a control group (opioid-based anesthesia) and the ORA group. The main outcome was morphine consumption at day 1. Results: 33 patients operated for AIS using ORA were compared with 36 with opioid-based anesthesia. Morphine consumption was decreased in the ORA group (1.1 mg.kg-1 [0.2–2] vs 0.8 mg.kg-1 [0.3–2]; p = 0.02) at day 1. Persistent neuropathic pain at 1 year was decreased in the ORA group (p = 0.02). Conclusion: The ORA protocol is efficient to reduce postoperative morphine consumption in AIS surgery and preventing neuropathic pain.

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