scholarly journals THE COMPARISON OF ETOMIDATE AND PROPOFOL FOR ATTENUATION OF HAEMODYNAMIC RESPONSE TO INDUCTION AND ENDOTRACHEAL INTUBATION

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Virendra Singh Rathore ◽  
Suresh Pandey ◽  
S.P. Chittora
Keyword(s):  
Renal Failure ◽  
Informed Consent ◽  
General Anesthesia ◽  
Endotracheal Intubation ◽  
Surgical Procedures ◽  
Cardiac Surgical Procedures ◽  
Hemodynamic Instability ◽  
Hemodynamic Stability ◽  
Medical College ◽  
Written Informed Consent

Background: This study is designed to compare the degree of attenuation of hemodynamic response to induction, laryngoscopy and endotracheal intubation of etomidate with those of propofol in patients undergoing noncardiac surgical procedures. Methods:  The present study conducted in Non Cardiac Surgeries in the Department of Anaesthesiology, Jhalawar Medical College & Associated Hospitals, Jhalawar, Rajasthan.After institutional ethical committee’s approval and written informed consent from the patient’s attendant in the format as per proforma, the present study was conducted on 60  patients of ASA Grade I and II of either sex, aged 18 to 60 years, scheduled for a variety of non-cardiac surgical procedures requiring general anaesthesia. Results: The findings of the study suggest that use of etomidate as inducing agent provides more hemodynamic stability as compared to propofol and can be preffered in patients prone to hemodynamic instability, cardiovascular abnormalities, hypovolemia, prone to renal failure due to hypotension. Propofol may be preffered for induction where hypertension is contraindicated or hypotension is preffered and myoclonus is to be avoided. Conclusion: Etomidate provides a more stable hemodynamics during general anesthesia as compared to propofol. Keyword:- Etomidate, Propofol, Hemodynamic.

scholarly journals Dexmedetomidine vs Fentanyl in Attenuating the Sympathetic Surge During Endotracheal Intubation: A Scoping Review

2021 ◽  
Author(s):  
Alexandra Schwieger ◽  
Kaelee Shrewsbury ◽  
Paul Shaver
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Systolic Blood Pressure ◽  
General Anesthesia ◽  
Diastolic Blood Pressure ◽  
Endotracheal Intubation ◽  
Scoping Review ◽  
Hemodynamic Stability

Purpose/Background Direct laryngoscopy and endotracheal intubation after induction of anesthesia can cause a reflex sympathetic surge of catecholamines caused by airway stimulation. This may cause hypertension, tachycardia, and arrhythmias. This reflex can be detrimental in patients with poor cardiac reserve and can be poorly tolerated and lead to adverse events such as myocardial ischemia. Fentanyl, a potent opioid, with a rapid onset and short duration of action is given during induction to block the sympathetic response. With a rise in the opioid crisis and finding ways to change the practice in medicine to use less opioids, dexmedetomidine, an alpha 2 adrenergic agonist, can decrease the release of norepinephrine, has analgesic properties, and can lower the heart rate. Methods In this scoping review, studies published between 2009 and 2021 that compared fentanyl and dexmedetomidine during general anesthesia induction and endotracheal intubation of surgical patients over the age of 18 were included. Full text, peer-reviewed studies in English were included with no limit on country of study. The outcomes included post-operative reviews of decrease in pain medication usage and hemodynamic stability. Studies that were included focused on hemodynamic variables such as systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and use of opioids post-surgery. Result Of 2,114 results from our search, 10 articles were selected based on multiple eligibility criteria of age greater than 18, patients undergoing endotracheal intubation after induction of general anesthesia, and required either a dose of dexmedetomidine or fentanyl to be given prior to intubation. Dexmedetomidine was shown to effectively attenuate the sympathetic surge during intubation over fentanyl. Dexmedetomidine showed a greater reduction in heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure than fentanyl, causing better hemodynamic stability in patients undergoing elective surgery.Implications for Nursing Practice Findings during this scoping review indicate that dexmedetomidine is a safe and effective alternative to fentanyl during induction of general anesthesia and endotracheal intubation in attenuating the hemodynamic response. It is also a safe choice for opioid-free anesthesia.

scholarly journals TO OBSERVE THE EFFECT OF ORAL GABAPENTIN, THEOPHYLLINE AND CAFFEINE ON SBP, DBP, MAP AND HR.

2019 ◽  
Vol 3 (12) ◽  
Author(s):  
Kunwar Singh Thakur ◽  
Rahul Meda
Keyword(s):  
Informed Consent ◽  
Caesarean Section ◽  
Spinal Anesthesia ◽  
Ethics Committee ◽  
Lower Segment ◽  
Medical College ◽  
Lower Segment Caesarean Section ◽  
Haemodynamic Parameters ◽  
Institutional Ethics ◽  
Written Informed Consent

After obtaining approval from institutional ethics committee, and written informed consent, the present study entitled "To Observe the Effect of Oral Gabapentin, Theophylline and Caffeine on SBP, DBP, MAP and HR"  was conducted on 120 patients of ASA grade I &II scheduled for elective and emergency lower segment caesarean section under spinal anesthesia in the Department of Anesthesiology, J.A. Group of Hospitals & G.R. Medical College, Gwalior (M.P.)  after getting written informed consent from the patients. No significant effects on haemodynamic parameters were observed with all the study drugs. Recurrence of PDPH was significantly high with caffeine treatment. No serious untoward effects or complications of study drugs were observed in the study. Keywords: Oral Gabapentin, Theophylline, Caffeine, SBP, DBP, MAP & HR.

CEREBRALANEURYSM SURGERY IN A PATIENT WITH CHRONIC RENAL FAILURE: PERIOPERATIVE CONCERNS AND CONFLICTS

2021 ◽  
pp. 58-59
Author(s):  
Izhar Faisal ◽  
Pragati Ganjoo
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Hemodynamic Instability ◽  
Electrolyte Imbalance ◽  
Anesthetic Drug ◽  
Hemodynamic Stability ◽  
Anesthetic Drugs ◽  
Coagulation Abnormalities ◽  
Brain Relaxation ◽  
Drug Doses

Chronic renal failure (CRF) and associated multi-system abnormalities can adversely impact the outcome in patients undergoing high-risk aneurysm surgeries by causing hemodynamic instability, uid-electrolyte imbalance, bleeding and coagulation abnormalities, decreased anesthetic drug excretion, and dialysis-related complications. Conicts between the standard perioperative practices in aneurysm surgery and those in CRF further contribute to the management challenges. These include, using low anesthetic drug doses but achieving good brain relaxation, using a restrictive uid therapy but preventing postoperative vasospasm, and avoiding diuretics causing nephrotoxicity but reducing intracranial pressure. Ayoung male with dialysis-dependent CRF and hypertension underwent emergency craniotomy and clipping of a cerebral aneurysm. He was managed with a modied protocol of reduced heparin hemodialysis, BIS-guided use of minimum anesthetic drugs, goal-directed optimum uid therapy, maintaining hemodynamic stability, and management of post-aneurysm clipping vasospasm with hypertension. His perioperative management and related conicts are discussed

scholarly journals Pain Control: Opioid vs. Nonopioid Analgesia During the Immediate Postoperative Period

2021 ◽  
Author(s):  
Shamsie Lumpkin ◽  
Isaac Parrish ◽  
Austin Terrell ◽  
Dwayne Accardo
Keyword(s):  
Informed Consent ◽  
Surgical Procedures ◽  
Pain Control ◽  
Small Sample ◽  
Opioid Analgesia ◽  
Specific Patient ◽  
Pain Scores ◽  
Opioid Sparing ◽  
Opioid Medications ◽  
Written Informed Consent

Background Opioid analgesia has become the mainstay for acute pain management in the postoperative setting. However, the use of opioid medications comes with significant risks and side effects. Due to increasing numbers of prescriptions to those with chronic pain, opioid medications have become more expensive while becoming less effective due to the buildup of patient tolerance. The idea of opioid-free analgesic techniques has rarely been breached in many hospitals. Emerging research has shown that opioid-sparing approaches have resulted in lower reported pain scores across the board, as well as significant cost reductions to hospitals and insurance agencies. In addition to providing adequate pain relief, the predicted cost burden of an opioid-free or opioid-sparing approach is significantly less than traditional methods. Methods The following groups were considered in our inclusion criteria: those who speak the English language, all races and ethnicities, male or female, home medications, those who are at least 18 years of age and able to provide written informed consent, those undergoing inpatient or same-day surgical procedures. In addition, our scoping review includes the following exclusion criteria: those who are non-English speaking, those who are less than 18 years of age, those who are not undergoing surgical procedures while admitted, those who are unable to provide numeric pain score due to clinical status, those who are unable to provide written informed consent, and those who decline participation in the study. Data was extracted by one reviewer and verified by the remaining two group members. Extraction was divided as equally as possible among the 11 listed references. Discrepancies in data extraction were discussed between the article reviewer, project editor, and group leader. Results We identified nine primary sources addressing the use of ketamine as an alternative to opioid analgesia and post-operative pain control. Our findings indicate a positive correlation between perioperative ketamine administration and postoperative pain control. While this information provides insight on opioid-free analgesia, it also revealed the limited amount of research conducted in this area of practice. The strategies for several of the clinical trials limited ketamine administration to a small niche of patients. The included studies provided evidence for lower pain scores, reductions in opioid consumption, and better patient outcomes. Implications for Nursing Practice Based on the results of the studies’ randomized controlled trials and meta-analyses, the effects of ketamine are shown as an adequate analgesic alternative to opioids postoperatively. The cited resources showed that ketamine can be used as a sole agent, or combined effectively with reduced doses of opioids for multimodal therapy. There were noted limitations in some of the research articles. Not all of the cited studies were able to include definitive evidence of proper blinding techniques or randomization methods. Small sample sizes and the inclusion of specific patient populations identified within several of the studies can skew data in one direction or another; therefore, significant clinical results cannot be generalized to patient populations across the board.

scholarly journals Face-to-Face Intubation in Adults: A Comparison of Video Laryngoscopes Kingvision and Airtraq for Intubation in Morbidly Obese Patients – Series of Cases.

2020 ◽  
Author(s):  
Justyna Nowak-Tim ◽  
Tomasz Gaszynski
Keyword(s):  
Informed Consent ◽  
Endotracheal Intubation ◽  
Ethics Committee ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Intubation Time ◽  
Face To Face ◽  
Significant Difference ◽  
Unlimited Access ◽  
Written Informed Consent

Abstract Backgroud: Traditional endotracheal intubation demands unlimited access to the patient and possibility to stand behind his head. However, in case of difficult conditions in emergency settings we can use an alternative method. Face-to-face intubation can be performed in patients in semi-erect position, prone position and in the situation of difficult access to the head. Method: After obtaining an approval from the Local Ethics Committee Nr RNN/62/20/KE and written informed consent from the patients, we performed 8 procedures of face-to-face intubations in 8 patients who were scheduled for planned operations, using Kingvision and Airtraq video laryngoscopes chosen in random way. Results: The intubation time was comparable between devices: 9.25 ±2.217 s vs 8 ±2.3 s (p=0.2322) in Kingvision and Airtraq videolaryngscopes respectively. Both devices appeared to deliver an optimal view of the larynx inlet and enable the operator to intubate with face-to-face method without any complications. Conclusions: There were no significant difference in effectiveness between Kingvision and Airtraq video laryngoscopes during face-to-face intubation. Utilisation of these devices allowed the anesthetist to stand in front of the patient during endotracheal intubation and ensured an excellent view of larynx entrance. We assume that in case of difficult access to the patient’s head or untypical position, the usage of examined video laryngoscopes, should be considered.

scholarly journals Laryngeal Mask Ventilation during Tracheostomy Improves Intraoperative Hemodynamic Stability in Patients Undergoing Total Laryngectomy

2019 ◽  
Vol 46 (3) ◽  
pp. 5-9
Author(s):  
Tz. Marinov ◽  
T. M. Popov ◽  
M. Belitova
Keyword(s):  
Laryngeal Mask Airway ◽  
General Anesthesia ◽  
Endotracheal Intubation ◽  
Local Anesthesia ◽  
Laryngeal Cancer ◽  
Total Laryngectomy ◽  
Laryngeal Mask ◽  
Mask Ventilation ◽  
Hemodynamic Parameters ◽  
Hemodynamic Stability

Abstract Background and objectives: Laryngectomy with extensive extirpational neck dissection is still the treatment of choice for patients with advanced laryngeal cancer. During the initial part of laryngectomy – tracheostomy, there is a significant upper airway obstruction, caused by the cancer process itself and worsened by surgical pressure and manipulation during creation of tracheostomy. This study aims to make comparative assessment of the patient’s hemodynamic parameters, operated using three of the most popular approaches during tracheostomy: local anesthesia with preserved spontaneous ventilation; general anesthesia with ventilation by endotracheal intubation and general anesthesia with ventilation by laryngeal mask airway. Methods: A prospective cohort study was conducted in a tertiary referral center. Sixty patients with advanced laryngeal cancer appointed for total laryngectomy, were enrolled in the study. They were randomly assigned into three groups, according to the ventilation method used during the tracheostomy. Results: Patients who underwent tracheostomy under local anesthesia displayed statistically the highest levels of SAP, DAP, MAP and heart rate intraoperatively. The group of patients who underwent tracheostomy with endotracheal intubation, also displayed significantly higher levels of hemodynamic parameters during the procedure compared with the group with laryngeal mask airway ventilation, despite the fact that both groups were under general anesthesia. Conclusions: To our knowledge, this is the first study to demonstrate that laryngeal mask ventilation during tracheostomy improves intraoperative hemodynamic stability in patients undergoing total laryngectomy compared to endotracheal intubation.

The Use of an Absorbable Microporous Polysaccharide Hemosphere Haemostat (AristaAH®) in Ventricular Assist Device Implant and Cardiac Transplantation Procedures

2012 ◽  
Vol 8 (2) ◽  
pp. 125
Author(s):  
Brian A Bruckner ◽  
Matthias Loebe ◽  
◽  
Keyword(s):  
Surgical Procedures ◽  
Ventricular Assist Device ◽  
Cardiac Transplantation ◽  
Cardiac Surgical Procedures ◽  
High Risk Group ◽  
Cardiac Transplant ◽  
Assist Device ◽  
Ventricular Assist ◽  
Refractory Heart Failure ◽  
Haemostatic Agents

Topical haemostatic agents are useful adjuncts for the overall approach to haemostasis during mechanical support and cardiac transplant surgical procedures. Increasing numbers of cardiac surgical patients are presenting with pharmacologically induced impairment of the clotting cascade. Additionally, there continues to be an increase in the numbers of ventricular assist device implantations worldwide and these patients have haemostasis challenges both at the time of implantation and at subsequent transplantation. Patients undergoing assist device placement or cardiac transplantation usually have severe, refractory heart failure and varying degrees of multi-organ dysfunction, which make them susceptible to bleeding during the surgical procedure. Despite routine blood conservation measures and the use of intravenous agents, local surgical field haemostasis still remains a challenge. Topical agents are increasingly used in cardiac surgical procedures, especially in assist device or transplant cases. Herein, we report our institutional approach to topical haemostasis in a high-risk group of patients undergoing assist device or cardiac transplant. AristaAH®, a novel polysaccharide topical haemostat, provides effective and safe control of challenging bleeding situations.

Microporous Polysaccharide Hemosphere Absorbable Hemostat (AristaAH®) in Re-Operative Cardiac Surgical Procedures

2012 ◽  
Vol 9 (2) ◽  
pp. 96-98
Author(s):  
Brian A Bruckner ◽  
Matthias Loebe
Keyword(s):  
Patient Outcomes ◽  
Surgical Procedures ◽  
Systematic Approach ◽  
Surgical Intervention ◽  
Transfusion Requirement ◽  
Cardiac Surgical Procedures ◽  
Platelet Inhibitors ◽  
Hemostatic Agents ◽  
Surgical Field ◽  
Improve Patient

Patients undergoing re-operative cardiac surgical procedures present a great challenge with regard to obtaining hemostasis in the surgical field. Adhesions are ever-present and these patients are often on oral anti-coagulants and platelet inhibitors. As part of a well-planned surgical intervention, a systematic approach to hemostasis should be employed to decrease blood transfusion requirement and improve patient outcomes. Topical hemostatic agents can be a great help to the surgeon in achieving surgical field hemostasis and are increasingly being employed. Our approach, to these difficult patients, includes the systematic and planned use of AristaAH, which is a novel hemostatic agent whose use has proven safe and efficacious in our patient population.

Risk Minimization Measures in Off-Label Drug Use: A Survey of Community Pharmacists in Malaysia

2020 ◽  
Vol 15 (3) ◽  
pp. 181-189
Author(s):  
Omotayo Fatokun
Keyword(s):  
Informed Consent ◽  
Drug Use ◽  
Perceived Risk ◽  
Adverse Drug Events ◽  
Community Pharmacists ◽  
Risk Minimization ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Off Label ◽  
Written Informed Consent

Background: While off-label drug use is common and sometimes necessary, it also presents considerable risks. Therefore, measures intended to prevent or reduce the potential exposure to off-label risks have been recommended. However, little is known about community pharmacists’ beliefs regarding these measures in Malaysia. Objectives: This study examined community pharmacists’ beliefs towards risk minimization measures in off-label drug use in Malaysia and assessed the relationship between perceived risk of off-label drug use and beliefs towards risk minimization measures. Methods: A cross-sectional survey was conducted among 154 pharmacists practicing in randomly selected community pharmacies in Kuala Lumpur and the State of Selangor, Malaysia. Results: The majority agreed or strongly agreed that adverse drug events from the off-label drug should be reported to the regulatory authority (90.9%) and the off-label drug should only be used when the benefit outweighs potential risks (88.3%). Less than half (48.1%) agreed or strongly agreed that written informed consent should be obtained before dispensing off-label drugs and a majority (63.7%) agreed or strongly agreed that the informed consent process will be burdensome to healthcare professionals. Beliefs towards risk minimization measures were significantly associated with perceived risk of off-label drug use regarding efficacy (p = 0. 033), safety (p = 0.001), adverse drug rection (p = 0.001) and medication errors (p = 0.002). Conclusion: The community pharmacists have positive beliefs towards most of the risk minimization measures. However, beliefs towards written informed consent requirements are not encouraging. Enhancing risk perception may help influence positive beliefs towards risk minimization measures.

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