Soft System Based on Fiber Bragg Grating Sensor for Loss of Resistance Detection during Epidural Procedures: In Silico and In Vivo Assessment

Epidural analgesia represents a clinical common practice aiming at pain mitigation. This loco-regional technique is widely used in several applications such as labor, surgery and lower back pain. It involves the injections of anesthetics or analgesics into the epidural space (ES). The ES detection is still demanding and is usually performed by the techniques named loss of resistance (LOR). In this study, we propose a novel soft system (SS) based on one fiber Bragg grating sensor (FBG) embedded in a soft polymeric matrix for LOR detection during the epidural puncture. The SS was designed to allow instrumenting the syringe’s plunger without relevant modifications of the anesthetist’s sensations during the procedure. After the metrological characterization of the SS, we assessed the capability of this solution in detecting LOR by carrying it out in silico and in clinical settings. For both trials, results revealed the capability of the proposed solutions in detecting the LOR and then in recording the force exerted on the plunger.

Anesthesia Considerations for Cataract Surgery in Patients with Schizophrenia: A Narrative Review

: Schizophrenia is ranked among the top 10 global burdens of disease. About 1% of people meet the diagnostic criteria for this disorder over their lifetime. Schizophrenic patients can develop cataract, particularly related to age and medications, requiring surgery and anesthesia. Many concerning factors, including cognitive function, anxiety, behavioral issues, poor cooperation and paroxysmal movements, may lead to general anesthesia as the default method. Antipsychotic agents should be continued during the perioperative period if possible. Topical/regional anesthesia is suitable in most schizophrenic patients undergoing cataract surgery. It reduces potential drug interactions and many postoperative complications; however, appropriate patient selection is paramount to its success. General anesthesia remains the primary technique for patients who are considered unsuitable for the topical/regional technique. Early involvement of a psychiatrist in the perioperative period, especially for patients requiring general anesthesia, is beneficial but often under-utilized. This narrative review summarizes the anesthetic considerations for cataract surgery in patients with schizophrenia.

Erector spinae plane block (ESPB): an adjuvant multimodal analgesic in the Combined Mandibulectomy and Neck Dissection (COMMANDO)—a case report

Background The Combined Mandibulectomy and Neck Dissection (COMMANDO) surgery results in severe postoperative pain and requires multimodal analgesia (MMA) for its management. We speculated that the erector spinae plane block (ESPB) which is the ultrasound (US)-guided regional technique and has been used in various types of surgeries due to its analgesic benefits could be used as an effective analgesic adjunct in COMMANDO surgery. Case presentation We report a case of a 68-year-old female patient who underwent left side COMMANDO surgery for carcinoma cheek. She was given an ultrasound-guided left erector spinae plane block (ESPB) in the preoperative period with catheter insertion at T3 (3rd thoracic vertebral level). Two boluses of local anesthetic were given each with 10 ml 0.25% ropivacaine one before and one after surgery, and then, the infusion was started with a volumetric pump. The ESPB provided effective intraoperative as well as postoperative pain relief without any side effects. Conclusion US-guided ESPB could be used as a potential opioid-sparing multimodal analgesic in head and neck surgeries based on the pain relief provided and the spread of contrast on imaging. This hypothesis needs to be explored in the form of case series and adequately powered randomized controlled trials.

A comparative evaluation of efficacy of epidural dexmedetomidine and fentanyl as adjunct to 0.2% ropivacaine for post-operative analgesia in elective abdominal surgeries

<p class="abstract"><strong>Background:</strong> Epidural analgesia as a central nuraxial technique which involves use of local anesthetics injected into the epidural space to produce a reversible loss of sensation and is the one of the most common regional technique used for lover abdominal and lover limb surgeries epidural analgesia provides excellent pain relief for surgical procedures below the umbilicus. This study compared the efficacy of epidural dexmedetomidine and fentanyl in addition to 0.2% ropivacaine for post-operative analgesia in elective abdominal surgeries.</p><p class="abstract"><strong>Methods:</strong> Total of 150 patients American Society of Anesthesiologists (ASA) I and II between 20-60 years, undergoing major abdominal surgery were included in this study. The patients divided in three groups of 50 patients each. First group R (ropivaciain 0.2% 9 ml with 1ml normal saline) second group RF (ropivacain 0.2% 9 ml with fentanyl 1 ml) and third group RD (ropivaciain 0.2% 9 ml with dexmedetomidine 1 μ/kg).</p><p class="abstract"><strong>Results:</strong> There is no significant difference in age, weight, sex, and ASA grade in all three groups.</p><p class="abstract">Hypotension was observed in 4 (8%) patients of R group, 2 (4%) in RD group and 4 (8%) in RF group. The shivering was present in 2 (4%) R group and 2 (4%) in RD group. Nausea, vomiting was present in R group 2 (4%) and 2 (4%) in RF group. There was no significant difference between the three groups with respect to hemodynamic parameters like heart rate, systolic and diastolic blood pressure and respiratory rate.</p><p class="abstract"><strong>Conclusions: </strong>Dexmedetomidine is a better adjuvant to ropivacaine through epidural route when compared to fentanyl for providing early onset prolonged post-operative analgesia, sedation and stable hemodynamic parameters in intra-abdominal surgeries.</p>

Regional techniques in pregnancy

Regional analgesia is the most effective way of managing pain associated with labour, and the majority of operative deliveries are conducted under regional anaesthesia, with the woman awake. The importance of appropriate consent, documentation, monitoring, positioning, and conduct of regional procedures is described. Supporting illustrations offer the reader tips to overcome common difficulties during epidural, spinal, and CSE placement, as well as the management of bloody tap or accidental dural puncture. Current guidance on the absolute and relative contra-indications to a regional technique and the management of the woman on anti-coagulants is also outlined.

Misconceptions about subarachnoid anesthesia block in the Egyptian female patients; causes and management

Spinal anesthesia is widely used for many surgeries and when compared to general anesthesia, it has lower rates of complications. However, anxiety or refusal of regional technique in our country seems to be multi factorial. This study tried to trace the main causes of refusal of spinal anesthesia and find different solutions for associated anxiety.

Efficacy of regional anaesthesia for paediatric surgery: Experience from a surgical expedition

Background: In developing countries where resources are scarce and health care financing is essentially by out-of-pocket payment, a surgical expedition is often a huge economic relief. Children are a category of the vulnerable group that can benefit from such exercises. However, an anaesthesia technique that is economical in both human and material resources should be explored, Objective: To describe the outcome of regional anaesthesia techniques during a surgical expedition for paediatric patients. Methods: Children aged 6 months to 16 years, who had been previously screened for free surgery in different surgical specialities, were recruited for the study. Results: Fifty-six (56) children were screened but only 35 were recruited for the surgical expedition. There were nineteen (19) males and sixteen (16) females with a male to female ratio of 1.5:1. Surgical procedures covered surgical specialities such as orthopaedics, plastic and general paediatric surgery. All the patients had one form of regional technique and/or peripheral nerve blocks. There were no intra-operative or post-operative anaesthetic complications up to a period of 30-days while on follow-up care. Conclusion: Regional anaesthesia is safe and a cheap choice of anaesthesia in children during surgical expeditions.

Manajemen Anestesi pada Pasien Seksio Sesarea Primigravida 35 Minggu dengan Sindroma Nefrotik

Sindroma nefrotik adalah sekumpulan gejala berupa proteinuria, hipoalbuminemia, edema, hiperkolesterolemia, dan lipiduria yang ditandai peningkatan permeabilitas dinding kapiler terhadap protein serum. Sindroma nefrotik pada kehamilan jarang terjadi namun bila tidak dikelola dengan baik akan meningkatkan morbiditas. Sindroma anefrotik dapat muncul sebelum umur kehamilan 20 minggu dan sering disebabkan oleh glomerulonephritis, sedangkan yang muncul sesudah umur kehamilan 20 minggu patut diduga disebabkan atau disertai suatu preeklampsia. Dilaporkan pasien 35 minggu dengan diagnosis preeklamsia, sindroma nefrotik dan suspek edema pulmo. Pasien di diagnosis sindroma nefrotik sejak kehamilan 12 minggu dan mendapat terapi metilprednisolone 16 mg 1-0-0 hingga sekarang. Pada usia kehamilan 28 minggu pasien didiagnosis preeklamsia. Datang karena kontraksi yang semakin kencang. Pasien dilakukan seksio sesarea dengan tehnik regional anestesi epidural Levobupivacain 0.5% isobarik 11 ml, janin cukup viable dilahirkan. Pasca operasi pasien dirawat di high care unit dan pulang ke rumah setelah perawatan 8 hari dalam kondisi baik. Manajemen anestesia pada ibu hamil dengan sindroma nefrotik antara lain sering disertai tekanan darah tinggi atau preeklampsia, malnutrisi dan hilangnya zat-zat yang diperlukan tubuh bersamaan dengan hilangnya protein melalui urine. Pasien seharusnya ditangani melalui pendekatan multidisipliner dengan spesialis perinatologi, nefrologi, dan neonatologi, dengan pemahaman terhadap pentingnya menjaga keseimbangan agar sesuai dengan perubahan fisiologis wanita hamil normal akan memberikan prognosis yang baik dalam menurunkan tingkat morbiditas. Anesthesia Management of Caesarean Section in 35 Weeks Primigravida Patients with Nephrotic Syndrome Abstract Nephrotic syndrome is a set of symptoms in the form of proteinuria, hypoalbuminemia, edema, hypercholesterolemia, and lipiduria which are characterized by an increase in capillary wall permeability to serum proteins. Nephrotic syndrome in pregnancy is rare but if not managed properly, it will increase a morbidity. Nephrotic syndrome can occur before 20 weeks of gestation and is often caused by glomerulonephritis, whereas if appears after 20 weeks' gestation is thought to be due to or accompanied by preeclampsia. A 35-week patient was reported with preeclampsia, nephrotic syndrome and suspected pulmonary edema. Patients were diagnosed with nephrotic syndrome since 12 weeks' gestation and were treated with methylprednisolone 16 mg 1-0-0 until now. At 28 weeks' gestation the patient was diagnosed with preeclampsia. she came to hospital due to primature contraction. Patient underwent SC with a 11 ml Levobupivacaine 0.5% drug isobaric epidural anesthesia regional technique, the fetus was viable enough to be born. After surgery the patient was treated at HCU and returned home after 8 days of treatment in good condition. Management of anesthesia in pregnant women with nephrotic syndrome is often accompanied by high blood pressure or preeclampsia, malnutrition and loss of substances needed by the body along with loss of protein through urine. Patients should be treated through a multidisciplinary approach, along with specialists in perinatology, nephrology, and neonatology. With an understanding of the importance of maintaining balance in accordance with the physiological changes of normal pregnant women will provide a good prognosis in reducing morbidity.