Continuous infusion of dipyrone in bitches in the intraoperative period: cardiorespiratory effects

Dipyrone is an effective analgesic for managing moderate or severe postoperative pain and can be used alone for mild pain or in combination with other analgesics for any type of pain. This study aimed to examine the administration of dipyrone by continuous infusion (CI) as an adjuvant analgesic in the intraoperative period for bitches undergoing elective ovariohysterectomy (OH) and its effect on these patients’ cardiorespiratory parameters. Twenty bitches underwent an elective OH procedure. The pre-anesthetic agent was a combination of acepromazine and morphine. Propofol was used to induce anesthesia, and isoflurane was used for maintenance. Subsequently, the animals were randomly allocated into two groups: the dipyrone group (DG) received a bolus dose of dipyrone (25 mg kg-1) by CI at a rate of 10 mg kg-1 h, and the control group (CG) received a bolus dose and a CI of 0.9% NaCl solution, both groups at a rate of 5 mL kg-1 h. The parametric variables were analyzed by ANOVA, followed by Tukey's test (p<0.05). The paired t-test (p<0.05) was used for comparison between the groups. Statistical differences were observed for heart rate, systolic, diastolic, and mean arterial pressure, respiratory rate, and blood glucose between the periods in both groups. There were differences only in the basal values of MAP between the groups; however, most values remained within the physiological range for the species. Using the drug as an adjuvant to anesthesia did not alter cardiorespiratory parameters, and it can be used as an adjuvant in analgesia during the intraoperative period of OH.

The use of intranasal glucocorticosteroids in patients with chronic rhinosinusitis in the preoperative period

Introduction. Chronic rhinosinusitis is a disease that occurs everywhere, characterized by inflammation of the mucous membrane of the paranasal sinuses and nasal cavity. If it is impossible to eliminate the causes of the recurrent disease with medical therapy, the use of surgical treatment help to recover the normal functioning of the ostium, including the ostiomeatal complex to improve ventilation and drainage of the paranasal sinuses and recover nasal breathing to relieve chronic inflammation.Purpose of the study. Assessment of the degree of intraoperative bleeding in patients with chronic rhinosinusitis.Materials and methods. On the basis of the FGBU SPB Research Institute of ENT of the Ministry of Health of the Russian Federation in the period from 2020 to 2021. the study of the effect of local intranasal glucocorticosteroids (INGKS) in the intraoperative period in patients with chronic polypous rhinosinusitis was carried out. The total amount of blood loss during surgery for chronic polypous rhinosinusitis in patients who used mometasone furoate preoperatively and in patients not taking topical hormonal drugs was analyzed.Results. In the study group, the average blood loss per operation was 257 ml, in the control group – 401 ml. In patients who took intranasal glucocorticosteroids during surgery, the intensity of bleeding is less pronounced. Undoubtedly, there are many reasons that affect the intensity of bleeding in general, however, a decrease in the inflammatory response in the nasal cavity and a decrease in inflammatory metabolites have a beneficial effect on the state of the nasal mucosa.Conclusion. The use of intranasal glucocorticosteroids in the preoperative period has a positive effect on reducing the inflammatory process in the nasal cavity, which helps to reduce the intensity of intraoperative bleeding.

Intraoperative Evaluation of Effects of Different Gas Mixtures (Oxygen 100%, O2 50%:N2O 50%, Air on Cuff Pressure of PLMA (Proseal LMA)

Introduction:- we study the intra operative evaluation of different gas mixture(oxygen 100%, O2 50%:N2O 50%, AIR on cuff pressure of PLMA. Aims and Objectives:- To study intracuff pressure changes and the change in final volume of gas mixture during inflation and deflation during intraoperative period and postoperative complications. Material and Methods:- This double blind, prospective Study was conducted in Department of Anaesthesiology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala following approval from institutional ethical committee and written informed patient consent. The sample size of 120 patient aged 18 to 60 years, belonging to ASA physical status 1 and 2 undergoing surgery in general anesthesia with PLMA as airway device divided into three group on the basis of PMLA cuff gas mixture:-Group O - oxygen 100%, Group ON - Nitrous 50%: Oxygen 50%, Group A – Air. Results and Conclusion:- Combination of N2O and O2 resulted in decreased intracuff pressure and air lead to a slight increase in intracuff pressure with O2 providing relatively stable cuff pressures. Keywords: PLMA,100% Oxygen, Air, Oxygen 50% N2O 50%, Air.

Effectiveness of a novel 1% glucose isotonic electrolyte solution for intraoperative fluid therapy in children: a randomized controlled trial

Background An appropriate electrolyte solution is important for safe intraoperative anesthesia management in children. This trial assessed the effectiveness of a novel 1% glucose isotonic electrolyte solution in intraoperative fluid therapy in children. Methods This trial analyzed data from 100 patients aged older than 1 month with an ASA score of I to II who received general anesthesia. Patients were randomly assigned to receive either the novel electrolyte solution (containing glucose, sodium, potassium, chloride, and bicarbonate) or lactated Ringer’s solution intraoperatively as a maintenance fluid. Patient demographics and the results of blood gas analysis at 1, 2, and 3 hours were documented, and changes in glucose and electrolyte concentrations and the acid–base status were analyzed. Results During infusion of the novel solution, the glucose and potassium concentrations were stable. Conversely, the solution was linked to increased sodium levels but decreased bicarbonate levels, although both changes were within the physiological ranges. In addition, pH remained stable during the intraoperative period. Hypoglycemia, hyperglycemia, hyponatremia, or hypernatremia was not detected. Conclusions The novel 1% glucose isotonic electrolyte solution helped to maintain glucose and electrolyte concentrations and acid–base stability, and it may therefore improve children’s safety during the intraoperative period.

Heating pad vs. infusion warmer to prevent hypothermia in intraopera-tive patients: which one is more effective?

Background: The use of heating pads and infusion warmers on intraoperative patients has been proven to prevent hypothermia. However, the differences in the effectiveness of the two methods have not been studied.Purpose: This study aims to compare the effectiveness of a heating pad and infusion warmer in preventing hypothermia (decreased body temperature and the incidence of shivering) in intraoperative patients.Methods: This research was a quasi-experimental design by a Posttest-Only Design with Nonequivalent Groups. The populations in this study were surgical patients with regional anesthesia, with a total sample of 64 respondents (32 respondents in the heating pad group and 32 respondents in the infusion warmer group) selected randomly. The incidence of hypothermia was perceived from two indicators: a decrease in body temperature and the prevalence of shivering, which was observed and recorded during the intraoperative period. The data were analyzed by discrimination tests (mean discrimination test and proportion discrimination test) to determine the difference in the effectiveness of the two groups.Results: The average decrease in body temperature during the intraoperative period (0-40 minutes of operation) in the group given the infusion warmer was greater than the group given the heating pad (p<0.001). The group given the infusion warmer was 8.750 times more likely to experience shivering than the group given the heating pad (p<0.001; OR=8.750).Conclusion: Using a heating pad is better in preventing hypothermia in intraoperative patients than using an infusion warmer.

Simultaneous Cranioplasty and External Ventricular Drain Implantation in Patients with Hydrocephalus: Case Series and Literature Review

Introduction The increase in intracranial pressure (ICP) is a neurological complication resulting from numerous pathologies that affect the brain and its compartments. Therefore, decompressive craniectomy (DC) is an alternative adopted to reduce ICP in emergencies, especially in cases refractory to clinical therapies, in favor of patient survival. However, DC is associated with several complications, including hydrocephalus (HC). The present study presents the results of an unusual intervention to this complication: the implantation of an external ventricular drain (EVD) in the intraoperative period of cranioplasty (CP). Methods Patients of both genders who presented with HC and externalization of the brain through the cranial vault after decompressive hemicraniectomy and underwent EVD implantation, to allow the CP procedure, in the same surgical procedure, were included. Results Five patients underwent DC due to a refractory increase in ICP, due to automobile accidents, firearm projectiles, falls from stairs, and ischemic strokes. All evolved with HC. There was no uniform time interval between DC and CP. The cerebrospinal fluid (CSF) was drained according to the need for correction of cerebral herniation in each patient, before undergoing cranioplasty. All patients progressed well, without neurological deficits in the immediate postoperative period. Conclusion There are still several uncertainties about the management of HC resulting from DC. In this context, other CP strategies simultaneous to the drainage of CSF, not necessarily related to ventriculoperitoneal shunt (VPS), should be considered and evaluated more deeply, in view of the verification of efficacy in procedures of this scope, such as the EVD addressed in this study.

Efficacy and safety of retrobulbar blockade of 0.5% ropivacaine during eyeball enucleation surgery in children with retinoblastoma

Introduction. Retinoblastoma (RB) is a malignant tumor of the embryonic nerve retina. Purpose. To determine the effectiveness of retrobulbar blockade (RbB) with ropivacaine 0.5% for intra- and postoperative analgesia, as well as for the prevention of oculocardial reflex (OCR), postoperative nausea and vomiting (PONV) during enucleation. Material and methods. A prospective, randomized, controlled clinical trial was performed. Eighty patients aged 0 to 10 years were included, who were randomly assigned to the RbB group (retrobulbar blockade with ropivacaine 0.5% with general anesthesia) N = 40 and the GA control group (general anesthesia) N = 40. Results. There were no complications in the RbB group caused by the methodology. In the intraoperative period, the average dose of fentanyl in the RbB group was 4.7 ± 0.7 μg / kg, which is significantly lower than in the OA group of 10.1 ± 1.9 μg / kg (P <0.05). OCR in the RbB group was observed in 5% of cases versus 100% in the GA group (P = 0.002). The average VAS score was 1.8 vs. 3.7 60 minutes after surgery (P <0.001). For the first time 12 hours after surgery, PONV was not observed in the RBB group, and in the control group it was observed in 45% of patients. Conclusions. The study revealed that intraoperative retrobulbar blockade with 0.5% ropivacaine solution in children with RB is effective and safe. Provides stable intraoperative hemodynamics and reduces the need for opioids. Promotes the prevention of OCD and PONV, as well as the improvement of postoperative analgesia during the operation of enucleation of the eyeball in pediatric. Key words: ropivacaine, retrobulbar block, oculocardial reflex, pain, retinoblastoma, enucleation, pediatric patients.

USE OF SMARTPHONE AMONG ANAESTHESIOLOGIST DURING ANAESTHESIA INTERFERES WITH PATIENT CARE: A SURVEY

Introduction: Usage of smart phones have become an integral part of the professional and personal lives of the population worldwide. Though the usage of smart phones applications has increased the efciency in the workplace, it can also be a signicant distraction to the patient care. Objective: The objective of this study is to determine whether the use of smart phone among anesthetists during patient care improves or provides distraction in patient care. Results: The present study has shown that the prevalence of smart phone usage was 85.7%. The purpose of smart phone usage in increasing order of their frequency was internet surng, phone calls, Messaging and usage of social media. Only 33.3% of the hospitals in which the study participants work had smart phone usage restriction inside the operation theatre and 27.6% had restriction except for communications. Conclusion: Smartphone usage result in increased reaction time, decreased focus and reduced behavioural performance during cognitive tasks. Hence its usage has to be strictly needed basis during the intraoperative period.

Inadequate completion of surgical data for patient safety: opinion of health professionals

Objective: to investigate variables related to inadequate completion of surgical data for patient safety in the hospital setting in the opinion of health professionals. Methods: retrospective study in 180 medical records of surgical patients in a public hospital and application of a structured questionnaire to caregivers responsible for filling out the surgical data of patients. Descriptive statistical analysis was performed. Results: the medical records showed incomplete surgical records in the preoperative period (61%), intraoperative period (66%) and immediate postoperative period (87%). Professionals reported not knowing the protocol for safe surgery (62%) and the institution's surgical safety form (68%), 87% were not trained to use the intraoperative checklist, 66% considered the number of staff inadequate and 55% considered communication ineffective. Conclusion: in the opinion of health professionals, insufficient professional knowledge, lack of training, inadequate staffing and ineffective communication may be related to inadequate completion of surgical data and patient safety.

ROLE AND PROBLEMATICS OF THE EPIDURAL ANESTHESIA DURING EXTENSIVE LIVER RESECTIONS

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.