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  • ISSN: 2333-6641
    Volume 4, Issue 2
    Research Article
    Kizilates Esra, Kizilates Ali, Sahin Ayca Sultan, Onuk Asuman Aslan, and Karsli Bilge*
    Abstract:
    Objective: In this study, we aimed to compare the efficacy of low dose bupivacaine vs. bupivacaine plus fentanyl, both administered via PCA, for pain relief during labor.
    Materials and Methods: A total of 40 healthy pregnant women in the active phase of labor were included and randomly allocated into the two following PCA analgesia groups: 0.125% bupivacaine (Group B) and 0.125% bupivacain + 2 μg/ml fentanyl (Group BF).
    Hemodynamic parameters were recorded. Fetal heart rate and uterine contractions were monitored.
    Also recorded were the time of onset of analgesia, pain score, sensory and motor block levels, and adverse effects, as well as amount of solutions required by the pregnant, bolus volumes administered, total solution volume used in PCA, mode of delivery and the result of initial newborns examination. Mothers were asked to rate their level of satisfaction with analgesia after delivery.
    Results: Onset of analgesia was more rapid in group BF than in group B. Subjects in Group BF had higher sedation, less pain, and less marked motor blockade than group B. The first phase of labor and total time of labor were shorter in Group BF. Volumes of solutions required by the pregnant women and of boluses given during the first phase were also lower in group BF. Satisfaction of pregnant women was higher in group BF. No significant differences were found in other variables between study groups.
    Conclusion: We conclude that bupivacaine and fentanyl combination provides higher quality of analgesia and better patient satisfaction in labor than bupivacaine alone.
    Manoel Ananias da SilvaNeto, Sérgio Veloso da Silveira Menezes, and Raphaella Amanda Maria Leite Fernandes*
    Abstract:
    Thoracic epidural anesthesia is an important and widely applied clinical procedure, but the injection depth poses a clinical challenge. The anatomical characteristics of the thoracic spinal column demand extreme caution at performing this technique. Ultrasound is a valuable method that adds to success in anesthetic blockages. However, literature registry on the ultrasound distance from skin to epidural space (epidural depth) at the thoracic level is scarce.
    The objective of this study is to measure the epidural depth at the level of interspace T3-T4.
    A cross-sectional study with 48 non-obese and healthy volunteers, being 20 men and 28 women was carried out. Measurements of epidural depth were accessed and correlated to anthropometric variables, gender and age of the subjects. The quality of the obtained ultrasound images was also inspected and associated to the study.
    Means epidural depth values were: 3.60 + 0.5 cm and 3.54 + 0.6 cm on the transverse and right sagittal oblique planes, respectively. The obtained distances were positively correlated to weight in both men and women, to height in men and to body mass index (BMI) and age in women. Eighty three percent of the ultrasound images on transverse plan were classified as conclusive and 16.7 % inconclusive, whereas 77.1 % on right sagittal oblique plan were conclusive and 22.9 % inconclusive.
    Epidural depth was 3.60 cm and 3.54 cm on transverse and right sagittal oblique planes, respectively. The index of conclusive images found in this study was higher than the ones reported in the literature.
    Brian M. Fitzgerald*
    Abstract:
    The optimal medical therapy for patients with chronic noncancer pain (CNCP) continues to be a challenging prospect. The use of oral opioids for the treatment of CNCP continues to be controversial because the true extent of their long-term efficacy, safety and effect on mental and physical functional status remains unclear. Recent studies have shown a correlation between long term opioid use and depression.
    Retrospective chart reviews of retired Department of Defense patients, without a diagnosis of depression, were randomly selected from files maintained in the Chronic Pain Clinic located at Wilford Hall Medical Center. Changes in patients’ depressive symptoms were assessed based on changes in patients’ reported Beck Depression Inventory (BDI) score from each of their clinic visit throughout the course of their therapy.
    A statistically significant increase in BDI scores was discovered in patients on high dose opioids (>50mg oral morphine equivalents per day) when compared to low dose opioid group (<50mg oral morphine equivalents per day). No significant changes were found in pain scores over the course of therapy.
    This finding suggests that long term opioid therapy could increase a patient’s depressive symptoms and those patients on such therapy should continue to be monitored closely for depression.
    Peter Martin Hansen*, Rikke Neess Pedersen, JorgenTrankjær Lauridsen, and Palle Toft
    Abstract:
    Background: The purpose of the study was to investigate the effects of intra hospital delay and time of admission on mortality and neurological outcome in endovascular coiling of ruptured intracranial aneurysms.
    Methods: A retrospective analysis of a database comprising all consecutive cases of proven ruptured intracranial aneurysms admitted to the Neurocenter at Odense University Hospital was performed. All aneurysms admitted in a period of 5 years and 3 months were investigated for inclusion in. Mortality was measured as death at 180 days.
    Results: 237 patients were included in the study. In 82,7% of patients, the procedure of endovascular coiling was started before 24 hours, in 17.3% beyond 24 hours. Mortality at six months was 15.3% in the <24H group vs. 39.0% in the ≥ 24H group, p<0, 0001. Increasing age was a significant predictor of delayed coiling (OR=1.046, p=0.002).
    Patients admitted during non-office time had 180 days mortality of 14.3% compared to 30.3 % in patients admitted during office hours, p= 0.004 .
    Conclusions: The presence of intra hospital delay was confirmed. Delayed endovascular coiling of ruptured intracranial aneurysms increased mortality and poor neurological outcome significantly. High age was a predictor of delayed treatment. The survival and outcome was improved when the patients arrived during non-office time.
    Short Note
    Lauren McLaughlin*, Keleigh McLaughlin, Ajay Vellore, and Rachael Rzasa-Lynn
    Abstract:
    "There is a great deal of human nature in people." -Mark Twain (May 18, 1867).
    Chronic pain has become a global and national epidemic, with approximately 100 million Americans believed to be affected [1]. Consequently, it is one of the most common reasons for seeking out primary care, accounting for up to 40% of clinic visits1. As a result, it is estimated that approximately 600 billion dollars is spent per year on healthcare associated costs as well as lost productivity [2,3].
    Review Article
    Hironori Tsuchiya*
    Abstract:
    Profound analgesia or pain control with local anesthetics is essential for most dental procedures in endodontic and restorative treatments, tooth extraction and minor oral surgery. However, dental clinicians frequently experience that it is difficult for infiltration and nerve block injections to achieve clinically acceptable local anesthesia in the presence of pupil and periapical inflammation. Local anesthetic failures are well documented especially when treating mandibular posterior teeth with inflamed pulps. Successful local anesthesia of patients with irreversible pulpitis is continually challenging in dentistry. A variety of mechanisms have been hypothetically proposed for such reduced efficacy of local anesthetics. Among mechanistic hypotheses, technical injection errors, mandibular anatomical variations and psychological factors are not directly related to inflammation, whereas inflammation-relevant mechanisms include alterations in the peripheral vascular system, nociceptive neurons, drug targets and central nervous sensitivity. However, none of them explain all aspects of dental anesthetic failures. The reasons why inflammatory lesions affect local anesthetics to decrease their effects are not fully understood. This article reviews pharmacological mechanisms underlying the failures of dental local anesthesia by focusing on inflammatory acidosis, products and mediators which would modify the properties of anesthetic agents and their targets. From a pharmacological point of view, different strategies to enhance the efficacy of local anesthetics are discussed about the drug selection based on structural and physicochemical characteristics, the buffering of injection solutions, the promotion of peripheral vasoconstriction, the premedication with anti-inflammatory drugs, the use of drug delivery systems, the application of new dental anesthetics, and the supplementary anesthesia.
    Research Article
    Bula-Bula IM*, Kabuni P, Kimbien J, Sikyala A, Ilunga M, Athombo J, Kimpanga P, Lepira F, Mbuyi M, Kilembe M
    Abstract:
    Introduction: The ASA score presents the disadvantage of being subjective and its inter-individual concordance rate is criticized by several authors. This study aims at assessing the concordance between ABCK score and ASA score.
    Methods: It is a descriptive study conducted from 1st December 2013 to 30th August 2014 in 3 hospitals of Kinshasa city: Hôpital de l’amitié sino-congolaise, Hôpital Saint Joseph and Hôpital Marie Biamba Mutombo. All patients admitted for pre-anaesthesia consultation during the period of the study were assessed using ASA score and ABCK score. Were excluded from the study all pregnant women and children.
    Informed consent was obtained from all participants. The conformity of the new score with the ASA score was assessed using the kappa of Cohen test.
    Results: 768 patients out of them 449 women and 319 men were examined. The sex ratio was 1.4 in favour of women. The average age was 39.4 ± 16.8 years. Low blood pressure and anaemia were the main complications during and post surgery operations and were mostly found in stages 3 and 4 for the 2 scores.
    Blood transfusion was frequent in stages 3 and 4 for the 2 scores. Mortality tends to increase with the patient’ stage in the 2 groups (ASA: X2 = 25.98; p < 0.001 and ABCK: X2 = 29.70; p < 0.001). The risk of death was not related to the score used (p = 0.31 as per Fisher for class 3 and X2 = 0.52; p = 0.24 for class 4). And, there was an excellent concordance with a Kappa at 0.86 between ABCK and ASA (p < 0.001).
    Conclusion: This study revealed the existence of an excellent concordance between the 2 scores.
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