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  • ISSN: 2333-6641
    Volume 4, Issue 1
    Case Report
    Craig McRobb, Glenn R Merritt, Mike Krieves, Sandeep Jhajj, Cindy Barrett, Kelley E. Capocelli, James Jaggers and Richard J Ing*
    Massive hemolysis during cardiopulmonary bypass (CPB) for repair of congenital cardiac defects is rare and life threatening. Potential etiologies of intra operative hemolysis during cardiac surgery include hemolytic transfusion reactions, CPB circuit and suction-related mechanical red blood cell(RBC) trauma, the generation of oxygen (O2) free radicals, activation of complement, inherited hemoglobinopathies, and complications involving the infusion of preparatory fluids and medications during CPB [1].
    Research Article
    Emine Ozcan, Ozlem Balkiz Soyal*, Mustafa Baydar, Nevzat Mehmet Mutlu and Nermin Gogus
    The aim of this study is to assess the effects of different routes of local anesthetic administration in epidural anesthesia applied to patients undergoing transurethral resection of the prostate (TUR-P).
    ASA I-III 60 patients were enrolled in the study. Patients were randomized into the following three groups: in Group N (needle), total volume of local anesthetic (16 mL) was administered through the Tuohy needle (n=20), in Group C (catheter), local anesthetic was administered through the epidural catheter (n=20) and in Group N/C (needle/catheter), local anesthetic was administered through both the needle (8mL) and the catheter (8mL) (n=20). Hemodynamic parameters (MAP, HR), times to reach sensory block T10 (block levels), side effects, patient and surgeon satisfaction were evaluated.
    In group C, the patients were hemodynamically more stable at the time of surgery compared to the other two groups (p <0.05). Times to reach sufficient block level were similar in all three groups and side effects were neglectable. Patient and surgeon satisfaction were high and similar in all groups.
    As a result, all three techniques can be used in TUR-P patients undergoing epidural anesthesia; however local anesthetic administration through the epidural catheter seems to be more effective in providing rapid and sufficient block levels and hemodynamic stability.
    Liv M. Freeman*, Albert Dahan, Jan MM van Lith, Kitty WM Bloemenkamp, Ben Willem J. Mol and Johanna M. Middeldorp
    Introduction: Epidural analgesia is widely recommended as method of choice for pain relief during labor whereas it is recommended to use remifentanil patient controlled analgesia only in the context of a randomized clinical trial.
    The aim of the study was to investigate the availability and use of epidural analgesia and remifentanil patient controlled analgesia, in all Dutch hospitals.
    Material and Methods: We extracted data on the use of epidural analgesia as pain relief for women in labor from the Netherlands Perinatal Registry. Because data on remifentanil patient controlled analgesia are not available in the registry, we also sent an anonymous online survey via email to all 90 hospitals with an obstetric ward in the Netherlands. The survey contained questions about obstetric analgesia with a focus on the availability and use of epidural analgesiaandremifentanil patient controlled analgesia.
    Results: In 2010 15% of 176,810 women giving birth in the Netherlands received epidural analgesia while 11.6 % received opioids. Response rate to the survey was 67% (60). Remifentanil patient controlled analgesia was available in 47% (28). In 67% of those hospitals remifentanil patient controlled analgesia was available for all laboring women whereas 14% only offered it to women with a contra-indication for epidural analgesia. Most hospitals use a flexible background infusion and a bolus dose of 30µgram. When only epidural analgesia was available 20% of women used pain relief (range 8-43%), versus 38% when epidural analgesia and remifentanil patient controlled analgesia were available (range 26-63%) (p<0. 001).
    Conclusion: Offering epidural analgesia and remifentanil patient controlled analgesia increases the use of analgesia over offering epidural analgesia alone. Despite the recommendation to use RPCA only in an experimental setting, remifentanil patient controlled analgesia is offered in almost 50% of hospitals.
    Daniela Pasero*, Nerlep Kahur Rana, Gabriele Giovenale, Alessandra Davi, Sara Viberti, Claudia Filippini, Mauro Rinaldi and Luca Brazzi
    Objective: Patients undergoing cardiopulmonary by-pass (CPB) often require prolonged mechanical ventilation during the post-operative period. Several observational studies have shown that, in critically ill patients undergoing mechanical ventilation without acute respiratory distress syndrome (ARDS), high tidal volume was associated with the development of ARDS, while the role of mechanical ventilation in the development of ARDS in CPB patients remains unknown. This study hypothesized that injurious mechanical ventilation during the post-operative period of CPB was a risk factor to the development of acute respiratory distress syndrome.
    Methods: A prospective observational study was conducted in the cardiac intensive care unit of a University Hospital, in Turin, between December 2010 and December 2012. Any patient admitted to cardiac intensive care unit, following cardiac surgery on CPB was enrolled. No intervention was required. Baseline, operative and post-operative variables were collected from each patient and the development of ARDS over 7 days was recorded. A multivariate logistic regressions analysis was performed to determine independent risk factor for the development of ARDS.
    Results: One hundred sixty three patients met inclusion criteria and were enrolled into the study. Twenty patients developed ARDS, on day 3.4±1.0. Multivariate logistic regression analysis identified high tidal volume, respiratory rate (RR), euroSCORE and fresh frozen plasma transfusions (FFP) as risk factors for ARDS.
    Conclusions: Injurious mechanical ventilation, characterized by high tidal volume and RR, together with high severity of the peri-operative conditions and transfusions, represent independent risk factors for ARDS in patients following CPB.
    Sebnem Dogu, Nurten Kayacan*, Bilge Karsli and Zekiye Bigat
    Background: The purpose of this study was to search the effects of epidural analgesia applied on primiparous pregnant women in case of early and late cervical dilatation, on the phases of labour, interventional labour and the necessity for cesarean delivery, in comparison to the control group with no demand of labour analgesia.
    Methods: Group I (n=25) was the early epidural analgesia (EEA) group, which the epidural analgesia began to be applied when cervical dilatation was 2-3 cm; Grup II (n=25) was regarded as the late epidural analgesia (LEA) group, which the epidural analgesia began to be applied when cervical dilatation was 4-5 cm. Grup III (n=25) was, on the other hand, the control group (C), that involved pregnant women who did not demand painless childbirth.
    Results: In the evaluation of obstetrical data, it was stated that the first phase of labour is significantly shorter and the second phase is significantly longer in the groups we applied analgesia in comparison with the control group. However, this statistically significant extension of time in the second phase is within acceptable limits for second phase. We also stated that the epidural analgesia never increased interventional labour incidence, and the rate of necessity for cesarean delivery was not so much different from the control group.
    Conclusion: We have concluded that it is unnecessary to delay the epidural analgesia application waiting for the cervical dilatation to proceed, in case that the labour pain comes up the VAS values (≥3).
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