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  • ISSN: 2333-6641
    Volume 6, Issue 1
    Review Article
    Suraci N*, Garcia P, and Poliwoda S
    When thinking of patient infection in the operating room setting, the anesthesiologist is not the first vector that comes to mind. However; several studies have demonstrated a connection between infection and the anesthetic clinician. Many of the infections induced by the clinician are due to cross contamination, inadequate hand hygiene, and infrequent cleaning of the anesthesia machine and equipment. In order to bring attention to the problem of anesthesiologist-mediated infection, we review the current literature as well as contemporary recommendations and interventions to identify preventable infections that can occur from the anesthesiologist and their work place in the operating room. This review is to provide better awareness of this growing problem and provide a better outlet for improved patient care.
    Spurthi* and Bindu George
    Background: Postoperative analgesia is a sine qua non in current clinical practice. So we are in need for an adjuvant that can prolong the action of local anaesthetics after single- injection blocks. Dexmedetomidine and clonidine are two commonly used adjuvants. This study was undertaken to assess which among them proved to be a superior analgesic adjuvant in lower doses.
    Materials and methods: After ethical committee approval study was conducted on 60 patients, aged 18-55 years, posted for upper limb surgery under USG guided supraclavicular brachial plexus block at St.John's Hospital, Bangalore. The study was conducted from January 2015-January 2016- Prospective randomised double blind study. Preoperative baseline values of heart rate, blood pressure and oxygen saturation was recorded. Brachial plexus block by supraclavicular approach was carried out under USG guidance using strict aseptic precautions. Patients were assigned randomly to one of the two groups using computer generated tables:-
    Group C- Clonidine 0.5 μg /kg added to 25ml of 0.375% bupivacaine.
    Group D - Dexmedetomidine 0.5 μg /kg and 25ml of 0.375% bupivacaine.
    The onset of sensory block and motor block, the duration of analgesia, duration of motor block and sedation scores were assessed. Complications were also noted.
    Results: In our study, the mean onset of sensory block was 11.6 +/-3.4 minutes in group C, 14.4 +/-4.5 minutes in group D. The mean onset of motor block was 17.6 +/-4.9 in group C, 20.6+/-5.9 in group D. The duration of sensory block in Group C was 9.7+/-1.6 hours, 13.3+/-1.9 hours in Group D. Duration of motor blockade (hrs) was 9.1+/-1.7 in Group C, 12.1+/-2.0 in Group D. Duration of sensory and motor blockade was longer in Dexmedetomidine group than Clonidine group. First rescue was required at 10.5 ± 1.7 hrs in Clonidine group and at 15 ± 2.2 hrs in Dexmedetomidine group. None of the subjects in Clonidine group had side effects; were as 10% of subjects in Dexmedetomidine group had side effects.
    Conclusions: Dexmedetomidine proves to be better adjuvant compared to clonidine as it notably prolongs analgesia and is also lesser complications at lower doses.
    Case Report
    Urvashi Tandon* and Deepak Dwivedi
    This inhalational agent has been in use since 1844 [1]. Of late there have been numerous debates on whether Nitrous Oxide should be used at all in the clinical practice of Anaesthesia. As it appears to be gradually phasing out of anaesthetic practice, here is a quick review on the properties of this gas, its clinical advantages and disadvantages.
    Teng-Fei Ma*
    Research utilizes a cyclical process of steps in order to conduct a study to prove or disprove a hypothesis or answer a specific question [1-2].
    Research Article
    Ajay Singh Thapa*, Binod Bhattarai, and Binita Dhakal
    Total intravenous anesthesia is a technique involving infusion and maintenance of anesthetic state with intravenous drugs alone. Propofol has three important characteristics of ideal TIVA agent, i.e. rapid induction, rapid metabolism and rapid recovery. In view of these advantages we studied the characteristics of propofol in total intravenous anesthesia for craniotomy.
    Aim: To study induction and recovery characteristics of propofol during craniotomy
    Methods: A total of 60 patients aged 18-60 years belonging to ASA I and II physical status with GCS more than 13 were included in the study. Exclusion criteria was GCS less than 13, ASA more than II, hemodynamic instability and other associated injuries. All patients were induced with propofol (2mg/kg) and maintained with 50 μg/kg/min infusion of propofol. Anesthesia was supplemented with fentanyl 2 mcg/kg and intubation facilitated with vecuronium 0.1 mg/kg. Based on hemodynamic signs, dose of propofol was adjusted in intraoperative period. Muscle relaxation was maintained with vecuronium 0.001mg/kg/min and analgesia with fentanyl 1 mcg/kg/hour intraoperatively. During skin closure, infusions were discontinued and neuromuscular blockade reversed at the end of surgery.
    Result: Propofol enabled smooth and rapid induction in all patients with mean induction time of 17.32 ± 2.43 seconds. During maintenance, propofol provided adequate depth of anesthesia in 53 (88.33%) of the patients, as assessed by hemodynamic changes. Recovery was good with short response time of 11.78 ± 2.99 minutes and orientation time of 21.86 ± 6.68 minutes.
    Interpretation and conclusion: Propofol based total intravenous anesthesia provides rapid induction and smooth recovery in most of the head injury patients.
    Review Article
    Laura Tyler Perryman*
    Background: Spinal cord stimulation (SCS) has been a time tested and cost-effective treatment to manage intractable chronic pain syndromes following spinal surgery, peripheral neuropathy, complex regional pain syndromes and others. However, the surgically implantable nature of all the components of SCS not only increases the surgical complications but the costs associated with the device also. Recent advancements in wireless technology appear to reduce these collateral burdens since the wireless device does not require an implantable pulse generator (IPG) or its connection cables.
    Material and results: A review of the available literature on traditional SCS (TSCS) and costs incurred, revealed that cost of a nonrechargeable battery was USD 13,150 (CSD 10,591; UK £ 7,243) in 2006 while a rechargeable battery had cost USD 20,858. Maintenance costs for the SCS equipment included a battery change every 4 years, on an average costing USD 3,539. IPG replacement involved expenses of CAD 5.071. A wireless device (Stimwave) is devoid of IPG costs and required 3-year maintenance costs of 1500 Euros only.
    Additionally, the wireless SCS (WSCS) is effective and without the complications of IPG which include pocket area pain, hematoma (in nearly 10% patients) and infection that accounts for 50% of infections following SCS implantation. Bench data had shown that a gluteal IPG location could produce nearly 9 cm of a thoracic lead displacement following spine motion in flexion, extension and rotation. Management of IPG complications costs additional health care budget, while with wireless SCS, this could be an avoidable expenditure. WSCS has been reported to be as effective as TSCS in patients with chronic pain following back surgery, herpes infection and complex regional pain syndrome in case illustrations.
    Conclusions: SCS has been an effective tool in chronic pain management. Traditional equipment includes an IPG cost between 13,000 and 20,000USD with a maintenance expense of 3,539 USD over 4 years (for battery change). On the other hand, wireless SCS had been reported to have nearly half of this maintenance cost for SCS therapy and without IPG costs and complications. Further clinical studies might indicate IPG expenditure as a redundant and unnecessary cost.
    Daniel Rodriguez*, Lady Alzate, Juan Camilo Gomez S, Federico Ocampo, and Alexander Trujillo
    Background: The optimal multimodal strategy for the management of postoperative pain in the pediatric population is still unknown; the use of regional blocks such as transverses abdominis block (TAP) in patients undergoing open appendectomy may reduce morphine requirements and increase the interval between boluses when using PCA.
    Objectives: To assess the effectiveness of TAP for the management of postoperative pain in the pediatric population who undergo open or laparoscopic appendectomy by comparing it to the use of placebo, exclusive systemic analgesia or wound infiltration. The secondary outcomes we asses were degree of patient satisfaction, nausea and postoperative and duration of hospitalization
    Selection Criteria: Randomized controlled clinical trials in patients younger than 18 years undergoing an open or urgent laparoscopic appendectomy under general anesthesia. The use of transversus abdominis plane block of the abdomen is compared to placebo, exclusive management with systemic analgesia or only wound infiltration.
    Data collection and analysis: Three reviewers independently assessed the trials to determine eligibility and risk of bias, then, data extraction was done.
    Main Results: Twenty-nine studies conducted until July 2017 was identified. Three of them were included and there were a total of 177 participants. Although not all included studies used the same measure for each outcome, the combination of the results of the three studies suggested that TAP blocks provide effective analgesia after appendectomy in the first two postoperative hours. In addition, when the surgical technique is open, the benefit extends up to 18 hours compared to standard opioid-based postoperative regimens, the consumption of opioids decreases and the time for the first dose increases.
    Research Article
    Ji Young Min, Jeong Rim Lee, Hye Mi Lee, Hyun Il Kim, and Hyo-Jin Byon*
    Objective: The dose of thiopental sodium for pediatric sedation has been determined mainly based on the patient’s weight. However, children’s demographic characteristics other than the weight can affect the sedative effect of thiopental sodium. The purpose of this study was to determine the demographic characteristics that affect the induction dose of thiopental sodium for pediatric sedation.
    Methods: We performed a retrospective chart review of children (<18 years of age) who underwent computed tomography/magnetic resonance imaging between January 2011 and August 2016 at a single tertiary medical center. We collected data on the demographics and the thiopental dose in children in whom sedation was successfully induced, without complications related to thiopental sodium. Regression analysis was performed to evaluate the relationship between the dose of thiopental sodium and the demographics.
    Ashraf S, Hassan Y*, Salmani UG, Ahmad GB, and Saleem B
    Introduction: Inhalational anaesthesia is the preferred technique of induction in the pediatric age group. Halothane with its negligible pungency and minimal effects on airway reactivity has been the cornerstone of pediatric inhalational induction despite its propensity to cause bradycardia, hypotension and arrhythmias. Sevoflurane with low blood gas solubility allows rapid induction and early emergence. Due to its pleasant odor, it is non-irritant to the airway which makes it an attractive alternative for inhalational induction in children.
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