867 E Stanley Blvd
Livermore CA 94550
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Postspinal hypotension in elderly patients undergoing orthopedic surgery, prophylactic ephedrine versus polygeline 3.5. - Anesthesia, essays and researches
Perioperative fluid management in elderly poses considerable challenge to the anesthesiologist. The conventional crystalloid loading may not be a preferred regime in this subgroup of patients since an exaggerated hemodynamic response is expected due to blunted sympathetic response and compromised cardiorespiratory system.This study was designed in the elderly patient for comparing efficacy, side-effects and limitations of prophylactic ephedrine 30 mg (intramuscular [i.m.]) versus polygeline 3.5% 500 ml (intravenous [i.v.]) for the maintenance of blood pressure after subarachnoid block (SAB).The sample size of 100 elderly (age > 50 years) patients undergoing orthopedic surgeries was administered SAB using bupivacaine 0.5% heavy. The primary outcome of this study was the attenuation of hypotension due to SAB using ephedrine or polygeline 3.5%.A total of 100 patients were randomly allocated to receive ephedrine 30 mg i.m. 10 min before the institution of SAB in Group I and preloading with 500 ml of polygeline 3.5% i.v. over 10 min prior to SAB in Group II. Patients in both groups were closely monitored for pulse rate, systolic blood pressure; any hypotension, requirement of rescue therapy and adverse effects.Results were interpreted using Student's t-test for parametric and Chi-square tests for nonparametric data.The incidence of hypotension and requirement for rescue therapy was statistically less in Group I compared with Group II (P < 0.05). Heart rates were better maintained in Group I than Group II, with few hemodynamic adverse effects in both groups.Ephedrine 30 mg i.m. given as pretreatment before SAB in elderly patients was more effective for the prevention of post-SAB hypotension.
Correlation between Epidurographic Contrast Flow Patterns and Clinical Effectiveness in Chronic Lumbar Discogenic Radicular Pain Treated with Epidural Steroid Injections Via Different Approaches. - The Korean journal of pain
Epidural steroid injections are an accepted procedure for the conservative management of chronic backache caused by lumbar disc pathology. The purpose of this study was to evaluate the epidurographic findings for the midline, transforaminal and parasagittal approaches in lumbar epidural steroid injections, and correlating them with the clinical improvement.Sixty chronic lower back pain patients with unilateral radiculitis from a herniated/degenerated disc were enrolled. After screening the patients according to the exclusion criteria and randomly allocating them to 3 groups of 20 patients, fluoroscopic contrast enhanced epidural steroids were injected via midline (group 1), transforaminal (group 2) and parasagittal interlaminar (group 3) approaches at the level of the pathology. The fluoroscopic patterns of the three groups were studied and correlated with the clinical improvement measured by the VAS over the next 3 months; any incidences of complications were recorded.The transforaminal group presented better results in terms of VAS reduction than the midline and parasagittal approach groups (P < 0.05). The epidurography showed a better ventral spread for both the transforaminal (P < 0.001) and the paramedian approaches (P < 0.05), as compared to the midline approach. The nerve root filling was greater in the transforaminal group (P < 0.001) than in the other two groups. The ventral spread of the contrast agent was associated with improvement in the VAS score and this difference was statistically significant in group 1 (P < 0.05), and highly significant in groups 2 and 3 (P < 0.001). In all the groups, any complications observed were transient and minor.The midline and paramedian approaches are technically easier and statistically comparable, but clinically less efficacious than the transforaminal approach. The incidence of ventral spread and nerve root delineation show a definite correlation with clinical improvement. However, an longer follow-up period is advisable for a better evaluation of the actual outcom.
A comparison of Epidural Butorphanol and Tramadol for Postoperative Analgesia Using CSEA Technique. - Journal of anaesthesiology, clinical pharmacology
Post operative analgesia in patients undergoing lower limb surgery is very essential for immediate postoperative pain relief which can be provided by oral or parentral medication, epidural analgesia, local blocks etc.The study was designed to evaluate the efficacy of epidural butorphanol and tramadol for postoperative pain relief. PATIENTS #ENTITYSTARTX00026;This was randomized, prospective, double blind study was conducted on 60 patients, ASA grade I&II, age 18-60 undergoing lower limb surgeries after approval from hospital ethics committee. Group allocation - Group I I (n=30) received 2 mg butorphanol as bolus epidurally, 1 mg for top up dose. Group II (n=30) received 100mg tramadol as bolus, 50 mg for top up. All the drugs were diluted to 10 ml normal saline & the observer was blinded to the drugs given. Postoperatively VAS, sedation score, vitals & side effects were observed. Top ups were given on achieving VAS>4. Diclofenac 75mg was given as rescue analgesia.Duration of analgesia was 5.35Â±0.29 hr and 6.25Â±1.58 hrs in Butorphanol and Tramadol groups respectively and the difference was found to be statistically significant. Pain scores were also significantly lower statistically in Group I as compared to Group II. Sedation scores were significantly higher in butorphanol group, whereas nausea vomiting was seen in tramadol group only (4 patients).No other side effects were observed.Both butorphanol and tramadol were effective for relieving postoperative pain, however quality of analgesia & patient satisfaction was more with butorphanol.
Challenges in paediatric laparoscopic surgeries. - Indian journal of anaesthesia
Today in the era of minimally invasive surgery, paediatric laparoscopy has become widely popular.The anaesthetic management in these cases poses special problems due to pneumoperitoneum created and extremes of position adopted in addition to the fact that paediatric anaesthesia itself is a challenge. Mostly the physiological as well as anaesthetic consideration are same except that child is not a small adult. The pressure of pnemoperitoneum needs to be kept between 6-12cm H(2)O, flow of gas about 0.9l, ventilation to be controlled, temperature monitoring being essential, use of atropine as premedicant, intravenous fluid management to be meticulous, induction with sevoflurane preferred as children may not allow i.v.puncture, intraoperative surgical complications being more, one needs to be very vigilant to diagnose and treat it. Using periumbilical area in paediatric age group should be avoided because the umbilical vessels have not involuted and can get punctured.Thus careful management in paediatric laparoscopic surgery will assume an important place in paediatric surgery.
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867 E Stanley Blvd Livermore, CA 94550
1171 Murrieta Blvd Suite 200
4951 Arroyo Rd Va Palo Alto Hcs- Ld-116A