Nurse Anesthesia
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- ItemIMPACT OF PERINEURAL DEXAMETHASONE ADDED TO BUPIVACAINE FOR TRANSVERSUS ABDOMINIS PLANE BLOCK IN POST-CESAREAN DELIVERY PAIN CONTROL. A PROSPECTIVE, RANDOMIZED, DOUBLE- BLIND, CONTROLLED TRIAL(2022-10-18) Noor Jamal Ahmad ShaheenBackground: Acute pain after Cesarean delivery (CD) is one of the most important outcomes that an obstetric anesthesiologist can influence. Aim: The major aim of the present study is to compare the efficacy of perineural dexamethasone as an adjuvant for bupivacaine versa bupivacaine alone on bilateral transverse abdominis plan block for pain control after cesarean section for patients undergoing spinal anesthesia. Method: This prospective, randomized, double-blinded, placebo-controlled trial, 80 women ASA II scheduled for caesarean section, followed by TAP block. The participants were randomized into two groups, Group (1) received mixture of 1ml dexamethasone (4 mg) added to 20 ml bupivacaine 0.25% for each side. Group (2) received 1ml normal saline 0.9% added to 20 ml bupivacaine 0.25% for each side, then the patients were observed postoperatively for 24 h for first rescue analgesic requirement, total rescue analgesic consumption, pain scores on the visual analogue scale (VAS), and the incidence of other complications (nausea, vomiting and shivering). Results: Data on demographics are comparable between the TABD and the TABA groupings. The first request analgesia mean in minutes in the TABA group (359.08 ± 12.86) is considerably lower than the first request analgesia mean in the TABD group (mean = 521.25), with a P-value of 0.001 for the test. When compared to the TABA group, the postoperative VAS score at rest was considerably lower in the TABD group. The findings indicate that, over the entire study period, the TABA group's mean VAS scale at rest (mean = 3.1) is substantially greater than the TABD group's mean VAS scale (mean = 2.2), P = 0.001. In addition, the TABA group's mean VAS score (mean = 3.19) when coughing is substantially greater than the TABD group's mean (mean = 2.39), with a P-value of 0.001 for the test. Conclusion: In patients undergoing cesarean section under spinal anesthesia, perineural dexamethasone 8 mg given to bupivacaine (40 ml (20 ml each side), 0.25%) is an effective adjuvant to bupivacaine on bilateral TAP block with extended and powerful analgesia that delayed the time to the first analgesic request and decreased the intensity of postoperative pain without side effects. Keywords: Cesarean Section; Dexamethasone; Pain; Transversus Abdominis Plane Block.
- ItemEFFECTS OF TWO DIFFERENT DOSE REGIMENS OF PROPOFOL ANESTHESIA ON SEIZURE ACTIVITY AND HEMODYNAMICS DURING ELECTROCONVULSIVE THERAPY FOR PSYCHIATRIC PATIENTS: A PROSPECTIVE, RANDOMIZED, OPEN-LABELED, AND CROSSOVER TRIAL(2023-09-13) Mohammad Shaban Abdulrahman HajBackground: Anesthesia is essential for the safety and efficiency of electroconvulsive therapy (ECT). While propofol is widely used as an anesthetic agent for ECT, there are concerns that it produces a dose-dependent reduction in seizure activity. Objectives: the study aimed to determine a therapeutic propofol dose for optimal ECT outcome by comparing two propofol doses and assessing their effects on seizure activity, hemodynamics, and clinical impacts over ECT. Methods: The researcher adopted a prospective randomized crossover design to evaluate 25 patients with different psychiatric disorders undergoing two sequential ECTs. Patients were randomly allocated to receive either 1 or 1.5 mg/kg of propofol on the first session of the study. In the subsequent session, the other dose was used. A total of 50 ECT sessions were divided into two groups. LP: low dose propofol (1 mg/kg) and HP: high dose propofol (1.5 mg/kg). Succinylcholine 0.6 mg/kg was given to all patients for neuromuscular blockade. Seizure duration (motor and electroencephalogram), hemodynamic parameters (systolic blood pressure, mean arterial pressure, and heart rate), recovery profile (return of spontaneous breathing, eye-opening, obeying verbal command and ambulation), adverse events, agitation, and patient satisfaction score, were recorded. Results: LP was associated with a significantly longer motor (P <0.002) and electroencephalogram seizure duration (P <0.001) and a significant increase in the incidence of optimal seizure duration compared with HP. Systolic blood pressure and mean arterial pressure were recorded at 0, 2, and 5 minutes after the seizure ended and were higher following LP. Time to obey verbal commands and ambulation was significantly longer (P <0.05) following LP. Headache was the most obvious adverse effect following ECT, especially following LP. Agitation and satisfaction scores were comparable following the two administered doses. Conclusions: Seizure activity and hemodynamics were optimized following LP. The duration of the ECT-induced seizure is the primary determinant of early recovery rather than the propofol dose. In conclusion, the researcher recommends using 1 mg/kg of propofol as it optimizes seizure activity. Further studies are recommended to investigate more anesthetic agents related to ECT practice with a larger sample and consider age-related dosing. Keywords: Propofol, anesthesia, electroconvulsive therapy, Seizure.
- ItemCOMPARISON OF POST-OPERATIVE AGITATION BETWEEN INHALATIONAL ANESTHESIA AND TOTAL INTRAVENOUS ANESTHESIA IN CHILDREN UNDERGOING TONSILLECTOMY\ ADENOIDECTOMY.(2022-09-13) Ibrahim SwaitiBackground: Tonsillectomy is a surgical procedure performed with or without adenoidectomy that completely removes the tonsil, a common complication in children undergoing general anesthesia is postoperative agitation. Aim: To compare the effect of inhalation anesthesia (sevoflurane) and total intravenous anesthesia (TIVA) by using propofol on postoperative emergence agitation in pediatric patients undergoing tonsillectomy/adenoidectomy. Methods: 80 children between the ages of 3 and 10 who were classified as ASA I and II received elective tonsillectomy/adenoidectomy as part of this prospective randomized, controlled, double-blinded research. The subjects were divided into two anesthetic groups at random: group 1 (P) Propofol (experiment group), which included 40 patients, and group 2 (S) Sevoflurane (control group), which included the same number of patients. A bolus injection of 3 mg/kg of propofol was used to produce anesthesia in group 1 (P), and a propofol infusion at a rate of 100–250 µg/kg/min was used to maintain it. Sevoflurane 7% was used to induce anesthesia in group 2(S), which was then maintained with 1MAC sevoflurane according to this age group and a bolus dose of 3 mg/kg of propofol was given at induction. Results: The mean of SAS in group S (Mean=4.55) is significantly higher than the mean of SAS in group P (Mean=3.83), P= <0.001. According to this, patients in the S group exhibit higher emerging agitation than those in the P group. The mean of VAS_P in group S (Mean=1.75) is significantly higher than the mean of VAS_P in group P (Mean=0.8), p=0.037. And the incidence of pain in the area of surgery cases in group S (N=40, P=100%) is significantly higher than the incidence of pain in group P (N=28, P=70%), P= 0.032, this demonstrates that the S group has a higher incidence and severity of pain than the P group. The mean of VAS_N in group S (Mean=1.69) is significantly higher than the mean of VAS_N in group P (Mean=0.55), P= 0.004. And the incidence of nausea in group S (N=19, P=48%) is significantly higher than the incidence of nausea in group P (N=8, P=20%). Regarding the incidence of vomiting in group S (N=12, P=30%) is significantly higher than the incidence of vomiting in group P (N=1, P=3%), P= 0.001. The incidence of retching in group S (N=8, P=20%) is significantly higher than the incidence of retching in group P (N=2, P=5%), this shows that the S group experiences nausea, vomiting, and retching more frequently and intensely than the P group. The incidence of drowsiness / dizziness in group S is significantly higher than the incidence of the drowsiness/dizziness in group P (N=3, P=8%), P= 0.001. Conclusions: In comparison to inhalational anesthesia with sevoflurane, total intravenous anesthesia with propofol decreased the likelihood of postoperative emergence of agitation, intensity of nausea, vomiting, retching, bleeding, hunger, thirsty and drowsiness/dizziness in children patients following tonsillectomy/adenoidectomy. Keywords: Tonsillectomy, Adenoidectomy, Total intravenous anesthesia (TIVA) Inhalational anesthesia, Sevoflurane, propofol, Emergence of Agitation, Nausea, Vomiting.
- ItemDose Response Study of Intrathecal Fentanyl Added to Bupivacaine in Patients Undergoing Elective Caesarean Section in Spinal Anesthesia(An-Najah National University, 2020-01-16) Yahya, AhedBackground Applying spinal anesthesia for caesarean sections associated with a certain side effect such as hypotension caused by the dose of hyperbaric bupivacaine, additives of potent opioid such as fentanyl may reduce the dose of toxic local anesthesia which will be more hemodynamic stability and also enhance of adequate analgesia. Aims This study conducted in order to evaluate the side effects of four spinal solutions in purpose of finding best possible combinations of fentanyl and bupivacaine, comparing the efficiency and safety of this combinations by using different doses of fentanyl in spinal anesthesia in cesarean section, and assessing the side effects, duration of analgesia, hemodynamic parameters and neonatal outcomes by using an Apgar score. Methods One hundred sixty Patients randomized into four groups 40 of each : Group-I (F10): received 1.5ml (7.5mg) of 0.5% Bupivacaine heavy & 10μg Fentanyl .Group-II (F15): received 1.5ml (7.5mg) of 0.5% Bupivacaine heavy & 15μg Fentanyl .Group-III (F25): received 1.5ml (7.5mg) of 0.5% Bupivacaine heavy & 25μg Fentanyl and (control group ). Group-IV (B10): received 2 ml (10mg) of 0.5% Bupivacaine heavy and saline containing no fentanyl. Side effects such as: nausea, vomiting, bradycardia, hypotension episodes, headache, pruritis, shivering, drowsiness, restlessness, dizziness, sedation, patients’ satisfaction, analgesic requirements and duration of effective analgesia were evaluated. Moreover, onset and duration of sensory and motor block were measured. Results Similar distribution of age, height, weight and duration of surgery as evidenced by statistical analysis, The results show that there was significant differences at the level (p ≤ 0.05) in comparison between B10 only and Fentanyl 10mcg, Fentanyl 15mcg and Fentanyl 25mcg related to the onset of sensory blockade to T10 and T6 and indicate fentanyl 25 mcg more fast onset of sensory block. Onset of motor block was earlier in bupivacaine 10 mg group in comparison with other three groups, which is statistically significant difference. According to bradycardia, there were no significant differences between groups. Hypotension episodes in bupivacaine 10mg more common mean (3.12), which is statistically significant difference when compared to other three groups. Incidence of headache was decreased in fentanyl groups in comparison with B10 group but there were no significant differences between the groups. There were significant differences regarding the incidence of pruritis in fentanyl 25 mcg (9/40) and fentanyl 15 mcg (6/40) groups when compared to B10. Nausea and vomiting were observed in B10 group while decreased significantly in other three groups. According to Restlessness, sedation and respiratory depression, there were no significant differences between all groups. There were no significant differences in Apgar scores at 1 and 5 min. The duration of sensory block was prolonged significantly in fentanyl groups. Duration of motor blocked was decreased significantly with decrease Bupivacaine dose and early motor recovery was observed significantly in fentanyl groups compared to B10 group. Duration of effective analgesia increased as increased fentanyl dose which was statistically significant difference in all fentanyl groups compared to B10 group. Regarding to postoperative analgesic needed, significant differences were found in all fentanyl groups in comparison to control group, fentanyl 25 mcg more significant and less rescue analgesic requirements in post-operative period by mean (1.85 ) followed by fentanyl 15 ( 2.3) mcg then B10 (2.37) and fourthly fentanyl 10 mcg (2.42 ) . Conclusion Addition of Fentanyl was effective with minimal side effects; also it improves the quality of anesthesia, prolongs the duration of sensory block, faster onset of sensory block and significantly reduces post-operative rescue analgesic needed, also better hemodynamic stability. Where 0.5% bupivacaine 10 mg alone faster of onset of motor blocked and prolonged of duration of motor blocked. Finally we conclude and recommend of best combination in spinal anesthesia for elective cesarean section is fentanyl 25 mcg with 0.5% bupivacaine 7.5 mg because it was superior in duration of effective analgesia and less post-operative rescue analgesic needed also more patients’ satisfaction, however may have less side effect in fentanyl 10 mcg and 15 mcg groups. In conclusion fentanyl 25 mcg with 0.5% bupivacaine 7.5 mg is more favorable.
- ItemThe effect of alkalized lidocaine, dexamethasone, and their combination versus air in the endotracheal tube cuff to evaluate post-extubation morbidity in smoker patients undergoing laparoscopic surgery. A double blind randomized control study(ِAn-Najah National University, 2019-01-10) Zagharneh, Islamالمزيج بين الليدوكائيين القلوي والديكساميثازون داخل كفة الأنبوب الرغامي لديه الافضليه والفائدة في تقليل حدوث السعال في مرحلة الافاقه. الليدوكايين القلوي والخليط بين الليدوكائيين القلوي والديكساميثازون متساويين في تقليل حدوث السعال وتقرح الحلق وبحة الصوت في جميع المراحل ابتداء من ساعتين بعد وحدة ما بعد التخدير وحتى 24 ساعة . الديكساميثازون ليس ذو فائدة في تقليل حدوث تقرح الحلق عند الساعتين و8 ساعات بعد وحدة ما بعد التخدير وكذلك ليس ذو فائدة في تقليل بحة الصوت عند الثمان ساعات. ولكنه يمتلك نفس التأثير لتقليل حدوث السعال تماما مثل الليدوكائيين القلوي والخليط بين الليدوكائيين القلوي والديكساميثازون. بالنسبة لشدة حدوث الأعراض /السعال/ وتقرح الحلق/ وبحة الصوت. فان المجموعات الثلاث /الليدوكائيين القلوي/ والديكساميثازون/ والخليط بين الليدوكائيين القلوي والديكساميثازون أفضل من الهواء لتقليل شدة الأعراض عند وقت الساعتين بعد وحدة ما بعد التخدير. بالنسبة لشدة حدوث بحة الصوت فان الليدوكائيين القلوي هو الأفضل لتقليله. الليدوكائيين القلوي والخليط بين الليدوكائيين القلوي والديكساميثزون يعمل على تحسين انسجام القصبة الهوائية للأنبوب الرغامي ويجعل عملية نزع الأنبوب أكثر سهوله. وبشكل عام نستطيع القول أن الليدو كائيين القلوي والخليط بين الليدوكائيين القلوي والديكساميثازون داخل كفة الأنبوب الرغامي أفضل من الديكساميثازون والهواء. ولا يوجد فرق بين الليدوكائيين القلوي والخليط بين الليدوكائيين القلوي والديكساميثازون. تطبيقات تمريض التخدير: المزيج بين الليدوكايين القلوي والديكساميثازون أو الليدوكايين القلوي لوحده داخل كفة الأنبوب الرغامي يؤدي إلى تأثيرات جيده لمنع حدوث اعتلالات القصبة الهوائية )السعال وتقرح الحلق وبحة الصوت( بعد نزع الأنبوب. بالإضافة إلى جعل عملية نزع الأنبوب أكثر سهوله واقل خطورة. الكلمات المفتاحية: التدخين. الليدوكائين. الديكساميثازون. السعال. بحة الصوت. تقرح الحلق.