Nurse Anesthesia
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- ItemCOMPARING THE USE OF IDOCAINE WITH NITROGLYCERIN VERSUS LIDOCAINE FOR PATIENTS UNDERGOING CARDIAC CATHETERIZATION FROM A RADIAL ROUTE IN TERMS OF PAIN INTENSITY, PATIENT SATISFACTION, AND SIDE EFFECTS(An-Najah National University, 2024-04-10) Qadous, MohammadCardiac catheterizations are specific and complex procedures that are performed either as therapeutic or diagnostic approaches in ischemic heart disease and coronary artery disease. Despite their undisputable benefits, they can also be associated with procedural and post-procedural complications including bleeding, hematoma, pain, radial artery spasms, and occlusion. This study was conducted to investigate and compare the effects of adding nitroglycerin to lidocaine compared to lidocaine for patients undergoing cardiac catheterization from a radial route. This was a single-center prospective randomized double-blind study that was conducted among patients scheduled for trans-radial cardiac catheterization. The interventional cardiologist and the patient were blinded to the type of anesthesia. The patients were assigned to receive either the intervention (Group A) or the standard treatment (Group B, control). The intervention consisted of subcutaneous 40 mg of lidocaine with 200 µg of nitroglycerin and intra-arterial 200 µg of nitroglycerin. The standard treatment (control) consisted of subcutaneous 40 mg of lidocaine and intra-arterial 200 µg of nitroglycerin. The assignment was made randomly. A total of 100 patients were selected randomly and distributed into two groups: 50 patients were allocated to Group A and 50 patients were allocated to Group B. The study patients in both groups were not different in demographic, clinical, and procedural variables (P-value > 0.05). In this study, the addition of nitroglycerin caused significantly less paleness and coldness as an indication of causing less ischemia to the hand (P-value < 0.05). Additionally, the patients who received nitroglycerin in addition to lidocaine reported statistically significant higher satisfaction compared to the patients who received lidocaine (P-value < 0.05). The findings of this study demonstrated that adding nitroglycerin to lidocaine significantly decreased indicators of hand ischemia as indicated by reduced paleness and coldness. Additionally, adding nitroglycerin to lidocaine significantly increased patient satisfaction. There were no statistically significant differences or increases in puncture time and duration of the intervention. The findings reported in this study might be used by interventional cardiologists and other healthcare providers to improve the provision of trans-radial cardiac catheterization care by reducing complications and improving the safety and recovery of patients. Based on the findings of this study, interventional cardiologists are recommended to add nitroglycerin to lidocaine to reduce hand ischemia and improve patient satisfaction.
- ItemONDANSETRON VERSUS KETOROLAC WITH ONDANSETRON FOR THE PROPHYLAXIS OF POSTOPERATIVE NAUSEA AND VOMITING IN PEDIATRIC PATIENTS UNDERGOING STRABISMUS SURGERY(An-Najah National University, 2024-05-27) Osama Mohammed SholiBackground: Nausea and vomiting after strabismus surgery are frequent side effects that can cause electrolyte imbalance, dehydration, sub-conjunctival hemorrhage, and problems with surgical attachment. These ailments may necessitate re-admission, lengthen post-anesthesia care, and increase hospital stays and expenses. Aims: Evaluating the effects of Ondansetron by itself versus Ondansetron plus Ketorolac on pain thresholds, the frequency of postoperative nausea and vomiting, and the consequent requirement for rescue antiemetic and analgesic drugs in pediatric strabismus patients. Methods: Seventy pediatric patients (ASA I and II, ages 3 to 12) were split into two groups for elective strabismus surgery under general anesthesia: 40 for Ondansetron and 30 for Ondansetron plus Ketorolac. Postoperative nausea, vomiting, pain, and need for rescue medication were assessed from 30 minutes to 8 hours. Results: Results from the PACU showed that the Ondansetron group (n=13, 32.5%) had a substantially higher incidence of surgical site pain than the combined Ondansetron and Ketorolac group (n=3, 10%; p= 0.042). Nevertheless, there were no significant variations between the two groups in terms of postoperative nausea, vomiting, retching, or the need for rescue drugs. In the pediatric ward, all of the complications are significantly lower in prevalence in the combined group compared to the ondansetron group, including vomiting (0.0% vs 22.5%), p-value = 0.008), nausea (6.7% vs 32.5%, p-value = 0.017), retching (0.0% vs 22.5%, p-value = 0.008), surgical site pain (13.3% vs 42.5%, p-value = 0.009), use of analgesics (6.7% vs 35.0%, p-value = 0.008) and rescue antiemetic (0.0% vs 27.5%, p-value = 0.002), respectively. In 8 hours postoperatively, there is a significantly lower incidence in the combined group compared to the ondansetron group in terms of nausea (0.0% vs 10%, p-value = 0.013), retching (0.0% vs 10%, p-value = 0.013), and the use of rescue medications (0.0% vs 10%, p-value = 0.013), while no significant differences in the Incidence of vomiting (0.0% vs 7.5%, p-value = 0.125) and use of analgesics (3.3% vs 10%, p-value = 0.284), respectively. Conclusion: Ketorolac, administered as an adjuvant to Ondansetron in pediatric strabismus patients, has been shown to reduce pain and the subsequent need for analgesics and rescue antiemetic drugs, as well as postoperative nausea and vomiting. Keywords:
- 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.