Articles: operative.
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Minerva anestesiologica · Oct 2024
Efficacy of ultrasound-guided bilateral rectus sheath block vs. local anesthetic infiltration in gynecologic oncology patients undergoing midline laparotomy: a triple-blinded randomized controlled trial.
Postoperative pain is a serious problem in gynecological oncology patients. Rectus sheath block (RSB) is increasingly utilized as a part of multimodal analgesia. The purpose of this three blinded, randomized-controlled trial is to compare the analgesic efficacy of ultrasound-guided (US-guided) bilateral rectus sheath block (BRSB) and local anesthetic wound infiltration (LAWI) application in patients undergoing midline laparotomy for gynecologic cancer. ⋯ The US-guided BRSB is a safe and feasible technique. This technique resulted in reduced postoperative pain scores, decreased tramadol usage, and prolonged pain relief compared to LAWI.
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Anesthesia and analgesia · Oct 2024
A Randomized, Controlled Trial of Palonosetron Versus Ondansetron for Nausea, Vomiting, and Pruritus in Cesarean Delivery with Intrathecal Morphine.
Spinal anesthesia is the preferred anesthetic technique for cesarean deliveries. Postoperative nausea and vomiting (PONV) and pruritus occur in up to 80% and 83% of patients, respectively, after cesarean delivery with intrathecal opioids. Ondansetron is the recommended medication for PONV prophylaxis, but palonosetron, a second-generation 5-HT3 receptor antagonist, has a higher receptor affinity and a longer half-life. However, studies on palonosetron use in cesarean deliveries are limited. This study aimed to determine whether palonosetron was more effective than ondansetron in preventing intrathecal morphine-induced PONV and pruritus in cesarean deliveries. ⋯ Palonosetron effectively prevents intrathecal morphine-induced PONV and pruritus during cesarean delivery. However, the efficacy of palonosetron is not significantly different from that of ondansetron.
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Postoperative nausea and vomiting (PONV) is common after general anesthesia, with consequences for patient outcomes, satisfaction with care and healthcare costs. Our aim was to compare a new treatment, chewing gum, with a widely-used intravenous agent, ondansetron, to treat PONV in female patients in the post anesthesia care unit (PACU). ⋯ Chewing gum cannot be recommended as an alternative to ondansetron for treatment of PONV in female patients administered antiemetic prophylaxis.
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Clinical comparisons between intertransverse process block (ITPB) and erector spinae plane block (ESPB) are lacking. ⋯ Although ITPB demonstrated more consistent anterior dermatomal spread and improved immediate postoperative analgesia compared to ESPB, no additional benefits were identified for breast cancer surgery. Future studies may investigate the potential of ITPB for surgical anaesthesia.
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Anesthesia and analgesia · Oct 2024
The Utility of Electroencephalograhy in Guiding General Anesthesia in Children.
Traditional pediatric anesthetic dosing using pharmacokinetic estimates based on age and weight is often imprecise, frequently leading to oversedation. Intraoperative electroencephalography (EEG) allows visualization of the brain's response to anesthetic agents in real time, facilitating precise titration of anesthetic drug doses optimized for the individual child. The goal of EEG-guided anesthesia management is to maintain an optimal state of hypnosis during various stages of the procedure while minimizing hemodynamic instability and other adverse effects of anesthesia. ⋯ We describe the use of nonproprietary EEG parameters in guiding anesthesia in children for various clinical end points including laryngoscopy, surgical incision, and maintenance of anesthesia, as well as sedation. We illustrate these principles with various case examples commonly encountered during pediatric anesthesia. Lastly, we discuss strategies to expand intraoperative EEG monitoring in children through education and training programs, as well as advocate for further research to assess clinical outcomes associated with EEG guidance to support its routine use in clinical care.