Volume 4 Issue 1
Research Article: Comparative Study of Intravenous Esmolol & Magnesium Sulphate in Attenuating Hemodynamic Response during Laryngoscopy & Endotracheal Intubation in Patients Undergoing Valvular Heart Surgery: a Randomised Clinical Trial
Indu Verma1*, CK Vyas2, Reema Meena2, Anjum Saiyed2 and Anita Meena2
The present study aimed to compare the effectiveness of esmolol & magnesium sulphate in attenuating the hemodynamic response to endotracheal intubation and to note any significant side effects caused by these drugs.
Background: Induction with endotracheal intubation in patients undergoing valvular heart replacement pose lot of hemodynamic variations. Obtunding hemodynamic response which can be deleterious in such patients pose a challenge to the cardiac anaesthetist. We hypothesized that using esmolol as compared to magnesium sulphate will attenuate the hemodynamic response during laryngoscopy & endotracheal intubation in patients undergoing valvular heart replacement.
Methods: This was a double blind, randomised, single centre, interventional, prospective study. In this study 96 patients were divided into two groups with 48 patients each (n = 48) by sealed enveloped method of randomisation. Group E received esmolol 1.5 mg/ kg i.v and Group M received magnesium sulphate 50 mg/ kg i.v each diluted in normal saline to make up a volume of 50 ml & given via infusion slowly over 5 minutes by a burette set. Hemodynamic parameters like Heart Rate (HR), Mean Arterial Pressure (MAP), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) at baseline, 5 minutes after premedication, just before intubation 3, 5, 10 & 15 minutes post intubation were recorded. The last observation at the end of 15 minutes post intubation was considered as the end of study.
Results: All the enrolled patients were analyzed. The esmolol group showed a decrease in the H.R from baseline (86.13 ± 15.87) as compared to magnesium sulphate (98.51 ± 16.81 with a 95% CI, 4.62-4.69, p value < 0.001) 5 minute after premedication. There was statistically significant difference in H.R between both groups 5 minutes after drug administration.
Conclusion: Administration of esmolol before intubation in valvular heart patients undergoing valve replacement surgery controls the hemodynamic response much better as compared to magnesium sulphate.
Keywords: Esmolol; Hemodynamic response; Magnesium sulphate; Valvular heart replacement
Cite this Article: Verma I, Vyas CK, Meena R, Saiyed A, Meena A. Comparative Study of Intravenous Esmolol & Magnesium Sulphate in Attenuating Hemodynamic Response during Laryngoscopy & Endotracheal Intubation in Patients Undergoing Valvular Heart Surgery: a Randomised Clinical Trial. Am J Anesth Clin Res. 2018;4(1): 025-030.
Published: 06 December 2018
Review Article: Spinal Cord Stimulation Costs and Complications can be reduced by Wireless Nanotechnology. A Review of Traditional Equipment Expenses Compared to Wireless Stimulation
Laura Tyler Perryman*
Background: Spinal Cord Stimulation (SCS) has been a cost-effective therapeutic approach for controlling chronic pain, following spinal surgery, peripheral neuropathy, complex regional pain syndromes and others. However, the surgically implantable nature of Traditional SCS (TSCS) components not only increased the surgical complications but also the costs associated with the device. Wireless SCS (WSCS) access to the implanted nanoelectrode can reduce the bulk of the equipment thus improving patient acceptance with fewer surgical complications as well as low costs.
Objective: Review of the literature on costs of TSCS compared to the costs of novel SCS with wireless technology.
Material and Results: A review of the available limited literature on TSCS costs show that implantation incurred USD 32,882 (CAD 21,595 and UK £ 15,081) while expenditure for WSCS was 18,000 Euro. Further analysis revealed that costs for 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 a 3-year maintenance costs of 1500 Euros only.
Additionally, the Wireless SCS (WSCS) was equally effective and without the added complications of IPG that included pocket area pain, hematoma (10%) and infection (50% of infections following TSCS implantation). Management of IPG complications costs additional health care budget, while with WSCS, this could be an avoidable burden. WSCS has been reported to be as effective as TSCS in management of chronic pain following back surgery, herpes infection and complex regional pain syndrome in case illustrations.
Conclusions: SCS has been an established tool in effective management of chronic pain. TSCS equipment costs more and includes IPG costs between 13,000 and 20,000 USD with a maintenance expense of 3,539 USD over 4 years (for battery change) while WSCS had been reported to have nearly half of this maintenance cost for SCS therapy and without IPG costs and complications.
Keywords: Spinal cord stimulation; Chronic pain; Implantable power generator; Costs; wireless
Cite this Article: Laura Tyler Perryman. Spinal Cord Stimulation Costs and Complications can be reduced by Wireless Nanotechnology. A Review of Traditional Equipment Expenses Compared to Wireless Stimulation. Am J Anesth Clin Res. 2018;4(1): 019-024.
Published: 28 November 2018
Case Report: Anesthetic Management for Anterior Mediastinal Mass with Strong Family History of Malignant Hyperthermia
Waleed Elmatite*, Surjya Upadhyay, Waseem Alfahel, Ramiro Mireles, Robert Ramsdell and Stacey Watt
Anesthesia for children with anterior mediastinal masses can present life-threatening and hemodynamic challenges in the perioperative period. We encountered a two-year-old child with a family history of malignant hyperthermia and a symptomatic anterior mediastinal mass due to significant airway compression. This case report describes an alternative technique of airway management by keeping the child breathing spontaneously without using inhalational anaesthetics and discusses other potential airway management techniques.
Cite this Article: Elmatite W, Upadhyay S, Alfahel W, Mireles R, Ramsdell R, et al. Anesthetic Management for Anterior Mediastinal Mass with Strong Family History of Malignant Hyperthermia. Am J Anesth Clin Res. 2018;4(1): 015-018.
Published: 16 July 2018
Review Article: Predicting Perioperative Fluid Responsiveness in Pediatric Patients; how it Differ from the Adults?
Waleed Elmatite1 and Surjya Upadhyay2*
Accurate Prediction of fluid responsiveness can be challenging, particularly in children. Although, fluid administration is the main stay of resuscitation during pediatric surgery associated with significant blood or third space loss, volume overload is frequently encountered in small children and is often associated with adverse outcomes. The parameters used to assess fluid responsive are basically classified into two categories, static and dynamic parameters. Static parameters like central venous pressure measurement are slowly becoming unpopular and are replaced by dynamic parameters which rely on the heart-lung interactions are more accurate predictors of fluid responsiveness. Unlike adults, there are insufficient data on the efficacy of dynamic variables for the prediction of fluid responsiveness in children. In this review article we discuss the strengths and limitations of both the static and dynamic parameters for assessing the fluid responsiveness in the perioperative period in pediatric patients.
Keywords: Fluid responsiveness; Pediatric surgery; Dynamic parameters; Static parameters
Cite this Article: Elmatite W, Upadhyay S. Predicting Perioperative Fluid Responsiveness in Pediatric Patients; how it Differ from the Adults? Am J Anesth Clin Res. 2018;4(1): 008-014.
Published: 04 July 2018
Brief Communication: Current Faults and Recommendations for Transfusion of Red Blood Cell Assessment and Clinical Evaluation of Changes in Hematocrit
Andrey Belousov*
The focus of the article is situated on current faults and recommendations for transfusion of red blood cell assessment and clinical evaluation of changes in hematocrit. The main task of therapy for acute massive blood loss is not urgent thoughtless transfusion of red blood cells for the fast recovery of the hemoglobin and hematocrit levels. The oxygen-carrying capacity of blood does not directly reflect the delivery of oxygen to tissues. The severity of the patient's condition depends on the individual ability of the organism to resist hypoxia, mechanisms resulting in physiological compensation for the anemia caused by blood loss. The main tasks of therapy are timely maintaining appropriate and effective compensatory-adaptive reactions of an organism and providing of the sanogenetic processes. Quickly and comfortable algorithm assessment changes in hematocrit were presented for use in practice. Objective analysis of hematocrit and hemoglobin levels should be carried out only in combination with data on blood pressure, pulse rate, respiratory rate, urine output and shock index.
Cite this Article: Belousov A. Current Faults and Recommendations for Transfusion of Red Blood Cell Assessment and Clinical Evaluation of Changes in Hematocrit. Am J Anesth Clin Res. 2018;4(1): 001-007.
Published: 14 April 2018
Kristy Kehoe, Kirsty Hudson, Joanna Janczyk, Sharon Yen Ming Chan, Ben Cooper and Bryce Renwick*
Objective: To elicit the efficacy of hybrid thrombectomy procedures for renal access salvage.
Background: Fistula thrombosis is a well recognised complication of patients undergoing haemodialysis. Salvage of thrombosed fistulae requires urgent intervention. Hybrid thrombectomy and fistuloplasty procedures require the coordinated efforts of the anesthetic, interventional radiology and vascular surgical teams.
Methods: All emergency renal access referrals made to a renal access unit over a 12 month period were analysed. 21 patients in total underwent a combined or hybrid thrombectomy of thrombosed fistula.
Results: We found that prosthetic graft thrombosis accounted for the majority of thrombosed fistulae and moreover, were much more likely to re-thrombose following salvage relative to primary vein fistula. The number of patients subsequently undergoing dialysis on the same fistula successfully at 3 and 6 months dropped significantly.
Conclusion: When combined with significant re-intervention rate, these findings are suggestive of a need for enhanced renal access surveillance, more so in prosthetic grafts.
Keywords: Hybrid thrombectomy; Renal Salvage; Haemodialysis
Cite this Article: Kehoe K, Hudson K, Janczyk J, Ming Chan SY, Renwick B, et al. Logistic Challenges in Renal Access Salvage. Am J Anesth Clin Res. 2018;4(1): 001-003.
Published: 10 March 2018
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