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Hasan D, Shono A, van Kalken CK, van der Spek PJ, Krenning EP, Kotani T. A novel definition and treatment of hyperinflammation in COVID-19 based on purinergic signalling. Purinergic Signal 2021; 18:13-59. [PMID: 34757513 PMCID: PMC8578920 DOI: 10.1007/s11302-021-09814-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/18/2021] [Indexed: 12/15/2022] Open
Abstract
Hyperinflammation plays an important role in severe and critical COVID-19. Using inconsistent criteria, many researchers define hyperinflammation as a form of very severe inflammation with cytokine storm. Therefore, COVID-19 patients are treated with anti-inflammatory drugs. These drugs appear to be less efficacious than expected and are sometimes accompanied by serious adverse effects. SARS-CoV-2 promotes cellular ATP release. Increased levels of extracellular ATP activate the purinergic receptors of the immune cells initiating the physiologic pro-inflammatory immune response. Persisting viral infection drives the ATP release even further leading to the activation of the P2X7 purinergic receptors (P2X7Rs) and a severe yet physiologic inflammation. Disease progression promotes prolonged vigorous activation of the P2X7R causing cell death and uncontrolled ATP release leading to cytokine storm and desensitisation of all other purinergic receptors of the immune cells. This results in immune paralysis with co-infections or secondary infections. We refer to this pathologic condition as hyperinflammation. The readily available and affordable P2X7R antagonist lidocaine can abrogate hyperinflammation and restore the normal immune function. The issue is that the half-maximal effective concentration for P2X7R inhibition of lidocaine is much higher than the maximal tolerable plasma concentration where adverse effects start to develop. To overcome this, we selectively inhibit the P2X7Rs of the immune cells of the lymphatic system inducing clonal expansion of Tregs in local lymph nodes. Subsequently, these Tregs migrate throughout the body exerting anti-inflammatory activities suppressing systemic and (distant) local hyperinflammation. We illustrate this with six critically ill COVID-19 patients treated with lidocaine.
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Affiliation(s)
| | - Atsuko Shono
- Department of Anaesthesiology and Critical Care Medicine, School of Medicine, Showa University, Tokyo, 142-8666, Japan
| | | | - Peter J van der Spek
- Department of Pathology & Clinical Bioinformatics, Erasmus MC, Erasmus Universiteit Rotterdam, 3015 CE, Rotterdam, The Netherlands
| | | | - Toru Kotani
- Department of Anaesthesiology and Critical Care Medicine, School of Medicine, Showa University, Tokyo, 142-8666, Japan
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Gao Y, Yan F. Comparison of Intra and Post-operative Sedation efficacy of Dexmedetomidine-Midazolam and Dexmedetomidine-Propofol for Major Abdominal Surgery. Curr Drug Metab 2021; 23:45-56. [PMID: 34732114 DOI: 10.2174/1389200222666211103121832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The effectiveness and side effects of dexmedetomidine (DEX) in combination with midazolam and propofol have not been comparatively studied in a single clinical trial as sedative agents to general anesthesia before. OBJECTIVE The objective of this study is to compare intra and post-operative sedation between DEX-Midazolam and DEX-Propofol in patients who underwent major abdominal surgery on the duration of general anesthesia, hemodynamic and sedation effect. METHOD This prospective, randomized, double-blinded clinical trial included 50 patients who were 20 to 60 years of age and admitted for major abdominal surgery. The patients were randomly assigned by a computer-generated random numbers table to sedation with DEX plus midazolam (DM group) (n=25) or DEX plus propofol (DP group) (n=25). In the DM group, patients received a bolus dose of 0.1 mg/kg of midazolam and immediately initiated the intravenous (i.v.) infusion of DEX 1 µg/kg over a 10 min and 0.5 µg/kg/hr by continuous i.v. infusion within operation period. In the DP group, patients received pre-anesthetic i.v. DEX 1 µg/kg over 15 min before anesthesia induction and 0.2-1 µg/kg/hr by continuous i.v. infusion during the operative period. After preoxygenation for at least 2 min, during the surgery, patients received propofol infusion dose of 250 μg/kg/min for 15 min then a basal infusion dose of 50 μg/kg/min. The bispectral index (BIS) value, as well as mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), oxygen saturation (SaO2), percutaneous arterial oxygen saturation (SpO2) and end-tidal carbon dioxide tension (ETCO2) were recorded before anesthesia (T0), during anesthesia (at 15-min intervals throughout the surgical procedure), by a blinded observer. Evidence of apnea, hypotension, hypertension and hypoxemia were recorded during surgery. RESULTS The hemodynamic changes, including HR, MAP, BIS, VT, SaO2, and RR had a downward tendency with time, but no significant difference was observed between the groups (P>0.05). However, the two groups showed no significant differences in ETCO2 and SPO2 values in any of the assessed interval (P>0.05). In this study, the two groups showed no significant differences in the incidence of nausea, vomiting, coughing, apnea, hypotension, hypertension, bradycardia and hypoxemia (P>0.05). Respiratory depression and serious adverse events were not reported in either group. Extubation time after surgery was respectively 6.3 ± 1.7 and 5.8 ± 1.4 hr. in the DM and DP groups and the difference was not statistically significant (P= 0.46). CONCLUSION Our study showed no significant differences between the groups in hemodynamic and respiratory changes in each of the time intervals. There were also no significant differences between the two groups in the incidence of complication intra and post-operative. Further investigations are required to specify the optimum doses of using drugs which provide safety in cardiovascular and respiratory system without adverse disturbance during surgery.
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Affiliation(s)
- Yuanyuan Gao
- Department of Anesthesiology, the second hospital of Yulin, Yulin, Shanxi Province. China
| | - Fei Yan
- Department of Anesthesiology, the Hospital of Traditional Chinese Medicine of Yulin, Yulin, Shanxi Province. China
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Han SR, Lee CS, Bae JH, Lee HJ, Yoon MR, Lee DS, Lee YS, Al-Sawat A, Shim JW, Hong SH, Lee IK. The additional analgesic effects of transverse abdominis plane block in patients receiving low-dose intrathecal morphine for minimally invasive colorectal surgery: a randomized, single-blinded study. Ann Surg Treat Res 2021; 101:221-230. [PMID: 34692594 PMCID: PMC8506017 DOI: 10.4174/astr.2021.101.4.221] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/09/2021] [Accepted: 09/01/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Intrathecal analgesia (ITA) and transverse abdominis plane block (TAPB) are effective pain control methods in abdominal surgery. However, there is still no gold standard for postoperative pain control in minimally invasive colorectal surgery. This study aimed to investigate whether the analgesic effect could be increased when TAPB, which can further reduce wound somatic pain, was administered in low-dose morphine ITA patients. Methods Patients undergoing elective colorectal surgery were randomized into an ITA with TAPB group or an ITA group. Patients were evaluated for pain 0, 8, 16, 24, and 48 hours after surgery. The primary outcome was the total morphine milligram equivalents administered 24 hours after surgery. The secondary outcomes were pain scores, ambulatory variables, inflammation markers, hospital stay duration, and complications within 48 hours after surgery. Results A total of 64 patients were recruited, and 55 were compared. There was no significant difference in morphine use over the 24 hours after surgery in the 2 groups (ITA with TAPB, 15.3 mg vs. ITA, 10.2 mg; P = 0.270). Also, there was no significant difference in pain scores. In both groups, the average pain score at 24 and 48 hours was 2 points or less, showing effective pain control. Conclusion ITA for pain control in patients with colorectal surgery is an effective pain method, and additional TAPB was not effective.
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Affiliation(s)
- Seung-Rim Han
- Division of Colorectal Surgery, Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Seung Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hoon Bae
- Division of Colorectal Surgery, Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyo Jin Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mi Ran Yoon
- Division of Colorectal Surgery, Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Do Sang Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Suk Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Abdullah Al-Sawat
- Division of Colorectal Surgery, Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia
| | - Jung-Woo Shim
- Department of Anesthesiology and Pain Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Hyun Hong
- Department of Anesthesiology and Pain Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Kyu Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Fernando H, Duong T, Huynh K, Noonan J, Shaw J, Duffy SJ, Nehme Z, Smith K, Myles PS, Meikle PJ, Peter K, Stub D. Effects of lignocaine vs. opioids on antiplatelet activity of ticagrelor: the LOCAL trial. Eur Heart J 2021; 42:4025-4036. [PMID: 34423354 DOI: 10.1093/eurheartj/ehab557] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/09/2021] [Accepted: 08/02/2021] [Indexed: 12/12/2022] Open
Abstract
AIMS We assessed the impact of intravenous fentanyl and lignocaine on the pharmacokinetics and pharmacodynamics of ticagrelor in patients with unstable angina and non-ST-elevation myocardial infarction and their procedural analgesic efficacy and safety. METHODS AND RESULTS Seventy patients undergoing coronary angiography with ticagrelor loading were included in the pharmacokinetic and pharmacodynamic analyses of this randomized trial. Plasma ticagrelor levels 2 h post-loading dose were significantly lower in the fentanyl arm than in the lignocaine treatment arm (598 vs. 1008 ng/mL, P = 0.014). The area under the plasma-time curves for ticagrelor (1228 vs. 2753 ng h/mL, P < 0.001) and its active metabolite (201 vs. 447 ng h/mL, P = 0.001) were both significantly lower in the fentanyl arm. Expression of activated platelet glycoprotein IIb/IIIa receptor (2829 vs. 1426 mean fluorescence intensity, P = 0.006) and P-selectin (439 vs. 211 mean fluorescence intensity, P = 0.001) was significantly higher at 60 min in the fentanyl arm. A higher proportion of patients had high on-treatment platelet reactivity in the fentanyl arm at 60 min using the Multiplate Analyzer (41% vs. 9%, P = 0.002) and 120 min using the VerifyNow (30% vs. 3%, P = 0.003) and VASP (37% vs. 6%, P = 0.002) assays. Both drugs were well tolerated with a high level of patient satisfaction. CONCLUSIONS Unlike fentanyl, lignocaine does not impair the bioavailability or delay the antiplatelet effect of ticagrelor. Both drugs were well tolerated and effective with a high level of patient satisfaction for procedural analgesia. Routine procedural analgesia during percutaneous coronary intervention should be reconsidered and if performed, lignocaine is a beneficial alternative to fentanyl.
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Affiliation(s)
- Himawan Fernando
- Department of Cardiology, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.,Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia.,Monash University, Wellington Road, Melbourne, Victoria 3800, Australia.,Department of Cardiology, Bendigo Health, 100 Barnard St, Bendigo, Victoria 3550, Australia
| | - Thy Duong
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - Kevin Huynh
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - Jonathan Noonan
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia.,Department of Cardiometabolic Health, University of Melbourne, 75 Commercial Road, Melbourne, Victoria 3004, Australia
| | - James Shaw
- Department of Cardiology, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.,Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia.,Monash University, Wellington Road, Melbourne, Victoria 3800, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.,Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia.,Centre of Cardiovascular Research and Education in Therapeutics (CCRE), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road Melbourne, Melbourne, Victoria 3004, Australia
| | - Ziad Nehme
- Monash University, Wellington Road, Melbourne, Victoria 3800, Australia.,Centre for Research and Evaluation, Ambulance Victoria, PO Box 2000, Doncaster, Victoria 3108, Australia
| | - Karen Smith
- Monash University, Wellington Road, Melbourne, Victoria 3800, Australia.,Centre for Research and Evaluation, Ambulance Victoria, PO Box 2000, Doncaster, Victoria 3108, Australia
| | - Paul S Myles
- Monash University, Wellington Road, Melbourne, Victoria 3800, Australia.,Department of Anaesthesiology and Perioperative Medicine, The Alfred and Monash University, 55 Commercial Road Melbourne, Melbourne, Victoria 3004, Australia
| | - Peter J Meikle
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia.,Monash University, Wellington Road, Melbourne, Victoria 3800, Australia.,Department of Cardiometabolic Health, University of Melbourne, 75 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Karlheinz Peter
- Department of Cardiology, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.,Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia.,Department of Cardiometabolic Health, University of Melbourne, 75 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.,Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia.,Monash University, Wellington Road, Melbourne, Victoria 3800, Australia.,Department of Cardiology, Western Health, 176 Furlong Rd, St Albans, Victoria 3021, Australia
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Mattevi C, van Coppenolle C, Selvy M, Pereira B, Slim K. Systematic review and meta-analysis of early removal of urinary catheter after colorectal surgery with infraperitoneal anastomosis. Langenbecks Arch Surg 2021; 407:15-23. [PMID: 34599682 DOI: 10.1007/s00423-021-02342-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022]
Abstract
AIM OF THE STUDY To review and to analyse the feasibility of using no urinary catheter or a catheter for less than 24 h compared with longer post-operative catheter after colorectal surgery with infraperitoneal dissection. METHODS We performed a systematic review and meta-analysis of studies comparing no urinary catheter or a catheter for less than 24 h (early removal, ER) and urinary catheter drainage for 2 days or longer (late removal, LR) after colorectal surgery with infraperitoneal dissection. Primary endpoint was acute urinary retention (AUR) requiring a re-catheterization. Secondary endpoints were urinary tract infection (UTI), overall morbidity and hospital length of stay. Meta-analysis met the PRISMA criteria, with a random model. RESULTS Out of 3659 articles found, 82 comparative studies on catheter duration were selected, of which five were in colorectal surgery: three randomized trials, one retrospective and one prospective series. There were 396 ER and 410 LR patients. All had undergone surgery with infraperitoneal dissection. There was no significant difference regarding AUR (OR = 2.09 [95%CI 0.97-4.52]) but significantly less UTI (OR = 0.39 [95%CI 0.22-0.67]) for early urinary catheter removal. The number needed to harm was much higher for AUR than for UTI (23.3 vs. 8). CONCLUSION This meta-analysis suggests that, in terms of benefit/risk ratio, in colorectal surgery with infraperitoneal anastomosis, early removal (< 24 h) of the urinary catheter would be beneficial (because of a more frequent UTI after LR than AUR after ER) and would reduce the occurrence of UTI if no AUR risk factors are present. However, these findings should be interpreted with caution because of the low quality of evidence.
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Affiliation(s)
- Catherine Mattevi
- Department of Digestive Surgery, University Hospital CHU, Clermont-Ferrand, France
| | | | - Marie Selvy
- Department of Digestive Surgery, University Hospital CHU, Clermont-Ferrand, France
| | - Bruno Pereira
- Department of Biostatistics, University Hospital CHU, Clermont-Ferrand, France
| | - Karem Slim
- Department of Digestive Surgery, University Hospital CHU, Clermont-Ferrand, France. .,Francophone Group for Enhanced Recovery After Surgery (GRACE), Beaumont, France. .,, Clermont-Ferrand, France.
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Liu J, Chen J, Nguyen PT. Neuraxial anesthesia and pain control for pediatric burn patients receiving excision and split-thickness skin grafts-A retrospective case series. Paediatr Anaesth 2021; 31:1113-1120. [PMID: 34270145 DOI: 10.1111/pan.14256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Postoperative pain management in pediatric burn patients requiring excision and split-thickness skin grafts remains largely under-studied. ICU care is often necessary due to the level of sedation and amount of opioids required to achieve adequate pain control. AIMS Our case series aimed to describe a pain management strategy using neuraxial anesthesia intraoperatively. Primary outcomes include pain scores, postoperative opioid consumption, and adverse events. METHODS A retrospective chart review was performed on a total of 61 patients who received intraoperative neuraxial anesthesia for split-thickness skin grafting between January 1st, 2017 and June 1st, 2018. Patient demographics, operating room data, and subsequent hospital course was extracted from their electronic medical record and plotted using R Studio statistical software. RESULTS The overwhelming majority of patients received single-shot spinals with both local anesthetic and either morphine or hydromorphone. Average pain scores were 1 out of 10 with standard deviation of 1.6 in the immediate postoperative period and decreased over the next 72 h. Oral morphine equivalents consumed did not exceed 0.61 ME/kg/day. The most common adverse reaction was pruritus. CONCLUSIONS Spinal anesthesia was most commonly used for split-thickness skin grafting in the pediatric burn population and provides excellent analgesia for patients' immediate postoperative course, including their initial dressing changes, with minimal risk for complications. Pain was well-controlled in all subgroups indicating that this strategy can be used flexibly in a variety of pediatric burn patients.
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Affiliation(s)
- John Liu
- Shriners Hospitals for Children Northern California, Sacramento, California, USA
| | - Joy Chen
- University of California Davis School of Medicine, Davis, California, USA
| | - Phat-Tan Nguyen
- University of California Davis School of Medicine, Davis, California, USA
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BAYRAKTAR D, KHORSHİD L. Total diz ve kalça protezi ameliyatı geçiren hastalarda kalıcı üriner kateteri çıkarmadan önce klemplemenin idrar miktarına ve miksiyon süresine etkisi. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.913607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Preparation and In Vivo Evaluation of a Lidocaine Self-Nanoemulsifying Ointment with Glycerol Monostearate for Local Delivery. Pharmaceutics 2021; 13:pharmaceutics13091468. [PMID: 34575544 PMCID: PMC8464853 DOI: 10.3390/pharmaceutics13091468] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022] Open
Abstract
Lidocaine, a commonly used local anesthetic, has recently been developed into a number of ointment products to treat hemorrhoids. This study examined its efficient delivery to the dermis through the pharmaceutical improvement of hemorrhoid treatment ointments. We attempted to increase the amount of skin deposition of lidocaine by forming a nanoemulsion through the self-nanoemulsifying effect that occurs when glycerol monostearate (GMS) is saturated with water. Using Raman mapping, the depth of penetration of lidocaine was visualized and confirmed, and the local anesthetic effect was evaluated via an in vivo tail-flick test. Evaluation of the physicochemical properties confirmed that lidocaine was amorphous and evenly dispersed in the ointment. The in vitro dissolution test confirmed that the nanoemulsifying effect of GMS accelerated the release of the drug from the ointment. At a specific concentration of GMS, lidocaine penetrated deeper into the dermis; the in vitro permeation test showed similar results. When compared with reference product A in the tail-flick test, the L5 and L6 compounds containing GMS had a significantly higher anesthetic effect. Altogether, the self-nanoemulsifying effect of GMS accelerated the release of lidocaine from the ointment. The compound with 5% GMS, the lowest concentration that saturated the dermis, was deemed most appropriate.
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Karnina R, Arif SK, Hatta M, Bukhari A. Molecular mechanisms of lidocaine. Ann Med Surg (Lond) 2021; 69:102733. [PMID: 34457261 PMCID: PMC8379473 DOI: 10.1016/j.amsu.2021.102733] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 02/08/2023] Open
Abstract
Lidocaine is an amide-class local anesthetic used clinically to inhibit pain sensations. Systemic administration of lidocaine has antinociceptive, antiarrhythmic, anti-inflammatory, and antithrombotic effects. Lidocaine exerts these effects under both acute and chronic pain conditions and acute respiratory distress syndrome through mechanisms that can be independent of its primary mechanism of action, sodium channel inhibition. Here we review the pathophysiological underpinnings of lidocaine's role as an anti-nociceptive, anti-inflammatory mediated by toll-like receptor (TLR) and nuclear factor kappa-β (NF-kβ) signalling pathways and downstream cytokine effectors high mobility group box 1 (HMGB1) and tumour necrosis factor-α (TNF-α).
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Affiliation(s)
- Resiana Karnina
- Doctoral Program of Biomedical Sciences, Faculty of Medicine, Hasanuddin University, Makassar, Sulawesi Selatan, Indonesia
- Faculty of Medicine, Muhammadiyah University of Jakarta, Banten, Indonesia
| | - Syafri Kamsul Arif
- Department of Anesthesiology, Faculty of Medicine, Hasanuddin University, Sulawesi Selatan, Indonesia
| | - Mochammad Hatta
- Department of Microbiology, Faculty of Medicine, Hasanuddin University, Makassar, Sulawesi Selatan, Indonesia
| | - Agussalim Bukhari
- Department of Nutritional Sciences, Faculty of Medicine, Hasanuddin University, Sulawesi Selatan, Indonesia
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Wei B, Asban A, Xie R, Sollie Z, Deng L, DeLay TK, Swicord WB, Kumar R, Kirklin JK, Donahue J. A prediction model for postoperative urinary retention after thoracic surgery. JTCVS OPEN 2021; 7:359-366. [PMID: 36003757 PMCID: PMC9390440 DOI: 10.1016/j.xjon.2021.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/21/2021] [Indexed: 11/21/2022]
Abstract
Background Urinary retention remains a frequent postoperative complication, associated with patient discomfort and delayed discharge following general thoracic surgery (GTS). We aimed to develop and prospectively validate a predictive model of postoperative urinary retention (POUR) among GTS patients. Methods We retrospectively developed a predictive model using data from the Society of Thoracic Surgeons GTS Database at our institution. The patient study cohort included adults undergoing elective in-patient surgical procedures without a history of renal failure or Foley catheter on entry to the recovery suite (August 2013 to March 2017). Multivariable logistic regression models identified factors associated with urinary retention, and a nomogram to aid medical decision making was developed. The predictive model was validated in a cohort of GTS patients between April 2017 and November 2018 using receiver operating characteristic (ROC) analysis. Results The predictive model was developed from 1484 GTS patients, 284 of whom (19%) experienced postoperative urinary retention within 24 hours of the operation. Risk factors for POUR included older age, male sex, higher preoperative creatinine, chronic obstructive pulmonary disease, primary diagnosis, primary procedure, and use of postoperative patient-controlled analgesia. A logistic nomogram for estimating the risk of POUR was created and validated in 646 patients, 65 of whom (10%) had urinary retention. The ROC curves of development and validation models had similar favorable c-statistics (0.77 vs 0.72; P > .05). Conclusions Postoperative urinary retention occurs in nearly 20% of patients undergoing major GTS. Using a validated predictive model may help by targeting certain patients with prophylactic measures to prevent this complication.
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Folch A, Gallo D, Miró J, Salvador-Carulla L, Martínez-Leal R. Mirror therapy for phantom limb pain in moderate intellectual disability. A case report. Eur J Pain 2021; 26:246-254. [PMID: 34464481 DOI: 10.1002/ejp.1859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/30/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Phantom limb pain (PLP) is a common problem after limb amputation. There is mounting evidence supporting the use of mirror therapy (MT) in the treatment of individuals with PLP. However, there is no research studying the effects of MT on PLP in individuals with intellectual developmental disorders (IDD). The aim of this study was to increase our understanding of MT when used with adults with IDD and PLP through a case study approach. METHODS Here, we describe the use of MT with a 53-year-old female with moderate IDD and PLP, related to her left leg being amputated after ulcer complications. The study followed an A-B-A-B design (baseline-treatment-withdrawal of treatment-re-introduction of treatment), lasting 2 years, which included a long-term follow-up. RESULTS The data showed that the PLP sensation decreased after the MT treatment, with a raw change of 3.92 points and a 48% decrease in mean pain intensity ratings from pre- to post-treatment. CONCLUSIONS This is a unique case-report on the use of MT with an individual with IDD suffering from PLP. The findings show that MT helped to significantly reduce the intensity of the PLP in this patient. SIGNIFICANCE This is a case-report that illustrates how mirror therapy can be applied to people with intellectual developmental disorders and phantom limb pain. The results showed that phantom limb pain decreased after the mirror therapy, with a raw change of 3,92 points and a percent change of 48%.
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Affiliation(s)
- Annabel Folch
- UNIVIDD, Intellectual Disability and Developmental Disorders Research Unit, Fundació Villablanca, IISPV, Institut d'Investigació Sanitària Pere Virgili, CIBERSAM, Centro de Investigación Biomédica en Red, Departament de Psicologia, Universitat Rovira i Virgili, Reus, Spain
| | - Daniel Gallo
- UNIVIDD, Intellectual Disability and Developmental Disorders Research Unit, Fundació Villablanca, IISPV, Institut d'Investigació Sanitària Pere Virgili, CIBERSAM, Centro de Investigación Biomédica en Red, Departament de Psicologia, Universitat Rovira i Virgili, Reus, Spain
| | - Jordi Miró
- Unit for the Study and Treatment of Pain-ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia.,Menzies Centre for Health Policy, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Rafael Martínez-Leal
- UNIVIDD, Intellectual Disability and Developmental Disorders Research Unit, Fundació Villablanca, IISPV, Institut d'Investigació Sanitària Pere Virgili, CIBERSAM, Centro de Investigación Biomédica en Red, Departament de Psicologia, Universitat Rovira i Virgili, Reus, Spain
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Wall TP, Buggy DJ. Perioperative Intravenous Lidocaine and Metastatic Cancer Recurrence - A Narrative Review. Front Oncol 2021; 11:688896. [PMID: 34408981 PMCID: PMC8365881 DOI: 10.3389/fonc.2021.688896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/15/2021] [Indexed: 12/17/2022] Open
Abstract
Cancer is a major global health problem and the second leading cause of death worldwide. When detected early, surgery provides a potentially curative intervention for many solid organ tumours. Unfortunately, cancer frequently recurs postoperatively. Evidence from laboratory and retrospective clinical studies suggests that the choice of anaesthetic and analgesic agents used perioperatively may influence the activity of residual cancer cells and thus affect subsequent recurrence risk. The amide local anaesthetic lidocaine has a well-established role in perioperative therapeutics, whether used systemically as an analgesic agent or in the provision of regional anaesthesia. Under laboratory conditions, lidocaine has been shown to inhibit cancer cell behaviour and exerts beneficial effects on components of the inflammatory and immune responses which are known to affect cancer biology. These findings raise the possibility that lidocaine administered perioperatively as a safe and inexpensive intravenous infusion may provide significant benefits in terms of long term cancer outcomes. However, despite the volume of promising laboratory data, robust prospective clinical evidence supporting beneficial anti-cancer effects of perioperative lidocaine treatment is lacking, although trials are planned to address this. This review provides a state of the art summary of the current knowledge base and recent advances regarding perioperative lidocaine therapy, its biological effects and influence on postoperative cancer outcomes.
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Affiliation(s)
- Thomas P Wall
- Department of Anaesthesiology, Mater Misericordiae University Hospital, School of Medicine, University College Dublin, Dublin, Ireland.,EU COST Action 15204, Euro-Periscope, Brussels, Belgium
| | - Donal J Buggy
- Department of Anaesthesiology, Mater Misericordiae University Hospital, School of Medicine, University College Dublin, Dublin, Ireland.,EU COST Action 15204, Euro-Periscope, Brussels, Belgium.,Outcomes Research, Cleveland Clinic, Cleveland, OH, United States
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113
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Viilmann I, Vettorato E. Perioperative use of thoracic epidural anaesthesia, dexmedetomidine and magnesium sulphate infusion in a dog undergoing neuroendocrine tumour resection. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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114
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Greuber E, Vought K, Patel K, Suzuki H, Usuda K, Shiramizu A, Koplowitz LP, Koplowitz B, Maibach HI, Lissin D. Biorelevant In Vitro Skin Permeation Testing and In Vivo Pharmacokinetic Characterization of Lidocaine from a Nonaqueous Drug-in-Matrix Topical System. AAPS PharmSciTech 2021; 22:215. [PMID: 34386908 PMCID: PMC8360843 DOI: 10.1208/s12249-021-02101-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022] Open
Abstract
Recently, lidocaine topical systems utilizing nonaqueous matrices have been developed and provide efficient lidocaine delivery through the skin, such that lower concentrations of drug provide equivalent or greater drug delivery than drug-in-matrix hydrogel lidocaine patches. This study characterizes drug delivery from a nonaqueous lidocaine topical system with increasing drug load both in vitro and in vivo. Topical systems formulated with either 1.8% or 5.4% lidocaine were applied to healthy volunteers' backs (n = 15) for 12 h in a single-center, open-label, four-treatment, four-period crossover pharmacokinetic study. Subjects were dosed with either three 1.8% systems or one, two, or three 5.4% systems in each period. Blood was collected for up to 48 h, and plasma lidocaine levels were measured with a validated HPLC method. In parallel, human and mouse skin models characterized the in vitro skin permeation profile. The pharmacokinetic profile was linear between one, two, and three lidocaine 5.4% applications. Application of three lidocaine 1.8% systems (108 mg lidocaine) was bioequivalent to one lidocaine 5.4% system (108 mg lidocaine). Both topical systems remained well adhered to the skin and irritation was mild. The 5.4% system had approximately threefold higher skin permeability than the 1.8% system in the mouse and human skin models. The results indicate increasing the drug load by three times results in triple the drug delivery both in vivo and in vitro. The relationship between the in vitro permeation and in vivo absorption correlates and is nonlinear.
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115
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Brown J. Implementation of Resistive Warmers for Total Joint Arthroplasty Procedures. AORN J 2021; 113:400-404. [PMID: 33788234 DOI: 10.1002/aorn.13350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/13/2020] [Accepted: 10/26/2020] [Indexed: 11/07/2022]
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Davis J, Raisis AL, Sharp CR, Cianciolo RE, Wallis SC, Ho KM. Improved Cardiovascular Tolerance to Hemorrhage after Oral Resveratrol Pretreatment in Dogs. Vet Sci 2021; 8:vetsci8070129. [PMID: 34357921 PMCID: PMC8310360 DOI: 10.3390/vetsci8070129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/06/2021] [Accepted: 07/10/2021] [Indexed: 11/21/2022] Open
Abstract
Resveratrol has been shown to preserve organ function and improve survival in hemorrhagic shock rat models. This study investigated whether seven days of oral resveratrol could improve hemodynamic response to hemorrhage and confer benefits on risk of acute kidney injury (AKI) without inducing coagulopathy in a canine model. Twelve greyhound dogs were randomly allocated to receive oral resveratrol (1000 mg/day) or placebo for seven days prior to inducing hemorrhage until a targeted mean blood pressure of ≤40 mmHg was achieved. AKI biomarkers and coagulation parameters were measured before, immediately following, and two hours after hemorrhage. Dogs were euthanized, and renal tissues were examined at the end of the experiment. All investigators were blinded to the treatment allocation. A linear mixed model was used to assess effect of resveratrol on AKI biomarkers and coagulation parameters while adjusting for volume of blood loss. A significant larger volume of blood loss was required to achieve the hypotension target in the resveratrol group compared to placebo group (median 64 vs. 55 mL/kg respectively, p = 0.041). Although histological evidence of AKI was evident in all dogs, the renal tubular injury scores were not significantly different between the two groups, neither were the AKI biomarkers. Baseline (pre-hemorrhage) maximum clot firmness on the Rotational Thromboelastometry (ROTEM®) was stronger in the resveratrol group than the placebo group (median 54 vs. 43 mm respectively, p = 0.009). In summary, seven days of oral resveratrol did not appear to induce increased bleeding risk and could improve greyhound dogs’ blood pressure tolerance to severe hemorrhage. Renal protective effect of resveratrol was, however, not observed.
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Affiliation(s)
- Jennifer Davis
- School of Veterinary Science, Murdoch University, Murdoch, WA 6150, Australia; (A.L.R.); (C.R.S.); (K.M.H.)
- Correspondence:
| | - Anthea L. Raisis
- School of Veterinary Science, Murdoch University, Murdoch, WA 6150, Australia; (A.L.R.); (C.R.S.); (K.M.H.)
| | - Claire R. Sharp
- School of Veterinary Science, Murdoch University, Murdoch, WA 6150, Australia; (A.L.R.); (C.R.S.); (K.M.H.)
- Centre for Terrestrial Ecosystem Science and Sustainability, Harry Butler Institute, Murdoch University, Murdoch, WA 6150, Australia
| | - Rachel E. Cianciolo
- Department of Veterinary Biosciences, The Ohio State University, Columbus, OH 43210, USA;
| | - Steven C. Wallis
- University of Queensland Centre for Clinical Research, Brisbane, QLD 4029, Australia;
| | - Kwok M. Ho
- School of Veterinary Science, Murdoch University, Murdoch, WA 6150, Australia; (A.L.R.); (C.R.S.); (K.M.H.)
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, WA 6000, Australia
- Medical School, University of Western Australia, Perth, WA 6009, Australia
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Fullerene C60 nanoparticle attenuates pain and tumor necrosis factor-α protein expression in hippocampus following diabetic neuropathy in rats. PHYSIOLOGY AND PHARMACOLOGY 2021. [DOI: 10.52547/phypha.26.4.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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118
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Xie Z, Nie X, Pan L, Zhang N, Xue H. The Comparison of Intrathecal Ropivacaine with Bupivacaine for Knee Arthroscopy: A Meta-analysis of Randomized Controlled Trials. J Knee Surg 2021; 34:971-977. [PMID: 31952093 DOI: 10.1055/s-0039-3402795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The comparison of intrathecal ropivacaine with bupivacaine for knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the efficacy of intrathecal ropivacaine versus bupivacaine for knee arthroscopy. We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through August 2019 for randomized controlled trials (RCTs) assessing the effect of intrathecal ropivacaine versus bupivacaine for knee arthroscopy. This meta-analysis is performed using the random effects model. Five RCTs are included in the meta-analysis. Overall, compared with intrathecal bupivacaine for knee arthroscopy, intrathecal ropivacaine is associated with increased onset time of motor block (mean difference [MD] = 2.05, 95% CI: 1.43-2.67, p < 0.00001) and decreased duration of sensory block (MD = -26.82, 95% CI: -31.96 to -21.67, p < 0.00001) but shows no remarkable influence on onset time of sensory block (MD = -0.09; 95% CI: -1.89 to 1.70, p = 0.92), duration of motor block (MD = -59.76; 95% CI: -124.44 to 4.91, p = 0.07), time to maximum block (MD = 2.35; 95% CI: -0.16 to 4.86, p = 0.07), first urination time (MD = -26.42, 95% CI: -57.34 to 4.51, p = 0.09), or first ambulation time (MD = 3.63, 95% CI: -25.20 to 32.47, p = 0.80).Intrathecal ropivacaine can substantially increase onset time of motor block and decrease the duration of sensory block than intrathecal bupivacaine for knee arthroscopy.
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Affiliation(s)
- Zhiwei Xie
- Department of Hand-foot and Microsurgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Xiaoying Nie
- Department of Minimally Invasive Spinal Surgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Linlin Pan
- Department of Minimally Invasive Spinal Surgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Na Zhang
- Department of Emergency Intensive Care Unit, The Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Huiqin Xue
- Department of Nursing, The Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
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Bezerra ASDM, Santos VB, Lopes CT, de Barros ALBL. Effect of nurse-initiated forced-air warming blanket on the reduction of hypothermia complications following coronary artery bypass grafting: a randomized clinical trial. Eur J Cardiovasc Nurs 2021; 20:445-453. [PMID: 33620461 DOI: 10.1093/eurjcn/zvaa023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 11/08/2020] [Indexed: 11/14/2022]
Abstract
AIMS To evaluate the effect of postoperative forced-air warming (FAW) on the incidence of excessive bleeding (ExB), arrhythmia, acute myocardial infarction (AMI), and blood product transfusion in hypothermic patients following on-pump CABG and compare temperatures associated with the use of FAW and warming with a sheet and wool blanket. METHODS AND RESULTS A randomized clinical trial conducted with 200 patients undergoing isolated on-pump CABG from January to November 2018. Patients were randomly assigned into an Intervention Group (IG, FAW, n = 100) and Control Group (CG, sheet and blanket, n = 100). The tympanic temperature of all patients was measured over a 24-h period. ExB was the primary outcome, while arrhythmia, AMI, and blood product transfusion were secondary outcomes. The effect of the interventions on the outcomes was investigated through using bivariate logistic regression, with a level of significance of 5%. The IG was 79% less likely to experience bleeding than the CG [odds ratio (OR) = 0.21, confidence interval (CI) 95% 0.12-0.39, P < 0.001]; the occurrence of AMI in the IG was 94% lower than that experienced by the CG (OR = 0.06, CI 95% 0.01-0.48, P < 0.001); and the IG was also 77% less likely to experience arrhythmia than the CG (OR = 0.23, CI 95% 0.12-0.47, P < 0.001); no difference was found between groups in terms of blood product transfusion (P < 0.279). CONCLUSIONS These findings show that FAW can be used following CABG until patients reach normothermia to avoid undesirable clinical outcomes. TRIAL REGISTRATION REBeC RBR-5t582g.
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Affiliation(s)
- Amanda Silva de Macêdo Bezerra
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), Departamento de Enfermagem Clínica e Cirúrgica and Programa de Pós Graduação em Enfermagem, 754 Napoleão de Barros St, Vila Clementino, São Paulo-SP, 04024-002, Brazil.,Instituto Dante Pazzanese de Cardiologia (IDPC), Divisão de Enfermagem. 500 Dr Dante Pazzanese Av, Ibirapuera, São Paulo-SP, 04012-909, Brazil
| | - Vinícius Batista Santos
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), Departamento de Enfermagem Clínica e Cirúrgica and Programa de Pós Graduação em Enfermagem, 754 Napoleão de Barros St, Vila Clementino, São Paulo-SP, 04024-002, Brazil
| | - Camila Takáo Lopes
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), Departamento de Enfermagem Clínica e Cirúrgica and Programa de Pós Graduação em Enfermagem, 754 Napoleão de Barros St, Vila Clementino, São Paulo-SP, 04024-002, Brazil
| | - Alba Lúcia Bottura Leite de Barros
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), Departamento de Enfermagem Clínica e Cirúrgica and Programa de Pós Graduação em Enfermagem, 754 Napoleão de Barros St, Vila Clementino, São Paulo-SP, 04024-002, Brazil
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120
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Sari S, Aksoy SM, But A. The incidence of inadvertent perioperative hypothermia in patients undergoing general anesthesia and an examination of risk factors. Int J Clin Pract 2021; 75:e14103. [PMID: 33616248 DOI: 10.1111/ijcp.14103] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/18/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Unintended perioperative hypothermia, defined as core body temperature less than 36°C, is closely related to many complications such as cardiovascular diseases, peroperative hemorrhagic diathesis and impairment of drug metabolism. Determination of the incidence of perioperative hypothermia and examination of risk factors may help to prevent hypothermia and its complications. METHODS We conducted a prospective, observational study of 2015 patients who underwent various operations under general anesthesia, and the risk factors of developing hypothermia were analysed. RESULTS The incidence of perioperative hypothermia was 78.6%. The incidence of hypothermia within 2 hours was 56.6%, and after 2 hours, it was 100%. Mean age was 49.36 ± 16.10, and 17.8% were over 65 years old. The mean body mass index (BMI) was 27.96 ± 3.94 kg/m2 ; 60.8% of the patients had American Society of Anesthesiologists (ASA) I score, 33.4% had ASA II and 5.8% had ASA III; 35.8% of the patients had co-morbidities. Intravenous and irrigation fluids were unwarmed; 99.9% of the patients were warmed passively, and only 0.1% of patients received active heating intraoperatively. The incidence of hypothermia was higher in overweight (BMI ≥ 25 kg/m2 ), elderly (>65 years) patients and those with co-morbidities. High American Society of Anesthesiologists (ASA) scores, grade 3-4 surgery, endoscopic surgery, duration of anesthesia >2 hours, infusion or irrigation >1000 mL significantly increased the incidence of hypothermia. CONCLUSION The incidence of perioperative hypothermia found was high. Important risk factors were found as prolonged duration of anesthesia and surgery, advanced age, overweight, high ASA scores, major surgeries, endoscopic operations and unwarmed fluid administration. High incidence may be reduced by raising awareness, considering fossible risk factors and following the recommendations of the guidelines on prevention of perioperative hypothermia.
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Affiliation(s)
- Suleyman Sari
- Department of Anesthesiology and Reanimation, Ministry of Health Yozgat City Hospital, Yozgat, Turkey
| | - Semsi Mustafa Aksoy
- Department of Anesthesiology and Reanimation, Ankara Yildirim Beyazit University, Faculty of Medicine, Ankara, Turkey
| | - Abdulkadir But
- Department of Anesthesiology and Reanimation, Ankara Yildirim Beyazit University, Faculty of Medicine, Ankara, Turkey
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121
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Etienne R, Laurent M, Henry A, Bioy A, Salleron J, Schohn CH, Cretineau N. Interest of a standardized hypnotic message for the reduction of pain and anxiety in cancer patients treated by capsaicin patch for neuropathic pain: a randomized controlled trial. BMC Complement Med Ther 2021; 21:154. [PMID: 34044838 PMCID: PMC8161949 DOI: 10.1186/s12906-021-03329-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neuropathic pain is characterized by spontaneous painful symptoms. Medical therapies include the use of a capsaicin 8% patch (Qutenza®, Grünenthal Gmbh, Germany), and patients may experience a sharp burning sensation at application and removal of the patch. This study aimed to evaluate the impact of playing a standardized hypnosis recording during application, on the pain and anxiety induced by capsaicin treatment. METHODS In a randomized, controlled trial, we assessed the benefits of the intervention firstly on pain and secondly on anxiety, as measured using numerical rating scales. All patients had application of the capsaicin patch, including the possibility for the patient to apply a cold patch. Participants were randomly assigned to one of 3 groups, namely the "Standard group" (no intervention), "Hypnosis group", in which a standardized hypnotic message was played during application, or the "Music group" in which relaxing music was played during application of the patch. RESULTS Sixty-nine patients were included. Overall, there was no significant difference in pain scores between groups (p = 0.355). Compared to standard application, anxiety was significantly lower in the hypnosis group after application (p = 0.007), with no significant difference between the standard and music arms (p = 0.271), or between the hypnosis and music arms (p = 0.423). CONCLUSIONS Listening to a standardized hypnotic message during application of a capsaicin patch was found to significantly lower anxiety. These findings indicate that the use of a hypnotic message can reduce discomfort and warrant its evaluation in other indications of pain or anxiety during treatment procedures. TRIAL REGISTRATION NCT02822625 .
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Affiliation(s)
- Rémi Etienne
- Department of Supportive Care in Oncology, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France
| | - Myriam Laurent
- Department of Supportive Care in Oncology, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France
| | - Aline Henry
- Department of Supportive Care in Oncology, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France
| | - Antoine Bioy
- University of Paris 8, Laboratory of Psychopathology and Neuropsychology, St Denis, Paris, France
| | - Julia Salleron
- Departement of biostatistics, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France.
| | - Cécile Huin Schohn
- Research Department, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France
| | - Nathalie Cretineau
- Department of Supportive Care in Oncology, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France
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Physiological and Clinical Responses in Pigs in Relation to Plasma Concentrations during Anesthesia with Dexmedetomidine, Tiletamine, Zolazepam, and Butorphanol. Animals (Basel) 2021; 11:ani11061482. [PMID: 34063808 PMCID: PMC8224090 DOI: 10.3390/ani11061482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Reliable protocols are needed for short-term anesthesia in pigs. The study’s aim is to identify an anesthetic procedure that, without the use of sophisticated equipment, ensures an acceptable depth and length of anesthesia, a regular spontaneous breathing pattern, and a stable hemodynamic condition for the animal. A total of 12 pigs were given a single intramuscular injection of dexmedetomidine, tiletamine, zolazepam, and butorphanol. To investigate the possibility of prolonging the anesthesia, six of the pigs also received an intravenous dose of the drug combination after one hour. Physiological and clinical responses and drug plasma concentrations were examined. The main results suggest that intramuscular administration of the drug combination provides up to two hours of anesthesia with stable physiological parameters and an acceptable level of analgesia. An intravenous administration of one-third of the original dosage prolonged the anesthesia for another 30 min. Since the pigs were able to breathe spontaneously, none of them were intubated. The study also provides new information about each drug’s plasma concentrations and the impact of the drug combination in pigs. This technique can be used to perform nonsurgical operations or transports when short-term anesthesia is required. Abstract Reliable protocols for short-term anesthetics are essential to safeguard animal welfare during medical investigations. The aim of the study was to assess the adequacy and reliability of an anesthetic protocol and to evaluate physiological and clinical responses, in relation to the drug plasma concentrations, for pigs undergoing short-term anesthesia. A second aim was to see whether an intravenous dosage could prolong the anesthesia. The anesthesia was induced by an intramuscular injection of dexmedetomidine, tiletamine-zolazepam, and butorphanol in 12 pigs. In six of the pigs, a repeated injection intravenously of one-third of the initial dose was given after one hour. The physiological and clinical effects from induction to recovery were examined. Plasma concentrations of the drugs were analyzed and pharmacokinetic parameters were calculated. Each drug’s absorption and time to maximal concentration were rapid. All pigs were able to maintain spontaneous respiration. The route of administration did not alter the half-life of the drug. The results suggest that intramuscular administration of the four-drug combination provides up to two hours of anesthesia with stable physiological parameters and an acceptable level of analgesia while maintaining spontaneous respiration. A repeated intravenous injection may be used to extend the time of anesthesia by 30 min.
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Christelis N, Simpson B, Russo M, Stanton-Hicks M, Barolat G, Thomson S, Schug S, Baron R, Buchser E, Carr DB, Deer TR, Dones I, Eldabe S, Gallagher R, Huygen F, Kloth D, Levy R, North R, Perruchoud C, Petersen E, Rigoard P, Slavin K, Turk D, Wetzel T, Loeser J. Persistent Spinal Pain Syndrome: A Proposal for Failed Back Surgery Syndrome and ICD-11. PAIN MEDICINE 2021; 22:807-818. [PMID: 33779730 PMCID: PMC8058770 DOI: 10.1093/pm/pnab015] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective For many medical professionals dealing with patients with persistent pain following spine surgery, the term Failed back surgery syndrome (FBSS) as a diagnostic label is inadequate, misleading, and potentially troublesome. It misrepresents causation. Alternative terms have been suggested, but none has replaced FBSS. The International Association for the Study of Pain (IASP) published a revised classification of chronic pain, as part of the new International Classification of Diseases (ICD-11), which has been accepted by the World Health Organization (WHO). This includes the term Chronic pain after spinal surgery (CPSS), which is suggested as a replacement for FBSS. Methods This article provides arguments and rationale for a replacement definition. In order to propose a broadly applicable yet more precise and clinically informative term, an international group of experts was established. Results 14 candidate replacement terms were considered and ranked. The application of agreed criteria reduced this to a shortlist of four. A preferred option—Persistent spinal pain syndrome—was selected by a structured workshop and Delphi process. We provide rationale for using Persistent spinal pain syndrome and a schema for its incorporation into ICD-11. We propose the adoption of this term would strengthen the new ICD-11 classification. Conclusions This project is important to those in the fields of pain management, spine surgery, and neuromodulation, as well as patients labeled with FBSS. Through a shift in perspective, it could facilitate the application of the new ICD-11 classification and allow clearer discussion among medical professionals, industry, funding organizations, academia, and the legal profession.
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Affiliation(s)
| | - Brian Simpson
- Department of Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Marc Russo
- Hunter Pain Specialists, Broadmeadow, New South Wales, Australia
| | | | | | - Simon Thomson
- Basildon and Thurrock University Hospitals, Basildon, UK
| | - Stephan Schug
- Anaesthesiology and Pain Medicine, Medical School, University of Western Australia and Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ralf Baron
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | | | - Daniel B Carr
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | | | - Ivano Dones
- Department of Neurosurgery, Fondazione Istituto Neurologico "C. Besta," Milano, Italy
| | - Sam Eldabe
- The James Cook University Hospital, Middlesbrough, UK
| | - Rollin Gallagher
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Frank Huygen
- Center for Pain Medicine, Erasmus MC Pijnbehandelcentrum, Rotterdam, Zuid-Holland, Netherlands
| | - David Kloth
- Department of Anesthesiology, Danbury Hospital, Danbury, Connecticut, USA
| | - Robert Levy
- Marcus Neuroscience Institute, Boca Raton, Florida, USA
| | - Richard North
- Department of Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Erika Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Philippe Rigoard
- Spine-Neurostimulation Functional Unit, PRISMATICS, Poitiers Hospital University, Poitiers, France
| | - Konstantin Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Dennis Turk
- University of Washington Seattle, Washington, USA
| | - Todd Wetzel
- Department of Orthopedics, Bassett Medical Center, Coopersown, New York, USA
| | - John Loeser
- Departments of Neurological Surgery & Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA
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Meister KD, Pandian V, Hillel AT, Walsh BK, Brodsky MB, Balakrishnan K, Best SR, Chinn SB, Cramer JD, Graboyes EM, McGrath BA, Rassekh CH, Bedwell JR, Brenner MJ. Multidisciplinary Safety Recommendations After Tracheostomy During COVID-19 Pandemic: State of the Art Review. Otolaryngol Head Neck Surg 2021; 164:984-1000. [PMID: 32960148 PMCID: PMC8198753 DOI: 10.1177/0194599820961990] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/06/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE In the chronic phase of the COVID-19 pandemic, questions have arisen regarding the care of patients with a tracheostomy and downstream management. This review addresses gaps in the literature regarding posttracheostomy care, emphasizing safety of multidisciplinary teams, coordinating complex care needs, and identifying and managing late complications of prolonged intubation and tracheostomy. DATA SOURCES PubMed, Cochrane Library, Scopus, Google Scholar, institutional guidance documents. REVIEW METHODS Literature through June 2020 on the care of patients with a tracheostomy was reviewed, including consensus statements, clinical practice guidelines, institutional guidance, and scientific literature on COVID-19 and SARS-CoV-2 virology and immunology. Where data were lacking, expert opinions were aggregated and adjudicated to arrive at consensus recommendations. CONCLUSIONS Best practices in caring for patients after a tracheostomy during the COVID-19 pandemic are multifaceted, encompassing precautions during aerosol-generating procedures; minimizing exposure risks to health care workers, caregivers, and patients; ensuring safe, timely tracheostomy care; and identifying and managing laryngotracheal injury, such as vocal fold injury, posterior glottic stenosis, and subglottic stenosis that may affect speech, swallowing, and airway protection. We present recommended approaches to tracheostomy care, outlining modifications to conventional algorithms, raising vigilance for heightened risks of bleeding or other complications, and offering recommendations for personal protective equipment, equipment, care protocols, and personnel. IMPLICATIONS FOR PRACTICE Treatment of patients with a tracheostomy in the COVID-19 pandemic requires foresight and may rival procedural considerations in tracheostomy in their complexity. By considering patient-specific factors, mitigating transmission risks, optimizing the clinical environment, and detecting late manifestations of severe COVID-19, clinicians can ensure due vigilance and quality care.
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Affiliation(s)
- Kara D. Meister
- Clinical Assistant Professor, Aerodigestive and Airway Reconstruction Center, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, Palo Alto, California, United States
- Clinical Assistant Professor, Center for Pediatric Voice and Swallowing Disorders, Department of Otolaryngology – Head & Neck Surgery, Division of Pediatric Otolaryngology, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, Palo Alto, California, United States
| | - Vinciya Pandian
- Associate Professor, Department of Nursing Faculty, Johns Hopkins University, Baltimore, Maryland, United States
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland, United States
| | - Alexander T. Hillel
- Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Brian K. Walsh
- Professor, Department of Health Sciences, Liberty University, Lynchburg, United States
| | - Martin B. Brodsky
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland, United States
- Associate Professor, Department of Physical and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, United States
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Karthik Balakrishnan
- Clinical Assistant Professor, Aerodigestive and Airway Reconstruction Center, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, Palo Alto, California, United States
- Clinical Assistant Professor, Center for Pediatric Voice and Swallowing Disorders, Department of Otolaryngology – Head & Neck Surgery, Division of Pediatric Otolaryngology, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, Palo Alto, California, United States
| | - Simon R. Best
- Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Steven B. Chinn
- Assistant Professor, Department of Otolaryngology – Head and Neck Surgery, University of Michigan, Michigan, United States
| | - John D. Cramer
- Assistant Professor, Department of Otolaryngology – Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Evan M. Graboyes
- Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, United States
- Hollings Cancer Center, Charleston, South Carolina, United States
| | - Brendan A. McGrath
- Anesthesiology Consultant, University of Manchester, NHS Foundation Trust, National Tracheostomy Safety Project, Manchester, United Kingdom
| | - Christopher H. Rassekh
- Professor, Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Joshua R. Bedwell
- Associate Professor, Baylor College of Medicine, Houston, Texas, United States
- Associate Professor, Division of Pediatric Otolaryngology-Head and Neck Surgery, Texas Children’s Hospital, Houston, Texas, United States
| | - Michael J. Brenner
- Associate Professor, Department of Otolaryngology – Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States, and President-elect, Global Tracheostomy Collaborative, Raleigh, North Carolina, United States
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125
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Crigger C, Kuzbel J, Al-Omar O. Choosing the Right Catheter for Pediatric Procedures: Patient Considerations and Preference. Res Rep Urol 2021; 13:185-195. [PMID: 33954151 PMCID: PMC8092428 DOI: 10.2147/rru.s282654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
Determining the need for bladder decompression and urinary diversion in the perioperative pediatric surgical patient can cause a clinical conundrum for the surgical team. Add in the several different types of urinary diversion devices possible, and the various materials associated therein and the process can suddenly seem unnecessarily daunting given the lack of concise recommendations and broad consensus. The decision to divert urine, though seemingly trivial, is associated with inherent risks. Managing and mitigating certain risks are best approached through proper education, selection, and technique. We provide a broad overview of pediatric catheter selection, indications, and pitfalls to streamline the process so that energy and attention can best be focused on the planned intervention at hand.
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Affiliation(s)
- Chad Crigger
- Department of Urology, Division of Pediatric Urology, West Virginia University, Morgantown, WV, 26506, USA
| | - Jake Kuzbel
- Department of Urology, Division of Pediatric Urology, West Virginia University, Morgantown, WV, 26506, USA
| | - Osama Al-Omar
- Department of Urology, Division of Pediatric Urology, West Virginia University, Morgantown, WV, 26506, USA
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126
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Fabrication of Alginate-Based O/W Nanoemulsions for Transdermal Drug Delivery of Lidocaine: Influence of the Oil Phase and Surfactant. Molecules 2021; 26:molecules26092556. [PMID: 33925764 PMCID: PMC8125457 DOI: 10.3390/molecules26092556] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
Transdermal drug delivery of lidocaine is a good choice for local anesthetic delivery. Microemulsions have shown great effectiveness for the transdermal transport of lidocaine. Oil-in-water nanoemulsions are particularly suitable for encapsulation of lipophilic molecules because of their ability to form stable and transparent delivery systems with good skin permeation. However, fabrication of nanoemulsions containing lidocaine to provide an extended local anesthetic effect is challenging. Hence, the aim of this study was to address this issue by employing alginate-based o/w nanocarriers using nanoemulsion template that is prepared by combined approaches of ultrasound and phase inversion temperature (PIT). In this study, the influence of system composition such as oil type, oil and surfactant concentration on the particle size, in vitro release and skin permeation of lidocaine nanoemulsions was investigated. Structural characterization of lidocaine nanoemulsions as a function of water dilution was done using DSC. Nanoemulsions with small droplet diameters (d < 150 nm) were obtained as demonstrated by dynamic light scattering (DLS) and cryo-TEM. These nanoemulsions were also able to release 90% of their content within 24-h through PDMS and pig skin and able to the drug release over a 48-h. This extended-release profile is highly favorable in transdermal drug delivery and shows the great potential of this nanoemulsion as delivery system.
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127
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Grace J, Zeiler G, Hartman M, Koeppel K, Buck R. Perianaesthetic management of a Patagonian cavy (
Dolichotis patagonum
) undergoing hemilaminectomy for treatment of acute intervertebral disk herniation. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Justin Grace
- Department of Companion Animal Clinical Studies University of Pretoria Pretoria South Africa
| | - Gareth Zeiler
- Department of Companion Animal Clinical Studies University of Pretoria Pretoria South Africa
- Department of Valley Farm Animal Hospital Pretoria South Africa
| | - Marthinus Hartman
- Department of Companion Animal Clinical Studies University of Pretoria Pretoria South Africa
| | - Katja Koeppel
- Department of Production Animal Studies, Faculty of Veterinary Science University of Pretoria Pretoria South Africa
| | - Roxanne Buck
- Department of Companion Animal Clinical Studies University of Pretoria Pretoria South Africa
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128
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Bi Y, Zhou J. Spinal subdural hematoma and subdural anesthesia following combined spinal-epidural anesthesia: a case report. BMC Anesthesiol 2021; 21:130. [PMID: 33902465 PMCID: PMC8074484 DOI: 10.1186/s12871-021-01352-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background Subdural anesthesia and spinal subdural hematoma are rare complications of combined spinal-epidural anesthesia. We present a patient who developed both after multiple attempts to achieve combined spinal–epidural anesthesia. Case presentation A 21-year-old parturient, gravida 1, para 1, with twin pregnancy at gestational age 34+ 5 weeks underwent cesarean delivery. Routine combined spinal–epidural anesthesia was planned; however, no cerebrospinal fluid outflow was achieved after several attempts. Bupivacaine (2.5 mL) administered via a spinal needle only achieved asymmetric blockade of the lower extremities, reaching T12. Then, epidural administration of low-dose 2-chlorprocaine caused unexpected blockade above T2 as well as tinnitus, dyspnea, and inability to speak. The patient was intubated, and the twins were delivered. Ten minutes after the operation, the patient was awake with normal tidal volume. The endotracheal tube was removed, and she was transferred to the intensive care unit for further observation. Postoperative magnetic resonance imaging suggested a spinal subdural hematoma extending from T12 to the cauda equina. Sensory and motor function completely recovered 5 h after surgery. She denied headache, low back pain, or other neurologic deficit. The patient was discharged 6 days after surgery. One month later, repeat MRI was normal. Conclusions All anesthesiologists should be aware of the possibility of SSDH and subdural block when performing neuraxial anesthesia, especially in patients in whom puncture is difficult. Less traumatic methods of achieving anesthesia, such as epidural anesthesia, single-shot spinal anesthesia, or general anesthesia should be considered in these patients. Furthermore, vital signs and neurologic function should be closely monitored during and after surgery.
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Affiliation(s)
- Yanmei Bi
- Department of Anesthesiology, West China Second University Hospital of Sichuan University, Sichuan Province, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan Province, Chengdu, China
| | - Junying Zhou
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan Province, Chengdu, China. .,Department of Operation Room, West China Second University Hospital of Sichuan University, Sichuan Province, Chengdu, China.
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129
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Lin JH, Yu YW, Chuang YC, Lee CH, Chen CC. ATF3-Expressing Large-Diameter Sensory Afferents at Acute Stage as Bio-Signatures of Persistent Pain Associated with Lumbar Radiculopathy. Cells 2021; 10:cells10050992. [PMID: 33922541 PMCID: PMC8145235 DOI: 10.3390/cells10050992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/09/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022] Open
Abstract
The mechanism of pain chronicity is largely unknown in lumbar radiculopathy (LR). The anatomical location of nerve injury is one of the important factors associated with pain chronicity of LR. Accumulating evidence has shown constriction distal to the dorsal root ganglion (DRG) caused more severe radiculopathy than constriction proximal to the DRG; thereby, the mechanism of pain chronicity in LR could be revealed by comparing the differences in pathological changes of DRGs between nerve constriction distal and proximal to the DRG. Here, we used 2 rat models of LR with nerve constriction distal or proximal to the DRG to probe how the different nerve injury sites could differentially affect pain chronicity and the pathological changes of DRG neuron subpopulations. As expected, rats with nerve constriction distal to the DRG showed more persistent pain behaviors than those with nerve constriction proximal to the DRG in 50% paw withdraw threshold, weight-bearing test, and acetone test. One day after the operation, distal and proximal nerve constriction showed differential pathological changes of DRG. The ratios of activating transcription factor3 (ATF3)-positive DRG neurons were significantly higher in rats with nerve constriction distal to DRG than those with nerve constriction proximal to DRG. In subpopulation analysis, the ratios of ATF3-immunoreactivity (IR) in neurofilament heavy chain (NFH)-positive DRG neurons significantly increased in distal nerve constriction compared to proximal nerve constriction; although, both distal and proximal nerve constriction presented increased ratios of ATF3-IR in calcitonin gene-related peptide (CGRP)-positive DRG neurons. Moreover, the nerve constriction proximal to DRG caused more hypoxia than did that distal to DRG. Together, ATF3 expression in NHF-positive DRG neurons at the acute stage is a potential bio-signature of persistent pain in rat models of LR.
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Affiliation(s)
- Jiann-Her Lin
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei 110301, Taiwan;
- Department of Surgery, Division of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 110301, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115201, Taiwan; (Y.-C.C.); (C.-H.L.)
| | - Yu-Wen Yu
- Department of Surgery, Division of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115201, Taiwan; (Y.-C.C.); (C.-H.L.)
| | - Yu-Chia Chuang
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115201, Taiwan; (Y.-C.C.); (C.-H.L.)
| | - Cheng-Han Lee
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115201, Taiwan; (Y.-C.C.); (C.-H.L.)
| | - Chih-Cheng Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115201, Taiwan; (Y.-C.C.); (C.-H.L.)
- Neuroscience Program of Academia Sinica, Academia Sinica, Taipei 115201, Taiwan
- Taiwan Mouse Clinic, Biomedical Translation Research Center, Academia Sinica, Taipei 115202, Taiwan
- Correspondence:
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130
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Fernando H, Milne C, Nehme Z, Ball J, Bernard S, Stephenson M, Myles PS, Bray JE, Lefkovits J, Liew D, Peter K, Brennan A, Dinh D, Andrew E, Taylor AJ, Smith K, Stub D. An open-label, non-inferiority randomized controlled trial of lidocAine Versus Opioids In MyocarDial Infarction study (AVOID-2 study) methods paper. Contemp Clin Trials 2021; 105:106411. [PMID: 33894363 DOI: 10.1016/j.cct.2021.106411] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
Background There is increasing evidence that opioids interfere with the oral bioavailability of P2Y12 inhibitors leading to delayed onset of antiplatelet effects. Several strategies have been proposed to mitigate this interaction including utilizing alternative analgesic agents in the management of ischemic chest pain. Methods The lidocAine Versus Opioids In MyocarDial Infarction (AVOID-2) study is a phase II, pre-hospital, open-label, non-inferiority, randomized controlled trial conducted by Ambulance Victoria and Monash University in metropolitan Melbourne, Victoria, Australia. The purpose of the study is to compare the analgesic effect (reduction in pain by arrival to hospital) and safety (e.g. adverse drug reactions) (co-primary endpoints) of intravenous lidocaine versus intravenous fentanyl in 300 adult patients attended by ambulance with suspected ST-elevation myocardial infarction (STEMI). Secondary endpoints and a cardiac magnetic resonance imaging (MRI) sub-study will also compare infarct size between these two groups. Conclusions The evaluation of alternative analgesic agents in the management of acute coronary syndromes is urgently needed to manage the opioid-P2Y12 inhibitor interaction. The results of this trial will have significant implications on the emergency management of acute coronary syndromes internationally.
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Affiliation(s)
- Himawan Fernando
- Department of Cardiology, Alfred Hospital, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia; Monash University, Melbourne, Australia
| | - Catherine Milne
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | - Ziad Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | - Jocasta Ball
- Baker Heart and Diabetes Institute, Melbourne, Australia; Monash University, Melbourne, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | - Stephen Bernard
- Monash University, Melbourne, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | - Michael Stephenson
- Monash University, Melbourne, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | - Paul S Myles
- Monash University, Melbourne, Australia; Department of Anesthesiology and Perioperative Medicine, The Alfred and Monash University, Australia
| | | | - Jeffrey Lefkovits
- Monash University, Melbourne, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - Karlheinz Peter
- Department of Cardiology, Alfred Hospital, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia; Monash University, Melbourne, Australia
| | | | - Diem Dinh
- Monash University, Melbourne, Australia
| | - Emily Andrew
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | - Andrew J Taylor
- Department of Cardiology, Alfred Hospital, Melbourne, Australia
| | - Karen Smith
- Monash University, Melbourne, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia; Monash University, Melbourne, Australia; Department of Cardiology, Western Health, Melbourne, Australia.
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131
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Feigin K, Fiocchi EH, Fleming MA, Looney AL. Anesthesia Case of the Month. J Am Vet Med Assoc 2021; 257:1125-1128. [PMID: 33226296 DOI: 10.2460/javma.2020.257.11.1125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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132
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Kiani CS, Hunt RW. Lidocaine Continuous Subcutaneous Infusion for Neuropathic Pain in Hospice Patients: Safety and Efficacy. J Pain Palliat Care Pharmacother 2021; 35:52-62. [PMID: 33793373 DOI: 10.1080/15360288.2020.1852357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Lidocaine continuous subcutaneous infusion (L-CSCI) for neuropathic pain in hospice patients has limited evidence for its safety and efficacy, and guidelines are lacking. This study assesses a series of patients admitted to a hospice over a six-month period that had neuropathic pain and received L-CSCI. The primary outcome was improvement in patient-rated distress from pain following L-CSCI titration. Also assessed were changes in oral morphine equivalent dose (OME), frequency of breakthrough medication, functional status, adverse effects and perception of response. Fifteen patients received L-CSCI for an average of 6.7 days (range 1-92). Average pain distress score decreased by 2 or more in six patients. Positive responses to L-CSCI were documented in the clinical notes of 10 patients. Opioid down-titration occurred in four patients. Lidocaine levels were performed in 3 patients but did not change management. Five patients experienced adverse effects attributable to lidocaine and all responded to simple measures. In conclusion, L-CSCI can help manage neuropathic pain in hospice patients, particularly in those who cannot swallow oral medications. Further systematic research is warranted to establish efficacy and tolerability, and to inform guideline development.
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133
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Eh-Haj BM. Metabolic N-Dealkylation and N-Oxidation as Elucidators of the Role of Alkylamino Moieties in Drugs Acting at Various Receptors. Molecules 2021; 26:1917. [PMID: 33805491 PMCID: PMC8036657 DOI: 10.3390/molecules26071917] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 12/16/2022] Open
Abstract
Metabolic reactions that occur at alkylamino moieties may provide insight into the roles of these moieties when they are parts of drug molecules that act at different receptors. N-dealkylation of N,N-dialkylamino moieties has been associated with retaining, attenuation or loss of pharmacologic activities of metabolites compared to their parent drugs. Further, N-dealkylation has resulted in clinically used drugs, activation of prodrugs, change of receptor selectivity, and providing potential for developing fully-fledged drugs. While both secondary and tertiary alkylamino moieties (open chain aliphatic or heterocyclic) are metabolized by CYP450 isozymes oxidative N-dealkylation, only tertiary alkylamino moieties are subject to metabolic N-oxidation by Flavin-containing monooxygenase (FMO) to give N-oxide products. In this review, two aspects will be examined after surveying the metabolism of representative alkylamino-moieties-containing drugs that act at various receptors (i) the pharmacologic activities and relevant physicochemical properties (basicity and polarity) of the metabolites with respect to their parent drugs and (ii) the role of alkylamino moieties on the molecular docking of drugs in receptors. Such information is illuminative in structure-based drug design considering that fully-fledged metabolite drugs and metabolite prodrugs have been, respectively, developed from N-desalkyl and N-oxide metabolites.
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Affiliation(s)
- Babiker M Eh-Haj
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, University of Science and Technology of Fujairah, Emirate of Fujairah, Fujairah 2022, United Arab Emirates
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Sheil M, Chambers M, Polkinghorne A, Sharpe B. Topical Application of Lidocaine and Bupivacaine to Disbudding Wounds in Dairy Calves: Safety, Toxicology and Wound Healing. Animals (Basel) 2021; 11:ani11030869. [PMID: 33803728 PMCID: PMC8003238 DOI: 10.3390/ani11030869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 02/08/2023] Open
Abstract
Simple Summary Disbudding is a common, but painful procedure performed on calves to prevent horn growth. Tri-Solfen® is a combination local anaesthetic and antiseptic formulation which, applied topically to the disbudding wound, is reported to reduce calf pain. Applied in this manner, the local anaesthetics in Tri-Solfen®, lidocaine and bupivacaine, are reported to be poorly absorbed, resulting in low risk of neurological or cardiotoxic effects. The potential impacts on other blood, urine and tissue parameters and on wound healing when used in this manner, and/or accidental overdose situations are unknown, however. We performed experiments investigating (i) the safety of Tri-Solfen® (including overdose situations) and (ii) the impact of Tri-Solfen® on disbudding wound healing under field conditions. No adverse health effects were observed in Tri-Solfen®-treated animals, even those receiving 5× the recommended dose, with no clinically significant differences in measured parameters between placebo and Tri-Solfen® groups. No negative impacts on wound healing were noted. Conversely, lower levels of bacterial wound colonisation were evident, and there was reduced incidence of abnormal wounds at days 11–12 in Tri-Solfen®-treated animals. Abstract Tri-Solfen® is a combination topical anaesthetic and antiseptic solution containing lidocaine, bupivacaine, adrenaline and cetrimide. Applied to wounds, it is reported to reduce the pain experienced by calves following thermocautery disbudding. While lidocaine and bupivacaine are widely used in medicine, conflicting data exist on the impact of these compounds when applied directly to the surgical wound. To investigate the safety of Tri-Solfen® applied to thermocautery disbudding wounds of calves, experiments were performed to measure (i) the safety of Tri-Solfen® (including in overdose situations); and (ii) the impact of Tri-Solfen® application at recommended doses on disbudding wound healing under field conditions. Haematological, biochemical and urinalysis parameters did not show clinically significant differences between placebo and Tri-Solfen® groups (1×, 3× and 5× dose). No adverse health impacts were reported. Histopathological analysis of wounds noted a reduction in bacterial colonies in Tri-Solfen®-treated wounds. Under field conditions, no negative impacts on wound healing were noted. Conversely, there was reduced incidence of abnormal wounds, with an associated trend toward improved average daily gain at days 11–12 in Tri-Solfen®-treated animals. These data are considered to support the safety of topical anaesthesia, as formulated in Tri-Solfen®, to the thermocautery disbudding wound in calves.
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Affiliation(s)
- Meredith Sheil
- Animal Ethics Pty. Ltd., Yarra Glen 3775, Australia
- Correspondence:
| | | | - Adam Polkinghorne
- Department of Microbiology and Infectious Diseases, NSW Health Pathology, Nepean Blue Mountains Pathology Service, Penrith 2751, Australia;
- Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Kingswood 2747, Australia
| | - Brendan Sharpe
- Invetus Pty. Ltd., Armidale 2350, Australia; (M.C.); (B.S.)
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Baboudjian M, Gondran-Tellier B, Tadrist A, Brioude G, Trousse D, D'Journo BX, Thomas PA. Predictors of Postoperative Urinary Retention Following Pulmonary Resection. Semin Thorac Cardiovasc Surg 2021; 33:1137-1143. [PMID: 33677097 DOI: 10.1053/j.semtcvs.2021.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
To identify predictors of postoperative urinary retention (POUR) following pulmonary resection. Retrospective chart review from a single academic institution of all patients who underwent pulmonary resection between June 2004 and January 2020. The surgical procedures consisted of pneumonectomy, lobectomy and sublobar resections. The primary outcome was occurrence of POUR within 30 days following surgery, defined as painful and palpable bladder, when the patient is unable to pass any urine, and requiring catheterization. A total of 6004 consecutive patients underwent pulmonary resection among which 306 pneumonectomies (5.1%), 3467 lobectomies (57.7%) and 2231 sublobar resection (37.2%). The surgical approach was a thoracotomy (n = 3546; 59.1%), a video-assisted [VATS] (n = 2075; 34.5%) or a robot-assisted thoracoscopy [RATS] (n = 383; 6.4%). POUR occurred in 301 cases (5%). On multivariable logistic regression analysis, male gender (OR 2.30 [1.70-3.17]; P < 0.001), age (OR 1.02 [1.01-1.03]; P < 0.001), benign prostatic hyperplasia (OR 7.08 [4.57-10.83]; P < 0.001), and COPD (OR 1.52 [1.13-2.01]; P = 0.004) were significant predictors of POUR. Conversely, VATS (OR 0.62 [0.46-0.83]; P = 0.001) had a protective effect on the occurrence of POUR. In a large single-center study, we disclosed significant clinical predictors of POUR after pulmonary resection, including age, sex, comorbidities and surgical approach. Prospective studies are necessary to evaluate the efficacy of chemoprophylaxis by perioperative α-blockers in order to prevent POUR.
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Affiliation(s)
- Michael Baboudjian
- Department of Thoracic Surgery, Diseases of the Esophagus, and lung Transplantation, North Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Bastien Gondran-Tellier
- Department of Urology and Kidney Transplantation, La conception Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Abel Tadrist
- Department of Thoracic Surgery, Diseases of the Esophagus, and lung Transplantation, North Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Geoffrey Brioude
- Department of Thoracic Surgery, Diseases of the Esophagus, and lung Transplantation, North Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Delphine Trousse
- Department of Thoracic Surgery, Diseases of the Esophagus, and lung Transplantation, North Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Benoît Xavier D'Journo
- Department of Thoracic Surgery, Diseases of the Esophagus, and lung Transplantation, North Hospital, Aix-Marseille University, APHM, Marseille, France; Predictive Oncology Laboratory, CRCM, INSERM UMR 1068, CNRS UMR 7258, Aix-Marseille University UM105, Marseille, France
| | - Pascal Alexandre Thomas
- Department of Thoracic Surgery, Diseases of the Esophagus, and lung Transplantation, North Hospital, Aix-Marseille University, APHM, Marseille, France; Predictive Oncology Laboratory, CRCM, INSERM UMR 1068, CNRS UMR 7258, Aix-Marseille University UM105, Marseille, France.
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Optimal Application of Forced Air Warming to Prevent Peri-Operative Hypothermia during Abdominal Surgery: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052517. [PMID: 33802589 PMCID: PMC7967382 DOI: 10.3390/ijerph18052517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/22/2021] [Accepted: 02/26/2021] [Indexed: 11/17/2022]
Abstract
Patients who undergo abdominal surgery under general anesthesia develop hypothermia in 80–90% of the cases within an hour after induction of anesthesia. Side effects include shivering, bleeding, and infection at the surgical site. However, the surgical team applies forced air warming to prevent peri-operative hypothermia, but these methods are insufficient. This study aimed to confirm the optimal application method of forced air warming (FAW) intervention for the prevention of peri-operative hypothermia during abdominal surgery. A systematic review and meta-analysis were conducted to provide a synthesized and critical appraisal of the studies included. We used PubMed, EMBASE, CINAHL, and Cochrane Library CENTRAL to systematically search for randomized controlled trials published through March 2020. Twelve studies were systematically reviewed for FAW intervention. FAW intervention effectively prevented peri-operative hypothermia among patients undergoing both open abdominal and laparoscopic surgery. Statistically significant effect size could not be confirmed in cases of only pre- or peri-operative application. The upper body was the primary application area, rather than the lower or full body. These findings could contribute detailed standards and criteria that can be effectively applied in the clinical field performing abdominal surgery.
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137
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Izquierdo LM, Moreno N, Ruiz S. Intravenous lidocaine infusion for the treatment of acute pain in the pediatric intensive care unit: case series. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.5554/22562087.e965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: The use of intravenous lidocaine infusion has increased over the past decade as part of a multimodal approach to analgesia in adults; however, information about its safety and tolerability in the pediatric population is limited.
Methods: Acute pain management using lidocaine infusion in eleven patients treated in the pediatric intensive care unit.
Results: Five cases of postoperative abdominal pain and six cases of non-operative abdominal pain. Two cases were cancer patients affected by neutropenic colitis. Analgesic control achieved was good.
Conclusion: Lidocaine infusions are apparently a safe option for the management of acute pain, either post-operative or not, in the pediatric population.
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Use of lidocaine with phenylephrine (Co-phenylcaine) spray for anaesthesia of the external auditory canal. The Journal of Laryngology & Otology 2021; 135:80-82. [PMID: 33478603 DOI: 10.1017/s0022215120002674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE A method is described for topical local anaesthesia of the tympanic membrane and ear canal using lidocaine and phenylephrine (Co-phenylcaine) spray and soaked micropatties. DISCUSSION The advantages of this method are discussed in comparison to existing methods.
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139
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Fujimori S, Sunada K. Effects of vasopressin on anesthetic response time and circulatory dynamics of lidocaine. Odontology 2021; 109:632-638. [PMID: 33449245 PMCID: PMC8178135 DOI: 10.1007/s10266-020-00585-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/15/2020] [Indexed: 11/26/2022]
Abstract
This study aimed to investigate the hypothesis that vasopressin extends the anesthetic response time of lidocaine and does not affect the circulatory dynamics. Rats were sedated with isoflurane; subsequently, breathing was maintained through mechanical ventilation. We infiltrated the first molar area of the upper left jaw with saline (NS, test solution), 2% lidocaine (L), 0.025 IU vasopressin-supplemented 2% lidocaine, 0.05 IU vasopressin-supplemented 2% lidocaine, 0.1 IU vasopressin-supplemented 2% lidocaine, and 0.2 IU vasopressin-supplemented 2% lidocaine (VL4). Further, anesthetic response times were measured up to 30 min using electric pulp testing methods (n = 4). The anesthetic response times of NS, L, and VL4 were measured up to 45 min with the aforementioned results as reference values (n = 7). The circulatory dynamics of NS, L, VL4, and 0.2 IU vasopressin (V) were measured up to 45 min using a non-invasive blood pressure measuring device. VL4 extended the anesthetic response times of lidocaine compared to L (p < 0.05). Further, V and VL4 significantly increased the systolic and diastolic blood pressure and significantly decreased the pulse rate (p < 0.05). VL4 is not a suitable addition to the local anesthetic solution used in dentistry. Further study is needed to determine vasopressin concentration that extends the anesthetic effect without affecting the circulatory dynamics.
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Affiliation(s)
- Shoko Fujimori
- Department of Dental Anesthesiology, The Nippon Dental University School of Life Dentistry at Tokyo, 1-9-20, Fujimi, Chiyoda-ku, Tokyo, 102-8159, Japan.
| | - Katsuhisa Sunada
- Department of Dental Anesthesiology, The Nippon Dental University School of Life Dentistry at Tokyo, 1-9-20, Fujimi, Chiyoda-ku, Tokyo, 102-8159, Japan
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Kolle G, Metterlein T, Gruber M, Seyfried T, Petermichl W, Pfaehler SM, Bitzinger D, Wittmann S, Bredthauer A. Potential Impact of Local Anesthetics Inducing Granulocyte Arrest and Altering Immune Functions on Perioperative Outcome. J Inflamm Res 2021; 14:1-12. [PMID: 33442284 PMCID: PMC7797324 DOI: 10.2147/jir.s275525] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Local anesthetics (LAs) are frequently used during anesthesia; however, they may influence granulocyte function which in turn could modify immune responses in the perioperative period. Therefore, the aim of this study was to investigate the impact of clinically used doses of bupivacaine and lidocaine on granulocyte function with regard to migration, reactive oxygen species (ROS) production, neutrophil extracellular traps (NETosis) formation, and viability. Methods A total of 38 granulocyte-enriched samples from healthy subjects were obtained by whole blood lysis. Polymorphonuclear neutrophil (PMN) samples were incubated simultaneously with different concentrations of either bupivacaine (0.03–3.16 mmol/L) or lidocaine (0.007–14.21 mmol/L), or without drug (control). Live cell imaging was conducted in order to observe granulocyte chemotaxis, migration, ROS production, and NETosis. Flow cytometry was used to analyze viability and antigen expression. Results The track length (TL) of PMNs exposed to bupivacaine concentrations of 0.16 mmol/L and above significantly decreased compared to the control. Low concentrations of lidocaine were associated with slight but significant increases in TL, whereas this changed with concentrations above 1.4 mmol/L, showing a significant decrease in TL. PMN incubated with bupivacaine concentrations of 1.58 mmol/L and above or lidocaine concentrations of at least 3.6 mmol/L showed no migration or chemotaxis at all. Time to onset of maximal ROS production and time for half-maximal NETosis decreased in a dose-dependent manner for both substances. Equipotency in NETosis induction was reached by bupivacaine (1.1 mmol/L) at significantly lower concentrations than lidocaine (7.96 mmol/L). Cell viability and oxidative burst were unaffected by LAs. Conclusion Local anesthetics in clinically used doses ameliorate granulocyte defense mechanisms, thus indicating their potentially decisive effect during the perioperative period.
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Affiliation(s)
- Gesche Kolle
- Department of Anesthesiology, University Medical Centre Regensburg, Regensburg 93053, Germany
| | - Thomas Metterlein
- Department of Anesthesiology, University Medical Centre Regensburg, Regensburg 93053, Germany.,Department of Anesthesiology, Klinikum Ansbach, Ansbach 91522, Germany
| | - Michael Gruber
- Department of Anesthesiology, University Medical Centre Regensburg, Regensburg 93053, Germany
| | - Timo Seyfried
- Department of Anesthesiology, University Medical Centre Regensburg, Regensburg 93053, Germany
| | - Walter Petermichl
- Department of Anesthesiology, University Medical Centre Regensburg, Regensburg 93053, Germany
| | - Sophie-Marie Pfaehler
- Department of Anesthesiology, University Medical Centre Regensburg, Regensburg 93053, Germany
| | - Diane Bitzinger
- Department of Anesthesiology, University Medical Centre Regensburg, Regensburg 93053, Germany
| | - Sigrid Wittmann
- Department of Anesthesiology, University Medical Centre Regensburg, Regensburg 93053, Germany
| | - Andre Bredthauer
- Department of Anesthesiology, University Medical Centre Regensburg, Regensburg 93053, Germany
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Rasappan K, Chua ITH, Tey JBL, Ho SWL. The continuous infusion fascia iliaca compartment block: a safe and effective analgesic modality in geriatric hip fracture patients. Arch Orthop Trauma Surg 2021; 141:29-37. [PMID: 32361955 DOI: 10.1007/s00402-020-03450-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Hip fractures are common orthopaedic injuries in the elderly. Opioids can provide peri-operative pain relief in hip fracture patients, but may have side effects. Peripheral nerve blocks such as the fascia iliaca compartment block (FICB) have become an established part of the multimodal analgesic regime administered peri-operatively to hip fracture patients. We compare the efficacy of the continuous infusion FICB (CFICB) on peri-operative pain relief, opioid usage, its associated complications and the short as well as long term rehabilitation status in geriatric hip fractures patients. MATERIALS AND METHODS In this retrospective matched case control study, 40 geriatric patients with hip fractures who had received the CFICB from Nov 2014 to April 2016 were matched in a 1:3 ratio with similar patients whom had not received the CFICB from our institution's hip fracture database of 913 patients. RESULTS A total of 157 patients in both the CFICB group (N = 40) and the control group (N = 117) were studied. The post-operative pain scores and the total opioid consumption during the first 3 days in the CFICB group were significantly less than the control group (p < 0.0001, respectively). The systemic complications in the CFICB group were comparable with the control group. The CFICB group had slower rehabilitation at up to 2 weeks but there was no significant difference at 1 year post surgery in terms of function and mobility between the two groups. In both groups, better pre-fracture function was associated with faster short term rehab outcomes in post-operative patients. CONCLUSION The CFICB provides safe and effective post-operative pain relief in geriatric hip fracture patients. Post-operative opioid usage is decreased in older hip fracture patients treated with CFICB. Rehabilitation milestones are slower in the short term, but have no significant difference at 1-year post surgery.
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Affiliation(s)
- Kumaran Rasappan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Ivan Tjun Huat Chua
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - John Boon Lim Tey
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hopsital, Singapore, Singapore
| | - Sean Wei Loong Ho
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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Kopel J, Sharma DP. Spinal surgery and urinary retention: A review of the literature. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415820916932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Postoperative urinary retention is a common complication for patients recovering from general anesthesia or invasive surgery near the spinal column. However, no study has systematically reviewed the incidence of postoperative urinary retention for spinal surgeries performed at the cervical, thoracic, or lumbar spinal regions. In this review, we critically analyze and summarize the known literature on the incidence and risk factors associated with postoperative urinary retention after spinal surgery. Methods: A comprehensive literature review was performed at the end of September 2019 within the PubMed database. Results: The average incidence of postoperative urinary retention from nine of the 10 studies was 17.2% with one paper that did not report on postoperative urinary retention incidence. Furthermore, age, male gender, location and history of spinal surgery, duration of surgery, benign prostatic hypertrophy, and Foley catheter were reported as major risk factors for postoperative urinary retention and spinal surgery. Conclusion: Overall, spinal cord and postoperative urinary retention remains a poorly understood area requiring further investigation into the incidence, risk factors, and surgical methods influence postoperative urinary retention and post-operative outcomes. We believe an overview of such data can help revise guidelines for the management of postoperative urinary retention and raise awareness of its prevalence in elderly patients undergoing spinal surgery. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
- Jonathan Kopel
- Texas Tech University Health Sciences Center, Lubbock, United States of America
| | - Dr Pranav Sharma
- Staff Physician, Department of Urology, Texas Tech University Health Sciences Center, Lubbock, United States of America
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143
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Mpasa F, van Rooyen DRM, Venter D, Jordan P, Ten Ham-Baloyi W. Improving nurses' knowledge of managing endotracheal tube cuff pressure in intensive care units: A quasi-experimental study. Health SA 2020; 25:1479. [PMID: 33391829 PMCID: PMC7756521 DOI: 10.4102/hsag.v25i0.1479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/20/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Previous studies conducted on nurses' knowledge regarding endotracheal tube cuff pressure revealed that there were differences in intensive care nurses' knowledge, leading to varying practices. AIM This study aimed to evaluate how an educational intervention based on the existing evidence-based guidelines, using both passive and active implementation strategies, could improve the knowledge of nurses regarding managing endotracheal tube cuff pressures in Malawian intensive care units. SETTING Six functional ICUs (four public and two private) in Malawi. METHODS The study followed a quasi-experimental, pre- and post-test design using an educational intervention. Intensive care nurses of six functional intensive care units in Malawi were randomly assigned to two intervention groups. Both groups received a half-day educational session, a printed version of the evidence-based guidelines, a printed and laminated summary of the guidelines and a related algorithm. Additionally, Intervention 2 group received four monitoring visits. Pre- and post-test questionnaires were conducted between February and August 2016. Descriptive and inferential data analyses (a chi-square test and t-test) were utilised. RESULTS An improvement in knowledge was observed on the nursing care practices for the management of endotracheal tube cuff pressure for both groups following the educational intervention, although only the results comparing Intervention 2 group participants indicate that the level of knowledge was significant (t[df = 48] = 2.08, p = 0.043, d = 0.59). CONCLUSION Implementation of a formal training and mentorship programme for Malawian intensive care nurses would be of great benefit to enhance the knowledge and skills managing endotracheal tube cuff pressure. Follow-up studies would also assist in understanding how guidelines could be implemented most effectively to achieve better knowledge outcomes.
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Affiliation(s)
- Ferestas Mpasa
- Department of Nursing Science, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa
- Department of Nursing and Midwifery Science, Mzuzu University, Luwinga, Malawi
| | | | - Danie Venter
- Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa
| | - Portia Jordan
- Department of Nursing Science, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Wilma Ten Ham-Baloyi
- Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa
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Itin C, Komargodski R, Barasch D, Domb AJ, Hoffman A. Prolonged Delivery of Apomorphine Through the Buccal Mucosa, Towards a Noninvasive Sustained Administration Method in Parkinson's Disease: In Vivo Investigations in Pigs. J Pharm Sci 2020; 110:1824-1833. [PMID: 33333142 DOI: 10.1016/j.xphs.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/20/2020] [Accepted: 12/09/2020] [Indexed: 01/01/2023]
Abstract
In the current work, prolonged systemic delivery of apomorphine via buccal mucosa was shown to be a promising treatment for Parkinson's disease as a substitute for clinically utilized subcutaneous infusions. Due to extensive 'first-pass' metabolism, apomorphine is administered parenterally to bypass liver metabolism. Drawbacks of parenteral administration cause low patient compliance and adherence to treatment. On the other hand, while also bypassing the liver, delivery through buccal mucosa has a superior safety profile, is less costly, lacks pain and discomfort, and possesses excellent accessibility, overall augmenting patient compliance. Current in vivo study in pigs showed: (1) steady plateau levels of apomorphine in plasma were obtained 30 min following administration and remained constant for 8 h until a delivery device was removed, (2) bioavailability of apomorphine was 55%-80% as opposed to <2% peroral and (3) simulation of the pharmacokinetic profile obtained in pigs predicted therapeutically relevant levels of apomorphine in human. Furthermore, antipyrine was incorporated as a permeation marker to enable mechanistic investigation of apomorphine release from the delivery device and its permeation through the buccal mucosa. In addition, limitations of an Ussing diffusion chamber as an ex vivo research tool were also discussed.
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Affiliation(s)
- Constantin Itin
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, P.O. Box 12065, Jerusalem 91120, Israel
| | - Rinat Komargodski
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, P.O. Box 12065, Jerusalem 91120, Israel
| | - Dinorah Barasch
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, P.O. Box 12065, Jerusalem 91120, Israel
| | - Abraham J Domb
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, P.O. Box 12065, Jerusalem 91120, Israel
| | - Amnon Hoffman
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, P.O. Box 12065, Jerusalem 91120, Israel.
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Mehraban S, Nematian S, Mehraban SS, Petrucci S, Tricorico G, Parnas Z, Shats L, Kanninen T, Moretti M, Cabbad M, Lakhi N. Randomized control trial of intravenous acetaminophen for reduction of intrapartum maternal fever. Am J Obstet Gynecol MFM 2020; 3:100287. [PMID: 33451627 DOI: 10.1016/j.ajogmf.2020.100287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/20/2020] [Accepted: 12/01/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intravenous acetaminophen reaches a higher mean peak plasma concentration than oral acetaminophen in a shorter period of time. The favorable pharmacokinetics of intravenous acetaminophen may be beneficial for treating intrapartum maternal fever. OBJECTIVE The primary objective was to compare intravenous and oral acetaminophen in time to defervescence (temperature <38°C). The secondary objective was to compare intravenous and oral acetaminophen in the percentage of participants being afebrile and percent reduction in maternal temperature 30 minutes after administration of first dose. Other outcomes evaluated were histopathological placental findings; neonatal outcomes; oxidative stress; and levels of RANTES, interferon-δ, interleukin 1β, interleukin 2, interleukin 4, interleukin 6, interleukin 8, interleukin 10, interleukin 13, and tumor necrosis factor-α in maternal and neonatal blood. STUDY DESIGN This was a randomized, comparator-controlled, double-dummy, double-blind clinical trial. At the onset of intrapartum fever ≥38°C, patients ≥36 weeks' gestation were either randomized to the control or experimental study arm. Patients in the control arm received 1000 mg of oral acetaminophen capsules and an intravenous placebo resembling intravenous acetaminophen. Patients randomized to the experimental arm received 1000 mg of intravenous acetaminophen and oral placebo capsules resembling acetaminophen. Maternal temperatures and fetal heart rates were recorded at consecutive intervals following administration of the first dose of acetaminophen. Maternal blood, collected at the onset of fever and after delivery, and neonatal cord blood collected at delivery were evaluated for oxidative stress (glutathione levels), levels of RANTES and cytokines (interferon-δ, interleukin 1β, interleukin 2, interleukin 4, interleukin 6, interleukin 8, interleukin 10, interleukin 13, and tumor necrosis factor-α). Placentas were collected for pathologic review. A P value of <.05 was considered statically significant. RESULTS A total of 121 patients (55 in the intravenous and 66 in the oral group) were recruited from December 1, 2016, to February 28, 2018. Patient demographics and intrapartum factors were similar between both arms. The intravenous group showed a mean time of 54.86 minutes (95% confidence interval, 20.57-39.43) to defervescence vs 52.58 minutes (95% confidence interval, 16.58-43.42) in the oral group (P=.71). In addition, intravenous and oral acetaminophen showed similar results in percentage of patients being afebrile and percent reduction in maternal temperature 30 minutes after administration of the first dose. Histopathological findings, neonatal outcomes, oxidative stress markers, and RANTES and cytokine levels were not statistically significant between intravenous and oral acetaminophen groups. CONCLUSION Intravenous acetaminophen did not demonstrate a higher efficacy than oral acetaminophen in treating intrapartum maternal fever. Select patients may benefit from intravenous acetaminophen for treatment of intrapartum fever, including those who cannot tolerate oral medication.
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Affiliation(s)
- Shadi Mehraban
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY
| | - Sepide Nematian
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY
| | - Shadan S Mehraban
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY
| | - Samantha Petrucci
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY
| | - Gabrielle Tricorico
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY
| | - Zarina Parnas
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY
| | - Lenny Shats
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY
| | - Tomi Kanninen
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY
| | - Michael Moretti
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY
| | - Michael Cabbad
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY
| | - Nisha Lakhi
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY; Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY.
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146
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Lim V, Mac-Thiong JM, Dionne A, Begin J, Richard-Denis A. Clinical Protocol for Identifying and Managing Bladder Dysfunction during Acute Care after Traumatic Spinal Cord Injury. J Neurotrauma 2020; 38:718-724. [PMID: 33121377 DOI: 10.1089/neu.2020.7190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Bladder dysfunction is widespread following traumatic spinal cord injury (TSCI). Early diagnosis of bladder dysfunction is crucial in preventing complications, determining prognosis, and planning rehabilitation. We aim to suggest the first clinical protocol specifically designed to evaluate and manage bladder dysfunction in TSCI patients during acute care. A retrospective cohort study was conducted on 101 patients admitted for an acute TSCI between C1 and T12. Following spinal surgery, presence of voluntary anal contraction (VAC) was used as a criterion for removal of indwelling catheter and initiating trial of void (TOV). Absence of bladder dysfunction was determined from three consecutive post-void bladder scan residuals ≤200 mL without incontinence. All patients were reassessed 3 months post-injury using the Spinal Cord Independence Measure (SCIM). A total of 74.3% were diagnosed with bladder dysfunction during acute care, while 57.4% had a motor-complete TSCI. Three months later, 94.7% of them reported impaired bladder function. None of the patients discharged from acute care after a functional bladder was diagnosed reported impaired bladder function at the 3-month follow-up. A total of 95.7% patients without VAC had persisting impaired bladder function at follow-up. The proposed protocol is specifically adapted to the dynamic nature of neurogenic bladder function following TSCI. The assessment of VAC into the protocol provides major insight on the potential for reaching adequate bladder function during the subacute phase. Conducting TOV using bladder scan residuals in patients with VAC is a non-invasive and easy method to discriminate between a functional and an impaired bladder following acute TSCI.
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Affiliation(s)
- Victor Lim
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Jean-Marc Mac-Thiong
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Department of Orthopedic Surgery, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada.,Department of Orthopedic Surgery, Hôpital Sainte-Justine, Montreal, Quebec, Canada
| | - Antoine Dionne
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Jean Begin
- Department of Orthopedic Surgery, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada.,Department of Physical Medicine and Rehabilitation, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Andréane Richard-Denis
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Department of Physical Medicine and Rehabilitation, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
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147
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Foo I, Macfarlane AJR, Srivastava D, Bhaskar A, Barker H, Knaggs R, Eipe N, Smith AF. The use of intravenous lidocaine for postoperative pain and recovery: international consensus statement on efficacy and safety. Anaesthesia 2020; 76:238-250. [PMID: 33141959 DOI: 10.1111/anae.15270] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 12/15/2022]
Abstract
Intravenous lidocaine is used widely for its effect on postoperative pain and recovery but it can be, and has been, fatal when used inappropriately and incorrectly. The risk-benefit ratio of i.v. lidocaine varies with type of surgery and with patient factors such as comorbidity (including pre-existing chronic pain). This consensus statement aims to address three questions. First, does i.v. lidocaine effectively reduce postoperative pain and facilitate recovery? Second, is i.v. lidocaine safe? Third, does the fact that i.v. lidocaine is not licensed for this indication affect its use? We suggest that i.v. lidocaine should be regarded as a 'high-risk' medicine. Individual anaesthetists may feel that, in selected patients, i.v. lidocaine may be beneficial as part of a multimodal peri-operative pain management strategy. This approach should be approved by hospital medication governance systems, and the individual clinical decision should be made with properly informed consent from the patient concerned. If i.v. lidocaine is used, we recommend an initial dose of no more than 1.5 mg.kg-1 , calculated using the patient's ideal body weight and given as an infusion over 10 min. Thereafter, an infusion of no more than 1.5 mg.kg-1 .h-1 for no longer than 24 h is recommended, subject to review and re-assessment. Intravenous lidocaine should not be used at the same time as, or within the period of action of, other local anaesthetic interventions. This includes not starting i.v. lidocaine within 4 h after any nerve block, and not performing any nerve block until 4 h after discontinuing an i.v. lidocaine infusion.
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Affiliation(s)
- I Foo
- Western General Infirmary, Edinburgh, UK
| | | | | | - A Bhaskar
- Imperial College Healthcare NHS Trust, London, UK
| | - H Barker
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - R Knaggs
- University of Nottingham, Nottingham, UK
| | - N Eipe
- Ottowa Hospital, Ottowa, Canada
| | - A F Smith
- Royal Lancaster Infirmary, Lancaster, UK
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148
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Gayas MA, Fazili MUR, Aijaz R, Handoo N, Gugjoo MB, Dar SH, Teeli AS. Distal paravertebral nerve block in sheep undergoing laparohysterotomy: Comparing the use of 1% and 2% lignocaine hydrochloride. Small Rumin Res 2020. [DOI: 10.1016/j.smallrumres.2020.106185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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149
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Lee JY, Kim HT, Won JM, Shin YD. A Rare Case of Euphoria Caused by Lidocaine After an Erector Spinae Plane Block: A Case Report. J Pain Res 2020; 13:2329-2332. [PMID: 33061547 PMCID: PMC7519830 DOI: 10.2147/jpr.s271535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/04/2020] [Indexed: 11/23/2022] Open
Abstract
Lidocaine is a cost-effective drug that is widely used for local and regional anesthesia. However, central nervous system (CNS) toxicity can occur when lidocaine is administered above the maximum recommended dose (approximately 4.5 mg/kg) or if lidocaine is injected intravascularly rather than administered locally. Systemic toxicity by lidocaine has been reported in several studies. However, psychotic reactions due to lidocaine have been rarely reported; furthermore, reports of lidocaine-related euphoria are very rare. We report a very rare case of euphoria caused by CNS toxicity that occurred during the local administration of lidocaine at the therapeutic dose. Therefore, anesthesiologists should be aware of the severe side effects of local anesthetics despite administering the appropriate dosage at the appropriate location. Future studies should investigate pharmacokinetics to determine the safety profile of local anesthetics.
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Affiliation(s)
- Joo Yong Lee
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Hyeon Tae Kim
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Jeong Moon Won
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Young Duck Shin
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Korea
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150
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Hawley P, Fyles G, Jefferys SG. Subcutaneous Lidocaine for Cancer-Related Pain. J Palliat Med 2020; 23:1357-1364. [DOI: 10.1089/jpm.2019.0621] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Philippa Hawley
- Pain and Symptom Management/Palliative Care Department, BC Cancer, Vancouver, British Columbia, Canada
- Division of Palliative Care, Interdepartmental Division of Departments of Medicine, Family Practice, and Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gillian Fyles
- Division of Palliative Care, Interdepartmental Division of Departments of Medicine, Family Practice, and Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Pain and Symptom Management/Palliative Care Program, BC Cancer, Kelowna, British Columbia, Canada
| | - Stephen G. Jefferys
- Pain and Symptom Management/Palliative Care Program, BC Cancer, Kelowna, British Columbia, Canada
- Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia-Okanagan, Kelowna, British Columbia, Canada
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