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Someili A, Alosail A, Brooks A, Irfan N, Leto D, Hadzic A, Alajmi A, Mertz D, Bader M. A100 ORAL VANCOMYCIN THERAPY FOR CLOSTRIDIOIDES DIFFICILE INFECTION AND RISK OF INFECTION WITH GRAM-NEGATIVE ORGANISMS. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Vancomycin is the recommended first-line therapy for mild to severe Clostridioides difficile infection (CDI). However, oral vancomycin is associated with disruption of the indigenous microbiota, predisposing patients to overgrowth of endogenous pathogens such as vancomycin-resistant enterococci.
Aims
The primary objective of the study is to examine the effect of the treatment regimens of CDI on the risk of infection with gram-negative organisms in adult patients treated for CDI.
Methods
A retrospective cohort study of 319 adult patients treated for CDI at Hamilton Health Sciences in the year 2015. A multivariate logistic regression analysis was performed to determine if oral vancomycin-based therapy is associated with an increased risk of infection with gram-negative organisms after adjustment for other factors.
Results
Eighty-one patients were excluded because of recurrent episodes of CDI within the same year or missing information. 238 patients were included in the final analysis. 48 (20.2%) patients had positive culture for gram-negative organisms after onset of CDI. Urine was the most common source for gram-negative organisms (39/48, 81.3%) followed by blood (8/48,16.7%). The most common isolated gram-negative organisms were Escherichia coli (18/48, 37.5%) and Klebsiella pneumonia (9/48, 18.8%).
The most common CDI treatment regimens were metronidazole monotherapy (137/238, 57.6%), vancomycin monotherapy (13/238, 5.5%), and combination therapy (88/238, 37.0%). Among patients who were treated with metronidazole monotherapy, vancomycin monotherapy, and combination therapy, 30(30/137, 21.9%), 3 (3/13,23.1%), and 15 (15/88, 17.1%) had positive culture for gram-negative organisms, respectively (P= 0.6).
Ninety-seven (97/238,40.8%) patients had severe CDI, 40 (40/97, 41.2%) were treated with metronidazole monotherapy, 5(5/97, 5.2%) with vancomycin monotherapy, and 52 (52/97, 53.6%) with combination therapy. 26 (26/141,18.4%) and 22 (22/97, 22.7%) had positive culture for gram-negative organisms among patients with non-severe and severe CDI, receptively (P= 0.7). In the multivariate analysis, neither type of CDI treatment regimen (P=0.2, 95% CI 0.30–1.31) nor CDI severity (P=0.4, 95% CI 0.67–2.69) was associated an increased risk of infection with gram-negative organisms after CDI onset.
Conclusions
Contrary to the reported literature, we did not find that oral vancomycin-based CDI treatment was associated with increased risk of infection with gram-negative organisms.
Funding Agencies
None
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Affiliation(s)
- A Someili
- McMaster university, Hamilton, ON, Canada
| | - A Alosail
- McMaster university, Hamilton, ON, Canada
| | - A Brooks
- McMaster university, Hamilton, ON, Canada
| | - N Irfan
- McMaster university, Hamilton, ON, Canada
| | - D Leto
- McMaster university, Hamilton, ON, Canada
| | - A Hadzic
- McMaster university, Hamilton, ON, Canada
| | - A Alajmi
- McMaster university, Hamilton, ON, Canada
| | - D Mertz
- McMaster university, Hamilton, ON, Canada
| | - M Bader
- McMaster university, Hamilton, ON, Canada
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Gautier N, Danklou J, Brichant JF, Lopez AM, Vandepitte C, Kuroda MM, Hadzic A, Gautier PE. The effect of force applied to the left paratracheal oesophagus on air entry into the gastric antrum during positive-pressure ventilation using a facemask. Anaesthesia 2018; 74:22-28. [DOI: 10.1111/anae.14442] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2018] [Indexed: 12/31/2022]
Affiliation(s)
- N. Gautier
- Department of Anesthesiology; University of Louvain; St Luc Hospital; Brussels Belgium
| | - J. Danklou
- Department of Anesthesia and Intensive Care Medicine; Liege University Hospital; Liege Belgium
| | - J. F. Brichant
- Department of Anesthesia and Intensive Care Medicine; Liege University Hospital; Liege Belgium
| | - A. M. Lopez
- Department of Anesthesiology; Hospital Clinic de Barcelona; Barcelona Spain
| | - C. Vandepitte
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Algology; ZOL; Genk Belgium
| | - M. M. Kuroda
- New York School of Regional Anesthesia (NYSORA); New York USA
| | - A. Hadzic
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Algology; ZOL; Genk Belgium
| | - P. E. Gautier
- Service D'Anesthesie; Clinique St Anne-St Remi; CHIREC; Bruxelles Belgium
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Damjanovska M, Cvetko E, Hadzic A, Seliskar A, Plavec T, Mis K, Vuckovic Hasanbegovic I, Stopar Pintaric T. Neurotoxicity of perineural vs intraneural-extrafascicular injection of liposomal bupivacaine in the porcine model of sciatic nerve block. Anaesthesia 2015; 70:1418-26. [PMID: 26338496 PMCID: PMC5049634 DOI: 10.1111/anae.13189] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2015] [Indexed: 11/30/2022]
Abstract
Liposomal bupivacaine is a prolonged-release local anaesthetic, the neurotoxicity of which has not yet been determined. We used quantitative histomorphometric and immunohistochemical analyses to evaluate the neurotoxic effect of liposomal bupivacaine after perineural and intraneural (extrafascicular) injection of the sciatic nerve in pigs. In this double-blind prospective randomised trial, 4 ml liposomal bupivacaine 1.3% was injected either perineurally (n = 5) or intraneurally extrafascicularly (n = 5). Intraneural-extrafascicular injection of saline (n = 5) was used as a control. After emergence from anaesthesia, neurological examinations were conducted over two weeks. After harvesting the sciatic nerves, no changes in nerve fibre density or myelin width indicative of nerve injury were observed in any of the groups. Intraneural injections resulted in longer sensory blockade than perineural (p < 0.003) without persistent motor or sensory deficit. Sciatic nerve block with liposomal bupivacaine in pigs did not result in histological evidence of nerve injury.
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Affiliation(s)
- M Damjanovska
- Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - E Cvetko
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - A Hadzic
- NAICE (North American Institute for Continuing Education), New York, NY, USA.,NYSORA (The New York School of Regional Anesthesia), New York, NY, USA.,Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - A Seliskar
- Clinic for Small Animal Medicine and Surgery, Veterinary Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - T Plavec
- Clinic for Small Animal Medicine and Surgery, Veterinary Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - K Mis
- Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - I Vuckovic Hasanbegovic
- Department of Anatomy, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - T Stopar Pintaric
- Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Lopez AM, Sala-Blanch X, Castillo R, Hadzic A. Ultrasound guided injection inside the common sheath of the sciatic nerve at division level has a higher success rate than an injection outside the sheath. Rev Esp Anestesiol Reanim 2014; 61:304-310. [PMID: 24556512 DOI: 10.1016/j.redar.2013.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/06/2013] [Accepted: 11/16/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND OBJECTIVE The recommendations for the level of injection and ideal placement of the needle tip required for successful ultrasound-guided sciatic popliteal block vary among authors. A hypothesis was made that, when the local anesthetic is injected at the division of the sciatic nerve within the common connective tissue sheath, the block has a higher success rate than an injection outside the sheath. METHODS Thirty-four patients scheduled for hallux valgus repair surgery were randomized to receive either a sub-sheath block (n=16) or a peri-sheath block (n=18) at the level of the division of the sciatic nerve at the popliteal fossa. For the sub-sheath block, the needle was advanced out of plane until the tip was positioned between the tibial and peroneal nerves, and local anesthetic was then injected without moving the needle. For the peri-sheath block, the needle was advanced out of plane both sides of the sciatic nerve, to surround the sheath. Mepivacaine 1.5% and levobupivacaine 0.5% 30mL were used in both groups. The progression of motor and sensory block was assessed at 5min intervals. Duration of block was recorded. RESULTS Adequate surgical block was achieved in all patients in the subsheath group (100%) compared to 12 patients (67%) in the peri-sheath group at 30min. Sensory block was achieved faster in the subsheath than peri-sheath (9.1±7.4min vs. 19.0±4.0; p<.001). CONCLUSIONS Our study suggests that for successful sciatic popliteal block in less than 30min, local anesthetic should be injected within the sheath.
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Affiliation(s)
- A M Lopez
- Department of Anesthesiology, Hospital Clínic Barcelona, Barcelona, Spain.
| | - X Sala-Blanch
- Department of Anesthesiology, Hospital Clínic Barcelona, Barcelona, Spain
| | - R Castillo
- Department of Anesthesiology, Hospital Clínic Barcelona, Barcelona, Spain
| | - A Hadzic
- Department of Anesthesiology, St Luke's-Roosevelt Hospital, College of Physicians and Surgeons, Columbia University, New York, USA
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Vandepitte C, Latmore M, O’Murchu E, Hadzic A, Van de Velde M, Nijs S. Combined interscalene-superficial cervical plexus blocks for surgical repair of a clavicular fracture in a 15-week pregnant woman. Int J Obstet Anesth 2014; 23:194-5. [DOI: 10.1016/j.ijoa.2013.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/03/2013] [Accepted: 10/07/2013] [Indexed: 11/15/2022]
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Levine M, Latmore M, Vandepitte C, Gadsden J, Hadzic A. It is 3 a.m. . . . do you know where your catheter tip is? Br J Anaesth 2014; 112:757-8. [DOI: 10.1093/bja/aeu069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ruiz A, Sala-Blanch X, Martinez-Ocón J, Carretero MJ, Sánchez-Etayo G, Hadzic A. Incidence of intraneural needle insertion in ultrasound-guided femoral nerve block: a comparison between the out-of-plane versus the in-plane approaches. Rev Esp Anestesiol Reanim 2014; 61:73-77. [PMID: 24314696 DOI: 10.1016/j.redar.2013.09.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/17/2013] [Accepted: 09/25/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND The optimal method of ultrasound-guided femoral nerve block (in-plane vs. out-of-plane) has not been established. We tested the hypothesis that the incidence of needle-nerve contact may be higher with out-of-plane than with in-plane needle insertion. METHODS Forty-four patients with hip fracture (American Society of Anaesthesiologists physical status I-III) were randomized to receive the femoral block with an out-of-plane approach (needle inserted at a 45-60° angle 1cm caudal to the midpoint of the ultrasound probe just above the femoral nerve) or with an in-plane technique (needle inserted 0.2-0.4 cm from the side of the probe lateral to the femoral nerve). Data collected included depth of needle insertion, response to nerve electric stimulation, and distribution of the injected volume in relation to the nerve (anterior vs. posterior, the latter assuming needle-nerve contact). The sensory block onset was tested at 20 min and block recovery and any neurologic symptoms were evaluated at 24h. RESULTS The incidence of needle-nerve contact was significantly higher with the out-of-plane approach (14/22 patients [64%]) than with the in-plane approach (2/22 patients [9%]) (p<0.001) (OR=17.5, 95% CI: 4-79). The rate of paraesthesia on crossing the fascia iliaca was similar in the two groups. All blocks uneventfully regressed; and no patient developed neurologic symptoms. CONCLUSIONS Under the conditions of our study, needle-nerve contact during femoral nerve block occurs frequently with the out-of-plane approach. An in-plane approach results in an equally effective femoral block and less incidence of needle-nerve contact.
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Affiliation(s)
- A Ruiz
- Department of Anaesthesiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - X Sala-Blanch
- Department of Anaesthesiology, Hospital Clínic, Universitat de Barcelona, Spain.
| | - J Martinez-Ocón
- Department of Anaesthesiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - M J Carretero
- Department of Anaesthesiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - G Sánchez-Etayo
- Department of Anaesthesiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - A Hadzic
- Department of Anaesthesia, St Luke's - Roosevelt Hospital Center, University Hospital of Columbia University, New York, USA
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Adhikary SD, Hadzic A, McQuillan PM. Simulator for teaching hand-eye coordination during ultrasound-guided regional anaesthesia. Br J Anaesth 2013; 111:844-5. [PMID: 24108733 DOI: 10.1093/bja/aet364] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vandepitte C, Gautier P, Bellen P, Murata H, Salviz EA, Hadzic A. Use of ultrasound-guided intercostal nerve block as a sole anaesthetic technique in a high-risk patient with Duchenne muscular dystrophy. Acta Anaesthesiol Belg 2013; 64:91-94. [PMID: 24191530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Duchenne muscular dystrophy is a progressive neuromuscular disease. Mortality is typically related to combined respiratory failure and dilated cardiomyopathy. Surgery under general anesthesia or deep sedation presents increased risks for pulmonary complications or ventilator dependency postoperatively. We describe the utility of ultrasound guided intercostal nerve blocks for surgery on the chest wall in a patient with Duchenne muscular dystrophy and severe respiratory compromise.
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Affiliation(s)
- C Vandepitte
- Department of Anesthesiology, Catholic University of Leuven, Leuven, Belgium
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Sala Blanch X, López AM, Carazo J, Hadzic A, Carrera A, Pomés J, Valls-Solé J. Intraneural injection during nerve stimulator-guided sciatic nerve block at the popliteal fossa. Br J Anaesth 2009; 102:855-61. [PMID: 19420006 DOI: 10.1093/bja/aep097] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Exact location of the needle tip during nerve stimulation-guided peripheral nerve blocks is unknown. Using high-frequency ultrasound imaging, we tested the hypothesis that intraneural injection is common with nerve stimulator-guided sciatic nerve (SN) block in popliteal fossa. METHODS Forty-two patients scheduled for hallux valgus repair were studied. Sciatic block at the popliteal fossa was accomplished using nerve stimulation. When a motor response was elicited at <0.5 mA (2 Hz, 0.1 ms), 40 ml of local anaesthetic (LA) was injected. Using ultrasound (Titan, Sonosite, 5-10 MHz), the diameters and area of the SN were measured before and after the injection. The presence of nerve swelling and proximal or distal diffusion of LA were also assessed. Intraneural injection was defined as nerve area (NA) increase of > OR =15% and one or more additional ultrasonographic markers (nerve swelling, proximal-distal diffusion within epineural tissue). Clinical neurological evaluation was performed 1 week after the block. RESULTS Post-injection NA increase > OR =15% was seen in 32 (76%) patients [0.54 (SD 0.19) cm(-2) vs 0.76 (0.24) cm(-2); P<0.05]. Nerve swelling with fascicular separation was observed in 37 (88%) patients; proximal and distal diffusion of LA were present in six (14%) and 14 (38%) patients, respectively. Intraneural injection criteria were met in 28 (66%) patients. Greater NA increase was present in patients with fast block onset [61 (45) vs 25 (33)%; (Dif 35% 95% CI 61-9%); P<0.05]. No patient developed neurological complications. CONCLUSIONS Intraneural (subepineural) injection is a common occurrence after nerve stimulator-guided SN block at the popliteal fossa, yet it may not inevitably lead to neurological complications.
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Affiliation(s)
- X Sala Blanch
- Department of Anesthesiology, Hospital Clinic, Universitat de Barcelona, C/Villarroel 170, Barcelona 08036, Spain.
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Kapur E, Vuckovic I, Dilberovic F, Zaciragic A, Cosovic E, Divanovic KA, Mornjakovic Z, Babic M, Borgeat A, Thys DM, Hadzic A. Neurologic and histologic outcome after intraneural injections of lidocaine in canine sciatic nerves. Acta Anaesthesiol Scand 2007; 51:101-7. [PMID: 17081151 DOI: 10.1111/j.1399-6576.2006.01169.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Inadvertent intraneural injection of local anesthetics may result in neurologic injury. We hypothesized that an intraneural injection may be associated with higher injection pressures and an increase in the risk of neurologic injury. METHODS The study was conducted in accordance with the principles of laboratory animal care, and was approved by the Laboratory Animal Care and Use Committee. Fifteen dogs of mixed breed (16-21 kg) were studied. After general endotracheal anesthesia, the sciatic nerves (n= 30) were exposed bilaterally. Under direct vision, a 25-gauge, long-beveled needle (30 degrees) was placed either epineurally (n= 10) or intraneurally (n= 20), and 4 ml of preservative-free lidocaine 20 mg/ml was injected using an automated infusion pump (4 ml/min). Injection pressure data were acquired using an in-line manometer coupled to a computer via an analog-to-digital conversion board. After injection, the animals were awakened and subjected to serial neurologic examinations. One week later, the dogs were killed, the sciatic nerves excised and histologic examination was performed by pathologists blind to the purpose of the study. RESULTS All perineural injections resulted in low pressures (< or = 5 psi). In contrast, eight of 20 intraneural injections resulted in high pressures (20-38 psi) at the beginning of the injection. Twelve intraneural injections, however, resulted in pressures of less than 12 psi. Neurologic function returned to baseline within 3 h after perineural injections and within 24 h after intraneural injections, when the measured injection pressures were less than 12 psi. Neurologic deficits persisted throughout the study period after all eight intraneural injections that resulted in high injection pressures. Histologic examination of the affected nerves revealed fascicular axonolysis and cellular infiltration. CONCLUSIONS The data in our canine model of intraneural injection suggest that intraneural injections do not always lead to nerve injury. High injection pressures during intraneural injection may be indicative of intrafascicular injection and may predict the development of neurologic injury.
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Affiliation(s)
- E Kapur
- Department of Anatomy, Medical School, University of Sarajevo, Bosnia and Herzegovina
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Hadzic A, Vloka JD, Santos AC. Research in regional anesthesia: objective versus subjective. Reg Anesth Pain Med 2001; 26:593-5. [PMID: 11707807 DOI: 10.1053/rapm.2001.26221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Edno-Mcheik L, Gaulier JM, Combourieu I, Lacassie E, Hadzic A. Heptaminol interferes in the AxSYM FPIA amphetamine/methamphetamine II assay. Clin Chem 2001; 47:1499-500. [PMID: 11468252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Abstract
PURPOSE To present a case of iatrogenic, unilateral pupillary dilatation after general anesthesia for nasal surgery. Unilateral pupillary dilatation after general anesthesia has sinister implications, which might prompt further investigations. However, in patients undergoing nasal surgery, it might be caused by the action of drugs injected intranasally. Consideration of iatrogenic causes of pupillary dilatation might help clinicians to avoid time-consuming and costly investigations. CLINICAL FEATURES A 24-yr-old healthy woman underwent a general anesthetic for septoplasty and bilateral turbinectomy. She was hemodynamically stable and did not suffer any hypoxia intraoperatively. At the end of the operation her right pupil was dilated (8 mm diameter). Her left pupil was normal. No other abnormality was detected. After she woke up, her vision was grossly normal. Neurological examination did not show any other abnormality. Six to eight hours later, both pupils were equal (2 mm in diameter) and reacting normally to light and accommodation. CONCLUSION The patient was a healthy 24-yr-old who underwent an operation in which there was no incident of hypoxia or hemodynamic instability. Since the patient recovered completely within six to eight hours, the pupillary dilatation was probably caused by epinephrine, which could have entered the eye through the nasolacrimal duct. Although pupillary dilatation after general anesthesia has been described, this is the first case report where the most likely causative agent was epinephrine, injected into the nasal submucosa.
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Affiliation(s)
- M G D'Souza
- Department of Anesthesiology, St. Luke's/Roosevelt Hospital Center, New York, NY 10025, USA.
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Vloka JD, Hadzic A, Mulcare R, Lesser JB, Koorn R, Thys DM. Combined popliteal and posterior cutaneous nerve of the thigh blocks for short saphenous vein stripping in outpatients: an alternative to spinal anesthesia. J Clin Anesth 1997; 9:618-22. [PMID: 9438888 DOI: 10.1016/s0952-8180(97)00150-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVE To compare a combination of peripheral nerve blocks with spinal anesthesia in ambulatory patients undergoing short saphenous vein stripping. DESIGN Prospective, randomized study. SETTING University hospital. PATIENTS 28 ASA physical status l and II ambulatory surgery patients undergoing short saphenous vein stripping. INTERVENTIONS 14 patients received a popliteal block (sciatic nerve block at the popliteal fossa) using 30 ml of alkalinized 3% chloroprocaine and a posterior cutaneous nerve of the thigh block with 10 ml of 1% lidocaine. The 14 patients who were randomized to the spinal anesthesia group received 65 mg of 5% hyperbaric lidocaine. MEASUREMENTS AND MAIN RESULTS There were no significant differences in age and gender between the two groups (mean age 53 +/- 13 years, 8 men and 20 women). Patients in the peripheral nerve block group recovered significantly faster in phase 1 of the postanesthesia care unit (PACU) (67 +/- 10 min vs. 122 +/- 50 min, p < 0.01) and were discharged home sooner (222 +/- 53 min vs. 294 +/- 69 min, p < 0.01) than the patients in the spinal anesthesia group. CONCLUSIONS The combination of popliteal and posterior cutaneous nerve of the thigh blocks provided adequate anesthesia and a faster recovery profile with a similar subjective acceptance of both anesthetic techniques in ambulatory patients undergoing short saphenous vein stripping in the prone position.
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Affiliation(s)
- J D Vloka
- Department of Anesthesiology, St. Luke's Roosevelt Hospital Center, New York, NY 10025, USA
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Hadzic A, Vloka JD, Koorn R. Effects of the auditory volume control knob on the stimulus amplitude display of the DualStim/Deluxe model NS-2CA/DX peripheral nerve stimulator. Anesthesiology 1997; 87:714-5. [PMID: 9316988 DOI: 10.1097/00000542-199709000-00044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Affiliation(s)
- A Hadzic
- Department of Anesthesiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York 10025, USA
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Hadzic A, Vloka J, Patel N, Birnbach D. Hypertensive crisis after a successful placement of an epidural anesthetic in a hypertensive parturient. Case report. Reg Anesth 1995; 20:156-8. [PMID: 7605764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND OBJECTIVES The use of epinephrine-containing local anesthetic solutions in pre-eclampsia is controversial. While epinephrine in local anesthetic solutions has been used without complications in this setting, a hypertensive reaction remains a concern among many clinicians. METHODS An epidural anesthetic containing epinephrine was administered to a hypertensive parturient for cesarean delivery. When a hypertensive crisis developed, the radial artery was cannulated and administration of sodium nitroprusside was initiated. Arterial blood samples were evaluated for plasma norepinephrine and serum lidocaine concentrations. RESULTS The introduction of lumbar epidural anesthesia for cesarean delivery using 30 mL 2% lidocaine with 1:200,000 epinephrine resulted in a profound hypertensive reaction, in the patient with pre-eclampsia, despite an adequate level of epidural anesthesia. CONCLUSIONS Epinephrine-containing local anesthetic solutions may place a hypertensive parturient at significant risk of an acute hypertensive reaction.
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Affiliation(s)
- A Hadzic
- Department of Anesthesiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York 10019, USA
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Vloka J, Hadzic A, Kitain E. A simple adaptation to the Olympus LF1 and LF2 flexible fiberoptic bronchoscopes for instillation of local anesthetic. Anesthesiology 1995; 82:792. [PMID: 7879952 DOI: 10.1097/00000542-199503000-00027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Kozlicic A, Hadzic A, Bevanda H. Improvised purification methods for obtaining individual drinking water supply under war and extreme shortage conditions. Prehosp Disaster Med 1994; 9:S25-8. [PMID: 10155514 DOI: 10.1017/s1049023x00041145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Supplying an adequate amount of drinking water to a population is a complex problem that becomes an extremely difficult task in war conditions. In this paper, several simple methods for obtaining individual supplies of drinking water by filtration of atmospheric water with common household items are reported. METHODS Samples of atmospheric water (rain and snow) were collected, filtered, and analyzed for bacteriological and chemical content. The ability of commonly available household materials (newspaper, filter paper, gauze, cotton, and white cotton cloth) to filter water from the environmental sources was compared. RESULTS According to chemical and biological analysis, the best results were obtained by filtering melted snow from the ground through white cotton cloth. CONCLUSIONS Atmospheric water collected during war or in extreme shortage conditions can be purified with simple improvised filtering techniques and, if chlorinated, used as an emergency potable water source.
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Affiliation(s)
- A Kozlicic
- Department for Preventive Medicine and Diagnostic Microbiology, State Hospital of Sarajevo, Bosnia and Herzegovina
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