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Safety
Published in Robert S. Holzman, Anesthesia and the Classics, 2022
Yet a narrow definition of safety has limited utility in the context of anesthesia or any medical practice. Although safety has been at the forefront of anesthetic practice for a very long time, there are some considerable compromises with always playing it safe. First of all, blind devotion to safety may promote hesitation and indecision as well as parochial thoughts. Second, when bold intervention is required, preoccupation with safety as avoidance of risk may inhibit the breadth and extent of such intervention. Finally, it may limit discovery, exploration and creativity – some of the maverick approaches that are daring, not uncommonly foolhardly and, occasionally, groundbreaking A careful balance has to be struck. Dire situations during an anesthetic demand second-by-second vigilance, and consistently altruistic (and occasionally, heroic) action, like the “Miracle on the Hudson”.‡ Microhypotheses of causation are often created in the operating room or in other aspects of acute or critical care and tested via interventions made in an uncertain and often “best educated guess” environment. Delivery from harm – Soteria, or salvation – is a laudable goal; it sometimes takes considerable daring to do so. The opposite of “harm,” in this context, is “daring.”
Analgesia
Published in Kelvin Yan, Surgical and Anaesthetic Instruments for OSCEs, 2021
There can be divided into drug and machine issues. Drugs:Opioid side effects include sedation, nausea, vomiting, addiction, constipation and respiratory depression.Local anaesthetic side effects include:Localised symptoms: motor weakness and paraesthesiaSystemic symptoms: central nervous system toxicity such as confusion, agitation, convulsions, coma and respiratory depression. Cardiovascular system toxicity such as myocardial depression, severe arrhythmias and hypotension.Machine-related issues: malfunction leading to over- and under-dosing, disconnection, tube kinking and infection.
Propagation of the Action Potential
Published in Nassir H. Sabah, Neuromuscular Fundamentals, 2020
Another optimization condition applies to the ratio l/d, or l/a, assuming that the ratio d/a has been optimized, as discussed in the preceding paragraph. An l that is too small sacrifices some of the advantage of myelination and reduces the speed of conduction by reducing the distance over which the AP “jumps”. If l is too large, the axial resistance of the internode increases together with the total internodal capacitance and conductance of the membrane, which reduces the speed of conduction, as discussed in the preceding paragraph. Moreover, if l is too large and the generation of the AP at a given node is blocked for some reason, the strength of the current at the next node further along in the direction of propagation may not be sufficient to generate an AP at this node. This reduces the safety margin for propagation of the AP. In practice, blocking the generation of the AP even at two adjacent nodes does not stop the propagation of the AP. It may be noted that the effect of local anesthetics is to inhibit the activation of the voltage-gated sodium channels, thereby blocking the propagation of APs along fibers that conduct pain signals to the central nervous system.
Comparison between pericapsular nerve group block and fascia iliaca compartment block for perioperative pain control in hip surgeries: A meta-analysis from randomized controlled trials
Published in Egyptian Journal of Anaesthesia, 2023
According to Table 1, the selected studies revealed both similarities and differences in several clinical aspects as follows: the sample sizes of all available literature were quite small, they ranged from 24 to 80 patients. All papers evaluated the analgesic efficacy of PENG compared to FICB in hip arthroplasty or hip fracture surgeries. PENG was given to the experimental groups, while FICB was given to the control groups. The dose and type of local anesthetics varied between articles. Preoperative nerve block was applied in eight studies (22,23,25,26,27,29,30,31), postoperative nerve block was used in two studies (24,27), and intra-operative nerve block was applied in one study (28). Nine studies (22,23,24,25,26,27,29,30,31)used spinal anesthesia (SA), and only one study (28) employed the general anesthesia. Participates in five studies (24,27,28,29,31) received patient-controlled analgesia (PCA) with opioids for acute pain management, while the remaining participants received IV analgesics at fixed time intervals with additional rescue opioid doses as needed. Pain intensity was expressed as a visual analog score or numeric rating score at different time points.
MATERNAL SATISFACTION TOWARDS SPINAL ANAESTHESIA FOR CAESAREAN SECTION
Published in Egyptian Journal of Anaesthesia, 2022
M Babajide Adegboye, I Kayode Kolawole, K. Adewale Adegboye, C Iyabo Oyewopo, O Oyewole Oladosu
The current study showed that 295 (77.6%) of the parturients accepted that they would choose spinal anaesthesia for a similar procedure in the future out of this 295, 293 (99.4%) of them were satisfied with the conduct of the current spinal anaesthetic technique. This was statistically significant p = 0.000. Similar findings were reported by Uziele et al. [24] and Sadeghi et al. [11] in which 95% and 78.6% of their parturient who had spinal anaesthesia as their choice of anaesthesia wished to use spinal anaesthesia for similar future surgeries. However, some factors such as dissatisfaction with the treatment of intraoperative shivering, intraoperative nausea, and vomiting, poor explanation of the spinal anaesthetic procedure, participation in decision-making and injection site pain are variables in the overall satisfaction to spinal anaesthesia, which could be simply controlled. The limitation of our study was that the level of maternal satisfaction to the spinal anaesthesia was done in the immediate postoperative period in the post-anaesthesia recovery room and assessment of complication like post-dual puncture headache PDPH could not be assessed.
Synthesis of nanocapsules blended polymeric hydrogel loaded with bupivacaine drug delivery system for local anesthetics and pain management
Published in Drug Delivery, 2022
Wentao Deng, Yu Yan, Peipei Zhuang, Xiaoxu Liu, Ke Tian, Wenfang Huang, Cai Li
Postoperative pain management is still one of the most common problems that have largely gone unexplored (Peccora & Zhou, 2015). Clinically, local anesthetics (LA) are used to control pain after operations (including gastrointestinal surgery) or to treat other acute and chronic pain (Sandhu et al., 2021). Antipyretic analgesics (e.g. acetaminophen and celecoxib) and opioids can be used to provide relief (e.g. morphine and oxycodone). However, many drugs, particularly opioids, have serious adverse effects such as nausea, respiratory suppression, and vomiting as well as the potential to cause sensitization (Nersesyan & Slavin, 2007). However, because anesthetics have a low molecular weight, the duration of analgesia generated by a single injection is typically only very few hours, which does not meet the criteria for clinical use (Becker & Reed, 2012). The use of LA in the field of postoperative analgesia has recently received considerable attention in both scientific and clinical studies. Plain LA drugs, on the other hand, have a short duration of action. LA drugs such as lidocaine, bupivacaine (BPV), ropivacaine, and others exhibit small-molecule features such as limited action duration (1–2 h for lidocaine; 2–4 h for bupivacaine and ropivacaine) and fast relocation and encapsulation of LA agents with nanosystems (El-Boghdadly et al., 2018). As a result, the design and implementation of continuous release systems to extend the analgesic activity for days while reducing side effects are essential.