This study compared the use of propofol versus sevoflurane for induction of general anesthesia and insertion of a laryngeal mask airway in 100 adult patients. Patients were randomly assigned to receive either propofol or sevoflurane, with fentanyl also administered to both groups. Induction was faster with propofol but it caused more episodes of apnea and lower blood pressure compared to sevoflurane. Sevoflurane provided a smoother induction with fewer complications and more hemodynamic stability, making it the preferred induction agent for laryngeal mask airway insertion according to this study.
To Evaluate the Role of Inj. Ketamine (0.3mg/Kg) Intravenously, Before Skin I...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This presentation was delivered during a webinar held by the association of anaesthetists in association with RA-UK entitled "New Blocks - Friend or Foe?".
This took place on 19th October 2021.
In this short presentation - Dr Pawa covers: a brief overview of the history of Paravertebral blocks; how he got introduced to them; some updates on our understanding on the anatomy; and whether they still have a role in modern anaesthetic practice.
ESP block - future direction and remaining questionsAmit Pawa
This Talk was delivered by Dr Pawa on 5th June 2021 as part of the ISURA 2021 hybrid conference held in Toronto.
The Future Direction of this block and remaining questions to be answered are covered here
This randomized controlled trial assessed the efficacy of paravertebral block (PVB) for perioperative analgesia in patients undergoing laparoscopic cholecystectomy. It found that patients receiving PVB before general anesthesia required significantly less intraoperative fentanyl and postoperative PCA morphine compared to those receiving only general anesthesia. PVB also resulted in lower pain scores in the immediate postoperative period and fewer opioid-related side effects. The study demonstrates that PVB can provide effective analgesia and reduce opioid consumption for laparoscopic cholecystectomy.
This study compared the effects of epidural analgesia and patient-controlled analgesia on patients undergoing laparoscopic right colectomy or low anterior resection. The study found that:
1) Epidural analgesia was associated with faster return of bowel function by 1 day in patients undergoing low anterior resection, but not in patients undergoing right colectomy.
2) Epidural analgesia provided significantly better pain control compared to patient-controlled analgesia for both right colectomy and low anterior resection patients.
3) However, epidural analgesia alone was inadequate for pain control in 28% of patients, who required the addition of patient-controlled analgesia.
This document describes a randomized clinical trial that aims to compare the incidence of blocking all three nerves (femoral, lateral femoral cutaneous, and obturator nerves) when performing ultrasound-guided fascia iliaca compartment block using either a supra-inguinal approach versus an infra-inguinal approach. Sixty patients undergoing lower limb surgery will be randomly assigned to receive the block using one of the two approaches. The primary outcome is the incidence of a three-nerve block, while secondary outcomes include time of nerve block onset and distance of injection point from the inguinal ligament.
1) The study assessed whether epidural chloroprocaine affects the pain relief provided by epidural morphine after cesarean delivery.
2) Forty women were randomly assigned to receive either epidural chloroprocaine or a placebo, followed by epidural morphine.
3) The study found no difference between the groups in the duration of pain relief from the morphine, pain levels, or need for additional pain medication, suggesting that chloroprocaine does not reduce the effectiveness of epidural morphine for post-cesarean analgesia.
L'ecografia nella BPCO: l'effetto dell'ostruzione delle vie aeree sull'escurs...Paj Ero
This document discusses using ultrasound to evaluate the diaphragm muscle in patients undergoing pulmonary rehabilitation.
The study examined over 1,300 patients using ultrasound before and after rehabilitation to measure diaphragm excursion. Ultrasound measurements improved in 76% of patients compared to 56% for the 6-minute walk test. Ultrasound was found to be a safe, fast, and reliable method for monitoring the effectiveness of rehabilitation.
The conclusions state that ultrasound evaluation of the diaphragm provides a valid, practical way to monitor treatment alongside traditional evaluation methods. Improvements measured by ultrasound correlate with improvements in walking tests and lung function tests. Ultrasound may be particularly useful for evaluating patients who cannot
To Evaluate the Role of Inj. Ketamine (0.3mg/Kg) Intravenously, Before Skin I...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This presentation was delivered during a webinar held by the association of anaesthetists in association with RA-UK entitled "New Blocks - Friend or Foe?".
This took place on 19th October 2021.
In this short presentation - Dr Pawa covers: a brief overview of the history of Paravertebral blocks; how he got introduced to them; some updates on our understanding on the anatomy; and whether they still have a role in modern anaesthetic practice.
ESP block - future direction and remaining questionsAmit Pawa
This Talk was delivered by Dr Pawa on 5th June 2021 as part of the ISURA 2021 hybrid conference held in Toronto.
The Future Direction of this block and remaining questions to be answered are covered here
This randomized controlled trial assessed the efficacy of paravertebral block (PVB) for perioperative analgesia in patients undergoing laparoscopic cholecystectomy. It found that patients receiving PVB before general anesthesia required significantly less intraoperative fentanyl and postoperative PCA morphine compared to those receiving only general anesthesia. PVB also resulted in lower pain scores in the immediate postoperative period and fewer opioid-related side effects. The study demonstrates that PVB can provide effective analgesia and reduce opioid consumption for laparoscopic cholecystectomy.
This study compared the effects of epidural analgesia and patient-controlled analgesia on patients undergoing laparoscopic right colectomy or low anterior resection. The study found that:
1) Epidural analgesia was associated with faster return of bowel function by 1 day in patients undergoing low anterior resection, but not in patients undergoing right colectomy.
2) Epidural analgesia provided significantly better pain control compared to patient-controlled analgesia for both right colectomy and low anterior resection patients.
3) However, epidural analgesia alone was inadequate for pain control in 28% of patients, who required the addition of patient-controlled analgesia.
This document describes a randomized clinical trial that aims to compare the incidence of blocking all three nerves (femoral, lateral femoral cutaneous, and obturator nerves) when performing ultrasound-guided fascia iliaca compartment block using either a supra-inguinal approach versus an infra-inguinal approach. Sixty patients undergoing lower limb surgery will be randomly assigned to receive the block using one of the two approaches. The primary outcome is the incidence of a three-nerve block, while secondary outcomes include time of nerve block onset and distance of injection point from the inguinal ligament.
1) The study assessed whether epidural chloroprocaine affects the pain relief provided by epidural morphine after cesarean delivery.
2) Forty women were randomly assigned to receive either epidural chloroprocaine or a placebo, followed by epidural morphine.
3) The study found no difference between the groups in the duration of pain relief from the morphine, pain levels, or need for additional pain medication, suggesting that chloroprocaine does not reduce the effectiveness of epidural morphine for post-cesarean analgesia.
L'ecografia nella BPCO: l'effetto dell'ostruzione delle vie aeree sull'escurs...Paj Ero
This document discusses using ultrasound to evaluate the diaphragm muscle in patients undergoing pulmonary rehabilitation.
The study examined over 1,300 patients using ultrasound before and after rehabilitation to measure diaphragm excursion. Ultrasound measurements improved in 76% of patients compared to 56% for the 6-minute walk test. Ultrasound was found to be a safe, fast, and reliable method for monitoring the effectiveness of rehabilitation.
The conclusions state that ultrasound evaluation of the diaphragm provides a valid, practical way to monitor treatment alongside traditional evaluation methods. Improvements measured by ultrasound correlate with improvements in walking tests and lung function tests. Ultrasound may be particularly useful for evaluating patients who cannot
Comparison of Efficacy of Various Doses of Esmolol In Attenuating Presssor Re...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The transverse abdominis plane (TAP) block involves injecting local anesthetic between the internal oblique and transverse abdominis muscles to anesthetize the abdominal wall nerves. Multiple studies have found that TAP blocks reduce postoperative opioid use, increase time to first request for analgesia, and provide effective pain relief following abdominal surgery compared to placebo. While results vary, TAP blocks generally decrease pain scores and opioid needs, though do not consistently reduce opioid side effects.
This clinical trial investigated whether neuromuscular electrical stimulation (NMES) could improve quadriceps muscle strength and activation in women with mild to moderate osteoarthritis of the knee. Thirty women were randomly assigned to either receive NMES treatments three times per week for four weeks or to a control group that received no treatment. Outcomes were assessed at baseline and at 5 and 16 weeks post-enrollment and found no improvements in muscle strength or activation in the NMES group compared to controls. The study was limited by a small sample size and lack of blinding of the assessor and participants to group assignment. Four weeks of NMES may have been insufficient to induce gains in this population and future research is needed to examine longer or more
This document provides a summary of a presentation on transversus abdominal plane (TAP) blocks. It begins with a brief history of regional anesthesia techniques leading to the development of TAP blocks. The background section describes how TAP blocks work to provide analgesia in the anterior abdominal wall region. The anatomy and technique sections explain the relevant abdominal wall structures and how TAP blocks are performed. Several studies are summarized that investigated the effectiveness of TAP blocks in reducing postoperative opioid use and pain scores for various surgeries. The findings generally showed lower opioid consumption and pain scores when TAP blocks were used. However, the degree of benefit varied across studies. Recommendations include the use of TAP blocks as an adjunct for
Effect of Intravenous Dexmedetomidine on Prolongation of Intrathecal Spinal A...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
INDUCTION CHEMOTHERAPY WITH TPF IN HEAD & NECK CANCERS Paul George
Three key points about induction chemotherapy for head and neck cancer:
1) Several trials have shown that a taxane-based induction chemotherapy regimen of docetaxel, cisplatin, and fluorouracil (TPF) improves overall survival compared to cisplatin and fluorouracil (PF) alone when followed by concurrent chemoradiotherapy. TPF also decreases locoregional and distant failures.
2) A large meta-analysis found TPF significantly improved overall survival, progression-free survival, organ preservation, and reduced cancer mortality compared to PF. However, no evidence shows TPF plus radiotherapy is superior to concurrent chemoradiotherapy alone.
3) While TPF is now considered standard
Rectal cancer treatment typically involves surgery. Local recurrence after conventional surgery occurs in 15-65% of cases on average. Long course preoperative chemoradiotherapy has been shown to reduce local recurrence rates compared to short course preoperative radiotherapy or radiotherapy alone. It increases local tumor control and survival rates with some toxicities but does not reduce colostomy rates. Preoperative chemoradiotherapy is superior to postoperative chemoradiotherapy in reducing local recurrence rates without affecting overall survival.
Fisiol e anat ponv.PONV anatomy and physiology,risk of Claudio Melloni
This document discusses risk factors for postoperative nausea and vomiting (PONV) from several studies. It identifies non-anesthetic factors like female gender, history of motion sickness or PONV, and anesthetic factors like use of volatile anesthetics, nitrous oxide, and opioids as increasing PONV risk. Surgical factors like longer duration and types of surgery also impact risk. A key study developed a PONV prediction model using logistic regression to calculate individual patient risks based on their characteristics and procedure. Understanding risk factors can help optimize PONV prevention and management.
This document provides information on a case presentation of anal squamous cell carcinoma, including staging, diagnostic workup, management, prognostic factors, and follow up. Key points include:
- The mean age of diagnosis is 62 years and most common symptom is rectal bleeding. Imaging includes CT, MRI, and PET scans to stage disease.
- Treatment depends on disease stage but typically involves chemoradiation with concurrent 5-FU and mitomycin C or cisplatin. Several trials have shown improved outcomes with chemoradiation compared to radiation alone.
- Follow up involves examination and imaging to monitor for recurrence or metastasis. Prognostic factors include tumor size, response to initial treatment, and presence of late
1) The document discusses endocrine therapy options for ER+ HER2- metastatic breast cancer (MBC), including first-line aromatase inhibitors versus tamoxifen, comparisons between different aromatase inhibitors, and the role of fulvestrant.
2) The FIRST trial found that fulvestrant 500 mg had significantly longer time to progression compared to anastrozole as first-line therapy for postmenopausal women.
3) For premenopausal women, combinations of luteinizing hormone-releasing hormone agonists with tamoxifen or aromatase inhibitors showed benefits, with no differences between the arms.
This study compared the effectiveness of ultrasound-guided pulsed radiofrequency (PRF) and fluoroscopy-guided conventional radiofrequency (CRF) on medial branches supplying lumbar facet joints. 60 patients received either PRF at 42°C for 480 seconds using ultrasound guidance or CRF at 80°C for 90 seconds using fluoroscopy guidance. Pain relief increased gradually over 1 month for both groups. At 6 months, PRF showed better outcomes for females and in the lateral position, while CRF showed better outcomes for males and in the prone position. Both techniques provided pain relief without adverse effects, with obesity not limiting ultrasound use.
The TEAM trial was a randomized phase III trial comparing 5 years of exemestane versus tamoxifen as initial adjuvant endocrine therapy in postmenopausal women with early breast cancer. An interim analysis at a median follow up of 2.75 years found that exemestane was associated with improvements in disease-free survival, on-study drug disease-free survival, relapse-free survival, and time to distant metastases compared to tamoxifen. No unexpected safety issues were observed with exemestane compared to tamoxifen. Final 5-year results comparing tamoxifen followed by exemestane versus exemestane alone are expected in 2009.
This document summarizes recent advances in the understanding and treatment of ano-rectal disorders that are frequently encountered by gastroenterologists. It discusses how newer diagnostic tools like high-resolution manometry and MR defecography have provided greater insight into conditions like defecatory disorders and fecal incontinence. Conservative approaches like biofeedback therapy remain first-line for managing most cases, but minimally invasive procedures are showing promise for treating refractory fecal incontinence. Proper clinical assessment is critical to diagnosis, and while symptoms and digital rectal exam are useful, anorectal tests help confirm diagnoses.
This study investigated the efficacy of pulsed electromagnetic field therapy (PEMF) in reducing delayed onset muscle soreness (DOMS) in marathon runners. A double-blind randomized controlled trial assigned 133 marathon runners to either an active PEMF device or placebo device to use for 20 minutes, 4 times per day for 5 days after a marathon. The primary outcome was thigh pain assessed using a visual analog scale during squats. Subjects using the active PEMF device had significantly lower pain scores compared to the placebo group, indicating PEMF reduced DOMS in marathon runners.
PowerPoint. Nonradioactive iodine competes with radioactive iodine. This has implications for the use of recombinant human TSH (rhTSH) when preparing differentiated thyroid cancer patients for radioiodine scanning with continued levothyroxine, because the latter contains iodine.
1) Pancreatic cancer is a lethal malignancy with increasing incidence rates and poor survival outcomes.
2) EUS-guided celiac plexus neurolysis (EUS-CPN) and celiac ganglia neurolysis (EUS-CGN) provide effective pain relief for pancreatic cancer patients, with EUS-CGN showing potential for longer pain relief.
3) Randomized studies have shown EUS-CPN provides significantly better pain relief than sham treatment or percutaneous CPN. Bilateral neurolysis may offer longer pain relief than central injection.
This document discusses the management of low risk prostate cancer. It outlines the natural history of untreated low risk prostate cancer and the problems of overdiagnosis and overtreatment. Active surveillance is presented as a management option for low risk prostate cancer, with the rationale being to avoid unnecessary treatment and preserve quality of life. Results from active surveillance studies show low rates of cancer progression and metastasis, with 62% free from intervention at 10 years in one study. Triggers for intervention on active surveillance like rising PSA, grade progression, or tumor volume increase are discussed.
Comparison of Ease of Insertion and Hemodynamic Response to Lma with Propofol...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Tracheal Intubation without muscle relaxant in children Ashraf Abdulhalim
Sevoflurane alone provides acceptable intubating conditions 49% of the time, but combining it with N2O (81.5%) or adjuvants like remifentanil (75-85% ), alfentanil, lidocaine (84%), or propofol (60-90% ) improves conditions. Propofol combined with remifentanil, alfentanil, or fentanyl also provides acceptable-excellent conditions but more coughing. Longer sevoflurane exposure time (3.7-5.7% end-tidal concentration over 197-504 seconds) and assisted ventilation improve intubating conditions without muscle relaxants in children aged 1-10 years.
Comparison of Efficacy of Various Doses of Esmolol In Attenuating Presssor Re...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The transverse abdominis plane (TAP) block involves injecting local anesthetic between the internal oblique and transverse abdominis muscles to anesthetize the abdominal wall nerves. Multiple studies have found that TAP blocks reduce postoperative opioid use, increase time to first request for analgesia, and provide effective pain relief following abdominal surgery compared to placebo. While results vary, TAP blocks generally decrease pain scores and opioid needs, though do not consistently reduce opioid side effects.
This clinical trial investigated whether neuromuscular electrical stimulation (NMES) could improve quadriceps muscle strength and activation in women with mild to moderate osteoarthritis of the knee. Thirty women were randomly assigned to either receive NMES treatments three times per week for four weeks or to a control group that received no treatment. Outcomes were assessed at baseline and at 5 and 16 weeks post-enrollment and found no improvements in muscle strength or activation in the NMES group compared to controls. The study was limited by a small sample size and lack of blinding of the assessor and participants to group assignment. Four weeks of NMES may have been insufficient to induce gains in this population and future research is needed to examine longer or more
This document provides a summary of a presentation on transversus abdominal plane (TAP) blocks. It begins with a brief history of regional anesthesia techniques leading to the development of TAP blocks. The background section describes how TAP blocks work to provide analgesia in the anterior abdominal wall region. The anatomy and technique sections explain the relevant abdominal wall structures and how TAP blocks are performed. Several studies are summarized that investigated the effectiveness of TAP blocks in reducing postoperative opioid use and pain scores for various surgeries. The findings generally showed lower opioid consumption and pain scores when TAP blocks were used. However, the degree of benefit varied across studies. Recommendations include the use of TAP blocks as an adjunct for
Effect of Intravenous Dexmedetomidine on Prolongation of Intrathecal Spinal A...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
INDUCTION CHEMOTHERAPY WITH TPF IN HEAD & NECK CANCERS Paul George
Three key points about induction chemotherapy for head and neck cancer:
1) Several trials have shown that a taxane-based induction chemotherapy regimen of docetaxel, cisplatin, and fluorouracil (TPF) improves overall survival compared to cisplatin and fluorouracil (PF) alone when followed by concurrent chemoradiotherapy. TPF also decreases locoregional and distant failures.
2) A large meta-analysis found TPF significantly improved overall survival, progression-free survival, organ preservation, and reduced cancer mortality compared to PF. However, no evidence shows TPF plus radiotherapy is superior to concurrent chemoradiotherapy alone.
3) While TPF is now considered standard
Rectal cancer treatment typically involves surgery. Local recurrence after conventional surgery occurs in 15-65% of cases on average. Long course preoperative chemoradiotherapy has been shown to reduce local recurrence rates compared to short course preoperative radiotherapy or radiotherapy alone. It increases local tumor control and survival rates with some toxicities but does not reduce colostomy rates. Preoperative chemoradiotherapy is superior to postoperative chemoradiotherapy in reducing local recurrence rates without affecting overall survival.
Fisiol e anat ponv.PONV anatomy and physiology,risk of Claudio Melloni
This document discusses risk factors for postoperative nausea and vomiting (PONV) from several studies. It identifies non-anesthetic factors like female gender, history of motion sickness or PONV, and anesthetic factors like use of volatile anesthetics, nitrous oxide, and opioids as increasing PONV risk. Surgical factors like longer duration and types of surgery also impact risk. A key study developed a PONV prediction model using logistic regression to calculate individual patient risks based on their characteristics and procedure. Understanding risk factors can help optimize PONV prevention and management.
This document provides information on a case presentation of anal squamous cell carcinoma, including staging, diagnostic workup, management, prognostic factors, and follow up. Key points include:
- The mean age of diagnosis is 62 years and most common symptom is rectal bleeding. Imaging includes CT, MRI, and PET scans to stage disease.
- Treatment depends on disease stage but typically involves chemoradiation with concurrent 5-FU and mitomycin C or cisplatin. Several trials have shown improved outcomes with chemoradiation compared to radiation alone.
- Follow up involves examination and imaging to monitor for recurrence or metastasis. Prognostic factors include tumor size, response to initial treatment, and presence of late
1) The document discusses endocrine therapy options for ER+ HER2- metastatic breast cancer (MBC), including first-line aromatase inhibitors versus tamoxifen, comparisons between different aromatase inhibitors, and the role of fulvestrant.
2) The FIRST trial found that fulvestrant 500 mg had significantly longer time to progression compared to anastrozole as first-line therapy for postmenopausal women.
3) For premenopausal women, combinations of luteinizing hormone-releasing hormone agonists with tamoxifen or aromatase inhibitors showed benefits, with no differences between the arms.
This study compared the effectiveness of ultrasound-guided pulsed radiofrequency (PRF) and fluoroscopy-guided conventional radiofrequency (CRF) on medial branches supplying lumbar facet joints. 60 patients received either PRF at 42°C for 480 seconds using ultrasound guidance or CRF at 80°C for 90 seconds using fluoroscopy guidance. Pain relief increased gradually over 1 month for both groups. At 6 months, PRF showed better outcomes for females and in the lateral position, while CRF showed better outcomes for males and in the prone position. Both techniques provided pain relief without adverse effects, with obesity not limiting ultrasound use.
The TEAM trial was a randomized phase III trial comparing 5 years of exemestane versus tamoxifen as initial adjuvant endocrine therapy in postmenopausal women with early breast cancer. An interim analysis at a median follow up of 2.75 years found that exemestane was associated with improvements in disease-free survival, on-study drug disease-free survival, relapse-free survival, and time to distant metastases compared to tamoxifen. No unexpected safety issues were observed with exemestane compared to tamoxifen. Final 5-year results comparing tamoxifen followed by exemestane versus exemestane alone are expected in 2009.
This document summarizes recent advances in the understanding and treatment of ano-rectal disorders that are frequently encountered by gastroenterologists. It discusses how newer diagnostic tools like high-resolution manometry and MR defecography have provided greater insight into conditions like defecatory disorders and fecal incontinence. Conservative approaches like biofeedback therapy remain first-line for managing most cases, but minimally invasive procedures are showing promise for treating refractory fecal incontinence. Proper clinical assessment is critical to diagnosis, and while symptoms and digital rectal exam are useful, anorectal tests help confirm diagnoses.
This study investigated the efficacy of pulsed electromagnetic field therapy (PEMF) in reducing delayed onset muscle soreness (DOMS) in marathon runners. A double-blind randomized controlled trial assigned 133 marathon runners to either an active PEMF device or placebo device to use for 20 minutes, 4 times per day for 5 days after a marathon. The primary outcome was thigh pain assessed using a visual analog scale during squats. Subjects using the active PEMF device had significantly lower pain scores compared to the placebo group, indicating PEMF reduced DOMS in marathon runners.
PowerPoint. Nonradioactive iodine competes with radioactive iodine. This has implications for the use of recombinant human TSH (rhTSH) when preparing differentiated thyroid cancer patients for radioiodine scanning with continued levothyroxine, because the latter contains iodine.
1) Pancreatic cancer is a lethal malignancy with increasing incidence rates and poor survival outcomes.
2) EUS-guided celiac plexus neurolysis (EUS-CPN) and celiac ganglia neurolysis (EUS-CGN) provide effective pain relief for pancreatic cancer patients, with EUS-CGN showing potential for longer pain relief.
3) Randomized studies have shown EUS-CPN provides significantly better pain relief than sham treatment or percutaneous CPN. Bilateral neurolysis may offer longer pain relief than central injection.
This document discusses the management of low risk prostate cancer. It outlines the natural history of untreated low risk prostate cancer and the problems of overdiagnosis and overtreatment. Active surveillance is presented as a management option for low risk prostate cancer, with the rationale being to avoid unnecessary treatment and preserve quality of life. Results from active surveillance studies show low rates of cancer progression and metastasis, with 62% free from intervention at 10 years in one study. Triggers for intervention on active surveillance like rising PSA, grade progression, or tumor volume increase are discussed.
Comparison of Ease of Insertion and Hemodynamic Response to Lma with Propofol...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Tracheal Intubation without muscle relaxant in children Ashraf Abdulhalim
Sevoflurane alone provides acceptable intubating conditions 49% of the time, but combining it with N2O (81.5%) or adjuvants like remifentanil (75-85% ), alfentanil, lidocaine (84%), or propofol (60-90% ) improves conditions. Propofol combined with remifentanil, alfentanil, or fentanyl also provides acceptable-excellent conditions but more coughing. Longer sevoflurane exposure time (3.7-5.7% end-tidal concentration over 197-504 seconds) and assisted ventilation improve intubating conditions without muscle relaxants in children aged 1-10 years.
The study compared the haemodynamic effects of propofol versus desflurane during remifentanil-based anesthesia for pediatric ENT surgery requiring controlled hypotension. Forty-one children were randomly assigned to receive either propofol/remifentanil or desflurane/remifentanil. The targeted hypotension was achieved in most cases for both groups, though MAP below 50 mmHg occurred more frequently with desflurane and MAP above 65 mmHg occurred more frequently with propofol. Hemodynamic stability was less maintained when desflurane and remifentanil were used compared to propofol-remifentanil. Both methods provided satisfactory surgical conditions though desflurane required more fluid resusc
This document discusses the advantages of using remifentanil for day surgery anesthesia. It notes that remifentanil provides rapid recovery due to its short context-sensitive half-life, metabolism independent of organs, and flexibility from light sedation to deep analgesia. Studies presented show remifentanil results in faster times to eye opening, extubation, orientation and recovery of cognitive function compared to other opioids like fentanyl or alfentanil. Remifentanil also allows for reduced inhalational agent doses and faster discharge from ambulatory surgery settings.
Background: This study compared the properties of propofol bolus for induction of general anaesthesia between proprietary and 3 generic formulations, to assess if solvent differences had clinically relevant consequences on effi cacy or side effects. Many studies have investigated different formulations of
propofol for side effects, in this study we also focused on effi cacy of different formulations for induction of general anesthesia.
Nursing Research MarchApril 2002 Vol 51, No 2 125 Back.docxcherishwinsland
Nursing Research March/April 2002 Vol 51, No 2 125
� Background: The mechanisms for postoperative nausea and
vomiting are numerous and pathways not well elucidated.
Although many medications have been developed to help
prevent postoperative nausea and vomiting, the search for
better approaches to recovery treatment continues.
� Objective: The purpose of this study was to evaluate the effec-
tiveness of isopropyl alcohol (IPA) inhalation for treatment of
postoperative nausea and vomiting for patients who have
general anesthesia for a surgical procedure.
� Method: Participants were recruited from an urban hospital on
the East Coast of the United States. Participants were
assigned to an experimental or control group and IPA inhala-
tion was compared to the standard anti-emetic treatment for
rescue treatment in the immediate postoperative period.
Postoperative nausea and vomiting was rated using a
descriptive ordinal scale.
� Results: The results of this study show IPA to be effective and
that there was no significant difference between the stan-
dard treatment protocol and treatment with IPA. Treatment
with IPA was significantly more cost effective than standard
drug treatment.
� Discussion: Further research is recommended to evaluate the
length of effectiveness, standard dose needed, most effec-
tive mode of inhalation, and factors blocking IPA effective-
ness.
� Key Words: alternative treatment • IPA • nausea • postopera-
tive • vomiting
oday’s healthcare concerns center on decreasing
costs, shortening hospital stays, and facilitating a
quick return to normal activity for patients. Post-operative
nausea and vomiting (PONV) is a major concern for
patients having same-day surgery under general anesthesia
as it causes increased complications and delays in dis-
charge from the hospital (Hirsch, 1994).
Approximately one-third of the 11 million patients under-
going outpatient surgery under general anesthesia will
experience significant nausea or emesis in the postopera-
tive period (Claybon, 1994). The mechanisms for PONV
are numerous and the causative pathways not well eluci-
dated. Many factors may play a role in an episode of nau-
sea and vomiting, and despite advances in new drug thera-
pies in minimizing the incidence, no ideal drug has been
found to prevent all the causes of PONV.
Aromatherapy is a relatively new and under-researched
alternative treatment that might hold promise in treating
PONV. Isopropyl alcohol (IPA) is among several aromas
displaying possible anti-emetic properties. Isopropyl alco-
hol inhalation is a new treatment with only limited inves-
tigations to date (Langevin & Brown, 1997).
Literature Review
Current PONV treatment strategies are based on the
understanding of the vomiting reflex; however, the lack of
well-elucidated pathways in the control of PONV has con-
tributed to the problems with these treatment strategies
and medications. It has been well documented that some
patients are more susceptible to P.
1. This study investigated the incidence of abdominal pain in patients receiving remifentanil versus fentanyl for anesthesia during cataract surgery.
2. The study found that 52.6% of patients who received remifentanil experienced postoperative abdominal pain, compared to only 2% of patients who received fentanyl.
3. Severe abdominal pain requiring intervention occurred in 6.7% of remifentanil patients but none of the fentanyl patients. The cause of remifentanil-induced abdominal pain is unknown.
A prospective, randomized, double blind study to evaluate Morphine sparing ef...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Safety and efficacy of aflibercept in combination with fluorouracil, leucovor...Mary Ondinee Manalo Igot
This study evaluated the safety and efficacy of combining aflibercept with FOLFIRI chemotherapy (fluorouracil, leucovorin, irinotecan) in Asian patients with metastatic colorectal cancer who had progressed after prior oxaliplatin-based therapy. Nineteen patients received treatment with aflibercept and FOLFIRI. The combination showed a median progression-free survival of 4.1 months and median overall survival of 11.6 months. The majority of adverse events were grade 1-2 and included neutropenia, anemia, fatigue, and liver enzyme elevation. Grade 3 toxicities included neutropenia and neutropenic complications. All adverse events were managed with supportive care and
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This study analyzed early postoperative complications in 145 adult patients who received total intravenous anesthesia (TIVA) with propofol and remifentanil for elective neurosurgery. The authors found:
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Abstract:
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A comparative study of sevofluorane and propofol for induction of general anaesthesia in adults for laryngeal mask airway insertion
1. 139
AJ Univ. R Vol. 3 (2013)
A COMPARATIVE STUDY OF SEVOFLUORANE AND PROPOFOL
FOR INDUCTION OF GENERAL ANAESTHESIA IN ADULTS FOR
LARYNGEAL MASK AIRWAY INSERTION
B. Chaurasia, I.J.Namazi, S.S.Patil
Dept. of Anaesthesiology, Dr D. Y. Patil Medical College, D.Y. Patil University Kolhapur- 416006, (INDIA).
Email id: drbasantc@gmail.com
ABSTRACT
We performed a prospective, randomized study to compare better conditions for Laryngeal Mask
Airway insertion, by using Propofol or Sevofluorane along with Fentanyl in both groups as a co-
induction agent. After approval from institutional ethical committee, 100 ASA I–II patients, aged 18-60
years, undergoing elective surgical procedures were included and randomly allocated to Group P
(Propofol) and Group S (Sevofluorane) for LMA insertion. IV Propofol allowed fast induction when
compared with Sevofluorane (95.26± 14.59 vs 118.30± 8.18 sec) but associated with more incidence of
apnoea (64% vs 0%). Complications in both groups i.e. coughing, gagging, biting, laryngospasm etc
were not reached to statistical significance. MAP was found to be significantly lower in Propofol group
after induction and persistent till the 5th
min. Present study conclude that induction with Sevofluorane
for LMA insertion is more efficacious in terms of smooth induction, rapid recovery, low incidence of
apnoea and better hemodynamic stability.
KEYWORDS: Laryngeal Mask Airway, Sevofluorane, Intravenous Propofol.
INTRODUCTION
Now a day’s Intravenous Propofol is considered to
be the most preferable induction agent of choice
for insertion of LMA, due to its rapid onset and
depressant effect on airway reflexes, however
Propofol induction is associated with frequent and
more prolonged apnoea. Furthermore,
Sevofluorane5
is a halogenated, volatile, non-
pungent anaesthetic agent which allows rapid,
smooth induction and early emergence.
LMA is a Supraglottic airway device1
which is less
stimulating to patients’ then endotracheal tube and
is now considered the first choice for diagnostic
and minimally invasive surgical procedures.
Hereby, we conducted a study to assess better
LMA insertion conditions following Propofol and
Sevofluorane.
METHODOLOGY
A prospective, randomized, observer blinded study
conducted on ASA I and II, aged 18-60 years,
undergoing elective surgical procedures.
Institutional ethical committee approval and
written informed consent were obtained from all
patients. Patients were randomly allocated in
Group P (Propofol) and Group S (Sevofluorane) of
50 each and both group received Fentanyl
Intravenously as co-induction agent.
2. 140 B. Chaurasia, I.J.Namazi, S.S.Patil
AJ Univ. R Vol. 3 (2013)
All patients underwent pre-anaesthetic check-up and
routine investigations were carried-out. Tab.
Diazepam 10 mg orally given on previous night and
kept NPO for at least 8 hours. On the day of
surgery, every patient received Inj. Glycopyrolate
0.2 mg IV, 20 min before induction and Inj.
Midazolam 0.03 mg/kg IV, 2 min before induction
with basal vital monitoring consisted of ECG,
NIBP, Spo2 and EtCo2. After an IV access with 20
G indwelling cannula was established, a slow
infusion of Ringer Lactate solution was started.
Each patient received Inj.Fentanyl 2mcg/kg IV, 2
min prior to induction.
Group P (Propofol) – After pre-oxygenation for 3
min, patients received Propofol 2 mg/kg over 30
seconds, followed by 20 mg increments as necessary
to achieve induction of anaesthesia.
Group S (Sevofluorane) – After pre-oxygenation
for 3 mins, patients were instructed to exhale to
residual and then to inhale a vital capacity of
Sevofluorane 8% in 100% oxygen by Using an
Ohmeda Sevotec 5 vaporiser and a circle system,
Sevofluorane 8% in 100% oxygen was delivered at
a fresh gas flow of 6 L/min. Patient was asked to
hold vital capacity breath for as long as possible. If
necessary, a second breath was taken.
The time to loss of eyelash reflex and jaw relaxation
was noted, when relaxed, the anaesthetist attempted
to insert a LMA (LMA No. 3 for 30-50 kg and LMA
No.4 for 50-70 kg). Correct placement of LMA was
confirmed by –
B/L equal air entry
B/L equal chest movement
Gel displacement test
If the first attempt was failed, second attempt was
tried after repeat administration of Propofol or
Sevofluorane. Total number of attempts and time
noted. The NIBP and PR were measured before and
at induction, at 1st
, 2nd
and 5th
min after start of
induction. All adverse effects associated with
induction were noted (i.e. apnoea, coughing,
gagging, laryngospasm, involuntary movements).
Statistical analysis was performed by computer
assisted software, SPSS ver. 16.0. For estimating the
significance of difference between proportions, the
test used was Chi-square test and Yate,
s correction
factor was applied wherever the expected value was
less than 5. The 5% level of probability (P<0.05)
was taken as significantly.
RESULTS
The patients in both groups were comparable in
means of age, sex and weight and ASA grade
(Table 1) but found to be statistically insignificant.
In our hypothesis we noted, HR initially increased
and then decreased compared to baseline in
Sevofluorane group (Fig.1). Significant decrease in
HR was noted in Propofol group at induction, 1 and
2 min (1 min, 77.44±8.04 vs 83.96±10.14 bpm,
P=0.00).
Variables Group P
N=50
Group S
N=50
Age(Yrs) 36.30±12.72 34.94±13.36
Sex(M/F) 19/31 20/30
Weight(kg) 52.6 52.22
ASA Grade I- 37
II- 13
I-38
II-12
Table 1 : Demographic Data
3. A COMPARATIVE STUDY OF SEVOFLUORANE AND PROPOFOL FOR INDUCTION OF GENERAL ANAESTHESIA IN ADULTS FOR LARYNGEAL MASK AIRWAY 141
AJ Univ. R Vol. 3 (2013)
*** highly significant P value.
TABLE 2 : Induction Characteristics
We noted decrease in systolic blood pressure in both
groups (Fig 2) but comparatively greater in Propofol
group which was statistically significant at 5th
min of
induction (111.28±7.03 vs 106.46±8.44). Induction
of anaesthesia was associated with a decrease in
MAP compared with baseline in both groups (fig
no.3). This was significantly more in Propofol
compared with Sevofluorane group (5 min,
78.18±5.90 and 81.87±5.36, P=0.001).
Group P Group S
Involuntary movement 0% 0%
Gagging 0% 0%
Coughing 0% 4%
Laryngospasm 0% 0%
TABLE 3 : Adverse events during LMA insertion
The induction was much faster with Propofol
comparatively to Sevofluorane for successful LMA
insertion. The mean time to successful LMA
placement in group P was 95.26 ± 14.59 sec. and in
group S 118.30 ± 13.54 sec. which was statistically
significant (Table 2).
HEMODYNAMIC DATA
A) COMPARISON OF HEART RATE
BETWEEN THE TWO GROUPS
Fig. 1 : Comparison of HR in two groups.
B) COMPARISON OF SYSTOLIC BLOOD
PRESSURE BETWEEN TWO GROUPS -
Fig.2- Comparison of systolic blood pressure in two
groups.
C) COMPARISON OF MAP BETWEEN THE
TWO GROUPS -
Fig.3 : Comparison of MAP in both groups.
10
20
30
40
50
60
70
80
90
Propofol Mean Sevofluorane Mean
90
100
110
120
130
Propofol Mean Sevofluorane Mean
70
75
80
85
90
95
Propofol
Mean
Sevofluorane
Mean
Group P Group S P
value
Loss of
eyelash
reflex(sec)
70.42±12.83 82.38±7.75 0.00
***
Jaw
relaxation
(sec)
84.60±14.24 98.22±9.88 0.00
***
Time to
LMA
insertion
(sec)
95.26±14.59 118.30±8.1
8
0.00
***
Incidence
of apnoea
64% 0%
4. 142 B. Chaurasia, I.J.Namazi, S.S.Patil
AJ Univ. R Vol. 3 (2013)
In this study inadequate jaw relaxation was found in
one patient in Sevofluorane group in the same
patient ease of LMA insertion was difficult and
requiring second attempt. The statistical analysis
revealed no significant difference between the two
groups. Coughing was found in two patients in
Sevofluorane group but was statistically
insignificant (Table 3). We found 64% incidence of
apnoea with Propofol but Sevofluorane induction
was associated with 0% incidence of apnoea (Table
2).
DISCUSSION
In this study, we demonstrated that induction with
Sevofluorane compares favourably with Propofol
for insertion of LMA in adults. Sevofluorane and
Propofol both successfully induced anaesthesia in
all patients. The hemodynamic responses were more
stable with Sevofluorane group. Insertion of LMA
after Sevofluorane induction was associated with
second attempt in one patient probably due to
tightness of jaw and two patients had coughing
during LMA insertion, comparatively with Propofol
the insertion of LMA was achieved in one attempt
in all patients without any complications but
associated with significant decrease in
hemodynamic parameters and higher incidences of
apnoea.
Anaesthetic induction and LMA insertion using
Sevofluorane have several advantages.
Sevofluorane allows a smoother transition to the
maintenance phase without a period of apnoea.
Apnoea occurred in 64% of the patients in Propofol
group but did not occur in Sevofluorane group. The
presence of apnoea requires the anaesthesiologist to
assist the ventilation. Sevofluorane prevents the
pain on injection associated with Propofol. MAP
was better maintained with Sevofluorane induction
comparatively to IV Propofol, relative hypotension
with Propofol may be disadvantageous for
compromised patients.
In a related study, Lian Kah Ti et al2
inserted LMA
faster by using IV Propofol in 74±29 sec whereas,
in our study it took much more time 95.26±14.59
sec. They found 32% incidence of apnoea, coughing
in two patients and there were four failures of LMA
insertion in Propofol group whereas, in our study
we noted 64% incidence of apnoea in Propofol
group and no patient had coughing. In our study we
noted coughing in two patients in Sevofluorane
group but we were able to insert LMA successfully
in all patients in both groups. Both groups had
stable hemodynamic profile in their study but we
noted significant decrease in MAP and in HR with
IV prpofol.
In another study, Sahar M Siddik-Sayyid et al7
,
compare Sevofluorane-Propofol vs Sevofluorane
or Propofol alone. They achieved rapid LMA
insertion with Propofol in 73±18 sec
comparatively to Sevofluorane and
Sevofluorane-propofol (140±42 vs 91±15 sec)
respectively, whereas in our study, we were able
to insert LMA much earlier in 118.30±8.18 sec
in Sevofluorane group comparatively to their
study. The incidence of apnoea was more with
Propofol alone (84%) in their study which was
higher than our study (64%). They noted apnoea
in Sevofluorane and Sevofluorane-propofol (7%
vs 16%) groups also whereas in our study,
induction with Sevofluorane had 0% incidence
of apnoea. In this study Sevofluorane required
more attempt for successfully LMA insertion as
similar to our study and hemodynamic
parameters were found to be stable in all groups
in their study whereas we noted more stable
hemodynamic parameters in only Sevofluorane
group.
A. Thwaites et al3
, achieved faster induction with
Propofol in comparison to Sevofluorane (57±11
vs 84±24 sec) in our study we noted, rapid
insertion of LMA with IV Propofol but it took
more time, comparatively to their study
(95.26±14.59 vs 118.30±8.18). Induction of
anaesthesia with Propofol was associated with
decrease in MAP comparatively to Sevofluorane
and was associated with more incidence of
apnoea (65% vs 0%) which correlates with our
study.
5. A COMPARATIVE STUDY OF SEVOFLUORANE AND PROPOFOL FOR INDUCTION OF GENERAL ANAESTHESIA IN ADULTS FOR LARYNGEAL MASK AIRWAY INSERTION 143
AJ Univ. R Vol. 3 (2013)
CONCLUSION
In conclusion, we found that using high inspired
concentration inhalational induction with
Sevofluorane is efficient for LMA insertion without
apnoea but requires more time than with IV
Propofol.
REFERENCES
1. Brain AIJ: A new concept in airway management;
British Journal of anaesthesia.1983; 55: 801 – 805.
2. Lian Kah Ti et al, “Comparison of Sevoflurane with
propofol for laryngeal mask airway insertion in
adults”AnesthAnalog, 1999; 88; 908 – 912.
3. A Thwaites, S. Edmends and I. Smith “Inhalation
induction with sevoflurane: a double – blind
comparison with propofol” British Journal of
Anesthesia 1997: 78:356- 361.
4. Dorsch JA, Dorsch SE. (eds). Laryngeal Mask
Airway. Understanding anaesthesia equipment
(4thEdn), Williams and Wilkins 1999; 15: 463-504.
5. Stoelting RK. Volatile anaesthetic agents. In
Stoelting RK editors, Pharmacology and Physiology
in Anesthetic practice. 3rd edition. Philidelphia,
Lippincott Raven; 1999.P. 140 – 57.
ACKNOWLEDGEMENTS
I would like to thank my Prof. Dr K.R.Kulkarni
Asst. Prof. Dr Anupama S. for their continuous and
valuable support & finally all my anaesthesia staff,
colleague & juniors without whom this would not
be possible.
6. Muzi M, Robinson BJ, Ebert TJ, O’Brien TJ.
Induction of anesthesia and tracheal intubation with
sevoflurane in adults. Anaesthesiology 1996; 85: 536
43.
7. Sahar M Siddik-Sayyid, A Comparison of
Sevoflurane-Propofol versus Sevoflurane or Propofol
for Laryngeal Mask Airway Insertion in Adults.
(AnesthAnalg 2005;100: 1204–9).
8. J. E. Hall et al, Sevofluorane anaesthesia with or
without N2O, Anaesthesia 1997,52,pages 410-415.
9. Ismail Kati et al, Comparison of Propofol and
Sevofluorane for Laryngeal Mask Airway Insertion,
Tohoku J. Exp. Med,2003,200,111-118.