A Series of Erector Spinae Plane Blocks Reduced Pain and Opioid Consumption in Patients with Post Herpetic Neuralgia: Two Patient Cases
Yuvaraj Kotteeswaran, MD, Varuna Manoo, MD, Alexander McLaren-Blades, MD, Michael Kahn, MD, Alexander Huang, MD and Hance Clarke, MD, PhD
Article Type: Case Report | First Published: June 26, 2020
Intense, refractory neuropathic pain is an unfortunate complication following a Herpes Zoster (HZ) infection/ rash and is regarded as post-herpetic neuralgia (PHN). The risk of PHN increases with age. The erector spinae plane (ESP) block has been demonstrated to block transmission through the thoracic and lumbar spinal nerves. This report describes two patients that were able to significantly reduce their chronic pain medications following a series of ESP blocks....
Sugammadex-Is Cost the Only Drawback?
Michael W Lew, MD and Joseph Chang, MD
Article Type: Letter to the Editor | First Published: June 04, 2020
Residual muscle paralysis is an important safety issue, with multiple studies demonstrating an association with increased postoperative complications. The pathophysiology of these complications isn’t difficult to explain. One can only imagine the signs and symptoms in an awake patient (i.e. the panic from not having the strength to take a deep breath or move at full strength; the anxiety of not controlling one’s body movement). A study by the Cleveland Clinic demonstrated that major complica...
Massive Subcutaneous Emphysema and Intraoperative Hypercarbia after Transanal Endoscopic Microsurgery (TEMS)
Abhishek Singh, Apala Roy Chowdhury, Ameya Pappu and Puneet khanna
Article Type: Case Report | First Published: May 06, 2020
Transanal endoscopic microsurgery (TEMS) is minimally invasive, safe and highly effective treatment modality for resecting small rectal lesion like adenomas, early stage carcinoma and strictures. We describe an unusual case of massive subcutaneous emphysema and hypercarbia secondary to TEMS leading to ventilatory difficulty and post-operative mechanical ventilation. Extra peritoneal insufflation of CO2 at high pressure, for prolonged duration and extent of tissue dissection are some of the predi...
General Anesthesia Affecting on Developing Brain: Evidence from Animal to Clinical Research
Xinyue Liu, MD, Jing Ji, MD and Guo-Qing Zhao, MD, PhD
Article Type: Review Article | First Published: January 04, 2020
As the recent update of General Anaesthesia compared to Spinal anaesthesia (GAS) studies has been published in 2019, together with other clinical evidence, the human studies provided an overwhelming mixed evidence of an association between anaesthesia exposure in early childhood and later neurodevelopment changes in children. Pre-clinical studies in animals provided strong evidence on how anaesthetic and sedative agents (ASAs) causing neurotoxicity in developing brain and deficits in long-term c...
Perioperative Management of Multiple Intracranial Nail Gun Injuries
Matthew B Ellison, MD, Jeremy Hensley, MD, Roy E Henrickson, MD, Jeffrey Puette, MD, Jason Shepherd, MD, Daniel Sloyer, MD and Pavithra R Ellison, MD
Article Type: Case Rep ort | First Published: January 04, 2020
A 51-year-old male presented to the emergency department with four self-inflicted nail gun wounds. Computed tomography angiography demonstrated three nails penetrating the frontal bone toward the falx cerebri causing small subdural hematomas. The fourth nail penetrated the parietal bone posteriorly, ending very close to the vein of Galen. Despite the ominous-appearing imaging, the patient was neurologically intact and cooperative to the point that consideration was given to the possibility of re...
Does Esmolol Havean Effect on Erythrocyte Deformability in Rat Lower Limb Ischemia Reperfusion Injury?
Ali Dogan Dursun, Faruk Metin Comu, Aysegul Kucuk, Ulku Sabuncu, Nevriye Salman, Timucin Sabuncu, Gulay Kip, Omer Kurtipek and Mustafa Arslan
Article Type: Original Article | First Published: December 20, 2019
Ischemia reperfusion (I/R) injury is a common problem in vascular surgery. We aimed to investigate the effects of esmolol on erythrocyte deformability in rat lower limb I/R injury. Following Ethics Commitee approval 24 rats were randomly divided into 4 groups, Control (Group C), Esmolol (Group E), Ischemia-reperfusion (Group I/R), I/R-Esmolol (Group I/R-E). In I/R group, atraumatic microvascular clamp was placed to infrarenal abdominal aorta. After 120 minutes from ischemia, the clamp was remove...
Anaesthesia Monitoring using Artificial Intelligence Techniques
Harry Mc Grath, Colin Flanagan, Liaoyuan Zeng and Yiming Lei
Article Type: Original Article | First Published: December 07, 2019
Artificial Intelligence (AI) will change our lives beyond recognition, it will have a far bigger impact than the internet or mobile technology. We are now at the threshold where machine intelligence is comparable with human intelligence, in certain limited aspects, for the first time in history. Enhancements in technology, both software and hardware, have resulted in some human decision-making being inferior to, and more erratic than, AI in many fields, including medicine. However, it is widely ...
Perioperative Management in Patients with Factor XI Deficiency
Antoine Legrand, Remi Bouquerel, Antoine Strzelecki, Benjamin Le Gaillard, Christophe Pelletier, Mireille Houadec and Edmundo Pereira de Souza Neto
Article Type: Case Report | First Published: March 13, 2019
White French female patient, 56-years-old, 76 kg, 170 cm, was scheduled for a Left knee arthroplasty. Vital signs (blood pressure, temperature, oxygen saturation and Glasgow coma score) were normal. His ASA physical status was 2 and she had no treatment. Past medical history found a cervicobrachial neuralgia. Past surgical history consisted of bilateral hallux valgus, left knee arthroscopy, blepharoplasty and an ovarian ectopic pregnancy....
N-Terminal Pro-Brain Natriuretic Peptide in Post Cardiac Surgery as a Predictor of Ventilator-Weaning Outcomes
Wacharin Sindhvananda, MD, MPH, PhD, Chonlada Bunpeth, MD and Nuthathai Chareonkulnawanun
Article Type: Original Article | First Published: March 09, 2019
An increase of NT-proBNP has been proved to be a predictor for ventilator weaning failure in several medical conditions. However, relation between NT-proBNP and ventilator-weaning outcomes after cardiac surgery has not yet been elucidated. This study was to investigate relationship between blood NT-proBNP and ventilator-weaning outcomes. A prospective analytical study was at Cardiovascular-thoracic intensive care unit. Cardiac-surgery patients (age 18-80 Y, consented and without exclusion criter...
Acute illness, Co-morbidity and Mortality in a Norwegian Intensive Care Population
K Tollisen, M Bjerva, GT Dahl, NK Meidell, L Sandvik, F Heyerdahl and D Jacobsen
Article Type: Original Article | First Published: February 16, 2019
Intensive care units (ICU) provide advanced health care for seriously injured and ill patients, demanding vast economic resources. The population is aging and the need for intensive care beds is expected to increase considerably over the next decades. This will have serious implications for planning and financing of the health care system. Descriptive studies of intensive care patients are needed to ensure that the health services can meet future needs. Evaluation of ICU services are challenging...