Project description:Tardive tremor is a 3-5 Hz bilateral resting and action tremor, associated with the use of dopamine receptor blocking drugs, accompanied by other tardive movement disorders and responsive to tetrabenazine or clozapine. We describe a case of a sensory trick associated with tardive tremor which raises important points about semiology and management. First, the presence of a sensory trick with tardive limb tremor suggests that the disorder may be a form of dystonia. Second, further study of osteopathic manipulative therapy for treatment of dystonia or tardive tremor is supported by a symptomatic response observed in our case.
Project description:This clinical trial is registered at ClinicalTrials.gov. (NCT02476981)This randomized, prospective double-blind study compared remifentanil with dexmedetomidine for monitored anaesthesia care during minimally invasive corrections of vertebral compression fractures (vertebroplasty or kyphoplasty).Patients?>?65 years of age with American Society of Anesthesiologists (ASA) classification I-III, scheduled for vertebroplasty or kyphoplasty under monitored anaesthesia care, received remifentanil (i.v. infusion 1-5?µg/kg/h) or dexmedetomidine (loading dose 0.3-0.4?µg/kg followed by i.v. infusion 0.2-1?µg/kg/h) to maintain observer's assessment of alertness/sedation (OAA/S) scale <4 during the procedure.There were no statistically significant differences in demographic data between the remifentanil (n?=?37) and dexmedetomidine groups (n?=?38). Patients on dexmedetomidine experienced lower mean arterial pressure (MAP) and heart rate (HR), and higher SpO2 values, than patients on remifentanil. Compared with dexmedetomidine, remifentanil produced more respiratory depression, oxygen desaturation, and reduced the need for additional intraoperative opioids. There were no significant between-group differences in terms of recovery time, investigators' satisfaction scores, or patients' overall pain experiences.During monitored anaesthesia care, dexmedetomidine provides less respiratory depression, lower MAP and HR, but also less analgesic effect than remifentanil in elderly patients undergoing vertebroplasty or kyphoplasty.
Project description:Importance:In the United States, sialendoscopy is most often performed under general anesthesia with endotracheal intubation (GETA); however, monitored anesthesia care (MAC) may be a viable alternative. Objective:To investigate patient characteristics and outcomes following sialendoscopy performed under MAC or GETA to assess the potential of MAC as an alternative anesthetic option. Design, Setting, and Participants:A retrospective review of medical records on patients who underwent sialendoscopy between October 1, 2011, and August 31, 2014, was performed. Patient characteristics, salivary stone characteristics, intraoperative findings, operative time (OT), anesthesia time (AT), and outcomes were evaluated. Data analysis was performed from November 1, 2015, to March 1, 2016. Main Outcomes and Measures:Operative and anesthetic times for sialendoscopy under MAC and GETA. Results:Sixty-five patients underwent 70 sialendoscopy procedures: 27 performed under MAC, 43 under GETA. Overall, 37 of 65 (56.9%) patients were women, with 17 (63.0%) in the MAC group and 20 (52.6%) in the GETA group. Mean (SD) patient age was 49.4 (17.3) and 47.2 (16.2) years for the MAC and GETA cohorts, respectively. Median (25th-75th quartiles) OT in minutes for MAC cases was significant for no stones (49.0 [31.0-49.0]) and stones (41.0 [28.0-92.0]) present; nonsignificant findings were stones in the Wharton (46.0 [28.0-92.0]) and Stenson (37.0; 1 case) ducts. For GETA cases, significance was also demonstrated for no stones (55.0 [52.0-91.0]) and stones (77.0 [56.0-107.0]) present; nonsignificant findings were stones in the Wharton (79.0 [56.0-107.0]) and Stenson (65.0 [49.0-98.0]) ducts. The AT in minutes for MAC cases was significant for no stones (33.0 [30.0-39.0]) and stones (38.0 [32.0-55.0]) present; nonsignificant findings were stones in the Wharton (60.0 [32.0-55.0]) and Stenson (37.0; 1 case) ducts. For GETA cases, findings were also significant for no stones (61.0 [52.0-67.0]) and stones (59.0 [53.0-67.0]) present; nonsignificant findings were stones in the Wharton (60.0 [54.0-69.0]) and Stenson (52.0 [48.0-61.0]) ducts. Conclusions and Relevance:This study suggests that sialendoscopy under MAC has faster median OT and AT, regardless of varying case circumstances, such as the presence or lack of stones, successful stone removal, stone size (>5 mm), stone location, and sialendoscopy-assisted open procedures. Sialendoscopy under MAC may be a reasonable anesthetic alternative to GETA in an appropriate setting with an experienced surgeon, experienced anesthesiologist comfortable with administering MAC, cases with small (<4-mm) singular stones, and patients comfortable with undergoing the procedure without GETA.
Project description:Eighty four out of 2151 militancy trauma patients sustained severe maxillofacial injury from Jan 1990 to March 1993. The resuscitation, stabilisation and intensive care of these patients was based on management priorities of primary resuscitation, care of airway, management of haemodynamics, oxygenation and monitoring. Anaesthesia was administered in a situation when the airway was likely to be compromised and the patients were critically sick. Initial ventilation and oxygenation was the most difficult and could be achieved with satisfactory seal around the face mask by applying water-soaked guaze pieces around the mouth and nose to "fill-in" the defects. Tracheal intubation could be accomplished with intravenous sedation by an experienced anaesthesiologist. Dental occlusion and wiring necessiated the placement of nasotracheal tube for 48-72 hours after surgery.
Project description:Background: Mechanical thrombectomy (MT) for ischemic stroke can be performed under local anesthesia (LA), conscious sedation (CS), or general anesthesia (GA). The need for monitoring by anesthesia providers may be resource intensive. We sought to determine differences in outcomes of MT when sedation is performed by an anesthesia team compared to sedation-trained providers. Methods: We performed a retrospective analysis on patients who were screened by a pre-hospital stroke severity screening tool and underwent MT at two stroke centers. Baseline characteristics, time metrics, sedatives, peri-procedural intubation, complications, and outcomes were recorded. Good outcome was defined as modified Rankin score of ≤2. Results: We analyzed 104 patients (sedation-trained provider = 63, anesthesia team = 41) between July 2015 and December 2017. In the sedation-trained provider group, four patients required intervention by an anesthesia team. There were no differences in patients receiving LA (sedation-trained provider 24% vs. anesthesia team 27% p = 0.82), CS (70 vs. 63%, p = 0.53), or GA (6 vs. 10%, p = 0.71) between groups. Sedation-trained providers were more likely to use only one drug during the procedure (62 vs. 34%, p = 0.009). The rate of procedural complications (9.5 vs. 4.5%, p = 0.48), good outcome (56 vs. 39%, p = 0.11), and mortality (22 vs. 24%, p = 0.82) was similar between groups. Sedation by provider type did not predict functional outcome or mortality at 3 months. Conclusions: Sedation-trained providers are capable of delivering appropriate sedation without compromising patient safety. The use of "as needed" anesthesia teams for MT may have considerable effect on resource allocation and cost.
Project description:ObjectiveExposure to waste anaesthetic gas (WAG) is a recognised occupational hazard for health care professionals (HCP). In recovery rooms, scavenging and ventilation systems differ from those in the operating room, raising the question as to how efficient they are. This study aims to measure the levels of ambient sevoflurane over the course of consecutive workdays in the paediatric recovery room of a tertiary academic centre.MethodsThe following is a descriptive-analytic study of ambient air sevoflurane levels measured using a MIRAN® 205B Series SapphIRe portable ambient air analyser. Samples were obtained between 7:30 am and 6:30 pm for two non-consecutive weeks on consecutive weekdays in our paediatric recovery room area.ResultsThe ambient air levels of sevoflurane exceeded the ceiling concentration of 0.5 ppm recommended by the National Institute for Occupational Safety and Health on all days of measurement. The concentration of sevoflurane in ambient air correlates directly with the number of patients present.ConclusionEven in a modern recovery room constructed according to current building standard and code, ambient air levels of WAG exceed the recommendations. Future research and practice standards are needed to reduce this occupational exposure. Disregarding whether chronic exposure to WAG is harmful, we have shown that HCP working in recovery rooms are chronically exposed to concentrations which exceed recommended levels. Strategies are needed to reduce ambient levels of WAG in post-anaesthesia care units.
Project description:This study aims to evaluate the safety and patient satisfaction of a fast-track procedure for cataract surgery under topical anaesthesia without perioperative anaesthesia care. This is a prospective single-centre study including all cataract procedures in the Centre Ambulatoire de la Chirurgie de la Cataracte at the Hospital of Bourges between May and August 2018. Procedures were performed under topical anaesthesia without the presence of a nurse anaesthesiologist or anaesthesiologist, the patient had not fasted, and no peripheral venous line was placed. Only heart rate and oxygen saturation were monitored intraoperatively with pulse oximetry. Incidence and nature of intraoperative adverse events and surgical complications were recorded. Patient satisfaction was assessed using the Iowa Satisfaction with Anaesthesia Scale (ISAS). In total, 651 cataract surgeries were performed among which 614 (94.3%) were uneventful. Thirty (4.6%) intraoperative adverse events and 8 (1.2%) surgical complications were recorded. All surgeries were successfully completed. No medical emergency team intervention or hospital admittance was encountered. The mean ISAS score was 5.7/6, indicating high patient satisfaction. Cataract surgery in an ambulatory cataract surgery centre without perioperative anaesthesia care is a safe procedure with high patient satisfaction for screened patients. Anaesthesia ressources are scarce and may be more beneficial to more complex ophthalmic or non-ophthalmic surgeries.
Project description:Anaesthesia time was varied between 4 hours and a quick 5 min sacrifice in streptozotocin diabetic rats and controls after four weeks of diabetes.
Project description:Therapeutic transfusion techniques such as apheresis and phlebotomy are frequently used in intensive care units. Use of the apheresis technique for the treatment of various diseases in critically ill patients is growing day by day. There are increasing evidences for using apheresis as a primary therapy or as an adjunct to other therapies for various diseases such as thrombotic thrombocytopenic purpura, haemolytic uremic syndrome, drug toxicities, autoimmune disease, sepsis and fulminant hepatic failure. Apheresis is an invasive procedure. It has significant physiologic consequences, so the care of these patients requires continuous supervision. Phlebotomy is performed as an intervention for some disease management. Its use is nowadays restricted to conditions such as polycythaemia, haemochromatosis and porphyria cutanea tarda. In this review, we have looked at various indications, procedure and complications of apheresis and phlebotomy in critical care unit.
Project description:Medical education programs in the United States or Canada comply with the Liaison Committee on medical education standards to ensure their graduates provide proficient medical care. One standard includes student development as a lifelong learner. The competency of lifelong learning is developed through self-directed activities such as students evaluating their learning objectives and resources without external help.Quick response (QR) codes were the technological tools introduced in a traditional medical institution to enhance students' self-directed initiative to tap resources. Relevant lecture objectives and other information such as supplemental discipline content, reading assignments and web-based link resources were embedded into codes and 'pasted' onto all pages of their course PDF handouts. It was anticipated that most students had access to smart phones to conveniently scan the codes and retrieve the information.However, an in-class survey conducted showed that only 30% of the students found the QR codes useful. Further questioning revealed that some students just didn't know how to use the codes or didn't think the information embedded was worth the effort to decrypt. Although students were tech-savvy in the social and entertainment realms, they were not adept in the use of technology for educational purposes.QR codes presented several theoretical, pedagogical advantages to enhance experiential and self-directed learning. However, implementation among students, in a traditional classroom, required prior instructions on usage. Student feedback was also imperative when introducing novel, innovative tools like QR codes.