Anticipated vs. Experienced Pain at Site of Spinal Needle Insertion in Patients Undergoing Elective Lower Segment Caesarean Section: Perspective from Resource-Limited RegionRead the full article
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Intramuscular Ketamine Effect on Postnasal Surgery Agitation: A Prospective Double-Blinded Randomized Controlled Trial
This study investigates the effect of intramuscular ketamine on emergence agitation (EA) following septoplasty and open septorhinoplasty (OSRP) when administered at subanesthetic doses at the end of surgery. A random sample of 160 ASA I-II adult patients who underwent septoplasty or OSRP between May and October, 2022, was divided into two groups of eighty patients each: ketamine (Group K) and saline (Group S) with the latter serving as the control group. At the end of surgery immediately after turning off the inhalational agent, Group K was administered with intramuscular 2 ml of normal saline containing 0.7 mg/kg ketamine and Group S with 2 ml of intramuscular normal saline. Sedation and agitation scores at emergence from anesthesia were recorded after extubation using the Richmond Agitation-Sedation Scale (RASS). The incidence of EA was higher in the saline group than in the ketamine group (56.3% vs. 5%; odds ratio (OR): 0.033; 95% confidence interval (CI): 0.010–0.103; ). Variables associated with a higher incidence of agitation were ASA II classification (OR: 3.286; 95% (CI): 1.359–7.944; ), longer duration of surgery (OR: 1.010; 95% CI: 1.001–1.020; ), and OSRP surgery (OR: 2.157; CI: 1.056–5.999; ). The study concluded that the administration of intramuscular ketamine at a dose of 0.7 mg/kg at the end of surgery effectively reduced the incidence of EA in septoplasty and OSRP surgery.
Impact of Ketamine on Quality of Recovery after Laparoscopic Surgery: A Single-Centre Single-Blinded Trial Using the QoR-15 Questionnaire
Background. The quality of recovery is a cluster of patient-related outcomes that emphasise not only pain but different physical and emotional dimensions. Traditionally, ketamine is used to improve postoperative analgesia and avoid opioid consumption and opioid-related side effects. Objective. The present study sought to evaluate if intraoperative ketamine administration (as a part of multimodal analgesia) influences the quality of recovery after laparoscopic surgery. Design. A prospective two-armed, single-blinded trial. Settings. Tertiary single-centre trial between July 2021 and January 2022. Patients. From the 146 patients initially admitted to the study, 127 patients were enrolled, 60 in the ketamine group (group K) and 67 in the control group (group NK). Intervention. Both groups received a rigid intraoperative anaesthesia protocol; furthermore, in group K, 0.5 mg/kg of the ideal body weight of ketamine was administered. Main Outcome Measures. The primary outcome was to evaluate the effect of ketamine administration on the postoperative quality of recovery using the Portuguese version of the Quality of Recovery-15 (QoR-15) Questionnaire 24 h after surgery. The total score and minimal clinically significant difference (MCID) of the QoR-15 were compared. Other variables were also assessed such as the presence of emergence delirium (ED), the Numeric Rating Scale (NRS) for pain, and the presence of postoperative nausea and vomiting (PONV). Results. A total of 127 patients were allocated to the study groups, 60 in group K and 67 in group NK. Regarding the primary outcome, no differences were found in individual categories (15 items) and in the total score of QoR-15 (). Concerning improvement (MCID ≥ 8) or worsening (MCID ≤ 8) in quality of recovery, no difference was found between the groups (24 vs. 32 and 6 vs. 6; ). Finally, no difference was found in secondary postoperative outcomes including ED (), NRS (), and PONV (). Conclusion. In this study, the administration of ketamine in laparoscopic surgery had no impact on the quality of recovery 24 h after surgery. This trial is registered with NCT03724019.
ICU-Managed Patients’ Epidemiology, Characteristics, and Outcomes: A Retrospective Single-Center Study
Background. Resources are limited, and it is exceedingly difficult to provide intensive care in developing nations. In Somalia, intensive care unit (ICU) care was introduced only a few years ago. Purpose. In this study, we aimed to determine the epidemiology, characteristics, and outcome of ICU-managed patients in a tertiary hospital in Mogadishu. Methods. We retrospectively evaluated the files of 1082 patients admitted to our ICU during the year 2021. Results. The majority (39.7%) of the patients were adults (aged between 20 and 39 years), and 67.8% were male patients. The median ICU length of stay was three days (IQR = 5 days), and nonsurvivors had shorter stays, one day. The mortality rate was 45.1%. The demand for critical care services in low-income countries is high. Conclusion. The country has a very low ICU bed capacity. Critical care remains a neglected area of health service delivery in this setting, with large numbers of patients with potentially treatable conditions not having access to such services.
Perioperative Respiratory Outcome of Patients with Eosinophilia: A Cohort Study in a Tertiary Care Hospital
Background. A respiratory adverse event is one of the main causes of critical events in the perioperative period. Perioperative distress symptoms like cough and stridor have been reported to occur in patients with hyperreactive airways. Objective. This study was conducted to determine the relationship between blood eosinophil count and perioperative adverse respiratory events among different age groups of patients who require general anesthesia for different types of surgeries. Methods. A cohort study was conducted on 197 patients of either gender, aged 3 years and above, belonging to ASA classes I–II, who were scheduled to undergo surgery requiring general anesthesia and intubation. Patients were stratified according to absolute eosinophil count into two groups: Group A (AEC 0 to 499/mm3) and Group B (AEC 500 to 1000/mm3). Patients were monitored for 24 hours in the perioperative period for adverse respiratory events such as bronchospasm, laryngospasm, a fall in SPO2 < 95%, and cough and stridor. Results. A total of 197 patients were evaluated, with a median age of 37 ± 14.4 years. The percentage range of adverse respiratory events across different age groups was 35% in adults to 60% in children. Major complications noted were a fall in SPO2 < 95% (62.5%) and cough (27.7%) as per CTCAE v5.0 (November 27, 2017). The Naranjo score of adverse respiratory events was categorized as possible with mild level 1 severity. Adverse respiratory events were managed with humidified oxygen, antitussives, and bronchodilators. Conclusions. Eosinophilia is seen in one-third of the patients undergoing surgical interventions. Patients with a blood eosinophil count of ≥400/mm3 had an increased risk of exacerbations of respiratory adverse events in the perioperative period.
Effects of Benson Relaxation Technique and Music Therapy on the Anxiety of Primiparous Women Prior to Cesarean Section: A Randomized Controlled Trial
Background and Aims. Primiparous women experience high levels of anxiety before cesarean section. Therefore, this research aimed to investigate the effects of the Benson Relaxation Technique (BRT) and Music Therapy (MT) on the anxiety of primiparous women prior to cesarean section. Methods. A randomized controlled trial was carried out on 105 women scheduled for cesarean section. They were randomly assigned into three groups: BRT, MT, and control (n = 35 per group). The women in the BRT and MT groups performed exercises and listened to music, respectively, for 20 minutes prior to cesarean section. The State Anxiety Inventory was used to measure the women’s anxiety in the groups before and after the intervention. Results. Within-group comparisons showed that the women in the BRT (t = 5.61, < 0.001, effect size (Cohen’s d) = 0.94) and MT (t = 3.83, = 0.001, d = 0.64) groups had significantly lower anxiety after the interventions compared to before the interventions. Also, between-group comparisons revealed that anxiety after the intervention was significantly lower in the BRT and MT groups compared to the control group ( = 0.007). Conclusions. Although both of the BRT and MT helped with the reduction of anxiety among primiparous women before cesarean section, the BRT was shown more effective. These nonpharmacologic methods are safe and cost-effective and can improve well-being among women undergoing this invasive procedure. They can be used along with pharmacologic methods for reducing overreliance on medications.
Effect of Dexmedetomidine Low Doses with or without Midazolam in Cats: Clinical, Hemodynamic, Blood Gas Analysis, and Echocardiographic Effects
Objectives. The aim of the study is to compare the sedative, cardiorespiratory, echocardiographic, and blood gas effects of dexmedetomidine and methadone associated or not with midazolam for restraint chemistry in cats. Methods. Eighteen healthy young cats (4.06 ± 0.48 kg) were randomly sedated with two protocols, through the intramuscular route: dexmedetomidine (5 µg.kg−1), methadone (0.3 mg. kg−1) and midazolam (0.3 mg. kg−1) (DMTM, n = 9), or dexmedetomidine (7.5 µg.kg−1) and methadone (0.3 mg. kg−1) (DMT, n = 9). The cardiorespiratory parameters were measured at baseline, 5 and 10 minutes after pharmacological latency. The sedation, analgesia, and muscle relaxation scores were assessed before and 5 minutes after pharmacological latency, while arterial blood gas analysis and echocardiography were assessed before and after 10 or 15 minutes, respectively. Results. There was no difference between the protocols regarding the cardiorespiratory, blood gas, and echocardiographic parameters used. The scores for sedation, analgesia, and muscle relaxation also did not differ between the protocols, with the degree of sedation, analgesia, and myorelaxation considered satisfactory in both groups. A significant decrease in heart rate (HR) was observed after administration of the sedative protocols, reaching a maximum reduction at T10 (46% and 53% reduction in the DMT and DMTM groups, respectively). The reduction in HR had an impact on echocardiographic parameters such as CO, which decreased 53% and 56% in the DMT and DMTM groups, respectively. There was a significant reduction in PaO2, SaO2, ejection fraction, and fractional shortening in both protocols. SpO2 decreased significantly after 5 minutes of sedation in the DMT group, but with a minimum mean SpO2 of 92% in T5. The respiratory rate decreased significantly at 5 and 10 minutes in the DMTM group, while PaCO2 increased in both groups, indicating respiratory depression caused by the drugs. Conclusions and Relevance. The study pointed out that both sedative protocols can be recommended for clinical sedation of young and healthy cats in the doses used. However, both protocols resulted in cardiorespiratory depression in cats and also the particularities of the animals should be evaluated regarding reducing cardiac output by more than 50%.