Continuous intra-articular infusion of bupivacaine for post-operative pain relief after total hip arthroplasty: A randomized, placebo-controlled, doub

– Continuous intra–articular infusion of 0.5% bupivacaine at 2 mL/h via a PCIP does not provide sustained post–operative pain relief in patients undergoing THA. Methods

• 92 patients undergoing THA were randomized to receive continuous intra–articular infusion of either 0.5% bupivacaine or 0.9% normal saline at a flow rate of 2 mL/h via a PCIP for 48 h.
• The primary outcome measure was pain intensity on Visual Analogue Scale (VAS) scores in the first 72 h.
• Other measures included time to first rescue dose of narcotics, amount of narcotic use, presence of adverse events, length of hospital stay, and hip function evaluated with the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index.

Results

• Despite a longer time to first narcotic rescue (56 versus 21min, p<0.0001) p="0.54).
• A lower VAS score was found only at time 0 and 2 h; no difference in VAS score was noted at any other time point.
• Additionally, no difference was found in terms of amount of narcotic use, incidence of adverse events, hospitalization days, and the WOMAC score.

Magnesium sulphate has beneficial effects as an adjuvant during general anaesthesia for Caesarean section

– Preoperative i.v. magnesium sulphate attenuated BIS and arterial pressure increases during the pre–delivery period. Magnesium sulphate can be recommended as an adjuvant during general anaesthesia for Caesarean section to avoid perioperative awareness and pressor response resulting from inadequate anaesthesia, analgesia, or both.

Laryngeal mask airways – to inflate or to deflate after insertion?

– This study demonstrates that LMAs, particularly when using small–sized LMAs or LMAs with a more rigid PVC surface, need to be deflated following insertion of the device rather than inflated to avoid cuff hyperinflation. Hence, cuff pressures should be measured routinely using a manometer to minimize potential pressure–related airway complications.

Histoires droles(កំប្លែងចុងសប្តាហ៍)

> Numéro 6 :
>
> Un ex va au mariage de son ancienne femme.
> Durant la soirée, l'ex va voir le nouveau marié et lui demande d'un air
arrogant :
> - Comment tu trouves ça, de rentrer dans du stock usagé
> Le nouveau marié le regarde droit dans les yeux et, inébranlable(!!!),
> Il lui répond :
> - C'est stupéfiant !! ... Passé les 6 premiers centimètres, c'est flambant neuf
!!!...
>
> Numéro 5 :
<>>
> Un homme se cogne contre une femme dans un hall d'hôtel.
Durant la collision son coude butte contre la poitrine de celle-ci.
> Ils sont tout deux surpris.
> L'homme se tourne vers elle et dit :
> "Madame, si votre coeur est aussi doux que votre poitrine, je
sais que vous me pardonnerez."
> Ce à quoi elle répond :
> " Si votre queue est aussi dure que votre coude, je suis dans la
chambre 221".
>
>
Numéro 4 :
>
> Un homme d'affaire monte à bord d'un train et se retrouve
assis à côté d'une superbe femme.
> Il remarque qu'elle est en train de lire un livre sur les
statistiques sexuelles.
> Il l'interroge sur ce sujet, et elle répond :
> " C'est un livre très intéressant. Ainsi les Indiens sont ceux
dont le pénis est le plus long, et les bretons sont ceux qui savent
le mieux s'en servir. Au fait je m'appelle Florence. Et vous "
> "Géronimo LE GENNEC ! Enchanté de vous rencontrer."
>
>
Numéro 3 :
>
> ; Un soir, alors qu'un couple se couche, le mari commence à
caresser le bras de sa femme.
> Elle se retourne et lui dit :
> " Je suis désolée chéri, j'ai un rendez-vous chez le
gynécologue demain et je veux rester fraîche".
> Le mari déçu se retourne.
> Quelques minutes plus tard, il se tourne de nouveau vers sa
femme.
> " Est-ce que tu as aussi un rendez-vous chez le dentiste
demain ?"
>
> <>Numéro 2 :
>
> Un prêtre et une nonne sont dans une tempête de neige. Après
un moment, ils trouvent une petite cabane. Exténués, ils se
préparent à dormir.
> Il y a une pile de couvertures et un duvet sur le sol, mais
seulement un lit.
> Gentleman, le prêtre dit :
> " Ma soeur, vous dormirez dans le lit, et je dormirai sur le sol,
dans le duvet".
> Alors qu'il venait juste de fermer son duvet et commençait à
s'endormir, la nonne dit :
> " Mon père, j'ai froid ".
> Il ouvre la fermeture de son duvet, se lève, prend une
couverture et la pose sur elle. De nouveau, il s'installe dans le
duvet, le ferme et se laisse
> sombrer dans le sommeil, quand la nonne dit encore :
> " Mon père, j'ai toujours très froid".
> Il se lève a nouveau, met une autre couverture sur elle et
retourne se coucher.
> Juste au moment ou il ferme les yeux, elle dit :
> "Mon père, j'ai siiiiii froid ".
> Cette fois, il reste couché et dit :
> "Ma soeur, j'ai une idée : nous sommes ici au milieu de nulle
part, et personne ne saura jamais ce qui s'est passé. Faisons
comme si nous
> étions mariés".
> Enfin exaucée, la nonne répond :
> " Oui, c'est d'accord ".> Et le prêtre crie :
> " Alors tu lèves ton cul et tu prends toi même ta putain de
couverture, conasse !!!"
>
> Numéro 1 :
>
> Un couple a était marié pendant 50 ans.
> Un matin au petit déjeuner, la femme déclare :
> " Rappelle - toi comme 50 ans en arrière, nous étions
probablement assis à cette même table ensemble."
> "Je sais," dit le vieil homme
> "nous étions probablement assis, complètement nus."
> " Eh, bien, " dit la vielle femme " revivons un peu du
passé."
> Alors les 2 se déshabillent entièrement et se rassoient.
> " Tu sais chéri, " dis la petite vieille toute excitée " mes
tétons sont toujours aussi chauds aujourd'hui qu'ils l'étaient
il y a 50 ans! "
> "Ca ne m'étonne pas, " répondit le grand-père " Il y en a
un dans le grille-pain et l'autre qui t rempe dans ton café.

Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: A double-blind placebo controlled study

– The results of this study warrant a larger randomized placebo controlled trial using higher doses of ketamine and a longer follow–up period. Methods

• Randomized double–blind placebo controlled trial.
• Before treatment, after informed consent was obtained, each subject was randomized into a ketamine or a placebo infusion group.
• Study subjects were evaluated for at least 2 weeks prior to treatment and for 3 months following treatment.
• All subjects were infused intravenously with normal saline with or without ketamine for 4 h (25 ml/h) daily for 10 days. The maximum ketamine infusion rate was 0.35 mg/kg/h, not to exceed 25 mg/h over a 4 h period.
• Subjects in both the ketamine and placebo groups were administered clonidine and versed.

Results

• Intravenous ketamine administered in an outpatient setting resulted in statistically significant reductions in many pain parameters.
• Subjects in the placebo group demonstrated no treatment effect in any parameter.

Ventilator-associated pneumonia and mortality: A systematic review of observational studies *

There is no evidence of attributable mortality due to ventilator–associated pneumonia in patients with trauma or acute respiratory distress syndrome. However, in other nonspecified patient groups, there is evidence for attributable mortality due to ventilator–associated pneumonia, but this could not be quantified due to heterogeneity in study results. More detailed studies, allowing subgroup analyses, are needed to determine the attributable mortality of ventilator–associated pneumonia in these patient populations.

ថ្នាំសណ្តំ ឬ អវិញ្ញាណកម្ម

នៅស្រុកខ្មែរគេទម្លាប់ហៅ Anesthésiste ថាអ្នកដាក់ថ្នាំសណ្តំខ្ញុំក៏ជាអ្នកដាក់ថ្នាំសណ្តំម្នាក់ដែរ
តែខ្ញុំស្តាប់ទៅវាដូចជាមិនទំនងសោះ ព្រោះថាថ្នាំសណ្តំវាគ្រាន់តែជាផ្នែកមួយនៃAnesthésie ប៉ុណ្ណោះ។
ខ្ញុំធ្លាប់បានឃើញសំណៅបកប្រែរបស់លោក វ៉ាន់ឌី កាអុន កាលដែលលោកធ្វើការនៅស្រុកខ្មែរ
សម័យរដ្ឋកម្ពុជា លោកបកប្រែរពាក្យ Anesthésie ថា អវិញ្ញាណកម្ម ។
នៅក្នុងវចនានុក្រមខ្មែររបស់សម្តេចជួន ណាត ខ្ញុំក៏បានរកឃើញពាក្យ
អវិញ្ញាណក ៖ អៈវិញ-ញា ណៈកៈ បា। ឬ សំ। ( គុ। ) (អវិញ្ញាណក, អវិជ្ញានក) ដែល​ឥត​វិញ្ញាណ ។ ន। អ្វី​ៗ​ដែល​ឥត​វិញ្ញាណ; អនុបាទិន្នក​រូប ។ ព। ផ្ទ. សវិញ្ញាណកៈ ។ អវិញ្ញាណក​ទ្រព្យ ទ្រព្យ​ឥត​វិញ្ញាណ : មាស, ប្រាក់, ត្បូង, ផ្តិល, ចាន, ទូ, តាំង, តុ, កៅអី,... ជា​អវិញ្ញាណក​ទ្រព្យ ។ ព. ផ្ទ. សវិញ្ញាណក​ទ្រព្យ ។ អវិញ្ញាណក​រូប រូប​ឥត​វិញ្ញាណ ។ល។
ខ្ញុំយល់ថា​ នេះជាឬសគល់នៃពាក្យខ្មែរដែលយើងអាចបំបែកចេញជាមែកធាងយ៉ាង
ច្រើនដូចជា៖អវិញ្ញាណកម្ម អវិញ្ញាណកម្មវិទ្យា អវិញ្ញាណកម្មវិទូ
អវិញ្ញាណកម្មបណ្ឌិត ។ល។ ហាស់ហា!!
ដូចពាក្យ Anesthésie វាចែកចេញជាច្រើនផ្នែកណាស់គឺមាន Anesthésie générale,Anesthésie locale,Anesthésie​ loco-régionale,។ល។
ដូច្នេះ Anesthésie générale គួរតែជា ការដាក់ថ្នាំសណ្តំឯ Anesthésie locale ការដាក់ថ្នាំស្ពឹក។ល។
ទាំងការដាក់ថ្នាំស្ពឹក ទាំងការដាក់ថ្នាំសណ្តំ គឺសុទ្ធសឹងតែការធ្វើ៎ឲ្យបាត់បង់វិញ្ញាណទាំងអស់
(អវិញ្ញាណកម្ម)មានការបាត់បង់ការឈឺចាប់ ការកំរើក មិនដឹងរស់ជាតិ ក្លឹន ការមើលឃើញ។ល។ រហូតដល់បាត់បង់វិញ្ញាណទាំងស្រុង លើកលែងតែ ចលនាបេះដូង និង ដង្ហើម តែប៉ុណ្ណោះ ។
ឯចំណែកអ្នកដាក់ថ្នាំសណ្តំគាត់ក៏ជាអ្នកដាក់ថ្នាំស្ពឹកដែរដូច្នេះគួរហៅគាត់ថា៖
អ្នកឯកទេសអវិញ្ញាណកម្ម និង​ប្រពោធនកម្ម ។
From Wikipedia

Le mot anesthésie provient du grec aïsthêsis (αισθησις: faculté de percevoir par les sens) combiné à l'alpha (α) privatif et du nu (ν) euphonique. L'anesthésie peut viser un membre, une région ou l'organisme entier (anesthésie générale). L'anesthésie est la suppression de la douleur. Elle vise à permettre une procédure médicale qui autrement serait trop douloureuse. L'anesthésie loco-régionale est aussi pratiquée dans les cas de douleurs chroniques.

Le domaine de la médecine qui étudie et pratique l'anesthésie est l'anesthésiologie. Cette spécialité médicale est récente, et elle a révolutionné la médecine en permettant une chirurgie de qualité.

Anesthesia, or anaesthesia (see spelling differences; from Greek αν-, an-, "without"; and αἲσθησις, aisthēsis, "sensation"), has traditionally meant the condition of having sensation (including the feeling of pain) blocked or temporarily taken away. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience. The word was coined by Oliver Wendell Holmes, Sr. in 1846.^[1] Another definition is a "reversible lack of awareness", whether this is a total lack of awareness (e.g. a general anaesthetic) or a lack of awareness of a part of the body such as a spinal anaesthetic or another nerve block would cause. Anesthesia is a pharmacologically induced reversible state of amnesia, analgesia, loss of consciousness, loss of skeletal muscle reflexes and decreased stress response.

Characteristics of patients with chronic back pain who benefit from acupuncture

– Overall, the strongest predictors of improvement in back function and symptoms were higher baseline levels of these measures, receipt of an acupuncture treatment, and non–use of narcotic analgesics. Benefit from acupuncture compared to usual care was greater with worse pre–treatment levels of back dysfunction (interaction p< 0.004 for the functional outcome, Roland Morris Disability Scale at 8 weeks). No other consistent interactions were observed. This secondary analysis found little evidence for the existence of subgroups of patients with chronic back pain that would be especially likely to benefit from acupuncture. However, persons with chronic low back pain who had more severe baseline dysfunction had the most short–term benefit from acupuncture.

Thinking beyond low-density lipoprotein cholesterol: strategies to further reduce cardiovascular risk

Some trials have highlighted the significance of residual cardiovascular risk after treatment of LDL–C to target levels. This residual risk is partially due to low HDL–C and high triglycerides (TG) despite achievement of LDL goals with statin therapy. The NCEP ATP III guidelines reported that low HDL–C is a significant and an independent risk factor for coronary heart disease (CHD) and is inversely related to CHD. Epidemiologic studies have also shown a similar inverse relationship of HDL–C with CHD. High–density lipoprotein cholesterol (HDL–C) may directly participate in the anti–atherogenic process by promoting efflux of cholesterol of the foam cells of atherogenic lesions. Many studies have demonstrated multiple anti–atherogenic actions of HDL–C and its role in promoting efflux of cholesterol from the foam cells. The residual risk by increased TG with or without low HDL–C can be assessed by calculating non–HDL–C and a reduction in TG results in decreased CHD.

Relative potencies of bupivacaine, levobupivacaine, and ropivacaine for neonatal spinal anaesthesia

– Comparing the relative potency of new local anaesthetics such as levobupivacaine and ropivacaine with bupivacaine by the minimum local analgesic concentration model has not been described for neonatal spinal anaesthesia. This information is important to compare agents and to determine the most effective spinal dose. Appropriate doses for infant spinal anaesthesia are 1 mg kg^–1 of isobaric 0.5% bupivacaine and ropivacaine and 1.2 mg kg^–1 of isobaric 0.5% levobupivacaine.

Obstructive Sleep Apnea Is Not a Risk Factor for Difficult Intubation in Morbidly Obese Patients

– In MO patients undergoing bariatric surgery in the "ramped position," there was no relationship between the presence and severity of OSA, BMI, or NC and difficulty of intubation or laryngoscopy grade. Only a Mallampati score of 3 or 4 or male gender predicted difficult intubation.

Blind intubation device for nasotracheal intubation in 100 oral and maxillofacial surgery patients with anticipated difficult airways: a prospective e

The authors have demonstrated the safe and effective use of the blind intubation device in 100 adult patients with anticipated difficult airways. The overall success rates of the oesophagus airway placement, the light–guiding catheter insertion and nasotracheal intubation over the light–guiding catheter were really satisfied. This technique could improve the success of blind nasal intubation, especially in situations in which fibreoptic equipment was unavailable. However, further studies are still required.

Overweight/Obesity and Gastric Fluid Characteristics in Pediatric Day Surgery: Implications for Fasting Guidelines and Pulmonary Aspiration Risk

– Twenty–seven percent of pediatric day surgery patients are overweight/obese. These children may be allowed clear liquids 2 h before surgery as GFV(IBW) averages 1 mL/kg regardless of BMI and fasting interval. Rare emetic episodes were not associated with shortened fasting intervals in this population.

Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1)v in Spain

– Over a 5–week period, influenza A (H1N1)v infection led to ICU admission in 32 adult patients, with frequently observed severe hypoxemia and a relatively high case–fatality rate. Clinicians should be aware of pulmonary complications of influenza A (H1N1)v infection, particularly in pregnant and young obese but previously healthy persons.

9thWorldCongressForNurseAnesthetists

Adenosine-An Old Drug Newly Discovered

At present, pharmacological approaches to modulate extracellular adenosine signaling are evaluated for their potential use in perioperative medicine, including attenuation of acute lung injury; renal, intestinal, hepatic and myocardial ischemia; or vascular leakage. If these laboratory studies can be translated into clinical practice, adenosine receptor–based therapeutics may become an integral pharmacological component of daily anesthesiology practice.

Acute Severe Arterial Hypertension:Therapeutic Options

– Treatment for hypertensive crisis should achieve a progressive control of blood pressure, avoiding any abrupt decrease in organ blood supply. Therapeutic options are many and different in terms of pharmacokinetics and pharmacodynamic profiles. The best option should be based upon the characteristics of the patient and the pathophysiology of the hypertensive crisis . Of particular interest, some agents are metabolized by blood esterase and have a very short half life (e.g., clevidipine). This allows tight titration of their effect, which is advisable when carefully lowering blood pressure. This is of particular importance when treating hypertensive crisis in surgical patients both intra–operatively or in critical care.

Epidural analgesia in the latent phase of labor at cervical dilation of 1.0 cm or more does not prolong the progression of labor and does not increase

Epidural analgesia in the latent phase of labor at cervical dilation of 1.0 cm or more does not prolong the progression of labor and does not increase the rate of Cesarean in nulliparous women compared with the delayed analgesia at the cervical dilation of 4.0 cm or more.

Infraclavicular brachial plexus blocks

Successful brachial plexus block requires a thorough knowledge of anatomy, both to decide on the appropriate approach and to locate the nerves. The plexus is traditionally found at specific anatomical points by using bony or vascular landmarks, whereas ultrasound allows block of the plexus at any point along its length.

General anaesthesia for Caesarean section

General anaesthesia for Caesarean section is still decreasing in incidence.
General anaesthesia may be indicated due to urgency, maternal refusal of regional techniques, inadequate regional block, or regional contraindications.
Obstetric indications, which were once considered absolute indications for general anaesthesia, such as placenta praevia, are now being routinely performed under regional anaesthesia.
Major complications include failed intubation, aspiration of gastric contents, increased blood loss, and awareness.
Difficulty in intubation is encountered 10 times more often than in the non-obstetric population.