Uvod: O kronični pooperativni bolečini govorimo, kadar ne najdemo drugega vzroka za njen nastanek in ko traja dlje kot 2 meseca po operaciji. Pojavi se pri 10-50 % bolnikov po velikih abdominalnih ...operacijah. Podskupina kronične bolečine, ki jo je najtežje zdraviti, je kronična nevropatska bolečina. Medoperativna epiduralna analgezija in infuzija deksmedetomidina lahko vplivata na incidenco kronične pooperativne bolečine in na incidenco nevropatske bolečine.
Metode: V prospektivno raziskavo smo vključili odrasle kirurške bolnike, sprejete na KO za abdominalno kirurgijo, pri katerih je bila načrtovana operacija želodca, operacija trebušne slinavke ali operacija črevesja. Vsi bolniki so imeli epiduralno analgezijo in medoperativno infuzijo deksmedetomidina. Tri mesece po operaciji smo bolnikom poslali vprašalnike. Ocenjevali smo jakost in vrsto bolečine. Za oceno smo uporabili DN4 (Douleur Neuropathique 4) in vprašalnik painDetect.
Rezultati: Prejeli smo 42 (50 %) pravilno izpolnjenih vprašalnikov DN4 in 45 (53 %) vprašalnikov painDetect. V naši raziskavi je bila incidenca kronične bolečine 25 %, nevropatske bolečine 7,1 % (3 bolniki so izpolnjevali merila za nevropatsko bolečino po vprašalniku DN4).
Zaključek: Rezultati naše prospektivne raziskave nakazujejo, da bi lahko medoperativna uporaba epiduralne analgezije in infuzije deksmedetomidina zmanjšala pojav pooperativne kronične bolečine.
Objective
The consumption of opioid analgesics could be reduced by the use of analgesics with different mechanisms of action. We investigated whether additional treatment with dexmedetomidine or ...lidocaine could reduce opioid consumption.
Methods
We randomized 59 study participants into three groups and examined: (i) fentanyl consumption, (ii) consumption of piritramide, and (iii) cognitive function and neuropathic pain. The control group received continuous propofol infusion and fentanyl boluses. Continuous intravenous infusion of dexmedetomidine (0.5 µg/kg/h) was administered to the dexmedetomidine group and lidocaine (1.5 mg/kg/h) was administered to the lidocaine group.
Results
No reduction in fentanyl consumption was observed among the groups. However, we noted a significantly lower consumption of piritramide on the first and second postoperative day in the lidocaine group. Total consumption of piritramide was significantly lower in the lidocaine group compared with the control group.
Conclusions
Lidocaine and dexmedetomidine reduced intraoperative propofol consumption, while lidocaine reduced postoperative piritramide consumption.
Clinical trial registration: NCT02616523
Objective. Multimodal analgesia and analgesics
with different modes of action can
reduce perioperative opioid demand and
their undesirable side effects.
In our study we presumed that patients
...anesthetised with additional perioperative
dexmedetomidine infusion, during radical
prostatectomy, would need less opioids
during and after surgery compared to the
control group.
Materials and methods. 40 patients, 18-80
years of age, ASA class 1-3 (American Society
of Anesthesiologists), scheduled for
radical prostatectomy, were included in
the study. Patients were randomly divided
into two groups (20 pts in each group). In
both groups, fentanyl in repeated boluses
was used as an analgesic; in the studied
group, an additional infusion of dexmedetomidine
(0.3 μg/kg/h) was started with
intravenous line insertion and continued
until the beginning of wound closure. Analgesic
consumption during the operation,
in the post-anaesthesia care unit, in the Intensive
Care Unit on the day of the operation
and on the first postoperative day was
recorded.
Results. The patients with perioperative
dexmedetomidine infusion were slightly
younger (p=0.007), also the duration of
their surgery was shorter (p =0.05). Differences
in opioid consumption between the
groups were not found. Also, pain assessment,
by visual analogue scale (VAS) after
12, 18, 24, 30, 36 and 42 hours, was not statistically
different between groups.
Conclusion. In our study, perioperative
dexmadetomidine did not reduce periand
postoperative opioid consumption.
Also, undesirable dexmedetomidine side
effects, such as bradycardia and hypotension,
were not observed.
Fluid optimisation in pancreas surgery JENKO, MATEJ; POŽAR-LUKANOVIĆ, NEVA; PERIĆ, MLADEN ...
Signa vitae,
01/2019, Letnik:
15, Številka:
2
Journal Article, Paper
Recenzirano
Odprti dostop
Background. Optimal intravascular blood volume, cardiac output and sufficient oxygen supply is a mainstay in major abdominal surgery. Adequate haemodynamic management can improve a favourable outcome ...and shorten the duration of hospital stay.
Our study anticipated different fluid and vasoactive drug consumption and less complications during the pancreatic surgery in the group of patients where extended haemodynamic monitoring was applied.
Materials and methods. 59 adult patients, ASA 2-3, undergoing elective pancreas surgery, were included in the study. In 29 patients in the study group (SG – extended haemodynamic monitoring), cardiac index (CI), mean arterial pressure (MAP) and nominal stroke index (SI) were maintained within 80% of baseline values with actions following study protocol. Patients’ groups were homogenous, even when divided into 4 subgroups (control group (CG) and without epidural catheter (EC), CG and with EC, SG and without EC, SG and with EC).
Intraoperative variables (amount of fluids, vasopressors, surgery duration) and hospitalisation duration, wound healing, reoperation, mortality and other complication were recorded on the postoperative days 3, 5, 8, 15 and on hospital discharge.
Results. There was no difference in ASA health status, intraoperative management and duration of hospitalisation in 4 subgroups. There is a significant difference in intraoperative use of vasopressor support between 4 subgroups (Fisher exact test, p=0,032). All patients in SG with EC required vasopressors. Number of patients with major complications were not statistically different between groups. Pulmonary embolism, postoperative food intolerance and myocardial infarction have occurred only in CG.
Conclusion. In our study there was no difference in overall fluid and vasoactive drug demand. Although in the studied subgroup of patients with additional epidural anaesthesia there was significantly increased demand for vasoactive drugs. The incidence of complication was low in both groups, however, some of major complications occurred only in CG.
We present our position statement for the use of sugammadex, a specific binder for aminosteroid muscle relaxants, in the most common clinical circumstances (in the case of an emergency intubation, ...when the patient cannot be ventilated or intubated; in patients with neuro-muscular disease, in patients with liver failure, in patients with renal failure, in patients with allergic reaction to sugammadex or to rocuronium, in cases of residual muscle relaxation and when we have to use a muscle relaxant short time after sugammadex application). Sugammadex is the drug of choice in cases of cardiac arhythmia, COPD, asthma, neuro-muscular diseases, pathological obesity, intraoperative use of continuous infusion of aminoglycoside muscle relaxants. It is therefore necessary to control the neuro-muscular block during surgery due to different response of patients to the muscle relaxant. Clinical tests alone are not an adequate substitute for objective control of muscular strength recovery.
We present our position statement for the use of sugammadex, a specific binder for aminosteroid muscle relaxants, in the most common clinical circumstances (in the case of an emergency intubation, ...when the patient cannot be ventilated or intubated; in patients with neuro-muscular disease, in patients with liver failure, in patients with renal failure, in patients with allergic reaction to sugammadex or to rocuronium, in cases of residual muscle relaxation and when we have to use a muscle relaxant short time after sugammadex application). Sugammadex is the drug of choice in cases of cardiac arhythmia, COPD, asthma, neuro-muscular diseases, pathological obesity, intraoperative use of continuous infusion of aminoglycoside muscle relaxants. It is therefore necessary to control the neuro-muscular block during surgery due to different response of patients to the muscle relaxant. Clinical tests alone are not an adequate substitute for objective control of muscular strength recovery.
Introduction.The maintainaning of optimal perioperative fluid and electrolyte balance in the perioparative period (before, during and after an operation) is a crucial for anaesthesia and intensive ...therapy. Fluid treatment interferes with the metabolism and functioning of all organ systems, therefore it is important that the patient gets the right type and quantity of fluid at the right time. Perioperative fluid therapy should be guided by the patient’s condition and type of the operation procedure. In fluid therapy, one should take into consideration the need for fluid maintenance (basal metabolism needs), preoperative fluid loss correction (e.c. duration of preoperative starving, especially in children), and aim for good tissue perfusion with an adequate fluid load. The final goal of fluid replacement is to maintain fluid and electrolyte balance, intravascular volume and consequently cardiovascular stability (adequate cardiac output), organ perfusion and tissue oxygenation. Before, during and after surgery balanced fluids should be used, in order to minimise disturbances to the electrolyte balance. In our article, literature of perioperative fluid replacement is reviewed. The results of the latest research have provoked a lot of criticism and disagreement about colloids. Only guidelines about crystalloid application are presented.Conclusions. The latest guidelines for perioperative fluid therapy emphasise the application of balanced intravenous fluids that minimise electrolyte and acid base balance disturbances. It is important to individualise the amount of the intravenous fluid to avoid hyper- or hypovolemia. The correct choice of the type of solution is equally important as any other medication that influences the patient’s outcome.
We present our position statement for the use of sugammadex, a specific binder for aminosteroid muscle relaxants, in the most common clinical circumstances (in the case of an emergency intubation, ...when the patient cannot be ventilated or intubated; in patients with neuro-muscular disease, in patients with liver failure, in patients with renal failure, in patients with allergic reaction to sugammadex or to rocuronium, in cases of residual muscle relaxation and when we have to use a muscle relaxant short time after sugammadex application). Sugammadex is the drug of choice in cases of cardiac arhythmia, COPD, asthma, neuro-muscular diseases, pathological obesity, intraoperative use of continuous infusion of aminoglycoside muscle relaxants. It is therefore necessary to control the neuro-muscular block during surgery due to different response of patients to the muscle relaxant. Clinical tests alone are not an adequate substitute for objective control of muscular strength recovery.
Introduction. The maintainaning of optimal perioperative fluid and electrolyte balance in the perioparative period (before, during and after an operation) is a crucial for anaesthesia and intensive ...therapy. Fluid treatment interferes with the metabolism and functioning of all organ systems, therefore it is important that the patient gets the right type and quantity of fluid at the right time. Perioperative fluid therapy should be guided by the patient’s condition and type of the operation procedure. In fluid therapy, one should take into consideration the need for fluid maintenance (basal metabolism needs), preoperative fluid loss correction (e.c. duration of preoperative starving, especially in children), and aim for good tissue perfusion with an adequate fluid load. The final goal of fluid replacement is to maintain fluid and electrolyte balance, intravascular volume and consequently cardiovascular stability (adequate cardiac output), organ perfusion and tissue oxygenation. Before, during and after surgery balanced fluids should be used, in order to minimise disturbances to the electrolyte balance.
In our article, literature of perioperative fluid replacement is reviewed. The results of the latest research have provoked a lot of criticism and disagreement about colloids. Only guidelines about crystalloid application are presented.
Conclusions. The latest guidelines for perioperative fluid therapy emphasise the application of balanced intravenous fluids that minimise electrolyte and acid base balance disturbances. It is important to individualise the amount of the intravenous fluid to avoid hyper- or hypovolemia. The correct choice of the type of solution is equally important as any other medication that influences the patient’s outcome.
Inflammatory response in surgery is associated with the release of cytokines. Many cytokines are produced by macrophages; therefore surgical injuries to the liver may have great influence on the ...release of cytokines. Ischemia creates tissue injury and may contribute to the cytokine release. A balanced ratio of pro- and anti-inflammatory cytokines is important for appropriate immune response; excessive inflammation or hypo-responsiveness can lead to post-operative complications. To determine the magnitude of the cytokine response caused by liver surgery and to evaluate the balance of pro- and anti-inflammatory cytokines released during the operation, we measured levels of tumor necrosis factor-α (TNFα), interleukin (IL)-1β, IL-6 and IL-10 in 19 patients undergoing liver resection. The results showed a continuous rise of IL-6 and a transient elevation of IL-10. Levels of TNFα remained low; IL-1β was not detected at any sampling time. We conclude that liver surgery induces cytokine response characterized predominantly by an early appearance of IL-6 and IL-10, the elevation of IL-6 may be mainly caused by splanchnic ischemia. The IL-6/IL-10 ratio could possibly reflect the balance of pro- and anti-inflammatory cytokines in liver surgery better than the TNFα/IL-10 ratio, which can well represent inflammatory status in sepsis.
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