Objective:To compare the effect of ketamine,lidocaine,acetaminophen,and dexmedetomidine combined with morphine patient-controlled analgesia for opium addicts after tibial fracture surgery.Methods:This double-blind cli...Objective:To compare the effect of ketamine,lidocaine,acetaminophen,and dexmedetomidine combined with morphine patient-controlled analgesia for opium addicts after tibial fracture surgery.Methods:This double-blind clinical trial included opium-addicted patients undergoing tibia fracture surgery.Patients were recruited and randomized to four different groups including the ketamine group,the lidocaine group,the acetaminophen group,and the dexmedetomidine group.The hemodynamic parameters such as heart rate(HR),mean arterial pressure,and arterial SaO2,alongside visual analog scale pain scores,sedation assessed by Ramsay score,nausea and vomiting,and opioid use were recorded and compared among the four groups.Results:This study included 140 patients,aged 37(32,41)years,with 92 males and 48 females,and each group had 35 patients.Dexmedetomidine-sedated subjects had the lowest blood pressure from 1 to 24 h after surgery,decreased HR at 12 and 24 h after surgery,and more satisfactory sedation(P<0.05).Notwithstanding no significant difference was noted in the pain scores,or nausea and vomiting among the groups(P>0.05).Conclusions:Dexmedetomidine has a better sedation effect compared to ketamine,lidocaine,and acetaminophen for pain control,but the final choice hinges on the patients’physical condition and the anesthesiologist's preference.Clinical registration:It is registered in Iranian Registry Clinical Trial by code IRCT20141209020258N146.展开更多
AIM To compare the results of midazolam-ketaminepropofol sedation performed by an endoscopy nurse and anaesthetist during colonoscopy in terms of patient satisfaction and safety.METHODS American Statistical Associatio...AIM To compare the results of midazolam-ketaminepropofol sedation performed by an endoscopy nurse and anaesthetist during colonoscopy in terms of patient satisfaction and safety.METHODS American Statistical Association(ASA) Ⅰ-Ⅱ 60 patients who underwent colonoscopy under sedation were randomly divided into two groups: sedation under the supervision of an anaesthetist(SSA) and sedation under the supervision of an endoscopy nurse(SSEN). Both groups were initially administered 1 mg midazolam, 50 mg ketamine and 30-50 mg propofol. Continuation of sedation was performed by the anaesthetist in the SSAgroup and the nurse with a patient-controlled analgesia(PCA) pump in the SSEN group. The total propofol consumption, procedure duration, recovery times, pain using the visual analogue scale(VAS) and satisfaction score of the patients, and side effects were recorded. In addition, the patients were asked whether they remembered the procedure and whether they would prefer the same method in the case of re-endoscopy.RESULTS Total propofol consumption in the SSEN group was significantly higher(P < 0.05) than that in the SSA group. When the groups were compared in terms of VAS score, recovery time, patient satisfaction, recall of the procedure, re-preference for the same method in case of re-endoscopy, and side effects, there were no significant differences(P > 0.05) between the two groups. No long-term required intervention side effects were observed in either group.CONCLUSION Colonoscopy sedation in ASA Ⅰ-Ⅱ patients can be safely performed by an endoscopy nurse using PCA pump with the incidence of side effects and patient satisfaction levels similar to sedation under anaesthetist supervision.展开更多
BACKGROUND Primary ciliary dyskinesia(PCD)is an inherited autosomal-recessive disorder of impaired mucociliary clearance characterized by chronic respiratory diseases,otolaryngological diseases,central nervous system ...BACKGROUND Primary ciliary dyskinesia(PCD)is an inherited autosomal-recessive disorder of impaired mucociliary clearance characterized by chronic respiratory diseases,otolaryngological diseases,central nervous system abnormalities,reproductive system abnormalities,and cardiac function abnormalities.General anesthesia in these patients is associated with a higher incidence of respiratory complications than in patients without the disease.CASE SUMMARY A 16-year-old male patient was referred to the emergency room complaining of right ankle pain due to distal tibiofibular fracture.Three years prior,he had been diagnosed with PCD.At that time,he had experienced several episodes of pneumonia,sinusitis,and chronic middle ear infections,for which he underwent surgical interventions.At the current admission,he presented with cough and sputum but no other respiratory symptoms.A chest computed tomography scan revealed centrilobular ground-glass opacities in both lower lobes and a calcified nodule in the left lower lobe.For the surgical procedure and postoperative pain management,combined spinal-epidural anesthesia was employed.The patient’s postoperative pain score was measured by the numerical rating scale(NRS).On the day of surgery,his NRS was 5 points.By the second postoperative day,the NRS score had decreased to 2–3 points.The epidural catheter was removed on the fourth day following the operation.The patient was subsequently discharged no respiratory complications.CONCLUSION We performed combined spinal-epidural anesthesia in a patient with PCD.The patient experienced no additional respiratory complications and was discharged with a low NRS score for pain.展开更多
Objective： To observe the effect of transcutaneous electrical acupoint stimulation （TEAS） on nausea and vomiting （N＆V） induced by patient controlled intravenous analgesia （PCIA） with Tramadol. Methods： Sixty ...Objective： To observe the effect of transcutaneous electrical acupoint stimulation （TEAS） on nausea and vomiting （N＆V） induced by patient controlled intravenous analgesia （PCIA） with Tramadol. Methods： Sixty patients who were ready to receive scheduled operation for tumor in the head-neck region and post-operation PCIA, aged 39-65 years, with the physique grades Ⅰ -Ⅱ of ASA, were randomized into two groups, A and B, 30 in each group. The pre-operation medication, induction of analgesia and continuous anesthesia used in the two groups were the same. TEAS on bilateral Hegu （LI4） and Neiguan （PC6） points was intermittently applied to the patients in group A starting from 30 min before analgesia induction to 24 h after operation, and the incidence and score of nausea and vomiting, antiemetic used, visual analogue scores （VAS）, and PCIA pressing times in 4 time segments （0-4, 4-8, 8-12 and 12-24 h after the operation was finished） were determined. The same management was applied to patients in Group B, with sham TEAS for control. Results： The incidence and degree of N＆V, as well as the number of patients who needed remedial antiemetic in Group A were less than those in Group B. The VAS score and PCIA pressing time were lower in Group A than those in Group B in the corresponding time segments respectively. Conclusion： TEAS could prevent N＆V induced by PCIA with Tramadol.展开更多
Objective:This survey was designed to understand the misconceptions about labor epidurals.Methods:This voluntary and anonymous online survey on wenjuan.com was conducted from September 1st,2015 to January 1st,2016 via...Objective:This survey was designed to understand the misconceptions about labor epidurals.Methods:This voluntary and anonymous online survey on wenjuan.com was conducted from September 1st,2015 to January 1st,2016 via mainly WeChat groups dedicated to perinatal healthcare providers in China.The questionnaire included items inquiring the knowledge and opinions about labor epidural analgesia related to maternal complications,baby safety,and effect on laboring.Incomplete surveys were excluded from the data analysis.The data was presented as percentages and a Chi-square test or Fisher's exact test,as appreciate,was used to quantitatively compare the results.Results:A total of 1412 respondents completed surveys with 42.9%(606/1412)of them being anesthesiologists,35.1%(495/1412)being obstetricians,11.8%(167/1412)being midwives,3.7%(52/1412)being labor and delivery nurses,and 6.5%(92/1412)being hospital administrators and unspecified.The study revealed a lack of knowledge in labor pain control.Although 82.4%(1164/1412)of respondents were familiar with labor epidural analgesia,8.9%(126/1412)did not know how it works,and 1.1%(15/1412)never heard it in a multiple-choice question.The three main groups(anesthesiologists,obstetricians,and midwives/labor and delivery nurses)were chosen for comparisons.Opinions among these three groups concerning five questions in the three main concerns were evaluated using a statistical significance of P<0.05.Conclusion:The results in our survey indicated an urgent need of continuing medical education to multidisciplinary specialties to improve evidence-based medical practices as these misconceptions have existed for over 10 years in the medical professionals.Lack of public awareness fueled by misconceptions related to labor epidural analgesia may be associated with a lack of professional knowledge.Correct knowledge in professionals needs to be disseminated to the public in order to dispel possible misconceptions and rumors about labor epidural analgesia.This would not only enhance patient understanding of their care but also improve maternal,fetal,and neonatal outcomes.展开更多
研究了镇痛镇静治疗对神经外科重症监护室(neurosurgical intensive care unit,NICU)患者颅内压及预后的影响。以接受不同治疗方法的NICU外伤性高颅压患者为例,比较了观察组和对照组患者的镇痛镇静效果、颅内压、意识状态、神经功能以...研究了镇痛镇静治疗对神经外科重症监护室(neurosurgical intensive care unit,NICU)患者颅内压及预后的影响。以接受不同治疗方法的NICU外伤性高颅压患者为例,比较了观察组和对照组患者的镇痛镇静效果、颅内压、意识状态、神经功能以及预后情况。结果表明,观察组VAS评分、Ramsay评分、颅内压、NIHSS评分均低于对照组,GCS评分均高于对照组,预后情况的有效率高于对照组,P<0.05。由此可见,联合应用镇痛镇静治疗对于神经重症监护室的患者是有效的,能降低患者的颅内压,减轻昏迷程度,改善NICU患者的神经功能,对患者康复预后有积极影响。展开更多
文摘Objective:To compare the effect of ketamine,lidocaine,acetaminophen,and dexmedetomidine combined with morphine patient-controlled analgesia for opium addicts after tibial fracture surgery.Methods:This double-blind clinical trial included opium-addicted patients undergoing tibia fracture surgery.Patients were recruited and randomized to four different groups including the ketamine group,the lidocaine group,the acetaminophen group,and the dexmedetomidine group.The hemodynamic parameters such as heart rate(HR),mean arterial pressure,and arterial SaO2,alongside visual analog scale pain scores,sedation assessed by Ramsay score,nausea and vomiting,and opioid use were recorded and compared among the four groups.Results:This study included 140 patients,aged 37(32,41)years,with 92 males and 48 females,and each group had 35 patients.Dexmedetomidine-sedated subjects had the lowest blood pressure from 1 to 24 h after surgery,decreased HR at 12 and 24 h after surgery,and more satisfactory sedation(P<0.05).Notwithstanding no significant difference was noted in the pain scores,or nausea and vomiting among the groups(P>0.05).Conclusions:Dexmedetomidine has a better sedation effect compared to ketamine,lidocaine,and acetaminophen for pain control,but the final choice hinges on the patients’physical condition and the anesthesiologist's preference.Clinical registration:It is registered in Iranian Registry Clinical Trial by code IRCT20141209020258N146.
文摘AIM To compare the results of midazolam-ketaminepropofol sedation performed by an endoscopy nurse and anaesthetist during colonoscopy in terms of patient satisfaction and safety.METHODS American Statistical Association(ASA) Ⅰ-Ⅱ 60 patients who underwent colonoscopy under sedation were randomly divided into two groups: sedation under the supervision of an anaesthetist(SSA) and sedation under the supervision of an endoscopy nurse(SSEN). Both groups were initially administered 1 mg midazolam, 50 mg ketamine and 30-50 mg propofol. Continuation of sedation was performed by the anaesthetist in the SSAgroup and the nurse with a patient-controlled analgesia(PCA) pump in the SSEN group. The total propofol consumption, procedure duration, recovery times, pain using the visual analogue scale(VAS) and satisfaction score of the patients, and side effects were recorded. In addition, the patients were asked whether they remembered the procedure and whether they would prefer the same method in the case of re-endoscopy.RESULTS Total propofol consumption in the SSEN group was significantly higher(P < 0.05) than that in the SSA group. When the groups were compared in terms of VAS score, recovery time, patient satisfaction, recall of the procedure, re-preference for the same method in case of re-endoscopy, and side effects, there were no significant differences(P > 0.05) between the two groups. No long-term required intervention side effects were observed in either group.CONCLUSION Colonoscopy sedation in ASA Ⅰ-Ⅱ patients can be safely performed by an endoscopy nurse using PCA pump with the incidence of side effects and patient satisfaction levels similar to sedation under anaesthetist supervision.
文摘BACKGROUND Primary ciliary dyskinesia(PCD)is an inherited autosomal-recessive disorder of impaired mucociliary clearance characterized by chronic respiratory diseases,otolaryngological diseases,central nervous system abnormalities,reproductive system abnormalities,and cardiac function abnormalities.General anesthesia in these patients is associated with a higher incidence of respiratory complications than in patients without the disease.CASE SUMMARY A 16-year-old male patient was referred to the emergency room complaining of right ankle pain due to distal tibiofibular fracture.Three years prior,he had been diagnosed with PCD.At that time,he had experienced several episodes of pneumonia,sinusitis,and chronic middle ear infections,for which he underwent surgical interventions.At the current admission,he presented with cough and sputum but no other respiratory symptoms.A chest computed tomography scan revealed centrilobular ground-glass opacities in both lower lobes and a calcified nodule in the left lower lobe.For the surgical procedure and postoperative pain management,combined spinal-epidural anesthesia was employed.The patient’s postoperative pain score was measured by the numerical rating scale(NRS).On the day of surgery,his NRS was 5 points.By the second postoperative day,the NRS score had decreased to 2–3 points.The epidural catheter was removed on the fourth day following the operation.The patient was subsequently discharged no respiratory complications.CONCLUSION We performed combined spinal-epidural anesthesia in a patient with PCD.The patient experienced no additional respiratory complications and was discharged with a low NRS score for pain.
文摘Objective： To observe the effect of transcutaneous electrical acupoint stimulation （TEAS） on nausea and vomiting （N＆V） induced by patient controlled intravenous analgesia （PCIA） with Tramadol. Methods： Sixty patients who were ready to receive scheduled operation for tumor in the head-neck region and post-operation PCIA, aged 39-65 years, with the physique grades Ⅰ -Ⅱ of ASA, were randomized into two groups, A and B, 30 in each group. The pre-operation medication, induction of analgesia and continuous anesthesia used in the two groups were the same. TEAS on bilateral Hegu （LI4） and Neiguan （PC6） points was intermittently applied to the patients in group A starting from 30 min before analgesia induction to 24 h after operation, and the incidence and score of nausea and vomiting, antiemetic used, visual analogue scores （VAS）, and PCIA pressing times in 4 time segments （0-4, 4-8, 8-12 and 12-24 h after the operation was finished） were determined. The same management was applied to patients in Group B, with sham TEAS for control. Results： The incidence and degree of N＆V, as well as the number of patients who needed remedial antiemetic in Group A were less than those in Group B. The VAS score and PCIA pressing time were lower in Group A than those in Group B in the corresponding time segments respectively. Conclusion： TEAS could prevent N＆V induced by PCIA with Tramadol.
文摘Objective:This survey was designed to understand the misconceptions about labor epidurals.Methods:This voluntary and anonymous online survey on wenjuan.com was conducted from September 1st,2015 to January 1st,2016 via mainly WeChat groups dedicated to perinatal healthcare providers in China.The questionnaire included items inquiring the knowledge and opinions about labor epidural analgesia related to maternal complications,baby safety,and effect on laboring.Incomplete surveys were excluded from the data analysis.The data was presented as percentages and a Chi-square test or Fisher's exact test,as appreciate,was used to quantitatively compare the results.Results:A total of 1412 respondents completed surveys with 42.9%(606/1412)of them being anesthesiologists,35.1%(495/1412)being obstetricians,11.8%(167/1412)being midwives,3.7%(52/1412)being labor and delivery nurses,and 6.5%(92/1412)being hospital administrators and unspecified.The study revealed a lack of knowledge in labor pain control.Although 82.4%(1164/1412)of respondents were familiar with labor epidural analgesia,8.9%(126/1412)did not know how it works,and 1.1%(15/1412)never heard it in a multiple-choice question.The three main groups(anesthesiologists,obstetricians,and midwives/labor and delivery nurses)were chosen for comparisons.Opinions among these three groups concerning five questions in the three main concerns were evaluated using a statistical significance of P<0.05.Conclusion:The results in our survey indicated an urgent need of continuing medical education to multidisciplinary specialties to improve evidence-based medical practices as these misconceptions have existed for over 10 years in the medical professionals.Lack of public awareness fueled by misconceptions related to labor epidural analgesia may be associated with a lack of professional knowledge.Correct knowledge in professionals needs to be disseminated to the public in order to dispel possible misconceptions and rumors about labor epidural analgesia.This would not only enhance patient understanding of their care but also improve maternal,fetal,and neonatal outcomes.
文摘研究了镇痛镇静治疗对神经外科重症监护室(neurosurgical intensive care unit,NICU)患者颅内压及预后的影响。以接受不同治疗方法的NICU外伤性高颅压患者为例,比较了观察组和对照组患者的镇痛镇静效果、颅内压、意识状态、神经功能以及预后情况。结果表明,观察组VAS评分、Ramsay评分、颅内压、NIHSS评分均低于对照组,GCS评分均高于对照组,预后情况的有效率高于对照组,P<0.05。由此可见,联合应用镇痛镇静治疗对于神经重症监护室的患者是有效的,能降低患者的颅内压,减轻昏迷程度,改善NICU患者的神经功能,对患者康复预后有积极影响。
