DOCSLIB.ORG

Effects of Prophylactic Ketamine and Pethidine to Control Postanesthetic Shivering: a Comparative Study

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Effects of Prophylactic Ketamine and Pethidine to Control Postanesthetic Shivering: a Comparative Study Biomedical Research and Therapy, 5(12):2898-2903 Original Research Effects of prophylactic ketamine and pethidine to control postanesthetic shivering: A comparative study Masoum Khoshfetrat1, Ali Rosom Jalali2, Gholamreza Komeili3, Aliakbar Keykha4;∗ ABSTRACT Background: Shivering is an undesirable complication following general anesthesia and spinal anesthesia, whose early control can reduce postoperative metabolic and respiratory complications. Therefore, this study aims to compare the effects of prophylactic injection of ketamine and pethi- dine on postoperative shivering.Methods: This double-blind clinical trial was performed on 105 patients with short-term orthopedic and ENT surgery. The patients were randomly divided into three groups; 20 minutes before the end of the surgery, 0.4 mg/kg of pethidine was injected to the first group, 0.5 mg/kg of ketamine was injected to the second group, and normal saline was injected to the third group. After the surgery, the tympanic membrane temperature was measured at 0, 10, 20, and 30 minutes. The shivering was also measured by a four-point grading from zero (no shiv- ering) to four (severe shivering). Data were analyzed by one-way ANOVA, Kruskal Wallis, Chi-square 1Doctor of Medicine (MD), Fellow of and Pearson correlation. Results: The mean age of patients was 35.811.45 years in the ketamine Critical Care Medicine (FCCM), group, 34.811.64 years in the normal saline group, and 33.1110.5 years in the pethidine group. Department of Anesthesiology and The one-way ANOVA showed no significant difference in the mean age between the three groups Critical Care, Khatam-Al-Anbiya (P=0.645). The incidence and intensity of shivering were significantly higher in the normal saline Hospital, Zahedan University of Medical Sciences, Zahedan, Iran group than in the ketamine and pethidine groups (p=0.001). However, there was no significant difference in the incidence and the intensity of shivering between the ketamine and thepethidine 2Resident of Anesthesiology and Critical groups (p=0.936). Conclusion: The results showed that the 0.5 mg/kg of ketamine could control Care, Zahedan University of Medical the post-anesthetic shivering. Sciences, Zahedan, Iran Key words: Ketamine, Pethidine, Post-anesthetic Shivering 3Physiology Department, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran 8 4PhD. Student of Nursing, Mashhad INTRODUCTION drug to control postanesthetic shivering . Another University of Medical Sciences, Surgery and anesthesia disturb the balance between study introduced the use of pethidine with dexam- Mashhad, Iran the production and loss of body temperature. The ethasone as the more effective method than ketamine 9 Correspondence use of anesthetics and opioids leads to motor and and midazolam . Ketamine controls postanesthetic Aliakbar Keykha, PhD. Student of behavioral inhibition, body movements and conse- shivering by multiple mechanism. Ketamine is a drug Nursing, Mashhad University of Medical quently a decrease in body temperature, which re- binding to N-methyl-d-aspartate (NMDA) receptor, Sciences, Mashhad, Iran sults in shivering 1. The core body temperature de- which is critical at different levels in thermoregula- Email: [email protected] creases from 0.5ºC to 1.5ºC after anesthesia induc- tion. NMDA receptors regulate noradrenergic and History tion. All anesthetic drugs specifically change the serotonergic systems in locus coeruleus 10. Previ- • Received: 20 October 2018 2 • temperature-regulating system . Postoperative shiv- ous studies have shown that ketamine is effective in Accepted: 02 December 2018 11–13 • Published: 25 December 2018 ering, in addition to discomfort and dissatisfaction controlling postanesthetic shivering . Therefore, of the patient, accounts for numerous complications this study was conducted to compare the effects of DOI : such as cardiorespiratory abnormalities, increased prophylactic injection of ketamine, and pethidine on https://doi.org/10.15419/bmrat.v5i12.508 oxygen consumption, subsequent cell hypoxia, and post-anesthetic shivering. increased production of lactic acid and carbon diox- ide. The shivering can also increase return time, pain METHODS perception, and intraocular and intracranial pres- Study Design, Ethical Considerations, Pa- sure 3,4. Previous studies recommended various med- Copyright tients ications such as Meperidine, Ketamine plus Midazo- © Biomedpress. This is an open- The current double-blind clinical trial was approved access article distributed under the lam, Neostigmine and Ketanserin to control and treat 5,6 terms of the Creative Commons post anesthetic shivering . by the Deputy of Research and Technology at Za- Attribution 4.0 International license. Pethidine is one of the most effective drugs to con- hedan University of Medical Sciences, Iran, and per- trol postoperative shivering 7. In more recent stud- mitted by the Ethics Committee of the University. All ies, ketamine has also been reported as an effective enrolled patients in the study signed consents after be- Cite this article : Khoshfetrat M, Jalali A R, Komeili G, Keykha A. Effects of prophylactic ketamine and pethidine to control postanesthetic shivering: A comparative study. Biomed. Res. Ther.; 5(12):2898-2903. 2898 Biomedical Research and Therapy, 5(12):2898-2903 ing fully informed. returned with neostigmine (0.04 mg/kg/IV) and at- ropine (0.02 mg/kg/IV). Sample Size andRandomization After obtaining the necessary criteria, the tracheal The sample size was calculated to be 105 people ac- tube was removed from the patients. The type and cording to previous studies and formula to calculate duration of operation were recorded in information sample size. These patients were divided randomly forms. The patients were transferred to a recovery into three groups of 35 after enrolling in the study ward and oxygen therapy was started with a face mask based on inclusion criteria 14. (7 liters per minute), and the patient’s body was cov- ered with a double layer linen bed sheet. Inclusion and Exclusion Criteria An anesthesiologist, who was unaware of processing The inclusion criteria were Class I and II Ameri- and grouping of the studied patients, assessed the pa- can Society of Anaesthesiology (ASA) including no tients for the shivering. The tympanic membrane history of cardiovascular, respiratory, psychiatric, temperature was recorded at 0, 10, 20 and 30 minutes neuromuscular (myoclonus, Parkinson, Huntington, after entering the recovery room. The shivering was multiple sclerosis, seizure), endocrine disorders (dia- evaluated with a four-point grading system. betes and thyroid disorders), and body temperature In case of obtaining the score of two and over, the ranging from 36.5ºC to 38ºC. In addition, patients shivering was treated with 25 mg/IV of pethidine. with intraoperative blood transfusion were also ex- cluded from the study. Statistical Analysis Data were then compared with SPSS version 22 Interventions software using descriptive statistics and one-way The operating room temperature was adjusted to ◦ ANOVA, Kruskal Wallis, chi-square and Pearson cor- 24 C by air conditioner according to the tropical na- relation. ture of the area. Then, the ear temperature was mea- sured and recorded. RESULTS Next, an angiocath number 18 was fixed in the left In total, the patients were composed of 62% of women antecubital fossa for all patients, followed by nor- and 38% of men. There was no significant difference mal saline infusion (10cc/kg). The monitoring device regarding gender distribution among patients in the (SAADAT, Iran) was used to non-invasively moni- three groups (P=0.176) (Table 2). tor of heart rhythm, arterial oxygen saturation, and The mean age of patients was 35.811.45 years in blood pressure. The oxygen was prescribed with a face the ketamine group, 33.1110.5 years in the pethi- mask for patients (7 liters per minute). The anesthe- dine group, and 34.811.64 years in the normal saline sia was induced with propofol (2 mg/kg/IV), midazo- group. The one-way ANOVA showed no significant lam (2 mg/IV), fentanyl (1 µg/kg/IV) and atracurium difference in the mean age between the three groups (0.5 mg/kg/IV). The intubation was done with a video (P=0.645). laryngoscope. During the operation, the anesthe- The mean duration of surgery was 109.2437.87 min- sia continued with 60% N2O, oxygen and propo- fol (100-200 µg/kg/min) and remifentanil (0.05-0.1 utes in the ketamine group, 105.30 36.97 minutes µg/kg/min). A repeated dose of the atracurium, if in the normal saline group and 106.41 35.94 in the needed (0.1 mg/kg/IV), was performed every 20 min- pethidine group, which was not significantly different utes. All medications were injected and stored at (P=0.975) Table 3. room temperature. The frequency of shivering in the groups receiving ke- Twenty minutes prior to the end of surgery, the first tamine and pethidine was significantly lower than in group was injected with 0.4 mg/kg of pethidine (Iran the normal saline group (p=0.001). Pharmaceutical darou pakhsh Company), the sec- The shivering grade was significantly lower inthe ond group with 0.5 mg/kg of ketamine (Manufac- ketamine and pethidine groups than in the normal ture of Germany ROTEXMEDICA company), and saline group (p=0.001). In the normal saline group, the third group with placebo (normal saline); the vol- 86% of patients had postoperative shivering, of which ume of three syringes reached 3 cc. For blinding, the only 6% were severe that reported in the same group. used drugs
Load more

Recommended publications
  • Tramadol (Ultram)
    TRAMADOL (ULTRAM) Tramadol is FDA approved for the treatment of musculoskeletal pain. Studies have shown it is useful in treating the pain associated with diabetic neuropathy and other pain conditions. Tramadol comes in 50 mg tablets. The maximum dose is two tablets four times per day unless your kidney function is below normal or you are over 75 years old, in which case the maximum dose is two tablets three times per day. The main side effects of Tramadol are drowsiness, sedation, and stomach upset, all of which are minimized by slowly raising the dose. About 5% of patients have stomach upset at any dose of Tramadol and cannot take the medicine. Other risks include seizures (occur in less than 1/100,000 and are more likely if you have seizures) and possibly abuse (relevant if you have abused drugs in the past). Tramadol should be started at a low dose and raise the dose slowly toward the maximum dose. Start with one tablet at bedtime. After 3 - 7 days, increase to one tablet twice daily (morning and bedtime). After an additional 3 - 7 days, increase to one tablet three times per day (morning, noon, and bedtime). After an additional 3 - 7 days, increase to one tablet four times per day (1 tablet with each meal and 1 at bedtime). At that point, the dose may be increased or adjusted depending on how you are doing. To increase further, you will: Add a second tablet at bedtime (one tablet three times per day and two tablets at bedtime). After 3 - 7 days, add a second tablet to another dose (one tablet twice per day and two tablets twice per day).
    [Show full text]
  • Current Awareness in Clinical Toxicology Editors: Damian Ballam Msc and Allister Vale MD
    Current Awareness in Clinical Toxicology Editors: Damian Ballam MSc and Allister Vale MD February 2016 CONTENTS General Toxicology 9 Metals 38 Management 21 Pesticides 41 Drugs 23 Chemical Warfare 42 Chemical Incidents & 32 Plants 43 Pollution Chemicals 33 Animals 43 CURRENT AWARENESS PAPERS OF THE MONTH How toxic is ibogaine? Litjens RPW, Brunt TM. Clin Toxicol 2016; online early: doi: 10.3109/15563650.2016.1138226: Context Ibogaine is a psychoactive indole alkaloid found in the African rainforest shrub Tabernanthe Iboga. It is unlicensed but used in the treatment of drug and alcohol addiction. However, reports of ibogaine's toxicity are cause for concern. Objectives To review ibogaine's pharmacokinetics and pharmacodynamics, mechanisms of action and reported toxicity. Methods A search of the literature available on PubMed was done, using the keywords "ibogaine" and "noribogaine". The search criteria were "mechanism of action", "pharmacokinetics", "pharmacodynamics", "neurotransmitters", "toxicology", "toxicity", "cardiac", "neurotoxic", "human data", "animal data", "addiction", "anti-addictive", "withdrawal", "death" and "fatalities". The searches identified 382 unique references, of which 156 involved human data. Further research revealed 14 detailed toxicological case reports. Current Awareness in Clinical Toxicology is produced monthly for the American Academy of Clinical Toxicology by the Birmingham Unit of the UK National Poisons Information Service, with contributions from the Cardiff, Edinburgh, and Newcastle Units. The NPIS is commissioned by Public Health England Current Awareness in Clinical Toxicology Editors: Damian Ballam MSc and Allister Vale MD February 2016 Current Awareness in Clinical Toxicology is produced monthly for the American Academy of Clinical Toxicology by the Birmingham Unit of the UK National Poisons Information Service, with contributions from the Cardiff, Edinburgh, and Newcastle Units.
    [Show full text]
  • The In¯Uence of Medication on Erectile Function
    International Journal of Impotence Research (1997) 9, 17±26 ß 1997 Stockton Press All rights reserved 0955-9930/97 $12.00 The in¯uence of medication on erectile function W Meinhardt1, RF Kropman2, P Vermeij3, AAB Lycklama aÁ Nijeholt4 and J Zwartendijk4 1Department of Urology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; 2Department of Urology, Leyenburg Hospital, Leyweg 275, 2545 CH The Hague, The Netherlands; 3Pharmacy; and 4Department of Urology, Leiden University Hospital, P.O. Box 9600, 2300 RC Leiden, The Netherlands Keywords: impotence; side-effect; antipsychotic; antihypertensive; physiology; erectile function Introduction stopped their antihypertensive treatment over a ®ve year period, because of side-effects on sexual function.5 In the drug registration procedures sexual Several physiological mechanisms are involved in function is not a major issue. This means that erectile function. A negative in¯uence of prescrip- knowledge of the problem is mainly dependent on tion-drugs on these mechanisms will not always case reports and the lists from side effect registries.6±8 come to the attention of the clinician, whereas a Another way of looking at the problem is drug causing priapism will rarely escape the atten- combining available data on mechanisms of action tion. of drugs with the knowledge of the physiological When erectile function is in¯uenced in a negative mechanisms involved in erectile function. The way compensation may occur. For example, age- advantage of this approach is that remedies may related penile sensory disorders may be compen- evolve from it. sated for by extra stimulation.1 Diminished in¯ux of In this paper we will discuss the subject in the blood will lead to a slower onset of the erection, but following order: may be accepted.
    [Show full text]
  • Quantitative Drug Test Menu Section 2
    1 Guthrie Square, Sayre, PA 18840 Bill To: Client GMG Toxicology Laboratory Requisition Toll Free Phone (844) 617-4719 Insurance Request Date: _____/______/______ Medical Director: Hani Hojjati, MD Fax (570) 887-4729 Patient PATIENT INFORMATION (PLEASE PRINT IN BLACK INK) INSURANCE BILLING INFORMATION (PLEASE PRINT IN BLACK INK) Pt Last Name First M I PRIMARY Medicare Medicaid Other Ins. Self Spouse Child __ Subscriber Last Name First M Address Birth Date Sex M F Beneficiary/Member # Group # City Pt. SS# or MRN Claims Name and Address City ST ZIP ST ZIP Home Phone (Attach a copy of the patient's insurance card and information) SECONDARY Medicare Medicaid Other Ins. Self Spouse Child Employer Work Phone Subscriber Last Name First M Work Address City ST ZIP Beneficiary/Member # Group # __ CLIENT INFORMATION - REFERRING PHYSICIAN Claims Name and Address City ST ZIP Client Address: (Atttach a copy of the patient's insurance card and information) COLLECTION / REPORTING INFORMATION Copy to: FAX Results to __ CALL Results to Phone: Fax: Date Collected: Time Collected: AM PM Specimen Type: Urine Saliva Other ___________________ Physician Signature (legible - No Stamp) For Lab Use Only (Required for Medicare & Medicaid patient orders) Signed ABN Obtained Place Lab Label Here Contact Laboratory Medical Director (570-887-4719) with questions concerning medical necessity PHYSICIAN When ordering tests, the physician is required to make an independent medical necessity decision with regard to each test thelaboratory will bill. The physician also understands he or she is required NOTICE to (1) submit ICD-10 diagnosis supported in the patient's medical record as documentation of the medical necessity or (2) explain and have the patient sign an ABN.
    [Show full text]
  • Muscular Hyperactivity After General Anaesthesia
    MUSCULAR HYPERACTIVITY AFTER GENERAL ANAESTHESIA MAGDIG. SOLIMA~,M.B., n.crl.,* and Dr_ara~lm M. M. CmLmS, wx.B., c~.~.* MvsctrzA~ HYPEr~,CrlWTY during recovery from general anaesthesia variously termed "spasticity, .... shivering," and "shakes," has been described by several authors and has been particularly related to halothane. 1~ Several mechanisms have been suggested in explanation including heat loss, t respiratory alkalosis, a early recovery of spinal reflex activity) at~d sympathetic overactivity.7 The re- ported incidence varies from 5 per cent to 70 per centa.s and this suggests that perhaps different phenomena are being described. Having noticed that some patients seemed to show true shivering whilst others showed intense muscular spasticity during emergence from general anaesthesia, this study was designed to try to elucidate whether there were, indeed, two dis- tinct phenomena, what was their incidence, and whether they were specifically i~lated to halothane anaesthesia. Spasticity was defined as sustained muscular hypertonieity most easily ob- served in jaw, neck and pectoral muscles, flexors of the upper limbs, and ex- tensors and adductors of the lower limbs. Shivering, on the other hand, was a rhythmic contraction of muscle groups with irregular intermittent periods of relaxation. METHODS The recovery of 215 unselected patients who had been anaesthetised for a wide variety of surgical procedures, both elective and emergent, was studied. Pre- medication was given one hour pre-operatively in the usual dosage, using ani- leridine and promethazine in the large majority. Induction was with thiolmntone. The largest group (I25) received halothane as the main agent, 50 received methuxyflurane, 20 cyelopropane, and 29 nitrous oxide, meperidine relaxant.
    [Show full text]
  • ANESTHESIA a Comprehensive Review
    ANESTHESIA A Comprehensive Review FIFTH EDITION Brian A. Hall, MD Assistant Professor of Anesthesiology College of Medicine, Mayo Clinic Rochester, Minnesota Robert C. Chantigian, MD Associate Professor of Anesthesiology College of Medicine, Mayo Clinic Rochester, Minnesota 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 ANESTHESIA: A COMPREHENSIVE REVIEW, FIFTH EDITION ISBN: 978-0-323-28662-6 Copyright © 2015, 2010, 2003, 1997, 1992 by Mayo Foundation for Medical Education and Research, Published by Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions poli- cies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a profes- sional responsibility.
    [Show full text]
  • CAN YOU TAKE TRAMADOL with NEFOPAM Can You Take Tramadol with Nefopam
    CAN YOU TAKE TRAMADOL WITH NEFOPAM can you take tramadol with nefopam tramadol 37 5 vs percocet 5 325 ultram tramadol pictures tramadol hcl tabs 50 mg tramadol 200 mg recreational drugs and heart can tramadol and percocet be mixed hbs robaxin tramadol interaction generic tramadol 319 immediate release how long tramadol stay in your urine does tramadol make you sleepy or awake tramadol acetaminophen\/codeine 120 12mg sol b tracert ex tramadol dosage for adults meloxicam/tramadol/amitriptyline/lidocaine/prilocaine apo tramadol high feeling on hydrocodone tramadol apteka internetowa olmed order tramadol/paracetamol from mexico tramadol quizlet flashcards microbiology tramadol has mu opioid agonist activity director jobs tramadol met ritalin sr strengths hur ta tramadol withdrawal in dogs tramadol te gebruiken bij tramadol dosis cachorros bulldog 2015 100mg tramadol 10mg hydrocodone images 100 tramadol termasuk jenis obat apa acyclovir side how to get rid of a tramadol high 200 ml tramadol withdrawal timeline drug interactions between percocet and tramadol comparison tramadol e morfina presentacion de tres can tramadol be taken with paracetamol indication and action tramadol review article template with photos tramadol codeine allergy rash best price tramadol online tramadol 93 58 dosage for ibuprofen tramadol v oxycodone pill colors can tramadol make you drowsy doll b tracert ex tramadol addiction withdrawal tramadol instant release oxycontin pictures can you drink wine with tramadol i can function tramadol hydrochloride sleepy tramadol cva
    [Show full text]
  • Parkinson's Disease Fact Sheet
    Parkinson’s Disease Fact Sheet About Parkinson’s Disease Parkinson’s disease is a progressive, incurable neurological disorder associated with a loss of dopamine-generating cells in the brain. It is primarily associated with progressive loss of motor control, but it results in a complex array of symptoms, including many non-motor symptoms. Parkinson’s impacts an estimated one million people in the United States. Critical Clinical Care Considerations • To avoid serious side effects, Parkinson’s patients need their medications on time, every time — do not skip or postpone doses. • Write down the exact times of day medications are to be administered so that doses are given on the same schedule the patient follows at home. • Do not substitute Parkinson’s medications or stop levodopa therapy abruptly. • Resume medications immediately following procedures, unless vomiting or severely incapacitated. • If an antipsychotic is necessary, use pimavanserin (Nuplazid), quetiapine (Seroquel) or clozapine (Clozaril). • Be alert for symptoms of dysphagia (trouble swallowing) and risk of pneumonia. • Ambulate as soon as medically safe. Patients may require assistance. Common Symptoms of Parkinson’s Disease Motor Non-Motor • Shaking or tremor at rest • Depression • Bradykinesia or freezing (being stuck • Anxiety in place when attempting to walk) • Constipation • Low voice volume or muffled speech • Cognitive decline and dementia • Lack of facial expression • Impulse control disorders • Stiffness or rigidity of the arms, legs • Orthostatic hypotension or
    [Show full text]
  • CT Myelogram Drugs to Avoid Hold for 48 Hours Before and 12 Hours After Your Myelogram UVA Neuroradiology
    CT Myelogram Drugs to Avoid Hold for 48 Hours Before and 12 Hours After Your Myelogram UVA Neuroradiology Generic Name (Brand Name) Cidofovir (Vistide) Acetaminophen/butalbital (Allzital; Citalopram (Celexa) Bupap) Clomipramine (Anafranil) Acetaminophen/butalbital/caffeine Clonidine (Catapres; Kapvay) (Fioricet; Butace) Clorazepate (Tranxene-T) Acetaminophen/butalbital/caffeine/ Clozapine (Clozaril; FazaClo; Versacloz) codeine (Fioricet with codeine) Cyclizine (No Brand Name) Acetaminophen/caffeine (Excedrin) Cyclobenzaprine (Flexeril) Acetaminophen/caffeine/dihydrocodeine Desipramine (Norpramine) (Panlor; Trezix) Desvenlafaxine (Pristiq; Khedezla) Acetaminophen/tramadol (Ultracet) Dexmethylphenidate (Focalin) Aliskiren (Tekturna) Dextroamphetamine (Dexedrine; Amitriptyline (Elavil) ProCentra; Zenzedi) Amitriptyline and chlordiazepoxide Dextroamphetamine and amphetamine (Limbril) (Adderall) Amoxapine (Asendin) Diazepam (Valium; Diastat) Aripiprazole (Abilify) Diethylpropion (No Brand Name) Armodafinil (Nuvigil) Dimenhydrinate (Dramamine) Asenapine (Saphris) Donepezil (Aricept) Aspirin/caffeine (BC Powder; Goody Doripenem (Doribax) Powder) Doxapram (Dopram) Atomoxetine (Strattera) Doxepin (Silenor) Baclofen (Gablofen; Lioresal) Droperidol (No Brand Name) Benzphetamine (Didrex; Regimex) Duloxetine (Cymbalta) Benztropine (Cogentin) Entacapone (Comtan) Bismuth Ergotamine and caffeine (Cafergot; subcitrate/metronidazole/tetracycline Migergot) (Pylera) Escitalopram (Lexapro) Bismuth subsalicylate (Pepto-Bismol) Fluoxetine (Prozac; Sarafem)
    [Show full text]
  • Anticoagulation, Hemostasis, and Transfusions
    FRONT OF BOOK ↑ [+] Cover [+] Authors - Foreword - Preface TABLE OF CONTENTS ↑ [+] 1 - General and Perioperative Care of the Surgical Patient [+] 2 - Common Postoperative Problems [+] 3 - Nutrition for the Surgical Patient [+] 4 - Fluid, Electrolytes, and Acid-Base Disorders [+] 5 - Anticoagulation, Hemostasis, and Transfusions [+] 6 - Anesthesia [+] 7 - Critical Care [+] 8 - Burns [+] 9 - Wound Care [+] 10 - Head, Neck, and Spinal Trauma [+] 11 - Chest Trauma [+] 12 - Abdominal Trauma [+] 13 - Extremity Trauma [+] 14 - Common Surgical Procedures [+] 15 - Acute Abdomen [+] 16 - Esophagus [+] 17 - Stomach [+] 18 - The Surgical Management of Obesity [+] 19 - Small Intestine [+] 20 - Surgical Diseases of the Liver [+] 21 - Surgical Diseases of the Biliary Tree [+] 22 - Surgical Diseases of the Pancreas [+] 23 - Spleen [+] 24 - Colon and Rectum [+] 25 - Anorectal Disease [+] 26 - Cerebrovascular Disease [+] 27 - Thoracoabdominal Vascular Disease [+] 28 - Peripheral Arterial Disease [+] 29 - Venous and Lymphatic Disease [+] 30 - Hemodialysis Access [+] 31 - Transplantation [+] 32 - Pediatric Surgery [+] 33 - Cardiac Surgery [+] 34 - Lung and Mediastinal Diseases [+] 35 - Breast [+] 36 - Skin and Soft-Tissue Tumors [+] 37 - Fundamentals of Laparoscopic, Robotic and Endoscopic Surgery [+] 38 - Hernias [+] 39 - Diseases of the Adrenal and Pituitary Gland and Hereditary Endocrine Syndromes [+] 40 - Thyroid and Parathyroid Glands [+] 41 - Otolaryngology for the General Surgeon [+] 42 - Plastic and Hand Surgery [+] 43 - Urology for the General Surgeon [+] 44 - Obstetrics and Gynecology for the General Surgeon [+] 45 - Biostatistics for the General Surgeon [+] 46 - Patient Safety and Quality Improvement in Surgery BACK OF BOOK ↑ [+] Answer Key [+] Index > Table of Contents > Authors Editors Mary E. Klingensmith MD1 1Department of Surgery Washington University School of Medicine St. Louis, Missouri Chandu Vemuri MD1 1Department of Surgery Washington University School of Medicine St. Louis, Missouri Oluwadamilola M.
    [Show full text]
  • ECT – Anesthesia
    Managing specific problems within anesthesia Alexander Sartorius Head of ECT Research and Supervison Head, Research Group Translational Imaging Department of Psychiatry and Psychotherapy Central Institute of Mental Health (CIMH) Medical Faculty Mannheim University of Heidelberg ECT – anesthesia: 1. Ketofol – two stones to catch one bird ? 2. Oxygen – the good gas ! 3. What’s that on the printout / monitor ? Part 1: Ketofol Adapted from: Folkerts HW. Electroconvulsive therapy. Indications, procedure and treatment results Nervenarzt. 2011 Jan;82(1):93-102 Swartz CM Electroconvulsive and neuromodulation therapies. 2009 Cambridge Univ, Cambridge New York Melbourne ECT – anesthesia: - thiopental 3-5 mg/kg - methohexital 50-120 mg - propofol 1-2 mg/kg German guidelines for tx of status epilepticus 1 => lorazepam up to 10mg i.v. 2 => phenytoin up to 30 mg/kg KG i.v. 3 => phenobarbital 20 mg/kg KG i.v. 4 => thiopental 4-7 mg/kg KG i.v. vs. propofol 1-2 mg/kg KG i.v. vs. midazolam or valproate Dosing of ECT anesthetics - experience of the anesthesiologist - experience from previous ECT sessions - time needed for full recovery - patient remembers muscle relaxation - systematic / non-systematic movements of the “cuffed” limb - objective criteria for “dosing” and “timing” do not exist … Br J Psychiatry. 1995 Jan;166(1):118-9. Anaesthetic technique in the practice of ECT. Collins IP, Scott IF. Bispectral Index Monitoring (BIS) - has been developed to prevent intraoperative awareness - uses combined EEG/EMG to derive a measure for “cortical integrity” inter alia by analyzing coherences between different frequency bands - More precisely: bispectrum is a 3rd order Fourier transformation that includes amplitude, phase AND coherence information.
    [Show full text]
  • Effect of Intraoperative Infusion of Sufentanil Versus Remifentanil on Postoperative Shivering in Korea: a Prospective, Double-Blinded, Randomized Control Study
    Turkish Journal of Medical Sciences Turk J Med Sci (2018) 48: 737-743 http://journals.tubitak.gov.tr/medical/ © TÜBİTAK Research Article doi:10.3906/sag-1709-161 Effect of intraoperative infusion of sufentanil versus remifentanil on postoperative shivering in Korea: a prospective, double-blinded, randomized control study 1,2 1,2 1 1,2 Ki Tae JUNG , Keum Young SO , In Gook JEE , Sang Hun KIM * 1 Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Republic of Korea 2 Department of Anesthesiology and Pain Medicine, Chosun University, School of Medicine, Gwangju, Republic of Korea Received: 29.09.2017 Accepted/Published Online: 03.04.2018 Final Version: 16.08.2018 Background/aim: The number of published papers that compare the incidence of sufentanil- and remifentanil-related postoperative shivering is insufficient. We investigated the incidence of postoperative shivering after total intravenous anesthesia with either sufentanil or remifentanil in patients who underwent elective surgery. Materials and methods: Eighty-three patients, with a physical status classified as American Society of Anesthesiologists I or II, were randomly allocated to either the remifentanil–propofol (RP group, n = 40) or sufentanil–propofol (SP group, n = 43) group. The primary endpoint was the incidence of postoperative shivering 1 h after entering the recovery room. The secondary endpoints were intraoperative core temperatures of the esophagus and tympanic membrane at 30 min after the induction of anesthesia and at the end of surgery. Results: The overall postoperative shivering incidence was not significantly different between the RP (15%) and SP (11.6%) groups (P = 0.651). The intraoperative temperatures and their changes (the temperature 30 min after induction minus that after surgery) as measured at the distal esophagus and tympanic membrane were not significantly different between the RP and SP groups.
    [Show full text]