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Yilmaz Inal F, Yilmaz Camgoz Y, Daskaya H, Kocoglu H. The Effect of Preoperative Anxiety and Pain Sensitivity on Preoperative Hemodynamics, Propofol Consumption, and Postoperative Recovery and Pain in Endoscopic Ultrasonography. Pain Ther 2021; 10:1283-1293. [PMID: 34292516 PMCID: PMC8586400 DOI: 10.1007/s40122-021-00292-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The present study investigates how preoperative anxiety and pain sensitivity affect the consumption of anesthetics, time elapsed until the desired sedation level is achieved, preoperative hemodynamics, postoperative recovery time, and postoperative pain. METHODS The present study includes 80 ASA 1-2 patients aged between 20 and 65 who were scheduled for endoscopic ultrasonography (EUS) under sedation. Patients were instructed to fill out the Spielberger State-Trait Anxiety Inventory (STAI) and Pain Sensitivity Questionnaire (PSQ) before the procedure. For sedation, 0.03 mg kg-1 intravenous midazolam, 1 mg kg-1 lidocaine, 1 µ kg-1 fentanyl, and then a bolus dose of 1 mg kg-1 propofol were infused over a period of 60 s. The time elapsed until the bispectral index (BIS) value reached 75 was recorded. For anesthesia maintenance, 2 mg kg-1 h-1 propofol infusion was administered. In the case of sedation failure, an additional dose of 0.1 mg kg-1 propofol (IV) was administered to ensure sedation depth with a BIS level of 65-75, and the propofol infusion was halted once the BIS value dropped below 65. RESULTS STAI-S and STAI-T scores were significantly positively correlated with PSQ minor pain and PSQ total scores. The time elapsed until reaching a BIS level of 75, propofol infusion dose used during sedation, and the need for additional doses of propofol, heart rate (HR), and duration of post-anesthesia care unit stay were significantly positively correlated with both preoperative anxiety and preoperative pain sensitivity. In terms of postoperative pain, the visual analog scale (VAS) at 1 h was more highly correlated with STAI-S and STAI-T than with PSQ. The VAS 2 h was only correlated with STAI-S and STAI-T. CONCLUSION The significant linear correlation between preoperative anxiety and pain sensitivity and anesthesia need can facilitate better preoperative management by predicting individual anesthetic consumption. TRIAL REGISTRATION The study was registered with the number NCT03114735 on ClinicalTrials.gov.
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Affiliation(s)
- Ferda Yilmaz Inal
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcın Sehir Hastanesi, Dr. Erkin Cad., Kadikoy, 34722, Istanbul, Turkey.
| | - Yadigar Yilmaz Camgoz
- Clinic of Anaesthesiology and Reanimation, Sultan Abdülhamid Han Training and Research Hospital, Selimiye mh, Tıbbiye Cd, Uskudar, 34668 Istanbul, Turkey
| | - Hayrettin Daskaya
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Bezmialem Vakif University, Iskender Pasa Mh, Adnan Menderes Blv., Fatih, 34093 Istanbul, Turkey
| | - Hasan Kocoglu
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcın Sehir Hastanesi, Dr. Erkin Cad., Kadikoy, 34722 Istanbul, Turkey
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López Castilla JD, Sánchez Fernández N, Charlo Molina MT, Vázquez Florido A, Murillo Pozo MA, Sánchez Ganfornina I, Fernández Elías M, Sánchez Valderrábanos E. [Midazolam/fentanyl vs propofol/remifentanil in immediate postoperative with short-term mechanical ventilation]. An Pediatr (Barc) 2021; 96:S1695-4033(20)30516-6. [PMID: 33509732 DOI: 10.1016/j.anpedi.2020.11.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Compare between 2sedoanalgesia regimes, the time from withdrawal of the medication until the patient wakes up and until extubation. METHODOLOGY Observational study on pediatric patients after elective surgery that needed mechanical ventilation for a period maximum to 72hours. We compared 2independent groups of patients: group A: patients collected prospectively who received sedoanalgesia with propofof-remifentanil and group B: patients who received midazolam-fentanyl collected retrospectively by reviewing medical records and database of the unit. The main variables studied were: Age, weight, sex, interventions type, sedoanalgesia scales, drugs dosages, time from withdrawal of medication to awakening and extubation, and adverse effects. RESULTS We collected 82 patients, 43 in group A and 39 in group B. Age (arithmetical mean±standard deviation of patients were 49±65 months, weight 17±16kg. Mechanical ventilation time medium was 22hours (3-72), wake-up time from withdrawal after removing sedoanalgesia was of 11,8±10,6minutes group A and 137,3±45minutes group B (P<.001), extubation time after removing sedoanalgesia was of 24±21minutes group A and 230±102minutes group B (P<.001). Adverse effects were found in 10.5% of patients group A (7.9% agitation, 2.6% bradycardia), and 13% of patients group B (respiratrory depression after extubation), P=.572. CONCLUSIONS Patients treated with propofol-remifentanil have significantly shorter times to wake up, extubation and withdrawal from mechanical ventilation after stopping the medication. In the midazolam-fentanyl group, respiratory depression was more frequent, although the percentage of adverse effects were similar in both groups. Both the combination of propofol-remifentanil and midazolam-fentanyl appear to be effective as a sedative-analgesic regimen for patients undergoing mechanical ventilation after surgery.
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Affiliation(s)
- José Domingo López Castilla
- Unidad de Gestión Clínica de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Sevilla.
| | - Norma Sánchez Fernández
- Unidad de Gestión Clínica de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Sevilla
| | - María Teresa Charlo Molina
- Unidad de Gestión Clínica de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Sevilla
| | - Antonio Vázquez Florido
- Unidad de Gestión Clínica de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Sevilla
| | - Maria Angeles Murillo Pozo
- Unidad de Gestión Clínica de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Sevilla
| | - Inmaculada Sánchez Ganfornina
- Unidad de Gestión Clínica de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Sevilla
| | - Manuel Fernández Elías
- Unidad de Gestión Clínica de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Sevilla
| | - Elía Sánchez Valderrábanos
- Unidad de Gestión Clínica de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Sevilla
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Sood R, Manasa T, Goel H, Singh RK, Singh R, Khattar N, Pandey P. Day care bipolar transurethral resection vs photoselective vaporisation under sedoanalgesia: A prospective, randomised study of the management of benign prostatic hyperplasia. Arab J Urol 2017; 15:331-338. [PMID: 29234537 PMCID: PMC5717456 DOI: 10.1016/j.aju.2017.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/11/2017] [Accepted: 06/17/2017] [Indexed: 11/21/2022] Open
Abstract
Objective To conduct a prospective randomised study comparing the safety, effectiveness and treatment outcomes in patients undergoing bipolar transurethral resection of the prostate (bTURP) and photoselective vaporisation of the prostate (PVP) under sedoanalgesia, as sedoanalgesia is a safe and effective technique suitable for minimally invasive endourological procedures and although studies have confirmed that both TURP and PVP are feasible under sedoanalgesia there are none comparing the two. Patients and methods Between November 2014 and April 2016, all patients satisfying the eligibility criteria underwent either bTURP or PVP under sedoanalgesia after randomisation. The groups were compared for functional outcomes, visual analogue scale (VAS) pain scores (range 0–10), perioperative variables and complications, with a follow-up of 3 months. Results In all, 42 and 36 patients underwent bTURP and PVP under sedoanalgesia, respectively. The mean VAS pain score was <2 at any time during the procedure, with no conversions to general anaesthesia. PVP patients had a shorter operating time [mean (SD) 55.64 (12.8) vs 61.79 (14.2) min, P = 0.035], shorter duration of hospitalisation [mean (SD) 14.58 (2.81) vs 19.21 (2.82) h, P < 0.001] and a higher dysuria rate when compared to bTURP patients. However, the catheterisation time was similar and both intraoperative and postoperative complications were minimal and comparable. Improvements in the International Prostate Symptom Score, quality of life, prostate volume, maximum urinary flow rate and post-void residual urine volume at 3 months were similar in both groups. None of our patients required re-admission or re-operation. Conclusion Both PVP and bTURP can be carried out safely under sedoanalgesia with excellent treatment outcomes.
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Affiliation(s)
- Rajeev Sood
- Departments of Urology and Anaesthesiology, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, Delhi, India
| | - T Manasa
- Departments of Urology and Anaesthesiology, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, Delhi, India
| | - Hemant Goel
- Departments of Urology and Anaesthesiology, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, Delhi, India
| | - Ritesh Kumar Singh
- Departments of Urology and Anaesthesiology, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, Delhi, India
| | - Rajpal Singh
- Departments of Urology and Anaesthesiology, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, Delhi, India
| | - Nikhil Khattar
- Departments of Urology and Anaesthesiology, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, Delhi, India
| | - Praveen Pandey
- Departments of Urology and Anaesthesiology, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, Delhi, India
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U. P S, K. B P, Mohammed SJ, Pereira NJ, Gupta S, K. R S, K. M T. Thyroidectomy Under Regional Anaesthesia: An ORL Perspective. J Clin Diagn Res 2015; 9:MC01-4. [PMID: 26557548 PMCID: PMC4625267 DOI: 10.7860/jcdr/2015/16055.6617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 08/26/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The use of regional anaesthesia as an effective alternative to general anaesthesia in thyroid surgeries is now being accepted in many parts of the world. In this day of computers and technology, there is an increased awareness among the people of the available options of anaesthesia and the adverse effects of general anaesthesia. They thus have an inclination to avoid general anaesthesia wherever feasible. This study dwells on the use of regional anaesthesia as an alternative tool that can be offered to the patients undergoing thyroidectomy. AIMS This study aims at analysing the effectiveness, safety, ease and patient acceptability of performing thyroidectomies under regional anaesthesia. SETTINGS AND DESIGN This prospective study was performed at a university - affiliated hospital. MATERIALS AND METHODS Twenty nine patients who underwent thyroidectomy for benign thyroid diseases under regional anaesthesia were included in this study: 20 patients under deep cervical plexus block and 9 patients under cervical epidural anaesthesia. STATISTICAL ANALYSIS USED Z-test and validity test. RESULTS In our study, all the 29 patients who underwent thyroidectomy under regional anaesthesia found the anaesthesia effective and were comfortable throughout the procedure. The surgeon too was at ease while performing the surgery. No complications were recorded. CONCLUSION In our present study, regional anaesthesia (Cervical epidural anaesthesia and Cervical plexus block) has been used safely and effectively in 29 thyroid surgeries. We conclude that although regional anaesthesia has been reserved for high risk thyroidectomies it may be offered as effective alternative to general anaesthesia even in routine thyroid surgeries.
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Affiliation(s)
- Santosh U. P
- Professor, Department of ENT and Head & Neck Surgery, JJM Medical college, Davangere, Karnataka, India
| | - Prashanth K. B
- Professor and Unit Chief, Department of ENT and Head & Neck surgery, JJM Medical college, Davangere, Karnataka, India
| | - Shamna J. Mohammed
- Postgraduate, Department of ENT and Head & Neck Surgery, JJM Medical College, Davangere, Karnataka, India
| | - Nivedeeta J. Pereira
- Postgraduate, Department of ENT and Head & Neck Surgery, JJM Medical College, Davangere, Karnataka, India
| | - Srijoy Gupta
- Postgraduate, Department of ENT and Head & Neck Surgery, JJM Medical College, Davangere, Karnataka, India
| | - Sumanth K. R
- Postgraduate, Department of ENT and Head & Neck Surgery, JJM Medical College, Davangere, Karnataka, India
| | - Triveni K. M
- Postgraduate, Department of ENT and Head & Neck Surgery, JJM Medical College, Davangere, Karnataka, India
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