Volume 3 Issue 1
Review Article: Local Anesthesia and Sedation in Otorhinolaryngology Endoscopic Surgery - Functional Endoscopic Sinus Surgery and Tympanoplasty - Routines and Epidemiology in a Reference Center
Sarita Franca Coffani*, Rogerio Hamerschmidt and MC. Jorge Dos Santos
Objectives: The purpose of this study is to confirm the possibility of performing Functional Endoscopic Sinus Surgery and Otologic Endoscopic Surgery under local anesthesia and sedation, with safety and lower costs, compared to general anesthesia.
Materials and Methods: During three months, all patients submitted to endoscopic surgery in otorhinolaryngology were evaluated, according to costs, surgical time, return because of anesthesia complications and patient's satisfaction with anesthesia.
Results: By T test analysis, local anesthesia with sedation has low cost, compared to general anesthesia. There were no complications among the patients and they had a high degree of satisfaction with the anesthesia.
Conclusion: local anesthesia with sedation is perfectly possible for functional endoscopic sinus surgery and endoscopic otologic surgeries.
Keywords: Sedation; Local anesthesia; Endoscopic surgery; Otorhinolaryngology anesthesia
Cite this Article: Coffani SF, Hamerschmidt R, Jorge Dos Santos MC. Local Anesthesia and Sedation in Otorhinolaryngology Endoscopic Surgery - Functional Endoscopic Sinus Surgery and Tympanoplasty - Routines and Epidemiology in a Reference Center. Am J Anesth Clin Res. 2017;3(1): 027-030.
Published: 31 July 2017
Blunt trauma of chest wall is the commonest cause of rib fracture. Patients with fracture of one or two ribs have low incidences of complications however; fractures of three or more ribs (Multiple Fractured Ribs, MFRs) have increased risk of morbidity and mortality. When multiple ribs are fractured pain relief with systemic opioids can result in over-sedation, inability for expectoration and worsening of pulmonary condition. In MFRs regional mode of analgesia is a preferred choice in the pain management. There are several regional analgesia techniques which can be used however; each technique has advantages and limitation for its usage. In current practice ultrasound guided interfacial plane blocks like serratus anterior plane block, rhomboid intercostal plane block and erector spinae plane block may provide effective pain relief without posing serious risk of procedure itself. This brief review has discussed various regional technique of pain relief in MFRs.
Cite this Article: Jadon A. Pain Management in Multiple Fractured Ribs; Role of Regional Analgesia. Am J Anesth Clin Res. 2017;3(1): 020-026.
Published: 23 March 2017
Case Report: Postoperative Diagnosed Coronary Artery Spasm during Tooth Extraction under Intravenous Sedation
This report describes a case of coronary artery spasm associated with ST-segment depression during intravenous sedation.
A 77-year-old woman with periapical periodontitis was scheduled for tooth extraction. She had a history of diabetes mellitus, but no history or evidence of ischemic heart disease. Intravenous propofol maintained sedation (Mackenzie and Grant sedation score 3-4). Four minutes after beginning the operation, ST-segment depression of 0.2mV was noted on the Electrocardiogram (ECG) monitor. Nitro-glycerine was immediately administered. Propofol administration was discontinued at the end of surgery as ST-segment depression showed a tendency to recover. On cessation of anesthesia, the patient had no anginal pain and ST-segment depression had recovered. Coronary angiography after anesthesia showed a normal coronary artery without significant narrowing.
As postoperative coronary angiography showed no abnormalities, coronary artery spasm was diagnosed as the cause of the ECG change. Possible inducing factors in the present case were diabetes mellitus and shallow anesthesia due to intravenous sedation. Careful anesthetic management is required to prevent intraoperative coronary artery spasm even in patients without a history of ischemic heart disease.
Cite this Article: Ouchi K. Postoperative Diagnosed Coronary Artery Spasm during Tooth Extraction under Intravenous Sedation. Am J Anesth Clin Res. 2017;3(1): 005-008.
Published: 02 January 2017
Case Report: Serratus Anterior Plane Block-An Analgesic Technique for Multiple Rib Fractures: A Case Series
Ashok Jadon* and Priyanka Jain
Introduction: Multiple rib fractures results in excruciating pain and can predispose to respiratory failure particularly in patients with compromised respiratory function. Thoracic epidural and thoracic paravertebral blocks are effective but invasive techniques to relieve the pain of multiple rib fractures; serratus anterior plane block is a relatively newer technique that is easier to perform and has a better safety profile.
Methods: Six patients with unilateral multiple rib fractures and severe pain were given serratus anterior plane block. Under ultrasound guidance, a bolus dose of 20ml 0.5% Ropivacaine was given between the serratus anterior and external intercostal muscle. A catheter was inserted and an infusion of 0.1% Ropivacaine+1mcg/ ml Fentanyl was given @6ml/ hr. Patients also received oral paracetamol round the clock and IV tramadol was given for breakthrough pain. Pain scores were recorded in all the patients before and after the block.
Results: All the patients had pain relief following the block and no additional doses of analgesics were required. The median pain score on deep breathing before block was 8.5 (± 1.211) while median pain score on deep breathing after block was 3.0 (± 0.894). None of the patients had respiratory complications owing to improved ability to cough. No complications were recorded from the block.
Conclusion: Serratus anterior plane block can provide effective analgesia in patients with multiple rib fractures. However, the results need to be further substantiated in randomised controlled studies with larger number of patients comparing the efficacy of this block with other regional anaesthetic techniques.
Cite this Article: Jadon A, Jain P. Serratus Anterior Plane Block-An Analgesic Technique for Multiple Rib Fractures: A Case Series. Am J Anesth Clin Res. 2017;3(1): 001-004.
Published: 02 January 2017
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