Effects of intraarticular tramadol, magnesium and ketamine on postoperative pain in arthroscopic meniscectomy

Publication date: Available online 6 October 2018

Source: Brazilian Journal of Anesthesiology (English Edition)

Author(s): Nevriye Salman, Bilge Olgunkeleş, Umut Bektaş, Derviş Güner, Meltem Bektas, Şadan Ay, Sumru Şekerci

Abstract

Objective

Postoperative pain control is important in terms of early recovery and rehabilitation in arthroscopic meniscectomy. For this purpose, we aimed to compare the effects of intraarticular tramadol, magnesium, and ketamine with combinations of pericapsular bupivacaine on postoperative pain and recovery in arthroscopic meniscectomy.

Methods

Ninety patients who underwent arthroscopic meniscectomy were enrolled in the study. Group T was given tramadol, Group K was given ketamine, and Group M was given magnesium reconstituted intraarticularly, and all groups received periarticular bupivacaine. Comparisons were made in terms of the patients' postoperative Visual Analogue Scale scores with and without movement, need for additional analgesics, first analgesic time, mobilization times, adverse effects, and satisfaction with the analgesics.

Results

The Visual Analogue Scale scores were lowest in Group T at 0 minutes, and were higher in the 15th and 30th minutes and 1st, 2nd, and 6th hours. Visual Analogue Scale values with movement were found to be high in Group M at 0 and 15 minutes, but they were found to be higher in group T in the 30th minute, 1st, 2nd and 6th hour. The groups were similar in terms of postoperative additional analgesic use, number of analgesic use, and satisfaction with analgesics; however, the first analgesic time was earlier in Group M, and the first mobilization time was earlier in Group K.

Conclusion

Intraarticular ketamine enables early mobilization and less need for additional analgesics, it also provides a better analgesic effect in comparison with intraarticular tramadol and magnesium.

Resumo

Objetivo

O controle da dor pós-operatória é importante para recuperação e reabilitação precoces em meniscectomia artroscópica. Portanto, nosso objetivo foi comparar os efeitos de tramadol, magnésio e cetamina administrados por via intra-articular em associação com bupivacaína pericapsular sobre a dor e a recuperação após meniscectomia artroscópica.

Métodos

Noventa pacientes submetidos à meniscectomia artroscópica foram incluídos no estudo. O Grupo T recebeu tramadol, o Grupo K recebeu cetamina e o Grupo M recebeu magnésio em doses reconstituídas por via intra-articular e todos os grupos receberam bupivacaína por via periarticular. As avaliações foram feitas mediante comparação dos escores em escala visual analógica no pós-operatório dos pacientes em movimento e em repouso, necessidade de analgésicos adicionais, tempo até a primeira necessidade de analgésico, tempo de mobilização, efeitos adversos e satisfação com os analgésicos.

Resultados

Os escores da escala visual analógica foram menores no minuto zero e maiores nos minutos 15 e 30 e nas horas 1, 2 e 6 no Grupo T. Os escores da escala visual analógica em movimento foram maiores nos minutos zero e 15 no Grupo M e maiores no minuto 30 e nas horas 1, 2 e 6 no Grupo T. Os escores dos grupos foram semelhantes em relação à necessidade de analgésico adicional no pós-operatório, ao consumo de analgésico e à satisfação com os analgésicos, mas os tempos até a primeira necessidade de analgesia e até a primeira mobilização foram mais curtos nos grupos M e K, respectivamente.

Conclusão

A administração intra-articular de cetamina permite mobilização precoce e diminui a necessidade de analgésicos adicionais, além de proporcionar um melhor efeito analgésico em comparação com tramadol e magnésio por via intra-articular.

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Transthoracic echocardiographic assessment of cardiac output in mechanically ventilated critically ill patients by intensive care unit physicians

Publication date: Available online 6 October 2018

Source: Brazilian Journal of Anesthesiology (English Edition)

Author(s): Valentina Bergamaschi, Gian Luca Vignazia, Antonio Messina, Davide Colombo, Gianmaria Cammarota, Francesco Della Corte, Egidio Traversi, Paolo Navalesi

Abstract

Background and objectives

Transthoracic echocardiography may potentially be useful to obtain a prompt, accurate and non-invasive estimation of cardiac output. We evaluated whether non-cardiologist intensivists may obtain accurate and reproducible cardiac output determination in hemodynamically unstable mechanically ventilated patients.

Methods

We studied 25 hemodynamically unstable mechanically ventilated intensive care unit patients with a pulmonary artery catheter in place. Cardiac output was calculated using the pulsed Doppler transthoracic echocardiography technique applied to the left ventricular outflow tract in apical 5 chamber view by two intensive care unit physicians who had received a basic Transthoracic Echocardiography training plus a specific training focused on Doppler, left ventricular outflow tract and velocity-time integral determination.

Results

Cardiac output assessment by transthoracic echocardiography was feasible in 20 out of 25 enrolled patients (80%) and showed an excellent inter-operator reproducibility (Pearson correlation test r = 0.987; Cohen's K = 0.840). Overall, the mean bias was 0.03 L.min⁻¹, with limits of agreement −0.52 and +0.57 L.min⁻¹. The concordance correlation coefficient (ρ_c) was 0.986 (95% IC 0.966–0.995) and 0.995 (95% IC 0.986–0.998) for physician 1 and 2, respectively. The value of accuracy (C_b) of CO_TTE measurement was 0.999 for both observers. The value of precision (ρ) of CO_TTE measurement was 0.986 and 0.995 for observer 1 and 2, respectively.

Conclusions

A specific training focused on Doppler and VTI determination added to the standard basic transthoracic echocardiography training allowed non-cardiologist intensive care unit physicians to achieve a quick, reproducible and accurate snapshot cardiac output assessment in the majority of mechanically ventilated intensive care unit patients.

Resumo

Justificativa e objetivos

A ecocardiografia transtorácica pode ser potencialmente útil para obter uma estimativa rápida, precisa e não invasiva do débito cardíaco. Avaliamos se os intensivistas não cardiologistas podem obter uma determinação precisa e reprodutível do débito cardíaco em pacientes mecanicamente ventilados e hemodinamicamente instáveis.

Métodos

Avaliamos 25 pacientes em unidade de terapia intensiva, mecanicamente ventilados, hemodinamicamente instáveis, com cateteres de artéria pulmonar posicionados. O débito cardíaco foi calculado usando a técnica de ecocardiografia transtorácica com Doppler pulsátil aplicada à via de saída do ventrículo esquerdo no corte apical (5-câmaras) por dois médicos intensivistas que receberam treinamento básico em ecocardiografia transtorácica e treinamento específico focado em Doppler, via de saída do ventrículo esquerdo e determinação da integral de tempo-velocidade.

Resultados

A avaliação do débito cardíaco pelo ecocardiograma transtorácico foi factível em 20 dos 25 pacientes inscritos (80%) e mostrou excelente reprodutibilidade entre operadores (teste de correlação de Pearson r = 0,987; K de Cohen = 0,840). No geral, o viés médio foi de 0,03 L.min⁻¹, com limites de concordância de −0,52 e +0,57 L.min⁻¹. O coeficiente de correlação de concordância (ρ_c) foi 0,986 (95% IC 0,966–0,995) e 0,995 (95% IC 0,986–0,998) para os médicos 1 e 2, respectivamente. O valor de precisão (C_b) da mensuração de CO_TTE foi de 0,999 para ambos os observadores. O valor de precisão (ρ) da mensuração de CO_TTE foi de 0,986 e 0,995 para os observadores 1 e 2, respectivamente.

Conclusões

Um treinamento específico focado na determinação do Doppler e VTI, adicionado ao treinamento padrão em ecocardiografia transtorácica básica, permitiu que médicos não cardiologistas da unidade de terapia intensiva obtivessem uma avaliação rápida, reprodutível e precisa do débito cardíaco instantâneo na maioria dos pacientes mecanicamente ventilados em unidade de terapia intensiva.

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Masthead

The Laryngoscope,Volume 128, Issue 9, Page i-ii, September 2018. (Source: The Laryngoscope)

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International neuromonitoring study group guidelines 2018: Part II: Optimal recurrent laryngeal nerve management for invasive thyroid cancer —incorporation of surgical, laryngeal, and neural electrophysiologic data

The Laryngoscope, EarlyView. (Source: The Laryngoscope)

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Instruments evaluating the clinical findings of laryngopharyngeal reflux: A systematic review

The Laryngoscope, EarlyView. (Source: The Laryngoscope)

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Table of contents

The Laryngoscope,Volume 128, Issue 9, Page iii-vi, September 2018. (Source: The Laryngoscope)

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Masthead

The Laryngoscope,Volume 128, Issue 9, Page i-ii, September 2018. (Source: The Laryngoscope)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2pFkCB3

International neuromonitoring study group guidelines 2018: Part II: Optimal recurrent laryngeal nerve management for invasive thyroid cancer —incorporation of surgical, laryngeal, and neural electrophysiologic data

The Laryngoscope, EarlyView. (Source: The Laryngoscope)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2ylEcWZ

Instruments evaluating the clinical findings of laryngopharyngeal reflux: A systematic review

The Laryngoscope, EarlyView. (Source: The Laryngoscope)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2pE6Ka3

Table of contents

The Laryngoscope,Volume 128, Issue 9, Page iii-vi, September 2018. (Source: The Laryngoscope)

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Restricted self-diffusion of adsorbed water in MIL-100(Al)

Publication date: Available online 7 October 2018

Source: Magnetic Resonance Imaging

Author(s): Tobias Splith, Frank Stallmach

Abstract

An extended two-site exchange model is presented, which is used to evaluate pulsed field gradient (PFG) nuclear magnetic resonance (NMR) measurements of water in the nanoporous metal-organic framework MIL-100(Al). Here the water molecules exchange between the inter- and the intracrystalline space during the observation time, but are also restricted in their movement by the crystal surface. The evaluation of temperature and loading dependent PFG NMR data yields information about the intracrystalline diffusion process, the radius of the restricting geometry and the time constants of the exchange process. The intracrystalline mean residence time is found to decrease with increasing temperature, which allows an estimate of the heat of adsorption under the equilibrium conditions of the NMR measurements.

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In situ reaction monitoring in heterogeneous catalysts by a benchtop NMR spectrometer

Publication date: Available online 6 October 2018

Source: Magnetic Resonance Imaging

Author(s): Markus Leutzsch, Andrew J. Sederman, Lynn F. Gladden, Michael D. Mantle

Abstract

Understanding the reactivity and mass transport properties of porous heterogenous catalysts is important for the development of new materials. Whereas MRI has previously been used to correlate chemical kinetics and hydrodynamics under operando conditions, this paper demonstrates that a modern benchtop NMR spectrometer is a suitable alternative to obtain diverse reaction information in porous heterogeneous catalyst materials on a smaller scale. Besides information about the chemical conversion within the pores, it can also be used to study changes of surface interaction by T₁/T₂ NMR relaxometry techniques and changes in mass transport by PFG NMR from a single chemical reaction.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2CsVsOg

Restricted self-diffusion of adsorbed water in MIL-100(Al)

Publication date: Available online 7 October 2018

Source: Magnetic Resonance Imaging

Author(s): Tobias Splith, Frank Stallmach

Abstract

An extended two-site exchange model is presented, which is used to evaluate pulsed field gradient (PFG) nuclear magnetic resonance (NMR) measurements of water in the nanoporous metal-organic framework MIL-100(Al). Here the water molecules exchange between the inter- and the intracrystalline space during the observation time, but are also restricted in their movement by the crystal surface. The evaluation of temperature and loading dependent PFG NMR data yields information about the intracrystalline diffusion process, the radius of the restricting geometry and the time constants of the exchange process. The intracrystalline mean residence time is found to decrease with increasing temperature, which allows an estimate of the heat of adsorption under the equilibrium conditions of the NMR measurements.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2IGcxEM

In situ reaction monitoring in heterogeneous catalysts by a benchtop NMR spectrometer

Publication date: Available online 6 October 2018

Source: Magnetic Resonance Imaging

Author(s): Markus Leutzsch, Andrew J. Sederman, Lynn F. Gladden, Michael D. Mantle

Abstract

Understanding the reactivity and mass transport properties of porous heterogenous catalysts is important for the development of new materials. Whereas MRI has previously been used to correlate chemical kinetics and hydrodynamics under operando conditions, this paper demonstrates that a modern benchtop NMR spectrometer is a suitable alternative to obtain diverse reaction information in porous heterogeneous catalyst materials on a smaller scale. Besides information about the chemical conversion within the pores, it can also be used to study changes of surface interaction by T₁/T₂ NMR relaxometry techniques and changes in mass transport by PFG NMR from a single chemical reaction.

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To transfuse or not to transfuse? Jehovah’s Witnesses and postoperative hemorrhage in pediatric otolaryngology

Publication date: Available online 6 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Andrew J. Redmann, Melissa Schopper, Armand H. Matheny Antommaria, Judith Ragsdale, Alessandro de Alarcón, Michael J. Rutter, Catherine K. Hart, Charles M. Myer

Abstract

Objectives

Discuss the ethical issues in the management of postoperative hemorrhage in pediatric patients whose parents are Jehovah's Witnesses (JW) and 2) Describe a framework for shared decision making in this population.

Methods

A recall review of pediatric otolaryngology patients with parents of the JW faith and postoperative hemorrhage was performed over a year long period at a single institution. The literature on transfusions for JW minors was reviewed.

Results

Two patients were identified. The first patient had a severe post-tonsillectomy hemorrhage requiring multiple emergency operative interventions. The child developed a hemoglobin of 5.2 g/dl and received an emergent transfusion against parents' wishes. The child subsequently did not require further intervention. The second patient hemorrhaged after a supraglottoplasty and was administered erythropoietin and iron infusion but did not require transfusion (hemoglobin nadir 7.9 g/dl). In both cases hematology was consulted, and extensive discussion with the families and the JW Hospital Liaison Committee occurred.

Conclusions

The risks of hemorrhage should be discussed with JW parents of patients undergoing even routine otolaryngologic surgery. In these cases, early shared decision making with family, the JW Hospital Liaison committee, and hematology was pursued regarding mutually acceptable interventions. Aggressive non-transfusion based resuscitation was carried out to minimize the likelihood of transfusion. In the first case, danger to the patient's life eventually necessitated transfusion in accordance with the patient's best interest and previous case law. A defined framework involving all stake-holders, including Pastoral Care, in the event of postoperative hemorrhage is critical.

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To transfuse or not to transfuse? Jehovah’s Witnesses and postoperative hemorrhage in pediatric otolaryngology

Publication date: Available online 6 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Andrew J. Redmann, Melissa Schopper, Armand H. Matheny Antommaria, Judith Ragsdale, Alessandro de Alarcón, Michael J. Rutter, Catherine K. Hart, Charles M. Myer

Abstract

Objectives

Discuss the ethical issues in the management of postoperative hemorrhage in pediatric patients whose parents are Jehovah's Witnesses (JW) and 2) Describe a framework for shared decision making in this population.

Methods

A recall review of pediatric otolaryngology patients with parents of the JW faith and postoperative hemorrhage was performed over a year long period at a single institution. The literature on transfusions for JW minors was reviewed.

Results

Two patients were identified. The first patient had a severe post-tonsillectomy hemorrhage requiring multiple emergency operative interventions. The child developed a hemoglobin of 5.2 g/dl and received an emergent transfusion against parents' wishes. The child subsequently did not require further intervention. The second patient hemorrhaged after a supraglottoplasty and was administered erythropoietin and iron infusion but did not require transfusion (hemoglobin nadir 7.9 g/dl). In both cases hematology was consulted, and extensive discussion with the families and the JW Hospital Liaison Committee occurred.

Conclusions

The risks of hemorrhage should be discussed with JW parents of patients undergoing even routine otolaryngologic surgery. In these cases, early shared decision making with family, the JW Hospital Liaison committee, and hematology was pursued regarding mutually acceptable interventions. Aggressive non-transfusion based resuscitation was carried out to minimize the likelihood of transfusion. In the first case, danger to the patient's life eventually necessitated transfusion in accordance with the patient's best interest and previous case law. A defined framework involving all stake-holders, including Pastoral Care, in the event of postoperative hemorrhage is critical.

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Bifunctional Anticaries Peptides with Antibacterial and Remineralizing Effects

Oral Diseases,Volume 0, Issue ja, -Not available-. (Source: Oral Diseases)

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Bifunctional Anticaries Peptides with Antibacterial and Remineralizing Effects

Oral Diseases,Volume 0, Issue ja, -Not available-. (Source: Oral Diseases)

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Patient preferences regarding the communication of biopsy results in the general otolaryngology clinic

Publication date: Available online 7 October 2018

Source: American Journal of Otolaryngology

Author(s): Anirudh Saraswathula, Jennifer Y. Lee, Uchechukwu C. Megwalu

Abstract

Objectives

To determine the preferred methods of communicating biopsy results for patients in our comprehensive otolaryngology clinic, and to examine factors associated with preferring remote vs. in-person communication of results.

Study design

Cross-sectional study.

Setting

Academic comprehensive otolaryngology clinic.

Subjects and methods

A survey instrument was administered to 107 consecutive adult otolaryngology patients undergoing head and neck fine needle aspiration biopsy from March 1, 2017 to April 30, 2018 assessing their health literacy using the Brief Health Literacy Score and their preferred method of notification of biopsy results (in-person vs. remote).

Results

69% of patients preferred remote notification of their biopsy results (either by telephone or via an online portal). 54% of patients prioritized clear explanation of the results as the most important factor when communicating a malignant result. Adequate health literacy was associated with lower odds of preferring in-person notification (adjusted odds ratio 0.11, 95% CI 0.03 to 0.39). Patients who prioritized clear explanation of the results were more likely to prefer in-person notification (adjusted OR 4.13, 95% CI 1.31 to 14.88).

Conclusions

A significant proportion of patients in our comprehensive otolaryngology clinic undergoing fine needle aspiration biopsy preferred remote communication of their biopsy results. Patients most valued clear explanations from the provider and prompt receipt of the result when communicating malignant results. This highlights the need for individualized results communication plans, for patients undergoing biopsy.

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Patient preferences regarding the communication of biopsy results in the general otolaryngology clinic

Publication date: Available online 7 October 2018

Source: American Journal of Otolaryngology

Author(s): Anirudh Saraswathula, Jennifer Y. Lee, Uchechukwu C. Megwalu

Abstract

Objectives

To determine the preferred methods of communicating biopsy results for patients in our comprehensive otolaryngology clinic, and to examine factors associated with preferring remote vs. in-person communication of results.

Study design

Cross-sectional study.

Setting

Academic comprehensive otolaryngology clinic.

Subjects and methods

A survey instrument was administered to 107 consecutive adult otolaryngology patients undergoing head and neck fine needle aspiration biopsy from March 1, 2017 to April 30, 2018 assessing their health literacy using the Brief Health Literacy Score and their preferred method of notification of biopsy results (in-person vs. remote).

Results

69% of patients preferred remote notification of their biopsy results (either by telephone or via an online portal). 54% of patients prioritized clear explanation of the results as the most important factor when communicating a malignant result. Adequate health literacy was associated with lower odds of preferring in-person notification (adjusted odds ratio 0.11, 95% CI 0.03 to 0.39). Patients who prioritized clear explanation of the results were more likely to prefer in-person notification (adjusted OR 4.13, 95% CI 1.31 to 14.88).

Conclusions

A significant proportion of patients in our comprehensive otolaryngology clinic undergoing fine needle aspiration biopsy preferred remote communication of their biopsy results. Patients most valued clear explanations from the provider and prompt receipt of the result when communicating malignant results. This highlights the need for individualized results communication plans, for patients undergoing biopsy.

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