Archives of Anesthesia and Critical Care

Artificial Intelligence in Mechanical Ventilation

2025-01-06T13:13:48+00:00

The Article Abstract is not available.

Burnout in Healthcare Professionals during Covid-19 Crisis

2025-01-06T13:13:46+00:00

Background: Since 2019, the COVID-19 disease has led to the death and disability of many people all over the world and the treatment staff has been providing services around the clock. Therefore, psychological burnout among them is highly possible. So far, no study has compared the incidence of mental burnout between doctors and nurses in the emergency department. This study has compared the psychological burnout between doctors and nurses during COVID-19 at the emergency department.

Methods: This cross-sectional study included 67 doctors and nurses working in the Emergency Department of Imam Reza Hospital of Tabriz University of Medical Sciences who had been working there during the COVID-19 outbreak. The instrument of study was the standard Copenhagen psychological burnout questionnaire. After obtaining the written consent, the questionnaire was distributed among the doctors and nurses of the emergency department. The data was graded by Excel software and data analysis was conducted by SPSS V. 22 software.

Results: According to the comparison of the high burnout rate in the Copenhagen burnout scale, 50% of doctors and 57.1% of nurses had personal burnout, 56.8% of doctors and 66.7% of nurses had work-related burnout, 69.4% of doctors and 69% of nurses had patient-related burnout, and the overall rate of high burnout in doctors was reported as 62.9% and nurses as 70.4%. There was no statistically significant difference in personal burnout between emergency department physicians and nurses.

(P= 0.347). As well, there was not a significant statistical difference in terms of work-related, patient-related, and overall burnouts between the two groups (P= 0.066), (P= 0.696), and (P= 0.108). Yet, Regarding the distribution of genders between the two groups, there was a statistically significant difference (P= 0.001).

Conclusion: The level of mental burnout of doctors and nurses employed in the Emergency Department of Imam Reza General Hospital during the COVID-19 crisis was at an average high. Thus, improving the conditions of medical environments in health centers can reduce the burnout of working doctors and nurses, especially during epidemic conditions, which will increase the quality of medical services.

Using Micro-Learning to Enhance Knowledge and Skills of Airway Management in Nurse Anesthesia Students: An Interventional Study

2025-01-06T13:13:43+00:00

Background: As a subfield of E-Learning, Micro-Learning provides asynchronous instruction to reduce mental strain and boost understanding by delivering educational content in bite-sized, concise learning modules. This study aimed to investigate the effect of Micro-Learning on the airway management knowledge and skills of nurse anesthesia students.

Methods: This Non-Randomized Controlled study, employing a Pre-test-Post-test design, included 52 nurse anesthesia students in Iran. Participants were first assessed with a Pre-test, and then assigned to either the M-L M (n=26) or T M (n=26) groups. Over three weeks, the M-L M group received Micro-Learning-based materials through social media, while the T M group received traditional face-to-face instruction. The intervention focused on airway management during peri-induction of general anesthesia. Then, the first and second Post-tests were given to assess the acquisition and retention of knowledge and skills, using a researcher-made instrument called AMAI-NA.

Results: Based on within-group comparisons, in both M-L M and T M groups mean scores of both Knowledge and Skills significantly increased from the Pre-test to 1st Post-test, then declined from 1st Post-test to 2nd Post-test. Yet, 2nd Post-test mean scores remained significantly higher than the Pre-test for both groups. Based on Inter-group comparisons, despite the absence of a statistically significant difference in Pre-test mean scores between the two groups, the mean scores for Knowledge and Skills of the M-L M group were significantly higher than those of the T M group in 1st and 2nd Post-tests. Furthermore, the M-L M group exhibited a greater increase in mean scores from the Pre-test to 1st and 2nd Post-tests compared to the T M group, as well as a lesser decrease from 1st Post-test to 2nd Post-test.

Conclusion: This study demonstrated that Micro-Learning significantly enhanced the acquisition and retention of knowledge and skills related to airway management, compared to the traditional method.

The Effect of a Training Program (Retention) on the Clinical Competence, Self-Efficacy, and Occupational Stress of Undergraduate Students of Anesthesia: The Transition from Studenthood to the Clinical Workforce

2025-01-06T13:13:41+00:00

Background: Transferring students from university to the workplace due to facing many challenging and stressful factors is one of the important stages that, if the educational authorities do not pay attention, it leads to low efficiency and an increase in the number of resignations from the workplace, which leads to financial and human losses for the system. Purpose: Investigating the effect of a training program on the clinical competence, self-efficacy, and occupational stress of Anesthesiology undergraduate students, in their transition from the studenthood to the clinical workforce.

Methods: In this prospective longitudinal semi-experimental study, all final-year undergraduate and newly graduated students of anesthesia studying at AJUMS, Ahvaz, Iran (60 people) were included in the study and were divided into two groups by a simple random method. The intervention consisted of an educational-supportive program called retention that was applied to the intervention group and lasted for 6 months. The required data in both groups were examined by nurses' competence questionnaires (CIRN), stress and job self-efficacy through pre- and post-tests. Chi-square, independent t and paired t tests were used to analyze the data.

Results: After the intervention, the two groups were significantly different in terms of clinical competence (P=0.020) and work self-efficacy (P=0.001). The results of the paired t-test of occupational stress in the intervention group showed that the difference between the pre-test and post-test scores was statistically significant. (P = 0.036)

Conclusion: Implementation of the intervention (the retention program) in the intervention group was effective in terms of clinical competence, self-efficacy, and occupational stress of the students after graduation.

The Most Important Measures in Reducing Infection Control in the Anesthesia Work Environment: An Evidence-Based Study

2025-01-06T13:13:39+00:00

Background: Anesthesia providers cross-contaminate their work environment. The hands of anesthesia providers are vectors for the transmission of infection between medical equipment in the anesthesia work environment and patients. The high work density of anesthesia providers around the patient has made it important to monitor infection control in the work environment and anesthesia procedures. This research aimed to find the best evidence for preventing or reducing infection in the anesthesia work environment.

Methods: The measures required for the guidelines in the field of infection control in the anesthesia work environment were determined according to the available resources and the use of expert opinions of anesthesiologists and faculty members. Then, the guidelines for infection control in the anesthesia work environment were designed based on the evidence-based method (Stettler model). Also, it has been implemented in a limited way in the operating room. To assess the validity of the approach used in calculating the content validity coefficient (CVR) and the content validity index (CVI), Finally, the Test-Retest method, and Cronbach's alpha coefficient were used to determine reliability.

Results: The guidelines for infection control in the anesthesia work environment were designed using evidence-based methods (Stettler's model). The content validity of anesthesia procedures requiring infection control guidelines was reported with a content validity index (CVI) of more than 0.79 and a content validity ratio (CVR) of more than 0.59. The reliability test was measured by Cronbach's alpha coefficient (0.806).

Conclusion: Based on this study, the use of global infection control guidelines changes the attitude of anesthesia nurses and reduces the rate of infection in the anesthesia work environment. Also, the use of evidence-based methods facilitates the implementation of guidelines in the target environment.

Investigating the Effects of Performing the Early Mobilization Protocol on Postoperative Hemorrhaging in Cardiac Surgery Patients

2025-01-06T13:13:38+00:00

Background: Most adverse effects following cardiac surgery, including hemorrhaging, are related to immobility. The early mobilization of the patient in enhanced recovery after surgery (ERAS) can counteract these adverse effects. Despite the awareness, however, the protocol has a low performance rate due to numerous barriers. The present research aims to investigate the effectiveness of performing the early mobilization protocol on hemorrhaging in cardiac surgery patients.

Methods: This research is a clinical trial study conducted in 2023-2024 at Ali Ibn AbiTalib Hospital in Zahedan, Iran, on 100 patients undergoing cardiac surgery. Purposive sampling was used based on the inclusion criteria. Hemorrhaging risk assessment in patients was evaluated according to the preoperative checklist. The early mobilization protocol was performed on day 2 after surgery on patients in the intervention group with mild to low risk of hemorrhage. The statistical tests of repeated measures, chi-square, and independent t-test were used for data analysis in SPSS 26.

Results: There were no statistically significant variations in the demographic characteristics of patients in the intervention and control groups. The mean and standard deviation (SD) of the blood volume loss in patients over three different time periods (days 2, 3, and 4 after surgery) were 326.500±16.81, 69.300±11.41, and 51.200±3.82 in the intervention group, respectively, and 350.00±16.81, 325.00±11.41, and 82.10±3.82 in the control group, respectively, indicating the effectiveness of performing the early mobilization protocol (P ˂ 0.001).

Conclusion: Performing the early mobilization protocol can reduce the volume of bleeding after cardiac surgery and the early discharge of patients, thus leading to reduced complications. Nurses as the main care providers in intensive care units play a key role in performing the protocol.

Assessment of the Logical Prescription of Albumin Drug According to Guideline and Patient Safety for Inpatients in Intensive Care Units of Iranian Hospital: A Cross-Sectional Study

2025-01-06T13:13:36+00:00

Background: Medication errors in healthcare settings, including outpatient and hospital environments, pose a significant risk to patient safety. These errors can arise from incorrect dosages, drug interactions, contraindications, or inappropriate drug combinations.

Methods: This study aimed to assess the logical prescription of albumin according to guidelines and patient safety for inpatients in the intensive care units of Imam Reza Hospital in Mashhad through a cross-sectional study. Methods: Data were collected over a 3-month period from albumin prescriptions in intensive care units, using a checklist based on information from prescription forms, patient files, and consultations.

Results: The study found that 60.57% of albumin prescriptions were reviewed by DUE unit, with 51.53% complying with guidelines and 48.47% not. The highest prescription rate was in the Intensive Care Unit of Heart Surgery (ICUOH), at 36.83%, and the lowest in the Neonatal Intensive Care Unit (NICU), at 0.63%. The patient safety parameter, calculated based on correct/incorrect albumin prescriptions according to guidelines, showed an average safety of 67.10% across prescribing units and 62.34% based on indications. It reduced the financial burden caused by inappropriate prescriptions approximately $21,390 through DUE process.

Conclusion: The research highlights the importance of continuous guideline-base DUE on rational drug utilization, patient safety and hospitals costs.

Investigating The Agreement of Hypomagnesemia Diagnosis in Three Perimeter of Serum, Urine, and Red Blood Cell in Intensive Care Unit: Pilot Study

2025-01-06T13:13:52+00:00

Background: Magnesium is a vital element in the body involved in biochemical and physiological processes. Magnesium deficiency can lead to serious consequences including cardiac, neurological, muscular disorders, and other clinical manifestations. In our country, commonly, magnesium measurement is done by measuring serum magnesium levels. This paper discusses the prevalence and consequences of magnesium deficiency in patients hospitalized in the ICU and emphasizes the importance of diagnosis and treating hypomagnesemia.

Methods: Diagnosis of hypomagnesemia is done by measuring serum magnesium, urine magnesium, and magnesium in RBCs. We conducted a prospective study on 30 critically ill patients (14 male, and 16 female) who were admitted to the ICU to examine the prevalence of magnesium deficiency. In eligible patients, after measuring serum and RBC magnesium levels, 7.5 grams of magnesium sulfate in 1000 ml isotonic saline was infused over 8 hours at a rate of 125 ml/hour and urine was collected for 24 hours from the start of the infusion.

Results: The mean age was 71. There was a significant difference between the levels of serum Mg and RBC Mg (U statistic = 266 and P<0.05). The results showed a significant difference between the levels of serum Mg and urinary Mg (U statistic was almost 0 and P<0.05). The results indicated a significant difference between the levels of urinary Mg and RBC Mg (U statistic was almost 0 and P<0.05).

Conclusion: There is no correlation between serum magnesium and the body’s magnesium requirement in patients, and serum magnesium does not reflect the actual status of patients in the ICU. Therefore, measuring the level of magnesium in red blood cells is preferable to urinary magnesium and serum magnesium to investigate hypomagnesemia in the ICU. Additionally, there is no correlation between age, gender, APACHE II score, and the percentage of infused magnesium absorption in patients.

Exploring the Effects of Sub-Dissociative Doses of Ketamine on Sedation Quality in Bronchoscopy: A Double-Blind Clinical Study

2025-01-06T13:13:34+00:00

Background: Sedation is recommended during flexible fiberoptic bronchoscopy (FFB) to aid in airway evaluation, minimize patient mobility, and enhance patient safety. This study was conducted to compare the impact of different sub-dissociative ketamine (SDK) doses on the quality of sedation within FFB.

Methods: This research utilized randomized clinical trial design involving three cohorts, each consisting of 30 participants. The cohorts were administered varying doses of ketamine: 0.2 mg/kg (SDK1), 0.4 mg/kg (SDK2), and 0.5 mg/kg (SDK3). After receiving ketamine, all participants received propofol in bolus dose 0.4 mg/kg followed by infusion 50-100 µg/kg.

FFB started when sedation level 4 was reached, according to Ramsey's sedation score.

Results: Regarding demographic variables revealed no statistically notable discrepancy among the cohorts (P>0.05). The SDK3 cohort exhibited a higher average sedation score and longer duration of sedation compared to the SDK2, with both metrics also surpassing those of the SDK1 cohort. (P>0.001). Furthermore, the satisfaction levels reported by the bronchoscopist (P=0.78) and the participants (P=0.019) were notably greater in the SDK3 cohort than in the other groups. Additionally, the amount of propofol administered to the SDK3 cohort was less than that given to the SDK2, and both cohort received lower doses than the SDK1 cohort (P>0.001).

Conclusion: Elevating the SDK from 0.2 mg/kg to 0.5 mg/kg when administered alongside propofol correlates with a rise in the score of sedation, increasing patient and bronchoscopist satisfaction, and decreasing propofol consumption in FFB in adults. A dosage of 0.5 mg/kg might be more advantageous compared to alternative dosages for FFB in adult patients.

The Effect of Implementing Self-Compassion Program on Moral Injury of Nursing Students

2025-01-06T13:13:32+00:00

Background: Self-compassion can have a significant role and impact on moral damage, and the positive components of self-compassion (self-kindness, common human sense, and mindfulness) reduce the negative effects of moral damage, so using self-compassion methods can reduce the moral damage caused to nursing students during their studies. Therefore, the present study was conducted with the aim of determining the effect of the self-compassion program on the moral damage of nursing students in 2024.

Methods: In this clinical trial study, 150 nursing students of the 7th and 8th semesters in the intership course of Zahedan School of Nursing in 2023 were randomly selected in two groups of 75, intervention and control. 8 sessions of face-to-face educational program were designed and implemented for students and the degree of application of the programs by them was followed up under the supervision of the researcher. Before and 2 months after the implementation of the intervention, students' moral damage was measured using the moral damage questionnaire. Data were analyzed using independent t, paired t and chi square statistical tests under SPSS 21 statistical software.

Results: The results showed a statistically significant difference for the average score of moral injury between the control and intervention groups (P=0.001). On the other hand, the t-pair test shows a significant increase in the mean score of moral injury two months after the completion of the educational intervention in the intervention group (P=0.001).

Conclusion: The results of the present study showed that the current self-compassion training program can reduce the moral damage of nursing students during the 7th and 8th semesters, before entering the hospital as a professional nurse; Therefore, it is necessary to use it in future planning for nursing students during the 7th and 8th semester.

Comparison of the Efficacy between Bilateral Ultrasound Guided Erector Spinae Block versus Incision Site Infiltration for Duration of Analgesia in Lumbar Spinal Surgery Using Levobupivacaine: A Prospective, Randomized Comparative Study

2025-01-06T13:13:30+00:00

Background: There are increasing number of patients undergoing lumbar spine surgeries. Many modalities have been developed to manage post operative pain. More recently, erector spinae plane blocks found to be effective in reducing post operative pain. The purpose of this study was to compare the analgesic efficacy of ultrasound guided Erector spinae block with wound infiltration using levobupivacaine in lumbar spine surgeries under general anaesthesia.

Methods: A prospective randomized single blinded study was carried out in 50 patients of ASA grade I and II, aged 20 to 60 years scheduled for elective lumbar spine surgeries. Under USG guidance, group A received bilateral erector spinae block at L2 with 20 ml of 0.125% levobupivacaine on each side and Group B received incision site infiltration with 40 ml 0.125% levobupivacaine. Patients were evaluated primarily for duration of analgesia using VAS score.

Results: Both groups were statistically comparable with respect to all demographic variables, ASA grading and duration of surgery. The duration of analgesia was prolonged in group A when compared to group B (496 ± 36.2 v/s 55±10.6) (P=0.0016). VAS score and total rescue analgesia requirement were higher in group B.

Conclusion: Erector spine block is more effective in providing post-operative analgesia compared to local site infiltration in patients undergoing spine surgeries following general anaesthesia using Inj Levobupivacaine 0.125% as local anaesthetic

Comparing the Effect of Intrathecal Injection of Pethidine with that of Bupivacaine on Hemodynamics in Hip Surgery: A Double Blinded Clinical Trial

2025-01-06T13:13:28+00:00

Background: The use of regional anesthesia for lower limb orthopedic surgery is preferable to general anesthesia. In some studies comparing regional anesthesia and general anesthesia, the one-month mortality of patients undergoing regional surgery was significantly lower. Given the relative advantages observed about intrathecal injection of pethidine, including fewer side effects, and longer postoperative analgesia, in combination with effective sensory, motor, and sympathetic blocks, we sought to compare the influence of intrathecal injection of pethidine and bupivacaine on the hemodynamics of patients.

Methods: In this double blind randomized parallel trial, patients undergoing surgery with femoral and hip fractures, were divided into two groups. In the first group bupivacaine and in the second group pethidine were used for spinal anesthesia. Hemodynamic changes were examined and recorded during surgery. The results were analyzed by SPSS18 software

Results: 67 patients undergoing surgery with femoral and hip fractures, were divided into two groups of 30 and 37 individuals. The mean heart rate in patients with a high risk of surgery was higher in the group receiving pethidine compared to the group of bupivacaine, with a Cohen's effect size of 0.294. This effect size is evaluated as average, while the rate of mean arterial pressure with Cohen's effect size of 0.511 was evaluated as large.

Conclusion: Pethidine can be a good alternative to bupivacaine, especially in patients at high risk of surgery, given its hemodynamic stability.

Higher AVCO2 and Lactate Gradient Combined with SOFA Score as a Mortality Predictor During the 6-hours of Resuscitation of Septic Shock

2025-01-06T13:13:27+00:00

Background: Sepsis is a severe and life-threatening condition leading to widespread inflammation and organ dysfunction. It is a medical emergency that requires immediate attention and treatment. One of the key indicators used to assess the severity and prognosis of sepsis is lactate level. Another key indicator of sepsis severity is a significant difference in the level of carbon dioxide (CO2) between veins and arteries.

Methods: In this study, we aimed to evaluate the differences in the venous and arterial PCO2 and lactate levels during the first 6 hours of treatment of septic shock. In this prospective observational-analytical study patients with septic shock admitted to the ICU were evaluated. Sepsis is defined as patients who had 1 or more of the SIRS criteria with a possible or proven source of infection and hypotension despite appropriate fluid therapy who needed to receive vasopressors.

Results: Among 85 patients the mean age was 64±17 years and 48 (56%) were men. Of these patients, 15 (17%) died, of them 8 (53.33%) were male, 14 (93%) were diabetic, 11(73.33%) were hypertensive, 11 (73.33%) had ischemic Heart disease and 9 (60%) patients had Chronic Obstructive Pulmonary Disease (COPD). The mean HR, SBP, and DBP were significantly higher in lived patients; the SOFA scores were significantly lower in these patients.

Conclusion: Overall, the gradient of AV PCO2 and lactate clearance combined with SOFA score can be a valuable tool for clinicians in predicting mortality risk in critically ill patients and guiding treatment decisions.

Shivering Management in Spinal Anesthesia: Evaluating the Role of Ketamine: A Narrative Review

2025-01-06T13:13:50+00:00

Background: Shivering is one of the most prevalent known complications due to dysregulation in the thermoregulatory system following regional anesthesia, with an incidence of 65%, leading to unpleasant outcomes and decreased patient satisfaction. Ketamine, a weak analgesic, affects the thermoregulatory center.

Methods: The authors conducted a search and selection of articles using reputable scientific databases. The search keywords included Shivering, Ketamine, and Spinal Anesthesia. The selected articles summarized the literature findings related to ketamine and shivering after spinal anesthesia.

Results: This narrative review synthesizes findings from multiple studies examining the role of ketamine in managing shivering following spinal anesthesia. Based on the results obtained, 10 areas were examined: Definition of shivering, Epidemiology of postoperative shivering, Pathophysiology of shivering, Risk factors for post-spinal anesthesia shivering, Spinal anesthesia, its benefits, and its impact on shivering, Post-anesthetic shivering (PAS) complications, Risk factors for postoperative shivering, Control and management of post-anesthetic shivering (PAS) dosage, Effective timing and benefits of ketamine administration in postoperative shivering.

Conclusion: The effectiveness of ketamine in preventing shivering after spinal anesthesia is evident from the mixed results of studies. Ketamine, regardless of dosage, can be effective in reducing shivering after spinal anesthesia based on the mentioned criteria. Standardized research with precise methods to determine optimal dosages and ensure safety is necessary.

The Role of Etomidate for Rapid Sequence Intubation in Emergency Medicine: A Systematic Review

2025-01-06T13:13:25+00:00

Background: Etomidate, a short-acting hypnotic drug, plays a pivotal role in induction for intubation, particularly in emergency settings. Its favourable hemodynamic profile renders it a suitable choice for patients with hemodynamic instability

Methods: In this systematic review, we aim to delineate its role in emergency ward settings. Through a systematic search across databases, we identified nine eligible studies for inclusion. We searched the databases of PubMed, Scopus, ProQuest, and Medline (Ovid) from 2004 to 2023 for Randomized Controlled Trials (RCTs) and observational studies in which the study population was referred to the emergency department and received etomidate for Rapid sequence intubation (RSI).

Results: These studies collectively underscored the safety and efficacy of etomidate in emergency patients, with its suppressive effects on the adrenal axis deemed clinically insignificant.

Conclusion: The rapid onset of action and favourable hemodynamic profile position etomidate as a desirable agent for rapid sequence induction. However, further studies are warranted to strengthen recommendations in this regard.

Diving into Diagnostic Complexity: A Case Study of Spontaneous Hemothorax

2025-01-06T13:13:22+00:00

Hemothorax, a condition characterized by blood accumulation in the pleural space, primarily results from trauma, affecting around 300,000 individuals annually in the United States. Spontaneous cases, although rare, pose diagnostic challenges due to diverse etiologies such as coagulation disorders, vascular anomalies, and neoplastic diseases. Diagnostic modalities like computed tomography, chest X-ray, and ultrasound play a crucial role in identification. A 29-year-old female with multiple sclerosis presented with severe chest symptoms, leading to pleural effusion requiring chest tube insertion. Despite inconclusive rheumatologic tests, evaluations excluded malignancies and thromboembolic events, enabling transfusions and supportive care. Global cases underscore varied causes of spontaneous hemothorax, with management strategies emphasizing interdisciplinary care. While certain conditions were ruled out, unresolved rheumatologic concerns persisted post-discharge, highlighting the need for further research to enhance diagnosis and management of spontaneous hemothorax.

Sepsis Management In A Case Of Myasthenic Crisis: A Case Report

2025-01-06T13:13:21+00:00

Myasthenic crisis can affect the respiratory muscles in a life-limiting way that requires intubation and mechanical ventilation. This is a case report of a myasthenic crisis in a 61-year-old woman that became complicated following a lack of response to plasmapheresis, intravenous immunoglobulin (IVIG) therapy, and the development of septic shock. The co-occurrence of myasthenic crisis and sepsis is a challenging condition. Many antibiotics cause flare-ups of myasthenia gravis. Infection and sepsis can exacerbate myasthenia. We discuss the successful management of certain unique challenges. To treat sepsis, drugs that may cause deterioration of myasthenia gravis, such as amikacin, ciprofloxacin, colistin, vancomycin, amphotericin B, and voriconazole were prescribed, but eventually the sepsis was cured. After eradicating the infections and stabilizing the patient's hemodynamic, she received rituximab. After 3 weeks of treatment, she responded well to the rituximab, the respiratory failure recovered, and she was extubated and discharged from the ICU after 3 months of hospitalization. This report demonstrates that when the myasthenic patient is under mechanical ventilation, can use even cautionary drugs.

Combining Ultrasound-Guided Popliteal Sciatic and Adductor Canal Block as a Lifesaver for High-Risk Patients Scheduled for Emergency Below Knee Surgery: A Case Series

2025-01-06T13:13:18+00:00

High risk patients with multiple comorbidities, sepsis, poor cardiopulmonary reserve when posted for emergency below knee surgeries definitely pose challenges in terms of Anaesthesia. In this case series we highlighted the important role of ultrasound guided popliteal sciatic combined with adductor canal block as a sole anaesthetic technique for safe outcome in high risk cases having significant and multiple comorbidites.

10 cases with ASA physical status III and IV, aged 50-70 years scheduled for below knee surgeries were enrolled. All the patients received ultrasound guided popliteal sciatic nerve block with 8 ml of 2% Lignocaine with Adrenaline and 8 ml of 0.5% of Bupivacaine and 4mg Dexamethasone (1ml) (total volume 17 ml) and Adductor canal block with 8 ml of 0.5% of Bupivacaine.

Adequate sensory and motor blockade required for surgery was achieved, with stable haemodynamic parameters throughout the procedure. No patient developed any serious complication in the perioperative period.

Combination of the popliteal sciatic nerve and adductor canal block provide sufficient sensory and motor block with good hemodynamic stability for below-knee surgeries. When used on high-risk patients with numerous comorbidities, this anesthetic technique has the potential to save lives.

A Well-Differentiated Liposarcoma with History of Benign Prostatic: A Case Report

2025-01-06T13:13:12+00:00

Liposarcoma, a malignant tumor originating from fat cells, is a rare occurrence in the retroperitoneal region. Surgical resection is the standard method for treating this cancer. This type of tumor is classified into common subtypes, which include well-differentiated liposarcoma and dedifferentiated liposarcoma.

A 53-year-old male patient presented with lower left quadrant (LLQ) pain and melena for two weeks. Further diagnostic evaluation, including colonoscopy, revealed a 50 mm polyp in the hepatic flexure or distal of the ascending colon.

The pathological assessment of the mass demonstrated a lipomatous lesion with a nuclear atypical lipomatous tumor, which was diagnosed as well-differentiated liposarcoma.

The patient underwent surgical treatment and was discharged following his recovery.

Is It Still Prohibited to Perform Spinal Anesthesia in Patients with Advanced Heart Disease?

2025-01-06T13:13:11+00:00

The Article Abstract is not available.