Editor note: Anesthesiology and Research

Editor note: Anesthesiology and Research

*Corresponding author: Dr. P. Priyanka, Department of Environmental Toxicology, Institute of Genetics,

Osmania University, Hyderabad-500017. India. Email : pallapolupriyanka11@gmail.com

This journal covers technical and clinical studies related to Anesthesiology and publishes original peer reviewed research, clinical work in all branches of anesthesia, pain, critical care and perioperative medicine including the application on basic sciences.

Jacobs Journal of Anesthesiology and Research of Volume 1 Issue 1 published articles presenting with two case reports discussing bladder distension causing severe bradycardia under spinal anesthesia [1], a case report of a patient who developed neuroleptic malignant syndrome that was managed with supportive therapy and dantrolene [2], a comparative study between the analgesic effectiveness of a peripheral nerve blocks (PNB) and local tissue infiltration for wrist surgery also counted effects on post-operative outcomes [3], and a case of intraoperative refractory shivering following spinal anesthesia, which was effectively managed with ketamine [4].

Saad Gomaa. [1]., presented two case reports discussing bladder distension causing severe bradycardia under spinal anesthesia. Both cases sustained life threatening events. Author through their article presented retrospective analysis of the possible causes and highlighted the effects of bladder distension as a possible precipitating factor. In both cases surgeons acknowledged that the due to bloating of bladder resulted in emptying a significant volume of irrigating fluid that could be a possible precipitating factor of severe bradycardia and hypotension. In mentioned cases, the first patient may have sustained this condition because of spinal anesthesia combined with the effects of digoxin and isosorbide dinitrates and second patient, due to the combination of spinal anesthesia and repeated bladder distension. However, it is noted the anesthetic management of elderly patients is compromised with cardiovascular reserve and potential dehydration which could be a challenge for the anesthetist. On this account a careful anesthetic planning, close monitoring and readily available vagility drugs should be prepared and are made ready to use. Also, its suggested that keeping rapport with the patients under spinal anesthesia is advisable to detect warning signs and loss of consciousness and treated should be considered carefully and promptly.

Neuroleptic malignant syndrome is a rare condition characterized as severe autonomic dysfunction, hyperthermia and muscle rigidity, among others. Its occurrences can be in response to drugs that interact with dopaminergic pathways. However, there is no specific laboratory test for this syndrome condition and a high mortality rate. This is a case report from Gustavo Cruz Suarez et al. [2]., of a patient who developed neuroleptic malignant syndrome that was managed with supportive therapy and dantrolene. In addition, to supporting therapies, treatment with dantrolene emerged as a highly effective alternative to blunt hypercatabolic response in advance to promptly return to hemodynamic stability and adequate amount of systemic oxygen delivery.

Ofelia L. Elvir-Lazo et al. [3]., presented a comparative study between the analgesic effectiveness of a peripheral nerve blocks (PNB) and local tissue infiltration for wrist surgery also counted effects on post-operative outcomes. Authors, hypothesized that the use of a PNB would provide more effective pain relief after surgery. Presented data suggests that administration of PNB improves postoperative pain compared to simple tissue infiltration. However, larger scale studies are still more needed to know the effects of using peripheral nerve blocks on functional recovery after discharge to home.

Shivering is characterized with increase in oxygen consumption, cardiac output, carbon-dioxide production and circulating catecholamines, also followed by spinal anesthesia is common. Various causes have been related to it with increase in physiological stress, plasma catecholamine and cardiac output. Numerous pharmacological agents have been shown to be effective for preventing and managing post-anesthesia shivering and furthermore, less data is available about management of refractory shivering. Here, Gentle S Shrestha et al. [4]., presented a case of intraoperative refractory shivering following spinal anesthesia, which was effectively managed with ketamine. Several studies have shown that ketamine is effective in preventing or treating shivering. Therefore, author analyzed with administration of 0.5mg/kg of ketamine, as this dose doesn’t show significant adverse effects. Anyhow, shivering was effectively controlled and both the heart rate and respiratory rate were settled. In conclusion, author inferred that the low dose intravenous ketamine may be helpful for management of refractory shivering during spinal anesthesia without much adverse side effects.

For more information: https://jacobspublishers.com/jacobs-journal-of-anesthesiology-and-research-issn-2376-9467

Reference:

  1. Saad Gomaa. Bladder Distension Precipitates Severe Bradycardia Under Spinal Anesthesia.
  2. Gustavo Cruz Suarez MD*, Sergio Jaramillo MD, Beatriz Sanchez MD, Fredy Ariza MD, Angy Cruz MD. Neuroleptic Malignant Syndrome and Dantrolene. A Case Report.
  3. Ofelia L. Elvir-Lazo, M.D, Paul F. White, PhD, MD*, Dermot P. Maher, MD MS, Stuart H Kuschner, MD, David A Kulber MD, Myles J Cohen MD, Christine Pham, BA, Roya Yumul MD, PhD, Ronald H. Wender MD. Comparison of Peripheral Nerve Blocks vs. Local Tissue Infiltration for Wrist Surgery: Effect on Postoperative Outcomes.
  4. Gentle S Shrestha*, Bijendra D Joshi. Ketamine for Management of Refractory Shivering During Spinal Anesthesia.

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