American Research Journal of Anesthesia

Sakshi Chawla, Mousumi Goswami, Bushra Rahman, Aayushi Sangal

To report on the safety and effectiveness of intravenous use of Dexmedetomidine for endodontic intervention in young and nervous children. Methods: In this prospective pilot study, 10 apprehensive (2–6-year-olds with ASA status I) children between the ages of 2 and 6 were scheduled for sedation for a primary molar pulpectomy. An initial 1 mg/kg propofol bolus was followed by an intravenous dexmedetomidine dose of 0.2-0.8 mg/kg. In order to meet Houpt’s total behavior score of 4, sedation was titrated Rescue propofol boluses (1 mg/kg) were given if the sedation wasn’t strong enough to keep the patient comfortable. Vitals were checked every five minutes, and the Alderete Modified Post Anesthesia Discharge Scoring System was used to measure recovery. Patients’ vital signs fluctuated by up to 20% at baseline, resulting in adverse events such as stridor, laryngitis, apnea, desaturation, tachycardia, and more. Results: According to the study’s protocol, the surgery was performed successfully in all of the participants under the present sedation regime. In eight of the patients, propofol boluses were required for rescue. Both during and after the operation, there were no unfavorable changes in vital signs or adverse events to report. Conclusion: Pediatric endodontic procedures may be safely and effectively sedated using intravenous Dexmedetomidine.

Waleed M.A. Al Taher, Emad E. Mansour

Dexmedetomidine is being compared to midazolam and protocol in a sedative study on pediatric dental patients. Methods: Patients with ASA I symptoms aged 4–10 years were referred from the pediatric outpatient clinic and tested in this study, which included 60 children. Anesthesia for dental procedures at the dentist’s office They were divided into two separate groups at random.Dexmedetomidine loading dosage of 2 lg/kg was administered to group I over a 5-minute period (the control group).A midazolam infusion was used to provide 0.4 mg/kg/h of Protocol (Group I) (Group II).It was delivered over 5 minutes, and then 5 mg/hour of protocol for the remainder of this study.”The continuous administering of medication. Oxygen saturation and respiratory rate are measured using heart rate, mean arterial blood pressure, and oxygen saturation. They were monitored every five minutes until they were finally released. You’ll know exactly how long you’ll be sedated, how long it will take to recuperate, and when you’ll be released from the hospital. Throughout the surgery, analgesia was discovered to be essential. Negative ramifications appear so quickly In advance.

Andrew G1, Davidson2, Nicola Disma3

Several general anesthetic effects on the developing brain in animal models have already been documented. Contrary to the results of human cohort studies, there is no clear evidence of a link between early children anesthetic exposure and neurobehavioral outcomes. Despite extensive study, it is still unclear whether or not the findings from animal studies have any use in human medicine, or even whether any changes to clinical practice are necessary. In light of the large number of children who have general anesthesia procedures, the answers to these concerns are crucial. Researchers and physicians met recently in Genoa to discuss the future of clinical trials. These debates and their outcomes are described in this work. Observational studies with a high sample size, as well as clinical trials with precise design parameters, were deemed essential. There is no way to completely rule out the possibility that anesthetics can cause long-term neurobehavioural changes in humans; however, observational studies will help us better understand which children are most at risk and may also reveal possible underlying causes, and clinical trials will provide the strongest evidence to test the efficacy of different strategies or anesthetises.

Anna-Maria Burgdorff1*, Ann-Kristin Feudlinske2, Astrid Förster3, Karl Werdan4, Susanne Unverzagt5 

Background: Patients who undergo surgery, especially with preexisting high cardiovascular risk and high-risk surgery, are vulnerable for developing myocardial ischemia or tachyarrhythmias through sympathetic stimulation during anesthesia. Aim of this systematic review is a summary of the evidence from all randomized controlled trials on the efficacy and safety of the short acting β1-selective adrenoreceptor blocker esmolol in the prevention and treatment of tachyarrhythmias and critical rises in blood pressure to avoid myocardial ischemia. Methods and Findings: We examined the effect of esmolol in three different settings and included 5765 participants from 110 trials in our meta-analysis. We searched Medline, Embase, the Cochrane Library and hand-searched until January 2012 with an update through additionally search via PubMed to 2017 for articles published in English and German language. Esmolol reduces blood pressure and heart rate significantly in comparison to placebo with better effects in controlling heart rate than heart rhythm. In comparison to other active drugs there are no significant benefits for esmolol in lowering blood pressure, heart rate or control of rhythm. Adverse effects of esmolol as hypotension, bradycardia Conclusion: Esmolol shows reduction in myocardial ischemia in patients with cardiac disease, and with respect to adverse effects and careful titration we recommend esmolol to prevent and treat crisis of blood pressure and heart rate. In healthy patients the perioperative use of esmolol or other active drugs need to document its beneficial effect, further studies are necessary.

Ayman Eskander Tawfek Saadalla, Osama Yehia Ahmad Khalifa

Background: The goals of preemptive analgesia are to decrease acute pain after tissue injury, prevent pathologic modulation of central nervous system caused by pain and prevent the development of chronic pain. The goal of this study is to evaluate analgesic efficacy of verapamil when added to epidural bupivacaine and fentanyl in patients undergoing knee arthroscopy. Patients and Methods: Forty patients undergoing knee arthroscopy were classified into 2 groups, first group (F) received epidural bupivacaine and fentanyl and second group (F-V) received epidural bupivacaine, fentanyl and verapamil. Pain assessment using prince henry score, the first time patient ask for analgesia (duration of analgesia) and post-operative analgesic consumption were recorded. Results: The duration of analgesia was significantly longer in group (F-V) than group (F). The total dose required for 24 hrs. postoperative analgesia was significantly reduced in group(F-V) compared to group (F). There was highly significant reduction in prince hennery score in group (F-V) in comparison to group (F) from 6th to 12th hours post operatively Conclusion: Epidural verapamil with fentanyl and bupivacaine produce effective and prolonged post-operative analgesia in patients undergoing knee arthroscopy compared with epidural bupivacaine and fentanyl alone.

Victor A Koriachkin, MD, PhD.1,2, Dmitriy V Zabolotskiy, MD, PhD

Difficulties in removing the epidural catheter are rare. In this report, we describe two cases breakage of epidural catheter. Both cases involve the use of a catheter with innovative tip design and leading edge technology extrusion of the catheter body. The article discusses the causes of difficulties in removing the catheter, the tactics of the anesthesiologist in the event of such situations, the indications for surgical extraction, the remaining fragment of an epidural catheter