Effect of esmolol and lidocaine on agitation in awake phase of anesthesia among children: a double-blind, randomized clinical study / 中华医学杂志(英文版)

BACKGROUND@#Sevoflurane is widely used to anesthetize children because of its rapid action with minimal irritation of the airways. However, there is a high risk of agitation after emergence from anesthesia. Strabismus surgery, in particular, can trigger agitation because patients have their eyes covered in the postoperative period. The aim of this study was to determine whether or not esmolol and lidocaine could decrease emergence agitation in children.@*METHODS@#Eighty-four patients aged 3 to 9 years undergoing strabismus surgery were randomly assigned to a control group (saline only), a group that received intravenous lidocaine 1.5 mg/kg, and a group that received intravenous esmolol 0.5 mg/kg and lidocaine 1.5 mg/kg. Agitation was measured using the objective pain score, Cole 5-point score, and Richmond Agitation Sedation Scale score at the end of surgery, on arrival in the recovery room, and 10 and 30 min after arrival.@*RESULTS@#The group that received the combination of esmolol and lidocaine showed lower OPS and RASS scores than the other two groups when patients awoke from anesthesia (OPS = 0 (0-4), RASS = -4 [(-5)-1]) and were transferred to the recovery room (OPS = 0 (0-8), RASS = -1 [(-5)-3]) (P  0.05).@*CONCLUSIONS@#When pediatric strabismus surgery is accompanied by sevoflurane anesthesia, an intravenous injection of esmolol and lidocaine could alleviate agitation until arrival in the recovery room.@*TRIAL REGISTRATION@#Clinical Research Information Service, No. KCT0002925; https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=11532.

Case Reports on the Effect of Stellate Ganglion Block in Patient with Postherpetic Neuralgia Accompanied by Itching

Herpes zoster is a disease that involves reactivation of the varicella-zoster virus and induces pain by injuring the nerve ganglia. We present the case of a 52-year-old woman without a notable medical history. She complained of painful itches that were causatively associated with infiltration to the ophthalmic nerve of the trigeminal nerve. Furthermore, the patient did not positively respond to antiviral agents, analgesics, and anticonvulsants. However, after inducing a stellate ganglion block, her Visual Analog Scale for pain and itching reduced from a scale of 8 to 2.

The Effect of the Valsalva Maneuver on the External Jugular Vein / 대한구급학회지

BACKGROUND: The external jugular vein (EJV) is a useful intravenous (IV) cannulation site for anesthesiologists, although it has a relatively high failure rate. Unlike other central veins, visualization of the EJV is important during IV cannulation, and the Valsalva maneuver distends the jugular venous system. However, the relationship between the maneuver and EJV visibility remains unknown. This study compared EJV visibility before and after the Valsalva maneuver. METHODS: This was a prospective observational study that included 200 participants. After the induction of anesthesia, EJV visibility grade, depth from the skin to the EJV superficial surface (EJV depth), and EJV cross-sectional area (CSA) before the Valsalva maneuver were measured. The same parameters were measured after the Valsalva maneuver was performed. The EJV visibility grade was defined as grade A: good appearance and good palpation, grade B: poor appearance and good palpation, and grade C: poor appearance and poor palpation. RESULTS: Patient body mass index and EJV depth affected the EJV visibility grade before the Valsalva maneuver (p < 0.05), although EJV CSA did not. The Valsalva maneuver distended EJV CSA and reduced EJV depth, although these changes were not correlated with EJV visibility grade. With regard to EJV visibility, 34.0% of grade B cases and 20.0% of grade C cases were improved by the Valsalva maneuver. CONCLUSIONS: Although the Valsalva maneuver improved EJV CSA and EJV depth, it did not greatly affect EJV visibility grade.

The Effect of the Valsalva Maneuver on the External Jugular Vein / 대한중환자의학회지

BACKGROUND: The external jugular vein (EJV) is a useful intravenous (IV) cannulation site for anesthesiologists, although it has a relatively high failure rate. Unlike other central veins, visualization of the EJV is important during IV cannulation, and the Valsalva maneuver distends the jugular venous system. However, the relationship between the maneuver and EJV visibility remains unknown. This study compared EJV visibility before and after the Valsalva maneuver. METHODS: This was a prospective observational study that included 200 participants. After the induction of anesthesia, EJV visibility grade, depth from the skin to the EJV superficial surface (EJV depth), and EJV cross-sectional area (CSA) before the Valsalva maneuver were measured. The same parameters were measured after the Valsalva maneuver was performed. The EJV visibility grade was defined as grade A: good appearance and good palpation, grade B: poor appearance and good palpation, and grade C: poor appearance and poor palpation. RESULTS: Patient body mass index and EJV depth affected the EJV visibility grade before the Valsalva maneuver (p < 0.05), although EJV CSA did not. The Valsalva maneuver distended EJV CSA and reduced EJV depth, although these changes were not correlated with EJV visibility grade. With regard to EJV visibility, 34.0% of grade B cases and 20.0% of grade C cases were improved by the Valsalva maneuver. CONCLUSIONS: Although the Valsalva maneuver improved EJV CSA and EJV depth, it did not greatly affect EJV visibility grade.

Erratum: Efficacy of noninvasive pulse co-oximetry as compared to invasive laboratory-based hemoglobin measurement during spinal anesthesia

We have corrected the subject area.

Efficacy of noninvasive pulse co-oximetry as compared to invasive laboratory-based hemoglobin measurement during spinal anesthesia

BACKGROUND: The Masimo Radical 7 (Masimo Corp., Irvine, CA, USA) pulse co-oximeter(R) noninvasively determines the hemoglobin concentration using the principle of transcutaneous spectrophotometry. We compared hemoglobin levels determined using this device (SpHb) with those determined using an invasive laboratory-based technique (tHb) during spinal anesthesia. METHODS: Thirty patients received spinal anesthesia with 0.5% hyperbaric bupivacaine. The pulse co-oximeter probe was mounted on the second toe, and arterial blood samples were obtained from a radial artery catheter. SpHb, tHb, and perfusion index (PI) values were recorded before and 20 and 40 min after intrathecal injection of bupivacaine. RESULTS: Before spinal anesthesia, the SpHb and tHb showed a significant difference of -2.86 +/- 1.56 g/dl (P < 0.005), but no significant differences were found between tHb and SpHb at 20 and 40 min after spinal anesthesia (-0.16 +/- 2.45 g/dl and 0.29 +/- 2.68 g/dl). Additionally, PI was significantly increased at 20 and 40 min after spinal anesthesia compared to the pre-anesthetic value (P < 0.001). CONCLUSIONS: The toe is not the monitoring site for pulse co-oximetry in adult patients, but the pulse co-oximetry on the toe appears to be appropriate as a noninvasive hemoglobin monitoring device after spinal anesthesia.