ABSTRACT
OBJECTIVES: Postoperative atrial fibrillation (POAF) is common following coronary artery bypass grafting (CABG) surgery. Hypomagnesemia is frequent after CABG surgery. No previous trials have assessed the effect of preoperative magnesium (Mg) loading on POAF incidence. METHODS: This was a single-centre, double-blind, placebo-controlled, parallel-group trial, with balanced randomization [1:1]. The participants were recruited from November 2018 until May 2019. Patients received either 3.2 g of Mg daily (4 tablets of 0.4 g each twice daily) for 72 h preoperatively and 1.6 g of Mg (4 tablets) on the day of surgery or placebo tablets. RESULTS: The primary outcome was the incidence of POAF. Secondary outcomes included time to extubation, transfusion rate, critical care unit and hospital length of stay. Of the 210 randomized participants, 200 (100 in each group) completed the study. A total of 10 (10%) and 22 (22%) subjects developed POAF in the Mg and placebo groups, respectively (RR = 0.45, 95% confidence interval: 0.23-0.91). Hospital and critical care unit length of stay were comparable between the 2 groups. No side effects related to Mg administration were documented. CONCLUSIONS: In this randomized controlled trial, preoperative loading with oral administration of Mg for 3 days in patients admitted for CABG surgery decreases the incidence of POAF compared to placebo. CLINICAL TRIAL REGISTRATION NUMBER: NCT03703349.
Subject(s)
Atrial Fibrillation , Humans , Atrial Fibrillation/epidemiology , Atrial Fibrillation/etiology , Atrial Fibrillation/prevention & control , Magnesium/therapeutic use , Prospective Studies , Postoperative Complications/epidemiology , Coronary Artery Bypass/adverse effectsABSTRACT
BACKGROUND: The role of type I thyroplasty (TIP) is well established as the treatment for glottal insufficiency due to vocal fold paralysis, but the ideal anesthetic management for this procedure is still largely debated. We present the case of a novel anesthetic approach for TIP using combined intermediate and superficial Cervical Plexus Block (CPB) and intermittent mild sedation analgesia. CASE REPORT: A 51-year-old presenting with left vocal fold paralysis and obstructive sleep apnea was scheduled for TIP. An ultrasound-guided intermediate CPB was performed using the posterior approach, and 15 mL of ropivacaine 0.5% were injected in the posterior cervical space between the sternocleidomastoid muscle and the prevertebral fascia. Then, for the superficial CPB, a total of 10 mL 0.5% ropivacaine was injected subcutaneously, adjacently to the posterior border of the sternocleidomastoid muscle, without penetrating the investing fascia. An intermittent sedation analgesia with a target-controlled infusion of remifentanyl (target 0.5 ng.mL-1) was used to facilitate prosthesis insertion and the fiberoptic laryngoscopy. This technique offered a safe anesthetic airway and good operating conditions for the surgeon, as well as feasible voice monitoring and optimal patient comfort. CONCLUSION: The use of regional technique is a promising method for the anesthetic management in TIP, especially in patients with compromised airway.
Subject(s)
Cervical Plexus Block/methods , Laryngoplasty/methods , Vocal Cord Paralysis/surgery , Anesthetics, Local/administration & dosage , Female , Humans , Middle Aged , Ropivacaine/administration & dosage , Ultrasonography, InterventionalABSTRACT
Abstract Background: The role of type I thyroplasty (TIP) is well established as the treatment for glottal insufficiency due to vocal fold paralysis, but the ideal anesthetic management for this procedure is still largely debated. We present the case of a novel anesthetic approach for TIP using combined intermediate and superficial Cervical Plexus Block (CPB) and intermittent mild sedation analgesia. Case report: A 51-year-old presenting with left vocal fold paralysis and obstructive sleep apnea was scheduled for TIP. An ultrasound-guided intermediate CPB was performed using the posterior approach, and 15 mL of ropivacaine 0.5% were injected in the posterior cervical space between the sternocleidomastoid muscle and the prevertebral fascia. Then, for the superficial CPB, a total of 10 mL 0.5% ropivacaine was injected subcutaneously, adjacently to the posterior border of the sternocleidomastoid muscle, without penetrating the investing fascia An intermittent sedation analgesia with a target-controlled infusion of remifentanyl (target 0.5 ng.mL-1) was used to facilitate prosthesis insertion and the fiberoptic laryngoscopy. This technique offered a safe anesthetic airway and good operating conditions for the surgeon, as well as feasible voice monitoring and optimal patient comfort. Conclusion: The use of a regional technique is a promising method for the anesthetic management in TIP, especially in patients with compromised airway.
Resumo Introdução: O papel da tireoplastia tipo I (TPI) está bem estabelecido no tratamento de insuficiência glótica após a paralisia das pregas vocais, mas o manejo anestésico ideal para a TPI ainda é controverso. Descrevemos uma nova técnica anestésica para a TPI usando o Bloqueio do Plexo Cervical (BPC) superficial e o BPC intermediário associados, em presença de analgo-sedação leve e intermitente. Relato de caso: Paciente de 51 anos de idade com paralisia da prega vocal esquerda e apneia obstrutiva do sono foi agendada para TPI. BPC intermediário guiado por ultrassom foi realizado usando acesso posterior, e 15 mL de ropivacaína a 0,5% foram injetados no espaço cervical posterior entre o músculo esternocleidomastoideo e a fáscia prevertebral. A seguir, para o BPC superficial, 10 mL de ropivacaína a 0,5% foram injetados na região subcutânea adjacente à borda posterior do músculo esternocleidomastoideo, sem transfixar a fáscia de revestimento. Analgo-sedação intermitente com infusão alvo-controlada de remifentanil (alvo de 0,5 ng.mL-1) foi usada para facilitar a inserção da prótese e a laringoscopia com fibra ótica. A técnica ofereceu via aérea segura durante a anestesia, boa condição para o cirurgião, possibilidade de monitorar a voz, além de ótimo conforto à paciente. Conclusões: O uso de anestesia regional é uma técnica promissora para o cuidado anestésico durante a TPI, especialmente em pacientes com via aérea comprometida.