To assess the efficacy and safety of local anaesthetics for premature ejaculation （PE）, a systematic review of the literature was performed using the Cochrane Library, PUBMED and EMBASE. We screened and retrieved th...To assess the efficacy and safety of local anaesthetics for premature ejaculation （PE）, a systematic review of the literature was performed using the Cochrane Library, PUBMED and EMBASE. We screened and retrieved the randomized controlled trials on the treatment of PE with local anaesthetics. End points included intravaginal ejaculation latency time （IELT）, patient-reported outcome assessments and adverse events. Meta-analyses were conducted with Stata 11.0. In total, seven publications involving 566 patients with local anaesthetics and 388 with placebos strictly met our eligibility criteria. Meta-analyses showed that after the patients were treated with the local anaesthetics, the value of the standardized mean difference of the changes in IELT was 5.02 （95% Ch 3.03- 7.00）. A higher rate of adverse events occurred compared with placebos （odds ratio： 3.30, 95% Ch 1.71-6.36）, but these events were restricted to local side effects. In addition, significantly greater improvement was observed in patient-reported outcomes. In summary, local anaesthetics can prolong IELT and improve ejaculatory control and sexual satisfaction.展开更多
There is a generally accepted conclusion that trifluoroacetic acid (TFA) does occur naturally, in part based on the large quantities of TFA in the oceans (61 - 205 million tonnes, measured in 1998-2002). However, the ...There is a generally accepted conclusion that trifluoroacetic acid (TFA) does occur naturally, in part based on the large quantities of TFA in the oceans (61 - 205 million tonnes, measured in 1998-2002). However, the recent review paper “Insufficient evidence for the existence of natural trifluoroacetic acid” concludes that “the presence of TFA in the deep ocean and lack of closed TFA budget is not sufficient evidence that TFA occurs naturally, especially without a reasonable mechanism of formation”. Industrial sources of TFA can only result from the use of fluoride minerals in industrial processes. Major industrial uses of fluorspar started significant expansion from about the same time (1930s). Over 190 million tonnes of fluorspar have been mined in the period 1930 to 1999. An inventory has been developed (1930-1999), accounting for most of the fluorspar production (86%) and estimating emissions of TFA. Industrial emissions of TFA are estimated as 230,000 to 470,000 tonnes. Significant other industrial uses of fluorides have not been identified that could account for the large burden of TFA in the oceans. This inventory provides complementary evidence that the quantity of TFA in the oceans must include a large natural burden.展开更多
The immune system plays a pivotal role against cancer. The development of a successful immune response involves the balance between the Th1 (antitumor) and Th2 (protumor) responses. Once this balance is lost, diseases...The immune system plays a pivotal role against cancer. The development of a successful immune response involves the balance between the Th1 (antitumor) and Th2 (protumor) responses. Once this balance is lost, diseases such as cancer may become apparent. Surgical stress, volatile anaesthetics, opioids and blood transfusions are known to favour a Th2 response that manifests as immune suppression. During surgery the load of circulating malignant cancer cells is increased by tumour manipulation. These cancer cells can migrate and seed in distant tissues and form metastasis. Also, some cancer patients may present with micrometastasis that may become invasive if left untreated. Therefore, the perioperative period is a moment of immunological vulnerability in cancer patients. A better understanding of the factors that affect the Th1/Th2 balance may allow anaesthesiologists to identify patients at high risk for cancer recurrence. This review describes the perioperative interventions that can alter the Th1/Th2 balance, during the perioperative period of oncological surgery.展开更多
Type I Arnold-Chiari malformation (ACM) usually presents in adulthood and consists of a downward displacement of the cerebellar tonsils through the foramen magnum. A 25-year-old woman presented with a 5-month history ...Type I Arnold-Chiari malformation (ACM) usually presents in adulthood and consists of a downward displacement of the cerebellar tonsils through the foramen magnum. A 25-year-old woman presented with a 5-month history of headache associated with blurred vision, tinnitus and sickness. Imaging recognised the need for surgical intervention, but whilst awaiting for surgery she fell pregnant. Considering the risks of neurological deterioration, the woman underwent surgical decompression of type I ACM at 15 weeks gestation. She subsequently presented with progressively worsening headaches during late pregnancy from 35 weeks. The obstetric plan was initially induction of labour at term but since the onset of worsening symptoms, this date was brought forward to 39 + 1 weeks gestation. She proceeded to have a normal delivery with no neonatal complications and an uneventful puerperium followed. Since the delivery, the patient reported fewer symptoms, showed no signs of neurological deficit and a repeat magnetic resonance imaging of the head showed good relief of neural compression. This case illustrates how judicious selection of the appropriate mode of delivery of women following surgically corrected ACM and a multidisciplinary approach is critical in the successful management of the antepartum period and labour.展开更多
An 80 years old, bronchial asthmatic, male was posted for left cataract extraction with intra ocular lens implantation. He was administered peribulbar block/left facial nerve block. There was no sensory or motor block...An 80 years old, bronchial asthmatic, male was posted for left cataract extraction with intra ocular lens implantation. He was administered peribulbar block/left facial nerve block. There was no sensory or motor block. Thereafter peribulbar block was repeated. Only partial akinesia was achieved, so under intermittent intra venous sedation, the surgery continued for 40 minutes. In the post-operative period, no signs of any residual/delayed block were noted. On specific enquiry, patient gave history of scorpion bite thrice, at the age of 27 years on his right foot, about 8-9 years back and again about 6-7 months back on his right hand. On 4th post-operative day after obtaining informed consent, local infiltration of the skin on the ventral aspect of the forearm, using, 6 mL, 2% lignocaine with adrenaline, was carried out. Confirming the suspicion, there was no sensory block after the injection, confirmed by pin prick method. Peribulbar block produces adequate intra-operative analgesia for cataract extraction. The cause of the failures may be due to technical inability to achieve block. However failure that occurs despite of technically correct injection of the correct drug can be mystifying. As the scorpion venom is known to affect the pumping mechanism of sodium channels in the nerve fibres, which are involved in the mechanism of action of local anaesthetic drugs, it may be responsible for the development of “resistance” to the action of local anaesthetic agents.展开更多
AIM To assess the feasibility and parental acceptance of diagnostic microlaryngobronchoscopy(MLB) as day case surgery.METHODS A prospective study was performed over a 26 moperiod at a tertiary paediatric ENT centre. P...AIM To assess the feasibility and parental acceptance of diagnostic microlaryngobronchoscopy(MLB) as day case surgery.METHODS A prospective study was performed over a 26 moperiod at a tertiary paediatric ENT centre. Patients were selected in clinic using set criteria. All MLBs were performed using a standardised anaesthetic protocol and patients monitored post-operatively. Six weeks following surgery, parents underwent questionnaire surveys.RESULTS Ninety-four out of 101 MLBs was successfully performed as day case surgery over the set period. Seven patients required an overnight stay for further observation. Fiftyseven parents took part in the questionnaire of which 68.4% were highly satisfied with same day discharge. CONCLUSION MLB is feasible, safe and acceptable as day case surgery in carefully selected patients.展开更多
Background: Transcatheter Aortic Valve Replacement (TAVR) is a new minimally-invasive surgical procedure in which a bioprosthetic aortic valve is placed via a small skin incision in the groin, over either the left or ...Background: Transcatheter Aortic Valve Replacement (TAVR) is a new minimally-invasive surgical procedure in which a bioprosthetic aortic valve is placed via a small skin incision in the groin, over either the left or right iliac artery. TAVR was recently approved by the FDA as a treatment option for aortic stenosis in patients who may be too frail to undergo open heart surgery. Anesthetic management of TAVR is complicated by the fact that rapid left ventricular pacing (to at least 180 beats per minute) is required at multiple points throughout the procedure. Aim: This rapid pacing creates a profound pathophysiologic stress on the heart, sometimes leading to severe left ventricular dysfunction and resultant complete hemodynamic collapse. We report that the use of prophylactic infusion of epinephrine and/or norepinephrine in patients undergoing TAVR results in improved recovery from rapid pacing as reflected by intraoperative trends in systolic systemic blood pressure and systolic pulmonary arterial pressure. Cases: Here we report three cases. During the first of these, we reacted to intraoperative hemodynamic changes by administering boluses of vasoactive medications as needed. During the other two cases, we preemptively infused vasopressors to facilitate a more rapid recovery from some of the hemodynamic disturbance associated with either TAVR or rapid pacing. Conclusion: The two patients in this series who were managed with a preemptive strategy had higher ratios of systemic systolic blood pressure to pulmonary arterial systolic blood pressure at the end of the case than did the patient who was managed reactively. This suggests that the preemptive strategy may lead to decreased left ventricular impairment and improved overall cardiac function after TAVR.展开更多
Introduction and Background: Lidocaine was recognised only as a local anesthetic and anti-arrhythmic drug for past decades. Nonetheless, more recently its utility in perioperative setting is being appreciated globally...Introduction and Background: Lidocaine was recognised only as a local anesthetic and anti-arrhythmic drug for past decades. Nonetheless, more recently its utility in perioperative setting is being appreciated globally. This review aims to analyse its work beyond its traditional use when employed intravenously in perioperative setting and overall impact on postoperative period. Content: A total of 41 articles were selected for study while 13 of them were chosen for data presentation. Databases such as CENTRAL, MEDLINE/Pubmed, LILACS, Ovid and Scielo were used to search the articles using keywords like Intravenous lidocaine, local anesthetics, perioperative analgesia or postoperative pain. A bolus dose of 1.5 mg/kg and maintenance dose of 2 - 3 mg/kg/h of intravenous lidocaine was used to bring out its analgesic effect and its positive impact on postoperative stage in nearly all the selected studies. Its anti-inflammatory, antinociceptive and immunomodulatory effects were also addressed. Conclusion: Perioperative implication of systemic lidocaine not only lessens pain perception but also assures early return of bowel function, lower incidence of postoperative nausea and vomiting, opioid sparing effect and shorter length of hospital stay. Thus, implementation of lidocaine as a part of perioperative approach should be seriously considered. Its role in surgeries other than abdominal needs more detailed study. In spite of current results encouraging, it may be too early to claim its similar impact in other types of surgeries.展开更多
文摘To assess the efficacy and safety of local anaesthetics for premature ejaculation （PE）, a systematic review of the literature was performed using the Cochrane Library, PUBMED and EMBASE. We screened and retrieved the randomized controlled trials on the treatment of PE with local anaesthetics. End points included intravaginal ejaculation latency time （IELT）, patient-reported outcome assessments and adverse events. Meta-analyses were conducted with Stata 11.0. In total, seven publications involving 566 patients with local anaesthetics and 388 with placebos strictly met our eligibility criteria. Meta-analyses showed that after the patients were treated with the local anaesthetics, the value of the standardized mean difference of the changes in IELT was 5.02 （95% Ch 3.03- 7.00）. A higher rate of adverse events occurred compared with placebos （odds ratio： 3.30, 95% Ch 1.71-6.36）, but these events were restricted to local side effects. In addition, significantly greater improvement was observed in patient-reported outcomes. In summary, local anaesthetics can prolong IELT and improve ejaculatory control and sexual satisfaction.
文摘There is a generally accepted conclusion that trifluoroacetic acid (TFA) does occur naturally, in part based on the large quantities of TFA in the oceans (61 - 205 million tonnes, measured in 1998-2002). However, the recent review paper “Insufficient evidence for the existence of natural trifluoroacetic acid” concludes that “the presence of TFA in the deep ocean and lack of closed TFA budget is not sufficient evidence that TFA occurs naturally, especially without a reasonable mechanism of formation”. Industrial sources of TFA can only result from the use of fluoride minerals in industrial processes. Major industrial uses of fluorspar started significant expansion from about the same time (1930s). Over 190 million tonnes of fluorspar have been mined in the period 1930 to 1999. An inventory has been developed (1930-1999), accounting for most of the fluorspar production (86%) and estimating emissions of TFA. Industrial emissions of TFA are estimated as 230,000 to 470,000 tonnes. Significant other industrial uses of fluorides have not been identified that could account for the large burden of TFA in the oceans. This inventory provides complementary evidence that the quantity of TFA in the oceans must include a large natural burden.
文摘The immune system plays a pivotal role against cancer. The development of a successful immune response involves the balance between the Th1 (antitumor) and Th2 (protumor) responses. Once this balance is lost, diseases such as cancer may become apparent. Surgical stress, volatile anaesthetics, opioids and blood transfusions are known to favour a Th2 response that manifests as immune suppression. During surgery the load of circulating malignant cancer cells is increased by tumour manipulation. These cancer cells can migrate and seed in distant tissues and form metastasis. Also, some cancer patients may present with micrometastasis that may become invasive if left untreated. Therefore, the perioperative period is a moment of immunological vulnerability in cancer patients. A better understanding of the factors that affect the Th1/Th2 balance may allow anaesthesiologists to identify patients at high risk for cancer recurrence. This review describes the perioperative interventions that can alter the Th1/Th2 balance, during the perioperative period of oncological surgery.
文摘Type I Arnold-Chiari malformation (ACM) usually presents in adulthood and consists of a downward displacement of the cerebellar tonsils through the foramen magnum. A 25-year-old woman presented with a 5-month history of headache associated with blurred vision, tinnitus and sickness. Imaging recognised the need for surgical intervention, but whilst awaiting for surgery she fell pregnant. Considering the risks of neurological deterioration, the woman underwent surgical decompression of type I ACM at 15 weeks gestation. She subsequently presented with progressively worsening headaches during late pregnancy from 35 weeks. The obstetric plan was initially induction of labour at term but since the onset of worsening symptoms, this date was brought forward to 39 + 1 weeks gestation. She proceeded to have a normal delivery with no neonatal complications and an uneventful puerperium followed. Since the delivery, the patient reported fewer symptoms, showed no signs of neurological deficit and a repeat magnetic resonance imaging of the head showed good relief of neural compression. This case illustrates how judicious selection of the appropriate mode of delivery of women following surgically corrected ACM and a multidisciplinary approach is critical in the successful management of the antepartum period and labour.
文摘An 80 years old, bronchial asthmatic, male was posted for left cataract extraction with intra ocular lens implantation. He was administered peribulbar block/left facial nerve block. There was no sensory or motor block. Thereafter peribulbar block was repeated. Only partial akinesia was achieved, so under intermittent intra venous sedation, the surgery continued for 40 minutes. In the post-operative period, no signs of any residual/delayed block were noted. On specific enquiry, patient gave history of scorpion bite thrice, at the age of 27 years on his right foot, about 8-9 years back and again about 6-7 months back on his right hand. On 4th post-operative day after obtaining informed consent, local infiltration of the skin on the ventral aspect of the forearm, using, 6 mL, 2% lignocaine with adrenaline, was carried out. Confirming the suspicion, there was no sensory block after the injection, confirmed by pin prick method. Peribulbar block produces adequate intra-operative analgesia for cataract extraction. The cause of the failures may be due to technical inability to achieve block. However failure that occurs despite of technically correct injection of the correct drug can be mystifying. As the scorpion venom is known to affect the pumping mechanism of sodium channels in the nerve fibres, which are involved in the mechanism of action of local anaesthetic drugs, it may be responsible for the development of “resistance” to the action of local anaesthetic agents.
文摘AIM To assess the feasibility and parental acceptance of diagnostic microlaryngobronchoscopy(MLB) as day case surgery.METHODS A prospective study was performed over a 26 moperiod at a tertiary paediatric ENT centre. Patients were selected in clinic using set criteria. All MLBs were performed using a standardised anaesthetic protocol and patients monitored post-operatively. Six weeks following surgery, parents underwent questionnaire surveys.RESULTS Ninety-four out of 101 MLBs was successfully performed as day case surgery over the set period. Seven patients required an overnight stay for further observation. Fiftyseven parents took part in the questionnaire of which 68.4% were highly satisfied with same day discharge. CONCLUSION MLB is feasible, safe and acceptable as day case surgery in carefully selected patients.
文摘Background: Transcatheter Aortic Valve Replacement (TAVR) is a new minimally-invasive surgical procedure in which a bioprosthetic aortic valve is placed via a small skin incision in the groin, over either the left or right iliac artery. TAVR was recently approved by the FDA as a treatment option for aortic stenosis in patients who may be too frail to undergo open heart surgery. Anesthetic management of TAVR is complicated by the fact that rapid left ventricular pacing (to at least 180 beats per minute) is required at multiple points throughout the procedure. Aim: This rapid pacing creates a profound pathophysiologic stress on the heart, sometimes leading to severe left ventricular dysfunction and resultant complete hemodynamic collapse. We report that the use of prophylactic infusion of epinephrine and/or norepinephrine in patients undergoing TAVR results in improved recovery from rapid pacing as reflected by intraoperative trends in systolic systemic blood pressure and systolic pulmonary arterial pressure. Cases: Here we report three cases. During the first of these, we reacted to intraoperative hemodynamic changes by administering boluses of vasoactive medications as needed. During the other two cases, we preemptively infused vasopressors to facilitate a more rapid recovery from some of the hemodynamic disturbance associated with either TAVR or rapid pacing. Conclusion: The two patients in this series who were managed with a preemptive strategy had higher ratios of systemic systolic blood pressure to pulmonary arterial systolic blood pressure at the end of the case than did the patient who was managed reactively. This suggests that the preemptive strategy may lead to decreased left ventricular impairment and improved overall cardiac function after TAVR.
文摘Introduction and Background: Lidocaine was recognised only as a local anesthetic and anti-arrhythmic drug for past decades. Nonetheless, more recently its utility in perioperative setting is being appreciated globally. This review aims to analyse its work beyond its traditional use when employed intravenously in perioperative setting and overall impact on postoperative period. Content: A total of 41 articles were selected for study while 13 of them were chosen for data presentation. Databases such as CENTRAL, MEDLINE/Pubmed, LILACS, Ovid and Scielo were used to search the articles using keywords like Intravenous lidocaine, local anesthetics, perioperative analgesia or postoperative pain. A bolus dose of 1.5 mg/kg and maintenance dose of 2 - 3 mg/kg/h of intravenous lidocaine was used to bring out its analgesic effect and its positive impact on postoperative stage in nearly all the selected studies. Its anti-inflammatory, antinociceptive and immunomodulatory effects were also addressed. Conclusion: Perioperative implication of systemic lidocaine not only lessens pain perception but also assures early return of bowel function, lower incidence of postoperative nausea and vomiting, opioid sparing effect and shorter length of hospital stay. Thus, implementation of lidocaine as a part of perioperative approach should be seriously considered. Its role in surgeries other than abdominal needs more detailed study. In spite of current results encouraging, it may be too early to claim its similar impact in other types of surgeries.
