The Greek e-journal of Perioperative Medicine

37-43

Authors: Soilemezi E, Tsagourias M, Matamis D

Ultrasonography is a useful tool in order to provide information regarding diaphragm function, especially in cases where local pathology coexists, as in pleural effusions or traumatic rupture. Ultrasound can also be used as a method for analyzing diaphragmatic movement using M-mode. M-mode sonography appears to be a simple, well tolerated, reproducible method of assessing hemidiaphragmatic movement. Its advantages are lack of risk from ionizing radiation, portability and direct quantitative information regarding the amplitude, duration and velocity of hemidiaphragmatic movement. By quantifying diaphragm function, one might be able to predict the timing for successful weaning from mechanical ventilation, evaluate diaphragm function during drug therapy, and assess mechanical ventilation strategies designed to strengthen the diaphragm.

49-69

Authors: Theodosiadis P, Samoladas E, Grosomanidis V, Karakoulas K, Vasilakos D

Chronic pain causes extreme suffering for millions of people worldwide. It is the leading cause for lost workdays and patients often undergo expensive courses of treatment. Because chronic pain is often difficult to relieve for sustained periods of time, it can have a significant impact on person’s quality of life. Current primary methods for treatment include drugs (usually opioids or antiinflammatory medications), surgical intervention, physical therapy and psychotherapy. However, more invasive treatments may be needed for patients with severe intractable pain who do not respond to these less invasive treatments. Since Melzack and Wall’s Gate Theory of Pain was first proposed, an improved understanding of neuroscience has lead to development of implantable ‘neuromodulatory’ technologies for refractory pain. Simply put, such technologies involve drug delivery to, electrical stimulation of neural pathways. In the pain management context, neuromodulation aims to reduce afferent activity within pain pathways by targeted electrical neurostimulation or drug delivery into CSF. Targets for implanted neurostimulators include the spinal cord, peripheral nerves or brain, while implantable pumps deliver analgesic drugs to intrathecal or intracerebroventricular sites. Implantable neuromodulation therapies are expensive, invasive and prone to side effects and complications. Clinicians and health professionals involved with implantation and aftercare of such devices require a high level of expertise. In spite of these challenges the uptake of these therapies continues to rise worldwide as does the evidence for cost effectiveness due to reduced expenditure on conventional medical management. This article will describe types of electrical neurostimulation in terms of “neuromodulation techniques” such as spinal cord stimulation, peripheral nerve stimulation, targeted stimulation and external neuromodulation procedures.

79-85

Authors: Papagiannopoulou P, Sfyra E, Georgi ou M, Georgiadou Th, Kanakoudis F

The objective of this study was to evaluate onset times and tracheal intubating conditions after administration of rocuronium or mivacurium in children of different ages. In this randomized double-blind study, 40 healthy (ASA I) children aged 1 to 14 years were studied. They were divided, according to age, into two groups: Group A (n=20) included patients 1 to 3 years of age and Group B (n=20) 4 to 14 years of age. After general anesthesia induction patients in both groups were further divided into two subgroups. So, half of patients (n=10) of each group were randomly assigned to receive a bolus of either rocuronium 0.6 mg*Kg-1 or mivacurium 0.2 mg*Kg-1. The onset time of neuromuscular blockade (from 100% to 0% response) was assessed by the accelerographic response (100-0%) of the adductor pollicis, stimulating the ulnar nerve with single twitch stimuli. Tracheal intubating conditions were assessed as good, excellent or poor, 60 sec after the initial dose of relaxant by an anaesthetist who was unaware of patient group. Statistical analysis was performed with Student t-test or Fisher’s exact test, where appropriate. Statistical significance was assumed at the level of p<0.05. Demographic data were similar between subgroups of each range of age. Intubating conditions did not differ significantly between groups although the incidence of excellent grade intubations was higher with rocuronium. The onset time of neuromuscular blockade was found significantly shorter in the subgroup of rocuronium compared with mivacurium, while for the same drug regimen no significant difference was found between groups A and B. This study demonstrates that, regardless children΄s age, the onset time of rocuronium is shorter than mivacurium, while both drugs provide within 60 sec excellent intubating conditions in the majority of cases.

92-94

Authors: Flossos A., Ganeli G., Mintza V., Vretzakis G.

Horner’s syndrome or occulo-sympathetic paralysis is a disorder occurring infrequently as a complication of epidural anaesthesia. The incidence increases when epidural analgesia is used in obstetrics possibly because of physiological and anatomical changes in obstetric patients favouring spread of the local anaesthetic. We report the case of a 27 year old woman receiving epidural analgesia for labour who developed transient, uncomplicated Horner’s syndrome. Although it is a relatively benign and transient condition not warranting further investigation, it may indicate high sympathetic blockade resulting in significant maternal hypotension.