Anesthesia Complications in Head and Neck Surgery

Lobo, Errol; Pellegrini, Francesca; Pusceddu, Elisabetta

doi:10.1016/b978-141604220-4.50005-5

Cited by 2 publications

(4 citation statements)

References 95 publications

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“…This action of morphine is due to its potential to suppress the pain by inhibiting the pain impulse transmission in the spinal cord and by regulating the central pain processing (3). This analgesic property of morphine allows it to remain as the gold standard opioid therapy (4). Morphine is one of the naturally occurring alkaloids in opium poppy.…”

Section: Introductionmentioning

confidence: 99%

Renal protective effect of Trigonella foenum-graecum seed extract on morphine withdrawal in rats

Krishnan¹,

Jeppu²,

Halim³

et al. 2022

Biomedicine

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Introduction and Aim: Morphine is widely used as a drug for treating chronic pain in post-operative and cancer patients. Unfortunately, over time, prolonged use of morphine can cause nephrotoxicity due to elevated level of oxidative stress. Trigonella foenum-graecum (TFG) commonly known as ‘fenugreek’ is well-known for its antioxidative properties. This study evaluated the renal protective effects of TFG on the morphine induced rats. Materials and Methods: Male Sprague Dawley rats were divided into 5 Groups (n=8). The positive control and treatment Groups were administered morphine intraperitoneally for 7 consecutive days. The treatment Groups were administered aqueous extract of TFG orally for 21 days. The weight of the kidneys was measured, and histological changes were studied. The oxidative stress in the kidney tissue was studied by measuring the malondialdehyde (MDA), superoxide dismutase (SOD), total antioxidant capacity (TAC) and glutathione (GSH) in the tissue homogenate. Results: The kidney weights were significantly reduced in morphine administered rats compared to the aqueous TFG extract treated Groups. Histological examinations revealed a greater number of healthy glomeruli and thick renal tubules in the aqueous TFG extract treated rats. In morphine administered rats, the oxidative stress was higher with the MDA level significantly increased while the levels of SOD, TAC and GSH were reduced compared to normal rats. Conclusion: The aqueous TFG extract treatment reduced the oxidative stress in the kidneys of the morphine administered rats. The nephroprotective effects of aqueous TFG extract may be related to its antioxidant activity.

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Section: Introductionmentioning

confidence: 99%

Renal protective effect of Trigonella foenum-graecum seed extract on morphine withdrawal in rats

Krishnan¹,

Jeppu²,

Halim³

et al. 2022

Biomedicine

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“…The toxic effects of bupivacaine are apparent at a dose of 2 mg/kg administered w ithout epinephrine and 3 mg /kg w ith epinephrine. 3,4 Combining anesthetics means that the toxic effects are additive, such that 50% of the toxic dose of lidocaine with 50% of the toxic dose of bupivacaine is equal to the toxic dose for that patient.Epinephrine is described as a dilutional ratio (eg, 1:100 000) as opposed to a concentration (mg/kg). We are now using concentrated epinephrine (1:1000) and adding it to our anesthetic mixture.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

“…It is important to remember that the toxic effects of lidocaine are apparent at a dose of 4.5 to 5 mg/kg administered without epinephrine and 7 mg/kg with epinephrine. The toxic effects of bupivacaine are apparent at a dose of 2 mg/kg administered without epinephrine and 3 mg/kg with epinephrine . Combining anesthetics means that the toxic effects are additive, such that 50% of the toxic dose of lidocaine with 50% of the toxic dose of bupivacaine is equal to the toxic dose for that patient.…”

mentioning

confidence: 99%

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Local Anesthesia Shortages—Adapting to a New Way of Life

Carniol

Gantous

Adamson

2018

JAMA Facial Plast Surg

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To the Editor Over the past several months, there have been increasing numbers of medication shortages throughout North America, exacerbated (but not solely caused) by Hurricane Maria's effect on the pharmaceutical manufacturing industry on the island of Puerto Rico. 1,2 Medication shortages are affecting health care facilities in new ways on a weekly basis without imminent solutions. In particular, within the field of facial plastic and reconstructive surgery, we have noted a shortage in formulations of lidocaine and bupivacaine. We have received various sizes of bottles of these anesthetics in varying concentrations with varying concentrations of epinephrine, further complicating our "typical" anesthesia protocol. Our clinic's typical anesthesia was a 1:1 mixture of lidocaine, 1%, with a dilutional ratio of 1:100 000 and bupivacaine, 0.5%, with a dilutional ratio of 1:200 000.It is important to remember that the toxic effects of lidocaine are apparent at a dose of 4.5 to 5 mg/kg administered without epinephrine and 7 mg/kg with epinephrine. The toxic effects of bupivacaine are apparent at a dose of 2 mg/kg administered w ithout epinephrine and 3 mg /kg w ith epinephrine. 3,4 Combining anesthetics means that the toxic effects are additive, such that 50% of the toxic dose of lidocaine with 50% of the toxic dose of bupivacaine is equal to the toxic dose for that patient.Epinephrine is described as a dilutional ratio (eg, 1:100 000) as opposed to a concentration (mg/kg). We are now using concentrated epinephrine (1:1000) and adding it to our anesthetic mixture. The Table describes common dose equivalents for epinephrine when mixing with local anesthesia without epinephrine.After discussions with our staff on the medication shortages and current medication stock, new local anesthesia protocols were developed to maintain anesthetic and vasoconstrictive concentrations for our most common procedures, including rhinoplasty, upper and/or lower blepharoplasty, and cervicofacial rhytidectomy with or without blepharoplasty (Box).Our current protocol (based on our current stock of anesthetics) is posted within the operating room and discussed prior to each case by the surgeon, anesthesiologist, and nurse. The epinephrine (which is drawn up in an insulin syringe) and the local anesthetics are confirmed by 2 staff members prior to drawing up the medications and placing in a mixing bowl. Anesthesia is then injected in a graduated approach before a given stage of the surgery.We encourage all surgeons to make similar protocols, which will adjust as medications become available. We believe that a team approach with excellent communication between surgeons, anesthesiologists, and nurses is paramount to prevent medication-related complications. Finally, we must continue to alert the public and our respective governments about this worsening crisis.

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Anesthesia Complications in Head and Neck Surgery

Cited by 2 publications

References 95 publications

Renal protective effect of Trigonella foenum-graecum seed extract on morphine withdrawal in rats

Renal protective effect of Trigonella foenum-graecum seed extract on morphine withdrawal in rats

Local Anesthesia Shortages—Adapting to a New Way of Life

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