Advances in Anesthesiology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Effect of Normal Saline Bicarbonate on Reversing Epidural Anesthesia Either with Bupivacaine Or Bupivacaine and Nalbuphine in Patients Undergoing Orthopedic Surgery Mon, 02 Mar 2015 11:52:39 +0000 Background. Orthopedic procedures are among the commonest surgeries in the elderly. On the other hand, those patients have many risk factors suitable for development of postoperative complication due to prolonged postoperative recumbent that decrease by using anesthesia technique allowed early ambulation as far as possible.  Aim of the Work. The aim of this study was to evaluate whether washout of the local anesthesia with 0.9% normal saline with bicarbonate through the epidural catheter could provide early ambulation throughout the faster recovery of the motor block. Patient and Methods. Sixty adult patients were included in this study and divided into three groups. In group I, epidural injection of bupivacaine was carried out without wash (control group). In group II, epidural injection of bupivacaine was followed by wash. In group III, epidural injection of both bupivacaine and nalbuphine was followed by wash. Results. They were significantly faster in both group II and group III as compared with group I. In group I, sensory recovery was insignificantly faster than the motor recovery. In group II motor recovery was significantly faster than sensory recovery. In group III motor recovery was significantly faster than the sensory recovery. Conclusions. These results suggested that early ambulation with an adequate postoperative analgesia was reported in patient receiving epidural injection of both bupivacaine and nalbuphine. Josef Attia, Ahamed Mohamed, and Yaser Bader Copyright © 2015 Josef Attia et al. All rights reserved. Mutations in Sodium Channel Gene SCN9A and the Pain Perception Disorders Sun, 15 Feb 2015 13:33:37 +0000 Voltage-gated sodium channels (NaV) play a crucial role in development and propagation of action potentials in neurons and muscle cells. NaV1.7 channels take a special place in modern science since it is believed that they contribute to nerve hyperexcitability. Mutations of the gene SCN9A, which codes the α subunit of NaV1.7 channels, are associated with pain perception disorders (primary erythermalgia, congenital analgesia, and paroxysmal pain disorder). It is considered that the SCN9A gene mutations may cause variations in sensitivity to pain, from complete insensitivity to extreme sensitivity. Further research of the SCN9A gene polymorphism influence on pain sensitivity is essential for the understanding of the pathophysiology of pain and the development of the appropriate targeted pain treatment. Danica Marković, Radmilo Janković, and Ines Veselinović Copyright © 2015 Danica Marković et al. All rights reserved. Pediatric Resuscitation: Outcome Effects of Location, Intervention, and Duration Sun, 08 Feb 2015 09:19:04 +0000 Cardiopulmonary resuscitation (CPR) is performed in order to restore oxygen delivery and prevent multiorgan system failure and death. Prompt initiation of CPR with appropriate medical or surgical therapy may shorten arrest duration before irreversible organ injury occurs. The brain is most susceptible to irreversible anoxic injury. Survival data suggests that children are more likely than adults to survive and have good neurologic outcomes following cardiac arrest. In this review of pediatric resuscitation, we discuss important predictors of postarrest outcomes as well as advances in resuscitation science focusing on the critical importance of oxygen delivery during periarrest care. John P. Scott, Lindsey Loveland Baptist, and Richard J. Berens Copyright © 2015 John P. Scott et al. All rights reserved. Comparison of 0.1% Ropivacaine-Fentanyl with 0.1% Bupivacaine-Fentanyl Epidurally for Labour Analgesia Sun, 14 Dec 2014 09:07:37 +0000 Ropivacaine is an alternative to epidural bupivacaine, with greater selectivity for sensory fibres than motor fibres, thus producing less motor blockade as compared to bupivacaine. The purpose of this study was to evaluate the efficacy of Ropivacaine 0.1% when administered epidurally for the relief of labour pain and to compare it with 0.1% bupivacaine, conducted at Rajindra Hospital Patiala, Baba Farid University of Health and Sciences, on 20 parturients after ethical approval from the institutional review board and obtaining written informed consent. Participants were randomly allocated to the two groups (bupivacaine 0.1% (Sensorcaine) + fentanyl 20 μg versus ropivacaine 0.1% (Ropin) + fentanyl 20 μg). It was observed that ropivacaine 0.1% and bupivacaine 0.1%, with fentanyl 20 μg/mL, produced equivalent analgesia for labour. There were no statistically significant differences in the amount of local anaesthetic used, pain scores, sensory levels, motor blockade, labour duration, mode of delivery, and side effects or patient satisfaction amongst the two local anaesthetics using the intermittent top-up technique. We conclude that the combinations of ropivacaine or bupivacaine with fentanyl achieve equally effective and excellent labour analgesia with no motor blockade and without jeopardizing the safety of the mother and foetus and, hence, are recommended for labour analgesia. Isha Chora and Akhlak Hussain Copyright © 2014 Isha Chora and Akhlak Hussain. All rights reserved. Epidural Anesthesia-Analgesia and Patient Outcomes: A Perspective Mon, 09 Jun 2014 05:18:03 +0000 The use of perioperative epidural anesthesia-analgesia may confer many benefits including superior postoperative analgesia, decreased morbidity, and improvement in patient-centered outcomes. We will review our group’s work on perioperative epidural anesthesia-analgesia on patient outcomes and discuss future research in this area Christopher L. Wu and Jamie D. Murphy Copyright © 2014 Christopher L. Wu and Jamie D. Murphy. All rights reserved. Outcomes Research in Perioperative Medicine Wed, 14 May 2014 14:15:07 +0000 Outcomes research is emerging as an invaluable approach to the scientific evaluation of healthcare in a real-world rather than an experimental environment. There is much interest in the differential evaluation of existing interventions with regard to different patient populations. Moreover, various comorbid conditions necessitate analysis for the specific additional risk those factors convey in the perioperative arena, a task often difficult to accomplish without population-based techniques. The authors' group has conducted significant work in perioperative outcomes research utilizing CER and database analysis methodology, with focus on orthopedic surgery and anesthesiology. Our research resulted in numerous publications affecting policy and patient care over the last number of years. Knowledge on immediate perioperative outcomes of anesthesia and surgery is of very high interest not only to clinicians but also to administrators and policymakers, as it allows for risk assessment and allocation of resources. This review is not intended to be a systematic review but rather to (1) provide a brief overview over the theoretical basis of CER and population-based database research, (2) give an overview of our work with various points of focus, and (3) offer a perspective on the future development in perioperative medicine. Ottokar Stundner and Stavros G. Memtsoudis Copyright © 2014 Ottokar Stundner and Stavros G. Memtsoudis. All rights reserved.