One of the effects of hyperbaric environment is considered to be peripheral vasoconstriction due to high oxygen tension. It was proposed that this could yield to changes in vascular properties, and to further investigate the issue we examined stiffness index (SI) and reflection index (RI) as calculated from a finger photoplethysmography under normobaric and hyperbaric environment. Eight subjects participated in the study comprising three different conditions spread over one session ‐ breathing air at 1 ATA, breathing air at 2 ATA and breathing 100% oxygen at 2 ATA. Each condition lasted for at least 10 minutes. Photoplethysmography and EKG were continuously recorded using Biopac MP100 multi‐modular system (BIOPAC Systems Inc., Goleta, CA). The compression was done in a multi‐place hyperbaric chamber (Clucas Diving Ltd). The results showed no overall differences in SI and RI when comparing the three conditions. For each subject however there were significant changes in the studied parameters, although in different directions. These findings suggest that SI and RI do change in hyperbaric environment. They also argue that at short exposure and low pressure the vascular effects most probably were not fully developed in order to overcome the inter‐individual differences. Such notion was also supported by the observed stable heart rate in all three conditions and the concomitant small changes in heart rate variability. Grant Funding Source: Saba Ubniversity School of Medicine
BackgroundRegional anesthesia allows for opioid‐sparing and enhanced recovery after many major surgeries. Erector spinae blockade, with reduced bleeding risk and the option for continuous infusion, offers an opportunity to promote this principle in pediatric liver transplant patients. Our goal was to evaluate pain scores, opioid use, and return of bowel function following continuous ESP blockade in pediatric liver transplant recipients.MethodsThis retrospective cohort study included extubated patients who received a liver transplant at St. Louis Children's Hospital from July 2016 to July 2021. The control group, which did not meet the criteria for ESP blockade and received standard analgesia regimens, was compared to the group receiving continuous ESP blockade. Measured outcomes included pain scores, opioid consumption through postoperative day two, date of first bowel movement, and length of stay in the ICU and the hospital.ResultsPatient demographics between control and ESP groups showed no significant differences. Pain scores between control and ESP groups also showed no significant differences. Intraoperative and postoperative opioid requirements, studied in oral morphine equivalents per kilogram (OME/kg), were significantly lower for patients with ESP blockade. Time to first bowel movement was also significantly earlier for the ESP group. No significant differences were found in length of ICU or hospital stay. There were no safety concerns or complications related to ESP blockade.ConclusionsUse of continuous ESP blockade resulted in reduced opioid consumption through postoperative day two and earlier return of bowel function.
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