No abstract

IntroductionProlonged intubation is associated with various ear, nose, and throat (ENT) complications, notably paresis or paralysis of the vocal cords [13,14]. Such complications may arise even after intubation of short duration [3,4,7] and regardless of the type of surgery. In reports of cervical spine surgery through the anterior approach, these complications have been noted and attributed to the surgical maneuvers as well as to intubation [1,2,10,11,12]. Moreover, these procedures may lead to other complications Abstract Cervical spinal surgery through anterior approaches can lead to ear, nose and throat (ENT) complications, some of which, such as obstruction of upper airways by edema, are potentially life threatening. The purpose of this study was to evaluate the incidence of various categories of ENT lesions and to determine whether preventive treatment with methylprednisolone (Mp) is useful in this indication. In a prospective trial, 236 patients who were undergoing anterior cervical spine surgery were separated into two groups, a control group (group I: 158 patients) and a group receiving 1 mg/kg of Mp intravenously at the end of the operation and 12 and 24 h later (group II: 78 patients). All 236 patients underwent nasofibroscopic examination by an ENT specialist the day before the operation and 24 and 36 h after the operation. The lesions observed during these examinations and reported symptoms such as uncomfortable sensation, odynophagia, or dysphagia were compared between the two groups (χ 2 or Mann-Whitney test) in terms of relative risk, with a confidence interval of 95%. Quantitative findings were compared using Student's t-test (P<0.05). Demographic characteristics and duration of endotracheal intubation were comparable in the two groups. The ENT examination was considered abnormal in 30 patients of group I and 15 patients of group II preoperatively (NS). It was abnormal in 146 patients of group I (92%) and 46 patients of group II (59%) postoperatively. Altered vocal cord motility was noted in six patients of group I and two patients of group II. The relative risk was 1.6 (CI: 1.3-1.9). Postoperatively, 130 patients in group I and 56 of group II (NS) reported unwanted symptoms. The observed lesions were significantly more severe in group I (P<0.001), involving primarily the pharyngeal wall, the arytenoids, and the vocal cords. The results of this study indicate that ENT complications of anterior cervical spinal surgery are diminished by administration of Mp. Systematic ENT examination is warranted before this type of operation.

This study evaluated the effects of propofol on somatosensory evoked cortical potentials in 20 ASA grade 1 or 2 patients who underwent spinal surgery. Anaesthesia consisted of propofol, dextromoramide, 50% nitrous oxide and oxygen mixture. The induction dose of propofol was 2 mg/kg and was followed by an infusion of 6 mg/kg for the first hour and 3 mg/kg subsequently. Somatosensory evoked cortical potentials were recorded on the scalp and compared to pre-operative values using Student's paired t-test. We observed a significant depression of evoked potential 10 minutes after induction, which continued until the early phase of recovery. Because of its short and quickly reversible action, propofol is an acceptable agent when clinical monitoring of the spinal cord is indicated but is not satisfactory when monitoring has to be based on somatosensory cortical evoked potentials.

The aim of this study was to improve knowledge of what happens in the coagulation of orthopaedic patients under rivaroxaban and apixaban, in order to finalize and cross-validate effective measurement methods and to provide arguments for helping to reference one or the other drug in our central pharmacy. One hundred and two patients undergoing total hip or knee replacement were included. Half of them received rivaroxaban and the other half received apixaban. Blood samples (n = 244 with each drug) were taken at Cmax preoperatively and twice a week, apart from the day of the patient's discharge, when Ctrough concentration was targeted. Routine coagulation parameters, and functional and liquid chromatography tandem mass spectrometry assays for measurement of circulating concentrations were studied. The LC-MS/MS assay and the functional assays carried out in patients under routine conditions were highly correlated, apart from low concentrations (<30 ng/ml), which were affected by the variable individual potential to inhibit the exogenous bovine Xa used in the functional assays. After 1 week of treatment, the drugs differed: Cmax and Ctrough were closer when apixaban was taken twice daily (83 ± 39 and 58 ± 17 ng/ml) than with rivaroxaban taken once a day (113 ± 67 and 13 ± 20 ng/ml). Rivaroxaban had a greater influence on routine coagulation tests and reduced the maximum thrombin concentration more efficiently, as assessed by the thrombin generation test. Although rivaroxaban and apixaban present apparently similar constant rates, they exhibit significant differences in their concentrations and anticoagulant effects when studied ex vivo in orthopedic patients.