RESUMO
BACKGROUND: Thoracic paravertebral block (TPVB) has emerged as an effective and feasible mode of providing analgesia in laparoscopic cholecystectomy. Though a variety of local anaesthetic combinations are used for providing TPVB, literature is sparse on use of dexmedetomidine in TPVB. We aimed to compare levobupivacaine and levobupivacaine-dexmedetomidine combination in ultrasound guided TPVB in patients undergoing laparoscopic cholecystectomy. METHODOLOGY: 70 ASA I/II patients, aged 18-60 years, scheduled to undergo laparoscopic cholecystectomy under general anaesthesia were enrolled and divided into two groups. Before anaesthesia induction, group A patients received unilateral right sided ultrasound guided TPVB with 15 ml 0.25% levobupivacaine plus 2 ml normal saline while group B patients received unilateral right sided ultrasound guided TPVB with 15 ml 0.25% levobupivacaine plus 2 ml solution containing dexmedetomidine 1 µg.kg-1. Patients were monitored for pain using Numeric Rating Scale (NRS) at rest, on movement, coughing and comfort scores post surgery. Total analgesic consumption in first 48 hour postoperative period, time to first request analgesic and pain scores were recorded. RESULTS: Total amount of rescue analgesia (injection tramadol plus injection tramadol intravenous equivalent dose) consumed during 48 hours postoperatively in group A was 146.55 mg while in group B was 111.30 mg (p = 0.026). Mean time for demanding rescue analgesia was 273 minutes in group A while in group B was 340 minutes (p = 0.00). CONCLUSION: TPVB using dexmedetomidine 1 µg.kg-1 added to levobupivacaine 0.25% in patients undergoing laparoscopic cholecystectomy significantly reduced total analgesic consumption in first 48 hours and provided longer duration of analgesia postoperatively compared to levobupivacaine 0.25% alone.
Assuntos
Analgesia , Colecistectomia Laparoscópica , Dexmedetomidina , Humanos , Levobupivacaína , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Estudos ProspectivosRESUMO
Psychopathy is a disorder characterized by severe and frequent moral violations in multiple domains of life. Numerous studies have shown psychopathy-related limbic brain abnormalities during moral processing; however, these studies only examined negatively valenced moral stimuli. Here, we aimed to replicate prior psychopathy research on negative moral judgments and to extend this work by examining psychopathy-related abnormalities in the processing of controversial moral stimuli and positive moral processing. Incarcerated adult males (N = 245) completed a functional magnetic resonance imaging protocol on a mobile imaging system stationed at the prison. Psychopathy was assessed using the Hare Psychopathy Checklist-Revised (PCL-R). Participants were then shown words describing three types of moral stimuli: wrong (e.g., stealing), not wrong (e.g., charity), and controversial (e.g., euthanasia). Participants rated each stimulus as either wrong or not wrong. PCL-R total scores were correlated with not wrong behavioral responses to wrong moral stimuli, and were inversely related to hemodynamic activity in the anterior cingulate cortex in the contrast of wrong > not wrong. In the controversial > noncontroversial comparison, psychopathy was inversely associated with activity in the temporal parietal junction and dorsolateral prefrontal cortex. These results indicate that psychopathy-related abnormalities are observed during the processing of complex, negative, and positive moral stimuli.
Assuntos
Transtorno da Personalidade Antissocial/fisiopatologia , Encéfalo/fisiopatologia , Princípios Morais , Adolescente , Adulto , Idoso , Transtorno da Personalidade Antissocial/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Circulação Cerebrovascular/fisiologia , Criminosos , Tomada de Decisões/fisiologia , Humanos , Entrevista Psicológica , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Prisioneiros , Escalas de Graduação Psiquiátrica , Tempo de Reação , Leitura , Percepção Visual/fisiologia , Adulto JovemRESUMO
The purpose of this study was to determine the anatomic parameters of the kidney in adults. The Renal lengths, width at superior and inferior poles, thickness at the superior and inferior poles were measured in 151 adult cadaver kidneys. A digital vernier caliper was used for performing the measurements. The data were statistically analyzed. The mean renal length was 8.9 ± 0.9 cm on the right side and 9.1 ± 0.9 cm on the left side. The mean width of the superior pole of the right kidney was 4.9 ± 0.6 cm and the left kidney was 5 ± 0.7 cm. The width of inferior pole of the right and left kidneys were 4.8 ± 0.6 cm and 4.5 ± 0.7 cm respectively. The mean thickness of the superior pole of the right kidney was 3 ± 0.4 cm and left kidney was 3.2 ± 0.5 cm. The mean thickness of the inferior pole of the right and left kidneys were 3.1 ± 0.4 cm and 3.2 ± 0.5 cm respectively. There was no statistical significance with respect to the length of both the kidneys. However there was some data on width and thickness among the right and left side showed the difference which was significant statistically. The present study has provided additional information on the renal morphometry which will be of use to the surgeons and radiologists.
El propósito de este estudio fue determinar los parámetros anatómicos del riñon en los adultos. La longitud renal, ancho de los polos inferior y superior, y grosor de los polos superior e inferior se midieron en riñones de 151 cadáveres adultos. Se utilizó un caliper vernier digital para realizar las mediciones y los datos fueron analizados estadísticamente. La longitud media renal fue 8,9±0,9 cm en el lado derecho y 9,1±0,9 cm en el lado izquierda. El ancho promedio del polo superior del riñón derecho fue 4,9±0,6 cm y del riñón izquierdo fue 5±0,7 cm. El ancho promedio del polo inferior del lado derecho e izquierdo riñones fueron 4,8±0,6 cm y 4,5±0,7 cm, respectivamente. El grosor promedio del polo superior en el riñón del lado derecho fue 3±0,4 cm y el izquierdo 3,2±0,5 cm. El grosor promedio del polo inferior del riñon del lado derecho e izquierdo fueron 3,1±0,4 cm y 3,2±0,5 cm, respectivamente. No hubo diferencia significativa en relación con la longitud de los riñones. Sin embargo hubo algunos datos en ancho y grosor entre el lado derecho e izquierdo que mostraron diferencia significativa. El presente estudio ha proporcionado información adicional sobre la morfometría renal que puede ser de utilidad para los cirujanos y radiólogos.