Usporedba poslijeoperacijskog analgezijskog učinka potkožne primjene tramadola i bupivakaina u bolesnica podvrgnutih carskom rezu

Cesarean section is associated with significant postoperative pain. The aim of this study was to evaluate the effects of tramadol versus bupivacaine administration at wound closure on postoperative pain relief in patients undergoing cesarean section. Sixty women undergoing cesarean deliveries were randomly assigned to receive either 10 mL of bupivacaine 0.5% (n=30) or 50 mg of tramadol in 10 mL of normal saline (n=30), both as local wound infiltration prior to skin closure at the end of operation. Postoperative pain was evaluated with a visual analogue scale (VAS: 0-10) at 1, 2 and 6 hours after operation. Time to first analgesic administration and analgesic consumption in 24 hours after operation were recorded and compared between the two groups. Dana were analyzed by SPSS software version 15 and p0.05; Fisher exact test). No side effects were reported in either group. This study showed that subcutaneous administration of tramadol provided analgesic effect equal to bupivacaine with longer pain relief after cesarean section.Carski rez je udružen sa značajnom poslijeoperacijskom boli. Cilj ove studije bio je procijeniti učinak primjene tramadola u usporedbi s bupivakainom pri zatvaranju rane na olakšanje poslijeoperacijske boli u bolesnica podvrgnutih carskom rezu. Po 30 od ukupno 60 žena podvrgnutih carskom rezu i uključenih u studiju nasumce je primilo 10 mL bupivakaina 0,5% ili 50 mg tramadola u normalnoj fiziološkoj otopini ukapljeno u operacijsku ranu prije zatvaranja rane na kraju zahvata. Poslijeoperacijska bol procjenjivala se pomoću vizualne analogne ljestvice (VAS: 0-10) 1, 2 i 6 sati nakon operacije. U obje skupine bilježilo se i usporedilo vrijeme do prvog davanja analgetika i potrošnja analgetika kroz 24 sata od operacije. Podaci su analizirani pomoću programa SPSS ver. 15, a razina statističke značajnosti utvrđena je kao P0.05; Fisherov egzaktni test). Ni u jednoj skupini nisu zabilježene nikakve nuspojave. Ova studija je pokazala da potkožna primjena tramadola ima jednak analgezijski učinak kao bupivakain, ali s dužim olakšanjem boli nakon carskog reza

Comparison of peritonsillar infiltration effects of ketamine and tramadol on post tonsillectomy pain: a double-blinded randomized placebo-controlled clinical trial

Aim To assess the effect of peritonsillar infiltration of ketamine and tramadol on post tonsillectomy pain and compare the side effects. Methods The double-blind randomized clinical trial was performed on 126 patients aged 5-12 years who had been scheduled for elective tonsillectomy. The patients were randomly divided into 3 groups to receive either ketamine, tramadol, or placebo. They had American Society of Anesthesiologists physical status class I and II. All patients underwent the same method of anesthesia and surgical procedure. The three groups did not differ according to their age, sex, and duration of anesthesia and surgery. Post operative pain was evaluated using CHEOPS score. Other parameters such as the time to the first request for analgesic, hemodynamic elements, sedation score, nausea, vomiting, and hallucination were also assessed during 12 hours after surgery. Results Tramadol group had significantly lower pain scores (P = 0.005), significantly longer time to the first request for analgesic (P = 0.001), significantly shorter time to the beginning of liquid regimen (P = 0.001), and lower hemodynamic parameters such as blood pressure (P = 0.001) and heart rate (P = 0.001) than other two groups. Ketamine group had significantly greater presence of hallucinations and negative behavior than tramadol and placebo groups. The groups did not differ significantly in the presence of nausea and vomiting. Conclusion Preoperative peritonsillar infiltration of tramadol can decrease post-tonsillectomy pain, analgesic consumption, and the time to recovery without significant side effects

Usporedba poslijeoperacijskog analgezijskog učinka potkožne primjene tramadola i bupivakaina u bolesnica podvrgnutih carskom rezu

Cesarean section is associated with significant postoperative pain. The aim of this study was to evaluate the effects of tramadol versus bupivacaine administration at wound closure on postoperative pain relief in patients undergoing cesarean section. Sixty women undergoing cesarean deliveries were randomly assigned to receive either 10 mL of bupivacaine 0.5% (n=30) or 50 mg of tramadol in 10 mL of normal saline (n=30), both as local wound infiltration prior to skin closure at the end of operation. Postoperative pain was evaluated with a visual analogue scale (VAS: 0-10) at 1, 2 and 6 hours after operation. Time to first analgesic administration and analgesic consumption in 24 hours after operation were recorded and compared between the two groups. Dana were analyzed by SPSS software version 15 and p0.05; Fisher exact test). No side effects were reported in either group. This study showed that subcutaneous administration of tramadol provided analgesic effect equal to bupivacaine with longer pain relief after cesarean section.Carski rez je udružen sa značajnom poslijeoperacijskom boli. Cilj ove studije bio je procijeniti učinak primjene tramadola u usporedbi s bupivakainom pri zatvaranju rane na olakšanje poslijeoperacijske boli u bolesnica podvrgnutih carskom rezu. Po 30 od ukupno 60 žena podvrgnutih carskom rezu i uključenih u studiju nasumce je primilo 10 mL bupivakaina 0,5% ili 50 mg tramadola u normalnoj fiziološkoj otopini ukapljeno u operacijsku ranu prije zatvaranja rane na kraju zahvata. Poslijeoperacijska bol procjenjivala se pomoću vizualne analogne ljestvice (VAS: 0-10) 1, 2 i 6 sati nakon operacije. U obje skupine bilježilo se i usporedilo vrijeme do prvog davanja analgetika i potrošnja analgetika kroz 24 sata od operacije. Podaci su analizirani pomoću programa SPSS ver. 15, a razina statističke značajnosti utvrđena je kao P0.05; Fisherov egzaktni test). Ni u jednoj skupini nisu zabilježene nikakve nuspojave. Ova studija je pokazala da potkožna primjena tramadola ima jednak analgezijski učinak kao bupivakain, ali s dužim olakšanjem boli nakon carskog reza

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Effect of oral gabapentin on haemodynamic variables during microlaryngoscopic surgery

Background: Manipulation of the larynx, such as laryngoscopy and tracheal intubation, is associated with haemodynamic and cardiovascular responses. In microlaryngoscopic procedures, these responses are more severe than laryngoscopy for endotracheal intubation because in microlaryngoscopic surgeries laryngoscope fixes for a longer time (15–20 minutes compared to 15–30 seconds in tracheal intubation). This study was performed to evaluate the effect of 800 mg oral gabapentin on the haemodynamic variables during microlaryngoscopic surgery.Methods: 30 patients aged 30–70 years, ASA physical status I or II, who underwent microlaryngeal surgery were included to the study. The night before surgery, 15 patients (group G) received 100 mg gabapentin and 15 patients (group P) received a placebo. Ninety minutes before the operation, they either received 800 mg gabapentin (group G), or received a placebo (group P).Results: Heart rate, systolic, diastolic and mean arterial blood pressure were measured on the night before the procedure, the morning before the procedure, at arrival to the operating room as baseline, before and after induction, 1, 3 min after tracheal intubation, 1, 5, 15, 25 min after fixing laryngoscope, before laryngoscope removal, and 1 min after that. Analyses revealed that the systolic blood pressure was lower in group G after induction, 1 and 5 min after fixing laryngoscope and before removing the laryngoscope. Diastolic blood pressure in group G was lower at the time of arriving in the operating room, after induction, 1 min after fixing surgical laryngoscope and before removing the laryngoscope. Mean arterial pressure behaved similarly, and additionally it was lower at 5 min after fixing the laryngoscope. Heart rate was reduced at the time after induction, 1, 3 min after intubation, 5 min after fixing the laryngoscope and before laryngoscope removal in group G. Overall, in the group G, diastolic blood pressure and mean arterial pressure were lower in the first 15 min after microlaryngoscopy compared to group P but there was no difference in mean systolic blood pressure and mean heart rate.Conclusion: 800 mg oral gabapentin given 90 min before a procedure attenuates the rise of diastolic blood pressure and mean arterial blood pressure in the first 15 min after microlaryngoscopy surgery, but has no effect on systolic blood pressure or heart rate.Background: Manipulation of the larynx, such as laryngoscopy and tracheal intubation, is associated with haemodynamic and cardiovascular responses. In microlaryngoscopic procedures, these responses are more severe than laryngoscopy for endotracheal intubation because in microlaryngoscopic surgeries laryngoscope fixes for a longer time (15–20 minutes compared to 15–30 seconds in tracheal intubation). This study was performed to evaluate the effect of 800 mg oral gabapentin on the haemodynamic variables during microlaryngoscopic surgery.Methods: 30 patients aged 30–70 years, ASA physical status I or II, who underwent microlaryngeal surgery were included to the study. The night before surgery, 15 patients (group G) received 100 mg gabapentin and 15 patients (group P) received a placebo. Ninety minutes before the operation, they either received 800 mg gabapentin (group G), or received a placebo (group P).Results: Heart rate, systolic, diastolic and mean arterial blood pressure were measured on the night before the procedure, the morning before the procedure, at arrival to the operating room as baseline, before and after induction, 1, 3 min after tracheal intubation, 1, 5, 15, 25 min after fixing laryngoscope, before laryngoscope removal, and 1 min after that. Analyses revealed that the systolic blood pressure was lower in group G after induction, 1 and 5 min after fixing laryngoscope and before removing the laryngoscope. Diastolic blood pressure in group G was lower at the time of arriving in the operating room, after induction, 1 min after fixing surgical laryngoscope and before removing the laryngoscope. Mean arterial pressure behaved similarly, and additionally it was lower at 5 min after fixing the laryngoscope. Heart rate was reduced at the time after induction, 1, 3 min after intubation, 5 min after fixing the laryngoscope and before laryngoscope removal in group G. Overall, in the group G, diastolic blood pressure and mean arterial pressure were lower in the first 15 min after microlaryngoscopy compared to group P but there was no difference in mean systolic blood pressure and mean heart rate.Conclusion: 800 mg oral gabapentin given 90 min before a procedure attenuates the rise of diastolic blood pressure and mean arterial blood pressure in the first 15 min after microlaryngoscopy surgery, but has no effect on systolic blood pressure or heart rate

The Effects of Propofol and Isoflurane on Blood Glucose during Abdominal Hysterectomy in Diabetic Patients

BackgroundAcute hyperglycemia in the perioperative period is associated with significantly increased complications. In few human studies the effects of propofol and inhalational anesthetic on the glucose metabolism were compared. In this study we evaluated the effect of propofol and isoflurane on blood glucose during abdominal hysterectomy in diabetic patients.MethodsAfter approval by the Ethical Committee and written informed consent, thirty 35 to 65 years old diabetic women underwent for elective abdominal hysterectomy under general anesthesia were studied in this randomized single blind clinical trial study. The plasma glucose was maintained at 100 to 180 mg/dL during the operation. Anesthesia protocol was similar in two groups except maintenance of anesthesia that was with infusion of propofol in the propofol group and with isoflurane in the isoflurane group. Blood glucose level and the rate of insulin intake during surgery compared between two groups.ResultsMean blood glucose before induction of anesthesia did not have significant difference between two groups, but 60 and 90 minutes after starting the operation blood glucose in the propofol group was significantly lower than isoflurane group. Also with using Repeated Measure test, two groups was significantly different according to blood glucose (P=0.045). Mean of administration of insulin during the surgery did not have significant difference between two groups by using repeated measure test and P=0.271. Also mean of bispectral index in different times during the surgery between two groups didn't have significant difference (P=0.35 repeated measure test).ConclusionBlood glucose increased during maintenance of anesthesia with isoflurane compared to propofol during the surgery

Učinak prijeoperacijskog intravenskog paracetamola tijekom carskog reza na hemodinamske varijable u odnosu na intubaciju, poslijeoperacijsku bol i apgar indeks novorođenčeta

Selection of anesthetic drugs for cesarean section requires many considerations. Anesthetic drugs for this purpose must prevent hemodynamic stress due to tracheal intubation, while inducing neonatal complications. This study was conducted to determine the effects of paracetamol given before induction of anesthesia on cardiovascular responses to tracheal intubation and postoperative pain in the mother, and on neonatal Apgar score. This double-blind randomized placebo- controlled trial included 60 women in ASA I, without underlying diseases and fetal distress, who were candidates for elective cesarean section under general anesthesia. Patients were divided into two groups of 30 patients. Patients in the paracetamol group received 1 g intravenous (IV ) paracetamol 20 min before the operation, while those in the placebo group received 1 cc normal saline at the same time. In both groups, anesthesia was induced by sodium thiopental and succinylcholine. Maternal systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR ) were measured before and immediately upon induction of anesthesia,and at first and fifth minute after tracheal intubation. Neonatal effects were assessed by Apgar score. Postoperative pain was assessed by use of the visual analog scale (VAS). The dose of analgesic used and the time of the first analgesic request by patients postoperatively were recorded. The SBP, DBP, MAP and HR were controlled significantly better in paracetamol group than in placebo group (P<0.05). The mean 1-min and 5-min Apgar scores of neonates did not differ between the groups. The VAS pain score was significantly lower in paracetamol group than in placebo group at all measuring times (P<0.05). Also, paracetamol caused later first analgesic request and lower dose of analgesic needed to control pain postoperatively (P<0.05). In conclusion, the results of our study suggested IV paracetamol to be an efficacious agent to decrease hemodynamic responses to tracheal intubation, while providing better postoperative pain management without considerable neonatal complications in women undergoing cesarean section in general anesthesia.Odabir anestetika kod carskog reza zahtijeva ozbiljno promišljanje. Anestetici koji se primjenjuju za ovu namjenu moraju spriječiti hemodinamski stres zbog trahealne intubacije, ali ne smiju izazvati komplikacije kod novorođenčeta. Cilj ove studije bio je utvrditi učinke paracetamola danog prije indukcije anestezije na kardiovaskularni odgovor na intubaciju traheje i poslijeoperacijsku bol kod majke, te na Apgar indeks novorođenčeta. U ovo dvostruko slijepo randomizirano placebom kontrolirano ispitivanje bilo je uključeno 60 žena, ASA I, bez osnovnih bolesti i fetalnog distresa, kod kojih je bio predviđen elektivni carski rez u općoj anesteziji. Trudnice su podijeljene u dvije skupine od po 30 žena. Žene u skupini paracetamol dobile su 1 g paracetamola intravenski 20 minuta prije operacije, dok su one u skupini placebo u isto vrijeme primile 1 cc normalne fiziološke otopine. U objema skupinama anestezija je inducirana natrij tiopentalom i sukcinilkolinom. Majčin sistolički krvni tlak (SKT), dijastolički krvni tlak (DKT), srednji arterijski tlak (SAT) i srčana frekvencija (SF) mjereni su prije i neposredno nakon indukcije anestezije te u 1. i 5. minuti nakon trahealne intubacije. Učinci na novorođenče procijenjeni su pomoću Apgar indeksa. Poslijeoperacijska bol procijenjena je pomoću vizualne analogne ljestvice (VAS). Zabilježena je doza analgetika i vrijeme kad je prvi put zatražen analgetik nakon operacije. Utvrđeno je da su SKT, DKT, SAT i SF značajno bolje regulirani u skupini na paracetamolu u usporedbi sa skupinom koja je primila placebo (P<0,05). Srednji Apgar indeks u 1. i 5. minuti nije se razlikovao između novorođenčadi dviju skupina. Zbroj VAS bio je značajno niži u skupini na paracetamolu nego u skupini na placebu u svim vremenskim točkama mjerenja (P<0,05). Uz to, uz paracetamol je prvi put nakon operacije analgetik zatražen kasnije i bila je potrebna niža doza analgetika za kontrolu boli (P<0,05). Zaključno, rezultati ovoga ispitivanja ukazuju na to da intravenski paracetamol učinkovito smanjuje hemodinamske odgovore na trahealnu intubaciju, dok istodobno osigurava bolje zbrinjavanje poslijeoperacijske boli bez većih neonatalnih komplikacija kod žena koje se podvrgavaju carskom rezu u općoj anesteziji

Comparison of peritonsillar infiltration effects of ketamine and tramadol on post tonsillectomy pain: a doubleblinded randomized lacebocontrolled clinical trial

Aim To assess the effect of peritonsillar infiltration of ketamine and tramadol on post tonsillectomy pain and compare the side effects. Methods The double-blind randomized clinical trial was performed on 126 patients aged 5-12 years who had been scheduled for elective tonsillectomy. The patients were randomly divided into 3 groups to receive either ketamine, tramadol, or placebo. They had American Society of Anesthesiologists physical status class I and II. All patients underwent the same method of anesthesia and surgical procedure. The three groups did not differ according to their age, sex, and duration of anesthesia and surgery. Post operative pain was evaluated using CHEOPS score. Other parameters such as the time to the first request for analgesic, hemodynamic elements, sedation score, nausea, vomiting, and hallucination were also assessed during 12 hours after surgery. Results Tramadol group had significantly lower pain scores (P = 0.005), significantly longer time to the first request for analgesic (P = 0.001), significantly shorter time to the beginning of liquid regimen (P = 0.001), and lower hemodynamic parameters such as blood pressure (P = 0.001) and heart rate (P = 0.001) than other two groups. Ketamine group had significantly greater presence of hallucinations and negative behavior than tramadol and placebo groups. The groups did not differ significantly in the presence of nausea and vomiting. Conclusion Preoperative peritonsillar infiltration of tramadol can decrease post-tonsillectomy pain, analgesic consumption, and the time to recovery without significant side effects

Comparison of prophylactic use of meperidine and two low doses of ketamine for prevention of post-anesthetic shivering: A randomized double-blind placebo controlled trial*

Abstract BACKGROUND: Postanesthetic shivering is one of the most common complications of anesthesia. We compared the efficacy of meperidine and two low doses of ketamine with placebo to prevent postanesthetic shivering after general anesthesia

Comparison of prophylactic use of meperidine and two low doses of ketamine for prevention of post-anesthetic shivering: A randomized double-blind placebo controlled trial

Background: Postanesthetic shivering is one of the most common complications of anesthesia. We compared the efficacy of meperidine and two low doses of ketamine with placebo to prevent postanesthetic shivering after general anesthesia. Methods: This was a prospective, randomized double-blind placebo controlled clinical trial involving 120 ASA I-II patients aging 20-50 years, undergoing endoscopic sinus surgery with general anesthesia. Patients were randomly allocated to receive meperidine 0.4 mg/kg (Group M, n = 30), ketamine 0.3 mg/kg (Group K 1 , n = 30), ketamine 0.5 mg/kg (Group K 2 , n = 30), or normal saline (Group N, n = 30) 20 minutes before completion of the surgery. Tympanic temperature, blood pressure, and heart rate were measured before and immediately after induction of anesthesia, 30 minutes after induction, and before administration of the study drugs. The drugs were prepared and diluted to a volume of 2 ml and presented as coded syringes. An investigator, blinded to the groups, graded postanesthetic shivering using a four-point scale. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) Windows version 16. A p-value < 0.05 was considered statistically significant. Results: Patient characteristics of the four groups were similar. The number of patients with observed shivering in groups was 0, 3, 1, and 9 in Groups M, K 1 , K 2 and N, respectively. The difference between groups M, K 1 , and K 2 with Group N was statistically significant. However, differences between groups M and K 1 , M and K 2 , and K 1 and K 2 were not significant. The number of patients with a shivering score of 2 or 3 was higher in Group N compared with other groups. Conclusions: Prophylactic use of low doses of intravenous ketamine (0.3 or 0.5 mg/kg) was found to be effective to prevent postanesthetic shivering. However, administration of 0.3 mg/kg ketamine lowered the rate of hallucination as compared with 0.5 mg/kg