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

Type IV Monteggia-equivalent fracture in an adult: a case report

A Monteggia fracture is a proximal ulnar fracture with proximal radioulnar ligamentous instability. While there is no precise definition, Monteggia-equivalent fractures are generally considered Monteggia fractures accompanied by radial head fractures. These are rare. In this study, we report a rare variation of a Bado type IV Monteggia-equivalent lesion (fracture of proximal ulnar shaft, proximal radial shaft, and radial head) and its management. Level of evidence V

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

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

Mental health status of infertile couples based on treatment outcome

Background: Infertility is accompanied by numerous psychological and social problems. Infertile couples are more anxious and emotionally distressed than other fertile people. Previous studies suggested that infertility is more stressful for women than men. Objective: The purpose of this study was to determine the status of general health of infertile couples. Materials and Methods: This cross-sectional study evaluated general health of 150 infertile couples attending to Yazd Research and Clinical Center for Infertility that were selected consequently. The data were gathered by the researchers, based on face to face interview before and after three months of treatment by two questionnaires. The first questionnaire had questions on demographic information and the second one was the General Health Questionnaire-28 (GHQ-28). This questionnaire has four sub- scales areas. All data were transferred directly to SPSS 15 and analyzed. Results: The mean age of women was 28.3 and men were 32.4 years. The scores for all sub- scales of GHQ in women were more than men. There was significant difference between age and general health at physical symptoms scales (p=0.002), anxiety and sleep disorders (p=0.003). The age group 25-29 years had higher scores (more than 7) than other age groups. There was significant difference between the scale of social dysfunction and results of treatment. Conclusion: Our results, similar to the previous studies have revealed negetive social and mental effects of infertility on women is more than men, so there is need that they be educated specially

Remifentanilo en la inducción de la anestesia general para la cesárea : estudio clínico doble ciego, ensayo clínico aleatorizado.

Introduction: Remifentanil, with its rapid activity onset and short duration of action, may be more effective than other opioids for providing hemodynamic stability during obstetric anesthesia. However, there is some evidence of adverse effects on neonatal respiratory function. We investigated maternal and fetal effects of remifentanil during cesarean section surgery. Methods: Eighteen women with singleton term pregnancies, and physical class status of I or II as defined by the American Society of Anesthesia (ASA), who were undergoing general anesthesia for semi-elective cesarean section were randomized into two groups (40 in each group) that received either an intravenous bolus of 0.5 μg/kg remifentanil or the same dose of saline as a placebo. Maternal hemodynamic variables and neonatal umbilical artery pH and Apgar score at first and fifth minutes were evaluated in both groups. Results: Systolic and diastolic blood pressure were significantly lower after tracheal intubation and skin incision in the remifentanil group as compared with the control group (p<0.05). There were no significant differences regarding heart rate between groups at any time (p> 0.05). Apgar scores at first and fifth minutes were not significantly different among groups (p>0.05). No neonate required assisted ventilation or naloxan administration. Conclusion: Remifentanil may be a safe and effective drug for the induction of general anesthesia and surgical stimulation without subsequent neonatal depression. Introducción: El remifentanilo, con su rápido comienzo de actividad y corta duración de acción, puede ser más eficaz que otros opioides para proporcionar la estabilidad hemodinámica durante la anestesia obstétrica. Sin embargo, hay alguna evidencia de efectos adversos sobre la función respiratoria neonatal. Se investigaron los efectos maternos y fetales de remifentanilo durante la cirugía cesárea. Métodos: Dieciocho mujeres con embarazo de feto uno y con clasificación Asa I o II (sociedad americana de anestesiología y que fueron sometidas a anestesia general para cesárea semi eletiva, se dividieron aleatoriamente en dos grupos (40 mujeres en cada grupo) que recibieron un bolo intravenoso de 0.5 mm/Kg de remifentanil o en el grupo control la misma dosis de solución salina como placebo.. Se evaluaron las variables hemodinámicas maternas y pH de la arteria umbilical neonatal y la puntuación de Apgar al primer y quinto minuto en ambos grupos. Resultados: La presión arterial sistólica y diastólica fueron significativamente más bajos después de la intubación traqueal y la incisión de la piel en el grupo remifentanilo en comparación con el grupo control (p <0,05). No hubo diferencias significativas en cuanto a la frecuencia cardíaca entre los grupos en cualquier tiempo (p> 0,05). Las puntuaciones de Apgar a los minutos primero y quinto no fueron significativamente diferentes entre los grupos (p> 0,05). Ningún neonato requirió ventilación asistida o administración naloxan. Conclusión: El remifentanilo es un fármaco seguro y eficaz para la inducción de la anestesia general y la estimulación quirúrgica sin depresión neonatal posterior