Comparing the effects of epidural methylprednisolone acetate injected in patients with pain due to lumbar spinal stenosis or herniated disks: a prospective study

Jafar Mobaleghi1, Faramarz Allahdini2, Karim Nasseri3, Behzad Ahsan3, Shoaleh Shami4, Mansour Faizi5, Fardin Gharibi51Department of Surgery, 2Department of Neurosurgery, 3Department of Anesthesia, 4Faculty of Nursing, 5Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Kurdistan, IranObjective: Satisfactory results have been seen with epidural steroid injections (ESI) in patients with herniated disks (HD), but the role in lumbar spinal stenosis (LSS) has been less investigated. We compared long-term effects of ESI in HD and LSS patients.Methods: In a prospective, single-blind uncontrolled study, 60 patients with radicular pain due to HD (n = 32) or LSS (n = 28) were enrolled over a 9-month period. Methylprednisolone acetate 80 mg plus 0.5% bupivacaine 10 mg were diluted in normal saline up to a total volume of 10 mL, and injected into the epidural space. The amount of pain based on numeric pain score, level of activity, and subjective improvement were reported by patients after 2 and 6 months by telephone. Demographic data were analyzed with the chi-square test. The differences in numeric pain scale scores between the two groups at different times were analyzed with the t-test.Results: There were no differences between HD and LSS patients regarding age, sex, and average duration of pain prior to ESI. The degree of pain was significantly higher in LSS patients in comparison with HD patients in the pre-injection period. The amount of pain was significantly reduced in both groups 2 months after injection. This pain reduction period lasted for 6 months in the HD group, but to a lesser extent in LSS patients (P < 0.05).Discussion: Epidural methylprednisolone injection has less analgesic effect in LSS, with less permanent effect in comparison with HD.Keywords: methylprednisolone acetate, lumbar spinal stenosis, herniated dis

Shortening Anesthesia Duration does not Affect Severity of Withdrawal Syndrome in Patients Undergoing Ultra Rapid Opioid Detoxification

Ultra rapid opioid detoxification (UROD) is one of the new methods of detoxification. This method of detoxification involves putting patients under general anesthesia and actively giving them opioid antagonists. The objective of this study was to evaluate effects of anesthesia duration in UROD on severity of withdrawal syndrome. Sixty addicted patients seeking UROD procedure assigned randomly to one of the 2hr, 4hr or 6hr anesthesia duration groups. Premedication and anesthesia procedure (induction and maintenance) were the same for three groups. Detoxification was done for all patients with 50 mg oral naltroxane (prior to induction) and 20 mg intravenous naloxane (8 mg/bolus and 12 mg/infusion). Blood pressure, heart rate and respiratory rate were automatically measured and recorded every 5 minutes. The severity of withdrawal syndrome was measured and recorded every one hour during anesthesia, 2hours post-anesthesia, and 12 and 24 hours following the induction of anesthesia according to the Wang Scale modified by Lomier (WSMBL). Patients aged 20-58 in three groups. Three cases experienced delirium after detoxification that lasted 24 hours in one. Severity of withdrawal syndrome in patients of groups 2, 4 and 6 hour were 8.7, 7.4 and 5.1 respectively during anesthesia and 12.3, 11.1 and 13.9 after 18 hours of anesthesia. Results of this study showed that, in standard settings, UROD is a safe method for detoxification and has low complications. The withdrawal symptoms during and after anesthesia are low. Shortening the duration of anesthesia has no affect on severity of withdrawal syndrome during and after anesthesia

Comparison of the Effects of Thoracic Epidural Anesthesia with General Anesthesia on Hemodynamic Changes and its Complications in Patients Undergoing Laparoscopic Cholecystectomy

Background: Epidural anesthesia (EA) today has been used extensively in surgical procedures and the management of pain associated with midwifery and chronic pain. This type of anesthesia can be done in different technical, physiological, and pharmacological ways. The aim of this study was to compare the effects of thoracic EA with general anesthesia (GA) on hemodynamic changes and its complications in patients underwent laparoscopic colonoscopy. Materials and Methods: This clinical trial study was conducted on 80 patients undergoing laparoscopic cholecystectomy with EA or GA based on inclusion and exclusion criteria. The patients were randomly divided into two groups of 40 and changes in blood pressure, systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), and arterial blood oxygen saturation were measured. The incidence of nausea, vomiting, chills, and itching in the two groups was recorded. The analysis was performed descriptively and also using t-test and Chi-square tests. Results: The results showed that the mean of SBP and DBP, HR, and arterial blood oxygen saturation and the incidence of nausea and vomiting was statistically significant (P 0.05). Conclusion: The results of this study indicated that thoracic EA in patients with laparoscopic cholecystectomy has significant effects on factors such as SBP and DBP and arterial blood oxygen saturation. Furthermore, EA has fewer complications than GA, and it is the preferable approac

Comparision between the effects of dexmedtomedian and fentanyl as adjuvants to lidocain on axillary plexus blockplexus block

Background and Aim: One of the common blocks used in upper extremity surgery is axillary block. The aim of this study was to make a comparision between the effects of dexmedtomedian and fentanyl as adjuvants to lidocain on axillary plexus block. Methods and Materials: This double-blinded clinical terial included 36 patients and was performed in Besat and Kosar Hospitals in Sanandaj in 2017. Patients were randomly divided into two equal groups. Patients in group 1 received 40 cc of lidocaine 1% and normal saline plus 50 μg fentanyl. Group 2 patients received 100 mg of dexmedetomidine plus 40 cc of lidocaine 1% (Matched with group 1). Using SPSS software version 21, data were analyzed by independent sample t-test. Results: There was a significant difference between the two groups in regard to the beginning and quality of the sensory block (p≤0.01) and motor block (p≤0.05). Based on visual analog scale addition of fentanyl to lidocaine at all times had a greater effect on reducing the pain intensity compared to the addition of dexmedetomidine and there was a significant difference between the two groups (p≤0.01). There was no significant difference in the incidence of nausea, vomiting, dizziness and seizure between the two groups. But, the groups showed significant differences in the incidence rates of heart arrhythmias and hypotension (p≤0.01). Conclusion: Comparison between fentanyl and dexmedetomidine showed that addition of fentanyl to lidocaine led to a greater effect on the properties of the axillary plexus block

Comparison of remifentanil - propofol with remifentanil- thiopental for tracheal intubation without muscle relaxant

Background and Objective: In particular medical situation administration of muscle relaxants following intravenous anesthetics for tracheal intubation may be unnecessary or hazardous. The aim of this study was the comparison of larengoscopy and intubation conditions after induction of anesthesia with propofol or thiopental with remifentanil in the absence of muscle relaxants. Materials and Methods: In a randomized, and double – blind clinical trails, 42 ASA class 1 and 2 patients assigned randomly to propofol 2mg/kg group or thiopental 5mg/kg group. All patients received lidocaine 1.5mg/kg and remifentanil 2.5 µg/kg 30 second before anesthetics administration. Ninety second after administration of the hypnotic agent's, larengoscopy and intubation were attempted. Intubating conditions were assessed as excellent, good, suitable or poor on the basis of mask ventilation, jaw relaxation, vocal cords position and patient's response to intubations and indotracheal tube cuff inflation. The mean arterial pressure and heart rate were measured before and after anesthetic administration, and immidately, 2 and 5 minutes after intubations. Results: 40% of patients in thiopental group and 80% of patients in propofol group showed either excellent or good conditions for larengoscopy and tracheal intubation (P<0.05). Mean arterial pressure and heart rate were decreased more significantly in propofol group in respect to thiopental group (P<0.05). Conclusion: This investigation showed that propofol in combination with remifentanil is better than thiopental for tracheal intubation without muscle relaxants. However, it induces more homodynamic changes

Implementation and Analyses of Yaw Based Coordinated Control of Wind Farms

This paper presents, with a live field experiment, the potential of increasing wind farm power generation by optimally yawing upstream wind turbine for reducing wake effects as a part of the SmartEOLE project. Two 2MW turbines from the Le Sole de Moulin Vieux (SMV) wind farm are used for this purpose. The upstream turbine (SMV6) is operated with a yaw offset (α) in a range of −12◦ to 8◦ for analysing the impact on the downstream turbine (SMV5). Simulations are performed with intelligent control strategies for estimating optimum α settings. Simulations show that optimal α can increase net production of the two turbines by more than 5%. The impact of α on SMV6 is quantified using the data obtained during the experiment. A comparison of the data obtained during theexperimentiscarriedoutwithdataobtainedduringnormaloperationsinsimilarwindconditions. This comparison show that an optimum or near-optimum α increases net production by more than 5% in wake affected wind conditions, which is in confirmation with the simulated results

The chemokine receptor CXCR4 is associated with the staging of gastric cancer

Background: CXCR4 is a cognitive receptor for stromal-derived factor-1 (SDF-1) and has been previously shown to be associated with tumor growth and invasion of many cancers. However, its expression and function in gastric cancer has not been well clarified. Materials and Methods: Herein, we studied the expression of CXCR4 on gastric samples from patients with gastric adenocarcinoma in comparison with precancerous lesions by employing qRT-PCR. Results: Our qRT-PCR data show that CXCR4 is highly expressed in tissue samples from patients with gastric cancer than precancerous lesions (2.4 times higher, P value < 0.05). When we correlated the level of CXCR4 with clinicopathological findings, we observed that CXCR4 level is associated with staging of the disease and lymphatic invasion. In conclusion: We present evidence that CXCR4 level is significantly elevated in later stages of gastric cancer. Thus, CXCR4 may play a crucial role in gastric cancer progression