Rh-Incompatibility-Induced Delayed Hemolytic Transfusion Reaction: Role of Immunologic Reactions in Rh-Incompatibility

Blood transfusions are given to increase oxygen-carrying capacity and intravascular volume. Despite all the benefits of transfusion, it may have some complications. When mistransfusions occur, or when no other option is available, incompatible packed-cells may be infused, which puts the patient at risk of experiencing a Hemolytic Transfusion Reaction (HTR). HTRs are classified as acute or delayed reactions having wide spectrum of clinical presentations. In this report, we present a case of delayed hemolytic reaction due to Rh incompatibility in the operation room. Critical incident reporting and evaluation of adverse transfusion reactions may provide effective patient management and prevent the occurrence or repetition of these events

Intravenous Acetaminophen Effect on Postoperative Narcotic Analgesic Demand after Elective Cesarean Section

Background: Opioid analgesics are the mainstay of the treatment of postoperative pain. Appropriate monitoring of patients receiving opioid analgesics is essential to detect those with side effects such as respiratory depression. The discovery of Acetaminophen as a COX-3 variant may represent a primary central mechanism by which acetaminophen decrease pain. The aim of this study was to assess the effect of intravenous acetaminophen on morphine requirement in post-operation pain after elective cesarean section.Materials and Methods: In a randomized clinical trial, patients’ candidate for elective cesarean section. In experiment group, intravenous acetaminophen (1000 mg/6 hour) was administered and normal saline to control group. Visual analogue scale (VAS) was measured at 1, 3, 6, 12, and 24 hours post-operation. Besides, Morphine dose requirement were measured during next 24 hours.Results: 83 patients were enrolled in the study; which 44 patients assigned in placebo group and 39 in Acetaminophen. Mean Age of placebo group was 29.64±5.55 and Acetaminophen was 30.33±5.50 which was not significantly different (p=0.568). Only at 1 and 3 hours, there was a significant difference between two groups of study. Total dose of morphine requirement was 5.73±2.78 mg/24 h in placebo group and 3.64±2.42 in Acetaminophen group which was significantly different (p=0.001).Conclusion: Intravenous Acetaminophen could decrease post cesarean pain and decrease post operation total morphine requirement particularly at first 3 hours post operation

Epidural Anesthesia with Lidocaine and Dexmedetomidine, Versus Lidocaine Alone on Plasma Levels of IL-6 in Patients with Proximal Femoral Fracture.

Interleukin-6 plays an important role in inflammatory responses and synthesis of acute hepatic phase proteins and its plasma level changes are used as a reliable prognostic factor for mortality in hospitalized patients. On the other hand, various methods for reducing inflammatory responses, including proper control of pain during and after surgery, and correction of hemodynamic disorders, can be monitored by monitoring of plasma levels of IL-6. Epidural anesthesia is an appropriate method for controlling pain in lower limb surgeries. The aim of this study was to evaluate the effect of adding Dexmedetomidine to lidocaine in the epidural injection for better control of post-surgical inflammatory responses by measuring interleukin-6 plasma levels.Patients referred to Taleghani Hospital in 1396 who suffered from lower limb fractures and requiring surgery were evaluated. 52 patients in two groups receiving Dexmedetomidine doses of media and controls for the quality of epidural anesthesia and IL-6 index. After obtaining written consent, the Dexmedetomidine treatment group and the normal saline control group were prescribed epidural with lidocaine. Finally, the level of IL-6 before surgery and 6 hours after surgery were evaluated.According to the results of statistical analysis, the two groups did not show a significant difference in age and level of interleukin prior to the operation. The mean age of patients in this study was 15.84639 ± 53.4038. The sex distribution of the study included 19 women (36.5%) and 33 men (63.5%). According to the U Mann Whitney test, the second injection time and total drug volume had a significant difference between the control and intervention groups and Dexmedetomidine reduced the volume of total drug needed and increase the time interval until the second injection (p <0.001). There was also a significant difference between the two groups in the level of interleukin 6 after 6 hours of operation and this was lower in the Dexmedetomidine group.keywords: Interleukin-6, Dexmedetomidine, lidocaine, Anesthesi

Comparing the Efficacy and Safety of Dexmedetomidine-Lidocaine and Propofol-Fentanyl-Midazolam Combinations during Endoscopic Retrograde Cholangiopancreatography

Background and Aims: Propofol is commonly used for providing sedation in endoscopic retrograde cholangio-pancreatography (ERCP). It’s simple to use and effective but presents cardiovascular and respiratory adverse effects. Recently, dexmedetomidine has been tried but very little evidence exists to support its use. The aim of this study was to compare the efficacy and safety of combination of dexmedetomidine and lidocaine (DL) with the standard propofol-fentanyl (PF) regimen.Methods: After approval of the hospital ethics committee, 63 patients (18-60 years of age) were randomly divided into 2 groups. Thirty-one patients received a PF combination (group PF), and 32 patients received DL combination (group DL). The level of sedation was adjusted to achieve a Ramasy Sedation Scale (RSS) score of 3 (moderate sedation) in both groups of patients. Arterial pressure (MAP), heart rate (HR), and peripheral oxygen saturation (SpO2) during ERCP and recovery was continuously assessed.Results: The oxygen saturation (SpO2) showed high statistical significant differences between both groups throughout the procedure with stability in DL group (P<0.01). There was no statistical difference in HR and MAP between the two groups (P>0.05). Post-procedural recovery time was significantly shorter in PF group (15.97±3.27 min) compared with (19.38±5.64 min) DL group (p<0.01). PONV was 3.2% in PF group, while it was absent in DL group. No drug adverse effect or cardiovascular complications were observed in both groups.Conclusion: Dexmedetomidine and lidocaine combination as total intravenous anesthesia (TIVA) during ERCP not only did not reported any oxygen desaturation (SpO2<90%) but also showed better stability of oxygen saturation (SpO2) and less PONV when compared with propofol and fentanyl combination

The Effect of Spinal and General Anesthesia on Cytokine Serum Levels Following Cesarean Section in Preeclampsia

 Background: The purpose of this study is to investigate the impact of different anesthetic techniques on the release of cytokines interleukin IL-6, IL-10 and tumor necrosis factor (TNF)-α in preeclampsia patients who undergo cesarean section.Materials and Methods: In the study 40 patients were enrolled with preeclampsia undergoing cesarean section, allocated into two equal groups to receive either general anesthesia (n = 20) or spinal anesthesia (n = 20). Non-invasive hemodynamic monitoring was used. Serum levels of IL-6, IL-10 and TNF-α were measured before and at the end of surgery.Results: There was no significant rise in serum levels of TNF-α in general anesthesia while IL-6 and IL-10 serum levels increased significantly. Also, compared with patients anaesthetized with general anesthesia patients who received regional anesthesia notably had lower levels of IL-6 and IL-10 after surgery (p < 0.05).Conclusion: Spinal anesthesia causes significant difference in post-operation IL-6 and IL-10 serum levels in preeclampsia patients undergoing cesarean section. Nevertheless, neither general nor spinal anesthesia made such effect on serum level of TNF-α. Further studies with higher sample size and comparing preeclamptic patients to healthy mothers undergoing cesarean section are required