Difficult ventilation from increased abdominal pressure

Airway management is one of the most important responsibilities of every anesthesiologist. A problematic situation arises when a patient is intubated correctly but not being ventilated. A case of a 4-year-old child who was involved in a car accident, presented for an exploratory laparotomy. Although she was successfully intubated, she could not be ventilated. The situation only improved after a large volume of fluid (urine) was drained from the abdomen

Validation of the Persian version of COOP/WONCA functional health status charts in liver transplant candidates

Context-Health-related quality of life is a preferred outcome measure for patients with advanced liver disease. The functional health status charts developed by the Dartmouth Primary Care Cooperative Information Project (COOP)/World Organization of National Colleges, Academies and Academic Associations (WONCA) make up a generic instrument for assessing health-related quality of life. Objective-To translate and validate the Persian version of COOP/WONCA in liver transplant candidates and to assess the correlation of Child Pugh classification and Model of End Stage Liver Disease (MELD) score with quality of life. Setting-The Shiraz liver transplant center, the most active liver transplant center in the Middle East. Participants-Consecutive adult outpatients waiting for their-first liver transplant who attended follow-up visits in the pretransplant clinic. Main Outcome Measures-Patients completed COOP/WONCA along with the Short Form (SF)-36. Data on the underlying cause of cirrhosis, Child-Pugh classification, and MELD scores were collected from medical records. Results-A Persian version of the COOP/WONCA was accepted by liver transplant candidates and showed adequate reliability and validity. Similar domains in COOP/WONCA charts and the SF-36 were highly correlated, indicating that construct validity of the COOP/WONCA in relation to the SF-36 was good (77% of correlations were as expected). Moreover, the exploratory factor analysis could not extract 2 different quality-of-life factors. These findings provide sufficient evidence to conclude that the Persian versions of COOP/WONCA charts and the SF-36 measure the same constructs of health-related quality of life and can be used interchangeably. Four of the 6 COOP/WONCA charts did not allow discrimination between groups of patients according to Child Pugh classification, indicating poor known group validity. (C)2014 NATCO, The Organization for Transplant Professional

Efficacy of dexamethasone on postoperative analgesia in children undergoing hypospadias repair

Background and Objective: Management of post operative pain in children undergoing hypospadiasis repair, accounts for optimized surgery outcomes and improved patients' satisfaction. Thus, various studies have widely investigated the best approaches for the pain management. In this study our aim was to determine the effect of dexamethasone in combination with penile nerve block on the postoperative pain and complications in the children undergoing hypospadias surgery. Methods: In this randomized double-blind placebo controlled trial, after obtaining informed consent from parents or legal guardians, 42 children undergoing surgical treatment of hypospadias were randomized in two groups to receive either IV dexamethasone 0.5 mg/kg (n=23) or placebo (normal saline) (n=19) during the operation. Penile block was performed in both groups using Bupivacaine 0.5% (1mg/kg) at the end of the procedure. By the end of the operation, FLACC (Face, Leg, Activity, Cry, Consolability) pain score was assessed as the primary outcome of the study. Secondary outcomes includes timing and episodes of rescue medication consumption, post operative nausea \ vomiting and bleeding. All the outcomes were assessed in the recovery room and after 2, 6, 12, and 24 hours. Results: The median of FLACC pain scores at the recovery room and 2, 6, 12, and 24 hours post operation was 2, 1, 1, 1, and 2 for the dexamethasone group and 8, 8, 7, 7, and 8 for the placebo group respectively. This were significantly different (P<0.000). The median time of first rescue medication consumption was 8 hours post operation for the dexamethasone group and three hours for the placebo group which was significantly different (z=4.57, p<0.000). The maximum episode of post operative rescue medication consumption in dexamethasone group was 4 episodes in only one patient and the minimum was one episode in 11 patients. In comparison numbers in placebo group were five episodes in seven patients and three episodes in four patients. The result indicated that there was statistically significant difference between two groups in terms of episodes of rescue medication consumption (Chi2= 31.4, p<0.000). Conclusion: Single dose of intravenous dexamethasone (0.5 mg/kg) in combination with penile block decreased the post operative pain measures, and total post operative analgesic requirement. It also increased the onset of the first analgesic requirement compared to penile block alone

Urethral catheter traction reduces bleeding compared with suturing of prostatic vesical junction during suprapubic prostatectomy: a randomized clinical trial study

To determine whether catheter traction during suprapubic prostatectomy can be beneficial in reducing intraoperative and postoperative bleeding. A total of 156 patients with lower urinary tract symptoms who had indications for open prostatectomy were enrolled in the study from September 2004 to January 2006. Of the patients, 78 underwent open prostatectomy with suturing at the prostatic vesical junction (group 1) and 78 were treated with urethral catheter traction to control bleeding (group 2). The duration of operation, duration of hospital stay, intraoperative blood loss, hemoglobin decrease, and weight of resected prostate were recorded in both groups. Three months later, we followed up patients with the International Prostate Symptom Score questionnaire, maximal flow rate measurement, and cystoscopic examination. The mean operative time was 59 +/- 7 minutes and 40 +/- 9 minutes (P = .015) and the mean hospital stay was 3.7 +/- 0.24 days and 4.4 +/- 0.46 days (P = .09) in groups 1 and 2, respectively. The mean blood loss during surgery was 279 +/- 155 mL and 219 +/- 139 mL (P = .04) and the mean hemoglobin decrease was 2.3 +/- 1.4 g/dL and 1.6 +/- 1.5g/dL (P = .04) in groups 1 and 2, respectively. The mean weight of the prostate was not significantly different statistically between the 2 groups at 63 +/- 23 g and 64 +/- 19 g in groups 1 and 2, respectively (P = .8). The urethrocystoscopy examination at 3 months postoperatively revealed bladder neck contractures in 6.41% of the patients in group 1 and 3.85% in group 2. The results of our study have shown that urethral catheter traction diminishes bleeding compared with suturing at the prostatic vesical junction during suprapubic prostatectomy

The Impact of Preoperative Variables on Intraoperative Blood Loss and Transfusion Requirements During Orthotopic Liver Transplant

Objectives: Liver transplant traditionally and potentially is associated with the risk of massive blood loss and transfusion, which can adversely affect transplant outcomes. Many variables influence the amount of bleeding, and these can be categorized as patient related, surgery related, and graft related. We aimed to assess the effects of these variables on the amount of bleeding and transfusion during liver transplant; predicting the risk of massive blood loss can help transplant teams to select and manage patients more effectively. Materials and Methods: We retrospectively studied 754 patients who underwent liver transplant from 2013 to 2016 and analyzed more than 20 variables that could influence the volume of blood loss and packed cell transfusion. Results: We found that at least 4 variables are strongly and independently correlated with blood loss volume: age, Model for End-Stage Liver Disease score, warm ischemia time, and total bilirubin. Furthermore, intraoperative blood loss had a weak but clinically important correlation with the underlying disease (ie, the cause of liver cirrhosis). Some variables, including international normalized ratio, platelet count, albumin, serum urea nitrogen, creatinine level, sodium level, and the amount of ascites, could be considered as "dependent" and weak predictors of massive blood loss. Sex of patient, cold ischemia time, surgery technique, and history of previous abdominal surgery were not correlated with the amount of bleeding. Conclusions: With the use of the variables identified, we can properly select patients and surgical teams and promptly use modalities for decreasing and managing blood loss

Music can effectively reduce pain perception in women rather than men

Objective: Nowadays music is used to decrease pain and increase relaxation in clinical settings. It is hypothesized that music can affect women more easily than men. We assessed the effect of two types of music (Iranian folkloric and preferred music) on pain tolerance and pain rating in cold pressor test. Methodology: A consecutive sample of 50 healthy Iranian medical students was enrolled. They reported pain tolerance and pain rating in cold pressor test in three different musical conditions served as the outcome measures. The results were analyzed with repeated measurement analysis of variance. Result: Mean tolerance time was significantly higher in preferred music compared to Iranian folkloric music (F (1,48) =25.44, p=0.0001) and no music (F(1,48)=3.51, p=0.0001) conditions. There was a significant interaction when tolerance time in no music condition was compared to preferred music condition, regarding sex; Tolerance time increased more in females (F(1,48)=5.53, p=0.023). The results also indicated that pain ratings, regardless of sex, were different in three musical conditions (F(1.7,81.34)=15.37, p=0.0001). Conclusion: Music distracted attention from pain and Women can be impressed and distracted more easily by music