Reduction of intraoperative bleeding with fibrinogen administration in posterior spinal fusion surgery

Background: Spinal surgeries are frequently complicated with high rate of intra- and post-operative hemorrhage. It is shown that the serum fibrinogen level is a pivotal factor in determining the degree of intra- and post-operative hemorrhage. This study sought to examine the effect of prophylactic infusion of fibrinogen in preventing hemorrhage in candidates for posterior spinal fusion surgery. Methods: 41 patients who were candidates for posterior spinal fusion surgery were randomly devided in two groups of intervention (21 patients) and control (20 patients), receiving either infusion of fibrinogen (1 g in 100 cc of normal saline infused within 5 minutes after induction) or placebo, respectively. Changes in serum hemoglobin and fibrinogen, the severity of intraoperative hemorrhage, and the need for blood transfusion were compared between the two groups. Findings: While pre- and postoperative changes in serum hemoglobin and fibrinogen did not differ significantly between the two groups, the mean blood loss (533.3 ± 157.9 vs. 679.0 ± 130.0 ml, P = 0.003) and the need for blood transfusion (0 vs. 30 percent, P = 0.030) were significantly higher in the control group. Conclusion: Prophylactic infusion of fibrinogen in candidates for posterior spinal fusion surgery may significantly decrease the amount of intra-operative hemorrhage and the need for blood transfusion. © 2015, Isfahan University of Medical Sciences(IUMS). All Rights Reserved

Success rate of airway devices insertion: Laryngeal mask airway versus supraglottic gel device

Background: The main important method for airway management during anesthesia is endotracheal intubation. Laryngeal mask airway (LMA) and supraglottic gel device (I-Gel) are considered alternatives to endotracheal tube. Objectives: This study sought to assess the success rate of airway management using LMA and I-Gel in elective orthopedic surgery. Patients and Methods: This single-blinded randomized clinical trial was performed on 61 ASA Class 1 and 2 patients requiring minor orthopedic surgeries. Patients were randomly allocated to two groups of LMA and I-Gel. Supraglottic airway placement was categorized into three groups regarding the number of placement attempts, i.e. on the first, second, and third attempts. Unsuccessful placement on the third attempt was considered failure and endotracheal tube was used in such cases. The success rate, insertion time, and postoperative complications such as bleeding, sore throat, and hoarseness were recorded. Results: In the I-Gel group, the success rate was 66.7 for placement on the first attempt, 16.7 for the second, and 3.33 for the third attempt. In the LMA group, the success rates were 80.6 and 12.9 for the first and second attempts, respectively. Failure in placement occurred in four cases in the I-Gel and two cases in LMA groups. The mean insertion time was not significantly different between two groups (21.35 seconds in LMA versus 27.96 seconds in I-Gel, P = 0.2). The incidence of postoperative complications was not significantly different between study groups. Conclusions: I-Gel can be inserted as fast as LMA with adequate ventilation in patients and has no major airway complications. Therefore, it could be a good alternative to LMA in emergency airway management or general anesthesia. © 2015, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM)

Analgesic effects of paracetamol and morphine after elective laparotomy surgeries

Background: Opioids have been traditionally used for postoperative pain control, but they have some unpleasant side effects such as respiratory depression or nausea. Some other analgesic drugs like non-steroidal anti-inflammatory drugs (NSAIDs) are also being used for pain management due to their fewer side effects. Objectives: The aim of our study was to compare the analgesic effects of paracetamol, an intravenous non-opioid analgesic and morphine infusion after elective laparotomy surgeries. Patients and Methods: This randomized clinical study was performed on 157 ASA (American Society of Anesthesiology) I-II patients, who were scheduled for elective laparotomy. These patients were managed by general anesthesia with TIVA technique in both groups and 150 patients were analyzed. Paracetamol (4 g/24 hours) in group 1 and morphine (20 mg/24 hours) in group 2 were administered by infusion pump after surgery. Postoperative pain evaluation was performed by visual analog scale (VAS) during several hours postoperatively. Meperidine was administered for patients complaining of pain with VAS > 3 and repeated if essential. Total doses of infused analgesics, were recorded following the surgery and compared. Analysis was performed on the basis of VAS findings and meperidine consumption. Results: There were no differences in demographic data between two groups. Significant difference in pain score was found between the two groups, in the first eight hours following operation (P value = 0.00), but not after 12 hours (P = 0.14).The total dose of rescue drug (meperidine) and number of doses injected showed a meaningful difference between the two groups (P = 0.00). Also nausea, vomiting and itching showed a significant difference between the two groups and patients in morphine group, experienced higher levels of them. Conclusions: Paracetamol is not enough for postoperative pain relief in the first eight hour postoperatively, but it can reduce postoperative opioid need and is efficient enough for pain management as morphine after the first eight hours following surgery. © 2014, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM)

Evaluation of intranasal dexmedetomidine in providing moderate sedation in patients undergoing ERCP: A randomized controlled trial

Background and purpose: Endoscopic retrograde cholangiopancreatography (ERCP) is usually performed under deep sedation. Respiratory depression and airway obstruction are the most dangerous complications of sedatives. Dexmedetomidine is a drug that does not cause respiratory depression so, this study evaluated the efficacy of nasal dexmedetomidine in inducing moderate sedation in patients undergoing ERCP. Materials and methods: In a double blind randomized controlled trial, the patients candidate for ERCP in Firoozgar hospital, were divided into two groups. Group I received normal saline while in group II dexmedetomidine 1μg/kg was administered intranasaly. Also, intravenous midazolam and fentanyl, and if needed, propofol were used for induction of sedation. Then total use of sedative drugs, hemodynamic parameters, patient and physician satisfaction and side effects of treatment were documented. Results: There were no significant differences in age, sex and BMI between the two groups. Mean use of midazolam and fentanyl was almost similar in two groups but the use of propofol was lower in group II (P= 0.002). The mean heart rate was found to be lower in the group receiving dexmedetomidine but systolic and diastolic blood pressure were almost similar in two groups (P> 0.05). Compared with the results in group I, the patients and physicians in group II were more satisfied with dexmedetomidine. Conclusion: Dexmedetomidine as an adjuvant drug for sedation in patients undergoing ERCP could reduce the need for other sedatives, and also satisfy both the patients and therapists. © 2016, Mazandaran University of Medical Sciences. All Rights reserved

Controlled hypotension during rhinoplasty: A comparison of dexmedetomidine with magnesium sulfate

Objective: The current study aimed at comparing the efficacy of dexmedetomidine and magnesium sulfate to control blood pressure (BP) during rhinoplasty and the resultant effects on the quality of surgical field in terms of bleeding and visibility. Methods: The current randomized, prospective, double-blind study was conducted on 60 patients aged 18 to 50 years classified as ASA (American Society of Anesthesiologists) physical status I who were candidates for rhinoplasty. Patients were randomly divided into 2 groups: (1) group Dex, received 1 µg/kg dexmedetomidine in 10 minutes before induction of anesthesia, followed by 0.4 - 0.6 µg/kg/hour during the maintenance of anesthesia, and (2) group Mg, received 40 mg/kg in 10 minutes before anesthesia induction followed by 10 - 15 mg/kg/hour during anesthesia maintenance. In both groups, the goal was to achieve a mean arterial pressure (MAP) of 60 - 70 mmHg. Hemodynamic variables, anesthetic, opioid, muscle relaxant requirements, and surgical field condition were recorded. Sedation score, time to reach modified Aldrete score � 9, and adverse effects including nausea and vomiting (N&V) and shivering were recorded. Results: Controlled hypotension was achieved in both groups. There was no significant difference in MAP between the groups, but heart rate (HR) was significantly lower in the Dex group (P < 0.001), compared with that of the Mg group. Bleeding score was lower (P < 0.001) and surgeon�s satisfaction score was higher (P < 0.001) in the Dex group. More patients required fentanyl (P < 0.001) or nitroglycerin (P < 0.001) and the mean fentanyl (P = 0.005) or nitroglycerin (P < 0.001) required doses were higher in the Mg group. Patients in the Dex group required more frequent administration of cisatracurium (P = 0.004). Five patients in the Dex group versus no patients in the Mg group received atropine (P = 0.023). Ramsay sedation score and time to reach modified Aldrete score � 9 were significantly higher in the Dex group (P < 0.001 and P < 0.001, respectively). The incidence rate of N&V and shivering were similar in both groups. Conclusion: Dexmedetomidine was more effective than magnesium to achieve controlled hypotension, and provide a favorable surgical field condition. However, dexmedetomidine also heightened the risk of induced bradycardia and prolonged sedation. These are 2 important points to consider when applying this drug as a hypotensive agent during operation. © 2017, Anesthesiology and Pain Medicine

Comparison of Coping Strategies, Perfectionism and Self-Efficacy in Individuals with Substance Use Disorder and Normal Individuals

Aim: The aim of the present study was to compare the coping strategies, perfectionism (positive and negative) and self-efficacy in individuals with substance use disorder and normal individuals. Method: In this casual-comparative study, 200 persons (100 individuals with substance use disorder and 100 normal individuals) were selected by cluster random sampling. The groups were matched with consideration of demographic characteristics (age, gender, marital status and education) and they completed the Lazarus and Folkman coping strategies inventory (1984), Terry-Short perfectionism scale (1995) and Schwartz and Jerusalem general self-efficacy questionnaire (1981). Results: Findings of the study showed that the two groups had significant differences on subscales of coping strategies namely: avoidance, self-control, responsibility, avoidance-escape and problem solving. In addition, substance abuse group had also lower scores on the positive perfectionism in comparison of normal group. A significant difference on the level of self-efficacy was observed between the two groups, in this regard, self-efficacy in normal group was more than substance abuse group. Conclusion: The selection of improper coping style, unrealistic and excessive expectations about the abilities and low levels of self-efficacy are factors that can lead to more substance abuse and finally addiction