The effect of combined conventional and modified ultrafiltration on mechanical ventilation and hemodynamic changes in congenital heart surgery

Background: Cardiopulmonary bypass is associated with increased fluid accumulation around the heart which influences pulmonary and cardiac diastolic function. The aim of this study was to compare the effects of modified ultrafiltration (MUF) versus conventional ultrafiltration (CUF) on duration of mechanical ventilation and hemodynamic status in children undergoing congenital heart surgery. Materials and Methods: A randomized clinical trial was conducted on 46 pediatric patients undergoing cardiopulmonary bypass throughout their congenital heart surgery. Arteriovenous MUF plus CUF was performed in 23 patients (intervention group) and sole CUF was performed for other 23 patients (control group). In MUF group, arterial cannula was linked to the filter inlet through the arterial line, and for 10 min, 10 ml/kg/min of blood was filtered and returned via cardioplegia line to the right atrium. Different parameters including hemodynamic variables, length of mechanical ventilation, Intensive Care Unit (ICU) stay, and inotrope requirement were compared between the two groups. Results: At immediate post�MUF phase, there was a statistically significant increase in the mean arterial pressure, systolic blood pressure, and diastolic blood pressure (P < 0.05) only in the study group. Furthermore, there was a significant difference in time of mechanical ventilation (P = 0.004) and ICU stay (P = 0.007) between the two groups. Inotropes including milrinone (P = 0.04), epinephrine (P = 0.001), and dobutamine (P = 0.002) were used significantly less frequently for patients in the intervention than the control group. Conclusion: Administration of MUF following surgery improves hemodynamic status of patients and also significantly decreases the duration of mechanical ventilation and inotrope requirement within 48 h after surgery. � 2016 Journal of Research in Medical Sciences

Intravenous Paracetamol Versus Patient-Controlled Analgesia With Morphine for the Pain Management Following Diagnostic Knee Arthroscopy in Trauma Patients: A Randomized Clinical Trial

Background: Most patients undergoing outpatient surgeries have the unpleasant experience of high level pain after surgery. Compared with open surgeries, arthroscopic procedures are less painful; however, inadequate pain management could be associated with significant concerns. Opioids alone or in combination with local anesthetics are frequently used for diminishing postoperative pain using intravenous or epidural infusion pumps. Despite morphine various disadvantages, it is commonly used for controlling pain after surgery. Objectives: The aim of this study was to compare intravenous paracetamol and patient-controlled analgesia (PCA) with morphine for the pain management following diagnostic knee arthroscopy in trauma patients. Patients and Methods: Sixty trauma patients who were scheduled to undergo knee arthroscopy were randomly divided into two groups. Patients immediately received intravenous infusion of 1 g paracetamol within 15 minutes after surgery and every 6 hours to 24 hours in the paracetamol group. The patient-controlled analgesia group received morphine through PCA infusion pump at 2 mL/h base rate and 1mL bolus every 15 minutes. Pain level, nausea and vomiting, and sedation were measured and recorded during entering the recovery, 15 and 30 minutes after entering the recovery, 2, 6, and 24 hours after starting morphine pump infusion in the morphine and paracetamol in the paracetamol groups. Results: There was no significant difference regarding the pain level at different times after entering the recovery between the two groups. No one from the paracetamol group developed drug complications. However, 22.3% in the PCA morphine suffered from postoperative nausea; there was a statistically significant difference regarding the sedation level, nausea, and vomiting at various times between the two groups. Conclusions: Intravenous administration of paracetamol immediately after knee arthroscopy improved postoperative pain, decreased analgesic administration, maintained stable hemodynamic parameters, had no complications related to opiates, no nausea and vomiting, and increased patient satisfaction and comfort in comparison to PCA with morphine

Sleep paralysis in medieval Persia – the Hidayat of Akhawayni (?–983 AD)

Among the first three manuscripts written in Persian, Akhawayni’s Hidayat al-muta’allemin fi al-tibb was the most significant work compiled in the 10th century. Along with the hundreds of chapters on hygiene, anatomy, physiology, symptoms and treatments of the diseases of various organs, there is a chapter on sleep paralysis (night-mare) prior to description and treatment of epilepsy. The present article is a review of the Akhawayni’s teachings on sleep paralysis and of descriptions and treatments of sleep paralysis by the Greek, medieval, and Renaissance scholars. Akhawayni’s descriptions along with other early writings provide insight into sleep paralysis during the Middle Ages in general and in Persia in particular

Adherence to hemovigilance protocols on storage, preparation, and administration among nurses in the open-heart intensive care unit

Background: Adherence to blood storage, preparation, and administration standards has an important role in preventing blood-transfusion errors. In addition, the blood-transfusion rate following open-heart surgery is quite high. The aim of this study was to assess the adherence to hemovigilance standards on blood storage, preparation, and administration among nurses in the intensive care unit (ICU). Methods: One hundred nurses of the Open-Heart ICU of Rajaie Cardiovascular, Medical, and Research Center, Tehran, Iran, participated in this descriptive study. The nurses� practice was supervised from the time of the entrance of the blood unit to the ICU until the end of the transfusion process. The ICU nurses� hemovigilance practice was compared with the Iranian Ministry of Health and Medical Education�s standards. The nurses' demographic and occupational characteristics were evaluated regarding the scores of the hemovigilance standards in their practice. Results: Concerning the standards of blood transfusion, 93 of the study nurses adhered to the protocols on blood-unit preservation, 84 on preparation, and 92 on transfusion. There were no statistically significant differences between the nurses� age, sex, work experience, education, last transfusion workshop participation and practice assessment, number of blood-transfusion procedures performed per month, and achieved standard scores on blood storage, preparation, and administration (all P>0.05). Conclusions: The study nurses achieved 85 of the standard scores on the preservation, preparation, and transfusion of blood units. The demographic and occupational characteristics of the ICU nurses had no effect on their hemovigilance practice. © 2015, Iranian Heart Association. All rights reserved

Effects of epidural injection of glucocorticoid and its combination with bupivacaine in palliating chronic low back pain due to discopathy

Chronic low back pain is defined as consistent or pendulous pain over 3 months. Epidural steroid injections (ESI) are common in treatment of chronic back pain. The present study was aimed to investigate the effects of epidural injection of glucocorticoid and bupivacaine compared to glucocorticoid alone in relieving chronic back pain due to discopathy. A randomized clinical trial was performed in the Shohada Medical Educational Center, Tabriz, Iran. Patients with chronic back pain who were candidates for epidural drug injection were recruited. They were divided into two groups of steroids or steroid and bupivacaine. Pain intensity, Oswestry Disability Index (ODI), Straight Leg Rising (SLR) test as well as clinical variables were evaluated before treatment and 3th month thereafter. Overall, 17 males and 23 females with a mean age ± SD of 47.54 ± 12.11 years were enrolled in two equal groups. No significant difference was observed between two groups in terms of gender and body mass index. In both groups, a significant relationship was observed for ODI (p =0.001), pain intensity (p =0.001), and SLR test (p=0.001) before and after treatment. However, the corresponding association was not observed for ODI, pain intensity and SLR test (p>0.05). Epidural steroid injections either alone or combined with Bupivacaine with no priority are effectively relief chronic low back pain due to discopathy