Laryngeal Mask Airway Prevented Pulmonary Aspiration in an Obese Patient with Massive Gastric Regurgitation

Laryngeal Mask Airway is used for airway management in anaesthesia and in emergency medicine. Aspiration of gastric contents with LMA occurs in 2 per 10000 patients. It is almost similar to tracheal intubation in elective patients with the incidence of 1.25 per 10000 patient

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

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

Validity and reliability of Persian version of chronic liver disease questionnaire (CLDQ)

Purpose The aim of this study is to test the psychometric properties of the Persian version of the Chronic Liver Disease Questionnaire (CLDQ) in Iranian candidates for liver transplantation. Method One hundred and fifty-five consecutive adult patients awaiting liver transplantation completed the Persian version of CLDQ and the short-form health survey (SF-36). The etiology of cirrhosis, Child Pugh classification and Model for End stage Liver Disease (MELD) scores were taken from medical records. Results The scaling success rate for convergent validity was 100% for all domains, and the success rate for item discriminant validity was 95.8% (139/145). The internal consistency (Cronbach alpha) for the domains ranged from 0.65 to 0.89. Multitrait-multimethod correlation matrix and factor analysis revealed that the CLDQ and SF-36 measure different constructs of quality of life. Conclusion The Persian version of the CLDQ, a disease-specific questionnaire for measuring health-related quality of life, is accepted by liver transplantation candidates with adequate reliability and validity. There is no significant correlation of Child Pugh classification and MELD score with quality of life

The effects of Aminophylline on clinical recovery and bispectral index in patients anesthetized with total intravenous anaesthesia

Objective: Aminophylline, which is clinically used as a bronchodilator, antagonizes the action of adenosine, so it can be used to shorten the recovery time after general anesthesia. Therefore, we wanted to test the hypothesis that the administration of anninophylline leads to an increase in bispectral index (BIS) and clinical recovery in patients anesthetized with total intravenous anesthesia (TIVA). Methods: Ninety two patients who were scheduled for elective inguinal herniorrhaphy were enrolled in this study. All patients were premedicated with midazolam and morphine. Anesthesia was induced with propofol 2.5 mg /kg and remifentanil 2.5 mu g/kg without muscle relaxant. For maintenance of anesthesia we used propofol 100pg/kg/min, remifentanil 0.2 mu g/kg/min and 100% oxygen with stable BIS readings in the range 40-60. After skin closure, aminophylline 4mg/kg was given to Group A and an equivalent volume of normal saline to Group R BIS values, heart rate, blood pressure, oxygen saturation and End tidal CO2 (ETco2) were determined. Time to eye opening, extubation time and response to command were measured. Results: There were no significant differences in SpO2, ETco2 and anesthesia time. Heart rate and systolic blood pressure were found to be statistically higher (p<0.001) in Group A. Time to eye opening, hand grip and extubation were significantly shorter (p<0.001) in Group A. Bispectral index scores were significantly higher in group A. Conclusions: Injection of aminophylline at emergence time led to significant increase in BIS and shortening recovery time from anesthesia

Preoperative Factors as Predictors of Blood Product Transfusion Requirements in Orthotopic Liver Transplantation

Context-Intraoperative transfusion can affect the chance of graft survival in liver transplantation, a complicated operation with massive blood loss. Verification of factors that are predictive of intraoperative blood loss and transfusion increases the quality of anesthesia management. Objective-To assess use of blood and blood products between 2002 and 2008 and to evaluate factors associated with blood loss and requirement for blood products in adult patients undergoing orthotopic liver transplantation via piggyback technique. Design-Medical charts and anesthesia records from 261 eligible adult recipients of an orthotopic liver transplant between March 2002 and May 2008 were reviewed. Setting-Shiraz Liver Transplantation Center, the only active liver transplantation center in Iran. Main Outcome Measures-Potential influencing factors in blood loss and transfusion, including sex, preoperative hemoglobin level, international normalized ratio, primary diagnosis, platelet count, creatinine level, Model for End-Stage Liver Disease (MELD) score, central venous pressure, and total anesthesia time, were measured and subjected to multivariable analysis. Results-Mean blood loss was 54.2 (SD, 47.9) mL/kg, the mean (SD) for amounts of blood products transfused was 25.3 (19.5) mL/kg for packed red blood cells, 2.6 (3.3) units for fresh frozen plasma, and 1.7 (3.1) units for platelets. Seven recipients (2.7%) underwent transplantation without intraoperative transfusion of red blood cells, whereas 25 patients (9.6%) received more than 10 units of red blood cells intraoperatively. Multivariable analysis showed that no preoperative factor was a predictor of blood loss or requirement for intraoperative transfusion. Transfusion of fresh frozen plasma and packed red blood cells was significantly lower in 2005, 2006, 2007, and 2008 than in 2003 to 2004 (P<.001). (Progress in Transplantation. 2011;21:254-259