The Effects of 6% Hydroxyethyl Starch Compared with Normal Saline on Controlling Undesirable Hemodynamic Changes Following Spinal Anesthesia in Patients Undergoing Orthopedic Surgery: A Randomized Clinical Trial

AbstractObjective: The aim of the current study was to compare the effects of normal saline solution and 6% hydroxyethyl starch (HES/HAES) solution on hemodynamic changes after spinal anesthesia in patients undergoing lower limb orthopedic surgery.Method: This randomized clinical trial was performed on 50 patients undergoing surgery, aged 20-60, with physical status of ASA I, II. Before surgery, the hemodynamic status of each patient including systolic and diastolic blood pressure, heart rate, and central venous pressure was measured. Then, the patients were randomly divided into two groups and for the control group, 7 ml/kg 9% (or normal) saline and for the experimental group 6% hydroxyethyl starch were administered. Hemodynamic indices were re-measured after the completion of infusion, and then spinal anesthesia was performed. After anesthesia, hemodynamic indices were measured every 5 minutes for 1 hour and then every 10 minutes for 2 hours. The analysis of variance (ANOVA) for repeated measures was used to evaluate the significant changes in hemodynamic indices.Results: The mean and standard deviation of systolic and diastolic blood pressure, heart rate, and central venous pressure in the control group were 113.0 (7.3), 73.0 (6.0), 95.6 (5.7), and 5.8 (0.9), respectively, and in the intervention group were 104.8 (5.5), 66.1 (4.2), 95.8 (8.2), and 4.3 (0.9(. ANOVA for repeated measures showed that the incidence of decreasing changes in systolic and diastolic blood pressure, heart rate, and central venous pressure of the patients for whom hydroxyethyl starch was prescribed was significantly less than that of the patients for whom normal saline was prescribed.Conclusion: Hydroxyethyl starch has a more effective role in controlling hemodynamic changes before spinal anesthesia than normal saline

Effect of intravenous lignocaine infusion on bispectral index during spinal anaesthesia for caesarean section: A prospective randomised double‑blind study

Background and Aims: Systemic lignocaine has been shown to have sedative effects. We designed this randomised-double-blind, placebo-controlled study to evaluate the effect of intravenous lignocaine on the bispectral index (BIS) during caesarean section under spinal anaesthesia. Methods: 80 patients scheduled for elective caesarean section under spinal anaesthesia were randomly allocated to 2 study groups. Group L received intravenous 1.5 mg/kg of lignocaine bolus, 15 minutes before spinal anaesthesia followed by an intravenous infusion 1.5 mg/kg/h for 60 minutes intravenously. The patients in the control group (C group) were given 0.9% sodium chloride in a double-blind fashion. Spinal anaesthesia was performed with 10 mg of 0.5% bupivacaine. The changes of Sao2, BIS and hemodynamic variables during caesarean section, Apgar score of neonate and the incidence of adverse effects were recorded. Results: BIS values were lower in the L group compared to C group (P ≤ 0.001). Comparison of mean arterial pressure (MAP) changes during spinal anaesthesia and surgery reveal statistically significant difference between two groups through repeated measure analysis (P ≤ 0.001), but comparision of heart rate (HR) changes during spinal anaesthesia and surgery failed to reveal any statistically significant difference between two groups. (P = 0.261). The Apgar scores did not reveal a significant difference between the two groups at first and five minutes after delivery (P = 0.99). Conclusion: Intravenous lignocaine infusion given with spinal anaesthesia in women undergoing elective caesarean delivery providing lower BIS values without respiratory depression, in the absence of foetal compromise

Effect of melatonin on postpartum hemorrhage in vaginal delivery: a prospective randomized double-blind study

BSTRACT Background. The similarities between the melatonin and oxytocin signaling could promote myometrium contractility. We conducted this study to determine the effect of melatonin on the bleeding during and after vaginal delivery. Methods. The current double-blind randomized clinical trial was conducted on 140 pregnant women at term with labor pain. Subjects in the melatonin group received three sublingual doses of melatonin from labor room staff as follows: 6 mg in 7 cm dilatation, 3 mg after delivery of the fetus and 3 mg one hour after the delivery. The same schedule was conducted for the subjects in the placebo group by giving the placebo. The hemoglobin levels before and 24 hours after vaginal delivery, the hemodynamic variables were recorded. Results. There was a significant difference between the groups regarding the mean of hematocrit changes in the melatonin (3.59 ± 2.89) and placebo (5.29 ± 3.19) groups (P = 0.001). The mean variation of systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) show a significant difference among two groups of the study (P = 0.021, P = .020 and 0.001, respectively). Conclusions. The sublingual of melatonin to pregnant women with labor pain could reduce the amount of blood loss after the vaginal delivery. Furthermore, melatonin could provide hemodynamic stability

Comparison of preemptive effect of intravenous ketorolac versus meperidine on postoperative shivering and pain in patients undergoing cesarean section under spinal anesthesia: A prospective, randomized, double-blind study

Background: Pain and shivering are two unpleasant problems in postoperative period. Various techniques are used to alleviate the postoperative shivering and pain. We compared the preemptive prescription of a single dose of intravenous meperidine and ketorolac on postoperative pain and shivering in patients undergoing cesarean section with spinal anesthesia. Methods: One hundred and fifty patients who were scheduled for elective cesarean section under spinal anesthesia were randomly allocated to one of three study groups to receive intravenous ketorolac (group K), meperidine (group M) or normal saline (group P). Time to first analgesic request, analgesic requirement in the first 24 hours after surgery, body tympanic temperature, hemodynamic variables and incidence of shivering were assessed as outcome variables. Results: There was no significant difference between meperidine and ketorolac groups in terms of prevalence of shivering, although both groups were different from the placebo group (p<0.04). The mean time to first analgesic request was longer in group k (3.8±1.4) and groups M (3.3±1.2) than in group P (2.1±0.8) hours (p<0.001). Conclusions: The preemptive prescription of a single dose of intravenous meperidine and ketorolac can provide a satisfying analgesia immediately after surgery and decrease shivering prevalence without any serious side effects

The Effect of Topical Lidocaine Gel, Intrauterine Lidocaine Injection and Combination of these Two Methods for Relieving Pain during Curettage: A Double Blind Randomized Clinical Trial

Introduction: Curettage is one of the most common gynecological surgeries in women. Its complication is pain which increases dissatisfaction in patients. Therefore, it is necessary to find a way to treat this complication. This study was performed with aim to compare the effects of three methods of using lidocaine gel in the cervix, intrauterine injection of lidocaine, and a combination of two methods to reduce pain during curettage. Methods: This clinical trial study was performed in 2017 on 120 patients candidates for curettage in Qazvin Kosar Hospital. Patients were randomly divided into three groups of topical lidocaine gel in the cervix, intrauterine injection of lidocaine and a combination of these two methods, and the drugs were prescribed before curettage. Vital signs and pain were recorded in patients and other information was collected by completing the questionnaire. Data analysis was performed using statistical software (version 22) and chi-square and ANOVA tests. P<0.05 was considered statistically significant. Results: The intrauterine and intra cervical injection of lidocaine (0.3±0.72) and then injection of intra cervical lidocaine (0.45±0.84) alone significantly reduced pain during curettage in women (P=0.04). On the other hand, no severe hemodynamic changes were observed in these patients. No complications such as nausea and vomiting and no instability of vital signs were observed in any of the groups (P>0.05). Conclusion: Intrauterine administration along with addition of topical lidocaine gel to the cervix can be used as a simple, low-cost, and safe method as to control pain during and after curettage

The Effect of Combined Oxytocin–Misoprostol Versus Oxytocin and Misoprostol Alone in Reducing Blood Loss at Cesarean Delivery: A Prospective Randomized Double-Blind Study

Abstract Purpose To compare the effect of combined oxytocin– misoprostol versus oxytocin and misoprostol alone in reducing blood loss at cesarean delivery. Methods One hundred fifty patients of 18–40 years with singleton term pregnancies scheduled for cesarean section under spinal anesthesia were recruited in a prospective double-blind randomized clinical trial to one of the three following groups to receive 20 IU infusion of oxytocin (group O), 400-lg sublingual misoprostol tablets (group M) or 200-lg misoprostol plus 5 IU bolus intravenous oxytocin (group MO) after delivery. The hemoglobin level before surgery and 24 h after surgery, the need for additional oxytocic therapy, and the incidence of adverse effects were recorded. Results The mean blood loss during surgery was significantly lower in group MO compared to other groups (P = 0.04). Comparison of mean arterial pressure (P = 0.38) and heart rate (P = 0.23) changes during spinal anesthesia and surgery failed to reveal any statistically significant differences between all groups through repeated measure analysis. Conclusion The use of combined lower dose of misoprostol– oxytocin significantly reduced the amount of blood loss during and after the lower segment cesarean section compared to higher dose of oxytocin and misoprostol alone, and its use was not associated with any serious side effects

Spontaneous uterine rupture after abdominal myomectomy at the gestational age of 20 weeks in pregnancy: A case report

Background: Uterine rupture in pregnancy is rare and often could be life threatening and catastrophic. Myomectomy is one of very common surgeries in gynecology, performed as the vaginal, abdominal and laparoscopic surgeries. Pregnancies occured after abdominal and laparoscopic myomectomy are high risk for uterine rapture. Case: Patient was a 28 Years old female, pregnant woman at the 20 wks of gestational age with abdominal pain and a history of abdominal myomectomy 6 yrs ago. Uterus was ruptured and fetus in amniotic sac was found in abdominal cavity. Conclusion: Early diagnosis of uterine rupture after myomectomy can save patients from death. Key Words: Myomectomy, Pregnancy, Uterine ruptur

Evaluation of the analgesic effect of ketamine as an additive to intrathecal bupivacaine in patients undergoing cesarean section

Objective: Nowadays, conventional analgesic agents, which are widely used for pain relief after cesarean section, provide suboptimal analgesia with occasional serious side effects. We designed a randomized, double-blind, placebo-controlled study to evaluate the analgesic efficacy of intrathecal ketamine added to bupivacaine after cesarean section. Methods: Sixty patients scheduled for cesarean section under spinal anesthesia were randomly allocated to one of the two groups to receive either bupivacaine 10 mg combined with 0.1 mg/kg ketamine, or bupivacaine 10 mg combined with 0.5 mL distilled water intrathecally. The time to the first analgesic request, analgesic requirement in the first 24 hours after surgery, onset times of sensory and motor blockades, the durations of sensory and motor blockades, and the incidences of adverse effects such as hypotension, ephedrine requirement, bradycardia, and hypoxemia, were recorded. Results: Patients who received ketamine had a significantly prolonged duration of anesthesia compared with those who did not in the control group [95% confidence intervals (CI) 195e217; p ¼ 0.001]. The mean time to the first analgesic request was also significantly longer in ketamine group (95% CI 252.5e275; p < 0.001). The total analgesic consumption in the 24 hours following surgery significantly lessened in the ketamine group compared with that of the control group (95% CI 2e2.5; p < 0.001). The two groups did not differ significantly in intraoperative and postoperative side effects. Conclusion: Intrathecal ketamine 0.1 mg/kg co-administered with spinal bupivacaine elongated the time to the first analgesic request and lessened the total analgesic consumption in the first 24 postoperative hours in comparison with bupivacaine alone in the control group following elective cesarean delivery. Copyright � 2014, Taiwan Society of Anesthesiologists. Published by Elsevier Taiwan LLC. All rights reserved

The effects of melatonin on anxiety and pain scores of patients, intraocular pressure, and operating conditions during cataract surgery under topical anesthesia

Aims: To evaluate the effects of melatonin premedication on anxiety and pain scores of patients, operating conditions, and intraocular pressure during cataract surgery under topical anesthesia. Materials and Methods: Sixty patients were randomly assigned to receive either sublingual melatonin 3 mg or placebo 60 min before surgery. Verbal anxiety scores and verbal pain scores, heart rate, systolic and diastolic blood pressure, intraocular pressure, and quality of operating conditions were recorded. Results: Melatonin significantly reduced the anxiety scores (median, interquartile range) from 5 and 5-3 to 3 and 2-4 after premedication and to 3 and 2-3 during surgery and to 0 and 0-1 postoperatively before discharge from the recovery room. There were significant differences between two groups in anxiety scores after premedication (95% CI 3-3.5; P = 0.023), intraoperatively (95% CI 2.5-3.5; P = 0.007), and postoperatively (95% CI 0.5-1; P = 0.007). The surgeon reported better quality of operating conditions in the melatonin group (P = 0.001). No significant difference in intraoperative and postoperative pain scores, intraocular pressure, heart rate, and systolic and diastolic blood pressure between two groups was recorded. Conclusion: Sublingual melatonin premedication for patients undergoing cataract surgery under topical anesthesia reduced the anxiety scores in patients and provided excellent operating conditions

Comparison of Postoperative Analgesic Effect of Intrathecal Clonidine and Fentanyl Added to Bupivacaine in Patients Undergoing Cesarean Section: A Prospective Randomized Double-Blind Study

Objectives. To compare the analgesic efficacy of intrathecal clonidine and fentanyl added to bupivacaine after cesarean section. Methods. Ninety patients scheduled for cesarean section under spinal anesthesia were randomly allocated to one of the three following groups to receive bupivacaine 10mg combined with 75 ..g clonidine (group C), bupivacaine 10mg combined with 0.5mL fentanyl (group F), and bupivacaine 10mg combined with 0.5mL distilled water (group P), intrathecally. The time to first analgesic request, analgesic requirement in the first 24 hours after surgery, sensory and motor blockade onset time, duration of sensory and motor blockade, the incidence of hypotension, ephedrine requirements, bradycardia, and hypoxemia were recorded. Results. The duration of anesthesia in clonidine group (275.10 �} 96.09) was longer compared to the placebo (211.73 �} 74.80) and fentanyl (192.33 �} 30.36) groups. This difference between group C versus F (.. = 0.006) and P groups (.. < 0.001) was significant. Similarly, the mean time to first analgesic request was also longer in group C (519.44 �} 86.25) than in groups F (277.88 �} 94.25) and P (235.43 �} 22.35 min).This difference between group C versus F (.. < 0.001) and P groups (.. < 0.001) was significant. Conclusion. Intrathecal clonidine 75 ..g with bupivacaine prolonged the time to first analgesic request compared to fentanyl; however, the total analgesic consumption within the first 24 h postoperative was similar in fentanyl and clonidine groups following cesarean section. This trial is registered with ACTRN12611000909921 and ClinicalTrials.gov NCT01425658