The Effect of Stretching Exercises and Caffeine Tablets on Reducing Headache after Spinal Anesthesia; A Randomized Clinical Trial

Abstract Introduction: We performed this study to compare the effect of Caffeine and stretching exercise on Post Dural Puncture Headache (PDHP). Methods: In this Randomized Clinical Trial, 160 candidates for elective inguinal hernia surgery or varicocele surgery in Shahid Modares Hospital in Tehran, were assigned into the following groups using a computer-generated randomization table: caffeine group received Caffeine tablet (200 mg TDS); exercise group received stretching exercise; caffeine combine exercise group received Caffeine tablet (200 mg TDS ), and stretching exercise and control group received placebo tablets. After the end of the surgery, up to 48 h, the Visual analog scale (VAS) was recorded every 6hours by the same clinician. Results: The occurrence of PDPH was less in the caffeine and exercise combined group than in the control group. Also, the headache was more severe in the control group than in the caffeine group. Furthermore, the need for rescue analgesics was more in the control group than in the caffeine group. Conclusion: caffeine and exercise combined had better outcomes than placebo regarding PDHP. &nbsp

Frequency of Patient Complaints Before and After Legal Medicine Consultation in Orthopedic Ward

Background: Patient who complain of the health community are unpleasant and may endanger the honor of the medical community. However, patients’ complaints can improve the quality of medical services, increase the accuracy of the medical staff, and reduce diagnostic and treatment costs. The aim of this study was to investigate the prevalence of patients’ complaints before and after legal medicine consultation in the orthopedic ward of Taleghani hospital in Tehran, Iran.Methods: This retrospective cross-sectional study investigated the frequency of the complaints of 460 patients before and after legal medicine consultation from spring 2011 to winter 2017. Data were analyzed by excel.Results: The results of this study showed that the frequency of complaints was lowest in spring and highest in fall. The number of complaints and frequencies also decreased over time compared with the previous year. The lowest number of complaints was in 2011 and the highest in 2013.Conclusion: In this study, performing legal medicine consultation in Taleghani hospital in Tehran, Iran reduced the number of registered complaints

Epidural catheter compared with local infiltration analgesia for postoperative pain relief in total knee replacement

AbstractBackground: This study compares the effects of epidural analgesia with infiltration analgesia in postoperative pain control for total knee arthroplasty. Materials and methods: 47 females and 13 males with an average age of 65.7 years were randomly allocated into epidural (EA; n=30) and local infiltration anesthesia (LIA; n=30) groups. All patients received spinal anesthesia and were inserted epidural catheter. In LIA group, 50mL of a mixture, containing bupivacaine, ketorolac, morphine sulfate, and epinephrine was injected in to periarticular tissue and in EA group normal saline was injected. In the EA group, after surgery, an epidural catheter was attached to the patient-controlled analgesia (PCA) infusion pump with 25cc bupivacaine diluted in 75mL of normal saline but in LIA group, the PCA pump of the epidural catheter contained 100cc of normal saline, and the pump was blocked.Results: The difference in demographic data was not significant between the groups. The mean VAS score (Pain) of EA group was significantly higher than LIA group until 12 hours after surgery, At 24 hours, there was no significant difference between two groups, and Pain of EA group was significantly lower than LIA group at 48 hours after the surgery. Dranage volume and hemoglobin drops were lower in LIA group. Knee range of motion in the LIA group was not superior to that of the EA group two weeks after surgery. The patients’ ability to perform active straight leg raise had no significant difference between two groups one day after the surgery.Conclusion: local infiltration analgesia is better than epidural for postoperative pain control at first 12 hours. However, epidural analgesia can control postoperative pain more effectively at 48 hours after surgery. There was no significantly difference between two groups regard to patients ability to perform straight leg rising and Knee range of motion was similar in two groups

Rh-Incompatibility-Induced Delayed Hemolytic Transfusion Reaction: Role of Immunologic Reactions in Rh-Incompatibility

Blood transfusions are given to increase oxygen-carrying capacity and intravascular volume. Despite all the benefits of transfusion, it may have some complications. When mistransfusions occur, or when no other option is available, incompatible packed-cells may be infused, which puts the patient at risk of experiencing a Hemolytic Transfusion Reaction (HTR). HTRs are classified as acute or delayed reactions having wide spectrum of clinical presentations. In this report, we present a case of delayed hemolytic reaction due to Rh incompatibility in the operation room. Critical incident reporting and evaluation of adverse transfusion reactions may provide effective patient management and prevent the occurrence or repetition of these events

The Mortality Rate in COVID-19 Patients Undergoing Anesthesia for Surgical Procedures

Background: Planning anesthesia for coronavirus disease (COVID) positive patients remains a big dilemma for anesthesiologists. Aside associated harms of postponing surgeries, there is concern about the outcome of COVID after surgical stress, limitation of resources, and personal safety. Therefore, we aimed to investigate the effect of surgery and anesthesia on the course of coronavirus disease 2019 (COVID-19). Methods: A total of 179 patients (COVID-positive) who underwent surgery under anesthesia from March 2020 until March 2021 were retrospectively evaluated. The type of surgery, type of anesthesia, and outcome of patients were recorded. Renal and liver function tests as well as respiratory system function before and after surgery were compared. Results: Among them, 39 patients died (27%). Laboratory data including creatinine (Cr), Aspartate Transaminase (AST), Alanine Transaminase (ALT), Alkaline Phosphatase (ALK), and troponin were not significantly different preoperatively and post-operatively. 28 patients (15.6%) were intubated due to post-operative respiratory failure. In our study mortality rate for all types of surgery was 27% and the postoperative intubation rate was 15.6%. We did not have any organ failure after interventional procedures. Conclusion: The risk of infection progression must be weighed before scheduling invasive procedures. Moreover, regional anesthesia may be less harmful in case of urgent or emergent need for surgery in infected patients

The effects of Ropivacaine and its Combination with Dexmedetomidine and Dexamethasone on Neural Apoptosis

Background: Neurotoxicity effects of anesthetics in different age groups is a major concern regarding neural injuries. It is reasonable to recognize the neurotoxicity risks of anesthetic drugs and their combinations. Materials and Methods: A total of 16 mice (Mus musculus) weighing 22 to 30 gr were randomly divided into four drug groups (control, Ropivacaine, Ropivacaine + Dexmedetomidine, Ropivacaine + Dexamethasone). 24 hours after unilateral injection of drugs into the femoral nerve of mice, the mice were killed and their femoral nerve was removed. Hematoxylin-eosin tissue staining was used to evaluate changes in the effects of the drugs, and nerve samples were extracted to measure TLR4 and caspase 3 expressions. After Western blotting, the protein expression level was checked between different groups. Results: Ropivacaine in combination with dexamethasone caused less damage to the rat nerve cells. The combination of ropivacaine with dexamethasone (p=0.53 and p=0.46) compared to the combination of ropivacaine with dexmedetomidine relatively had better results in terms of cytotoxicity. Conclusion: A combination of ropivacaine with dexamethasone reduces neurotoxicity risk

Effect of bupivacaine and combination with dexmedetomidine and dexamethasone on mice neural apoptosis

Background: Numerous studies have shown the neurotoxicity of anesthetic substances in different age groups. This toxicity is often associated with damage or apoptosis of nerve cells that can lead to various diseases, including Alzheimer's, behavioral changes and transient and even persistent cognitive changes. In this study, it was attempted to evaluate the cytotoxic conditions following the use of three common anesthetic drugs (bupivacaine, dexmedetomidine and dexamethasone) by providing a suitable substrate.Methods and Materials: Mice (Mus musculus) with the same weight (22 to 30 gr) were used for assessment of neurotoxicity in Bupivacaine, Dexmedetomidine and Dexamethasone. Unilateral femoral nerve injections were done; animals were randomly divided into four groups: control, bupivacaine alone, "bupivacaine + dexmedetomidine" and "bupivacaine + dexamethasone". After 24 hours, the mice were sacrificed and the femoral nerve removed. Hematoxylin-eosin tissue staining was used to evaluate changes in the effects of the drugs, and nerve samples were extracted to assess the expression of TLR4 and caspase3. Protein expression level was checked between different groups using Western blot technique.Results: The bupivacaine + dexamethasone group showed better outcomes in terms of cytotoxicity than bupivacaine + dexmedetomidine (p=0.568); also, bupivacaine + dexamethasone reduced neurotoxicity risk (P=0.431).Conclusion: Bupivacaine+dexamethasone leeds to better outcomes in terms of neurotoxicity compared with bupivacaine+dexmedetomidine

Comparing the Efficacy and Safety of Dexmedetomidine-Lidocaine and Propofol-Fentanyl-Midazolam Combinations during Endoscopic Retrograde Cholangiopancreatography

Background and Aims: Propofol is commonly used for providing sedation in endoscopic retrograde cholangio-pancreatography (ERCP). It’s simple to use and effective but presents cardiovascular and respiratory adverse effects. Recently, dexmedetomidine has been tried but very little evidence exists to support its use. The aim of this study was to compare the efficacy and safety of combination of dexmedetomidine and lidocaine (DL) with the standard propofol-fentanyl (PF) regimen.Methods: After approval of the hospital ethics committee, 63 patients (18-60 years of age) were randomly divided into 2 groups. Thirty-one patients received a PF combination (group PF), and 32 patients received DL combination (group DL). The level of sedation was adjusted to achieve a Ramasy Sedation Scale (RSS) score of 3 (moderate sedation) in both groups of patients. Arterial pressure (MAP), heart rate (HR), and peripheral oxygen saturation (SpO2) during ERCP and recovery was continuously assessed.Results: The oxygen saturation (SpO2) showed high statistical significant differences between both groups throughout the procedure with stability in DL group (P<0.01). There was no statistical difference in HR and MAP between the two groups (P>0.05). Post-procedural recovery time was significantly shorter in PF group (15.97±3.27 min) compared with (19.38±5.64 min) DL group (p<0.01). PONV was 3.2% in PF group, while it was absent in DL group. No drug adverse effect or cardiovascular complications were observed in both groups.Conclusion: Dexmedetomidine and lidocaine combination as total intravenous anesthesia (TIVA) during ERCP not only did not reported any oxygen desaturation (SpO2<90%) but also showed better stability of oxygen saturation (SpO2) and less PONV when compared with propofol and fentanyl combination

Epidural Anesthesia with Lidocaine and Dexmedetomidine, Versus Lidocaine Alone on Plasma Levels of IL-6 in Patients with Proximal Femoral Fracture.

Interleukin-6 plays an important role in inflammatory responses and synthesis of acute hepatic phase proteins and its plasma level changes are used as a reliable prognostic factor for mortality in hospitalized patients. On the other hand, various methods for reducing inflammatory responses, including proper control of pain during and after surgery, and correction of hemodynamic disorders, can be monitored by monitoring of plasma levels of IL-6. Epidural anesthesia is an appropriate method for controlling pain in lower limb surgeries. The aim of this study was to evaluate the effect of adding Dexmedetomidine to lidocaine in the epidural injection for better control of post-surgical inflammatory responses by measuring interleukin-6 plasma levels.Patients referred to Taleghani Hospital in 1396 who suffered from lower limb fractures and requiring surgery were evaluated. 52 patients in two groups receiving Dexmedetomidine doses of media and controls for the quality of epidural anesthesia and IL-6 index. After obtaining written consent, the Dexmedetomidine treatment group and the normal saline control group were prescribed epidural with lidocaine. Finally, the level of IL-6 before surgery and 6 hours after surgery were evaluated.According to the results of statistical analysis, the two groups did not show a significant difference in age and level of interleukin prior to the operation. The mean age of patients in this study was 15.84639 ± 53.4038. The sex distribution of the study included 19 women (36.5%) and 33 men (63.5%). According to the U Mann Whitney test, the second injection time and total drug volume had a significant difference between the control and intervention groups and Dexmedetomidine reduced the volume of total drug needed and increase the time interval until the second injection (p <0.001). There was also a significant difference between the two groups in the level of interleukin 6 after 6 hours of operation and this was lower in the Dexmedetomidine group.keywords: Interleukin-6, Dexmedetomidine, lidocaine, Anesthesi

Anesthesia Depth Measurement with Bispectral Index Monitoring during Minor Surgery among Children With and Without Cerebral Palsy

Introduction: Unfortunately, few studies have been performed on the pharmacodynamic effects of anesthesia in children suffering cerebral palsy(CP).Patients were candidates for surgeryfor various reasons. Due to the lower need for anesthesiain these children, side effects of various anesthetic agents, adverse drug reactions, delayed awareness and higher costs can be prevented in these children. The present study aims to evaluate and compare the depth of anesthesia in minor surgeries using Bispectral Index (BSI) in children sufferingCP. Materials and Methods: This cohort study was performed on 64 children aged two to ten years in two groups with and without cerebral palsy inMofid Hospital, Tehran, Iran in 2020. BIS index, mean arterial blood pressure and heart rate were measured before and after anesthesia induction, every ten minutes during operation, after extubation and when being able to respond to verbal stimulation. Results: This studyexamined 64 patients equally divided into two study groups “with and without cerebral palsy”. The mean BIS level in children suffering CP was lower than children without cerebral palsy. The dosage of isoflurane gas used for anesthesia in CPpatientswas meaningfully lower than itsdosage in children without cerebral palsy. Conclusion: Monitoring of anesthesia in this study, showed that use of BIS could reduce the use of anesthetic agents and related side effects to provide the appropriate depth of anesthesia