Post anesthetic shivering in children: incidence and causative factors

چکیده: زمینه و هدف: بیماران در طی بیهوشی حرارت از دست می دهند و پیدایش لرز روشی برای مقابله با آن است. تاکنون مطالعات متعددی در مورد لرز در بالغین انجام شده، ولی میزان این مطالعات در کودکان محدود است. لذا این مطالعه با هدف بررسی شیوع لرز پس از بیهوشی در کودکان و عوامل مربوط به آن انجام شد. روش بررسی: در این مطالعه توصیفی - تحلیلی ٢٠٠ کودک سه ماهه تا چهارده ساله در اطاق بهبودی از نظر عوامل زمینه ای، دریافت پیش داروی بیهوشی، روش بیهوشی، مدت زمان بیهوشی، درجه حرارت بیمار در اطاق بهبودی و درجه حرارت اطاق بهبودی مورد بررسی قرار گرفتند. پس از جمع آوری داده ها با کمک پرسشنامه، اطلاعات با استفاده از تست های آماری کای دو و اسپیرمن مورد تجزیه و تحلیل قرار گرفتند. یافته ها: تعداد کل موارد مشاهده شده لرز ٧ (١٤ نفر) بود. شیوع لرز در بیهوشی استنشاقی (6/13) به صورت معنی دار بیشتر از بیهوشی وریدی (صفر) بود (05/0

Comparison of sedative effect of midazolam and propofol in patients with renal failure

چکیده: زمینه و هدف: دیالیز صفاقی روشی از دیالیز است که بیشتر در اطفال کاربرد دارد. برای کارگذاری کاتتر دیالیز صفاقی به آرام بخشی (Sedation) نیاز است که معمولاً با دو داروی میدازولام و فنتانیل انجام می شود. ولی در بعضی از مطالعات از پروپوفول نیز در بیماران کلیوی در بخش مراقبت های ویژه استفاده شده است. با توجه به این که مطالعه ای در مورد مقایسه اثر سداتیو میدازولام با پروپوفول در جراحی کارگذاری کاتتر دیالیز صفاقی انجام نشده است، این مطالعه با هدف بررسی مقایسه ای اثر آرامبخشی میدازولام با پروپوفول به همراه فنتانیل در بیماران با نارسائی کلیه که نیاز به کارگذاری کاتتر دیالیز صفاقی دارند، انجام شده است. روش بررسی: در این مطالعه کارآزمایی بالینی تعداد 44 بیمار با رنج سنی 65-18 سال، وضعیت فیزیکی کلاس سه و چهار (ASA III, IV) که دارای نارسایی کلیه بوده و کاندیدای کارگذاری کاتتر دیالیز صفاقی بودند به طور تصادفی به دو گروه 22 نفره تقسیم شدند. به گروه اول پروپوفول (50 میکروگرم در کیلوگرم وزن بیمار) به همراه فنتانیل و به گروه دوم میدازولام (50 میکروگرم در کیلوگرم وزن بیمار) به همراه فنتانیل تزریق گردیده، سپس میزان اشیاع اکسیژن، ضربان قلب، فشارخون و سدیشن اسکور (با استفاده از اسکور Ramsay) قبل و بعد از مداخله مورد بررسی قرار گرفت. علائم بالینی مورد نیاز توسط محققین در پرسشنامه مخصوص جمع آوری و با استفاده از آزمون آماری من ویتنی وt-test بررسی شد. یافته ها: بر اساس نتایج، پروپوفول نسبت به میدازولام آرامبخشی بیشتر و بهتری را ایجاد کرد (001/0

Comparison of the effects of intravenous premedication: Midazolam, Ketamine, and combination of both on reducing anxiety in pediatric patients before general anesthesia

Objective: In some medical circumstances, pediatric patients may need premedication for transferring to the operating room. In these situations, using intravenous premedication is preferred. We assessed the efficacy and safety of intravenous midazolam, intravenous ketamine, and combination of both to reduce the anxiety and improve behavior in children undergoing general anesthesia. Methods: In a double-blind randomized clinical trial, 90 pediatric patients aged 6 months to 6 years with American Society of Anesthesiologist grade I or II were enrolled. Before anesthesia, children were randomly divided into three groups to receive intravenous midazolam 0.1 mg/kg, or intravenous ketamine 1 mg/kg, or combination of half doses of both. Behavior types and sedation scores were recorded before premedication, after premedication, before anesthesia, and after anesthesia in the postanesthesia care unit. Anesthesia time, recovery duration, blood pressure, and heart rate were also recorded. For comparing distribution of behavior types and sedation scores among three groups, we used Kruskal–Wallis test, and for comparing mean and standard deviation of blood pressure and heart rates, we used analysis of variance. Findings: After premedication, children's behavior was significantly better in the combination group (P < 0.001). After anesthesia, behavior type was same among three groups (P = 0.421). Sedation scores among three groups were also different after premedication and the combination group was significantly more sedated than the other two groups (P < 0.001). Conclusion: Combination of 0.05 mg/kg of intravenous midazolam and 0.5 mg/kg of intravenous ketamine as premedication produced more deep sedation and more desirable behavior in children compared with each midazolam 0.1 mg/kg or ketamine 1 mg/kg

Comparative evaluation between two methods of induced hypotension with infusion of Remifentanil and Labetalol during sinus endoscopy

Objective: This study aimed to compare two methods of controlled hypotension using labetalol and remifentanil in terms of capability to create controlled hypotension and to investigate the obtained complications, and satisfaction rate of surgeon and patient during functional endoscopic sinus surgery. Methods: In this prospective clinical trial, 62 patients underwent endoscopic sinus surgery in Al-Zahra and Ayatollah Kashani Hospitals of Isfahan were divided into two groups: in the first group, 20 mg bolus dose of labetalol and then infusion of it, at a rate of 0.5–2.0 mg/min and in the second group, remifentanil with dose of 0.5–1 μg/kg started and then 0.25–0.5 μg/kg/min were prescribed. Hemodynamic parameters during anesthesia and recovery time, surgeon and patient satisfaction, and recovery time were measured and recorded. Findings: Hemodynamics variable were comparable between two groups at different times of the study. The mean of bleeding and the frequency of side effects were higher in labetalol group (P = 0.033 and P < 0.0001, respectively). The median of surgeon satisfaction score in remifentanil group was statistically higher in labetalol group (P < 0.0001). Recovery time, fluid requirement, and pain score in labetalol group reported significantly more than remifentanil group. Richmond Agitation–Sedation Scale status at time points in the postanesthetic care unit showed differences between groups. Conclusion: With infusion of labetalol and remifentanil after a bolus dose we can induce effective controlled hypotension under general anesthesia. Remifentanil is a short-acting narcotic drug; then, patient satisfaction was better and recovery time was shorter. From the economic aspect, labetalol prefers to remifentanil

EFFECT OF INTERPLEURAL MEPERIDINE WITH AND WITHOUT BUPI-VACAINE ON POSTOPERATIVE PAIN AFTER STERNOTOMY

Abstract &nbsp;&nbsp; INTRODUCTION: No unique technique has proved efficient enough in controlling post cardiothoracic surgery pain. A variety of agents and techniques have been used to control pain following cardiothoracic surgery; interpleural regional analgesia is one such technique. &nbsp;&nbsp; OBJECTIVE: There are many nerve endings in the pleural cavity. The local anesthetic action of meperidine administered interpleurally was evaluated in this study. &nbsp;&nbsp; METHODS: In a double blind clinical trial, 90 patients undergoing coronary artery bypass graft surgery were randomized into four groups as intravenous meperidine (G1), interpleural meperidine (G2), interpleural meperidine and bupivacaine (G3) and interpleural bupivacaine (G4) groups. At the end of surgery, interpleural catheter was placed in all groups and the medication was prescribed. In the cardiac intensive care unit, narcotic requirements and pain scores were registered. Collected data were analyzed by appropriate tests including t-test and chi-square test. P values below 0.05 were considered as significant. &nbsp;&nbsp; RESULTS: There were no significant differences in age, weight, sex and ASA (American Society of Anesthesiologists) class between the four groups. At all time periods, the pain levels measured by the visual analogue score (VAS) were significantly lower in the G3 and G4 groups (P&lt;0.05). The total narcotic requirements in the first 24 hours of postoperative period were significantly lower in the G3 and G4 groups (P&lt;0.05). &nbsp;&nbsp; CONCLUSION: In spite of analgesic effects of subarachnoid meperidine, intraarticular morphine and interpleural bupivacaine, interpleural meperidine does not change pain scores or narcotic requirements postoperatively. &nbsp;&nbsp; &nbsp; &nbsp;&nbsp; Keywords: Meperidine, bupivacaine, postoperative, pain, thoracic surgery, cardiac surgical procedure..</p

Minimum effective dose of Tramadol in the treatment of postanesthetic shivering

&lt;ul&gt;&lt;li&gt;&lt;strong&gt;BACKGROUND&lt;/strong&gt;: To determine the minimum effective dose of intravenous administration of tramadol on controlling postanesthetic shivering (PAS) and frequency of effects. &lt;/li&gt;&lt;li&gt;&lt;strong&gt;METHODS&lt;/strong&gt;: Seventy five patients who had shivering grade III or IV after general anesthesia with isoflurane in the recovery room were included in the study. The patients were divided randomly among five groups to receive the same dose of tramadol: 0.2 mg/kg, 0.4 mg/kg, 0.6 mg/kg, 0.8 mg/kg and 1 mg/kg. The shivering grades, tympanic temperature immediately prior to administering the treatment, time spent to control shivering, shivering relapse, time interval between the two shivering periods and side effects were registered. Data were analyzed with SPSS software, version 14. Chi-square test, t-student test and analysis of variance were used where they were appropriate. P value &lt; 0.05 was considered significant.&lt;/li&gt;&lt;li&gt;&lt;strong&gt;RESULTS&lt;/strong&gt;: There were no statistically significant differences among treatment groups with respect to demographic data, duration of anesthesia, room temperature of postanesthesia care unit, shivering grade before treatment and central temperature at the time of treatment. There was no significant difference among the number of patients who stopped shivering with 0.2 mg/kg compared with 1 mg/kg of tramadol. There was no significant difference among the five doses for shivering relapse. Frequency distributions of side effects were not different among the five groups.&lt;/li&gt;&lt;li&gt;&lt;strong&gt;CONCLUSIONS&lt;/strong&gt;: All patients completely stopped shivering with tramadol 0.4 mg/kg or more in 5 minutes after treatment. With 0.2 mg/kg only 80% of patients stopped shivering. Although the difference between 0.2 mg/kg and 1 mg/kg was not statistically significant, because of the limited number of cases we were not able to reject type two errors. According to this study, we suggest 0.4 mg/kg of tramadol for shivering control&lt;/li&gt;&lt;li&gt;&lt;strong&gt;KEY WORDS&lt;/strong&gt;: Tramadol, postanesthetic shivering, minimum effective dose.&lt;/li&gt;&lt;/ul&gt

The effect of intravenous infusion of paracetamol before anesthesia induction on the core and peripheral temperature changes and post-operative shivering in patients undergoing general anesthesia

Background: Post-operative shivering is an unpleasant complication that various drugs are used to prevent and treat. It is tried to advice a suitable drug with the least side-effects. This study was carried out to examine the effect of intravenous Apotel on the post-operative shivering and core and peripheral body temperature. Materials and Methods: This clinical trial conducted in Al Zahra and Kashani Hospitals in Isfahan in 2012 on 64 patients undergoing upper limbs surgery with general anesthesia, which divided in two equal groups. In the first group, before induction, 15 mg/kg and up to 1 g paracetamol was infused in 100 cc normal saline within 20 min and control group was infused 100 cc normal saline during 20 min. Post-operative shivering and pain were recorded in the same time in addition to the core and peripheral temperature. The results were analyzed by SPSS ve.20 software. Results: In patients receiving Apotel, the core and peripheral temperature were significantly lower (P < 0.05). At 10 min after entering in recovery, 10 patients in the control group and 2 in the intervention group suffered from shivering (31.2% vs. 6.2%), which was significantly different (P = 0.02). Nineteen patients (29.7%) suffered from shivering in recovery (14 patients in the control group and 5 patients in the intervention group (43.8% vs. 15.6%)). In Apotel receiving group, the incidence of shivering in recovery was significantly lower (P = 0.014). Conclusion: Given the beneficial effects of Apotel in post-operative shivering and pain reduction, using the drug as a pre-drug is recommended in patients undergoing surgery with general anesthesia

Effect of pre vs. post incision inguinal field block on postoperative pain after pediatric herniorrhaphy, a different approach

BACKGROUNDS: The aim of this study was to determine if preemptive local anesthesia yields better postoperative pain control than infiltration of local anesthesia at the time of wound closure. METHODS: Forty patients aged between 1 and 10 years were randomly allocated to one of the two groups by using a sealed envelope technique. Group 1 received 0.5 mg/kg bupivacaine 20 minutes before the incision of skin and the same volume of normal saline at the end of skin suture. Group 2 received 0.5 mg /kg bupivacaine at the end of skin suture and the same volume of normal saline 20 minutes before the incision of skin. Pain scores of patients in the recovery room, 6, 12 and 24 hours after surgery were measured. If patients complained of post surgical wound pain, 30 mg/kg of acetaminophen was administered by rectal suppository. Data were analyzed by chi-square test, t -test and ANOVA. RESULTS: There were no statistical significance between the two groups for age, weight and sex. The overall mean of pain was 4.6 &amp;plusmn; 2.6 for group 1 and 18.6 &amp;plusmn; 8.7 for group 2 and the difference between the two groups was statistically significant (P&amp;lt;0.001). The mean dosage of acetaminophen administration was significantly higher in group 2 compared with group 1 (P&amp;lt;0.05). CONCLUSIONS: Pre-surgical infiltration of bupivacaine in the surgical field is a useful method in decreasing both post-surgical wound pain for up to 24 hours and analgesic consumption after inguinal hernia repair

Comparison of pre- vs. post-incisional caudal bupivacaine for postoperative analgesia in unilateral pediatric herniorrhaphy: A double-blind randomized clinical trial

Introduction: This study was designed to evaluate the pre- vs. post-incisional analgesic efficacy of bupivacaine administered caudally in children undergoing unilateral hernia repair. Methods: Fifty children aged 6 months to 6 years were included in the study. Children were divided blindly between the two groups to receive pre- vs. post-incisional caudal bupivacaine. The preincisional group received 1 ml/kg of 0.125% bupivacaine caudally after induction of anesthesia and the postincisional group received the same dose caudally at the end of surgery. Heart rate, SaO 2 , end tidal CO 2 , and noninvasive arterial blood pressure were recorded every 10 min. The duration of surgery, extubation time, and duration of recovery period were also recorded. The pain scores were measured with using an Oucher chart in the recovery room, 2, 4, 6, 12, and 24 h after surgery. Time to first analgesia, numbers of supplementary analgesics required by each child in a 24-h period and total analgesic consumptions were recorded. Any local and systemic complications were recorded. Quantitative data were compared using a two-tailed t-test. Sex distribution and frequency of acetaminophen consumption were measured using χ2 test. P<0.05 was considered statistically significant. Results: The Oucher pain scale at 4, 6, 12, and 24 h after surgery, the total analgesic consumption and the numbers of demand for supplemental acetaminophen were lower statistically in preincisional group ( P<0.05). Extubation time and duration were higher in preincisional group ( P<0.05). Mean changes of heart rates were statistically lower during the anesthesia period and recovery time in preincisional group (P<0.05). Conclusion: Preincisional caudal analgesia with a single injection of 0.125% bupivacaine is more effective than the postincisional one for postoperative pain relief and analgesic consumption in unilateral pediatric herniorrhaphy

Prophylactic Use of Oral Acetaminophen or IV Dexamethasone and Combination of them on Prevention Emergence Agitation in Pediatric after Adenotonsillectomy

Background: The present study was aimed to evaluate the efficacy of acetaminophen plus dexamethasone on post-operative emergence agitation in pediatric adenotonsillectomy. Methods: A total of 128 patients were randomized and assigned among four groups as: Intravenous (IV) dexamethasone, oral acetaminophen, IV dexamethasone plus oral acetaminophen, placebo. Group 1 received 0.2 mg/kg dexamethasone plus 0.25 mg/kg strawberry syrup 2 h before surgery. Group 2 received 20 mg/kg oral acetaminophen (0.25 ml/kg) with 0.05 ml/kg IV normal saline. Group 3 received 20 mg/kg acetaminophen and 0.2 mg/kg dexamethasone intravenously. Group 4 received 0.25 ml/kg strawberry syrup and 0.05 ml/kg normal saline. Agitation was measured according to Richmond agitation sedation score in the post anesthetic care unit (PACU) after admission, 10, 20 and 30 min after extubation. Pain score was measured with FACE scale. Nurse satisfaction was measured with verbal analog scale. If agitation scale was 3 ≥ or pain scale was 4 ≥ meperidine was prescribed. If symptoms did not control wit in 15 min midazolam was prescribed. Patients were discharged from PACU according Modified Alderet Score. Data were analyzed with ANOVA, Chi-square, and Kruskal-Wallis among four groups. P < 0.05 was considered statistically significant. Results: A total of 140 patients were recruited in the study, which 12 of them were excluded. Thus, 128 patients were randomized and assigned among four groups. The four treatment groups were generally matched at baseline data. Median of pain score in 0, 10, 20 and 30 min after extubation were different between each study group with the control group (<0.001, 0.003 respectively). Also median of agitation score in 0, 10, 20 and 30 min after extubation were different between each study group with the control group (<0.001). Incidence of pain and incidence of agitation after extubation were not statistically identical among groups (P < 0.001 and P = 0.002 respectively). Mean of recovery time, duration of agitation and 1 st time to agitation appearance, meperidine and midazolam consumption, nurse satisfaction and complication frequency were not statistically identical among groups (P < 0.001). Conclusions: Acetaminophen, dexamethasone and combination of them are superior to placebo for prevention of agitation after adenotonsillectomy in children. Furthermore combinations of both drugs are superior to acetaminophen or dexamethasone separately