Preoperative Oral Valiflore Reduces Anxiety in Laparoscopic Cholecystectomy: A Double Blind, Placebo Controlled Study

AbstractMany patients undergoing surgical procedures experience preoperative anxiety. Therefore; develop a drug as a premedication with strong anxiolytic effect and minimal psychomotor impairment is desirable. Under ethics committee approval, eighty patients, who met the inclusion criteria, were randomly assigned to two groups to receive either oral Valiflore (600 mg, Niak) or placebo as a premedication, 90 minutes before surgery. A numerical rating scale (NRS) for anxiety and the Ramsay sedation scale were measured at baseline, and 15, 30, 60, 90 minutes after premedication. Psychomotor function recovery was assessed using the Digit Symbol Substitution Test and the Trieger Dot Test on arrival in the operating room, 30 and 90 minutes after tracheal extubation. The duration of anesthesia, surgery and recovery time were recorded for each patient. There were no statistically significant differences in the patients’ demographic characteristics, ASA physical status, basal NRS score, the sedation level at different time intervals, duration of anesthesia, surgery and recovery time in the two groups (P > 0.05).The NRS anxiety scores were significantly lower in the Valiflore group in comparison with the control group (P < 0.001). There was no significant difference in psychomotor function test in both groups. Oral Administration of Valiflore as a premedication reduces anxiety before surgery without inducing sedation. Keywords:Anxiety; Herbal Medicine; Premedication; Preoperative anxiety; Valiflore Trial registry number:IRCT201404115175N13 Short title: Valiflore reduces pre-operative anxiety

Plethysmography Variability Index as a Guidance for Intraoperative Fluid Management in Cesarean Section Delivery under Spinal Anesthesia: A Pilot Study

Background: Plethysmography variability index (PVI) is a measure of the dynamic changes in the perfusion index (PI) that occur during one or more complete respiratory cycles. This study was designed to investigate the accuracy of PVI in guidance of fluid management in parturient undergoing cesarean section surgery under spinal anesthesia.Methods: This randomized clinical trial was performed on 21 consecutive patients who were candidate for cesarean section surgery under spinal anesthesia at Shariati Hospital in Tehran, Iran, between April 2015 and April 2016. The patients were randomly assigned to one of the PVI or conventional group. In all patients, serum level of lactate, mean arterial pressure (MAP), total amount of infused intraoperative fluids, urine output, and duration of surgery were recorded.Results: In total, 21 patients (10 in PVI group and 11 in control group) were assessed. The trend of the change in MAP was significantly different between the two groups with a downward trend in PVI group and a fluctuated trend in the conventional group (P = 0.003). The mean amount of infused fluid was 2565.00 ± 563.74 ml in PVI group that was significantly lower than control group (3122.73 ± 321.99 ml) (P = 0.011). Although urine output was numerically higher in PVI than in control group (425.00 ± 274.12 ml vs. 322.00 ± 121.82 ml), it was not statistically significant (P = 0.292). In PVI group, the primary value of PVI was 23.80 ± 6.93 that reached to 12.20 ± 1.75 at the end of surgery indicating a significant reduction (P < 0.001).Conclusions: Regarding clinical and hemodynamic stability as well as fluid therapy responsiveness (less requiring fluids within surgery), PVI monitoring seems to be superior to the conventional method

First- And Second-Order Bragg Gratings In Single-Mode Planar Waveguides Of Chalcogenide Glasses

First- and second-order Bragg reflectors at telecommunication wavelength (1.5 μm) were fabricated in single-mode monolayer (As2S3) and multilayer (As-S-Se/As-S) chalcogenide glass (ChG) planar waveguides with near bandgap illumination using an interferometric technique. Reflectivities as high as 90% near 1555 nm, and index modulations up to 3 × 10-4 were achieved. The volume photodarkening effect is the principal mechanism involved in the formation of the Bragg gratings

Photoinduced Bragg Reflectors In As-S-Se/As-S Based Chalcogenide Glass Multilayer Channel Waveguides

We have fabricated Bragg reflectors at 1550 nm in multilayer channel waveguides of As- S-Se/As-S chalcogenide glasses using near-bandgap light (~514 nm). A reflectivitity up to 86% (~8.5 dB), and a linewidth of ~0.3 nm were achieved for a 3.0 mm long first order Bragg grating. The polarization dependence of these Bragg filters was also studied. © 2001 Taylor & Francis

A Rare Central Venous Catheter Malposition in a 10-Year-Old Girl

Central venous catheters (CVCs) are placed in operating rooms worldwide via different approaches. Like any other medical procedure, CVC placement can cause a variety of complications. We report the case of an unexpected malposition of a catheter in the right internal jugular vein, where it looped back on itself during placement and went upward into the right internal jugular vein. CVC line placement should always be viewed as a procedure that could become complicated, even in the hands of the most experienced operators

Comparison of granisetron and lidocaine on reducing injection pain of etomidate: a controlled randomized study

Background and objectives: Reducing pain on injection of anesthetic drugs is of importance to every anesthesiologist. In this study we pursued to define if pretreatment by granisetron reduces the pain on injection of etomidate similar to lidocaine. Methods: Thirty patients aged between 18 and 50 years of American Society of Anesthesiologists physical status class I or II, whom were candidates for elective laparoscopic cholecystectomy surgery were enrolled in this study. Two 20 gauge cannulas were inserted into the veins on the dorsum of both hands and 100 mL of normal saline was administered during a 10 min period from each cannula. Using an elastic band as a tourniquet, venous drainage of both hands was occluded. 2 mL of granisetron was administered into one hand and 2 mL of lidocaine 2% at the same time into the other hand. One minute later the elastic band was opened and 2 mL of etomidate was administered to each hand with equal rates. The patients were asked to give a score from 0 to 10 (0 = no pain, 10 = severe pain) to each the pain sensed in each hand. Results: Two patients were deeply sedated after injection of etomidate and unable to answer any questions. The mean numerical rating score for injection pain of intravenously administered etomidate after intravenous granisetron was 2.3 ± 1.7, which was lower when compared with pain sensed due to intravenously administered etomidate after administration of lidocaine 2% (4.6 ± 1.8), p < 0.05. Conclusion: The result of this study demonstrated that, granisetron reduces pain on injection of etomidate more efficiently than lidocaine. Resumo: Justificativa e objetivos: A redução da dor causada pela injeção de anestésicos é importante para todos os anestesiologistas. Neste estudo buscamos definir se o pré-tratamento com granisetrona reduz a dor causada pela injeção de etomidato de forma semelhante à lidocaína. Métodos: Trinta pacientes com idades entre 18 e 50 anos, estado físico ASA I ou II (de acordo com a classificação da Sociedade Americana de Anestesiologistas) e candidatos à colecistectomia laparoscópica eletiva foram incluídos neste estudo. Duas cânulas de calibre 20 foram inseridas nas veias do dorso de ambas as mãos e 100 mL de soro fisiológico foram administrados durante 10 minutos através de cada cânula. Usando um torniquete elástico, a drenagem venosa de ambas as mãos foi ocluída. Granisetrona (2 mL) foi administrado em uma das mãos e lidocaína a 2% (2 mL) na outra mão ao mesmo tempo. Após um minuto, o torniquete foi liberado e 2 mL de etomidato foram administrados em velocidade igual a cada uma das mãos. Solicitamos dos pacientes uma classificação de 0 a 10 para a dor sentida em cada uma das mãos (0 = sem dor, 10 = dor intensa). Resultados: Dois pacientes estavam profundamente sedados após a injeção de etomidato e, portanto, incapazes de responder a qualquer pergunta. O escore médio de classificação da dor à injeção de etomidato administrado por via endovenosa após granisetrona intravenosa foi de 2,3 ± 1,7, o que foi menor em comparação com a dor sentida à administração intravenosa de etomidato após a administração de lidocaína a 2% (4,6 ± 1,8), p < 0,05. Conclusão: O resultado deste estudo demonstrou que granisetrona reduz a dor causada pela injeção de etomidato com mais eficácia que lidocaína. Keywords: Granisetron, Lidocaine, Etomidate, Pain, Palavras-chave: Granisetrona, Lidocaína, Etomidato, Do

Comparison of granisetron and lidocaine on reducing injection pain of etomidate: a controlled randomized study

Abstract Background and objectives Reducing pain on injection of anesthetic drugs is of importance to every anesthesiologist. In this study we pursued to define if pretreatment by granisetron reduces the pain on injection of etomidate similar to lidocaine. Methods Thirty patients aged between 18 and 50 years of American Society of Anesthesiologists physical status class I or II, whom were candidates for elective laparoscopic cholecystectomy surgery were enrolled in this study. Two 20 gauge cannulas were inserted into the veins on the dorsum of both hands and 100 mL of normal saline was administered during a 10 min period from each cannula. Using an elastic band as a tourniquet, venous drainage of both hands was occluded. 2 mL of granisetron was administered into one hand and 2 mL of lidocaine 2% at the same time into the other hand. One minute later the elastic band was opened and 2 mL of etomidate was administered to each hand with equal rates. The patients were asked to give a score from 0 to 10 (0 = no pain, 10 = severe pain) to each the pain sensed in each hand. Results Two patients were deeply sedated after injection of etomidate and unable to answer any questions. The mean numerical rating score for injection pain of intravenously administered etomidate after intravenous granisetron was 2.3 ± 1.7, which was lower when compared with pain sensed due to intravenously administered etomidate after administration of lidocaine 2% (4.6 ± 1.8), p < 0.05. Conclusion The result of this study demonstrated that, granisetron reduces pain on injection of etomidate more efficiently than lidocaine

Polarization-Dependent Photoinduced Surface Microgratings In Amorphous Chalcogenide Glasses

Recently, the chalcogenide glasses (ChG) have attracted much attention in the field of optical communication and integrated optics. High transparency in the infrared spectral region, low phonon energy, high nonlinear properties, and high photosensitivity at near band-gap (Eg 2.35 eV, a 1-2 x iO cm1 at 5 14 nm) are important characteristics of these glasses. In particular, the photosensitive effects, among them photodarkening and giant photoexpansion (2-5%) [1], have been extensively studied and several holographic elements, such as microlenses, diffraction and Bragg gratings, and channel waveguides have been realized in fiber, bulk, and thin film forms of these materials [2-4]. In this work, we report for the first time to our knowledge, the observation and study of the strong polarization dependent photoinduced surface relief gratings in As2S3 thin films. A model to describe the observed phenomena is also presented. © 2000 SPIE

Effect of Magnesium Sulfate on Hemodynamic Changes During Sternotomy and Laryngoscopy in Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial

Background: This study was designed to evaluate the effectiveness of low and high dose magnesium sulfate in&nbsp;reducing pressure responses to laryngoscopy and sternotomy.Methods: A total of 90 patients were assigned into three groups. The patients in Group L received a 20 mg/kg bolus dose of magnesium sulfate 3 minutes before intubation followed by an infusion of magnesium sulfate (10 mg/kg/h) in contrast to 40 mg/kg of magnesium sulfate followed by an infusion of 20 mg/kg/h magnesium sulfate administered to Group H. Patients in Group P received saline as placebo. Heart rate and mean arterial pressure (MAP) recorded at the baseline were noted down again before intubation and 30 seconds, 2 and 4 minutes after intubation and 1 minute before, and 30 seconds, 2 and 4 minutes after sternotomy.Results: MAP in Groups L and H compared to Group P was significantly lower, after intubation (P =&nbsp;0.0040). The difference between MAP in Groups L and H was only statistically significant 30 seconds after intubation. MAP 30 seconds and 2 minutes after sternotomy was statistically different between Groups L and H compared to Group P. The difference between Groups H and P was only statistically significant before sternotomy and 4 minutes after sternotomy (P = 0.0001).Conclusions: A low dose magnesium sulfate attenuates the hemodynamic response to laryngoscopy and&nbsp;sternotomy in coronary artery bypass graft surgery