Is tele-education a proper substitute for regular method to train anesthesiology residents?

Background: Communication technology development has provided easier and quicker services in various medical fields. One of the main applications of tele-communication is tele-education, which helps in remote education of students. This study was designed to compare impact of tele-education and regular education methods on anesthesiology residents.Methods and Materials: Anesthesiology residents participated in both tele-education and regular courses during a one-year period. Various related subjects were taught in tele conference and regular sessions. In each course, residents were assessed by pretest and posttest exams. Finally, satisfaction was evaluated regarding quality of sessions using questionnaires especially prepared for the purpose.Results: Mann-Whitney U test showed no statistically significant difference in pretest (p=0.15) and posttest (p=0.07) results of both courses, although this difference was notably in favor of tele- posttest results. The highest rate of satisfaction among residents was dedicated to "saving time" to get to tele conference classes. Moreover, 92.59% of residents preferred to take part in tele conference classes.Conclusion: The study showed that tele-education and regular methods could be equally effective in the education of residents. Some advantages of tele-education for anesthesiology residents were high satisfaction of residents, time saving, and overcoming long distance. Tele-education could be regarded as an effective substitute for regular education of anesthesiology residents.s

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

The Effect of Different Combination Doses of Intrathecal Hyperbaric Bupivacaine 0.5% and Sufentanil on the Hemodynamic Profile of Geriatric Patients Undergoing Hip Surgery under Spinal Anesthesia

Background: With the increasing number of elderly patients with fragile hemodynamic profiles undergoing lower limb surgery, avoiding hypotension in this population is of great importance. We intended to study the effect of different combination doses of intrathecal hyperbaric bupivacaine 0.5% and sufentanil on the hemodynamic profile of geriatric patients undergoing lower limb surgery.Methods: A total of 60 patients aged over 70, candidates for lower limb surgery under spinal anesthesia were enrolled in this study. The patients were randomly allocated into three groups. Group 1 (G1: 5 mg bupivacaine plus 10 µg sufentanil intrathecally), Group 2 (G2: 10 mg bupivacaine plus 5 µg sufentanil intrathecally), and Group 3 (G3: 15 mg bupivacaine intrathecally). Non-invasive automated blood pressure was checked every 1 minute for the first 5 minutes, and every 5 minutes for 25 minutes and every 15 minutes for 30 minutes during surgery. Heart rate (HR) was recorded at the same intervals. The quality of the blocks was also compared.Results: A total of 60 patients met the inclusion criteria and were enrolled in the study. Five patients had failed spinal anesthesia whom were replaced with new patients. There was no difference between the groups in their baseline characteristics. Mean arterial pressure after 1 minute in Groups 2 and 3 was significantly lower than Group 1 (86.0 ± 9.0, 87.3 ± 11.0, 92.2 ± 13.0, P = 0.001). No statistically significant difference in HR was observed in between the three groups. The degree of motor and sensory block was adequate in all three groups, and no patients required any additional analgesics. 15 (75%) patients in Group 3 received ephedrine in comparison to 11 (55%) patients in Group 2. 3 (15%) patients in group one needed ephedrine.Conclusions: In conclusion, adding sufentanil as an adjuvant and decreasing the dose of intrathecal hyperbaric bupivacaine may help maintain a stable hemodynamic during lower limb surgery in the elderly

Intravenous Acetaminophen Effect on Postoperative Narcotic Analgesic Demand after Elective Cesarean Section

Background: Opioid analgesics are the mainstay of the treatment of postoperative pain. Appropriate monitoring of patients receiving opioid analgesics is essential to detect those with side effects such as respiratory depression. The discovery of Acetaminophen as a COX-3 variant may represent a primary central mechanism by which acetaminophen decrease pain. The aim of this study was to assess the effect of intravenous acetaminophen on morphine requirement in post-operation pain after elective cesarean section.Materials and Methods: In a randomized clinical trial, patients’ candidate for elective cesarean section. In experiment group, intravenous acetaminophen (1000 mg/6 hour) was administered and normal saline to control group. Visual analogue scale (VAS) was measured at 1, 3, 6, 12, and 24 hours post-operation. Besides, Morphine dose requirement were measured during next 24 hours.Results: 83 patients were enrolled in the study; which 44 patients assigned in placebo group and 39 in Acetaminophen. Mean Age of placebo group was 29.64±5.55 and Acetaminophen was 30.33±5.50 which was not significantly different (p=0.568). Only at 1 and 3 hours, there was a significant difference between two groups of study. Total dose of morphine requirement was 5.73±2.78 mg/24 h in placebo group and 3.64±2.42 in Acetaminophen group which was significantly different (p=0.001).Conclusion: Intravenous Acetaminophen could decrease post cesarean pain and decrease post operation total morphine requirement particularly at first 3 hours post operation

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

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

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

Supplemental Oxygen therapy and Non-Invasive Ventilation in Corona Virus Disease (COVID-19)

The world has experienced a pandemic due to novel Severe Acute Respiratory Disease Corona Virus-2 (SARS-CoV2) since December 2019. The clinical spectrum of the disease known as Coronavirus Disease 2019 (COVID-19) is so much wide, starting from an asymptomatic state to paucisymptomatic clinical presentation, pneumonia, respiratory failure to even death. Supplemental oxygen therapy is essential in managing COVID-19. Also, there is sparse evidence regarding use of non-invasive ventilation (NIV) in pandemics like SARS-CoV-2. This study reviews the currently available methods for respiratory support in COVID-19 with a discussion about using these modalieties in the COVID-19 pandemic

Regenerative Medicine And Perioperative Hypoxic Organ Damage: Targeting Hypoxia-Inducible Factors

Regenerative medicine is defined by utilizing body’s own repair mechanisms in order to restore normal function of tissues. An important perioperative cause of organ injury is hypoperfusion mostly due to hypoxia. Hypoxia can promote genomic pathway and increase the level of hypoxia-inducible factors (HIF). In this review we introduce HIF as a pioneer role of regenerative medicine for prevention of perioperative complications