Effects of Oral Gabapentin, Local Bupivacaine and Intravenous Pethidine on Post Tonsillectomy Pain

Introduction: Tonsillectomy is one of the most common surgeries performed worldwide. Post-operative pain arising from tonsillectomy is one of the earliest complications that can postpone oral nutrition and increase the hospitalization period. Administration of opioids via injection is usually preferred to relieve pain in these patients. However, the side effects of this approach prompted us to seek alternative treatments. In this study, the effectiveness of oral gabapentin is compared with an intravenous (IV) injection of pethidine and a local injection of bupivacaine in the control of pain after tonsillectomy. Materials and Methods: This clinical trial was performed on 7-15 year-old patients who were candidates for tonsillectomy at Shahrekord Kashani hospital from 2012–2013. The patients were divided into three groups at random. Group 1 was give 20 mg/kg oral gabapentin 1 hour before anesthesia. In Group 2, 2.5 ml bupivacaine 0.25% was injected into each tonsil bed by a surgeon. In Group 3,1 mg/kg pethidine was injected intravenously after intubation. To assess postoperative pain, the Oucher scale was used in recovery as well as 3,6,12, and 24 hours after surgery. Results: The pain score was lowest in the gabapentin group and highest in the bupivacaine group during the study. The pain score in the gabapentin group was significantly lower than that in the bupivacaine group (P<0.05). No statistically significant difference was found between the pain score of the Pethidine group and that of the Bupivacaine group (P>0.05). Conclusion: Gabapentin, with its antihyperalgesic properties and other unknown properties, is a convenient drug for controlling pain following tonsillectomy

Effect of lidocaine on duration of seizure and hemodynamic alterations in electroconvulsive therapy

Background and Objective: Electroconvulsive therapy (ECT) is one of the most common methods in treatment of different types of psychological disorder. The effectiveness of this therapy has a direct relation with the duration of convulsion. This study was conducted to assess the effect of lidocaine on duration of seizure and hemodynamic alterations in electroconvulsive therapy. Materials and Methods: This clinical trial study was conducted on 72 ASA-I, II patients with psychotic disorders in Hajar Medical Center in Shahrekord, Iran during 2010. The patients randomly divided into intervention and control group. The interventional group was received 1.5 mg/kg lidocaine and controls were received normal saline. For induction of anesthesia, all patients were received Sodium Thiopental (2mg/kg), Succinylcholine (1mg/kg) and Atropine (0.5mg) Propofol and Succinylcholine during 72 sessions of ECT. Duration of objective convulsion and hemodynamic alterations including blood pressure and heart rate were recorded (before, immediately and 3, 5 minutes after ECT). Data were analyzed using SPSS-11.5 and t-test. Results: Systolic and diastolic blood pressures and heart rate in 3rd minutes in interventional group following electroconvulsive therapy were 143.38±16 mmHg, 79.86±6.7 mmHg, 91.9±9.9 mmHg, respectively and in controls were 128.88±13.04 mmHg, 87.63±5.79 mmHg and 102.86±13 mmHg, respectively. These difference were significant (P<0.05). The above-mentioned indices for 5th minutes in intervention and controls were as follow: systolic (113.47±9.97 mmHg, 122.36±13 mmHg), diastolic (73.47±4.27 mmHg, 77.63±6.26 mmHg) heart rate (84.41±4.6 in minute, 93.19±12.53 in minute). These differences in above indices were significant (P<0.05). Conclusion: This study showed that lidocaine administration during electroconvulsive therapy increase the duration of convulsion and reduces heart rate and blood pressur

Retained Intraabdominal Gossypiboma, Five Years after Bilateral Orchiopexy

Introduction. Gossypiboma or textiloma is used to describe a retained surgical swab in the body after an operation. Intraabdominal surgical sponge is an uncommon surgical error. The incidence of gossypiboma has been reported as high as 1 in 1000 to 15,000 intraabdominal operations. Gossypiboma may cause serious morbidity and may lead to mortality. Case presentation. Herein, we report a 24 years-old man who was admitted due to the intraabdominal mass after evaluation of primary infertility. He had a surgical history of bilateral abdominal orchiopexy 5 years previously, performed at another hospital. Hydatid cyst was suspected by abdominal computed tomography. After laparotomy excision, the cyst wall opened incidentally, and draining of a large amount of thick pus with retained surgical gauze within the cyst was found, with final diagnosis of gossypiboma. Conclusion. The policy that prevention is far more important than cure is highly appreciated. Accurate sponge and instrument counts, along with radiologic evaluation when a discrepancy is found, can be helpful. Although human errors cannot be completely avoided, continuous medical training and strict adherence to rules of the operation room should reduce the incidence of gossypiboma to a minimum. Surgical sponges should be counted once at the start and twice at the end of all surgical operations

Comparison of the effects of pethidine and diclofenac on post appendectomy pain

روش معمول کنترل دردهای پس از عمل استفاده از داروهای مخدر می باشد. استفاده از این داروها می تواند باعث بروز عوارض خطرناکی مثل ضعف تنفس یا حتی قطع تنفس و عوارض خطرناک دیگر شود. از طرفی کار برد این داروها خطر سوء مصرف هم دارد. بنا براین همیشه جایگزین کردن این داروها با داروهای کم خطرتر مد نظر بوده است. هدف از این مطالعه بررسی مقایسه ای اثر ضد درد دیکلوفناک سدیم (داروی مسکن با خواص ضد التهابی) با پتیدین (داروی مخدری که به طور معمول برای کنترل درد های پس از عمل به کار برده می شود) پس از جراحی آپاندکتومی بوده است. این مطالعه از نوع مداخله ای ـ مقایسه ای است که بر روی 72 بیمار پس از عمل آپاندکتومی، بالای 15 سال که به صورت تصادفی ساده انتخاب شدند انجام شد. به گروه مورد (p) آمپول پتیدین یک میلی گرم به ازاء هر کیلو گرم وزن به صورت داخل عضلانی در سه مرحله بلافاصله پس از هوشیاری کامل (مرحله یک)، 6 ساعت بعد (مرحله دو) و 12 ساعت بعد از هوشیاری (مرحله سه) و به گروه شاهد (D) آمپول دیکلوفناک سدیم 75-50 میلی گرم داخل عضلانی در زمان های مشابه تجویز شد. در مراحل مختلف تحقیق شدت درد بر حسب نوع مسکن در هر دو گروه، با استفاده از پرسشنامه مک گیل ارزیابی شد. مقایسه شدت درد مرحله 2 به 1 در گروه P (پتیدین)40/42 و در گروه D (دیکلوفناک سدیم)60/30 (05/0

Torsion of Testis in an Infant with Unilateral UDT

Torsion of an undescended testis is uncommon. Torsion of a cryptorchid testicle presents a nonspecific symptomatology. Clinical suspicion indicates emergent surgical exploration, irrespective of Doppler ultrasound with its inherent false negative results. Management of the contralateral testis is controversial. We emphasize the need of a complete physical examination of the child who goes to the emergency room with nonspecific symptoms of abdominal pain and ipsilateral empty hemiscrotum to rule out torsion of a cryptorchid testicle. Herein, we report a one-year-old infant with missed torsion of undescended left testis

External Genitalia Trauma Following the First Manic Episode in an Elderly Woman With Sexual Disinhibition

Introduction: Late onset bipolar disorder is not common. In addition, bipolar disorder with a dominancy over sexual behaviors is very rare. Hence, traumatic and vigorous sexual behavior, such as masturbation and self-mutilation, are odd and rare occurrences. Case Presentation: An elderly woman in a manic phase of bipolar disorder without a previous history of psychiatric disorders was concomitant with problematic sexual over stimulation in the context of hyper sexuality. She had traumatized her genitals and underwent surgery for their repair. Following her admission and psychopharmacologic therapy, she recovered. Conclusions: The presentation of bipolar disorder in the elderly can be seen in sexual behaviors and self-mutilation that can lead to the need for reparative surgery. In each case with trauma to the external genitalia, psychiatric problems should be considered

EEG-Based Effective Connectivity Analysis for Attention Deficit Hyperactivity Disorder Detection Using Color-Coded Granger-Causality Images and Custom Convolutional Neural Network

Background: Attention deficit hyperactivity disorder (ADHD) is prevalent worldwide, affecting approximately 8-12% of children. Early detection and effective treatment of ADHD are crucial for improving academic, social, and emotional outcomes. Despite numerous studies on ADHD detection, existing models still lack accuracy distinguishing between ADHD and healthy control (HC) children.Methods: This study introduces an innovative methodology that utilizes granger causality (GC), a well-established brain connectivity analysis technique, to reduce the required EEG electrodes. We computed GC indexes (GCI) for the entire brain and specific brain regions, known as regional GCI, across different frequency bands. Subsequently, these GCIs were transformed into color-coded images and fed into a custom-developed 11-layer convolutional neural network.Results: The proposed model is evaluated through a five-fold cross-validation, achieving the highest accuracy of 99.80% in the gamma frequency band for the entire brain and an accuracy of 98.50% in distinguishing the theta frequency band of the right hemisphere of ADHD and HC children by only using eight electrodes.Conclusion: The proposed framework provides a powerful automated tool for accurately classifying ADHD and HC children. The study’s outcome demonstrates that the innovative proposed methodology utilizing GCI and a custom-developed convolutional neural network can significantly improve ADHD detection accuracy, improving affected children’s overall quality of life

Predicting Difficult Laryngoscopy and Intubation With Laryngoscopic Exam Test: A New Method.

Airway assessment is fundamental skill for anesthesiologists and failure to maintain a patient's airway is the tremendous cause of anesthesia-related morbidity and mortality. None of the tests which have recommended for predicting difficult intubation stands out to be the best clinical test or have high diagnostic accuracy. Our study aimed to determine the utility of a new test as "laryngoscopic exam test (LET)" in predicting difficult intubation. Three hundred and eleven patients aged 16-60 years participated and completed the study. Airway assessment was carried out with modified Mallampati test, upper lip bit test and LET preoperatively, and Cormack and Lehane's grading of laryngoscopy were assessed during intubation as a gold standard, and difficult laryngoscopy was considered as Cormack and Lehane's grade ΙΙΙ or ΙV of laryngoscopic view. The incidence of difficult intubation was 6.1%. The LET showed higher sensitivity, specificity, and accuracy (P<0.05), without revealing significant differences among three tests (P=0.375). The LET is a simple bedside test and an alternative method for predicting difficult intubation

Pharmacutical effects of ephedrine, atropine and mucosal phenilephrin on hemodynamic alterations of women during spinal anesthesia in cesarean section

Background and Objective: Hemodynamic alteration and hypotension due to spinal anesthesia can reduce tissue perfusion and increase ischemic risk, myocardial infraction, renal failures spinal damages and even deep veins thrombosis. This study was designed to compare pharmaceutical effects of ephedrine, atropine and mucosal phenilephrin on hemodynamic alteration of women during spinal anesthesia in cesarean section. Materials and Methods: This randomized clinical and double blind study was done on 90 singleton pregnant women with ASA I and II class .the subjects gone elective cesarean section and allocated into three groups. subjects were received 500 ml ringer lactate before spinal anesthesia. Subjects in group I, II and III first received 0.1 mg/kg atropine (IV) 0.01mg/kg ephedrine and 100µgr phenilephrin (mucosal) prior spinal anesthesia, respectively. Hemodaynamic indexes including blood pressure, heart Rate, oxygen saturation and drug side effects were determined every 5 minutes interval through the surgery. Data was analyzed by using SPSS-11.5, Chi-Square and ANOVA tests. Results: Hemodaynamic indexes were changed during study, but three medicine showed similar effect on heart Rate, blood pressure and changes of oxygen saturation (P<0.05). There was a significant differences among three groups for dosage of extra ephedrine to control of blood pressure (P<0.05). This increase dosage of extra ephedrine was 56.7%,20% and in ephedrine, phenilephrin and atropine groups,respectively. Nosia rate was 6.7%, 50% and 46.7% in phenilephrin, atropine and ephedrine groups, respectively (P<0.05). Conclusion: This study showed that to prevent of blood pressure drop following spinal anestasia atropine, phenilephrin and ephedrine can be prescribed, but ephedrine is recommended for lowering the rate of nosi

Effect of naloxone on seizure duration after electroshock therapy (ECT

ECT is a process in which a generalized seizure is induced by passing electrical current for 25 to 150 seconds through the brain under general anesthesia. It is a highly effective treatment for major depression, mania and schizophrenia. Seizure is terminated by active inhibitory processes. The inhibition of seizure is due to the production of endogenous opioids. Naloxone, as an opioid antagonist, may lessen the effect of endogenous opioids. This clinical trial study was conducted to determine the effect of naloxone on length of the seizure. Sixty patients (30 male and 30 female), who met the diagnostic criteria were included in this study. The control group comprised of 30 patients, received ECT without naloxone, and the experimental group comprised of 30 patients, received ECT and 2 mg naloxone (i.v.). Duration of seizure was compared between two groups by t-test. The mean of seizure length was 21.3s in the control and 27.8s in the experimental group. Therefore naloxone can be used for lengthening of seizure and consequently for improving its treatment benefit