Comparison of adding neostigmine and fentanyl to bupivacaine in caudal analgesia in pediatric inguinal herniorrhaphy

AbstractObjective: The aim of the present trial was to compare efficacy and adverse effects of neostigmine against fentanyl when used as adjuvant to bupivacaine in caudal anesthesia.Method: A total of 140 children, aged 1-6 year scheduled to elective herniorrhaphy, were enrolled. Exclusion criteria were sacral area infection, history of allergic reactions to local anesthetics, bleeding tendency, neurological or spinal disease and lack of parent consent. Patients were assigned, using permuted block randomization method, into four groups of 35. Children in the first group received a caudal injection of 0.5 ml/kg bupivacaine 0.25% plus fentanyl 1µ/kg. The second group received 0.5 ml/kg bupivacaine 0.25% plus neostigmine 1µ/kg. Patients in the third group received 0.5 ml/kg bupivacaine 0.25% plus combination of fentanyl 1µ/kg and neostigmine 1µ/kg, and those in the fourth group only received 0.5 ml/kg bupivacaine 0.25% concentration. To assess pain intensity, Wong-Baker Scale was used. Time to first analgesic request and the dosage of analgesic agent was recorded. Data were analyzed using SPSS 17.0.Results:Significant differences were observed among groups in terms of number of patients needing analgesic (p=0.01), time to first analgesic request (p=0.005) and analgesic dose. (p=0.05) The lowest number of requests for analgesia, lowest dose of pethidine and longest time to first analgesic request were in patients receiving combination of bupivacaine, neostigmine and fentanyl.Conclusion: The present study shows that the combination of fentanyl and neostigmine, could prolong duration of analgesia, and decrease severity of pain when added to bupivacain

Comparison the efficacy of pre-emptive oral celecoxib with acetaminophen in controlling post-operative pain and nausea after lower limb surgery under general anesthesia

IntroductionUp to now, there is no single opinion on how to control pain after surgeryand molecular and clinical research in this area has been continuing. This study aimed to compare the effect of premedication with oral administration of celecoxib and acetaminophen on postoperative pain relief in the lower extremity surgery under general anesthesia.                                                         Materials and methods:In a prospective, randomized, double-blinded, clinical trial study, 70 patients undergoing lower limb surgery under general anesthesia were distributed into two equal groups. In the first and second group, oral acetaminophen 1000 mg orcelecoxib 400 mg capsules were prescribed one hour before the operation, respectively. Postoperative painand nausea severity in both groups were evaluatedby VAS score and compared with each other. ResultsAssessment of pain intensity at 1, 2, 6, 12 and 24 hours after surgery revealed that acetaminophen group at the first hour had more intensity of  postoperative pain (5.46±1.17) compared with celecoxib group(4.31±1.32)(P <0.001). In the rest of the time, there was no significant difference between the two groups. Analysis of variance with repeated observations showed, the trend of postoperative pain intensity during the study in both groups had a significant difference (p = 0.013). The intensity of nausea in the first hour after surgery was significantly more in acetaminophen group compared with celecoxib group (2.8±1.1 vs. 2.2±1.3, p<0.034). Conclusions:Celecoxib may be a better choice in reducing pain and nausea after surgery compared with acetaminophen. Considering no significant adverse effects in many studies, celecoxib may be used as a pre-emptive medication to reduce pain after lower extremity surgery.Key words: Premedication, Post-operative, PONV, pain, Celecoxib, Acetaminophe

Efficacy of Glucose-Insulin-Potassium Infusion on Left Ventricular Performance in Type II Diabetic Patients Undergoing Elective Coronary Artery Bypass Graft.Dy

BACKGROUND: Glucose-insulin-potassium (GIK) may improve cardiovascular performance after coronary artery bypass graft surgery (CABG). Our study investigated whether an infusion of GIK during elective CABG surgery in type II diabetic patient improved left ventricular performance.    METHODS: We measured left ventricular ejection fraction and troponin (Tn), a myofibrillar structural protein. In this research, after ethics committee approval, 50 patients with type 2 diabetes mellitus (DM) were enrolled into a randomized simple sampling, prospective, double-blind clinical trial study. In the case group, 500 cc dextrose water 5% plus 80 IU regular insulin and 40 mEq KCL were infused at the rate of 30 cc/hr. Patients in control group received 5% dextrose solution at the rate of 30cc/hr. Venous blood samples were taken before induction of anesthesia, after removal of the aortic clamp and before discharging from hospital. The Mann-Whitney-test was used to test for differences in Tn concentration between the groups. Fisher’s exact test was used to determine whether there was a difference in the proportion of patients with a low ejection fraction (<45%) in the case group compared with that in the control group. Changes in potassium and glucose concentrations over time within the groups were examined by ANOVA and paired t-tests. P<0.05 was regarded as significant level for all tests.    RESULTS: In this study, 50 patients with type 2 DM were evaluated in case and control groups. The mean age ± SD in the case group was 57.7 ±9.9 years and in the other group was 61.2 ± 8.4 years. The groups were well-matched for age, sex and number of bypass grafts. Randomization did not give an equal distribution of male and female patients. There wasn’t any significant difference in ejection fraction between the case and control groups before and after CABG (P>0.05). Tn concentration in the case group was 3.3 ± 5.0 and in the control group was 3.9 ± 5.1. There was no significant difference in Tn between the two groups before and after CABG (P>0.05). There was not any significant difference in hospitalization time between the two groups.     CONCLUSION: The results suggested that GIK can’t improve left ventricular performance in routine CABG surgery.      Keywords: Cardiovascular surgery, Glucose-Insulin-Potassium, Cardiac troponin

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

Correlation between timing of tracheostomy and duration of mechanical ventilation in patients with potentially normal lungs admitted to intensive care unit

Background: There is insufficient evidence to conclude that the timing of tracheostomy alters the duration of mechanical ventilation, hence this study was designed to investigate the correlation between timing of tracheostomy and duration of mechanical ventilation for patients admitted to intensive care unit (ICU) with potentially normal lungs. Materials and Methods: In a retrospective study for a period of 2 years, all adult patients admitted to the medical ICU of Al-Zahra Hospital in Isfahan University of Medical Sciences who needed endotracheal intubation and prolonged mechanical ventilation were considered for inclusion in this study. Data of underlying disease, causes of respiratory failure, age and gender, duration of mechanical ventilation, and interval between intubation time and tracheostomy were collected. The correlations between intubation period and ventilation period were analyzed using a Pearson correlation test. Results: Sixty-six percent of patients (100 patients) were men. The mean ± SD of age of patients was 56.2 ± 20.8 years (18-90 years.). The timing of tracheostomy (duration of endotracheal intubation until tracheostomy) did not exhibit any correlation with the length of mechanical ventilation ( P = 0.43, r = 0.08). The timing of tracheostomy had not any correlation with the age of patients ( P = 0.20, r = 0.129). The length of mechanical ventilation had not any correlation with the age of patients ( P = 0.83, r = 0.02). The timing of tracheostomy was similar in men and women ( P = 0.5). Mechanical ventilation period was not significantly different in both genders ( P = 0.89). Conclusion: Our study with mentioned sample size could not show any relationship between timing of tracheostomy and duration of mechanical ventilation in patients under mechanical ventilation with good pulmonary function in ICU

The efficacy of preventive parasternal single injection of bupivacaine on intubation time, blood gas parameters, narcotic requirement, and pain relief after open heart surgery: A randomized clinical trial study

Background: Postsurgical pain usually results in some complications in the patients. This study has tried to investigate the effects of parasternal single injection of bupivacaine on postoperative pulmonary and pain consequences in patients after open heart surgery. Methods: : In a prospective double blind clinical study, 100 consenting patients undergoing elective open heart surgery were randomized into two groups. In case group, bupivacaine was injected at both sides of sternum, immediately before sternal closure. In the control group, no intervention was performed. Then, the patients were investigated regarding intubation period, length of ICU stay, arterial blood gas (ABG) parameters, morphine requirement, and their severity of postoperative pain using a visual analogue scale (VAS) device. Results: No differences were found between the two groups regarding to age, sex, pump time, operation time, and body mass index and preoperative cardiac ejection fraction. Mean intubation length in case group was much shorter than that in control group. Mean PaO 2 in case group was lower in different checking times in postoperative period. The patients in the case group needed less morphine compared to those in the control group during the 24-hour observation period in the ICU. Finally, mean VAS scores of pain in case group were significantly lower than those in control group at 6, 12, and 24 hours postoperatively. Conclusions: Patients′ pain relief by parasternal single injection of bupivacaine in early postoperative period can facilitate earlier ventilator weaning and tracheal extubation after open heart surgery as well as achieving lower pain scores and narcotic requirements

Prevalence of Delirium in Opium Users after Coronary Artery Bypass Graft Surgery

Background: Postoperative cognitive dysfunction, especially delirium commonly occurs after cardiac surgery. Clinical evidences suggest an increase in delirium in opium abusers after Coronary Artery Bypass Graft (CABG) surgery. In this study, the prevalence of delirium in addict (opium user) and nonaddict patients after CABG were compared. Methods: In a cross-sectional study after obtaining institutional approval and informed consent, 325 patients candidate for elective CABG were included in the study. All patients with history of opium abuse met the criteria for opioid dependence using Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition definitions. Delirium after CABG was assessed in addict (opium user) and nonaddict patients up to a maximum of 5 days after surgery with the Intensive Care Delirium Screening Checklist. Results: A total of 325 patients were evaluated (208 without and 117 with a history of opium abuse). Postoperative delirium occurred within 72 h after surgery in 44.31% of all patients. There was a significant difference in the prevalence of postoperative delirium between the opium users (80.7%) and nonaddict patients (25%) in the intensive care unit (P < 0.001). Opium addiction was a risk factor for postoperative delirium after CABG Surgery. Conclusions: Delirium after CABG surgery is more prevalent in opium users compared with nonaddict patients. Therefore, opium abuse is a possible risk factor for postoperative delirium in cardiac surgical patients

Comparison the Efficiency and the Effectiveness of a New Comprehensive Test Management Software (NAJMA Software) with Traditional Method in Resident in-training and pre-board Examinations in Isfahan University of Medical Sciences

Background and Object: Considering new e-teaching and e-learning systems, and electronic assessment tools, this study was performed assessing the efficiency and the effectiveness of a new generated comprehensive test management software (CTMS), named NAJMA, in medical resident evaluation. Materials and Methods: This cross sectional descriptive study was conducted in Isfahan University of Medical Sciences in 2015. Statistical analysis of the questions was done comparing the two models of examination management performed in 2014 and 2015 to evaluate all medical residents of 21 specialties in Faculty of Medicine. Totally 6300 questions from 42 question books based on the model of exams hold in 2014 and 2015 were analyzed. A survey questionnaire was administered to faculty members to obtain their insight into their perceptions of the two models. Results: The cost of formatting and performing the examinations was considerably lower in CTMS method. From the whole 377 members. 64.8% of faculties preferred the CTMS method in management of resident examinations. Number of residents participated in the examinations was 711 in 2014 and 668 in 2015. There were no differences among traditional and CTMS methods considering statistical analysis and Millman structural criteria. Conclusion: Improving and utilization of CTMS method in all university and state examinations will result in reducing human and material costs. Meanwhile satisfaction of faculty members and security of the examinations will be improved by eliminating intermediate processes from developing to analyzing the examination questions