Journal of Anesthesiology and Pain
Year:2016 | Volume:6 | Issue:3|Papers Count:23

Aim and Background: Relieving preoperative anxiety is an important concern for the pediatric anesthesiologists. Anxiety can cause aggressive reactions and increases child’s restlessness. It might even make postoperative pain management impossible. Oral midazolam has been the most frequently used premedication in children. The purpose of this study was to evaluate preoperative sedative effects and anxiety level changes by using intra nasal dexmedetomidine compared with intra nasal midazolam in children scheduled for elective surgery.Materials and Methods: This double blind randomized clinical trial was done on sixty 2-8 years old, ASA I - II children scheduled for elective surgery in academic hospitals in Rasht, Iran. Using random blocks the children were divided into 2 equal groups (group D and group M). Group D received 1 mg/kg intranasal dexmedetomidine and group M received 2 mg/kg intranasal midazolam 30 minutes before entering OR. Preoperative sedation effects, sing the Ramsy sedation score, anxiety level changes, and recovery time were assessed and compared in two groups using Chi square, t-test, KS and repeated measure statistical tests.Findings: The study was done on 49 (81.7%) boys and 11 (18.3) girls with the mean age of 4.45±1.67 years. No statistical difference was seen between the two groups in sex, age, asal heart rate (HR), blood pressure (BP) and arterial O2 saturation (SpO2). The sedation Ramsay score before administration of the drug and when entering the OR were not different between two groups, although it was lower in both groups at the time of entering OR. (p=0.009 for group D and p=0.000 for group M) The anxiety level before administering drug was the same in two groups (p=0.911) and decreased at the time of entering OR. (p=0.000 in both group D and M) Children receiving midazolam were less anxious when entering the OR (p=0.034), but there was no difference between two groups in recovery time (p=0.947).Conclusion: Administration of intranasal midazolam and dexmedetomidine before surgery results in less anxiety. Although midazolam is superior to dexmedetomidine in reducing anxiety, dexmedetomidine causes less respiratory depression than midazolam.

Aim and Background: Postoperative sore throat (POST) is an undesirable complaint after orotracheal intubation. Magnesium is a noncompetitive N-methyl-D-aspartate receptor antagonist thought to be involved in the modulation of pain. The present study aimed to investigate the effect of preoperative administration of intravenous magnesium on POST.Methods and Materials: Seventy two patients undergoing lumbar laminectomy surgery were randomly allocated into two groups. They either received saline (control) or 40 mg/kg magnesium intravenously after intubation in 30 minutes. Patients were assessed for incidence of POST and postoperative cough at recovery room postoperatively.Findings: The incidence of POST during recovery state was higher in the control group than the magnesium group (P=0.04). The highest incidence of post-operative cough occurred in the control group in recovery room after surgery (P=0.03). The highest stability of hemodynamics was seen in the magnesium group.Conclusions: The administration of intravenous magnesium in 30 minute preoperatively after intubation is effective to reduce both incidence of POST and postoperative cough in the postoperative period in recovery.

Aim and Background: Hyperglycemia is one of the complications after blood transfusion, which has been less considered. The aim of this study was to evaluate changes in blood glucose after blood transfusion in non-diabetic Patients undergoing Posterior lumbar fusion surgery.Materials and Methods: In this analytical study, 44 Patients undergoing Posterior lumbar spine fusion elective surgery in Rasoul Akram hospital entered the study based on inclusion and exclusion criteria. The number of blood bags received by Patients during surgery was recorded. Hemodynamic Parameters, hemoglobin and blood glucose were measured before blood transfusion and after the transfusion of first, second, and the third bag. For data analysis including the significance of changes at different times, repeated measure test was used.Findings: The results of this study showed that blood glucose level significantly increased in Patients receiving blood bags (P=0.0001). Heart rate (P=0.0001) and hemoglobin (P=0.0001) also showed significant increases. Changes in mean arterial blood Pressure, arterial oxygen Pressure, and end-tidal CO2 (ETCO2) were not significant.Conclusion: Although serum glucose was significantly higher in Patients who received the third blood bag, this rise needed no specific clinical action.

Aim and Background: More than 50% of patients suffer from phantom limb pain after amputation. This study was conducted to identify the effect of eye movement desensitization and reprocessing on phantom limb pain in patients with amputation.Methods and Materials: This quasi experimental study was performed in Yasuj City between 2012 to 2014. A total of forty (40) patients suffering from phantom limb pain, were selected using sampling and randomly divided into experimental and control groups. In the experimental group, eye movement desensitization and reprocessing therapy was performed in twelve (12) sessions. The control group received no intervention. Data were gathered on phantom limb pain at pretreatment and post-treatment and analyzed using descriptive statistics, T test, Paired T test and Chi- square.Findings: The results showed that there is a significant difference between the mean of phantom limb pain before and after intervention in the experimental group (P<0.001). Also, the mean of phantom limb pain in the control group after the intervention compared to before intervention, There was no significant change (P>0.05).Conclusions: Eye movement desensitization and reprocessing reduced phantom limb pain in patients with amputation. Therefore, its use as a therapeutic and alleviative method could be suggested for patients suffering from phantom limb pain.

Aims and Background: Bleeding during rhinoplasty is a complication that decreases the surgeon’s vision and even causes more side effects. Different methods have been proposed to reduce bleeding during otorhinolaryngology surgeries. The aim of this study is to compare the effect of tranexamic acid (TXA) and Dexmedetomidine (DEX) on the amount of bleeding in patients candidate for rhinoplasty.Materials and methods: In this randomized double-blind clinical trial, 76 patients who were candidate for elective rhinoplasty surgery entered the study. The first group received 10 mg/kg Tranexamic acid (TXA), and the second group received 1 mg/kg Dexmedetomidine (DEX) intravenously within 15 minutes immediately after induction. Bleeding volume, hemodynamic parameters and surgeon’s satisfaction were evaluated.Findings: The amount of intra-operative bleeding was 145.2±22.1 ml in DEX group and 141.8±24.1 ml in TXA group (p=0.46). The mean score of surgeon’s satisfaction was 1.65±0.53 in DEX group and 1.42±0.64 in TXA group (p=0.089).Conclusions: Totally the efficacy of DEX and TXA was equal. TXA reduces bleeding in major surgeries but for rhinoplasty, in which bleeding volume is not so much perhaps using DEX is a better option.

Aims and Background: The baricity of the solutions used for spinal anesthesia significantly affects the distribution and dissemination of local anesthetics into the spinal space. The purpose of this study was to compare the effects of hyperbaric and isobaric bupivacaine for spinal anesthesia in cesarean section.Materials and Methods: This was a randomized double blind clinical trial on sixty patients (18-40 years old) with ASA I-II, who were candidate for elective cesarean section. Spinal anesthesia was applied by isobaric bupivacaine in the first group and hyperbaric bupivacaine in the second group. The data including hemodynamic parameters of the patients, oxygen saturation level, sensory and motor block levels, and consumption of ephedrine and complications of spinal anesthesia were all recorded. Statistical analysis by using SPSS software was applied using T-test, Chi-square test, and repeated ANOVA. P values<0.05 were considered significant.Findings: Patients in both groups were almost similar regarding demographic values and the duration of surgery. Among the other recorded variables only the duration of analgesia and the frequency of nausea and vomiting was considerably higherin the isobaric group compared with the hyperbaric one (P<0.001, P= 0.001 respectively). There was no significant difference between the two groups regarding the other variables.Conclusions: Isobaric bupivacaine had the same effectiveness as hyperbaric type for spinal anesthesia, and it even had a longer duration of analgesia. However the higher incidence of nausea and vomiting with isobaric type must be taken into account.

Aims and Background: Prevention of bedsore is considered as a priority in acute and long-term care in intensive care units (ICU).This study aimed to determine the effect of olive oil on prevention of pressure ulcers in patients hospitalized in the ICU of Shahid Beheshti Hospital in Yasuj.Materials and Methods: In this double-blind randomized clinical trial 70 patients 18-74 years old were investigated from 2013 to 2015. Patients were selected by purposive sampling method and were divided into two groups. During two weeks, patients of the control group received their usual skin care including changing positions every two hours and flow mattress while the patients of the intervention group received usual care in addition to daily use of 15 ml olive oil on special areas of body without massage. Data about pressure ulcers was collected using a questionnaire and was analyzed by chi-square test, Fisher’s exact test and t-test in SPSS software version 20.Findings: In the intervention group 11.4 % had a grade 1 pressure ulcer, and 8.2 % had second grade decubitus ulcers while 85.7 % had no pressure ulcer. In the control group, 8.5 % had a grade 1 pressure ulcer, and 25.7% had second grade decubitus ulcers while 65.7 % had no pressure ulcer. The results of this study showed that the incidence of pressure ulcers in the intervention group was lower than the control group (p<0.03).Conclusion: According to our data, it can be concluded that the use of local olive oil is effective in prevention of pressure ulcers.

Aims and Background: Chronic pain is a debilitating status accompanied by multiple psychological variables. Thus the study aims to investigate the comparison between two psychological variants of catastrophizing and fear of movement based on different attachment styles in patients with chronic musculoskeletal pain.Methods and materials: In this study 150 subjects participated who were selected through the available clients of Shohada, Emam Hossein and Sina hospitals in Tehran. After being diagnosed with chronic pain in the process of screening they answered the Hazen and Shaver attachment style, catastrophizing (PCQ), and fear of movement (TSK) questionnaires. Data were analyzed using multivariate variance analysis (MANOVA).Findings: The results showed that among the 3 secure, avoidant and ambivalent attachment styles, the ambivalent style is the only that is related to catastrophizing and fear of movement.Conclusions: People with ambivalent style, facing threats such as pain, use emotion regulation strategies with hyper- activating style (like catastrophizing). The theoretical and practical implications of the findings are discussed in details in the last section of the article.

Aims and background: The infraclavicular nerve block as a method for anesthesia or analgesia in upper extremities that can be performed under guide of nerve stimulation or ultrasound. One of the adverse reaction to this method is the local anesthetic systemic toxicity that has been decreased when using the ultrasound to avoid intravascular injection.Case report: This case report explains an infraclavicular block under guide of ultrasound in a 52-year-old patient who was experienced local anesthetic systemic toxicity with lidocaine due to anomalous vasculature that normally cannot be visualized in ultrasound guide. The epilepsy was controlled by barbiturate and after one day, he was discharged.