Journal of Anesthesiology and Pain
Year:2015 | Volume:5 | Issue:3|Papers Count:9

Aim and Background: Untreated, one third of patients who undergo surgery will have postoperative nausea and vomiting (PONV). In the meanwhile, active smoking can protect against the development of this complication. We investigated the role of cigarette smoking history on postoperative nausea and vomiting.Methods and Materials: In a prospective analytical study, 50 cigarette smokers and nonsmoker patients, candidate for transurethral lithotripsy under general anesthesia, were evaluated. All patients received the same anesthesia regimen. At the end of operation patients were assessed for postoperative nausea and vomiting at post anesthesia care unit.Findings: Nausea was significantly lower in smokers in comparion with nonsmokers (32% vs. 64% and p=0.02). Vomiting was also significantly lower in smokers compared to nonsmokers (36% vs. 68% and p= 0.02). Also smoker patients above 30 years old significantly had lower incidence of vomiting in comparison with nonsmokers, and pethidine (20-25 mg) had more emetic effect in nonsmokers.Conclusions: The risk of postoperative nausea and vomiting (PONV) is reduced in cigarette smokers by unknown mechanisms.

Aim and Background: Open cholecystectomy has many complications like respiratory dysfunction and stress response because of pain. The aim of this study was to compare the efficacy of intercostal nerve block added to intravenous infusion of morphine with sole intravenous morphine infusion on pain control after open cholecystectomy.Methods and Materials: 100 patients, candidate for open cholecystectomy, were randomly divided into two groups of 50. The patients underwent elective cholecystectomy by Kocher’s (Subcostal) incision and were randomly allocated to any of the following two groups. The intervention group received intercostal nerve block with 0.25 milligram per kilogram of 0.25% bupivacaine which was infiltrated into the subcostal 6th to 10th rib margin. Then intravenous infusion of 0.5 milligram per kilogram morphine was also started for them. In the control Group, patients had intravenous infusion of 0.5 milligram per kilogram morphine. The infusion rate was 5 milliliter per hour in both group. When the patients were transferred to postoperative recovery room, intensity of pain was recorded by response from the patients using 100 mm linear visual analogue scale (VAS) ranging from 0 to 100. The pain scoring was done at 30 minutes, 6 hours, 12 hours, 18 hours and 24 hours postoperatively.Findings: our in study the severity of pain was lower at 30 minutes, 6 hours, 12 hours, and 18 hours in the intercostal nerve block group than the control group. But at 24 hours postoperatively no significant difference was shown between the groups.Conclusions: Adding Intercostal nerve block to intravenous infusion of morphine is better than sole intravenous infusion of morphine in controling pain severity after open cholecystectomy.

Aim and Background: Tranexamic acid has been used to reduce blood loss and the need for blood transfusion in many surgeries. Traumatic mandibular surgeries can be associated with significant bleeding which affects the field of operation and creates difficulties for the surgeon. Therefore we decided to evaluate the effect of tranexamic acid on the amount of bleeding during traumatic mandibular surgeries.Methods and Materials: In this randomized double blinded clinical trail, 90 patients, scheduled for traumatic mandibular surgeries with ASA class I-II and aged between 18 to 40 years, were included. They were randomly assigned to each group (n=45). After induction of general anesthesia with the same plan; they received tranexamic acid (10 mg/kg) or equal volume of normal saline, intravenously. Intra operative bleeding, pre-op hemoglobin (Hb), hematocrit (Hct) concentration, post-op (after 6 hours) Hb and Hct concentration, rate of blood transfusion and the quality of surgical field were recorded for each patient. Then data analyisis was performed with (SPSS software version 16).Findings: Mean intraoperative bleeding in the tranexamic acid and placebo group were 80.44±49.43 ml and 183.0±69.53ml, respectively (P=0.0001). Post-op decreasing rate of Hb and Hct were less in the tranexamic acid group vs. the control one (P=0.0001 for Hb, P=0.001 for Hct). The Quality of surgical field leading to the surgeon’s satisfaction was better in the tranexamic group than the control group. (P=0.0001). None of the patients needed blood transfusion. Adverse effects were not seen in any of the groups.Conclusions: Administration of IV tranexamic acid decreases the amount of bleeding during mandibular surgeries.

Aims and Background: Esophageal foreign body can be harmful. Esophagoscopy is the most common method of foreign body extraction. But in many cases during laryngoscopy the foreign body is visible in hypopharynx region and anesthesiologist can remove it with a Magill forceps. In these cases laryngoscopy should give an appropriate and sufficient view from hypopharynx. The aim of this study was to compare two common laryngoscopy blades including Miller and Macintosh in producing direct view of hypopharynx and the possibility of foreign body removal, in order to present the preferred method.Materials and methods: After performing lateral and anteroposterior neck radiography for confirming foreign body existence above the 7th cervical spine, patients over 10 years old with history of swallowed foreign body and candidate for esophagoscopy, were included in this study. Randomly one of the Miller and Macintosh blades was chosen and after induction of anesthesia and laryngoscopy the grade of hypopharynx view was recorded. In this grading system created by author, increasing grade of hypopharynx was associated with better view of hypopharyngeal inlet and more possibility of visualizing and removing foreign body. After laryngoscopy and in case of visualizing, attempt to remove the foreign body by Magill forceps was done.Findings: In 60 patients, with similar BMI and Demographic data , the Grade 4 of hypopharyngeal view ,creating a better view for the removing foreign bodies, was approximately 3 times more common in Macintosh group than Miller one (56.% vs. 20%).In grade 4 of hypophangeal view the success rate of Macintosh blade was (94.1%) and for Miller it was(50%)(P value:0.04).Overall, the success rate of Macintosh blade in all grades was 4.3 times more than Miller blade.Conclusions: Comparing laryngeal view and success rate of two laryngoscopes (Macintosh and Miller) showed that grade 4 of laryngoscopy, which seems to be more appropriate for removing foreign body, is more common in Macintosh group than the other one. Regarding the success rate, we observed that Macintosh blade had a higher chance of removing foreign body. In general, the success rate of the Macintosh laryngoscope was more than Miller.

Aims and Background: Chronic pain is a health issue that affects millions of people around the world. Research has indicated that psychological factors such as anxiety and aggression are common consequences of living with chronic pain. The aim of the present study was to investigate the effectiveness of cognitive therapy for females with chronic pain.Materials and Methods: This was a quasi-experimental study with pretest-posttest design with a control group. In this study, 40 females with chronic musculoskeletal pain were recruited and 18 females with high score in anxiety and aggression were selected. They were divided randomly into two groups including, cognitive group therapy and the control group (9 persons per each group). Participants completed the DASS-21, the Aggression questionnaire, and the Multidimensional pain inventory. The cognitive group therapy was adopted as the experimental group under therapy over eight weeks and participants again completed the post treatment assessments. Analysis of Covariance was used for analyzing the data.Findings: The results showed that anxiety (p<0.05) and aggression (p<0.05) in the experimental group have significantly decreased in comparison with the control group.Conclusions: According to the research findings, cognitive therapy can reduce anxiety and aggression in females with chronic pain.

Aims and Background: Neurology researches have shown that pain would affect the neurologic development, leading to further changes in response to pain and behavioral responses. Also pain could damage the involved subjects psychologically. Our goal was to evaluate the effect of Breast- feeding and Melody- listening on pain intensity in neonates during blood sampling in neonatal intensive care units(NICU).Methods and Materials: This study was performed in a quasi- experimental fashion with three groups of control, melody- listening, and breast- feeding in three stages. The study was done on 75 neonates being randomly divided into these groups, and the neonatal specific pain assessment tool was used in this regard.Findings: The mean pain score in neonates was the same before intervention in the three groups (p>0.05). However the mean pain score showed significant difference during and three minutes after Heel blood sampling among the three groups, using the One-way ANOVA analytic test (p<0.05).Conclusions: This study shows that both Melody listening and Breast-feeding in neonates during heel blood sampling would decrease their pain intensity.

Aims and Background: Reflexology is one of the new therapeutic methods for musculoskeletal disorders, especially low back pain. To achieve conclusive results in this field and also to follow up pain and functional disability afterwards, we designed this study. The purpose of this study was to examine the effect of using foot reflecology for six weeks on pain and disability in male subjects with non-specific chronic low back pain during a four-month period.Methods and materials: This experimental study included 24 male patients with non-specific chronic low back pain, who underwent six weeks of therapy (foot reflexology) by the sports therapist. The amount of pain and functional disability were redpectively measured using visual analogue scale (VAS) and Oswestry disability index (ODI) questionnaire before, just after, and with a four months’ interval after the intervention. Data were analyzed using independent T test. The Statistical significance was resumed to be a p£0.05.Findings: Our findings showed that immediately after six-weeks of foot Reflexology, the amount of pain and functional disability in participants with non-specific chronic low back pain was significantly decreased (p=0.001). Also, according to the results obtained after a four-month follow-up, no significant reduction in pain and functional disability in patients was found compared to the pretest values (p>0.05).Conclusions: Based on the current results, the foot reflexology method could have temporary and short-term effects on rehabilitation of subjects with chronic low back pain. As shown the pain and disability appeared again in our patients after four months.

Aims and Background: Pain is a common complication following surgery. The aim of this study was to evaluate the effectiveness of aromatherapy on postoperative pain intensity in children.Methods and materials: In a double blind placebo-controlled clinical trial we selected 96 children between 3-6 years old, who were divided randomly into three groups. Patients in group A were given inhalation aromatherapy with Rosa damascene mill and in group B, they were given pelargonium graveolens, and finally group C received almond oil as placebo. Inhalation aromatherapy was used when the child just entered the ward as 0 time and then at 3, 6, 9 and 12 hours afterwards. Thirty minutes after each aromatherapy session, postoperative pain in children was evaluated with the Toddler Preschooler Postoperative Pain Scale (TPPPS). Data was statistically analyzed using chi-square test, one way analysis of variance and repeated measure test.Findings: We found that the pain score exactly when a child entered the ward (before receiving any aromatherapy or palliative care) was not significantly different among the three groups. After each time of aromatherapy and at the end of treatment, the pain scores were reduced in the two aromatherapy groups in comparison with the placebo group. Severity of pain reduction was not significantly different between these two groups.Conclusions: According to our study, aromatherapy with Rosa damascene mill or pelargonium graveolens can be used in reducing postoperative pain in children with other common treatments without any significant side effects.

Aims and backgrounds: The pathophysiologic changes of Hypertrophic Cardiomyopathy (HCM) is complex and the physiologic changes of pregnancy and anesthesia for cesarean section have great effects on maternal hemodynamic status; and they can even lead to maternal death. We report a 21 year-old pregnant woman with HCM who was candidate for elective cesarean section.Case report: A 21 year-old woman, with gestational age of 38 weeks and a history of Hypertrophic Cardiomyopathy was candidate for elective cesarean section. Epidural anesthesia was performed with lidocaine%1. The patient was discharged after 72 hours without any complication. According to our results, we recommend epidural anesthesia with lidocaine for cesarean section in patients with Hypertrophic Cardiomyopathy.