Journal of Anesthesiology and Pain
Year:2014 | Volume:5 | Issue:1|Papers Count:10

Aim and Background: Considering the importance of postoperative hyperlactatemia, rehydration impact on lactate amount, and different challenges in using crystalloid and colloid solutions for rehydration, we decided to investigate the effect of Ringer solution and Hemaxel on blood lactate level with comparing the changes before and after the operation, in patients undergoing appendectomy.Methods and Materials: 168 patients scheduled for appendectomy, were randomly divided into two groups (using Ringer solution or Hemaxel) after obtaining their consent. A blood sample of 2ml was obtained before and 1 hour after the surgery and the amount of lactate level was measured. The data was analyzed by SPSS.Findings: The results showed that Ringer solution reduced the post-operative serum lactate level significant, while Hemaxel increased it (p=0.0001).Conclusions: According to this study, we can perhaps say that Ringer solution is preferred to Hemaxel in order to reduce lactate level after surgery in patients undergoing appendectomy.

Aim and Background: Surgery is a factor of anxiety which creates a physiological reaction in body. As a result of this physiological response of the body, breathing, heart rate and blood pressure would increase. The present study was done to evaluate the effect of wordless music on some physiological indices and anxiety of patients.Materials and Methods: This research is a randomized controlled clinical trial, which has been based on 60 patients undergoing spinal anesthesia for surgery in hospitals affiliated to Ilam University of medical sciences, during the year 1392. Including criteria were: the patient’s willingness to participate in the study, non-emergency surgery, being between 20 to 40 years old, undergoing spinal anesthesia for the first time, as well as having hemodynamic stability (systolic blood pressure greater than 90 mm Hg, absence of any dangerous form of heart rate and heart rhythm whatsoever between 60-100). In both groups, vital signs including diastolic blood pressure, systolic blood pressure, pulse rate, respiratory rate, and arterial blood O2 saturation were recorded. After the baseline assessment patients underwent spinal anesthesia by the anesthesiologist, and immediately the wordless song was played for the case group with mp3 player and disposable headphone for 10 minutes. Immediately afterwards, again the arterial blood saturation level and the vital signs were assessed. The same action was taken for the control group without playing the music.Findings: Comparison between physiological indices before and after the intervention in the two groups showed significant differences; so that broadcasting the song without words had beneficial effect on the average number of pulse pressure, systolic and diastolic blood pressure, and respiratory rate (p<0.05). However there was no significant difference considering the percentage of arterial blood saturation (p>0.05).Conclusion: Hearing wordless song had a significant effect on systolic and diastolic blood pressures, heart rate, and respiratory rate; but It did not affect the percentage of arterial oxygen saturation.

Aim and Background: Due to the nature of the orthopaedic surgery, affecting bone and joint, it is associated with a high rate of Postoperative Pain. Using intravenous, intramuscular, intrathecal and epidural opioids are methods for Postoperative Pain control for which the side effects are numerous. However, Intrathecal administration of magnesium with blocking NMDA receptors reduces Postoperative Pain without increasing side effects. The aim of this study was to investigate the effect of adding magnesium sulfate to Intrathecal lidocaine- epinephrine mixture on duration of Postoperative analgesia in lower limb orthopaedic surgeries.Methods and Materials: This double blind study was performed on patients who were candidate for lower extremity orthopaedic surgeries. For this purpose, 156 patients were randomly divided into two groups. One group received magnesium sulfate with lidocaine- epinephrine mixture and other group received the same drugs with distilled water as placebo. The duration of postoperative pain was determined according to patients’ request for analgesics. Patients’ pain degree was evaluated according to visual analogue score (VAS), and Pethedine consumption was also calculated. Data were analyzed by SPSS software..Findings: Mean age of our Patients in magnesium and control groups were 34.5±7.5 and 31.9±8.1 years old, respectively.The Mean (±SD) of Postoperative analgesia duration in the magnesium group was 143.7±29.7min and it was 100.9±18.1 min in the control group, which shows a significant difference between two groups (P<0.000). Patients’ Pain score according to VAS in magnesium group was 3.9±0.36 and it was 5.65±0.35 in the control one. This was also significantly different between the two groups (P=0.000). Also mean Pethedine consumption was 15±6.24 mg and 33±6.27 mg in the magnesium and control groups, which was again statistically significant (P=0.000).Conclusions: Magnesium sulfate combined with lidocaine Produces a reduction in Postoperative Pain in comparison with lidocaine alone.

Aims and Background: Nowadays, multimodal approach is used to control post-operative pain. Pregabalin has been shown to have analgesic effects on postoperative pain as a Gaba-Amino-Buteric (GABA) analogue. This prospective, randomized, double-blind, controlled study has evaluated the beneficial effect of Pregabalin pretreatment on postoperative pain and opioid consumption in patints undergoing orthopedic elective surgery.Materials and methods: Sixty ASA 1-2 patients, scheduled for orthopedic elective surgery under spinal anesthesia, were randomly divided into two groups. Group 1 received 300 mg Pregabalin one hour before the operation and Group 2 was given Placebo capsule. Patient-controlled intravenous analgesia (PCIA) device, prepared with Sufentanil, was connected to both groups for postoperative analgesia. Postoperative pain scores according to visual analogue scale (VAS), opioid consumption, and side-effects like nausea were recorded for 12 hours after surgery. P value<0.05 was considered significant.Findings: According to visual analogue scale (VAS), pain scores were significantly lower in Pregabalin group at post anesthesia care unit (PACU), 6 hours and 12 hours post-operatively (p<0.05). Also pethidine consumption was significantly less than the placebo group in Pregabalin group (p<0.05).Conclusions: Administering a single dose of 300 mg Pregabalin orally, and 1 hour before elective orthopedic surgery under spinal anesthesia, significantly reduces postoperative pain and opioid consumption.

Aims and Background: Evaluation and management of pain is an important issue in the intensive care unit and Limited research there is on clinical decision making in relation to the management of pain in patients with decreased level of consciousness. The purpose of this study was to determine the effect of a pain management program on pain management In patients with decreased level of consciousness of patients in intensive care units.Materials and Methods: This study is a clinical trial across the two groups before and after and stage to stage design. In this study, 50 hospitalized patients with decreased level of consciousness in the intensive care unit selected sampling and randomly divided into two groups. Pain management program was implemented the patient’s level of consciousness, to reach more than 8 (GCS), as or planned until 48 hours. For the control group implemented routine unit. With used of the adult non-verbal pain scale collected the pain intensity scores in two group in before and after of pain therapy. Data were analyzed by SPSS (16) software. To describe the data, analytic statistics (independent t-tests, chi-square and ANOVA with repeated) were used.Findings: Results showed that the mean pain intensity scores (after one stage) was significantly more in the control group than the experimental group after of implemented program, and the mean change in pain intensity scores in the experimental group using independent t-test Was significantly lower than control group (p=0.04).Conclusions: This study showed that with applying a pain management program can the pain controlled properly for patients with loss of consciousness after general surgery.

Aims and Background: The most common used anesthetic gas in operating rooms is nitrous oxide which is a poor anesthetic agent. Moreover, the level of serum cortisol is resumed as an indicator of stress. As a result an increase of serum cortisol could indicate stress and nervous condition. The aim of this study was to evaluate the relationship between the concentrations of anesthetic agent, named nitrous oxide, on urinary cortisol levels of the operating room’s personnel.Materials and Methods: This study was a cross-sectional and correlational one. The Study population were the operating room’s personnel (n=30) and the Official personnel (n=30) in Besat Hospital of Hamedan. The concentration of nitrous oxide was measured in operating room for a week in the morning and afternoon. To investigate the effect of the inhalation and absorption of harmful chemical agents on neurobiological factors, urine samples were taken at the beginning and at the end of each day continuously for 5 days from the test and control groups. To reach the goal, Cortisol level in urine samples was measured.Findings: The concentration of anesthetic and antiseptic agents in the operating room space was 388.26±101.4 ppm. Mean Cortisol level in urine samples of the operating room personnel (test group), at the beginning and the end of the day, for 5 days was 648.4±2.74 ng/ml. Mean Urine Level of cortisol in the official personnel (control group), collected in the same manner was 579.2±3.1 ng/ml. Our findings showed that there is a significant difference between the mean concentration of the breathing gas nitrous oxide in operating rooms’ and recovery workers at three-time sampling a day according to ANOVA test (P<0.05) (P=0.028). T test showed no significant difference in urinary free cortisol (ng per ml) between the two groups (P=0.559).Conclusion: Pearson correlation showed that there is a direct positive and incomplete relation between the concentration of nitrous oxide in the operating room space the and urinary free cortisol (ng/ml) of the operating room’s personnel (r=0.857) (P=0.004). This means that increasing the concentration of nitrous oxide in the operating room space, increased urinary free cortisol levels. (P<0.05).

Aims and Background: Nausea and vomiting after surgery is a common complication that can cause unpleasant feeling, increased hospitalization time, and increased cost. Even in some cases it leads to severe dehydration, electrolyte imbalance, aspiration, pneumonia, and even the opening of the surgical site which has been sutured. Selecting the device for airway management may affect postoperative nausea and vomiting, in part due to the irritation of the airway. Therefore, we decided to compare two methods of airway management in patients undergoing strabismus surgery regarding the incidence of postoperative nausea and vomiting.Methods and materials: The study population underwent strabismus surgery with general anesthesia. Patients were randomly divided into two groups with either endotracheal intubation or laryngeal mask airway insertion. The severity of nausea and vomiting was assessed in the recovery room, 6, and 18 hours after the surgery. Nausea was measured according to the Verbal Rating Scale (VRS) criteria.Findings: 160 patients were enrolled and divided into two groups of 80. The groups were identical in terms of demographic data (age, weight, gender, symptoms, hemodynamics (except for heart rate before induction, 5 min and 15 min after induction), duration of surgery, number of muscles under surgery and number of eyes under surgery.Conclusions: Incidence of PONV in the recovery room, 6 hours and 18 hours after surgery were similar in both groups.

Aim and Background: Regarding the importance of providing analgesia for patients during and after orthopedic surgeries, the present study has been designed to evaluate the analgesic effect of Intravenous Acetaminophen (Apotel) and its effect on opioid consumption in patients undergoing radius shaft fracture surgery.Materials and Methods: In this research, 160 patients with radius shaft fracture who met the inclusion criteria were randomly divided into two groups using random number table: Apotel (A) and placebo (P). The Apotel group received 1mg paracetamol in 200cc N/S, 20 min before surgery; while the placebo group received 200cc N/S only. The mean dose of opioid consumption during surgery and 24 hours after the surgery, and also the mean interval to first analgesic request have been recorded.Visual analogue scale (VAS) was used for measuring pain score of patients after surgery.Findings: The mean dose of opioid consumption during surgery (fentanyl based on micrograms) in Apotel group was 51.42-/+2.3 and it was 70.10-/+3.6 in the placebo group. Considering the p.value<0.05 to be significant, there has been a significant difference between the two group regarding opioid consumption during surgery. This amount has been clearly less in Apotel group. Pain scores of two groups were determined, which showed no significant difference between the groups in recovery period, 4 hours, 12 hours, and 24 hours after surgery. Regarding p value which was>0.05, pain score in two group has been almost the same.Interval to first analgesic request in Apotel and placebo groups were 254.71-/+28.2 198.28/-+34.2 min, respectively. Considering p value which was<0.05, the interval to first analgesic request in Apotel group has been significantly longer.Conclusions: Premedication with intravenous paracetamol (Apotel) provided rapid and effective analgesia and was well tolerated. At the same time it reduced opioid consumption during and after orthopedic surgery.

Aim and Background: Pulmonary aspiration of gastric contents is one of the most important complications of general anesthesia. Prevention and specially management of this complication are still both challenging subjects for all anesthesiologists. In this case report beside case presentation we will discuss about comprehensive guidelines for prevention and management of this event.Case report: This study presents a case of milk aspiration in a 6-year-old boy during induction of anesthesia for an elective surgery, which occurred because of incorrect parent-reported information about fasting time of the child. The operation has been continued after appropriate interventions and drainage of the milk. After the operation, he was extubated in the operating room and then was moved to the recovery room with O2 saturation of 95% on room air. After two days’ stay in the pediatric intensive care unit (PICU), the patient was transferred to the pediatric ward with stable physiologic conditions.