Anesthesiology and Pain Medicine
Year:2012 | Volume:2 | Issue:6 (2)|Papers Count:12

Background: Intravenous opioids are administered to prevent and control hemodynamic changes due to endotracheal intubation. Except in special cases such as preeclampsia, these drugs are not suggested in parturient candidate for cesarean section because of respiratory depression in the newborn.Objectives: According to rapid metabolism of remifentanil, we aimed to compare hemodynamic changes in preeclamptic parturient who are received remifentanil and fentanyl for cesarean section under general anesthesia.Patients and Methods: This single blind randomized clinical trial was performed on preeclamptic pregnant women candidate for cesarean section under general anesthesia. They were divided into two groups. In the first group 0.05 mg/kg/min remifentanil was infused for 3 minutes before induction of anesthesia and in the second group 1ml (50 mg) fentanyl was injected before induction. Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) before and after intubation and also Apgar index was measured and compared between the two groups.Results: All hemodynamic variables were increased after intubation in the fentanyl group (pSBP = 0.146, pDBP = 0.019, pHR < 0.001). Additionally, decrease in SBP (P = 0.018) and DBP (P = 0.955) and mild increase in HR (P = 0.069) after intubation in the remifentanil group was observed. No significant difference was found between Apgar indexes of the two groups (P = 0.771).Conclusion: We postulate that remifentanil can be used in parturient candidate for cesarean delivery under general anesthesia to prevent severe increase in blood pressure and heart rate during tracheal intubation without adverse effects on newborn.

Background: Post-operative nausea and vomiting (PONV) is one of the common problems after laparoscopic cholecystectomy.Objectives: We tried to compare Dexamethasone effect with Granisetron in prevention of PONV.Patients and Methods: In our study 104 patients aged 20-60 with ASA I or II class who were candidates for laparoscopic cholecystectomy entered the study. Patients were divided into two groups of A and B randomly. 15 minutes before anesthesia induction, 3 mg Granisetron was intravenously injected in group A and 8 mg Dexamethasone in group B. Then both groups underwent general anesthesia with similar medications. After operation the prevalence of nausea and vomiting was assessed in three time intervals (0-6 hours, 6-12 hours and 12-24 hours after consciousness). We used SPSS software version 16 to analyze data. T test, chi square test and Fischer exact test were performed. P value < 0.05 was considered as significant.Results: there was no significant difference between age, gender proportion, weight and height and body mass index (BMI) between the two groups. In Dexamethasone group, seven patients experienced nausea and three patients had vomiting. In Granisetron group, five patients experienced nausea and three patients had vomiting. Statistical analysis showed no significant difference between these two groups in this field.Conclusion: Intravenous injection of 8 mg Dexamethasone or 3 mg Granisetron before anesthesia induction had similar effect in prophylaxis of nausea and vomiting after laparoscopic cholecystectomy.

Explaining the etiology of Complex Regional Pain Syndrome (CRPS) from the psychogenic model is exceedingly unsophisticated, because neurocognitive deficits, neuroanatomical abnormalities, and distortions in cognitive mapping are features of CRPS Pathology. More importantly, many people who have developed CRPS have no history of mental illness. The psychogenic model offers comfort to physicians and mental health practitioners (MHPs) who have difficulty understanding pain maintained by newly uncovered neuro inflammatory processes. With increased education about CRPS through a biopsychosocial perspective, both physicians and MHPs can better diagnose, treat, and manage CRPS symptomatology.

Acute upper airway obstruction (UAO) is a life threatening complication that is well recognized after carotid endarterectomy, thyroidectomy and pharyngeal area intervention. It is not widely acknowledged that airway obstruction can occur after cervical spinal fusion surgery which was first described in 1955. There are a number of common postoperative problems which may become apparent in the short to medium term. These include: sore throat, dysphagia, hoarseness, dysphonia, recurrent laryngeal nerve palsyand soft tissue swelling.

Background: The current study aimed to assess user satisfaction and functionality of two ambulatory, electronic patient controlled analgesia devices, the GemStar@ pump (Hospira Inc., Illinois, USA) and the ambIT@ Ambulatory Infusion Therapy pump (Sorenson Medical Products, Utah, USA).Patients and Methods: It was a randomized clinical trial of laboring women and postoperative gynecology patients receiving patient-controlled epidural analgesia. Patients were randomized to use one of the pumps and both anesthesiologists and patients completed questionnaires about the aspects of pump function, and rated their satisfaction with the equipment. Midwives and high-dependency unit nurses also evaluated the pumps in each clinical setting.Results: Forty patients, 20 laboring women and 20 postoperative patients were randomized and completed the study. The pumps were compared by nine anesthesiologists.Patient and staff satisfaction with both devices was high. Patient satisfaction did not significantly differ between groups (median 10 (8-10) for the GemStar and 10 (9, 10) for the ambIT, P=0.525). The median staff satisfaction score was 8 (6, 8) for the GemStar and 7 (5, 8) for the ambIT (P=0.154). Both patient cohorts rated each pump highly for most aspects of clinical function. Staff rated the ambIT pump more favourably with respect to portability and storage at the bedside whilst the GemStar had better assessments with respect to its consumables and interactions involving the electronic interface.Conclusions: Both devices were well-rated by patients and staff, with no significant difference between them for overall satisfaction, and only minor differences were reported with respect to their respective strengths and weaknesses.

Postsurgical pain is normally perceived as nociceptive pain. Surgical trauma has been known to induce central and peripheral sensitization and hyperalgesia, which in untreated cases could lead to chronic postoperative pain after surgery. Indeed pain is one of the three most common medical causes of delayed discharge after ambulatory surgery, the other two being drowsiness and nausea/ vomiting. Antihyperalgesic drugs improve postoperative pain by preventing the development of central sensitization.

Background: Gabapentin is an anticonvulsant that has postoperative analgesic effects but there are limited studies on its postoperative administration.Objectives: The present study was conducted to evaluate the effect of the postoperative oral gabapentin on pain and morphine consumption.Patients and Methods: In a double blind, randomized study, 64 patients undergoing internal fixation of tibia under spinal anesthesia were randomly assigned to receive oral gabapentin or placebo immediately after the surgery. Pain scores were recorded at time points of 2, 12 and 24 hours postoperatively using visual analog scale (VAS). Time duration from the end of surgery until morphine administration and total morphine requirement in the first 24 hours were recorded.Results: The estimated duration of surgeries was 120-150 minutes. VAS score was not significantly different between the two groups at 2, 12 and 24 hours after surgery. There was no significant morphine consumption difference between the groups.Conclusions: Our study showed no significant analgesic efficacy of oral gabapentin 300 mg immediately after tibia internal fixation surgery under spinal anesthesia at time points of 2, 12 and 24 hours postoperatively.

Several medications have been proposed as the first line drugs in the treatment of migraine attack. However, the low efficacy, potential complications of medications and the intolerance of some patients for oral route due to nausea and vomiting establish a difficult situation in some migraine patients. This report describes a dramatic pain relief with 60 mg of intravenous propofol in a patient with migraine attack refractory to treatment with metoclopramide, promethazine, dexamethasone and meperidine. Pain relief in this patient besides earlier case reports suggests that subanesthetic doses of propofol may be an alternative to other treatment modalities for acute migraine.

Background: Pain control in children is still a therapeutic dilemma. Preschool patients are among those who suffer from the undesirable effects of postoperative pain more than adults. Tonsillectomy is associated with high incidence of postoperative pain, complicating the recovery and delaying patient discharge.Objectives: Despite using different surgical and anesthetic techniques in post-tonsillectomy pain relief, this is still a clinical problem. The study was designed to evaluate the efficacy of low dose ketamine ketamine in post tonsillectomy pain relief.Patients and Methods: Our prospective randomized double blind study enrolled 75 pediatric patients (3-10 years old) who were scheduled for tonsillectomy. Patients were randomly assigned to one of three groups: one receiving intravenous (IV) ketamine 0.5mg/kg, the other receiving subcutaneous (SC) ketamine 0.5 mg/kg and the third receiving placebo at the end of the surgery. Post-operative pain score was assessed by modified CHEOPS.Results: In our study we didn’t find significant difference between the three groups with regards to sex, age, weight, duration of surgery, hemodynamic stability, nausea and vomiting. However, for ketamine groups, pain score and analgesic consumption were significantly lower (P < 0.00). The efficacy of the both ketamine groups was similar.Conclusions: The study demonstrated that both subcutaneous and intravenous injection of ketamine at the end of the surgery were safe and effective for reducing post-tonsillectomy pain. Ketamine reduced postoperative analgesic consumption without increasing the risk of complications.

Background: Postoperative pain of dacryocystorhinostomy (DCA) surgery is one of the serious issues to be considered. Administrating opioids to relieve postoperative pain and facing their increasing side effects in eye surgeries, make the use of non-opioid drugs inevitable.Objectives: The present study examined the efficacy of pregabalin in alleviating the postoperative pain of DCA surgery.Patients and Methods: The present study has been carried out as a double-blind, randomized clinical trial on the patient candidates for DCR. The patients were randomly divided in to two groups of pregabalin and placebo. Patients in pregabalin group received 300 mg of pregabalin, an hour before the operation in the morning of the surgery. Pain intensity on visual analog scale (VAS) was recorded until 24 hours after the operation, also the rate of administrated opioids and nausea/vomiting frequency were recorded during the first 24-hour period after the operation and the resultsof the two groups were compared.Results: Postoperative pain intensity in the pregabalin group at the time of recovery was significantly lower than that of the placebo group (P = 0.001) until 24 hours after the surgery. In the pregabalin group 17.5% of the patients received opioids while in the placebo group the figure was 52.5% (P = 0.001). Nausea frequency was also higher in the placebo group than the pregabalin group (P = 0.003).Conclusions: A single 300 mg dose of pregabalin, an hour before DCA can effectively reduce pain intensity and also reduce opioid dose and nausea/vomiting.

Trigeminal neuralgia (TN) is "a sudden, usually unilateral, severe, brief, stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial nerve" according to the international association for the study of pain. It is a debilitating condition of clinical importance not just because recent British and Dutch epidemiological studies show it to be more common than previously thought, affecting close to 30 per 100, 000 people, but also because it is commonly misdiagnosed by dental and medical professionals.

Nowadays, coronary artery bypass grafting (CABG) is considered to be one of the most common surgical procedures. This procedure has been the main topic in many clinical research studies, which have assessed the effect of the procedure on patients’ outcomes.Like other surgical procedures, this procedure is also accompanied by a number of unwanted complications, including those of the respiratory system. Since the respiratory system plays an integral role in defining the clinical outcome of patients, improvements in studies that can assess and predict clinical outcomes of the respiratory system, assume greater importance. There are a number of predictive models which can assess patients in the preoperative period and introduce a number of risk factors, which could be considered as prognostic factors for patients undergoing CABG. The respiratory system is among the clinical systems that are assessed in many prediction scoring systems.This review assesses the main studies which have evaluated the possible risk factors for postoperative respiratory mortality and morbidity, in patients undergoing CABG.