Anesthesiology and Pain Medicine
Year:2015 | Volume:5 | Issue:2|Papers Count:11

Introduction: Failed back surgery syndrome (FBSS) is an increasing cause of chronic pain in most countries. This poses high costs to both patients and National Health Organizations.Case Presentation: In this report, multimodal pain management based on daily high-dose oxycodone/naloxone (OXN 180.90 mg) led to reduced patient's pain score and improved quality of life.Conclusions: Oxycodone/naloxone can be a good alternative for the management of FBSS when other interventional or pharmacologic strategies have failed. In this case report, higher doses than those recommended as a maximum daily ceiling (80.40 mg) were safely used in one selected patient with noncancer severe pain.

Background: Cataract is one of the most common surgical procedures in the elderly. In most cases, the elderly have cardiac ischemia or chronic coronary diseases, which would lead to more ischemic events during general anesthesia. Therefore, surgeons and anesthetists prefer regional aesthesia to the general one owing to its more advantages and less complications. Objectives: Therefore, this study aimed to compare topical method and retrobulbar block for pain intensity, patient’s satisfaction, hemodynamic changes and intra and postoperative complications.Patients and Methods: In a single-blinded clinical trial, 114 patients scheduled for cataract surgery, aged 50 to 90 years with ASA physical status of I-III, were randomly assigned to two groups under monitored anesthesia care as topical anesthesia and retrobulbar block. After the injection of intravenous sedation, which was the combination of midazolam 0.5-1 mg with fentanyl 0.5-1 m/kg, patients received retro bulbar block or topical anesthesia. During the operation, heart rate, systolic and diastolic blood pressure, mean arterial blood pressure and arterial saturation of O2 were measured every five minutes. In addition, pain (VAS) and satisfaction (ISAS) scores were recorded every 15 minutes, then at recovery and one hour after the ending of operation in the ward. Findings were statistically analyzed using SPSS 16.Results: In this study, no significant association was found between age, gender, education and physical condition of patients in both topical and retro bulbar block groups. Comparison of pain based on VAS, satisfaction based on ISAS score and MAP in the studied periods had no significant differences between the two groups of patients undergoing cataract surgery. However, significant differences were found between the two groups (P=0.045, 0.02, 0.042 and P<0.05) regarding heart rate, systolic and diastolic blood pressure and arterial oxygen saturation percentage after 20-30 minutes of the operation. Conclusions: Both methods, topical and retro bulbar block had similar impression in cataract surgery regarding analgesia and patient satisfaction. However, in non-complicated cataract surgeries with short duration, topical anesthesia may be the preferable method, because of non-invasiveness, appropriate analgesia, patient satisfaction and hemodynamic stability.

Background: Endotracheal intubation is usually associated with hemodynamic changes, especially in patients undergoing cesarean section by general anesthesia. GlideScope® videolaryngoscope (GVL) is a novel video laryngoscope, which does not need direct exposure of vocal cords and produces lesser hemodynamic changes due to lower degrees of trauma and stimuli to oropharynx than the Macintosh direct laryngoscope (MDL).Objectives: The aim of this study was to compare hemodynamic changes following endotracheal intubation with GVL and MDL in patients undergoing cesarean section by general anesthesia.Materials and Methods: Seventy patients undergoing elective cesarean section by general anesthesia requiring endotracheal intubation were randomly allocated to be intubated with either GVL (n=35) or MDL (n=35). Systolic, diastolic and mean arterial blood pressure (MAP), as well as pulse rates, and rate pressure product (RPP) were compared at baseline, after induction of anesthesia, and after intubation at oneminute interval for five minutes between the two groups. The patients were also compared for Mallampati score, sore throat, intubation time and neonates’ Apgar scores.Results: The patients were similar regarding systolic, diastolic and mean arterial blood pressure. Pulse rate changes were significantly lower only at 1 and 3 minutes in the GVL group. The intubation times were 9.3±1.4 and 10.6±1.7 seconds in the MDL and GVL groups, respectively (P>0.05). RPP was also lower in the GVL group at 1 and 2 minutes (P<0.05) and returned to baseline afterwards. There was no significant difference between the groups for Mallampati score, sore throat and Apgar scores.Conclusions: Our study revealed that hemodynamic parameters with GVL are only better preserved in the first three minutes after intubation in patients undergoing elective cesarean section and patients are similar regarding intubation time, sore throat and Apgar score.

Introduction: Nowadays, many types of intravascular devices and catheters are used in order to diagnose and treat diseases. Complications related to these instruments are the costs that doctors and patients have to pay to benefit from their advantages. Catheter embolization is one of these side effects. Patients with devices in their cardiopulmonary system are at risk for severe complications such as arrhythmias, pulmonary embolism, myocardial injuries, hemoptysis, thrombosis and perforation.Case Presentation: A 50-years-old woman, with a history of breast cancer, had a PermCath emplacement in right subclavian vein for a course of chemotherapy. The treatment for cancer seemed to be successful and the PermCath had remained in its position without complication, for a couple of years however, the catheter was founded broken and embolized to the right ventricle and the main left pulmonary artery, diagnosed by a chest X-ray study incidentally.Conclusions: It is better to remove the unused devices safely to prevent and decrease their possible complications.

Background: Surgical stress response is among the most severe stress tolerated by the patient, which needs suppression by anesthesia.Objectives: We assessed the effect of three methods of anesthesia on postoperative levels of pro-brain natriuretic peptide (pro-BNP) to determine the most effective one in preventing surgical stress response.Patients and Methods: In a randomized clinical trial, 120 patients who were 18 to 65 years old and met inclusion and exclusion criteria were selected and randomly allocated to three groups of 40:Group A, general anesthesia plus epidural catheter; Group B, general anesthesia and intravenous patient-controlled analgesia; and Group C, spinal anesthesia plus intravenous patient-controlled analgesia.Results: There was no difference between three groups for basic characteristics and variables and baseline pro-BNP levels; however, postoperative pro-BNP levels in Groups A, B, and C were respectively 63.8±10.1, 83.2±12.3, and 51.5±8.5 ng/L (ANOVA, P=0.01).Conclusions: The results of the current study suggested that spinal anesthesia plus intravenous patient-controlled analgesia have the most favorable cardiac effects regarding postoperative levels of pro-BNP.

Background: Recovery after anesthesia and surgery is a complex process and depends on many factors such as patient, anesthesia and surgery conditions as well pre-existing comorbidities.Objectives: The aims of this study were to translate the 40-item quality of recovery score (QoR-40) into Persian and evaluate its psychometric properties in Iranian patients.Patients and Methods: We enrolled patients candidate for elective general surgery undergoing general anesthesia from July 2013 to December 2013 at Shahid Rajaee Hospital, Qazvin, Iran. Translation was performed based on Beaton’s and Bullinger’s recommendations. Estimates of internal consistency, test-retest reliability, concurrent validity, predictive validity and clinical validity were performed.Results: All estimates of internal consistency were high (Cronbach's alpha =0.89 for global estimates, subscales between 0.89 and 0.93). All test-retest scores and subscales were between 0.71 and 0.88.The correlation with a recovery visual analogue scale was 0.51, and all subscales correlated significantly with comparable subscales of the SF-36. An exploratory factor analysis found five-components and explained 52% of the variance. A confirmatory factor analysis based on the five-components, yielded good fit statistics (CFI=0.93).Conclusions: Overall, the Persian version of the QoR-40 was both conceptually and linguistically equivalent to the original English QoR-40. This study revealed that the Persian version of the QoR-40 is a valid and reliable instrument to assess the recovery quality in Iranian patients after surgery.

Dear editor,As the most active American and European Societies (1-4), we collect data about pediatric regional anesthesia (PRA) to evaluate the reached degree of safety and efficacy over the years. Each block has been recorded in our database since September 1998. After our Institutional Review Board approval, we made a retrospective analysis of the whole period up to November 2013.

Background: The main important method for airway management during anesthesia is endotracheal intubation. Laryngeal mask airway (LMA) and supraglottic gel device (I-Gel) are considered alternatives to endotracheal tube. Objectives: This study sought to assess the success rate of airway management using LMA and I-Gel in elective orthopedic surgery.Patients and Methods: This single-blinded randomized clinical trial was performed on 61 ASA Class 1 and 2 patients requiring minor orthopedic surgeries. Patients were randomly allocated to two groups of LMA and I-Gel. Supraglottic airway placement was categorized into three groups regarding the number of placement attempts, i.e. on the first, second, and third attempts. Unsuccessful placement on the third attempt was considered failure and endotracheal tube was used in such cases. The success rate, insertion time, and postoperative complications such as bleeding, sore throat, and hoarseness were recorded.Results: In the I-Gel group, the success rate was 66.7% for placement on the first attempt, 16.7% for the second, and 3.33% for the third attempt. In the LMA group, the success rates were 80.6% and 12.9% for the first and second attempts, respectively. Failure in placement occurred in four cases in the I-Gel and two cases in LMA groups. The mean insertion time was not significantly different between two groups (21.35 seconds in LMA versus 27.96 seconds in I-Gel, P=0.2). The incidence of postoperative complications was not significantly different between study groups.Conclusions: I-Gel can be inserted as fast as LMA with adequate ventilation in patients and has no major airway complications. Therefore, it could be a good alternative to LMA in emergency airway management or general anesthesia.

In current anesthesia practice, neuraxial anesthesia is a major method among all anesthesia modalities. The most frequently performed neuraxial blocks are consecutively subarachnoid, epidural, and caudal blocks. Major indications are intraoperative anesthesia and analgesia, postoperative analgesia, analgesia for vaginal delivery, and management of chronic pain.

Background: Occlusion of central venous catheters is one of the limiting factors in using them. Heparinized saline solution is the standard solution used for keeping the catheters open.Objectives: This study aimed to determine the effect of heparin saline solution and normal saline in maintenance of patency of central venous catheters.Patients and Methods: This double-blind study was performed on 84 patients of intensive care unit who had central venous catheters. The patients were randomly divided into two groups of heparin saline receivers and normal saline receivers. In the heparin group after each drug injection into the lumen, 3 mL of heparin saline solution was injected in the catheter as well. The other group only received 10 mL of normal saline instead. The catheters were examined for blood return and flushing every eight hours for 21 days. Data was analyzed using SPSS software version 20 and descriptive and analytic statistics were studied.Results: There was no significant difference in the rate of flushing (P=0.872) and possibility of taking blood samples from catheters (P=0.745) in the two groups of heparin and normal saline receivers. Furthermore, using heparin had no effect on prolonging the survival of catheters.Conclusions: Considering possible side effects of heparin and the increase in treatment charges and the fact that using heparin did not have a significant effect on patency and survival of catheters in the studied patients, it is recommended to use normal saline solution to maintain the patency of central venous catheters.

Background: Premenstrual syndrome (PMS) is a common finding in luteal phase of menstrual cycle resulting in several changes in woman life including pain sensation.Objectives: This study evaluated the alterations of postoperative pain sensation in those with and without a history of PMS.Patients and Methods: A total of 140 women in in postoperative period were assigned to four groups regarding luteal or follicular phase of menstrual cycle and the history of PMS and were evaluated regarding scale of pain sensation and morphine demand in recovery room. To evaluate the difference among the groups, Mann Whitney U, Kruskal-Wallis, and Bonferroni tests were used.Results: Patients with PMS presented higher pain sensation and analgesia request (P=0.003). Patients in luteal phase showed less pain and analgesia request in two out of five studied outcomes (P=0.075).Conclusions: The most comfortable postoperative women were those in luteal phase without history of PMS group.