Journal of Anesthesiology and Pain
Year:2011 | Volume:2 | Issue:5|Papers Count:11

Background: Hypothermia is the most common complication of general and neuroaxial anesthesia. In previous studies, the effects of anesthesia on the temperature were assessed in different surgeries. In this study we evaluated the effects of general and spinal anesthesia on the core temperature of the mother and neonate in cesarean section.Methods: Eighty pregnant women were randomly assigned to receive general or spinal anesthesia.Maternal core temperature was measured five times with a digital ear thermometer just before anesthesia, at the beginning of surgery, after delivery, 30 and 60 minutes after the end of the operation. In addition, umbilical vein blood was sampled for pH. The rectal temperatures of the babies were recorded immediately after delivery by rectal probe, and Apgar scores were determined 1 and 5 min after birth.Results: There were no differences between maternal and newborn temperatures in different times in both groups, but, the umbilical vein pH value were lower in the spinal anesthesia group. Temperature of the operating room was 26 and recovery was 20.Conclusion: According to the results of this study, spinal and general anesthesia have similar effects on core temperatures in mothers underwent cesarean section.

Background: Myofacialpain syndrome and fibromyalgia are two painful clinical disorders of soft tissues that encountered to pain specialists. Low level laser therapy is one of the nonpharmacological treatment modality seems controversial. Aim of this review articles is to investigate of the efficacy of low level laser therapy (LLLT) in fibromyalgia and myofacial pain patients inthe literature.Methods: A comprehensive evaluation of the literature relating to LLLT in fibromyalgia and myofacial pain syndrome patients was performed. 34 articles allocated for this study The time frame covered was 2000 to 2010. Not only the journals of laser therapy allocated for this study, but also varieties of journals of medicine specialties selected for avoidance of bias error.Results: From 34 articles, 13 articles supported, the efficacy of low level laser therapy in pain score, in12 studies there was no difference between (LLLT) and placebo and did not study for pain criteria in9 studies. In case of the number of trigger points, 2 studies supported, the efficacy of (LLLT), there was no difference between (LLLT) and placebo in 5 studies and did not study for number of trigger points in 9 studies. For patient's quality of life, (LLLT) significantly improved of this criteria in 10 studies, there was no difference between (LLLT) and placebo in7 studies and did not study for patient's quality of life in 7studies. The increased levels of 5-hydroxy-tryptamine, 5-hydroxy-tryptophan and 5-hydroxy indol acetic acid, reported in one sudy.Conclusion: This study revealed that, application of LLLT was effective in pain relief, improvement of functional ability and patient's quality of life and number of trigger points in 15 studies. However, no significant differences were obtained between placebo and LLLT in 6 studies. In conclusion, although the laser therapy has no superiority over placebo in few groups in this study, we cannot exclude the possibility of effectivity of LLLT in fibromyalgia and myofacialpian syndrome patients. We recommended another treatment regimen including different laser wavelengths and dosages (different intensity and density and/or treatment interval) for this aim.

Background: Postoperative pain control is one of the problems for these patients. Opioid agents are the most important analgesics which commonly used for postoperative pain control. There are several trials for reducing the doses of opioids. It seems addition of ketamine to the opioids other than postoperative pain relief, reduces the total opioid consumption. The goal of this study was evaluation of postoperative analgesic effects of adding ketamine to morphine and tramadol after major abdominal surgery.Methods: Eighty patients candidate for major abdominal surgery under similar general anesthesia were enrolled in this study. Postoperative pain was managed by iv patient controlled analgesia (PCA) for aal patients. After the end of surgery, they were randomly allocated into the 1) morphine (M), 2) tramadol (T), 3) ketamine and morphine (KM), and 4) ketamine and tramadol (KT) groups. Analgesic solution in PCA in M group was morphine (0.2 mg/ml), in T group was tramadol (2 mg/ml), in KM group was ketamine (2 mg/ml) and morphine (0.2 mg/ml), and in KT group was ketamine (2 mg/ml) and tramadol (2 mg/ml). Visual analogue scale (VAS), total opioid consumption, complications, and satisfaction were measured and recorded for during the first 24 hours after surgery.Results: Demographic data was not differences between groups. Pain score in early period (1st and 6th hours) was significantly lower in KM group than the others. Furthermore, addition of ketamine significantly reduced total morphine and tramadol consumption. No side effects were observed in the all groups.Conclusions: Our finding showed that addition of ketamine to morphine could reduce pain score and total opioid consumption after major abdominal surgery.

Morquio's syndrome is an autosomal recessive disease. It is from mucopolysacaridosis group disease and it's obvious clinical signs are severe skeletal dysplasia and normal intelligence. Deposition of keratan sulfate in different tissues is seen and with progression of the disease, connective tissue of cornea, airways, lung and heart valves will be involved. In this article we present a case of Morquio's rare syndrome that we terminated the pregnancy due to severe respiratory distress of mother and also we present the anesthesia management of this case.

Background: Progress in high-contrast ultrasound technology in recent years brought more attention to its rule in the diagnosis of carpal tunnel syndrome (CTS). The aim of this study is to evaluate the diagnostic value of sonography in the diagnosis of CTS and its relationship with disease severity.Methods: In this prospective study, 100 patients who had unilateral upper extremity involvement were studied. All patients were initially undergone electro diagnostic test and the test was assumed as the gold standard. Afterwards the cross-sectional area and anteroposterior diameter of the median nerve in the carpal tunnel inlet and outlet and the thickness of the flexor retinaculum were measured by ultrasound in all patients. Relationships between ultrasound and electro diagnostic findings were evaluated using SPSS software ver.19th.Results: Patients included 84 women and 16 men in the age range 19 to 72 years (mean age 44.43±12.05 years). Among the criteria evaluated, the proximal and distal cross sectional area of the nerve showed significant correlation with disease diagnosis (P=0.018 and P=0.022 respectively). In addition, significant relationship was found between mentioned two criteria and the severity of the disease (P<0.05 both). The best cut-off point at the proximal cross sectional area was 9.45 mm2 in which the sensitivity was 78.9%, specificity was 82.8%, positive predictive value was 91.8% and negative predictive value was 61.5%.Conclusion: The present study indicated that evaluating the cross sectional area of the median nerve using ultrasound at the carpal tunnel inlet is useful in diagnosing CTS. According to its high sensitivity, specificity and positive predictive value, it is not only useful in diagnosing suspected patients but also can be useful in screening the population at risk.

Background: Propofol is one of the most common drugs used in anesthesia induction and the pain during its intravenous injection is the most important and another side effect of it. Therefore a lot of methods and drugs are examined to reduce or eliminate this side effect. In this study the effects of Alfentanil, Magnesium sulfate and Ketamin drugs on reducing of pain during intravenous injection of propofol are investigated.Methods: This study was performed on 220 patients who were under orthopedic surgery in Poursina hospital in 2010. The intensity of propofol intravenous injection pain is measured after using premedication by VAS, result is analyzed by SPSS v16 software under Chi square and Post Hoc exams.Results: According to data and variance analysis statistic exam ANOVA it is definded that after propofol injection there is a meaningful difference in quantity of VAS among studied groups (Chi square=49.78 and df=3 and P<0.0003). The VAS score in Magnesium sulfate group has a meaningful difference in comparison of other groups according to Post Hoc exams and there is no meaningful difference among other groups (P>0.05).Conclusion: Despite reduction the propofol intravenous injection pain in three studies drugs in this thesis, there is no preference among them.

Background: The pre anesthetic management and separation anxiety of infants and children can be a challenge for the anesthesiologist. In this study we compared the effects of dextromethorphan, diphenhydramine and midazolam for this purpose.Methods: Ninety 1-6 year old patient candidate for Eye Examination Under Anesthesia (EUA) were randomly assigned into one of 3 groups receiving Diphenhydramine syrup (1mg/kg), Dextromethorphan syrup (1mg/kg) or oral Midazolam (0.3 mg/kg) 20 to 30 minutes before entering into the operating room, and were evaluated in a randomized clinical trial. Sedation score was evaluated1) at 20 minutes after premedication and with the child untouched, 2) on separation from parents, 3) during mask induction and IV line insertion and 4) 15 minutes from the beginning of recovery. Duration of anesthesia and recovery were considered too. One way ANOVA and repeated measurement of analysis was used for data analysis.Results: sedation scores before the child getting touched were significantly better for group dextromethorphan (p=0.04). There was no statistically significant difference among groups on separation from parents (p=0.348). Sedation scores were significantly better in Dextromethorphan group during induction of anesthesia and in the recovery too (p=0.002 and p=0.001 respectively). There were no significant differences among groups in duration of anesthesia and recovery.Conclusions: Our finding showed that dextromethorphan can provide an acceptable level of sedation and anxiolysis in children without increasing the recovery time and is comparable to midazolam, as a routine premedication in this setting.

Background: Electroconvulsive therapy (ECT) is used in the treatment of various medical conditions such as severe depression, mainly in situations where the patient does not respond effectively to drug treatment and during pregnancy where drug intake can result in severe complication for fetus. ECT carried out under general anesthesia, therefore before ECT some physical exam and some lab data is necessary. Patients who are ECT candidates also include diabetic patients which renders the study of the effect of ECT on blood glucose and serum electrolyte level significantly important.Methods: Blood sample were taken from patients before induction of anesthesia. After 30 seconds preoxygenation anesthesia was induced by making use of sodium thiopental and succinylcholine. 20 minutes after ECT, the second blood samples were taken. The resulting data was gathered and then subjected to statistical analysis.Results: To investigate changes in blood sugar and serum electrolytes level in 70 patients who were subjected to ECT, significant changes were noted in pre and post ECT in glucose between men and women and sodium in men and women and potassium in men. But no significant changes were noted in pre and post ECT calcium level and in potassium level in women.Conclusion: ECT carried out under general anesthesia, therefore pre ECT physical exam and blood samples are required. Electrolytes change under ECT, therefore attention to these electrolytes specially sodium and potassium are important.

Background: Intravenous regional anesthesia (IVRA) is an efficient method for short-term procedures of the upper extremities. Some defects are associated with IVRA including tourniquet-related pain and insufficient duration of the anesthesia. The main purpose of the current study was to compare the effects of adding paracetamol or magnesium sulfate to lidocaine in IVRA on pain, venous blood gasses (VBG) and sensory and motor block.Methods: There were 90 patients contributed in the current study. Patients were divided into paracetamol (P), magnesium sulfate (Mg) and control (C) groups, randomly. Severity of the pain, time interval between the injection and onset of the sensory and motor block, duration of the sensory and motor block and the changes of VBG were measured.Results: The onset of the sensory and motor block was reduced significantly in Mg group (p<0.05). There was a meaningful increase in the motor block duration in Mg group in relation to C group (p<0.05), but no statistically significant difference between Mg and P groups. Also, there was no meaningful difference between C and P groups in the means of onset of block and block duration. Neither MgSO4 nor paracetamol decreased the tourniquet-related pain. The changes of VBG were significantly lesser in the P group.Conclusion: Adding MgSO4 to lidocaine improves the sensory and motor block in the IVRA. In other hand, paracetamol prevents ischemic changes to occur. None of these drugs are helpful to relief the tourniquet-related pain.

Background: Bleeding during nasal operations is a determinant factor in surgical outcome, thus any method that could decrease blood loss during this surgery will be valuable. So this study was conducted to compare the amount of blood loss in septorhinoplasty with two different anesthetic technique, propofol or isoflurane.Methods: In this prospective randomized clinical trial, 60 patients with ASA physical class I & II, scheduled for septorhinoplasty were studied. Patients were randomly allocated into two groups (30 patients in each group). After similar induction of anesthesia in all patients, in Group I, propofol with remifentanil, and in Group II, isoflurane with remifentanil used for maintenance of anesthesia. The bleeding, surgeons' satisfaction from surgical field and also hemodynamic parameters was noted and compared with SPSS statistical software between two groups across the study.Results: The demographic parameters, surgical and anesthesia related factors were similar in both groups. The mean blood loss volume was less in propofol group (35.3±18.8 ml) than isoflurane (91±18.3 ml) group significantly (p 0.001 Surgeon satisfaction was higher in propofol group too (p<0.01). Hemodynamic parameters such as heart rate, systolic and diastolic blood pressure and SPO2 were comparable between two groups (except in a few short intervals).Conclusion: It may be concluded that anesthesia with Propofol (TIVA) may result in decreased blood loss and higher surgeons satisfaction in septorhinoplasty compared with isoflurane anesthesia.