JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2018 | Volume:40 | Issue:2 (102) |Papers Count:10

Background and Aim: Laparoscopic cholecystectomy is a procedure of choice for treatment of chronic cholecystitis. Intensity of pain following this procedure in the first 24 hours after surgery is very high and is intolerable for many patients. The aim of this study was comparison of bupivacaine and hydrocortisone topical instillation in gallbladder bed for pain relief after laparoscopic cholecystectomy in patient with chronic cholecystitis. Materials and methods: This single blind clinical trial was done in patients who underwent laparoscopic cholecystectomy due to chronic cholecystitis in Ayatollah Kashani hospital of Shahre-Kord in 2017. Sampling of patients was convenient method. Patients were divided into three groups: A group: 100 mg hydrocortisone group: 20 mL of bupivacaine solution 0. 5% and C group: 20 ml of normal saline without medication. Pain was measured using VAS scale in the recovery room and 6 and 18 hours after surgery and if VAS score was more than 5, patients received 30 mg pethidine Stat. Results: In this study the mean VAS scale in the recovery room and 6 hours after surgery had not significant difference between the groups. But VAS scale of 18 hours after surgery had a significant difference among the three groups. So that the VAS scale in the hydrocortisone group lesser than the control group and bupivacaine 0. 5% group (p =0. 009). In general, during this study, all three groups, pain intensity was significantly reduced. The satisfaction of patients in the three groups were similar (p =0. 969). Regarding amount of nausea after surgery, 26. 7% of hydrocortisone group, 20% of bupivacaine group 0. 5%, and 23. 3% of control group had postoperative nausea (p =0. 830). In all three groups no headaches were reported. Conclusion: In this study, postoperative pain intensity in all three groups during the third phase of the study was reduced. And the use of hydrocortisone in laparoscopic cholecystectomy reduced the pain intensity in 18 hours after surgery significantly compared with the control group and bupivacaine 0. 5%.

Introduction and scope: sepsis is a severe inflammatory response mediated by infection witch is characterized by oxidative stress, cytokines release and impairment of mitochondrial function. Sepsis associated encephalopathy is a transient and reversible impairment of brain function witch is affect approximately 30 percent of septic patients. Melatonin has an important physiologic role in sleep and circadian rhythm regulation, immunity system regulation, antioxidant and mitochondria protective functions, reproduction control and mood regulation. We done a double blind randomized clinical trial in order to evaluate effect of melatonin supplement on damage indicators in 28 patients with sepsis admitted to general intensive care unit. Materials and methods: patients in melatonin receiving group, as soon as possible after the confirmation of the diagnosis of sepsis, was taken melatonin tablets with the dose of 51 milligrams 2 hours after the administration of night dietary gavage each night for the duration of 5 nights in addition to antibiotic regimen by the nurse. Patients in control group received antibiotic regimen without melatonin. Standard antibiotic protocol considered for the patients included in the study is similar and contains imipenem or meropenem plus vancomycin plus amikacin. Blood sample obtain from all patients included in the study in order to measure laboratory indicators associate with sepsis such as serum lactate, serum procalcitonin, CRP and also serum levels of S100B and NSE one time on arrival to the study and other time after receipt of the last dose of melatonin. Moreover, SOFA score and TISS 28 score were evaluated before and after intervention with melatonin. Results: in this study the mean ± S. D. of SOFA score in melatonin receiving group after the end of intervention was significantly lower than the control group (5. 71 ± 3. 56 vs 7. 14 ± 3. 70, P=0. 011). Other clinically and laboratory findings did not show any significant difference between two groups after the end of study. Conclusion: according to investigational aspect of melatonin administration for improvement of sepsis associated indicators and lack of comprehensive clinical guideline in order to determine optimal dose, route of administration and appropriate duration of treatment with melatonin in this indication, further investigations is necessary in this field to exactly determine the above mentioned points. Altogether it is necessary to note that with consideration of the results of this study and few other studies in this field with small sample sizes, decision about melatonin supplement efficacy or not as additive therapy in patients with sepsis, require performance of more clinical trials with greater study populations.

Background: Hip fracture is one of fairly common issue in orthopedic surgeries and also is one of the most common problems in health system. Incidence of hip fracture in elderly individuals may cause irreversible serious problems and needs special attention and important care procedures. The aim of present study is to evaluate incidence and causes of hip fracture in patients above 65 years old who referred Shohada educational center of Tabriz University of medical Sciences. Materials and methods: In a cross-sectional study, all patients above 65 years old that referred whit hip fracture to Shohada educational center of Tabriz University of medical Sciences during 2015, were selected and studied. Age, sex, history of previous fracture, and cause of the hip fracture were evaluated in patients. Results: During 2015, 504 patients above 65 years old were admitted to Shohada educational center. Mean age of patients was 79. 25± 7. 44 years old in range of 65 to 95 years old. Among 504 patients, 244 patients (48. 4%) were male and 260 patients (51. 6%) were female. Also 118 patients had history of previous fracture. In relation to case of fracture, in 422 patients (83. 7%) falling and in 82 patients (16. 3%) accident caused hip fracture. Conclusion: based on finding of present study, hip fracture is a fairly common problem among patients whom above 65 years old and falling is the most common cause of that. Doing supportive and protective actions can reduce the rate of falling and incidence of hip fracture among elderly individuals.

Introduction: Delirium is one of the most commonly occurring disorders in the intensive care unit. Various studies have been done in this regard. In this study, we investigate the frequency and effect of Delirium on the short-term outcome of patients admitted to Imam Hospital in Urmia province. Materials and methods: This cross-sectional study was conducted to determine the frequency and effect of delirium on short-term outcomes (duration of mechanical ventilation, duration of hospitalization in ICU, duration of hospitalization, mortality) in patients admitted to the General Intensive Care Unit (GICU) of Imam Hospital in Urmia province during 2015. Demographic characteristics, underlying illness, duration of mechanical ventilation, length of hospitalization in intensive care unit, duration of hospitalization, mortality and delirium of patients entered the check Listed. Independent T test and Fisher exact test was used to analyze data. Results: This study was included 322 patients. There was no significant difference between patients in term of age, sex and mortality (P> 0. 05). Although, there were significant difference between two groups of patients in term of underlying disease, duration of mechanical ventilation and the length of hospitalization and duration of hospitalization in intensive care unit(P<0. 5). Moreover, 18. 94% of the patients suffered from delirium and the rest did not have delirium. Conclusion: The present study showed that delirium is a relatively common disorder in ICU. Moreover, its prevalence is different in compared to other studies. Furthermore, delirium can affect duration of mechanical ventilation, duration of hospitalization in intensive care unit and length of hospitalization.

Introduction: chronic opioid abuse might be led to poor pain control and need of high dose of analgesic drug in postop surgery. The research has been demonestrated that duration of spinal anesthesia is lower in opium abusers than other patiants therefore it might result in more demand for pain killers, morbidity and hospital stay. As we know Dexmedetomidine and Magnesium Sulphate have been the medicines used to control pain; in this study the propable effect of IV injection of these 2 medicines on opium consumers who had been under spinal anesthesia has been assessed intraop and postop surgery. Materials and methods: In clinical trial, 150 male opium abusers (ASA class 1, 2) after matching features were randomly allocated in three groups (A: Dexmedetomidine, B: Magnesium Sulphate, C: Control). The percentage of first time pain killer requests of the patients in need of Intraop fentanyl, in the recovery room and complication were compared within three groups. Findings: Results show that percentage of the Patients in need of Intraop fentanyl in group A was 13/6%, B22/7%, and C was 63/6% (P=0/005). The first time request of opioid from 0-180 min postop displayed a statistically significant difference between three groups. (P=0/001) Conclusion: IV injection of Dexmedetomidine and Magnesium Sulphate Reduced Intraop and postop opioid consumption and delayed the first time request of opioid in recovery room and significantly reduced VNRS in group A, B compared with control group.

Background and Objectives: Recently, the issue of pain-related mental images in chronic pain disorder has received much attention. The conducted studies are few in terms of number, but have considerable variety in terms of methodology, sample number, pain type, and assumptions about the impacts of mental image; and different reports have been obtained. The present study aims to examine these studies precisely, in order to integrate the existing reports about prevalence and quality of pain-related automatic mental images and its relation to pain and mood. Materials and methods: A review study was conducted by searching in 4 electronic databases including EBSCOhost Web-PsycARTICLES, Scopus, ProQuest, and ScienceDirect. A total of 9 studies which met the entry criteria were identified. The results of these studies were examined on the basis of some main hypotheses and the relationship between mental images and pain dimensions. Results: Prevalence of pain-related mental images has been reported from 24% to 100%. Calling pain-related mental images leads to stimulation of higher levels of pain and changing of direction toward negative mood. It is also related to cognitive bias. Reconstruction of mental image affects immediate reduction of pain and distress, but its clinical effectiveness which is beyond its immediate effect, has not yet been investigated. Conclusion: The conducted studies have provided us extensive information about pain mental image and its impact on pain experience, and introduce a new path for relieving the pain and distress associated with chronic pain.

Background: Post-operative pain is cause of suffering in most patients and can cause a lot of problems. Analgesic effects of many narcotics have been widely studied. In this study, the effects of intramuscular morphine and methadone on postoperative analgesia in patients with tibial fracture were assessed. Materials and methods: This case-control study was conducted on 60 patients who fractured tibia in Zahedan in1392. Sampling was performed using a randomized block design in two groups of patients were receiving intravenous intramuscular methadone and morphine. In both groups were evaluated different levels of pain and analgesic requirement. Data were analyzed by chi-square and T-test. Results: Mean age of patients was 32. 9± 2. 2 years. 39 patients (65%) were male and 21 patients (35%) were female. (P>0. 05) the mean use of diclofenac suppository in groups receiving methadone was 1. 9± 0. 9 and in the group with receiving morphine was 2. 7± 1. 2. (P=0. 011) the level of pain in the methadone group was lower than the morphine group at all times. (P<0. 05) the mean use of scuere in the methadone group was 2. 1± 0. 89 and in the morphine group was 2. 6± 0. 88. (P=0. 024) Conclusions: The study showed that administration of methadone as premedication for tibial fractures patients reduces the postoperative pain more than morphine. Therefore, premedication with methadone for opium addict patients undergoing orthopedic surgery is recommended.

Introduction: Complications may occur in operative hysteroscopy after using distention solution. These complications are different according to type of solution, severity and velocity of absorption. We report a 45-year-old female with fluid overload complication after absorption of Glycine 1. 5% during hysteroscopy. The patient underwent operative hysteroscopy for myomectomy. She developed hyponatremia, hypocalcemia and hypokalemia as well as ventricular tachycardia. Serial laboratory tests for serum electrolytes and assessment of atrial blood gases (ABG) were performed. Serum sodium, potassium and calcium levels were 118, 2. 9 and 5. 5 mmol/L, respectively. Finally, furosemide, amiodarone and calcium chloride were administered and cardio-pulmonary resuscitation (CPR) was done. Conclusion: Successful management of this complication depends on early diagnosis and prompt treatment. The best protocol for preventing this complication is arrangement of equipment for accurate fluid monitoring of intake/output volume of distension solution.