ABSTRACT
Introduction: Pneumonectomy is the standard treatment of lung cancer, even though patients should undergo several evaluations before surgery; deterioration of cardiopulmonary function after pulmonary resection is inevitable. We have evaluated the effects of digoxin on the improvement of right ventricular function and prevention of probable complications after lung resection surgery
Materials and Methods: All patients who were candidate for pneumonectomy or extensive lobectomy in Ghaem hospital from 2010 to 2012 were enrolled into this study and were divided into two groups randomly. The first group [group D] received digoxin during surgery and in the second group [group C] normal saline was administered as placebo. Echocardiographic evaluation of the patients was accomplished the day before and the day after surgery
Results: Among 20 patients in each group, male to female ratio was almost 2:1 and mean age was 63.8 [ranged 46-83 years]. The most common cause of pneumonectomy was lung cancer. Comparison of the preoperative demographic variables, blood biochemistry, pulmonary function tests, echocardiographic and blood gas indexes showed no statistically significant differences between two groups. But postoperative evaluations showed a significant improvement in left ventricular ejection fraction in group D. Right ventricular systolic and diastolic diameters and pulmonary artery pressure were decreased significantly as well
Conclusion: According to our results, we suggest a single dose of digoxin during lung resection surgery to improve cardiac performance after pneumonectomy
ABSTRACT
Ventriculoperitoneal [VP] shunt placement that diverts the cerebrospinal fluid [CSF] into the peritoneal cavity is the most common method of treatment of hydrocephalus. This shunt has a high incidence of malfunction mainly due to catheter obstruction or infection. About 20% of these complications are abdominal that may occur at any time after shunt placement from 1 week to several years. This study reports a case of 2.5-year old child with a history of hydrocephalus who had a VP shunt placed which was protruded from the anus on the day of referral. The patient was treated successfully after extrusion of the shunt through the anus, receiving antibiotics and being carefully observed. He was discharged from the hospital after one week
ABSTRACT
Myasthenia gravis is an autoimmune disorder resulting from a decreased number of active acetylcholine receptors at the neuromuscular junction. Thymectomy is one of its current treatments. Due to sensitivity of myasthenic patients to non-depolarizing muscle relaxants and also the interaction of this medication with anti-cholinestrase drugs, determining the dosage of non-depolarizing muscle relaxants for induction of anesthesia is one of the hurdles in thymectomy. Twenty myasthenic patients undergoing transsternal thymectomy were enrolled into the study. They were divided into two groups randomly, and received either 0.25 mg/kg or 0.50 mg/kg of atracurium to facilitate tracheal intubation. Neuromuscular blockade was measured using train of four [TOF] mode of neuromuscular stimulator 15 minutes after administration of atracurium and then each 5 minutes till entered the recovery phase. The time between injection of atracurium and the recovery phase was compared between the two groups. The two groups were similar with respect to age and gender. The time from the onset of myasthenia gravis to surgery, dosage and duration of pyridostegmine used preoperatively were not significantly different between the two groups. The time from administration of atracurium to recovery phase was not significant between the two groups [P=0.24]. There was no difference between two different doses of atracurium regarding entering the recovery phase, and as the effects of nondepolarizing muscle relaxants are unpredictable in myasthenic patients, we recommend the lower dose to prevent profound skeletal muscle weakness and postoperative complications
Subject(s)
Humans , Male , Female , Myasthenia Gravis , Thymectomy , Pyridostigmine BromideABSTRACT
Endoscopy is an invasive and painful procedure in children. Since children can not tolerate pain and stress, sedation is necessary in pediatric endoscopy. The aim of this study was comparison of propofol versus intravenous midazolam for reducing anxiety in children. In this study, 103 patients [2-14 years old] in whom endoscopy was indicated were divided into three groups. In the first group, patients received propofol, in the second group, intravenous midazolam was given and patients in the third group received no sedation. Procedures were performed in the endoscopy room. Heart rate, respiratory rate and oxygen saturation were recorded before and during endoscopy in 1 minute intervals. Tremor, sweating and pain scores were recorded by using Visual Analogue Scale [VAS]. A significant increase in heart rate was documented in all groups [p=0.038]. Respiratory rate also increased in all groups. Too Oxygen saturation decreased in the propofol group, but it was not statistically significant [p=0.17]. Pain score in propofol group was significantly lower than those receiving midazolam [20 +/- 22 vs 50 +/- 27, p<0.001]. No noticeable side effect was seen in the propofol group. It seems that propofol is a very useful and effective drug for reducing pain and stress in children and its administration leads to a safe sedation in pediatric endoscopy