[Comparison of pulseoximetry oxygen saturation and arterial oxygen saturation in open heart intensive care unit]

Pulseoximetry is widely used in the critical care setting, currently used to guide therapeutic interventions. Few studies have evaluated the accuracy of SPO[2] [pulseoximetry oxygen saturation] in intensive care unit after cardiac surgery. Our objective was to compare pulseoximetry with arterial oxygen saturation [SaO[2]] during clinical routine in such patients, and to examine the effect of mild acidosis on this relationship. In an observational prospective study 80 patients were evaluated in intensive care unit after cardiac surgery. SPO[2] was recorded and compared with SaO[2] obtained by blood gas analysis. One or serial arterial blood gas analyses [ABGs] were performed via a radial artery line while a reliable pulseoximeter signal was present. One hundred thirty seven samples were collected and for each blood gas analyses, SaO[2] and SPO[2] we recorded. O[2] saturation as a marker of peripheral perfusion was measured by Pulseoximetry [SPO[2]]. The mean difference between arterial oxygen saturation and pulseoximetry oxygen saturation was 0.12% +/- 1.6%. A total of 137 paired readings demonstrated good correlation [r=0.754; P<0.0001] between changes in SPO[2] and those in SaO[2] in samples with normal hemoglobin. Also in forty seven samples with mild acidosis, paired readings demonstrated good correlation [r=0.799; P<0.0001] and the mean difference between SaO[2] and SPO[2] was 0.05% +/- 1.5%.Data showed that in patients with stable hemodynamic and good signal quality, changes in pulseoximetry oxygen saturation reliably predict equivalent changes in arterial oxygen saturation. Mild acidosis doesn't alter the relation between SPO[2] and SaO[2] to any clinically important extent. In conclusion, the pulse oximeter is useful to monitor oxygen saturation in patients with stable hemodynamic.

[Efficacy of subcutaneous infiltration of bupivacaine for postoperative pain mangment after inguinal herniorrhaphy]

Poor controlled postoperative pain not only causes acute and chronic consequences but also increases mortality and morbidity. Local anesthesic drug infiltrations in the incision site is another method of managing the postoperative pain. This study aims to evaluate the effect of bupivacaine wound infiltration in improving postoperative pain managing in abdominal surgeries. In a randomized double-blind clinical trial, 50 patients scheduled for abdominal surgery enrolled into two equal groups. 20 ml of bupivacaine 0.5% for the study group and an equal volume of normal saline for the control group was infiltrated sub-cutanesly on both sides after closure of incision wound Intensity of pain was assessed by Visual Analogue Scale in recovery room and at 2, 4 hours postoperatively. Whenever VAS was more than 4, meperidine 0.7 mg/kg IV was injected. VAS scores and opioid consumption between two groups in recovery room and at 2, 4 hours postoperatively were statistically significant. In study group, VAS scores and meperedine consumption were less. Local anesthetic wound infiltration in abdominal surgeries decreases postoperative pain and lowers opioid consumption. As a method of postoperative pain management, infiltration analgesia may be considered in abdominal surgeries along with other modalities of acute pain management

[ effects of tranexamic acid on postoperative bleeding in coronary artery bypass graft surgery]

Perioperative administration of tranexamic acid [TA], decreases bleeding and the need for transfusion after cardiac procedures. Hence, the results may vary in different clinical settings and the most appropriate timing to get the best results is unclear. The primary objectives of the present study were to determine the efficacy of TA in decreasing chest tube drainage, the need for perioperative allogeneic transfusions and the best timing for TA administration following primary, elective, coronary artery bypass grafting [CABG] in patients with a low baseline risk of postoperative bleeding. In this double-blind, prospective, placebo-controlled clinical trial in Seiedoshohada Hospital during 2011-2012, we evaluated 150 patients scheduled for elective, primary coronary revascularization. They were randomly divided into three groups. Group B received tranexamic 10 mg/kg prior to, Group A received tranexamic acid 10 mg/kg after cardiopulmonary bypass and group C received an equivalent volume of saline solution. Blood requirement and postoperative chest tube drainage were recorded. The placebo group [group C] had a greater postoperative blood loss 12 h after surgery [501 +/- 288 vs. 395 +/- 184 in group B and 353 +/- 181 mL in group A, P=0.004]. The placebo group also had greater postoperative total blood loss [800 +/- 347 vs. 614 +/- 276 in group B and 577 +/- 228 mL in group A, P=0.001]. There was a significant increase in allogeneic blood requirement in the placebo group [P=0.001]. For elective, first time coronary artery bypass surgery, a single dose of tranexamic acid before or after cardiopulmonary bypass is equally effective

effect of nitroglycerin as an adjuvant to lidocaine in intravenous regional anesthesia

The disadvantages of intravenous regional anesthesia [IVRA] include slow onset, poor muscle relaxation, tourniquet pain, and rapid onset of pain after tourniquet deflation. In this randomized, double-blind study, we evaluated the effect of nitroglycerin [NTG] in quality improvement when added to lidocaine in IVRA. Forty-six patients [20?50 yrs], were randomly allocated in two equal groups. Under identical condition, the control group received a total dose of 3mg/kg of lidocaine 1% diluted with saline, and the study group received an additional 200 microg NTG. Vital signs and tourniquet pain, based on visual analog scale [VAS] score were measured and recorded before and 5, 10, 15, 20, and 30 min after anesthetic solution administration. The onset times of sensory and motor block were measured and recorded in all patients. After the tourniquet deflation, at 30 min and 2, 4, 6, 12 and 24h, VAS score, time to first analgesic requirement, total analgesic consumption in the first 24 h after operation, and side effects were noted. The sensory and motor block onset time were shortened in study group [2.61 vs. 5.09 and 4.22 vs. 7.04 min, respectively] [p <0.05]. The recovery time of sensory and motor block and onset of tourniquet pain were also prolonged [7.26 vs. 3.43, 9.70 vs. 3.74 and 25 vs. 16.65min., respectively] [p <0.05]. Analgesia time after tourniquet deflation was prolonged and tourniquet pain intensity was lowered in study group [p <0.05]. Intraoperative fentanyl and meperedine requirement during first postoperative day and pain intensity at 4, 6, 12 and 24 hr postoperatively were lower in the study group [p <0.05]. There were no significant side effects...The NTG adding to lidocaine in intravenous regional anesthesia shortens onset times of sensory and motor block and decreases the tourniquet and postoperative pain, without any side effect