ABSTRACT
Background and Objective: Management of post operative pain in children undergoing hypospadiasis repair, accounts for optimized surgery outcomes and improved patients' satisfaction. Thus, various studies have widely investigated the best approaches for the pain management. In this study our aim was to determine the effect of dexamethasone in combination with penile nerve block on the postoperative pain and complications in the children undergoing hypospadias surgery
Methods: In this randomized double-blind placebo controlled trial, after obtaining informed consent from parents or legal guardians, 42 children undergoing surgical treatment of hypospadias were randomized in two groups to receive either IV dexamethasone 0.5 mg/kg [n=23] or placebo [normal saline] [n=19] during the operation. Penile block was performed in both groups using Bupivacaine 0.5% [1mg/kg] at the end of the procedure. By the end of the operation, FLACC [Face, Leg, Activity, Cry, Consolability] pain score was assessed as the primary outcome of the study. Secondary outcomes includes timing and episodes of rescue medication consumption, post operative nausea /vomiting and bleeding. All the outcomes were assessed in the recovery room and after 2, 6, 12, and 24 hours
Results: The median of FLACC pain scores at the recovery room and 2, 6, 12, and 24 hours post operation was 2, 1, 1, 1, and 2 for the dexamethasone group and 8, 8, 7, 7, and 8 for the placebo group respectively. This were significantly different [P<0.000]. The median time of first rescue medication consumption was 8 hours post operation for the dexamethasone group and three hours for the placebo group which was significantly different [z= 4.57, p<0.000]. The maximum episode of post operative rescue medication consumption in dexamethasone group was 4 episodes in only one patient and the minimum was one episode in 11 patients. In comparison numbers in placebo group were five episodes in seven patients and three episodes in four patients. The result indicated that there was statistically significant difference between two groups in terms of episodes of rescue medication consumption [Chi2= 31.4, p<0.000]
Conclusion: Single dose of intravenous dexamethasone [0.5 mg/kg] in combination with penile block decreased the post operative pain measures, and total post operative analgesic requirement. It also increased the onset of the first analgesic requirement compared to penile block alone
ABSTRACT
Aminophylline, which is clinically used as a bronchodilator, antagonizes the action of adenosine, so it can be used to shorten the recovery time after general anesthesia. Therefore, we wanted to test the hypothesis that the administration of aminophylline leads to an increase in bispectral index [BIS] and clinical recovery in patients anesthetized with total intravenous anesthesia [TIVA]. Ninety two patients who were scheduled for elective inguinal herniorrhaphy were enrolled in this study. All patients were premedicated with midazolam and morphine. Anesthesia was induced with propofol 2.5 mg/kg and remifentanil 2.5 microg/kg without muscle relaxant. For maintenance of anesthesia we used propofol 100 microg/kg/min, remifentanil 0.2 microg/kg/min and 100% oxygen with stable BIS readings in the range 40-60. After skin closure, aminophylline 4 mg/kg was given to Group A and an equivalent volume of normal saline to Group P. BIS values, heart rate, blood pressure, oxygen saturation and End tidal CO2 [ETco2] were determined. Time to eye opening, extubation time and response to command were measured. There were no significant differences in SpO2, ETco2 and anesthesia time. Heart rate and systolic blood pressure were found to be statistically higher [p<0.001] in Group A. Time to eye opening, hand grip and extubation were significantly shorter [p<0.001] in Group A. Bispectral index scores were significantly higher in group A. Injection of aminophylline at emergence time led to significant increase in BIS and shortening recovery time from anesthesia
Subject(s)
Humans , Male , Female , Anesthesia Recovery Period , Consciousness Monitors , Anesthesia, IntravenousABSTRACT
Nosocomial infections [NIs] are one of the most important health issues, particularly in developing countries, because these infections cause high mortality and morbidity, and economic and human resource loss as a consequence. To date, most surveillance studies have been conducted in developed countries, and only a few have been performed in Iran. All of the few Iranian studies have been performed using paper-based collection forms, and none was conducted with the aid of an electronic patient data retrieving and collecting tool. The aim of this study is to determine the incidence of NIs in a big university hospital of Shiraz, with the help of specifically programmed surveillance software merging electronically the available patient data and the infection results input manually. The study was conducted prospectively through 6 months from 21[st] March up to 22[nd] September 2006, in a 374-bedded educational hospital. All patients admitted during this period were included in the study and examined everyday for detecting four types of NIs: surgical site infection [SSI], urinary tract infection [UTI], pneumonia [PNEU], and blood stream infection [BSI]. Centres for Disease Control and Prevention National Nosocomial Infection Surveillance system criteria were applied. 4013 patients were admitted in the hospital. The overall infection rate was 4.14, and UTI, SSI, BSI, and PNEU rates were 1.82, 1.22, 0.5, and 0.5, respectively, per 1000 patient days of admission. The results of this study showed that the frequency of NI in the investigated hospital was not higher than in many other reported surveillance results from other countries. This, however, might be a bias as the administration of antibiotics was very high in this study and the quality of microbiological investigation might have influenced significantly, resulting in more false-negative results than expected. Overall, the use of the Iranian National Nosocomial Infection Surveillance System Software proved to be useful and allowed both rapid data collection and detailed data analysis
ABSTRACT
Nowadays music is used to decrease pain and increase relaxation in clinical settings. It is hypothesized that music can affect women more easily than men. We assessed the effect of two types of music [Iranian folkloric and preferred music] on pain tolerance and pain rating in cold pressor test. A consecutive sample of 50 healthy Iranian medical students was enrolled. They reported pain tolerance and pain rating in cold pressor test in three different musical conditions served as the outcome measures. The results were analyzed with repeated measurement analysis of variance. Mean tolerance time was significantly higher in preferred music compared to Iranian folkloric music [F [1,48] =25.44, p=0.0001] and no music [F[1,48]=3.51, p=0.0001] conditions. There was a significant interaction when tolerance time in no music condition was compared to preferred music condition, regarding sex; Tolerance time increased more in females [F[1,48]=5.53, p=0.023]. The results also indicated that pain ratings, regardless of sex, were different in three musical conditions [F[1.7,81.34]=15.37, p=0.0001]. Music distracted attention from pain and Women can be impressed and distracted more easily by music
Subject(s)
Humans , Male , Female , Pain Perception , Women , Men , PainABSTRACT
Propofol is an intravenous agent used extensively in total venous anesthesia [TIVA], but its acquisition cost is nearly 1 to 3 folds higher than other intravenous or inhalation agents. Thiopental is an ultra short acting barbiturate which can reduce the cost of induction to one seventh of Propofol induction cost. In this study, by BIS monitoring of the depth of anesthesia, we evaluated maintaining anesthesia with Propofol while Thiopental has been used for induction of anesthesia and the aim of study was to find a cost effective method. In a single blind clinical trial, 82 patients with ASA II and I scheduled for cataract surgery were randomized in two groups. In the first group [A], induction of anesthesia was done with Propofol 2 mg/kg and then anesthesia maintained with Propofol 100 micro/kg. In the other group [B], induction was Thiopental 5 mg/kg and anesthesia maintained with Propofol 160 micro/ kg. BIS monitored depth of anesthesia throughout the procedure. We compared the BIS values in each step of the procedure in both groups. After extubation, mean of BIS score were 87.53[ +/- 2.52] and 88.79[ +/- 2.07] for groups A and B respectively. This difference was not clinically significant. Multiple linear regression analysis, identified decreased maintenance dose of Propofol and duration of surgery as independent predictors for BIS span 40-60.[P < 0.000,r[2] =0.558]. Cost effectiveness [acquisition cost/percent of 40-60 BIS span] for groups A and B were 2.95 S and 1.03 S respectively. Minor surgeries like ophthalmic surgery can be conducted with maintenance of Propofol while induction is with Thiopental. Monitoring the depth of anesthesia with BIS showed that if we choose 160 micro/kg Propofol for maintenance then it is not necessary to have a loading dose and induction can be done by Thiopental. Further studies with different type of surgery and different maintenance doses of Propofol must be done
ABSTRACT
Airplane flying and anesthesia are both not entirely safe. Passengers and patients have the right not to be endangered during flight or anesthesia. Flying and anesthesia have always been associated with anxiety in passengers and patients. This study was undertaken to compare the anxiety between passengers to fly and patients to receive anesthesia. One hundred and eighty persons were randomly selected and divided into six equal groups. Pilots and flight crew; anesthetist, resident of anesthesiology and nurse anesthetists; people who had flown but without any history of anesthesia; people without any experience of flight or anesthesia; people with previous experiences of both the flight and anesthesia and finally people with a previous history of anesthesia but without any experience of flight as Groups 1 to 6 respectively. A questionnaire was used to evaluate the level of anxiety during both the flight and anesthesia. All six groups had significantly more anxiety from anesthesia than flying [p<0.05] except in group 5 [p = 0.460]. Anxiety of flying was significantly less in pilots and flight crews [group 1] when compared with other groups [p<0.004]. The anxiety of anesthesia was significantly less in anesthetist team when compared with those who have not experienced general anesthesia. People who had not experienced anesthesia showed more fear about anesthesia than those who had experienced general anesthesia [p<0.002]. The results showed that having enough information about flying causes less anxiety just as preoperative visits help the patient to undergo a more comfortable anesthesia