[Comparison of post-operative nausea, vomiting and laryngospasm in children using control ventilation and spontaneous respiration anesthetic methods]

Post-operative nausea vomiting [PONV] and laryngospasm are the most common of complication following surgery. This study was conducted to compare the incidence of laryngospasm and PONV after pediatric infra umbilical surgery using two anesthetic methods: control ventilation and spontaneous respiration. This double-blind clinical trial study was conducted on 192 children with 2-7 year-old undergoing infra-umbilical surgery of ASA-I class with the estimated operation period of an hour in Tehran pediatric hospital, Tehran-Iran during 2009-10. The patients were randomly divided into two groups: controlled ventilation and spontaneous respiration. After anesthetization, Atracurium was injected to the control ventilation [CV] group and anesthesia continued with mechanical ventilation. For the patients of the second group [spontaneous respiration/SR], after the gradual increase of the dose of halothane and certainty of the optimal depth of anesthesia, patients were intubated to allow spontaneous respiration. After intubation, all patients were anesthetized with Halothane 1-2% and the N[2]O/O[2]. The rate of nausea, vomiting, laryngospasm, excessive post-operative discharge was recorded. Data were analyzed using SPSS-13, student's t-test, chi-square and Fisher's exact tests. Post-operative nausea was non significantly higher in CV group [8%] than SR [6.52%]. The rate of vomiting was higher in CV [16%] as compared to SR group [2.17%]. [P<0.001, RR=8.57, CI: 1.91-38.41]. The rate of laryngospasm at the end of the surgery was higher in CV group [15.21%] as compared to SR group [26%] [P<0.02, RR=0.94, CI: 0.05-1.77]. The rate of excessive discharge at the end of the surgery was significantly higher in CV group [52%] in comparison with SR group [11.95%] [P<0.001, RR=0.94, CI: 0.05-1.77]. This study showed that in infra-umbilical surgeries in a period of less than an hour the incidence of post-operative vomiting and laryngospasm is higher in control ventilation group than spontaneous respiration group, which might be due to the injection of neostigmine to counter-act the effects of muscle relaxants

Intrathecal fentanyl added to lidocaine for cesarean delivery under spinal anesthesia- a randomised clinical trial

The addition of opioids to local anesthetics improves the analgesic potency of spinal analgesia. The purpose of this study was to evaluate the efficacy and safety of intrathecal fentanyl 15 micro g when added to lidocaine 80 mg in patients undergoing Cesarean section under spinal anesthesia. Forty healthy parturients scheduled for elective Cesarean section using 80 mg of 5% lidocaine were randomly allocated to additionally receive intrathecal fentanyl 15 micro g or 0.9% saline, as control. Characteristics of spinal block, intraoperative quality of spinal anesthesia, side effects, time of first feeling of pain [complete analgesia] and time to first request of analgesics [effective analgesia] were assessed. Duration of sensory block was prolonged in the fentanyl group [p < 0.05]. The quality of intraoperative analgesia was also better. Incidence of side effects did not differ between groups. Duration of complete analgesia [140.2 +/- 29.06 minutes vs 77.90 +/- 20.21 minutes: P < 0.001] and effective analgesia [195.50 +/- 34.06 minutes vs 98.05 +/- 23.48 minutes: P < 0.001] were prolonged in fentanyl group. Adding fentanyl 15 micro g to lidocaine 80 mg for spinal anesthesia for Cesarean section, improves the quality of intraoperative analgesia and increases the duration of analgesia in the early postoperative period without increasing maternal or neonatal side effects

[ relation between parity and cure of stress incontinence after anterior colporraphy with Kelly suture]

Background: when pelvic organs prolapse exist with anatomic hyper mobility of the urethra, stress incontinence that is the most common cause of the incontinence in women. One of the procedures used in treatment of the stress incontinence is anterior colporraphy with Kelly suture. The aim of this study is to determine the rate of success of this method of surgery in women with different parity

Methods and materials: in this descriptive analysis study in 2000 2002 women were chosen with stress incontinence in Ghods hospital and after anterior colporraphy with Kelly suture the rate of cure of stress incontinence 6 months after operation was determined on them. The women were divided in two groups for comparing the rate of success of operation; first group consisted of 40 patients with parity between 1-3 and second group! 60 patients with 4 or above 4 parity

Results: rate of overall successful results after 6 months in patients [164 cases] was [83%]. Surgery in first group was successful in 38 cases [95%] and in second group 144 cases [80%] immediately after surgery. After 6 months 38 cases [95%] in first group and! 28 cases [80%] in second group were treated. The difference between two groups is significantly confirmed with chi -square test [P= 0.046]

Conclusions: the rate of success in our study in the patients below fourth parity was greater than the rate of success reported by other studies; so anterior colporraphy with Kelly suture is a good choice in low parity women

[ effects of different volumes of hypertonic saline in serum sodium concentration and pH in hemorrhagic shock in rabbits]

Background: in these years, the use of hypertonic saline for treatment of hemorrhagic shock and its effect on pH, osmotic pressure, serum sodium and Potassium concentration was the subject of very studies. Although there is no doubt in preference of hypertonic saline for treatment of homodynamic parameters due to hemorrhagic shock there is some controversies for routine of use hypertonic saline due to some complication after tra11sfi1sion of hypertonic saline like hepernatremia. The aim of this study is to determine the Frequency of hepernatremia after administration 4mllkg and 7mllkg of hypertonic saline for treatment of hemorrhagic shock

Methods and Materials: in this study, 16 male rabbits ·with 2-2.5 kg weight randomly were divided equally in two groups. After removal of 25% of total blood volume by phlebotomy and inducing hemorrhagic shock, one group was resuscitated with 4ml/kg NaCl 5% and the other group with 7 ml/kg NaCl 5% .Serum Na, K. pH and lactate and level of consciousness before and after the treatment were compared

Results: there was significant difference in condition and in blood pH in two groups and the 7mllkg group had better in condition and consciousness [P=0/04] and in blood pH [P=0/03]. There was no significant difference in serum concentration of sodium in two groups after resuscitation

Conclusions: by attention to the results of this study and similar results of other studies, we hope by using of hypertonic saline routinely faster treatment of hemorrhagic shock and its complications such metabolic acidosis occurs

[ comparison between oxytocin and syntometrine for preventing postpartum hemorrhage]

The third and forth stages of labor which involve the separation and expulsion or the placenta and an hour immediately following delivery are the two critical phases. Many maternal deaths in the developing countries result from complications of the third stage of labor and postpartum hemorrhage. Active management of labor and use of oxytocic drugs can reduce postpartum hemorrhage. This study compares the effects of oxytocin and syntometrine in preventing postpartum hemorrhage which is an important problem causing maternal morbidity and mortality after delivery. A clinical trial was designed to study 618 patients admitted to Zahedan Ghods Birth Center in 2001 for normal delivery. The patients were randomly divided into two groups. All Pregnancies were singletone, normotensive [BP<140/90] and free from medical disease. After exiting the anterior shoulder of fetus, 5 IU of oxytocin in the first group and 0.5 mg ergometrine plus 5 IU of oxytocin in the second group was injected intramusculary. The abnormal postpartum hemorrhage by obstetrician's estimation, the need for repeated oxytocic or other interventions and less than 100 mm Hg fall in systolic blood pressure was determined. The length of third stage was determined for all of the patients. Among the first group there were 20 cases [%6.47] with abnormal hemorrhage, compared to 8 cases [%2.58] in the second group. There was a significant difference between the two groups in postpartum hemorrhage [p<0.05] [using Chi-square test, CI=%95]. There was no significant difference between two groups concerning the duration of third stage and the need for manual removal of placenta. The side effects were uncommon and the incidence of hypertention [Bp> 140/90] was not different between two groups. Some studies do not recommend the use of syntometrine, believing that there is no clinical difference in the effectiveness of oxytocin and syntometrine, whereas syntometrine can cause hypertention and retained placenta. Our results similar to other researches show that syntometrine is more effective than oxytocin in preventing postpartum hemorrhage