Intravenous acetaminophen effect on postoperative narcotic analgesic demand after elective cesarean section

Background: Opioid analgesics are the mainstay of the treatment of postoperative pain. Appropriate monitoring of patients receiving opioid analgesics is essential to detect those with side effects such as respiratory depression. The discovery of Acetaminophen as a COX-3 variant may represent a primary central mechanism by which acetaminophen decrease pain. The aim of this study was to assess the effect of intravenous acetaminophen on morphine requirement in post-operation pain after elective cesarean section

Materials and Methods: In a randomized clinical trial, patients' candidate for elective cesarean section. In experiment group, intravenous acetaminophen [1000 mg/6 hour] was administered and normal saline to control group. Visual analogue scale [VAS] was measured at 1, 3, 6, 12, and 24 hours post-operation. Besides, Morphine dose requirement were measured during next 24 hours

Results: 83 patients were enrolled in the study; which 44 patients assigned in placebo group and 39 in Acetaminophen. Mean Age of placebo group was 29.64 +/- 5.55 and Acetaminophen was 30.33 +/- 5.50 which was not significantly different [p=0.568]. Only at 1 and 3 hours, there was a significant difference between two groups of study. Total dose of morphine requirement was 5.73 +/- 2.78 mg/24 h in placebo group and 3.64 +/- 2.42 in Acetaminophen group which was significantly different [p=0.001]

Conclusion: Intravenous Acetaminophen could decrease post cesarean pain and decrease post operation total morphine requirement particularly at first 3 hours post operation

Pulmonary emboli manifestation during spinal anesthesia for cesarean section in two pregnant women

Pregnancy causes a small increase in risk of venous thromboembolism [VTE], but a large increase in concern upon presentation during cesarean section with symptoms of pulmonary embolism [PE]. Pulmonary embolism clinical manifestations during spinal anesthesia could be misleading. We have presented 2 interesting cases of pregnant women underwent spinal anesthesia for cesarean section and manifested with non-specific clinical symptoms of PE during spinal anesthesia mistaken for high spinal scenarios. Two young pregnant women candidate for cesarean section underwent spinal anesthesia. During surgery, patient grows chest discomfort and dyspnea. Anesthesiologist misleaded for high spinal but observed patients during surgery and in recovery. Further investigation detected pulmonary embolism which was further treated in ICU and patients were discharged subsequently. Anesthesiologists cannot safely rule out pulmonary embolism during spinal anesthesia in cesarean section without additional testing, at least not in pregnant women with a relatively high risk of PE

Blood biomarkers alterations with administration of propofol for anaesthesia maintenance during long term oral and maxillofacial surgeries

Objective: This prospective study performed to evaluate blood biomarkers alterations with administration of propofol for maintenance of anaesthesia during long oral and maxillofacial surgeries in order to estimate the risk of Propofol Infusion Syndrome [PRIS]. This rare syndrome often would be happened in long duration or high dose infusion which is characterized by the combination of metabolic acidosis, acute bradycardia and/or asystole, and rhabdomyolysis and can be fatal

Methods: Patients undergoing maxillofacial surgeries [>3h] were the subjects of this quasi experimental prospective clinical trial study. Induction of anaesthesia was performed with midazolam 0.025 mg/kg, fentanyl 2 micro g/kg, thiopental sodium 5 mg/kg, and atracurium 0.5 mg/kg. Infusion of propofol was initiated [100 micro g/kg/min] for maintenance of anesthesia. Serum potassium level, creatine kinase, lactate and blood PH, were evaluated at baseline, and at 2, 4, 6 hours following the initiation of propofol infusion. Generalized estimating equation was used to evaluate the longitudinal changes for each of the evaluated biomarkers. The relation between the biomarkers and the following factors were appraised by using covariance linear [enter mode] regression analysis: age, gender, weight, administered dose of dexamethasone and epinephrine, duration of surgery, and a history of trauma prior to surgery

Results: A total of 55 participants, 31 women and 24 men, were studied. The mean duration of surgery was 4.8[1] hours. Despite the rise in the level of potassium and creatine kinase and the reduction of blood PH, no case of hyperkalemia or severe metabolic acidosis was observed. Serum lactate level gradually increased to higher than normal in few patients; though did not necessitate any intervention. All alterations were statistically significant. Potassium and creatine kinase level at baseline had relation to pre-surgical trauma

Conclusion: Maintenance of anaesthesia with 100 micro g/kg/min propofol along with administration of low-dose epinephrine and dexamethasone did not cause clinically important alterations in blood biomarkers during long-duration maxillofacial surgeries and might not cause PRIS

[Minor dental injuries [cracks] due to oral and nasal endotracheal intubation and related factors in Tehran Taleghani hospital]

Oral and dental injuries commonly occur during oral and nasal intubation and comprise one third of lawsuits against anesthesiologists. This study sought to assess dental traumas [especially minor injuries like cracks] due to oral and nasal intubation and related risk factors. This observational prospective study was conducted on 60 patients [30 patients in the oral and 30 in the nasal intubation groups] during 2010-2011 in Taleghani Hospital in Tehran. Patients were examined using a disposable sterile clinical examination kit, a periodontal probe and a light curing unit. Maxillary central incisors had the highest incidence of new cracks [60% and 63.3% in the oral and nasal intubation groups, respectively]. Gender, BMI, ASA class, Angle's classification, and experience of the operator who inserted the tube had no significant association with higher frequency of cracks in the two groups. Incidence of visible dental injuries following nasal and oral intubation was 1.7% and 10%, respectively. Invisible dental injuries due to intubation are highly prevalent. These injuries are mostly disregarded by the anesthesiologists since they are not visible and do not cause any complication or problem during anesthesia. Enhancing the knowledge of anesthesiologists about dental anatomy, physiology and pathology and use of teeth-guard are necessary measures to prevent such injuries