Effect of Intravenous Intraoperative Esmolol on Pain Management Following Lower Limb Orthopedic Surgery

BACKGROUND: Lack of proper control of acute postoperative pain often leads to lingering or chronic pain. Several studies have emphasized the role of beta-blockers in reducing postoperative pain. Esmolol is a selective short-acting beta-blocker that produces few side effects. The purpose of this study was to examine the effect of intravenous intraoperative esmolol on postoperative pain reduction following orthopedic leg fracture surgery. METHODS: In a clinical trial, 82 patients between 20-65 years of age with tibia fractures and American Society of Anesthesiologists (ASA) physical status I & II who underwent surgery were divided into two groups. Group A received esmolol and group B received normal saline. Postoperative pain was measured at three time points: entering the recovery unit, and at 3 h and 6 h following surgery, using the Visual Analogue Scale (VAS). A P value of < 0.05 was considered significant. RESULTS: Mean VAS scores at all three time points were significantly different between the two test groups (P = 0.02, P = 0.0001, and P = 0.0001, respectively). The consumption of pethidine was lower in group A than in group B (P = 0.004) and the duration of its effect was significantly longer in time (P = 0.026). CONCLUSIONS: Intravenous intraoperative esmolol is effective in the reduction of postoperative pain following leg fracture surgery. It reduced opioid consumption following surgery and delayed patient requests for analgesics.

Effectiveness of coping skills education program to reduce craving beliefs among addicts referred to addiction centers in Hamadan: a randomized controlled trial

One of the most important factors affecting relapse of addiction is craving beliefs of substance use. The goal of the present study was assessment of the effectiveness of coping skills education program to reduce craving beliefs among opium addicts. In a randomized controlled trial, during September 2011 to August 2012, 70 opium addicted men referred to the Behavioral Disorders and Substance Abuse Research Center in Hamadan, western Iran were assigned to intervention group [receiving coping skills education program] and control groups. The study information was analyzed using SPSS software. Regarding craving beliefs for continuing drug use, the two groups had similar scales at the beginning of interventional program, while the level of these beliefs was significantly reduced in the intervention group [P = 0.002], but not in the control group [P = 0.105]. Also, a significant correlation was also revealed between taking advantage of the educational program and increase awareness of the signs of relapse in the intervention group [P = 0.003] that was not revealed in the control [P = 0.174]. On the other hand, executing coping skills education program led to reduce craving beliefs and improve knowledge towards signs of relapse. Our findings demonstrate positive impact of coping skills education program after detoxification process on decrease of craving beliefs among opium addicts

comparative study of cardioprotective effect of three anesthetic agents by measuring serum level of troponin-T after coronary artery bypass grafting

Cardiac surgery is associated with some degree of myocardial injury. Preconditioning first described in 1986 was pharmacologic and non- pharmacologic. Among the long list of anesthetic drugs, isoflurane as an inhaling agent along with midazolam and propofol as injectable substances have been documented to confer some preconditioning effects on myocardium. In this study cardiac Troponin T [cTnT] ,as a reliable marker, was used for evaluating myocardial injury. This prospective double blind study was comprised of 60 patients scheduled for CABG and were randomly assigned into three groups who received infusion of propofol or midazolam or isoflorane. Surgical procedures and anesthetics were similar for 3 groups. cTnT measured preoperatively and at 12, 24 and 36hr after arrival in ICU. There were no statistically significant differences in mean cTnT levels between three groups in the preoperative period and 12-24 hours after arrival in ICU. However, mean cTnT in 3 groups at 36 hours after arrival in ICU were different [P< 0.013] and cTnT level was significantly higher in midazolam group [P<0.001] and lowest in isoflurane group [P=0.002]. There were significant differences on cTnT levels between anesthetic groups of isofluran, midazolam and propofol at 36 hr after surgery. Preconditioning effect of isoflurane was higher than the other two groups

[Case report: hereditary methemoglobinemia during general anesthesia, a diagnostic and therapeutic review]

The case report that will be presented is an inherited methemoglobinemia, during general anesthesia of 36year old patient and was suspected by some clinical examination such as decreased oxygen saturation in pulse oximetry and a normal finding in ABG sample that has been prepared at the preparation of patient for anesthesia. We are going to write about this problem in preoperative period and how to manage it

Comparing two methods of LMA insertion; classic versus simplified [airway]

The aim of this study is to compare two methods of LMA insertion, "classic" versus "simplified" [AIRWAY], due to factors such as: time to insertion, number of attempts, blood stained LMA, air leak around LMA, and gastric inflation. The word "AIRWAY" refers to the similarity of this method to oropharyngeal airway insertion. One hundred ASA class I and II patients elected for lower limb orthopedic surgery but without any head and face injury or head and neck abnormality, having their tooth intact, were selected and divided to two groups of fifty; classic and simplified. In the classic group, the index finger used as a guide, pushes the back of LMA towards the hard palate, inserting it into the pharynx till a resistance is felt and the LMA is then fixed it its place. In the AIRWAY group, the deflated LMA is entered into the mouth in a 180 degree inside-out position compared to the classic method without using fingers and is proceeded until it enters the pharynx [sudden loss of resistance] and then returned 180 degree back to its normal position to be fixed in the right place. The attempt numbers, time to insertion, complications such as laryngospasm, blood stained LMA and gastric inflation is being investigated. Demographic data such as age, sex and ASA class, demonstrate no meaningful statistic difference between the two groups. Successful first attempt in AIRWAY group [86%] had no meaningful statistic difference with the classic group [80%] [p>0.05]. The overall success rate in LMA insertion [within two attempts] was 100% and 82% in AIRWAY and classic groups respectively [p>0.05] and 11 patients with failed insertion attempts, were excluded from the study. The time for successful insertion was meaningfully less in the AIRWAY group compared to the classic one [p<0.0001].In the classic group 32% of LMAs became blood stained compared to 16% in the AIRWAY group, which the difference was not meaningful. No other complications such as laryngospasm or oxygen desaturation occurred. Comparison of the whole advantages and disadvantages of both groups, mention that, by putting the LMA insertion time together with the low complication rates, the AIRWAY method can be assumed as a preferred simplified method with few complications for inserting LMA