ABSTRACT
Incidence of anterior cruciate ligament [ACL] tearing is especially high in athletes, and reconstruction surgery is often required, associated with severe post-operative pain requiring active interventions. In the present study we compared the continuous intravenous morphine infusion technique with femoral nerve block regarding efficacy of pain management and patients' satisfaction, so that the best post-operative pain management for ACL reconstruction can be decided. We recruited 54 patients for this study and divided them randomly in 2 equal groups; Group-A [continuous intravenous morphine infusion] and Group-B [femoral nerve block]. Femoral block for coded subjects was performed at the end of the surgery right before shifting the patient. For patients in the other group, catheter was inserted for continuous infusion after extubation and transfer to recovery room. Pain intensity was assessed and recorded in recovery service and right after complete consciousness, and then every 4 hours by trained nurses of the department, using visual analogue scale [VAS]. After complete consciousness and every 12 hours, patients' satisfaction from post-operative analgesia was questioned and recorded, using five Likert scale items. Post-operative complication were recorded. The pain in Group-A [the continuous infusion pump group] at 20 and 24 hours after surgery was significantly lower than Group-B [nerve block group][p<0.05]. Post-operative complications [especially nausea] in femoral nerve block was lower. Analgesic degree of nerve block is comparable with the impact of continuous infusion pump at least during 20 hours after anterior cruciate ligament reconstruction surgery
ABSTRACT
New-onset atrial fibrillation [AF] after cardiac surgery contributes to increased morbidity, hospital length of stay, and resource utilization. Although many aspects of AF after cardiac surgery have already been elucidated, the mechanism by which cardiac surgery predisposes patients to AF has hitherto remained unknown. Recent evidence supports the notion that blood transfusion enhances the inflammatory response, thereby increasing the incidence of post-operative AF. This retrospective study was conducted on 2095 patients who underwent coronary artery bypass grafting [CABG] alone or accompanied by valve surgery between January 2005 and July 2007. Variables associated with the development of new-onset AF were identified using logistic regression. Intensive care unit blood transfusion increased the risk of AF [odds ratio per unit transfused, 1.16; 95% confidence limits, 1.14, 1.24; P<0.001]. Blood transfusion was performed in 487 patients and was associated with a significant increase in new-onset of AF [45.9% vs. 37.9%; P < 0.01]. Homologous blood transfusion can increase the incidence of new-onset AF after CABG. This factor should be considered in identifying patients who might benefit from prophylaxis in order to prevent this common post-operative complication and the adverse consequences thereof
Subject(s)
Humans , Male , Female , Atrial Fibrillation/etiology , Coronary Artery Bypass/adverse effects , Retrospective StudiesABSTRACT
The use of halogenated agents during balanced general anesthesia may result in an increase in blood loss associated with cesarean section but in some studies this result rejected. The aim of this study was. Comparison of hemoglobin concentration, after cesarean section between two methods: general anesthesia and spinal anesthesia. This clinical trial study comprised 170 pregnant women, who were elective cesarean section candidates for the second time. This study was approved by the local committee of medical ethics. Patients were randomly divided into two groups, each with 85 members. Exclusion criteria were: cardiac diseases, coagulate disorders, anemia, preeclampsia, abruptio placenta, emergent cesarean section cases, atonia [polyhydramnius ....], birth weight more than 4kg, and long duration of the operation [more than 90']. Patients of the first group underwent general anesthesia and spinal anesthesia was applied for the second group. There was no significant difference between both groups regarding the mean age, operation, and anesthesia durations [p>0.05]. The mean hemoglobin [HP] and hematocrit [Hct] levels were significantly lower in both groups post operatively compared with the same values pre operatively [p<0.05]. Post operative, Hb.Hct reduction rate [preoperative Hb.Hct minus post operative Hct] was significantly higher in general anesthesia group [p<0.05]. If duration of operation time was longer than one hour, Hct significantly decreased. Results of the present study showed that postoperative Hct reduction rate in cesaeran section was higher in patients who received general anesthesia in comparison with spinal anesthesia