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

Radiologic manifestations of pulmonary tuberculosis in patients of intensive care units

Tuberculosis [TB] is a serpent disease with various pulmonary manifestations, and timely diagnosis of the disease is paramount, since delayed treatment is associated with severe morbidity, particularly in intensive care units [ICU]. Therefore, it is imperative that intensivists understand the typical distribution, patterns, and imaging manifestations of TB. To describe different manifestations of pulmonary TB in patients in the ICU. In a retrospective study, all patients with a clinical and a laboratory-confirmed diagnosis of TB who were admitted to the ICU were entered in the study. All patients had a confirmatory laboratory diagnosis of TB including positive smears. The patterns of parenchymal lesions, involved segments and presence of cavity, bronchiectasis and bronchogenic spread of the lesions with computed tomography [CT] and chest/X-ray [CXR] were recorded and analyzed. Data of 146 patients with TB were entered in the study. The most common finding in CT was acute respiratory distress syndrome [ARDS]-like radiologic manifestations [17.1%], followed by parenchymal nodular infiltration [13.6%] and cavitation [10.9%], consolidation [10.2%], interstitial involvement [9.5%], calcified parenchymal mass [8.3%], ground-glass opacities [7.5%], and pleural effusion or thickening [6.9%]. Radiologic evidence of lymphadenopathy was seen in up to 43% of adults. Miliary TB was observed in 2.3% of patients, mostly in those older than 60 years of age. ARDS-like [64.5%] manifestations on CT and miliary TB [85.5%] had the highest mortality rates among other pulmonary manifestations. ARDS, interstitial involvement, and Parenchymal nodular infiltration are the most common manifestations of pulmonary TB. Various features of TB in ICU patients could be misleading for intensivists

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

[Subclavian vein cannulation success or failure in neonates and children]

Central vein cannulation [CVC] allows administration of large volumes of fluids in short times and at high osmolaritiy for rehydration, volume replacement, chemotherapy and parenteral nutrition. Percutaneous central venous line insertion has replaced peripheral venous cut-down as the primary mode of short term venous access in children. 3264 subclavian vein cannulations in neonates and children were analyzed regarding successful attempt for catheterization and early complication rates after the procedure retrospectively. We had 1340 newborn patients [first 28 days of life] in our study population. In this group, only 55cannulations were failed, 1 patient were complicated with pneumothorax, in 21 cases guide wires became malfunction and only in 981 cases attempts to cannulation were successful in first attempt. In the remaining 1924 patients, 1 month to 8 years old, only 14 attempts to cannulation of subclavian vein was failed and in 1655 cases cannulation performed successfully at first attempt. CVC success rate was significantly higher in children older than 1 month compare to less than 1 month age [P=0.03]. Cannulation of central vein in neonates and children in a skilled hand would be performed with great success rate and low complications but in neonates less than 1 month age it has higher failure rate

impact of reverse trendelenburg versus head-up position on intraoperative bleeding of elective rhinoplasty

In spite of several efforts for decreasing blood loss, our experience sometimes shows that some patients bleed more profusely during rhinoplasty. Patient position could have deep impact on bleeding amount during surgical procedures. In this study, we aimed to compare reverse trendelenburg position and head-up position on intra-operative bleeding of elective rhinoplasty. This was to check the effects of reverse trendelenburg position and head up position on the intraoperative bleeding of elective rhinoplasty. In this study, 30 ASA I [American Society of Anesthesiology physical condition classification] patients between 18 and 40 years of age who were candidate to rhinoplasty operations for first time were included. Patients were randomly assigned to reverse trendelenburg or head-up position. Exclusion criteria was any history or lab indicating coagulation problems or using any drug. All gauzes used and the blood that accumulated in the aspirator throughout the operation were calculated. Our results showed that the mean amount of blood loss in reverse trendelenburg was lower [77.00 +/- 13.20 ml] than head up position [83.33 +/- 21.18 ml], although, there was no statistical difference between two groups. However, there was no significant differences among two groups in different aspects of hemodynamic determinants and bleeding amount during and after rhinoplasty. Our results showed that patient bleeding is not increased because of positioning per se. In conclusion, perhaps in the future reverse trendelenburg will be given more often during rhinoplasry