Intrathecal injection of magnesium sulfate: shivering prevention during cesarean section: a randomized, double-blinded, controlled study / 대한마취과학회지

BACKGROUND: Regional anesthesia is known to significantly impair thermoregulation and predispose patients to hypothermia. We hypothesized that the addition of an intrathecal injection of magnesium sulfate (MgSO4) to bupivacaine would improve perioperative shivering in female patients undergoing elective caesarean section. METHODS: In a block-randomized, double-blinded, controlled trial 72 patients scheduled for elective caesarean section with spinal anesthesia were separated into two groups. In the treatment group, 2 ml of 0.5% bupivacaine plus 25 mg MgSO4 (0.5 ml) were injected intrathecally, and in the control group 2 ml of 0.5% bupivacaine plus 0.5 ml normal saline were injected intrathecally. Core temperature was measured before and after drug injection at predetermined intervals. Sedation was graded using the Ramsay sedation scale. RESULTS: No significant intergroup differences in appearance of shivering were seen immediately or at 5, 30, 40, 50, 60, and 90 min after block administration. However, at 10, 15, and 20 min post block, there was a significant difference in shivering. The group administered MgSO4 showed lower shivering grades compared with the control group. Core temperature was significantly reduced in the MgSO4 group compared to the normal saline group 30 min after blocking. CONCLUSIONS: Intrathecal injection of MgSO4 improved perioperative shivering in female patients undergoing elective caesarean section.

Sonoanatomic Variation of Pes Anserine Bursa

BACKGROUND: The pes anserine bursa lies beneath the pes anserine tendon, which is the insertional tendon of the sartorius, gracilis, and semitendinosus muscles on the medial side of the tibia, but it can lie in different sites in the medial knee. Accurate diagnosis of the position of the bursa is critical for diagnostic and therapeutic goals. The aim of this study was to evaluate sonoanatomic variations of the pes anserine bursa in the medial knee. METHODS: One hundred seventy asymptomatic volunteers were enrolled in this study. Using ultrasound imaging (transverse approach, 7-13 MHz linear array probe) the sonoanatomic position of the pes anserine bursa and its relation to the pes anserine tendon were evaluated. Additionally, we evaluated the sonoanatomic variation of the saphenous nerve. RESULTS: The position of the pes anserine bursa was between the medial collateral ligament and the pes anserine tendons in 21.2%/18.8% (males/females) of subjects; between the pes anserine tendons and the tibia in 67.1%/64.7% (m/f); and among the pes anserine tendons in 8.2%/12.9% (m/f). No significant differences in the position of the bursa existed between males and females. The saphenous nerve was found within the pes anserine tendons in 77.6%/74.1% (m/f) of subjects, but outside the pes anserine tendons in 18.8%/15.3% (m/f). Visibility of sonoanatomic structures was not related to either gender or BMI. CONCLUSIONS: Ultrasound provides very accurate information about variations in the pes anserine bursa and the saphenous nerve. This suggests that our proposed ultrasound method can be a reliable guide to facilitate approaches to the medial knee for diagnostic and therapeutic objectives.

[Surgical tracheostomy versus percutaneous tracheostomy in the intensive care unit]

Prolonged intubation and need to mechanical ventilation is an indication for tracheostomy. This procedure can be done, surgical or percutaneous. In this study, we compare surgical and percutaneous dilated tracheostomy. In this retrospective study, which was conducted in ICU wards of Rasool Akram Hospital from Mehr 1387 to Mehr 1390. We compared complication of tracheostomized patients in two groups. In this study, early postoperative bleeding, in 11 cases, 1 case [4.2%] in PDT group and 10 cases [17.5%] in surgical group was shown [with a significant difference]. Surgical site infection in 1 case, 2 cases [7.4%] in PDT group and 1 case [4.2%] in surgical group was shown [with a non-significant difference]. Subcutaneous emphysema in 11 cases, 2 case [8.3%] in PDT group and 1 case [1.7%] in surgical group with a significant difference, was shown. Other complications such as tracheal posterior wall were not shown in both groups. Because of lower complications rate and bedside PDT doing, percutaneous tracheostomy is a safe and suitable alternative for surgical tracheostomy