ABSTRACT
Background and Objective: Management of post operative pain in children undergoing hypospadiasis repair, accounts for optimized surgery outcomes and improved patients' satisfaction. Thus, various studies have widely investigated the best approaches for the pain management. In this study our aim was to determine the effect of dexamethasone in combination with penile nerve block on the postoperative pain and complications in the children undergoing hypospadias surgery
Methods: In this randomized double-blind placebo controlled trial, after obtaining informed consent from parents or legal guardians, 42 children undergoing surgical treatment of hypospadias were randomized in two groups to receive either IV dexamethasone 0.5 mg/kg [n=23] or placebo [normal saline] [n=19] during the operation. Penile block was performed in both groups using Bupivacaine 0.5% [1mg/kg] at the end of the procedure. By the end of the operation, FLACC [Face, Leg, Activity, Cry, Consolability] pain score was assessed as the primary outcome of the study. Secondary outcomes includes timing and episodes of rescue medication consumption, post operative nausea /vomiting and bleeding. All the outcomes were assessed in the recovery room and after 2, 6, 12, and 24 hours
Results: The median of FLACC pain scores at the recovery room and 2, 6, 12, and 24 hours post operation was 2, 1, 1, 1, and 2 for the dexamethasone group and 8, 8, 7, 7, and 8 for the placebo group respectively. This were significantly different [P<0.000]. The median time of first rescue medication consumption was 8 hours post operation for the dexamethasone group and three hours for the placebo group which was significantly different [z= 4.57, p<0.000]. The maximum episode of post operative rescue medication consumption in dexamethasone group was 4 episodes in only one patient and the minimum was one episode in 11 patients. In comparison numbers in placebo group were five episodes in seven patients and three episodes in four patients. The result indicated that there was statistically significant difference between two groups in terms of episodes of rescue medication consumption [Chi2= 31.4, p<0.000]
Conclusion: Single dose of intravenous dexamethasone [0.5 mg/kg] in combination with penile block decreased the post operative pain measures, and total post operative analgesic requirement. It also increased the onset of the first analgesic requirement compared to penile block alone
ABSTRACT
Aminophylline, which is clinically used as a bronchodilator, antagonizes the action of adenosine, so it can be used to shorten the recovery time after general anesthesia. Therefore, we wanted to test the hypothesis that the administration of aminophylline leads to an increase in bispectral index [BIS] and clinical recovery in patients anesthetized with total intravenous anesthesia [TIVA]. Ninety two patients who were scheduled for elective inguinal herniorrhaphy were enrolled in this study. All patients were premedicated with midazolam and morphine. Anesthesia was induced with propofol 2.5 mg/kg and remifentanil 2.5 microg/kg without muscle relaxant. For maintenance of anesthesia we used propofol 100 microg/kg/min, remifentanil 0.2 microg/kg/min and 100% oxygen with stable BIS readings in the range 40-60. After skin closure, aminophylline 4 mg/kg was given to Group A and an equivalent volume of normal saline to Group P. BIS values, heart rate, blood pressure, oxygen saturation and End tidal CO2 [ETco2] were determined. Time to eye opening, extubation time and response to command were measured. There were no significant differences in SpO2, ETco2 and anesthesia time. Heart rate and systolic blood pressure were found to be statistically higher [p<0.001] in Group A. Time to eye opening, hand grip and extubation were significantly shorter [p<0.001] in Group A. Bispectral index scores were significantly higher in group A. Injection of aminophylline at emergence time led to significant increase in BIS and shortening recovery time from anesthesia
Subject(s)
Humans , Male , Female , Anesthesia Recovery Period , Consciousness Monitors , Anesthesia, IntravenousABSTRACT
Background: Severe metabolic acidosis occurs during orthotopic liver transplantation [OLT] particularly during the anhepatic phase. Although NaHCO[3] is considered as the current standard therapy, there are numerous adverse effects. The aim of this study was to determine whether the restricted use of normal saline during anesthesia could reduce the need for NaHCO[3]
Methods: In this study we enrolled 75 patients with end-stage liver disease who underwent OLT from February 2010 until September 2010 at the Shiraz Organ Transplantation Center. Fluid management of two different transplant anesthetics were compared. The effect of restricted normal saline fluid was compared with non-restricted normal saline fluid on hemodynamic and acid-base parameters at three times during OLT: after the skin incision [T1], 15 min before reperfusion [T2], and 5 min after reperfusion [T3]
Results: There were no significant differences in demographic characteristics of the donors and recipients [P>0.05]. In the restricted normal saline group there was significantly lower central venous pressure [CVP] than in the non-restricted normal saline group [P=0.002]. No significant differences were noted in the other hemodynamic parameters between the two groups [P>0.05]. In the non-restricted normal saline group arterial blood pH [P=0.01] and HCO[3] [P=0.0001] were significantly less than the restricted normal saline group. The NaHCO[3] requirement before reperfusion was significantly more than with the restricted normal saline group [P=0.001]
Conclusion: Restricted normal saline administration during OLT reduced the severity of metabolic acidosis and the need for NaHCO[3] during the anhepatic phase
ABSTRACT
Objective: To investigate the decrease in hemoglobin concentration and hematocrit during elective surgery
Methods: This was a prospective study being performed in Nemazee Hospital of Shiraz University of Medical Sciences. We included a total of 50 American Society of Anesthesiology [ASA] I and II patients undergoing elective minor surgeries. Perioperative fluid administration was performed for all the patients and hemoglobin and hematocrit levels were measured three times: Once before the operation, once one hour after start of operation and once in the recovery room. Values were compared using paired sample t-test
Results: The mean age of the patients and controls was 39.66 +/- 8.27 years. Hemoglobin level decreases significantly after one hour [p<0.001] and after the end of operation [p<0.00l]. In the same way hematocrit level was decreased significantly after one hour [p<0.001] and after the end of operation [p<0.001]
Conclusion: In this patient population undergoing elective minor operations, there was significant decrease in the hemoglobin and hematocrit levels in response to the IV fluids administration
ABSTRACT
Nowadays music is used to decrease pain and increase relaxation in clinical settings. It is hypothesized that music can affect women more easily than men. We assessed the effect of two types of music [Iranian folkloric and preferred music] on pain tolerance and pain rating in cold pressor test. A consecutive sample of 50 healthy Iranian medical students was enrolled. They reported pain tolerance and pain rating in cold pressor test in three different musical conditions served as the outcome measures. The results were analyzed with repeated measurement analysis of variance. Mean tolerance time was significantly higher in preferred music compared to Iranian folkloric music [F [1,48] =25.44, p=0.0001] and no music [F[1,48]=3.51, p=0.0001] conditions. There was a significant interaction when tolerance time in no music condition was compared to preferred music condition, regarding sex; Tolerance time increased more in females [F[1,48]=5.53, p=0.023]. The results also indicated that pain ratings, regardless of sex, were different in three musical conditions [F[1.7,81.34]=15.37, p=0.0001]. Music distracted attention from pain and Women can be impressed and distracted more easily by music
Subject(s)
Humans , Male , Female , Pain Perception , Women , Men , PainABSTRACT
Propofol is an intravenous agent used extensively in total venous anesthesia [TIVA], but its acquisition cost is nearly 1 to 3 folds higher than other intravenous or inhalation agents. Thiopental is an ultra short acting barbiturate which can reduce the cost of induction to one seventh of Propofol induction cost. In this study, by BIS monitoring of the depth of anesthesia, we evaluated maintaining anesthesia with Propofol while Thiopental has been used for induction of anesthesia and the aim of study was to find a cost effective method. In a single blind clinical trial, 82 patients with ASA II and I scheduled for cataract surgery were randomized in two groups. In the first group [A], induction of anesthesia was done with Propofol 2 mg/kg and then anesthesia maintained with Propofol 100 micro/kg. In the other group [B], induction was Thiopental 5 mg/kg and anesthesia maintained with Propofol 160 micro/ kg. BIS monitored depth of anesthesia throughout the procedure. We compared the BIS values in each step of the procedure in both groups. After extubation, mean of BIS score were 87.53[ +/- 2.52] and 88.79[ +/- 2.07] for groups A and B respectively. This difference was not clinically significant. Multiple linear regression analysis, identified decreased maintenance dose of Propofol and duration of surgery as independent predictors for BIS span 40-60.[P < 0.000,r[2] =0.558]. Cost effectiveness [acquisition cost/percent of 40-60 BIS span] for groups A and B were 2.95 S and 1.03 S respectively. Minor surgeries like ophthalmic surgery can be conducted with maintenance of Propofol while induction is with Thiopental. Monitoring the depth of anesthesia with BIS showed that if we choose 160 micro/kg Propofol for maintenance then it is not necessary to have a loading dose and induction can be done by Thiopental. Further studies with different type of surgery and different maintenance doses of Propofol must be done