[Emergency caesarean section in patient with thyroid storm and severe preeclampsia: a case report]

Hyperthyroidism can occur with pregnancy. Thyroid storm is a life-threatening exacerbation of hyperthyroidism. The mortality rate for thyroid storm remains surprisingly high at approximately 20%. A 21-year-old primigravida woman presented at 25 weeks, with severe pre-eclampsia and uncontrolled hyperthyroidism was scheduled for emergency cesarean section. Treatment includes rapid alleviation of thyrotoxicosis and general supportive care. Thyroid function tests may not help in differentiating thyroid storm from symptomatic hyperthyroidism. The major risk of anesthesia in the poorly controlled thyrotoxic patient is thyroid storm, which must be aggressively treated with beta-blockers, iodide, and antithyroid drugs

Chronopharmacodynamics of intrathecal co-injection of sufentanyl and bupivacaine in orthopedic surgery of lower extremities

In chronopharmacology the biological rhythm variations caused by drug administration is assessed. Evaluation of the time of drug administration and the qualitative and quantitative effects of reactions to drugs is called Chronopharmacodynamics. In this study, we assessed the Chronopharmacodynamics of intrathecal co-administration of sufentanyl and bupivacaine in surgical operations of lower extremities. In 2006, patients aged 20-50 with ASA physical status of I and II, who underwent surgical operation of lower extremities were entered into this prospective study. The patients received a slow intrathecal injection of 10 micro g sufentanyl and 15mg bupivacaine into subarachnoid of third and fourth lumbar spaces in 30 seconds. After the operation, the time of first pain sensation and the visual analogue scale [VAS] score, as the measure of severity of pain, were recorded. 115 patients were studied in this project. The pain-free interval was considered as the time between injection and patient's demand for pain relief. This interval was 746 [ +/- 322] minutes. The average score of pain severity on VAS at the time of demand for pain relief was 24.7 [ +/- 9.3]. The average pain-free duration in patients injected about noon or at midnight was significantly longer than the pain-free interval of other patients. The results show that intrathecal co-administration of sufentanyl and bupivacaine at noon or midnight [conforming to the circadian rhythm] causes better pain-relief with longer duration in comparison with other times of the day or night

Analgesic effects of propofol on orthopedics' day surgeries.

The present study was designed to assess analgesic effects of propofol on orthopedics' day surgeries. 150 adult patients undergoing orthopedics' day surgeries were randomly divided into 3 groups and allocated to receive either propofol, ketamine or thiopenal for induction and maintaining anesthesia, after premedication by 1 [micro] g/kg of fentanyl. To evaluate pain and to detect painful stimulation, parameters such as heart rate, systolic and diastolic arterial blood pressure, respiratory rate, pupil size, perspiration, muscle movement, awareness in recovery room, recall during surgery and satisfaction from anesthesia were used. Changes in these parameters were significantly greater in propofol group. We concluded that propofol does not have analgesic effects during anesthesia and must be accompanied by an analgesic like fentanyl or alfentanil and can be used by intravenous bolus method

Tracheal tube aspiration: a case report

A 62-yr-old woman with a history of papillary carcinoma of thyroid who had undergone thyroidectomy and tracheostomy 5 years prior to admission, presented with bleeding from the site of tracheostomy. Attempts to control the bleeding failed, and the patient was immediately transported to the operating room. Awake intubation was performed and the endotracheal tube was sutured to the skin. A tear in the left common carotid artery was detected and repaired during neck exploration. To secure airway, the trachea was not extubated postoperatively. Six hours after surgery, the tracheal tube was found to be missing. The patient had no respiratory difficulty. Chest radiography revealed aspirated tracheal tube lodged in the left main bronchus. A tracheostomy was performed under local anesthesia, the aspirated tube was removed and a tracheostomy tube was inserted. The patient was discharged from the hospital 5 days later in a good condition. Improper fixation of the tracheal tube and impaired airway reflexes due to old age might have led to tracheal tube aspiration