Postoperative respiratory distress in a patient with history of familial Mediterranean fever

Postoperative respiratory distress and pulmonary edema can be seen after a wide variety of serious clinical situations, or rare diseases such as familial Mediterranean fever [FMF]. FMF is a multisystemic disorder characterized by recurrent bouts of fever and pain due to inflammation of the peritoneum, synovia, or pleura. We report a case with history of FMF who developed postoperative respiratory distress after repairing the abdominal incisional hernia. Ten hours after administration of colchicine, the patient's symptoms were reduced. This rare disease should be included as a differential diagnosis for acute-onset respiratory distress in postoperative period

[Evaluation of the effect of ketamine as oral premedication on quality of pediatric anesthesia]

Strange and unfamiliar setting of the operation room and also fear of operation cause numerous problems for the patient, parents of the patient and anesthesiologist. Prescription of intravenous sedatives or opiates in addition to their side effects leads to more fear and anxiety because of venipuncture. To prevent these problems, we prescribed oral sedatives. In this controlled double blind clinical trial, sixty children, aged 1-7 year were divided randomly into two groups; group 1 received oral Ketamine but placebo was prescribed for group 2. Behavioral changes together with heart rate and respiratory rate alternations were evaluated before and 30 minutes after prescription of the medication. The results of this study showed that the children who received oral ketamin were calmer and separated from their parents easier in comparison to those who received placebo, which showed a significant statistical difference [p<0.001]. Also heart and respiratory rates decreased in the patients of ketamine group which revealed a significant difference [p < 0.01]. It seems that prescription of oral ketamine as a premedication thirty minutes before anesthesia can produce appropriate sedation and a relative decrease in heart and respiratory rates in children, which in turn can lead to less panic, easier separation of children from their parents and facilitation of induction of anesthesia

Intratracheal administration of lidocaine for sedation of patients under mechanical ventilation: a double-blind randomized clinical trial

Some patients with respiratory failure who are in need of mechanical ventilation require sedation to tolerate the inserted endotracheal tube [ETT] and other unpleasant stimuli. While a light sedation is satisfactory, deep sedation can interfere with the weaning process of patient from mechanical ventilator. Nevertheless, so far, the ideal regimen for sedatives and analgesics has not been found. We evaluate the effect of intratracheal administration of lidocaine for sedation of patients under mechanical ventilation. In a double-blind randomized clinical trial, 50 patients aged 33-65 years who had no obvious brain injury, in need of mechanical ventilation were enrolled into this study. They were randomized into two groups; the treatment group received 2.5 mL of 2% lidocaine, and the control group received 2.5 mL of normal saline via ETT each two hours for 12 h under sterile conditions. The baseline sedation was maintained with morphine, midazolam, or both, which were titrated to patient comfort and to maintain an optimum sedation score throughout the entire study. During 12 h of the study, the mean +/- SD total morphine and midazolam requirements were 7.13 +/- 0.96 and 4.65 +/- 1.15 mg, respectively, in the treatment group, and 11.08 +/- 0.77 and 6.37 +/- 1.17 mg, respectively, in the control group. There was a significant [P<0.05] reduction in the requirements for both drugs during the study in the treatment group as compared to the control group. Intratracheal administration of lidocaine significantly reduces sedative requirements in intubated patients during 12 h. In the short-term, no side effects or complications were observed

Evaluation of the effectiveness of lidocaine infusion in reduction of postoperative pain

Postoperative pain is an acute pain related to size and site of operation, patient's psychologic and physiological condition, degree of manipulation and damage of tissues. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Administration of opioids is one of the common techniques for postoperative pain management, but complications related to opioids leads to use of other methods for pain control. In this study we evaluated the effect of low dose lidocaine infusion for postoperative pain control. In this study, 30 patients were randomized in two study and control groups under similar conditions. In study group, administration of lidocaine 1% [1.5mg/kg followed by 1.5 mg/ kg /h infusion] was started 30 minutes before operation, and continued 1 hour after operation. In control group, normal saline [placebo] was used. After 24 hours, pain of patients and systemic analgesic consumption was assessed and analyzed. Results showed that infusion of low dose lidocaine does not reduce postoperative pain and amount of morphine consumption 24 hours after operation. Difference in results of this study and other similar investigations can result from difference in design and selected surgical procedures. Also, lack of medical and research equipments such as appropriate PCA [Patient Controlled Analgesia] and measurement of blood levels of lidocaine were limitations of this study

Intra - articular bupivacaine versus bupivacaine plus dexamethasone for analgesia after knee surgery

Postoperative pain is a common problem suffering the patients after knee surgery. Treatment with intra-articular corticosteroid preparation has been advocated but the value of this approach has not been established. We compared the efficacy of intra-articular dexamethasone plus bupivacaine with the efficacy of intra-articular bupivacaine alone to prevent post-operative pain after meniscectomy. Sixty ASAI patients undergoing meniscectomy with general anesthesia were randomly assigned to receive intra-operative intra-articular bupivacaine, bupivacaine plus dexamethasone, or placebo under double blinded condition. The group 1 [n=20] received 10ml of bupivacaine 0.5% with epinephrine 1 :2000000, group 2 [n=20] received 8ml bupivacaine 0.5% with epinephrine 1 :200000 plus 2ml [8mg] dexamethasone and group 3 [n=20] received 10ml of normal saline. The patients were evaluated until 12 hours after the operation and pain levels at rest measured by a Visual Analogue Scale [VAS]. During the first six hours after the operation, both combination of bupivacaine and dexamethasone and bupivacaine alone significantly reduced patient's pain [P=0.000] and during six to twelve hours after operation the patients in dexamethasone group had significantly lower pain scores comparing to the other group [P=0.037]. The low pain scores were associated with lower requirement of supplementary analgesics [P=0.000]. Combination of intra-articular dexamethasone and bupivacaine significantly reduces post-operative pain and consumption of analgesics following meniscectomy than intra-articular bupivacaine alone