evaluation of the efficacy of different doses of ketamine for treatment of catheter-related bladder discomfort in patients underwent urologic surgery: a prospective, randomized, placebo-controlled, double-blind study

Urinary catheterization might have catheter-related bladder discomfort [CRBD]. We evaluated the efficacy of different doses of ketamine in comparison to placebo as a treatment of CRBD. One hundred twenty patients who were candidate for urological surgery requiring catheterization of the urinary bladder were randomly divided into four groups including 30 patients in each. Group I received normal saline, Group II received ketamine 150 micro g/kg/iv, Group III received ketamine 200 micro g/kg/iv, and Group IV received 250 micro g/kg/iv in the equal volume of 2 mL. The patients were observed for each 15 min in the recovery room and in the 1 h, 2 h, 6 h, 12 h, and 24 h after discharging from it for severity of CRBD and pain, levels of sedation, and post-operative nausea and vomiting. The severity of CRBD at the recovery room was significantly reduced in Group III and Group IV after 24 h compared with Group I and Group II [P < 0.05]. There was no significant difference between Group III and Group IV in this respect. The median sedation level was significantly lower in 15 min and 30 min after arrival to the recovery in Group III and Group IV compared with Group I and Group II [P < 0.05]. There was no significant difference between Group III and Group IV in this regard. Ketamine 200 micro g/kg/iv had similar efficacy with ketamine 250 micro g/kg/iv in reducing the severity of CRBD without occurring significant side effect

Prophylactic administration of haloperidol plus midazolam reduces postoperative nausea and vomiting better than using each drug alone in patients undergoing middle ear surgery

The efficacy of using midazolam or haloperidol for prevention of postoperative nausea and vomiting [PONV] has been investigated before. The main object of the present study was to evaluate the anti-emetic effects of combining administration of intravenous haloperidol with intravenous midazolam on PONV in patients underwent middle ear surgery in comparison with using each drug alone. Study design was randomized, double-blind, placebo-controlled. 80 patients, aged 18-60 years, scheduled for middle ear surgery in Kashani Hospital Medical Center under general anesthesia were enrolled in this randomized, double-blind, placebo-controlled study. Patients were divided into 4 groups of 20 each and received haloperidol 2 mg i.v. [Group H]; midazolam 2 mg i.v. [Group M]; haloperidol 2 mg plus midazolam 2 mg i.v. [Group HM]; saline i.v. [Group C]. The incidences of PONV and complete response were evaluated at 0-2 hours after arrival to the PACU and 2-24 hours after arrival to the ward in 4 groups. Patients in group HM had significantly lower incidence of PONV compared with groups H, M, and C throughout 0-24 h [P<00.5]. The HM group had the lowest incidence of PONV [0-2, 2-24, and 0-24 h] and the highest incidence of complete response. Postoperative anti-emetic requirement was significantly less in group HM compared with group M or H [P<0.05]. Combine administration of haloperidol 2 mg plus midazolam 2 mg significantly reduced PONV better than using each drug alone in patients underwent middle ear surgery under general anesthesia

comparison of the ratio of patient's height to thyromental distance with the modified Mallampati and the upper lip bite test in predicting difficult laryngoscopy

The aim of the present study was to compare the ability to predict difficult visualization of the larynx from the following preoperative airway predictive indices, in isolation and combination: modified Mallampati test [MMT], the ratio of height to thyromental distance [RHTMD] and the Upper-Lip-Bite test [ULBT]. We collected data on 603 consecutive patients scheduled for elective surgery under general anesthesia requiring endotracheal intubation and then evaluated all three factors before surgery. An experienced anesthesiologist, not informed of the recorded preoperative airway evaluation, performed the laryngoscopy and grading [as per Cormack and Lehane's classification]. Sensitivity, specificity, and positive and negative predictive value, Receiver operating characteristic [ROC] Curve and the area under ROC curve [AUC] for each airway predictor in isolation and in combination were determined. Difficult laryngoscopy [Grade 3 or 4] occurred in 41 [6.8%] patients. The main endpoint of the present study, the AUC of the ROC, was significantly lower for the MMT [AUC, 0.511; 95% CI, 0.470-0.552] than the ULBT [AUC, 0.709; 95% CI, 0.671-0.745, P=0.002] and the RHTMD score [AUC, 0.711; 95% CI, 0.673-0.747, P=0.001]. There was no significant difference between the AUC of the ROC for the ULBT and the RHTMD score. By using discrimination analysis, the optimal cutoff point for the RHTMD for predicting difficult laryngoscopy was 21.06 [sensitivity, 75.6%; specificity, 58.5%]. The RHTMD is comparable with ULBT for prediction of difficult laryngoscopy in general population

Post-delivery cardiomyopathy in a patient admitted to critical care unit; a rare case report

Peripartum cardiomyopathy [PPCM] is an uncommon disease that affects women in the last month of pregnancy or within the first five months postpartum, occurring in about 1 in 3500 live births. The disease bears potentially devastating effects both on mother and the fetus if not treated early in its course. The case was a 34-year old woman with a triple pregnancy who presented to the ward immediately after cesarean section with signs of dyspnea, cyanosis and pulmonary edema. She was diagnosed with PPCM upon echocardiography. The patient improved remarkably despite the PPCM's devastating complications. This case report aims to describe a female patient who developed PPCM after a triple delivery. Regarding the high risks of developing PPCM in subsequent pregnancies and avoiding multiparty, especially in older age, a reliable contraception in childbearing women would be helpful. The best prevention of PPCM is to avoid subsequent pregnancies

Effects of intraoperative-intrathecal sufentanil injection on postoperative pain management after single level lumbar discectomy

For lumbar disc operation a chain of painful procedures including skin incision, muscle dissection and sometimes laminectomy should be performed. The combination of these manoeuvres results in significant post-operative pain. The standard way to reduce post-operative pain consist of intra-operative injection of local anaesthetic [Bupivicaine or Lidocaine] to the superficial tissues and intravenous, oral or rectal prescription of Opioid analgesics or other analgesics after operation, but inadequate analgesia, constipation and delayed mobilisation are frequent side effect of those treatments. The goal of this study was to reduce postoperative pain of patients which causes a reduction in analgesic consumption and eventually shortened hospital stay and acceleration in physical therapy programs and ambulation. After ethical comitte approval, patients allocated in two groups A and B. Each group consisted 30 patients which all of them underwent general anesthesia. All of operations performed by same surgeon... After discectomy and at the end of surgerybased on patients odd or even number of hospital admission, one group [group-A] received sufentanil [Iranian pharmaceutic company] 0.05/kg intrathecaly injected in surgical level and the placebo group [group-B] normal saline was injected. In recovery room when patients were sufficiently awake for pain assessment, patients were asked to score pain on the verbal pain assessment score In both groups we compaired pain scores pre and postoperativly. The total dose of opioid requirement for patients and its time after operation was recorded

Attenuation of cardiovascular responses to laryngoscopy and tracheal intubation - intravenous sufentanil vs pethidine

The study was undertaken to compare the eftects of small doses of sufentanil or pethidine on cardiovascular responses induced by tracheal intubation. Sixty ASA physical status I-II patients, scheduled for elective abdominal surgery under general anesthesia, were randomly allocated in a double blind fashion to receive an intravenous bolus of either sufantanil 0.1 micro g/kg [Group S, n = 30] or pethidine 1.5 mg/kg [Group P, n = 30] for induction of anesthesia. The heart rate [HR], systolic arterial pressure [SAP], diastolic arterial pressure [DAP], and mean arterial pressure [MAP] were measured before induction of anesthesia [baseline], at 1 -min intervals for 3 min after the induction of anesthesia, and at 1, 3, 5, and 7 mm after start of laryngoscopy. No significant differences in SAP. DAP. and MAP were observed between the two groups. Heart rate was significantly increased 2 and 3 minutes alter induction of anesthesia and 1 minute after intubation in group P as compared to group S [P < 0.01]. However, the numbers of patients who developed a heart rate increase more than 20% of basal value were not different between two groups. At the end of the study period, systolic, diastolic, and mean arterial pressure slightly decreased from preinduction values was transient and did not require treatment. If adequate timing in opioid administration is warranted according to the time to peak effect of each opioid drug, small doses of sufentanil or pethidine could provide effective control of the inotropic response induced by laryngoseopy and tracheal intubation

Tracheal intubation without muscle relaxants: a randomized study of remifentanil or alfentanil in combination with thiopental

The combination of alfentanil-propofol or remifentanil-propofol provides adequate conditions for tracheal intubation without neuromuscular blocking drugs in most patients, but hypotension can occur during induction of anesthesia with propofol. We compared clinically acceptable intubating conditions and cardiovascular responses to induction and endotracheal intubation in patients receiving either alfentanil 40 micro g/kg or remifentanil 2, 3 or 4 micro g/kg, followed by thiopental 5 mg/kg. In a randomized trial, 80 patients were assigned in equal numbers to one of four groups: remifentanil 2, 3, or 4 micro g/kg [groups R2, R3, R4, respectively] or alfentanil 40 micro g/kg [group A40]. In each group, the injection was given over 90 seconds followed by thiopental 5 mg/kg. Ninety seconds after the administration of thiopental, laryngoscopy and intubation were attempted. Intubating conditions were assessed as excellent, satisfactory, fair, or unsatisfactory. Arterial blood pressure and heart rate changes accompanying the four induction techniques were also recorded. Overall conditions at intubation were significantly better [P<.05], and the frequency of excellent conditions was significantly higher [P<.05] in the R4 or A40 group compared with the R2 or R3 group. Intubating conditions were not significantly different between group R4 and A40 [P>.05]. The highest dose of remifentanil [4 microg/kg] resulted in an 18.7% decrease in mean arterial pressure [MAP] after induction of anesthesia compared with a 16.4% decrease in MAP with alfentanil 40 micro g/kg [difference not statistically significant]. The administration of remifentanil 4 micro g/kg or alfentanil 40 micro g/kg before thiopental 5 mg/kg provided good to excellent conditions for endotracheal intubation with acceptable hemodynamic changes

Beclomethasone inhaler versus intravenous lidocaine in the prevention of postoperative airway and throat complaints: a randomized, controlled trial

Previous reports indicate that inhaled corticosteroids attenuate airway inflammation. Beclomethasone inhaler was highly effective in the prevention of postoperative airway symptoms. Intravenous lidocaine prior to endotracheal intubation has also been shown to decrease the incidence of postoperative sore throat and cough. The aim of the present study was to compare the effect of beclomethasone inhaler with various clinically used dosages of intravenous lidocaine prior to endotracheal intubation on the incidence and severity of postoperative sore throat, cough, sputum, hoarseness, and dysphagia. One hundred twenty patients undergoing elective operations were assigned to one of four treatments: intravenous lidocaine 1mg/kg [Group L1, n=30], intravenous lidocaine 1.5 mg/kg [Group L2, n=30], beclomethasone inhaler 50 micro g [Group B, n=30] or intravenous normal saline [Group C, n=30]. The incidence and severity of sore throat, cough, sputum, hoarseness, and dysphagia were compared between the beclomethasone inhaler and intravenous lidocaine groups before they left the operating room, 1 hour later, at time of the first postoperative drink or meal [for assessment of dysphagia], and on the morning after surgery. In the evaluation of postoperative symptoms, the incidence and severity of sore throat were significantly lower in Group L2 and B than Group C [P<.05] at all time intervals. One and 20 hours after emergence from anesthesia, the incidence and severity of cough were significantly lower in Group L2 and B than Group C [P<.05]. The incidence and severity of sore throat or cough was not significantly different between Groups L2 and B. Throughout the study, the incidence and severity of sputum were significantly lower in Group B than group C [P<.05]. Beclomethasone inhaler is comparable with intravenous lidocaine prior to intubation in decreasing postoperative sore throat and cough. In addition, beclomethasone inhaler decreases the incidence and severity of postoperative sputum

Admission hypomagnesemia - impact on mortality or morbidity in critically ill patients

No previous study exists to evaluate admission serum magnesium level as a predictor of morbidity or mortality. The aim of this study was to define the prevalence of admission hypomagnesemia in critically ill patients and to evaluate its relationship with organ dysfunction, length of stay, and mortality. A retrospective study was done on 100 patients >/= 16 years old, admitted to the medical-surgical intensive care unit [ICU] at the University Hospital over 2 years period. Observations were made on admission total serum magnesium level, a variety of lab tests related to magnesium, need for ventilator, duration of mechanical ventilation, hospital/ICU lengths of stay, and general patient demographics. The serum magnesium level [normal value, 1.3-2.1 mEq/L] was measured at admission. At admission, 51% of patients had hypomagnesemia, 49% had normal magnesium levels. There was significant difference in mortality rate [55% vs 35%], the length of hospital [15.29 +/- 0.66 vs 12.81 +/- 0.91], or ICU [9.16 +/- 0.53 vs 5.71 +/- 0.55] stay between these two groups of patients [p < 0.05 for all]. Hypomagnesemic patients more frequently had total hypocalcemia, hypokalemia, and hyponatremia. A total of 51 patients developed hypomagnesemia during their ICU stay; these patients had higher Acute Physiology And Chronic Health Evaluation II [APACHE II] [14.16 +/- 1.03 vs 10.80 +/- 0.94] and Sequential Organ Failure Assessment [SOFA; 10.89 +/- 0.90 vs 7.58 +/- 5.01] scores at admission [p < 0.01 for both], a higher maximum SOFA score during their ICU stay [14.75 +/- 0.73 vs 8.08 +/- 0.52, p < 0.01], a more need to ventilator [58.6% vs 41.4%, p < 0.05], and longer duration of mechanical ventilation [7.2 vs 4.7 day, p < 0.01] than the other patients. The ROC curve of SOFA score in the hypomagnesemia yields significantly better results than APACHE II. An increase of 5 units in the APACHE II or SOFA measured on admission increase relative probability of hypomagnesemia by a factor of 0.12 and 0.16 respectively. Development of hypomagnesemia during an ICU stay is associated with guarded prognosis. Monitoring of serum magnesium levels may have prognostic, and perhaps therapeutic, implications