Comparison of blood glucose level in diabetics undergoing orthopedic surgeries with general or spinal anesthesia

Background: Diabetes increases the risk of peri-operative morbidity and mortality and research to decrease intraoperative blood glucose variations has been continued without any results. The objective of this study was to evaluate the blood glucose level in diabetics undergoing orthopedic surgeries with general or spinal anesthesia

Methods: In this prospective cross-sectional descriptive analytic study the blood glucose levels were evaluated in 80 diabetic patients undergoing orthopedic surgeries during general and spinal anesthesia before surgery, after incision, after one hour and in recovery

Results: 25 patients were male and 55 were female. The age of patients in spinal group was 64.90+/- 10.73 and in general group 60.78+/-10.86 years old. Body Mass Index in spinal group was 27.85+/-3.69 and in general group 29.43+/-3.57. Blood glucose levels were not significantly different between two groups. The blood glucose levels were significant in samples taken between incision and recovery period in both groups

Conclusions: The blood glucose level during surgery and anesthesia has been increased continuously and this increase in general group had a steeper slope but it was acceptable

The Effect of Intravenous Paracetamol on Postoperative Pain after Lumbar Discectomy

STUDY DESIGN: A randomized, double-blinded controlled trial. PURPOSE: Postoperative pain relief especially using analgesic drugs with minimal side effects has considerable clinical importance. This study aimed to examine the effect of intravenous paracetamol on pain relief after lumbar discectomy as a major surgery. OVERVIEW OF LITERATURE: Patients undergoing lumbar discectomy experience a high degree of lumbar pain. Some authors emphasize the use of intravenous paracetamol to improve postoperative pain and increase patients' satisfaction following this surgery. METHODS: Fifty-two patients scheduled for lumbar discectomy were randomly allocated into two groups: a group that received intravenous paracetamol (1 g/100 mL normal saline) within the last 20 minutes of surgery as the case group (n=24) and a group that received sodium chloride 0.9% 100 mL as the control group (n=28). Postoperative pain was assessed at 1, 6, 12, 18, and 24 hours after surgery by a visual analogue scale (VAS). The dosage of the administered opioid (morphine), as well as drug-related side effects within the first 24 hours after surgery were also recorded. RESULTS: The mean VAS score was significantly lower in the paracetamol group than the controls for all of the assessed time points. Although the dose of the administered morphine was numerically lower in the paracetamol group, this difference was not statistically significant (5.53+/-4.49 mL vs. 7.85+/-4.17 mL). CONCLUSIONS: Intravenous paracetamol as a non-opioid analgesic can relieve postoperative pain in patients undergoing lumbar discectomy; however, its use alone may not represent the best regimen for reducing the needed dose of opioids after operation.

Efficacy of low dose interscalene brachial plexus block on post anesthesia recovery parameters after shoulder surgery

Excellent postoperative pain control plays central role in the outcome of open shoulder surgery which provides early rehabilitation and accelerates functional recuperation. Fifty patients who were candidate for elective shoulder surgery were enrolled in this study. Patients were randomized to two 25-patient groups. One group received morphin sulfate and in the other group small volume Interscalene Brachial Plexus Block [ISBPB] was performed. Pain severity, patient satisfaction scores and post anesthesia recovery parameters were assessed. Patients satisfaction score was significantly improved in ISBPB [P<0.001]. Agitation in ISBPB group was significantly reduced compared to the other group [P: 0.009]. Pain severity score was significantly reduced with ISBPB [P=0.001]. ISBPB did not have any side effects on post anesthesia recovery parameters. Small volume ISBPB may be considered as a suitable technique for reducing intermediate postoperative pain without any effect on post anesthesia care unit parameters and stay in patients undergoing open shoulder surgery

comparative study of efficacy of intensive insulin therapy versus conventional method on mortality and morbidity of critically ill patients

Hyperglycemia is associated with increased mortality and morbidity. Current evidence has controversies about Intensive Insulin Therapy [NT] and its effect on reducing mortality in critically ill patients. In this trial we evaluated the effect of intensive insulin therapy with a simple protocol versus traditional method on morbidity and mortality of critically ill patients who were admitted to surgical intensive care unit. Sixty adult patients admitted to surgical intensive care unit between Feb 2009 to Feb 2010 in Shohada Hospital, were enrolled in this study. Patients were randomly allocated to intensive insulin therapy group [with a target blood sugar of 80-120 mg/dl] and conventional group [received insulin if blood glucose was more than 200 mg/dl]. Study was continued through the ICU stay of all patients. Acute Kidney Injury, Renal Replacement Therapy, Bactremia and transfusion were less in intensive insulin therapy without significant difference compared to control group. Mortality also was not significant between two groups. Because of the consequences of hyperglycemia, NT might be considered in critically ill patients, but intermediate levels may be more safe and effective and remains the best practice in Intensive Care Units. Defining ICU capability is critical for implementing tight glycemic control and future multi center studies are needed to consider the effect of NT on mortality as an essential outcome

effect of intramuscular ephedrine in prevention of hypotension due to propofol

To evaluate the effect of intramuscular [IM] ephedrine before injection of propofol, to reduce hypotension. It was a prospective, hospital based study conducted during March 2003 to December 2003, at Nikookary Hospital, Tabriz Medical Science University, Iran. This study was performed on one hundred patients who were candidates for elective ophthalmic surgeries randomized to two groups of 50 patients. In one group [group A] ephedrine 10mg [2cc] and in other group [group B] sterile water 2cc were injected intramuscularly. Twenty minutes before induction of anesthesia or before injection of propofol, during intubation, in 1[st], 4[th], 7[th] and 10th minutes of anesthesia blood pressure and heart rate were measured in both groups. The mean values were compared in two groups. There was only one case with significant mean diastolic blood pressure drop at 1[st] minute after intubation in group A comparing with group B. P=0.001. In other cases, differences of mean blood pressures were not significant. Also heart rates in all mentioned minutes were significantly higher in group A than group B. P<0.05]. IM injection of ephedrine before induction of anaesthesia with propofol does not have any significant effect in decreasing of patient's hypotension during operation, however it increases their heart rates. According to the potential hazards of the later complication, especially in old patients, this procedure is not recommended

Comparison of recovery after anesthesia with remifentanil infusion versus halothane in children undergoing strabismus surgery

To compare recovery after anesthesia with remifentanil infusion versus halothane for strabismus surgery. This study was performed from September 2004 to March 2005 in Tabriz Nikookary Hospital, Tabriz, Iran on children aged 2-12 years scheduled for strabismus surgery randomized into 2 groups of 25 patients each: the H group in which anesthesia was maintained with halothane and the R group in which anesthesia was maintained with remifentanil. There was no meaningful difference in extubation time after discontinuing drugs between the 2 groups [p=0.14]. However, there was a significant difference in the time of purposeful movements, proper oxygenation, consciousness, and discharge from the post anesthetic care unit between the 2 groups, all being shorter in group R. Also in group R, the time to spontaneous breathing return was longer, cases of neuromuscular reversal were fewer and cases of limb movements were more than group H. Maintenance of anesthesia with remifentanil in children aged 2-12 years undergoing strabismus surgery provided desired hemodynamic status and shorter time of discharge criteria

Validity of fasting blood sugar on the day of surgery compared with the preinduction blood glucose level in type II diabetic patients

It is necessary that the diabetic patients who are scheduled for elective surgery, be operated as the first cases, but usually it is not possible due to large number of surgeries. The aim of this study was to compare the fasting blood sugar [FBS] on the morning of operation day with pre-operative blood glucose level. Prospective, hospital based study conducted during September 2004-July 2005. Nikookary Hospital, Tabriz Medical Science University, Iran. One hundred patients scheduled for ophthalmic surgery, were enrolled in this study. The levels of fasting and preoperative blood sugar [by lab and glucometery] were measured and compared with the FBS and with each other, as well. There was a significant difference between FBS and pre-operative Blood Sugar glucometery and the laboratory [P< 0.001 and P=0.001, respectively], and also between the mean preoperative BS by the glucometery and the laboratory procedures [P<0.001]. It is not possible to use FBS on the morning of operation day instead of the pre-operative BS level in diabetic patients