bibliometric study of epidural anesthesia: a 24-year review

After introduction of epidural anesthesia [EA] in the early 20[th] century, it has become an essential technique in anesthesiology and many physicians consider it the gold standard analgesic technique for major surgeries. As EA has improved anesthesia methods dramatically and aimed to perform a scientometric analysis on this topic. Cross-sectional study Mashad University of Medical Sciences, Iran Articles were retrieved from the Web of Science [ISI] from 1990 to 2013. Intervention[s]: The total number of published items was 4612; subsequent analysis was performed on results considering published items per year, country, funding agency, institution, journal, publication language, and author and subject area. The results were analyzed considering published items per year, country, funding agency and institution, journal, publication language and author. Additionally, subject areas under which the articles were published were evaluated. The primary search yielded 4612 publications; out of these 3200 [69.38%] were original articles. More than half of articles [2466] were published under "anesthesiology" subject. The USA was the leading country in producing articles under this topic and engaged highest collaboration rate with 64 collaborations. It seems that there is an overall increase in total number of articles, citations and highly cited articles about EA during these two decades

Prophylactic effect of ondansetron for intrathecal fentanyl-induced pruritus

Using opioids along with local analgesic increase anesthesia duration and provide appropriate postoperative analgesia. However, intrathecal injection of opioids is associated with upsetting side effects including pruritus. Ondansetron [5-HT3 receptor agonist] has anti-pruritus effects. Therefore, we conducted a double blind randomized case-control study to evaluate prophylactic effects of ondansetron for preventing intrathecal fentanyl-induced pruritus. Two hundred seven patients with ASA status I, II or III, who were candidate for pelvic or lower extremity surgery with spinal anesthesia [SA] using bupivacaine hyperbaric [10-15 mg] and fentanyl [25 micro g] were included in the study. Patients were randomly assigned to two groups of case [ondansetron 8mg IV] and control [4 ml normal saline IV]. Patients' hemodynamic indexes and side effects were evaluated at 5, 10, 30, 60 minutes and then hourly up to 6 hours after SA. Pruritus presence, degree, and site were evaluated after two and six hours. Data were analyzed using Kolmogorov-Smirnov test, student t-test, Mann-Whitney U, chi[2], Fisher exact test, and Spearman linear correlation coefficient. The pruritus incidence was 60% in control and 34% in case group. Severe pruritus was observed in 18% of control group and 6% of case group. Ninety four percent of patients with pruritus in control group expressed it in above T[6] dermatomes and 74% of patients with pruritus in case group had pruritus in T[6]-L[1] dermatomes. The incidence of pruritus in L[1]-lower dermatomes was similar in two groups. Headache and nausea after anesthesia were more common in control group [p=0.035]. Ondansetron decrease incidence and degree of intrathecal fentanyl-induced pruritus. This reduction was more significant around injection area T[6]-L[1] dermatomes. Ondansetron injection does not influence systolic blood pressure, duration of anesthesia and analgesia, and does not induced urinary retention and back pain

A Scientometric Analysis of 20 Years of Research on Breast Reconstruction Surgery: A Guide for Research Design and Journal Selection

BACKGROUND: Breast reconstruction refers to the rebuilding of a woman's breast using autologous tissue or prosthetic material to form a natural-looking breast. It is increasingly offered to women undergoing mastectomy for breast cancer. However, there is no systematic analysis available for the expanding area of research on breast reconstruction. METHODS: A bibliometric method was used to obtain a view of the scientific production about breast reconstruction by data extracted from the Institute for Scientific Information (ISI). Specific parameters were retrieved from the ISI. Articles about breast reconstruction were analyzed to obtain a view of the topic's structure, history, and document relationships using HistCite software. Trends in the most influential publications and authors were analyzed. RESULTS: The number of articles was constantly increasing. Most highly cited articles described the methods of flap construction in the surgery. Other highly cited articles discussed the psychological or emotional aspects of breast reconstruction, skin sparing mastectomy, and breast reconstruction in the irradiated breast. CONCLUSIONS: This was the first breast reconstruction scientometric analysis, representing the characteristics of papers and the trends of scientific production. A constant increase in the number of breast reconstruction papers and also the increasing number of citations shows that there is an increasing interest in this area of medical science. It seems that most of the research in this field is focused on the technical aspects of surgery.

[ incidence of hypotension, nausea and vomiting after spinal anesthesia for elective caesarean section: a comparison between bupivacaine 0.5% and lidocaine 5%]

Hypotension and nausea are common side effects during spinal anesthesia. This study compared the incidence of hypotension and nausea-vomiting induced by bupivacaine and lidocaine in parturients undergoing caesarean section under spinal anaesthesia. In this clinical trial, 120 parturients undergoing caesarean section were randomly allocated into two groups. 60 patients received subarachnoid lidocaine 5% [75-100 mg] and the other group of patients received bupivacaine 0.5% [12-15 mg]. If systolic blood pressure decreased to 80 mm Hg or less than 70% of the pre-anesthesia value, 5mg ephedrine was injected. We evaluated Blood pressure each 3 minutes up to 15 min and every 5 min thereafter till the end of the recovery stay. There was no statistically significant difference in the incidence of nausea -vomiting between the two groups after spinal anesthesia. On the other hand, there was significant difference in systolic blood pressure 12 minutes after the procedure and also a significant difference was noted in diastolic blood pressure 3, 9, 15, and 40 minutes after performing spinal anesthesia [P < 0.05]. The amount of ephedrine used in both groups did not show either any significant difference. Intrathecal bupivacaine may yield more hemodynamic stability than intrathecal lidocaine in elective cesarean section

[ outcome of transanal anorectal myectomy in the patients with ultrashort_segment hirschsprung's disease]

Anorectal myectomy and anal dilation under anesthesia could be an effective way in the treatment of patients with ultrashort_segment Hirschprung.In this article we studied the outcomes of anorectal myectomy. Our study group was 61 patients with the disease who had reffered to SHEIKH hospital from the second half of 1386 to the first half of 1388. Barium enema and anorectal myectomy was performed in all patient. Follow up after myectomy was in the second week after surgery and then monthly. For the complications and results, patients were also divided in to 3 groups based on the presence or absence of ganglion cell in the muscular resectal region,and the results were compared in each group. Bleeding, infection of the operation zone, sepsis, entrocolitis, and anal stenosis was not observed in any patient after surgery. 4 patients had gas incontinence and 3 had fecal incontinence after surgery which was cured in 3-6 months with bio-feedback orders. 40 patients [87.5%] had complete remission after surgery and 2[4.17%] had partial remission and 4[8.33%] had no remission at all. Based on these results, there is no relation between gender, complications of surgery and the results of surgery. Anorectal myectomy could be an effective treatment strategy for patients with following situations: absence of anatomical abnormalities-chronic constipation in spite of medical treatment-absence of transitional zone in barium enema-failure of anorectal reflex relaxation with rectal distention in anorectal manometry

[Outcomes of rectopexy of rectal prolapse through anus by sub mucosal injection of 5% dextrose]

Considering the vast methods of rectal prolapsed, a very common condition in children, either surgical [by abdominal or perineal approach] or non-surgical [sclerozing agents' injection], the authors evaluated the therapeutic effects of injecting dextrose 50% through perineal rectopexy. All those referred patients with rectal prolaps to Dr. sheikh children hospital were included in this study. All were sub-mucusally injected 5 cc of dextrose 50% solution and the therapeutic results [recurrence and complications] were evaluated. During this study 46 patients were injected about 5 cc of dextrose 50% solution. All went through the operation without any complications and during a 6 month following up none of the complications such as fistulae, abscess formation, urinary retention, and mucosal necrosis were detected. Nine patients were re-injected due to the prolapsed recurrence however no complications occurred in the second operation. The described procedure is a simple, inexpensive, and repeatable one. Deflux has been suggested as the best sclorizing agent in articles but it is expensive. Sub-mucusally injection of dextrose 50% is a simple, inexpensive, and repeatable procedure with a 100% positive therapeutic results, therefore could be, suggested as a substitution procedure in treating children's rectal prolapsed