Baricity of bupivacaine on maternal hemodynamics after spinal anesthesia for cesarean section: a randomized controlled trial

Background: After spinal anesthesia, patients undergoing cesarean section are more likely to develop hemodynamic changes. The baricity of local anesthetic has an important role on spinal blockade effects. The aim of this study was to compare the isobar and hyperbaric bupivacaine 0.5% plus fentanyl on maternal hemodynamics after spinal anesthesia for C/S

Methods: In this double-blind study, 84 healthy pregnant women undergoing C/S using bupivacaine 0.5% isobar [study group, n=42] or hyperbaric [control group, n=42] for spinal anesthesia were scheduled. The study was conducted from 21 April 2014 to 21 November 2014 at Al-Zahra Hospital, Tabriz, Iran. Parameters such as maternal hemodynamics, block characteristics, side effects, and neonatal Apgar scores were recorded. Data were analyzed using the SPSS software by performing chi-square test, Fisher's exact test, one-way ANOVA, Mann-Whitney U-test, and student's t test

Results: The incidence of hypotension in the isobar group was lower than the hyperbaric group, although it was not statistically significant [40.47% vs. 61.9%, P=0.08]. The duration of hypotension was shorter in the study group [1.6 +/- 7.8 min vs. 7.4 +/- 12.5 min, P=0.004]. The dose of ephedrine was lower in the study group [2.4 +/- 6.6 mg vs. 5.3 +/- 10.7 mg, P=0.006]. The main maternal side effect is sustained hypotension that was seen in 0 patients of the isobar and 7 [16.66%] of hyperbaric groups [P=0.006]. None of the neonates had Apgar score

Conclusion: Isobaric bupivacaine is associated with more hemodynamic stability and shorter sensory and motor blockade in mothers under spinal anesthesia for C/S

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

Albumin and fibrinogen levels' relation with orthopedics traumatic patients' outcome after massive transfusion

Severe bleeding is common during limb trauma. It can lead to hemorrhagic shock required to massive blood transfusion. Coagulopathy is the major complication of massive transfusion-induced increased mortality rate. Aim of this study was evaluation of fibrinogen and albumin levels association with orthopedics traumatic patients' outcome who received massive transfusion. In a cross sectional study, 23 patients with severe limb injury admitted to orthopedic emergency department were studied. All the patients received massive transfusion, that is, >10 unit blood. Albumin and fibrinogen levels are measured at admission and 24 h later, and compared according to final outcome. Twenty-three traumatic patients with severe limb injuries were studied, out of which ten [43.2%] died and 13 [56.8%] were alive. There was significant difference between patients outcome in fibrinogen level after 24 h, but no difference was observed in albumin levels. Based on regression model, fibrinogen after 24 h had a significant role in determining the final outcome in traumatic patients who received massive transfusion [odds ratio 0.48, 95% confidence interval 0.15-0.92, P = 0.02]. According to our results, fibrinogen level is the most important factor in determination of orthopedics traumatic patients when received massive transfusion. However, serum albumin does not play any role in patients' outcome

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