investigation of safety and efficacy of intravenous paracetamol in pain management following cardiac surgery

Introduction: Optimum pain management immediately after surgeries can lower the possibility of pain syndrome and its following consequences. Opioids are amongst the analgesics used for postoperative pain control; however, their application can bring about several adverse effects. In this study, all the published articles regarding efficacy of Paracetamol in post-cardiac surgery pain management were systematically reviewed

Materials and Methods: Pubmed and Scopus were searched for relevant articles. The employed search strategy was as follows: [Paracetamol OR Acetaminophen OR Propacetamol] AND [pain OR analgesia] AND coronary. All the English-language articles [with no time restriction], investigating the effectiveness of Acetaminophen in comparison with other analgesics or placebo, were included in the study. All the articles examining the efficacy of Paracetamol in combination with other analgesics were excluded from the search results

Results: On the whole, our electronic search retrieved 192 articles from PubMed and 365 articles from Scopus. After screening the titles, abstracts, and full texts of the search results, only 5 English-language articles met our inclusion criteria

Conclusion: Although Paracetamol demonstrated considerable efficacy in minimizing application of post-operative opioids, its strength in soothing post-operative pain is not significantly different from opioids. Further, conducting randomized-controlled-trials with large sample size are necessary to accurately reveal the efficacy of Paracetamol in curtailing application of opioids in post cardiac surgeries

Does airway pressure release ventilation mode make difference in cardiopulmonary function of ICU patients?

Introduction: Mechanical ventilation is essential in intensive care unit [ICU] patients who are unable to maintain adequate gas exchange without support. Different ventilation modalities have been introduced to imitate normal respiratory pattern but there are some disadvantages in each modality. The aim of present study was to compare the cardiopulmonary and airway pressure changes in ICU patients undergoing pressure controlled ventilation [PCV], one of the basic modalities with airway pressure release ventilation [APRV], an advanced ventilation mode which allows spontaneous breathing in any time of respiratory cycle

Materials and Methods: In this cross over study, 18 patients were randomized to receive either PCV or APRV ventilation for 30 minutes then after washout period, switched to another group. Cardiopulmonary and arterial blood gas variables and airway pressure were recorded prior to study and after 30 minutes of starting each modalities and compared between groups

Results: Airway pressure were significantly higher in APRV mode [9.3 +/- 3.3 vs. 6.9 +/- 1.5, p=0.044 in PCV group and 9.1 +/- 3.4 vs. 6.6 +/- 1.4, p=0.021 in APRV group] and arterial blood gas in PCV mode was insignificantly higher than APRV mode in both protocols. There was no significant difference in other cardiopulmonary variables

Conclusion: This study has shown no hemodynamic change's difference due to two studied protocol. The mean airway pressure in APRV mode was more than PCV mode with lower arterial blood O2 pressure in both protocols

effect of tranexamic acid on cardiac surgery bleeding

Serious bleeding in cardiac surgery leads to re-exploration, blood transfusion and increases the risks of mortality and morbidity. Using the lysine analogous of antifibrionlytic agents are the preferred strategy to suppress the need for transfusion procedures and blood products. Although tranexamic acid has been very influential in reducing the transfusion requirement after operation, tranexamic acid induced seizures is one of the common side effects of this drug. Due to inhibiting the fibrinolysis, thrombotic events are other possible side effects of using tranexamic acid. There are no certain results regarding decreasing the mortality rate by using the drug but it is identified that tranexamic acid does not increase the mortality. In this article, we aimed to review the literature on using tranexamic acid in cardiac surgeries

Intraperitoneal hydrocortisone for pain relief after laparoscopic cholecystectomy

Laparoscopic cholecystectomy is associated with shorter hospital stay and less pain in comparison to open surgery. The aim of this study was to evaluate the effect of intraperitoneal hydrocortisone on pain relief following laparoscopic cholecystectomy. Sixty two patients were enrolled in a double-blind, randomized clinical trial. Patients randomly received intraperitoneal instillation of either 250 ml normal saline [n=31] or 100 mg hydrocortisone in 250 ml normal saline [n=31] before insufflation of CO[2] into the peritoneum. Abdominal and shoulder pain were evaluated using VAS after surgery and at 6, 12, and 24 hours postoperatively. The patients were also followed for postoperative analgesic requirements, nausea and vomiting, and return of bowel function. Sixty patients completed the study. Patients in the hydrocortisone group had significantly lower abdominal and shoulder pain scores [10.95 vs 12.95; P<0.01]. The patients were similar regarding analgesic requirements in the recovery room. However, those in the hydrocortisone group required less meperidine than the saline group [151.66 [ +/- 49.9] mg vs 61.66 [ +/- 38.69] mg; P=0.00]. The patients were similar with respect to return of bowel function, nausea and vomiting. No adverse reaction was observed in either group. Intraperitoneal administration of hydrocortisone can significantly decrease pain and analgesic requirements after laparoscopic cholecystectomy with no adverse effects

use of remifentanil in general anesthesia for cesarean section in a parturient with severe mitral stenosis and pulmonary edema

Valvular heart diseases have adverse effects on hemodynamic condition in the parturients during pregnancy. Cesarean section with an opioid based general anesthesia has been used to alleviate these deleterious effects. We hereby describe the effective application of remifentanil, for cesarean section under general anesthesia, in a 30 yr old primigravida suffering of severe multivalvular heart disease and pulmonary hypertension presenting with pulmonary edema who was in active labor and without neonatal respiratory depression

prophylactic effect of rectal acetaminophen on postoperative pain and opioid requirements after adenotonsillectomy in children

Postoperative pain in children is common after adenotonsillectomy. Rectal acetaminophen has been used effectively for postoperative pain management in small children. The aim of this randomized double blind study was to evaluate the prophylactic effect of rectal acetaminophen on postoperative pain management and opioid requirements in children undergoing adenotonsillectomy. 104 children, 7 to 15 yr, ASA I or II scheduled for elective adenotonsillectomy were recruited for the study. Patients were randomized to receive either rectal acetaminophen 40 mg/kg or nothing after induction of standard anesthesia. The postoperative pain was assessed using visual analog scale [VAS] every 2 hours for the first 6 hours. The need for rescue analgesic, intravenous pethedine of 0.5 mg/kg, was recorded at 24 hours after surgery. Pain scores were significantly lower in acetaminophen group at different times [p<0.001] and needed less rescue analgesic [p<0.001]. We conclude that prophylactic rectal acetaminophen is effective in reducing pain after adenotonsillectomy and postoperative analgesic requirement