Analgesic properties of a dexmedetomidine infusion after uvulopalatopharyngoplasty in patients with obstructive sleep apnea

Dexmedetomidine is an alpha2-adrenergic agonist with sedative and analgesic properties. This study aimed to investigate if the use of a continuous dexmedetomidine infusion with i.v. morphine patient-controlled analgesia [PCA] could improve postoperative analgesia while reducing opioid consumption and opioid-related side effects. In this prospective randomized, double-blinded, controlled study, 39 patients with obstructive sleep apnea syndrome undergoing uvulopalatopharyngoplasty were assigned to two groups. Group D [dexmedetomidine group] received a loading dose of dexmedetomidine 1 microg.kg[-1] i.v., 30 minutes before the anticipated end of surgery, followed by infusion at 0.6 microg.kg[-1] h[-1] for 24 hours. Group P [placebo group] received a bolus and infusion of placebo. In both groups, postoperative pain was initially controlled by i.v. morphine titration and then PCA with morphine. Cumulative PCA morphine consumption, pain intensities, sedation scores, cardiovascular and respiratory variables and opioid-related adverse effects were recorded for 48 hours after operation. Compared with placebo group, patients in the dexmedetomidine group required 52.7% less PCA morphine during the first 24 hours postoperatively, with significantly better visual analogue scale scores, less incidence of respiratory obstruction [5 vs. 12 patients, respectively; P = .037] and longer time to first analgesic request [21 [11] vs. 9 [4] minutes; P = .002]. Fewer patients in group D experienced nausea and vomiting than those in group P [7 vs. 24 patients, respectively; P < .05]. Continuous dexmedetomidine infusion may be a useful analgesic adjuvant for patients susceptible to opioid-induced respiratory depression

cautionary case of female genital mutilation

We report a case of a tightly circumcised woman who bled irregularly throughout her first year of marriage but failed to conceive. The detection and management of a large but hidden cervical polyp solved her problems. We suggest that such cases, especially in immigrant women, require deeper investigation than might at first appear to be needed

outcome of pregnancies associated with intrauterine contraceptive devices

In this retrospective study we sought to determine the outcome of pregnancies associated with intrauterine contraceptive devices. Medical records of 2000 women, who used IUCD, were reviewed in detail. All IUCDs were inserted either post menstrual, post delivery or post miscarriage. 1196 [60%] IUCDs were inserted by doctors and the remaining 804 [40%] by midwives. The cohort was divided to four groups on the basis of their age. There were 300, 950,300 and 450 women in 18-22,23-27,28-32 and 33-37 years groups respectively. They were also divided to three groups on the basis of their parity with 300 Para 1 women, 1100 Para 2-4 women and 600 Para 5 or more. 37 [1.85%] unintended pregnancies occurred, including 35 intrauterine pregnancy and 2 ectopic pregnancies. 9 [3%] of these pregnancies occurred in 18-22 year group, 16 [1.68%] in 23-27 age group, 8 [2.67%] in 28-32 age group and 4 [0.89%] in 33-37 age group [Figure 1]. 19 [1.59%] of the pregnancies occurred in women whose IUCDs were inserted by medical staff and 18 [1.51%] in those whose IUCDs were inserted by midwives. The outcome of intrauterine pregnancies included 19 [51%] term pregnancies, 9 [24%] miscarriages, no septic abortions, 7 [19%] Preterm labour including 2, 26-28 weeks and 5 29-32 weeks. No puerperal sepsis or congenital abnormalities were reported [Figure 2]