Management of iliofemoral vein injury during open inguinal hernia repair.

BACKGROUND: Vascular injuries during inguinal hernia repair are rarely reported. Especially in children, we have little information about vascular management. CASE REPORT: In this article, we present a 6-year-old girl with right iliac vein ligation during inguinal hernia repair who was referred to our center and managed at the day of surgery. We recommended prior surgeon to order therapeutic heparin in dispatch time. The patient was treated with primary anastomosis of iliac vein and was admitted to pediatric intensive care unit (PICU). On the day following the operation, she had minimal dyspnea with low oxygen saturation and the investigations revealed pulmonary micro-embolization. Blood flow in lower extremity was normal and after a few days, she was discharged with good health and oral anticoagulation. CONCLUSION: Any unusual bleeding at the time of inguinal hernia repair should be considered as major vascular injury by the surgeon, and to prevent more injuries, minimum attempt must be performed to control the bleeding.

The Effects of Acupuncture on Hemodynamic Changes During Endotracheal Intubation for General Anesthesia.

Objective: The goal of this research was to investigate the efficacy of perioperative manual acupuncture in the LV 3 and LI 4 points for lessening hemodynamic changes during endotracheal intubation in patients who were receiving anesthesia. Materials and Methods: This double-blinded randomized controlled study enrolled patients who were undergoing endotracheal intubation, in 2015-2016, during general anesthesia in the general surgery department of the Imam Khomeini Hospital complex, in the Tehran University of Medical Sciences, Iran. The patients were randomly allocated into 2 groups with 30 patients in each group. In the treatment group, acupuncture needles were placed at LV 3 and LI 4, whereas, in the control group, the needles were placed 1 cm lateral to these points. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), and heart rate (HR) before and after placing the acupuncture needles, after induction, immediately, 1 minute, and 3 minutes after intubation were measured and recorded prospectively. Results: The patients had a mean age of 44.45 ± 12.72 years and included 35 (58.3%) males. Before acupuncture, demographic data, mean blood pressure (BP), and mean HR of the patients were not significantly different in the treatment and control groups. The mean SBP, DBP, MAP, and HR of all patients changed over time significantly (P < 0.001 for all). In the treatment group, mean SBP, DBP, and MAP changes immediately after the needles were placed were significantly less than those in the control group (P = 0.033, 0.024, and 0.024, respectively). Conclusions: Although acupuncture could have a very-short-term effect that reduces BP during endotracheal intubation, hemodynamic changes might not be prevented during endotracheal intubation.

Association of Serum Serotonin and Pain in Patients with Chronic Low Back Pain before and after Spinal Surgery.

INTRODUCTION: In this study we are aiming to evaluate the changes of serum serotonin and its association with pain in patients suffering from chronic low back pain before and after lumbar discectomy surgery. PATIENTS AND METHODS: A prospective study was performed on the patients referring to the outpatient clinic in Besat hospital, Hamadan University of Medical Sciences, Hamadan, Iran, during 2016. A 2 mL fasting blood sample was collected from each patient at preoperative day 1 and postoperative day 14 and they were measured for level of serum serotonin. Besides, all patients were asked for severity of their low back pain in preoperative day 1 and postoperative day 14 and scored their pain from zero to ten using a Numerical Rating Scale. RESULTS: Forty patients with the mean age of 47 ± 13 yrs/old (range 25-77) including 15 (37.5%) males were enrolled into the study. The overall mean score of preoperative pain was significantly decreased from 7.4 ± 2.18 (range 4-10) to the postoperative pain score 3.87 ± 2.92 (range 0-10) (P < .001). The overall levels of pre- and postoperative serum serotonin were 3.37 ± 1.27 (range 1.1-6.4) and 3.58 ± 1.32 (range .94-7.1) ng/mL, respectively, with no significant difference (P = .09). The levels of pre- and postoperative serum serotonin were significantly higher in males and patients older than 50 yrs/old compared to the females and patients younger than 50 yrs/old, respectively (P = .03 and .005, respectively). A significant inverse correlation between the postoperative levels of pain and serum serotonin was observed (r = -.36 and P = .02). CONCLUSION: A negative medium strength linear relationship may exist between the postoperative serum serotonin and low back pain.

Subarachnoid block with low dose of bupivacaine and sufentanil in patients with coronary artery disease.

BACKGROUND: Subarachnoid block with local anesthetics and opioids enable efficacious spinal anesthesia because of their synergistic effect and permit the use of low-dose local anesthetics, which results in a stable hemodynamic state. The purpose of this study was to describe the cardiovascular effects of spinal anesthesia with low-dose bupivacaine and sufentanil on patients with coronary artery disease. METHODS: This study was a double-blind randomized clinical trial. A total of 18 patients who had known coronary artery disease were enrolled. Our subjects underwent spinal block for lower limb surgery with 7.5 mg hyperbaric bupivacaine 0.5% and 5 µg sufentanil. Complications related to anesthesia such as hypotension, bradycardia, vasopressor need, and blood or volume use were recorded. RESULTS: The average mean arterial pressure decreased 15% in the first 15 min of spinal block in our cases. No patients presented with hypotension and the subjects were without complaints during the spinal anesthesia. All patients remained alert, and no ST segment changes were observed intraoperatively and until 6 h after the operation. Baseline ejection fraction (EF) 40% or less was observed in 10 patients and these subjects were compared with other patients. Systolic and diastolic blood pressures, mean arterial pressure, and heart rate decreased during the first 15 min in response to spinal anesthesia in both groups of patients, but decreased more significantly in patients with EF > 40%. CONCLUSION: We recommend spinal block with low-dose bupivacaine and sufentanil in patients with coronary artery disease and especially in patients with low EF.

The Effect of Low Tidal Volume Ventilation during Cardiopulmonary Bypass on Postoperative Pulmonary Function.

BACKGROUND: Postoperative pulmonary dysfunction is one of the most frequent complications after cardiac surgery and it is believed to result from the use of cardiopulmonary bypass (CPB). In this study, we investigated the effect of low tidal volume ventilation during CPB on postoperative gas exchange and lung mechanics. METHODS: This prospective randomized study included 100 patients undergoing elective coronary artery bypass grafting. In 50 patients, low tidal volume ventilation [tidal volume (TV) = 3 ml/kg, respiratory rate (RR) = 12/min, fraction of inspiratory oxygen (FIO(2))= 1.0, positive end expiratory pressure (PEEP) = 5 cmH(2)O] was applied during CPB (group I); and in the other 50 patients (group II), the lungs were open to the atmosphere without ventilation. Measurements were taken preoperatively, after CPB, and before discharge. RESULTS: Post-bypass PaO(2) (just after CPB 85 versus75) was higher significantly in group I (P value < 0.05). Decrease in postoperative forced expiratory volume in 1 second (25% versus 30%) and forced vital capacity (32% versus 35%) was less significant in group I. Also, time to extubation (5 hrs versus 5.5 hrs) was shorter in group I. CONCLUSION: Continued low tidal volume ventilation during CPB improved post-bypass oxygenation and lung mechanics.

Intrathecal meperidine for prevention of shivering during transurethral resection of prostate.

INTRODUCTION: The aim of this study was to investigate low-dose intrathecal meperidine for prevention or alleviation of shivering after induction of spinal anesthesia for transurethral resection of the prostate (TURP). MATERIALS AND METHODS: In a randomized controlled trial, 80 patients scheduled for TURP under spinal anesthesia were assigned into two groups of case and control. Spinal anesthesia was performed using 75 mg of hyperbaric lidocaine 5% plus meperidine, 15 mg, in the patients of the case group and the same dose of lidocaine plus normal saline in the patients of the control group. Shivering episodes were recorded during the operation and in the recovery room. Data on systolic blood pressure, heart rate, arterial oxygen saturation, and body temperature were collected before the induction of anesthesia; 5, 15, and 30 minutes after the induction; and in the recovery room. RESULTS: Maximum level of sensory block was similar in the patients of the case and control groups. Shivering was not seen in the patients who received meperidine, while in the control group, 11 (27.5%) experienced some degrees of shivering (P = .001). Blood pressure, body temperature, and arterial oxygen saturation did not have a clinically significant change and they were not different between the two groups. Side effects of opioids were unremarkable. CONCLUSION: Low-dose intrathecal meperidine is effective and safe in reducing the incidence of shivering associated with spinal anesthesia for TURP.