The efficacy of nasal tip hold-press on venous cannulation pain in children: a prospective randomized controlled study.

BACKGROUND: Venipuncture is a common and quiet unpleasant experience for pediatric patients. The pain associated with venous cannulation disturbs the children. Different methods have been used to minimize the pain. The present study evaluated the efficacy of holding and pressing the tip of the nose on the venipuncture pain in pediatric patients. METHODS: A prospective randomize controlled study carried out using the Visual Analogue Scale (YAS) for assessment cannulation pain and the Yale Preoperative Anxiety Scale (YPAS) for the assessment of anxiety before cannulation. Sixty patients aged 6 to 12 years, who needed venipuncture for general anesthesia, were divided into two groups of 30 each: a control group and a study group. Nasal tip was held and pressed during venipuncture by the parents in the study group. No intervention was done in the control group. RESULTS: The YPAS scores were not different between the two groups before venous cannulation (P=0.136). Comparing the two groups. There was no difference regarding the change in HR and BP during venous cannulation. There was significantly lower cannulation pain in the study in comparison with the control group (P=0.010). CONCLUSIONS: Holding and pressing the tip of the nose during venipuncture reduce the severity of venipuncture pain in pediatric patients. This could be secondary to distraction along with the physiological effect of the Valsalva maneuver on pain. Therefore, we recommend that holding and pressing the tip of the nose is a safe and effective method for reducing the severity of pain from venipuncture in pediatric patients.

Comparison of lidocaine, lidocaine-morphine, lidocaine-tramadol or bupivacaine for neural blockade of the brachial plexus in fat-tailed lambs.

OBJECTIVE: To evaluate the onset time and duration of action of lidocaine, lidocaine-morphine, lidocaine-tramadol or bupivacaine for a neural blockade of the brachial plexus in fat-tailed lambs. STUDY DESIGN: Prospective, randomized, crossover, experimental study. ANIMALS: Seven healthy female fat-tailed Ghezel lambs weighing 27.0 ± 2.2 kg (mean ± SD). METHODS: Each lamb was administered four treatments for brachial plexus block (BPB): lidocaine 2% (5 mg kg(-1)) (LID), lidocaine 2% combined with morphine (0.1 mg kg(-1)) (LIDMO), lidocaine 2% combined with tramadol (1 mg kg(-1)) (LIDTR) or bupivacaine 0.5% (1.25 mg kg(-1)) (BUP), for a total treatment volume of 0.25 mL kg(-1). The brachial plexus was located with a peripheral nerve stimulator, and the treatment volume was injected in increments. Treatments were randomized and separated by at least 7 days. Onset and duration of a sensory block of the distal thoracic limb were evaluated using superficial and deep pin pricks and pinching of the skin with haemostatic forceps. RESULTS: The mean duration of sensory block was 100 ± 38 minutes in LID, 103 ± 35 minutes in LIDMO, 79 ± 28 minutes in LIDTR, and 335 ± 134 minutes in BUP. The mean duration of sensory and motor blocks in BUP were significantly longer compared with other treatments (p < 0.05). No clinical signs of local anaesthetic toxicity were noticed, and the rectal temperature did not differ significantly from baseline values in any treatments. CONCLUSIONS AND CLINICAL RELEVANCE: The addition of morphine or tramadol to lidocaine did not affect the duration of antinociception of lidocaine for brachial plexus block in fat-tailed lambs. Administration of bupivacaine provided a prolonged duration of action without obvious adverse effects.

Factors associated with extubation time in coronary artery bypass grafting patients.

Background and Objectives. Cardiovascular diseases are the leading cause of death worldwide, with coronary artery disease being the most common. With increasing numbers of patients, Coronary Artery Bypass Grafting (CABG) has become the most common operation in the world. Respiratory disorder is one of the most prevalent complications of CABG. Thus, weaning off the mechanical ventilation and extubation are of great clinical importance for these patients. Some post-operative problems also relate to the tracheal tube and mechanical ventilation. Therefore, an increase in this leads to an increase in the number of complications, length of hospital stay, and treatment costs. Since a large number of factors affect the post-operative period, the present study aims to identify the predictors of extubation time in CABG patients using casualty network analysis. Method. This longitudinal study was conducted on 800 over 18 year old patients who had undergone CABG surgery in three treatment centers affiliated to Shiraz University of Medical Sciences. The patients' information, including pre-operative, peri-operative, and post-operative variables, was retrospectively extracted from their medical records. Then, the data was comprehensively analyzed through path analysis using MPLUS-7.1 software. Results. The mean of extubation time was 10.27 + 4.39 h. Moreover, extubation time was significantly affected by packed cells during the Cardiopulmonary Bypass (CPB), packed cells after CPB, inotrope use on arrival at ICU, mean arterial pressure 1st ICU, packed cells 1st ICU, platelets 1st ICU, Blood Urea Nitrogen 1st ICU, and hematocrit 1st ICU. Conclusion. Considering all of the factors under investigation, some peri-operative and post-operative factors had significant effects. Therefore, considering the post-operative factors is important for designing a treatment plan and evaluating patients' prognosis.

Post-operative quadriplegia as the initial manifestation of tumefactive multiple sclerosis.

Post-operative quadriplegia is a rarely encountered complication and not previously reported as the initial presentation of tumefactive multiple sclerosis. We present an unusual case of a patient with such manifestation and atypical lesions on brain magnetic resonance imaging. The patient was treated with methyl prednisolone pulse therapy and showed a dramatic response. Uncommon neurologic diseases can have very unusual presentations, which should be taken into consideration when encountered with such patients. Considering this fact will help physicians in better decision-making and proper treatment planning.

A model for decision making for intensive care unit admission in source limited hospitals.

BACKGROUND: Demand for ICU beds is exceeding its supply. Since the sources are limited in some centers, it is necessary to design a model to identify the patients who benefit more from ICU beds. OBJECTIVES: The present study aimed to develop a model to prioritize adult patients according to their clinical indications by a three rounded Delphi method study. PATIENTS AND METHODS: In this study, 22 physicians who practiced in a source limited hospital in southern Iran were invited to participate in a three phase Delphi survey. RESULTS: At first, the panelists recommended 30 indications. The indications in the first checklist plus those obtained by literature review formed the second checklist which contained 36 items. The items were scored from 0 to 10 by the panelists. According to the scores, the indications were categorized into three priority levels, which were confirmed by the panelists in the third round. CONCLUSIONS: This simple checklist contains the indications for ICU admission categorized into three priority levels. This checklist can be considered as a guide for physicians who practice in hospitals with limited number of ICU beds.

Molecular diagnosis of nasopharyngeal carcinoma using detection of Epstein-Barr virus latent membrane protein-1 gene in cervical metastatic lymph nodes.

BACKGROUND: Cervical lymphadenopathy could be a manifestation of occult nasopharyngeal carcinoma (NPC). Epstein-Barr virus (EBV) is frequently detected in NPC, and its malignant transformation is associated through the action of the oncoprotein latent membrane protein-1 (LMP-1). PURPOSE: The aim of this study was to investigate whether a primary nasopharyngeal origin could be localized by detection of EBV LMP-1 gene in cervical metastatic lymph nodes. MATERIALS AND METHODS: In this prospective study, 32 paraffin-embedded tissues of various head and neck carcinomas and 20 normal tonsil specimens were examined for the presence of LMP-1 gene, using polymerase chain reaction. RESULTS: Ten of 12 nasopharyngeal biopsies and 8 of 10 metastatic lymph nodes of the same NPC were positive for LMP-1 gene. The LMP-1 gene was detected in metastatic lymph nodes of NPC, with a sensitivity of 80%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 91%. On the contrary, the LMP-1 gene was not detected in any of the samples of other head and neck carcinomas and their metastatic nodes as well as in tonsillar specimens. There was a significant association between the presence of LMP-1 gene and tumor location in the nasopharynx (P < .0001). CONCLUSION: The presence of LMP-1 gene in metastatic cervical lymph nodes is significantly associated with nasopharyngeal origin of the carcinoma. Meanwhile, EBV has no role in the tumorigenesis of carcinomas arising from other head and neck regions.

Analgesia for retrobulbar block--comparison of remifentanil, alfentanil and fentanyl.

BACKGROUND: The injection of retrobulbar block is associated with significant pain and discomfort. Therefore a short-acting IV analgesic before retrobulbar injection has been advocated. OBJECTIVE: To compare remifentanil, alfentanil and fentanyl in providing analgesia for retrobulbar block injection. METHODS: 69 patients were enrolled randomly into three groups of 23 each to receive either Remifentanil 1 microg/kg, Alfentanil 20 microg/kg or Fentanyl 2 microg/kg as an IV bolus dose prior to retrobulbar injection. Mean arterial pressure (MAP) and heart rate (HR) were recorded and Numerical Pain Score (NPS) were assessed by a blinded observer. RESULTS: Remifentanil prevented increase in MAP and HR while alfentanil and fentanyl were ineffective in this purpose (p < 0.05). NPS was significantly lower in remifentanil group (p < 0.05). CONCLUSION: Remifentanil 1 microg/kg prior to retrobulbar injection provide excellent hemodynamic stability and ensure analgesia.

Succinylcholine-induced masseter muscle rigidity during bronchoscopic removal of a tracheal foreign body.

Masseter muscle rigidity during general anesthesia is considered an early warning sign of a possible episode of malignant hyperthermia. The decision whether to continue or discontinue the procedure depends on the urgency of the surgery and severity of masseter muscle rigidity. Here, we describe a case of severe masseter muscle rigidity (jaw of steel) after succinylcholine (Sch) administration during general anesthetic management for rigid bronchoscopic removal of a tracheal foreign body. Anesthesia was continued uneventfully with propofol infusion while all facilities were available to detect and treat malignant hyperthermia.