RESUMO
Symptomatic patients with coronavirus disease 2019 (COVID-19) mostly have flu-like symptoms. However, neurologic manifestations are common and may be the early findings of COVID-19. Data for COVID-19 do not indicate an increased risk of infection in pregnant individuals, but the risk of disease severity and mortality is high in this patient population. We report a case of a pregnant woman in the 10th gestational week, who presented with neurological symptoms of sudden impairment in walking, balance, speech, and consciousness, started the night before, and a seven-day history of fever, chills, myalgia, and general weakness before admission. The polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive for the cerebrospinal fluid sample a day before the positive nasopharyngeal sample. Axial brain magnetic resonance imaging revealed the involvement of the spinothalamic tract. Following treatment with intravenous immunoglobulin, the patient's neurological condition gradually recovered, except for lower limb muscle strength, and she was discharged from the hospital on the 10th day of admission. This case is unique as it emphasizes the importance of considering COVID-19 when uncommon neurologic manifestations with negative nasopharyngeal PCR are present.
RESUMO
Background: Obesity is a growing problem worldwide and can affect both the pharmacodynamics and pharmacokinetics of various drugs, including anesthetics, resulting in the under-or overdosing of certain drugs. There is no consensus on the ideal dosing regimen for obese populations. Objectives: In this study, 2 weight-based dosing of propofol used for induction of anesthesia were compared in terms of the onset of action time, adequacy of anesthesia, and effects on hemodynamic indices (eg, heart rate [HR] and blood pressure). Methods: In this randomized, double-blind clinical trial, 40 patients with morbid obesity (MO) scheduled for bariatric surgery with body mass index (BMI) > 35, age 18 - 59 years, American Society of Anesthesiologists physical status (ASA-PS) II and III were randomly divided into 2 groups, using block randomization method, to receive 2 mg/kg of propofol for induction of anesthesia based on either fat-free mass (FFM) group or ideal body weight (IBW) group. The primary outcome was the time duration to reach the bispectral index (BIS) ≤ 60. Time to the disappearance of eyelash reflex, signs of inadequate anesthesia (ie, BIS > 60, straining during intubation, or eye-opening), requirements for additional doses, and hemodynamic indices (including HR and mean arterial pressure [MAP]) were also compared. Results: The mean time to reach BIS ≤ 60 was 134.1 s in the FFM group and 148.7 s in the IBW group. This difference was not statistically significant (P = 0.334). The time of disappearance of eyelash reflex was also not significantly different between the study groups (P = 0.814). However, 2 patients in the FFM group and 8 patients in the IBW group showed signs of inadequate anesthesia and required additional doses. This difference was statistically significant (P = 0.032). Hemodynamic variables, before and 2 min after propofol induction dose administration were comparable between the study groups (P = 0.520, P = 0.327, P = 0.847, P = 0.516 for pre-intervention MAP, post-intervention MAP, pre-intervention HR, and post-intervention HR, respectively). Conclusions: Propofol dosing, based on FFM and IBW, for induction of anesthesia, provides comparable onset time of action and hemodynamic effects; however, in terms of the adequacy of anesthesia, the dosing based on FFM is more favorable compared to the dosing based on IBW.
RESUMO
Background: Cleft lip and palate are birth defects due to a lack of proper formation of the lip or mouth. Controlling bleeding during cleft lip and palate surgeries is very important. Objectives: This study aimed to evaluate the effect of phenylephrine nasal drops on bleeding during and after cleft palate repair surgery in children. Methods: This controlled, randomized, double-blind, clinical trial was performed on 36 children aged 6 months to 2 years with cleft palate who were candidates for repair surgery. Patients were randomly divided into 2 groups of 18 patients. In the intervention group, 0.25% phenylephrine drops were poured into the nostrils, and the same amount of normal saline was poured in the control group. Changes in systolic and diastolic blood pressures, heart rate, bleeding during surgery based on the gauzes used, the volume of blood in the suction canister, and the amount of blood in the field, as well as the surgical field quality and surgeon satisfaction, were evaluated using analysis. Results: No statistically significant difference was observed between the 2 groups in terms of age, sex, weight, heart rate, and systolic and diastolic blood pressures. The mean volume of bleeding based on the total weight of gauzes used and suctioned blood during surgery showed a statistically significant difference between the intervention and control groups (P = 0.0016). The surgeon satisfaction in terms of the surgical field quality using a 5-point Likert scale showed a significant difference between the 2 groups (P = 0.0068), as well as more satisfaction in the intervention group according to the Boezaart scale (P = 0.0043). Conclusions: It seems that the use of nasal phenylephrine drops in pediatric cleft palate surgeries can significantly reduce bleeding and increase the quality of the operation field. Therefore, nasal phenylephrine drops can be used to control bleeding in this type of surgery.
