Combination sedoanalgesia with remifentanil and propofol versus remifentanil and midazolam for elective cardioversion after coronary artery bypass grafting.

Postoperative atrial fibrillation (AF) occurs in up to 50% of cardiac surgery patients and represents the most common postoperative arrhythmic complication. Elective cardioversion, a short but painful procedure, remains an option for patients who do not convert to sinus rhythm with medical therapy. Combinations of remifentanil (a potent analgesic with a short elimination time) with propofol (a hypnotic agent) or midazolam (a sedative agent) produce a synergistic interaction. This study was undertaken to compare these combinations in terms of effectiveness and pain relief when given as sedoanalgesia for elective cardioversion. In this prospective, randomized trial, 60 adult patients with postoperative AF after coronary artery bypass grafting were given a single dose of propofol 1 mg/kg combined with remifentanil 0.1 microg/kg (group 1), or midazolam 0.05 mg/kg combined with remifentanil 0.1 microg/kg (group 2). Cardiorespiratory parameters were monitored and recorded. Demographic data were similar (P>.05) and sufficient sedoanalgesia and successful cardioversion were achieved in both groups. Hemodynamic parameters revealed no significant differences between groups (P>.05); however, induction time, time to eye opening, recuperation time, and time to full recovery of psychomotor function were faster in group 1 than in group 2 (P<.05). The remifentanil/propofol combination provided sufficient analgesia, satisfactory hemodynamic stability, and mild respiratory depression, along with faster recovery and discharge times from the intensive care unit.

A typical low-back pain caused by an atypical etiology.

OBJECTIVE: Pain arising in the lumbar spine can have many etiologies, nearly 80% of which cannot be established with certainty. We present a very rare cause of back pain. CASE REPORT: A 54-year-old woman presented with a 2-month history of low-back pain and right-sided sciatica. Conventional analgesics, physiotherapy, and epidural steroid application had failed to provide relief. She had tenderness of the right sacroiliac joint. Diagnostic fluoroscopic-guided sacroiliac-joint injection with lidocaine did not produce symptomatic relief. Pelvic ultrasonography and magnetic resonance imaging showed septated multilocular hydatic cysts along the sciatic nerve. Surgical exploration noted multicystic lesions along the sciatic nerve woven to the nerve. Her low-back pain disappeared completely after the operation. She received oral albendazole for 6 months to prevent any recurrence of the disease and remains asymptomatic. CONCLUSION: Hydatid cyst can be included in the differential diagnosis of lumbar back pain, especially in the endemic areas.

Direct versus guidewire-assisted pediatric radial artery cannulation technique.

OBJECTIVE: Radial artery cannulation is a more difficult procedure in pediatric patients. Direct technique commonly fails in these patients, and several techniques have been developed for successful arterial cannulation. The purpose of this study was to compare direct radial artery cannulation with guidewire-assisted cannulation in children undergoing cardiac or aortic surgery. The hypothesis was that the guidewire-assisted technique would lead to fewer attempts and provide better long-term blood pressure monitoring and blood sampling. MATERIALS AND METHODS: One hundred pediatric patients with congenital heart defects undergoing major cardiovascular surgery, who required a radial artery catheter, were included in the study. Patients were divided into 2 groups: group 1 included 50 patients who had radial artery cannulation with the direct technique, and group 2 included 50 patients who had a guidewire-assisted radial artery cannulation. RESULTS: A radial artery was successfully cannulated in 48 patients in group 2 but only 38 patients in group 1. Mean elapsed time for radial artery cannulation was 22 +/- 4.6 minutes in group 1 and 7 +/- 4.2 minutes in group 2 (p = 0.001). The average number of attempts for cannulation was 4.5 in group 1 and 2.1 in group 2 (p = 0.022). The opposite radial or an alternative artery was used more commonly in the direct technique group. Satisfactory blood pressure monitoring and sampling of blood were obtained in 28 patients in group 1 and 46 patients in group 2 (p < 0.001). CONCLUSION: The authors recommend the use of a guidewire-assisted radial artery cannulation technique rather than a direct technique. The guidewire-assisted technique provided easy, safe, and quick cannulation and allowed for long-term satisfactory blood pressure monitoring and blood sampling because of the longer length of the Teflon catheter advanced into the artery over the guidewire, and a low rate of dissection of the radial artery.

Accuracy of caudal epidural injection: the importance of real-time imaging.

Caudal epidural steroid injections are often used for low back pain. Fluoroscopic guidance has been frequently cited as a requirement for this procedure. In this preliminary report, we demonstrate that fluoroscopic guidance for caudal epidural Tuohy needle placement without real-time imaging may result in inadvertent intravenous injection of the drug. We detected intravenous leakage of the drug in 4 cases of 10 when real-time fluoroscopic imaging was used. Thus, real-time imaging may be recommended in addition to routine fluoroscopic guidance for caudal epidural procedures, as it may improve efficacy and safety by assuring accurate drug deposition.

Cannabinoids blocks tactile allodynia in diabetic mice without attenuation of its antinociceptive effect.

Diabetic neuropathic pain is one of the most commonly encountered neuropathic pain syndromes. However, the treatment of diabetic neuropathic pain is challenging because of partial effectiveness of currently available pain relievers. It is well known that diabetic animals are less sensitive to the analgesic effect of morphine, and opioids are found to be ineffective in the treatment of diabetic neuropathic pain. Cannabinoids are promising drugs and they share a similar pharmacological properties with opioids. It has been reported that cannabinoid analgesia remained intact and to be effective in some models of nerve injury. Thus, we investigated antinociceptive efficacy and the effects of cannabinoids on behavioral sign of diabetic neuropathic pain in diabetic mice by using WIN 55, 212-2, a cannabinoid receptor agonist. Diabetes was induced by streptozotocin (STZ) (200mg/kg) and animals were tested between 45 and 60 days after onset of diabetes. Antinociception was assessed using the radiant tail-flick test. Mechanical and thermal sensitivities were measured by Von Frey filaments and hot-plate test, respectively. Tactile allodynia, but not thermal hyperalgesia developed in diabetic mice. Systemic WIN 55, 212-2 (1, 5 and 10mg/kg) produced a dose-dependent antinociception both in diabetic and control mice. WIN 55, 212-2-induced antinociception were found to be similar in diabetic mice when compared to controls suggesting efficacy of cannabinoid antinociception was not diminished in diabetic mice. WIN 55, 212-2 also produced a dose-dependent antiallodynic effect in diabetic mice. This study suggests that cannabinoids have a potential beneficial effect on experimental diabetic neuropathic pain.

An alternative simple method in laryngoscope blade decontamination.

The cleaning and disinfection of laryngoscope blades is controversial. The aim of this study is to investigate the efficacy of two different chemical disinfectant agents and tap water where the laryngoscope blades were contaminated by different microorganisms and try to create a simple, effective and easy decontamination method. The results of our study demonstrate that the decontamination of the laryngoscope blades, which are cleansed with tap water, is not a reliable approach. In conclusion, mechanical cleaning of blades with water and the immersion in 2% glutaraldehyde or 10% polyvinyl pyrrolidine iodine for 10 minutes is an effective method for decontamination of laryngoscope blades.