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BACKGROUND: Surgery for hip fractures can be done under general or neuraxial anesthesia. This study aimed to compare these two methods concerning their postoperative complications, duration of operation, hospitalization and the mortality rate within a period of one month after surgery. METHODS: 400 patients aged more than 30 years old and scheduled for elective operative fixation of fractured hip, randomly enrolled in two equal groups of general (GA) and neuraxial (NA) anesthesia. Hemoglobin level was measured before and 6 hours, 2, 3 and 5 days after the surgery. The intra and postoperative blood loss, duration of surgery, the severity of pain at the time of discharge from recovery and at the 2(nd), 3(rd) and 5(th) postoperative days were recorded. Statistical analysis was performed using SPSS version 12.0 by Mann-Whitney, chi-square, and t tests. P < 0.05 was considered significant. RESULTS: Both groups were similar regarding age, weight, and gender ratio. There was no significant difference in baseline hemoglobin, duration of surgery, length of hospitalization before surgery and the type of surgery. The mean of intraoperative blood loss and visual analogue score (VAS) in recovery and at the 3(rd) postoperative day, and also the length of hospitalization after surgery were significantly less in neuraxial anesthesia group. Both groups showed a significant decrease in hemoglobin values on the 2(nd) and 3(rd) postoperative days comparing to the baseline (p < 0.001). CONCLUSIONS: The morbidity and mortality rates of patients undergoing hip surgery were similar in both methods of anesthesia, but postoperative pain, blood loss, and duration of hospitalization were more in patients undergoing general anesthesia.
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BACKGROUND: Residual neuromuscular blockade continues to be a clinical problem after surgical procedures. The purpose of this study was to determine the incidence of residual paralysis in the postanesthesia care unit (PACU) after a single intubating dose of twice of the 95% estimated dose (ED95) of a nondepolarizing muscle relaxant with an intermediate duration of action. METHODS: Two hundred and sixteen patients scheduled for elective surgery under general anaesthesia requiring tracheal intubation were included in the study. They received a single intubating dose of intravenous atracurium (0.5 mg/kg) to facilitate tracheal intubation. At the end of surgery, if train of four (TOF)-ratio was ≤ 0.9, neostigmine 40 µg/kg intravenously was given. If TOF-ratio was ≥ 0.9, no neostigmine was given. Also, in awake patients with TOF > 0.9, residual neuromuscular paralysis was evaluated by using clinical tests such as head lift test and tongue depressor test. RESULTS: TOF was less than 0.9 in 48 (22.2%) patients while after 120 minutes, no patients had TOF less than 0.9. Of 33 patients whose operation lasted less than 120 minutes, 4 patients had TOF less than 0.9 at the end of surgery. There was no case of hypoventilation or hypoxia at PACU. The incidence of negative value in clinical tests was high. CONCLUSIONS: Our study gave the impression that more than two hours between the administration of a single intubating dose of an intermediate-acting nondepolarizing muscle relaxant (atracurium) and arrival to the PACU can probably guarantee the lack of a residual paralysis.
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BACKGROUND: Peripartum cardiomyopathy (PPCM) is an uncommon disease that affects women in the last month of pregnancy or within the first five months postpartum, occurring in about 1 in 3500 live births. The disease bears potentially devastating effects both on mother and the fetus if not treated early in its course. CASE PRESENTATION: The case was a 34-year old woman with a triple pregnancy who presented to the ward immediately after cesarean section with signs of dyspnea, cyanosis and pulmonary edema. She was diagnosed with PPCM upon echocardiography. The patient improved remarkably despite the PPCM's devastating complications. This case report aims to describe a female patient who developed PPCM after a triple delivery. CONCLUSION: Regarding the high risks of developing PPCM in subsequent pregnancies and avoiding multiparty, especially in older age, a reliable contraception in childbearing women would be helpful. The best prevention of PPCM is to avoid subsequent pregnancies.
RESUMO
BACKGROUND: Ketamine is a potent analgesic agent in addition to its anesthetic properties. Oral ketamine has been used to treat postoperative stump pain following lower limb amputation. In this study, oral ketamine was used to reduce the severity of postoperative pain following orthopedic surgery. METHODS: Seventy-two adult traumatic patients undergoing orthopedic operations were randomly divided into ketamine and placebo groups. In ketamine group, oral ketamine administered at 8-hour intervals postoperatively. Severity of postoperative pain, amount of morphine used, and the time to first rescue analgesic were determined and compared between two groups. RESULTS: Patients in ketamine group had significantly lower scores of postoperative pain (5.2 +/- 1.2, 4.9 +/- 1.6, 4.4 +/- 2.2, 4.3 +/- 1.5, and 3.4 +/- 1.3 at 2, 4, 8, 16, and 24 h postoperatively vs. 7.7 +/- 1.5, 7.3 +/- 1.6, 6.3 +/- 1.9, 6.0 +/- 1.6, and 5.1 +/- 1.8 in placebo group; P < 0.05). The amount of morphine required in the first postoperative day was significantly lower in ketamine group (10.1 +/- 5.6 mg vs. 13.4 +/- 7.8 mg in placebo group; P < 0.05). Time to first rescue analgesic in the ward was significantly longer in ketamine group (3.5 +/- 1.5 h vs. 1.9 +/- 1.2 h in placebo group; P < 0.05). A female patient in ketamine group developed postoperative emergence reaction following extubation. CONCLUSIONS: Oral ketamine may be used to reduce postoperative pain following orthopedic procedures in the traumatic patients. Since only one patient developed psychological side effect (which we can not attribute to ketamine with certainty) it can be concluded that oral ketamine is not so fearsome with respect to emergence reaction.
