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BACKGROUND: Deep vitrectomy is one of the most frequently performed ophthalmic procedures. Postoperative pain is a common complaint among patients. Consequently, we investigated whether metoclopramide and aminophylline could decrease pain intensity following deep vitrectomy. METHODS: This double-blinded clinical trial study that was approved by the Ethical Committee of Isfahan University of Medical Sciences (IR.MUI.REC.1396.3.217) (Thesis Reg. number: 396217) and registered at the Iranian Registry of Clinical Trials (IRCT) (Reg. number: IRCT20170716035104N5, available at https://www.irct.ir/trial/59146) aimed to evaluate 105 patients who were candidates for deep vitrectomy. They were randomly assigned into three groups: metoclopramide (received 0.1 mg/kg diluted in 10 ml of normal saline), aminophylline (received 4 mg/kg diluted in 10 ml of normal saline), and placebo (received 10 ml of normal saline). Postoperative pain was evaluated in all groups. RESULTS: The postoperative pain levels of the three groups differed significantly from the start of the recovery to 30 minutes, 60 minutes, 2 hours, and 4 hours postoperatively, with metoclopramide and aminophylline groups experiencing less postoperative pain than the placebo group. Moreover, there was a significant difference between the groups regarding patient satisfaction (P<0.05). CONCLUSION: Both metoclopramide and aminophylline significantly reduce postoperative pain after deep vitrectomy, although metoclopramide has a greater effect.
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BACKGROUND: Tracheal sound analysis is a simple way to study the abnormalities of upper airway like airway obstruction. Hence, it may be an effective method for detection of alveolar hypoventilation and respiratory depression. This study was designed to investigate the importance of tracheal sound analysis to detect respiratory depression during cataract surgery under sedation. Methods: After Institutional Ethical Committee approval and informed patients' consent, we studied thirty adults American Society of Anesthesiologists I and II patients scheduled for cataract surgery under sedation anesthesia. Recording of tracheal sounds started 1 min before administration of sedative drugs using a microphone. Recorded sounds were examined by the anesthesiologist to detect periods of respiratory depression longer than 10 s. Then, tracheal sound signals converted to spectrogram images, and image processing was done to detect respiratory depression. Finally, depression periods detected from tracheal sound analysis were compared to the depression periods detected by the anesthesiologist. RESULTS: We extracted five features from spectrogram images of tracheal sounds for the detection of respiratory depression. Then, decision tree and support vector machine (SVM) with Radial Basis Function (RBF) kernel were used to classify the data using these features, where the designed decision tree outperforms the SVM with a sensitivity of 89% and specificity of 97%. CONCLUSIONS: The results of this study show that morphological processing of spectrogram images of tracheal sound signals from a microphone placed over suprasternal notch may reliably provide an early warning of respiratory depression and the onset of airway obstruction in patients under sedation.
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BACKGROUND: Surgeries may trigger the stress response which leads to changes in blood glucose level, and studies suggest that different sedation and anesthesia methods have different effects on blood glucose level. The aim of this study was to investigate changes of blood glucose levels in diabetic patients and compare them in two sedation methods of propofol + fentanyl and midazolam + fentanyl. MATERIALS AND METHODS: Totally, 80 diabetic candidates for cataract surgery who had all the inclusion criteria, underwent cataract surgery using two methods of propofol (1 mg/kg/h) + fentanyl (2 µg/kg) (Group P) and midazolam (0.03 mg/kg) + fentanyl (2 µg/kg) (Group M) for light sedation. In the end, 70 patients (Group P n = 35 and Group M n = 35) remained in the study. Patients' blood glucose levels, vital signs, and hemodynamic data were assessed 30 min prior to the surgery, each 15 min during surgery and at the end of surgery. RESULTS: Hemodynamic parameters did not have a statistically significant difference between the two groups mean blood glucose level in Group M was 149.15 mg/dl and in Group P was 149.2 mg/dl, and based on repeated measures analysis of variance test, significant differences were not observed between the two groups (P = 0.99). T-test showed no significant differences in the blood glucose level at any time of the study between the two groups. CONCLUSIONS: Light sedation methods of propofol + fentanyl and midazolam + fentanyl did not have any differences in alteration of blood glucose level.
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BACKGROUND: Supraclavicular brachial plexus block is one of the most effective anesthetic procedures in operations for the upper extremity. Ketamine has been reported to enhance the analgesic effects of local anesthetics. We have conducted this study to assess whether coadministration of ketamine can prolong the local analgesic effect of lidocaine in the supraclavicular brachial plexus block for patients undergoing elective upper extremity surgery. MATERIALS AND METHODS: Sixty adult patients undergoing elective surgery of the elbow, forearm, wrist or hand were randomly allocated in two groups of 30 patients each. Group 1 (ketamine group) received 5 mg/kg lidocaine 1.5% plus 2 mg/kg ketamine, Group 2 (control group) received 5 mg/kg lidocaine 1.5% and saline. The outcome measures included severity of pain by using visual analog scale (VAS, 0 = no pain 10 cm = the most severe pain), time of first request for analgesia, and total dose of postoperative opioid administration. The data was analyzed using the χ(2) test, student's t-test, Kaplan-Meier survival analysis, and Multivariate analysis tests. RESULTS: Patients in the control group had a higher VAS than patients who received ketamine, at all time points during the first 24 hours after surgery (all P < 0.05). The time of first request for analgesia in the ketamine group was significantly more than in the control group (8.93 ± 1.0 vs. 7.30 ± 1.9, respectively, P < 0.001). CONCLUSION: The addition of ketamine to lidocaine in the ultrasound-guided brachial plexus block could decrease the postoperative pain and need for analgesic. Therefore, it could be considered as an option in the brachial plexus block to enhance the analgesic action of lidocaine.
