The Value of Inferior Vena Cava Ultrasonography Administration for Hypovolemia Detection in Patients with Acute Kidney Injury Hospitalized in Intensive Care Unit.

Background: The hypo-perfusion of the kidneys can lead to impairment in renal function and induce renal injury in case of delayed diagnosis and treatment. To date, laboratory markers are routinely used to determine the fluid volume status of the patients. The current study aims to evaluate the values of inferior vena cava (IVC) collapsibility index in hypovolemia diagnosis among critical patients admitted at the intensive care unit (ICU). Materials and Methods: This is a cross-sectional study performed on 67 patients admitted to the ICU due to acute kidney injury from May 2018 to October 2019. Hypovolemia was assessed assessing IVC collapsibility using ultrasonography. Laboratory data, including urine osmolality, urine-plasma creatinine ratio, sodium excretion fraction and urinary sodium level were checked. Afterward, IVC collapsibility index was measured for each patient using ultrasonography and the values of this index in accordance with the mentioned criteria was evaluated. Accordingly, reciever operating curve was depicted. Results: There was no significant asosociation between IVC collapsibility index with fractional excretion of sodium (P = 0.69), urine Na (P = 0.93) and urine osmolality ([P = 0.09]), while urine: Plasma creatinie ration revealed a significant association with IVC collapsibility index at cut point of 40.5% with sensitivity and specificity of 96% and 44% (P = 0.017, area under the curve: 0.67, 95% confidence interval: 0.551-0.804), respectively. Conclusion: According to the findings of this study, IVC collapsibility detected via ultrasonography was not an appropriate index to figure out hypovolemia in ICU patients. Furthermore, detailed studies are recommended.

Comparative Assessment of the Effects of Two Methods of Pressure Support Adjustment on Respiratory Distress in Patients under Mechanical Ventilation Admitted to Intensive Care Units.

BACKGROUND: Incorrect adjustment of the respiratory parameters of the mechanical ventilator increases respiratory distress and work of breathing (WOB) in mechanically ventilated patients. The accurate adjustment of pressure support increases thepatient's comfort and decreases respiratory distress and WOB, etc.; thus, the present study was conducted to compare the effects of two pressure support adjustment methods on respiratory distress in patients under mechanical ventilation to investigate whether the rapid shallow breathing index (RSBI)method can reduce patients' respiratory distress more and faster than the tidal volume (VT) and respiratory rate (RR) methods. PATIENTS AND METHODS: The study was conducted in 2020 on 56 mechanically ventilated patients with respiratory distress. The patients' respiratory distress was first measured using RSBI and the respiratory distress observation scale (RDOS). The pressuresupport was then adjusted in the patients according to the RSBI (in the trial group, n = 33)and VT and RR (in the control group, n = 23). The patients' respiratory distress was measured again in both groups 15 and 30 minutes after the pressure support adjustment. RESULTS: The results showed no significant differences between the two groups in the mean RSBI and RDOS before (p = 0.374, p = 0.657 respectively) and 30 (p = 0.103, p = 0.218 respectively) minutes after the adjustment of the pressure support, but these mean values differed significantly (p = 0.025 for RSBI and p = 0.044 for RDOS) between the groups 15 minutes after the adjustment. Moreover, the interaction effect of the group * time for RDOS has become significant nonlinearly (p = 0.037), but none of the interaction effects of the group * time were significant for RSBI (linear: p = 0.531; nonlinear: p = 0.272). CONCLUSION: These two methods finally reduced the patients' respiratory distress almost equally, but RSBI method can relieve the patients' respiratory distress faster than the VT and RR methods. HOW TO CITE THIS ARTICLE: Barati P, Ghafari S, Saghaei M. Comparative Assessment of the Effects of Two Methods of Pressure Support Adjustment on Respiratory Distress in Patients under Mechanical Ventilation Admitted to Intensive Care Units. Indian J Crit Care Med 2021;25(9):1026-1030. KEY MESSAGE: VT, RR, and RSBI methods finally reduced the patients' respiratory distress almost equally, but RSBI method can relieve the patients' respiratory distress faster than the VT and RR methods.

Electrical stimulation of acupuncture points for analgesia during bone marrow aspiration and biopsy: A randomized double-blind placebo-controlled trial.

BACKGROUND: Bone marrow aspiration and biopsy (BMA/BMB) is a painful procedure mostly used in diagnosing and staging of a broad spectrum of hematological diseases. In spite of local anesthesia, the prevalence and intensity of the pain and patient discomfort caused by this procedure are considerable. The effect of acupuncture and electrical stimulation of acupoints (acupuncture points) in the treatment of many medical conditions, including pain, have been approved. The study is designed to evaluate the effect of electrical stimulation of acupoints to decrease the pain during BMA/BMB in adults. MATERIALS AND METHODS: In a double-blind controlled clinical trial, 50 patients undergoing BMA/BMB were randomly allocated into two groups, to receive either true or placebo electrical stimulation of acupoints LI-4 (large intestine 4, Hegu) and LI-11 (large intestine 11, Quchi), bilaterally. Both groups received infiltrative local anesthesia. The pain level caused by BMA/BMB was measured using the Visual Analog Scale (VAS). RESULTS: The means of the VAS in the case and control groups were 41.84 ± 20.54 and 69.40 ± 20.06 respectively (P < 0.001). The systolic and diastolic blood pressure and pulse rate rose significantly in both the groups compared to the basal values. The rise was lower in the acupuncture group compared to the placebo group regarding systolic blood pressure and pulse rate (P = 0.018 and P < 0.001, respectively). CONCLUSIONS: The results of this study show that the electrical stimulation of acupoints significantly decreases the pain caused by BMA/BMB and some of the complications of the pain.

Comparative evaluation of the effects of hydroxyethyl starch on coagulation state of patients during brain tumor surgeries in comparison to crystalloids by thromboelastography.

BACKGROUND: Hypercoagulability has been reported in primary brain tumors which can lead to thrombotic complications. Hydroxyethyl starch (hetastarch) is a synthetic colloid solution with adverse effects on blood coagulation. The aim of this study was to evaluate the protective effect of hetastarch in reducing thromboembolic events in these patients. MATERIALS AND METHODS: In a double-blinded clinical trial, 60 brain tumor surgery patients were randomly divided into two groups and given 10 mL/kg hetastarch or normal saline during surgery. Blood coagulation was compared before and after infusion of these fluids within and between groups by thromboelastography (TEG). RESULTS: There were no significant differences in bleeding (P = 0.126), duration of surgery (P = 0.504), and fluid intake (0.09L) between the two groups. Percentage of changes in R (R: Time to initiate fibrin formation), K (K: Measure of the speed taken to reach a specific level of clot strength), and Ly30 (Ly30: Percent of fibrin distraction after 30 minutes of clot formation) in the crystalloid group were -20.61 ± 26.46, -30.02 ± 49.10, and 1.27 ± 22.63, and that in the colloid group were 22.10 ± 26.11, 41.79 ± 37.15, and 59.09 ± 37.12, respectively. Deterioration in hemostasis during and after surgery was not observed. CONCLUSION: There was a reduction in the speed of clot formation and increase in clot lysis in the hetastarch group. Coagulability was decreased in the colloid group. Infusion of 10 mL/kg hetastarch in brain tumor resection surgeries can probably decrease susceptibility of these patients to deep vein thrombosis (DVT) and thromboembolic events.

Effect of preoperative volume loading on the intraoperative variability of blood pressure and postoperative nausea and vomiting.

INTRODUCTION: Preoperative volume loading (PVL) in addition to counteract the decreases in blood pressure during intraoperative period, also may decrease postoperative nausea and vomiting (PONV). This study was designed to investigate the effect of preoperative volume loading on the intraoperative blood pressure variability and postoperative nausea and vomiting. METHODS: Thirty subjects scheduled for elective orthopedic procedures randomly divided into case and control groups. The patients in the case group received lactated Ringer 10 ml/kg before induction of general anesthesia. Mean arterial blood pressure (MAP) and heart rate were recorded in two groups every 3 minutes from induction of anesthesia until five minutes after extubation. Variability of mean arterial blood pressure and heart rate were defined as the standard deviation (SD) of the measured values for each patient. Means of these individual SD values were compared between two groups using Mann-Whitney U test. RESULTS: The mean variability of mean arterial blood pressure and heart rate ware significantly lower in case group (8.3 +/- 3 mmHg and 8.4 +/- 2.5 bpm vs. 13 +/- 6 mmHg and 11 +/- 2.6 bpm in control group; p < 0.5). The severity of nausea (measured as a ten-point visual analog scale) was significantly lower in case group (1.2 +/- 0.9 vs. 3.9 +/- 1.8 in control group; p < 0.05). No patients in case group developed postoperative vomiting (compared to 5 patients in control group). CONCLUSIONS: The results of this study shows that preoperative volume loading is associated with lower variability of blood pressure and heart rate during operative period and also reduces the severity and incidence of postoperative nausea and vomiting.

Comparative evaluation of Glasgow Coma Score and gag reflex in predicting aspiration pneumonitis in acute poisoning.

PURPOSE: The purpose of the study was to assess the incidence of aspiration pneumonitis (AP) and its association with gag reflex and Glasgow Coma Score (GCS). MATERIALS AND METHODS: In a retrospective analysis study after prospective data collection, 155 poisoned patients with GCS less than or equal to 12 were evaluated. An assessment of GCS and the quality of gag reflex was made on arrival and recorded. Intubation status before gastrointestinal decontamination was noted. All patients were subsequently followed for developing of AP. RESULTS: The incidence of AP was 15.5%, with significant variance among patients with respect to the gag reflex, GCS, and the performance of intubation. A logistic regression model for predicting AP contained the following predictors: GCS (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.30-0.62), intubation (OR, 0.07; 95% CI, 0.01-0.49), organophosphate ingestion (OR, 1.39; 95% CI, 0.96-2.01), and gastric evacuation (OR, 4.29; 95% CI, 0.94-9.51). In patients with reduced gag reflex, variations in GCS were associated with AP (OR, 0.43; 95% CI, 0.20-0.90), whereas in patients with absent gag reflex, age was the most important predictor of AP (OR, 2.67; 95% CI, 0.99-7.22). CONCLUSIONS: A reduced GCS and a nonintubated trachea are associated with an increased incidence of AP.

Effect of oral ketamine on the postoperative pain and analgesic requirement following orthopedic surgery.

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.

Clinical trial of nitroglycerin-induced controlled hypotension with or without acupoint electrical stimulation in microscopic middle ear surgery under general anesthesia with halothane.

BACKGROUND: Transcutaneous electrical stimulation (ES) has been shown to produce long-lasting fall of arterial blood pressure in animal or human models. Previous reports have shown that ES of acupuncture points (acupoints) enhances the hypotensive effect of isoflurane anesthesia. This study was designed to investigate the combined effect of acupoint ES and different infusion rates of nitroglycerin on controlled hypotension. METHODS: Fifty-one adult ASA I patients undergoing elective mastoeidectomy were randomly divided into two groups, to receive either true or sham ES of ST36 (Zusanli) and ST38 (Tiaokou) acupoints. Each group was further subdivided into four groups to receive four different rates of nitroglycerin infusion (1.5, 2, 2.5 and 3 microg/kg/min). Steady state mean arterial blood pressure (MAP) and time to reach it were compared between two groups. The amount of bleeding in microscopic surgical field was quantitatively assessed and compared between two groups. RESULTS: Steady state MAP was significantly lower in true ES group compared with sham ES group (60 +/- 4 mmHg in true ES vs. 66 +/- 5 mmHg in sham ES, P = 0.000) and the difference was significantly greater in lower dosage of nitroglycerin compared with higher dosage. In addition time to reach steady state MAP was significantly shorter in true ES compared with sham group (10 +/- 3 min in true ES vs. 15.8 +/- 4 min in sham ES, P = 0.000). Heart rate decreased significantly in true ES compared with sham ES group after commencement of ES and nitroglycerin infusion. Quality of operative ischemia was excellent in 20 (83.3%) patients of true ES compared with 6 (25%) patients in sham ES group (P = 0.000). CONCLUSIONS: The result of this study shows that ES of ST36 combined with nitroglycerin infusion facilitates lowering of blood pressure and produces a bloodless surgical field. The mechanism of blood pressure lowering effect of acupoint ES may be reducing of norepinephrine and other sympathomimetic substances in the blood.

Evaluation of relationship between arterial and venous blood gas values in the patients with tricyclic antidepressant poisoning.

INTRODUCTION: Determination of arterial blood gas (ABG) values is essential in the evaluation of patients with TCA poisoning. The relationship between arterial and venous blood gas pH has not been established in TCA poisoning. In TCA poisoning, blood vessels vasodilatation due to antidepressant-induced alpha-blockade and also metabolic acidosis may lead to arterialization of venous blood, which in turn enhances the relationship between ABG and VBG parameters. Therefore this study was designed to evaluate the relationship between ABG and VBG pH values in TCA poisoned patients. METHODS: This prospective study was performed in the Poisoning Emergency Department of Noor Hospital, Isfahan, Iran. Samples for arterial and venous blood gas analysis were obtained during initial evaluation of TCA-poisoned patients and 30 min after treatment with sodium bicarbonate. The venous blood gas samples were collected with samples for other blood tests at the time of intravenous line insertion. Laboratory data were recorded on a database form initiated in the emergency department and analyzed by paired student t-test. The degree of agreement between the arterial and venous pH measurements was evaluated by Bland and Altman method. RESULTS: Data from 50 TCA-poisoned patients were analyzed. There were significant differences between mean differences of ABG and VBG parameter values on the initial evaluation. There was also a relationship between arterial and venous pH on the initial evaluation. CONCLUSION: In TCA poisoning, the peripheral venous pH measurement is a valid and reliable substitute for arterial pH.

Prophylactic versus therapeutic administration of intravenous lidocaine for suppression of post-extubation cough following cataract surgery: a randomized double blind placebo controlled clinical trial.

BACKGROUND: Post-extubation cough causes considerable patient discomfort and in certain surgical procedures may lead to postoperative surgical complication. Different drugs and techniques have been used for the prevention of post-extubation cough with variable success rates. Prophylactic administration of lidocaine has been tried for the prevention of post-extubation cough with controversial results. No previous study has been performed to evaluate the therapeutic effect of intravenous lidocaine for treatment of post-extubation cough. This study was designed to compare the prophylactic effect of intravenous lidocaine with that of the therapeutic lidocaine in a sample of adult patients undergoing general anesthesia for cataract surgery. METHODS: The study was performed in two phases. In the first phase 200 adult patients were consecutively included in the study. They were randomly divided into two groups to receive either intravenous lidocaine 1 mg/kg or the same volume of normal saline as placebo prior to extubation. Proportions of patient with post-extubation cough were compared between two groups. Patients with established cough comprised the sample of the second phase of the study in which they randomly divided into two groups to receive either intravenous lidocaine 0.5 mg/kg or placebo to abort the coughs. Proportions of patients with successful response to lidocaine were compared between two groups. RESULTS: Proportions of patients with post-extubation cough were not significantly different in two prophylactic groups as revealed by 19 (20.7%) in lidocaine vs. 27 (28.7%) in placebo. The efficacy of prophylactic lidocaine for suppression of post-extubation cough was estimated to be 28.1%. Proportion of patients who were successfully treated in the second phase of the study was significantly higher in therapeutic lidocaine group 20 (80%) vs. 10 (38.5%) in placebo group (P = 0.003). CONCLUSIONS: The outcome of this study shows that prophylactic administration of lidocaine prior to tracheal extubation may be ineffective to prevent post-extubation cough. Based on the results of this study it can be recommended that post-extubation cough should be treated upon occurrence instead of routine prophylactic administration of lidocaine.

Random allocation software for parallel group randomized trials.

BACKGROUND: Typically, randomization software should allow users to exert control over the different aspects of randomization including block design, provision of unique identifiers and control over the format and type of program output. While some of these characteristics have been addressed by available software, none of them have all of these capabilities integrated into one package. The main objective of the Random Allocation Software project was to enhance the user's control over different aspects of randomization in parallel group trials, including output type and format, structure and ordering of generated unique identifiers and enabling users to specify group names for more than two groups. RESULTS: The program has different settings for: simple and blocked randomizations; length, format and ordering of generated unique identifiers; type and format of program output; and saving sessions for future use. A formatted random list generated by this program can be used directly (without further formatting) by the coordinator of the research team to prepare and encode different drugs or instruments necessary for the parallel group trial. CONCLUSIONS: Random Allocation Software enables users to control different attributes of the random allocation sequence and produce qualified lists for parallel group trials.

Paradoxical reaction following intravenous midazolam premedication in pediatric patients - a randomized placebo controlled trial of ketamine for rapid tranquilization.

BACKGROUND: Paradoxical reactions to benzodiazepines include restlessness, violent behavior, physical assault, act of self-injury and need for restraints. These may occur at variable times after administration. This study was designed to determine the incidence of paradoxical reactions following intravenous midazolam premedication in pediatric patients and to compare the efficacy of extra doses of midazolam with low-dose intravenous ketamine to rapidly tranquillize them. METHODS: A total of 706 ASA I, II children scheduled for elective surgery were given intravenous midazolam premedication. Children who developed a paradoxical reaction were randomly divided into three equal groups to receive: (i) extra midazolam, (ii) ketamine, or (iii) placebo as the test drug for treatment of paradoxical reaction. Ease of rapid tranquillization and need for a rescue tranquillizer (i.e. ketamine; irrespective of patient group) were compared among the three groups. RESULTS: Twenty-four (3.4%) children developed paradoxical reaction after midazolam premedication. Those who received ketamine as the test drug responded rapidly to ketamine. But the responses of the other two groups to their test drug were poor and the majority of them required ketamine as rescue tranquillizer (six in midazolam, seven in placebo, but no patient in the ketamine group; P < 0.05). CONCLUSIONS: The results of this study demonstrate that ketamine is an effective drug for the treatment of paradoxical reaction following intravenous midazolam premedication. The exact mechanisms of these reactions and how it is aborted by ketamine are not clear.

Effect of intravenous midazolam premedication on postoperative nausea and vomiting after cholecystectomy.

BACKGROUND: Several drugs and techniques have been used to reduce the incidence of postoperative nausea and vomiting (PONV). However PONV continues to be a common postoperative complication. Midazolam premedication in pediatric patients has been reported to reduce the incidence of PONV. In the present study the effect of intravenous midazolam premedication on the incidence and severity of PONV was investigated in a sample of adult patients undergoing anesthesia for cholecystectomy. METHODS: Eighty-two adult patients undergoing general anesthesia for cholecystectomy were randomly divided into two groups to receive either midazolam 75 microg/kg or a same volume of normal saline intravenously fifteen minutes prior to induction of anesthesia. Incidence and severity of PONV together with the total amount of administered metoclopramide during the first postoperative day were compared between two groups. RESULTS: Severity of nausea was significantly lightened in midazolam group during the first six hours after recovery period compared with placebo group (3.7 +/- 1.6 of a ten point visual analog scale vs. 4.9 +/- 2.2 in placebo group; P < 0.05). Mean number of vomiting episodes was significantly lower in midazolam group (0.4 +/- 0.7 vs. 1.1 +/- 1.4 in placebo group; P < 0.05). Midazolam group received a significantly less amount of metoclopramide during the first postoperative day (2.1 +/- 3.7 mg vs. 5.3 +/- 6.8 mg in placebo group; P < 0.05). CONCLUSIONS: The results of this study suggest the effectiveness of prophylactic intravenous midazolam premedication to reduce the incidence and severity of postoperative nausea and vomiting. Possible mechanisms for this effect of midazolam may be GABA receptor antagonism, inhibition of dopamine release, and anxiolytic effects.

Effect of controlled hyperventilation on the pressor response to laryngoscopy and tracheal intubation.

Pressor response to laryngoscopy and tracheal intubation includes rises in blood pressure and heart rate. This response may be harmful in the presence of cerebral or myocardial diseases. Although different preventive measures have been developed the choice of the agent or method has not been defined clearly. Hypocapnia is commonly used in anesthesia practice for different indications. It depresses the cardiovascular system and lowers the cardiac output. This study investigated the effect of controlled hyperventilation on the pressor response to laryngoscopy and tracheal intubation in three groups of healthy adult patients with different levels of end tidal CO2. The blood pressure and heart rate were recorded during induction of general anesthesia before and after laryngoscopy and tracheal intubation. The pressor responses to laryngoscopy and tracheal intubation in hypocapnic and normocapnic groups were comparable. Moderate degrees of controlled hyperventilation caused relatively more fluctuation in blood pressure during induction of anesthesia. It can be concluded that controlled hyperventilation has no beneficial effect upon the pressor response to laryngoscopy and tracheal intubation.

Evaluating the relationship between arterial blood pressure changes and indices of pulse oximetric plethysmography.

UNLABELLED: The finger plethysmographic waveform of pulse oximeters is a qualitative indicator of fingertip perfusion. This waveform has been used to assess the depth of anesthesia. Its cyclical changes associated with mechanical ventilation have also been used to detect changes in blood volume under normotensive conditions and has revealed that minimal normotensive hypovolemia can cause a significant increase in the delta-down component of this waveform. Hypovolemia may be associated with hypotension; the latter may be due to causes other than hypovolemia. Because the effects of the hypotension on plethysmographic waveform have not been evaluated, it may be difficult to detect hypovolemia in these conditions by inspecting a plethysmogram. Therefore, we performed this study to evaluate the effect of normovolemic hypotension on characteristics of plethysmographic waveform in 33 adult patients undergoing general anesthesia with controlled hypotension. The delta-down and ventilatory systolic variation components were increased significantly with decreases in systolic blood pressure. The result of this study shows that the effect of pharmacologic hypotension on the plethysmographic waveform of pulse oximeter is similar to that of minimal hypovolemia. Therefore, blood volume may be inaccurately assessed by the inspection of ventilatory-induced cyclical changes of pulse oximetric waveform in the presence of hypotension. IMPLICATIONS: The cyclical respiratory-induced changes in the amplitude of the pulse oximeter waveform can be used to detect normotensive hypovolemia. This study shows that hypotension produces the same effect. Therefore, in hypotensive conditions, we cannot determine the presence of hypovolemia.

Blood pressure measurement by pulse oxymetric method and comparison with conventional technique.

BACKGROUND: Measurement of systolic arterial blood pressure using a pulse oxymeter involves the evaluation of plethysmographic waveform during inflation and/or deflation of a blood pressure cuff. The purpose of this study was to determine that during slow inflation and deflation of cuff, which one of the pulse oxymetry-based readings of blood pressure is in best agreement with the value obtained by conventional method. METHODS: Blood pressure was measured in a sample of 50 healthy adult volunteers with conventional and pulse oxymetric methods. The degree of agreement between two methods was calculated. RESULTS: The mean difference between systolic blood pressure and pulse oximetric blood pressure during inflation of the cuff was 0.06 +/- 1.75 mmHg which was not different from zero. The highest correlation was also between these two pressures (0.988). CONCLUSIONS: This study shows that the best agreement is between systolic blood pressure and pulse oxymetric blood pressure during inflation. We conclude that for accurate measurement of blood pressure by pulse oxymetric method it is necessary to inflate the blood pressure cuff at a slow speed for the pulse oxymeter to have enough time to reach equilibrium state.

The effect of acupuncture on the acute withdrawal symptoms from rapid opiate detoxification.

BACKGROUND: Rapid Opiate Detoxification (ROD) is among the best treatments for substance abuse. Unfortunately this method is associated with severe withdrawal reaction. The effect of body acupuncture has not been clearly identified during ROD. This study was designed to evaluate the effect of acupuncture on the severity of withdrawal reaction during ROD. METHODS: Forty adult male subjects addicted to opioids and scheduled for ROD by naloxone were randomly divided into acupuncture and control groups. In the acupuncture group during three consecutive days immediately before induction of ROD, body acupuncture was performed while in the control group it was exempted. Severity of withdrawal reaction was assessed having recourse to Clinical Institute Narcotic Assessment (CINA) Score and compared between two groups. RESULTS: After induction of ROD, CINA score raised significantly during the consecutive days in both groups compared with baseline values but the rise was significantly lower in acupuncture group. CONCLUSIONS: The result of this study shows that body acupuncture reduces the severity of withdrawal symptoms associated with rapid opiate detoxification and it is recommended that this nonpharmacologic method of treatment should be included in ROD program.