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Anesthesiology and Pain Medicine - Volume:7 Issue: 1, Feb 2017

Anesthesiology and Pain Medicine
Volume:7 Issue: 1, Feb 2017

  • تاریخ انتشار: 1395/12/18
  • تعداد عناوین: 16
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  • Nikita Mikhailov, Oleg V. Mamontov, Alexei A. Kamshilin*, Rashid Giniatullin Page 1
    Context: Migraine mechanisms remain largely uncovered for various reasons including a very high complexity of the neurophysiological mechanisms implicated in this disorder and a plethora of endogenous biologically active compounds involved in the pathological process. The functional role of parasympathetic innervation of meninges and cholinergic mechanisms of migraine are among little explored issues despite multiple evidence indirectly indicating the role of acetylcholine (ACh) and its analogues in migraine and other types of headache. In the current short review, we discuss morphological, functional, and clinical issues related to the role of ACh and its analogues such as carbachol and nicotine in this most common neurological disorder..
    Evidence Acquisition: In the present work, studies published from 1953 to 2016 were investigated. Literature was searched with following keywords: acetylcholine (ACh), carbachol, nicotine, parasympathetic, mast cells, vasoactive intestinal polypeptide (VIP), and pituitary adenylate cyclase-activating polypeptide (PACAP)..
    Results
    Parasympathetic fibers originated from SPG and trigeminal nerves can interact at the level of meninges which is considered to be the origin site of migraine pain. Here, in dura mater, ACh, VIP, and PACAP released by parasympathetic afferents can both affect mast cells provoking its degranulation and additional release of neurotransmitters, or they can directly affect trigeminal nerves inducing nociception..
    Conclusions
    In summary, cholinergic mechanisms in migraine and other types of headache remain little elucidated and future studies should clarify the role of parasympathetic nerves and molecular mechanisms of cholinergic modulation within the nociceptive system..
    Keywords: Migraine, Headache, Cholinergic, Trigeminal Pain, Mast Cells, Nicotine
  • Ali Tabrizi *, Fardin Mirza Tolouei, Ebrahim Hassani, Hassan Taleb, Asghar Elmi Page 2
    Background
    Distal radius fractures are among common fractures in the elderly. Regarding the age, background diseases, and possible risks, analgesia method is of great importance in this group..
    Objectives
    The aim of this study was to compare two analgesia methods including hematoma block and general anesthesia in people over 60 years in the orthopedic emergency department..
    Methods
    68 elderly patients referring to the emergency department of a medical teaching center were selected based on the inclusion criteria for a non-randomized clinical trial. The patients were placed in two groups of 34, which were matched for age and sex. Hematoma block was used as the analgesic method in one group and general anesthesia was used in the other group. These two groups were compared for pain intensity, analgesia duration, and anesthesia side effects. The SPSS software (Statistical Package for the Social Sciences, version 17.0, SPSS Inc., Chicago, Ill, USA) was used for data analysis..
    Results
    68 elderly patients (mean age of 70.3 ± 6.6) with a dislocated distal radius fracture which required closed reduction were examined. The duration of manipulation and surgery and discharging time were significantly different between two groups and they were all lower in the hematoma blocked group. Pain intensity evaluation indicated a statistically significant difference during initial hours after fracture reduction and fixation so that pain intensity was less in elderly patients under hematoma block than patients who underwent general anesthesia in one and six hours after surgery. Need for narcotic was 35.2% in the general anesthesia group which also showed a significant between-group difference..
    Conclusions
    Hematoma block analgesia used in distal radius fractures of the elderly is a very safe and effective method that seems preferable to general anesthesia in emergency departments..
    Keywords: Distal Radius Fractures, General Anesthesia, Hematoma Block
  • Faranak Rokhtabnak, Mohammad Reza Ghodraty, Alireza Kholdebarin, Ali Khatibi, Seyedeh Somayeh Seyed Alizadeh, Zahra Sadat Koleini, Mohammad Mahdi Zamani, Alireza Pournajafian* Page 3
    Background
    Anxiety is a preoperative complication, which most patients encounter. The use of a premedication to reduce preoperative anxiety with minimal cognitive impairment is crucial..
    Objectives
    This study was conducted to compare the sedative effect of preoperative melatonin and Passiflora incarnata in patients undergoing elective surgery regarding their potential for postoperative cognitive disorders..
    Methods
    In this clinical trial, 52 patients American society of anesthesiologists grade (ASA) I and II of both genders were selected to receive either Passiflora incarnata (1000 mg nature made) (n = 26) or melatonin (6 mg) (n = 26) as premedication one hour before surgery. Post-operative pain was evaluated using the visual analogue scale (VAS). Patient’s anxiety and cognitive dysfunction was evaluated with the Ramsey score and the digital symbol substitution test (DSST), respectively. All tests were carried out and evaluated at arrival in the operating room, before induction and before discharge from the post anesthesia care unit (PACU)..
    Results
    There were no statistically differences between groups in VAS (P > 0.05). However, the mean score of pain was higher in the melatonin group compared to the Pssiflora incarnata group when discharged from the PACU (27.63 vs. 25.37). The anxiety scores were statistically significant in both drugs (P = 0.001), however higher sedation scores was caused by premedication with melatonin (P = 0.003 vs. 0.008). Regarding the DSST, there was a significant difference between the two groups one hour before the surgery (P = 0.04) and at the time of discharge from the PACU (P = 0.007). When evaluating each group, the Passiflora incarnata group revealed a significant difference (P = 0.003)..
    Conclusions
    Our findings show that premedication with Passiflora incarnata reduces anxiety as well as Melatonin. However, Melatonin causes less cognitive impairment compared to Passiflora incarnata..
    Keywords: Melatonin, Passiflora incarnata, Cognitive Impairment, Anxiety
  • Young Ho Jang, June Hong Kim, Yong Cheol Lee* Page 4
    Background
    Mitochondrial ATP-sensitive potassium (mKATP) channels play a role in reperfusion arrhythmias (RAs) in ischemia-reperfusion (I/R) injury. Evidence suggests that remote ischemic preconditioning (RIPC) reduces RAs, however not much is known on the mechanistic role of mKATP in RIPC. We evaluated whether mKATP channels are associated with reducing arrhythmia and infarct size in RIPC..
    Methods
    Isolated rat hearts received 30 minutes of regional ischemia followed by 2 hours of reperfusion through the Langendorff perfusion system. RIPC was induced by 3 cycles of 5 minutes occlusion and 5 minutes release of the bilateral femoral artery. The animals were randomly divided into 4 groups as follows: 1) CON, I/R injury but not RIPC, 2) RIPC, 3) HD䒃, pretreatment of the selective mKATP channel blocker, 5-hydroxydecanoate (5-HD), in RIPC, and 4) HD, pretreatment of 5-HD in CON. Cardiodynamics and infarct size were determined. The severity of arrhythmia was quantitated via the Curtis and Walker scoring system as well as the Lepran scoring system..
    Results
    RIPC significantly reduced the infarct size over AR (25.7 ± 2.6%) compared to CON (37.0 ± 2.6%, P
    Conclusions
    The selective mKATP channel blocker, 5-HD, inhibited the infarct-limitation and anti-arrhythmic effect of RIPC. The mKATP channels play a role in the reduction of both infarct size and RAs in RIPC..
    Keywords: Arrhythmia, Ischemic Preconditioning, Potassium Channel, Reperfusion Injury
  • Liza Maniquis Smigel, Kenneth Dean Reeves*, Howard Jeffrey Rosen, John Lyftogt, Cassie Graham Coleman, An Lin Cheng, David Rabago Page 5
    Background
    Hypertonic dextrose injection (prolotherapy) is reported to reduce pain including non-surgical chronic low back pain (CLBP), and subcutaneous injection of 5% dextrose is reported to reduce neurogenic pain, hyperalgesia and allodynia. The mechanism in both cases is unclear, though a direct effect of dextrose on neurogenic pain has been proposed. This study assessed the short-term analgesic effects of epidural 5% dextrose injection compared with saline for non-surgical CLBP..
    Methods
    Randomized double-blind (injector, participant) controlled trial. Adults with moderate-to-severe non-surgical low back pain with radiation to gluteal or leg areas for at least 6 months received a single epidurogram-confirmed epidural injection of 10 mL of 5% dextrose or 0.9% saline using a published vertical caudal injection technique. The primary outcome was change in a numerical rating scale (NRS, 0 - 10 points) pain score between baseline and 15 minutes; and 2, 4, and 48 hours and 2 weeks post-injection. The secondary outcome was percentage of participants achieving 50% or more pain improvement at 4 hours..
    Results and
    Conclusions
    No baseline differences existed between groups; 35 participants (54 ± 10.7 years old; 11 female) with moderate-to-severe CLBP (6.7 ± 1.3 points) for 10.6 ± 10.5 years. Dextrose participants reported greater NRS pain score change at 15 minutes (4.4 ± 1.7 vs 2.4 ± 2.8 points; P = 0.015), 2 hours (4.6 ± 1.9 vs 1.8 ± 2.8 points; P = 0.001), 4 hours (4.6 ± 2.0 vs 1.4 ± 2.3 points; P
    Keywords: Analgesia, Epidural, Anesthesia, Caudal, Dextrose
  • Hossein Zeraati, Javad Shahinfar*, Hamidreza Behnam Vashani, Tayebeh Reyhani Page 6
    Background
    Eye examination as one of the painful procedures for retinopathy of prematurity screening can cause some pain-related physiological and behavioral changes in preterm infants. Multisensory stimulation is an analgesic non-pharmacological method that has analgesic effects on infants during painful procedures..
    Objectives
    This study aimed to determine the effect of multisensory stimulation on induced pain during eye examination for retinopathy of prematurity screening in preterm infants..
    Methods
    In this double-blind clinical trial, 80 preterm infants were randomly divided into two groups. In the intervention group, multisensory stimulation program was performed for 15 minutes before the beginning of examination while the control group received the routine care. Pain score for each infant was recorded by premature infant pain profile. Data were analyzed using independent t-test, Mann-Whitney, and ANOVA with repeated measures by SPSS software (version 16)..
    Results
    The mean gestational age was 30.4 ± 1.7 weeks in the multisensory stimulation group and 30.6 ± 1.8 weeks in the control group. Based on ANOVA with repeated measures, the pain score was significantly different between two groups during the assessment process (P
    Conclusions
    Multisensory stimulation program as a safe and easy method can reduce pain in neonates and may be used as a way to reduce pain during eye examination in infants..
    Keywords: Multisensory Stimulation, Pain, Retinopathy of Prematurity, Preterm Infant
  • Navid Noraee, Mohammad Fathi, Majid Golestani Eraghi, Ali Dabbagh, Nilofar Massoudi * Page 7
    Background
    Intraoperative care and anesthesia method in patients undergoing allograft renal transplantation surgery are very necessary. Acid-base imbalance can alter neuromuscular blockade and recovery time..
    Objectives
    The aim of the present study was to investigate the effect of acid-base balance on atracurium blockade in renal transplantation..
    Methods
    In this randomized-controlled trial, 31 end-stage renal disease (ESRD) patients undergoing renal transplantation were randomly assigned into two equal groups. The case group received intravenous sodium bicarbonate based on base excess in the first ABG sample, while the control group received sterile water for injection during the interval between anesthesia and beginning of surgery. Arterial blood gas (ABG) sample was drawn first prior to surgery and again at declamping time. Train-of-four (TOF) was measured before anesthesia and repeatedly after declamping time until acceptable recovery (TOF 3 of 4). The time of achieving TOF 3 was recorded and compared between the groups..
    Results
    There was no significant difference in blood pH between the groups in the first evaluation (P = 0.649). The pH and base excess (BE) in the case group significantly increased after the intervention. There was a significant decrease in after-surgery measurement of pH in the control group (P = 0.011). The mean time to achieve TOF = 3 was 23.75 ± 5.32 and 41.80 ± 5.2 minutes after declamping in the case and control groups, respectively. Patients in the sodium bicarbonate group achieved TOF = 3 significantly faster than the control group..
    Conclusions
    Based on our results, intraoperative alkali and acid-base imbalance treatment can reduce neuromuscular blockade and recovery time, and it can be regarded as a potential casual factor to enhance transplantation outcome..
    Keywords: ESRD, Kidney Transplantation, Acid Base Imbalance, Sodium Bicarbonate
  • Ali Mirmansouri, Vali Imantalab, Ali Mohammadzadeh Jouryabi, Gholamreza Kanani, Bahram Naderi Nabi, Farnoush Farzi, Gelareh Biazar *, Samaneh Ghazanfar Tehran, Masoud Tarbiat Page 8
    Background
    In spite of significant improvements in surgical and anesthetic techniques, acute stress response to surgery remains a main cause of mortality and morbidity in coronary artery bypass graft (CABG) surgery patients. Therefore, doing research to find safe and effective modalities with more cardio protective properties seems necessary..
    Objectives
    In this study, we sought to determine whether intravenous injection of 600 μg Selenium (Se) prior to surgery would limit stress response measured by blood sugar..
    Methods
    This double blind clinical trial was conducted at a referral center of cardiac surgery affiliated to Guilan University of Medical Sciences (GUMS) from June 2015 to October 2015. 73 eligible patients candidate for elective isolated CABG surgery were enrolled in the trial. They were randomly allocated to either Se group (n = 36) receiving 600 μg Se prior to surgery or control group (n = 37). Our evaluation was based on blood sugar (BS) which was measured at four point times, including before induction of anesthesia (T0), at the end of CPB (T1), 24 hours (T2) and 48 hours (T3) after surgery..
    Results
    The data obtained from 73 patients in group S (n = 36) and group C (n = 37) were analyzed. There was no significant difference between the two groups regarding the baseline characteristics. In both groups, a sharp rise in BS levels was observed following CPB (P = 0.0001). Although the trend of BS changes was remarkable in both groups (P = 0.0001), there was no statistically significant difference between the groups at all point times including T0 (P = 0.45), T1 (P = 0.48), T2 (P = 0.92), and T3 (P = 0.42). Within the study time, our patients were monitored for any adverse effect but nothing was observed..
    Conclusions
    This investigation showed that intravenous single dose of 600 μg Se was safe in CABG patients, but had no positive effect on stress response to surgery..
    Keywords: Coronary Artery Bypass Graft Surgery, Selenium, Stress Response, Blood Sugar
  • Shoko Nakano, Junko Nakahira*, Yosuke Kuzukawa, Toshiyuki Sawai, Toshiaki Minami Page 9
    Background
    The forced oscillation technique (FOT) is a non-invasive means of measuring respiratory resistance and reactance. We tested our hypothesis that endotracheal intubation would cause more substantial preoperative increases in FOT parameters than a supraglottic airway device (SGD)..
    Methods
    Forty patients requiring general anesthesia and mechanical ventilation for transurethral bladder tumor resection underwent spirometry the day before surgery. Forced oscillation was measured using a MostGraph-01 device the day before surgery and immediately after removal of the airway adjunct. Changes in respiratory resistance and reactance were compared between those intubated and those who used SGD..
    Results
    The trachea was intubated in 23 patients and SGD was used in the remaining 17 patients. Both airway adjuncts caused significant increases in preoperative respiratory resistance and reactance; however, the magnitude of the changes was significantly greater in the intubated patients..
    Conclusions
    The SGD appears to cause less pulmonary injury than tracheal intubation. Further study is needed to illuminate the influence of mechanical ventilation, and longer-term consequences and clinical significance of the changes we found in this study. Spontaneous ventilation through an SGD may be preferable in patients with severe respiratory disease..
    Keywords: Forced Oscillation Technique, Respiratory Impedance, Endotracheal Intubation, Supraglottic Airway Device
  • Ali Dabbagh *, Mohammad Kazem Arabnia, Mahnoosh Foroughi, Mehran Shahzamani, Hassan Rahmian Page 10
    Introduction
    Aortic dissection is a life threatening disease and is usually accompanied by a high rate of mortality and morbidity. Here we present a case report in which intraoperative tranesophageal echocardiography was used for intraoperative assessments of thoracic aortic dissection due to cocaine abuse..
    Case Presentation
    A 45- year- old male was admitted to a university hospital due to severe chest pain. He was suffering from severe excruciating chest pain that had started after a psychological stress, leading to heavy cocaine abuse. He was admitted to the emergency department of the hospital, and was then transferred to the cardiac care unit to control the chest pain. The patient underwent emergent surgery. After induction of anesthesia, tranesophageal echocardiography probe was introduced gently and a full exam was done. The surgeon decided to perform a classic Bentall procedure. Cardiopulmonary bypass was started. Everything was acceptable, but bleeding was uncontrolled. The surgical team could not control the bleeding, and he passed away due to bleeding..
    Conclusions
    This case report stresses the use of IOTEE as a means for more accurate diagnosis of the lesion under general anesthesia, especially when there is not time to do preoperative TEE, or when bedside echocardiography does not give us adequate data..
    Keywords: Intraoperative Tranesophageal Echocardiography, Dissection of Aorta, Cocaine
  • Afshin Iranpour *, Ata Mahmoodpoor Page 11
    Introduction
    Papillon-Lefèvre syndrome (PLS) is a rare autosomal recessive trait; it often requires some interventions with general anesthesia because of the accompanied complications..
    Case Presentation
    We report a 19-year-old girl with palmoplantar hyperkeratosis who presented total loss of her teeth. She was candidate to mandibular bone graft and lower jaw dental implants under general anesthesia..
    Conclusions
    There are only a few studies about perioperative management of these patients; however, the anesthesiologists should consider a few important issues during pre-operative and intra-operative management..
    Keywords: Papillon-Lefèvre Syndrome, Fiberoptic, Nasal Intubation, Dexmedetomidine, Dental Implants
  • Sun Kyung Park, Yun Suk Choi * Page 12
    Postherpetic neuralgia (PHN) is a severe neuropathic pain syndrome. The treatment of PHN is complex and refractory in some patients. We present two cases with refractory anterior abdominal wall pain due to PHN that were successfully treated with transversus abdominis plane (TAP) block. The TAP block seems to be an alternative for patients with PHN who suffer from anterior abdominal wall pain accompanied by allodynia and hyperalgesia and do not respond to the existing conservative treatments..
    Keywords: Postherpetic Neuralgia, Transversus Abdominis Plane Block, Abdominal Wall Pain
  • Ali Shahriari *, Mahdi Sheikh Page 15