فهرست مطالب

Anesthesiology and Pain Medicine - Volume:8 Issue: 4, Aug 2018

Anesthesiology and Pain Medicine
Volume:8 Issue: 4, Aug 2018

  • تاریخ انتشار: 1397/07/04
  • تعداد عناوین: 10
|
  • Kazuma Hashimoto, Ayano Tsuji, Shiho Takenaka, Akimune Ohmura, Ryusuke Ueki, Hideki Noma, Michiko Imamura, Yasuo Miyoshi, Nobutaka Kariya, Tsuneo Tatara, Munetaka Hirose * Page 1
    Background
    C-reactive protein (CRP) is an acute phase reactant released in response to inflammation or tissue injury. Inflammation is one of the pathogenic factors related to transition from acute postsurgical pain (APSP) to chronic postsurgical pain (CPSP). Although several risk factors are reportedly associated with CPSP, the effects of CRP levels on CPSP have not been examined.
    Objectives
    The present study investigated the relationship between perioperative risk factors, including CRP levels on postoperative day one and CPSP, in patients undergoing mastectomy.
    Methods
    Preoperative anxiety and depression levels were evaluated in female patients undergoing mastectomy under general anesthesia, with or without peripheral nerve block. Patients with chronic preoperative pain and/or preoperative breast pain were excluded. The intensity of postoperative pain was prospectively examined one and six days, and three and twelve months after surgery using a numerical rating scale (NRS).
    Results
    The current researchers conducted univariate and multivariate linear regression analyses to explore risk factors for CPSP in 36 patients. Patient demographics, preoperative psychological states, and anesthetic managements showed no relationship with CPSP. On the other hand, pain intensity of APSP and CRP levels on postoperative day one was significantly associated with the pain intensity of CPSP.
    Conclusions
    Postoperative CRP level is likely to be associated with the development of CPSP after mastectomy.
    Keywords: Breast Cancer, Chronic Pain, Mastectomy, Postoperative Pain
  • Mohammad Reza Gousheh, Reza Akhondzade*, Hamid Asl Aghahoseini, Alireza Olapour, Mahbobe Rashidi Page 2
    Background
    Spinal anesthesia is an appropriate alternative for general anesthesia in many operations, particularly in cesarean section. However, the induced hypotension is the main drawback of this method. Therefore, the current study aimed at comparing the effects of crystalloid and colloid solutions used as the preload on the post-spinal hypotension and its complications in females who are candidate for elective cesarean section.
    Methods
    The current randomized, controlled, double-blind study was conducted on the female candidate of elective cesarean section (n = 96; age range: 20 to 40 years). The patients were in their 37 to 42 weeks of gestational age during the experiments. The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) variation, amount of injected ephedrine during surgery, Apgar score at birth, total solution infused after spinal anesthesia, urine output, nausea, and vomiting were comparatively assessed between the two groups.
    Results
    The percentages of reduction in SBP and DBP variables in the crystalloid solution were higher than those of the colloid group and the differences were statistically significant (P = 0.042 and P = 0.008, respectively). Average percentage of HR changes was more significant in the crystalloid than the colloid group (P = 0.032). In contrary, administration of the two types of solutions did not result in significant differences in the Apgar scores. The prevalence of nausea and vomiting in the colloid group subjects was lower than those of the crystalloid solution group; however, the differences were not significant.
    Conclusions
    The current study findings recommend colloid solution to prevent hemodynamic instability after spinal anesthesia. However, the costs and availability of the solution and recommendation of anesthesiologist should be considered. Conduction of further clinical trials with larger sample sizes is recommended.
    Keywords: Hypotension, Colloid Solution, Crystalloid Solution, Spinal Anesthesia, Cesarean Section
  • Farnad Imani *, Poupak Rahimzadeh, Hamid-Reza Faiz, Alireza Abdullahzadeh-Baghaei Page 3
    Background
    Post-hysterectomy pain is extremely annoying and using transverse abdominis plane (TAP) block can be a useful method to manage postoperative pain, but its duration of effect is challenging. Magnesium sulfate increases, in some cases, the effects of local anesthetics on the peripheral nerve blocks.
    Objectives
    The current study aimed at investigating the effects of adding magnesium sulfate to ropivacaine in the transverse abdominis plane block after hysterectomy.
    Methods
    The current randomized, double blind, clinical trial, to manage postoperative pain, was conducted on a total of 60 patients, 30 - 60 years old, ASA (American Society of Anesthesiologists) class I-II undergone elective abdominal hysterectomy candidates to receive ultrasound-guided bilateral transverse abdominis abdominis plane (TAP) blocks. Patients with coagulation disorders, infection, history of any addiction, sensitivity to the local anesthetics and magnesium sulfate were excluded. The subjects were equally allocated into two groups, the control group, ropivacaine plus normal saline (R), and the study group, ropivacaine plus magnesium sulfate (RM). The injection contained 19 mL ropivacaine 0.2% plus 1 mL normal saline in the group R, and 19 mL ropivacaine 0.2% plus 1 mL magnesium sulfate 50% in the RM group on each side. As well as the patients’ characteristics, the level of pain score (visual analogue scale = VAS), rescue analgesic demand (diclofenac suppository), and possible adverse effects were evaluated at 1, 2, 6, 12, and 24 hours after the operation in the two groups.
    Results
    The mean pain scores of the patients at the first hour after surgery were 5.7 ± 0.9 and 5.9 ± 1.1 in R and RM groups, respectively. The scores reached 2.9 ± 0.5 and 2.7 ± 0.4 at the second hour after surgery (the first post-block measurement) and 3.1 ± 0.7 and 2.8 ± 0.7 within the next 24 hours, respectively. Although the pain scores were generally lower at all hours in the RM group, none was statistically significant. The rescue analgesic consumption gradually increased in the two groups, and it was less in the study group than in the control group in the first hours after the block (second hour after surgery); however, it was not statistically significant. No adverse effects were observed in the two groups.
    Conclusions
    Results of the current study suggested that the addition of magnesium sulfate to ropivacaine in TAP block does not affect the post-hysterectomy pain.
    Keywords: Magnesium Sulfate, Postoperative Pain, Ropivacaine, Transverse Abdominis Plane Block
  • Simin Atashkhoei, Reyhaneh Abri *, Bahman Naghipour, Pouya Hatami Marandi, Mohammad Taher Fazeli Danesh Page 4
    Background
    Despite preventive strategies, hypotension is the most common complication of spinal anesthesia in cesarean section.
    Objectives
    The aim of this study was to assess the effect of glucose-containing crystalloid infusion on maternal hemodynamic status after spinal anesthesia for cesarean section.
    Methods
    In this prospective, randomized, double-blind clinical trial, 80 parturients undergoing elective cesarean section with spinal anesthesia were studied. In group A (n = 40) ringer with 1% glucose solution (10 gr glucose in 1000 mL ringer) and in group B (n = 40) only ringer solution infused before and after spinal anesthesia. Demographic data, hemodynamic change, complications and their treatments, maternal blood sugar level and neonatal APGAR (appearance, pulse, grimace, activity and respiration) score, intraoperative fluid, duration of surgery, and anesthesia were recorded in the two groups.
    Results
    The incidence of hypotension in group A was significantly lower than group B (27.5% vs 75%) (P = 0.002). Other complications (sustained hypotension, nausea, pallor, and shivering were significantly lower in parturients of the group A (P
    Conclusions
    It seems that adding 1% glucose to crystalloid solution improves the hemodynamic status and decreases post-spinal anesthesia complications without significant changes in the maternal blood sugar level and APGAR score of neonates.
    Keywords: Glucose, Crystalloid, Hemodynamic, Spinal Anesthesia, Cesarean Section
  • Seydalireza Seyed Siamdoust, Faranak Rokhtabnak*, Soudabeh Djalali Motlagh, Poupak Rahimzadeh, Valiollah Hassani, Mahdi Farnaghizad Page 5
    Background
    Rapid placement of a reliable airway is the most important task in anesthesia practice. Airway management is a critical skill to provide safe anesthesia since morbidity. In addition, mortality due to anesthesia could be linked to difficulty or failure in airway management. In this study, intubation success was compared between two methods, AirQ-ILA and LMAfastrach, among candidates for elective surgery under general anesthesia.
    Methods
    In this clinical trial, patients, who were candidates for elective surgery under general anesthesia at Firoozgar and Rasoul Akram Hospitals, were randomly divided into LMAfastrach and AirQ-ILA groups. Heart rate before and after induction and intubation, diastolic blood pressure, systolic blood pressure, duration of device insertion, intubation time, number of attempts until successful device insertion and trachea intubation, and success or failure in the insertion of the device and the tube were recorded; as for statistical analysis, SPSS version 21 was considered.
    Results
    In comparison with the LMAfastrach group, the device insertion time and intubation time were significantly longer in the AirQ-ILA group (P 0.05). Moreover, no significant difference was observed in the success of device insertion and intubation in either LMAfastrach or AirQ-ILA group (P > 0.05).
    Conclusions
    The LMAfastrach and AirQ-ILA methods were not significantly different regarding the success of airway instrument application and intubation, while the device insertion time and intubation time were significantly longer in the AirQ-ILA group in comparison with the LMAfastrach group.
    Keywords: LMAfastrach, AirQ-ILA, Endotracheal Tube
  • Valiollah Hassani, Gholamreza Movaseghi, Reza Safaeeyan, Sahar Masghati *, Batool Ghorbani Yekta, Reza Farahmand Rad Page 6
    Background
    Hypotension is a common problem in general anesthesia. Maintaining the mean arterial pressure by choosing a vasopressor with minimal complications is still discussed in various surgeries.
    Objectives
    The aim of this study is comparison of ephedrine versus norepinephrine in treating anesthesia-induced hypotension in hypertensive patients in spinal surgery in a randomized double-blinded study.
    Methods
    This randomized, double-blinded study was approved by Iran University of Medical Sciences, operating room of medical center. Data collection was completed between Jan to Dec 2017. Inclusion criteria included age between 20 and 75 years, history of high blood pressure (a patient who has been treated for maximum 5 years with a anti hypertensive medication), and patients under general anesthesia in spinal surgery. The exclusion criteria were based on American Society of Anesthesiologists physical status of 3 or higher, history of arrhythmia, heart valve disease, cerebrovascular disease, kidney failure, beta-blocker use and diabetes, as well as intra operative massive blood loss. After initiation of anesthesia, when the pressure reaches less than 60, the patient entered the protocol and simultaneously administration of 5 mL/kg serum crystalloid and vasopressor. Patients were randomized to the ephedrine group (n = 28) who received 5 mg ephedrine intravenous (i.v.) or norepinephrine Group (n = 28) who received 10 µg (i.v.) bolus norepinephrine at anesthesia-induced hypotension. The administration of 5 mL/kg serum crystalloid and vasopressor was simultaneous. If the mean arterial pressure (MAP) had not reached 60 mmHg, the same dose should be repeated at a maximum of three or more times at five-minute intervals in the ephedrine group and at two minutes intervals in the norepinephrine group. All parameters were collected before and at the end of administration anesthesia drug and during episodes of hypotension. Hemodynamic variables, frequency of hypotension, and total number of vasopressors doses during anesthesia were recorded and analyzed.
    Results
    The mean number of hypotension times, the number of vasopressors doses in the first hypotension, the total number of doses consumed during the anesthesia, and heart rate at the end of anesthesia were lower in the norepinephrine group (P) respectively. MAP, 5 minutes after the first episode of hypotension and MAP at the end of anesthesia were higher in norepinephrine group.
    Conclusions
    Norepinephrine is more effective than ephedrine in maintenance of MAP in hypertensive patients undergoing spinal surgery under general anesthesia.
    Keywords: Ephedrine, Norepinephrine, Hypotension, MAP, General Anesthesia
  • Maryam Soleimanpour, Farzad Rahmani, Hamid Reza Morteza Bagi, Alireza Ala, Ata Mahmoodpoor, Fatemeh Hassani, Seyed Mahdi Sharifi, Robab Mehdizadeh Esfanjani, Hassan Soleimanpour * Page 7
    Background
    Rapid and secure management of airway is an important lifesaving intervention in critically ill patients at emergency wards. Training undergraduate students about airway management must be regarded as a priority in their education period. The aim of the present study was to compare the quality of three ventilation techniques with a bag and mask among two groups of undergraduate students (Novices) and senior group (Experienced) in Tabriz University of Medical Sciences.
    Methods
    This study was a mannequin type research that was carried out in the faculty of medicine, Tabriz University of Medical Sciences. The study population consisted of two elementary groups (Novices) and senior group (Experienced). The number of participants included 100 individuals. Ventilation quality by bag and mask in two groups was recorded based on the rise of lungs and two reviewer's opinions who gave a score from 1 as weak to 4 as excellent using three techniques of E-C, E-O, and Thenar Eminence. In the E-C technique, index fingers and thumbs form two “C”s facing each other while the remaining fingers lift the mandible and form two “E”s. In E-O techniques, the web between thumb and index finger is used to form a circle around the neck of the mask while other fingers perform a chin lift. In thenar eminence techniques, the thenar eminence and thumb are placed on the top of the mask while other fingers perform jaw thrust.
    Results
    In our study, 27% of undergraduate participants and 59% of seniors were male and the others were female. The mean of age of elementary and seniors were 24 and 33.5, respectively (P
    Conclusions
    Based on our results, it was concluded that the elementary group performed E-O bag and mask ventilation technique appropriately. Therefore, it can be suggested that training of this technique will be placed in educational curriculum of undergraduate students.
    Keywords: Bag-Mask-Ventilation, Airway Management, E-C Technique, Thenar Eminence Technique, E-O Technique
  • Valiollah Hassani, Shahla Chaichian*, Abolfazl Rahimizadeh, Mohammad Esmaeil Darabi, Mohammad Rezvan Nobahar, Morteza Jabbary Moghaddam, Mohsen Homai E. Gita Fotouhi, Yousef Alimohamadi, Yousef Moradi Page 8
    Background
    Perioperative inadvertent hypothermia (PIH) commonly occurs after major surgical procedures under local or general anesthesia and increases the risk of complications such as organ failure, hypoperfusion, and peripheral vasoconstriction, as well as adverse postoperative outcomes, such as wound infection and increased surgical bleeding.
    Objectives
    We hypothesized that the intra-operative warming may affect these complications and thus, we aimed to compare the most appropriate temperature of the warmer to decrease patients’ complications.
    Methods
    The present randomized clinical trial investigated 90 patients undergoing total intravenous anesthesia in posterior spinal fusion surgery, randomly divided into two groups of 45. The warmer was set at 38°C for group “A” during surgery and at 40°C for group “B.” Patient’s demographic characteristics, the serum level of hemoglobin, hematocrit, and platelet counts, mean core temperature, systolic blood pressure (BP), heart rate, and respiratory rate were recorded before and after the surgery. Variables were compared between the two groups at three time intervals (during induction, during operation, and during recovery).
    Results
    The mean temperature was not different between the two groups at the three time intervals. Other laboratory serum tests, vital signs, and oxygen consumption were maintained within the normal range although they did not improve significantly in two groups at the three time intervals.
    Conclusions
    There was no significant difference in warming of the patients during operation at 38 or 40°C to prevent hypothermia-induced complications during induction, operation, and recovery.
    Keywords: Anesthesia, General, Hypothermia, Intraoperative, Spinal Fusion
  • Reza Akhondzadeh *, Mahbobe Rashidi, Mohammadreza Gousheh, Alireza Olapour, Amirhossein Baniahmad Page 9
    Background
    To improve the brachial plexus block (BPB) performance, different compounds have been used as adjuvants to local analgesics.
    Objectives
    The aim of the present study was to investigate the effects of adding DEX to lidocaine on effectiveness of nerve block, and postoperative pain in forearm fracture surgery by supraclavicular BPB undergoing ultrasound-guided.
    Methods
    This was a double-blinded randomized clinical trial conducted on 72 patients with ASA classes I and II, which were candidates for forearm fracture surgery. In group A, patients received 3 mg/kg of lidocaine 2%. In group B, patients received 3 mg/kg of lidocaine 2% and DEX (1 µg/kg). The ultrasound-guided supraclavicular BPB was performed in all patients. The onset of sensory and motor blocks were evaluated with pin prick test and modified Bromage scale, respectively. The sensory and motor block moment was recorded as the onset of the block. The first analgesic request time, total consumed analgesic, adverse effect, and hemodynamic parameters of patients were recorded. A visual analog scale (VAS) was used for recording the severity of pain.
    Results
    The two groups showed no significant difference in the demographic variables. The onset of sensory and motor block in the DEX groups was shorter. The duration of sensory and motor block, and analgesic request was significantly longer than the control groups. Total analgesic consumption 24 hours after surgery in the DEX groups was significantly lower. Moreover, hemodynamic status of patients in both groups was stable and no significant difference was observed between groups. This study showed that DEX, as an adjuvant to lidocaine, improve the characteristics of supraclavicular BPB and decrease the postoperative pain.
    Keywords: Dexmedetomidine, Lidocaine, Pain, Brachial Plexus Block (BPB), Ultrasound-Guided
  • Young-Chang Arai, Yukiko Shiro*, Yasushi Funak, Kunio Kasugaii, Yusuke Omichi, Hiroki Sakurai, Takako Matsubara, Masayuki Inou E. Kazuhiro Shimo, Hironori Saisu, Tatsunori Ikemoto, Keiko Owari, Makoto Nishihara, Takahiro Ushida Page 10
    Background
    Bacteria can influence a variety of gut functions. Some studies showed that stool consistency and constipation were associated with gut microbiome (GM) composition, and enterotype, dysbiosis. Growing evidence indicates the significant role of GM in the homeostatic function of the host body. The GM may regulate multiple neurochemical and neurometabolic pathways. Chronicity of the pain is actively modulated at the molecular to the network level by means of several neurotransmitters. The GM to some extent can affect pain perception.
    Objectives
    The current study aimed at investigating the relationship between constipation state or usual stool form and pain severity of patients with chronic pain.
    Methods
    The current study was conducted on 365 patients with chronic pain. The participants were evaluated on their stool form (the Bristol stool form scale; BSFS), constipation state (the Cleveland clinic constipation score; CCCS), body mass index (BMI), and usual pain severity (numerical rating scale; NRS). In addition, the participants were assigned into five groups according to the pain region (i e, low back and/or lower limb, whole body, neck and/or upper back and/or upper limb, head and/or face, chest and/or abdominal).
    Results
    The CCS showed a significant and positive association with the pain severity of the total patients and patients with low back and/or lower limb pain. Simultaneous multiple linear regression analyses revealed that a predictor of the pain severity was the CCS for the total patients and patients with low back and/or lower limb, whole body pain.
    Conclusions
    Constipation displayed a significant and positive association with the pain severity of the total patients and patients with low back and/or lower limb pain, whole body.
    Keywords: Gut Microbiome, Pain Severity, Stool Form, Constipation, Chronic Pain