Anesthesiology and Pain Medicine
Volume:5 Issue: 4, Aug 2015

Many papers have reported that TAP block provides effective postoperative analgesia, but the sole use of TAP block for surgical anesthesia has been rarely reported.. Therefore, we presented an 80-year-old male undergoing ultrasound-guided unilateral subcostal TAP block providing surgical anesthesia for open gastrostomy. Left subcostal TAP block was performed using the method described by Hebbard with the M-Turbo® ultrasound system and a linear probe placing immediately inferior and parallel to the costal margin. Using a 100 -mm long, 23 G short-bevel needle in-plane technique, 20 mL of 0.25% levobupivacaine was injected on the TAP. A sensory block from T7 to T11 was established and the satisfaction score was 7 - 8.. Open gastrostomy was successfully performed under subcostal TAP block with small dose fentanyl supplementation. The subcostal TAP block is considered a useful anesthetic choice in surgery for high risk patients..

In supine position, pressure support ventilation causes a redistribution of ventilation towards the ventral regions of the lung. Theoretically, a less sensitive support trigger would cause the patient to breathe more actively, potentially attenuating the effect of positive pressure ventilation.. To quantify the effect of trigger setting, we assessed redistribution of ventilation during pressure support ventilation (PSV) using electrical impedance tomography (EIT)..Patients and With approval from the local ethics committee, six orthopedic patients were enrolled. All patients had general anesthesia with a laryngeal mask airway and a standardized anesthetic regimen (sufentanil, propofol and sevoflurane). Pressure support trigger settings varied between 2 and 15 L/minute and compared to unassisted spontaneous breathing. From EIT data, the center of ventilation (COV), the fraction of the total ventilation per region of interest (ROI) and intratidal gas distribution were calculated.. At all trigger settings, pressure support ventilation caused a significant ventral shift of the center of ventilation compared with during spontaneous breathing, confirmed by the analysis by regions of interest. During spontaneous breathing, COV was not different from baseline values obtained before induction of anesthesia. During PSV, the intratidal regional gas distribution (ITV-analysis) revealed subtle changes during the early inspiratory phase not detected by the COV-analysis.. Pressure support ventilation, but not spontaneous breathing, induces a significant redistribution of ventilation towards the ventral region. The sensitivity of the support trigger appears to influence the distribution of ventilation only during the early phase of inspiration..

The current randomized double-blind clinical trial aimed to compare the incidence of post-operative cough with intravenous vs. topical lidocaine in children with mild upper respiratory infection (URI) anesthetized with laryngeal mask airway (LMA) in the university-affiliated medical center..

To assess the incidence of adverse respiratory event including cough, apnea, laryngospasm, bronchospasm following two different methods of lidocaine administration in anesthetized children with mild URI..Patients and

One hundred and thirty pediatric patients with mild URI (within the previous two weeks) aged between one and six years were enrolled. They were candidates to undergo immediate full ophthalmic examination, and randomly divided into two groups of 65to receive intravenous (1.5 mg/kg) or topical lidocaine on LMA. Anesthesia was induced with sevoflurane, subsequently LMA was inserted when the patient was in deep anesthesia status and maintained on (50% N2O, 50% O2) and 3% sevoflurane. Spontaneous ventilation was maintained throughout the procedure and LMA was removed in deep anesthesia. Outcomes (cough, laryngospasm, bronchospasm and vomiting) were evaluated peri-operatively and one day post-operation..

One hundred and twenty four patients fulfilled the trial. Cough (primary outcome) was significantly more frequent among those with topical compared with intravenous lidocaine (46% vs. 26%; P = 0.004). The incidence of laryngospasm (32% vs. 27%), bronchospasm (18% vs. 12%), desaturation (18% vs. 12%) and vomiting (5% vs. 2%) was not statistically different between the groups..

The pediatric patients undergoing general anesthesia with LMA with intravenous lidocaine experienced fewer incidence of postoperative cough compared to the ones in the topical lidocaine group..

Although local anesthesia is a suitable method for upper limb surgeries, there is debate regarding the effects of appropriate dosing.. In the current study, we investigated the effects of the concentration and volume of a local anesthetic on the beginning and quality of anesthesia during upper limb orthopedic surgeries..Patients and This double-blinded, randomized, clinical trial was conducted on 60 patients aged between 18 and 85 years candidated for upper limb orthopedic operations. The patients were equally and randomly distributed into two groups (n = 30). Under ultrasound imaging guidance, the first group received 7 mL of 2% lidocaine and the second group 10 mL of 1.3% lidocaine into the brachial plexus cords. The onset of block and the level of sensory and motor block were documented for each nerve territory.. The onset of sensory and motor block was significantly shorter in the 1.3% lidocaine group than in the 2% lidocaine group (P ≤ 0.05). The success rate of sensory and motor block was not different. The quality (completeness) of sensory block for the musculocutaneous nerve and that of motor block for the radial nerve were significantly better in the 1.3% lidocaine group than in the 2% lidocaine group.. The volume of the injected anesthetic accelerated the onset of sensory and motor block without affecting the rate of success in our patients..

Heparinized saline solution is used to prevent occlusion in the arterial catheters and central venous pressure monitoring catheters. Even at low dose, heparin administration can be associated with serious complications. Normal saline solution can maintain patency of arterial catheters and central venous pressure monitoring catheters.. The current study aimed to compare the efficacy of normal saline with that of heparinized one to maintain patency of arterial and central venous catheters after cardiac surgery..Patients and In the current randomized controlled trial, 100 patients, with an age range of 18 - 65 years of valve and coronary artery surgery were studied in Rajaie heart center, Tehran, Iran. Patients were randomized to receive either heparinized saline (n = 50) or normal saline flush solutions (n = 50). In the study, arterial catheters and central venous pressure monitoring catheters were daily checked for any signs of occlusion in three postoperative days as primary end-point of the study.. According to the information obtained from the study, four (8%) arterial catheters in the saline group (P value: 0.135) and three (6%) arterial catheters in the heparin group (P value = 0.097) were obstructed. Statistical analysis showed that the incidence of obstruction and changes in all other parameters between the two groups during the three-day follow-up was not significant (all P values > 0.05).. It seems that there is no difference in the use of heparinized and normal saline solutions to prevent catheter occlusion of arterial and central venous pressure..

Preoperative anxiety is associated with adverse clinical, behavioral, and psychological outcomes. Various effective interventions targeting preoperative anxiety in children exist.. The aim of this study was to evaluate the educational intervention by residents on children and maternal anxiety and their satisfaction from anxiety management..Patients and After obtaining the institutional ethics committee approval and written informed parental consent, 36 ASA-I, II children (age range, 8 - 10 years) underwent small operations were included in this prospective randomized study. The participants were allocated into the intervention (n =18) and control (n =18) groups. Children in the first group were prepared routinely. In the second group children and their mothers received data about anesthesia and operation by the booklet. Children-maternal anxiety was assessed using the anxiety level form, at the night and in the morning before surgery. Few days after surgery mothers, residents, and children experiences and satisfaction from anxiety management were assessed in the focus group discussion.. Mean scores and standard deviations of state anxiety in the intervention group before and after training were 33.1 ± 5.5 and 30.8 ± 6, respectively (P = 0.06). In the control group it was 32 ± 6.5 on the night and 34.1 ± 6.7 in the morning before surgery (P = 0.00). Comparison between groups was not significant (P = 0.6) and (P = 0.1). The mean levels of anxiety in the control group mothers on the night before and in the morning of surgery were 39.2 ± 13.1 and 42.8 ± 14 (P = 0.00), respectively. In the intervention group, mothers’ anxiety before education was 41 ± 12.7 and after education it was 35.6 ± 9.5 (P = 0.04). Comparison between groups was not significant (P = 0.7) and (P = 0.1). According to the focus group discussions, booklet study, provided education, sympathy of medical team, spiritual issues and beliefs reduced anxiety and fear of surgery. Anesthesia and lack of knowledge of what will happen, crying and restlessness of children increased preoperative anxiety.. In this study, the preoperative anxiety was reduced by explaining anesthesia and surgery to the mothers and children (in mothers it was significant P < 0.05). Since there is a direct relation between mothers’ and their children’s anxiety, using an effective method to reduce anxiety in children and their mothers together at the same time would be very useful for children and their mothers..

The effects of chronic pain (CP) on physical function and emotional and mental health of individuals, families, and community are well established. No adequate research is conducted in this field in Iran.. The current study aimed to assess the prevalence of CP, types of treatments used for CP and patients’ satisfaction with the CP treatments in an Iranian urban population..Patients and In the current study, CP was investigated using the international CP questionnaire administered to 1,050 adults living in Shiraz, Iran. The questionnaire consisted of 28 questions used to evaluate the effects of CP on the studied population including the prevalence of CP, pharmacological and non-pharmacological treatments for CP, and participants’ satisfaction with CP treatments. All the statistical analyses were performed using SPSS software, version 18.. In the current study, 6.95% of the 1,050 subjects willing to participate in the study had CP for more than six months. According to the results, 54% of the subjects with CP used analgesics, mostly non-steroidal anti-inflammatory drugs (NSAIDs) and narcotic analgesics. Besides, 37% of the subjects used other pain relief methods such as traditional medicine and acupuncture. The results also showed an acceptable rate of satisfaction with treatments.. The number of subjects with CP proved it as a prevalent problem in the study population. Furthermore, characteristics and associations of those experiencing CP demonstrated that it might have significant negative health and psychosocial outcomes in this group. The problem was found significant enough to consider special health programs to prevent and manage CP in urban population of Shiraz..

Opium is an addictive agent and one of the most common narcotics With great challenges of intraoperative hemodynamic instabilities.. The current study aimed to assess the effects of clonidine on intraoperative blood loss in patients with and without opium addiction in femoral fracture surgeries..Patients and In a randomized clinical trial, 160 candidates for elective femoral fracture operations under general anesthesia were divided into four groups of 40 subjects: group 1 (placebo 1), subjects without addiction received placebo 90 minutes before the operation; group 2 (placebo 2), patients with opium addiction received placebo as group 1; group 3 (Clonidine 1), patients without addiction received clonidine 90 minutes before the operation and group 4 (Clonidine 2), patients with opium addiction received clonidine as premedication.. Intraoperative blood loss in clonidine recipient groups, patients with and without addiction, was less than that of the placebos (both P values < 0.01) and the difference magnitude was higher in patients with opium addiction.. Premedication with clonidine to decrease intraoperative blood loss can be more effective in patients with opium addiction than the ones without addiction..