فهرست مطالب

Anesthesiology and Pain Medicine - Volume:6 Issue: 1, 2016
  • Volume:6 Issue: 1, 2016
  • تاریخ انتشار: 1394/11/20
  • تعداد عناوین: 20
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  • Mansoureh Gorginzadeh, Farnad Imani, Saeid Safari* Page 1
  • Aries Perdana *, Alfan Mahdi Nugroho, Ade Ariadi, Diatri Nari Lastri Page 2
    Background
    The practice of anesthesia requires good awareness, parallel decision-making and fine motor skills. The duration of working hours of anesthesiology residents is often more than 12 hours..
    Objectives
    This study aimed to measure cognitive and psychomotor functions of anesthesiology residents after 12 working hours..Patients and
    Methods
    This was an observational study on anesthesiology residents who underwent 12 working hours. Each subject, who fulfilled inclusion and exclusion criteria, had their cognitive and psychomotor functions tested at 0 and 12 hours. The cognitive function was measured by “Cognitive Stimulation” test, while the psychomotor function was measured by the grooved pegboard. Statistical analysis was conducted to compare the results between 0 and 12 hours..
    Results
    Cognitive Stimulation” test revealed statistically significant decrease at sequential image frequency stimulation (P = 0.035). Other stimulation tests did not show any statistically significant result. Grooved pegboard test showed statistically significant decrease in psychomotor function from 0 to 12 hours (P = 0.037)..
    Conclusions
    There was a decrease in cognitive function, including attention, visual memory, naming, and executive function, as well as psychomotor function among residents of Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, who underwent 12 working hours..
    Keywords: Anesthesiology, Executive Function, Psychomotor Performance
  • Farsad Imani, Hamid Reza Karimi Rouzbahani, Mehrdad Goudarzi, Mohammad Javad Tarrahi, Alireza Ebrahim Soltani* Page 3
    Background
    During anesthesia, continuous body temperature monitoring is essential, especially in children. Anesthesia can increase the risk of loss of body temperature by three to four times. Hypothermia in children results in increased morbidity and mortality. Since the measurement points of the core body temperature are not easily accessible, near core sites, like rectum, are used..
    Objectives
    The purpose of this study was to measure skin temperature over the carotid artery and compare it with the rectum temperature, in order to propose a model for accurate estimation of near core body temperature..Patients and
    Methods
    Totally, 124 patients within the age range of 2 - 6 years, undergoing elective surgery, were selected. Temperature of rectum and skin over the carotid artery was measured. Then, the patients were randomly divided into two groups (each including 62 subjects), namely modeling (MG) and validation groups (VG). First, in the modeling group, the average temperature of the rectum and skin over the carotid artery were measured separately. The appropriate model was determined, according to the significance of the model’s coefficients. The obtained model was used to predict the rectum temperature in the second group (VG group). Correlation of the predicted values with the real values (the measured rectum temperature) in the second group was investigated. Also, the difference in the average values of these two groups was examined in terms of significance..
    Results
    In the modeling group, the average rectum and carotid temperatures were 36.47 ± 0.54°C and 35.45 ± 0.62°C, respectively. The final model was obtained, as follows: Carotid temperature × 0.561 + 16.583 = Rectum temperature. The predicted value was calculated based on the regression model and then compared with the measured rectum value, which showed no significant difference (P = 0.361)..
    Conclusions
    The present study was the first research, in which rectum temperature was compared with that of skin over carotid artery, to find a safe location with easier access and higher accuracy for estimating near core body temperature. Results obtained in this study showed that, using a model, it is possible to evaluate near core body temperature in children, by measuring skin temperature over carotid artery..
    Keywords: Anesthesia, Hypothermia, Child, Carotid Arteries, Temperature
  • Majid Kiavar, Rasoul Azarfarin, Ziae Totonchi, Fatemeh Tavakoli*, Azin Alizadehasl, Mitra Teymouri Page 4
    Background
    Critical-care patients are at higher risk of untreated pain, because they are often unable to communicate owing to altered mental status, tracheal intubation and sedation..
    Objectives
    This study compared two pain assessment tools on tracheal intubated critically ill patients in a cardiac post-anesthesia care unit, who were unable to communicate verbally. The studied tools were “critical-care pain observation tool (CPOT)” and “facial expression (FE)”..Patients and
    Methods
    This was a prospective study based on diagnostic test evaluation. A sample of 91 intubated patients was selected from cardiac post-anesthesia care unit. Collected data were demographic characteristics, vital signs, FE and CPOT tools’ scale. Pain was assessed with CPOT and FE scores five times. The first assessment was performed in at least 3 hours after admission of patients to ICU. Then, the pain intensity was reassessed every 30 minutes. In addition, blood pressure, heart rate, respiratory rate and oxygen saturation were measured simultaneously..
    Results
    At the first period, the frequency of “severe” pain intensity using the CPOT was 58.2% and with the FE tool was 67% (P = 0.001). Both tools demonstrated reduction in severity of pain on second and third assessment times. Significantly increasing level of pain and blood pressure due to nursing painful procedures (endo-tracheal suctioning, changing patient’s position, etc.), were obtained by CPOT in fourth assessment. FE was not able to detect such important findings (κ = 0.249). In the fifth step, pain intensity was reduced. The most agreement between the two tools was observed when the reported pain was “severe” (κ = 0.787, P < 0.001) and “mild” (κ = 0.851, P < 0.001)..
    Conclusions
    The sensitivity of CPOT was higher for detection and evaluation of pain in intubated postoperative patients compared with “Facial Expression”. Best agreement between these tools was observed in two extremes of pain intensity..
    Keywords: Pain Assessment, Intensive Care Unit, Cardiac Surgery
  • Saeed Mohammadi, Mohammad Zarei *, Mohammad Mahdi Zarei, Iraj Salehi Page 5
    Background
    The drive toward the use of medicinal plants has been increasing in recent years. They have few side effects and a large variety of efficient components..
    Objectives
    This study was designed to investigate the analgesic effects of hydroalcoholic Rhus coriaria leaf extract (HRCLE) in a rat model..
    Materials And Methods
    A total of 42 adult male rats were divided into seven groups: a control group (the animals did not receive any drug), three HRCLE groups, (receiving 80, 100, and 300 mg/kg, intraperitoneally [ip]), a morphine group (1 mg/kg, ip) an aspirin group (1 mg/kg, ip), and a group that received 300 mg/kg of HRCLE plus naloxone (1 mg/kg, ip). The analgesic effects of HRCLE were assessed via writhing, tail flick, and formalin tests, and the data obtained were compared with the control group using one-way analysis of variance and Tukey post hoc tests..
    Results
    HRCLE significantly inhibited the number of contractions induced by acetic acid in the writhing test at all doses, while anti-nociceptive activity was only shown at the 100 mg/kg dose (in the chronic phase) and at the 300 mg/kg dose (in the chronic-acute phase) in the formalin test. Interestingly, the greatest effect was observed at the 300 mg/kg HRCLE dose in the tail flick test. Simultaneous utilization of naloxone and HRCLE inhibited the anti-nociceptive effect of the extract in all tests. It is worth mentioning that aspirin and morphine revealed anti-nociceptive effects in all tests..
    Conclusions
    Our findings suggest that the analgesic effect of HRCLE may be mediated via both peripheral and central mechanisms. The presence of flavonoids might be responsible for the anti-nociceptive activity of this plant..
    Keywords: Pain, Formaldehyde, Medicinal Plants, Rats, Saponins, Flavonoids, Rhus coriaria
  • Mahmood Hosseinzadeh Maleki, Pooya Derakhshan*, Amir Rahmanian Sharifabad, Ahmad Amouzeshi Page 6
    Background
    The ideal strategy to prime the cardiopulmonary bypass (CPB) circuit in adult cardiac surgery is still a matter of debate..
    Objectives
    In this retrospective study, we examined Albumin solution and hydroxyethyl starch (HES) for priming the CPB circuit and evaluated the differences in kidney function and bleeding and coagulation status in the two groups of patients..Patients and
    Methods
    Sixty consecutive patients undergoing elective coronary artery bypass grafting were studied. Patients were excluded due to emergency surgery, history of cardiac surgery, history of receiving medication with antiplatelet agents except ASA 80 (mg/day) within the previous five days, preoperative coagulation disorder, left ventricular ejection fraction less than 50%, preoperative renal dysfunction (serum creatinine > 1.4 mg/dL), preoperative hepatic dysfunction (serum aspartate/alanine amino transferase > 60 U/l), preoperative electrolyte imbalance, known hypersensitivity to HES and chronic diuretic therapy. The patients were divided randomly into two groups of HES (n = 30) and Albumin (n = 30). Hemodynamic parameters, serum creatinine concentrations and glomerular filtration rate, PT, PTT and INR were measured. Early bleeding was measured according to the first 24-hour drainage from the tube. Hemodynamics and all laboratory measurements were performed after induction of anesthesia and at the morning of the first, second and third postoperative days in the ICU..
    Results
    GFR differences were statistically lower in Albumin group in comparison with Group B at 24, 48 and 72 hours postoperation. Platelet count difference and postoperative bleeding were significantly lower in Albumin group..
    Conclusions
    Administration of Albumin compared to HES in patients with a normal renal function results in a lower drop of GFR and platelet count, less bleeding and lower rise of serum creatinine..
    Keywords: Cardiopulmonary Bypass, Albumin
  • Bahman Hasannasab, Nadia Banihashem*, Arash Khoshbakht Page 7
    Background
    Postanaesthetic shivering is one of the most common unpleasant complications in patients..
    Objectives
    The aim of this study was to compare the efficacy of doxapram, ketamine and meperidine in prevention of shivering after anaesthesia..Patients and
    Methods
    In this randomized, double-blind clinical trial, 120 patients aged between 20 - 45 years old under general anaesthesia were enrolled. The patients were randomly allocated into one of three groups: group M received 20 mg meperidine (n = 40), group K received 0.25 mg/kg ketamine (n = 40) and group D received 0.25 mg/kg doxapram (n = 40). All of the drugs were administered intravenously. The core temperature, shivering, time of the first postoperative analgesic requirement, and some of the other side effects were recorded. Obtained data from the three groups were compared using one-way ANOVA and chi-square test..
    Results
    Three patients (7.5%) of group K, four patients (10%) of group D and one patient (2.5%) of group M experienced shivering (P = 0.39). The interval to the first analgesic requirement significantly prolonged in the groups K and M compared to the group D (P < 0.001). No significant differences were identified in nausea and vomiting among the groups. No significant pharmaceutical adverse effects were observed in our study..
    Conclusions
    The results of this study showed that ketamine, doxapram and meperidine are equally effective in the prevention of postoperative shivering..
    Keywords: Doxapram, Ketamine, Meperidine, Postanaesthetic Shivering
  • Ozkan Onal*, Gulten Ozgun Page 8
    Background
    Elderly patients constitute the majority of patients undergoing treatment in the intensive care unit (ICU). Patients over the age of 65 account for 42%–52% of admission to ICU. Previous studies have shown that malnutrition is an important factor influencing the prognosis in intensive care..
    Objectives
    In this study, the effect of body mass index (BMI) and albumin values at first admission to the ICU on the course and prognosis of geriatric patients were investigated..Patients and
    Methods
    Patients over the age of 65 who were admitted to the anesthesia ICU were included in the study. Demographic and clinical data were recorded retrospectively. Major outcome variables were length of ICU and hospital stay, mortality rate, BMI, and albumin values. APACHE II and SOFA scores at admission were evaluated..
    Results
    Overall, 113 patients were included in the study. Mean BMI (kg/m2) value was found to be lower in the died group than in the discharged and transferred groups (P < 0.001). Albumin levels were lower in the died group than in the discharged and transferred groups (P < 0.001). An inverse relation was found between Apache and BMI and albumin values, whereas a significant direct relation was found between Apache and mechanical ventilation day (P < 0.05). A significant negative correlation was found between SOFA and BMI and albumin, values, respectively, and a positive correlation was found between SOFA and mechanical ventilation duration (P < 0.005)..
    Conclusions
    In this study, a low albumin level (≤ 3 mg/dL) was an indicator of nutritional status. Patients’ albumin levels, BMI, nutritional status, APACHE II score, and SOFA score were associated with mortality. Age in itself did not predict mortality in the elderly..
    Keywords: Elderly, Intensive Care Unit, Mortality, Serum Albumin, Body Mass Index
  • Mohammad Taghi Beigmohammadi, Zahid Hussain Khan *, Shahram Samadi, Ata Mahmoodpoor, Akbar Fotouhi, Abbas Rahimiforoushani, Mehrnaz Asadi Gharabaghi Page 9
    Background
    Hematocrit (Hct) is an important parameter for optimal oxygenation during discontinuation from ventilator, but there is no consensus about its concentration and effectiveness on successful extubation..
    Objectives
    The current study aimed to determine the role of Hct concentration on extubation failure in critically ill patients..Patients and
    Methods
    The current prospective cohort study investigated the effect of age, gender and Hct level on successful extubation of 163 mechanically ventilated patients in Imam Khomeini hospital intensive care units (ICUs), Tehran, Iran. Following successful weaning process, the patients were classified into two groups on the basis of Hct level; 62 with an Hct level of 21% - 27% and the other 101 patients with Hct levels above 27%. The data were analyzed by chi-square test and multiple logistic regressions. A probability value of less than 0.05 was considered significant..
    Results
    There was no significant association between the level of Hct concentration and extubation failure (8.9% vs. 9.2%, P = 0.507). Gender and age were significantly associated with extubation failure (OR = 9.1, P = 0.034, OR = 12.5, P = 0.014, respectively). Although the differences between, before and after extubation of PaO2 and P/F ratio, were of significant values between the two different groups of Hct (P = 0.001, P = 0.004 respectively), they had no effect on the failure of extubation (P= 0.259, P = 0.403, respectively)..
    Conclusions
    Although some studies showed association between anemia and extubation failure, the current study could not confirm it. The study showed that males, regardless of the Hct level, had a better extubation success rate than those of females..
    Keywords: Airway Extubation, Anemia, Hematocrit, Critical Illness
  • Manish Tandon *, Anshuman Singh, Vandana Saluja, Mandeep Dhankhar, Chandra Kant Pandey, Priyanka Jain Page 10
    Background
    Pain scores are used for acute pain management. The assessment of pain by the patient as well as the caregiver can be influenced by a variety of factors. The numeric rating scale (NRS) is widely used due to its easy application. The NRS requires abstract thinking by a patient to assign a score to correctly reflect analgesic needs, and its interpretation is subject to bias..
    Objectives
    The study was done to validate a 4-point objective pain score (OPS) for the evaluation of acute postoperative pain and its comparison with the NRS..Patient and
    Methods
    A total of 1021 paired readings of the OPS and NRS of 93 patients who underwent laparotomy and used patient-controlled analgesia were evaluated. Acute pain service (APS) personnel recorded the OPS and NRS. Rescue analgesia was divided into two incremental levels (level 1-paracetamol 1 g for NRS 2 - 5 and OPS 3, Level 2-Fentanyl 25 mcg for NRS ≥ 6 and OPS 1 and 2). In cases of disagreement between the two scores, an independent consultant decided the rescue analgesia..
    Results
    The NRS and OPS agreed across the range of pain. There were 25 disagreements in 8 patients. On 24 occasions, rescue analgesia was increased from level 1 to 2, and one occasion it was decreased from level 2 to 1. On all 25 occasions, the decision to supplement analgesia went in favor of the OPS over the NRS. Besides these 25 disagreements, there were 17 occasions in which observer bias was possible for level 2 rescue analgesia..
    Conclusions
    The OPS is a good stand-alone pain score and is better than the NRS for defining mild and moderate pain. It may even be used to supplement NRS when it is indicative of mild or moderate pain..
    Keywords: Pain Assessment, Acute Pain Service, Postoperative Pain
  • Farnoush Farzi, Bahram Naderi Nabi, Ali Mirmansouri *, Fereshteh Fakoor, Zahra Atrkar Roshan, Gelareh Biazar, Tayyebeh Zarei Page 11
    Background
    Uncontrolled postoperative pain, characteristic to abdominal hysterectomy, results in multiple complications. One of the methods for controlling postoperative pain is preemptive analgesia. Gabapentin and tramadol are both used for this purpose..
    Objectives
    This study aims to compare the effects of tramadol and gabapentin, as premedication, in decreasing the pain after hysterectomy..Patients and
    Methods
    This clinical trial was performed on 120 eligible elective abdominal hysterectomy patients, divided in three groups of 40, receiving tramadol, gabapentin and placebo, respectively. Two hours before the surgery, the first group was given 300 mg gabapentin, the second one was given 100 mg tramadol, while the other group was given placebo, with 50 ml water. After the surgery, in case of visual analog pain scale (VAS) > 3, up to 3 mg of diclofenac suppository would be used. Pain score, nausea, vomiting, sedation, patient’s satisfaction and the number of meperidine administered during 24 hours (1 - 4 - 8 - 12 - 16 - 20 - 24 hours) were recorded. If patients had VAS > 3, despite using diclofenac, intravenous meperidine (0.25 mg/kg) would be prescribed. Data were analyzed using SPSS 21 software, chi-square test, general linear model and repeated measurement..
    Results
    The three groups were similar regarding age and length of surgery (up to 2 hours). The average VAS, in the placebo group, was higher than in the other two groups (P = 0.0001) and the average received doses of meperidine during 24-hour time were considerably higher in placebo group, compared to the other two groups (55.62 mg in placebo, 18.75 mg in gabapentin and 17.5 mg in tramadol groups, P = 0.0001). Nausea, vomiting and sedation, in the tramadol group, were higher than in the other two groups, although they were not significant. Patients’ dissatisfaction, in the placebo group, during initial hours, especially in the fourth hour, was higher (P = 0.0001). In the gabapentin and tramadol groups, the trend of changes in satisfaction score was similar. However, satisfaction in the gabapentin group, during the initial 4 hours was higher, in comparison to the tramadol group (P = 0.0001)..
    Conclusions
    This study revealed that prescribing gabapentin or tramadol, as premedication, was effective in reducing postoperative pain, without any concerning side-effects..
    Keywords: Gabapentin, Pain Postoperative, Tramadol, Hysterectomy, Analgesia, Preanesthetic Medication
  • Afshin Gholipour Baradari, Abolfazl Firouzian *, Alieh Zamani Kiasari, Mohsen Aarabi, Seyed Abdollah Emadi, Ali Davanlou, Nima Motamed, Ensieh Yousefi Abdolmaleki Page 12
    Background
    Laryngoscopy and intubation frequently used for airway management during general anesthesia, is frequently associated with undesirable hemodynamic disturbances..
    Objectives
    The aim of this study was to compare the effects of etomidate, combination of propofol-ketamine and thiopental-ketamine as induction agents on hemodynamic response to laryngoscopy and intubation..Patients and
    Methods
    In a double blind, randomized clinical trial a total of 120 adult patients of both sexes, aged 18 - 45 years, scheduled for elective surgery under general anesthesia were randomly assigned into three equally sized groups. Patients in group A received etomidate (0.3 mg/kg) plus normal saline as placebo. Patients in group B and C received propofol (1.5 mg/kg) plus ketamine (0.5 mg/kg) and thiopental sodium (3 mg/kg) plus ketamine (0.5 mg/kg), respectively for anesthesia induction. Before laryngoscopy and tracheal intubation, immediately after, and also one and three minutes after the procedures, hemodynamic values (SBP, DBP, MAP and HR) were measured..
    Results
    A repeated measurement ANOVA showed significant changes in mean SBP and DBP between the time points (P < 0.05). In addition, the main effect of MAP and HR were statistically significant during the course of study (P < 0.05). Furthermore, after induction of anesthesia, the three study groups had significantly different SBP, DBP and MAP changes overtime (P < 0.05). However, HR changes over time were not statistically significant (P > 0.05). Combination of propofol-ketamine had superior hemodynamic stability compared to other induction agents..
    Conclusions
    Combination of propofol-ketamine may be recommended as an effective and safe induction agent for attenuating hemodynamic responses to laryngoscopy and intubation with better hemodynamic stability. Although, further well-designed randomized clinical trials to confirm the safety and efficacy of this combination, especially in critically ill patients or patients with cardiovascular disease, are warranted..
    Keywords: Etomidate, Propofol, Ketamine, Thiopental, Hemodynamics, Laryngoscopy
  • Shun Muramatsu, Seiji Shiraishi, Kanako Miyano, Yuka Sudo, Akiko Toda, Masayuki Mogi, Mayumi Hara, Akinobu Yokoyama, Yoshihiko Kawasaki, Mikio Taniguchi, Yasuhito Uezono* Page 13
    Background
    Acetaminophen, an analgesic and antipyretic drug, has been used clinically for more than a century. Previous studies showed that acetaminophen undergoes metabolic transformations to form an analgesic compound, N-(4-hydroxyphenyl) arachidonamide (AM404), in the rodent brain. However, these studies were performed with higher concentrations of acetaminophen than are used in humans..
    Objectives
    The aim of the present study was to examine the metabolism of AM404 from acetaminophen in the rat brain at a concentration of 20 mg/kg, which is used in therapeutic practice in humans, and to compare the pharmacokinetics between them..
    Materials And Methods
    We used rat brains to investigate the metabolism of AM404 from acetaminophen at concentrations (20 mg/kg) used in humans. In addition, we determined the mean pharmacokinetic parameters for acetaminophen and its metabolites, including AM404..
    Results
    The maximum plasma concentrations of acetaminophen and AM404 in the rat brain were 15.8 µg/g and 150 pg/g, respectively, with corresponding AUC0-2h values of 8.96 μg hour/g and 117 pg hour/g. The tmax for both acetaminophen and AM404 was 0.25 hour..
    Conclusions
    These data suggest that AM404’s concentration-time profile in the brain is similar to those of acetaminophen and its other metabolites. Measurement of blood acetaminophen concentration seems to reflect the concentration of the prospective bioactive substance, AM404..
    Keywords: Acetaminophen, N, (4, Hydroxyphenyl) Arachidonamide (AM404), Brain, Pharmacokinetics
  • Kianoush Saberi *, Mohammad Amin Gorji Mahlabani, Mohammad Tashayoie, Farinaz Nasiri Nejad Page 14
    Background
    Because the trend of pharmacotherapy is toward controlling diet rather than administration of drugs, in our study we examined the probable relationship between Creatine (Cr) or Whey (Wh) consumption and anesthesia (analgesia effect of ketamine). Creatine and Wh are among the most favorable supplements in the market. Whey is a protein, which is extracted from milk and is a rich source of amino acids. Creatine is an amino acid derivative that can change to ATP in the body. Both of these supplements result in Nitric Oxide (NO) retention, which is believed to be effective in N-Methyl-D-aspartate (NMDA) receptor analgesia..
    Objectives
    The main question of this study was whether Wh and Cr are effective on analgesic and anesthetic characteristics of ketamine and whether this is related to NO retention or amino acids’ features.
    Materials And Methods
    We divided 30 male Wistar rats to three (n = 10) groups; including Cr, Wh and sham (water only) groups. Each group was administered (by gavage) the supplements for an intermediate dosage during 25 days. After this period, they became anesthetized using a Ketamine-Xylazine (KX) and their time to anesthesia and analgesia, and total sleep time were recorded..
    Results
    Data were analyzed twice using the SPSS 18 software with Analysis of Variance (ANOVA) and post hoc test; first time we expunged the rats that didn’t become anesthetized and the second time we included all of the samples. There was a significant P-value (P < 0.05) for total anesthesia time in the second analysis. Bonferroni multiple comparison indicated that the difference was between Cr and Sham groups (P < 0.021)..
    Conclusions
    The data only indicated that there might be a significant relationship between Cr consumption and total sleep time. Further studies, with rats of different gender and different dosage of supplement and anesthetics are suggested..
    Keywords: Creatine, Whey, Ketamine, Anesthesia, Analgesia
  • Ata Mahmoodpoor, Hadi Hamishehkar, Mohammad Tagi Beigmohammadi, Sarvin Sanaie, Kamran Shadvar, Hassan Soleimanpour, Ahsan Rahimi, Saeed Safari, Maryam Soleimapour* Page 15
    Background
    Hypoglycemia is a common and the most important complication of intensive insulin therapy in critically ill patients. Because of hypoglycemia’s impact on the cardinal organs as a fuel, if untreated it could results in permanent brain damage and increased mortality..
    Objectives
    In this study, we aim to evaluate the incidence of hypoglycemia, its risk factors, and its relationship with mortality in critically ill patients..Patients and
    Methods
    Five hundred adult patients who admitted to an intensive care unit (ICU) were enrolled in this study. A program of glycemic control with a target of 100 - 140 mg/dL was instituted. We used the threshold of 150 mg/dL for septic patients, which were monitored by point of care devices for capillary blood measurement. We detected hypoglycemia with a blood sugar of less than 50 mg/dL and with the detection of each episode of hypoglycemia, blood glucose measurement was performed every 30 minutes..
    Results
    Five hundred patients experienced at least one episode of hypoglycemia, almost always on the third day. Of 15 expired patients who had one hypoglycemia episode, the most common causes were multiple trauma and sepsis. Increases in the sequential organ failure assessment (SOFA) number augmented the hypoglycemia risk to 52% (P < 0.001). Moreover, in patients with acute kidney injury (AKI), the risk of hypoglycemia is 10 times greater than in those without AKI (RR: 10.3, CI: 3.16 - 33.6, P < 0.001). ICU admission blood sugar has a significant relationship with mortality (RR: 1.01, CI: 1.004 - 1.02, P < 0.006). Hypoglycemia increased the mortality rate twofold, but it was not significant (RR: 1.2, CI: 0.927 - 1.58, P = 0.221)..
    Conclusions
    Our results showed that the SOFA score, AKI, and hemoglobin A1c are the independent risk factors for the development of hypoglycemia and demonstrated that ICU admission blood glucose, Hba1c, and hypoglycemia increased the risk of death, but only ICU admission blood glucose is significantly related to increased mortality..
    Keywords: Hypoglycemia, Risk Factors, Mortality, Intensive Care Unit
  • Farhad Safari, Reza Aminnejad, Seyed Amir Mohajerani, Farshad Farivar, Kamran Mottaghi, Hasan Safdari * Page 16
    Background
    Addicted patients have innate tolerance to local anesthetics in both neuraxial and peripheral blocks. Dexmedetomidine (Dex) is a highly selective α2 adrenergic receptor agonist used as additive to increase quality and duration of peripheral nerve blocks..
    Objectives
    The current study aimed to compare the effect of dexmedetomidine and fentanyl additives on bupivacaine to prolong the duration of block and minimizing side effects..Patients and
    Methods
    Patients were candidates for elective surgery less than three hours of lower abdomen or lower extremities surgeries. Patients were randomly allocated to receive dexmedetomidine 5 µg added to 12.5 mg (2.5 mL) of 0.5% hyperbaric bupivacaine (DEX group), or 25 µg (0.5 mL) fentanyl added to 12.5 mg (2.5 mL) of 0.5% hyperbaric bupivacaine (F group) or only 12.5 mg of 0.5% hyperbaric bupivacaine. Data were recorded based on sensory block. Motor block was tested using modified Bromage scale every 30 minutes until the end of block. Time to return of sensory block to 4 dermatomes below and time to return of Bromage scale to 0 were recorded. All vital measurements (oxygen saturation, heart rate, electrocardiogram, and non-invasive blood pressure) were performed at 0, 30, 60, 90, 120 and 180 minutes in all three groups of the study. Group DEX received dexmedetomidine additive and group F received fentanyl additive and group C (control) received normal saline..
    Results
    Totally, 84 patients were randomly divided into three groups of 28 patients. Onset of sensory block in DEX group was significantly lower than those of fentanyl (P = 0.012) and control groups (P = 0.001). Duration of sensory block was significantly longer in DEX group compared to Fentanyl (P = 0.043) and control (P = 0.016) groups. Duration of motor block in the DEX group was significantly longer than those of the fentanyl (P = 0.014) and control groups. Heart rate and mean arterial pressure were significantly higher in the DEX group at 30, 60, 90,120, and 180 minutes compared to those of the other two groups (P < 0.05)..
    Conclusions
    Dexmedetomidine added to bupivacaine in spinal anesthesia is more effective to increase duration of block, providing more appropriate sedation and less postoperative pain scale and post-operative nausea and vomiting (PONV) compared to fentanyl additive..
    Keywords: Dexmedetomidine, Fentanyl, Bupivacaine, Spinal Anesthesia, Addicted Patients, Addiction
  • Hosein Kimiaei Asadi, Mahshid Nikooseresht*, Lida Noori, Fatholah Behnoud Page 17
    Background
    Tonsillectomy is one of the most common surgeries in children and posttonsillectomy pain and agitation management is a great challenge for anesthesiologists..
    Objectives
    The aim of this study was to compare the efficacy of a single dose of ketamine combined with paracetamol with paracetamol alone in the management of postoperative pain in tonsillectomy..
    Materials And Methods
    In this study, the subjects were randomly allocated into the two groups: the ketamine and control. Intravenous paracetamol infusion (15 mg/kg) was started 15 minutes before the end of surgery in both groups, continued with the IV injection of ketamine (0.25 mg/kg) in the ketamine group and an equal volume of saline in the control group. Using the children’s hospital of eastern Ontario (CHEOPS) pain scale, pain and agitation score and also the incidence of nausea and vomiting after the surgery were recorded in 0.5, 6 and 12 hours after the operation. Data were analyzed using SPSS software version 16 and P value less than 0.05 was considered as statistically significant in all cases..
    Results
    There was no significant difference between the two groups considering demographic data (age, sex distribution, weight and height). The CHEOPS pain scales were significantly lower in the ketamine group compared to the control group at 0.5 and 6 hours after the surgery (P = 0.003 and P = 0.023, respectively). There was no significant difference in the CHEOPS scale at 12 hours after the surgery, dose of adjuvant analgesic and the incidence of nausea and vomiting after the surgery between the two groups..
    Conclusions
    According to the results of the current study, postoperative analgesia in children was improved in the ketamine group. Therefore, for better management of posttonsillectomy pain, low-dose ketamine administration with paracetamol is recommended..
    Keywords: Paracetamol, Ketamine, Tonsillectomy, Pain
  • Zahid Hussain Khan*, Shahram Samadi, Sanaz Ameli, Cyrus Emir Alavi Page 18
    Introduction
    Induction of anaesthesia and its associated spikes in blood pressure can cause rupture of an aneurysm during intracranial surgery. Lidocaine can reportedly provide hemodynamic stability when applied before endotracheal intubation. Rapid injection of large doses of lidocaine can cause unconsciousness..
    Case Presentation
    Lidocaine was applied as the sole anaesthetic for induction and maintenance during aneurysm surgery in four patients undergoing intracranial aneurysm surgery. Blood pressure alteration after induction and during surgery, bleeding, brain laxity, intracranial pressure and extubation time were acceptable..
    Conclusions
    Although propofol remains a standard agent for such types of surgeries, lidocaine proved equally effective and coupled with its low cost, minimal side effects and omission of other hypnotic agents was a plausible induction agent and a maintenance drug in the selected cases..
    Keywords: Anaesthesia, Clipping, Lidocaine, Intracranial Aneurysm
  • Bartosz Godlewski *, Grzegorz Klauz, Ryszard Czepko Page 19
    Introduction
    Spinal tumours may be classified in three groups: 1) extradural, 2) intradural extramedullary and 3) intramedullary spinal cord tumours. Intradural extramedullary tumours arise from the leptomeninges or nerve roots and include schwannomas. A schwannoma is usually a firm grey-whitish tumour growing near a nerve trunk or ramus. It can be separated from the nerve without damaging neural tissue. Schwannomas are usually solitary tumours..
    Case Presentation
    We present the case of a 37-year-old male who underwent surgery for a tumour in the upper thoracic segment of the spinal canal. Although the tumour filled the spinal canal almost entirely, the patient did not manifest any neurological deficits. During the surgery, the tumour was removed completely. A histological examination confirmed a benign schwannoma lesion (WHO G1)..
    Conclusions
    The question whether doctors are keen to order more diagnostic investigations (including both laboratory and imaging studies) than are necessary is often asked in clinical practice. The cost factor is also important. Not every patient with back pain is referred for an MRI study in the absence of characteristic neurological signs. The case of our patient, however, speaks in favour of early referral for such diagnostic modalities. Appropriate imaging studies, even in patients presenting with no neurological deficits, may help detect pathologies than can lead to severe disability. A spinal canal tumour filling the spinal canal almost entirely and displacing the spinal cord could cause spinal cord damage at any time with all the dire consequences such as paraplegia and loss of the ability to walk..
    Keywords: Neuroradiology, Neurooncology, Schwannoma, Spinal Tumours
  • Ozkan Onal *, Muhammed Emin Zora, Ali Saltali, Serdal Bozdogan, Jale Bengi Celik Page 20