فهرست مطالب

Anesthesiology and Pain Medicine - Volume:8 Issue: 1, 2018
  • Volume:8 Issue: 1, 2018
  • تاریخ انتشار: 1397/01/30
  • تعداد عناوین: 10
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  • Sarvin Sanaie, Ata Mahmoodpoor, Hadi Hamishehkar, Kamran Shadvar, Nasim Salimi, Majid Montazer, Afshin Iranpour, Elnaz Faramarzi * Page 1
    Background
    Hypocalcemia is very common in critically ill patients admitted to ICU. However, its clinical importance and relation to patient’s outcome during early days of ICU admission is questionable. Based on the mentioned problem, it seems that calcium assessment is highly important in these patients. The present study aimed at evaluating the relationship between different calcium concentrations (total/ionized/corrected) and disease severity in critically ill patients.
    Methods
    A total of 100 patients admitted to intensive care units of Imam Reza and Shohada hospitals during Feb 2014 and Apr 2016 were enrolled in this prospective trial. Concentrations of total, corrected, and ionized calcium and their relationship with APACHE score and disease severity were noted during the study.
    Results
    There was a strong and inverse correlation between disease severity and ionized calcium concentration (P
    Conclusions
    A significant correlation was found between total and ionized calcium, but there was not any significant correlation between corrected and ionized calcium. Hypocalcemia is a predictor of disease severity and mortality. We recommend measuring ionized calcium concentration for patients admitted to ICU.
    Keywords: Serum Calcium, Hospital Mortality, Critically Ill Patients, Disease Severity
  • Zahra Vahdat Shariatpanahi, Fatemeh Jamshidi, Javad Nasrollahzadeh, Zohreh Amiri, Houman Teymourian * Page 2
    Background
    In patients admitted to the Intensive Care Unit (ICU), Enteral Nutrition (EN) is the first choice for feeding support, however, it is often complicated by gastrointestinal side effects, such as diarrhea. There are no studies that have specifically evaluated effect of a prebiotic, which prevents diarrhea during enteral nutrition.
    Objective
    This study aimed at evaluating the effect of honey in enteral diet during occurrence of diarrhea and fecal microbiotain in critically ill patients.
    Materials And Methods
    In this double-blind, randomized controlled single-center study, 32 patients were randomly selected to receive a high protein kitchen enteral diet and the study group had honey as 10% of its carbohydrate intake. Quantitative analyses of bifidobacterium and Lactobacillus species of fecal samples were assessed by Real-Time Polymerase Chain Reaction (PCR) on days 0 and 7.
    Results
    Patients in the honey group showed an insignificant increase in the frequency of bifidobacterium DNA by study day 7 in comparison with the control group. In the honey group, there was a considerable reduction in diarrhea (P = 0.09). A significant difference was found in length of Intensive Care Unit (ICU) stay (P = 0.001) and Sequential Organ Failure Assessment (SOFA) score (P = 0.04) in favor of the honey group.
    Conclusions
    Enteral nutrition with honey might reduce the length of stay at the ICU and development of organ failure in critically ill patients. It seems that honey helps reduce the incidence of diarrhea.
    Keywords: Enteral Nutrition, Diarrhea, Honey, Intestinal Microflora, ICU, PCR
  • Sarvin Sanaie, Issa Bilejani, Mirmohammadtaghi Mortazavi, Ata Mahmoodpoor, Sohrab Negargar, Elnaz Faramarzi, Nazanin Hazhir, Qasem Golalizadeh Bibalan, Hassan Soleimanpour * Page 3
    Background
    The prevalence of obesity has substantially increased all over the world in the past decades and anesthesiologists more commonly encounter these patients. Excess cervical adipose tissues can result in the narrowing of the pharyngeal opening and affect laryngoscopic grade.
    Objectives
    To evaluate the effect of manual caudal and cervical displacement of cervical adipose tissue on laryngoscopic view of morbid obese patients.
    Methods
    A total of 70 patients with a BMI ≥ 35 were enrolled in this study. All patients were placed in the ramp position. Manual caudal and downward displacement of cervical adipose tissue was performed by an anesthesiologist. Laryngoscopy was performed by an anesthesiologist before and after manual displacement. The anesthesiologist was blinded as we had drawn a curtain, therefore, he could not recognize if the maneuver was being performed or not. Thyromental distance, upper lip bite test, hyomental distance, and BMI were recorded for all patients.
    Results
    Age, weight, and BMI didn’t have any significant relation with difficult intubation. There was a significant relationship between difficult intubation and thyromental distance, upper lip bite test, Mallampati score, and hyomentaldistance (P: 0.01, 0.04, 0.001, and 0.005, respectively). Cormack-Lehane grade significantly improved after the maneuver (P: 0.001).
    Conclusions
    Preparation and appropriate management of airway is very important for morbid obese patients. Manual caudal and downward displacement of adipose tissue has a significant effect on the improvement of laryngoscopic view in morbid obese patients. Therefore, ramped position or manual and caudal displacement of chest wall fat tissue can be added to "standard" preoperative airway assessment.
    Keywords: Cervical, Adipose Tissue, Morbid Obese, Laryngoscopic View
  • Vasanth Rao Kadam *, Stuart Howell Page 4
    Background
    Sugammadex is used for the rapid reversal of neuro muscular block. It was used on an unrestricted basis in our facility prior to July 2014 but has subsequently been restricted due to the removal of cost subsidies. Our aim is to determine the impact of restricting the use of Sugammadex on clinical outcomes.
    Methods
    A retrospective audit was conducted for the period January 1st to December 31st 2014. Sugammadex use was unrestricted during the first 6 months of this period and restricted over the following period. Patients who had endotracheal intubation for any surgery were included in the audit. Non- intubated patients, patients with incomplete data and patients who were intubated and transferred to the intensive care unit were excluded. The Operating Room Information System and medical records were used to obtain information on the operating theatre time, post-anesthesia care unit time and side effects such as postoperative nausea and vomiting, oxygen-de-saturation during recovery and anaphylaxis; Sugammadex usage and cost data obtained from the hospital pharmacy.
    Results
    1347 and 1302 patients were included for the unrestricted and restricted periods, respectively. There were no significant differences between the time periods with respect to patient characteristics (Age, ASA) or side effects (oxygen de-saturation, nausea). While mean time in theatre was similar across the time periods, mean recovery time was significantly longer during the restricted period (P
    Conclusions
    Though unrestricting Sugammadex reduced recovery time but has had minimal impact on other clinical outcomes. Neostigmine represents a cheaper alternative and its use remains standard practice in our facility.
    Keywords: Sugammadex, Unrestricted Use, Restricted Use, Theatre Time, Anaphylaxis
  • Sandeep Jain, Peter J. Kallio, Kenneth Less, Jutta Novalija, Paul S. Pagel, Thomas J. Ebert * Page 5
    Background
    Nasal fiberoptic videoendoscopy is an established technique to assess upper airway pathology in conscious and sedated patients.
    Objectives
    The authors conducted a prospective proof-of-concept pilot study to evaluate whether airway narrowing detected using nasal fiberoptic videoendoscopy in the anesthesia preoperative clinic was capable of defining the severity of obstructive sleep apnea (OSA) in patients scheduled for elective surgery.
    Methods
    After application of topical local anesthesia (4% lidocaine with phenylephrine), sixteen patients (ASA physical status 2 or 3) underwent nasal fiberoptic videoendoscopy in sitting position. The magnitudes of retropalatal and retrolingual luminal narrowing were assessed as predictors of OSA. Patients also underwent polysomnography and completed STOP-Bang questionnaires. The endoscopist’s clinical impression of OSA severity based on the history and airway examination was quantified.
    Results
    Retropalatal luminal narrowing and STOP-Bang score ≥ 4 predicted OSA severity as either “none or mild” or “moderate to severe” in 13 (81%) and 9 (56%) of 16 patients who underwent polysomnography, respectively. OSA severity was significantly (Spearman’s rank correlation coefficient) associated with retropalatal airway narrowing (P = 0.0048), STOP-BANG score (P = 0.0072), and body mass index (P = 0.0091), whereas clinical impression and retrolingual pharyngeal narrowing were not (P=0.093 and P = 0.11, respectively).
    Conclusions
    The current results suggest that nasal fiberoptic videoendoscopy quantification of retropalatal airway narrowing may be a useful tool for assessing the severity of OSA in the anesthesia preoperative clinic. The current findings document a proof-of-concept feasibility of nasal fiberoptic videoendoscopy as a screening tool for OSA in conscious patients during preoperative evaluation that may justify further prospective clinical trials of this technique.
    Keywords: Obstructive Sleep Apnea, fiberoptic Videoendoscopy, STOP, Bang, Polysomnography, Anesthesia Preoperative Clinic
  • Mohammad Amin Valizadeh, Ahmadreza Afshar, Ebrahim Hassani, Ali Tabrizi *, Shaghayeg Rezalo, Nilsa Dourandish Page 6
    Background
    Chronic plantar heel pain (CPHP) is one of the common, disabling, and painful problems in the foot. Obesity is one of the known causes of CPHP. The aim of this study is to investigate the relationship between the body mass and the treatment of chronic plantar heel pain.
    Methods
    In a cohort study, 80 CPHP patients, including 16 men and 64 women, who referred to orthopedic clinic from 2014 to 2016, were investigated. All the patients were initially treated by corticosteroid injections. A total of 80 studied patients were classified according to their body mass index (BMI) in 3 groups: obese, overweight, and ideal weight. Their pain severity, symptoms recurrence, and foot performance were examined.
    Results
    The severity of morning pain was 6.6 ± 1.2 in the obese patients while it was 5.6 ± 1.7 and 5.9 ± 1.7 in overweight and ideal weight patients, respectively, which had significant difference (P = 0.005). In 57% of obese patients, symptoms recurrence was observed; this rate was 12% and 5.3% in overweight and ideal-weight patients, which showed significant difference (P = 0.001). Obese people had higher relative risk of CPHP recurrence (OR = 7.52, 95% CI = 4.28 to 16.53, P
    Conclusions
    High BMI is a strong risk factor in recurrence of chronic plantar heel pain. There is a strong relationship between the BMI of the patients and the severity of pain in the morning.
    Keywords: Plantar Fasciitis, Corticosteroid, Obesity, Chronic Plantar Heel Pain
  • Fardin Yousefshahi, Mamak Tahmasebi * Page 7
    This case report presents a 55 years old man, presented with abdominal pain and diagnosed with a metastatic pancreatic tumor, who developed long lasting orthostatic hypotension and constipation following a celiac plexus block.
    Keywords: Celiac Plexus, Orthostatic, Hypotension, Sympathetic Block, Neurolysis, Constipation, Pancreatic Tumor
  • Wasa Ueda, Shigeto Hatakeyama, Young-Chang P. Arai * Page 8
    Although several studies have reported that the ramped position (torso and head elevated) significantly improves laryngoscopic view, in our experience, the ramped position fails to provide good laryngeal visualization in some cases. When the ramped position failed to provide good laryngeal visualization, we added a head rotation in order to improve laryngeal visualization in 62 patients. The method significantly improved laryngeal visualization and did not cause laryngeal disturbances postoperatively.
    Keywords: Ramped Position, Difficult Tracheal Intubation, Head Rotation
  • Sara Ferraz *, Telma Caria, Aline Vaz Da Silva, Maria Jose Candeias, Teresa Cenicante Page 9
    Introduction
    Opioids are used intrathecally to manage surgical pain. There are few reports of hypothermia after spinal morphine injection, none in the pediatric population. We present a teenager’s case of mild hypothermia.
    Case Presentation
    A 15-year-old boy was scheduled for elective abdominal laparotomy. General anesthesia was combined with spinal anesthesia, using levobupivacaine and morphine. In the recovery room, he presented a decreased tympanic temperature (34.4°C) associated with excessive sweating, hyperglycemia, and complained of feeling hot. All other vital signs were normal. It was decided to maintain clinical vigilance and hourly monitoring of temperature and glycaemia values. Despite active warming, he remained hypothermic for 16 hours, with gradual remission of symptoms and normalization of glycemic values. It is unknown how intrathecal morphine causes hypothermia. The most viable hypothesis is its effect on the hypothalamus. In our case the most probable causes of post anesthesia hypothermia were excluded; therefore, we can admit that the cause of hypothermia was the spinal administration of morphine. Some reports used naloxone and lorazepam successfully. In our report, they disappeared spontaneously 16 hours later, which corroborates our diagnosis.
    Conclusions
    Children undergoing subarachnoid block with with intrathecal morphine may develop a disruption on thermoregulation, leading to a resistant postoperative hypothermia associated with excessive sweating.
    Keywords: Anesthesia, Spinal, Pediatric Anesthesia, Hypothermia, Morphine
  • Ozkan Onal *, Muhammed Emin Zora, Emine Aslanlar, Aysun Ozdemirkan, Jale Bengi Celik Page 10