فهرست مطالب

  • Volume:8 Issue: 5, 2018
  • تاریخ انتشار: 1397/07/10
  • تعداد عناوین: 12
|
  • Sun Kyung Park , Ji Min Han , Keumo Lee , Woo Jin Cho , Ji Hun Oh , Yun Suk Choi Page 1
    Background
    Spinal epidural lipomatosis (SEL) is a rare disease, defined as diffuse hypertrophy of unencapsulated adipose tissue causing spinal canal compression and progressive neurologic deficits. However, there are few studies on SEL in Korea.
    Objectives
    The purpose of this study was to describe the prevalence and clinical characteristics of SEL in Korea.
    Methods
    Of the 3702 symptomatic patients (1575 males and 2127 females) who underwent lumbar spine magnetic resonance imaging (MRI) at the age of 20 years or older from January 2014 to December 2016, 42 patients (27 males and 15 females) diagnosed with SEL were selected. Medical records and telephone counseling were used to document sex, age, height, weight, clinical symptoms, coexistent spinal disease, accompanying diseases, and alcoholism and smoking status. One radiologist classified the severity of epidural lipomatosis into three grades from I to III according to Borre et al. We obtained four linear measurements at the axial plane parallel based in the narrowest on MRI image.
    Results
    The incidence of SEL in the lumbar spine was 1.1%, which was 1.71% in men and 0.7% in women. The mean age was 69.4 ± 10.9 years and the mean body mass index (BMI) was 26.4 ± 3.5 kg/m2. The most common clinical symptoms were lower back pain and radiating leg pain (26 patients, 61.9%). The level of affected SEL was found to be most prevalent at L5 - S1 (21 patients, 50%). Concomitant diseases were hypertension (26 patients, 61.9%) and diabetes (12 patients, 28.5%). The most common SEL grade was type III (21 patients, 50%), followed by types II (17 patients, 40.4%) and I (4 patients, 9.5%).
    Conclusions
    Lumbar spine MRI at one hospital showed that the incidence of symptomatic SEL was 1.1%; SEL is common at the L5-S1 level and in male patients, and severity grade is often severe
    Keywords: Spinal, Epidural Lipomatosis, Lumbar, MRI, Grade, Severity
  • Dita Aditianingsih , Chaidir Arif Mochtar , Susilo Chandra , Raden Besthadi Sukmono , Ilham Wahyudi Soamole Page 2
    Background
    Postoperative pain management is important for the early recovery of the living donor patient. Patient-controlled opioid analgesia, epidural analgesia, or a combination of both is the preferred pain management after abdominal surgery although these approaches have serious side effects. The transversus abdominis plane (TAP) block has been increasingly used for postoperative pain management and the addition of dexamethasone to local anesthetic can prolong the duration of action.
    Objectives
    This study evaluated the efficacy of ultrasound-guided three-quadrant TAP block analgesia with the addition of dexamethasone, compared to the continuous epidural analgesia in postoperative cumulative opioid consumption and pain scale in the first 24 hours following transperitoneal laparoscopic living donor nephrectomy.
    Methods
    A prospective randomized control study was conducted on 50 patients with ASA I-II, 18 - 65 years old, BMI 18 - 30, and undergoing transperitoneal laparoscopic donor nephrectomy under general anesthesia. The patients were randomly assigned into either a three-quadrant TAP block group (n = 25) with 20 mL of 0.25% bupivacaine plus dexamethasone 8 mg or a continuous epidural group (n = 25) using 0.125% bupivacaine postoperatively. The morphine consumption and the numerical rating scale (NRS) at rest and movement were evaluated at 2, 6, 12, and 24 hours postoperatively. The postoperative first-time mobilization and duration of urinary catheter usage were recorded.
    Results
    Patients demographic characteristics were similar in the two groups. During 24 hours after the surgery, cumulative morphine consumption (P = 0.232), the NRS at rest and movement (P > 0.05), and the first-time mobilization (P = 0.075) were not significantly different between the groups, except that the NRS during movement at 12 hours was significantly lower in the TAP block group (P = 0.004). The duration of urinary catheterization was significantly longer as a side effect in the continuous epidural group (P < 0.001).
    Conclusions
    The three-quadrant TAP block with the addition of dexamethasone showed comparable analgesic effects as the continuous epidural analgesia in cumulative opioid consumption and pain scale in the first 24 hours following transperitoneal laparoscopic donor nephrectomy.
    Keywords: Pain Management, Transversus Abdominis Plane Block, Continuous Epidural Block, Laparoscopic Nephrectomy
  • Houman Teymourian , * , Shayesteh Khorasanizadeh , Padideh Ansar , Leila Nazari , Masih Ebrahimy Dehkordy Page 3
    Objectives
    In this study, we aimed to compare the effects of bupivacaine alone and in combination with dexmedetomidine on postoperative analgesia, neonatal Apgar score, and bispectral index (BIS), which has been shown to correlate with increased sedation and loss of consciousness in women undergoing cesarean section under spinal anesthesia.
    Methods
    A total of 152 term parturient women scheduled to have elective cesarean section with American Society of Anesthesiologist (ASA) physical status I or II were allocated randomly into two groups to receive either bupivacaine plus placebo (BV group) or bupivacaine plus dexmedetomidine (BVD group). BIS, sedation scale scores, Apgar scores, and hemodynamic characteristics were recorded and statistically compared between the groups.
    Results
    Onset of post-operative pain was delayed in the BVD group. Sedation score (Ramsay sedation section) was improved in the BVD group with the least values of 0 - 3 followed by 1 - 4. There was no significant difference in Apgar score between the two groups. Also, there was a significant distinction between the two groups in terms of BIS during cesarean section.
    Conclusions
    The use of intrathecal dexmedetomidine as an adjuvant to bupivacaine in cesarean surgeries provides better intra-operative and post-operative analgesia without any significant impact on Apgar scores or incidence of side effects
    Keywords: Dexmedetomidine, Cesarean Section, Bispectral Index, Sedation Scale
  • Pooya Derakhshan , Farnad Imani , Zahra Sadat Koleini , Amin Barati Page 4
    Background
    Spinal anesthesia, as an effective approach, is widely performed in various surgeries with possible complications. To reduce the side effects, many adjuvants are used to maintain desirable sensory and motor blockades and increase the quality and prolong the analgesia.
    Methods
    In the current double-blind, randomized clinical trial, 105 participants aged 18 - 60 years with ASA class I or II who were candidate for lower limb surgery were randomly allocated to patients receiving bupivacaine 15 mg + normal saline 1 mL (B group), bupivacaine 15 mg + epinephrine 10 µg (BE group), and bupivacaine 15 mg + sufentanyl 5 µg (BS group). Onset of sensory blockade was determined bilaterally with the pinprick test. The maximum Bromage scale was assessed for the onset of motor blockage. Recovery from sensory and motor blockades was also evaluated. Pain score (visual analogue scale; VAS) was determined for all participants.
    Results
    Onset of sensory and motor blockades was statistically different among the groups. Intrathecal bupivacaine (the placebo group) had the lowest onset of sensory blockage, whereas the onset of motor blockade was significantly shorter with the administration of sufentanil + epinephrine (P = 0.001) (BS and BE groups). However, epinephrine (BE group) did not significantly prolong sensory and motor blockade. Recovery time from sensory and motor blockade was significantly lower with the bupivacaine alone (the placebo group).
    Conclusions
    The current study results suggested that the combination of 10 µg epinephrine and 5 µg sufentanil + bupivacaine did not prolong the sensory and motor blockades in spinal anesthesia for lower limb surgery, compared with bupivacaine alone
    Keywords: Spinal Anesthesia, Bupivacaine, Sufentanil, Epinephrine
  • Soudabeh Haddadi , Reyhaneh Shahrokhirad , Malek Moien Ansar , , * , Shideh Marzban , Mitra Akbari , Arman Parvizi Page 5
    Background
    Retrobulbar block is one of the chosen methods for local anesthesia in cataract surgery. Since it is a painful procedure, using analgesic and sedative drugs is recommended. Current medications have side effects and evaluating of new drugs or new uses of existing safer drugs is necessary.
    Objectives
    The aim of this study was to compare the administration of melatonin and acetaminophen on pain and hemodynamic changes during retrobulbar block.
    Methods
    In a double-blinded randomized trial, 180 patients undergoing cataract surgery were randomly divided into three groups: Melatonin group (received melatonin 6 mg), acetaminophen group (received acetaminophen 500 mg), and control group (received placebo). All drugs were administered orally 60 min before arrival to the operating room by nurses blinded to the drugs administered. All patients received fentanyl 0.5 μg/kg before retrobulbar block intravenously. Hemodynamic variables and pain score in each patient were evaluated on arrival in the operating room, during retrobulbar block, during surgery, 20 min after operation, at the end of surgery, and in the recovery room. In case of pain score more than three, additional fentanyl was administered. All data were recorded in structured data sheets.
    Results
    Data analysis indicated no significant differences among the groups at baseline on any of the demographic variables. Both acetaminophen and melatonin reduced the pain score significantly compared with control during retrobulbar block (P < 0.05 and P < 0.01, respectively). Administration of additional fentanyl was significantly lower in the melatonin group than the control group (P < 0.05). Hemodynamic changes were not significantly different among all groups.
    Conclusions
    For the first time, as far as we have studied, the analgesic effect of acetaminophen on the retrobulbar block was indicated. We also showed that melatonin can reduce pain during retrobulbar block leading to reduction of additional fentanyl during operation. It seems that both melatonin and acetaminophen may have a beneficial effect on pain control in the retrobulbar block
    Keywords: Pain, Acetaminophen, Cataract, Melatonin
  • Farnad Imani , * , Poupak Rahimzadeh , Hamid, Reza Faiz , Shiva Nowruzina , * , Asadolla Shakeri , Mohammad Ghahremani Page 6
    Background
    Paracetamol and non-steroidal anti-inflammatory drugs (e.g. ketorolac) can be considered for mild to moderate post-caesarean pain. As a selective α-2 agonist adrenergic receptor, dexmedetomidine has analgesic and sedative effects without causing respiratory depression.
    Objectives
    This study aimed to evaluate the effects of adding dexmedetomidine to paracetamol or ketorolac on post-caesarean pain and the associated complications thereof.
    Methods
    Sixty pregnant women, who were candidates for caesarean section with spinal anesthesia, were randomly assigned to either of two groups of 30 patients. For post-operative pain management, an intravenous patient-controlled analgesia (PCA) device was used for 24 hours. Dexmedetomidine (3 µg kg-1) was added to paracetamol (35 mg kg-1) in the group DP and to ketorolac (1 mg kg-1) in the group DK. Visual analog scale (VAS), Ramsay sedation scale, hemodynamic changes, rescue analgesic (meperidine) consumption, patient satisfaction, and possible complications were recorded at 6, 12, and 24, hours after surgery, and compared afterward.
    Results
    The pain score was significantly lower in the DK group than in the DP group (P < 0.05). The hemodynamics and sedation scale were similar in both groups. The total meperidine consumption was higher in the DP group, but it was not significantly different. Maternal satisfaction was greater in the DK group (P < 0.05). Concerning complications, the two groups did not show statistically significant differences (P = 0.4).
    Conclusions
    The addition of dexmedetomidine to ketorolac, compared with its addition to paracetamol, causes further reduction in the post-operative pain score and provides more satisfaction
    Keywords: Analgesia, Caesarean Section, Dexmedetomidine, Ketorolac, Paracetamol
  • Susilo Chandra , * , Pryambodho Pryambodho , Annemarie Chrysantia Melati , Rizki Iwan Kusuma Page 7
    Background
    The frequency of postoperative sore throat (POST) after laryngeal mask airway insertion (LMA) was relatively high. Lidocaine might reduce the pain and inflammatory response. Additionally, inhalation form might result in a better distribution, which results in a better airway analgesia and minimal systemic effect.
    Objectives
    To compare the incidence of sore throat post LMA insertion after 1.5 mg/kg of lidocaine inhalation and 10 mg of intravenous dexamethasone.
    Methods
    This was a single-blinded randomized clinical trial, which included 128 patients who underwent ophthalmic surgery under general anesthesia with LMA insertion. Inclusion criteria were individuals 18 - 65 years old, ASA 1 or 2, Mallampati class I or II, and no sore throat before surgery. After University of Indonesia Research Ethical Committee approval and informed consent, all subjects were randomly divided into two groups: lidocaine inhalation group, which would receive lidocaine inhalation 2% 1.5 mg/kg (additional NaCl 0.9% until total 6 mL volume) and intravenous 2 mL NaCl 0.9%, and dexamethasone group, which would received NaCl 0.9% inhalation (6 mL volume) and dexamethasone 10 mg intravenously 10 minutes before LMA insertion. POST incidence and pain severity assessment were done 2 hours postoperatively. Statistical analysis were done with SPSS version 21.
    Results
    There were 10.9% of subjects in the lidocaine inhalation group and 9.4% subjects in the dexamethasone group who suffer from POST postoperatively (P > 0.05). The median of POST pain in the lidocaine inhalation group was 0 (0 - 1), whereas in dexamethasone group it was 0 (0 - 3). This study did not find any side effects on both groups.
    Conclusions
    Lidocaine inhalation 1.5 mg/kg was proportional to intravenous dexamethasone 10 mg in reducing the incidence and severity of POST after LMA insertion
    Keywords: Laryngeal Mask Airway, Sore Throat, Lidocaine, Dexamethasone
  • Masoumeh Albooghobeish , Ali Ghomeishi , Sara Adarvishi , * , Abdolkazem Neisi , Kamran Mahmoodi , Masoomeh Asadi , Fereshteh Amiri , Nasrin Khajeh Ali , Maryam Kouchak , Saba Arya Nasab Page 8
    Background
    Postoperative nausea and vomiting (PONV), as one of the complications after laparoscopic cholecystectomy, occurs in over 40% - 77% of cases. Considering the numerous complications of synthetic drugs, there is a growing tendency towards the use of herbal medicines due to their unique features. Ginger root is one of the herbal compounds effective on nausea and vomiting.
    Objectives
    The aim of this study was to evaluate the effect of preoperative Zintoma capsules on PONV after laparoscopic cholecystectomy.
    Methods
    In this quasi-experimental study, 130 eligible patients were randomly assigned to intervention (n = 65) and control (n = 65) groups using the four-block method. The intervention group received two capsules of 500 mg and one of 250 mg Zintoma. The control group received three placebo capsules. The severity of patients’ PONV was recorded at 0, 2, 6, 12, and 24 hours after surgery using a checklist and a standard VAS instrument. Data were analyzed using t-test, Chi-square test, and LSD Post Hoc test (ANOVA) in SPSS 19.
    Results
    The severity of PONV and vomiting was significantly different between the two groups (P = 0.001) at the above time points. The mean severity of nausea (by VAS) changed in the intervention group from 7.92 ± 1.28 to 0.33 ± 0.67 and in the control group from 8.00 ± 1.20 to 2.11 ± 1.55. The postoperative vomiting was less frequent in the group receiving the Zintoma capsules. The postoperative use of chemical anti-vomiting and nausea drugs was significantly lower in the intervention group than in the placebo group (P = 0.001).
    Conclusions
    Zintoma capsules can be used as a supportive treatment in the prevention of nausea and vomiting by reducing the incidence rate of PONV
    Keywords: Ginger, Preoperative Period, Postoperative Nausea, Vomiting, Laparoscopic Cholecystectomy
  • Farahzad Janatmakan , * , Fatemeh Javaherforoosh Zadeh , Masomeh Alizadeh , * , Zeinab Alizadeh , Amin Bahreini Page 9
    The alterations in liver function in patients after major liver resection are complex. Partial hepatectomy surgery is considered as a selective therapeutic approach in many benign and malignant liver tumors, secondary metastases, and liver trauma. According to surgical techniques most often based on vascular control and hepatic venous closure (Pringle maneuver), related complications such as ischemia and decreased venous return during and after surgery can be seen. In this study, the effects of Mannitol and N-acetylcysteine, on liver function, after hepatectomy surgery, were compared. This study was shown that infusion N-acetylcysteine next to mannitol, in partial hepatectomy surgeries, was not the significant difference to improve liver function, hemodynamic status, and laboratory tests.
    Keywords: Partial Hepatectomy, N-acetylcysteine, Mannitol, Liver Function
  • Marayam Narimani, Ali Ansari Jaberi, Tayebeh Negahban Bonabi *, Tabandeh Sadeghi Page 10
    Background

    Considering the contradictory results on the role of complementary therapies in correcting post-operative side effects, the aim of this study was to evaluate the effect of acupressure on pain severity in patients undergoing coronary artery graft admitted to a coronary care unit.

    Methods

    In this double-blind, randomized, clinical trial, 70 patients were selected randomly after coronary artery bypass grafting (CABG) surgery based on inclusion criteria and then assigned to two groups (35 in acupressure and 35 in control) randomly by the minimization method. The intervention group received acupressure at the LI4 point for 20 minutes in 10-second pressure and 2-second resting periods. In the control group, only touching was applied without any pressure in the same pattern as the intervention group. Pain severity was measured before, immediately, and 20 minutes after applying pressure and touch in both groups using the visual analogue scale.

    Results

    The results of repeated measures analysis of variance (ANOVA) showed a decrease in the pain score in the intervention group (group effect) during multiple measurements (time effect) and a reduction in the mean pain score in the various measurements taking into account the groups (the interaction between time and group; P = 0.001).

    Conclusions

    Acupressure can be used as a complementary and alternative therapeutic approach to relieve post-operative pain in CABG patients.

    Keywords: Acupressure, Complementary Alternative Medicine, Coronary Artery Disease, Coronary Artery Graft
  • Ziae Totonchi , Rasoul Azarfarin , Louise Jafari , Alireza Alizadeh Ghavidel , Bahador Baharestani , Azin Alizadehasl , Farideh Mohammadi Alasti , Mohammad Hassan Ghaffarinejad Page 11
    Background
    The use of short-acting anesthetics, muscle relaxation, and anesthesia depth monitoring allows maintaining sufficient anesthesia depth, fast recovery, and extubation of the patients in the operating room (OR). We evaluated the feasibility of extubation in the OR in cardiac surgery.
    Methods
    This clinical trial was performed on 100 adult patients who underwent elective noncomplex cardiac surgery using cardiopulmonary bypass. Additional to the routine monitoring, the patients’ depth of anesthesia and neuromuscular blocked were assessed by bispectral index and nerve stimulator, respectively. In the on-table extubation (OTE) group (n = 50), a limited dose of sufentanil (0.15 µg/kg/h) and inhalational anesthetics were used for early waking. In the control group (n = 50), the same anesthesia-inducing drugs were used but the dose of sufentanil during the operation was 0.7 - 0.8 µg/kg/h. After the operation, cardiorespiratory parameters and ICU stay were documented.
    Results
    Demographic and clinical variables were comparable in both study groups. In the OTE group, we failed to extubate two patients in the OR (success rate of 96%). There were no significant differences between the two groups in terms of systolic and diastolic blood pressure at the time of entering the ICU (P > 0.05). Heart rate was lower in the OTE than in the control group at ICU admission (89.4 ± 13.1 vs. 97.6 ± 12.0 bpm; P = 0.008). The ICU stay time was lower in the OTE group (34 (21.5 - 44) vs. 48 (44 - 60) h; P = 0.001).
    Conclusions
    Combined inhalational-intravenous anesthesia along with using multiple anesthesia monitoring systems allows reducing the dose of total anesthetics and maintaining adequate anesthesia depth during noncomplex cardiac surgery with cardiopulmonary bypass. Thus, extubation of the trachea in the OR is feasible in these patients
    Keywords: Anesthesia, Cardiopulmonary Bypass, Cardiac Surgery, Monitoring, Early Extubation
  • Ozkan Onal , * , Irem Gumus , Mehmet Sari , Muhammed Emin Zora , Mehmet Ali Acar Page 12
    Dear Editor, We describe a case of Freeman-Sheldon syndrome (FSS) in a 22-month-old infant weighing 6.5 kg scheduled to undergo knee web-plasty in the prone position, in which fiber-optic intubation was successfully performed in an easy way. We briefly review the features of FSS, discuss anesthetic challenges associated with intubation of pediatric patients, and describe the ease and success of fiber-optic intubation using a new technique. FSS, also known as cranio-carpo-tarsal dysplasia and whistling face syndrome, is a rare congenital myopathy disorder first reported in 1938 and characterized by malformations of the face, oral cavity, and musculoskeletal system (1). Common facial features include microstomia, microglossia, a high arched palate, hypoplastic mandible, and a short neck with relatively limited mobility. The combination of abnormal facial characteristics makes direct laryngoscopy and orotracheal intubation difficult or impossible (2). According to the literature, the most frequent challenge during anesthesia is difficult intubation. Studies also reported that FSS can be related with muscle rigidity, pyrexia, and malignant hyperthermia, however, these findings have not been confirmed (3, 4). Our patient was a 22-month-old with Freeman-Sheldon syndrome (FSS) scheduled for web-plasty in the prone position. The male patient weighed only 6.5 kg and had dysmorphic features (Figure 1), with retrognathia, microstomia, microglossia, a high arched palate, a hypoplastic mandible, ulnar deviation of fingers, bilateral congenital talipes equinovarus, and knee dislocation. Intubation had been unsuccessful on two previous occasions due to the presence of the aforementioned anomalies associated with FSS. Given the patient’s history of unsuccessful intubation and the need to perform the surgery in the prone position, we chose fiberoptic-assisted nasotracheal intubation, with the patient sedated but maintaining spontaneous respiration. In addition, spinal anesthesia was administered to prevent postoperative pain. The procedure was explained to the parents and they provided signed informed consent for a combination of regional and general anesthesia. Pre-operative chest radiography, electrocardiography (ECG), hematological and biochemical investigations, baseline vitals recorded using ECG, pulse oximetry, and noninvasive blood pressure were normal. A skin temperature probe was placed after intubation. Anesthesia was induced via a mask with sevoflurane, oxygen, and nitrous oxide, with gradual increases in concentration every few breaths, up to a concentration of 6%. Upon loss of consciousness, the sevoflurane-inspired concentration was reduced to 2% - 4%. Anesthesia was achieved via incremental doses of 1 mg/kg propofol (Lipuro, Braun, Germany) administered intravenously. Spontaneous respiration was maintained during the induction of intravenous (i.v.) anesthesia
    Keywords: Freeman-Sheldon Syndrome, Intubation, Intratracheal, Investigative Techniques, Bronchoscope