Anesthesiology and Pain Medicine
Volume:12 Issue: 4, Aug 2022

Context:

 This systematic review and meta-analysis evaluated the effect of the intra-articular injection of platelet-rich plasma (PRP) and oxygen-ozone therapy and provided an evidence-based methodology to treat KOA.

 Databases, including Cochrane Library, PubMed, and EMBASE, were searched. The retrieval period was before 2021. Two reviewers performed the process of screening and data extraction. Mean differences were calculated [95% confidence interval (CI)] with an inverse-variance method and fixed effect model. Meta-analysis was performed using the latest version of STATA version 16.

 A total of 12 studies out of 769 articles were evaluated. The mean difference of visual analog scale score between ozone and control groups in the first month after injection was -0.02 (MD, -0.02; 95% CI: -0.32, 0.28; P < 0.05). Mean differences of WOMAC pain, stiffness, and physical function score between baseline and after PRP were -3.53 (MD: -3.53; 95% CI: -4.04, -3.02; P = 0.00), -0.60 (MD: -0.60; 95% CI: -4.0 - 0.864, -0.34; P = 0.00), and -5.96 (MD: -5.96; 95% CI: -7.83, -4.09; P = 0.00).

 Our results showed that to treat knee osteoarthritis, using PRP for a longer period of 6-12 months after the intervention shows better clinical results, while oxygen-ozone therapy has short-term results.

Low back pain (LBP) is the leading cause of pain and debility worldwide and the most frequent reason for work-related disability. Global expenditures related to LBP are staggering and amount to billions of dollars each year in the United States alone. Yet, despite the considerable healthcare resources consumed, the care provided to patients with LBP has regularly been cited as both ineffective and exorbitant. Among the myriad reasons for this suboptimal care, the current approach to evaluation and management of patients with LBP is a likely contributor and is hitherto un-investigated. Following the current methodology, over 90% of patients with LBP are provided with no specific diagnosis, are managed inconsistently, and receive no express preventative care. We believed that this approach added costs and promoted chronic unresolved pain and disability. This narrative review highlights problems with the current methodology, proposes a novel concept for categorizing patients with LBP, and recommends strategies for improvement. Stratifying patients according to the etiology, in lieu of the prospects for morbidity, the strategy proposed in this article may help ascertain the cause of patient’s LBP early, consolidate treatments, permit timely preventative measures, and, as a result, may improve patient outcomes.

 Percutaneous nephrolithotomy (PNL) is the treatment of choice for renal stones as a safe, effective, and minimally invasive method. However, bleeding remains a major concern in the procedure.

 This study aimed to investigate the risk factors of bleeding in PNL.

 This retrospective descriptive cross-sectional study was conducted in the Urology department of Razi hospital. The data of patients with urinary calculi staghorn type who underwent PNL in a prone position under general anesthesia were recorded. A checklist including patients' demographics, surgical characteristics, and outcomes was filled out for each patient.

 The data from 151 complete files were gathered. The mean age of the cases was 47.89 ± 12.41 years. The mean hemoglobin (Hb) drop was 1.92 ± 1.56 mg/dL. At least 1 mg/dL Hb drop was observed in all cases. The highest Hb drop was 3 mg/dL.). There was no significant relationship between stone bulk, age, BMI, GFR, surgery duration, and the number of tracts, and Hb drop during PNL (P > 0.05). But there was a positive correlation between Urinary Tract Infection (UTI) history (P = 0.01) and transfusion (P = 0.0001) and Hb drop during PNL. Also, the history of open kidney surgery (P = 0.031), nephrostomy insertion (P = 0.003), and extracorporeal shock wave lithotripsy therapy (ESWL) (P = 0.041) were correlated with the increased risk of Hb drop.

 Urinary tract infection, history of open surgery, nephrostomy implantation, and ESWL were significantly associated with more bleeding in PNL.

 Acute kidney injury (AKI) is a complication that occurs for various reasons after surgery, especially cardiac surgery. This complication can lead to a prolonged treatment process, increased costs, and sometimes death. Prediction of postoperative AKI can help anesthesiologists to implement preventive and early treatment strategies to reduce the risk of AKI.

 This study tries to predict postoperative AKI using interpretable machine learning models.

 For this study, the information of 1435 patients was collected from multiple centers. The gathered data are in six categories: demographic characteristics and type of surgery, past medical history (PMH), drug history (DH), laboratory information, anesthesia and surgery information, and postoperative variables. Machine learning methods, including support vector machine (SVM), multilayer perceptron (MLP), decision tree (DT), random forest (RF), logistic regression, XGBoost, and AdaBoost, were used to predict postoperative AKI. Local interpretable model-agnostic explanations (LIME) and the Shapley methods were then leveraged to check the interpretability of models.

 Comparing the area under the curves (AUCs) obtained for different machine learning models show that the RF and XGBoost methods with values of 0.81 and 0.80 best predict postoperative AKI. The interpretations obtained for the machine learning models show that creatinine (Cr), cardiopulmonary bypass time (CPB time), blood sugar (BS), and albumin (Alb) have the most significant impact on predictions.

 The treatment team can be informed about the possibility of postoperative AKI before cardiac surgery using machine learning models such as RF and XGBoost and adjust the treatment procedure accordingly. Interpretability of predictions for each patient ensures the validity of obtained predictions.

 Obesity and increased body mass index (BMI) are associated with coronavirus disease 2019 (COVID-19)-related complications and severity. They can exacerbate the cytokine storm and lead to severe symptoms or death in obese patients.

 This cross-sectional descriptive study included patients with COVID-19 admitted to the Razi Hospital in Ahvaz, Iran, from January 2019 to December 2020.

 We evaluated the effect of BMI of patients admitted to the general ward and invasive unit care (ICU) on the length of hospitalization.

 We included a total of 466 patients (male: 281 or 60.3% vs. female: 185 or 39.7%) with a mean age of 59.49 ± 14.5 years in the study. Also, 47 (10.1%) patients were admitted to the ICU, and 418 (89.7%) patients to the general ward. A higher BMI was associated with longer hospitalization (P < 0.001). Patients with BMI in the range of 18.5 - 24.9 experienced a longer hospitalization (10-20 days) (P < 0.001). BMI had no significant effect on ICU hospitalization (P = 0.36). Also, there was no significant difference between the two groups regarding the length of hospitalization (P = 0.49). Furthermore, non-diabetic patients were less likely to be admitted to the ICU (73.3% vs. 26.7%) (P < 0.001). The number of discharged patients was higher in patients admitted to the general ward compared to those admitted to the ICU (93.8% vs. 63.8%) (P < 0.001).

 According to our results, a higher BMI was a risk factor for COVID-19, especially in the early stage of infection.

 The quadratus lumborum (QL) block, also known as the abdominal truncal block, was developed to provide visceral and somatic analgesia during abdominal procedures.

 This study aimed to assess pain alleviation, the incidence of complications in lower abdominal procedures, and hemodynamic stability between the caudal block and ultrasound-guided QL block.

 Fifty-two patients aged 1 to 7 years old from both genders scheduled for unilateral lower abdominal surgery were randomly assigned to 2 study groups: group QL, unilateral QL block (n = 26), and group C, caudal block (n = 26). In group C, children received caudal block. In group QL, an ultrasound-guided QL block was performed. The time to first rescue analgesia was evaluated as a primary outcome. The quality of analgesia was determined using the face, legs, activity, cry, consolability scale (FLACC scale), hemodynamic parameters, and incidence of complications because hemodynamic instability was recorded under ultrasound guidance. Signs of local anesthetics toxicity and the parents’ satisfaction were secondary outcomes.

 The time until the first demand for analgesia postoperatively was statistically longer in group QL compared to group C. A non-significant difference was observed between the 2 groups (P > 0.05) regarding age, weight, gender, duration of surgery, type of surgery, FLACC scale, and hemodynamics (SBP, systolic blood pressure), except at 30 minutes, which was significant in QL block. Also, a non-significant difference was observed in the severity of postoperative pain up to 1 day postoperatively. Group QL showed more satisfaction than group C. No intraoperative complications were detected.

 Compared to caudal block, QL block produced sustained and adequate analgesia time postoperatively, with higher satisfaction.

 Postoperative cognitive dysfunction (POCD) following cesarean section (CS) is a growing and underestimated problem with unknown mechanisms. Studies suggest that general anesthesia (GA) plays a role in the development of early POCD.

 This study aimed to assess the incidence of early POCD after elective and emergent CS under GA.

 We assessed the difference between the elective and emergent groups regarding the mini-mental state examination (MMSE), hemodynamic effects such as mean blood pressure (MBP), and heart rate (HR). Paired t-test was applied for intragroup comparison, and Student’s t-test (or Mann–Whitney U test, as appropriate) for intergroup comparison.

 MMSE one hour after the operation was significantly lower than preoperative MMSE in the emergent group, and the MMSE tended to return to normal values faster in the elective than in the emergent group. Moreover, we found a significantly lower MBP and higher HR (at 15, 30, and 45 minutes) in both groups compared to preoperative values. Regarding intergroup comparison, MBP (at 30 minutes) significantly decreased in the elective group compared to the emergent group.

 There was a significantly lower POCD, especially at the first hour postoperatively, in the elective CS than in the emergent CS. Elective CS might have a positive effect on the women’s health as a mode of delivery.

 Due to the high prevalence of postoperative nausea and vomiting (PONV), this study aimed to determine the preventive effect of intranasal dexamethasone on the incidence of nausea and vomiting after adult strabismus surgery.

 This randomized clinical trial study was performed on 72 patient candidates for strabismus surgery at Feiz University Hospital in Isfahan in 2020. Patients were divided into 2 groups of 36 with random allocation software and entered into the study. After induction of similar anesthesia, endotracheal intubation was performed in patients. Immediately after inflating the cuff, the first group (intranasal dexamethasone (ND)) received 1 mL of dexamethasone (4 mg) per nasal passage, and the second group (intranasal normal saline (NS)) received 1 mL of normal saline per nasal passage. Patients of the 2 groups were evaluated and compared at first 2 hours and 2 - 24 hours after surgery for the incidence and severity of nausea and vomiting, and pain after surgery. Data were analyzed using SPSS software version 23.

 There were no significant differences in terms of age (P = 0.304), weight (P = 0.21), gender (P = 0.81), and American Society of Anesthesiologists (ASA) Physical Status class (P = 1) between the 2 groups. In the first 2 hours after surgery, the incidence of nausea (P = 0.034) and its severity (P = 0.019) was significantly lower in the ND group compared to the NS group. Also, 24 hours after surgery, the incidence of nausea (P = 0.38) and its severity (P = 0.55) were insignificantly lower in the ND group. Both groups showed no significant difference in the incidence of vomiting at 2 hours (P = 0.11) and 24 hours (P = 0.16) postoperative. Two hours after surgery, the incidence of pain (P = 0.001) and its severity (P < 0.001), and also 24 hours after surgery, the incidence of pain (P < 0.001) and its severity (P < 0.001) were significantly lower in the ND group. Getting ondansetron (P = 0.023) and pethidine (P < 0.001), extubation time (P < 0.001), and recovery time (P = 0.03) were significantly lower in the ND group. Patients’ satisfaction was significantly higher in the ND group compared to the NS group (P = 0.031).

 The findings of the present study show that the intranasal use of dexamethasone with a dose of 8 mg compared to saline is associated with a decrease in PONV and postoperative pain, a decrease in the use of ondansetron and pethidine, and an increase in patient’s satisfaction. Intranasal use of dexamethasone may be an effective and safe method, especially in cases where we do not have access to an intravenous line.

 Heparinized and saline solutions can prevent clot formation in arterial and central venous catheters. However, heparin can decrease the platelet count and induce thrombocytopenia. Patients undergoing cardiac surgeries are more likely to develop heparin-induced thrombocytopenia.

 This study aimed to investigate the effect of heparinized and saline solutions of arterial and central venous catheters on complete blood count (CBC) after cardiac surgery.

 This randomized controlled trial was conducted on 100 participants. All subjects underwent cardiac surgery at Rajaie Cardiovascular, Medical, and Research Center, Tehran, Iran. Patients were randomly divided into two groups intervention (A) for whom heparinized normal saline solution was used to maintain central arterial and venous catheters, and control (B) for whom normal saline solution was used. The CBC of subjects was monitored for three days (before surgery and the first and second days after surgery).

 In the present study, there were no significant differences between CBC, white blood cell differential count, prothrombin time, partial thromboplastin time (PTT), and international normalized ratio in groups A and B. However, we found significant differences in platelet count (P = 0.049), red blood cell count (P = 0.0001), hemoglobin (P = 0.0001), and hematocrit (P = 0.0001) between before surgery and the second day after surgery in group A. Platelet count (P = 0.027) and PTT (P = 0.0001) before and after surgery were significantly different in group B.

 According to the results of this study, normal saline solution catheters have fewer side effects and can be a suitable replacement for heparinized catheters.