Vol 3 No 3 (2017): Summer
Preoperative Oral Passiflora Incarnata Reduces Coughing Following Extubation: A Double Blind, Placebo-Controlled Study
Background: The incidence of coughing following extubation can result in a number of undesirable side effects. Therefore, the development of antitussive premedication may be desirable.
Methods: In this study, 138 patients were randomized into two groups to receive either oral Passiflora incarnata (500 mg, PassipyTM IranDarouk) (n = 69) or placebo (n = 69) as premedication, 120 min before surgery. After extubation, all patients were observed to record the incidence of coughing during a 15 minute period. Hemodynamic variables were recorded before induction of anesthesia, 1 minute following intubation, and 5 minutes after extubation.
Results: The demographic characteristics of patients, ASA physical status, duration of surgery, hemodynamic variables were similar in the two groups. The incidence of cough following extubation was significantly lower in the passiflora group compared to the control group (P <0.001).
Conclusion: In outpatient surgery, administration of oral Passiflora incarnata as a premedication reduces incidence of coughing following extubation.
Comparing the Injection Pain of Propofol Emulsion 1% (MCT/LCT) and Propofol Emulsion 2% (Propofol Lipuro) in Combination with Lidocaine in Patients Undergoing Gynecologic Surgery with General Anesthesia
Background: Propofol causes a high incidence of pain during intravenous injection. The aim of this study was to compare incidence and severity of injection pain following the administration of two different formulations of Propofol with and without 10mg Lidocaine in female patients.
Methods: One hundred ASA (American Society of Anesthesiologists) grade I and II patients, planned to undergo gynecologic surgery under general anesthesia, were included in four groups of 25 in a prospectively, randomized and double-blind study. Group A received Propofol 1%+10mg lidocaine (1cc of lidocaine1%), Group B received Propofol 1%+ 1cc preservative-free saline, Group C received Lipuropropofol +10mg lidocaine (1cc of lidocaine1%) and Group D received Lipuropropofol+1cc preservative-free saline. Injection pain was assessed using the McCrirrick and Hunter scale.
Results: No differences were found in the mean age, weight and given dose of propofol administered between all groups (P>0.05). Comparison of groups revealed significant difference in pain scores between groups (mean pain scores, GroupA:2.84 ± 0.850 vs. GroupB:3.16 ± 0.800 vs. GroupC:1.8±0.866 vs. GroupD:2.12±0.833 points).
Conclusion: The highest pain scores were found in the propofol1% without lidocaine use while lipuropropofol plus lidocaine had the lowest pain scores. We recommend premixing 10 mg of lidocaine to Lipuropropofolfor preventing or mitigation of propofol injection pain compared to Lipuropropofol alone or propofol1% with lidocaine.
Patient Communication before General Anesthesia to Reduce Post-Operative Pain and Agitation after Endoscopic Sinus Surgery: A Randomized Clinical Trial
Background: Patients often name post-operative pain as the most horrifying aspect of the surgery. The purpose of this study was to evaluate the effect of communication with patients on post-operative pain and agitation in the patients recovering from endoscopic sinus surgery.
Methods: This was a randomized clinical trial. Sixty patients scheduled for endoscopic sinus surgery were randomly allocated to control and intervention groups (30 patients in each group). A supportive and informative session was established for 20-30 minutes in two stages for the intervention group while the control group received routine information. After surgery, pain and agitation were assessed using the non-verbal pain scale, visual analog scale and Riker's sedation-agitation score.
Results: The average pain scores in the recovery room by non-verbal pain scale and visual analog scale were (3.4±1.6) and (6.2±3.0) for the control group and (1.2±1.5) and (3.0±3.3) for the intervention group, respectively (P≤0.001). The average agitation score in the recovery room for the control group and the intervention group were (4.6±0.6) and (4.1±0.3), respectively (P=0.008).
Conclusion: The results demonstrate that simple communication techniques before the surgery can be effective in reducing post-operative pain and agitation in patients recovering from endoscopic sinus surgery.
This clinical trial was registered from IRCT with registration number IRCT201404278589N3.
The Effect of Intravenous Lidocaine Infusion on Post-Operative Pain after Percutaneous Nephro Lithotomy: A Randomized Clinical Trial
Background: Percutaneous Nephro Lithotomy (PCNL) is an efficient treatment for complicated, large and staghorn calculi. Optimal pain control has long been a concern for the surgeons and the anesthesiologist. The pivotal aim of this study is to evaluate the effects of intravenous lidocaine infusion on pain levels, sedation score, foley catheter tolerance and level of nausea and vomiting in patients undergoing the procedure.
Methods: In a randomized parallel group double blind clinical trial, 60 patients with ASA physical class I candidate for PCNL were enrolled in the study. During the operation, group A patients received 1mg/kg/hr infusion of intravenous lidocaine infusion while group B patients received normal saline infusion as placebo.
Results: Patients receiving lidocaine infusion had better foley catheter tolerance compared to the placebo group. Similarly VAS pain scores in the PACU were 2.5 ± 1.7 in group A versus 3.7 ± 1.2 in group B was observed to be higher in the placebo group leading to significant difference. (p= 0.03) One hour after surgery 4 (23%) and 26 (87%) of the patients in group A were drowsy and alert, while the results in group B were 13 (77%) and 6 (20%) respectively.
Conclusion: The results of our study demonstrates significant difference in sedation score (15 minutes and one hour after surgery) and foley catheter tolerance in patients who received lidocaine infusion through PCNL surgery. In addition, patients receiving lidocaine infusion convey better pain scores after surgery.
The Relationship Between the Location of the Nasogastric Tube and Ventilator-Associated Pneumonia in Patients Hospitalized in the Intensive Care Unit
Background: It is recommended to start nutrition early in critically ill patients and the preferred method to do so is enteral nutrition which in most cases is achieved by inserting a feeding tube during the first 24 hours. These tubes are placed blindly so the tip of the tube can be placed in different locations. The authors had predicted that placing the tip of the feeding tube in various locations could produce different results in terms of the prevalence of ventilator-associated pneumonia.
Methods: We performed this cross-sectional study on 147 patients admitted to the intensive care unit of the Rohani hospital and intubated for at least 5 days receiving enteral feeding via nasogastric (NGT) or gastric tube. Patients were divided into two groups based on the location of the tip of the feeding tube- esophagus or stomach. They were compared in terms of early ventilator-associated pneumonia (VAP) within the first 3-5 days and nasogastric complications such as bleeding, sinusitis and obstruction of the feeding tube.
Results: Based on our findings, VAP occurred in 12.2%of the patients. This rate was 9.6% when we placed the nasogastric tube into the stomach and 27.2% when in the esophagus. This difference between the two groups was statistically and clinically significant, while the rate of bleeding, sinusitis and nasogastric tube obstruction was the same between them.
Conclusion: The rate of VAP is significantly different when we feed the patients by a nasogastric tube inserted into the stomach (9.6%) and when we do so by placing the tube into the esophagus (27.2%).
The effects of high Fresh Gas Flow in treatment of Pediatric Severe Hypercapnia During General Anesthesia: A Case Report
Hypercapnia is a frequent event but severe hypercapnia is a harmful complication of general anesthesia. A 6 month old Iranian baby boy who had an appendicitis under general anesthesia exhibited severe hypercapnia during surgery. Arterial blood gas revealed a PCO2 of 95mmHg. Troubleshooting immediately were taken but the level of CO2 did not decline. Under that situation by elevating fresh gas flow to twice or three times the hypercapnia decreased and by adjusting FGF we could reach the best end tidal PCO2 and paco2.