Vol 2 No 1 (2016): Winter
Evaluation of the Postoperative Analgesic Efficacy of Intraperitoneal Ketamine Compared with Bupivacaine in Laparoscopic Cholecystectomy
Background: This randomized controlled study was designed to compare the postoperative analgesic efficacy of intraperitoneal ketamine versus bupivacaine in patients undergoing laparoscopic cholecystectomy.
Methods: We randomly divided 60 patients undergoing elective laparoscopic cholecystectomy into two groups. The intervention group patients received intraperitoneal ketamine (0.5 mg/ kg) diluted in 30ml normal saline and the control group received intraperitoneal bupivacaine 30 ml 0.25% (75mg) at the end of the procedure, before removal of the trocars. The primary end point of this study was, time to tracheal extubation and the intensity of postoperative pain by using visual analogue scale (VAS) score at 5-15min, 6, 12 and 24 h after surgery. The secondary outcome included time to the first request of analgesia in the postoperative period, total dose of analgesic used in first 24 h postoperative period and any postoperative complication.
Results: Time to tracheal extubation was higher in ketamine group compared to bupivacaine group that caused prolongation of anesthetic duration in this group. During the first 6 h after surgery, the pain scores were significantly lower in patients receiving ketamine compared with bupivacaine group. Pain scores in the subsequent time were low but were not different between the two groups. Time to first request of analgesia was longer in ketamine group (21.43±0.50 min) compared to bupivacaine group (6.32±0.64 min) (p=0.001). Total meperidine consumption was also lowest in ketamine group compared to bupivacaine group.
Conclusion: Intraperitoneal instillation of 0.5mg/kg ketamine in elective laparoscopic cholecystectomy significantly reduces the postoperative pain and the analgesic requirement in the first 6 h after surgery as compared to bupivacaine but it increased extubation time.
Promoting Knowledge and Practical Skills of Interns in Transport of Critically Ill Patients: Small Group Teaching Method
Background: Transport of the critically ill patient is potentially risky and the transport team should be careful in making decision and be prepared to deal with them in any condition. Our physicians are not qualified in safe transport. We want to evaluate the effect of small group teaching method for promotion of physicians' skills in transport of critically ill patients.
Methods: In an interventional study, 161 interns took part in one day workshop planned in small group system. Each participant under observation of an anesthesiologist in operation room and intensive care unit (ICU) was acquainted with mask ventilation, intubation and learned working with defibrillator, infusion pump, portable ventilator and pulse oximeter. Their knowledge and skill was scored by pre and post tests in all items.
Results: In our precipitants, 62 males and 99 females; training caused improvement in their abilities about care and monitoring of patient during transport. The offered training caused improvements in the interns’ knowledge and ability of intubation, ventilation and use of defibrillator and ventilator (P<0.005). The competency of males was better than females in laryngoscopy but progress of females was significantly better than males (P=0.003).
Conclusion: This method could promote knowledge and skill of interns in transport of critically ill patients.
Comparing Intravenous Lidocaine, Ondansetron and Their Combination on Reducing Pain of Injection of Propofol
Background: Propofol is a widely used intravenous anesthetic drug. One of its side effects is pain during injection. We investigate the effects of intravenous ondansetron, lidocaine, and their combination on pain reduction of intravenous propofol.
Methods: Eighty eight women with ASA class (American Society of Anesthesiologists) classification I-II patients undergoing elective gynecologic surgeries allocated into four equal groups including normal saline, lidocaine, ondansetron, and the combination of two drugs. All drugs were prepared in the same volume of 5 ml. Pain during propofol injection after intravenous injection of study drugs was assessed using Numeric Rating Scale (NRS). Demographic data and pain scores were recorded and compared in all patients.
Results: The overall incidence of pain on propofol injection was lower in lidocaine (4%), ondansetron (9%) and combination group (zero) than in saline group (72%) (P=0.001).
Sixteen patients (72%) in saline group had moderate to severe pain. Two patients (9%) in ondansetron group and one patient (4%) in lidocaine group had mild pain (P= 0.06). No patient in lidocaine, ondansetron and combination group had moderate to severe pain (P>0.05).
Conclusion: Pretreatment with ondansetron with or without lidocaine is effective in preventing pain from propofol injection.
The Effect of Post-Cardiopulmonary Resuscitation N-acetylcysteine on Renal Function: A Randomized Clinical Trial
Background: The purpose of our study was to determine the effect of N-acetylcysteine (NAC) administered after successful cardiopulmonary resuscitation (CPR) on renal function of the survived patients.
Methods: In this double-blinded randomized clinical trial, 44 patients who experienced cardiopulmonary arrest and underwent successful cardiopulmonary resuscitation (CPR) were entered into the study. They were randomly divided into two groups. One group received NAC (150 mg/kg) and the control group received normal saline (NS).
Results: Serum levels of blood urea nitrogen (BUN), creatinine, and neutrophil gelatinase-associated lipocalin (NGAL) were significantly lower in the NAC group when compared to the NS group at 6, 12,24, 48, and 72 hours after resuscitation. However, alanine aminotransferase (ALT), cardiac troponin, creatine kinase MB fraction (CK-MB) and arterial blood gases did not differ between the two groups.
Conclusion: We observed significantly lower serum levels of BUN, creatinine, and NGAL in patients who received NAC after successful CPR following cardiopulmonary arrest. This can be used in clinical practice to decrease the chance of developing renal failure in such patient population.
Dissociative Conscious Sedation versus Airway Regional Blocks in Patients with Predicted Difficult Airway: Advantages and Disadvantages
Background: Establishment of a patent airway and preserving spontaneous ventilation is a necessity in predicted difficult airway. Airway regional blocks are commonly used in predicted difficult airway but the known limitations of these techniques propose the need to suggest alternative methods. This study compares subcutaneous dissociative conscious sedation (sDCS); a recently reported method of conscious sedation versus airway regional blocks in patients with predicted difficult airway.
Methods: This study was conducted in 60 patients scheduled for direct laryngoscopic biopsy (DLB).
Patients were randomly assigned into two groups: subcutaneous dissociative conscious sedation (sDCS) (n=30) and airway regional blocks (ARB) (n=30).
Patients were compared for direct laryngoscopy, insertion of endotracheal tube, hemodynamic changes, oxygen saturation, patient cooperation, patient comfort, hallucination, nystagmus, salivation and event of recall.
Results: Direct laryngoscopy was successfully performed in all patients in sDCS group and 28 patients in ARB group. Insertion of endotracheal tube was successfully done in 28 patients of sDCS group and failed in two cases. In group ARB, endotracheal intubation was successfully done in 26 patients. Despite the lower success rate in group, ARB it was not statistically significant. Patient cooperation was significantly higher in sDCS group. No event of recall was observed in sDCS group versus 8 in group ARB.
Conclusion: Subcutaneous dissociative conscious sedation (sDCS) is a safe anesthesia method for endotracheal intubation and it is comparable and even superior to airway regional blocks in some aspects.
Procalcitonin is widely used as a biomarker for diagnosis and prognosis for sepsis and infection as well as monitoring the response to antibiotic therapy. In this study we systematically reviewed the value of procalcitonin in diagnosis, treatment, and prognosis in patients with sepsis or infection.
Evaluation Electrical Activity of Diaphragm and Respiratory Drive During Successful Weaning of Traumatic Quadriplegic Patient by Neutrally Adjusted Ventilatory Assist Mode
The case is 43 years old woman referred to emergency department of our hospital with quadriplegia and severe respiratory insufficiency due to C5-C6 injury after falling. She discharged from ICU after fixation of the lesion and successful weaning. We evaluated electrical activity of diaphragm signal (Edi), Respiratory drive (P100) during one month period. We detected increase in level of electrical activity of diaphragm and respiratory drive during weaning of patient.