Anesthesiology and pain medicine
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The control of pain in traumatic patients with chest injury leading to rib fracture is one of the primary goals in traumatic patients. The efficacy of the thoracic epidural approach in comparison with other approaches for relieving post-thoracotomy pain is unknown. The goal of the present study was to compare thoracic epidural analgesia with bupivacaine alone and in combination with dexmedetomidine in patients with multiple rib fractures. ⋯ The results of the present study showed that epidural infusion of a combination of bupivacaine and dexmedetomidine could provide better control of rib fracture pain in traumatic patients, and is a proper alternative for bupivacaine alone.
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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. ⋯ 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.
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Difficult intubation is dangerous and sometimes fatal, especially in patients with obesity. In difficult intubation cases the best device should be applied to decrease the risk of complications. The current study aimed at comparing laryngoscopes, Macintosh, McCoy, GlideScope® and devices for intubation purposes. ⋯ In the current study, the shortest and longest intubation time in patients with obesity was observed in the GlideScope® and the McCoy laryngoscope groups, respectively. Moreover, the direct relationships of BMI and neck circumference with laryngoscopy time were observed in all 3 groups. These results suggested using GlideScope® in patients with high BMI to reduce laryngoscopy time.
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Shoulder tip pain is a common problem after laparoscopic cholecystectomy. There are a few clinical trial studies on the effect of clonidine on post laparoscopic shoulder pain (PLSP). This study aimed at evaluating the effect of oral clonidine on PLSP in semi-sitting position and post-operative hemodynamic response of patients undergoing LC surgery. ⋯ Oral clonidine is not effective in preventing the PLSP. However, it alleviates PLSP intensity in the patient under LC procedure on the first post-operative hours.
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Spinal anesthesia is the method of choice for most elective and emergency Cesarean sections. To increase the duration of anesthesia and improve the quality of analgesia during and after surgery, intrathecal opioids, as adjuvant drugs, are used in combination with local anesthetics. ⋯ According to the results, adding 25 microgram fentanyl or 2.5 microgram sufentanil to intrathecal bupivacaine increased the duration of analgesia and provided hemodynamic stability with no major complication. As administering intrathecal fentanyl had a similar duration of analgesia like sufentanil with faster return of motor block and ambulation, it seems that it is a preferred additive for Cesarean section surgery.