Evaluating the Effect of Dexmedetomidine Intravenous Infusion on Labour Pain Management in Primipara Pregnant Women: A Nonrandomised Clinical Trial Study.

Background and aims: The pain of labour is very severe. Most women prefer painless labour to routine labour if they are aware of the methods of analgesia. The aim of this study was to evaluate the effect of dexmedetomidine intravenous infusion on labour pain management in primipara term pregnant women. Methods: In this nonrandomised clinical trial with control group, all primipara term pregnant women from August 2019 to March 2020 were included. In the intervention group, after the active phase of labour, dexmedetomidine was given according to the protocol and continued until phase 2 of labour. The control group received no intervention to reduce pain. Patients in both groups were evaluated for fetal heart rate, Apgar scores, vital signs, pain intensity, and sedation score. Results: There were no significant differences in primary fetal heart rate, primary maternal hemodynamics, and mean Apgar scores at 1 and 5 minutes between the two groups (p > .05). There was no significant difference in the mean fetal heart rate in different stages between the two groups. Intragroup analysis in the intervention group showed that mean systolic and diastolic blood pressures were significantly decreased after drug administration but were in the normal range. The active phase of labour in the intervention group was significantly shorter than in the control group (p = 0.002). The mean Visual Analogue Scale (VAS) score after dexmedetomidine administration decreased significantly from 9.25 at baseline to 4.61 after drug administration, 3.88 during labour, and 1.88 after placental expulsion. The mean Ramsay Sedation Scale score after dexmedetomidine administration increased significantly from 1.00 at baseline to 2.05 after drug administration, 2.22 during labour, and 2.05 after placental expulsion. Conclusion: Based on the study's results, the administration of dexmedetomidine to manage labour pain with careful monitoring of mother and fetus is recommended.

The Effects of Hydroxyethyl Starch 6% and Crystalloid on Volume Preloading Changes following Spinal Anesthesia.

BACKGROUND: Hypotension is one of the most common complications after spinal anesthesia for cesarean delivery. Normally, preloading with fluids, especially crystalloids, is used to prevention of hypotension. METHODS: In the present randomized clinical trial study, 120 parturients presenting for elective cesarean section with the American Society of Anesthesiologists Class I and II received either 15 cc normal saline or 7 cc/kg hydroxyethyl starch 6% (Voluven) fluid. Information regarding to systolic, diastolic, mean arterial pressure, and heart rate, incidence of hypotension, adverse effects, the total dose of atropine, and ephedrine were recorded in before and 3, 6, 9, 15, and 20 min after spinal anesthesia. Furthermore, Apgar score of newborn at the 1st and 5th min after birth was recorded. RESULTS: There was no significant difference in mean arterial pressure at different stages such as: Exactly after spinal and 3, 6, 15, and 20 min after spinal anesthesia between two groups (P > 0.05). Total dose of ephedrine and atropine were similar between groups (P > 0.05), respectively. There was no significant difference in Apgar score at the 1st and 5th min after birth between two groups. There were not any adverse effects of drugs in two groups. CONCLUSIONS: The results of this study show that hydroxyethyl starch 6% compared to normal saline are similar to prevent hypotension during spinal anesthesia for cesarean delivery.

Analgesic Effect of Clonidine Added to Bupivacaine in Spinal Anesthesia for Cruciate Ligament Repair.

BACKGROUND: Several researchers have suggested that addition of local anesthetics to spinal anesthesia increases the duration of post-operative analgesia. OBJECTIVES: This study sought to assess the effect of addition of clonidine to bupivacaine in spinal anesthesia on analgesia after cruciate ligament repair. PATIENTS AND METHODS: This double-blind clinical trial was conducted on 50 American Society of Anesthesiologists (ASA) class I or II patients who were candidates for cruciate ligament repair. Patients were randomly assigned to two groups; one group received 15 mg of bupivacaine (group B) and the other 15 mg of bupivacaine plus clonidine (75 µg, group BC). The two groups were compared in terms of post-operative analgesia and related factors using the SPSS software version 20. RESULTS: All patients were males with a mean age of 24.9 years in group B, and 25.2 years in group BC (P > 0.05). In group BC, time lapse to request analgesics was 160 minutes longer and the Visual Analog Scale (VAS) at this time was 0.3 units less than group B. The time to regression of sensory block by two dermatomes was seven minutes longer, VAS in the recovery room was 1 unit less and Bromage scale in the recovery room and ward was 0.6 and 0.9 units more, respectively in the BC group. Hypotension and ephedrine usage was 36% more in the BC group (P < 0.05). CONCLUSIONS: Clonidine plus bupivacaine can increase the duration of motor and sensory block in arthroscopic cruciate ligament repair under spinal anesthesia. However, due to significant hemodynamic changes, further studies are required to determine a safer dose.

Addition of clonidine in caudal anesthesia in children increases duration of post-operative analgesia.

BACKGROUND: Pain in infancy is a developmental process. Due to the underdeveloped pain pathways in the spinal cord, the threshold of stimulation and sensation of pain is low at birth and has potential impacts on increasing the central effects of pain. Primary trauma during infancy can cause long term changes in structure and function of pain pathways that continue until adulthood. Lack of pain management in children can result in morbidity and mortality. OBJECTIVES: In this study we examined the duration of post-operative analgesia in children when clonidine is added to bupivacaine in caudal anesthesia. MATERIALS AND METHODS: In this clinical trial, 40 children aged 1-8 years who were candidates for elective inguinal hernia repair were studied. Induction and maintenance of anesthesia were achieved using sodium thiopenthal, halothane and nitrous oxide. Children were randomly divided into 2 groups in a double-blind fashion, and were given caudal anesthesia with 0.125% bupivacaine (1ml/kg) alone or b bupivacaine plus 2 µg/kg clonidine. Blood pressure and heart rate were recorded peri-operatively. Analgesia was evaluated using objective pain scale (OPS) and sedation was assessed using Ramsay sedation scale (RSS). Acetaminophen was administered rectally for cases with OPS score greater than five. RESULTS: Duration of analgesia was found to be significantly longer in the group given bupivacaine plus clonidine (mean 417.50 min vs. 162.00 min). Peri-operative hypotension or bradycardia, post-operative respiratory depression, nausea or vomiting were not recorded in any patient. CONCLUSIONS: We concluded that addition of clonidine to bupivacaine prolongs the duration of post-operative analgesia without any respiratory or hemodynamic side-effects.

Additional burden of intensive care to rehospitalizations following kidney transplantation: a study of rate, causes, and risk factors.

INTRODUCTION: Little information exists on the burden of intensive care unit (ICU) to the posttransplant rehospitalizations of kidney allograft recipients. We do not clearly know the extent of the need for ICU during rehospitalizations and causes of readmissions. In this study, we aimed to assess ICU admissions of kidney transplant recipients, to determine the risk factors of ICU admissions in rehospitalized patients, and to evaluate the additional burden of ICU admission. MATERIALS AND METHODS: A total of 581 posttransplant rehospitalizations of kidney transplant recipients were assessed for ICU admission. Clinical characteristics of the patients and the length of hospital stay, transplantation-admission interval, hospitalization costs, and mortality rate were reviewed. RESULTS: Twenty-five rehospitalized kidney transplant recipients (4.3%) had been admitted to ICU with kidney dysfunction (36.0%), cerebrovascular accident (24.0%), sepsis (16.0%), brain tumor (8.0%), brain abscess (4.0%), diabetic ketoacidosis (4.0%), trauma (4.0%), and hemodynamic shock (4.0%). The risk factors of referral to ICU were higher age (P = .001) and hospitalization for cerebrovascular accident (P = .001) and malignancy (P = .004). Additional burdens were 1.8, 3.3, and 11.4 times as high as the rehospitalization burden for the length of hospital stay, hospitalization costs, and mortality rate, respectively. CONCLUSIONS: Age and some special causes of hospitalizations are risk factors of ICU admission of kidney transplant recipients, and this occurs in about 5% of rehospitalizations. Admission to ICU adds considerably to the burden of rehospitalizations, warranting measures to prevent conditions that lead to the need for intensive care in these patients.