The Effect of Half Percent Oxymetazoline Nasal Drops on Post-Tonsillectomy Cough, Sore Throat and Bleeding in Children; A Double-Blind Randomized Clinical Trial.

Background: Considering the high prevalence of tonsillectomy in children and concerns of postoperative management, this study was conducted with the aim of evaluating the effects of oxymetazoline on bleeding, cough, and sore throat in children undergoing tonsillectomy. Materials and Methods: The current double-blind clinical trial study was conducted on 88 tonsillectomy candidate patients. These patients were randomly divided into two groups. In the first group, oxymetazoline 0.05% nasal spray (OXY group) and in the second group, distilled water spray (Control group) was prescribed as one puff in each nostril immediately after anesthesia induction., the nasal spray was prescribed again in both nostrils at 12 h after tonsillectomy. Then the hemodynamic parameters, post-tonsillectomy hemorrhage (PTH) and sore throat were evaluated. Results: The mean of the sore throat of children was not significantly different between the two groups in any of the follow-up times (P value >0.05). PTH in recovery and in the ward in the OXY group with the mean of 57.60 ± 71.82 ml and 22.11 ± 22.50 ml, respectively, was significantly lower than the control group (83.50 ± 113.64 ml and 27.52 ± 35.11 ml) (P value < 0.05). Also, the frequency of cough in the ward in the OXY group with 27.3% was significantly lower than the control group with 56.8% (P value = 0.005). Conclusion: Regarding the results of the present study, sore throat and hemodynamic parameters did not change significantly with the administration of oxymetazoline. But this drug has played a significant role in reducing PTH and cough in children.

The Effect of Two Different Dexmedetomidine Doses on the Prevention of Nausea and Vomiting in Discectomy Surgery under Spinal Anesthesia.

Background: Considering the preventative effect of various medications on such complications after surgery, the present study evaluated the effect of two different dexmedetomidine doses on the prevention of nausea and vomiting in discectomy surgery. Materials and Methods: The present controlled, double-blind clinical trial was performed on 135 patients that were candidates for discectomy surgery under spinal anesthesia, which were randomly allocated into three groups. Two different dexmedetomidine doses of 0.2 and 0.5 mcg/kg/h were intravenously administered using an infusion pump for 10 min in the first (DEX-0.2 group) and second (DEX-0.5 group) groups, respectively, with the third placebo group being used as a control group. Hemodynamic parameters, the severity of nausea and vomiting, and the incidence of complications were evaluated and recorded up to 24 h after surgery. Results: The results of the present study revealed that, 20 min after the intervention, the severity of nausea and vomiting in the control group (with the mean of 1.95 ± 1.58) was significantly higher than that of the DEX-0.2 and DEX-0.5 groups with the means of 1.52 ± 1.11 and 1.27 ± 0.99, respectively (P = 0.010). In addition, no significant difference was found between the two dexmedetomidine doses in terms of the severity of nausea and vomiting (P > 0.05). Conclusion: According to the results of the present study, a low dose of dexmedetomidine may be a more preferable choice as a preventive drug in the incidence of nausea and vomiting in discectomy surgery due to its lower complications, further reduction of nausea and vomiting, and more desirable hemodynamic stability.

Comparative study of the effect of two different doses of remifentanil on bleeding control in lumbar fusion surgery: A randomized clinical trial.

Objectives: Spinal fusion surgery completely prevents movement or friction between the two vertebrae. Remifentanil, a selective drug agonist, suppresses and decreases the vasomotor system upon release of histamine. In this study, the efficacy of remifentanil infusion at doses of 0.1 and 0.3 µg/kg/min in the control of low blood pressure was compared. Methods: In this randomized clinical trial, 110 candidates for selective spinal fusion surgery were entered and randomized into 2 groups. The first group received 0.1 µg/kg/min and in the second group 0.3 µg/kg/min remifentanil. The systolic and diastolic blood pressure, pulse rate, SPO2, and surgeon's satisfaction were measured and compared between groups. Results: the systolic blood pressure was significantly lower in patients receiving 0.3 µg of remifentanil by the time 30, 45, 60, and 90 min during the surgeries (P < 0.05). No significant difference was observed in terms of PR (P = 0.19) and SPO2 (P = 0.41) between the two groups. We also observed significantly higher duration of surgeries (P = 0.002), duration of anesthesia (P = 0.009), significantly higher bleeding volume (P < 0.001), higher fluid intake (P = 0.01) and higher transfused blood (P = 0.01) in patients that received 0.1 µg remifentanil compared to other patients. Conclusion: Here we showed that administration of 0.3 µg/kg/min remifentanil was associated with significantly lower systolic blood pressure during the surgeries. On the other hand, patients that received 0.1 µg/kg/min remifentanil had significantly higher duration of surgeries, duration of anesthesia, significantly higher bleeding volume, higher fluid intake, and also higher transfused blood.

Comparison of the Effect of Two Different Doses of Labetalol to Induce Controlled Hypotension on Hemodynamic Changes During Spinal Fusion Surgery.

BACKGROUND: Spinal fusion surgery is often associated with heavy bleeding. Labetalol is one of the most effective drugs used to control bleeding in surgery. OBJECTIVES: Here, we measured the effect of two therapeutic doses of labetalol on the amount of bleeding. METHODS: This is a randomized clinical trial that was performed in 2020-2021 in Al-Zahra hospital in Isfahan, Iran, on patients that were candidates for posterior spinal fusion surgery under general anesthesia. A total number of 64 patients were entered and randomized into two groups, one receiving labetalol at the dose of 2 mg/min and another group at 4 mg/min during surgery. The amount of bleeding in patients, heart rate, blood pressure, blood oxygen saturation, hypotension or bradycardia, and the mean length of stay in the recovery room were measured and compared between the groups. RESULTS: Extubation time (14 ± 4) and recovery time (76 ± 17) were significantly lower in patients that received labetalol (2 mg/min) compared to another group (21 ± 7 for intubation time and 116 ± 32 for recovery time (P < 0.001 for both items). Patients that received labetalol (4 mg/min) had significantly lower amounts of hemorrhage compared to other group (P = 0.001), and the surgeon's satisfaction was significantly higher in the second group (P = 0.001). The frequency of hypotension and bradycardia during the surgery were significantly higher among patients that received labetalol at the dose of 4 mg/min (P = 0.002 and P = 0.001, respectively). The patients in the group labetalol at 4 mg/min had also significantly lower systolic and diastolic blood pressure and lower mean arterial pressure (MAP) compared to the other group (P < 0.05). CONCLUSIONS: Administration of labetalol at the dose of 4 mg/min had significantly desirable effects on hemodynamics that resulted in reduced bleeding volume and blood pressures compared to labetalol at the dose of 2 mg/min.

Effect of venous dexamethasone, oral caffeine and acetaminophen on relative frequency and intensity of postdural puncture headache after spinal anesthesia.

BACKGROUND: Postdural puncture headache (PDPH) is a relatively common complication after regional anesthesia, especially in younger people, bothersome to patients and needs prophylaxis to prevent this complication. This study was conducted aiming to determine the preventive effect of dexamethasone plus caffeine and acetaminophen on relative frequency and intensity of PDPH after spinal anesthesia. MATERIALS AND METHODS: In a clinical trial study, 90 candidates for the lower extremities orthopedic elective operation were divided into two groups of 45 individuals each. Intervention group received the compound of 500 mg acetaminophen +65 mg oral caffeine +8 mg venous dexamethasone an hour before spinal blocking, and the control group received placebo tablets + a dexamethasone equivalent volume of venous normal saline. The level of postoperative headache at the time of entrance to recovery and discharge, 6, 12, 24, 48, and 72 h postoperatively were measured based on Visual Analog Scale criterion in the two groups and then compared with each other. RESULTS: During the study, 24 patients in the control group and 17 patients in the intervention group were afflicted with headache; however, with no significant difference (P = 0.14). Total frequency of headache incidence was 35 times in the control group and 27 times in the intervention group (P = 0.32). CONCLUSIONS: Though the taking of acetaminophen + caffeine + dexamethasone is associated with a decrease in headache intensity and duration and decrease in PDPH incidence, compared with placebo, however, no essentially and statistically significant effect was produced.

Analyzing the effects of intra-operation video-clip display on hemodynamic and satisfaction of patients during lumbar discectomy under spinal anesthesia.

OBJECTIVE: Most neurosurgeons and anesthesiologists prefer the less invasive intervention for most surgeries; recently, the lumbar anesthesia is more popular method. In this study we have tried to distract the attention of the patients to their favorite video-clip instead of their surrounding operating room background to evaluate the hemodynamic as well as their satisfaction during the operation. METHODS: 80 patients who were scheduled for an elective one level discectomy under the regional spinal anesthesia enrolled in this prospective randomized clinical trial. The patients were randomized with sealed envelope method and each envelope was randomly assigned from this set of envelops to be either in case group one (video group) or control groups two (no audio and video and only head phone on their ears) group. In all patients, systolic and diastolic blood pressure, pulse rate and SPO2 were measured and recorded in the questionnaire charts. RESULTS: Of the 80 patients with Lumbar disk herniation, 53 patients were male and 27 female. The mean age for all patients was 44 year. Systolic and diastolic blood pressure at the end of surgery was significantly lower in video group (P=0.045 and 0.004). Systolic Blood pressure differences between 3(rd) and 5(th) and the end of the surgery with minute zero was significantly less in the video group. (P=0.025, 0.018 and 0.030). Diastolic blood pressure differences between 3(rd) and 5(th) and the end of the surgery with minute zero was significantly less in the video group.(P=0.051, 0.019 and 0.15). Pulse rate differences between first, 3(rd), 5(th) and exactly before leaving the recovery room with minute zero was significantly less in the video group. (P=0.015, 0.028, 0.030 and 0.008). CONCLUSION: According to our study, by displaying patient's favorite video clip during the surgical intervention we could highly reduce the patient's attention to what is happening in operating room and therefore, decrease their anxiety and stress.

Can selection of mechanical ventilation mode prevent increased intra-abdominal pressure in patients admitted to the intensive care unit?

BACKGROUND: Increased intra-abdominal pressure (IAP) results in dysfunction of vital organs. The aim of the present study was to evaluate the effect of mechanical ventilation mode on IAP. METHODS: In a cohort study, a total of 60 patients aged 20-70 years who were admitted to the ICU and underwent mechanical ventilation were recruited. Mechanical ventilation included one of the three modes: Biphasic positive airway pressure (BIPAP) group, synchronize intermittent mandatory ventilation (SIMV) group, or continuous positive airway pressure (CPAP) group. For each patient, mechanical ventilation mode and its parameters, blood pressure, SpO2, and status of tube feeding and IAP were recorded. RESULTS: Our findings indicate that the study groups were not significantly different in terms of anthropometric characteristics including age (64.5 ± 4, P = 0.1), gender (male/female 31/29, P = 0.63), and body mass index (24 ± 1.2, P = 0.11). Increase IAP was related to the type of respiratory mode with the more increased IAP observed in SIMV mode, followed by BIPAP and CPAP modes (P = 0.01). There were significant correlations between increased IAP and respiratory variables including respiratory rate, pressure support ventilation, and inspiratory pressure (P < 0.05). Tube feeding tolerance through NG-tube was lower in SIMV group, followed by BIPAP and CPAP groups (P < 0.05). CONCLUSIONS: There is a significant relationship between respiratory modes and IAP; therefore, it is better to utilize those types of mechanical ventilation like CPAP and BIPAP mode in patients who are prone to Intra-abdominal hypertension.

Comparison of cardiovascular response to laryngoscopy and tracheal intubation after induction of anesthesia by Propofol and Etomidate.

BACKGROUND: Etomidate and Propofol are common anesthetic agents. Previous studies say that Etomidate can be used in patients with limited hemodynamic reserve and Propofol can lead to more hemodynamic instabilities. This study was performed to explore the cardiovascular response during the induction of anesthesia with Etomidate or for comparison, Propofol in elective orthopedic surgeries. MATERIALS AND METHODS: This study was a double-blinded randomized clinical trial study including patients 18-45 years of age that were admitted for elective orthopedic surgeries in 2012. 25consenting, ASA I (American Society of Anaesthesiologists), patients were evaluated randomly in two groups, and their cardiovascular responses including: systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), and O2 saturation (O2 sat) were measured before the laryngoscopy, during the anesthesia induction with Etomidate (0.3 mg/kg) in group A and propfol (2-2.5 mg/kg) in group B and at 1, 3, 5,10 min after the induction. RESULTS: There were no statistical differences between both groups regarding gender, age, body mass index, and laryngoscopic grade of patients (P > 0.05). Changes of SBP in the group B was significantly higher (P = 0.019). Furthermore, changes of the DBP was significantly higher in the group B (P = 0.001). The changes of MAP was higher in group B (P = 0.008). Hypotension happened in 26.1% of group B and 8% of group A (P = 0.09). There were no significant differences among groups A and B in terms of HR (P = 0.47) and O2 sat (P = 0.21), tachycardia (P = 0.6), bradycardia (P = 0.66) and hypertension (P = 0.95). CONCLUSION: Since, patients receiving Etomidate have more stable hemodynamic condition, if there would be no contraindications, it could be preferred over Propofol for general anesthesia.

Correlation between timing of tracheostomy and duration of mechanical ventilation in patients with potentially normal lungs admitted to intensive care unit.

BACKGROUND: There is insufficient evidence to conclude that the timing of tracheostomy alters the duration of mechanical ventilation, hence this study was designed to investigate the correlation between timing of tracheostomy and duration of mechanical ventilation for patients admitted to intensive care unit (ICU) with potentially normal lungs. MATERIALS AND METHODS: In a retrospective study for a period of 2 years, all adult patients admitted to the medical ICU of Al-Zahra Hospital in Isfahan University of Medical Sciences who needed endotracheal intubation and prolonged mechanical ventilation were considered for inclusion in this study. Data of underlying disease, causes of respiratory failure, age and gender, duration of mechanical ventilation, and interval between intubation time and tracheostomy were collected. The correlations between intubation period and ventilation period were analyzed using a Pearson correlation test. RESULTS: Sixty-six percent of patients (100 patients) were men. The mean ± SD of age of patients was 56.2 ± 20.8 years (18-90 years.). The timing of tracheostomy (duration of endotracheal intubation until tracheostomy) did not exhibit any correlation with the length of mechanical ventilation (P = 0.43, r = 0.08). The timing of tracheostomy had not any correlation with the age of patients (P = 0.20, r = 0.129). The length of mechanical ventilation had not any correlation with the age of patients (P = 0.83, r = 0.02). The timing of tracheostomy was similar in men and women (P = 0.5). Mechanical ventilation period was not significantly different in both genders (P = 0.89). CONCLUSION: Our study with mentioned sample size could not show any relationship between timing of tracheostomy and duration of mechanical ventilation in patients under mechanical ventilation with good pulmonary function in ICU.

The effect of intravenous morphine on the level of spinal anesthesia with lidocaine.

UNLABELLED: One of the major concerns in spinal anesthesia with lidocaine is its short duration of action. Enhancement is necessary in some situations during surgery, because surgeons encounter with unexpected events and need more time. Therefore there is a need to increase anesthesia duration in these situations. Many studies investigated various additives with different administration routes to enhance spread and duration of spinal block with lidocaine. Because we only have morphine sulfate in our clinics and the sulfate compounds are neurotoxic, we cannot prescribe it by intrathecal route; for this reason we investigated effects of intravenous morphine on the spinal anesthesia with lidocaine. METHODS: This double blinded randomized clinical trial study was performed on 36 patients who were allocated to two groups. All patients underwent spinal anesthesia with lidocaine by the same method. Patients in the case group received morphine plus midazolam intravenously as the additive medication and in the control group received normal saline plus midazolam. Duration, spinal block level, recovery time, sedation score and adverse effects were compared between the two groups. RESULTS: This study showed that although intravenous morphine can provide better safe sedation (p-value < 0.01), it has no effect on the level (p-value: 0.42) and duration of spinal block (p-value: 0.26). Although heart rate and blood pressure had significant decrease in the case group (p-value < 0.01 and < 0.05 respectively) but the need for administration of ephedrine was completely similar in both groups. CONCLUSION: Although some studies had proved the efficacy of systemic use of other opioids including fentanyl and sufentanil, morphine had no effect on the level and duration of spinal block. It can be due to differences in the chemical structures of these substances. However, intravenous morphine as an additive to spinal anesthesia with lidocaine can provide acceptable sedation with no major side effects.