A Case Report: Surgical Removal of Missing Guide Wire, Is it the Best Intervention?

Nowadays, the use of central venous catheter insertion (CVC), has abundantly increased. It is a common technique in critically ill patients who are admitted to intensive care and emergency departments in order to hemodynamic monitoring and fluid and medication administration. In this report, we express a 28-year-old man who has multiple trauma with decreased level of consciousness during a car accident three months ago and needs intensive care and monitoring by central venous catheter placing. A missed guide wire remaining inside the venous system after peripherally inserted in femoral vein that was incidentally diagnosed by taking a chest X-ray after three months. Although, guide wires are often retrieved by snaring catheter under fluoroscopic guidance and an interventional cardiologist, we have successfully extracted the lost wire through vascular surgery. Eventually, this report is supposed to increase awareness of this rare and preventable complication and to provide a solution to prevent this complication. Finally, the purpose of this report is to emphasize that surgical extracting is the best intervention to remove the missed guide wire (after 3 months) and this option could be developed, introduced and standardized in appropriate and controlled conditions.

Benzodiazepines related sexual dysfunctions: A critical review on pharmacology and mechanism of action / Disfunciones sexuales relacionadas con las benzodiazepinas: una revisión crítica sobre farmacología y mecanismo de acción

INTRODUCTION: Normal sexual functioning of both men and women, being a very complex process, is affected by numerous issues besides aging. Many factors affect the sexual function and lifestyle of the young population. In this article, we tried to review the literature to update the knowledge on benzodiazepine-related (BZD) sexual dysfunction (SD) and involved mechanisms of actions based on animal and human studies. METHODS: Different standard websites such as PubMed were used to review the literature and keywords including benzodiazepines, sexual dysfunction, gammaaminobutyric acid A (GABAA) receptor and erectile dysfunction were used. RESULTS: SD is one of the most common disorders in males and females which has recently been demonstrated to be associated with psychotropic medications such as antihypertensive agents, tranquilizers, antihistamines, appetite suppressants, antidepressants and anxiolytics. BZDs are among the most common psychotropic agents worldwide. SD including decreased libido, erectile dysfunction (ED) and other undesired sexual urges were observed in the patients receiving BZDs. DISCUSSION: The mechanisms of action of BZDs to induce SD mainly relate to enhanced GABAA receptor function which reduces penile erection

INTRODUCCIÓN: El funcionamiento sexual normal de los varones y las mujeres, al ser un proceso muy complejo, se ve afectado por numerosos problemas, además del envejecimiento. Muchos factores afectan a la función sexual y al estilo de vida de la población joven. En este artículo intentamos revisar la literatura para actualizar el conocimiento sobre las disfunciones sexuales (SD, por sus siglas en inglés) relacionadas con benzodiacepinas (BZD) y los mecanismos de acción involucrados en estudios con animales y humanos. MÉTODOS: Se utilizaron diferentes sitios web estándar, como PubMed, para revisar la literatura y las palabras clave que incluyen BZD, disfunciones sexuales, ácido gamma-aminobutírico A y disfunción eréctil. RESULTADOS: Las SD son uno de los trastornos más comunes en los varones y las mujeres, ya que recientemente se ha demostrado que están asociados a medicamentos psicotrópicos como agentes antihipertensivos, tranquilizantes, antihistamínicos, supresores del apetito, antidepresivos y ansiolíticos. Las BZD son uno de los agentes psicotrópicos más comunes en todo el mundo. Las SD que incluían disminución de la libido, la disfunción eréctil (DE) y otros impulsos sexuales no deseados, se observaron en los pacientes que recibieron BZD. DISCUSIÓN: Los mecanismos de acción de las BZD para inducir SD se relacionan principalmente con la función mejorada del receptor de ácido gamma-aminobutírico A (GABAA) que reduce la erección del pene

Benzodiazepines related sexual dysfunctions: A critical review on pharmacology and mechanism of action.

INTRODUCTION: Normal sexual functioning of both men and women, being a very complex process, is affected by numerous issues besides aging. Many factors affect the sexual function and lifestyle of the young population. In this article, we tried to review the literature to update the knowledge on benzodiazepine-related (BZD) sexual dysfunction (SD) and involved mechanisms of actions based on animal and human studies. METHODS: Different standard websites such as PubMed were used to review the literature and keywords including benzodiazepines, sexual dysfunction, gammaaminobutyric acid A (GABAA) receptor and erectile dysfunction were used. RESULTS: SD is one of the most common disorders in males and females which has recently been demonstrated to be associated with psychotropic medications such as antihypertensive agents, tranquilizers, antihistamines, appetite suppressants, antidepressants and anxiolytics. BZDs are among the most common psychotropic agents worldwide. SD including decreased libido, erectile dysfunction (ED) and other undesired sexual urges were observed in the patients receiving BZDs. DISCUSSION: The mechanisms of action of BZDs to induce SD mainly relate to enhanced GABAA receptor function which reduces penile erection.

Nutritional status of trauma patients hospitalized at surgical intensive care unit.

Malnutrition results from a decrease or increase or imbalance of energy, protein and other nutrients, leading to measurable negative effects on body tissue, body shape, organ function and clinical status. Research shows that nutritional support is one of the necessary processes for survival of traumatic patient hospitalized at surgical intensive care unit. The purpose of this study is to evaluate the nutritional status of trauma patients hospitalized at surgical intensive care unit of Kowsar Hospital in Semnan, Iran. This cross-sectional descriptive study was performed on patients older than 18 years with head, neck and femur injuries. Initial data were collected using a checklist containing demographic information questions, designed from the Ministry of Health and Medical Education's Nutrition Screening Form, which was available in the Nutrition Assessment Forms and Guidelines for Hospitalized Patients Approved in 2013. The data were analyzed using Chi-square or Fisher's exact tests, paired t-test and Pearson coefficient. The confidence level was 95% and significance level was less than 0.05 in all tests. The amount of energy determined by the intensive care unit for the patients, with a significantly lower relationship than the amount of energy required by the patients for 24 hours, based on the Harris Benedict formula was (918.20±474.80 calories vs. 1535.76±243.73 calories, respectively and P-value˂0.001). The amount of protein determined by the intensive care unit for the patients for 24 hours, with a significantly relationship lower than the protein required for the patients for 24 hours, was (51.68±34.39 vs. 106.57±13.67, respectively, and P-value˂ 0.001). There was a statistically significant relationship between the age of the patients and energy (P˂0.001) and protein (P˂0.001) determined by the intensive care unit for the patients for 24 hours and energy (P˂0.001) and protein (P˂0.001) required for the patients for 24 hours. The results of this study showed that both the amount of energy and the amount of protein determined by the intensive care unit for trauma patients for less than 24 hours were lower than the required level; therefore, dietary modification for these patients is recommended.

A review on the recent application of ketamine in management of anesthesia, pain, and health care.

Ketamine is considered as a promising drug for many clinical applications even after five decades since its discovery. Ketamine is a dissociative anesthetic agent with a variety of pharmacological effects from anesthetic induction and maintenance to analgesic and sedative depending on the consuming dose. It can be used solely or in combination with other co-adjuvant drugs, increasing their efficacy. Many therapeutic properties of ketamine have been attributed to its antagonism mechanism to N-Methyl-D-aspartate receptor. Identifying new properties of ketamine such as neuroprotective, antiinflammatory, and antitumor effects, on one hand, and taking advantage of subanesthetic regimens of ketamine, on the other hand, have resulted in a widespread use of ketamine in various clinical applications. Ketamine is solvable in aqueous and lipid solutions, providing convenient administration via multiple routes, including oral, nasal, rectal, intravenous, intramuscular, subcutaneous, transdermal, sublingual, and intraosseous administration. Application of ketamine has some advantages over other sedative and anesthetic agents. It produces bronchodilation status, allowing for most secure induction of anesthesia in patients with life-threatening asthma and intense acute bronchial constriction. Ketamine has an excellent hemodynamic profile, makes it the agent of choice for patients with unstable hemodynamics, such as shocked or hypotensive patients. Ketamine usage has been associated with a lower risk of respiratory depression and relatively more conserved airway reflexes. Although being an anesthetic agent, ketamine has been increasingly used in subanesthetic doses for acute and chronic pain as well as depression. Using ketamine in pre and postoperative pain management is well established. However, the studies on ketamine performance in pain management demonstrated contradicting results. On the other hand, various side effects along with no confirmatory data on long-term treatment demand great caution when using ketamine for treating complex chronic pains. The present study aimed to provide a general review on the recent applications of ketamine in anesthesia, pain management, and critical care.

Examination of the sedative and analgesic effects of gabapentin and dexmedetomidine in patients undergoing laparoscopic cholecystectomy surgery: A randomized controlled trial.

INTRODUCTION: At present, laparoscopic surgery is a very common method, especially for the removal of the gallbladder, because pain and anxiety following surgery is a major problem in surgical operations. Various studies have demonstrated the effectiveness of gabapentin and dexmedetomidine in reducing pain intensity after surgery. The present study is aimed at examining the sedative and analgesic effects of gabapentin and dexmedetomidine in patients undergoing laparoscopic cholecystectomy. METHODS: This was a double-blinded clinical trial involving 40 patients who were candidates for laparoscopic cholecystectomy. The patients were randomly allotted in two groups of dexmedetomidine (n = 20) and gabapentin (n = 20). Then, pain intensity based on the visual analog scale (VAS) and sedation level based on the Ramsay Sedation Scale (RSS) were measured at the curtained times. As the data were not normally distributed, the Mann-Whitney U test was used to analyze the data, and the significance level was set at 0.05. RESULTS: Across the follow-up points, more reduction in pain intensity was observed in the dexmedetomidine group as compared with the gabapentin group. The available dissimilarities between these two groups in pain decrement at the recovery room and 3 h after being discharged from the recovery room were not significant (P ≥ 0.414). In addition, across all the time points, there was considerable growth in sedation in the dexmedetomidine group in comparison with the gabapentin group (P < 0.024). This finding indicated that dexmedetomidine was more effective than gabapentin in creating sedation. CONCLUSION: Compared with gabapentin, dexmedetomidine leads to more pain reduction after surgery and better sedation during and after surgery.

Effects of Adding Midazolam and Sufentanil to Intrathecal Bupivacaine on Analgesia Quality and Postoperative Complications in Elective Cesarean Section.

BACKGROUND: Intrathecal adjutants can be used for regional anesthesia (RA) in cesarean section to improve its quality in terms of time and complications. Some previous studies focused on the effects of adding sufentanil and/or midazolam to bupivacaine and compared each with using bupivacaine alone. However, there has been no study to assess the effects of using sufentanil and midazolam in combination with bupivacaine. OBJECTIVES: The aim of this study was to evaluate and compare properties (time of achievement/recovery of sensory/motor blocks; and time to request opium), complications (nausea, vomiting, shivering and hypotension), and neonatal first minute Apgar score with and without the addition of midazolam (M) or sufentanil (S) to bupivacaine (B) through intrathecal injection for spinal anesthesia, after the cesarean section. PATIENTS AND METHODS: In this double blind randomized clinical trial participants were randomly allocated to three equal groups: Group B (2.5 cc of bupivacaine 0.5% + 1 cc normal saline 0.9%), Group BM (2.5 cc of bupivacaine + 0.02 mg/kg midazolam) and Group BS (2.5 cc of bupivacaine 0.5% + 0.7 cc normal saline 0.9% + 1.5 µg of sufentanil, 0.3 cc). We used analysis of variance (ANOVA), post hoc test with Bonferroni adjustment, and chi-square test for statistical analysis; the analyses were performed using the SPSS-16 software. Given a significant level of 0.05, overall and pair-wise comparisons were made. RESULTS: Seventy-five females participated in the study with no significant age difference (mean ± standard deviation (SD): 28.60 ± 6.06, 28.12 ± 5.29 and 28.76 ± 3.97 year; P = 0.9). Except for "time to motor block recovery" (P = 0.057), the overall differences among the three groups was significant in terms of "time to sensory/motor block" (P < 0.001), "time to sensory block recovery" (P < 0.001), and "time to request opium" (P < 0.001). In all pair-wise comparisons there was no significant difference between the BM and BS group, except for "time to request opium", which was longer in the BS group (P < 0.001). The occurrence of nausea (P = 0.02), postoperative shivering (P = 0.01) and hypotension (P < 0.001) were significantly different between the groups, unlike vomiting, where the difference was not significant (P = 0.2). All neonates had an Apgar score of nine. CONCLUSIONS: The findings showed that adding sufentanil or midazolam to bupivacaine shortens the onset of spinal anesthesia and increases the time duration of anesthesia; however it does not change the motor block recovery time. Adding sufentanil delays the first request for narcotic analgesics while adding midazolam leads to a decrease in nausea and hypotension. Adding sufentanil or midazolam does not have any deleterious effect on infants' Apgar scores. However, increases shivering in patients.