Anesthesiology and Pain Medicine最新文献

Background: Post-induction positioning influences the onset speed of the sensory block by affecting anesthetic distribution. Techniques such as using opioids and extending recovery stays aim to enhance this process.

Objectives: This study aimed to evaluate the impact of transitioning patients from a sitting to a lateral position immediately after the induction of 0.5% hyperbaric bupivacaine spinal anesthesia on postoperative pain and opioid consumption.

Methods: In this prospective, randomized clinical trial, patients scheduled for percutaneous nephrolithotomy (PCNL) under spinal anesthesia at Shahid Labafinejad Hospital in 2023 were divided into intervention (lateral position) and control (supine position) groups. Blood pressure, mean arterial pressure (MAP), and heart rate were recorded upon entering recovery, then every 10 minutes up to 60 minutes, and every 15 minutes up to 120 minutes post-operation. Pain levels were assessed using the Visual Analogue Scale (VAS) at specified intervals. Patient satisfaction with analgesia quality was also evaluated.

Results: The study included 35 patients in the lateral group and 34 in the supine group. Pain levels significantly differed between the groups over time (P = 0.0001). The lateral group had a longer analgesia duration (28.8 ± 10.0 minutes vs. 22.9 ± 2.9 minutes, P = 0.105) and lower total narcotic consumption (21.7 ± 5.8 mg vs. 30.4 ± 10.2 mg, P = 0.012). Mean arterial pressure changes showed no significant difference (P = 0.061). Patient satisfaction was significantly higher in the lateral group (P = 0.0001).

Conclusions: Transitioning from the sitting to lateral position post-induction with hyperbaric bupivacaine enhances hemodynamic stability, improves drug distribution in the cerebrospinal fluid (CSF), and enhances sensory block quality. This approach increases postoperative analgesia duration, reduces opioid use and related complications, and decreases the duration of surgery.

Background: The objective structured clinical examination (OSCE) is an appropriate method for assessing clinical competency among students in universities worldwide. With nowadays technological advances, there is a growing interest in virtual OSCEs (VOSCEs).

Objectives: The present study aimed to design, implement, and evaluate a VOSCE for assessing anesthesia students' clinical competency.

Methods: This quasi-experiment study was conducted in six phases: (1) Defining the exam's specifications and design, (2) determining validity and reliability, (3) setting up and conducting a pilot VOSCE, (4) familiarizing students with the VOSCE, (5) administering the exam, and (6) evaluating and providing feedback. Seventy-five senior anesthesia students from Abadan University of Medical Sciences were selected by census and participated in this study between 2021 and 2023. The scores of virtual and in-person OSCEs were compared, and the correlation between the two exams was investigated. At the end of each semester, students participated in a survey related to the VOSCE. The exam results and survey data were presented at the faculty's educational development office meetings, and suggestions for amending and eliminating shortcomings were considered in the following semester. Data were analyzed using SPSS 20 by calculating means, standard deviations, and Pearson's correlation.

Results: The students' mean scores in the virtual and in-person OSCEs were 17.68 and 16.75, respectively. No significant difference was observed between the scores of the two exams. The total score of the VOSCE had a direct and significant correlation with the in-person OSCE (r = 0.861, P < 0.001), and this correlation was also observed in all stations of both exams (P < 0.05). Student surveys indicated that the VOSCE fostered a sense of empowerment, self-confidence, and enhanced learning, causing students to express strong agreement with its continuation in the future.

Conclusions: The VOSCE can be an appropriate substitute for or an integral part of the in-person OSCE. It is recommended that educational planners and instructors develop this exam as a new assessment method. Given advances in technology and the requirement for improving the quality of virtual exams, professors need to be empowered in the field of modern electronic assessment methods.

Background: Among the available tools, the SAMPE and ALDERTE checklists have been specifically designed to facilitate timely patient discharge, minimize human error, and optimize resource utilization. Given the complexities associated with surgical care, a comparative analysis of these two checklists is essential to evaluate their efficacy in improving discharge outcomes and preventing complications.

Methods: This descriptive-analytical cross-sectional study assessed the distribution of complications following radical prostatectomy surgery by utilizing the SAMPE and ALDERTE checklists for discharge from the post-anesthesia care unit (PACU). A total of 156 participants, divided into three groups of 52 individuals each, were monitored for post-discharge complications 12 hours after their discharge from the PACU across three training centers. This methodology enabled a thorough evaluation of the roles of both checklists in mitigating adverse events during the critical post-operative period.

Results: No significant differences in complication rates were observed among the groups; however, bleeding and vomiting were slightly more common in the SAMPE group.

Conclusions: This study concluded that neither the SAMPE nor the ALDERTE checklist provided a distinct advantage over the control group, which comprised patients routinely discharged from the same treatment center. Both checklists demonstrated similar functionalities, with each showing relative strengths in specific aspects; however, neither was found to be universally superior to the other.

Background: One of the fundamental principles of medical interventions is to avoid causing pain to patients, and childbirth is no exception. With the rising prevalence of cesarean sections, addressing factors that may diminish maternal satisfaction is crucial. Spinal anesthesia, the most common method for cesarean sections, faces challenges such as patient anxiety. To mitigate pain associated with needle insertion, various methods, including lidocaine spray and Xyla-P cream, have been recommended.

Objectives: This study aimed to evaluate the effectiveness of lidocaine spray and Xyla-P cream in reducing pain during needle insertion for spinal anesthesia in cesarean sections.

Methods: This randomized, placebo-controlled interventional study included 263 pregnant women at 37 weeks or more of gestational age who were candidates for elective cesarean sections. Participants were randomly assigned to intervention and control groups using a block permutation technique. In intervention group 1, 10 g of Xyla-P cream was applied 30 minutes before spinal anesthesia. In intervention group 2, three puffs of 10% lidocaine spray were used. The control group received three puffs of water spray ten minutes before anesthesia. Pain intensity and anxiety were assessed using the Visual Analog Scale (VAS), and maternal cooperation was scored by the anesthesiologist.

Results: The mean age of the participants was 30 years, and 21% had no prior history of cesarean section. There was no significant difference in pain, anxiety, satisfaction, and cooperation between the Xyla-P and lidocaine groups. However, in the group receiving lidocaine, satisfaction (P-value: 0.001) and cooperation (P-value: 0.019) improved significantly compared to the placebo group, whereas anxiety increased significantly compared to the placebo group (P-value: 0.045).

Conclusions: Lidocaine had a positive effect on maternal satisfaction with spinal anesthesia and, compared to the placebo, led to significant improvements in maternal satisfaction and cooperation. In light of these findings, lidocaine emerges as a more appropriate choice than Xyla-P cream.

Background: Nausea and vomiting are among the most common complications after surgery.

Objectives: The aim of this study was to investigate the effectiveness of chamomile in reducing the incidence and severity of nausea and vomiting after middle ear surgery.

Methods: A total of 110 patients who met the inclusion criteria were randomly assigned to either the chamomile or placebo group. Group A consumed chamomile drops (500 mg), while group B consumed cornstarch with 30 mL of water, one hour before surgery. The severity of nausea and frequency of vomiting were recorded at recovery (time of zero), 1, 2, 4, and 6 hours after surgery using the Rhodes Index. Data were analyzed using SPSS v.21 software, paired t-tests, and chi-square tests.

Results: A total of 110 patients were included, with an average age of 36.14 ± 10.3 years (group A) and 34.28 ± 13.3 years (group B). There was no statistically significant difference between the chamomile and placebo groups in terms of the severity of nausea and the frequency of vomiting immediately after recovery (time of zero), 1, 2, and 6 hours after surgery (P > 0.05). However, 4 hours post-surgery, the severity of nausea in the chamomile group was lower than in the placebo group, and a statistically significant difference was observed between the two groups (P = 0.03). No gastrointestinal side effects were reported.

Conclusions: Based on the results of this study, chamomile can be used to reduce nausea and vomiting after middle ear surgery, given its availability and low cost.

Objectives: The primary objective was to test the hypothesis that the preemptive/preventive effect of Dexmedetomidine would attenuate the post-operative pain more effectively compared to ketorolac and control groups.

Methods: This study was conducted in Shahid Mohamadi Hospital. Sixty patients undergoing appendectomy operations were randomized in 3 groups. Group A received intravenous Dexmedetomidine bolus (1 μg/kg) and infusion (0.5 μg/kg/h). Group B received slow intravenous bolus ketorolac 30 mg. Group C was the control group. Post-operatively fentanyl (5µg/mL) as patient control analgesia (PCA) was provided only on demand. The primary outcome was the Visual Analogue Scale (VAS) pain scores recorded at 1, 3, 6, 12 and 24 hours postoperatively. The secondary outcome was the 24-hour cumulative fentanyl PCA dose. Tertiary outcomes; changes in blood pressure, heart rate, body temperature, SpO₂ perioperatively. Quaternary outcomes were PONV, shivering.

Results: In the Dexmedetomidine group the mean ± SD pain VAS scores 1.15 ± 1.98 and 0.95 ± 1.76 were significantly lower at 12 and 24 hours after operation (P = 0.004 and P = 0.003) compared to the other two (ketorolac and control) groups. The cumulative volume dose of fentanyl PCA 21.35 ± 11.77 mL was less in the Dexmedetomidine group compared to ketorolac (28.35 ± 9.82 mL, P = 0.629) and control (40.35 ± 12.90 mL, P = 0.003) groups.

Conclusions: Preemptive/preventive effects of Dexmedetomidine were greatest after operation compared to the ketorolac and control groups in the terms of pain scores and amount of analgesia needed postoperatively.

Background: Opioid-free anesthesia (OFA) is a relatively new approach, and many studies are still needed to assess its effectiveness and compare it to opioid-based anesthesia (OBA).

Objectives: This study investigated the use of OFA in obese patients undergoing upper limb surgery and compares its outcomes with those of OBA.Methods:This prospective randomized clinical study included 76 obese patients with a Body Mass Index (BMI) ≥ 30 kg/m² who were scheduled for upper limb surgery. Patients were randomly assigned to receive either OFA (group A, n = 38) or OBA (group B, n = 38). The OBA group was administered propofol, fentanyl, and atracurium, while the OFA group received lidocaine, propofol, atracurium, and dexmedetomidine. All patients were mechanically ventilated, and anesthesia was maintained with isoflurane and atracurium. Primary outcomes monitored included postoperative pain [Visual Analog Scale (VAS) ≥ 4] and the number of rescue doses of tramadol. Secondary outcomes included extubation time, any cardiac events, hypoxia, postoperative nausea and vomiting (PONV), intensive care unit (ICU) admission rates, and duration of hospital stay.

Results: The OFA group had significantly lower extubation time, mean arterial pressure (MAP), and heart rate (HR) compared to the OBA group. Additionally, VAS scores were significantly lower at the 30-minute and 2-hour marks after extubation (P < 0.001 and P < 0.001, respectively) in patients receiving OFA. The OFA group also experienced fewer adverse effects, required fewer rescue doses of tramadol, and had shorter hospital stays.

Conclusions: Opioid-free anesthesia may result in better and safer outcomes for obese patients undergoing upper limb surgeries, with fewer postoperative complications and shorter hospital stays. However, further research is needed to fully understand the potential benefits of OFA compared to OBA.

Background: Pediatric dentists employ both pharmacological and non-pharmacological behavior control methods. Despite the use of behavioral control techniques, some young children cannot undergo treatment in the office, making sedation or general anesthesia necessary. Premedication drugs can be used before general anesthesia to reduce anxiety, control pain, induce amnesia, prevent nausea, and avert potential complications. The search for the ideal premedication for children is ongoing.

Objectives: This study aims to compare the effects of pregabalin and midazolam (MID) in children undergoing dental treatment under general anesthesia.

Methods: This prospective, triple-blind study included 64 children aged 2 - 6 years who required dental treatment under general anesthesia. Participants who met the inclusion criteria were enrolled. One group of children received pregabalin syrup, while the other group received MID syrup. The comfort of the child during separation from the parents, ease of venous access, and degree of sedation upon entering the operating room were evaluated. Blood pressure, heart rate, and blood oxygen levels were measured at baseline and every 30 minutes thereafter. Additionally, the duration of the patient's stay in recovery until discharge was recorded and compared between the two groups. Statistical analyses were performed using chi-square, Mann-Whitney U, Fisher's exact test, and SPSS version 14 software.

Results: No statistically significant differences were found between premedication with MID and pregabalin in terms of anxiety during venous access, parental separation anxiety, restlessness in recovery, duration of recovery stay, or changes in heart rate, blood pressure, and blood oxygen levels between the two groups. However, a statistically significant difference was observed between the two groups regarding the degree of sedation before entering the operating room.

Conclusions: Both pregabalin and MID were effective for premedication in terms of sedation and anxiety reduction, with no significant difference between the two drugs in these outcomes.

Background: Pleurectomy/decortication (P/D), a surgical procedure for malignant pleural mesothelioma (MPM), is a highly invasive surgery requiring prolonged hospitalization. Previous studies have reported that postoperative analgesia using regional anesthesia contributes to shorter hospital stays after surgery under general anesthesia by reducing acute postoperative pain. However, the association between postoperative analgesia and the length of hospital stay (LOHS) following P/D has not been evaluated.

Objectives: To evaluate the association between postoperative analgesia and postoperative LOHS after P/D.

Methods: This single-institution observational study enrolled consecutive adult patients undergoing P/D under general anesthesia, who postoperatively received either intertransverse process block (ITPB) or continuous intravenous (IV) fentanyl infusion as postoperative analgesia between March 2022 and February 2023.

Results: Among all enrolled patients with ASA physical status II or III (n = 60), postoperative analgesia was administered using either continuous ITPB (n = 19) or continuous IV fentanyl infusion (n = 41). Multivariable logistic regression analysis revealed that postoperative analgesia with continuous ITPB (P = 0.007), a lower incidence of major complications after surgery (P = 0.034), and female sex (P = 0.033) were significantly associated with a shorter postoperative LOHS. In subgroup analysis, patients who received continuous ITPB had significantly lower postoperative LOHS, lower postoperative serum C-reactive protein levels on postoperative day (POD) 3, and reduced acute postoperative pain on POD3 compared to those who received continuous IV fentanyl infusion.

Conclusions: Postoperative analgesia using continuous ITPB appears to be associated with a reduction in LOHS following P/D for MPM under general anesthesia.

Background: Residency is a critical period in the development of medical professionals. It provides hands-on training and exposure to various medical specialties, enabling residents to improve their skills and achieve expertise in their chosen field.

Objectives: This study aimed to extract frequent patterns in annual and board examination performance among anesthesiology residents by analyzing results from the department's weekly exams.

Methods: This cross-sectional study was conducted in the Department of Anesthesiology, Critical Care, and Pain Medicine (DACCPM) from September 2022 to June 2023. Weekly intra-group exams were administered at the university's electronic exam center for residents in their first to fourth years (CA-1 to CA-4), with a total of 61 participants. Learner grades were categorized as excellent (A), good (B), average (C), poor (D), and inferior (E). The Apriori algorithm was employed to extract frequently repeated patterns in these exams and compare them with results from the final national examination.

Results: A total of 24 exams were conducted, with all 61 residents participating. The most frequent patterns, identified with a minimum support of 0.41, revealed that residents generally achieved average scores in exam 7 and very poor scores in exams 1 and 5. The study found a statistically significant relationship between residents' scores in in-training examinations (ITEs) and their national examination performance.

Conclusions: Analyzing residents' exam performance using frequent pattern recognition can help identify their strengths and weaknesses. Faculty members can utilize these insights to better plan curricula and enhance the quality of education.