Anesthesiology and Pain Medicine最新文献

Background: Laryngoscopy is the most painful noxious stimulus during anesthesia and surgery. Dexmedetomidine is increasingly used as a sedative in surgeries involving microlaryngoscopy.

Objectives: This study aimed to evaluate the effect of dexmedetomidine and a combination of fentanyl and midazolam on mitigating the stress response in patients scheduled for microlaryngoscopy.

Methods: This randomized, double-blind clinical trial enrolled 60 patients (28 males and 32 females) aged 18 - 65 years with the American Society of Anesthesiologists (ASA) physical status I - III. The patients were scheduled for microlaryngoscopy and equally divided into 2 groups. Group D received 1 μg/kg of dexmedetomidine and saline bolus dose over 10 minutes before general anesthesia (GA) induction, followed by 0.5 μg/kg/h of dexmedetomidine and saline infusions after GA induction. Group MF received 0.8 μg/kg of fentanyl plus 0.05 mg/kg of midazolam over 10 minutes before GA induction, followed by 1 μg/kg/h of fentanyl plus 0.05 mg/kg/h of midazolam as an infusion. The heart rate (HR) and mean arterial blood pressure (MAP) pressure were recorded from baseline until the end of surgery. Infusions were stopped at the end of the surgery.

Results: The number of patients requiring propofol and intraoperative supplemental propofol was significantly lower in group D than in group MF. The heart rate was significantly lower in group D than in group MF (P = 0.022, 0.048, 0.032, 0.045, 0.041, 0.026, 0.030, and 0.036) from induction until the end of surgery; in addition, it was comparable between both groups at baseline and before induction. MAP was comparable between both groups for all measurements.

Conclusions: Dexmedetomidine mitigates the hemodynamic changes related to microlaryngoscopy more effectively than the fentanyl-midazolam combination.

Context: Hemiplegic shoulder pain (HSP) is one of the complications of a stroke.

Objectives: This study aimed to determine shoulder pain prevalence in cerebrovascular accident (CVA) patients.

Methods: This meta-analysis study searched English and Persian descriptive or descriptive-analytical full-text studies on CVA patients. The search was carried out in all databases by two researchers using keywords such as stroke, pain, CVA, hemiplegic, and shoulder pain. Data analysis was done with the software CMA3.

Results: In the initial search, 109 articles were found, and finally, the data from four articles were analyzed. The prevalence of HSP was 23% (confidence interval (CI) = 10.3% - 43.5%).

Conclusions: Considering the HSP prevalence (28.1%) among CVA patients, it is necessary to carry out rehabilitation interventions to prevent such pain in these patients. It is also suggested that rehabilitation interventions be included in the patient education of the healthcare system.

Parkinson's disease (PD) is a chronic neurological degenerative disease affecting the central nervous system, which is responsible for progressive disorders such as slow movements, tremors, rigidity, and cognitive disorders. There are no specific recommendations and guidelines for anesthetic management of patients with PD undergoing ophthalmic procedures. This narrative review aims to summarise the anesthetic considerations in patients with PD presenting for cataract surgery.

Background: Stroke is prevalent in Iran, and its complications can decline patients' quality of life and psychological state.

Objectives: This study aimed to investigate the relationship between pain following stroke (PFS) and disability in stroke patients.

Methods: The current case-control study was conducted on 184 stroke patients (92 cases and 92 controls). Data collection tools included a demographic questionnaire, the Visual Analog Scale (VAS), and the Disabilities of the Arm Shoulder and Hand (DASH) questionnaire. Based on the medical files of all patients with stroke, eligible ones were invited to participate in the study via phone calls. The collected data were then analyzed.

Results: The disability rate was higher in the case group of patients with a history of hemorrhagic stroke, smoking, stroke, and diabetes (P < 0.05). The mean ± SD age was 72.45 (11.54). Also, the level of disability in patients increased with age (P = 0.000). The mean ± SD disability score was 78.63 (6.92) in patients with PFS and 54.9 (10.87) in patients without PFS. Also, R = 0.795 and R²= 0.631 indicated the significance of disability severity in patients with PFS.

Conclusions: The prevalence of disability was higher in patients with higher PFS levels. Hence, drug interventions or rehabilitation programs can be used to reduce the disability of stroke patients.

Background: Patients may experience anxiety, discomfort, and pain during endoscopy, which cannot be tolerated without sedative drugs.

Objectives: This study aimed to compare the sedative effects of dexmedetomidine and midazolam on patients undergoing endosonography outside the operating room.

Methods: This randomized, double-blind clinical trial was conducted on 126 patients aged 18 - 65 years old with American Society of Anesthesiologists (ASA) physical status I - II undergoing elective endosonography. Patients were randomly divided into 2 groups. The dexmedetomidine group received dexmedetomidine (1 μg/kg) for 25 minutes with propofol (0.5 mg/kg) and fentanyl (1 μg/kg) at the start of the procedure. The midazolam group received midazolam (0.03 mg/kg) with propofol (0.5 mg/kg) and fentanyl (1 μg/kg). Heart rate, mean arterial pressure (MAP), and oxygen saturation (SpO₂) were recorded before and 5, 10, and 15 minutes after starting the procedure. The Ramsay Sedation Scale (RSS) and the need for an additional dose of propofol were recorded during the procedure. The Numeric Pain Rating scale (Ambesh score) scores were recorded at the beginning, immediately after, and 1 hour after the procedure. Nausea and vomiting were assessed using the Visual Analogue Scale in cooperation with the patient.

Results: The dexmedetomidine group had significantly higher SpO₂ and RSS scores during sedation than the midazolam group (P = 0.02). Overall, specialist satisfaction was higher in the dexmedetomidine group than in the midazolam group. There was no clinically significant difference in pain score and nausea and vomiting frequencies between the 2 groups.

Conclusions: Dexmedetomidine is more effective than midazolam for sedation during gastrointestinal endosonography.

Background: Direct laryngoscopy is the standard method for intubation in pediatric patients. The introduction of video laryngoscopy brought a paradigm shift in managing pediatric airways.

Objectives: We compared the tracheal intubation technique between direct and video laryngoscopy with McIntosh Blade 2 in pediatric patients 2 - 8 years of age requiring airway management. The glottic view and the first pass success rate were compared and analyzed.

Methods: An observational cross-sectional study was conducted with 120 children between 2 - 8 years with normal airways. They were divided into video laryngoscopy (Group V) and direct laryngoscopy (Group D). The primary outcome measures included time taken for intubation, number of attempts required, Cormack-Lehane glottic view, use of optimization maneuvers, the requirement of tube repositioning, and hemodynamic parameters before and after intubation.

Results: The time taken for intubation was longer in the video laryngoscopy group (group D, 24.28 sec vs. group V, 27.65 seconds (P = 0.01). The Cormack-Lehane glottic view was grade 1 in all the patients in the video laryngoscopy group, while only 35 children showed grade 1 in the direct laryngoscopy group. (P < 0.001). We observed a significant increase in both heart rate and mean arterial pressure in the video laryngoscopy group at 1, 3, 5, and 10 min after intubation (P < 0.001, P < 0.05).

Conclusions: The time taken for intubation was more in group V, but the glottic view was much better, and the requirement for external maneuvers was also less. Pressure response to intubation was more in group V compared to group D.

Background: Despite the high acceptability of the extracorporeal shock wave lithotripsy (ESWL) procedure in the treatment of urinary stones at all ages, it is necessary to use a variety of analgesic drugs during the procedure, especially among children.

Objectives: We aimed to evaluate the effect of dexmedetomidine-ketamine (DK) and midazolam-ketamine (MK) compounds in the sedation of children (2-6 years old) undergoing ESWL.

Methods: This randomized, double-blind clinical trial was performed on children aged 2 to 6 years with renal stones undergoing ESWL. The participants were randomly assigned to the DK and MK regimen groups (dexmedetomidine, 0.05 mcg/kg within 10 minutes infusion; midazolam, 0.05 mg/kg within 3 minutes infusion; ketamine, 0.5 mg/kg bolus injection). The patients were assessed with respect to sedation degree, post-procedure hemodynamic status, recovery time and awakening, and operator satisfaction.

Results: Recovery time was significantly shorter in the DK group than in the MK group. Also, the DK regimen was more analgesic than the MK regimen; therefore, the need to repeat ketamine administration was less. There was no difference between the 2 methods in terms of cooperation at the time of separation of children from their parents, patient cooperation during the procedure, average verbal response time and average cooperation time after entering recovery, and operator satisfaction with the operation. No side effects were observed in the 2 groups.

Conclusions: Ketamine with dexmedetomidine is associated with greater analgesia and shorter recovery time; however, sedation time was longer (insignificant) in ketamine with midazolam than in ketamine with dexmedetomidine. Thus, ketamine with dexmedetomidine is more preferred.

Symptomatic patients with coronavirus disease 2019 (COVID-19) mostly have flu-like symptoms. However, neurologic manifestations are common and may be the early findings of COVID-19. Data for COVID-19 do not indicate an increased risk of infection in pregnant individuals, but the risk of disease severity and mortality is high in this patient population. We report a case of a pregnant woman in the 10th gestational week, who presented with neurological symptoms of sudden impairment in walking, balance, speech, and consciousness, started the night before, and a seven-day history of fever, chills, myalgia, and general weakness before admission. The polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive for the cerebrospinal fluid sample a day before the positive nasopharyngeal sample. Axial brain magnetic resonance imaging revealed the involvement of the spinothalamic tract. Following treatment with intravenous immunoglobulin, the patient's neurological condition gradually recovered, except for lower limb muscle strength, and she was discharged from the hospital on the 10th day of admission. This case is unique as it emphasizes the importance of considering COVID-19 when uncommon neurologic manifestations with negative nasopharyngeal PCR are present.

Background: Unilateral spinal anesthesia is often accompanied by technical difficulties in implementation, multiple puncture attempts, unsuccessful punctures, and, as a result, insufficient anesthesia, along with various complications associated with a dural puncture.

Objectives: This work compares the efficacy and safety of conventional Unilateral Spinal Anesthesia (USpA) and unilateral spinal anesthesia with electrical nerve stimulation (USpA+ENS).

Methods: A total of 134 patients with an upcoming vascular surgery on one lower extremity were randomly assigned to two groups. All the patients were positioned with the operated limb below and used 7.5 mg of Bupivacaine-Spinal®. In the UsPA group, anesthesia was performed according to the standard technique. In the USpA+ENS group, electrical nerve stimulation was additionally used. Primary outcomes were the presence or absence of post-dural puncture headache (PDPH), number of puncture attempts, lateralization, and anesthesia adequacy. Secondary outcomes were intraoperative pain scores, the presence or absence of nausea and vomiting, and the need for hemodynamics correction.

Results: The frequency of puncture complications was sufficiently lower in the USpA+ENS group than in the UsPA group. The local anesthetic solution distribution, pain score indicators, and secondary outcomes were comparable in both groups with a slight difference.

Conclusions: We showed that USpA+ENS reduces the incidence of puncture complications and improves the quality of anesthesia and adherence of both patients and anesthesiologists to the unilateral spinal anesthesia technique.

Background: Handheld ultrasound devices have become popular among clinicians due to their affordability and compatibility with tablets and smartphones. Several handheld ultrasound devices have the capability to construct three-dimensional (3D) images using a traditional two-dimensional (2D) ultrasound transducer.

Objectives: The current study aimed to construct 3D images of common peripheral nerve and fascial plane blocks using a handheld ultrasound device with a 2D ultrasound probe.

Methods: A total of 10 patients who were scheduled to receive ultrasound-guided peripheral nerve blocks for outpatient surgery and classified as the American Society of Anesthesiologists physical status I or II with a body mass index of ≤ 30 kg/m² were included in the study. Patients who presented with anatomical variations during the initial ultrasound scanning were excluded.

Results: This study successfully constructed 3D images of 10 peripheral nerve blocks. The average time to complete each 3D scan was less than 5 seconds per attempt, with fascial plane blocks requiring twice the amount of time to complete. All the nerve blocks provided effective postoperative analgesia without complications. The 3D images were successfully captured in all patients.

Conclusions: The 3D images provide clinicians with valuable information on the anatomical boundaries of the injectate that can further direct needle direction and placement of local anesthetic to achieve visual confidence of anesthetic spread.