Stellate ganglion block as a complementary therapeutic modality for arterial thrombosis in upper limb of a neonate

Stellate ganglion block or lower cervical sympathetic block is an interventional procedure, in which a local anesthetic is injected to the sympathetic trunk of the neck, for adjustment of autonomic tone in head, neck and the upper extremity. This procedure is frequently used as a complementary therapeutic modality in a variety of complex heterogeneous problems. We report a case of rapid onset radial and brachial artery thrombosis, which developed in a neonate patient after multiple attempts for a peripheral venous access by cannulation. The condition was diagnosed with Doppler ultrasound, and was successfully managed with stellate ganglion block along with intravenous administration of an anticoagulant. Citation: Taheri M, Radfar M, Tabasi S, Alijanpour E, Jabbari A. Stellate ganglion block as a complementary therapeutic modality for arterial thrombosis in upper limb of a neonate. Anaesth pain & intensive care 2019;23(4)__ Received: 22 July 2019; Reviewed: 18 August, 15 November 2019; Revised: 2 December 2019; Accepted: 6 December 2019

The diagnostic value of fine needle aspiration in comparison with frozen section in thyroid nodules: A 20-year study

Background:

Fine needle aspiration (FNA) is the most important method in the diagnosis of thyroid nodules before surgery. Recently, the efficiency of FNA in thyroid nodule management has been debatable. On the other hand, intraoperative frozen section (FS) has been used to confirm the diagnosis of FNA and select the proper surgical approach. In this regard, the present study aimed to assess the diagnostic value of FNA as compared to FS in the diagnosis of thyroid nodules.

Methods:

This retrospective study was performed on 69 patients with FNA and FS and histopathological examination from 1993 to 2014 in Babol, northern Iran. FNA was classified into 5 groups: benign (colloid goiter), lymphocytic thyroiditis, follicular lesions, suspicious and malignant, and FS was classified as after benign or malignant. The results of both methods were compared with each other.

Results:

This retrospective study was performed on 69 patients with FNA and FS and histopathological examination from 1993 to 2014 in Babol, northern Iran. FNA was classified into 5 groups: benign (colloid goiter), lymphocytic thyroiditis, follicular lesions, suspicious and malignant, and FS was classified as after benign or malignant. The results of both methods were compared with each other.

Conclusion:

FNA was considered as a simple, less invasive and cost effective method with fewer side effects for evaluation of thyroid nodules. Particulary it had a high sensitivity and specificity in experienced and skilled hands.

Prophylactic Effects of Lidocaine or Beclomethasone Spray on Post-Operative Sore Throat and Cough after Orotracheal Intubation

INTRODUCTION

Post-operative sore throat and cough are common complications of endotracheal intubation. These conditions may be very distressing for the patient and may lead to unpleasant memories. This study was performed in order to determine whether beclomethasone and lidocaine spray could reduce the frequency of post-operative sore throat and hoarseness after tracheal extubation.

MATERIALS AND METHODS

Ninety women (18-60 years of age) with an American Society of Anesthesiologists (ASA) physical status I or II and undergoing elective mastoidectomy were randomized into three groups of 30 patients. The endotracheal tubes in each group were sprayed with 50% beclomethasone, 10% lidocaine hydrochloride, or normal saline (control group) before endotracheal intubation. Patients were examined for sore throat (none, mild, moderate, or severe), cough, and hoarseness at 1 and 24 h after extubation.

RESULTS

There was a significantly lower incidence and severity of post-operative sore throat in the beclomethasone group than the lidocaine and control groups (P<0.05) at each observation time point. At 24 h after extubation, the incidence and severity of sore throat and cough was significantly lower in the lidocaine compared with the control group. The incidence of hoarseness was not significantly different among the three groups.

CONCLUSION

Spraying beclomethasone and lidocaine on the endotracheal tube is a simple and effective method to reduce the incidence and severity of post-operative sore throat.

A case of methanol poisoning leading to prolonged respirator dependency with consequent blindness and irreversible brain damage

BACKGROUND

Methanol is a colorless and poisonous liquid that is commonly used as an industrial and household solvent. Methanol poisoning is a rare but extremely hazardous form of in toxication that affects the central nervous system and causes visual disorder, drowsiness, seizures and coma.

CASE PRESENTATION

A 29-years-old man with methanol intoxication presented with drowsiness and acidosis with subsequent brain hemorrhage requiring prolong mechanical ventilation resulted in persistent visual impairment and disequilibrium.

CONCLUSION

Prolonged mechanical ventilation in patients with methanol intoxication may be assouated with irreversible brain damage.

Sedation with etomidate-fentanyl versus propofol-fentanyl in colonoscopies: A prospective randomized study

BACKGROUND

The combination of propofol-fentanyl for sedation during colonoscopy is characterized by high prevalence of side effects. Etomidate-fentanyl provides fewer hemodynamic and respiratory complications. The aim of our study was to compare the safety and efficacy of propofol-fentanyl and etomidate-fentanyl for conscious sedation in elective colonoscopy.

METHODS

This double-blind clinical trial was conducted on 90 patients aged between 18- 55 years old who were candidates for elective colonoscopy. Patients were randomized to receive sedation with fentanyl plus propofol or etomidate. Two minutes after injecting 1 micro/kg of fentanyl, the patients received 0.5mg/kg propofol by infusion (25 µ/kg/min) or 0.1 mg/kg etmoidate (15 µ/kg/min). Pulse rate, mean arterial blood pressure, respiratory rate, and saturation of peripheral oxygen (SPO2) were monitored. In addition, the patient and colonoscopist satisfaction, the recovery time, sedation and pain score in both groups were assessed.

RESULTS

Sedation score in propofol group was higher. Pain score as well as the physician and patient satisfaction showed no significant difference between the two study groups. Hemodynamic changes and arterial saturation were the same in both groups. The duration of recovery was 1.27±0.82 minutes in the etomidate group; versus 2.57±2.46 minutes in the propofol group (P=0.001). Recovery time in the etmoid group was 2.68±3.14 minutes and in the propofol group was 5.53±4.67 minutes (p=0.001).

CONCLUSION

The combination of fentanyl and etomidate provides an acceptable alternative to sedation with fentanyl and propofol with the advantage of significantly faster recovery time, in the outpatient setting.

Benefits of using intrathecal buprenorphine

BACKGROUND

General anesthesia draws attention to the most commonly used modalities for post cesarean delivery pain relief in systemic administration of opioids, while the administration of small dose of intrathecal opioid during spinal anesthesia can be a possible alternative. The aim of this study was to evaluate the effects of buprenorphine on cesarean section prescribed intrathecally.

METHODS

This double blind randomized clinical trial study was conducted in patients for cesarean section under spinal anesthesia. The patients were randomly divided into case and control groups. Case group (208 patients) received 65-70 mg of 5% lidocaine plus 0.2 ml of buprenorphine while the same amount of 5% lidocaine diluted with 0.2 ml of normal saline was given to 234 cases in the control group. Hemodynamic changes and neonatal APGAR scores (Appearance, Pulse, Grimace, Activity, Respiration) were recorded. Pain score was recorded according to the visual analog scale. This study was registered in the Iranian Registry of clinical Trials; IRCT2013022112552N1.

RESULTS

The mean age of case and control groups was 24.4±5.38 and 26.84±5.42 years, respectively. Systolic blood pressure was not significantly different until the 45th minute but diastolic blood pressure showed a significant difference at the 15th and the 60th minutes (P<0.001). Heart rate changes were significantly different between cases and controls at the initial 5th, 15th and after 60th minutes (P<0.001). Pain-free period was significantly different between two groups (1.25 h versus 18.73 h) (P<0.001).

CONCLUSION

The results show that prescription of intratechal buprenorphine prolongs the duration of analgesia without any significant considerable side effects.

Serum lactate as a prognostic factor in coronary artery bypass graft operation by on pump method

BACKGROUND

Lactic acidosis in cardiac surgical patients is a manifestation of systemic inflammation and excess pro-inflammatory cytokine production. This investigation was designed to integrate basic concepts about lactate acidosis with a clinically used of serum lactate in patients under coronary artery bypass surgery (CABG) by on pump method.

METHODS

From August to September 2012, 15 patients scheduled for routine cardiac surgery entered to our sample and followed up two weeks. Lactate concentration in arterial blood sample was studied. Method of surgery duration of cardiopulmonary bypass, aorta cross clamp timing, hemodynamic parameters, inotrope dosage and patient outcome were documented. The data were collected and analyzed.

RESULTS

The mean age of the patients was 62±14 years. The patients with a poor outcome had significantly higher lactate levels in ABG samples (p<0.001). ABG lactate levels did not correlate with the magnitude of intra-operative bleeding or volume of packed cell transfusion (p>0.05). The PH of ABG samples did not generally correlate with the ABG lactate concentration (r=0.116, p=0.68). Increased lactate concentration was reliably associated with patient hemodynamic parameters, inotrope dosage, duration of on pump time and aorta cross clamp time.

CONCLUSION

This study demonstrates a correlation between serum lactate levels and patient prognosis after CABG surgery by on pump method.

Post spinal puncture headache, an old problem and new concepts: review of articles about predisposing factors

Post spinal puncture headache (PSPH) is a well known complication of spinal anesthesia. It occurs after spinal anesthesia induction due to dural and arachnoid puncture and has a significant effect on the patient's postoperative well being. This manuscript is based on an observational study that runs on Babol University of Medical Sciences and review of literatures about current concepts about the incidence, risk factors and predisposing factors of post spinal puncture headache. The overall incidence of post-dural puncture headache after intentional dural puncture varies form 0.1-36%, while it is about 3.1% by atraumatic spinal needle 25G Whitacre. 25G Quincke needle with a medium bevel cutting is popular with widespread use and the incidence of PSPH is about 25%, but its incidence obtained 17.3% by spinal needle 25G Quincke in our observation. The association of predisposing factors like female, young age, pregnancy, low body mass index, multiple dural puncture, inexpert operators and past medical history of chronic headache, expose the patient to PSPH. The identification of factors that predict the likelihood of PSPH is important so that measures can be taken to minimize this painful complication resulting from spinal anesthesia.

Crimean congo hemorrhagic fever appearance in the north of Iran

BACKGROUND

Crimean-congo hemorrhagic fever (CCHF) is an acute tick-borne viral, zoonotic disease with hemorrhagic manifestations and considerable mortality in humans. The purpose of this study was to introduce CCHF as a case report from Babol, north of Iran. It is known as an endemic pathogen in some regions of Iran.

CASE PRESENTATION

We present a case of CCHF suffering from sudden onset of fever, headache, nausea, vomiting, melena and hemorrhagic manifestations like petechiae and epistaxis accompanied with evidence of ticks bite in a non-endemic area in the north of Iran. The laboratory dignosis was CCHF. He was treated with ribavirin and recovered completely.

CONCLUSION

CCHF may be seen in non- endemic regions and clinicians must be awarded about its diagnosis and treatment.

Transfusion-related acute lung injury in multiple traumatized patients

BACKGROUND

Many of the multiple traumatized patients who refer to the hospital need transfusion. Transfusion-related acute lung injury (TRALI) is a serious clinical syndrome associated with the transfusion of plasma-containing blood components. In the article, we present a case of TRALI following transfusion of packed red blood cells Case Presentation: A 24 year old male referred to Shahid Beheshti Hospital due to multiple trauma with left femoral and humerus fractures. Due to severe anemia he received 3 units of packed red blood cells. The symptoms of TRALI began 2 hours after transfusion. He was transferred to intensive care unit (ICU) due to metabolic acidosis and severe hypoxia. The TRALI was confirmed after ruling out the other probable pulmonary diseases. He recovered and was discharged.

CONCLUSION

Transfusion related acute lung injury should be considered in any case receiving transfusion of plasma containing blood components.

Optimization of Human Peripheral Blood Mononuclear Cells (PBMCs) Cryopreservation

Cryopreservation is the method of choice for long term storage of human PBMCs. This study was designed to compare the different combinations of variables affecting the cryopreservation of PBMCs samples. The viability of PBMCs separated from 2×5 ml peripheral blood samples obtained from 16 healthy adult volunteers, were measured using trypan blue dye exclusion method just before freezing with different concentrations of DMSO (10, 15, and 20%) and FBS (40 or 70%) at two different temperatures (either 4(o)C or 25(o)C). Then after 2 weeks the cells were thawed and the viability was measured again. Also the PBMCs response to PHA was measured after 48 h using MTT assay. The effects of the different variables were calculated and compared among the groups. A total of 192 PBMCs cryotubes made from blood samples of 16 volunteers were tested. The viability of the cells obtained by the two centrifugation procedure was the same (both more than 99%). The concentration of the FBS (40 vs 70%) did not show to have significant effects on either cells viability or response to PHA. On the other hand 20% DMSO concentration and freezing temperature at 25(o)C decreased both cells. Based on the obtained results, it is recommended to centrifuge the PBMCs under higher revolt speed at shorter time (700 g for 20 minutes) and decrease the FBS concentration to 40%. The DMSO concentration should be kept at 10-15% and the freezing medium be cooled down to 4(o)C.

Comparison of sodium diclofenac, ketamine and propofol with fentanyl and midazolam in balanced anaesthesia

Context:

Analgesia is based on balanced anaesthesia, which is usually maintained by administration of narcotic agents. In some patients, it is not possible to use narcotics. We compared hemodynamic changes, anaesthesia depth, emetic sequelae and post-operative pain between sodium Diclofenac, Ketamine-Propofol (DKP) and Fentanyl-Midazolam (FM).

Aims:

The effectiveness of an anaesthetic technique employing sodium was compared against in patients undergoing elective surgery.

Settings and Design:

In a clinical trial study, 82 patients who attended for an elective surgery were randomly divided into two groups.

Materials and Methods:

In DKP group pre-medication included Sodium Diclofenac 1 mg/kg and Midazolam 0.02 mg/kg, whereas, in FM group they were Fentanyl 2 μg/kg and Midazolam 0.02 mg/ kg. Anaesthesia induction in both groups was the same. Anaesthesia was conserved in DKP group by using Propofol plus Ketamine infusion plus N₂O 50% and in FM group with Fentanyl plus Midazolam plus N₂O 50%. Hemodynamic changes, depth of anaesthesia, nausea and vomiting, post operative analgesic effects were recorded.

Results:

Hemodynamic changes and depth of anaesthesia were similar throughout the maintenance phase in two groups. In FM group, significant increase in heart rate was recorded in recovery room. Pain score according to visual analogue scale (VAS) and need for analgesics, was significantly more in FM group compared to DKP group (P = 0.000). No patient suffered from nausea, vomiting or hallucinations.

Conclusions:

This study revealed that intravenous administration of Sodium Diclofenac along with Ketamine and Propofolplus N₂O 50% for general anaesthesia provides a balanced anaesthesia as well as hemodynamic stability, and adequate depth of anaesthesia. It also reduces the postoperative pain and need for narcotics. We recommended DKP plus N₂O 50% method for patients prohibited from opioid administration. It will be an acceptable method in sensitive patients.