Evaluating the Effects of Post-Intubation Endotracheal Suctioning Before Surgery on Respiratory Parameters in Children with Airway Secretion

Background

Endotracheal suctioning (ETS) is a common procedure in intubated patients for the clearance of secretions and improvement of oxygenation.

Objectives

Owing to the controversies in previous studies, we studied the effects of open ETS before surgery on respiratory parameters in children with pulmonary crackles.

Methods

In this clinical trial, 100 children with pulmonary crackles, candidates for surgery were randomly assigned into two groups. After intubation, in the group A (n = 50), deep and open suction was done until the crackle was cleared and in the group B (n = 50), anesthesia without suctioning was continued. Hemodynamic and respiratory parameters were compared.

Results

The patients in group A had higher oxygen saturation with a statistically significant difference in 15th to 75th minutes of the operation (P < 0.001) and in post-anesthetic care unit (P = 0.004). After suction, before and after extubation, there was a statistically significant reduction of crackles in the group A in comparison to the group B (P < 0.001). There was no statistically significant difference in the end-tidal CO₂, airway pressure and respiratory rate between the two groups (P > 0.05). Relevant complications and the emergence of anesthesia time were statistically lower in the group A (P < 0.001). There was no statistically significant change in terms of blood pressure in the two groups (P > 0.05). The heart rate in the 15th, 30th, and 45th minutes of surgery was statistically lower in the group B (P < 0.05).

Conclusions

This study indicates positive effects of open and deep suction in improving oxygen saturation and reducing complications and emergence time. Pulmonary auscultation of the group A before and after weaning was statistically better than group B. However, this study found no positive effect of ETS on airway pressure, ETCO₂, blood pressure, and respiratory rate. Meanwhile, increased heart rate in the group A might introduce the potential risk of dysrhythmia and hemodynamic instability.

Effect of Glucose Containing Crystalloid Infusion on Maternal Hemodynamic Status After Spinal Anesthesia for Cesarean Section

Background

Despite preventive strategies, hypotension is the most common complication of spinal anesthesia in cesarean section.

Objectives

The aim of this study was to assess the effect of glucose-containing crystalloid infusion on maternal hemodynamic status after spinal anesthesia for cesarean section.

Methods

In this prospective, randomized, double-blind clinical trial, 80 parturients undergoing elective cesarean section with spinal anesthesia were studied. In group A (n = 40) ringer with 1% glucose solution (10 gr glucose in 1000 mL ringer) and in group B (n = 40) only ringer solution infused before and after spinal anesthesia. Demographic data, hemodynamic change, complications and their treatments, maternal blood sugar level and neonatal APGAR (appearance, pulse, grimace, activity and respiration) score, intraoperative fluid, duration of surgery, and anesthesia were recorded in the two groups.

Results

The incidence of hypotension in group A was significantly lower than group B (27.5% vs 75%) (P = 0.002). Other complications (sustained hypotension, nausea, pallor, and shivering were significantly lower in parturients of the group A (P < 0.05). Maternal blood sugar (BS), before and after surgery, was not significantly different in the two groups (P = 0.207 and P = 0.239, respectively). There was no statistically significant difference in the APGAR score of neonates at the 1st and 5th minutes of the birth between the two groups (P = 0.076).

Conclusions

It seems that adding 1% glucose to crystalloid solution improves the hemodynamic status and decreases post-spinal anesthesia complications without significant changes in the maternal blood sugar level and APGAR score of neonates.

Comparing the efficacy of intravenous acetaminophen and intravenous meperidine in pain relief after outpatient urological surgery

Background:

Pain relief after surgery is an essential component of postoperative care.

Objectives:

The purpose of this study was to compare the efficacy of intravenous acetaminophen and intravenous meperidine in pain relief after outpatient urological surgery.

Patients and Methods:

In a prospective, randomized, double-blind clinical trial, 100 outpatients of urological surgery were studied in two groups of acetaminophen (A) and meperidine (M). Patients in group A received 1g of acetaminophen in 100 mL saline within 15 minutes and patients in group M received a single intravenous injection of meperidine 0.5 mg/kg, 15 minutes prior to the end of operation. Postoperative pain was recorded using visual analog scale (VAS). Vital signs, nausea, vomiting, dizziness and respiratory depressions were compared between the two groups.

Results:

Pain severity in patients treated with intravenous acetaminophen six hours after the operation within one-hour interval was significantly lower than meperidine group (P < 0.0001). Ninety patients in the meperidine group and five patients in the acetaminophen group required additional doses of analgesics. Nausea was significantly lower in acetaminophen group than meperidine group.

Conclusions:

Intravenous acetaminophen reduced pain following outpatient urological surgery more significantly than meperidine.