Study DesignA randomized, double-blinded controlled trial.PurposePostoperative pain relief especially using analgesic drugs with minimal side effects has considerable clinical importance. This study aimed to examine the effect of intravenous paracetamol on pain relief after lumbar discectomy as a major surgery.Overview of LiteraturePatients undergoing lumbar discectomy experience a high degree of lumbar pain. Some authors emphasize the use of intravenous paracetamol to improve postoperative pain and increase patients' satisfaction following this surgery.MethodsFifty-two patients scheduled for lumbar discectomy were randomly allocated into two groups: a group that received intravenous paracetamol (1 g/100 mL normal saline) within the last 20 minutes of surgery as the case group (n=24) and a group that received sodium chloride 0.9% 100 mL as the control group (n=28). Postoperative pain was assessed at 1, 6, 12, 18, and 24 hours after surgery by a visual analogue scale (VAS). The dosage of the administered opioid (morphine), as well as drug-related side effects within the first 24 hours after surgery were also recorded.ResultsThe mean VAS score was significantly lower in the paracetamol group than the controls for all of the assessed time points. Although the dose of the administered morphine was numerically lower in the paracetamol group, this difference was not statistically significant (5.53±4.49 mL vs. 7.85±4.17 mL).ConclusionsIntravenous paracetamol as a non-opioid analgesic can relieve postoperative pain in patients undergoing lumbar discectomy; however, its use alone may not represent the best regimen for reducing the needed dose of opioids after operation.

There is increasing evidence that vascular endothelial growth factor (VEGF) has a role in the development of vascular leakage in the hypoxic brain. Our recent work showed an anti-edematous effect of ghrelin on brain hypoxia. However, the underlying mechanisms by which ghrelin exerts its anti-edematous effect are still unclear. For this purpose, we examined the effects of ghrelin on VEGF expression in the hypoxic brain. Adult male Wistar rats were divided into acute or chronic controls, acute or chronic hypoxia, and ghrelin-treated acute or chronic hypoxia groups. Systemic hypoxia was induced in rats by a hypoxic chamber (O2 10-11 %) for 2 days (acute) or 10 days (chronic). Effects of ghrelin on VEGF expression were evaluated using immunoblotting. Our data revealed that acute and chronic hypoxia increased VEGF expression in both acute and chronic hypoxia (P < 0.001). Ghrelin significantly reduced this expression in hypoxic conditions (P < 0.001). Our findings demonstrated the beneficial effects of ghrelin might be mediated, at least in part, through a decline in VEGF production.

Objectives:Although Spinal anesthesia is the most common and safe anesthetic method for patients undergoing cesarean section, difficult access to it is a frequent problem in operating theaters. The predictive factors for the difficulty of spinal anesthesia in patients undergoing cesarean section were investigated.Methods:A total of 110 pregnant women, single-stranded, aged 18-40 years old and ASA class I or II candidates for elective cesarean section with spinal anesthesia were studied. Demographic information, body appearance, ability to bend the back of the patient was recoded. Also the position of the anatomical landmarks of the lumbar spine, the presence or absence of deformity in the spinal column lumbar was recorded for all patients.Results:The correlation coefficient of age, weight, body mass index, general body appearance, retention ability, anatomical signs of the spinal column (touching the spinous process) and the interval between the vertebra with the difficulty of spinal anesthesia were statistically significant (p<0.05). Complications after spinal anesthesia had a statistically significant relationship with the difficulty of performing spinal blockade (p: 0.006).Conclusion:Increasing age, weight, body mass index, reducing the ability to bend the waist, the non-touching of the spinous process and interstitial space causes the difficulty of performing spinal anesthesia in patients undergoing cesarean section. The results can contribute to determining and designing a spinal blockade scoring system based on the patient’s characteristics and effective factors before the surgery, to facilitate the technique by anesthesiologist.

BackgroundThe management of the airways is an essential component of anesthesia planning. Laryngeal mask airway (LMA) plays an important role in modern anesthesia, however, intubation by LMA has some complications. It may cause inadequate anesthesia depth, which can lead to adverse events. The aim of this study was to evaluate the optimal time for intubation by LMA under general anesthesia.MethodsThis study was conducted on 96 patients, who underwent operation and were appropriate candidates for intubation with appropriate LMA. The participants were divided to four groups, each with 24 cases, based on the time interval between anesthetic agent administration and intubation with LMA; 15 seconds for the first group, 16 to 30 seconds for the second group, 31 to 45 seconds for the third group, and 45 to 60 seconds for the fourth group. The patients involved in these groups were selected based on the following prerequisites, patients’ age, gender, easy intubation, need for additional drug administration, basic blood pressure before drug administration, within the time intervals one, three, and five minutes after placement of LMA, duration of LMA, SaO2 before and after placement of LMA, coughing, patient’s movement, laryngospasm, gag reflex after intubation, allowing appropriate ventilation, presence of sore throat after surgery, number of attempts, extent of mouth opening and leak in peri-LMA space.ResultsOverall, 72 males and 24 females participated in this study with a mean age of 40.64. Intubation by LMA was performed easily during the first attempt in 58% of the participants, with minimal resistance in 28.6% and with some problems during the second attempt in 10.5% of the cases. Throat pain after the operation was significantly lower. Systolic and diastolic pressure and heart rate had no statistically significant difference.ConclusionsThe results showed that in the first 15 seconds after the drug (e.g. propofol) administration, there were lower complications, rapid placement, and optimized time for the placement of LMA. The rate of success and its quality were reduced during the first attempt of insertion and termination of the effect of propofol.

Background: Anemia is a common disease in older patients and prevalence of anemia increases with high age. Preoperative anemia is associated with high mortality after surgery. The severity of anemia is variable and is affected by blood loss volume, pre-operative hemoglobin (Hb) value and transfusion during surgery. However, the strategies of blood management for optimization of Hb before surgery are more important. Therefore, surgery and anesthesia teams always follow these issues: how we can decrease intraoperative blood loss and complications of bleeding and transfusion? However, the aim of study was comparison of Hb in pre- and post- operative period in older patients undergoing major orthopedic operation. Methods: A descriptive cross-sectional study was conducted on 230 patients aged more than 65 years who underwent orthopedic surgery from 2016 through 2017. Hb value was measured after and before surgery and compared. Results: The mean age of participants was 75.8. 54.3% of cases were female. Most of the patients (70.4%) had concurrent disease such as hypertension, diabetes mellitus and heart disease. The most common types of surgery were as follows: DHS, total replacement of knee and hip bipolar hemiarthroplasty. The mean difference value of Hb in pre and post– operative period was significant and was reduced from 12.6 to 10.3g/dL. Conclusion: The mean difference value of Hb in pre and post– operative period was significant. However, orthopedic surgeries can reduce Hb in older patients. In regard to older subjects being considered as high-risk group, routine control and proper correction of Hb in such operations is necessary.