Objective:To assess the efficacy of intercostal nerve protection by intercostal muscle (ICM) flap in post-thoracotomy pain improvement compared to intracostal suturing.Methods:In a randomized controlled trial, ninety-four patients undergoing posterolateral thoracotomy surgery were divided into two subgroups. Intracostal sutures in isolation and in combination with ICM flap techniques were used for thoracotomy closure in both groups. Numeric Pain Scale and Visual Pain Scale as pain scores were assessed on the first, second, third, fourth, fifth, sixth and seventh postoperative days and follow-up visits during the 2nd week, 1st, 2nd, 4th and 6th months after thoracotomy.Results:Out of 94 patients, 58 were male and 36 were females. While the mean age of patients in intracostal group was 45.3 ± 17.6 years, it was 47.4 ± 16.1 years in intracostal plus ICM flap group. The mean operation time for the first group was 191.0 ± 74.7 minutes, while it was 219.3 ± 68.8 minutes in the second (p>0.05). Numeric rating score and visual pain scale did not demonstrate any significant difference in pain severity on postoperative days and follow-up visits between both groups (p>0.05). Although the trend of pain reduction was significant in each group (p<0.001), the difference was not statistically significant (p>0.001).Conclusion:Intracostal sutures in combination with muscle flap did not reduce postoperative pain in thoracotomy compared with intracostal sutures alone in thoracotomy closure.
Background: Postoperative shivering is a frequent complication in recovery room after general anesthesia and has been reported in 40-70% of patients undergoing surgery. Postoperative shivering might cause hypoxemia, increase in oxygen consumption, a linear increase in carbon dioxide production, lactic acidosis, and increased intraocular pressure and intracranial pressure. The aim of this study was to compare the effects of different doses of granisetron on preventing postoperative shivering in patients undergoing septorhinoplasty under general anesthesia. Methods: 90 patients aged 18-60 years old with grades Ι or ΙΙ of American Society of Anesthesiologists (ASA) physicals classification were allocated to the study. The first group (G1) received Granisetron 1mg Intra Venous (IV) before anesthesia induction; the second group (G2) received 3mg Granisetron IV before anesthesia induction and the last group, the control group, received Normal Saline (NS). Three groups were matched regarding age, gender, weight and duration of surgery. Shivering grade and time of operation were recorded in the recovery room. Results: 90 patients scheduled for septorhinoplasty, including 54 men and 36 women, were enrolled to the study. The mean age of the patients was 28.53 ± 8.62 (18-60) years. The number of the patients suffering from shivering in the recovery room was significantly less in group G2 rather than control group (P=0.006) and also need to therapy was significantly less in this group (G2) compared with the control group (P=0.002). Conclusion: Prophylactic use of granisetron (3mg, IV) can be effective in preventing postoperative shivering following septorhinoplasty.
The aim of this study was determine the opinions of clinicians in order to modify the surgical safety checklist(SSC) to make it compatible for use in hospitalsof Iran. Methods:In a cross-sectional study, the views of surgeons and anesthesiologists of the main teaching hospital in Tabriz-Imam Reza Hospital-were taken by a form attached to the main checklist. The participants in this study were asked to write their opinions on each item of the checklist based on the environment of the hospital. The opinions were classified and analyzed. Results:Most of the anesthesiologists(87.5%) and some of the surgeons (18%)recommended to change the fourth item of sign-in part. They suggested using vital sign and base monitoring instead of pulse oximetry. Three of the physicians added the "Internal Medicine Consultation" and "output monitoring" to the Critical Events Anticipation item. Hemorrhage, vomiting, nausea, and hemodynamic disorders were added to the key concerns of recovery and management item by 75% of anesthesiologists. Conclusion:It is better to modify the Surgical Safety Checklist based on the local needs and facilities of each hospital. Surgeons and anesthesiologists in an Iranian teaching hospital suggested adding some items to each part of SSC.
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