مقاله:اثر متوکلوپرامید بر تهوع ،استفراغ سزارین

Metoclopramide for nausea and vomiting prophylaxis during and after Caesarean delivery: a systematic review and meta-analysis

Abstract

Nausea and vomiting occur commonly during and after Caesarean delivery (CD) performed under neuraxial anaesthesia. Metoclopramide is a prokinetic agent reported to be safe in parturients. This meta-analysis assesses the efficacy of metoclopramide for prophylaxis against intra- and postoperative nausea and vomiting (IONV and PONV) in parturients undergoing CD under neuraxial anaesthesia. We performed a literature search of MEDLINE (1966–2011), Cochrane Central Register of Controlled Trials, EMBASE (1947–2011), Google scholar, and CINAHL for randomized controlled trials which compared metoclopramide with placebo in women having CD under neuraxial anaesthesia. Eleven studies with 702 patients were included in the analysis. Administration of metoclopramide (10 mg) resulted in a significant reduction in the incidence of ION and IOV when given before block placement [relative risk (RR) (95% confidence interval, 95% CI)=0.27 (0.16, 0.45) and 0.14 (0.03, 0.56), respectively] or after delivery [RR (95% CI)=0.38 (0.20, 0.75) and 0.34 (0.18, 0.66), respectively]. The incidence of early (0–3 or 0–4 h) PON and POV [RR (95% CI)=0.47 (0.26, 0.87) and 0.45 (0.21, 0.93), respectively] and overall (0–24 or 3–24 h) PON (RR 0.69; 95% CI 0.52, 0.92) were also reduced with metoclopramide. Extra-pyramidal side-effects were not reported in any patient. In conclusion, this review suggests that metoclopramide is effective and safe for IONV and PONV prophylaxis in this patient population. Given the quality of the studies and the infrequent use of neuraxial opioids, these results should be interpreted with caution in current practice and further studies are needed to confirm those findings.

Br. J. Anaesth. (2012) 108 (3): 374-383

خبر

جلسه ماهانه انجمن بیهوشی اصفهان با سخنرانی دکتر محجوبی در مورد مرگ مغزی

سه شنبه دوم اسفند ماه ۹۰ ساعت ۱۹  نظام پزشکی اصفهان

مقاله:اثر احتمالی بیهوشی بر افزایش خطر زونا پس از سزارین

Possible effects of anaesthetic management on the 1 yr followed-up risk of herpes zoster after Caesarean deliveries

Background As general anaesthesia may compromise the immune system, it has been hypothesized that latent varicella-zoster virus is more likely to be reactivated and cause herpes zoster in mothers after Caesarean deliveries under general anaesthesia. Our study was thus aimed at investigating the risk of herpes zoster among women during the first year after Caesarean deliveries under either general or regional anaesthesia.

ادامه مطلب

اطلاعات تخصصی : گایدلاین جدید اندازه گیری قند خون

 A new clinical practice guideline (CPG) from The Endocrine Society

Specific recommendations in the guideline include the following:

All patients, independent of a prior diagnosis of diabetes, should undergo laboratory blood glucose testing on admission. Inpatients with known diabetes or with hyperglycemia (glucose >7.8 mmol/L) should undergo testing of hemoglobin A1c levels if this had not been done in the preceding 2 or 3 months.

For most hospitalized patients with noncritical illness, the premeal glucose target is less than 140 mg/dL and the target for a random blood glucose level is less than 180 mg/dL. Antidiabetic treatment should be reevaluated when glucose levels drop below 5.6 mmol/L (100 mg/dL) and should be modified if glucose levels are below 3.9 mmol/L (70 mg/dL).

Glycemic targets should be modified according to clinical status, with tighter control for patients who are not prone to hypoglycemia, and a higher target range (<11.1 mmol/L or 200 mg/dL) for patients with terminal illness or limited life expectancy, or who are at high risk for hypoglycemia.

Patients with diabetes who receive insulin at home should receive a scheduled regimen of subcutaneous insulin while they are hospitalized.

To prevent perioperative hyperglycemia, all patients with type 1 diabetes, and most patients with type 2 diabetes who undergo surgery, should be treated with intravenous continuous insulin infusion or subcutaneous basal insulin with as-needed bolus insulin.

All patients with high glucose values (>7.8 mmol/L [140 mg/dL]) on admission, and all patients receiving enteral or parenteral nutrition, should be monitored with bedside capillary point-of-care glucose testing, independent of diabetes history. The same applies to patients receiving therapies associated with hyperglycemia, such as corticosteroids or octreotide.

At least 1 to 2 hours before intravenous continuous insulin infusion is discontinued, all patients with type 1 and type 2 diabetes should be transitioned to scheduled subcutaneous insulin therapy.

J Clin Endocrinol Metabol. 2012;97:16-38

اطلاعات تخصصی : گایدلاین انتقال خون در اطفال

Transfusion Guidelines in Children

 Thresholds for transfusing children vary from those in adults, according to a 2-part review study published in the January 2012 issue of Anaesthesia and Intensive Care Medicine.

ادامه مطلب

استاد یگانه جامعه بیهوشی ایران دکتر محمد اسماعیل تشید به دیدار دوست شتافت.

 

دكتر محمد اسماعیل تشید در سال 1306 خورشیدی در تهران متولد شد.در دانشكده پزشكی به تحصیل پرداخت و تخصص اش را از كشور آمریكا دریافت كرد. او پس از مراجعت به ایران در دانشگاه تهران مشغول به كار شد و در سال 1349 به مقام استادی نائل آمد.دكتر تشید بنیانگذار بیهوشی نوین در ایران است.ایشان پس از چند دهه تلاش در عرصه ها مختلف علمی و پژوهشی در سال 1373 به افتخار بازنشستگی نائل آمد.

 

ادامه مطلب

مقاله

Nitrous oxide (N2O) reduces postoperative opioid-induced hyperalgesia after remifentanil-propofol anaesthesia in humans

Introduction

These authors carried out a study to test if intraoperative administration of N₂O during propofol–remifentanil anaesthesia prevented the onset of postoperative opioid-induced hyperalgesia (OIH).

ادامه مطلب

Fluid Resuscitation with 6% Hydroxyethyl Starch (130/0.4) in Acutely Ill Patients: An Updated Systematic Review and Meta-Analysis

BACKGROUND: Recent research suggests that 6% hydroxyethyl starch (HES) 130/0.4 is one of the most frequently used resuscitation fluids worldwide. The retraction of studies evaluating its use necessitates a reevaluation of available evidence regarding its safety and efficacy.

ادامه مطلب

مقاله

Validity of the 6 min walk test in prediction of the anaerobic threshold before major non-cardiac surgery

Background For perioperative risk stratification, a robust, practical test could be used where cardiopulmonary exercise testing (CPET) is unavailable. The aim of this study was to assess the utility of the 6 min walk test (6MWT) distance to discriminate between low and high anaerobic threshold (AT) in patients awaiting major non-cardiac surgery.

ادامه مطلب

اطلاعات عمومی:اثر تغیرات فشار خون در میانسالی

Middle-age blood pressure changes affect lifetime heart disease, stroke risk

Study Highlights:

• Changes in blood pressure during middle age can affect lifetime risk for heart disease and stroke.
• People who maintain or reduce their blood pressure to normal levels during middle age have the lowest lifetime risk of cardiovascular disease, while those with an increase in blood pressure have the highest risk.
• Age and duration of blood pressure changes can help determine individualized lifetime risk for ― and prevention of ― cardiovascular disease.

ادامه مطلب

اطلاعات عمومی:اثر تغیرات فشار خون در میانسالی

Middle-age blood pressure changes affect lifetime heart disease, stroke risk

Study Highlights:

• Changes in blood pressure during middle age can affect lifetime risk for heart disease and stroke.
• People who maintain or reduce their blood pressure to normal levels during middle age have the lowest lifetime risk of cardiovascular disease, while those with an increase in blood pressure have the highest risk.
• Age and duration of blood pressure changes can help determine individualized lifetime risk for ― and prevention of ― cardiovascular disease.

ادامه مطلب

مقاله

Meningitis or epidural abscesses after neuraxial block for removal of infected hip or knee prostheses

Background Infection, whether localized or systemic, can be a relative contraindication to neuraxial anaesthesia. Data correlating neuraxial anaesthesia and the development of meningitis or epidural abscess in this setting are limited.

ادامه مطلب

مقاله:افزودن لیدوکائین به بوپیواکائین در اسپاینال آنستزی

The Addition of Lidocaine to Bupivacaine Does Not Shorten the Duration of Spinal Anesthesia: A Randomized, Double-Blinded Study of Patients Undergoing Knee Arthroscopy

BACKGROUND: The duration of spinal anesthesia with bupivacaine is often too long for day surgery. A recent study of patients presenting for transurethral surgery suggested that the addition of a small amount of lidocaine to intrathecal hyperbaric bupivacaine could shorten the duration of the sensory and motor blocks. In this prospective, randomized double-blind study we investigated these findings in patients undergoing unilateral knee arthroscopy.

ادامه مطلب

مقاله:افزاش رضایت بیمار از مراقبتهای بیهوشی با ویزیت بعد از عمل

Does a Postoperative Visit Increase Patient Satisfaction With Anaesthesia Care?

Background. 'Continuity of personal care by anaesthetist', as defined by a single anaesthetist providing preoperative evaluation, performing anaesthesia, and delivering a postoperative visit to the patient, has been shown to be a major factor for patient satisfaction with anaesthesia care. This prospective randomized study investigated whether a single postoperative visit increased the patient's perception of 'Continuity of personal care by anaesthetist' and hence satisfaction.

ادامه مطلب

مقاله:اثر N2O در کاهش درد مزمن پس از جراحی

Chronic postsurgical pain after nitrous oxide anesthesia

Introduction

Nitrous oxide is an antagonist at the N-methyl-d-aspartate receptor and may prevent the development of chronic postsurgical pain. The Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA) trial was a randomised, controlled trial of nitrous oxide-based or nitrous oxide-free general anaesthesia in patients presenting for non-cardiac surgery lasting more than 2 hours. These authors conducted a follow-up study in the ENIGMA trial patients to evaluate the preventive analgesic efficacy of nitrous oxide after major surgery.

ادامه مطلب

اطلاعات تخصصی : قطع یا مصرف آسپرین قبل از عمل

Impact of preoperative maintenance or interruption of aspirin on thrombotic and bleeding events after elective non-cardiac surgery: the multicentre, randomized, blinded, placebo-controlled, STRATAGEM trial

Background: Patients receiving anti-platelet agents for secondary cardiovascular prevention frequently require non-cardiac surgery. A substantial proportion of these patients have their anti-platelet drug discontinued before operation; however, there is uncertainty about the impact of this practice. The aim of this study was to compare the effect of maintenance or interruption of aspirin before surgery, in terms of major thrombotic and bleeding events.

Methods: Patients treated with anti-platelet agents for secondary prevention and undergoing intermediate- or high-risk non-cardiac surgery were included in this multicentre, randomized, placebo-controlled, trial. We substituted non-aspirin anti-platelets with aspirin (75 mg daily) or placebo starting 10 days before surgery. The primary outcome was a composite score evaluating both major thrombotic and bleeding adverse events occurring within the first 30 postoperative days weighted by their severity (weights were established a priori using a Delphi consensus process). Analyses followed the intention-to-treat principle.

Results: We randomized 291 patients (n=145, aspirin group, and n=146, placebo group). The most frequent surgical procedures were orthopaedic surgery (52.2%), abdominal surgery (20.6%), and urologic surgery (15.5%). No significant difference was observed neither in the primary outcome score [mean values (sd)=0.67 (2.05) in the aspirin group vs 0.65 (2.04) in the placebo group, P=0.94] nor at day 30 in the number of major complications between groups.

Conclusions: In these at-risk patients undergoing elective non-cardiac surgery, we did not find any difference in terms of occurrence of major thrombotic or bleeding events between preoperative maintenance or interruption of aspirin.ClinicalTrials.gov identifier.

BJA

Volume107, Issue6

Pp. 899-910

اطلاعات عمومی:افزایش خطر سکته مغزی و قلبی در کمبود ویتامین D

Low Vitamin D May Increase Stroke, Heart Attack Risk in Women

Low levels of vitamin D may put women at greater risk for heart attack and stroke, according to one of several new studies on the important nutrient.

ادامه مطلب

مقاله:اثر عوامل روانی بر نیاز به هوشبر

Preoperative anxiety and pain sensitivity are independent predictors of propofol and sevoflurane requirements in general anaesthesia

Background:

 Psychological factors are thought to drive inter-patient variations in anaesthetic and analgesic requirements. This cross-sectional study investigated whether preoperative psychological factors can predict anaesthetic requirements and postoperative pain.

ادامه مطلب

اطلاعات تخصصی:مدت زمان ناشتا بودن قبل از عمل

Summary of Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures

An Updated Report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters

Ingested Material Minimum Fasting Period

Clear liquids:  2 h

Breast milk:  4 h

Infant formula:  6 h

Nonhuman milk:  6 h

Light meal:  6 h 

 

ادامه مطلب

اطلاعات تخصصی:داروهای بیهوشی در بارداری

Anesthetic agents during pregnancy

Local and general anesthetic agents are commonly used in pregnancy, especially for epidural or combined spinal epidural analgesia at delivery. Although surgery requiring general anesthesia is less common, such use is still relatively frequent.

ادامه مطلب