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  • ISSN: 2333-6641
    Volume 3, Issue 1
    Research Article
    Mohammad Sadegh Zamani-Ranani1, Najme Galyan Moghaddam1, Abolfazl Firouzian2, Mehran Fazli3* and Seyyed Abbas Hashemi4
    Abstract:
    Background: Inguinal hernia repair is one of the most common surgeries and can be performed under general, spinal or local anesthesia. The aim of this study was to compare the complications of local anesthesia (LA) with spinal anesthesia (SA) in surgical treatment of inguinal hernia.
    Methods: We designed a randomized clinical trial study. Based on our inclusion and exclusion criteria, 60 patients were randomly selected and were put into 2 equal groups (LA and SA groups). All hernia repairs were performed by Lichtenstein technique. The early postoperative complications, surgery time, hospitalization time and pain score (by Visual Analogue Scale (VAS) score in millimeter) were evaluated.
    Results: All patients were male. The mean age of LA and SA groups were 59.53±9.62 and 59.16±12.17 years, respectively (P=0.89). There was no significant difference in the body mass index (BMI), surgery time, surgery complications and hospitalization time between these two groups (P>0.05). The pain score at the 3, 6 and 12 hour periods after surgery was significantly lower in LA group (P<0.0001). But there was no significant difference between groups in pain score at the 24 hour period after surgery (P=0.24). Also, the LA group needed lower analgesic agents (P=0.001).
    Conclusion: Our study showed that employing local anesthesia in inguinal hernia repair leads to reduction of postoperative pain at the first 12 hour period after surgery.
    Case Report
    Diana Ly-Liu*, Jacobo Benatar-Haserfaty, Lucía Serra Bellver
    Abstract:
    The underlying pathophysiology in low-pressure hydrocephalus (LPH) includes brain viscoelastic properties, brain turgor, transmantle pressure gradient and cerebrospinal fluid leaks. LPH consists of ventriculomegaly with low or negative intracranial pressure values. It is a rare entity and it can appear after hydrocephaly ventriculoperitoneal shunts, subarachnoid or intraventricular hemorrhage, cranial traumatism, lumbar puncture, meningitis among others. LPH clinical manifestations include: headaches, low level of consciousness, vomiting and cranial neuropathies, similarly to those occurred in high intracranial pressure hydrocephaly. A better understanding of LPH mechanism may help us to optimize treatment, as its diagnosis and management are complex.
    Eyup Aydogan, Hatice Toprak, Mehmet Sargin* and Sadik Ozmen
    Abstract:
    The number of patients receiving organ transplant s is increasing around the world. So, anesthesiologists are often have to manage transplant recipients in hospitals for procedures that are not related to transplantation. There are many possible problems that anesthesiologists have to deal with such as the physiological and pharmacological problems of allograft denervation, the side effects of immunosuppression, the risk of infection and rejection.
    Mustafa Kilickaya and Hasan R. Koyuncuoglu
    Abstract:
    Acute radial nerve paralysis developed following general anaesthesia for tympanoplasty surgery in a 22-year old male with a 4-year history of manual work. Standard pads were used under the extremities and the patient position was changed at intervals. Preoperatively and postoperatively, no intervention such as intravenous or intramuscular injection was made to the right arm. Only the automatic blood pressure device cuff was attached.In this patient was considered to be a case of radial paralysis caused by hypertrophy as a result of excessive use of the arm muscles, and the radial nerve, having been previously relatively compressed was under increased compression between the muscles as the cuff of the automatic blood pressure device regularly inflated affecting the vasa nervorum and therefore the nerve remained in hypoxia resulting in the development of paralysis. Especially in patients who have to use the arm muscles excessively in work or sport, to overcome the risk of partial nerve compression because of muscle hypertrophy, the use of an FDA approved automatic blood presssure device without a cuff is recommended during general anaesthesia.
    Review Article
    Surjya Prasad Upadhyay*, Ulka Samanth, Sudhakar Tellicherry and PiyushMallick
    Abstract:
    Intravenous dexmedetomidine is been increasingly used in perioperative setting including as an adjunct to local anaesthetic in various regional techniques with an intent to either improve the block quality, increase the duration of block or to provide sedation and patient comfort during the periblock period. Intravenous dexmedetomidine when used just before or after spinal anaesthesia has many desirable effects such as adequate sedation and patient comfort, longer sensory-motor blockade, prolonged postoperative analgesia and reduced post-anaesthesia shivering. The optimal dose or method of administration of intravenous dexmedetomidine under spinal anaesthesia has not been defined yet. Current literatures suggest a ceiling effect on prolonging post-spinal analgesia after 0.5mcg/kg boluses. With increasing the dose beyond 0.5 mcg/kg resulted in unwanted side effects notably bradycardia and excessive sedation. Further study with diverse population is needed to define the optimal dose of intravenous dexmedetomidine.
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