Effect of Sequential Compression Device on Hemodynamic Changes After Spinal Anesthesia for Caesarean Section: A Randomized Controlled Trial

Background

The benefit of sequential compression device (SCD) for the prevention of hypotension after spinal anesthesia in cesarean sections has not been determined.

Objectives

In this study, an attempt was made to determine whether SCD can prevent hemodynamic changes following spinal anesthesia for cesarean sections.

Methods

In a prospective clinical trial, 76 parturient women undergoing elective cesarean sections under spinal anesthesia were randomly divided into SCD or control groups. The maternal hemodynamic changes within 75 min after spinal anesthesia, nausea, vomiting, and neonatal Apgar score at 1 and 5 min were compared between the groups.

Results

There were no significant differences between the groups in the patients' characteristics, maximum sensory block, skin incision to delivery time, spinal anesthesia to delivery time (min), and the total duration of surgery. Concerning heart rate changes, RM ANOVA showed a significant difference in the effect of time, groups, and the interaction of the two factors (P < 0.0001, P < 0.0001, and P < 0.0001, respectively). Tukey post hoc test showed that 3 min after spinal anesthesia, diastolic blood pressure was significantly higher in the SCD group than in the control group (P < 0.05). The SCD group had meaningfully lower rates of nausea (P = 0.005) and vomiting (P = 0.001) than the control group. The SCD group also demonstrated a significantly lower mean ephedrine dosage per patient (4.1 mg against 17.1 mg, P = 0.001). However, no significant difference was observed between the groups in terms of neonatal Apgar scores at 1 and 5 minutes.

Conclusions

This study showed that SCD could reduce extensive changes in diastolic blood pressure as an important hemodynamic parameter and the incidence of nausea and vomiting. Thus, SCD can be used in spinal anesthesia care practices for elective cesarean sections.

High-performance liquid chromatographic determination of propofol in human plasma: comparison of different heteroscedastic calibration curve models

PURPOSE

The aim of this study was to select the best calibration model for determination of propofol plasma concentration by high-performance liquid chromatography method.

METHODS

Determination of propofol in plasma after deproteinization with acetonitrile containing thymol (as internal standard) was carried out on a C18 column with a mixture of acetonitrile and trifluoroacetic acid 0.1% (60:40) as mobile phase which delivered at the flow rate of 1.2 mL/minute . Fluorescence detection was done at the excitation and emission wavelengths of 276 and 310 nm, respectively. After fitting different equations to the calibration data using weighted regression, the adequacy of models were assessed by lack-of-fit test, significance of all model parameters, adjusted coefficient of determination (R(2) adjusted) and by measuring the predictive performance with median relative prediction error and median absolute relative prediction error of the validation data set.

RESULTS

The best model was a linear equation without intercept with median relative prediction error and median absolute relative prediction error of 4.0 and 9.4%, respectively in the range of 10-5000 ng/mL. The method showed good accuracy and precision.

CONCLUSION

The presented statistical framework could be used to choose the best model for heteroscedastic calibration data for analytes like propofol with wide range of expected concentration.

Effect of trigger point injection on lumbosacral radiculopathy source

Background:

Active muscular trigger points (aMTPs) presenting with radiating pain can interfere in diagnosis and treatment of patients suffering from lumbosacral radiculopathy.

Objectives:

We aimed to diagnose and evaluate the trigger point therapy on the outcome of pain in patients with lumbosacral radiculopathy.

Materials and Methods:

A total of 98 patients were enrolled suffered with chronic pain andlumbosacral radiculopathy at L4-L5 and L5-S1 who were candidates of non-surgical management. All patients received conservative modalities, including bed rest, non-steroidal anti-inflammatory agents (NSAID), and physiotherapy. These treatments continued for a week. Patients were examined for the presence of trigger points in their lower extremities. Those who had trigger points were divided into 2 groups (TP and N). Patients in TP group underwent trigger point injection therapy. No further therapy was done for the N group. Pain scores and straight leg raise (SLR) test in both groups were collected and analyzed on the seventh and 10th days of the therapy. Results were analyzed by paired t test and chi-square test.

Results:

Out of 98 patients, 64 had trigger points. Thirty-two patients were assigned to each group. Pain scores (Mean ± SD) in TP group was 7.12 ± 1.13 and in N group was 6.7 ± 1.16, P = 0.196. Following the treatment, pain scores were 2.4 ± 1.5 in TP group and 4.06 ± 1.76 in N group P = 0.008. SLR test became negative in all patients in TP group but only in 6 (19%) patients in N group, P = 0.001.

Conclusions:

Results show that trigger point injection therapy in patients suffering from chronic lumbosacral radiculopathy with trigger points can significantly improve their recovery, and conservative therapy may not be adequate.

Results of primary extensor tendon repair of the hand with respect to the zone of injury

BACKGROUND

Laceration of the hand extensor tendons is common in the upper extremities, causing soft tissue trauma. These tendons, because of their superficial location and lying adjacent to bones, have a greater tendency to be injured than flexor tendons.

OBJECTIVES

The aim of this study was to determine the results of primary repairs of lacerated extensor tendons of the fingers, with respect to the zone of injury, and also whether the results are different according to the anatomical zone in which they occur.

PATIENTS AND METHODS

During a period of two years and four months, 32 patients with open wounds and lacerated extensor tendons of the hand were hospitalized and underwent surgery. Repairs were done by a modified Kessler technique using 0 - 4 nylon suture. After repairing, the wrist was splinted for four weeks. Patients were followed-up for 12 months and the results were evaluated according to the Miller's scoring system.

RESULTS

A total of 72 extensor tendons were repaired. The mean age of the patients was 24.6 years. The best results were obtained in zones 3 and 5 (84% and 88% respectively), and the worst results were seen in zones 1, 2 and 4, P = 0.01. Wound infections or re-ruptures were not seen.

CONCLUSIONS

Repair of extensor tendon cuts on the dorsal surface of the hand and forearm were associated with better results in zones 3 and 5 than in zones 1, 2 and 4. Repair by the modified Kessler suture method provides proper stability at the site of the tendon cut.