Intraperitoneal lidocaine decreases intraoperative pain during postpartum tubal ligation.

We conducted a randomized, double-blinded, placebo-controlled trial to evaluate the effectiveness of intraperitoneal lidocaine, IM morphine, or both drugs together for pain relief in postpartum tubal ligation. Eighty postpartum patients scheduled to have tubal sterilization were randomly divided into four groups to receive IM isotonic sodium chloride solution (1 mL) and intraperitoneal instillation of 80 mL of isotonic sodium chloride solution (Group P); IM morphine (10 mg in 1 mL) and intraperitoneal instillation of 80 mL of isotonic sodium chloride solution (Group M); IM injection of isotonic sodium chloride solution and intraperitoneal instillation of 0.5% lidocaine in 80 mL (Group L); and both IM morphine and intraperitoneal lidocaine instillation (Group ML). The minilaparotomy was performed after local infiltration with 15 mL of 1% lidocaine. A numerical rating score was used to rate pain on a 0-10 scale during the surgical procedures. The mean pain scores were 1.2 in Group L and 0.8 in Group ML. These pain scores were significantly lower than those in Groups P and M, which were 5.5 and 6.0, respectively (P < 0.001). IMPLICATIONS: Pain relief was inadequate in patients undergoing postpartum tubal ligation under local anesthesia, even after the administration of IM morphine. Instilling lidocaine into the abdominal cavity, however, effectively decreased intraoperative pain in these patients.     

Predictor of core hypothermia and the surgical intensive care unit

Inadvertent postoperative core hypothermia is associated with multiple physiological effects, especially in patients admitted to the intensive care unit (ICU). Despite previous reports of the relationship between patient, surgical, and anesthetic factors and immediate postoperative core hypothermia, this information might need to be reconsidered in the light of progress in surgery, anesthetic, and warming techniques. We designed this prospective study of 194 postgeneral surgical patients to assess the incidence, predictive factors, and outcome of core hypothermia (tympanic membrane core temperature [Tc] <36.0 degrees C) at the time of admission to the general ICU in a large tertiary university medical center from December 2000 to March 2001. The following variables were studied: age, sex, body weight, body surface area, preoperative body temperature, ASA physical status, history of diabetic neuropathy, emergency surgery, surgical subspecialty performing surgery, type of surgery, type of anesthesia (general, regional, or combined epidural and general), temperature monitoring, use of a forced air warming technique, amount of fluid and blood replacement, duration of anesthesia, duration of surgery, and the ambient operating room temperature. Other outcomes, i.e., length of ICU stay and mortality, were also assessed. The incidence of core hypothermia was 57.1%, 41.3%, and 28.3% according to the definition of Tc <36.0 degrees C, <35.5 degrees C, and <35.0 degrees C, respectively. Multiple logistic regression showed the following risk factors for core hypothermia: high ASA physical status (odds ratio, 2.87; 95% confidence interval [CI], 0.82-10.03 for ASA II; odds ratio, 8.35; 95% CI, 1.67-41.88 for ASA >II), magnitude of surgical procedure (odds ratio, 6.60; 95% CI, 1.66-26.19 for medium surgery; odds ratio, 22.23; 95% CI, 5.41-91.36 for major surgery), use of combined epidural and general anesthesia (odds ratio, 3.39; 95% CI, 1.05-10.88), and duration of surgery >2 h (odds ratio, 4.50; 95% CI, 1.48-13.68). Not using temperature monitoring seems to be a risk factor as well (odds ratio, 3.00; 95% CI, 0.87-10.12). Significant protective factors against core hypothermia were heavier body weight (odds ratio, 0.94; 95% CI, 0.89-0.98), higher preoperative body temperature (odds ratio, 0.31; 95% CI, 0.15-0.65), and warmer ambient operating room temperature (odds ratio, 0.67; 95% CI, 0.51-0.88). In conclusion, the incidence of core hypothermia (Tc <36.0 degrees C) at the time of admission to the general ICU is still frequent. To reduce the incidence, more efforts and concern should be taken to prevent core hypothermia, especially in the patient with high ASA physical status, undergoing more intensive and lengthy surgery, and using combined epidural and general anesthesia. IMPLICATIONS: In an effort to decrease the frequent incidence of core hypothermia at the time of admission to the general surgical intensive care unit, this prospective study showed that high ASA physical status, the use of a combined epidural and general anesthesia, surgery lasting longer than 2 h, and extensive surgery were the important risk factors, whereas heavier body weight, higher preoperative body temperature, and warmer ambient operating room temperature were important protective factors.     

Maternal and neonatal outcomes in women with severe pre-eclampsia undergoing cesarean section: a 10-year retrospective study from a single tertiary care center: anesthetic point of view

Objective: This study is aiming to determine an actual incidence and characteristics of complications in cesarean section for severe pre-eclampsia (PE) by analysis of a large cohort from a single tertiary care center according to two choices of anesthesia.

Methods: Electronic medical records of pregnant women complicated with severe PE delivered by cesarean section from January 2002 to December 2011 were retrospectively reviewed. Medical records of their corresponding neonates were also identified and reviewed.

Results: A total of 701 women and 740 neonates (28 twin pairs) were identified. Anesthetic techniques were spinal anesthesia (SA) (88%) and general anesthesia (GA) (12%). Total maternal and neonatal deaths were 0.3% and 1.2%, respectively. Patients in GA group had a higher incidence of coagulopathy, immediate postpartum hemorrhage, intensive care unit admission, renal failure, respiratory complications, and death (p?<?0.05). Neonates born from women in GA group had a higher incidence of lower birth weight, birth asphyxia, prematurity, neonatal intensive care admission, respiratory complications, and death (p?<?0.05).

Conclusion: Spinal anesthesia can be safely administered to severely pre-eclamptic parturients undergoing cesarean section. General anesthesia is associated with more untoward outcomes, as it has been chosen in patients with more severity of the disease.     

Does computer‐assisted instruction really help to improve the learning process?

OBJECTIVES: We have developed both a computer-assisted instruction (CAI) multimedia program and a textbook on arterial blood gas interpretation with the same content as formal didactic instruction. A prospective, randomized study was designed to compare the outcomes of self-learning using the software and using the textbook. METHODS: 80 third-year medical students were randomly allocated to two groups: the CAI (n=40) and text group (n=40). A 30-item, type-K examination was administered as the pre-test. After the pre-test, the volunteers in the CAI group studied the software program, whereas those in the text group spent their time reading the textbook covering the same material. The post-test was held immediately at the end of a full day of study, and 3 weeks later, the final test was performed without prior notice. A P value of <0.05 was considered to be a statistically significant difference. RESULTS: Students in the text group seemed to fulfil their assignments and improved their scores post-test better than those in the CAI group. After 3 weeks, the final test scores of both groups demonstrated a significant decrease, but showed an insignificant difference between the two groups. CONCLUSION: Text-based learning seems to be a convenient method of education where time is limited. However, with more time available, use of software may be as good as the conventional learning method and can be an alternative tool. The computer-assisted instruction program seems to enhance the learning process.