Anesthesia
Olumide Mathew Adebisi; Adebayo Augustine Adeniyi; Olabisi Timothy Adeyemo; Olayinka Tesleem Orewole; Olumide Emmanuel Adewara; Babatunde Sunday Awoyinka; Idowu Oluwaseyi Adebara; Adewumi Bakare; Oluwasesan Bamidele Afolabi; Adeola Emmanuel Adekanye
Articles in Press, Accepted Manuscript, Available Online from 01 December 2023
Abstract
Background and Objective: The commonly used analgesia for post caesarean pain include combination regimens containing acetaminophen, non-steroidal anti-inflammatory agents (NSAIDs) and opioids. The objective of this study is inter alia to determine the effects of dexamethasone as adjuvant to commonly ...
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Background and Objective: The commonly used analgesia for post caesarean pain include combination regimens containing acetaminophen, non-steroidal anti-inflammatory agents (NSAIDs) and opioids. The objective of this study is inter alia to determine the effects of dexamethasone as adjuvant to commonly used NSAIDs for post-caesarean pain management.
Materials and methods: One hundred and eighty-eight participants slated for caesarean delivery under spinal anaesthesia were randomized into two groups of 94 participants each. One group received 2ml intravenous 8mg dexamethasone while the second group received 2ml of intravenous sterile water as placebo . Both groups received similar doses of intramuscular acetaminophen and diclofenac. Intramuscular pentazocine at a dose of 0.5mg/kg body weight was used as rescue analgesia. Primary outcome was the mean summed pain intensity difference (MDPID) in the two groups while the secondary outcomes include the needs and frequency of rescue analgesia, and the levels of maternal satisfaction. P-value set as ≤0.05.
Results: The mean summed pain intensity difference (MSPID) at 24hours post-caesarean was higher in the dexamethasone group, (29.27±18.10 versus 24.24±13.14, p=0.036). The percentage of the participants that required rescue analgesia in the dexamethasone group was less (60.6% versus 76.1%, p=0.024). The Overall levels of maternal satisfaction were comparable in both groups.
Conclusion: Intraoperative dexamethasone given intravenously as adjuvant to intramuscular diclofenac and acetaminophen minimizes opioid administration within the first 24hours after caesarean section.
Anesthesia
Aseel Alfil; Lubna AL Anbari
Volume 8, Issue 5 , September and October 2023, , Pages 509-513
Abstract
Background & Objective: Granulosa cells, the endometrium, and the placenta all play a role in the secretion of G-CSF in the reproductive tract. G-CSF affects immunological regulation, which is crucial for enhancing pregnancy viability and maintenance. To evaluate the effects of granulocyte-colony ...
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Background & Objective: Granulosa cells, the endometrium, and the placenta all play a role in the secretion of G-CSF in the reproductive tract. G-CSF affects immunological regulation, which is crucial for enhancing pregnancy viability and maintenance. To evaluate the effects of granulocyte-colony stimulating factor subcutaneous injection on the miscarriage rate, ongoing pregnancy rate, and livebirth rate after single and multiple doses of G-CSF factor.Materials & Methods: At the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies at Al-Nahrain University, a prospective comparison study with a random sample selection was conducted from December 2021 to December 2022. It included 121 infertile women who had previously unsuccessful intracytoplasmic sperm injection (ICSI) procedures and who had finished ICSI protocols and reached the embryo transfer day. Patients were divided into three groups on the day of the embryo transfer: The non-G-CSF group (49 patients) received no additional treatment; the single-G-CSF group (31 patients) received a single subcutaneous injection of granulocyte-colony stimulating factor one hour after embryo transfer; and the multiple-G-CSF group (41 patients) received weekly injections of G-CSF until a fetal heartbeat could be detected, starting one hour after the embryo transfer.Results: The multiple G-CSF group had better results in the miscarriage rate, ongoing pregnancy rate, and livebirth rate (23.5%, 34.1%, and 31.7%, respectively) when compared to the single G-CSF group (42.9%, 16.1, and 12.9%, respectively) and the non-G-CSF group (37.5%, 12.2%, and 10.2%, respectively).Conclusion: Multiple subcutaneous G-CSF doses can improve the miscarriage rate, ongoing pregnancy rate, and live birth rate. A single dose of G-CSF for infertile women has no appreciable benefits.
Anesthesia
Shahram Sayadi; Shideh Ariana; Maral Hosseinzadeh; Arezou Ashari; Tannaz Yeganegi; Elham Memari; Ebtehaj Heshmatkhah; Dariush Abtahi
Volume 8, Issue 3 , May and June 2023, , Pages 194-203
Abstract
Background & Objective: Postpartum hemorrhage is the most common cause of maternal morbidity and mortality, which can occur unexpectedly without warning, and without any underlying causes. We hypothesized that administering fibrinogen concentrate to cesarean section patients before surgery would ...
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Background & Objective: Postpartum hemorrhage is the most common cause of maternal morbidity and mortality, which can occur unexpectedly without warning, and without any underlying causes. We hypothesized that administering fibrinogen concentrate to cesarean section patients before surgery would reduce perioperative blood loss.Materials & Methods: In this double-blind randomized controlled parallel group study, a single dosage of fibrinogen concentrate or a placebo was given to 260 cesarean section patients at random (by G*Power software, Heinrich-Heine-Universität Düsseldorf, Germany) in a university-affiliated general hospital between November 11, 2022, to January 8, 2023. Individuals in the fibrinogen group received a dose of one gram of fibrinogen concentrate and those in the placebo group received normal saline solution with the same volume in the placebo group. Total blood loss was the primary outcome of this study.Results: A total of 280 cases were screened and 260 were randomized. With a P-value of 0.001, the median (IQR) volume of bleeding in the fibrinogen group was 660 (341.25) mL, as opposed to 790 (475.00) mL in the placebo group. Comparatively, only 10 (7.7%) of the fibrinogen group and 26 (20%) of the placebo group required blood transfusions (P=0.006). No adverse event related to fibrinogen was reported.Conclusion: Empiric treatment with fibrinogen concentrate results in reduced blood loss.
Anesthesia
Maryam Sadat Hosseini; Dariush Abtahi; Ardeshir Tajbakhsh; Farah Farzaneh; Shahram Sayadi; Nooshin Amjadi; Maral Hosseinzadeh
Volume 8, Issue 2 , March and April 2023, , Pages 157-166
Abstract
Background & Objective: Delayed diagnosis and treatment of postpartum hemorrhage could result in mortality. Today, there is a strong desire to determine the factors affecting postpartum hemorrhage, particularly fibrinogen levels. This study aimed to investigate the role of plasma fibrinogen ...
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Background & Objective: Delayed diagnosis and treatment of postpartum hemorrhage could result in mortality. Today, there is a strong desire to determine the factors affecting postpartum hemorrhage, particularly fibrinogen levels. This study aimed to investigate the role of plasma fibrinogen levels in postpartum hemorrhage and severe postpartum hemorrhage.Materials & Methods: This cross-sectional study was conducted on 169 term pregnant women who were candidates for an elective Cesarean section. Fibrinogen and other coagulating factors were measured before and at the end of the surgery, and twenty-four hours after surgery. Bleeding volume was also measured during and at the end of the surgery, and twenty-four hours after that. The relationship between coagulation factors and the amount of bleeding was examined using statistical tests.Results: Mean plasma fibrinogen levels measured before, at the end of, and 24 hours after surgery were 247.65±91.07 mg/dl, 219.4±75.60 mg/dl, and 223.91±65.44 mg/dl, respectively. Sixty-five patients (38.5%) had postpartum hemorrhage (1000-2000mL) and seven patients (4.1%) had severe postpartum hemorrhage (>2000mL). Of the cases with preoperative fibrinogen levels less than 200mg/dl, 72% had postpartum hemorrhage and 14% had the severe form. There was a strong association between the patient's plasma fibrinogen level with PPH and sPPH (P=0.000).Conclusion: This study showed a strong correlation between plasma fibrinogen levels and postpartum hemorrhage and severe postpartum hemorrhage. In addition, it has been shown that low plasma fibrinogen levels could be a direct prognostic factor for postpartum hemorrhage and severe postpartum hemorrhage. Younger women and preoperative anemia were other strong predictors.
Anesthesia
Dariush Abtahi; Mehrdad Feizi; Shahram Sayadi; Ardeshir Tajbakhsh; Samira Abbaspour; Sara Salarian; Alireza Mirkheshti
Volume 7, Issue 4 , March and April 2022, , Pages 314-322
Abstract
Background and Objective: This study was performed to determine and compare the ED90 of prophylactic oxytocin (OX) infusion after delivery of the placenta during cesarean section (CS) in low- and high-risk parturients for uterine atony.Methods: This experimental study was a single-blind and dose-response ...
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Background and Objective: This study was performed to determine and compare the ED90 of prophylactic oxytocin (OX) infusion after delivery of the placenta during cesarean section (CS) in low- and high-risk parturients for uterine atony.Methods: This experimental study was a single-blind and dose-response study using a 9:1 biased-coin sequential allocation method to estimate the ED90 of prophylactic infusion of OX in women with high and low risk for uterine atony who underwent CS. The total administrated OX dose of each patient was determined in the two study groups. The primary outcome was the ED90 for desirable uterine tone based on the opinion of the in-charge obstetrician. The number of subjects receiving supplemental uterotonics was compared.Results: In the low-risk group, three (3.7%), out of the 41 parturients, did not achieve a satisfactory suitable response to OX dose of 9; on the other hand, 24 high-risk parturients (58%) did not achieve a satisfactory and reasonable response to OX dose of 9. The OX ED90 was significantly greater for the high risk-group (11.55 units, 10.39-14.86) than the low-risk group (8.13 units, 8.31-9.56). Fisher’s exact probability test showed a significant difference in ED90 of OX between the two groups (P < /em>=0.02).Conclusion: The present study results showed that the mean ED90 of OX in low-risk parturients was significantly lower than that of high-risk ones. We suggest differentiation between low-risk and high-risk parturients in the guidelines of OX administration.
