Anxiety About Surgery and Anticipated Intraoperative Pain Independently Predict Pain During Extension of Epidural Analgesia for Intrapartum Cesarean Delivery: A Prospective Cohort Study
In Ho Lee,
Hea-Jo Yoon,
Dong Woo Kim
Issue:
Volume 6, Issue 2, December 2018
Pages:
45-49
Received:
24 August 2018
Accepted:
6 September 2018
Published:
10 October 2018
DOI:
10.11648/j.ja.20180602.11
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Abstract: Few studies have investigated the effects of preoperative psychological factors on pain during surgery. In this study, the association of preoperative psychological factors with the occurrence of intraoperative pain, the need for opioid supplementation, and the conversion to general anesthesia were examined during the extension of epidural analgesia for cesarean delivery. In parturients who received epidural labor analgesia, the visual analog scale (VAS; 0–100 mm) were used to evaluate trait anxiety, anxiety about surgery, and anticipated intraoperative pain before emergency cesarean delivery performed because of failure to progress. During surgery, the occurrence of intraoperative pain, need for opioid supplementation, and conversion to general anesthesia were observed. Spearman rank order correlation revealed a positive correlation between anxiety about surgery and the occurrence of intraoperative pain (correlation coefficient = 0.23, P = 0.008), between anticipated intraoperative pain and the occurrence of intraoperative pain (correlation coefficient = 0.31, P < 0.001), and between anticipated intraoperative pain and the need for opioid supplementation (correlation coefficient = 0.35, P = 0.012). Anxiety about surgery (odds ratio = 1.04 [1.02–1.07], P = 0.032) and anticipated intraoperative pain (odds ratio = 1.06 [1.02–1.11], P = 0.002) were independent predictors of the occurrence of intraoperative pain according to multiple logistic regression analysis, after controlling for maternal age and pain VAS score before cesarean delivery during labor pain. Anxiety about surgery and anticipated intraoperative pain are independent predictors of the occurrence of intraoperative pain during extension of epidural labor analgesia for intrapartum cesarean delivery performed because of failure to progress.
Abstract: Few studies have investigated the effects of preoperative psychological factors on pain during surgery. In this study, the association of preoperative psychological factors with the occurrence of intraoperative pain, the need for opioid supplementation, and the conversion to general anesthesia were examined during the extension of epidural analgesi...
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Effects of Dexmedetomidine on Hepatic Ischemia Reperfusion Injury in Rats with Cholestasis and Liver Fibrosis
Yi Zou,
Le Zhang,
Lai Wei,
Hongjue Huang,
Wenyan Chen,
Qian Huang,
Gaoyin Kong
Issue:
Volume 6, Issue 2, December 2018
Pages:
50-56
Received:
6 October 2018
Accepted:
23 October 2018
Published:
13 November 2018
DOI:
10.11648/j.ja.20180602.12
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Abstract: Back ground: Liver complicated with cholestasis and fibrosis is vulnerable to ischemia reperfusion injury (IRI). Objectives: To investigate the effects of dexmedetomidine on hepatic ischemia reperfusion injury in rats with cholestasis and liver fibrosis. Material and Methods: Model of rats with cholestasis and liver fibrosis is established by bile duct ligation (BDL) for 18 days. Thirty-two male modeled SD rats were randomized into four groups (n=8): Group S: rats underwent laparotomy but the hepatic pedicle was not occluded. Group IRI: the hepatic pedicle was occluded for 30min. Group D10: dexmedetomidine 10μg/kg was injected intraperitoneally before hepatic ischemia. Group D100: dexmedetomidine 100μg/kg was injected intraperitoneally before hepatic ischemia. Blood samples were obtained for analysis of total billirubin (TBIL), direct billirubin (DBIL), aspertate transaminase (AST), alanine transaminase (ALT), and tumor necrosis factor-α (TNF-α). Liver tissues were obtained for analysis of superoxide dismutase (SOD) and malondialdehyde (MDA), and were observed after hemotoxylin-eosin (HE) or Masson staining for histopathological assessment. Results: TBIL and DBIL values were not significantly different between four groups (P > 0.05). AST, MDA and TNF-α values in group IRI, D10 and D100 were significantly higher than in group S, while SOD value were lower (P < 0.05), AST, MDA and TNF-α values in group D10 and D100 were significantly lower than in group IRI, while SOD values were higher (P < 0.05). The degrees of bile duct proliferation and fibrosis in liver tissues in four groups were similar. In group IRI, there were severe inflammatory cells infiltration, hepatocellular swelling and even local necrosis in liver tissue, but injuries in group D10 and D100 was moderate. Conclusions: Dexmedetomidine may attenuate hepatic IRI in rats with cholestasis and liver fibrosis, possibly by up-regulation of SOD activity and down-regulation of TNF-α expression.
Abstract: Back ground: Liver complicated with cholestasis and fibrosis is vulnerable to ischemia reperfusion injury (IRI). Objectives: To investigate the effects of dexmedetomidine on hepatic ischemia reperfusion injury in rats with cholestasis and liver fibrosis. Material and Methods: Model of rats with cholestasis and liver fibrosis is established by bile ...
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Preoperative Anxiety and Its Determinants Among Patients Scheduled for Major Surgery: A Hospital Based Study
Ramesh Ghimire,
Pramila Poudel
Issue:
Volume 6, Issue 2, December 2018
Pages:
57-60
Received:
25 November 2018
Accepted:
3 January 2019
Published:
18 February 2019
DOI:
10.11648/j.ja.20180602.13
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Abstract: Surgery is considered as a life threatening or a major concern that need significant psychological adaptation whether it be a major or a minor one. Pre-operative period is a stressful event that triggers specific emotional, cognitive and physiological response of a patient. Anxiety during this period is determined by various factors that need to be considered by a anesthesiologists and the team. A descriptive cross sectional study was conducted to assess the prevalence and determinants of pre-operative anxiety among adult patients scheduled for major surgery in a teaching hospital at Parsa district, Nepal using State and trait inventory (STAI) and a checklist prepared to assess the determinants of anxiety. The obtained data were analyzed by descriptive and inferential statistics using SPSS 16 version. The result of the study revealed that 38.2% of the patients were in the age group of 29-38 years. Among total patient studied 85.3% were scheduled for elective surgery. The mean anxiety score was 44.25±5.97. Majority 70.6% had preoperative anxiety at moderate level. The level of anxiety was significantly associated with age and type of surgery at (p value 0.030) and (p value (0.028) respectively. The major determinants of anxiety were concern about family, financial crises due to surgery, fear of unawakening from anesthesia, and the outcome of surgery. Patient needs to be assessed regularly for anxiety during their pre anesthetic check up by an anesthesiologist thus implementing anxiety reducing activities among the patients.
Abstract: Surgery is considered as a life threatening or a major concern that need significant psychological adaptation whether it be a major or a minor one. Pre-operative period is a stressful event that triggers specific emotional, cognitive and physiological response of a patient. Anxiety during this period is determined by various factors that need to be...
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