The Article Abstract is not available.

Background: Spinal anesthesia is widely used for cesarean deliveries due to its effectiveness and safety. However, it often causes post-anesthesia hypotension, which poses risks to both the mother and baby. Fluid preloading is a common method to prevent hypotension, yet the ideal type and volume of fluid remain uncertain. This research investigates how crystalloid and colloid preloading influence sensory block levels and hemodynamic stability during spinal anesthesia for cesarean sections. Methods: Conducted as a randomized, double-blind, controlled trial at Imam Hossein Hospital in Tehran, Iran, from January to June 2022, this study involved 141 women undergoing elective cesarean sections under spinal anesthesia. Participants were randomly divided into three groups: normal saline, Ringer's lactate, or 6% hydroxyethyl starch (130/0.4). Sensory block levels were assessed every 5 minutes for the first 30 minutes and then at 60 and 90 minutes post-anesthesia. Continuous monitoring of hemodynamic parameters, such as systolic blood pressure and heart rate, was performed throughout the procedure. Results: The findings revealed that normal saline achieved the highest maximum sensory block level. Hydroxyethyl starch (HES) showed a slightly longer duration of the block and a reduced incidence of hypotension. Despite these trends, the observed differences among the groups were not statistically significant. Conclusion: This study demonstrates that the choice of preload fluid influences sensory block characteristics and hemodynamic stability during spinal anesthesia for cesarean sections. Additional research with larger sample sizes is necessary to refine fluid management strategies in this context.

Background: Gestational diabetes mellitus (GDM) causes various complications for the patient. Methods: This study included patients admitted to the women’s ICU. These patients were divided into a case and control group. Vitamin D was measured in all patients using the same laboratory kit and the results were categorized as Vit D insufficiency, Vit D deficiency and Vit D severe deficiency. Data This study was conducted using a registry checklist that included questions on Serum vitamin D levels, Anemia, Education, Age and Body mass index (kg/m2) which was completed using information available in the patient's clinical record. Results: Result showed, in the Case Group, the mean (SD) age was 28.96 (1.54), BMI was 24.6 (0.81), and 48% of the mothers had anemia. Also, in the control group, the mean (SD) age was 29.2 (1.22), BMI was 25.96 (1.69), and 28% of the mothers had anemia. also, the findings showed that in the Case Group, 56% of mothers had Vit D deficiency, 16% had Vit D insufficiency, and 28% had severe Vit D deficiency. Also, in the Control Group, 32% of mothers had Vit D deficiency, 56% had Vit D insufficiency, and 12% had severe Vit D deficiency. Also, different vitamin D percentages were reported in the two groups studied(p<0.05). Conclusion: Given the relationship between vitamin D and GDM, it is recommended that necessary preventive measures be taken in this regard to prevent pregnant mothers from contracting the disease.

Background: Nursing interventions in neonatal intensive care units of hospitals can occasionally turn into futile and costly measures, bringing about ethical conundrums. The aim of the present study was to investigate the relationship between futile care and moral sensitivity among nurses working at the neonatal intensive care units (NICU) of teaching medical centers in Gorgan city, North of Iran. Methods: This 2024 descriptive-analytical study was conducted on 100 NICU nurses enrolled by quota sampling. Data collection tools included a demographic information questionnaire, the Lutzen moral sensitivity questionnaire, and a futile care questionnaire developed based on the Corley moral distress scale. The data gathered were entered into SPSS version 21 software and analyzed using descriptive (tables, mean, and standard deviation) and inferential (Pearson correlation coefficient) statistics. Results: According to the results, the participants acquired the mean score of 62.12 ± 4.08 for moral sensitivity and 44.16 ± 5.81 for futile care. The Pearson correlation coefficient showed no significant association between moral sensitivity and futile care (r = - 0.12, P = 0.2). Conclusion: Regarding the impact of nurses’ moral sensitivity and perception of futile care on the quality of health service provision, authorities are advised to consider plans and solutions (such as professional ethics training courses) to improve nurses’ awareness of ethical dilemmas, moral sensitivity, and attitudes towards futile care.

The Article Abstract is not available.

Background: Despite advances in pain management, the incidence of postoperative pain remains a concern. In addition, analgesics have many side effects. Therefore, non-pharmacological interventions aimed at reducing the dosage of analgesics seem necessary, whether as a complementary or independent medication. In this regard, the present study was conducted with the aim of investigating the impact of music and acupressure on the pain intensity in the conscious patients hospitalized in intensive care units (ICU). Methods: The present quasi-experimental study was conducted on conscious patients undergoing laparotomy surgery who were hospitalized in the surgical ICU of hospitals affiliated with Shahid Beheshti University in 2023. We randomly assigned 90 patients to one of three groups: nature music, acupressure, or combined. The data collection tools consisted of patients' demographic information form and the visual pain assessment scale, which was measured once before the intervention and over five time points after it. For participants in the nature music group, sounds of rivers, birds, and waterfalls were played using an MP3 player device and headphones for 20 minutes on one occasion. For the participants in the acupressure group, pressure was applied to L14 or Hogo for 10 seconds of pressure, followed by 2 seconds of rest, for a duration of 20 minutes, so that the patient could feel heat, numbness, and heaviness. We simultaneously performed nature music and acupressure for the participants in the combined group. SPSS version 19 was used for data analysis. Results: Three groups of participants were homogeneous, with no statistically significant differences in terms of demographic characteristics (P value < 0.05). There was no statistically significant difference in the pain intensity of the patients among the three groups before the intervention. However, there was a significant difference among the three groups at 30 minutes, 60 minutes, 2 hours, 3 hours, and 4 hours after the intervention, and the combined and concurrent use of music therapy and acupressure proved to be more effective in reducing the pain intensity. Conclusion: The results indicated the effectiveness of both nature music and acupressure when used alone or in combination. Their combined and concurrent implementation is more effective. Therefore, we recommend that nurses adopt combined care programs for pain management in ICU patients.

Trigeminal neuralgia (TN) is one of the most severe painful conditions known to man. Contradictory results regarding the effectiveness of pulsed radiofrequency (PRF) treatment of the trigeminal ganglion have been published in the literature. In the past few years, reports in support of prolonged (extended duration) radiofrequency treatment of the trigeminal ganglion have been emerging. Unlike most other interventional procedures that include nerve or ganglion destruction and its resultant potential complications, PRF treatment is believed to be much safer. Working toward the establishment of effective PRF protocols proves highly valuable in the management of TNs refractory to medical treatment. This article showcases the successful control of two cases of refractory trigeminal neuralgia (TN) through extended duration pulsed radiofrequency treatment. Recent studies, however, suggest prolonged PRF ablation may provide a more durable solution. PRF offers a potentially safer alternative to traditional interventions by minimizing nerve destruction.

Background: Providing adequate sedation in patients undergoing cataract surgery, can create analgesia and sedation during injection and retrobulbar surgery in order to prevent eye movement during open eye surgery. This study was aimed at assessing the effects of melatonin premedication on the quality of sedation and pain control during cataract surgery. Methods: The study was a triple-blind randomized clinical trial that was performed in Isfahan on 40 patients. The patients were allocated randomly into two groups of 20 subjects, one group receiving 3 mgs of sublingual melatonin pill and another group 3mgs of placebo. This was done 60 minutes prior to surgery. Hemodynamic parameters, level of pain, and sedation were measured at specific intervals. In order to measure the level of pain and sedation, the VAS score and Richmond scales were used, respectively. Results: Surgery duration (P value=0.059), duration of anesthesia (P value=0.14), duration of recovery (P value=0.34), ASA (P value=0.27), Richmond scale (P value=0.45), oxygen saturation level (P value=0.12), and PR (P value=0.87) did not show a significant difference between the two groups. The changes in mean arterial pressure (P value=0.02) and pain intensity (P value=0.04) were significantly higher in the placebo group compared to the melatonin group. Conclusion: Premedication with oral melatonin was beneficial in providing better pain control and hemodynamic stability in patients undergoing cataract surgery under sedation and local anesthesia.

Background: Spinal anesthesia in orthopedic surgeries presents challenges, especially concerning the choice of anesthetic agents and their adjuncts, which affect analgesia quality and potential side effects. This study was conducted with the aim of determining the effects of intrathecal bupivacaine, meperidine and magnesium sulfate on hemodynamic parameters, onset and duration of sensory/motor block in spinal anesthesia in patients with lower limb fractures. Methods: This double-blind, randomized clinical trial included 130 patients who were candidates for planned lower limb orthopaedic surgery. They were divided into four groups: 1: bupivacaine 10 mg, 2: meperidine (1 mg/kg), 3: bupivacaine 10 mg + magnesium sulfate of 100 mg, and 4: meperidine (1 mg/kg) + magnesium sulfate with (100 mg). Parameters measured included hemodynamic status and sensory and motor block onset and duration. The level of sensory block was assessed via the pinprick sensation method, while the Bromage scale was used to evaluate motor block. Results: No clinically significant differences in hemodynamic parameters were observed across the groups. The onset of sensory block (P value= 0.235), onset of motor block (P value= 0.097), and duration of motor block (P value= 0.135) were statistically similar across the groups. However, significant differences were found in the duration of the sensory block (P value= 0.035). Magnesium sulfate increased the duration of motor block in the meperidine group (80.93 ± 30.28 minutes). However, it reduced the duration in the bupivacaine group (75.23 ± 38.56 minutes) Motor block onset was prolonged in groups receiving magnesium sulfate, with a significant difference between the meperidine and meperidine with magnesium sulfate groups (CI = 1.10 to 12.52, P value = 0.04). Conclusion: The intrathecal drugs used did not produce significant side effects, suggesting that they can be used interchangeably... However, magnesium sulfate, as an adjuvant, did not enhance the length or quality of the block in spinal anesthesia when used with meperidine and bupivacaine

Central venous catheterization is a critical procedure for patients undergoing major surgeries, particularly when peripheral venous access is compromised. This case report delineates the emergency placement of a central venous catheter (CVC) through the right internal jugular vein in a 63-year-old female patient positioned prone during spinal surgery. The necessity arose following significant intraoperative blood loss and the failure of peripheral venous access, presenting unique challenges due to the patient's position and the absence of sonographic guidance. The procedure was successfully executed by anatomically identifying the insertion site and utilizing a posterior lateral approach, which underscores the feasibility and urgent need for CVC placement in atypical scenarios. The patient demonstrated significant improvement with stable postoperative outcomes, emphasizing the importance of adaptability in clinical practices. This case contributes to the limited but growing body of literature on prone position CVC insertion, highlighting its viability in emergencies, despite inherent risks and technical difficulties. The findings advocate for further research and development of guidelines to enhance patient safety and procedural success in complex clinical settings.