Background:Unilateral spinal anesthesia is used to limit the spread of block. The aim of the present study was to compare hemodynamic changes and complications in unilateral spinal anesthesia and epidural anesthesia below the T10 sensory level in unilateral surgeries.Materials and Methods:In this double-blind randomized clinical trial in total 120 patients were randomly divided into a unilateral spinal anesthesia group (Group S) and an epidural anesthesia group (Group E). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rates were measured before and immediately after the administration of spinal or epidural anesthesia and then at 5-, 10-, 15-, 20-, 25-, and 30-min intervals. The rates of prescribed ephedrine and intraoperative respiratory arrest were recorded, in addition to postoperative nausea and vomiting, puncture headaches, and back pain during the first 24 h after the surgery.Results:SBP, DBP, and MAP values initially showed a statistically significant downward trend in both groups (p = 0.001). The prevalence of hypotension in Group S was lower than in Group E, and the observed difference was statistically significant (p < 0.0001). The mean heart rate change in Group E was greater than in Group S, although the difference was not statistically significant (p = 0.68). The incidence of prescribed ephedrine in response to a critical hemodynamic situation was 5.1% (n = 3) and 75% (n = 42) in Group S and Group E, respectively (p = 0.0001). The incidence of headaches, back pain, and nausea/vomiting was 15.3%, 15.3%, and 10.2% in Group S and 1.8%, 30.4%, and 5.4% in Group E (p = 0.017, 0.07, and 0.49, respectively).Conclusion:Hemodynamic stability, reduced administration of ephedrine, a simple, low-cost technique, and adequate sensory and motor block are major advantages of unilateral spinal anesthesia.

Context: Supraglottic Airway Devices (SADs) are applied in airway management of pediatric emergency conditions. Objective: This review study aimed to examine the literature regarding pediatric supraglottic airway devices, to introduce the optimal devices in terms of Oropharyngeal Leak Pressure (OLP), risk of insertion failure on the first attempt and risk for blood staining of the device.Data Sources: An electronic search was conducted on MEDLINE, EMBASE, CINAHL and PubMed databases. We also searched the Cochrane database (CENTRAL) and Web of Science up to July 1, 2017. Study Selection:Of 112 potential studies, the full texts of 53 articles were available, in which 15 were duplicated and omitted, accordingly. Papers which did not directly discuss SADs were also excluded. In total, 30 papers were identified related to the children supraglottic devices.Data Extraction: The current review was conducted and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Results:The LMA ProSeal may be the best supraglottic airway device for children due to its high oropharyngeal leakage pressure and low risk of insertion failure. It seems that i-gel is a very functional tool as well. Conclusions:Further research is recommended to investigate the most appropriate supraglottic airway in diverse clinical situations and various conditions among children.

Amphetamines and methamphetamines are two groups of substance whose use are increasing globally. Methamphetamines poisoning may develop different sympathetic symptoms; however, developing some complications, such as vasculitis, central nervous system involvement, and kidney injury. In this study, we report a case of methamphetamine poisoning that presented with loss of consciousness and developed Thrombocytopenic Purpura (TTP), Disseminated Intravascular Coagulation (DIC), and pulmonary pseud vasculitis

BACKGROUND: Despite advances in surgical and anesthesiology techniques, many patients continue to experience postoperative pain after lumbar disc surgeries. The aim of this study was to investigate the effect of preoperative oral melatonin on the severity of postoperative pain after lumbar laminectomy/discectomy. METHODS: In this double blinded randomized controlled clinical trial 80 patients undergoing an elective mini-open microdiscectomy surgery at Imam Khomeini educational hospital in Sari, Iran, were selected and randomly assigned into one of four groups. Patients in group A, B, C, and D received 3, 5 and 10 mg melatonin or placebo tablets one hour before surgery, respectively. Using the visual analogue scale (VAS) the severity of pain, nausea and vomiting, pruritus, and use of narcotics were assessed immediately after surgery and before leaving the post-anesthesia care unit, 6, 12 and 24 hours postoperatively. RESULTS: In all three groups receiving melatonin at all three different doses, postoperative pain was significantly less than the placebo group (P<0.01). There were no statistically significant differences in postoperative pain level between the three groups receiving melatonin (P>0.05). The amount of opioid received by the patients within 24 hours after surgery had statistically significant differences within the groups (P=0.043, F=2.58). The results of post hoc analysis in terms of postoperative pain intensity showed statistically significant differences between the two groups receiving melatonin at a dose of 5 mg and the placebo group (P= 0.04). No serious side effects reported in four groups. CONCLUSION: The use of oral melatonin with a dose of 5 mg, 1 hour before the surgery as an inexpensive method can effectively reduce pain intensity as well as the amount opioid use after lumbar laminectomy and discectomy.