BackgroundShivering is among the common troublesome complications of spinal anesthesia (SA), and causes discomfort and discontentment in parturients undergoing cesarean sections (CSs). The aim of this study was to investigate the effects of intrathecal dexmedetomidine in the prevention of shivering in those who underwent CS under SA.Subjects and methodsFifty parturients planned for elective CSs under SA were enrolled in this prospective, double-blinded, controlled study and randomly divided into two equal groups. Spinal block was achieved with 12.5 mg 0.5% heavy bupivacaine plus 5 μg dexmedetomidine (BD group) or 0.5 mL 0.9% normal saline (BN group). The incidence and intensity of shivering, peripheral and core body temperature, hemodynamic parameters, and adverse events was recorded.ResultsThe incidence of shivering was significantly higher in the BN group (52%) than the BD group (24%) (P=0.04). Likewise, the intensity of shivering was significantly higher in the BN group than the BD group (P=0.04). The incidence of adverse events, such as hypotension, nausea/vomiting, and bradycardia, was not significantly different between the two groups, although the grade of sedation was higher in the BD group than the BN group (P=0.004).ConclusionWe conclude that intrathecal dexmedetomidine is effective in lowering the incidence and intensity of shivering in parturients undergoing CSs under SA without major adverse effects.

Background:One of the shortcomings of the available treatments for major depressive disorder (MDD) is the time delay between starting the treatment and achieving an antidepressant response.Objectives:We aimed to determine the effect of Ketamine as a synergistic antidepressant and anesthetic agent on MDD in electroconvulsive therapy (ECT).Patients and Methods:Twenty-two patients with MDD received Ketamine and Propofol as anesthetic agents compared with 20 patients as the control group who received Propofol in a double-blind randomized clinical trial. The Hamilton rating scale for depression was used to determine the changes in symptoms severity during ECT and a 2-week follow-up.Results:Both groups showed a reduction in depression severity, but there was no significant difference between the groups in the recovery process (P = 0.92). However, the cognitive performance recovery time in the Ketamine group was lower than that in the control group (P = 0.042).Conclusions:This study could not show the effect of Ketamine on depression recovery in a 2-week follow-up period. Nevertheless, Ketamine may provide a better cognitive performance in patients under ECT.

IntroductionShivering is among the unpleasant and potentially harmful side effects of spinal anesthesia. The aim of this randomized double-blind clinical trial was to compare the antishivering effect of two different doses of intrathecal pethidine on the incidence and intensity of shivering and other side effects in patients who underwent cesarean section.MethodsIn this study, 150 parturient females scheduled for nonemergent cesarean section were randomly allocated to three groups. Spinal anesthesia was performed with 0.5% hyperbaric bupivacaine (12.5 mg), plus 0.5 mL of 0.9% saline in the standard group (S group), and the same dose of bupivacaine with 5 mg (P5 group) or 10 mg of pethidine (P10 group). Demographic and surgical data, incidence and intensity of shivering (primary outcome), hemodynamic indices, forehead and core temperatures, maximum sensory level, Apgar scores, and adverse events were evaluated by a blinded observer.ResultsThere were no significant differences between the three study groups regarding the demographic and surgical data, hemodynamic indices, core temperatures, and maximum sensory level (P>0.05). The incidence and intensity of shivering were significantly less in the P5 and P10 groups (P<0.001) when compared with the S group. There were no significant differences between groups for secondary outcomes, except pruritus, which was more common in the P5 and P10 groups when compared with the S group (P=0.01).ConclusionLow dose of intrathecal pethidine is safe, and can decrease the incidence and intensity of shivering during cesarean section, without having major side effects.

Background: Adding dexmedetomidine to bupivacaine has been shown to prolong the analgesic effects of the transversus abdominis plane (TAP) block. However, the optimal dose of this adjuvant drug is unclear. Objectives: Identifying optimal doses of dexmedetomidine added to bupivacaine in the TAP block. Methods: In this randomized controlled trial, 86 patients candidate for elective open inguinal herniorrhaphy under spinal anesthesia were divided randomly into three groups; low (L), medium (M), and high (H) dose of dexmedetomidine, that finally 80 cases ended the study and were analyzed. At the end of the surgery, the patients underwent ultrasound-guided TAP block. In all patients of the three groups, the analgesic base of the block was 20 mL bupivacaine 0.125% that was supplemented with 0.5, 1, or 1.5 µ/kg of dexmedetomidine in groups L, M, and H, respectively. Results: The maximum duration of the block was 4 hours in group L and 8 hours in groups M and H. None of the patients needed to receive analgesic at 0, 2, and 24 hours after the block. The dose of analgesic required in the first 8 hours of the block in groups M and H was less than in group L (P < 0.02). Patients in groups H and M were more satisfied with the block (P < 0.01) and experienced less pain compared with group L (P < 0.01). Drowsiness and sedation were observed in patients up to 4 hours after the TAP block, which was dependent on the dexmedetomidine dose (P < 0.01). Conclusions: Based on our results, the optimal dose of supplemental dexmedetomidine could be 1 µ/kg in the TAP block.

Purpose The purpose of this paper is to determine the second victims’ experience and its related factors among medical staff. Design/methodology/approach This research is a cross-sectional study that was conducted in public hospitals of Sanandaj, west of Iran, in 2017. The sample consisted of 338 medical staff including physicians, nurses and mid-wives. A self-report questionnaire was used for data collection. Descriptive statistics, cross-tabs and χ2 test were used for data analysis using SPSS20. Findings A total of 51.5 percent (n=174) of the medical staff had experienced medical error in the past year, of which 90.2 percent (n=157) had at least one of the symptoms of “second victims.” Tachycardia and sleep disturbances were the most commonly referred physical symptoms with 73 and 51.7 percent, respectively. Also, repetitive/intrusive memories and fear of reputation damage were the most commonly referred psychosocial symptoms with 68.3 and 51.7 percent, respectively. The experience of physical and psychosocial symptoms was different according to the occupational category. In addition, there was a significant association between the experience of physical symptoms with the hospital administrators’ awareness of medical errors and the consequences of medical errors for patients. Practical implications Adoption of coping strategies, including learning from medical errors as well as hospital administrators’ support from second victims, is recommended. It is also suggested that medical staff be informed about the consequences of medical errors as well as physical and psychological symptoms of second victims so that they can ask for help from managers and colleagues when the symptoms occur. Originality/value This study outlines the prevalence, the most psychological and physical symptoms, and the demographic and occupational factors associated with the second victim phenomenon in medical staff. Also, the most important strategies for coping with this phenomenon are prioritized from the perspective of medical staff.