Background:Anesthesia induction in patients with current substance abuse can be a challenge for anesthesiologists.Objectives:This study aimed to evaluate the effect of adding Sufentanil to Bupivacaine on duration of brachial plexus nerve block.Patients and Methods:One hundred and twenty patients with (Groups C and D) and without (Groups A and B) a history of opium abuse (60 in each group) scheduled for elective upper extremity procedures were randomly assigned to either receive 30 mL bupivacaine alone (Groups A and C) or in combination with additional 10 µg sufentanil (Groups B and D). An ultrasound-guided technique was applied to perform upper extremity brachial plexus blockade. The onset and duration of sensory and motor blocks were recorded and compared between the four groups.Results:The duration of sensory and motor block were significantly less in Group C (537.0 ± 40.1 minutes, 479.0 ± 34.8 minutes) and the longest duration of sensory and motor block was observed in group B (705.0 ± 43.8 minutes, 640.0 ± 32.5 minutes). The duration of sensory and motor block in Group B (705.0 ± 43.8 minutes, 640.0 ± 32.5 minutes) was longer and statistically higher than group A (619.5 ± 48.0 minutes, 573.2 ± 31.5 minutes), the same trend was observed in group D (598.6 ± 53.2 minutes, 569.3 ± 39.9 minutes) over group C (537.0 ± 40.1 minutes, 479.0 ± 34.8 minutes) (P < 0.001, one-way ANOVA).Conclusions:The length of sensory and motor blockade is shorter in chronic opioid abusers. Adding 10 µg sufentanil to hyperbaric bupivacaine in opium abusers lengthened the sensory and motor block duration.

Escherichia coli (E. coli) has many serotypes. The O157:H7 E. coli serotype is the most prominent serotype of enterohemorrhagic E. coli. It produces the Shiga toxin, which is one of the most important virulent factors discovered till today and has different subtypes with different antigenic and molecular traits. Consumption of contaminated water, milk or even eating an uncooked raw meat can cause bloody diarrhea that can end up in a life-threatening disease, such as hemolytic uremic syndrome (HUS). This is a condition that affects endothelial cells in the blood vessels and leads to thrombocytopenic purpura (TTP) that can cause blood clots formation in small blood vessels. The E. coli O157:H7 can be isolated from patient’s stool and be identified by serological tests such as enzyme-linked immunosorbent assay (ELISA) and immunoblotting methods. This special strain of E. coli can be used as a biological weapon, as it can be so dangerous and has the ability to spread easily form person to person.

This article is an Editorial and does not include an Abstract.

Background: Postoperative complications and patient safety are of great importance to every anesthesiologist. These complications are even more important when related to the respiratory or cardiovascular system.  The present study aimed to evaluate the frequency of major and minor respiratory complications that occur after tracheal extubation in an academic-based hospital in Iran. Methods: In this preliminary prospective survey, the incidence of immediate major and minor complications associated with tracheal extubation after elective surgery in an academic-based hospital affiliated with Tehran University of Medical Sciences with anesthesiology residents was studied. All patients undergoing intubation in the operating room of Shariati Hospital, during the elective lists from Saturdays to Wednesdays, during two months were enrolled. Emergency patients and patients who had any complication during their intubation such as difficulty in intubation or more than two tries for tracheal intubation and patients who were transferred from the operating rooms to the intensive care unit were not included in the study. Patients with BMI over 35 were also not included in the study. During tracheal extubation and up to recovery, all respiratory adverse events including coughing and bucking, Spo2˂%90, difficult mask ventilation, apnea/hypoventilation, vomiting, laryngospasm, and aspiration were recorded. The time of the day at which complications occurred was also recorded. Results: Three hundred and seventeen patients were randomly studied. 171 (53.9%) patients were male and 146 (46.0%) of the studied patients were female. Overall, 184 number (58.0%) of all the patients experienced either coughing or bucking on extubation. 29 (9.1%) patients experienced apnea and/or hypoventilation, out of which 8 (2.5%) of them developed laryngospasm which was more frequent in the male population. Conclusion: In this preliminary survey, it was observed that 59.6% of all the patients experienced at least one of the minor or major respiratory complications of tracheal tube extubation at the end of surgery which was more frequent in women compared to men.