Suitability of CPOT and BPS to Assess Pain Response in Intubated Mohammad Hoesin Hospital Intensive Care Patients

Background. Assessing pain in mechanically ventilated patients is an important thing for leads to improved outcome and better quality life of patients in the ICU. CPOT and BPS has been developed for measuring nonverbal patients. Aims. To validate suitability the use of CPOT and BPS in ICU RSMH. Methods. Observational analytic with cross sectional design was chosen for 50 samples conducted on July 2020 in ICU RSMH. Data was collected before and after pain procedure. Result. From 50 patients mostly 27(54%) male with age majority > 30 years old 39 (78%). The lowest GCS 2 and the highest 10. Length of treatment in ICU was 1 – 20 days. Bleeding variations was 0 - 1200 cc. BPS average before painful procedure was 2 – 5 and after panful procedure was 5 – 7. CPOT average before painful procedure was 1 – 6 and after painful procedure was 3 - 8. Kappa before painful procedure are moderate (kappa=0,435) and after painful procedure are fair (kappa=0,248) with strongly correlated in Pearson correlation (r = 0,644, r = 0,610) (p < 0,05). Conclusion. This study demonstrated that CPOT more detail than BPS for measuring pain in intubated patients.

ĀKĀRAKARA AS DERMAL ANAESTHETIC

Nowadays, the role of local anaesthesia in the surgical field is highly appraisable. Local anaesthetics are the drugs that produce a loss of sensation over the localised areas without producing a loss of consciousness. Humans have been using various methods to block pain for thousands of years. Controlling pain during the śhastrakarma in śalyatantra has been always challenging. There has been the introduction of various methods of local anaesthetics since the origin of medical science, topical anaesthetics being one of them. Studies have been conducted to discover novel anaesthetic agents by various scholars. Herbal extracts do not stand far in the pathway of this search. Owing to these discoveries, 30% ethanolic extract gel of Ākārakara (Spilanthes calva DC.) is selected here as a topical anaesthetic to evaluate the efficacy in facilitating the management of warts by a painful procedure agnikarma. Keywords: Dermal anaesthetic, Ākārakara, Spilanthol

Procedural pain distraction

This chapter focus on distraction as an intervention for children’s acute medical pain. We start by highlighting the consequences of untreated procedural pain for children. Next, we discuss the theoretical rationale for distraction and its anesthetic qualities. Subsequently, we present the literature examining the effectiveness of distraction for lowering children’s distress associated with immunizations, venous access, burn debridement, and cancer treatments. Then we synthesize the distraction for procedural pain literature, and we highlight some of the issues to consider when conducting research or applying distraction in clinical settings. We conclude the chapter with a vignette, which illustrates some of the nuances to consider when applying and personalizing distraction for a child undergoing an acute painful procedure.

Simple Concentration Method Enables the Use of Gargle and Mouthwash Instead of Nasopharyngeal Swab Sampling for the Diagnosis of Covid19 by PCR

Purpose Since its emergence in December 2019, SARS-CoV-2 is causing one of the most devastating pandemics in human history. Currently, the most important method for definitive diagnosis of COVID-19 is identification of SARS-CoV-2 RNA in nasopharyngeal swab samples by RT-PCR. Nasopharyngeal swab sampling is a discomforting procedure sometimes with adverse effects, which also poses a risk for infection for the personnel performing the sampling. We have developed a new method for concentrating biological samples, which enabled us to use gargle and mouth-wash samples to be used in RT-PCR, for the diagnosis of COVID-19, as an alternative to nasopharyngeal swab samples.Methods We have analyzed nasopharyngeal and gargle and mouthwash samples, before and after concentration, of 363 patients by RT-PCR for the presence of SARS-CoV-2.Results Among 114 patients in which SARS-CoV-2 was identified in at least one of their samples, the virus was identified in 76 (66.7%), 67 (58.8%) and 101 (88.6%) of nasopharyngeal swab, gargle and mouth-wash samples before and after concentration, respectively.Conclusion When concentrated by our new method, gargle and mouthwash samples can be used instead of nasopharyngeal samples in identification of SARS-CoV-2 by RT-PCR, with the same or better sensitivity. Eliminating the need for nasopharyngeal sampling, will save the patients from an invasive and painful procedure and will lower the risk of infection for the healthcare personnel taking the sample. This easy sampling procedure may decrease the workload of hospitals, shorten the turn-around time of obtaining test results and thus enable rapid isolation of infected patients.

Multimodal Signal Analysis for Pain Recognition in Physiotherapy Using Wavelet Scattering Transform

Fascial therapy is an effective, yet painful, procedure. Information about pain level is essential for the physiotherapist to adjust the therapy course and avoid potential tissue damage. We have developed a method for automatic pain-related reaction assessment in physiotherapy due to the subjectivity of a self-report. Based on a multimodal data set, we determine the feature vector, including wavelet scattering transforms coefficients. The AdaBoost classification model distinguishes three levels of reaction (no-pain, moderate pain, and severe pain). Because patients vary in pain reactions and pain resistance, our survey assumes a subject-dependent protocol. The results reflect an individual perception of pain in patients. They also show that multiclass evaluation outperforms the binary recognition.

The effect of mother’s voice on pain and physiological parameters during arterial blood sampling in children hospitalized in PICUs

Introduction: Arterial blood sampling is a painful procedure, and is frequently performed in PICUs. Listening to mother's voice may be effective in reducing pain during arterial blood sampling in children. This study was aimed to determine the effect of mother’s recorded voice on pain and physiological parameters during arterial blood sampling in children hospitalized in PICUs. Methodology: This study was a single blind randomized clinical trial with crossover design. Fifty children hospitalized in PICUs participated in this study. The participants were selected through “sequential sampling” and randomly allocated into two groups; e.g., Group AB (n = 25) and Group BA (n = 25). Physiological parameters and pain in each child were measured before and during arterial blood sampling with (B) and without (A) listening to their mothers’ voices with a minimum of 24 hrs interval. To measure the pain, COMFORT pain scale was used and the physiological parameters were measured using the monitoring devices connected to the children. Data were analyzed with SPSS version 22, repeated measure test, paired and non-paired t-test, Wilcoxon and Mann-Whitney test. Results: Means of pain scores and physiologic parameters did not show a significant difference before the intervention on the first and second day between the two groups (AB-BA). The results showed the period effect (f = 0.581 and p = 0.89) and carry over effect (f = 0.055, p-value = 0.881) were not significant. Results of paired t-test showed that the mean pain score during arterial blood sampling with (B: 21.82 ± 5.53) and without (A: 22.40 ± 4.76) listening to their mothers’ voices was significantly different (p = 0.002). That is, with the mother’s voice, the children felt a lower level of pain. The SpO2 decline during the sampling was less with the mother’s voice. Additionally, the heart rate declined less during the sampling compared to the rate before the sampling with the mother’s voice; still, the difference was not significant (p > 0.05). Conclusion: Listening to mothers’ recorded voice was effective to alleviate pain during arterial blood sampling in children hospitalized in PICUs. The use of this method to reduce pain during this painful procedure is effective even in the absence of the mother. Key words: Pain; Mother’s voice; Arterial blood sampling; Physiological indices; PICU Citation: Shoghi M, Ahmadi M, Rasouli M. The effect of mother’s voice on pain and physiological parameters during arterial blood sampling in children hospitalized in PICUs. Anaesth. pain intensive care 2021;25(1):40-47.DOI: 10.35975/apic.v25i1.1440 Received: 20 June 2020, Reviewed: 16 September 2020, Accepted: 25 November 2020

Step Back

Is natural always the best choice? Should humans should step in and usurp nature? Are there uniquely human experiences that should take place, even if it means greater risk? In this work of philosophical short story fiction, Beth and Bob are expecting a baby. However, in this future, womb carried babies have been almost entirely replaced by the far safer “womb farms.” Beth has already decided she wants to have a natural pregnancy and carry the baby to term herself. She is shunned by others who see it as dangerous and selfish. Their neighbor, Sandy is the daughter of a Neo-Shaker family who used science to have their daughter born neuter, that is to say, without sexual organs or gender. Sex, they argue, is no longer necessary and sinful as procreation can now be handled without sex. Sandy self-identifies as female and intends to undergo a dangerous and painful procedure to add female sexual organs to her body. Beth dies during childbirth, but her baby survives. Bob and Sandy continue their friendship, and, overtime, start to fall in love. Sandy is finally scheduled for the operation, but Bob tries to talk her out of it. He has lost too many loved ones already. Sandy insists she must be made the gender to match her mental state and does the procedure.

Suitability of CPOT and BPS to Assess Pain Response in Intubated Mohammad Hoesin Hospital Intensive Care Patients

Background. Assessing pain in mechanically ventilated patients is an important thing for leads to improved outcome and better quality life of patients in the ICU. CPOT and BPS has been developed for measuring nonverbal patients. Aims. To validate suitability the use of CPOT and BPS in ICU RSMH. Methods. Observational analytic with cross sectional design was chosen for 50 samples conducted on July 2020 in ICU RSMH. Data was collected before and after pain procedure. Result. From 50 patients mostly 27(54%) male with age majority > 30 years old 39 (78%). The lowest GCS 2 and the highest 10. Length of treatment in ICU was 1 – 20 days. Bleeding variations was 0 - 1200 cc. BPS average before painful procedure was 2 – 5 and after panful procedure was 5 – 7. CPOT average before painful procedure was 1 – 6 and after painful procedure was 3 - 8. Kappa before painful procedure are moderate (kappa=0,435) and after painful procedure are fair (kappa=0,248) with strongly correlated in Pearson correlation (r = 0,644, r = 0,610) (p < 0,05). Conclusion. This study demonstrated that CPOT more detail than BPS for measuring pain in intubated patients. Keywords. BPS, CPOT, ICU, Intubated, Pain