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ABSTRACT: Intrduction & Objective: There are several methods for relief of labor pain but not all are appropriate for every patient. In intrathecal block, administration of local anesthetic and patient management in labor process should be with supervision of an experienced physician. Agents used for this purpose consisted of: chlorprocaine, bupivacaine and lidocaine. Drug concentration and volume depend on level and degree of sensory and motor block. Recently, intrathecal epinephrine 25 microgram and even 200 microgram, has been used for prolonging labor analgesia along with opioids and local anesthetics. The aim of this study was to assess the effect of intrathecal low dose epinephrine on pain intensity and duration of labour. Materials & Methods: This clinical trial study was performed on 60 parturients. After starting the active phase of labor (cervix dilatation of 5 cm), spinal analgesia was done in all of the patients. In conventional group analgesia was achieved by 1.5 ml bupivacaine of 0.125 percent, 15 microgram fentanyl, along with 1.25 microgram epinephrine(1:800000) and the same drugs except for epinephrine were used in the control group. Pain intensity before and after block, analgesia duration, systolic and diastolic blood pressure, heart rate, frequency of nausea and vomiting in mother, and first and 5th APGAR scores in neonates were recorded. Results: Complete analgesia duration was 95.3 + 18.2 and 81.2 + 15.1 minutes in epinephrine group and in control group (without epinephrine), respectively. Mean pain intensity score in epinephrine group was less than that of the control group but the difference was not statistically significant. There was no significant difference in the frequency of nausea and vomitting, heart rates, systolic and diastolic pressure in mother and APGAR scores between two groups . Conclusion: Intrathecal low dose epinephrine with bupivacaine and fentanyl can prolong duration of analgesia and relieve pain intensity without any side-effects on mother and fetus .

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ABSTRACT: Introduction & Objective: Opiates include natural alkaloids and synthetic derivates. Their pharmacologic effects are based on bounding opiate receptors. Peak toxic and therapeutic effect of opiate is 90 minutes after oral administration. Acute presentations of opiate poisoning are CNS, respiratory and GI involvements. In long term, opiate can change numbers and sensitivity of their receptors, and result in tolerance or withdrawal syndrome. In opiate over dosage, morbidity and mortality decrease with careful therapeutic and supportive managements. Study of frequency distribution of opiate poisoning according to individual characteristics and clinical manifestations are the main objectives of recent investigation. Materials & Methods: In this retrospective descriptive study, 2520 patients were enrolled in 2001-2002. Information including demographic and clinical characteristics of the subjects was collected. Results: 263 cases of 2520 (10.4%) were poisoned with opiates. The most frequent age group was 21-30 years old (38.3%) and the most common hospital stay was 1-7 days (55.8%). The males were more poisoned than female (71.4%) and respiratory support was used for 29 patients (18%). Poisoning route was often (68.8%) by ingestion (181 cases). The most common clinical presentation was CNS involvement (74.1%). The most common type of used narcotic substances was opium (60.4%). Mortality rate was 4.5% (12 cases). Conclusion: Opiate poisoning can result in morbidity and mortality. Complications were more among those who referred to hospital with delay or used high dose or potent agents. The main cause of mortality in opiate overdose was hypoxia with respiratory depression.

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Background & aim: Chronic infection of the adenoid tissue is one of the causes of hypertrophy. Adenoids are considered to be as reservoirs of pathogenic bacteria such as Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae. The aim of this study was to determine the prevalence of mentioned bacteria in children with adenoid hypertrophy. Methods: A total of 113 children with adenoid hypertrophy who underwent adenoidectomy were included in this study. Subsequently, adenoidectomy was performed under general anesthesia. All of the adenoid samples were evaluated for bacterial infection by culture and PCR methods. Results: Streptococcus. pneumoniae was the most common (33.6%) bacteria isolated by culture followed by H. influenzae (22.9%) and M. catarrhalis (9.7%). PCR method detected S. pneumoniae, H. influenzae and M. catarrhalis in 31%, 29.2% and 9.7% of samples respectively. Conclusion: Streptococcus. Pneumonia, H. influenzae and M. catarrhalis are isolated with different frequency in patients with adenoid hypertrophy.