Vol 3-2 Case Report

Intranasal phenylephrine in the operating room - how many drops?

Background: Topical vasoconstrictors are commonly used to minimize bleeding during Ear, Nose and Throat surgeries. Phenylephrine is one of the most commonly used and could be an underrecognized source of intra-operative events. Total dose of administered drugs is often unmeasured.

Cases of acute pulmonary edema, cardiac arrest and death after topical vasoconstrictors (TV) have been reported. Maintenance of cardiac output is of paramount importance to avoid cardiovascular collapse. β1 receptor blockage reduces cardiac output, it is contraindicated in these situations.

Case: This case describes an intra-operative critical event after an unknown amount of phenylephrine administration.

Conclusion: Lack of awareness about phenylephrine maximum recommended dose may induce complications leading to haemodynamic instability. The authors aim to raise awareness about the use of TV, including dose, administration site and also clinical signs and symptoms that may appear after its use.  Special attention must be addressed to the drug choice for the support treatment of eventual cardiovascular symptoms.

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Vol 3-2 Review Article

Intensive Short-term Dynamic Psychotherapy for Pain

Intensive short-term dynamic psychotherapy (ISTDP) has been studied for a broad range of somatic symptom presentations including chronic pain. Drawn from two recent meta-analyses, data using ISTDP treatment for pain conditions was extracted and meta-analyzed. Ten studies, including 6 randomized controlled trials, were examined. Short- and medium-term results were available and ISTDP yielded large and persistent treatment effects for both pain and depression within group. In the short-term follow-up, large within group effects were seen for measures of anxiety, and medium within group effects were seen on measures of interpersonal problems. When ISTDP was compared to cognitive behavioral therapy methods (CBT) in randomized controlled trials, it yielded superior effects to CBT on pain and depression measures in both short- and medium-term follow-up. There was evidence of heterogeneity which was reduced by removing 2 outlying studies, yet the results remained significant and of moderate to large effects. Two studies suggested the method was cost effective by reducing healthcare costs, medication and disability costs. Based on these findings ISTDP should be considered for chronic pain treatment guidelines. Future research directions are discussed.

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