Journal of Anesthesiology and Pain
Year:2012 | Volume:2 | Issue:6|Papers Count:10

Aim and Background: The aim of this study is comparing ACTH changes in epidural and intravenous analgesia technique after lower limb orthopedic surgery.Methods and Materials: In a randomized clinical trial in Hazrat Rasool Akram Hospital during 1387-88, 60 patients candidate for surgery on the lower extremities were randomly allocated to receive either postoperative analgesia with epidural analgesia (PCEA) or IV analgesia (PCIA). Measurement of ACTH levels and Visual analogue scale (VAS) was performed in four relief phases including at the time of arrival to the operating room, immediately after surgery and 12 hours after intravenous pump functionary and 24 hours after surgery were recorded.Findings: The mean level of ACTH and VAS, 24 hours and 12 hours after surgery in the PCEA group were less than PCIA. Ramsey Sedation Score (RSS) in PCEA group at these intervals was more than PCIA cases.Conclusions: It seems that PCEA relieves pain more effectively than PCIA method. However, the proper method of anesthesia for each patient as well as patients' preferences should be considered in selecting the method of postoperative analgesia.

Aim and Background: Use of drugs with short apnea duration and less hemodynamic changes for intubation of trachea in intensive care units is necessary. This study compares the effects of propofol and sodium thiopental on hemodynamic changes and apnea duration after tracheal intubation in patients admitted to intensive care units.Methods and Materials: In this double blind clinical trial, 25 ICU-admitted patients were evaluated. They were intubated two times with 72 hours interval, once received 1.5 mg/kg sodium thiopental, and the other time 0.75 mg/kg propofol, while the drug used for intubation in the first time was randomly selected. Hemodynamic variables include systolic and diastolic BP, heart rate, MAP, RPP, MAP/HR and apnea duration in two times, during pre intubation, intubation and after intubation were measured. Data were analyzed with statistical tests of independent's t and ANOVA repeated test.Findings: In comparison with pre-intubation, hemodynamic variables such as systolic and diastolic BP, MAP and MAP/HR were decreased during tracheal intubation in both groups, but range of changes in propofol group is less than those of thiopental group and the difference is statistically significant (P<0.0001).Conclusions: In comparison with thiopental, Propofol has fewer changes in hemodynamics in patients who needed tracheal intubation, and also has shorter apnea period. Accordingly use of propofol over thiopental is recommended for tracheal intubation in ICU patients.

Aim and Background: Ventilator-Associated pneumonia (VAP) is the second common infections with high mortality (24-40%).In this study designed to determined effect of continuous (infusion) and intermittent (bolus) feeding on the Ventilator-associated Pneumonia in ICU Patient.Methods and Materials: This randomized controlled trial was performed on 76 patients admitted in ICU. They were randomly allocated to equal two groups (n=38). In case group, continuous feeding and in controlled group intermittent feeding was performed during the first five days. The incidences of early pneumonia (the first 3 to 5 days) and increase WBC (White Blood Cell) and PMN (Poly Morph Nuclear) in both groups were compared during the first 5 days.Findings: Therate of increase in WBC (>11000/ml) and PMN (band cell>50%) in continuous group was 8 patients (10.5%) and in intermittent group were 7 patients (9.2%) (pv=0.32). The incidences of early pneumonia (CPIS>or=6) in case group were 4 patients (5.3%) and in control group were 7 patients (9.2%) (pv=0.77).Conclusions: The results of this study showed that incidence of early VAP in case group was lesser, but this difference was not significant. Also, there was no significant difference in increase of WBC and PMN in both groups.

Aim and Background: Postoperative shivering is one of the most common problems after general and local anesthesia. We compared the efficacy of low dose ketamine versus pethidine in controlling shivering after surgery.Methods and Materials: In a double-blind randomized Clinical trial, 132 ASA I, II patients candidate for tonsillectomy were randomized to receive either pethidine and ketamine. At the time of arrival to the recovery and after 30 minutes, the occurrence of chills and possible complications were evaluated and compared between the two groups.Findings: Two patients in the ketamin group (3%) experienced shivering while none of the patients in the pethidine group reported shivering (p>0.05). Other complications were more in the ketamin group (p<0.05).Conclusions: Ketamin and pethidine are equally effective in controlling postoperative shivering, but regarding the lower incidence of other complications, pethidine is still the first choice of treatment.

Aim and Background: Laparoscopic surgery is associated with post operative pain. optimal pain treatment with minimal side effects is essential for early recovery and mobility in patients undergoing laparoscopic surgery. we compared the analgesic effect Pregabalin and Gabapentin with different doses in these surgical procedures.Methods and Materials: In a randomized, double blind, ninety patients were allocated to either Group A Pregabalin 300mg, GroupB Gabapentin 600mg and Group C Gabapentin 900mg .these were administered 1 h before operation. General anesthesia was performed. we collected data on pain intensity through Visual Analogue Scale (VAS) in recovery, 6, 24 h after operation. Consumption of supp Diclofenac was recorded. p<0.05 was considered statistically significant.Findings: Pregabalin 300 mg was significantly more effective in reducing post operative pain up to 24 hours following the surgery (p<0.001). Furthermore, the amount of analgesic consumption was less in the Pregabalin group (p<0.001). Consumption analgesic and VAS were more than the other groups in patient who receive Gabapentin 600 mg.Conclusions: Our finding showed that single dose of pregabalin 300mg oral is more effective than Gabapatin on the management of postoperative pain following abdominal laparoscopic surgery. And Pregabalin resulted in reduction in 24 h postoperative analgesic requirements. Gabapentin 900mg decrease VAS and consumption of analgesic significantly.

Aim and Background: Colonization of bacteria on the equipments in touch with airway and respiratory mucosa may cause respiratory infections. According to available protocols, endotracheal tube connectors should be disposable, but because of financial issues many hospitals use it more than once. In the present study, the colonization rate of endotracheal tube connectors after 24, 48 and 72 hours of administration in multiple patients on mechanical ventilation in the operating room was assessed.Methods and Materials: In this study, 150 endotracheal tube connectors after repeated use in different patients have been sampled and cultured using standard microbiological methods. Samples were categorized in three groups based on the duration of administration (24, 48 or 72 hours). Colony counts were identified and compared among the three groups.Findings: Colonization rate after 24, 48 and 72 hours of usage was 2%, 18% and 30%, respectively (p<0.05). Separated bacteria usually were in kinds of Streptococci, Bacillus SP, Coagulate negative staphylococci, Klebsiella SP and Mold.Conclusions: Using endotracheal tube connector for more than 24 hours significantly increases the colonization rate. In hospitals with limited financial resources, repeated use of endotracheal tube connector up to twenty four hours maybe acceptable.

Aim and Background: Thoracotomy is a particularly painful surgery and good pain control is crucial to maximize the ability to cough and breath. The most common methods of post operative pain management are systemic narcotics and epidural administration of local anesthetic agents or narcotics. The purpose of this study was to compare post thoracotomy analgesia of extra plural and epidural catheters.Methods and Materials: This is a randomized clinical control trial study performed in Alzahra's hospital of medical university of Isfahan.64 patients were randomized in two groups. In group A, 15cc %0.125 bupivacaine before surgery and in group B, 10cc %0.5 bupivacaine at the end of surgery were injected and repeated every hour post operatively. Visual analog scale in two group collected and comparcd.Findings: VAS in epidural catleter was better than extra plural catheter but this difference is not significant (P<0.05). No significant respiratory complication was reported in both groups.Conclusions: Due to results this difference is related to position, drainage of chest tube, volume of local anesthetic and type of surgery in the extra plural groups. Because of no significant difference between them we can use this techniques based on experience and preference of anesthesiologist and surgeon.

Aim and Background: Blood loss is one of the most critical problems in major surgery. Spinal surgery usually associated with considerable blood loss and allogeneic transfusions. Controlled hypotension is one of efficient methods for decreasing operative blood loss. The objective of this study was evaluation of the efficacy of magnesium sulfate in comparison with remifentanil for induction of relative hypotension in posterior fusion of spine surgery.Methods and Materials: In this double blind randomized clinical trial, 40 patients with ASA I & II physical status candidate for lumbar posterior spinal fusion surgery were enrolled and assigned in two groups (remifentanil and magnesium sulfate) randomly. After the induction of anesthesia and giving the prone position, relative controlled hypotension was induced for one group with 0.15 mg/kg remifentanil infusions and in second group with 50 mg/kg loading dose and then 15 mg/kg/hr magnesium sulfate infusion. All other aspects of anesthesia and surgery were similar in two groups. The target MAP range used in this study was 60-70 mmhg. In the course of surgery the hemodynamic variables, volume of blood loss, urine output, fluid intake and surgeon’s satisfaction were recorded. Data was analyzed with SPSS version 13 software and P- value less than 0.05 was considered meaningful.Findings: Twenty patients in Mg group and 19 patients in remifentanil group were studied. There was no statistical difference between two groups according to the hemodynamic variables, volume of blood loss, urine output, fluid intake and surgeon's satisfaction (p>0.05). The target mean arterial pressure was achieved in 75% of Mg and 58% of remifentanil groups. Although, the frequency of TNG consumption was higher (42.1%) in remifentanil group than magnesium sulfate (25%), but this difference wasn't statistically significant (p=0.320).Conclusions: Our finding showed that in patients undergoing lumbar posterior spinal fusion surgery, remifentanil and magnesium sulfate has the same hypotensive effect and the volume of blood loss without any significant side effects.

The case report that will be presented is an inherited methemoglobinemia, during general anesthesia of 36year old patient and was suspected by some clinical examination such as decreased oxygen saturation in pulse oximetry and a normal finding in ABG sample that has been prepared at the preparation of patient for anesthesia. We are going to write about this problem in preoperative period and how to manage it.