JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2000 | Volume:5 | Issue:Supplement 1|Papers Count:17

Background. Postoperative cough in general anesthesia is a common and also dangerous problem that can result in complications such as hypertension, tachycardia, cardiac arrhythmias, myocardial ischemia, bronchospasm, increased intracranial and intraocular pressure. This is important in operations such as cataract surgery in which increasing intraocular pressure can produce many complications. In this survey we used intravenous or topical lidocaine by different routs and evaluated the prevalence of postoperative cough and sorethroat.Methods. In a clinical trial study, 204 ASA 1 and 2 patients prepared for cataract surgery under general anesthesia, were selected by convenience sampling and then randomized into six groups according to lidocaine usage route. All patients received intravenous fluid and were induced general anesthesia in a similar manner. Before intubation, in the first group lidocaine spray was used on the terminal end of tracheal tube; lidocaine spray was used on laryngopharyngeal stractures in 2nd group; terminal end of tracheal tube was lubricated with lidocaine gel; intravenous lidocaine at the end of operation was used in 4th group; intracuff lidocaine was used in 5th group and normal saline was used on the terminal end of tracheal tube in 6th group. At the end of surgery and after extubation, patients were evaluated about postoperative cough in the PACU. One hour and the day after surgery patients were cvaluated about sorethroat. The results are written as Mean±SD and Chi-square, ANOV A and multiple comparison tests used. P<0.05 is considered significant. Findings. Mean age of patients was 63.7±11.9 of whom 51.8 percent were male and 42.2 percent weer fcmale. There was no significant difference between six groups condidering age, sex, smoking, duration of surgery, preoperative systolic and diastolic pressure and heart rate. In the PACU, 64.7 percent of patients suffered from cough that its incidence was more in 3rd, 6th and groups consequently and less in 4th and 5th groups documented by statistical analysis. The incidence of postoperative sorethroat was 52.5 percent after one hour and 17.2 percent one day later, which was greater in 3rd, 2nd and 6th groups consequently. Conclusion. Reducing postoperative cough results in less complications and according to this study, using intracuff lidocaine or intravenous lidocaine at the end of operation will result in better outcome for patients and also better results for anesthesiologist and surgon.

Background. Special management and intropic drugs are required for homodynamic stability due to weaning of cardiopulmonary bypass (CPB). The inotropic drugs in this manner are very controversial. However, there is a little study about the choice inotropic. The porpuse of this study is evaluation of epinephrine and dopamine effect on the mean arterial pressure (MAP) during pump weaning.Methods. This clinical trial study was done on the 124 patients which were divided into two groups E (Epinephrine) and D (Dopamine) randomly. Epinephrine infusion (0.05 mg/kg/min) was started in group E (n=56) due to unclamping of the aorta (zero time) and dopamine (8 mg/kg/min) in group D (n=68) samely. MAP was recorded in 0, 10, 20, 30, 60, 120 and 360 minutes. The partial time (the duration time between unclamping and complete weaning of the pump) was the determined in two groups.Findings. The mean percentage rising of MAP was 69.9 and 27.3 in group E and D respectively (P<0.01). Partial time was 49 and 46 minutes in group E and D respectively (P>0.05).Conclusion. Epinephrine increase MAP more than dopamine and prevents of hypotension during pump weaning. Nevertheless, epinephrine could not reduce partial time because many other factors except stabilizing of MAP have important role in the weaning.

Background. Preanesthetic medication may reduce the risks of adverse psychological and physiological sequel of induction in children. Administration of premedication by sublingual route may provide the best compromise because of relatively rapid absorption without causing pain. In this study sedative and anxitolytic effects of sublingual midazolam and buprenorphine in children were compared.Methods. In a randomized, controlled, double blind clinical trial, one hundred and fifty children aged between 4 to 10 years in first or second class of ASA scheduled for adenotonsillectomy were divided in three equal groups. These groups recieved sublingual bupronorphine 3 µg/kg, midazolam 0.2 mg/kg and no premedication respectively. Cardiorespiratory variables were recorded from the time of premedication to awakening from anesthesia. Anxiety and sedation scores and patients acceptance of mask at induction were recorded using four point rating scales. Time of spontaneous eye opening and postoperative emesis occurrence were also recorded.Findings. Children recieving sublingual midazolam or buprenorphine had similar sedation, anxiety and mask acceptance scores, but different from no premedication group (P<0.0001). None of the children experienced respiratory depression or oxygen desaturation after drug administration and during postoperative period. Time of spontaneous eye opening was longer in the midazolam group (P<0.0001).Emetic episodes were similar in all groups. Conclusion. Midazolam is extensively studied and demonstrated that the drug is highly effective in alleviating anxiety and increasing cooperation. We concluded that sublingual buprenorphine is as effective as sublingual midazolam in providing sedation and anxitolysis for pediatric premedication.

Background. In this study, we evaluated the effects of oral clonidine & diazepam on IOP & homodynamic stability after General Anesthesia (GA) with scholine & intubation in ECCE & intraocular lens implantation. Methods. In this study 109 patients with ASA 1 to 3 were randomly allocated to two groups. Oral clonidine (3 µg/kg) and oral diazepam (0.15 mg/kg) were administered to interventional (54 subjects) and control (55 subjects) groups respectively as premeditation. All of patients under GA has given scholine (1.5 mg/kg), sodium thiopentone (5 mg/kg) and fentanyl (2 µg/kg). Heart rate, systolic and diastolic blood pressure and MAP were recorded before and 2hr after premeditation, immediately after intubation and 5th and 10th minute after scholine. IOP before  and 2hr after premeditation & 5th and 10th minute      after scholine with schiotz tonometer were measured. Findings. In two groups, mean of IOP in 5th & 10th minute after scholine as compared to before scholine demonstrated significant decrease, so reduction was more significant in experimental group. In two groups, mean of MAP, SBP and DBP after intubation as compared to before intubation and gradually decrease. In 5th & 10th minutes after scholine, MAP and SBP has more stability in experimental group. HR has more significant stability in experimental group. Conclusion. Clonidine is an imidazoline derivative and central alpha2 receptor stimulator absorbed almost completely after oral administration. Clonidine has antihypertensive, sedative and analgesic effect. It reduces IOP. Diazepam is a benzodiazepine that reduce BP, IOP and has sedative effect. Our results suggest that oral clonidine as compared to oral diazepam as premeditation is more appropriate for reduction of IOP and homodynamic stability for patients undergoing cataract surgery under GA.

Background. Preoperative evaluation and psychological preparation is important before anesthesia. Children are very dependent to their parents, specially before 5 years. Anesthesiologist must administer anxiolytic and sedative drugs before separation from parents as premeditation. The aim of this study is comparison survey on effect of oral midazolam and intranasal midazolam in children 1 to 5 years as premeditation.Methods. In a clinical trial study performed through first half of 1377 at St. Alzahra Center (Isfahan University of Medicine), sixty healthy children in first class of ASA who had non gastrointestinal elective surgery were studied. Group one consisted of thirty children who received intravenous form midazolam (0.5 mg/kg) with fruit juice orally 45 to 60 minutes before operation. Group 2 consisted of thirty children who received midazolam (IV form) 0.2 mg/kg intranasally 15 minutes before operation.Findings. Anxiety was less in first group during administration of drug. Forty four percent were quiet in this group (P<0.005). Seventy six percent of children who well accepted the drug, were in the first group (P<0.005). There was no significant statistical difference between two groups in other aspects of study. Conclusion. Oral administration of midazolam has better acceptance in children than intranasal with less anxiety.

Background. Administration of alfentanil followed by propofol intravenously (IV) without neuromuscular blockage for induction of anesthesia provides adaquate conditions for tracheal intubation. Other hypnotic drugs have not been thoroughly investigated in this regard. The aim of the present study was comparison of intubation conditions and hemodynamic responses of anesthesia induction with alfentanil/midazolam, alfentanil/Na thiopental and alfentanil/ ketamine. Methods. In a clinical trial study one hundred and twenty children were randomly allocated to  four groups. Medication in these groups were alfentanil 40 µg/kg+ midazolam 200 µg/kg,alfentanil 40 µg/kg+Na thiopental 6 µg/kg, alfentanil 40 µg/kg+ketamin 2 mg/kg & Na thipental 6 mg/kg+suxamethonium 2 mg/kg (as control group). In all patients the ease of ventilation via face mask, jaw mobility, degree of exposure and position of vocal cords, patient's response to tracheal intubation, duration of time was needed for intubation and hemodynamic  changes after intubation were assessed and recorded.Findings. There are significant differences between first three groups (interventional groups) for jaw mebility, ventilation, vocal cord visuality, vocal cord position, patient movement during laryngoscopy and mean laryngoscopy time, (P < 0.05). There is significant difference between all groups of nesdonal+alfentanil except for patient movement. There is significant difference between mean SBP and PR before and after intubation in first and third group.Conclusion. Results represent that the group of Alfentanil plus Nesdonal had a better quality of ventilation rather than two other groups. It is recommended that administration of alfentanil plus thiopental combination is preferred in cases that using muscle relaxant is contraindicated.

Background. Nowadays, important aim of surgical and anesthetic teams is removing of postoperative pain. One way for decreasing of postoperative pain is usage of interathecal injection of neostigmine. Neostigmine is an anticholinesterase drug to reverse the muscle relaxant effects. The main purpose of this study was evaluation the postoperative pain analgesic efficacy and safety of intrathecal neostigmine in patient undergoing below knee surgery with spinal anesthesia. Methods. In a clinical trial study sixty adult patients in ASA physical Status I or II were randomly divided into two groups. Group one received normal 1 ml normal saline plus 3ml marcaine and another one received 1ml neostigmine (50µg) plus 3ml normal saline intrathecaly. The severity of postoperative pain was measured using a 10 cm visual analogue scale (0 mean no pain, 10 excruciating pain). If visual analogue scale was> 3, the patient requested analgesia.Findings. The mean time to the first analgesic administration was significantly prolonged by intrathecal neostigmine (10 h) compared to normal saline (4.5 h) (P< 0.001). Hypertension is seen in 2 patients in the neostigmine group but isn't seen in the normal saline (SO). also hypotension is seen only in one patient in the neostigmine group and 4 patients in the normal saline (SO). Four patients in the neostigmine group, one patient in the normal saline (SO) had nausea. In the neostigmine group there isn't any vomiting, sweating, agitation or pruritis.

Background. Although epidural anesthesia is a Successful method for most surgical procedures on lower extremities and lower abdomen. It is not so favorable because of it's slow onset and differential sensory and motor block. In order to solve this problem effects of additive KCl (5 meq/L) into Bupivacaine 0.5 percent according to onset, intensity, duration of block and homodynamic changes during epidural anesthesia will be investigated through the present study. Methods. All the ASA I or II patients at medical centers of Isfahan university of medical sciences throughout 1378, candidate for elective Surgical procedures on lower extremities and lower abdomen with no contraindication for epidural anesthesia were Subdivided into Case (35 patients) and Control (35 patients) groups in a random manner to perform a double blind clinical trial. Epidural anesthesia applied to cases (by Bupivacaine 0.5 percent+ KCl 5meq/L) and controls (by Bupivacaine 0.5 percent). Under identical conditions, data indicating basic MAP, basic heart rate and their changes as well as the onset, duration and intensity of motor and sensory block, were obtained and recorded by the anesthesiologist. Quantitative & qualitative variables were examined by T.test and X2 test respectively.Findings. Sensory onset for cases (8.22±1.43Min) was faster than controls (11.56±1.45Min) (P<0.005). Motor onset for cases (12.77±1.83Min) was faster than controls (20.24±1.71Min) (P<0.005). Sensory duration for cases (l86.34±8.37 Min) was longer than controls (162.17±7.47Min) (P<0.005). Motor duration for cases (106.25±13.50 Min) was longer than controls (77.60±9.94Min) (P<0.005).Intensity of sensory block for cases was greater than controls (P<0.01). Intensity of motor block for cases was greater than controls (P<0.001). Mean heart rate changes for cases (7.28±9.37 percent) and controls (7±8 percent) were not different (P<0.8). Mean decrease in MAP for cases (20.17±2.10n percent) was greater than controls (18.08±2.105 percent) (P<0.01). Conclusion. According to the results, it is understood that addition of KCl (5 meq/L) into bupivacaine 0.5 percent not only can improve the onset, intensity and duration of epidural  anesthesia which modifies this technique to a more practical and fovorable one, but also avoids administration of high concentrations (≥120 meq/L) of potassium and it's subsequent side effects which terminated further investigation as described by literature with no additional side effects.

Background. Postoperative sore throat is a common complication seen after general anesthesia; different methods have been proposed for its prevention and treatment. One of these methods is mouth washing with normal saline. Methods. This research was designed and executed to assess the above washing method. In a clinical trial study, two "one hundred cases" groups were selected. In one of them, mouth washing with normal saline was performed. A checklist was designed for data collection; which was filled out twice to reduce recall bias as much as possible; the second time, the checklist was filled out 24 hours after extubation. Findings. The cases undergone mouth washing had less sore throat (P<0.001). The two groups did not have statistical differences regarding demographic characteristics.Conclusion. The results suggest that washing of pharynx before extubation can decrease severity of post operative sore throat.

Background. Oxygen transport to tissue after an acute ischemia is strongly important.  Fluorocarbon liquids are able to facilitated the oxygen transport. An animal experiment was designed to study the effect of FC-34 in acute brain ischemia.Methods. The left common carotid arteries were ligated in three groups of anesthetized animals for 30 minutes to obtain acute brain edema. The animals were subjected to received 15 ml/kg saline (group 1), 10% monitol (group 2) or FC-43 (group 3). All animals were recovered, and they monitored for two weeks. The electrolytes, BUN, and creatinine were measured before (all animals) and after two weeks (survived animals). Pathological investigation was obtained by light and electron microscope via pathological process. Findings. The group 1 animals were died during first five days, but one and four animals were survived by two weeks in groups 2 & 3 respectively (P<0.05). The pathological determinations indicate less cellular damages in group 3. No significant differences were detected in potassium, calcium, BUN, and creatinine before and after the experiment.Conclusion. The particle size and oxygen solubility in FC-43 is the major factors for better oxygen transport in ischemic tissues.

Background. Laryngoscopy and endotracheal intabation my produce adverse homodynamic effects such as hypertension and tachycardia. Magnesium has direct vasodilating properties on coronary arteries and inhibits catecholamine release, that attenuating the homodynamic effects during endotracheal intubations.Methods. This randomized, double blind study compared the effects of magnesium sulphate with lidocaine for attenuating of pressor response to tracheal intubations in 120 patients undergoing general anesthesia for cataract surgery. We have studied the effect of pretreatment with magnesium sulphate 0.1 mg/kg (50 percent) or 1.5 mg/kg lodocaine on this pressor response.Findings. There were no significant differences between two groups with respect preinduction of heart rate, mean arterial pressure, sex and age (P>0.05). A combined analysis showed that the 0.1ml/kg magnesium sulphate were significantly (P<0.05) better than 1.5mg/kg lidocaine in attenuating pressur response to tracheal intubation. Conclusion. Intravenous magnesium sulphate is safe and effective at preventing postoperative tachycardia and hypertension and it is better than lidocaine.