JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2002 | Volume:22 | Issue:38|Papers Count:11

Sodium thiopental and propofol are two populary used anesthetic induction agents that have different pharmacological and pharmacokinetic actions. It is not clear how the hemodynamic responses differ in patients using these two drugs for anesthetic induction. The aim of this study was to investigate the hemodynamic responses of patients receiving propofol and thiopental during endotracheal intubation.Sixty male patients, 20 to 50 years old, were included in this study. Patients were randomly divided into two groups according to different inductive anesthetics. Non invasive blood pressure (NIBP) monitoring was performed in five stages, A: Before premedication, B: Before induction with 5 mg/kg thiopental or 2 mg/kg propofol intravenously, C: Immediately after intubation, D: Five minutes after intubation and E: Five minutes after surgical incision.Propofol induction produced smaller mean arterial pressure and heart rate changes immediately after intubation and five minutes after surgical incision than the thiopental group (1.16% and 9.59% decreases in propofol group VS. 22.57% and 9.92% increases in the thiopental group immediately after intubation and five minutes after surgical incision, p<0.0005). Differences in heart rate changes between propofol and thiopental groups were found in patients. (0.42 and 4.81% decreases in propofol group VS. 39.23% and 20.10% increases in thiopental group immediately after intubation and five minutes after surgical incision. P<0.0005).Propofol induction produced more stable hemodynamics after intubation in patients than did thiopental induction therefore, it is suggested to use propofol for induction and intubation in patients.

To determine the attenuation in the incidence of myalgia and fasciculations in atleths when gallamine and lidocaine were used in combination and separately as pretratment before succinylcholine. In this prospective, double blind randomizes study, 100 ASA I patients 21-40 yr. were assigned to one of four groups. Anesthesia was induced with thiopental and fentanyl. Group C (Control Group) received placebo pretreatment before 1.5 mg/kg -1 succinylcholine; Group G 0.3 mg/kg-1 gallamine three minutes before, Group L 1.5 mg/kg-1 lidocaine 15 sec before, and group GL both gallamine and lidocaine. Fascicu-lations and postoperative myalgia at 24hr were recorded. Patients received i.m. diclofenac or p.o. acetaminophen for postoperative analgesia. The incidence of fasciculations (P<0.05) was less in the gallamine (20%) and gallamine - lidocaine (12%) than the lidocaine (80%) and control (100%) groups. Postoperative myalgia was lowest (P<0.05) in the gallamine - lidocaine groups (4%) followed by the gallamine (16%) and lidocaine (36%) groups and highest in the control (72% ).This study showed that gallamine and lidocaine individually reduce postoperative myalgia, with further decrease occuring when used together.This study failed to show a meaningful relationship between body. Weight and incidence Of postoperative myalgia. The comparison of the results of previous studies and our study demonstrated no significant difference regarding the incidence of postoperative myalgia and fasciculations

The aim of our study is comparison of premedication with oral Diazepam and intranasal Midazolam according to the production of sedation in children and evaluation of the efficacy of premedication of these drugs.Our study is a clinical trial study. We had collected samples of four months in E.N.T operating room. The number of patients were 80 who candidated for this clinical study. These patients were divided into two age groups (1-6 years and 6-12 years old). These patients had no co-existing (ASApsI) disease; they had no history of previous surgeries. The time limit of the surgery would not exceed one hour.Two sub-groups were formed randomly based on premedication given.Group M= 0.2mg/kg Mdz intranasal 10 minutes before induction.Group D= 0.2mg/kg Dz oral 60 minutes before induction.Patients were evaluated according to the level of sedation (awake- sleepy - sleep) and amount of cooperation during the induction (excellent - nil)With Midazolam 67/5% children were sleepy and 17/5% were sleep during induction.With Diazepam 55% of the children were sleepy and 10% were asleep during induction.There is a statistical relationship between the two drugs and their sedative effects.There is significant difference in two subgroups M and D as for as sedation is concerned (P<0.05).Amount of sedation with intranasal Midazolam was greater than oral Diazepam as a premedication according to the comparison of two age groups (1-6 years and 6-12 years old) there is no statistical relationship and significant in the amount of sedation in both drugs (P>0.05) Our statistical analysis was Chi - square (X2). We therefor conclude that intranasal Midazolam is preferred as compared to oral Diazepam accordings to its fast effect and greater amount of sedation. Premedication with intranasal Midazolam was safe and efficacious in our two age groups and there is no difference in production of sedation.

One of the greatest problems in emergency departments and operating rooms in resuscitation of traumatic patients with hemorrhagic shock specially children who do not have IV accessibility for substitution of blood and fluid due to collapse of circulation.The purpose of this study is evaluation of the efficacy of intraosseous injection (IOI) of fluids in such situations.In this study 39 victims of war without accessibility to veins in the range of 8 months to 5 year old were resuscitated with intraosseous injection of blood and fluids through their femur, tibia and iliac bones by spinal needles No 16 to 20 gauges.The fluids injected were crystaloid, blood and some drugs such as atropin, adrenaline and calcium gluconate.30 of patients were resuscitated successfully during 1-3 hours and had hemodynamic stability to access a suitable IV line and performing surgical procedures.In four patients resuscitation was not success full and were expired in a few hours after admission to the hospital. 5 patients were died in intensive care unit in 2-7 days after operation because of severe cerebral and pulmonary contusion.Intraosseous injection of fluids and blood is a safe and effective method for resuscitation of hemorrhagic children under 5-6 year old in whom there is no accessibility to vessels due to collapse of circulation.

Previous studies had demonstrated that transient neurologic symptoms (TNS) after spinal lidocaine is a manifestation of local anesthetic neurotoxicity.The purpose of this study was determining the effect of lower doses of intrathecal lidocaine compared with conventional dose Lidocaine on the incidence of TNS.110 patients in ASA class I-II presenting for caesarean section were randomly assigned to receive spinal anesthesia with either hyperbaric Lidocaine 50mg+25ug fentanyl or hyperbaric Lidocaine 75mg.Patients were evaluated for hemodynamic status, peak block level, regression, and transient neuroloic symptoms.Both groups had a median peak block level of T4.The control group had a greater need for ephedrine (p<0.05).Ketamin requirment was similar in both groups (P=NS). Block regression was faster in case group (P<0.05). TNS incidence was 29.1% in control group and 5.4% in case group (P<0.05). PSH incidence was similar in both groups (P=NS).Spinal anesthesia with 50mg Lidocaine and 25,ug fentanyl provides adequate anesthesia with more hemodynamic stability, faster recovery and lesser incidence of TNS syndrome than spinal anesthesia with 75mg Lidocaine.

Postspinal headache is one of the most complications of spinal anesthesia. The role of fine needles in reducing headache is obvious, but use of fine needles is difficult in clinical practice. The gole of this study was to compare the benefits and complications of the use of smaller needles versus the bigger ones.90 women undergoing caesarean section were randomly received spinal anesthesia using either a 23G or 27G Quincke needle. Imoprtant factors in this study include incidence of postspinal headache, failure rate, time taken for spinal anesthesia and the level of block.With 27G needle incidence of headache is significantly lower than 23G needle (P<0.05). But the failure rate with 23G needle is lower than 27G needle (P<0.05). The time for spinal anesthesia and the level of block had no significant differences in two groups.As the use of 27G needle has better outcome in reducing the incidence of headache it is logic that in high risk patients who show headache (caesarean section patients) to use smaller needles for spinal anesthesia. But the use of smaller needles is accompanied with technical difficulties and high failure. To dissolve this problem we can use bigger needles after failure.

One of the commonest complications following surgery and anesthesia is nausea and vomiting. This complication prolongs the patient's stay in the recovery room and the hospital and leads to electrolyte disturbances, dehydration and hemorrhage from the sutures. Thus necessitating a therapeutic and non therapeutic intervention to curtail nausea and vomiting following surgery. In this study, the effect of acupressure on nausea and vomiting in patients undergoing cesarean section under general anesthesia and was studied as against those not receiving acupressure. In comparison with the group in whom acuband was utilized as against those in whom it was not used, despite a significant decrease of nausea and vomiting in the recovery room, the statistical difference was not significant following surgery. In the ward, however this difference was statistically significant with an apparent decrease of nausea and vomiting. Also, in this study the effect of BMI and past history of nausea and vomiting in both groups were evaluated. In the witness group, those having a past history of l1ausea and vomiting and an increased BMI had a higher incidence of nausea and vomiting. On the other hand, in the acupressure group, these two did not have a significant effect on nausea and vomiting.

In order to determine prevalence of spinal anesthesia complications and their treatments, 150 patients who received spinal anesthesia in Dr. Shariati Hospital of Tehran, are reviewed.Prospective data analysis of 150 consecutive patients who were interviewed and examined within 3 days after spinal anesthesia complications in references by T-test exam.9 patients had post dural puncture headache (6%), 6 patients had hypo or hyperesthesia of lower extrimity (4%), 1 patient had urinary retention (patiens who had fuley catheter were excluded), no one had auditory disorders and defections problems.There was no significants difference between our study and references except PDPH was more (6% versus 3%) that can be due to multiple puncture and inadequate post surgical fluid therapy, because most of the patients were treated after adequate fluid therapy.