JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2016 | Volume:38 | Issue:2 (94) |Papers Count:11

Background: 0T In about 50% of cases, 0T Children undergoing surgery receive premedication and midazolam is the most frequently used drug. Although midazolam is used for its preoperative anxiolytic effect in pediatrics; it is far from an ideal premed ication, especially due to its effect on cognition including amnesia, confusion and emergence agitation. Clonidine lacks the majority of the side effects associated with midazolam and is associated with a number of beneficial perioperative effects.0T 0T Objective: To compare perioperative anxiolytic and analgesic effects of clonidine and midazolam in pediatric patients.Aterials and methods: Total 50 pediatric patients’ candidate for elective surgery between 1-12 year ages were enrolled in the study and randomly assigned to one of two groups of study. Group M received 0.5 mg/kg Midazolam plus 0.02 mg/kg Atropine, and in group C, 0.004 mg/kg Clonidine p lus 0.02 mg/kg Atropine was administered 1 hour prior to surgery. The Preoperative anxiety and postoperative pain and agitation were compared between two groups of study.Results: Age and sex was not significantly different between two groups of study. There were no significant differences between two groups of study in drug acceptance (p=0.447), separation anxiety (0.54), mask ventilation acceptance (p=0.051), sedation level at the time of induction of anesthesia (p=0.77). However emergence agitation (p=0.007) and postoperative pain score (p=0.001) was significantly lower in clonidine group compare to midazolam group.Conclusion: Premedication with clonidine improves perioperative management of pediatric patients in compare to Midazolam in both inpatient and outpatient settings.

Introduction: Direct laryngoscopy and biopsy are important procedures in otorhynolaryngology .There would be severe consequences due to the extensive manipulations during these procedures.Ideal condition for this type of surgery requires adequate depth of anesthesia to prevent hemodynamic changes and short-term recovery. The effects of inhaled and intravenous anesthesia (TIVA) on the hemodynamic changes and recovery time, is investigated in this study.Materials and Methods: sixty four patients entered the study and divided into two groups of inhaled and intravenous (TIVA) anesthesia, thirty two patients each. Heart rate and blood pressure were recorded before induction and in defined intervals in both groups. At the end of surgery, recovery time recorded in both groups.Results: Average heart rate in 1st, 3rd, 5th, 10th, 15th, 20th and 30th minute post induction was 77.87, 74.38, 72.23, 68.83, 68.92, 69.03 and 69.55 beats/min in TIVA group respectively and 94.73, 93.26, 91.56, 86.97, 87.83, 87.12 and 87.75 beats/min in inhaled anesthesia group respectively, which was statistically meaningful. Average Systolic BP in 1st, 3rd, 5th, 10th, 15th, 20th and 30th minute post induction was 118.83, 113.17, 108.33, 105.50, 102, 97 and 101.33 mmHg in TIVA group respectively and 127.50, 133.83, 131, 135.12, 127.83, 123.83 and 120.83 in inhaled anesthesia group respectively, which was statistically meaningful. Average recovery time to respond to verbal stimulation was 12.13 minute and 22.43 minute in TIVA and inhalation group respectively which was statistically meaningfu l.Conclusion: Intravenous anesthesia is a wise choice for d irect laryngoscopy and biopsy surgery, since exerts better control on hemodynamics and causes a short-term recovery.

Introduction: Considering the decreased duration and quality of neuro-axial block in opioids addicted patients, adjuvant medications could improve the anesthetic and analgesic properties of local anesthetics.Materials and methods: fifty six opioids addicted patients candidate for lower extremities surgery were randomly assigned into two groups of Dexmedetomine (5 mcg) and Midazolam (2mg) added to intratechal Bupivacaine. Sensory block, motor block, pain and sedation were evaluated using pin prick test, modified bromage scale, visual analog scale (VAS) and ramsey score respectively. Morphine consumption in 12 hour and 24 hour post operative period were recorded as well.Results: duration of sensory block was 175 ± 18.9 minute and 147 ± 16.3 minute in Dexmedetomidine and Midazolam groups respectively which was statistically meaningful (p 0.001). Pain in 6 and 12 hour post operative period was meaningfully higher in Midazolam group (p 0.003 and p 0.02 respectively) but not in 24 hour period (p 0.18). Morphine consumption in 24 hour post operative period was much lower in Dexmedetomidine group which was statistically meaningful (p 0.029).Conclusion: Dexmedetomidine, as an adjuvant medication for spinal anesthesia in opioids addicted patients, can lengthen the sensory block more than Midazolam; moreover, it has less adverse effects and augments sedation and analgesia.

Background: Central venous catheter insertion in the most of critically ill patients is needed.Central venous catheter insertion complications including infectious and mechanical complications. Which can be divided into two categories, early or delayed. Several studies have been done in this regard. In this study we compare two approach (supra & infraclavicular) of subclavian catheter insertion in patients admitted to the General intensive care unit of Urmia emam hospital.Materials and methods: After approval of the Ethics Committee of the Urmia university of medical sciences this study conducted in the General intensive care unit of Urmia emam Hospital in second half of 1394, And 260 patients randomly into two groups of 130 patients were enrolled.Demographiccharacteristics (age, gender), the success, the number of attempts for central venous catheter insertion, central venous catheters complications included pneumothorax, cutaneous infection, hematoma, thrombosis, catheter infection in special forms made by researchers arrived and after completion of the study the data were analyzed. Statistical tests and SPSS statistical software version 20 used for this purpose.Results: The mean age of patients was 16.72 ± 65.23 totally. 56.53% of patients were male and the rest were female. The mean age and sex distribution of patients in both groups there was no significant difference (P>0.05). The mean frequency of pneumothorax and trying to CVC placement between two groups was statistically significant (P<0.05), but no difference between the other variables between two groups was not statistically significant. (P>0.05) Conclusion: The number of attempts and pneumothorax during infra clavicular approach of subclavian catheter insertion was lower than that of infra clavicular method. There was no statistically significant difference between other complications.

Introduction: This study was performed with the aim of comparing the dosage of opioid consumption for induction and maintenance of anesthesia in people with and without sleep disorder.Materials and methods: In this cohort study for patients who candidate for cataract surgery, Pittsburgh sleep quality questionnaire was completed and based on the results, patients were divided into 2 groups of normal, and sleep disorder. The same protocol was used for induction and maintenance of anesthesia in all patients. Total dose of fentanyl consumption was calculated and recorded.Results: 70 patients with the mean age of 63.8 ± 10.7 years were entered (67.1% female).Demographic and baseline characteristics of the patients were not significantly different between normal and sleep disorder groups. Fentanyl consumption for induction and maintenance of anesthesia were lower in the sleep disorder group compared to the normal g roup, but the difference was not statistically significant (p<0.070).Conclusion: Based on the findings of this study, it seems that although patients with sleep disorders need a lower dose of opioids for induction and maintenance of anesthesia during surgery, compared to those who are normal in this regard, the difference is not statistically significant.

Introduction: Endoscopic sinus surgery is the most common actions in the field of ear, nose and throat that such acts always accompanied with b leeding that can cause hemodynamic disorders and direct effect on the outcome of the surgeon.The use of anesthesia drugs can help to control hemodynamic, isoflurane can help keep blood pressure in the ideal range. The aim of this study was to evaluate the hemodynamic with different percentages of isoflurane in endoscopic sinus surgery was done.Methods and reviews: In a clinical trial, 90 patients were randomized to 3 groups of 30 people, ASA class I and II were selected.  The induction was the same in both groups, the first group following the induction of isoflurane  with 1 percent and 1.2 percent in Group 2 and Group 3 1.5 Badrsd was used.  Fixed-dose group and remifentanil g / kg / min m0.1 were used during surgery.Results: The demographic characteristics and the duration of operation were not significant in the three groups (P>0.05). mean arterial pressure in 15, 30, 45, 60 min after start of surgery reduced significantly between group 1& 3, group 2& 3 and also heart rate in 30, 45 min after start of surgery had significantly reduction change between group 1& 2.Conclusion: I soflurane 1.5 percent compared to 1.2 percent and 1 percent significant the arterial blood pressure and heart rate are generally affected at different times. The average heart rate in Group 2 with 1.2 percent lower than other groups.

Introduction: The aim of this study is to compare the Reliability and validity of ULBT Method with Cormac and Malampati, for Anticipation on Recognition of Difficult Intubation for Patients Calling on Farabi Hospital During the 1392-1393 Period. In some patients with serious difficulties, difficult intubation is more probable and there is no need for further tests. The main problem is to diagnose the probability of difficult intubation in patients with no apparent signs. At the moment the gold standard method for recognition of difficult intubation is Cormac-Leihan, which is invasive and need to be in operatingroom, therefore finding a simpler way is remedial. In this study it was decided to compare ULBT as a simple, low cost and no side effects method with more common ones for predicting this phenomena like Cormac and Malampathy and LLBT.Materials and methods: 95 patients whom needed general anesthesia in farabi hospital in 1393 were taken for this study. These patients visited by an anesthesiologist before surgery and all demographic informations, ULBT, LLBT, Malampathy measures were recorded. But the Cormac measurments were performed by another anesthesiologist.Results: Sensitivity, specificity, positive and negative predictive values, and accuracy were 75.8%, 91.7%, 35.3%, 95, 2% and 89.8%, respectively, for the ULBT, and 79.3%, 63.7%, 19.2%, 95.8% and 61.2% respectively, for TMD. Specificity and positive predictive value and accuracy were found to be significantly higher for the ULBT than for mallampati (p<0.05).Conclusion: We conclude that the specificity, positive predictive value and accuracy of the ULBT is significantly higher than the mallampati test then is reliable for screening of difficult intubation. it is signify that a positive ULBT is more predictive of a difficult airway than mallampati test.

Introduction: Coronary artery bypass graft (CABG) surgery is the most common surgical procedure for patients suffering from coronary artery diseases. Many studies demonstrated CABG as a serious crisis for patients resulting in excessive stress and anxiety. the purpose of this study was to determine stressors and adjustment strategies from viewpoint of patients undergoing open heart surgery.Material and Methods: This descriptive study was performed at the Shafa hospital of Kerman -Iran on 163 Patients undergoing coronary artery bypass surgery. The data were collected using demographic questionnaire, Revised Cardiac Surgery Stressors Scale (RCSSS and adjustment strategies questionnaire.Results: The findings showed that intrapersonal stressors are perceived more than interpersonal and extra personal stressors by patients. The most important adjustment strategy was ensuring the nurse about continuous nursing care and giving analgesic after surgery.Discussion: In this study the intrapersonal stressors were perceived more than interpersonal and extra personal stressors by patients, so real identification of patients’needs and anxieties is very important in clinical nurses’ care planning.

Peripheral vascular surgery due to prolonged duration of surgery and itP , Ps association with blood loss is a challenging setting in anesthetic practice. Furthermore because of high incidence of comorbidities, diabetes mellitus (DM), hypertension (HTN) older age, Chronic Kidney Disease (CKD), card iac arrhythmia and long term or recent anticoagulation Therapy, These Patient P , Ps are as a high risk group. Selection of the most appropriate anesthetic method with, the less hemodynamic disturbance, is of major importance, in increasing patient survival, reducing hospitalization.In addition of this patient, Two other patients having all risk factor mentioned above, undergone vascular embolectomy and discharged the next day.