JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2007 | Volume:28 | Issue:56|Papers Count:12

Backgrounds: Tricyclic antidepressants (TCA) poisoning is the most common cause of drug poisoning in Poisoning Emergency Department of Noor Hospital, Isfahan, Iran. TCAs poisoning can nervous system and cardiovascular toxicity, the latter being responsible for the mortality. The ECG is a simple readily available diagnostic test that can predict the development' of significant toxicity. The objective of this study was to compare APACHE Score with ECG abnormalities in predicting the complications of toxicity in TCAs poisoned patients.Materials and Methods: This study was a descriptive-analytic and prospective cohort. 84 TCAs poisoned patients were evaluated in Poisoning Emergency Department of Noor Hospital Isfahan, Iran.After taking history and physical examination, ECG and other lab tests were performed. The APACHE 11 score was also determined for all patients. SPSS software, using paired student Hest and Chi-square test analyzed the data.Results: There was a significant relationship between ECG abnormality and APACHE 11 score (p-value<0.001). APACHE 11 score mean in-patients with normal and abnormal ECG were 1.76±1.4B, and 5.93±3.15 respectively. There was also a significant relationship between APACHE Score with prognosis (p-value<0.001). The mean of APACHE Score in the patients with poor prognosis (arrhythmia. hypotention, seizure and mortality) was 5.95±0.48 and in patients with good prognosis was 1.73±0.22.Conclusion: APACHE 11 score can be used as a useful method for prediction of severity of toxicity.

Background: Non opioid treatments for pain after therapeutic procedures on patients with burns have become popular because of the side effects associated with narcotics. The aim of this study was to evaluate the analgesic and sedative effects of clonidine, an a2 adrenoceptor agonist in burn patients.Materials and Methods: In this randomized, double-blind, placebo-controlled clinical trial 100 burn patients were divided in two groups. Case group (n=50) received oral clonidine, 3.3mg/kg TDS and controls (n=50) received placebo. Pain severity (VAS), heart rate and systolic blood pressure were recorded after clonidine administration. Statistical analysis was done by means of analysis variance, Chi-square and T-test.Results: 50 patients (mean age 28.96±10 years) in case group, and 50 patients (mean age 27.60±11.4 years) in control group were studied. VAS pain scores and heart rate in the clonidine group were significantly lower than control group (p<0.0001, p<0.02). There was no significant difference in systolic blood pressure between two groups in first and second day but in third day the systolic blood pressure in clonidine group was lower than controls significantly (p=0.002). Conclusion: This study demonstrates that the topical use of oral clonidine affects the hemodynamic response to pain in burn patients.

Background: Inguinal herniorrhaphy is one of the most prevalent surgical procedures which is performed under general, regional or local anesthesia. The postoperative pain is one of the reasons for discharge delaying in these patients. The aim of this study was to determine whether marcaine placed in the incisional area, subcutaneously decreases postoperative pain or opioid requirements.Materials and Methods: In a triple blind randomized study, 67 patients undergoing unilateral inguinal herniorrhaphy were studied. Upon completion of the mesh repair, 1 mg/kg of either 0.25% marcaine (n=32) or normal saline (n=35) was injected into the incisional area, subcutaneously. Each patient's postoperative pethidine requirements using a patient controlled analgesia (PCA) pump during first 24 hours were recorded.Results: A total of 67 patients (32 cases and 35 controls) with the mean age of 42.3±17.2 years were studied. The mean duration of surgery in cases and controls were 48.8±23.8 mins and 44.5±26.6 mins, respectively. The groups did not differ in age, demographic characteristics, or duration of surgery.Mean number of pethidine injections in cases and controls were 2 and 1.71, respectively. Surgery-first injection interval was 3.07±2.24 hrs in cases and 3.1±3.7 hrs in controls which was not significantly different.Conclusion: Incisional injection of marcaine did not decrease postoperative pain and opioid requirement. This issue has been confirmed by some previous studies but not in all. Incisional site (subcutaneous versus subfascial) and age groups may be the reason for this issue. Future studies are needed in order to reveal factors influencing patients' pain.

Background: The patients under mechanical ventilation are involved in immobility and its complications. Patient's position change is an important nursing intervention to prevent complications due to immobility. Although, many studies have reported the effect of body position on pulmonary ventilation and perfusion but yet, there are more questions on the effect of kinetic and static positions on cardiopulmonary indices.Materials and Methods: This is a clinical trial on 16 patients under mechanical ventilation hospitalized in central ICU of Al-Zahra Hospital. Method of sampling was continue convenience and tool of data collection was check list, and was used content validity for validity and pilot study for reliability. Intervention process consist of those patients before of each position first received basal position (supine), then with random order were positioned either kinetic-static (prone) or static (Prone-kinetic). Remain duration in each position was 30 minutes and cardiopulmonary parameters were measured in basal position and 15 minutes intervals then after for two times after each position. Statistical analysis was done with descriptive and inferential statics (ANOVA repeated measurement and T Paired).Results: In both of positions was shown increased SPO2 and decreased static compliance that SPO2 increase after static position and static compliance decrease after administrating kinetic position were statistically but no significant in cardiopulmonary parameters (RR, TV and airway R) in before and after both of positions.Discussion: Whereas no significant clinical cardiovascular change occurred following kinetic or static positioning. It can be concluded that both positioning method; could be used safely in mechanically ventilated patients. Relative benefits of static position in decreased of airway resistance; increase of TV and SPO2 may be considered in mechanically ventilated patients.

Background: Restricted use of opioids is one of the problems in elective cesarean section surgery, because it may cause fetus complications such as central nervous system and respiratory system depression in neonates. Nevertheless, disuse of opioids in cesarean may endanger the mothers. Using new short acting opioids, such problem might not be confronted. This study was performed to evaluate the effect of remifentanil on maternal blood pressure, heart rate and neonatal APGAR score during induction of general anesthesia in elective cesarean section surgery.Materials and Methods: This study is a double blinded randomized clinical trial. 44, 18-35 years old women candidated for elective cesarean section surgery in Motazedi Hospital were put in two equal randomized groups. Remifentanil was infused in dose of 0.5 mg/ Kg/min of a 25 mg/mL solution in case group one minute before thiopental injection untill one minute after intubation. Normal saline was infused in control group at the volume of 0.02 mL/kg. Total infusion time in both groups was 3 minutes. Maternal blood pressure and heart rate were measured before induction (one minute before intubation) and one minute after intubation in both groups. APGAR score was measured 1 minute, 5 minutes and 20 minutes after birth in neonates in both groups.Results: Comparison of the mean systolic blood pressure changes before and after induction of anesthesia showed significant difference between case and control group (case group: 0.59±7.3 mmHg; control group 23.5±8.4 mmHg, p<0.001). Mean mothers heart rate changes before and after induction, also showed significant difference between cases and control (case group: 1.6±5.4 beat/min; control group 19.3±10 beat/min, p<0.05).The first and the fifth minute APGAR score did not show any significant difference between these groups. Conclusion: According to the findings of this study, it seems that remifentanil can prevent maternal hemodynamic changes during cesarean section surgery and does not reduce neonates APGAR score comparing with those whose mothers haven't taken remifentanil.By more research studies and similar findings remifentanil might be allowed to administer for induction of cesarean section surgery.

Background: The reusable laryngeal tube "LT-RD and disposable laryngeal tube "LT-D" are two relatively new devices introduced for maintaining the airway during controlled ventilation under general ansthesia. Materials and Methods: The present investigation compared the performance of the LT-R and LT-D randomized controlled study 100 ASA I, II, III patients, aged 15-65 years undergoing elective minor surgery received either a LT-R (n=50) or LT-D (n=50) for airway management. After induction of general anesthesia, devices were inserted, correct placement was verified, and airway leak pressure was measured. Time of insertion, quality of airway seal, fiberoptic view and post-operative pharyngeal morbidity was examined. Results: First time and second time success rates were comparable for both groups (90 vs 96% and 96 vs 98% in LT-D and LT-R groups, respectively). The airway of two patients in first group could not be maintained with LT-D. Time until delivery of first tidal volume for LT-D and LTR was 28.48±2.1 sec and 23±2.1, fixation and manipulation time was 50±2.2 and 47±2.5 respectively.Conclusion: Patients were questioned for a variety of post-operative pharyngeal morbidities. Significant differences were seen between these groups in the morbidities. Both devices seem to provide a secure airway, work similar in clinical utility, and are easy to insert.

Background: The study undertaken to compare the effectiveness of second dose of thiopental with intravenous lidocaine on the hemodynamic response to laryngoscopy and intubation.Materials and Methods: 120 patients aged between 15 to 65 years were enrolled to this study in four divided groups (n= 30 each group). Patients in each group were given 2mg/kg fentanyl IV, 4mg/kg thiopental for induction of anaesthesia, then 0.5 mg/kg atracurium for muscle relaxation and a second dose of thiopental (1 mg/kg in group 1,2mg/kg in group 11) just before laryngoscopy and intubation, lidocaine 1.5mg/kg (group III) or normal saline 5 ml (group IV) and 2 mins later laryngoscopy and intubation. The heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (OAP), mean arterial pressure (MAP), and rate pressure product (RPP) were measured before induction of anaesthesia (baseline), before laryngoscopy (BL), at 1, 3, 5, and 10 mins after laryngoscopy and intubation (T1, T3, T5, T10 respectively). Results: Our results showed that comparable with lidocaine second dose thiopental attenuated increase in OAP, SAP and MAP, RPP and HRtill 1 min, 3 min, and 5 min and after endotracheal intubation (El) respectively. Changes in hemodynamic variables after El from the baseline values showed that comparable with lidocaine, the second dose thiopental 2 mg/kg significantly decreased SAP, MAP, and RPP changes till3 min after El. Compared with placebo, HR changes were significantly reduced after the second dose thiopental 2 mg/kg till 5 min after El.Conclusions: Second dose thiopental can be used as an alternative to lidocaine in attenuation of cardiovascular response to intubation in patients without ischemic heart disease. 

Background: Administration of a sedative drug for the patients who undergo ophthalmic procedure with regional anesthesia will decrease anxiety and increase cooperation and tolerance of patients. For this purpose drugs with minimal side effects must be used. The goal of this study is to evaluate the effects of the combination of fentanyl-diazepam on sedation of patients in cataract extraction and its comparison with propofol-diazepam.Materials and Methods: In this clinical trial study, 100 patients who were the candidates for cataract extraction were divided in two groups. In one group, fentanyl (1.5mg/kg) with diazepam (0.04mg/kg) was administered. The other group received propofol (40mg/kg/min) and diazepam (0.04mg/kg) Sedation score, BP, PR and SPO2 were recorded during the operation period. Recall score, satisfaction of patients and post operation complications were recorded in the recovery ward. The results were compared between two groups.Results: The mean sedation score, recall score and satisfaction of patients were (3.1±0.6), (2.1±0.5) and (2.1±0.7) respectively in fentanyl-diazepam group. In propofol-diazepam group, results were (2.2±9.5), (2.2±0.4) and (2±0.4) respectively. Sedation score was significantly higher in fentanyl-diazepam group than the other one. No major side effects, e.g apnea, patient's movement and postoperative compilications were observed in the two groups.Conclusion: We conclude that fentanyl-diazepam combination provides reliable degree of sedation and decrease recall with minimal side effects in cataract surgery with regional anesthesia. This combination is better than propofol-diazepam administration.

Malignant hyperthermia is a pharmacokinetic syndrome. It appears with critical hypermetabolic state when the patients exposed to stimulant factors specially depolarizing muscular relaxants and volatile anesthetics. Clinical signs include: abnormal increase of end tidal CO2, muscular rigidity, acidosis, tachycardia, tachypnea, increase of body temperature and rhabdomyolysis. Here you find a case report of malignant hyperthermia under general anesthesia.