JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2008 | Volume:30 | Issue:62|Papers Count:13

Introduction: Methadone is used for the treatment of opioid dependency. Methadone causes QTc prolongation & occasionally torsade de pointes. Because the wide availability of methadone in methadone maintenance treatment (MMT) centers, dose-related effects of methadone on QT interval were evaluated.Methods: The study was clinical trial. Ninety patients who were under Methadone maintenance treatment in the MMT center of Noor Hospital and Ghaedi Clinic were evaluated. According to methadone doses patients divided into three groups (0-59 mg, 60-109 mg, 110-150 mg). Twelve-lead electrocardiograms (ECGs) were performed in patients at both baseline and after the maximum daily doses of methadone therapy. The ECGs were manually interpreted. The QTc intervals were calculated for each patient. In different groups, comparison of mean differences of QTc interval between baseline and follow up were analyzed by ANOVA.Results: There were significant differences between means of QTC interval before and after treatment with methadone in all groups. Methadone modestly increased QTc interval.Conclusion: Although QTc interval prolongation may occur after methadone treatment, the risks for torsade depoint arrhythmia is low.

Background: Spinal anesthesia recently has gained popularity for cesarean delivery. It is a simple and economical method, and a small dose of local anesthetic produces an effective block with complete muscle relaxation and reduces blood loss during surgery.Materials and Methods : To evaluate the effect of Lidocaine 5% and Bupivacaine 0.5% on hemodynamic variables and complications in cesarean surgery with spinal anesthesia, we studied prospectively 80 patients (Age range 21-38) as a randomized, double blind, clinical trail with ASA physical status I that candidate for elective or emergency cesarean delivery. The patients divided to two groups, group I (n=40) received Lidocaine %5 (75 mg), group II (n=40) received Bupivacaine 0.5% (12.5mg) for spinal anesthesia undergoing cesarean surgery. We use chi square and independent t-test for compression between two groups. P-value less than 0.05 consider significance. Results: A total of 80 women were studied with the mean age of Lidocaine and Bupivacaine were 28.5±4 and 27.8±4.6 years, respectively. The groups did not differ in age, weight, height and demographic characteristics (p-value>0.05). Comparison of the mean systolic blood pressure changes before and after spinal anesthesia showed no significant difference between two groups (P-value <0.05).Our result showed that patients remained longer in the post- anesthesia care unit (PACU) after Bupivacain spinal block due to prolonging recovery of motor function (P-value <0.01).Conclusion: We concluded the both method could be used safely in uncomplicated cesarean delivery. Although that spinal block with Bupivacaine compared with Lidocaine may provide better duration of sensory anesthesia for uncomplicated cesarean section but due to disturbance in mother-infant contact and delayed breast feeding not appropriate choice for cesarean delivery.

Background: Postoperative shivering is one of the common problems after general anesthesia and may lead to multiple complications such as latent recovery from anesthesia and heart problems. Different drugs and methods have been used in prevention and treatment of the postoperative shivering. The aim of this study was to examine the effects of pre-anesthesia administration of ondansetron and meperidine on the postoperative shivering incidence in compare to the effect of placebo.Methods: In this randomized placebo-controlled double blind clinical trial, 90 patients who were scheduled for elective gynecologic operations randomly assigned to one of three groups. In first group, 4 mg ondansetron, in second group 0.4 mg/kg meperidine and in third group (control group) 2 cc normal saline were administered immediately before the induction of anesthesia. In all patients anesthesia induced equivalently. Core temperature, dermal temperature, systolic and diastolic blood pressure and heart rate of patients were measured before the induction of anesthesia and during that and in the recovery room. Also incidence of postoperative shivering, nausea and vomiting was monitored and recorded by the nurse who was responsible for the recovery section.Results: Postoperative shivering was observed in 13.3% of patients in ondansetron group and 20% of meperidine group which were significantly less than the incidence of postoperative shivering in control group (50%) (P<0.05). The reduction of core and dermal temperature during the anesthesia and recovery was seen in all three groups of study and did not significantly differ from each other (P>0.05). The changes of systolic and diastolic blood pressure and heart rate did not show any significant difference in three groups (P>0.05).  The incidence of nausea was similar among three groups of study 10 % (three patients in each group), however vomiting was found in 6.7% of meperidine and 3.3 % of control group. None of the patients of ondansetron group had post operative vomiting.Conclusion: Administration of 4 mg ondansetron before the induction of anesthesia have significant effect on the reduction of post operative shivering incidence. As a result of hemodynamic stability and reduction of nausea and vomiting, ondansetron can be used in outpatients operation particularly in patients with cardiovascular problems.

Introduction: The aim of this study was to assess incidence of abnormalities in preoperative screening tests and to determine their necessity in preoperative assessment.Materials and Methods: In this descriptive study, 1220 patients underwent elective surgery at general and vascular surgery wards of Taleghani Hospital between April 2005 and March 2006. The tests included Chest X-ray, white blood cell count (WBC), hemoglobin (Hb), blood urea nitrogen (BUN), creatinine (Cr), sodium (Na), potassium (K), blood sugar (BS) and urinalysis (U/A) were classified as normal or abnormal.Results: Of 10980 tests, abnormal tests were detected in CXR (9.6%), WBC (1.3%), BUN (3.5%), Cr (2.4%), BS (8.4%), Na (0.2%), K (0.3%), and U/A (10.3%). Abnormal level of Hb was totally detected in 11.5% of female and 4.0% of male patients. Abnormalities were increasing with age, so that they were detected in 18% and 7.7% of BS and Hb (men) in over 50 years old, 23.7% and 14.4% of BUN and Cr respectively in over 60 years old, 0.2% and 0.3% of Na and K respectively in over 70 years old, 70.8% and 4.1% of CXR and WBC respectively in over 80 years old. Abnormal level of Hb was detected in all age groups of females. It is estimated that about $57,000 was spent for these 10980 tests.Conclusion: Routine preoperative tests should be justified by a specific symptom, sign, or diagnosis identified during the history or physical examination. According to our result selecting test, instead of routine test, can be justified by using both age and history or observation. This policy can reduce number of unnecessary preoperative paraclinical tests and their expensive cost.

Background: During induction of general anesthesia, a rapid and short-acting opioid is administered to suppress the pain caused by endotracheal intubation. In this study, it has been compared the effects of the four opioids Fentanyl, Alfentanil, Sufentanil and Remifentanil on the changes in arterial blood pressure and heart rate following inducation of GA and endotracheal intubation in 1-6 year old children.Material and Methods: 80 children between 16 years old, who were in ASA classes 1 & 2 and were candidates for elective surgical procedures, entered a double-blind randomized clinical trial (RCT) and randomized between 4 groups. Hemodynamic parameters were measured before induction of GA; then induction and endotracheal intubation performed and agin after 1 minute, hemodynamic parameters were measured and recorded.Results: Changes in the Sys. BP were significantly different (p=0.006) between four groups and Fentanyl had the least and sufentanil had the most changes. Similarly, changes in the Diastolic BP were significantly different (p=0.013) between four groups and fentanyl had the least and sufentanil had the most changes. Changes in the heart Rate were not significantly different (p=0.153) between four groups; although Fentanyl haD THE LEAST AND Alfentanil had the most changes.Conclusion: According to the findings of this study, Fentanyl is associated with the least changes in hemodynamic parameters in children.

Background: Today never less of many attempt’s of medical society and too development of medical technology the rate of patient claims against health’s care team is increased. According to another branch of medicine, as a result of too many operations which may be done, today malpractice claims against anesthetic team increased. The aim of this study is recognition of causes and contributing factors in anesthetic-associated malpractice claims.Material & Methods: This is a cross sectional, retrograde descriptive study .Decision reports related to criminal lawsuits for which expert opinions of this study were evaluated retrospectively for the years 1379-1383 in Esfahan (Isfahan council of medicine and center of legal medicine). Data contained from anesthetic malpractice claims and medical document their hospital.Results: 31 cases of anesthetic-associated malpractice claims is accessed. In this study average age of patients was 40 years old. General anesthesia was applied to 25 of the cases while five received regional (local) anesthesia.27 cases (87%) are undergoing elective surgical operation and the most surgical operation is related to obstetrics and gynecology specialty. Autopsy was performed on 10(46%) cases of the dead (23 cases). Respiratory depression is the most mechanism of damage in16 case (52%). Anesthetic Health workers were found to have different degrees of liability in the 12 (39%) of the 31 decision reports.Discussion: In attention to specific condition of patients in operating room any malpractice or negligence by anesthetic team can cause patients death, such death attract intense attention from the juridical system as well as general public. It is a widely accepted fact that preoperating visit with anesthesiologist, complete laboratory and consultation, attention in chosen the best anesthetic method especially in elective surgery, pay special attention to patient’s respiration function and status during the whole length of operation and in recovery and in ward , and in case of dead emphasizing to performation of autopsy have a great role in decreasing malpractice during anesthetic work also in minimizing damage or death of patients and recognition of guilty person.

Background: Direct laryngoscopy and intubation causes painful stimulation and increase blood pressure and heart rate and myocardial infarction and cerebral hemorrhage heart failure in serious patients.Different pharmacologic and nonpharmacologic methods were be used to control these hemodynamic changes. One kind of praying is praise to god, mohammad (s) and his descendants (a) This study evaluated the influence of this nonpharmacologic treatment on hemodynamic changes.Materials and methods: In this clinical trial study 200 patients ASAI-II randomly divided in two equal 100 groups for their elective surgery. In both groups basic variables such as systolic and diastolic and heart rate were measured and in case group requested for 5 praise to god, mohammad (s) and his descendants (a) just before induction of anesthesia then both groups were anesthetized with same method. At 1,3,6,9 minutes after laryngoscopy and intubation, systolic and diastolic blood pressure and heart rate and Rate-Pressure Product were remeasured.Results: Acceleration in heart rate and blood pressures and Rate-Pressure Product in case group was lesser than control group (p<0.05).Return time to basic volume of measured variables in case group were shorter than control group (p<0.05).Conclusion: Psychological tranquility by praise to god, mohammad (s) and his descendants (a) before induction of anesthesia lead to modification in hemodynamic changes due to direct laryngoscopy and intratracheal intubation.

Background and aim: Sore throat is one of the common difficulties after tracheal extubation, some times it continues for 72 hours and many patients suffer from it, because general Anesthesia by intubation is the most current anesthesia methode in IRAN. Studies have shown Dexamethasone is effective for some of the anesthesia side effects, such as Stridor, nausea and Vomiting. We want to show intravenous dexamethasone is effective in preventation of this kind of sore throat.Materials and methods: this is a clinical trial research. The samples are patients (180), who have been operated under general anesthesia by intubation electively. Selected patients were divided by simple accidental way in two equal groups. Only one group had intravenous dexamethasone injection (0.1 mg/kg) .After two hours both group patients were questioned about sore throat and records in questionnaire.Results: After extubation in injection group only 22.2% (20 from 90) and in non injected group 78.9% (71 from 90) shows sore throat. It indicated high effectiveness of dexamethasone as a preventing agent (p<0.001). Sorethroat In relation to age, range of sore throat under 30 years old is higher than others. It indicated to age and sore throat relation (p<0.001). Patients in two groups (injection–non injection) had the same distribution, then all of the age groups shows decrease of sore throat (p<0.001).

A trichobezoar is a ball of swallowed hair that collects in the stomach and fails to pass through the intestines. Upper gastrointestinal endoscopy is usually useful for diagnosis and retrieval of a portion of the gastric Trichobezoars but have Complications. Upper airway obstruction may occur during removal of bezoar. This complication may be life threatening.We report a 17-year-old girl during diagnostic upper GI endoscopy, a large piece of hairball compressed the upper airway, leading cyanosis, respiratory arrest and cardiovascular collapse. The patient immediately transferred to operation room for emergency esophagoscopy. On the operation room, after hemodynamic stabilization، the otolaryngologist removed the large piece by esophagoscope. Then the patient was transferred to ICU ward with spontaneous ventilation. The day after, she became stable and consciousness.