JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2003 | Volume:22 | Issue:40|Papers Count:12

Postoperative nausea and vomiting (PONV) are distressing and common Occurrences after operative procedure requiring general anesthesia. The purpose of this study was determine the effect of a preoperative 15cc/kg fluid bolus of ringer solution on a patient’s postoperative nausea and vomiting. This study compared the incidence of nausea and vomiting between an experimental group [(who received 15cc/kg fluid bolus of ringer pre-operatively and 4cc/kg/hr Ringer solution to replace third space loss (Minimal surgical trauma)], and a control group who were given the standard fluid requirements (1cc/kg/hr ringer solution to replace insensible fluid losses and 4cc/kg ringer solution to replace third space loss.We performed a Clinical trial study.Subjects consisted of 400 patients (outpatient) with P-S 1 & 2 that were admitted to Farabi Eye Hospital for strabismus surgery in 1380, were randomly assigned to two equal groups.The average age in the experimental and the control groups was 33. The weight of the control group was significantly higher (72kg vs 62kg in the experimental group).15% of the control group had nausea and 3.5% experienced vomiting. The experimental group and 6% nausea rates and no vomiting. In both groups, we did not use any drug(s) to control nausea and vomiting in the postoperative period. We kept them under close observation and we had no readmission.Our finding suggest that administering preoperative fluid bolus of ringer solution decreases the incidence of nausea and vomiting in this population.

Many methods have been used to assess quality of recovery after anesthesia. Most of them are narrowly focused, are not patient-rated, and have not been validated. But "Quality of Recovery Score" (QoRS) is a valid test that was intruduced by Paul S. Myles and et al in 1999.We have used QoRS on 89 patients who undergone general anesthesia and surgery. There is a good convergent validity between QoRS and Post Anesthetic Discharge Criteria (PADC) (p=0.52, p<0.01). The mean of QoRS for major surgery is different from its mean for minor (p<0.006) and intermediated (p<0.0025) surgeries. This differences are significant. In addition, there is a negative correlation between QoRS and duration of recovery room stay (p=0.47), as well as duration of hospital stay (p=-0.32).It seems, therefore, that the QoRS is a valid, reliable, and clinicaly acceptable test for adult patients undergoing different types of surgery, and that this score is a useful measure for the quality of recovery after general anesthesia and surgery.

During cardiac surgery and cardiopulmonary bypass (CPB) significant shift of body water and electrolytes occurs. Considering these changes has important role in appropriate management of these patients and prevention of homodynamic, respiratory, renal complications and coagulopathy. Body water distribution can be evaluated by repeated measurements of body weight and fluid balance. In this study fluid balance status and pattern of its changes in postoperative period were evaluated.Sixty patients underwent coronary artery bypass graft surgery (CABG) (n=42) and valve replacement surgery (n=18) with CPB. Anesthesia technique and priming method of CPB in all patients were the same.The patients had positive fluid balance at first (310± 108 ml) and second (5 ±117 ml) postoperative days, but fluid balance in the second day was significantly lower than the first day (p=0.001). Fluid balance at first and second postoperative days and total postoperative fluid balance and weight gain were not different between CABG and valve surgery patients (p>0.05). Patients have significantly more weight gain (2.43± 0.39 kg) than fluid balance (total) (179 ±172 ml) during discharging from ICU.Despite of the common method of fluid and salt restriction in postoperative period, there is a positive fluid balance at first postoperative day. This positive balance is minimal in the second day. Despite of small positive fluid balance (total) in postoperative period, patients have considerable weight gain during discharge from ICU, which means persistence of intraoperative fluid overload in patients.

Postoperative cognitive dysfunction is a significant problem in elderly patients. Among proposed causes is used of tranquilizers including benzodiazepines. Related studies have different and occasionally opposite results.We decided to evaluate and compare the postoperative cognitive dysfunction in elderly patients after receiving midazolan and diazepam as premeditation.We studied 120 ASA physical status I-II elderly patients (>60yrs old) undergoing surgery with general anesthesia, that they were randomly assigned to one of three groups (each group 40 patients). Patients who were illiterates, opium addicts, patients with psychologic problem, patients who had used any tranquilizer (even as a single dose on the evening prior to operation) and who had neurosurgical or open heart surgery. Patients in the first group (control) did not receive any benzodiazepine for premeditation while diazepam (0.1mg/kg) and midazolam (0.03mg/ kg) were given intravenously to the second and third group. In addition morphine (0.1mg/kg) administered to all patients.Anesthesia was induced with hypnotic doses of thiopental and trachea was intubated by the aid of atracurium (0.5mg/kg).Anesthesia was maintained with halothane (0.5-0.75%) in combination with nitrous oxide 50% in oxygen.To asses cognitive function, the Mini-Mental State (MMS) test was used half an hour preoperatively and 4 hours postoperatively.The means scores calculated and compared in the groups. In the three groups means of MMS scores were reduced postoperative from preoperative scores. Patients in the control group showed 1.12, in diazepam group 1.72 and in midazolam group 1.35 decline in means of MMS scores. Besides, because reduction of two or more scores in MMS test was accepted as cognitive dysfunction, 11 patients (27.5%) in control group, 25 patients (62.5%) in diazepam group and 17 patients (42.5%) in midazolam group had postoperative cognitive dysfunction (p value< 0.05).We concluded that both midazolam and diazepam cause significant reduction in early postoperative cognitive function of the elderly and this was more prominent with diazepam.

Laryngoscope and tracheal intubations may be accompanied by tachycardia, hypertension and myocardial ischemia in susceptible individuals. In a double blind study we have compared effect of different doses of remifentanil on homodynamic responses to tracheal intubation in hypertensive patients.60 hypertensive patients, ASA class II, between 40-80 years old who were candidate for elective ophthalmic surgery were divided to three groups. All patients received normal saline or ringer’s lactate solution 5 ml/kg about 5-10 minutes before induction.Group 1, 2, 3 received remifentanil 1μg/kg, 2μg/kg, 4μg/kg respectively during induction of anesthesia in 30 seconds then an unique method of TIVA was used for all patients. Propofol 0.5mg/kg was given bolus dose and 10mg every 10 seconds until loss of verbal contact and then cistracurium 0.2mg/kg was injected IV and then the patients were ventilated for 3 minutes with O2 100% and finally intubated with proper  ETT.For maintenance of anesthesia propofol 50μg/kg and remifentanil 0.05μg/kg were given.Systolic and diastolic blood pressure, MAP and heart rate were recorded before and 1, 3 minutes after induction and 1, 3, 5 minutes after intubation of anesthesia.Systolic and diastolic blood pressure, MAP and heart rate were significantly decreased after induction in all groups (p<0.05) and were increased significantly after intubation group 1 which was continued till third minute after intubation but increasing these variables were not significant after intubation in group 2 and 3. Frequency of hypertention in group 3 was significantly more than other groups (25% vs 10%, p<0.05). In third and fifth minutes after intubation 10% (2 patients) in group 1 and 25% (5 patients) in group 3 had bradycardia. Remifentanil 2μg/kg in hypertensive patients blunted haemodynamic responses to intubation and higher doses has more frequency of hypotension and bradycardia. For decreasing these complications extensive studies in large samples with premeditation by vagolytic drugs is suggested.

There exits quite a large variety of congenital heart disease (CHD), that include abnormality of building and function of heart at birth. The generally accepted rate of incidence of congenital cardiac malformation in the human species is roughly 5-7 per one thousand live births.In transposition of the great arteries, the aorta arises from the right ventricle and the pulmonary artery from the left ventricle. Mixing of blood between the two sided of the heart via PDA, ASD or VSD is essential for survival. Two kinds of surgical operation has been done for correction as name switch, atrial switch or arterial switch. The most advantage of arterial switch is heart anatomy protection. After the arterial switch operation, the right and left ventricles are correctly restored to the pulmonary and systemic circuit, respectively. A preferred and successful arterial switch operation can be performed during 2 weeks after birthday.In this study, during 5 years we had 17 arterial switches from 2468 congenital heart diseases. The procedure of the anesthesia was the same for all patients. All patients had VSD, 7 cases need to intrope for separation of CPB and the main drug was dopamine, for two cases dobutamin and adrenalin had been used. Four patients operated during 2 early weeks of live and 13 cases were oprated in infancy. The intubations time for neonates were 6.5 days and for older infancy was 2.78 days. The ICU staying duration for neonates were 10.5 days and for older 6.7 days.After wearing of pump 15 patients received platelet and F.F.P.Bleeding is the most important complication after arterial switch in the operating room and ICU, that was threated with platelet.Decreasing of cardiac output is the later complication that is treated with inotropes and the pulmonary edema the later complications may be threated with toilet of bronchial tree, optimum ventilation by IPPV and PEEP.

Adjuvant drugs have been proposed to the accompanied with local anesthetic drugs to increase their analgesic efficacy. In this study, neostigmine has been added to lidocaine to assess its additive analgestic effects in caudal anesthesia.In a double blind descriptive analytical clinical trial, 60 patients aged 2 to 8 years and in ASA class I were allocated randomly in the case and control groups. All the patients had lower abdominal operations and were anesthetized generally with 1μg/kg fentanyl, 5mg/kg sodium thiopental, 66% N2O, 34% O2 and 1 MAC halothane. The patients had spontaneous ventilation after completion of the surgery, the case group received a caudal block with 0.5% lidocaine (1cc/kg) plus neostigmine (20μg/kg) and a total volume of caudally administered drug of 1cc/kg. The control group received the same dose and volume of lidocaine without neostigmine. Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) was used as the pain assessment scale, in the 1st, 3th, 6th and 24th hours after the surgery. Student t-test and chi-square tests were used for data analysis. SPSS software (version 10) was used for data entry and analysis.The two groups were similar regarding demographic variables. Pain scores were lower in the case group in the 3th, 6th and 24th hours after the surgery (a significant statistical difference); while the control group had lower pain scores at the first hour post-operatively. None of the patients in the 2 groups needed post-operative analgesics. Also, no post-operative complication was encountered.This study suggests that neostigmine could be an effective adjuvant for lidocaine in caudal anesthesia for pediatric patients compared with lidocaine administered lonely.Complementary studies are suggested to determine the best dosage of neostigmine.

This study was designed to obtain a standard blood sugar curve in coronary bypass grafting (CABG) surgery patients during cardiopulmonary bypass (CPB). Diabetic patients undergoing cardiac surgery had their blood sugar level determined by glucometer every five minutes during cardiopulmonary bypass. From 50 patients who entered in the study, 8 of them were excluded and the remaining of 42, completed the study. Blood surgar levels were also determined before and after initiation of CPB. The obtained curve from blood level determinations revealed a gradually increasing slope, reaching a peak during CPB. The curve has 5 parts, point A correlating to the stress of anesthesia and pre-CPB surgery, point B depicting the maximum point of hem dilution, point C correlating to maximum hypothermia, Point D correlating to rewarming phase, and point E depicting hemoconcentation.These five parts correlate well with the various phases of open heart surgery. 10 patients (23.3%) in the study revealed hyperglycemia above the acceptable level, and required insulin administration during CPB.