JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2007 | Volume:29 | Issue:57|Papers Count:12

Background: Monitoring the muscle relaxants by nerve stimulator is one of the important standards of modern anesthesia. In our institution we used this service as a monitor to compare the total dosage and recovery time of atracurium in two different routs of its administration: infusion versus bolus injections. Materials and Method: In this prospective double blind clinical trial two groups of ASA Class I patients (50 patients each group) undergoing general anesthesia were elected. In one group atracurium used with infusion technique and in the second group as intermittent blous injections. In this study nerve stimulator was monitoring of choice. In both groups the effective dosage were approached when only one responce to TOF were present. At the end of operation recovery time were estimated with the return of the fourth response of TOF.Results: The result of this study showed that the total amount of atracurium used by infusion was less than the total amount of bolus injections. In contrast recovery time by infusion was shorter than recovery time by bolus technique.Conclusion: The results of this study shows that by applying the nerve stimulator to monitor the depth of muscle relaxation we are able to use much lower doses of atracurium and faster recovery.

Background: Failed endotracheal intubation is one of the principal causes of morbidity and mortality in anesthetized patients. The aim of this study was to investigate the efficiency of forward movement of the mandible in predicting difficult intubation. Materials and methods: In a prospective study, 300 patients (aged more than 16 yr), scheduled for elective surgery were enrolled. Forward movement of the mandible was measured in each of the patients before operation by a single anesthesiologist. It was defined as the difference between the distances of lower and upper incisores in neutral and during maximum mandibular protrusion in millimeter. At the time of intubation, another anesthesiologist blinded to the preoperative airway assessment test performed a laryngoscopy and determined the laryngoscopic view according to the Cormack and Lehane scoring system. Difficult intubation was defined as laryngoscopic views of grade III and IV.Results: Twenty one patients were identified as having difficult intubation. The forward movement of the mandible as significantly more in patients with easy intubation compared to those with difficult intubation (6.42±1.95 mm vs. 3.58±1.26 mm respectively, p<0.001). Using the cutoff point of 5 mm or less for prediction of difficult intubation was accompanied with  the sensitivity of 92.86% and the specificity of 70.43%. Conclusion: The forward movement of the mandible is significantly more in patients with easy intubation compared to difficult intubation.

Background: For 40 years cricoid pressure has been used to prevent regurgitation of gastric contents during induction of anesthesia. Available studies have highlighted poor techniques regarding cricoid pressure. Patient safety could be challenged by incorrect use of cricoid pressure. The aim of this study was to assess the practice and knowledge of cricoid pressure among anesthesiologist attending in the ninth International Congress of Anesthesiology and Resucitaltion in Iran. Materials and methods: This cross sectional observational study included 59 anesthesionlogists attending the 9th International Iranian Congress of Anesthesia and Resuscitation in 2006. Each subject was asked to apply cricoid pressure on an undressed laryngeal model for one minute. The model was an anatomically correct representation of the human larynx. It was mounted onto the base plate of kitchen scales (LAICA Italy) with a range of 0.000 to 10.000 kg and a resolution of 100g. The model was placed on a table such that the crioid cartilage was at a height of 1 metre from the ground. Participants were blinded to the results. Five measurements were obtained from each candidate (0, 15, 30, 45 and 60th second). Participants were also asked to complete a questionnaire containing demographic data and some questions regarding attiude and knowledge of participants regarding Sellicks maeuver.Results: Eighteen (30%) participants applied the target cricoid force (3-4 kg). When considering both correct anatomical position and right range of applied force only 11 (19%) participants were successful. Mean applied force significantly decreased at the end of one minute and mean applied force by women was significantly less than men. There was no statistically significant difference between academic staff and other anesthesiologist in application of target force. Only eight (13.6%) participant were aware of the target cricoid force.Conclusion: Application of cricoid pressure by the participant anesthesiologist is poor. Use of simple models for training of anesthesia trainee and in refresher courses for practicing anesthesiologist in addition of stressing on the theorytical base may improve the quality of performance of the Sellicks maneuver.

Background: Serum sodium disturbances frequently occur in head trauma patients that might exacerbate their neurological disturbances. The disturbance may be manifested as hypematremia or hyponatremia. Hypernatremia usually occurs in the form of syndrome of diabetes insipidus, whereas hyponatremia develops as a syndrome of inappropriate secretion of ant diuretics hormone (SIADH) or cerebral salt wasting (CSWS).Materials and methods: In a prospective descriptive survey, we studied 150 patients with isolated head trauma admitted to the intensive care unit at Khatamal- Anbia Hospital from April 2003 to September 2004. For all the patients the following parameters were recorded daily: sex, age, blood pressure, Na, K, BUN, Cr, BS, Ca. In the case of any sodium disturbances, further lab data such as urine sodium, osmoloarity, SG, urine output plasma and urine uric acid were requested to determine the etiology. All data were analyzed by SPSS software, X2, and exact Fischer test.Results: Of 150 patients with head trauma sodium disturbances were detcted in 34 patients: Hypernatremia in 22 and hyponatremia in 12 patients. The patients with hypernatremia in 22 and hyponatremia in 12 patients. The patients with hypernatremia developed 01. The mean of GCS in this group was 5.59 and 18 (81.8%) patients died. The mortality rate was higher in patients with more severe hypematremia with lower GCS. In patients with hyponatremia, 9 (75%) of them developed SIADH and 3 (25%) developed CSW. The mean of GCS in this group was 7.25 and 3 (25%) of them died. There was no statistically significant relationship between hyponatremia and mortality (p=0.7) but there was statistically significant relationship between hypematremia and mortality (P<0.001).Discussion: disturbances of plasma sodium concentration should be seriously considered in patients with head trauma to allow timely and appropriate therapeutic intervention that may exacerbate the patients condition and eventully lead to death.

Background: Aspiration is an important complication of general anesthesia and any delay in intubation could increase this risk. There are a few methods for rapid intubation. In this research we use combination of ephedrine and cisatracorium, in order to reduce onset time of cisatracorium.Materials and Methods: In this randomized double blind controlled clinical trial research, 60 patients were divided in two groups. Blood pressure and pulse rate were measured before induction, 1 min after injection of ephedrine and 1, 3 and 5 mins after intubation. The onset of cisatracorium is measured by nerve stimulator by stimulation of adductorpollicis and TOF.Results: There is no difference between measured blood pressure and pulse rates in two groups (p<0.001). Onset time of cisatracorium for the control group was 3.86±0.6, and it was 2.89±0.6 for the case group. It shows statistical meaningful difference (p<0.001).Conclusion: Low dose of ephedrine (70 mg/kg) during the induction of general anesthesia could reduce the onset of cisatracorium without any increase in blood pressure or heart rate.

Background: The aim of this study is the comparison of lidocaine and diazepam as a pretreatment to prevent or decline the fasculation and myalgia due to depolarizing muscle relaxant, succinylcholine. Materials and Methods: 60 patients who had been chosen for small to moderate elective surgery were divided into 3 groups. Each group was 20 patients, and a double blinded controlled randomized prospective study was performed.In group I, 0.1 mg/kg diazepam 5 min before induction, in group II lidocaine 1.5 mg/kg, 90 seconds befoere induction and in group III 3 ml normal saline, 3 min before induction was injectd. 120 seconds before intubation after administration of 15 mg/kg alfentanyl, induction was done with 3mg/kg Na-thiopental and 1.5 mg/kg succinylcholine. The presence and severity of pasciculation due to succinylcholine was recorded by an anesthesiologist who was unknown about the survey. The post operate myalgia was evaluated by the same anesthesiologist.Results: Rate of fasciculation was significantly decreased in group I and II versus control group, but there was no difference in defasciulation between diazepam and lidocaine group (p-value=0.018). Lidocaine decreased postoperative myalgia efficiently versus diazepam and normal saline, but this difference was not statistically significant among the groups. Conclusion: Both lidocaine and diazepam have similar defasciulation effect, but it seems that lidocaine prevents myalgia more effectively than diazepam.

Background: Treatment of the postoperative pain in transureteral lithotripsy (TUL) surgeryis is one of the aims of an anesthesiologist. One of the drugs that have been commonly used is non steroidal anti inflammatory drugs (NSAIDs). Their benefits are absence of respiratory depression, drug dependency in addition to their availability. The aim of this study is to compare the analgesic effect of celebrex with indomethacine and placebo in postoperative pain of TUL surgeries. Materias and methods: In a randomized double blind, controlled trial study, 180 patients who were referred for TUL surgery allocated randomly (according to the table of randomization) into one of three groups: Group L who received one capsule of celebrex (100mg) one hour before the operation. Group II who received one capsule of indomethacine (25mg), one hour before the operation and Group III (placebo) who did not received any medication. In all of the three groups, induction and maintenance of anesthesia were similar, post operation pain, burning, nausea and vomiting were recorded in five different timas (30, 60, 90, 120 and 240 minute).Statistical evaluation was performed using the SPSS, version 13. The tests ANOVA, Kruskal Wallis test and Mann - Whitney tests were used to analyze data dividing Alpha to the number of comparison p-value <0.01 was considered significant. Results: Patients in group I, who received Celebrex showed significantly less pain and burning compared to group II and placebo (p-value<0.001). The post operative opioid use was significantly less than placebo (p<0.000) but no significant difference was observed between group I (celebrex) and II (indomethacine) regarding rescue drug.Conclusion: The post transureteral lithotripsy (TUL) surgery pain was significantly less after 60 minutes until 4 hours in patients who received celebrex. So, celebrex can be used for reducing the pain after TUL surgery.

Background: Pain is a common sign of many diseases and many efforts and techniques have been performed to control it. Beside new drugs and surgical techniques, the non pharmacological methods are used to control the wide range of clinical pain syndrome. Hypnosis is one of the nonpharmacological methods with results in relaxation and analgesia. Its analgesic effects are related to suggestions that are induced to persons. There are two types of analgesic hypontic suggestion: direct and indirect. Materials and methods: In this study, 20 highly hypnotizable volunteers were selected. After 4 hypnotic sessions and conditioning the volunteers, they were divided into 2 groups randomly, and then two types analgesic suggestions were induced to volunteers of both groups who were in hypnotic state. Then we measure impression of groups who were in hypnotic state. Then we measure impression of suggestions on reduction of cold pressor pain. The succession of suggestion was different in two groups. The mean of pain scoring number in first and second groups were 8.5p1.02 and 8.3±1.1 respectively in an awake state. Also the mean of pain scoring after direct and indirect hypnotic analgesic suggestion were 2.0±0.83 and 2.7±1.1 in the first group, and were 2.4±1.01 and 2.2±0.74 in the second group. Results: The result of our study indicates that hypnosis is an effective method in attenuation of pain, and there is no difference between these two types of suggestion.

A 38 year old man, with ASA Class 1, was scheduled for laparoscopic cholesystectomy. General anesthesia was selected and induced. About 40 minutes after induction of anesthesia a progressive tachycardia and hypertention was noticed. We checked anesthetic machine and appropriate location of tracheal tube. Then extra narcotic and muscle relaxant repeated but our efforts were ineffective. The operation ceased and when laparoscope was withdrawing, accidentally touched the anesthesiologist's hand. It was abnormally hot. The abdomen was opend immediately. Intra-abdominal temperature was too high and bowel and visceral organs were inflamed. After irrigation of abdomen with cold normal saline, tachycardia and hypertention regressed to normal situation and open cholesystectony was down.