JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2009 | Volume:30 | Issue:65|Papers Count:11

Background: Throat pain is a common postoperative complaint. There are no published studies reporting incidence of throat pain after conscious sedation (CS). In this study, we aimed to determine its incidence after rhinoplasty by general anesthesia (GA) or CS.Materials and methods: We evaluated throat pain in recovery, four, twelve and 24 hours after surgery using Numerical Rating Scale (NRS) in 202 consecutive females, aged>18 underwent elective rhinoplasty anesthetized by GA or CS in a prognostic cohort study. Age, duration of anesthesia and nausea/vomiting after surgery was also recorded. Candidates with negative histories of throat pain prior to surgery, smoking, head and neck trauma or surgery, known cases of cardiac, respiratory or airway, gastrointestinal or endocrine disorders and any history of sensitivity to sedative or anesthetic agents were included. Subjects with mallampathy grade 3 or 4 and laryngospasm during anesthesia were excluded. Logistic regression models were developed to predict throat pain.Results: The incidence of throat pain after CS and GA in recovery, four, twelve and 24 hours after rhinoplasty were 40.6% vs. 42.6% (p=0.78), 28.7% vs. 38.6% (p=0.14), 26.7% vs. 14.9% (p=0.037), 11.9% vs. 19.8% (p=0.12) respectively. The odds for throat pain were statistically significant for nausea/vomiting in recovery (OR=11, 95%CI: 5.1-22.3; P<0.0001) and for type of anesthesia at 12h after rhinoplasty (OR=2.1, 95%CI: 1.04-4.23; P=0.04).Conclusion: Incidence of throat pain is relatively more at 12 hours after rhinoplasty in CS than GA. Although it has no difference in other times.

Background: We designed a prospective, randomized, double-blind study to evaluate the effect of ultra - low dose of naloxone added to lidocaine and fentanyl mixture on the onset and duration of axillary brachial plexus block.Materials and methods: Fifty four patients scheduled for elective hand and forearm surgery under axillary brachial plexus block were randomly allocated to receive either 34 mL lidocaine 1.5% with 2 mL(100 mg) of fentanyl and 1 mL of isotonic saline chloride (control group, n= 27) or 34 mL lidocaine 1.5% with 2 mL(100 mg) of fentanyl and 100 ng(1 mL) naloxone(naloxone group, n= 27). After performance of the block, sensory and motor blockade of radial, median, musculocutaneous, and ulnar nerves were recorded.Results: The duration of surgery and the patient's characteristics were similar in the two groups. There was significant difference in the onset time of the sensory and motor block between groups.The duration of sensory and motor blockade were significantly longer in the naloxone than in the control group.Conclusions: The addition of ultra-low dose of naloxone to lidocaine 1.5% and fentanyl solution in axillary brachial plexus block prolongs the duration of sensory and motor blockade.

Background: The laryngeal tube suction II (LTS-II) is a recent version of supraglottic airway devices allowing gastric drainage. In this prospective, randomized study we compared insertion and ventilation of disposable LTS-II with reusable type for airway management under conditions with elevated intra abdominal pressure induced by capnoperitoneum.Materials and methods: 60 ASA I-II patients undergoing elective laparoscopic cholecystectomy were randomized to receive either a disposable (n=30) or reusable LTS-II (n=30) for airway management. After induction of general anaesthesia the devices were inserted, their correct placement was verified and airway leak pressure was measured. Ease of insertion, quality of airway seal, fiber-optic view, risk of gastric insufflation, insertion of nasogastric tube and post operative pharyngeal morbidity were examined.Results: First time and second time success rates were equal for both groups (96.6%). One patient in each group could not be intubated with LTS-II after three attempts. After gas insufflation, ventilation of one and two patients in disposable and reusable LTS-II groups was failed respectively, and the patients were intubated with endotracheal tube. Nasogastric tube insertion was successful in all patients. No significant gastric distention occurred in both groups. There were no significant differences in post operative complaints.Conclusion: Both devices provide a secure airway under conditions of elevated intra abdominal pressure. No diffe-rences concerning handling or quality of airway seal were detected between disposable and reusable LTS-II.

Background: The purpose of this study is to determine the effects of propofol and nesdonal on the incidence rate of postoperative fasciculation, myalgia and sore throat after succinylcholine administration.Materials and methods: In a prospective randomized double-blind study, 100 patients who were in ASA class I, II (between 20-60 years old) allocated into two equal groups (I, II). In group I and II propofol (2 mg/kg) and nesdonal (5 mg/kg) were used for induction, respectively. In both groups succinylcholine (1 mg/kg) had administrated for orotracheal intubation. Fasciculation after administration of succinylcholine, and myalgia and sore throat 24 hours after operation were observed.Results:  In the patients who received propofol (Group I), 8 patients had not any fasciculation (16%) and in the other 42 patients (84%) the occurred fasciculation was not severe. In the patients who received nesdonal (Group II), only 2 patients had not any fasciculation (4%) and 48 patients had fasciculation (96%). Incidence rate and severity rate of fasciculation in group II were significantly more than group I (P=0.046).Sore throat in group I was seen in 34 patients (68%) and in group II was seen in 46 patients (92%). There is a significant deference between two groups (p=0.003). Myalgia also was reported in 30 patients (60%) of group I and in 40 patients (80%) of group II (P=0.029).Conclusion: Using propofol versus nesdonal can reduce the succinylcholine-induced fasciculation, myalgia and postoperative sore throat.

Background and Objective: The induction of anaesthesia for surgery is a stressful event for children and they have increased anxiety during the preoperative period. To treat pre - operative anxiety in children pharmacological methods (premedication) are used in combination with behavioral methods. The purpose of this investigation was to study the effect of rectal diazepam and oral midazolam to alleviate preoperative anxiety of children who are undergoing eye surgery.Materials and methods: The study was designed and conducted as a double blinded randomized clinical trial. Children candidate correction eye surgery (2-6 years old) were enrolled and divided in two comparative groups randomly. In group 1, patients received rectal diazepam 0.5 mg/kg and in group 2, children received 0.5 mg/kg oral midazolam. Severity of anxiety and sedation score (Ramsay score) was recorded.Results: 49 patients and 48 patients were enrolled in oral midazolam and rectal diazepam, respectively. Sedation score in patients received rectal was less than in patients received oral midazolam significantly (p=0.031). There was no significant difference between two groups according to anxiety score.Conclusion: our finding showed that rectal diazepam could obtain sedative effect than oral midazolam.

Background: The purpose of this study was to assess the relation between the patient's physical status in regard with ASA and Goldman scoring with the incidence of complication and mortality following open cholecystectomy surgery in order to identify the best scoring system in predicting the outcome of the surgery in this group of patients.Materials and methods: The records of all the patients undergoing open surgery in a tertiary teaching hospital during the years 1997 and 2006 were enrolled in this retrospective, cross sectional study. The patients' records were reviewed to calculate the patient's physical status in ASA and Goldman scoring system.Results: Hundred forty one patients were enrolled in this study, 86 (61%) of which were female. There was a significant relation between ASA and Goldman scores and also between ASA and Goldman score, and the fetal complications. This correlation was highly significant for ASA scores less than 2. Seven deaths were reported in the first 4 weeks after the surgery; all of them had ASA and Goldman scores of higher than 2.Conclusion: Goldman can predict the possibility of developing cardiovascular related mortality and morbidity following the operation; ASA, however, is the best predictor of the patients' postoperative prognosis.

Background: Because of no need to many of systemic drugs and muscle relaxants, neuraxial anesthesia is a favorite method of anesthesia especially in children anesthesia domain. Spinal anesthesia with it s deep level of analgesia is an important anesthesia method for many kind of surgeries.Materials and methods: The level of anesthesia needs for inguinal hernia and undiscending testis surgeries are sometimes up to level of T10 which is not usually easy to access with caudal block.This study designed to evaluate spinal anesthesia in 1 to 12 years old children with inguinal hernia or undiscending testis surgeries.We anesthetized 77 patients in anesthesia group with thiopental, Fentanyl and atracurium and 69 patients in spinal group with intrathechal lidocaine. Both groups evaluate for hemodynamic changes, time of discharge to recovery and pain scores with Cheops score and SPSS software.Discussion: Decrease in blood pressure was more significant in spinal group. Children with spinal anesthesia discharged to recovery room sooner. Spinal anesthesia has been done with lower cost of materials.Conclusion: Spinal anesthesia had a better profile for cost and efficiency in operating room turn over and it needed more vigilance for hypotension. There was not any difference in pain scores up to 30 minutes in recovery room.

Background: Regional anesthesia is strongly recommended for caesarean section, but the most important preventing factor is patient refusal. This study is conducted to determine the factors influencing choice of anesthesia and the refusal reasons.Materials and methods: 240 pregnant patients candidate for elective caesarean section, just prior to surgery were interviewed about choice of anesthesia and reason for it, history of previous anesthesia and knowledge of anesthesia. Data's were recorded in a questionnaire.Results: 120 patients preferred GA while 72 patients chose SA. For 48 patients made no difference. The most common reasons for refusing spinal anesthesia were fears of back pain, hearing or seeing and headache. Fear of not waking up, nausea and vomiting and feeling pain were refusal factors of GA. Patients had knowledge about GA (64.2%) and SA (76.7%). The rest (11.2%) had no information about anesthesia.Level of education related to knowledge of anesthesia (p<0.05) although had no correlation to choice of anesthesia.Source of information were mostly other patients and relatives (50%), previous experience of anesthesia (36.3% ), medias (10.08%) and anesthesiologist comment (0.08%)  as an influencing factor.Conclusion: The majority of patients prefer GA in odder to avoid spinal anesthesia and its complications.By improving information and effective communication, spinal anesthesia may be encouraged for caesarean patients.

As we all know, one of the most serious consequence of incompatible blood transfusion is intravascular hemolytic reaction which, it may lead to life-threatening with even as little as 10cc of incompatible blood. ABO incompatibility is the most common cause of acute hemolytic transfusion reaction.We present a patient who had been transfused with incompatible blood under general anesthesia. At the almost end of the surgery we started to infused patient's blood cells due to estimated  blood loss during surgery and also Hb, Hct patient at the start of surgery. Following that patient transferred to recovery room, we encountered with routine sign of incompatible blood reaction such as tachycardia, tachypnea, and hemoglobinuria and also surprisingly, hypertension.  The last sign is really rare. We immediately suspected that we had transfused incompatible blood and stopped infusion blood and following that patient has been completely treated.