JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2004 | Volume:25 | Issue:47|Papers Count:12

Wake -up test can be used during posterior spinal fusion (PSF) to ensure that spinal function remains intact. The goals of this study were assessment of wake - up test time and their quality, hemodynamic changes, and costs between propofol - alfentanil versus midazolam - alfentanil infusions during PSF surgery.Intraoperative wake - up tests were performed in 90 patients randomized to either propofol - alfentanil (PA) or midazolam - alfentanil (MA) infusions for PSF surgery. In both groups, after premedication with midazolam 30 mcg.kg-1 and alfentanil 30 mcg.kg-1,anesthesia was induced with thiopental 5 mg.kg-1 and atracurium 0.6mg.kg-1 and 2 mins later trachea was intubated.Atracurium 0.2mg.kg-1 every 20 mins and 50% N2O/O2 was given to all patients. Infusions in PA group were propofol 50 mcg kg-1. min-1, and in MA group consist of midazolam 1 mcg.kg-1.min-1. Alfentanill Mcg.kg-1. min-1 was given to all patients. At the surgeon's request, N2O was turned off and infusions were discontinued. Patients were asked to move hands and feet, and after movement, their anesthetic protocol was continued again. Times from anesthetic discontinuation to spontaneous ventilation (T1), and from then until their hands and feet movement (T1), hemodynamic changes, and costs were recorded.The average T1 and T2 were significantly shorter PA group (6.1±4 and 7.5±4.5 min) than MA group (11±6.3 and l7.6±10 min) (p<0.001). Quality of wake-up test was not different. Blood pressure was lower in PA than MA group (p<0.05), but heart rate was not significantly differences. Also, cost was slightly more in PA group. Wake - up test can be conducted not only faster with propofol - alfentanil versus midazolam - alfentanil infusion, but also more blood pressure lowering and less hypotensive agent requirement during PSF surgery.

Postoperative pain is an unpleasant sensation and can cause many complications. Recently, a lot of methods are used to decrease of eradicate the pain. The most common of these methods are narcotic use. Although these mothods are effective, some side effects limit use of them. The aim of this study is to evaluate the effect of oxygen therapy on postoperative pain.This study is performed on 120 patients who were candidate of elective cesarean section. These patients were assigned into two groups (experimental and control). Anesthasia technique the druge which were used during the postoperative (6 hours) period were the same for all the patients. For study group oxygen 8 Lit/min was given in postoperative up to 6 hours (in recovery room and the ward). But the control group did not receive oxygen (except in recovery room for half an hour). Trained nurses recorded SpO2 and the degree of pain of the patients. Comparison between the groups were performed with the Hest and Chi-Square and the significant p-value was considered ≤0.05.All tests were performed by SPSS. Demographic and morphometric factors were the same in two groups. Mean of intraoperative SpO2 was comparable but postoperative SpO2 (in recovery and ward) was higher in the experimental group compared to the control group (p<0.5). The severity of pain in first and second patient"s narcotic request after surgery in study group was significantly decerased. The mean of narcotic drugs in first 24 hours after surgery in study group was significantly decreased (p<0.5).The results of this study show that postoperative oxygen therapy (8 lit/min) with simple face mask may reduce the dose of narcotic drugs after cesarean section.

Infraclavicular plexus block has recently become a technique with increasing interest. However, no approach has provided easily identifiable landmarks and lack of complications (mainly pneumothorax). In this study we performed the infraclavicular block with modified approach of the Raj technique.The block was performed in 30 pateints (Mean age 22.64±0.96 years) based on the identification of the acromial process of the scapula, jugular notch, and emergence of the axillary artery within the axillary fossa, with the arm abducted to 90. and elevated by approximately 30° We performed this approach by injecting 40-50 ml mixture of lidocain 1% and bupivacain 0.25% with epinephrin 1.200000. Success was define as a sensory block of the 5 nerves of the forearm within 30 min after performeing the block.The success rate was 100% when a distal response (flexion or extension of the wrist or fingers) was elicited and 72.7% when a proximal (contraction of the triceps, biceps) was obtained using a nerve stimulator. Complications were rate. Aspiration of blood was seen in 3% of patients and 11% complained sever pain during the procedure; no pneumothorax or hematoma was occured.In Conclusion the modified approach of the Raj technique for infraclavicular block is very effective when a distal nerve stimulator response is obtained with a small complication rate.

Cataract surgery is the most common procedures in geriatrics. There has been a significant shift toward the use of topical anesthesia with light sedation for routine cataract surgery. This study evaluated the sedation, cooperation and pain score, patient and surgeon satisfaction, PONV and delirium following use of three intravenous sedation techniques in phacoemulsification under topical anesthesia for cataract surgery.In this controlled clinical trial study, 150 patients who were candidate for phacoemulsification surgery were randomly divided in three groups. After oral explanation and topical anesthesia with tetracaine 0.5%, first group received fentanyl 1-1.5, µg/kg and ketamine 0.2mg/kg intravenously. Then propofol 10-20, µg/kg/min for second group and lidocaine 0.7mglkg for third group were Administered in addition to drugs of first group. Data were collected analyzed.There were no differences in the demographics data, preoperative BP and HR between the 3 groups. The mean pain score in 3 groups were 1.20±2.14, 1.78±2.68, and 2.18±3.05 respectively. Frequency of appropriate sedation in 3 groups was 80%, 86% and 78% respectively. Frequency of appropriate cooperation in 3 groups was 70%, 76% and 76% respectively. No significant differences in other parameters were observed in 3 groups.In previous studies, the preference of some sedation methods to other protocols was proved but in present study this issue was not significant. This may be due to patient selection, preoperative psychological preparation; optimum drugs dose selection, administration quality, compatible drugs combination and surgeon skill. There is necessary to more studies for detection of these effects on sedation quality.

General and regional anesthesia can be performed successfully for lumbar laminectomy. The purpose of this study was to evaluate the general or spinal anesthesia supplemented with intravenous (IV) propofol to determine whether one method is superior in reducing the blood loss in elective lumbar laminectomy.58 patients with ASA Class I - III elective surgeries candidate were selected and were divided in two 26 spinal anesthesia (SA) and 32 general anesthesia (GA) groups randomly. Those with excessive obesity and systemic disorders like bleeding disorder were excluded. After using standard monitoring and premedication, anesthesia induction were done for (GA) group and intrathechal injection for (SA) group.All of the information's were analyzed using SPSS program and using T-test and Chi-square. There were no differences in age, sex, SaO2% heart rate (HR), mean arterial pressure (MAP), initiation of operation and duration of anesthesia. Surgical time (89.84±21.12 vs 75.12±11.34 minutes) was longer in the GA group. Blood loss was less in the SA group than in the GA group (148.65±20.89 vs 20656±42.63 ml). Nausea was more common in the GA group both in PACU and 24 hours after surgery.Compared to GA, SA reduced blood loss by sympathetic blockage providing vasodilation, hypotension and more importantly SA permits spontaneous ventilation which results in lower intrathorasic pressure and possibly less destination of the epidural vein. Reduction of bleeding facilitate the surgery and decrease the duration of operation. Considering all the above results, it seems that spinal anesthesia supplemented with intravenous (IV) propofol sedation is an effective alternative method compared to general anesthesia for lumbar spine surgery and has reduced the rate of minor complications.

Coughing during emergence from general anesthesia is common clinical problem and can result in number of undesirable side effects. The purpose of this prospective randomized study was to compare the incidence of coughing after using lidocaine to inflate the endotracheal tube cuff with air and nitrous oxide 50% inflation of cuff. Because we beleive lidocaine can diffiuse across the cuff membrane to aneshtetize the mucosa.220 ASA physical status I and II patients undergoing elective surgery with general anesthesia divided in two blocks (Supa, Rusch) and after similar intubation each block was divided into three groups, the cuff of the tube was inflated with lidocaine 1%, air of room, nitrous oxide 50% with oxygen. At the end of the surgery after extubation, patients were observed to records the incidence and severity of cough immidiately (10 mins), 2 hours and at 2-24 hours. Data were analyzed by using Chi 2 and Kruskal- Wallis test, and ANOVA.The groups were demographically comparable. There was no difference in age weight, time of intubation and sugery. The incidence of coughing decreased in the lidocaine group comporable to air and notrous oxide groups for the time period 0-10 mins and from in 1 to 2 hours after extubation (20% Comporable to 43% and 48%) (p<0.001). The incidence of coughing In Supa group was lower than Rusch (p<0.003).We conclude the inflation of the cuff with lidocaine 1% can reduce the incidence of coughing in the post extubation. Our study shows that inflating the cuff of an endotracheal tube with lidocaine 1% rather than air and lower than Rusch tube.

Nosocomial infections (especially ventilator associated pneumonia) are the major cause of mortality in the ICU. It has been documented that the appropriate use of disinfectants and sterilants can help to control the incidence of nosocomial infection and reduces the morbidity and mortality and the costs.In this cross sectional open-label clinical trial we compare the efficacy of disinfecting of the environment (the surface of instruments) by Sodium Hypochlorite and ventilator tubes by Glutaraldehyde and Sanosil (a disinfectant by the main composition of Silver and H2O2). For this reason positive cultures and the type of microorganisms in the microbial culture were detected.In sanosil group a considerable reduction was noted compared with Sodium Hypochlorite in frequency of total positive cultures (from 75.7% to 10.6%), gram positive bacteria (from 72.1% to 10.6%), and gram negative bacteria (from 9.0% to 0.0%), including pseudomonas (from 7.2% to 0.0%), and poly-microbial growths (from 12.6% to 0.96%), and also fungi (from 4.5 to 0.96%).In ventilator tubes there were no differences between cultures immediately after disinfection with Sanosil compared with Glutaraldehyde. There was a reduction in positive cultures after at least 24 hours usage in total positive cultures (from 76.7% to 68.5%), two or poly-microbial growths (from 5.0.% to 33.3%), gram positive bacteria (from 60.0% to 51.8%), and gram negative bacteria (from 66.6% to 50.5), including Pseudomonas (from 66.7% to 18.5%), and an increase in the rate of Enterobacteriaceae (except of E.coli and Klebsiella) (from 0.0% to 24%) but only the latest two differences were meaningful.

Fear of labor pain is a leading cause which increases the trend of elective cesarean deliveries, so it is mandatory to change this trend by a number of interventions. Spinal analgesia could be an effective method for this purpose. This study was designed and execurted to assess the effectiveness of epinephrine added to intrathecal bupivacaine + sufentanil in alleviating the labor pain. In a randomized clinical trial, 39 parturient women in their second labor, who had their first experience of labor painfully, were allocated in 2 groups randomly: the first group received intrathecal bupivacain (2.5 mg) + sufentanil (5 mcg) and the second group received the same regimen with 0.2 mg epinephrine. Total analgesia time, FHR trend, nausea, pruritus, SpO2 trend, patient's respiratory status and blood pressure changes were monitored to see the possible differences. Student t-test and Chi-square test were used to analyze part of the results and p-value<0.05 was considered significant. The results did not suggest any significant statistical difference between the 2 groups regarding the aforementioned criteria. This study could not prove epinephrine as an effective adjunct for the intrathecal bupivacaine + sufentanil in alleviating the labor pain, and at the same time, due to possible epinephrine hazards in the parturient, discourages its usage in labor analgesia.

Over the past several years, considerable experience has been gained in performing coronary artery anastomoses on beating heart. As a result other aspects of minimally invasive approaches such as high thoracic has been demonstrated. High thoracic epidural anesthesia (T.E.A) in awake patient reduces intraoperative stress, postoperative pain and completely avoidance of mechanical ventilation along with good recovery period. Nonetheless we have to consider potential hazards of this method. This report describes our initial experience in performing coronary artery bypass surgery in conscious patient while awake.