JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2005 | Volume:27 | Issue:50|Papers Count:11

Background: Endotracheal  intubation can cause some hemodynamic changes such as increased blood pressure and heart rate that particularly in patient with cardiovascular disease may lead to an undesirable outcome. Different techniques are used to prevent this problem, for example administration of appropriate agents for induction of anesthesia. In this study we compared cardiovascular effects of ketamine+ remifentail and propofol + remifentanil. Materials and Methods: Fifty patients, 20-50 yrs, in physical status ASA I, were studied in two groups. "Group K (n=25) received ketamine 1mg/ kg and remifentanil 0.5 μ g/kg/min and group P (n=25) received propofol 1mg/kg and remifentanil 0.5 μg/kg. Intubation was facilitated with atracurium 0.6 in both groups. Arterial blood pressure and heart rate were measured noninvasively, before induction of anesthesia (base measurement) and first fifteen minutes after intubation. Results: Heart rate and mean arterial blood pressure were increased more in group K, immediately after intubation (p<0.05), and were remained elevated longer in group K (p<0.05) while the incidence of hypotension was significantly more in group P (p<0.002). Conclusion: The hemodynamic changes were lower in group ketamine + remifentanil than propofol + remifentanil.    

Background: Regional anesthesia is becoming more popular in children because of its benefits for patients in the post operative period. Capability of safely providing better conditions of pain and discomfort will enhance by increasing understanding local anesthetic pharamcology toxicity and complications. Materials and Methods: In this study 60 children undergoing lower extremity orthopedic surgery were assigned in a single blind randomized clinical trial to receive either caudal anesthesia (30 cases: sedated by 0.05-0.1 mg/kg Midazolam, 0.5 mg/kg Ketamine and 1 µg/kg Fentanyl and caudal injection of 1 cc/kg Lidocaine 1% plus Marcaine 0.25%) or general anesthesia (30 controls: sedated by 0.05-0.1 mg/kg Midazolam and 1 µg/kg Fentanyul and induction of anesthesia by 5-6 mg/kg Nesdonal and 0.5 mg/kg Atracorium and the Halothan 0.5% and N2O 50% plus Fentanyl and Atracoruim as needed). Patients with gross spinal anomalies, CNS or local infections, coagulopathy, history of allergic reaction to local anesthetic agents and seizure were excluded. Arterial O2 saturation and pulse rate during surgery duration of recovery agitation and common drug complications and severity of pain during the first twelve hours after surgery were compared. Fisher's exact test. Chi square test, independent sample T-Test was used as required for statistical analysis. P<0.05 was considered significant. Results: The two groups were similar in age, sex, duration of anesthesia and surgery. Pulse rate was significantly lower in cases at 15th and 75th minutes of surgery and recovery. The average duration of recovery was shorter among cases versus controls (16 vs. 21 minutes) the severity of pain at 1st and 3rd hours after surgery and frequency of analgesic injection in ward during the 3rd and nausea during the 1st hour after surgery was statistically significant lower than controls. There were no differences in other outcome variables between groups. Conclusion: The results of caudal anesthesia (especially post operative pain) were better than general anesthesia overally in our study. Of course it seems that experience and skill of anesthesiologist in performing caudal anesthesia are important influencing factors on its outcome.      

Background: Nowadays, because of the risk of bleeding, blood reserving is inevitable in many of the surgical operations but moreover this reservation should be accomplished on the basis of a standard protocol, both on account of the limitation in blood products and also as a mean to prevent reserving the amounts more than enough. So MSBOS is the procedure used in most of medical centers in the world. This study has been done to find a new protocol for blood reservation in Sina Hospital. Materials and Methods: This study is done in Sina Hospital in 2 steps: First, in a period of 6 months, the amount of the reserved blood units for 14 types of the commonest operation of this hospital was reckoned. The amount of blood reserved and utilized was defined and at last the amounts needed for each operation were calculated. In the second part of the study, the computed protocol for 5 types of these operations (cholecystectomy, prostatectomy, hysterectomy, and thyroidectomy and disc herniation) was performed in a period of one year. Results: The amount of reserved blood units for each of these operations, before undergoing this study were as below: cholecystectomy: 1.63 units, prostatectomy: 1.96 units, hysterectomy: 2.25 units, thyroidectomy: 2.5 units and disc herniation: 2.88 units. But after performing the protocol, this amount was diminished to near 0 for cholecystectomy and thyroidectomy and to about one unit for prostatectomy, hysterectomy and disk herniation without causing any problem for the patient during neither of the operations.Conclusion: It must be notified that thes8 12 months of utilizing the protocol has prevented reserving of 340 unwanted units of blood and losing of 40 blood units and at last has saved near 10,700,000 Rials.    

Background: Severe postoperative pain and burning in burned patients due to extensive debridement and graft removal requires administration of adequate potent analgesics. Ketamine has potent analgesic and sedative effects and by inhibition of NMDA receptors in spinal cord reduces pain intensity and prevents it to become chronic. Materials and Methods: This controlled and double-blinded trial was performed in patients age range between 15 to 50 years old and during percentage between 10% to 50%. Oral ketamine was administered for 20 Patients (2 mg/kg tid). Results: Pain intensity and opioid dosage in trial group were considerably less than those of control group, as mentioned by patients and nurses. There were no correlations between pain intensity and age, sex and burning percehtage, but pain intensity had a direct correlation with opioid dosage and heart rate. Conclusion: We concluded that 2mg/kg oral ketamine. Results in lower pain intensity and opioid usage in burned patients without any effects on mental status.    

Background: After coronary artery bypass graft (CABG) surgery and other open heart surgeries because of discontinuation of anesthetic drugs, during a short time after operation pain may start and it causes hemodynamic instability and analgesic requirement of the patients. Also these patients need a period of controlled mechanical ventilation. To reduce hemodynamic instability and analgesic requirement of the patients, short - acting sedative like propofol has been recommended. Materials and Methods: The present study performed as a prospective randomized clinical trial analysis on 50 patients after CABG surgery in Shahid Rajaii Hospital's ICU. Inclusion criteria included patients aged between 35-55 years, hemodynamic stability, ejection fraction more than 35% and exclusion criteria were patients with underlying and co-existing diseases and require intra-aortic balloon pump therapy after surgery. Premedication and anaesthetic drugs (propofol, sufentanil, atracurium) in all of patients were the same and standard. The patients were divided into two groups upon arrival in the ICU. The first group received sedative dose of propofol (group 1) and the other group received sedative dose of midazolam (group 2). Hemodynamic changes and sedative status all of these patients were monitored upon Ramsay sedation scale. Results: Analgesic requirement of patients in group 1 was 16% while 28% of patients in the group 2 needed analgesic. There were no statistically significant differences (p>0.05) between two groups. Conclusion: There were no significant differences between the propofol and midazolam groups as far as the amount of analgesics required postoperatively in CABG pateints. However it seems that propofol is a better sedative than midazolam in these patients.      

Background: Postoperative nausea and vomiting is one of the main complications after laparoscopy. We compared the antiemetic effect of i.v dexamethasone with placebo in preventing nausea and vomiting after diagnostic laparoscopy in infertile females. Materials and Methods: We evaluated 102 infertile females who were candidate for laparoscopy in three groups in a double' blind, randomized, placebo-controlled trial study. Patients received placebo in group I (n=34), 8 mg dexamethasone in group II (n=34) or 12 mg dexamethasone in group III (n=34) before anesthesia. Anesthesia was started with fentanyl, thiopental Na and atracurium and maintained with oxygen and halothane. Postoperative nausea and vomiting (PONV) was evaluated in recovery room and during the first 24 hours after surgery. Results: The incidence of PONV during the 24 hrs Postoperative period was 50% in group 11 (p.v=0.7) and 30% in group III (p.v=0.047) when compared with 54.8% in group I (placebo). Conclusion: Prophylactic iv dexamethasone 12 mg significantly reduces the incidence of PONV in infertile females undergoing diagnostic laparoscopy while 8 mg dexamethaspon is not so effective. This discrepancy may be due to the anxiety of these patients.  

Background: Headache after spinal anesthesia is a complication of dural puncture that occurs in varying degrees in patients undergoing this procedure. Symptomatic and conventional treatments are complete bed rest, hydration, and analgesics. Epidural blood patch is the only definitive but invasive therapy. In this randomized clinical trial we evaluated the efficacy of intravenous hydrocortisone in postdural puncture headache in women who received spinal anesthesia for cesarean section. Material and Methods: 60 patients with headache after spinal anesthesia were included in the study. Patients with previous history of headache such as migraine, cluster headache, and preeclampsia were excluded. After obtaining informed consent, 30 patients randomly received conventional therapy (complete bed rest, hydration, acetaminophen codeine and pethidine) while other 30 patients received intravenous hydrocortisone (200 mg first, then 100mg TDS for 2 days) in addition to the above drug. Mean (±SD) headache intensity was measured using visual analog scale. At the beginning of therapy and 6, 24 and 48 hours later. Results: There was no significant difference in headache intensity between the two groups before beginning of treatment. After 6 hours, the mean of headache intensity in 30 patients treated conventionally was 6.63 (± 1.35) while it was 2.77 (± 1.07) in other patients who received intravenous hydrocortisone too (p<0.001). After 24 hours, mean headache intensity was 3.87 (±1.63) in conventionally treated group versus 0.73 (±0.74) in hydrocortisone group (p<0.001). After 48 hours, mean headache intensity was 1.87 (±0.93) in conventionally treated group versus 0.63 (±0.61) in hydrocortisone group (p=0.001). Conclusion: This study showed the efficacy of intravenous hydrocortisone in reducing headache after spinal anesthesia in women who underwent cesarean section. However, further studies are needed to consider steroid therapy as a standard treatment for postural puncture headache and further investigations are needed to determine true mechanism of action of steroids in pain management.      

Background: Nausea and vomiting are very common following strabismus surgery. As the incidence of -vomiting after pediatric strabismus surgery may be as high, as 85%, in this prospective, double blind randomized study, we compared the efficacy of Propofol, Promethazine and Metoclopramide in preventing vomiting after strabismus surgery in 3-14 years old children. Materials and Methods: Ninety ASA I, 3-14 years old children, undergoing strabismus surgery were randomly allocated to three groups with 30 patients in each group. The anesthesia was managed in a similarly standard manner in all patients. At the end of operation, patients in group I received Propofol 0.5 mg/kg, group 1IMetoclopramide 0.1 mg/kg and group III Promethazine 0.5 mg/kg intravenously. The incidence of vomiting in the recovery room and during the first 18 hours after discharge from the hospital was recorded in all patients. Results: The incidence of vomiting in recovery room was 16.7% in Propofol group, 36.7% in Metoclopramide group and 30% in Promethazine group. These differences were not statistically significant. The incidence of vomiting during 18 hours after discharge from hospital was significantly lower in Promethazine group (16.7%) as compared with 40% in Metoclopramide group and 63.3% in propofol group.(p<0.001) Conclusion: This study does not reveal any significant differences in antiemetic efficacy of three drugs in the recovery room, but during the first 18 house after discharge from the hospital, Promethazine seems to be the most effective one.    

Background: Negative pressure pulmonary edema after endotracheal extubation is an uncommon and potentially serious complication of patients undergoing general anesthesia. Materials and Methods: In this paper a case of a 16 years old male patient with the diagnosis of hand tumor is reported. Results: The patient underwent general anesthesia for excision of tumor and immediately after extubation developed laryngospasm. Patient developed negative pressure pulmonary edema and bloody sputum after transmission to the ward. He was treated with prompt treatments but because of ischemic changes in ECG, he was transferred to the coronary care unit. There were no enzymatic evidences of infarction. Finally, after ischemic changes return to normal, he was discharged.