JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2006 | Volume:28 | Issue:53|Papers Count:11

Background: There are some controversies in methods of stress ulcer prophylaxis in critically ill patients. The aim of this study was to compare the efficacy of ranitidine and sucralfate on stress ulcer prophylaxis, gastric acidity and contamination and development of lung infection in critically ill patients under mechanical ventilation.Material and Methods: In this clinical trial, 44 patients were randomly divided in two groups and received ranitidine or sucralfate for stress ulcer prophylaxis. The occurrence of stress ulcer, lung infection, positive culture and pH of gastric secretions were determined in both groups. Statistical anlaysis was performed using X2 and T-tests.Results: There was no statistical difference between two groups as far as demographic data and the reasons of stress ulcer prophylaxis was concerned. The frequency of stress ulcer in ranitidine and sucralfate groups was 7.4% vs. 17.6%, lung infection was 14.8% vs. 17.6%, positive gastric secretion culture was 59.3% vs. 47.1%and the mean of gastric pH was 4.3±1.4 vs. 3.9±1.1 respectively. Positive fungal culture of gastric secretions was significantly greater in ranitidine than sucralfate group (48% vs. 11%. p=0.01).Conclusion: In some studies, the preference of sucralfate to ranitidine has been advocated for stress ulcer prophylaxis. In present study the frequency of positive fungal culture of gastric secretions was lower in sucralfate than ranitidine group.

Background: 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 hemodynamic changes, wake-up test times and their quality, and costs between propofol alfentanil (PA) versus propofol-remifentanil (PR) total intravenous anesthesia (TIVA) during PSF surgery.Material and Methods: 40 patients with scoliosis who were candidates for PSF surgery randomly allocated in either alfentanil (PA) or remifentanil (PR) groups. After intravnous premedication with midzaolam 30µg/kg in both groups, and alfentanil 30µg/kg in PA group and remifentanil 1µg/kg in PR group, anesthesia was induced with thiopental 5 mg/kg and atracurium 0.6 mg/kg 2 minutes later trachea was intubated. Then atracurium 0.2 mg/kg was given every 20 minutes PA group was infused with alfentanil 1µg/kg/min and in PR group infusion of remifentanil 0.2µg/kg/min was given propofol 50µg/kg/min was given to all patients. At the surgeon's request, infusions were discontinued. Patients were asked to move their hands and feet, and then their anesthetic protocol was continued again. The duration of anesthetic discontinuation to the times when spontaneous respiration was started (T1) and, the hands and feet movement (T2) were recorded. We also compared the hemodynamic changes and the costs of drugs between the two groups. Results: Average of blood predsure and heart rate were lower in PR group than PA group (p<0.01 and p<0.05, respectively). Hypotensive agents requirement was also less in remifentanil group (p<0.001). The average T1 and T2 were significantly shorter in PR group (3.6±2.5 and 4.1±2 min) than PA group (6.1±4 and 7.5±4.5 min) (p<0.01). Quality of wake-up test was not different. The cost was more in PR group than PA group (p<0.01).Conclusion: During posterior spinal fusion the use of propofol-remifentanil infusion in comparison to propofol-alfentanil infusion not only makes the conduction of wake-up test faster, but also by lowering the patient's blood pressure decreases the need of hypotensive agents.

Background: Many different methods have been used in an effort to provide adequate analgesia after knee surgery. We chose sufentanil because of its greater lipophilic characteristics, which should provide a faster onset of analgesia than morphine.Material and Methods: In a double blind randomized study,96 ASA physical status 1-11 patients ranging 20-45 years undergoing knee arthroscopic meniscec tomy were studeid. Patients were allocated to 3 groups receiving IV sufentanil, intraarticular sufen- tanil 10µg, or sufentanil 10µg plus methylpredni- solone 40mg at the end of arthroscopy during general anesthesia. Postoperatively, pain levels at rest and during movement (i.e., active flexion of the knee) were measured by a visual analogue scale. Supplementary analgesia - acetaminophen codein orally - was given at patient request. Statistical analysis was performed by the Mann-Whitney, U-test, Wilcoxon's test and the X2 test as appropriate. All data are presented as mean ±SD.Results: With regard to demographic data, duration of anesthesia and tourniquet time, significant difference were not observed among groups A, Band C. Postoperatively, pain score during rest and movement were significantly higher in the IV group than in the other groups (p<0.05) and the difference between the Band C groups were also significant (p<0.05). Postopera- tively, supplementary analgesic consumption was significantly decreased in the intraartcular sufentanil and sufentanil plus methylprednisolone groups (p<0.05), and the difference between the Band C groups were also significant (p<0.05).Conclusion: Intraarticular administration of sufentanil alone and combination of sufentanil and methylpred-nisolone after knee menisectomy are effective, reliable, and well tolerated analgesic techniques. Sufentanil plus methyl prednisolone reduced pain and use of supplementary analgesics effectively.

Background: Electro convulsive therapy is a common and routine treatment which is dependent to anesthesiologist cooperation. One of the side effect of this method is adverse effect on hemodynamic responses. Remifentanyl is an ultra rapid opioid which can decrease this adverse effect without prolonging the length of seizure and recovery time.We designed this prospective double blinded study to evaluate the effects of remifentanyl on the acute hemodynamic response and seizure activity and recovery time of ECT.Materials and Methods: Sixthy patients candidate for ECT were divided into two groups randomly. The first group was received 2µ/kg IV remifentanyl as premedication. The second one was received placebo as premedication.Results: In both groups blood pressure, heart rate, seizure activity and recovery time were documented. There were no significant differences between blood pressure, heart rate, seizure activity and recovery time between two groups.Conclusion: Premedication by remifentanyl 2µ/kg can not improvethe patient'scondition in ECT.

Background: Postoperative. pain management is important in patient's outcome. Magnesium sulfate reduces pain via inhibition of calcuim entrance into the cell and also via the block of NMDA receptors in brain. In this study we assessed analgesic effects of pre-induction Magnesium administration in ASA class I and II undergoing elective spine surgery.Materials and Methods: In a randomized double blind clinical trial study, 2 groups of patients were analyzed; one group received Magnesium 50 mg/kg pre-induction. The other group received normal saline. Induction and maintenance of anesthesia were similar in both groups. Post-operative pain was measured by VAS every 2 hours till 6 hours. If opium was administered it was recorded.Results: "Magnesium sulfate group" required less opium than the other (53% versus 20%, p-value: 0.02). Control group had higher pain score than Magnesium sulfate group.Conclusion: Magnesium sulfate infusion can be used immediately before induction of anesthesia in order to reduce post-operative pain safely.

Background: Digital block is an effective and common method for inducing anesthesia at the digits in order to perform surgery either after trauma or for elective surgical interventions. in traditional methods for digital block including circumferential and bilateral infiltration of local anesthetics around the digit. The risk of injury to digital nerves may be increased and the patient feels more pain due to multiple injections. In the present study we report the results of a new method for digital block using a single injection of local anesthetic agent into the flexor tendon sheath at volar aspect (A1 pulley area). Materials and Methods: We injected a combination of 1.5 ml of 2% lidocaine and 1 ml of 0.5% bupivacain using a 27 G insuline needle into the flexor tendon sheath of the digit in the area of A1 pulley. From September 2004 to March 2005 25 patients with ASA I and 11were included in our study. After receiving inform consent, the questionnaire was completed including demographic data, the reason for operation, the type and site of operation, patient and finally surgeons satisfaction from anesthesia during the procedure.Results: Patients had perfect analgesia during surgical procedure (they reported 92% good and 8% fair analgesia during surgical procedure). Surgeons' satisfaction were excellent (96% good and only 4% fair). All of the procedures were performed with the same method and there was no need for using another method of regional anesthesia or general anesthesia due to pain or failure of the block. Conclusion: We prefere this method of digital block to traditional method, in which more than one injection is needed. Our method is less painful and the risk of damage to the digital nerve is less.

Background: Post-cesarean delivery pain relief is important. Good pain relief will improve mobility and can reduce the risk of thromboembolic disease, which is increased during pregnancy. Pain may also impair the mother's ability to optimal/y care for her infant in the immediate postpartum period and may adversely affect early interactions between mother and infant. It is necessary that pain relief be safe and effective and that it results in no adverse neonatal effects in breast - feeding women. Music may be considered as a potential method of post cesarean pain therapy due to its noninvasiveness and lack of side effects. In this study we evaluated the effect of intraoperative music under general anesthesia for reducing postoperative morphine requirements after cesarean section. Materials and Methods: In a double blind placebo - controlled trial, 100 women in ASA I scheduled for elective cesarean section under general anesthesia were randomly allocated in two groups of fifty. After standardization of anesthesia, patients in the music group exposed to guitar in Spanish style after induction of anesthesia up to the time of wound dressing. In the control group patients were exposed to white music. Postoperative pain and anxiety were evaluated by visual analog scale CJAS) up to six hours after discharge from PACU. Morphine was given intravenously for reducing pain to VASs3 postoperatively.Results: There was not statistically significant difference in VAS for pain between two groups up to six hours postoperatively (p>0.05). In addition, morphine requirements was not different between the two groups at different time intervals up to six hours postoperatively (p>O.05). There was not statistically significant difference between the two groups regarding to postoperative anxiety score and vomiting frequency (p>0.05).Conclusion: In this study, it was shown, intra-operative Spanish music was not effective in reducing postoperative pain after cesarean section. In addition postoperative morphine requirement, anxiety and vomiting were not effected by the music during general anesthesia.  

Background: This descriptive cross sectional prospective study was designed to assess the incidence of postanesthetic shivering in Dr Masih Daneshvari hospital, which is a thoracic surgery center.Materials and Methods: 1150 patients undergoing various types of elective thoracic, airway, head and neck and general surgery or procedures with general, regional and sedation anesthesia techniques were entered into the study. Also, data regarding the all anesthetic/ operation data, patient characteristics and shivering were recorded.Results: The overal incidence of shivering was 17/9%. Subsequent analysis demonstrated the importance of a number of factors that were significantly related to increasing shivering including female gender, young adult, general anesthetic technique, intramuscular morphine and hydrocortisone premedication. Surgery and procedures less than 1 hr in duration and performance of procedures in comparison with surgery significantly reduced the incidence of shivering postoperatively. Conclusion: We found that age, general anesthesia, gender, performing surgery rather than procedures, and duration of surgery increases the risk of postoperative shivering.

The term aortic aneurysm refers to pathologic dilation of the normal aortic lumen. Rupture is the major complication of thoracic aortic aneurysms. Fewer than half of patients with rupture may arrive at hospital alive. This is a case of descending aortic aneurysm that was ruptured acutely in CCU. He arrested and was resuscitated immediately and repaired surgically. He had a well done the hill course postoperatively and discharged after 28 days.