JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2004 | Volume:26 | Issue:48|Papers Count:12

This study compares two different concentrations of bupivacaine 0.25% and 0.125% for caudal anesthesia in pediatric surgery. In many pediatric procedures regional anesthesia can be used as a part of balanced anesthesia. Caudal epidural anesthesia has become widely accepted as a good technique for providing postoperative pain relief and intraoperative supplementation of general anesthesia of children. We compared the effects of two concentrations of bupivacaine in combination with general caudal anesthesia in children on 60 children, 1-7 years old, scheduled for elective surgery which was done below the umbilicus. For every patient caudal anesthesia with bupivacaine in one of two concentrations 0.125% or 0.25% was done. After surgical incision, a programmed reduction in inspired halothane concentration was done. Results show that children who received caudal block with concentration of 0.125% of bupivacaine had a higher pain score in comparison to 0.25% group, and older children had a lower pain score postoperatively than the younger children in both groups.      

Although the patients who undergo CABG with CPB under fast track cardiac anesthesia are extubated earlier than those who are operated under conventional anesthesia, there is no general belief that their length of hospital stay is shorter. In this study we examined the effect of these two methods of cardiac anesthesia on the length of the hospital stay of the patients. In this clinical trial study 51 patients who were candidate for CABG under CPB were divided into two groups. The first 22 patients were anesthetized with fast track method and the conventional method of anesthesia was used for the second 29 patients. The time of extubation and the length of stay in the hospital were recorded in all patients. Conclusion criteria were ASA 2-3 and the necessity of CABG under CPB. Patients who were on inotrops on mechanical ventilatory support or IABP before surgery were excluded from the study. Induction of anesthesia was the same in all patients. Infusion of propofol and fentanyl were used for maintenance of anesthesia in the first group and anesthesia in the second group was maintained with halothane, N2O, fentanyl and droperidol. Pooled T-test was used for examining the difference between the mean length of extubation and the mean length of stay in the hospital and p of less than $)/05was considered as significant. The mean length of intubation time was 5.57 hours (SD= 1.04) for the first group and 8.14 hours (SD= 2.28) for the second group. The difference was significant and the p was less than 0.0001. The mean length of ICU stay was 2.1 days (SD=1.1) in the first group and 2.8 days (SD=1.3) in the second group. And the difference was significant. (p=0.065). Although the patients in fast track groups were extubated earlier and stayed in ICU for a shorter time than those who had conventional anesthesia the length of stay in hospital was the same in both groups.    

Selection of anesthesia techniques in cesarean section is related to condition of surgery, emergency physical status of patient and request of the patient. Anesthesiologist must select a method of anesthesia that is simple, careful and safe for the mother and the fetus. This study was done on 50 patients in ASA Class I, who were candidates for elective cesarean section surgery after consent and without contraindication for spinal anesthesia. Patients were divided into two groups, 25 patients in each group. Group A was control group and patients in group B received 10mg intradermal ephedrine. All patients received 3-5 ml/kg crystalloid, fluid and then comforted under spinal anesthesia with 75 mg lidocaine 5%. 20% reduction in systolic blood pressure was considered for hypotension. Patients received 3-5 ml/kg crystalloid, fluid and then 5 mg intravenous ephedrine which were repeated if it was necessary. In comparison to group A, hypotension occurred less frequently in group B, during the first 20 minutes after administration of spinal anesthesia (p: 0.05) We found that 10 mg intradermal ephedrine can reduce risk of hypotension after spinal anesthesia in cesarean section surgery (especially during the first 20 minutes which is the most common time for hypotension after spinal anesthesia) and can reduce necessity for fluid therapy, but there were not any significant changes between two groups after 20 minutes. So intradermal ephedrine may be significantly reduce the occurrence of hypotension after spinal anesthesia.      

In order to compare efficacy of sucralfate and ranitidine in prevention of aspiration pneumonia as one of the important causes of mortality and morbidity in critically ill patients, this study was performed on the mechanically ventilated patients in Sina Hospital in the years of 1382-83. In this study 80 traumatic patients that needed mechanical ventilation were accidentally divided in two equal groups. The first group received sucralfate for the prevention of stress ulcers and the latter ranitidine, meanwhile the incidence of aspiration pneumonia and stress ulcer were observed. In the first group sucralfate therapy was began with 1 gr oral sucralfate and continued each 6 hrs and in the second group 100 mg loading dose of ranitidine continued with 50 mg each 8 hrs. For all of patients we examined CBC, CXR, ABG, intragastric pH monitoring and aspiration pneumonia. Criteria contains rising WBC, Chest Xray infiltration especially in the right lung, positive blood culture and concomitant positive ETT secretion culture were observed. Stress Ulcer was considered with more than 5 RBC's in each mg of gastric juice. After completion of study, aspiration pneumonia incidence were 3.40 (7.5%) in sucralfate and 11.40 (27.5%) in ranitidine group (p value = 0.019). There was no significant difference between the incidence of stress ulcer in sucralfate (6.40, 15%) and in ranitidine group (4.40, 10%) (p value = 0.739). There is a significant difference in aspiration pneumonia prevention in these groups. Based on the results of this study we recommend using sucralfate in critically ill patients for both stress ulcer and aspiration pneumonia prevention.    

This study was designed to evaluate the efficacy of subtenon block (preemptive analgesia) after general anesthesia and before beginning the repair of retinal detachment (RD) surgery by using scleral buckle and cryopexy (preemptive analgesia). 68 patients who were scheduled for retinal detachment surgical repair using scleral buckle and cryopexy and who was American Society of Anesthesiologists (ASA) I and 11were included in this clinical trail study. The patients were randomly and blindly divided in two equal groups (case n=34, control n=34). The surgery was done under general anesthesia in both groups, but in the case group, sub-tenon block was given as preemptive analgesia after induction of general anesthesia with similar methods and before start of surgery. The incidences of intra and postoperative (up to 24 hours) oculocardiac reflex (OCR), IHD changes, nausea and vomiting, delirium, total analgesic consumption, ocular severity of pain were significantly lower in the case group compared with the control group (p<0.05). Mean blood pressure, heart rate, time of discharge from the hospital, frequency of requirement with analgesic drug intra and postoperatively (up to 24 hours) were significantly lower in the case group  compared with the control group (p<0.05). According to this research the use of sub- tenon block in retinal detachment surgery effectively reduced postoperative pain, nausea, vomiting, analogic drug requirements, delirium, discharge time from hospital, IHD and hemodynamic changes, oculocardiac reflex (OCR) (up to 24 hours) compared with the unblock group.    

This study sought to determine patient characteristics, process of care, and outcome as predictors of reintubation after open heart surgery. We performed a retrospective case control study that included all patients undergoing cardiac surgery who required reintubation and an equal number of control patients not requiring reintubation. Putative risk factors were analyzed univariately by T-test and X2 tests and multivariatly by linear and logistic regression. Of the 300 consecutive patients reviewed, 39 required reintubation for cardio-respiratory reason. Univariate predictors of reintubation (p=0/05) were preoperative CO2, ejection fraction, weight, diabetes, and intra operative fluid balances. Multivariate predictors of reintubation for each group of cardio-respiratory reasons and for total patients were determinated that includes, preoperative PaCO2, Type of operation, ejection fraction pre operative paO2, number of graft, age, intra aortic ballon pump, pump time, clamp time, pH in extubation time, and PaO2 in extubation time. Patient who required reintubation had worse respiratory function. Patient identified as having as high risk factor for reintubation should be followed closely and treating the problems leading to reintubation.      

Foreign body aspiration is one of the most important emergency problems in medicine which has a wide spectrum of signs and symptoms. As are symptoms, may mimic symptoms of other diseases, accurate diagnosis denotes physician expertise and carefulness. The aim of this study is defining its important signs & symptoms and role of the bronchoscopy in its diagnosis & treatment. This is a retrospective analysis of 44 patients, records who had been suspected to have foreign body aspiration between 1998-2002 in Loghman Hospital. The signs and symptoms and the bronchoscopic results were evaluated. 72.2 % of patients had airway foreign body and most of them were 1-2 years old. Cough and respiratory distress with 93.8% and 90.6 % respectively had the most common objects were food materials and in children of school ages it was school related objects. Radiography reveals no abnormality in 37.5%. Every patient with sudden onest cough & respiratory distress should be suspected to have aspirated foreign body. History and physical exam are the most important diagnostic factors. Radiography although is supportive but could not rule out the diagnosis and if  clinical suspicion rise rigid bronchoscopy is a safe diagnostic and therapeutic tool.      

Postoperative nausea and vomiting is one of the most common and distressing complications in the recovery period. The aim of this study was to evaluate the prophylactic effect of low dose (5 mg) dexamethasone on postoperative nausea and vomiting (PONV) in women undergoing anterior & posterior colporraphy under general anesthesia. Saline served as control. Forty women (n=20 in each group) undergoing APR and ASA I & II were enrolled in this randomized double-blind placebo-controlled study. Immediately before the induction of anesthesia, group 1 received 5 mg dexamethasone intravenously whereas group 2 received saline with the same volume as group 1. There was no statistically significant difference between group 1 & 2 in the incidence of PONV (p>0/05). We concluded that although the effectiveness of low dose dexamethasone has been proven in previous studies, but low dose dexamethasone dose not significantly decrease PONV in patients undergoing APR.      

Negative pressure pumonary edema, is a well recognized phenomenon, and in the formation of pulmonary edema following an acute upper airway obstruction (UAO), an incidence of as high as 11%. The principal physiologic mechanism underlying the formation of edema in this setting involves the generation of markedly negative intrathoracic pressure leading to a net increase in the pulmonary vascular volume and the pulmonary capillary transmural pressure (Ptm). This is a report of a case of diffuse alveolar edema following an acute UAO. The pathophysiology and etiologes of NPPE is discussed.