JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2005 | Volume:27 | Issue:52|Papers Count:12

Background: Adequate depth of anesthesia is very important for anesthesiologists. By using bispecteral monitoring we can use proper doses of drugs while providing adequate depth of anesthesia. The aim of this study is to see if using BIS monitoring during CABG surgery will reduce the amount of propofol and remifentanil needed for maintenance of anesthesia.Materials and Methods: This prospective randomized controlled study was performed on 60 patients scheduled for CABG surgery in a university affiliated hospital. Patients were randomly divided into two groups. Induction of anesthesia was similar in both groups. Maintenance of anesthesia was with infusion of propofol and remifentanil adjusted for proper depth of anesthesia. In the study group the depth of anesthesia was monitored by BIS monitoring (maintaining BIS number between 40-60), and in the control group. The depth of anesthesia was controlled by the clinical and hemodynamic signs. Management of hemodynamic changes during anesthesia was performed with the same protocol in both groups. The amount of total anesthetic drugs was measured at the end of anesthesia. Comparison of two groups was performed with "T-test". Results: Both control and study groups were similar in age, sex, CPB time and the duration of anesthesia. There was no difference between the two groups in consumption of propofol and remifentanil and the p-value were 0.212 and 0.513, respectively. Conclusion: This study showed no difference in the dosage of propofol and remifentanil between two groups. We concluded that the use of BIS monitoring may have little effect on reducing dose of propofol and remifentanil during anesthesia for SABG surgery, when compared with the clinical signs.

Background: In respect of great advantages of bispectral Index (BIS) usage in assessment of depth of anesthesia, the question that "if we can assume benefits of this index, relating to sedation" seems to be logic. In this study the relation between BIS and amnesia during midazolam and midazolam-propofol sedation is evaluated. Materials & Methods: In this prospective clinical trial 107 ASA 1-11patients undergone elective orthopedic surgery under regional I local anesthesia randomly divided into 2 groups named M and MP. Both groups received 2.5 mg midzaolam. Before procedure after blocking, in M group incremental bolus of midazolam and MP group continuous infusion of propofol adjustably administered. In recovery room patients were questioned indirectly about any events during their presence in operating room and any spontaneously recall were considered positive (loss of amnesia). BIS index was measured using frontotemporal leads besides standard monitorings.Results: All patients remembered anesthetic procedure completely and clearly. None had delayed recovery. Overal recall incidence was 13.1% and 12.5% and 13.6% respectively in M and MP groups. Mean BIS index was 81.4 in MP and 80.1 in M (p.val.> 0.3). There wasn't any significant statistical difference between BIS in recall cases and Mean BIS index of groups.Conclusion: BIS can be used as a monitor of depth of sedation in conjunction, but not as the sole. Clinical sedation doesn't guarantee amnesia.

Background: Deliberate hypotension by different methods is a useful technique in anesthesia. This technique by decreasing bleeding provides a better surgical field while reducing the need for allogenic blood transfusion. One method is to use the inhalational anesthetics. In the present research halothane and isoflurane, each one alone and in combination have been compared regarding their arterial blood pressure reducing effect. The aim of this research is to find a simple and suitable technique for blood pressure reduction during surgery. Materials & Methods: Sixty spinal column surgery patients (duration of surgeries: 1-3 hrs), with ASA physical status class one and between 19-44 yrs of age, were allocated randomly to three groups (20 in each). All of the patients were operated by one surgeon. Induction of anesthesia was similar for all patients. Then maintenance phase of anesthesia was started differently in each group as: Group 1: Halothane (1.2 MAC) + Nitrous oxide (50%) + Oxygen (50%)Group 2: Isoflurane (1.2 MAC) + Nitrous oxide (50%) + Oxygen (50%)Group 3: Halothane (0.6 MAC) + Isoflurane (0.6 MAC) + Nitrous oxide (50%) + Oxygen (50%)The patients' blood pressures were measured from the beginning of anesthesia till the end of the surgery by "NIBP" (non. invasive blood pressure) monitoring every 5 minutes. The recorded data were analyzed by one-way analysis of variance (one-way ANOVA) and Scheff's paired compare means tests.Results: The results showed that the mean arterial blood pressure has greater drop in group 3 (halothane + isoflurane comparing groups 1 and 2 (p values 0.04% and 0.014 respectively).Conclusion: It can be concluded that the blood pressure lowering effect of halothane and isoflurane in combination is more effective than isoflurane of halothane alone.

Background: Hypotension and bradycardia are the common side effects of spinal anesthesia. Strategies for treating spinal anesthesia-induced hypotension include intravenous volume administration or pharmacological reverse of systemic vascular resistance reduction, by using vasopressor agents. However, rapid infusion of large amounts of fluid is not appropriate, and sometimes may be hazardous in patients with cardiac dysfunction. We investigated efficacy of intravenous atropine usage for prevention of spinal anesthesia-induced hypotension.Materials & Methods: In a randomized, double blind clinical trial, 42 ASA I patients, aged between 20-50 yrs, undergoing elective lower abdominal surgery, were studied in two groups. The patients were received either placebo (group P, n = 21) or atropine 10 µg/kg (group A, n=21) after induction of spinal anesthesia. All patients received IV infusion of 7 ml/kg balance salt solution (Ringer) and midazolam 0.02 mg/kg before induction of spinal anesthesia. Heart rate, systolic and diastolic blood pressure were measured before and during the first 30 mins after induction of anesthesia. Results: Hemodynamic changes, in placebo group were significantly more than atropine group (p<0.03). Conclusion: In patients without present contraindication, administration of atropine is beneficial for prevention of hypotension following spinal anesthesia.

Background: Caudal block with local anesthetic agents has been extensively used in pediatric patients to provide intra and postoperative analgesia for surgical procedures such as herniorrhaphy or orchidopexy. Various additives to local anesthetic solutions have been used to prolong and enhance analgesia after caudal block. The aim of this study was to evaluate effectiveness of bupivacaine 0.25% with the addition of fentanyl or neostigmine for caudal block in children undergoing inguinal herniorrhaphy. Materials & Methods: 75 children were randomly allocated to three groups to receive a caudal block with either 0.75 ml/kg bupivacaine, 0.25% with 1mg/kg neostigmine (group BN), or 1µg/kg fentanyl (group SF) or 0.75ml/kg bupivacaine 0.25% alone (group B). Haemodynamic variables, degrees of pain and sedation, additional analgesic requirments, and side effects were evaluated. Mean age, weight and duration of anesthesia and surgery were similar in the three groups. Baseline systolic arterial pressure and heart rate were silmilar in the three groups.Results: Mean intraoperative systolic arterial pressure and heart rate were higher in group B than the other groups, but this was not statistically significant. Adequate analgesia was obtained in 21 (84%) patients in group B, 23 (92%) in group BN and group BF. This difference was not significant. There was no difference in degree of sedation and analgesia between the groups. The incidence of vomiting was similar between the groups. No other side effects were seen.Conclusion: We found that addition of 1µg/kg fentanyl or 1mg/kg neostigmine to 0.75ml/kg bupivacaine 0.25% provide no further analgesic advantage when compared to 0.75 ml/kg bupivacaine of 0.25% alone in caudal block in children undergoing unilateral herniorraphy.

Background: Different studies have documented development of chronic pain after varieties of operations such as amputation, thoracotomy and inguinal hernia repair. Cesarean section is one of the most common types of surgeries in females. In review of literatures there are few studies about chronic pain after cesaren section. In the present survey we studied the prevalence of chronic pain after cesarean section and the risk factors predisposing to chronic pain state. Materials & Methods: With reviewing the medica records of all patients who had cesarean section from March 2001 to March 2003, after obtaining some data such as type of incision and demographic data, a predetermined question, which were written in lay language and modified from a survey used previously, asked about pain at the site of operation by a telephone contact. The questionnaire included demographic data and some questions about duration of incisional pain after surgery. If patient had pain at the time of study other questions were asked about the character of pain and its effect on daily life.Results: Among 1668 patients who were operated on, between 2001 and 2003 at Dr. Ali Shariati Teaching Hospital, 202 patients were available and completed the questionnaire (12%). The mean follow-up time was 22 months. Postoperative sin resolve in most patients within 3 months but 22 (11.4%) of them still had pain at the time of study. Among 22 patients (22.7%) had constant pain. Patients with history of previous cesarean section or other abdominal operations had significantly increased chronic incisional pain (p<0.05).Conclusion: Chronic incisional pain is a common problem after cesarean section (11.4%) and its prevalence increases with the presence other chronic pain problems and history of previous cesarean section and other operations.

Background: Despite of ESWL that is non invasive method for treatment of renal stone, energy that is released in enter area causes pain which is out of tolerance threshold and needs analgesic drugs. We decided to compare efficacy and adverse effects of three new generation of opioids including Fentanyl, Sufentanil and Alfentanilin patients undergoing ESWL.Material & Methods:. This study was a double blind clinicaltrial and was done on 90 patients under ESWL, were accidentally divided in three equal groups to evaluate efficacy and adverse effects of three drugs. In first group Fentanyl 1 µg/kg, in second group Sufentanil 0.15 µg/kg and in third group Alfentanil 5 µg/kg was given IV, 3 minutes before beginning of ESWL. Additive doses were given on the requisition of patients. We analyzed our data by SPSS 9.01 software and statistical tests.Results: Analyzing data shows no difference among 3 groups in demographic characteristics. In review point of efficacy, the use of intermittent doses of Fentanyl was dramatically less than Alfentanil (2.6 v.S 3.3) (p=0.047).Average doses of Sufentanil was less than Alfentanil (6.5 v.s 8.3) (p=0.049). Visual analogue scale (VAS) in fentanyl and sufentanil groups was lesser than Alfentanil group (3.4 v.s 4.7) (p=0.03). Adverse effects including changes in systolic and diastolic blood pressure and heart rate and SP02, incidence of nausea, vomiting and shivering had no significant difference between the groups.Conclusion: Based on the results of this study we recommend using Fentanyl and Sufentanil in patients undergoing ESWL.

Background: Electroconvulsive therapy (ECT) is an effective treatment of major depression and other psychological disorders especially resistant to medical therapy. ECT has some effects such as cardiac dysrhythmia, hypertension and myocardial infarction. Therefore for prevention, or attenuation of these side effects, some medications have been used. In this study we assessed oral clonidine (α2 agonist) as premedication on hemodynamic responses to ECT.Materials and Methods: This double blinded (cross over) clinical trial was done on 37 patients of class I and 11, who were candidates for ECT in Baharan Hospital of Zahedan in 1382 and received one of the regiments of placebo, 100 and 200 mg clondine. Results: After the same anesthesia we compared the heart rate and mean arterial pressure (MAP) before and after ECT in all groups. Our results showed that oral clonidine decreased significantly the heart rate (p<0.001) and mean arterial pressure, while convulsion time, recovery of spontaneous breathing, and recovery time did not significantly change in clonidine groups.Conclusion: Based on the results, oral clonidine by attenuation of stress and pain reactions, causes stabilization of hemodynamics especially heart rate after ECT, although has no affect on convulsion and recovery time. We suggest using this drug as premedication for patients who are candidates for convulsion therapy (ECT), especially those with abnormal cardiac stability.