JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2004 | Volume:25 | Issue:46|Papers Count:10

One of the most important complications of elective cesarean is the effects of anesthetic drugs on the fetus. On the other hand preventing the use of them could also be really dangerous to the mothers. It has been shown that sedative drugs with short acting effect could be helpful in this issue.This study was conducted to evaluate the effect of remifentanil on blood pressure and pulse rate of the mothers and the APGAR Score changes in fetus of those who underwent elective cesarean.In this double blinded randomized clinical trial, of the 18-35 years old pregnant women, who were candidated for elective cesarean in Loghman Hospital, 60 were selected sequentially. The study population was divided into two randomized equal number of patients in case and control groups.Remifentanil was used for cases. Hemodynamic factors and APGAR score were evaluated in both groups.Comparison of the mean mothers heart rate changes before and after induction of anesthesia showed significant difference between cases and controls (5.4±16.5 Per minute vs. 29.5± 13.6 per minute, p<0.05). Mean systolic blood pressure changes before and after induction also showed significant difference between cases and controls (3.8±18.4 mmHg, vs. 28.0± 16.3 mm Hg, p<0.05).Mean diastolic blood pressure changes before and after induction also showed significant difference between cases and controls (3.8± 11.8 mm Hg, vs. 20.9mmHg, p<0.05). Mean MAP changes before and after induction showed significant difference between cases and controls (3.8± 11.3 mm Hg, vs. 23.3± 11.9 mm Hg, p<0.05), but mean MAP before and after fundal maneuver did not show any significant difference between. these groups. Mean of first minute APGAR score did not show any significant difference, where as mean of fifth minute APGAR score did show significant difference between these groups (9.9± 0.3 vs. 10.0± 0.0 mmHg, p<0.05).Considering the results of this study and comparing with other studies it seems that remifentanil can prevent hemodynamic changes during cesarean section. It also will not change the APGAR score. By conducting more research studies, it may be possible to state that remifentanil is suitable for cesarian section

Jet ventilator creats an unobstructed view of Larynx and produce adequate ventilation without inflammable endotracheal tube in airway laser surgery. The goal of this study was evaluation of arterial blood gas during laryngeal polyp surgery and its correlation with duration of operation, age and Body Mass Index. In a prospective study thirty four patients with ASA PS I and ASA PS II elective laryngeal polyp surgery were ventilated by percutaneas transtracheal jet ventilation with 24-30 Respiratory Rate. After standard monitoring, arterial line established, one sample of arterial blood gas assessed, just before anesthesia and every 15 minutes after Anesthesia.Data were analyzed with SPSS. 34 patients were studied of whom 21 were males and 13 were female. Mean age of the patients was 44.59± 12.48 years and mean weight was 70.09± 12.33 kg. Mean BMI was 24.80±2.78 and mean time of operation was 33.12±5.75 minutes. We found an strange correlation between increase of PaCO2, decrease pH and increase of BMI, age and the time of operation.

The Larynegeal Mask Airway (LMA) is used to maintain a reliable airway for elective surgery.During general anesthesia with the laryngeal mask airway a significant increase in cuff pressure due to diffusion of nitrous oxide through the cuff occurs.This descriptive clinical study was conducted in a university teaching hospital with 123 patients (ASA physical status, I & II, 10-60 years, weight 30-60 kg).After induction of anesthesia with the same technique, an appropriate size LMA was inserted.The LMA leak was detected by closing the pop-off valve and listening the patients neck by stetoscope. Then LMA cuff pressure was determined by connecting the check valve of the LMA pilot balloon to an sphygmomanometer.The mean LMA cuff pressure was 15.03 mm Hg (0-20 minute group) 9.2 mm Hg (20-40 minutes group). 4.5 mm Hg (40-0 minutes group), 0.95 mm Hg (60-80 minutes group), and -1.11 (80-100 minutes group).This study demonstrated that there was a gradual increase in the cuff pressure well over an 80 minutes period during nitrous oxide and oxygen anesthesia.

To study the hemodynamic and respiratory effects of adding 20 mg pethidine to 75 mg 5% hyperbaric lidocaine in elderly patients with ASA III or IV. We selected 150 elderly patients aged 60-80 years old, with ASA III or IV, who were scheduled for lower abdominal or lower extremity surgery. These patients received 20 mg pethidine, 75 mg 5% heperbaric lidocaine for spinal anesthesia. Non invasive systolic (SAP), mean (MAP), diastolic (DAP) blood pressure, heart rate (HR), and respiratory rate (RR) were measured pre- and intraoperatively, and 1 hour after the end of surgery. Visual Analog Scale (VAS) was also assessed during surgery and in first and sixth hours after surgery.SAP, MAP, DAP, HR, and RR were not significantly different during these times. Side effects such as nausea, vomiting, pruritus, flushing, and apnea were not observed. non of the patients need to general anesthesia due to inadequate analgesia.We found that adding 20 mg pethidine to 75 mg 5% hyperbaric lidocaine for spinal anesthesia in elderly patients with ASA III or IV had no hemodynamic and respiratory complications.

Patients receiving transplanted kidneys present many problems to the anesthetists. The use of continuous epidural anesthesia in these patients is still controversial but promising. To evaluate the effectiveness and safety of epidural lidocaine anesthesia in these surgeries we designed a prospective randomized clinical trial with 60 patients between 20-55 yrs old that candidate for renal transplantation. The patients randomly divided in two groups, general and continuous epidural anesthesia. We used thiopental, fentanyl, midazolam, halothane and atracurium for general anesthesia group and in another group epidural needle was inserted on spine level T12-L3 and then 18 cc lidocaine in 4 mg/kg with 2cc bicarbonate was injected, and then the epidural catheter was inserted in epidural space. During the first hour after the bolus injection of lidocaine, infusion of 8 ml of lidocaine 1% was started and continued until the end of operation. All patients were sedated with midazolam as needed. In both groups SBP (systolic blood pressure), HR (heart rate) and ABG before and after induction were checked until 60 minutes.SBP didn't have any significant deference in both groups, but in epidural patients 15 min after induction HR significantly decreased (pIn conclusion continuous epidural anesthesia seems preferable method in selective patients for renal transplant and postoperative pain will be controlled better.

Post anesthetic shivering is an unpleasant complication and develops 5-60% with respiratory and hemodynamic changes. Tramadol is a synthetic µ agonist and its side effects is less than other synthetic agonists.Dexamethasone is an anti-inflammatory drug and decreases the gradient between central and peripheral temperature.165 patients were chosen randomly. For control group we did not administer antishivering drugs. The second group received 8 mg dexamethasone before induction of anesthesia and the third group received 25 mg tramadol during skin closure.The results were analyzed with X2 or Ci-squered test. The incidence of shivering was 36.3% in control group, 21.8% in dexamethasone group, and 9.1% in tramadol group. Differences were statistically signifcant between control or tramadol groups (p<0.005).Post anesthetic shivering has been decreased with 25 mg tramadol in our survey and we recommend it for all patients in any age group and cardiac patients specially.

After intubation, inflating a cuff around the endotracheal tube maintains a seal, which can result in bucking during emergence from anesthesia that accounts one of the most common clinical problems. We sought to evaluate the effect of filling an endotracheal tube cuff with lidocaine as a reservoir in order to aneshetize the mucosa and attenuating stimulation during extubation of the trachea.A total of 90 patients with ASA Class I-II undergoing elective surgery were enrolled in a prospective, randomized. double-blinded study and divided to three groups (n=30. each group).After intubation of the trachea with an endotracheal tube, the cuff of the tube was filled with either 5 ml saline 0.9%, lidocaine or 4 ml lidocaine 4% plus 1 ml bicarbonate. After extubation, a blinded observer noted heart rate, blood pressure, severity and the incidence of bucking. Data were analyzed by using analysis of variance, Student's t-test, and the Kruskal-Wallis test for multiple variables.The groups were demographically comparable (p>0.05). Increasing of heart rate, blood pressure, severity and the incidence of bucking and incidence of sore throat were significantly lower in lidocaine, lidocaine -Bicarbonate compared to normal saline (p<0.05).We conclude that inflation of the cuff of the endotracheal tube can reduce the incidenceof bucking and hemodynamic changes.

Postoperative nausea and vomiting is the most common complications of adenotonsilectomy that accompanies a lot of problems.In this study we assessed the effect of dexamethasone and metoclopramide on nausea and vomiting after adenotonsilectomy.60 patients with age between 2-12 years and ASA I-II that were candidate for adenotonsilectomy were divided in two groups. After general anesthesia which was the same in all patients, for the first patient we prescribed metoclopramide with the dose of 0.3 mg/kg up 10 mg, and for the later one we prescribed dexamethasone the dose of 0.15 mg/kg up 8 mg.Nausea and vomiting were assessed in all patients, during two phase, the early phase (O-4hr) and the late phase (4-24hr).The result of this study demonstrated the metoclopramide was effective on nausea for the early phase (0-4hr) and dexmaethason was significantly more effective than metoclopramide during the late phase.As the potency and cost effectiveness of dexamethasone, is more than metocloperamide, its prescription for prevention of nausea and vomiting is advocated.

Non cardiac pulmonary edema which is known as pulmonary edema with negative pressure (NPPE) during airway anesthesia is caused by upper airway obstruction due to laryngospasm. This problem happened for a patient who was anesthtized for cataract surgery.A 60 y/o male who was candidate for cataract extraction, after induction of anesthesia was found to have an unpredictable difficult intubation because of anterior position of the larynx. At the end of operation, immediately after extraction of endotracheal tube, severe laryngospasm with copious amounts of pink foamy secretions was developed. Supportive measures including reintubation and mechanical ventilation were performed and the patient was admitted in the ICD and supportive ventilation was started. Successful weaning was done after two days and the patient was extubated.NPPE is non cardiogenic pulmonary edema which is caused by a negative intrathoracic pressure due to upper airway obstruction which causes shifting of fluid to the interstitial lung space. Signs and symptoms includs tachypnea, shortness of breath, production of copious amounts of pink, foamy secretions and decreased arterial oxygen saturation. Great degree of suspicious is very important for its diagnosis. Our patient undergone immediate supportive managements including establishment of airway, medical management, complete monitoring, and ventilatory support in intensive care unit. 2 days later weaning and extubation was done successfully