JOURNAL OF IRANIAN SOCIETY ANAESTHESIOLOGY AND INTENSIVE CARE
Year:2001 | Volume:21 | Issue:35-36|Papers Count:10

The effect of anesthesia technique on the rate of fertilization and pregnancy is very important in the artificial pregnancy.In our study we have compared the effects of general anesthesia and conscious sedation in two equal group of women admitted for artificial fertilization to Valiasr Hospital. General anesthesia was IV anesthesia with Thiopental and Alfentanil and inhalation anesthesia was avoided.Sedation was with Midazolam and Alfentanil.The rate of fertilization was detected by dividing the amount of fertilized ovum to the amount of matured oocytes.The rate of pregnancy was detected 15 days later by Gravindex test. The rate of fertilization and pregnancy in conscious sedation group was 75.4% and 25% and in general anesthesia group was 77.7% and 20.8%. Although we could not find significant differences between two groups on the rate of fertilization (P=0.620) and on the rate of pregnancy (p=0.404), but the result of our study was providing two appropriate methods of anesthesia for IVF which could be chosen each of them depending on general condition, or desire of the patient.

We studied 40 patients aged 20-65 years ASA. I , undergoing abdominal surgery.Twenty patients in the propofol group with fentanyl received propofol infusion rate with microset 4mglkglhour reduced to 2mglkglhour after 10 minutes, intravenous injection fentanyl one micrograme/ Kg each 30 minutes and O2.20 patients in the ketamine group with fentanyl received Ketamine infusion rate with microset 4mg/kg/hour reduced to 2 mg/kg/hour after 10 minutes. Intravenous injection Fentanyl one micrograme /kg each 30 minutes and O2.We performed a prospective, randomized Propofol group and Ketamine group: A comparison effect on haemodynamic response and recovery.Systolic and diastolic blood pressure was recorded at 5 minutes intervals, mean at the end of surgery 120 minutes.Patients at Ketamine group responded to skin incision with increasing blood pressure higher than Propofol group.Recovery by measuring mean time to spontaneous ventilation, tracheal extubation, opening of the eyes and stating correct name. Recovery was more rapid in the Propofol group than Ketamine group and clinically the difference was significant.

Background: Postoperative shivering is an important problem during recovery from general anesthesia. Corticosteroids have been recommended to facilitate recovery after cardiac surgery. Previous studies recommended 0.6 mg/kg dexamethasone for reducing postoperative shivering in patients who have undergoning cardiac surgery. In our study, we used dexamethasone 0.15 mg/kg in patients undergone routine surgeries like laparatomy , thoractomy , orhtopedy , urology and gynecology.Methods: A total of 200 patients undergoing elective surgery were randomized to receive 0.15 mg/kg dexamethasone or placebo after the induction of anesthesia and before skin incision. Patients didn't use any drug continuously for co-existing diseases like: D.M., HTN, I.H.D. etc.Results: It is found that the patients who had recieved dexamethasone had a lower incidence of posoperative shivering compare to the others who received placebo. (12% V/S 31% p=0.001)Conclusion: Small dose of dexamethasone (0.15mglkg) can decrease the incidence of postoperative shivering in routine surgeries, when diazepam, morphin, S.T.P, O2 N2O, halothane are used for induction and maintenance of general anesthesia.

History and Objectives: In Islamic Republic of Iran there have been few studies about mortality and Morbidity due to anesthesia and surgery. So we designed a descriptive retrospective study in Hazrate - Fatimeh Hospital which is a center for maxillo facial & reconstructive surgery to find out what is the rate & what have been the causes of mortality & important complications in 48hrs after surgery that leaded to ICU admission.Materials and Methods: In a descriptive retrospective study, we went through medical records of those patients who had died or have been admitted to ICD within 48hrs after operation. And we found out what has been the cause of complications.Results: There have been 23623 surgical operations in last 18 years in this center. Mortality rate in 48hrs after surgery was 9 23623 (0.04%) and 199 (0.8%) cases were admitted to ICU due to important complications. 90% of complications were due to respiratory complications and airway management.Conclusions: Most of the incidences were related to airway & respiratory problems. It seems that half of the mortality cases could be prevented by better management. Our mortality rate  (1:5000) in comparison to other studies in other countries were similar at the same time.

In this study the efficacy of intrathecal Midazolam in the management of acute post operative Pain in C/S has been examined.Methods: 151 patients scheduled for caesrean section under spinal anesthesia were randomly allocated in two groups in subject group with 75 patiens spinal anesthesia was performed by 80g of lidocain Hyperbaric Solution plus 2.5mg Midiazolam and in Control group spinal Anesthesia was performed with 80mg Lidocain Hyperbaric. In post operative period, pain evaluation was determined by Visual Analogue Score in one and three hours after C/S.Results: The mean of VAS in 1 and 3 hours after C/S in Subject and Control groups respectively: (2.5±1.2, 4.9±1.9), (8.8±1.5, 5.9±1.7) with (p<0.0001). Ketamine injection, hypotention and shivering in subject group is lower than control group (p<0.01) respectively: (1.3% Versus 50%), (29.3% Versus 42.1%), (4% Versus 57%).Conclution: Midazolam intrathecal without side effects can reduce postoperative pain.

Objective: With increasing number of critical patients in intensive care units which are intubated and under mechanical ventilation, the number of patients that need endotracheal suctioning is increasing too.Endotracheal suctioning is done in critical patients to clear and patent airway but this procedure is invasive and has many side effects such as homodynamic and AEG disturbances. This study was designed in order to compare homodynamic and ABG values before and after endotracheal suctioning.Methods: For this purpose, in this descriptive study, 60 patients after open heart surgery in PACU were selected by convenient sampling. All of them were intubated and under mechanical ventilation. Their hyperinflation of the lungs, after hyperinflation and after endotrcheal suctioning.Methods: The most common changes were tachycardia and hypoxemia after endotracheal suctioning. In most patients there was 5-15% tachycardia and there was 2-6% hypertention too. Common arrhythmia were PVCs which occured in 11 patients but resolved without any pharmacologic intervention.Conclution: Correct method of endotracheal suctioning can decrease homodynamic and ABG disturbances to the level that has no serious danger for critical patients. Hyperinflation of lungs before endotracheal suction without hyperoxygeation has not any effect in prevention of hypoxemia.

Introduction: This study was designed to evaluate and find optimal treatments for discrete membranous sub aortic stenosis (DMSAS). DMSAS presented by Chevers in 1884 and its pathology was published by Sir Arthur Keith in 1924.Material and Method: During 15 years (1986-2001) 377 patients from 8418 pediatric cases went under surgical operation for DMSAS Surgery performed with mild hypothermic CPB and cardiopelgic. The membrane was resected by transaortic approach. We collect data with a cheque list and analyzed them with SPSS software.Results: Surgery operation was not recommended for 49 patients (13%) at the first observation of DMSAS, because the gradient was under 40mmHg, mean age of patients was 8.2 (3-21) years and 24.4% (n=92) of them had aortic valve insufficiency (AI) before surgical operation. Mean aortic gradient was 109 (40-189) mmHg. For 117 cases the surgery operation was accompanied with AVR. Mean pump time was 37 (29-157) min. The most frequent complication after surgery was left hiss bundle branch block (17.77%). Mitral valve damage and ventricular septal defect (YSD) were others complications.Requirement (17.77%) and inotropic drug (10.11%) were needed for weaning of CPB.Discussion: Discrete membranous sub aortic stenosis is an acquired disease. Published studies show that DMSAS is not congenital. Surgical operation is optimal treatment for DMSAS in which the lesion must be removed totally in case of requirence of the IHSS will be seen.

Primary Hyperaldosteronism in an uncommon cause of Hypertension, and with respect to high incidence of Ischemic Heart Disease and Hypertension in this syndrome, homodynamic stability in the management of anesthesia in this syndrome is very important.This is a case report of Conn's syndrome in a 31 years old male, i.e., homodynamic stability during anesthesia is achieved by infusion of propofol.