effects of aminophylline on clinical recovery and bispectral index in patients anesthetized with total intravenous anaesthesia

Aminophylline, which is clinically used as a bronchodilator, antagonizes the action of adenosine, so it can be used to shorten the recovery time after general anesthesia. Therefore, we wanted to test the hypothesis that the administration of aminophylline leads to an increase in bispectral index [BIS] and clinical recovery in patients anesthetized with total intravenous anesthesia [TIVA]. Ninety two patients who were scheduled for elective inguinal herniorrhaphy were enrolled in this study. All patients were premedicated with midazolam and morphine. Anesthesia was induced with propofol 2.5 mg/kg and remifentanil 2.5 microg/kg without muscle relaxant. For maintenance of anesthesia we used propofol 100 microg/kg/min, remifentanil 0.2 microg/kg/min and 100% oxygen with stable BIS readings in the range 40-60. After skin closure, aminophylline 4 mg/kg was given to Group A and an equivalent volume of normal saline to Group P. BIS values, heart rate, blood pressure, oxygen saturation and End tidal CO2 [ETco2] were determined. Time to eye opening, extubation time and response to command were measured. There were no significant differences in SpO2, ETco2 and anesthesia time. Heart rate and systolic blood pressure were found to be statistically higher [p<0.001] in Group A. Time to eye opening, hand grip and extubation were significantly shorter [p<0.001] in Group A. Bispectral index scores were significantly higher in group A. Injection of aminophylline at emergence time led to significant increase in BIS and shortening recovery time from anesthesia

Music can effectively reduce pain perception in women rather than men

Nowadays music is used to decrease pain and increase relaxation in clinical settings. It is hypothesized that music can affect women more easily than men. We assessed the effect of two types of music [Iranian folkloric and preferred music] on pain tolerance and pain rating in cold pressor test. A consecutive sample of 50 healthy Iranian medical students was enrolled. They reported pain tolerance and pain rating in cold pressor test in three different musical conditions served as the outcome measures. The results were analyzed with repeated measurement analysis of variance. Mean tolerance time was significantly higher in preferred music compared to Iranian folkloric music [F [1,48] =25.44, p=0.0001] and no music [F[1,48]=3.51, p=0.0001] conditions. There was a significant interaction when tolerance time in no music condition was compared to preferred music condition, regarding sex; Tolerance time increased more in females [F[1,48]=5.53, p=0.023]. The results also indicated that pain ratings, regardless of sex, were different in three musical conditions [F[1.7,81.34]=15.37, p=0.0001]. Music distracted attention from pain and Women can be impressed and distracted more easily by music

comparative study of depth of anesthesia monitored by BIS values in two anesthesia techniques and their cost-effectiveness

Propofol is an intravenous agent used extensively in total venous anesthesia [TIVA], but its acquisition cost is nearly 1 to 3 folds higher than other intravenous or inhalation agents. Thiopental is an ultra short acting barbiturate which can reduce the cost of induction to one seventh of Propofol induction cost. In this study, by BIS monitoring of the depth of anesthesia, we evaluated maintaining anesthesia with Propofol while Thiopental has been used for induction of anesthesia and the aim of study was to find a cost effective method. In a single blind clinical trial, 82 patients with ASA II and I scheduled for cataract surgery were randomized in two groups. In the first group [A], induction of anesthesia was done with Propofol 2 mg/kg and then anesthesia maintained with Propofol 100 micro/kg. In the other group [B], induction was Thiopental 5 mg/kg and anesthesia maintained with Propofol 160 micro/ kg. BIS monitored depth of anesthesia throughout the procedure. We compared the BIS values in each step of the procedure in both groups. After extubation, mean of BIS score were 87.53[ +/- 2.52] and 88.79[ +/- 2.07] for groups A and B respectively. This difference was not clinically significant. Multiple linear regression analysis, identified decreased maintenance dose of Propofol and duration of surgery as independent predictors for BIS span 40-60.[P < 0.000,r[2] =0.558]. Cost effectiveness [acquisition cost/percent of 40-60 BIS span] for groups A and B were 2.95 S and 1.03 S respectively. Minor surgeries like ophthalmic surgery can be conducted with maintenance of Propofol while induction is with Thiopental. Monitoring the depth of anesthesia with BIS showed that if we choose 160 micro/kg Propofol for maintenance then it is not necessary to have a loading dose and induction can be done by Thiopental. Further studies with different type of surgery and different maintenance doses of Propofol must be done