[Evaluation of BIS alteration and pupil dilatation after arterial unclamping following vascular anastomosis in kidney transplant surgery]

Renal transplantation is the best method of treatment for renal failure and anesthetic management during this procedure is of great importance. Proper dosage of the anesthetic drug for maintaining the respective depth is crucial as well. Arterial unclamping following anastomosis between the donor and recipient's kidney vessels, during which the functional kidney is inserted in the recipient's circulation, is a critical step in transplantation. To investigate the changes in Bispectral number and pupil dilatation as confirmed and probable markers of anesthesia depth have been investigated. This descriptive-analytic study was conducted on 25 patients undergoing renal transplantation in Razi hospital. Alteration in the depth of anesthesia was analyzed using BIS [Bispectral] index [at unclamping moment and its highest value within five minutes following unclamping] as well as pupil dilatation [5 minutes after unclamping]. All the patients underwent identical method of general anesthesia. Data were analyzed using SPSS version16, paired t- test and Mann-Whitney U test. Mean and SD value of the maximum BIS number within 5 minutes after arterial unclamping [68/32 +/- 9/13] and its value at unclamping moment [59/48 +/- 10/65] were significantly different [P<0.0001].The pupil became wider in 84% of the patients immediately after unclamping. No significant relationship was found between the pupil size and BIS change. Considering the present findings, it seems that the depth of anesthesia declines after arterial unclamping following vascular anastomosis of the transplanted kidney. We also found a new sign in kidney transplantation anesthesia, introduced as "PUPIL SIGN", that happens prior to urination from the transplanted kidney, which could have clinical implications for early prognosis of transplantation success

[ comparison of different propofol dose for anesthesia induction based on BIS [bispectral index] monitoring]

Abstract Introduction: Propofol is a new intravenous hypnotic drug that in combine with a short acting opioid have been used in total intravenous anesthesia [TIVA]. The BIS provides additional information for standard monitoring techniques to recognize depth of sleep and achieve the appropriate dose of drug

Objective: Comparison of different propofol dose for anesthesia induction based on BIS [bispectral index] monitoring

Materials and Methods: forty five patients with ASA class I, II who underwent surgical operation on leg fracture were randomly assigned to 3 groups. Group A with a propofol dose of 1mg/kg, Group B at a dose of 1.5mg/kg and Group C at a dose of 2mg/kg were studied. Remifentanyl [0.5mcg/kg] was added to propofol as opioid drug. The method of BIS index [50-60] has been used for determination of consciousness level and the depth of sleep and for achieving the appropriate dose of propofol. The patients were evaluated to determine occurrence of hypotension, bradycardia, the presence of intubation movement and the autonomic signs

Results: The mean levels of BIS was 58.8 +/- 9.85 in the Group A, 50.2 +/- 6.55 in Group B, and 44 +/- 5.65 in Group C. Comparison between the mean levels of BIS revealed that the Group A was significantly different with the other two groups [p=0.009]. Optimum level of BIS was significantly different in 3 groups .group B [%66.7], group A [%40], group C [%20], less than of all groups [P=0.034]. Hypertension incidence following intubation in group A was 33.3% and Group B was [%6.7] and in group C wasn't any hypertension which detected a significantly different between three groups [P=0.018]. Regarding to need further propofol dose, there was a significant difference [P<0.001]. In group A, it was in %40 of cases, and in groups B and C it was not observed. Regarding to tachycardia, bradycardia, hypotension, movement and autonomic signs, there was no significantly different between 3 groups

Conclusion: It was appeared that group A is not appropriate due to incompatible with BIS, need Further propofol dose and hypertension. Considering the best BIS level in group B and lack of any benefit in group C for further propofol in achieving the optimum level of BIS [50-60], can be concluded that group B with propofol [1.5mg/kg] is the best dose for achieving the desired level of BIS with remifentanil at the mentioned dose

[Comparing the effect of normal saline and sodium bicarbonate on duration of anesthesia following epidural anesthesia by lidocaine 2% in patients with femoral fracture]

Introduction: Epidural anesthesia is one of effective regional anesthesia methods for different kinds of [small and large] surgeries. Prolongation of sensory and motor block following epidural anesthesia is accompanied by long stay in PACU and more post anesthesia care requirements. One of the essential needs is limiting hospital stay and decreasing epidural anesthesia side effects. Therefore, using methods that can cause early discharge and reduce sensory-motor and sympathetic blockade period are necessary. Using crystalloid solutions is one of these methods

Objective: In this study the researcher tried to compare the effectiveness of two crystalloid solutions – normal saline and sodium bicarbonate solution – to access the best method

Materials and Methods: This research is a randomized double blind clinical trial study. Sixty ASA-II patients who had repairing surgery for fracture of femor were divided into two equal groups [thirty patients in each group]. And all of them received 20ml lidocaine 2% through epidural catheter insertion. In the end of surgery, the patient was transported to recovery room and 15ml crystalloid solution – normal saline or sodium bicarbonate – was injected and then catheter was removed. The level of sensory blockage based on blocked spinal and motor blockage were examined and registered every 15 minutes by Bromage scale [zero=none, 1=motor blockage of hip, 2=hip and knee block, 3=ankle, hip and knee block]. Data was analyzed by t-test and Anova tests by SPSS.10 software

Results: The mean age in normal saline group was 41±12 and in sodium bicarbonate group was 43±11 years. There were 13 female and 17 males in normal saline group and 15 female and 15 males in sodium bicarbonate group. The mean of regression time of sensory block of sodium bicarbonate was 92min and 50sec, and due to normal saline was 99min and 25sec. The regression time of motor block due to sodium bicarbonate was 89min and 25sec, and due to normal saline was 94min and 50sec. All results were significant [P<0.05]. The regression of sensory and motor block due to sodium bicarbonate was more rapid than normal saline. Any side effect was not detected

Conclusion: According to data obtained, it seems that using sodium bicarbonate as compared to normal saline at the end of femoral surgery improves sensory-motor blockade sensation due to injection of Lidocaine 2%soution and educes PACU stay period and improves anesthesia tolerance. This method could be used for all patients whom receive epidural anesthesia