Comparing the combination effect of propofol-ketamine and propofol-alfentanil on hemodynamic stability during induction of general anesthesia in the elderly

Propofol [Diprivan], a modern intravenous hypnotic drug, produces a reduction in both cardiac index [CI] and mean arterial pressure [MAP] due to its sympatholytic activity. S-Ketamine [Ketanest], a potent analgesic, in contrast, causes an increase in both CI and MAP due to its sympathomimetic activity. This study was performed to compare the combination effects of propofol-ketamine and propofol-alfentanil on hemodynamic stability during induction of general anesthesia. In a prospective study, 100 patients over 60 [ASA I, II] scheduled for elective lower abdominal interventions were randomly divided into two groups. For induction of general anesthesia, after injection of midazolam, the first group [A] received alfentanil and propofol and the second group [B] received S-ketamine and propofol. Each group received atracurium as muscle relaxant. Blood pressure [BP] and heart rate [HR] were measured before and 1 and 5 minutes after induction of anesthesia. The increase in HR and decrease in MAP were statistically significant in both groups 1 and 5 minutes after general anesthesia. The increase in HR and decrease in MAP were significantly more in Group A, 1 and 5 minutes after general anesthesia. The dose of S-ketamine administered during induction of general anesthesia may not be enough to neutralize the cardio-depressant effect of propofol. A better hemodynamic activity was observed in Group B compared to Group A due to partial neutralization of the opposing action

Local infiltration of lidocaine versus lidocaine iontophoresis in pain relief during radial artery cannulation for open heart surgery

Traditionally, pain has been thought to be an unfortunate but inevitable part of disease and its treatment. Pain associated with medical procedures was ignored because it was thought to be unavoidable. The question of why physicians should treat pain is as important as the knowledge of preventing it, since it is a right measure to take. This study was conducted to compare the effectiveness of lidocaine iontophoresis with that of local infiltration of lidocaine for the prevention and reduction of pain during radial artery cannulation, in patients undergoing open heart surgery. The present study comprised 60 adult patients, 36 males and 24 females, aged from 29 to 84 years with a median age of 63.8 [ +/- 10.35 SD] and 65.4 [10.48 +/- SD] for groups 1 and 2, respectively. The patients underwent elective open-heart surgery in Nemazee Hospital affiliated to Shiraz University of Medical Sciences. Prior to induction of general anesthesia, patients were randomly allocated to one of two groups for analgesia prior to radial artery cannulation on an alternate week basis. Group 1 [n=30] patients received one-week analgesia using lidocaine iontophoresis, and analgesia in Group 2 [n=30] was performed using lidocaine infiltration the following week. Both groups were similar in terms of gender distribution. The VAS scores in group 1 were significantly lower than group 2 with no significant difference in the difficulty of cannulations between the two groups. There was no complaint of pain from patients during iontophoresis, and no report of any significant side effects. Slight skin erythma was noted after removal of the iontophoretic anode patch in 4 patients, which lasted for about 0.5-4 hours. This study has demonstrated that lidocaine iontophoresis is a useful, non-invasive, rapid, painless alternative to lidocaine infiltration for dermal analgesia for radial artery cannulation

Comparison of single dose of buprenorphine versus morphine administered during induction of Anesthesia for pain relief and sedation after lumber laminectomies

Post operative pain is, a common phenomenon that it is one of the important problems in surgery. Different methods have been used to control post operative pain. Morphine and Buprenorphine are classified as narcotics, and their effect on post operative pain relief has been evaluated in this study. This randomized clinical trial [RCT] was done on 40 patients with lumbar disk herniation that randomly classified in morphine and buprenorphine group. During induction of anaesthesia 0.2 mg/kg morphine and 4.5micro kg buprenorphine were injected intravenously to the corresponding groups, respectively. At the end of anesthesia, heart rate, systolic and diastolic blood pressure was evaluated as well as severity of pain. Then, collected achieved data were analysed. The severity of pain in buprenorphine group was less than morphine at all the times except the time of discharge from recovery [p<0.05]. With respect to sedation there was a meaningful difference between the two groups at the time of entering recovery and 15 minutes later. The sedation was more in buprenorphine group, [p<0.05] There was no meaningful statistical difference in relation to heart rate between the two groups. Systolic blood pressure, between two groups was significant except at the time of entering recovery. Also, systolic blood pressure was not significant between two groups. This study showed the bupernorphine has long anaesthesia and sedation

[Comparison of the effects of topical Lidocaine spray applied oropharyngealy before and hypopharyngealy after induction of anesthesia on the pressor response to direct laryngoscopy and intubation]

Background and Objective: the deterious effects of pressor response [Tachycardia and hypertension] are not hidden from any personal of anesthesia group. The present study is performed in Chamran Hospital affiliated to the university of medical sciences, Shiraz, with the aim to introduce the most effective, cheapest as well as the easiest method to prevent or reduce the pressor response to direct laryngoscopy and intubation

Materials and Methods: this randomized clinical trial was conducted in Chamran Hospital in Shiraz. 90 patients scheduled for elective surgical fixation of femur or tibia were randomly divided in group A [30 patients], group B [30 patients] and group C [30 patients]. In-group A patients were directly sprayed with Lidocaine 10%, hypopharyngealy, after induction of anesthesia and 3 minutes before tracheal intubation. Patients in group B were sprayed with Lidocaine 10% oropharyngealy before induction of anesthesia while the patients, were awake, patients in group C were not sprayed with Lidocaine [Control group]. Premedication and drugs used for induction of anesthesia were same in 3 groups. The heart rate, systolic and diastolic blood pressure were recorded in all patients included in the study, before tracheal intubation [Base line] just after tracheal intubation and 3 and 5 minutes after intubation

Results: spraying Lidocaine oropharyngealy before induction of anesthesia and hypopharyngealy after induction of anesthesia both were effective in controlling the pressor response to laryngoscopy and tracheal intubation, but spraying Lidocaine oropharyngealy before induction of anesthesia is more effective than spraying Lidocaine hypopharyngealy after induction of anesthesia [P<0.05]

Conclusion: according to the results of present study, applying Lidocaine spray, oropharyngealy is a simple, very effective as well as cheap method for controlling pressor response to tracheal intubation

New method for the fixation of the endotracheal tube in patients with facial hair

A problem faced by anaesthetists in Islamic countries is the unwillingness of patients to shave their facial hair. Adhesive tapes may not adequately secure an endotracheal tube in these patients, and a cotton b and around the neck may cause obstruction of the venous return. A new device, a synthetic leather mask, was compared with the two other methods in a r and omized trial on 900 patients undergoing general anaesthesia. No displacement of the endotracheal tube, pressure on the neck veins, or skin reaction were observed in the mask group compared with the adhesive tape and the cotton b and groups. The mask can be reused, autoclaved and made in several sizes, prevents allergies to adhesive tape and is suitable for laryngoscopy, suctioning and inserting the oral airway

Determination of central venous pressure from intraocular pressure

In many clinical situations, knowledge of central venous pressure [CVP] is important. Measurement of CVP is not always possible. To determine if intraocular pressure [IOP] can be used as an estimate for CVP. IOP and CVP were measured concurrently in 30 candidates of coronary artery bypass graft surgery. Those with carotid artery or jugular venous diseases as well as those with glaucoma or cardiac ejection fraction of less than 50% were excluded from the study. A linear correlation was found between CVP and IOP [r = 0.66, p<0.001]. CVP can be easily derived by halving the IOP. The use of this very simple method, particularly in those health care centers where due to the lack of necessary equipment for accessing central veins, CVP measurement is not possible, may provide useful information to physicians