[ effect of low flow inhalation anesthesia on operative hemodynamic condition in comparison with high flow anesthesia]

Low flow anesthesia technique in which the flow fresh gas is lower than minute volume of the patient results in improvement in the patient's care such as reduction of operative hypothermia, reduction of postoperative shivering and leads to an increase in economical and enviornmental interests. The goal of the study was to investigate the patients' operative hemodynamic variations using the high and low flow anesthesia techniques. This prospective, clincal and single blind study was carried out in Tbriz Emam Khomeini Hospital in 1384. In this study 97 patients in ASA class I or II after routine induction of G.A, during maintenance of anesthesia were randomly divided in two groups; group I [high flow anesthesia] and group II [low flow anesthesia]. For all patients ECG, HR, SPO[2], BP, B.T, ETCO[2] and inspiratory, expiratory percentage of O[2], N[2]O, halothane, postoprative shievring and duration of oprations were recorded. 46 patients underwent high flow anesthesia and 51 patients underwent low flow anesthesia. The average blood pressure in group I was as follow: preoperative, systol=138 +/- 20 mmHg and diastol=78 +/- 15 mmHg, intraoperative, systol=105 +/- 31 mmHg and diastol=64 +/- 10 mmHg and in recovery systol=116 +/- 15 mmHg and diastol=70 +/- 13 mmHg. In group II who had low flow anesthesia the blood pressure was found to be systol=139 +/- 22 mmHg and diastol=79 +/- 22 mmHg preoperative, systol=122 +/- 21 mmHg and diastol=75 +/- 17 mmHg intraoperative and systol=118 +/- 15 mmHg and diastol=77 +/- 17 mmHg in recovery. The differences in blood pressure in both group were statiscally significant [p=0.01]. The average heart rate in group I was 90 +/- 18 beat/min preoperative, 70 +/- 14 intraoperative and 126 in recovery. The avrage heart rate in group II was 87.9 +/- 21 preoperative, 86 +/- 16 intraoperative and 104 +/- 17 in recovery. The differences were statiscally significant but there was no significant difference between the two groups with regard to sex, age and weight. Maintenance of anesthesia with low flow anesthesia gasses maintains more hemodynamic condition during operation

Effect of extradural Ketamine on onset time and sensory block in extradural bupivacaine-induced anesthesia

Epidural anesthesia is an appropriate approach for surgical operations on lower limbs, abdominal region and painless delivery. Since the application of epidural anesthesia is time-consuming and the onset of the effects of injected anesthetic drugs in epidural space is slow [about 20 minutes], therefore, the time of occupying the operating room is prolonged and this results in wasting of time of the surgeon and staff in the operating room. This study was conducted to assess the effect of bupivacaine while used with ketamine on shortening the onset time. This double blind study was done on 40 patients. All the patients were physically ASA I, II and they underwent orthopedic and urologic surgical operations. The patients were randomly divided into two groups of 20 individuals, receiving the drugs as follows: study group: bupivacaine 0.5% - 20 ml + ketamine 25mg [0.5ml] + adrnaline 1/200000, control group: bupivacaine 0.5%, 20ml + ketamine 25mg [0.5ml] + saline 0.9%, 0.5ml + adrenaline 1/200000. After injecting the drug in epidural space in L3-L4 or L4-L5 regions, blood pressure, heartbeat, onset of anesthesia and the level of anesthesia were evaluated in all patients. Patients in both groups were compared with regard to their height, weight, sex, age and systolic blood pressure before the injection of the drugs and no significant difference was noted among them. The systolic blood pressure and heartbeat of patients in both groups were checked in 2[nd], 5[th], 10[th], 15[th], 20[th], 25[th] and 30[th] minutes after drug injection and no significant differences were found in both groups compared to pre-anesthesia status. However, the onset and level of anesthesia was statistically significant in the two groups. The onset of anesthesia in study group was 3.5 to 4 minutes faster and the anesthesia level was two segments higher than that of the control group. Results of this study demonstrated that the addition of 25mg of ketamine to bupivacaine resulted in the acceleration of the onset as well as increase the level of anesthesia in extradural bupivacaine-induced anesthesia and this might be a useful approach in emergency surgical procedures