[Comparison between hemodynamic effects of propofol-remifentanil and isoflurane for induction of anesthesia in lumbar disc operations]

Background and Objectives: there are different anesthetic methods for hemodynamic stabilization during lumbar disc surgery. Anesthesias with intravenous drug including propofol-remifentanil and isoflurane have acceptable results inthis regard. In this study we compared the hemodynamic effects of these two anesthesia methods in patients, candidate for lumbar disc surgery

Materials and Methods: in this study, 70 patients, who were candidate for lumbar disc surgery underwent general anesthesia using propofol-remifentanil or isoflurane. After induction with lidocaine, propofol and sisatracorium, anesthesia was maintained in isoflurane group with controlled respiration using oxygen and N20 with 50% ratio with isoflurane l% and in propofol-remifentanil group, with controlled respiration using 100% oxygen with propofol 5 mg/kg/h and remifentanil 0.125 [micro]g/kg/min. Hemodynamic findings during surgery and after surgery were recorded in both groups

Results: there were no significant differences between groups in their systolic and diastolic blood pressure, heart rate and oxygen saturation. Also, both groups were similar in their return to spontaneous breathing and extubation, time for eye opening and ability of verbal communication, meanwhile, frequency of general presentations such as chill, agitation, degree of post-surgery hypoxia. Nausea and vomiting were not significantly different between two groups

Conclusion: anesthesia with both methods; intravenous propofol-remifentanil or inhaled isoflurane in patients who are undergoing lumber disc surgery regarding to heir hemodynamic effects such as hypotension and brady cardia are acceptable

comparison of preoperative ondansetron and dexamethasone in the prevention of post-tympanoplasty nausea and vomiting

Nausea and vomiting are common complications of anesthesia and surgery. Patients undergoing tympanoplasty are exposed to a higher risk of postoperative nausea vomiting [PONV]. These complications may alter the results of reconstruction and anatomical alignments. Numerous antiemetics have been studied to prevent and treat PONV in patients undergoing tympanoplasty. The aim of this study was to compare the effect of intravenous ondansetron and dexamethasone on post-tympanoplasty PONV. In a double-blind randomized controlled clinical trial, 219 patients were divided into three groups including one receiving ondansetron, one receiving dexamethazone, and one receiving distilled water. All patients were subjected to tympanoplasty type I. The patients in the first group received ondansetron [4 mg IV], second group received oexamethasone [8 mg IV], and third group received distilled water prior to induction of anesthesia. Using Bellivelle's scoring system, the incidence of PONV and its severity during the 24-hour period after surgery were measured and compared. There was no significant difference among PONV in the three groups in the first two hours after the surgery. However, in 2-8, 8-16 and 16-24 hours after the surgery the PONV in ondansetron and dexamethasone groups were significantly lower than that in the control group. Ondansetron and dexamethasone were more effective than placebo in controlling PONV after tympanoplasty surgeries. Moreover, dexamethasone was more effective than ondansetron in preventing PONV

[Effect of thoracic epidural anesthesia on oxygen saturation during one-lung ventilation in pulmonary resection surgery]

The perfusion in the nonventilated, operative lung during one-lung ventilation [OLV] in patients undergoing thoracic surgery increases intrapulmonary shunt and decreases systemic arterial oxygenation. The anesthesia with OLV may affect oxygenation. The aim of this study was comparing the effect of total intravenous anesthesia [TIVA] and thoracic epidural anesthesia [TEA] combined with TIVA on saturation of oxygen during OLV in patients undergoing pulmonary resection. In a randomized double-blind clinical trial, 60 patients undergoing elective pulmonary resection were Divided in to two groups. The intervention group received TEA [bupivacaine 0.25%] plus TIVA [propofol+remifentanil] while the control group received TEA [saline] plus TIVA.The hemodynamic parameters, Aldrete score and possible complications were compared between the two groups, within the study period. The change of hemodynamic parameters, as well as SaO2, PaO2 and ETCO2 within the study period was not significantly different between the two groups. The mean Aldrete score was comparable between the two groups upon entering recovery and after getting discharged from there. During the recovery stay, frequency of patients with pain and shivering was significantly higher in the group with sole TIVA. There was no significant difference in nausea and hypotension between the two groups. TEA plus TIVA does not have a significant effect on O2 saturation in OLV in patients comparing with sole TIVA. However, this combination significantly decreases the post-operative pain and shivering and so may be recommended

Incidence of back pain following spinal anesthesia and its relationship to various factors in 176 patients

After neuraxial anesthesia, back pain is the most common complaint. The back pain may be related to needle trauma or surgical positioning or transient neurotoxicity of concentrated local anesthetics. The goal of this study was to compare the incidence of back pain following spinal anesthesia with hyperbaric lidocaine 5% and bupivacaine 0.5% and spinal needle insertion spaces. In this clinical trial after approving ethics committee and obtaining patients consent, we included 176 adult patients with physical status of I- II ASA from May 2006 to May 2008 undergoing various elective urologic surgeries under spinal anesthesia in Imam Hospital in Tabriz, Iran. Patients were allocated randomly in two equal groups. Group lidocaine, a nesthetized with hyperbaric 5% lidocaine and group bupivacaine. All patients were interviewed 6, 24, 48 hours after surgery for back pain. This study indicated no statistically significance difference in the incidence of back pain following spinal anesthesia considering age and frequency of needle puncture during spinal anesthesia. Incidence of back pain was higher in lidocaine group than bupivacaine group [31.82% vs. 18.18%; respectively; P<0.001].Incidence of back pain was higher in L3-4 interspace of needle insertion than L4-5 [23.7% vs. 12.8%, respectively; P<0.001]. The intensity of back pain was slight and tolerable in 77% of the cases, and the back pain in all the patients lasted not more than 48 hours. This study implies that the area of needle insertion and type of anesthetics have effects on the back pain following spinal anesthesia

Evaluation of tracheal intubating condition in adults after coinduction with propofol plus lidocaine and different doses of remifentanil

To evaluate tracheal intubation condition in adults after anesthetic coinduction with lidocaine and propofol and various doses of remifentanil. In three groups, induction was compared with lidocaine [1.5 mg/kg], propofol [2 mg/kg], and three varing doses of remifentanil [0.5-1-2 micro g/kg]. Tracheal intubation was graded according to the ease of laryngoscopy, the position of vocal cords, coughing, jaw relaxation and the movement of limbs. Hemodynamic variables were compared during preoxygination and 45 seconds after induction. There were 90 ASA I or ASA II patients with 30 in each group. Tracheal intubating condition was regarded as acceptable in 33%, 53% and 90% of patients in groups 1, 2 and 3 respectively. All three groups had a decrease in heart rate and mean arterial pressure after induction but this changes wasn't clinically significant. Tracheal intubating condition was best after induction with lidocaine 1.5mg/kg, propofol 2mg/kg and remifentanil 2microg/kg