[Pharmaceutical effects of ephedrine, atropine and mucosal phenilephrin on hemodynamic alterations of women during spinal anesthesia in cesarean section]

Hemodynamic alteration and hypotension due to spinal anesthesia can reduce tissue perfusion and increase ischemic risk, myocardial infraction, renal failures spinal damages and even deep veins thrombosis. This study was designed to compare pharmaceutical effects of ephedrine, atropine and mucosal phenilephrin on hemodynamic alteration of women during spinal anesthesia in cesarean section. This randomized clinical and double blind study was done on 90 singleton pregnant women with ASA I and II class .the subjects gone elective cesarean section and allocated into three groups. subjects were received 500 ml ringer lactate before spinal anesthesia. Subjects in group I, II and III first received 0.1 mg/kg atropine [IV] 0.01mg/kg ephedrine and 100 micro gr phenilephrin [mucosal] prior spinal anesthesia, respectively. Hemodaynamic indexes including blood pressure, heart Rate, oxygen saturation and drug side effects were determined every 5 minutes interval through the surgery. Data was analyzed by using SPSS-11.5, Chi-Square and ANOVA tests. Hemodaynamic indexes were changed during study, but three medicine showed similar effect on heart Rate, blood pressure and changes of oxygen saturation [P<0.05]. There was a significant differences among three groups for dosage of extra ephedrine to control of blood pressure [P<0.05]. This increase dosage of extra ephedrine was 56.7%, 20% and in ephedrine, phenilephrin and atropine groups,respectively. Nosia rate was 6.7%, 50% and 46.7% in phenilephrin, atropine and ephedrine groups, respectively [P<0.05]. This study showed that to prevent of blood pressure drop following spinal anestasia atropine, phenilephrin and ephedrine can be prescribed, but ephedrine is recommended for lowering the rate of nosia

[ speed of decreasing of arterial oxygen saturation following induction of anesthesia, using 3 methods of pre-oxygenation techniques]

Determination of preoxygenation before anesthesia is an important factor in prevention of hypoxia and its complications. Regarding the height of Shahrekord from the sea surface [2061 m] and low level of oxygen pressure in this area [600 mg], this study was aimed to determine the onset of desaturation of oxygen following, using of three pre-oxygenation methods in apnostic adult healthy patients. In this clinical single blind study, sixty-six healthy, non-smoker adults undergoing elective surgery were randomly divided into three groups. Following the record of systolic and diastolic blood pressure and heart pulse from the patients, group one were not pre-oxygenated, groups two and three were pre-oxygenated with 50% oxygen and nitrous oxide and 100% oxygen, respectively for three minutes. After induction of the same anesthesia in the 3 groups, the patients were kept in apnostic until their saturated pressure O2 [SpO2] decreased to 91%. Subsequently, their systolic and diastolic blood pressure and heart pulse required to achieve SpO2 of 91% were measured. The data were analyzed using Chi-square and ANOVA tests. Mean age of the patients was 30.5 +/- 14.1 in whom 58% of them were male. All of the three groups were sex and age matched [p>0.05]. The delay time to achieve SpO2 in group one, group two and group three were 44 +/- 16, 114.3 +/- 36.8 and 241.6 +/- 84, respectively [p<0.001]. In all of the 3 groups, the increasing of heart pulse after the intervention was significantly different compared to before that [p<0.001]. However, the difference was not significant between the groups. Pre-oxygenation of the patients for 3 min. before induction of anesthesia with normal breathing and with 100% oxygen would significantly increase the time required for oxygen saturation of the patients to 91%

Effects of local injection of bupivacaine and dexamethasone on postoperative pain of adenotonsillectomy

Adenotonsillectomy is a common surgical operation which is frequently associated with complications such as pain, hemorrhage and laryngospasm. For reduction of the possibility of postoperative bleeding and agitation, pain control is important. The opioid drugs are now being used for pain control, but their inconvenient side effects such as apnea may worry physicians. Therefore, the aim of this study was to compare the effect of local application of bupivacaine and dexamethasone with that of placebo on postoperative pain of adenotonsillectomy. This double-blind and case-control study was performed on 90 patients subjected to tonsillectomy operation with 3-30 years old, during spring and summer of 2005 in Kashani hospital, Shahrekord, Iran. The patients were randomly divided into three equal groups of A, B and C. The individuals in group A [cases] received a local injection of 2 ml of 0.5% bupivacaine, group B received a local injection of and group C [control] received a local injection of 2 ml of normal saline. Six, 12 and 18 hours after the operation, using McGill questioners, pain intensity was evaluated. Data was analyzed using X[2] test. Mean age was not significantly different among the 3 groups. 45.6% of the patients were male and the rest were female. Six hours after the operation, pain intensity in group received bupivacaine was more than that of in group received placebo [p<0.05]. However, 12 and 18 hours after the operation there was no statistically significant difference in pain intensity among the groups. Bupivacaine and dexamethason with dosage used in this study had no effect on pain intensity in these patients

[Comparison of post cesarean section pain with general and spinal anesthesia]

Post cesarean section pain causes physiologic and psychological complications for mothers. The aim of this study was to compare the post operative pain between spinal and general anesthesia. Sixty women candidates for elective cesarean section were double blindly divided into tow groups of thirty. One group was operated under spinal anesthesia and the other group under general anesthesia. After the section, the mean administrated pethidine was calculated and the mark of the pain intensity was measured by MC-QILL questionnaire. Both the means of pethidine used and the marks of the pain intensity were significantly [P < 0.05] higher in the patients operated under general anesthesia. Local spinal anesthetics prevent post operativehyperalgesia, and reduce physiologic and endocrine responses. They also reduce the morbidity and expenditure of treatment