[Pain control and ACTH changes in postoperative intravenous analgesia versus epidural analgesia in limb orthopedic surgery patients]

The aim of this study is comparing ACTH changes in epidural and intravenous analgesia technique after lower limb orthopedic surgery. In a randomized clinical trial in Hazrat Rasool Akram Hospital during 1387-88, 60 patients candidate for surgery on the lower extremities were randomly allocated to receive either postoperative analgesia with epidural analgesia [PCEA] or IV analgesia [PCIA]. Measurement of ACTH levels and Visual analogue scale [VAS] was performed in four relief phases including at the time of arrival to the operating room, immediately after surgery and 12 hours after intravenous pump functionary and 24 hours after surgery were recorded. The mean level of ACTH and VAS, 24 hours and 12 hours after surgery in the PCEA group were less than PCIA. Ramsey Sedation Score [RSS] in PCEA group at these intervals was more than PCIA cases. It seems that PCEA relieves pain more effectively than PCIA method. However, the proper method of anesthesia for each patient as well as patients' preferences should be considered in selecting the method of postoperative analgesia

[Comparison of Propofol with Thiopental in hemodynamic changes and apnea duration in intensive care units for intubation of trachea]

Use of drugs with short apnea duration and less hemodynamic changes for intubation of trachea in intensive care units is necessary. This study compares the effects of propofol and sodium thiopental on hemodynamic changes and apnea duration after tracheal intubation in patients admitted to intensive care units. In this double blind clinical trial, 25 ICU-admitted patients were evaluated. They were intubated two times with 72 hours interval, once received 1.5mg/kg sodium thiopental, and the other time 0.75 mg/kg propofol, while the drug used for intubation in the first time was randomly selected. Hemodynamic variables include systolic and diastolic BP, heart rate, MAP, RPP, MAP/HR and apnea duration in two times, during pre intubation, intubation and after intubation were measured. Data were analyzed with statistical tests of independent's t and ANOVA repeated test. In comparison with pre-intubation, hemodynamic variables such as systolic and diastolic BP, MAP and MAP/HR were decreased during tracheal intubation in both groups, but range of changes in propofol group is less than those of thiopental group and the difference is statistically significant [P<0.0001]. In comparison with thiopental, Propofol has fewer changes in hemodynamics in patients who needed tracheal intubation, and also has shorter apnea period. Accordingly use of propofol over thiopental is recommended for tracheal intubation in ICU patients

[Comparison of sedative effect of remifentanil with propofol in senile cataract surgery under retrobulbar block]

As general anesthesia is not a suitable choice in elderly ASA>II patients candidate for cataract surgery performored by ophthalmology Residents and lack of cooperation in these patients, sedative effect and hemodynamic status and side effects of two drugs, Remifentanil and propofol are compared in this study. In a Randomized clinical trial 60 patient candidates for cataract surgery were divided in two groups each containing 30 patients. In group A [remifentanil group], patients were sedated with a bolus dose of 0.5 micro g/kg within 1 minute, and maintenance dose of 0.05 micro g/kg/min. In group B [propofol group], patients were sedated with a bolus dose of 0.25 micro g/kg, and maintenance dose of 25 micro g/kg/min. After retrobulbar blockage was performored on all the patients by residents, Hemodynamic responses, including HR, DBP, SBP and O2Sat and sedation level according to MOAA/SS were measured. Modified Observers Assessment of Awareness/Sedation Scale = MOAA/SS. Sedation was deeper in group A [Remifentanil] were statistically meaningful during the measured times after blockage .The heart rate was reduced in group A 20 minutes after blockage and were statistically meaningful [p<0.05]. 7 patients in group A [Remifentanil] had nausea after drug administration [P=0.011]. Remifentanil can induce high level of sedation for patients compare to propofol. But Nausea could be troublesome and in this point propofol has less adverse effect

[Sonoanatomy survey of the distance between the suface of the skin and sixth cervical transverse process]

One of interventional procedure in pain specialty is Stellate Ganglion Block. In this study we tried to show more on the sonoanatomy of the area, including the diameter of longus coli muscle and the distance between sixth cervical transverse process and the surface of skin. Obviously, understanding different anatomical locations can help to more successful block and avoid possible complications. This descriptive study was performed on 145 patients who were candidated for elective orthopedic surgery. After patients consented, neck sonography was performed. Demographic data were recorded. Neck circumference, diameter of longus coli muscle and the distance between sixth cervical transverse process and the surface of skin were measured. The average distance from the skin to the transverse process was 2.84 cm and a maximum of 3.7 cm was recorded. Anteroposterior diameter of Longus coli muscle was 0.76 cm, on average. The distance from skin to the transverse process was significantly correlated with body mass index and neck circumference in both sexes. Since the average distance from the skin to the transverse process was 2.84 cm therefore, without any pressure on the skin, inserting the needle more than 2.84 cm has to be with coution, and when it is inserted more than 3.7 cm, it is possibly going off the main path