Effect of clonidine premedication on blood loss in spine surgery

Blood loss in spine surgery is an important issue, even though it has been understudied compared with hip and knee arthroplasty. In this study, we evaluated the effect of oral clonidine as premedication on blood loss in lumbar spine fusion surgery under anesthesia with propofol and remifentanil. In this double-blind, randomized clinical trial, 30 patients who were undergoing lumbar spine posterior fusion surgery due to traumatic fracture were allocated randomly into 2 groups. The study group [clonidine group] received a 200-microg oral clonidine tablet 60-90 minutes before anesthesia, and the control group received placebo at the same time. Induction and maintenance of anesthesia and the mean target arterial pressure for controlled hypotension with remifentanil were the same in the 2 groups. We compared the amount of intraoperative blood loss, dose of remifentanil/hour administered, need for nitroglycerine to reach the mean target arterial pressure when remifentanil was insufficient, duration of operation, and surgeon's satisfaction of a bloodless field between groups. There was no statistically significant difference between groups in age [P = 0.115], sex [P = 0.439], weight [P = 0.899], operation time [P = 0.2], or American Society of Anesthesiologists physical status score [P = 0.390]. Intraoperative blood loss and remifentanil dose administered per hour in the clonidine group were significantly less than in the control group [P = 0.002 and P = 0.001, respectively], but there was no significant difference in surgeon's satisfaction between groups [P = 0.169]. As an oral premedication, clonidine can reduce surgical blood loss in lumbar spine posterior fusion surgery, even at the same levels of mean arterial pressure [MAP] with the control group. Its use can be studied in more complicated spine surgeries, such as scoliosis and spinal deformity surgeries

Surgeon satisfaction during endoscopic management of cerebrospinal fluid rhinorrhea: a comparison between propofol-remifentanil and isoflurane-remifentanil anesthesia

Surgeon's depend to a large degree on the amount of blood loss and a clear view of the surgical field, when conducting endoscopic procedures in order to achieve satisfactory outcomes. The anesthesiologist's choice of method for the induction and maintenance of anesthesia plays a major role in achieving this goal. This study was performed in order to compare the two most well-known methods in this regard; total intravenous anesthesia [TIVA] and venous inhalational mixed anesthesia [VIMA]. This study included the endoscopic management of 89 patients with cerebrospinal leakage [CSF leakage] covering a period of nine years [1999-2008] for whom a subarachnoid injection of fluorescein was first administered, and afterwards they were maintained under general anesthesia using two distinct methods; propofol-remifentanil versus isoflurane-remifentanil [inhalational or intravenous]. During the operation, hemodynamic indices, blood loss, and surgeon's satisfaction, were assessed and compared between the two groups. Endoscopic management and autografts were successful in repairing anterior skull defects in 90% of cases. Regarding the surgeon's satisfaction level, and hemodynamic stability no significant difference between the two groups was observed [P > 0.01]. Both isoflurane and propofol in combination with remifentanil afford optimal surgical conditions with regard to hemodynamic parameters and the satisfaction of the surgeon with the surgical field

[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

[ effect of patient-selected music on early postoperative pain, anxiety, and hemodynamic profile in cesarean section surgery]

After cesarean section surgery, routine pharmacologic methods of analgesia, opioids and benzodiazepines may impair the immediate close contact of mother and neonate for their sedative and emetic effects. The aim of this study was to explore the effect of patient-selected music on postoperative pain, anxiety, opioid requirement, and hemodynamic profile. A total of 80 patients, American Society of Anesthesiologists [ASA] physical status I-II, scheduled to undergo general anesthesia and elective cesarean section surgery were enrolled. Patients were randomly allocated to receive 30 minutes of music or silence via headphones postoperatively. Pain and anxiety were measured with a visual analogue scale. Total postoperative morphine requirement as well as blood pressure and heart rate were recorded after the intervention period. Pain score and postoperative cumulative opioid consumption were significantly lower among patients in the music group [p< 0.05], while there were no group differences in terms of anxiety score, blood pressure, or heart rate [p > 0.05]. Postoperative use of patient-selected music in cesarean section surgery would alleviate the pain and reduce the need for other analgesics, thus improving the recovery and early contact of mothers with their children

[ effect of oral clonidine premedication on blood loss and the quality of the surgical field during endoscopic sinus surgery: a placebo-controlled clinical trial]

Bleeding during functional endoscopic sinus surgery [FESS] remains a challenge for both surgeons and anesthesiologists despite several modalities available for improving the surgical field. This study was conducted to evaluate the effect of oral clonidine premedication on blood loss and the quality of the surgical field in FESS. In a placebo-controlled clinical trial, a total of 84 American Society of Anesthesiologists [ASA] physical status I-II patients undergoing endoscopic sinus surgery for chronic sinusitis were randomly allocated to receive either oral clonidine 0.2 mg or identical looking placebo tablets 90 min before arrival at the operating room. Blood loss in the clonidine group was 214 +/- 67 ml on average and that in the placebo group was 276 +/- 78 ml [mean +/- SD, p 0.01]. The median [range] bleeding score in the clonidine group was significantly lower than that in the placebo group [2 [1-3] vs. 2.5 [2-4], p<0.0001]. Accordingly, the surgeon was more satisfied with the surgical field in the clonidine group than with that in the placebo group [median score, 4 [3-5] vs. 3 [1-5], p<0.001]. Premedication with oral clonidine 0.2 mg can effectively reduce bleeding during FESS