ABSTRACT
Emergence from general anesthesia and especially post-extubation phase are the stages associated with cardiovascular hyperdynamic status in which patients with increased intracranial pressure [ICP] could be affected by severe cardiac and or cerebral complications. Administering remifentanil could be helpful in maintaining the hemodynamic stability at the end of the surgery and recovery stages and reducing recovery phase length. In a double-blind prospective randomized clinical trial, 60 adult patients with ASA [American Society of Anesthesiologist] class of I-II scheduled to undergo elective neurosurgery operations were randomly divided into two groups receiving remifentanil and placebo as IV infusion within four minutes prior to extubation continued by an IV infusion for 10 minutes after extubation. There was a significant difference between two groups regarding the changes of Mean Arterial Pressure after extubation and five minutes after extubation [P< 0.001].Remifentanil group compared with control group was of significant difference at all heart rate values after extubation [P< 0.001]. Remifentanil could be used in preventing hyperdynamic status throughout extubation phase without extending recovery phase length. However, administration of this medication should be performed cautiously.
ABSTRACT
Leech infestation could be associated with wide range of complications including epistaxis, stridor, hemoptysis, globus sensation, hematemesis, and vaginal bleeding. In the present case report., we introduce a case of leech infestation in a 41-year-old female presenting with chronic globus sensation, stridor, vomiting and dysphagia later diagnosed with leech infestation. Therefore, leech bites might be considered as a differential. Diagnosis of globus sensation in the endemic rural areas where in unhealthy water from natural sources is consumed without taking required hygienic precautions.