[Airway pressure release ventilation [APRV] for the treatment of severe life-threatening hypoxia in ARDS patients]

Airway pressure release ventilation [APRV] is a new mode of ventilation. APRV is used in the acute respiratory distress syndrome when the low tidal volume strategy was not responding to assisted controlled mandatory ventilation [ACMV]. Four cases of acute respiratory distress syndrome and severe life threatening hypoxia with ACMV whom were successfully managed with APRV are reported in this article. Although hypoxemia patients were treated by APRV method but eventually two patients died

[Aspiration pneumonitis after seizure in a patient undergone cesarean section: a case report]

Pulmonary aspiration of gastric contents during the peri-operative period is rare but with significant morbidity and mortality. A 21 years old pregnant woman with preeclampsia was scheduled for an emergency cesarean section under spinal anesthesia. After 18 hours of operation, epilepticus status was occurred. One day after control of seizure, aspiration pneumonitis was diagnosed and treated with mechanical ventilation and positive end-expiratory pressure [PEEP]. In patients with the history of loss, consciousness, complication of aspiration, aspiration pneumonia and pneumonitis particularly should be considerated. In case of onset of pneumonitis, PEEP treated procedure with other mechanical ventilation is recommaded

Comparison of Lidocaine and magnesium sulfate on hemodynamic changes in response to endotracheal intubation

Laryngoscopy and endotracheal intubation may produce adverse hemodynamic effects such as hypertension and tachycardia. To attenuate these stimulating responses, various methods and drugs were recommended. The objective of this study was to compare the effect of lidocaine and magnesium sulfate on hemodynamic changes in response to endotracheal intubation. In this study, 100 patients [ASA class I-II] were selected and divided randomly into two groups [50 patients in each group]. Premedication and induction drugs were the same in both groups according to weight. In case group, magnesium sulfates 40mg/kg [50%] and in control group, lidocaine lmg/kg [1%] was used before induction of anesthesia. In both groups, BP and HR checked in all patients and recorded before and after premedication after induction and in the 1st, 3rd, 5th minutes after endotracheal intubation. Data were analyzed by SPSS. T-test was used to compare the mean heart rate and systolic and diastolic blood pressure in different time and p<0.05 was considered significant. Two groups were equal in ASA class, frequency distribution of gender and age, HR, systolic and diastolic BP before and after premedication. But decrease in BP and HR after inducation of anesthesia in control group was more than study group [p<0.05]. There were no significant differences between two groups in mean BP and HR in the 1st, 3rd, 5th minutes after endotracheal intubation. Magnesium sulfate and lidocaine have the same effect on attenuating cardiovascular responses to endotracheal intubation

Fast tracheal intubation with adminstration of ephedrine before atracurium

The most important duty of anesthesiologist is to maintain a secure airway that in emergency patients by injection of intravenous anesthetic drugs such as nesdonal and succinylcholine, tracheal intubation is performed with a 30-45 second delay. But in cases that succinylcholine is contraindicated, nondepolarizing muscle relaxant like atracurium is injected and tracheal intubation is performed with a 3-5 minute delay. The aim of this study was to compare the effect of atracurium and ephedrine with atracurium alone for shortening the time of tracheal intubation. One hundred patients [ASA class I] were randomly divided into two groups of 50 cases. Induction of anesthesia was performed in both groups with nesdonal and then atracurium with dose 0.6mg/kg was administered in both groups. After premedication in case group, ephedrine with dose 70 micro g/kg was performed. In control group, tracheal intubation was performed 3-5 minutes after injection atracurium. Systolic and diastolic blood pressure and heart rate were measured and recorded at different times and also intubaion condition was recorded and data was compared. The mean age was 26.3 +/- 10 years in case group and 31.4 +/- 10 years in control group. In case group, tracheal intubation was performed in all patients during 2 minutes. After anesthesia induction, systolic and diastolic blood pressure decreased and heart rate increased in both groups, but there was a significant difference after intubation at minute 1 and 5 [p<0.05]. Quality of tracheal intubation was seen in 88% of subjects in case group and 96% of subjects in control group, this difference was not statistically significant. Ephedrine can cause a decrease in the onset time of atracurium and faster intubation without adverse hemodynamic effect

[Comparison of recovery duration of Propofol and Thiopental Sodium in ECT]

Thiopental sodium is not and ideal intravenous drug for inducing general anesthesia and compared to intravenous anesthetic drugs like propofol has a long standing recovery time. The aim of this study was to compare the recovery duration of propofol and thiopental sodium in ECT [Electroconvulsive therapy]. Methods: In a clinical trial, 70 patients aged between 15-40 years old in ASA class I and II were selected for ECT. They were randomly divided into two groups of 35 patients. After patient monitoring, 2-3 mg/kg thiopental sodium or 1-1.5 mg/kg propofol [Randomly in each patient] and then 0.5 mg/kg succinylcholine were administered. Patients were ventilated with mask and oxygen [100%]. After ECT, seizure and recovery durations were recorded. During these procedures, blood pressure and heart rate were recorded before and after anesthetic induction and 1 and 5 min after ECT. Findings: Mean recovery duration of propofol and thiopental sodium were 5.49 +/- 2.57 min and 6.4 +/- 3.69 min, respectively [P=0.233]. Also, seizure duration of propofol and thiopental sodium were 32.06 +/- 13.78 sec and 35.06 +/- 10.08 sec [P=0.302]. Hemodynamic changes [Systolic blood pressure] in two groups were not significant except at 1 minute after seizure [P<0.05]. Conclusion: According to the results, there was not a significant difference between two groups in seizure and recovery duration. But propofol can prevent increasing hemodynamic response to ECT better than thiopental sodium. In patients with hypertension or restriction of thiopental sodium, propofol can be a suitable replacement

[Comparison of the effects of pethidine plus lidocaine and lidocaine alone on depth and duration of post operative analgesia in IV block of upper limb]

Background and Objective: One of the alternative methods for general anesthesia that has been used for a long time by means of local anesthetic drugs for brief limbs procedures is intravenous regional block. This research was designed to study the effects of pethidine plus lidocaine in intravenous regional anesthesia and comparing it with the conventional method of lidocaine alone in order to intensity the depth of block and duration of postoperative analgesia in upper limb procedures

Methods: In a prospective and clinical trial, 50 patients [20-60 years old] in ASA class I and II were divided into two groups: the patients in group 1 were injected 40 ml lidocaine 0.5% and to the patients in group 2 we added 50 ml pepthidine to their 40 ml lidocaine 0.5% regionally. At the end of surgery, along with tourinquet deflation 50 mg intravenous pethidine was injected to group 1. The onset time of tourniquet was recorded and the depth of the block was assessed according to the patient response to painful stimulation just before beginning of the surgery with five points scale. All the patients were followed up for 12 hours after procedure to determine the onset of postoperative pain and then it was recorded

Findings: the onset time of tourniquet, pain was 29.45 and 42.41 minutes in group I and 2, respectively [p=0.023]. The duration of postoperative analgesia in group 2 was 6.83 hours, which was obviously longer than that of group 1 [3.72 hours] [p=0.002]. The intensity of the block in group 2 was significantly more than group 1 [p=0.13]

Conclusions: According to the results, addition of pethidine to lidocaine in upper limb intravenous regional anesthesia, in contrast to the conventional method of lidocaine alone, not only delays the tourinquet pain and postoperative pain but also increases the intensity of block with clear improvement of the perioperative conditions

[Comparison of spinal analgesia with lidocaine plus buprenorphine and lidocaine alone]

Background and Objective: The control of postoperative pain that is one of the main goals of anesthesia care can lead to patients' satisfaction and reduce time and expense of hospitalization. This study was done to compare the postoperative analgesia indices of free Lidocaine spinal anesthesia with Lidocaine plus Buprenorphine

Methods: This clinical trial study was performed on 100 patients aged 17-80 years in ASA Class I. They were randomly divided into two groups [Each group=50]. In group 1 [Control], 75-100 mg Lidocaine [5%] with 0.5ml distilled water and in group 2 [Study], 75-100 mg Lidocaine [5%] plus 50microg Buprenorphine were injected intrathecally equal volumes. Patients were followed up for 24 hrs because of vital sign, severity of pain and respiratory rate and then compared to each other

Findings: The mean duration of postoperative analgesia in group 1 and 2 were 2.1 and 22.7 hours, respectively [P=0.000]. The difference of range of hemodynamic changes was not statistically significant

Conclusion: According to the results, the mean duration of postoperative analgesia in study group [Buprenorphine+Lidocaine] was longer than the control group and there were no hemodynamic changes between two groups