effect of intravenous tranexamic acid on blood loss in lumbar hernial disc resection under inhalation and total intravenous anesthesia

Tranexamic acid is a synthetic antifibrinolytic drug that reduces bleeding and transfusion requirements in cardiac surgery and total knee arthroplasty. In this study, we evaluated the efficacy of the prophylactic tranexamic acid on intraoperative bleeding in patients undergoing lumbar hernial dics resection. Eighty patients in ASA class I and II were randomized into 4 groups. In group 1, anesthesia was achieved by total intravenous anaesthesia and also the administration of tranexamic acid. The other groups were group 2, anesthetized by total intravenous anaesthesia without tranexamic acid; group 3, anesthetized by halothane and the administration of tranexamic acid and group 4, anesthetized by halothane without tranexamic acid. Blood loss and surgeon's satisfaction were registered. The amount of blood loss in group 1 was 267.1 177.3 ml; in group 2: 656 411.6 ml; in group 3: 357 307.2 ml and in group 4: 550 406.7 ml. The least bleeding was recorded in group 1 which had a significant difference with groups 2 and 4 for which tranexamic acid was not administered. Blood loss in groups 2 and 4 was more or less similar with no significant difference. The surgeon's highest satisfaction was with group 1. No complications were recorded in the 4 groups. We concluded that administration of prophylactic tranexamic acid in patients undergoing hernial disc resection has the potential to reduce intraoperative bleeding and improving visualization of the surgical field especially when administered with total intravenous anesthesia

[Comparison of remifetanil with halothane as the anesthesia maintenance method regarding endoscopic sinus surgery conditions]

Endoscopic surgery is a new standard method of treatment for chronic sinusitis. During this operation even small amount of bleeding may reduce the visual field of surgeon significantly and make the procedure troublesome. In this study we compared the operative conditions between patients who receive either remifentanil or halothane for general anesthesia. Endoscopic sinus surgery was performed in 60 patients. Pre- medication was done by fentanil and midazolam and induction was done by propofol and atracurium. The patients were divided into two groups and received either halothane or remifentanil for anesthesia maintenance. Monitoring was performed during anesthesia. Bleeding volume was measured and operation field condition was assessed by the surgeon. Patients' characteristics such as age and gender were the same in both groups. Intra- operative systolic blood pressure was significantly lower in the remifentanil group but diastolic and mean blood pressure and heart rate didn't change after induction and during maintenance in either group. Recovery time in the remifentanil group was also significantly shorter than the halothane group. Bleeding volume was also lower and the operation field condition was better in the remifentanil group. Remifentanil is a good choice to maintain an ideal anesthesia for endoscopic sinus surgery

Comparison of the effects of inhalational salbutamol, inhalational beclomethasone and intravenous lidocaine in prevention of fentanyl-induced coughing before induction of anesthesia

Fentanyl, a synthetic opioid is a popular choice amongst anesthesiologists in the operating room, Preinduction IV fentanyl bolus is associated with coughing in 28-45% of patients. Coughing due to fentanyl is not always benign and at times maybe explosive requiring immediate intervention. The goal of this study was to compare the role of inhalation of salbutamol beclomethasone and IV lidocaine in preventing fentanyl induced coughing. This clinical trial study was performed in Ghaem Hospital in 2006. 320 patients aged 20-60 years, undergoing elective orthopedics surgery were randomized into four groups of 80. Group I served as control, while groups II, III, IV received an inhalation of salbutamol, beclomethasone or IV lidocaine before induction of anesthesia. Following IV fentanyl [2 micro g/kg] the incidence of cough was recorded and graded as mild [1-2], moderate [3-4] and severe [>/= 5] depending on the number of coughs observed. Patients' characteristics and coughs, and the results of using different drugs were recorded in a questionnaire and analyzed by descriptive statistical methods. A p value of =/< 0.05 was considered significant. The incidence of cough was 40% in the control group, 6.25%, 1.25% and 11.25% in the salbutamol, beclomethasone and lidocaine groups, respectively. Occurrence of cough was significantly low in the treatment groups; however the difference among the groups was not significant. The use of inhalation salbutamol, beclomethasone or IV lidocaine prior to IV fentanyl administration minimizes fentanyl induced coughing, and in conditions like corneal rupture or increased intracranial pressure, which coughing is highly dangerous, they are beneficial

Combination of propofol and tranexamic acid as a protocol of providing optimal surgical condition in comparison with halothane during tympanoplasty

Tympanoplasty is accomplished under general anesthesia. One major drawback of general anesthesia is the increased bleeding encountered, which can interfere with optimal visualization of the microscopic surgical field. We performed a prospective study to compare the effect of combination of propofol and tranexamic acid as a protocol versus halothane on blood loss and the surgeon's subjective assessment of operating conditions during tympanoplasty. 40 patients undergoing tympanoplasty were randomly assigned to receive the mentioned protocol or halothane [n=20]. One surgeon, who was blinded to the anesthetic agent, performed all the operations, and assessed surgical condition, using a grading system of score as follow: 1. minimal or no bleeding 2. modest bleeding 3. significant bleeding 4. severe bleeding. Results were compared in the two anesthetic groups using appropriate statistical tests. There was no difference between the duration of surgery or the intraoperative mean arterial pressure when comparing the two groups. Mean bleeding scores were less over time with above protocol. 80% of the patients had a satisfactory visualization of the surgical field in protocol group, while it was 45% in halothane group. General anesthesia, based on the combination of propofol and tranexamic acid may have the advantage of decreased bleeding compared with conventional inhalation agents, making tympanoplasty technically easier and safer by improving visualization of surgical field. This anesthetic technique may have other applications in otolaryngology, when bleeding within a confined space frequently can interfere with visibility

Evaluation of psoas compartment block in knee arthroscopy

Introduction: Psoas Compartment block [Perivascular approach] is a type of the lower limp blocks, which can block the nerves of knee area. The advantage of peripheral nerve blocking to general anesthesia is early patient's discharge from hospital, lower cost and lower complications

Material and Method: In this study, 50 patients who underwent knee arthroscopy received Psoas compartment block. The Success rate of this kind of anesthesia was evaluated in these patients

Results: 76% of patients showed a good or moderated degree of painless but most of patients experienced some degree of anxiety and nervousness and only 20% of patients were satisfied completely from this kind of anesthesia. From the surgeon's point of view 80% of patients had a good cooperation during surgery. In addition, the majority of patients had increased HR and BP during surgery

Conclusion: As a result, Just Psoas compartment block couldn't provide an adequate anesthesia for knee arthroscopy. If the block proceeded by adequate sedation or a light anesthesia, may result in a good anesthesia