Prevention of bradycardia by atropine sulfate during urological laparoscopic surgery. A randomized controlled trial

Cardiac arrhythmias are well-recognized complication of anesthesia for laparoscopy. The aim of this study was to evaluate the efficacy of atropine sulfate for prevention of bradyarrhythimia during laparoscopic surgery. Sixty-four candidates for urological laparscopic surgery were randomly assigned into 2 groups to receive either atropine sulfate or hypertonic saline solution [as placebo], intravenously 3 minutes before induction of anesthesia for the laparoscopic procedure. Then, all of the patients underwent anesthesia intravenous sodium thiopental and atracurium, followed by isoflurane or halothane inhalation. Heart rate and blood pressure were recorded preoperatively in the recovery room, preoperatively in the operation room, after induction of anesthesia, after induction of pneumoperitoneum, and postoperatively. A significant decreasing trend was seen in the heart rates during the operation in patients without atropine sulfate. Nine of 32 patients [28.1] in this group developed bradycardia, while none of the patients with atropine sulfate prophylaxis had bradycardia perioperatively [P<.001]. The mean decreased in systolic blood pressure between induction of anesthesia and pneumoperitoneum were 15.7 +/- 10.02 mm Hg in group 1 and 23.5 +/- 9.8 mm Hg in group 2 [P<.001]. The mean decreases in diastolic blood pressure between these two measurements were 8.7 +/- 5.2 mm Hg in group 1 compared to 12.1 +/- 6.2 mm Hg in group 2 [P=.001]. This study suggests that routine prophylaxis with an anticholinergic agent might be helpful in prevention of sinus bradycardia during urological laparoscopic surgery

Varicocele in brothers of patients with varicocele

The aim of this study was to evaluate varicocele patients' brothers to determine whether they are at a higher risk of varicocele than the general population of men. A total of 56 patients with varicocele and their 131 brothers [> 16 years old] were evaluated. The brothers had no complaints of infertility, pain, or cosmetic problems. They were all examined for varicocele. One hundred and fifty men who referred for employment medical examinations were considered as the control group. Of the subjects, 39 [69.6%] had grade III varicocele. Sixty [45.8%] of the brothers had varicocele. The grade of varicocele was III in 16 [26.7%] brothers. In the control group, varicocele was present in 15 [10%] which was grade III in 5 [33.3%]. The frequency of varicocele was 4.5-fold greater in the brothers of the patients than the controls [P < .001]. Also, the frequency of grade III varicocele was significantly more than grades I and II in the patients in comparison with their brothers and controls with varicocele [P < .001]. There was no significant difference in the grades between the controls and the patients' brothers [P = .31]. The frequency of bilateral varicocele was not statistically different between the three groups [P = .14]. Our findings showed that a significant increase is seen in the prevalence of varicocele in the patients' brothers compared to men in the general population, warranting evaluation of the first-degree relatives of men who present with varicocele

Blind puncture in comparison with fluoroscopic guidance in percutaneous nephrolithotomy: a randomized controlled trial

Our aim was to evaluate blind puncture in percutaneous nephrolithotomy [PCNL] for decreasing the risk of radiation. One hundred candidates for PCNL were randomly assigned into 2 groups. Blind access was performed for the patients in group 1 and the standard access using fluoroscopy for those in group 2. In group 1, displacement of the targeted calyx in the prone position was estimated by fluoroscopy comparing to the image on intravenous urography. Puncture of the calyx was attempted 3 cm to 4 cm below the marked site of the targeted calyx with a 30 degree sign angle. If the access to the collecting system was felt and urine came out, the site of puncture would be controlled by fluoroscopy. If the access failed, we would repeat puncturing up to 5 times. The mean time to access was 6.6 +/- 2.1 minutes and 5.5 +/- 1.7 minutes in groups 1 and 2, respectively [P=.008]. The mean time of radiation exposure was 0.95 +/- 0.44 minutes in group 2. A successful puncture of the targeted calyx was achieved in 50% and 90% of the patients in groups 1 and 2, respectively [P<.001] and a successful calculus removal in 62% and 100% of the patients in groups 1 and 2 [P<.001]. Although about half of the patients benefited from blind access in our study, this technique can not be solely relied on, and fluoroscopy or ultrasonography should be available for prevention of complications