ABSTRACT
Because of airway stimulations during bronchoscopy and lack of direct access to the airway, preferred method of anesthesia for rigid bronchoscopy is already controversial. In this study we compared inhalation anesthesia with total intravenous anesthesia [TIVA] for rigid bronchoscopy. 30 patients aged 2-6 years were chosen divided into two same groups. Anesthesia in group I maintained with halothane and in group II maintained with remifentanil and propofol. Oxygenation, heart rate, respiratory rate, coughing, bucking, laryngospasm, bronchospasm were evaluated during and after surgery. Also operation success and surgeon's satisfaction were recorded as well. Demographic findings were the same in both groups. Oxygenation and heart rate were more stable in group II [P=0.047 and P=0.026 respectively] but there was no significant difference in respiratory rate between two groups [P=1]. Success rate was also similar in both groups but surgeon's satisfaction was significantly higher in TIVA [P=0.003]. There was not any significant different between complications in two groups. We suggest TIVA for rigid bronchoscopy because of better oxygenation, more homodynamic stability, surgeon's satisfaction, lack of air pollution and less interference with surgeon's visual field
ABSTRACT
Using opioids along with local analgesic increase anesthesia duration and provide appropriate postoperative analgesia. However, intrathecal injection of opioids is associated with upsetting side effects including pruritus. Ondansetron [5-HT3 receptor agonist] has anti-pruritus effects. Therefore, we conducted a double blind randomized case-control study to evaluate prophylactic effects of ondansetron for preventing intrathecal fentanyl-induced pruritus. Two hundred seven patients with ASA status I, II or III, who were candidate for pelvic or lower extremity surgery with spinal anesthesia [SA] using bupivacaine hyperbaric [10-15 mg] and fentanyl [25 micro g] were included in the study. Patients were randomly assigned to two groups of case [ondansetron 8mg IV] and control [4 ml normal saline IV]. Patients' hemodynamic indexes and side effects were evaluated at 5, 10, 30, 60 minutes and then hourly up to 6 hours after SA. Pruritus presence, degree, and site were evaluated after two and six hours. Data were analyzed using Kolmogorov-Smirnov test, student t-test, Mann-Whitney U, chi[2], Fisher exact test, and Spearman linear correlation coefficient. The pruritus incidence was 60% in control and 34% in case group. Severe pruritus was observed in 18% of control group and 6% of case group. Ninety four percent of patients with pruritus in control group expressed it in above T[6] dermatomes and 74% of patients with pruritus in case group had pruritus in T[6]-L[1] dermatomes. The incidence of pruritus in L[1]-lower dermatomes was similar in two groups. Headache and nausea after anesthesia were more common in control group [p=0.035]. Ondansetron decrease incidence and degree of intrathecal fentanyl-induced pruritus. This reduction was more significant around injection area T[6]-L[1] dermatomes. Ondansetron injection does not influence systolic blood pressure, duration of anesthesia and analgesia, and does not induced urinary retention and back pain