comparison of the effect of three anesthetic induction regimens on the arterial oxygen saturation in children with tetralogy of fallot undergoing cardiac surgery

Tetralogy of fallot [TOF] is the most common cyanotic congenital heart disease. Anesthesia induction is a challenging issue in these patients due to the risk of worsening hypoxemia following decrease in pulmonary blood flow. We evaluated the effect of three anesthetic induction regimens on the arterial oxygen saturation [SaO2%] in children with TOF. Seventy six children aged 50 days to 15 years old with TOF, scheduled in Nemazee and Faghihi hospitals to undergo elective cardiac surgery during 1385-1388 were randomly divided into 3 groups to receive three anesthetic induction agents including ketamine [2 mg/kg, IV], ketamine [5 mg/kg, IM] and halothane for gas induction. SaO2% and heart rate were recorded before induction and thereafter every 1 minute during induction of anesthesia till 10 min post-induction. There were not significant differences between three groups regarding pattern of changes in SaO2% during 10 min post-induction. All three groups showed an increase in SaO2% committed over 6[th] minute but this pattern was not seen after that time. In addition, there were not significant differences among groups according to heart rate in the study period. It seems that anesthesia induction in TOF patients with ketamine IV and IM and halothane did not have significant adverse effects on SaO2%

Effect of colloid versus crystalloid administration of cardiopulmonary bypass prime solution on tissue and organ perfusion

We evaluated the effects of tissue and organ perfusion during and after coronary artery bypass graft surgery with either colloid [Voluven] or crystalloid [Lactated ringer's] as prime solution. In this prospective randomized-controlled trial study, 70 patients undergoing on-pump coronary artery bypass graft surgery were randomly assigned to receive either colloid [Voluven] or crystalloid [Lactated ringer's] as prime solution, for initiation of cardiopulmonary bypass machine procedure. Tissue and organ perfusion markers including lactate, troponin I, liver and renal function tests and electrolytes were measured sequentially, before induction [T1] to second days after surgery [T5]. With exception of chloride and potassium levels no significant differences detected in other measurements, and the laboratory results were entirely identical in both procedures. There was no significant difference between Voluven[registered] [ hydroxyethyl starch, HES 130/0.4] and crystalloid [Lactated ringer's] as priming solution on the basis of organ and tissue perfusion tests assessment

[Assessment of arterial oxygen saturation by pulse oximetry before, during and after electroconvulsive therapy]

Electroconvulsive therapy [ECT] is used widely in psychiatric practice. The goal of anesthesia for ECT is the prevention of complications such as discomfort, fractures, aspiration of gastric contents and hypoxia. However, general anesthesia can cause some adverse effects as hypoxia. Prevention and treatment of hypoxia is important due to its undesirable effects on seizure duration and cardiovascular system. This study was designed to detect the incidence and probable times of desaturation in patients receiving ECT. This prospective randomized clinical trial was carried out on 100 patients [18-50 y/o] with ASA I or II who were scheduled for ECT. After pre-oxygenation and similar anesthesia induction the patients received ECT. The patients were ventilated by oxygen and face masked until the return of their spontaneous respiration with adequate tidal volume and respiratory rate. Then they were transferred to recovery room where there was no oxygen supplementation. Oxygen saturation was measured by a Nell core pulse oximeter and was recorded at six stages: before and after anesthesia induction, during ECT, after ECT, 5 minutes after entering recovery room and before leaving there. The data were analyzed by standard statistical tests using SPSS software. Data analysis revealed that desaturation was not noticed at any stage except for the 5[th] stage [5 minutes after entering recovery room], when 13% of patients developed Sao2% less than 90%. Also there was a significant difference between Sao2% of patients between this stage [5[th]] and other stages [p<0.001]. According to our findings, appropriate oxygen supplementation and pulse oximetry monitoring during recovery period after ECT can be recommend

[Comparison of preoperative administration of rectal diclofenac and acetaminophen for reducing post operative pain in septorhinoplastic surgeries]

Post operative pain is usually treated by opioids, which is expensive and may induce various side effects. Non steroidal anti-inflammatory drugs have been considered recently for controlling pain due to their cheapness, fewer side effects and availability. This study compares the analgesic efficacy of preoperative administration of single dose of rectally diclofenac and acetaminophen for post operative analgesia in septorhinoplasty, one of the most common head and neck surgeries. Sixty adult patients with ASA =1 underwent septorhinoplasty were randomly divided into two equal groups. Thirty minutes before induction of anesthesia, 100 mg diclofenac suppository and 325 mg of rectal acetaminophen were given to group I and group II respectively. Induction and maintenance of anesthesia were similar in all patients. Then the severity of pain was graded 1, 2 and 4 hours after operation according to Visual Analogue Scale. Also the first time of analgesic request and: total administered dose of analgesics were assessed by another person in all patients. Results revealed that severity of pain in diclofenac group in all three defined times was significantly less than that in the other group [p<0.05]. Also the average of first time analgesic request in group 1 and 2 was 205 and 97 minutes respectively and the average dose of administered pehtidine was 12.25 mg in diclofenac and 37.15mg in acetaminophen group. The pre-operative administration of rectal diclofenac was more effective for post septorhioplasty analgesia than the rectal acetaminophen and thus it could be used and recommended as a safe, compensive and effective method for post operative pain relief in this common surgery