[Comparison between hemodynamic effects of propofol-remifentanil and isoflurane for induction of anesthesia in lumbar disc operations]

Background and Objectives: there are different anesthetic methods for hemodynamic stabilization during lumbar disc surgery. Anesthesias with intravenous drug including propofol-remifentanil and isoflurane have acceptable results inthis regard. In this study we compared the hemodynamic effects of these two anesthesia methods in patients, candidate for lumbar disc surgery

Materials and Methods: in this study, 70 patients, who were candidate for lumbar disc surgery underwent general anesthesia using propofol-remifentanil or isoflurane. After induction with lidocaine, propofol and sisatracorium, anesthesia was maintained in isoflurane group with controlled respiration using oxygen and N20 with 50% ratio with isoflurane l% and in propofol-remifentanil group, with controlled respiration using 100% oxygen with propofol 5 mg/kg/h and remifentanil 0.125 [micro]g/kg/min. Hemodynamic findings during surgery and after surgery were recorded in both groups

Results: there were no significant differences between groups in their systolic and diastolic blood pressure, heart rate and oxygen saturation. Also, both groups were similar in their return to spontaneous breathing and extubation, time for eye opening and ability of verbal communication, meanwhile, frequency of general presentations such as chill, agitation, degree of post-surgery hypoxia. Nausea and vomiting were not significantly different between two groups

Conclusion: anesthesia with both methods; intravenous propofol-remifentanil or inhaled isoflurane in patients who are undergoing lumber disc surgery regarding to heir hemodynamic effects such as hypotension and brady cardia are acceptable

Effect of low level laser application at the end of surgery to reduce pain after tonsillectomy in adults

Tonsillectomy is among commonest otorhinolaryngologic surgeries. Many methods have been used to control post surgical pain, but despite it, pain is still one of the problems related to this operation. Recently, due to the non invasiveness of low level lasers, this modality has attracted attention. The purpose of this study is to evaluate the effects of low level laser irradiation at the end of surgery on reduction of pain after tonsillectomy in adults. In a clinical trial, 60 adult patients, candidates for tonsillectomy were randomly assigned to two groups, A and B, and both groups were anesthetized similarly by the same technique. At the end of surgery, in the case group, the tonsils' bed were irradiated by infrared laser with 980nm wavelength, 100Hz, 4J/cm[2] from the infra mandibular angle. In the control group, the tonsils' bed had laser therapy with a turned off probe. Following laser treatment, the patients were reversed and extubated and consciousness achieved, pain and odynophagia were assessed at 2, 4, 6, 8, 12 and 24h post surgery based on visual analog scale for pain [VAS] and analgesic consumption. In the laser group frequency of patients with pain sensation in each evaluated hour was lower than in the control group. The amount of pain decrease and analgesic consumption reduction was significantly higher in patients who received laser [P=0.01]. Based on the results of this study, use of low level lasers is effective in reducing tonsillectomy post surgical pain in adults

Administration of remifentanil in establishing a more stable post-anesthesia cardiovascular status in neurosurgical procedures

Emergence from general anesthesia and especially post-extubation phase are the stages associated with cardiovascular hyperdynamic status in which patients with increased intracranial pressure [ICP] could be affected by severe cardiac and or cerebral complications. Administering remifentanil could be helpful in maintaining the hemodynamic stability at the end of the surgery and recovery stages and reducing recovery phase length. In a double-blind prospective randomized clinical trial, 60 adult patients with ASA [American Society of Anesthesiologist] class of I-II scheduled to undergo elective neurosurgery operations were randomly divided into two groups receiving remifentanil and placebo as IV infusion within four minutes prior to extubation continued by an IV infusion for 10 minutes after extubation. There was a significant difference between two groups regarding the changes of Mean Arterial Pressure after extubation and five minutes after extubation [P< 0.001].Remifentanil group compared with control group was of significant difference at all heart rate values after extubation [P< 0.001]. Remifentanil could be used in preventing hyperdynamic status throughout extubation phase without extending recovery phase length. However, administration of this medication should be performed cautiously.

evaluation of the effect of morphine on abdominal pain and peritonealirritation signs in patients with acute surgical abdomen

Acute surgical abdomen is one of the most common emergency surgical causes all over the world and also one of the most important abdominal pain causes which is sometimes intolerable for the patients referring to the emergency departments. Diagnosis and planning for operation in these cases is based on time-demanding serial examinations and results of paraclinical data. In this waiting period, patients have to tolerate pain. Therefore, we aimed to study the hypothesis that relieving pain has no influence on valuable findings in physical examination. This double blind randomized clinical trial was carried out on 120 patients above 12 years old referred to an emergency department of a referral hospital with acute abdomen. Patients were divided into two groups of receiving intravenous placebo and Morphine randomly. Pain score, change in tenderness as well as change in rebound tenderness before and after receiving morphine or placebo were measured based on Numeric Pain Assessment Scale. Statistically significant difference was observed between both groups regarding the mean pain score. Prevalence of tenderness and rebound tenderness after medication administration revealed a significant difference between two groups. Furthermore, pain and tenderness showed a significant decrease in patients receiving morphine also a significant difference occurred in rebound tenderness between two groups. Despite the fact that opioid analgesics decrease pain in patients with acute surgical abdomen, they do not tend to eliminate required diagnostic data being obtained from physical examination like tenderness and rebound tenderness. Surprisingly, all the acute abdomen cases had rebound tenderness after morphine administration. Therefore, this research advises a cautious usage of morphine in patients with acute abdomen.

Multimodal preincisional premedication to prevent acute pain after cholecystectomy

Postoperative pain as an important medical concern is usually treated by opioids which also are of various inevitable side effects. The aim of this study was to assess the efficacy of multimodal preincisional premedication on preventing post-cholecystectomy acute pain. In a randomized clinical trial, sixty patients undergoing open cholecystectomy were randomized into two groups. Before anesthesia induction, Diclofenac suppository [100 mg] and oral Clonidine [0.2 mg] were administered in the first group. Immediately before operation, patients received Ketamine [1 mg/kg IV] while the control group received placebo. The site of incision was infiltrated by the surgeon with 20 mL Bupivacaine 0.25% in both groups. Anesthesia induction and maintenance were similar in both groups. The severity of pain was recorded 2, 4, 6, 12, 24 and 48 hours after operation according to Visual Analogue Scale. The severity of pain at two defined stages [6 and 12 hours later] was significantly less in the intervention group than the control group [P<0.005]. The average pain severity score was less than the control group [P<0.005]. In our study, the administration of Clonidine, Diclofenac and Ketamine and bupivacaine infiltration to the site of incision, altogether was associated with a significant decrease in pain score and opioid requirement after cholecystectomy in comparison to bupivacaine infiltration to the site of incision.

comparison of preoperative ondansetron and dexamethasone in the prevention of post-tympanoplasty nausea and vomiting

Nausea and vomiting are common complications of anesthesia and surgery. Patients undergoing tympanoplasty are exposed to a higher risk of postoperative nausea vomiting [PONV]. These complications may alter the results of reconstruction and anatomical alignments. Numerous antiemetics have been studied to prevent and treat PONV in patients undergoing tympanoplasty. The aim of this study was to compare the effect of intravenous ondansetron and dexamethasone on post-tympanoplasty PONV. In a double-blind randomized controlled clinical trial, 219 patients were divided into three groups including one receiving ondansetron, one receiving dexamethazone, and one receiving distilled water. All patients were subjected to tympanoplasty type I. The patients in the first group received ondansetron [4 mg IV], second group received oexamethasone [8 mg IV], and third group received distilled water prior to induction of anesthesia. Using Bellivelle's scoring system, the incidence of PONV and its severity during the 24-hour period after surgery were measured and compared. There was no significant difference among PONV in the three groups in the first two hours after the surgery. However, in 2-8, 8-16 and 16-24 hours after the surgery the PONV in ondansetron and dexamethasone groups were significantly lower than that in the control group. Ondansetron and dexamethasone were more effective than placebo in controlling PONV after tympanoplasty surgeries. Moreover, dexamethasone was more effective than ondansetron in preventing PONV

[Effect of thoracic epidural anesthesia on oxygen saturation during one-lung ventilation in pulmonary resection surgery]

The perfusion in the nonventilated, operative lung during one-lung ventilation [OLV] in patients undergoing thoracic surgery increases intrapulmonary shunt and decreases systemic arterial oxygenation. The anesthesia with OLV may affect oxygenation. The aim of this study was comparing the effect of total intravenous anesthesia [TIVA] and thoracic epidural anesthesia [TEA] combined with TIVA on saturation of oxygen during OLV in patients undergoing pulmonary resection. In a randomized double-blind clinical trial, 60 patients undergoing elective pulmonary resection were Divided in to two groups. The intervention group received TEA [bupivacaine 0.25%] plus TIVA [propofol+remifentanil] while the control group received TEA [saline] plus TIVA.The hemodynamic parameters, Aldrete score and possible complications were compared between the two groups, within the study period. The change of hemodynamic parameters, as well as SaO2, PaO2 and ETCO2 within the study period was not significantly different between the two groups. The mean Aldrete score was comparable between the two groups upon entering recovery and after getting discharged from there. During the recovery stay, frequency of patients with pain and shivering was significantly higher in the group with sole TIVA. There was no significant difference in nausea and hypotension between the two groups. TEA plus TIVA does not have a significant effect on O2 saturation in OLV in patients comparing with sole TIVA. However, this combination significantly decreases the post-operative pain and shivering and so may be recommended

Comparison thoracic epidural and intercostal block to improve ventilation parameters and reduce pain in patients with multiple rib fractures

Chest wall blunt trauma causes multiple rib fractures and will often be associated with significant pain and may compromise ventilator mechanics. Analgesia has great roll in rib fracture therapies, opioid are useful, but when used as sole agent may re-quire such high dose that they produce respiratory depression, especially in elderly .the best analgesia for a severe chest wall injury is a continuous epidural infusion of local anesthetic. This provides complete analgesia allowing inspiration and coughing without of the risk of respiratory depression. sixty adult patients who with multiple rib fractures were enrolled in this study. They were divided into Group A or thoracic epidural with bupivacaine 0.125% +lmg/5ml morphine and group B or intercostal block with%0.25 bupivacaine. The patients were assessed through ICU and hospital stay length, ventilation function tests. Pain score among the patients was measured with verbal rating scale, before and after administration of the analgesia. We found a significant improvement in ventilatory function tests during the 1st, 2nd, and 3rd days after epidural analgesia compared with the intercostal block [P < 0.004]. Changes in the visual Analogue Scale were associated with marked improvement regarding pain at rest and pain caused by coughing and deep breathing in group A compared group B... ICU and hospital stay markedly reduced in Group A. thoracic epidural analgesia is superior to intercostals block regarding pain relief of rib fractures. Patients who received epidural analgesia had significantly lower pain scores at all studied times

Preincisional ipsilateral stellate ganglion block for acute post operative pain control in unilateral mastectomy

To evaluate the effect of preincisional ipsilateral stellate ganglion block for acute post operative pain control in unilateral mastectomy. In a randomized clinical trial, 62 patients selected for unilateral mastectomy were recruited in Tabriz Imam Reza educational Hospital during 18-month period. They were randomly divided into two equal groups; receiving either preincisional ipsilateral stellate ganglion block using bupivacaine [study group] or without these blocks [control group]. Postoperative pain was evaluated based on visual analogue scale [VAS]. The total dose of analgesics were also compared between the two groups. Thirty one female patients with a mean age of 48.7 +/- 7.4 [36-60] years and 31 other female patients with a mean age of 50.7 +/- 6.9 [36-60] years were enrolled in the study and control groups, respectively [p=0.292]. The number of patients with decrease in postoperative pain was significantly higher in the case study group comparing with that of the control group [p < 0.001]. Decrease in total dose of postoperative analgesics was also significantly lower in the case study group compared with control group [P < 0.001]. Forty eight hours after operation, there were 15 pain-free patients in the study group with no pain-free patients in the control group. This difference was statistically significant [P < 0.001]. Based on our findings, the preincisional ipsilateral stellate ganglion block is an effective method in controlling the postoperative pain after unilateral mastectomy. This approach had also got a considerable analgesic-sparing effect

Incidence of back pain following spinal anesthesia and its relationship to various factors in 176 patients

After neuraxial anesthesia, back pain is the most common complaint. The back pain may be related to needle trauma or surgical positioning or transient neurotoxicity of concentrated local anesthetics. The goal of this study was to compare the incidence of back pain following spinal anesthesia with hyperbaric lidocaine 5% and bupivacaine 0.5% and spinal needle insertion spaces. In this clinical trial after approving ethics committee and obtaining patients consent, we included 176 adult patients with physical status of I- II ASA from May 2006 to May 2008 undergoing various elective urologic surgeries under spinal anesthesia in Imam Hospital in Tabriz, Iran. Patients were allocated randomly in two equal groups. Group lidocaine, a nesthetized with hyperbaric 5% lidocaine and group bupivacaine. All patients were interviewed 6, 24, 48 hours after surgery for back pain. This study indicated no statistically significance difference in the incidence of back pain following spinal anesthesia considering age and frequency of needle puncture during spinal anesthesia. Incidence of back pain was higher in lidocaine group than bupivacaine group [31.82% vs. 18.18%; respectively; P<0.001].Incidence of back pain was higher in L3-4 interspace of needle insertion than L4-5 [23.7% vs. 12.8%, respectively; P<0.001]. The intensity of back pain was slight and tolerable in 77% of the cases, and the back pain in all the patients lasted not more than 48 hours. This study implies that the area of needle insertion and type of anesthetics have effects on the back pain following spinal anesthesia