role of ventilation mode using a laryngeal mask airway during gynecological laparoscopy on lung mechanics, hemodynamic response and blood gas analysis

Background: There are two methods for ventilation in gynecological laparoscopy: volume-controlled ventilation [VCV] and pressure-controlled ventilation [PCV]

Objective: To compare the lung mechanics, hemodynamic response and arterial blood gas analysis and gas exchange of two modes of VCV and PCV using laryngeal mask airway [LMA] at different time intervals

Materials and Methods: Sixty infertile women referred for diagnostic laparoscopy, based on ventilation mode, were randomly divided into two groups of VCV [tidal volume: 10 ml/kg] and PCV. In the PCV group, ventilation was initiated with a peak airway pressure [tidal volume: 10 ml/kg, upper limit: 35 cm H[2]O]. In both groups, the arterial blood samples were taken in several time intervals [5, 10 and 15 min after LMA insertion] for blood gas evaluation. Also the lung mechanics parameters were continuously monitored and were recorded at different time intervals

Results: There were no significant differences for patient's age, weight, height and BMI in two groups. The peak and plateau airway pressure were significantly higher in VCV group compared to PCV group 5 and 10 min after insertion of LMA. PaO[2] was significantly higher after 10 and 15 min in VCV group compared to PCV group [p=0.005 and p=0.03, respectively]. PaCO[2] showed significant increase after 5 min in PCV group, but the differences were not significant after 10 and 15 min in two groups. The end tidal CO2 showed significant increase after 10 and 15 min in VCV compared to PCV group

Conclusion: Both VCV and PCV seem to be suitable for gynecological laparoscopy. However, airway pressures are significantly lower in PCV compared to VCV

Efficacy of prophylactic dexamethasone in prevention of postoperative nausea and vomiting

Objective Many trials have been conducted with regard to the relative benefits of prophylactic anti-emetic interventions given alone or in combination, yet the results remain unknown. This study reviewed the efficacy of a single prophylactic dose of dexamethasone on postoperative nausea or vomiting [PONV] after abdominal hysterectomy. Methods In a prospective study of 100 women undergoing total abdominal hysterectomy [TAH] under general anesthesia, the dexamethasone group [n = 50] received a single dose [8 mg] immediately after the operation, and the saline group [n = 50] received a dose of saline as a placebo, in addition to conventional management. The incidence of nausea, vomiting, the need for an anti-emetic and patient satisfaction with the management of PONV were evaluated during the first 24 postoperative hours. Results The overall frequency of nausea during the initial postoperative 24 in the dexamethasone and saline groups were 12% and 18%, respectively, and vomiting was 10% and 16%, respectively [P = 0.001]. However, there was a lower need for a rescue anti-emetic drugs in the dexamethasone group [18% vs 24%], but it was not statistically significant [P = 0.06]. Conclusion The results of this study indicate that a single prophylactic dose of dexamethasone after an operation can reduce postoperative nauseaandvomiting

The Effects of Propofol and Isoflurane on Blood Glucose during Abdominal Hysterectomy in Diabetic Patients

BACKGROUND: Acute hyperglycemia in the perioperative period is associated with significantly increased complications. In few human studies the effects of propofol and inhalational anesthetic on the glucose metabolism were compared. In this study we evaluated the effect of propofol and isoflurane on blood glucose during abdominal hysterectomy in diabetic patients. METHODS: After approval by the Ethical Committee and written informed consent, thirty 35 to 65 years old diabetic women underwent for elective abdominal hysterectomy under general anesthesia were studied in this randomized single blind clinical trial study. The plasma glucose was maintained at 100 to 180 mg/dL during the operation. Anesthesia protocol was similar in two groups except maintenance of anesthesia that was with infusion of propofol in the propofol group and with isoflurane in the isoflurane group. Blood glucose level and the rate of insulin intake during surgery compared between two groups. RESULTS: Mean blood glucose before induction of anesthesia did not have significant difference between two groups, but 60 and 90 minutes after starting the operation blood glucose in the propofol group was significantly lower than isoflurane group. Also with using Repeated Measure test, two groups was significantly different according to blood glucose (P=0.045). Mean of administration of insulin during the surgery did not have significant difference between two groups by using repeated measure test and P=0.271. Also mean of bispectral index in different times during the surgery between two groups didn't have significant difference (P=0.35 repeated measure test). CONCLUSION: Blood glucose increased during maintenance of anesthesia with isoflurane compared to propofol during the surgery.

Comparison of effects of ephedrine, lidocaine and ketamine with placebo on injection pain, hypotension and bradycardia due to propofol injection: a randomized placebo controlled clinical trial

Propofol is a widely used anesthetic drug because of its minor complication and also its fast effect. One of most popular complication in using this drug is pain during injection that is more sever in new generation of its components [lipid-free microemulsion]. Other complications of propofol are bradycardia and hypotension. This study compares 3 drugs with placebo in control of these complications of propofol. In this double blinded randomized placebo controlled trial 140 patient who were candidates for elective surgery were divided in 4 groups [35 patients in each groups] and drugs [ephedrine, lidocaine, ketamine and NaCl solution [as placebo] were tried on each group by a blinded technician and responses to drugs were evaluated under supervision of a blinded anesthesiologist. Pain after injection, systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP] and heart rate [HR] were measured 5 times during anesthesia process of each patient. All gathered data were analyzed using t-test and Chi-square under SPSS software. Our data shows that in pain management all tested drugs can decrease pain significantly comparing with placebo [P=0.017]. In control of hemodynamic parameters ephedrine could efficiently control SBP, DBP, MAP at the time 1 min after intubation. Based on our study ephedrine can be an appropriate suggestion for control of both pain and hemodynamic changes induced by propofol, although because of inconsistent result in other studies it is recommended to design a systematic review to draw a broader view on this issue.

[ effect of administering warmed intravenous fluids on maternal body core temperature in cesarean delivery]

Hypothermia is a common complication in surgeries patients and may have serious consequences in both mother and fetal in cesarean surgery. This study was implemented to assess the effect of intravenous [IV] infusion of warm fluids on decreasing hypothermia in mothers and its consequences on newborns. This randomized controlled clinical trial was done on 70 candidates of elective caesarean surgery. First group received IV infusion of 38[degree] C fluids, second group got IV infusion of room temperature fluids. Mother`s core temperature, during the surgery and after the surgery, systolic blood pressure, pulse rate, postoperative shivering and APGAR of newborns were assessed. The administration of warmed fluids prevented shivering [p < 0.01] and hypothermia 30 minutes postoperatively and 1 hour after in the recovery [p<0.01]. There were no significant differences in other variables. Infusion of warmed IV fluids can decrease hypothermia and its complications namely shivering in cesarean section