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