Correlation of intra abdominal pressure with intra and post operative anesthetic complications

Intra-abdominal pressure, [IAP], is the pressure inside the abdominal cavity. Its normal value has not been defined clearly, but it may range from sub-atmospheric to about 7 mmHg. Intra-abdominal hypertension, defined as IAP greater than 12 mmHg, has been reported in critically ill patients and is associated with cardio-respiratory and renal co-morbidities. The effect of borderline values of IAP on the peri-operative morbidities has not been investigated in previous studies. This study was designed to investigate the effect of high normal values of IAP on anesthesia-related peri-operative complications. Intra-abdominal pressure was measured before induction of general anesthesia in 60 adult non-obese patients scheduled for elective orthopedic surgery. Patients were observed throughout the operative and recovery period for any evidence of anesthesia-related complications viz. oxygen desaturation, hypertension, dysrhythmia etc. Patients were categorized into two group, those with >2 episodes of complications, and those with 2 episodes of complications. The mean IAP was 8.21 +/- 2.1 mmHg in this group and was significantly different from the group with fewer complications in whom the mean IAP was 4.2 +/- 1.51 mmHg, [p < 0.05]. Binary logistic regression analysis showed that IAP was an independent predictor for development of anesthesia-related complications with an Odds ratio of 1.4 [1.17-1.81, p=0.015]. The result of this study shows that high normal values of IAP are an independent predictor for the development of peri-operative anesthesia-related complications

[Comparison of sedative effect of midazolam and propofol in patients with renal failure]

Peritoneal dialysis [PD] is a form of dialysis which is used mostly in children. Insertion of PD devices catheter needs a sedation and midazolam and fentanyl usually are used for this purpose. In some studies propofol also used as a sedative in renal failure patients, hospitalized in intensive care units [ICU]. No study has been conducted so far on comparison of midazolam with propofol in patients. Therefore, this study was aimed to compare the sedative effect of midazolam and propofol in the patients with renal failure, used PD device. In this clinical trial study, a total of 44 patients aged ranged 18-65 years, with physical condition of class III and IV [based on ASA classification] and with chronic renal failure who needed peritoneal dialysis catheter were randomly designated into two groups of 22 individuals. The first group was injected with propofol [50 mg/kg] and fentanyl and the second one with midazolam [50 mg/kg] and fentanyl. Then, using Ramsay score, sedation score and vital markers, before and after the intervention, were evaluated. The required clinical symptoms were obtained using an appropriate questionnaire and using Man-Whitney and t test, the data were analyzed. According to the results of this study propofol induced a higher sedation level than that of midazolam [P<0.001]. There was no significant difference in O2 saturation between the two groups. Blood pressure and pulse rate in the group received propofol were [P<0.001] decreased whereas in the group received midazolam were increased [P<0.05]. The mean of pain, based on visual analog scale [VAS], in the groups received propofol and midazolam was 2.68 +/- 0.49 and 3.64 +/- 0.4, respectively [P<0.05]. Durations of recovery in the groups received propofol and midazolam were 25.86 +/- 2.98 and 31.68 +/- 3.12, respectively [P<0.01]. Based on the results, the patients received propofol had more relief and less pain than those received midazolam. Thus, propofol is suggested to be used in the patients with renal failure who need PD catheterization

Effect of fentanyl and epinephrine, alone or together with and without lidocaine on the sensory and motor block duration and hemodynamic variations in spinal anesthesia

Spinal anesthesia due to its simplicity, rapid onset of its effect and low dose of drug administration, is a desirable procedure to anesthetics particularly for lower extremity and lower abdomen operations. Lidocaine is widely used in this method of anesthesia for prolongation of the sensory block. In the method, different drugs are used to prolong the duration of sensory block. Fentanyl and epinephrine are being used widely for this purpose and so far, the effects of these drugs were not compared. Therefore, in this study, the effect of the two drugs, alone or together, with and without lidocaine, on the duration and intensity of sensory and motor block has been investigated. In this double-blinded clinical trial, 60 c and idates for elective surgery of lower abdomen were randomly divided into three equal groups. For spinal anesthesia, the first group was subjected to 50 mg lidocaine plus 0.2 mg epinephrine, the second one to 50 mg lidocaine plus 0.2 mg epinephrine and 20-micro g fentanyl and the third group to 50 mg lidocaine plus 20-micro g fentanyl. Subsequently, the patients in the 3 groups were evaluated and compared for the duration of sensory and motor block and their hemodynamic variations. The data was analyzed using ANOVA and Chi-square tests. Age and sex distribution among the three groups was not significantly different. The mean of sensory block duration in the first, second and third groups were 130.25 +/- 9.05, 133 +/- 32.7 and 116 +/- 14.58 min, respectively with no significant difference. The mean of motor block duration in the first, second and third groups were 120.95 +/- 14.63, 118.75 +/- 25.74 and 107 +/- 18.23 min, respectively. ANOVA test showed no significant difference among the three groups as well. Also, with respect to hemodynamic variation, there was no significant difference among the three groups. Our findings showed that addition of epinephrine and fentanyl and combination of them to the lidocaine had no effect on the duration of sensory and motor block and hemodynamic variations. Therefore, combined use of these drugs is not necessary

Effects of magnesium sulphate in delibrated hypotension for mastoidectomy surgery

Deliberated hypotension and administration of vasoconstrictive drugs such as epinephrine during ear microsurgery are of the most important aids for reducing blood loss and improving the surgical field. One of the important challenges in selecting the appropriate method of deliberated hypotension is to easily reach to desired blood pressure and to have the least interaction to anesthetic drugs and the function of vital organs. This study aimed to assess the efficacy of magnesium sulphate for deliberated hypotension during ear microsurgery. In this clinical trial, 55 patients candidate for mastoidectomy surgery, and aged 15-65 yrs, were randomly assigned to receive placebo [n=27] or magnesium sulphate [n=28] infuse 60 mg/Kg over 15 minute followed by a maintenance dose of 10 mg/Kg/h until 30 minutes prior to the end of surgery. Intra-operative bleeding, the surgery duration, surgeon satisfaction, serum magnesium level, recovery time, anesthetic drug requirements [atracurium-halothane], and vasodilator [TNG] were measured in both groups and then compared with independent t and Mann-Whitney statistical tests. Patients receiving magnesium sulphate had less blood loss than controls [59.46 +/- 27.19 vs. 97.57 +/- 31.41 ml, respectively, p<0.01]]. Serum magnesium levels were in the therapeutic range [3.1 +/- 0.78 meq/L]. Patients had no significant arrhythmia, received lower doses of T.N.G [101.71 +/- 56.69 vs. 1107 +/- 450.45 /g]], and muscle relaxant [45.89 +/- 14.08 vs. [60.17 +/- 9.76 mg, respectively,p<0.01] but not significant difference in Halothane [[3.1 +/- 0.64 MAC/hr] vs. [3.45 +/- 0.6 MAC/hr]]. Also surgeon satisfaction was better in magnesium group [p<0.001]. There were not statistically difference in surgical time [[155.71 +/- 27.27 min] vs. [157.50 +/- 33.62 min]] and recovery time [[44.64 +/- 7.92 min] vs. [45.71 +/- 8.99 min]] between two groups. Administration of intravenous magnesium sulphate as a hypotensive drug in mastoidectomy surgery may be effective in decreasing intraoperative bleeding, using atracurium and TNG drugs,however in spite of improvement of the surgeon satisfaction, it had no effect on reducing the duration of surgery and recovery time. Overall, its administration is recommended for deliberate hypotension is a feasible method in mastoidectomy surgery

single dose of propofol can produce exellent sedation and comparable amnesia with midazolam in cystoscopic examination

In this study we compared the sedative and amnesic effects of propofol with midazolam in cystoscopy examination. This prospective clinical trial was done on 44 adults, with American Society of Anesthesiology physical status I, II, III, who were candidate for cystoscopic examination. Patients were recruited according to convenience sampling method and randomized into two equal groups. In study group, propofol plus fentanyl and in control group midazolam plus fentanyl were given intravenously. Vital signs and SaO2, the number of patients movements, presence of eyelid movements and verbal contact all at the first and 10th minutes after beginning the procedure were recorded. Also, frequency distributions of patients recalls, VAS [visual analog scale] for pain and VAS for satisfaction scores were evaluated in recovery room. Frequency distribution of patients movements, frequency distribution of verbal contact and eyelid movements at the first and 10th minutes were higher in midazolam group [P<0.05]. There were a lower VAS pain score and higher VAS satisfaction score in propofol group [P = 0.009 and P = 0.041 respectively]. Propofol was more effective than midazolam in inducing deep sedation and immobility in patients undergoing cystoscopy examination, without interfacing patients with additional danger