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.

Thoracic complications in patients with traumatic fractures in Thoracic spine needing surgical fusion

Thoracic spine fractures and their operation have many undesirable problems and complications including pneumothorax, hemothorax, chyiothorax, trachea and esophagus injuries, mediastinurn hemtoma, rib and sternum fractures and injuries of major vessels. This study surveys the incidence of the above mentioned complications. 50 hospitalized patients in the trauma ward of Tabriz Imarn Hospital from 2005 to 2010 were studied retrospectively these patients had Thoracic spine fractures needing stabilization and fusion. 78% of the patient's mere male and 22% female with the mean age of 34. The most common cause of trauma was motor vehicle accidents [56%]. Rib fracture was reported in 18% of the patients, pneumothorax in 10% and lung contusion in 12%. No cases of chylothorax, major vessels and trachea and esophagus injuries or complications related to the operation were reported. Patient's with thoracic spine fractures considering the extended injuries associated with primary trauma and complications related to operation in thoracic region need the cooperation of diverse specialists