RESUMO
Control of intracranial pressure [ICP] before, during and after neurosurgical operations is crucially important. Therefore, trying different methods and drug combinations to attain this goal is an ongoing effort in anesthesiology. In this study we compared two combinations of a narcotic agent with propofol in neurosurgical operations to control intracranial pressure. In this prospective randomized double-blind clinical trial, we enrolled 34 patients with supratentorial brain tumors who were candidates for craniotomy in Alzahra Hospital in Isfahan, Iran from April 2008 to April 2009. The patients were randomly divided into two groups of 17, in whom the first and the second group, respectively, received a combination of "propofol and fentanyl" and a combination of "propofol and remifentanyl" as maintenance of anesthesia. The hemodynamic status, ICP during the surgery, and post-surgical complications in recovery unit were observed for and registered in a questionnaire. Hemodynamic status was similar in both groups and they did not differ in recovery complications except for pain which was more prevalent in remifentanil group [P<0.03]. Although the patients in fentanyl group better responded to the drug for lowering ICP than remifentanyl group, but the difference was not statistically significant. There is no difference between these two anesthetic agent combinations and both could be useful in the anesthesia of neurosurgical operations. However combination of propofol and fentanyl seem to be superior because of more pain relief and a smoother recovery period.
RESUMO
Emergence agitation [EA] is a post-anesthetic problem which interferes with a child's recovery and presents a challenge in terms of assessment and management. In this study, we compared the effects of midazolam and ketamine as premedication in the management of EA in children aged 1-6 years. In this prospective, randomized clinical trial study, 58 children aged 1-6 years who were undergoing general anesthesia for elective surgery in Alzahra Hospital in Isfahan during 2008 until 2009. The patients were randomly assigned to receive 0.1 mg/kg midozolam [28] or 0.5 mg/kg ketamine [29] by IV route in the premedication room. All patients received a standardized anesthetic regimen and isoflurane was used for the maintenance of anesthesia. The incidence and severity of agitation [agitation score], severity of pain [pain score], anesthesia, recovery and extubation durations were recorded postoperatively. The prevalence of agitation in midazolam [21.4%] was lower than ketamine group [34.5%; P<0.05]. In addition, the duration of agitation in ketamine group [21 +/- 16.67 min] was significantly higher than midazolam group [6.83 +/- 6.55 min], [P<0.05]. However, no significant differences were seen in agitation score, pain score, anesthesia, recovery or extubation durations in the two groups [P>0.05]. The study showed that midazolam could reduce the frequency of agitation better than ketamine but both drugs were able to reduce the severity of agitation after short-time surgeries in young children