comparison of hemodynamic changes during laryngoscopy and endotracheal intubation by using three modalities of anesthesia induction

Laryngoscopy and endotracheal intubation is usually associated with hemodynamic changes increases in blood pressure and heart rate. We aimed to compare the hemodynamic effects of combined use of low dose thiopentone and propofol during induction of anesthesia with conventional dose of thiopentone and propofol separately. This trial was conducted prospectively among 90 candidates, American Society of Anaesthesiologists grade-l [ASA-I], scheduled for elective surgery, with an age range of 20-50 years. Selected patients were randomly assigned to three equal groups. Thiopentone was used in group 1, propofol in group 2, and a combination of low dose thiopentone and propofol in group 3 as an induction agent. Heart rate and blood pressures were measured non-invasively at five different times: prior to the injection of study drugs, three minutes after the last injection of induction drug and immediately before the laryngoscopy and endotracheal intubation, as well as at the first, third and fifth minutes after endotracheal intubation. The adjusted mean values of systolic blood pressure, diastolic blood pressure, and heart rate were assessed by paired comparisons, by considering the variable of time; all changes were significantly different between Groups 1 and 2. Moreover, changes in systolic and diastolic blood pressures were significantly different between Groups 1 and 3. They were not significant for heart rate. No significant difference was documented between Groups 2 and 3; showing that in these groups the hemodynamic changes were small during drug injection, laryngoscopy, and intubation as well as until five minutes after endotracheal intubation. The combined use of low dose thiopentone and propofol for anesthetic induction caused less hemodynamic changes than the higher dose of either alone. This modality of anesthesia induction may have clinical importance for the elderly patients as well as those with high blood pressure and heart diseases

perioperative effect of ascorbic acid on inflammatory response in coronary artery bypass graft surgery; a randomized controlled trial coronary artery bypass graft surgery

Different pharmacological agents may decrease the inflammatory response during cardiac surgery. The aim of this study was to evaluate the effect of ascorbic acid as an antioxidant on inflammatory markers [interleukins 6 and interleukin 8] released during cardiopulmonary bypass. Forty patients scheduled for elective coronary artery bypass grafting surgery, were randomly assigned to two groups. The patients in the case group were given 3 grams ascorbic acid 12-18 hours before operation and 3 grams during CPB initiation. The patients in the control group were given the same amounts of normal saline at similar times. Blood samples were collected 6 hours preoperatively and postoperative serum interleukin 6 and 8 were measured using enzyme-linked immunosorbent assay [ELISA]. In both groups CPB caused an increase in IL6 and IL8 plasma concentrations ; compared with baseline levels, but the pattern of changes at such levels were similar in both groups after receiving ascorbic acid or placebo. Ascorbic acid did not reduce the inflammatory cytokines during CPB. Compared to the placebo, ascorbic acid had no significant effect on hemodynamic parameters such as systolic and diastolic blood pressure, heart rate, arterial blood gases, BUN, Creatinine and WBC and platelet counts. Ascorbic acid has no effect on the reduction of IL6 and IL8 during CPB. Also, it causes no improvement in hemodynamics, blood gas variables, and the outcomes of patients undergoing CABG

Effects of different methods of diuresis on renal function of patients receiving kidney transplantation: a randomized, controlled, double-blind trial

A number of pharmacological methods are being used for preserving the function of the transplanted kidney; however, their effects on the future performance of these kidneys remain controversial. We aimed to compare the effects of different methods of induced diuresis on the function of transplanted kidneys. This randomized, controlled, double-blind trial was conducted among 140 candidates of renal transplantation. They were randomly assigned into four equal groups of 35 patients each: control group [receiving furosemide and mannitol], group receiving dopamine, group receiving aminophylline, and group receiving a hyperosmolar solution containing dextrose and sodium bicarbonate [forced diuresis group]. To assess renal function, urine volume, creatinine clearance, urinary sodium excretion, and serum creatinine were measured. Data were analyzed using SPSS software. Pearson correlation and analysis of variance [ANOVA] tests were used as appropriate. Age and gender distribution of kidney graft recipients and donors of transplanted kidneys had no statistically significant difference among the four studied groups. During the first postoperative day, creatinine clearance was significantly higher in the groups receiving either dopamine or forced diuresis compared with other groups. Likewise, in the first 2 hours after surgery the mean urinary output and creatinine clearance were significantly higher in the groups receiving either dopamine or forced diuresis. The stimulation of transplanted kidneys by dopamine and using forced diuresis were the best methods in increasing the surrogate markers of renal function, i.e. urinary output, and creatinine clearance. They may be suggested as methods of choice for supporting the function of transplanted kidneys

Clemastine to prevent adverse effects of protamin sulfate after coronary artery bypass graft surgery

Heparin is the only widely used pharmacologic agent for anticoagulation during coronary artery bypass graft surgery [CABG]. Failure of adequate and prompt heparin reversal by protamine sulfate can result in hemodynamic instability. Protamine has various side effects. Clemastine as an H1 receptor blocking agent shows positive inotropic effect but not some side effects of non-sedative antihistamines such as cardiac arrhythmia. The aim of this study was to evaluate the effect of clemastine on several hemodynamic responses after protamine sulfate administration in patients subjected to CABG. In a prospective randomized controlled trial, 60 patients aged 34-87, with the ASA class II to IV and cardiac ejection fraction >/= 50% who subjected to elective CABG were enrolled to two equal groups. Patients in group 1 received normal saline [2ml] intravenously as placebo before the operation was completed. Patients in group 2 received clemastine 2 mg [2ml] intravenously at the same time as group 1. After the operation all patients received slowly infusion of protamine sulfate within 7 minutes, through peripheral vein. Change of MAP in 5 minutes after protamine administration was clinically significant in group 1. No drop in MAP in 5 and 10 minutes after protamine administration was seen in group 2. There was a significant increase in heart rate in 5 and 10 minutes after protamine administration in group 1. There was no significant rise in heart rate before and after protamine administration in group 2. Clemastine can prevent MAP decrease after protamine administration in patients subjected to coronary artery bypass graft surgery

relief of anxiety: comparative study - Air plane flying vs anesthesia -

Airplane flying and anesthesia are both not entirely safe. Passengers and patients have the right not to be endangered during flight or anesthesia. Flying and anesthesia have always been associated with anxiety in passengers and patients. This study was undertaken to compare the anxiety between passengers to fly and patients to receive anesthesia. One hundred and eighty persons were randomly selected and divided into six equal groups. Pilots and flight crew; anesthetist, resident of anesthesiology and nurse anesthetists; people who had flown but without any history of anesthesia; people without any experience of flight or anesthesia; people with previous experiences of both the flight and anesthesia and finally people with a previous history of anesthesia but without any experience of flight as Groups 1 to 6 respectively. A questionnaire was used to evaluate the level of anxiety during both the flight and anesthesia. All six groups had significantly more anxiety from anesthesia than flying [p<0.05] except in group 5 [p = 0.460]. Anxiety of flying was significantly less in pilots and flight crews [group 1] when compared with other groups [p<0.004]. The anxiety of anesthesia was significantly less in anesthetist team when compared with those who have not experienced general anesthesia. People who had not experienced anesthesia showed more fear about anesthesia than those who had experienced general anesthesia [p<0.002]. The results showed that having enough information about flying causes less anxiety just as preoperative visits help the patient to undergo a more comfortable anesthesia