[Ephedrine reduces the pain from propofol injection]

Propofol is the most frequently used intravenous anesthetic today. One of its side effects is the pain on injection. Various methods such as adding lidocaine, cooling or warming and dilution of the propofol solution have been used for reducing the pain. However, each of these methods comes with a degree of failure. We designed this double-blinded randomized clinical trial to evaluate the effects of ephedrine of the injection pain caused by propofol. Fifty patients, between 20-60 years old and in the ASA physical status I and II, were enrolled in this experimental study and randomly divided into two equal groups. The basal vital signs for all patients were recorded, and 30 seconds prior to the induction of anesthesia, either 70 micro g/kg of ephedrine [study group] or an equal volume of normal saline [control group] was administered without premedication. Then, 20% of propofol was administered to each patient, and the pain intensity was measured and recorded by both the Verbal Rating Scale [VRS; grading 0-3] and Face Pain Scale [FPS; grading 1-6]. The remaining dose of propofol and atracurium were administered. Patients of two groups were similar with respect to age, sex, ASA status, and basal vital signs [P>0.05]. The mean degrees of pain severity, in the study and control group were 0.48 +/- 0.51 and 1.08 +/- 759 by VRS [P = 0.002], and 1.48 +/- 0.586 and 2.04 +/- 0.841 by FPS [P=0.009], respectively. Based on the results of the present study, also supported by other studies, it seems that administration of ephedrine prior to propofol is a suitable method for reduction of pain from propofol injection

[Evaluation of Intravenous ephedrine's effect on shortening the onset time of muscle relaxation of induced by atracurium]

Delayed onset time of neuromuscular blocking is one of the limitations of using nondepolarizing muscle relaxants for facilitation of endotracheal intubation. This double-blinded randomized clinical trial was designed with the presumption that ephedrine can increase cardiac index and muscle blood flow and therefore it may shorten the onset time of muscle relaxation by atracurium. Sixty patients, aged 18-60 yr, with ASA physical status I, II were randomly assigned into two equal groups. Baseline vital signs were recorded and then all patients received intravenous midazolam and fentanyl, as premedication. One minute before induction of anesthesia with propofol and atracurium, the experimental group received intravenous ephedrine 70 micro g/kg and control group received an equal volume of normal saline. Muscle relaxation was assessed by means of peripheral nerve stimulator, based on TOF pattern of stimulation on ulnar nerve. The time interval between atracurium injection and the absence of TOF response [TOF=0] was recorded in all patients. Using SPSS software, data were analyzed by means of student's t-test and Chi-square test. Demographic data and baseline vital signs were similar in both groups [p>0.05]. The mean time taken for onset of relaxation, needed for endotracheal intubation [from atracurium administration to the time of TOF =0], was less in study group compared to control group [185.1 +/- 21.59 vs. 258.43 +/- 20.63 seconds] which was statistically significant [p<0.001]. intravenous injection of ephedrine shortens the onset time of atracurium induced muscle relaxation which is similar to other nondepolarizing muscle relaxants, such as vecuronium and rocuronium

[Comparison of sedative effects of propofol-ketamine with propofol during retrobulbar nerve block in cataract surgery]

Retrobulbar block is a relatively unpleasant and painful procedure. For well being and safety of the patients during retrobulbar block, sedation is required. This study was designed to compare the sum of sedative effects of ketamine and propofol with that of propofol alone in patients receiving retrobulbar block for cataract surgery. Sixty patients were assigned into two groups randomly and received retrobulbar nerve block for cataract surgery. Under identical conditions, in the propofol group sedation was induced with 0.3mg/kg propofol while sedation in ketamine plus propofol group was induced with 0.3mg/kg propofol plus 0.15mg/kg ketamine. In all patients, vital signs, the status of sedation and hypnoses, intraocular pressure, amnesia, onset and duration of sedation were measured and recorded. Side effects of the drugs were evaluated in the first 24 h after operation. Data were analyzed by means of T-test and x[2]. Duration of sedation was longer in ketamine plus propofol group [5.8 +/- 2.8 min] than that of propofol group [4.1 +/- 2.4 min] [p<0/05[. Intraocular pressure in ketamine plus propofol group was less than that of propofol group [p>0/05]. On the other hand ketamine plus propofol group patients showed a decline in the need for excess sedation, awareness, and psychological reactions. Seven patients in propofol group developed vertigo and six patients in ketamine plus propofol group developed agitation as the side effects of these drugs. Addition of low dose ketamine to propofol will increase duration of sedation and decrease IOP, without increasing unwanted side effects, in comparison with propofol alone for performing retrobulbarblock

effect of addition of intravenous nitroglycerin to lidocaine for improvement of quality of intravenous regional anesthesia

Disadvantages of intravenous regional anesthesia [IVRA] include slow onset, poor muscle relaxation, tourniquet pain, and rapid onset of pain after tourniquet deflation. In this randomized, double-blind study, we evaluated the effect of addition of nitroglycerine [NTG] to lidocaine for improvement of IVRA. Forty six patients [20-50 yrs] were randomly assigned into 2 equal groups. Under identical conditions, the control group received 3 mg/kg of lidocaine 0.5% diluted with saline, and the study group received an additional 200 microgram NTG. Vital signs and tourniquet pain were measured on the basis of VAS score and recorded before applying tourniquet and 5, 10, 15, 20, and 30 min after administration of anesthetic solution. The onset of sensory and motor block was measured and recorded for all patients. Severity of pain was measured at 5 min, 2, 4, 6, 12, 24, hours after deflation of tourniquet and the total dosage of pethidin injected in the first 24 hours after operation was calculated. Sensory and motor block began more rapidly in study group than control group [2.61 vs. 5.09 and 4.22 vs. 7.04 min., respectively] [p<0.05]. Recovery from sensory and motor block and onset of tourniquet pain were delayed [7.26 vs. 3.43, 9.70 vs. 3.74 and 25 vs. 16.65min., respectively] [p<0.05]. Duration of analgesia after tourniquet deflation was more prolonged and tourniquet pain intensity was lower in study group [p<0.05]. Fentanyl requirement during operation and meperidine used during first postoperative day and pain intensity at 4, 6, 12 and 24hr postoperatively were lower in study group p<0.05. No significant side effect was noted in the patients of both groups. Addition of NTG to lidocaine in intravenous regional anesthesia accelerates the onset of anesthesia and decreases the tourniquet and postoperative pain, without any side effect

[Trans-sphenoidal surgery in 95 acromegalic patients: clinical and radiological findings]

Acromegaly, a multisystem disease, produced by growth hormone [GH] secreting pituitary adenomas, has devastating effects shortening life expectancy; thus control of the disease is vital. Surgical removal of adenomas is the primary and standard treatment in these patients. In this study, results of trans-sphenoidal surgery in 95 patients admitted consecutively to the Shohada-e Tadjrish Hospital, over 9 years beginning 1996, were analyzed. Data were collected retrospectively from files of all patients admitted to our hospital, over 9 years, and operated using a trans-sphenoidal approach. Clinical and radiological evaluations were reviewed and intra-operative findings, postoperative complications, immediate hormonal assay results and long term follow ups were analyzed. Forty eight patients were female and 47 male [1/1 ratio] with mean age of 39.2 +/- 12 years. Acromegalic features were present in almost every patient with a mean duration of 46 +/- 43 months. Macroadenomas were discovered in 70 patients and microadenomas in the other 25; there was no mortality. Postoperative complications were as follows: Temporary Dl in 80, CSF rhinorrhea in 11 and meningitis in 4 [all were managed conservatively with only one case of permanent Dl]; 79 patients had follow up [mean 13 +/- 12 months]; 64% of patients [76% of microadenomas and 62% of macroadenomas] had remission [post-operative GH < 5 ng/mL], but with remission criteria of GH < 2.5 ng/mL there was 51% remission rate [65% of microadenomas and 44% of macroadenomas]. In five patients, following initial surgery, there was recurrence after 1 to 4 years, which was controlled in 4 of with a second trans-sphenoidal surgery, with the remaining one case being referred for radiotherapy

[Microvascular decompression in patients with trigeminal neuralgia]

Trigeminal neuralgia is a common disorder with well established diagnostic characteristics. Remission of symptoms with carbamazepine seems diagnostic, however, cases who failed to respond might advise surgery. In the present study, we investigate postoperative complications and outcomes in a group of Iranian patients referring with trigeminal neuralgia during a 10-year period. It was a retrospective study. We reviewed medical files of patients referring with trigeminal neuralgia and underwent microvascular decompression during a 10-year period [1995-2004]. Totally, 35 patients with the mean age of 55 years and male to female ratio of 1.33 underwent microvascular decompression. A combination of maxillary and mandibular branches of trigeminal nerve was the most commonly involved root, reported in almost half of the patients. Superior cerebellar artery was, by far, the most frequent compressor of the nerve. Immediate response to surgery was reported in 83%. Postoperative complications were observed in 8 patients, 4 due to medications while the other 4 were believed to be neurologic in origin. Unfortunately, 2 patients died. Patients were followed for 1-46 months [mean 14 months], during which 4 returned with symptoms recurrence and received medical therapy. Microvascular decompression is the standard surgical approach for trigeminal neuralgia since it is associated with symptoms relief, excellent postoperative outcomes, minor complications and low recurrence rate