Studying analgesic effect of preincisional infiltration of lidocaine as a local anesthetic with different concentrations on postoperative pain

Preincisional infiltration of anesthetics into surgical wounds may be effective in various elective surgeries. The aim of this study was to asses the effect of lidocaine infiltration with different concentrations in relieving post operative pain in tubectomy patients. This is a placebo controlled double blind trial, performed on 80 female patients candidated for tubectomy with general anesthesia between the years 2006-2007. The study was conducted in Tabriz University of Medical Sciences, Tabriz, IRAN. The patients were consecutively randomized into four groups. Three groups which consisted of 20 patients each received lidocaine infiltration before skin incision with different concentrations [0.5%, 1%, 1.5%] and were examined for intensity of feeling pain and the duration of analgesia in comparison to the fourth group or control group [20 patients], in which normal saline solution infiltration was used. In this study the intensity of postoperative pain was assessed using VRS [Verbal Rating Scale]. Data collection was done using the questionnaire, and collected data was analyzed by student t-test, using SPSS software and descriptive statistical program. P<0.05 was considered significant. Average duration of analgesia was five hours about groups I, 3:30 hours for group II and it reported to be 20 hours in group III. In the control group, however, it was only an hour. Preincisional local infiltration of lidocaine 1.5% is an effective, simple and cost-effective approach for postoperative pain relief among tubectomy patients

[Effect of preoperative fasting on hemodynamic status of elective hysterectomy patients with general anesthesia]

Preoperative fasting for performing elective operations can lead to a metabolic state which is unfavorable for patients. The aim of this study was to determine the outcome of preoperative fasting on hemodynamic status of patients with elective operations by general anesthesia. This is a descriptive study performed in Tabriz University of Medical Sciences, in Alzahra educational and therapeutic center on 60 ASA class I, and II patients candidate for elective hysterectomy in 1385. Simple sampling method was used for recruitment of patients and a questionnaire was used for data collection. Collected data were analyzed by student t-test, using SPSS software. The average age of the patients was 47 +/- 15.69 years and their body weight was 56 +/- 7.56 kg. The average of fasting time [in hours] was 12.66 for operations performed in the morning and 16 for evening surgeries. Changes of hemodynamic parameters [including systolic and diastolic blood pressure and heart rate] during 5 to 10 minutes of induction were significant during induction of anesthesia in comparison to baseline levels [p<0.05]. For signs of dehydration, 25 [41.66%] of patients had dry mucosa and 14 [23.33%] cases complained of being thirsty. Urinary output during the first 30 minutes of surgery reported to be less than 15 ml/hr in all cases. No significant changes in body temperature were observed in studied patients. Results of this study revealed that preoperative fasting before elective operations for prevention of aspiration must be considered in order to decrease its effect on hemodynamic status of patients especially during induction of general anesthesia

[Comparison of feasibility of endotracheal intubation with and without succinylcholine in the elderly patients]

Orotracheal intubation is a common method for airway management in critical situations and for performing different surgeries in operating rooms under general anesthesia. Firstly, an ultra shortacting anesthetic is administered by intravenous [i.v], mask ventilation instituted and then the most common depolarizing muscle relaxant, succinylcholine, injected. Since succinylcholine and other muscle relaxants have some adverse effects, the current study was performed to present an alternative method for endotracheal intubation without muscle relaxants in some certain situations. The present study was a double-blinded clinical trial, which it is performed on 150 elderly patients in Nikocari Hospital, Tabriz. The patients were divided into two groups, study and control. The patients were elective and anesthesia technique was general anesthesia with endotracheal intubation. Patient selection was based on the physical status classification by American Society of Anesthesiologists [ASA]. Therefore, the patients who categorized as class I and II of the ASA classification were selected. All the patients' airway classification was class I with respect to Mallampati test. lidocaine 1-1.5mg/kg, midazolam 1mg, alfentanyl 30 micro g/kg, and propofol 2mg/kg was administered for patients in the study group. Patients in the control group were received the following drugs: lidocaine 1-1.5mg/kg, midazolam 1mg, propofol 2mg/kg and succinylcholine 1-1.5 mg/kg. In the study, all the patients were intubated by an anesthesiologist who was not aware of the medications administered and airway classification. Data collection including the time of consciousness loss, jaw relaxation, quality of ventilation, vocal cards position, patients' response to laryngoscopy, duration of laryngoscopy, was performed using a questionnaire. Statistical analysis was performed by SPSS software. 51.7% of patients were male and 48.3% were female. Average age of the patients was 61.19 +/- 12.06 year and their weight mean was 59 +/- 1.06Kg. Only 45% of the patients had a previous history of anesthesia and surgery, but none of them had an experience of difficult intubation. According to ASA classfication, 26.7% of the patients were in class ? and 73.3% in class II. All patients had the capability of head extension and mouth opening more than 40mm. In the study group, loss of consciousness occurred in less than one minute and more than two minutes was respectively observed in 35% and 1.7% of the patients. No significant difference was detected between the study and the control group with respect to loss of consciousness. Jaw relaxation was very good in 86.7% of patients and ventilation was easy in 94.5% of patients in the study group. In the control group, jaw relaxation was excellent in 98.2% of patients and ventilation was easy about all patients. Vocal cords had an open and complete view in 91.2% of cases in the study group, while it was 94% in control group [p<0.05]. In the study group, an easy laryngoscopy was reported in 85% of cases and the duration of laryngoscopy was 11 +/- 7.16 seconds, whilst, the duration of laryngoscopy was 10 +/- 6.08 seconds and easy laryngoscopy was observed in 90.17% of cases in the control group [p<0.05]. Hemodynamic changes were sensible in both groups but SPO2 changes were not obvious. Only 17.9% of patients in the study group responded to intubation in form of feeble cough. No response was observed in the control group. Respectively, 96.8% and 98% of the patients in the study and control group did not experience any significant problem about respiratory system in postoperative period. Considering adverse effects of muscle relaxants used for airway management and necessity of performing endotracheal intubation without muscle relaxants by skilled and expert people, as well as given the study results, using this technique is recommend in patients with some certain criteria

Lidocaine spray for relief of extubation laryngospasm in anesthetized patient

To asses use of lidocaine spray to relieve post anesthesia laryngospasm. The study was performed for one year between 2004-2005 in Tabriz Medical Sciences University, Tabriz, IRAN. Patients with ASA class I and II with laryngospasm were given two puffs of lidocaine spray locally onto vocal cords and response was observed for 60 seconds. The study included 20 patients during one year study in which 38 percent of the patients were female and 62 percent were male. Average age of the patients was 30'1.9 years. 85 percent of the patients were in ASA class I and 15 percent in class II. The treatment relieved laryngospasm in 90 percent of the patients in 10'0.1 seconds. In 10 percent anesthesiology team members applied other conventional airway opening maneuvers. Spraying 10 percent lidocaine onto the vocal cords under direct vision can suppress stimulated laryngeal receptors in most patients. Advantages of this approach include drug availability, its prompt effect and easy usage

Role of routine preoperative ECG on anesthesia planning in elderly patients

ECG is a test which is used for diagnosis and confirmation of cardiovascular diseases. Many studies regarding the validity of this test in different age groups have been performed and different results were obtained. This study was performed to assess the role of ECG on anesthesia planning in elderly patients. One hundred elderly patients who referred to Nikocari hospital in Tabriz for eye surgery were enrolled in this study. Findings of clinical examination and medical history were compared with those obtained from the interpretation of ECG by anesthetists. The data were analyzed using descriptive statistical methods. Results showed that only 4% of the patients without positive findings in clinical examination had ECG abnormalities; 3% had RBBB; and 1% had T inversion in pre-cordial leads. It is noticeable that reported abnormalities are not so important on the basis of anesthesia care planning. According to the results obtained, it seems logical to pay more attention to selection of patients for ECG and ordering ECG test only for patients with positive clinical findings

Bilateral vocal cord paralysis after extubation

Vocal cord paralysis is an uncommon complication of endotracheal intubation after induction of general anesthesia. It may be due to the endotracheal tube cuff pressure on the recurrent nerves. Vocal cord edema occuring in the presence of a paralyzed cord may precipitate complete airway obstruction and can cause bilateral cord paralysis. Here, we describe post anesthetic bilateral vocal cord paralysis in an elderly female patient which diagnosed by direct larayngoscopy and successfully treated by tracheostomy in respiratory intensive care unit. The patient discharged after two weeks and achieved complete recovery one