[Comparison of sedative effect of midazolam and propofol in patients with renal failure]

Peritoneal dialysis [PD] is a form of dialysis which is used mostly in children. Insertion of PD devices catheter needs a sedation and midazolam and fentanyl usually are used for this purpose. In some studies propofol also used as a sedative in renal failure patients, hospitalized in intensive care units [ICU]. No study has been conducted so far on comparison of midazolam with propofol in patients. Therefore, this study was aimed to compare the sedative effect of midazolam and propofol in the patients with renal failure, used PD device. In this clinical trial study, a total of 44 patients aged ranged 18-65 years, with physical condition of class III and IV [based on ASA classification] and with chronic renal failure who needed peritoneal dialysis catheter were randomly designated into two groups of 22 individuals. The first group was injected with propofol [50 mg/kg] and fentanyl and the second one with midazolam [50 mg/kg] and fentanyl. Then, using Ramsay score, sedation score and vital markers, before and after the intervention, were evaluated. The required clinical symptoms were obtained using an appropriate questionnaire and using Man-Whitney and t test, the data were analyzed. According to the results of this study propofol induced a higher sedation level than that of midazolam [P<0.001]. There was no significant difference in O2 saturation between the two groups. Blood pressure and pulse rate in the group received propofol were [P<0.001] decreased whereas in the group received midazolam were increased [P<0.05]. The mean of pain, based on visual analog scale [VAS], in the groups received propofol and midazolam was 2.68 +/- 0.49 and 3.64 +/- 0.4, respectively [P<0.05]. Durations of recovery in the groups received propofol and midazolam were 25.86 +/- 2.98 and 31.68 +/- 3.12, respectively [P<0.01]. Based on the results, the patients received propofol had more relief and less pain than those received midazolam. Thus, propofol is suggested to be used in the patients with renal failure who need PD catheterization

Risk factors of re-intubation of patients in intensive care units

Re-intubation of the trachea is one of the complications of the patients encounter with critical illness in the intensive care unit. The incidence of this complication has reported between 2% and 25%. Many risk factors contribute with this phenomenon; such as female sex, aging, narcotic and sedative drugs, etc. Re-intubation increases the duration of hospitalization, as well as pulmonary complications and mortality rate. The aim of this study was to evaluate the risk factors of re-intubation in the intensive care units [ICU]. This study was a retrospective cross- sectional study and was conducted in 2004 among the data documented 210 medical records. These records were obtained from three ICUs of AL-Zahra medical Center. Incomplete medical records were. All data was extracted and filled in speciallydesigned questionnaires. Obtained data was analyzed with SPSS software by using Chi-square and t-tests. From the 210 medical records studied, 15 patients [7.1%] were re-intubated. There was a positive correlation between re-intubation and hemoglobin when it was lees than 12 gr/dL or more than 15 gr/dL. Aging [age>65 years], hyponatermia [Na<135 meq/L], hypokalemia [K<3.5meq/L] and co-existing diseases [cardiac, renal, diabetes and hypertension] might have a role in increasing the frequency of re-intubation

[Post anesthetic shivering in children: incidence and causative factors]

Patients loss their body heat during the anesthetic period and postoperative shivering is occurred to compensate it. To date, most of the studies about postoperative shivering were done in adults and there are limited data in pediatric patients. The aim of this study was to investigate the incidence of shivering in children and to reveal the causative factors as well as any possible clinical implications. This cross sectional study was performed on 200 pediatric patients with age ranging from 3 months to 14 years. Demographic data, kind of anesthesia, body temperature and recovery temperature were recorded. Data were analyzed using chi 2, Spearman and Pierson tests. The incidence of shivering was 7%. Shivering was significantly more in the patients receiving inspirational anesthesia [13.6%] than in the patients receiving intervenes anesthesia [0%] [p<0.05]. Shivering was high when body temperature was below 36.4°C or when recovery temperature was below 26°C [p<0.05]. The incidence of shivering in patients who received pre-medication was lower than that of in patients who received no medication [p<0.05]. The incidence of shivering in pediatric patients was related with their body temperature, recovery temperature, pre-medication and method of anesthesia

single dose of propofol can produce exellent sedation and comparable amnesia with midazolam in cystoscopic examination

In this study we compared the sedative and amnesic effects of propofol with midazolam in cystoscopy examination. This prospective clinical trial was done on 44 adults, with American Society of Anesthesiology physical status I, II, III, who were candidate for cystoscopic examination. Patients were recruited according to convenience sampling method and randomized into two equal groups. In study group, propofol plus fentanyl and in control group midazolam plus fentanyl were given intravenously. Vital signs and SaO2, the number of patients movements, presence of eyelid movements and verbal contact all at the first and 10th minutes after beginning the procedure were recorded. Also, frequency distributions of patients recalls, VAS [visual analog scale] for pain and VAS for satisfaction scores were evaluated in recovery room. Frequency distribution of patients movements, frequency distribution of verbal contact and eyelid movements at the first and 10th minutes were higher in midazolam group [P<0.05]. There were a lower VAS pain score and higher VAS satisfaction score in propofol group [P = 0.009 and P = 0.041 respectively]. Propofol was more effective than midazolam in inducing deep sedation and immobility in patients undergoing cystoscopy examination, without interfacing patients with additional danger