Effect of Intranasal Remifentanil versus Lidocaine on Facilitation of Laryngeal Mask Airway Insertion and Cardiovascular Response: A Double-blind Clinical Trial Study.

Objective: This study aimed to assess and compare the effects of intranasal administration of lidocaine and remifentanil on the condition of LMA insertion and cardiovascular response. Methods: From March 2019 to March 2020, this double-blind randomized clinical trial study was conducted on 60 patients, who underwent general anesthesia with LMA insertion at Faiz Hospital, Isfahan, Iran. After induction of anesthesia and before placing the laryngeal mask, the first group received remifentanil 1 µg/Kg, the second group received lidocaine 2% 1 mg/Kg, and the third group received normal saline with the same volume intranasally. The conditions of LMA insertion and hemodynamic changes that occurred during its insertion were investigated. Results: In terms of demographics characteristics (p>0.05), success in placing the LMA on the first try (p=0.73), number of attempts to insert LMA (p=0.61), performance of LMA (p=0.73), need for additional propofol (p=0.53), frequency of gagging (p=0.53), cough (p=0.15) p), and laryngospasm (p=0.99) did not differ significantly. In the remifentanil group, the cardiovascular response to LMA injection was less than that of the lidocaine group. Moreover, both groups were lower than the saline group, but no significant difference was observed. Conclusion: In facilitating LMA insertion, the effect of intranasal remifentanil was comparable to intranasal lidocaine. Intranasal remifentanil was somewhat more effective than intranasal lidocaine in weakening the cardiovascular response to LMA insertion, but it did not outperform lidocaine.

Evaluation of the Effect of Propofol-Remifentanil and Propofol-Hydralazine on the Bleeding Volume During Dacryocystorhinostomy Surgery Under General Anesthesia.

Background: The present study was performed to compare the effectiveness of propofol-remifentanil and propofol-hydralazine in inducing controlled hypotension in patients undergoing the dacryocystorhinostomy (DCR) surgery and reducing their bleeding volume during surgery. Materials and Methods: The present double-blind, randomized clinical trial was performed on 70 patients who were candidates for DCR surgery and divided into two groups. In both the groups, general anesthesia protocol was performed. Moreover, in the first group, a syringe containing 2 mg of remifentanil in 20 ml of distilled water (0.1 mg/ml) was infused at the rate of 0.15 µg/kg/min (P + R group). In the second group, a syringe containing 20 mg of hydralazine in 20 ml of distilled water (1 mg/ml) was infused at the rate of 0.5-10 mg/h (P + H group). Results: The hemodynamic parameters were not significantly different between the two groups in the studied times (P > 0.05). In contrast, the bleeding volume in the P + R group with the mean of 61.29 ± 50.06 ml was significantly lower than that of the P + H group with the mean of 152.31 ± 90.81 ml (P < 0.001). Moreover, the mean score of surgeon's satisfaction level in the P + R group was higher than that of the P + H group (5.91 ± 0.28 vs. 4.29 ± 0.65; P < 0.001). Conclusion: According to the results of this study, there was no significant difference between the P + H and P + R groups in terms of fluctuations in the hemodynamic parameters and the occurrence of complications. However, a reduction in the bleeding volume and a higher satisfaction level of the surgeon were observed in the P + R group compared with the P + H group.

Efficacy of two doses of dexmedetomidine on attenuating cardiovascular response and safety of respiratory tract to extubation.

Introduction: Extubation can be associated with an adverse hemodynamic or respiratory response, which may be serious in cardiovascular written or in the elderly. The present study was conducted with the aim of investigating the effect of two different doses of dexmedetomidine in the prevention of extubation complications. Methods: This randomized clinical trial was conducted in Isfahan in 2020-2021 on 174 patients undergoing elective surgery. Patients were randomly divided into 3 groups receiving dexmedetomidine 1 µg/kg (D1), dexmedetomidine 0.5 µg/kg (D2), and normal saline (S). Hemodynamic variables include heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and peripheral blood oxygen saturation (Spo2) was measured and recorded before removing the endotracheal tube and at 1, 3, 5 and 10 minutes after extubation. Also, airway responses to extubation such as cough, hoarseness, and laryngospasm were investigated. Results: SBP, MAP, and HR in the D1 group were significantly lower than in other groups. In the D2 group, these measurements were lower than the control group at 3, 5, and 10 minutes after extubation (P<0.05 for all). In placebo group, SBP, MAP, and HR increased significantly after extubation (P=0.01). In group D1, cough (P=0.007) and its intensity (P=0.013), nausea and vomiting (P=0.04) and chills (P=0.001) were less than in other groups. Conclusion: In the D1 group, attenuation of autonomic response to extubation was more than other groups and side effects were less than D2 group, and in both groups, these side effects were less than the saline group.

Comparative study of the effect of two different doses of intravenous labetalol on the cardiovascular response to endotracheal extubation.

Introduction: Providing a stable hemodynamic in extubation is important. We aimed to compare the effect of two different doses of intravenous labetalol on the cardiovascular response to endotracheal extubation. Methods: This double-blind randomized trial was performed in 2019-2020 in Isfahan on 72 patients under general anesthesia. Patients using Random Allocation software were divided into three groups and received 0.1 mg/ kg or 0.2 mg/kg labetalol and normal saline intravenously 10 min before extubation. Hemodynamic variables including heart rate (HR), Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and peripheral blood oxygen saturation(SPO2) was measured for each patient before induction of anesthesia and 1, 3, 5 and 10 minutes after extubation. Results: SBP changes were significantly different between the three groups at 1, 3, 5 minutes after extubation (P=0.036, P=0.009, P=0.005 respectively) unlike the other two groups, patients who received 0.2 mg/kg labetalol did not have an increase in DBP after extubation (P>0.05). DBP was significantly different between the three groups one minute after extubation (P=0.03). At minutes 1 and 3 following extubation, there was a significant difference in the MAP between the three groups. (P=0.029 and P=0.012 respectively). There was no significant difference between the three groups regarding heart rate (P>0.05). Conclusion: Tracheal extubation is usually associated with an increase in hemodynamic variables. Both doses of labetalol attenuate the hemodynamic response accompanying tracheal extubation. But labetalol 0.2 mg/kg in reducing hemodynamic response to extubation acted more effectively than labetalol 0.1mg/kg.

The Effect of Preoperative Combined with Intravenous Lidocaine and Ketamine vs. Intravenous Ketamine on Pediatric Patients Undergoing Upper Gastrointestinal Endoscopy.

Background: Ketamine is widely used in pediatric sedation. New studies have recommended combination therapy to reduce the side effects of ketamine. Objectives: This study investigated the effect of adding intravenous (IV) lidocaine to ketamine on hemodynamic parameters, endoscopist satisfaction, and recovery time of children undergoing gastrointestinal endoscopy. Methods: This triple-blind, randomized, controlled clinical trial was conducted in Isfahan, Iran (2021). One hundred twenty children between the ages of 1 and 6 were enrolled. Patients were divided into 2 groups. The intervention group received 1.0 mg/kg of IV lidocaine and 1.0 mg/kg of IV ketamine, and the placebo group received 1.0 mg/kg of IV ketamine and placebo 2 minutes before entering the endoscopic room. Patients in both groups were sedated with 1.0 mg/kg of propofol, 0.1 mg/kg of midazolam, and 2.0 ug/kg of fentanyl for the procedure. The pulse rate, mean arterial pressure (MAP), respiratory rate, and oxygen saturation were recorded 1 minute before injection and every 5 minutes afterward. Results: The mean (SD) ages of the intervention and control groups were 3.4 (1.5) and 3.4 (1.7), respectively. The mean difference in hemodynamic parameters between the 2 groups was insignificant during the investigation (P > 0.05). Furthermore, no significant differences were found regarding endoscopist satisfaction scores and length of recovery room stay (P > 0.05). Conclusions: Adding low-dose IV lidocaine to ketamine for pediatric sedation does not significantly affect the hemodynamic status, endoscopist satisfaction, and recovery time.

Evaluation of Four Techniques to Administer Laryngeal Mask Airway.

Background: Laryngeal mask airway (LMA) plays a crucial role in the field of modern anesthesia. There are different techniques to administer LMA. Here we aimed to compare the four methods of standard, 90° rotation, 180° rotation, and thumb placement in LMA mast placement. Materials and Methods: This is a clinical trial that was performed on 257 candidates of elective surgical operations requiring general anesthesia. All patients were categorized into four groups of LMA placement with index finger (standard method), mask placement with 90° rotation, 180° rotation method, and thumb finger group. We collected data regarding the success rates of LMA placement, the need for any manipulation when placing the mask, LMA placement time, failure of mask placement, presence of blood on the LMA, and laryngospasm and sore throats 1 hour after surgery in patients. Results: The 90° rotation method had a significantly higher first attempt success rate than that in the other three methods (98.4%, P = 0.02). Total success rate in 90° rotation method was also significantly higher than the other techniques (100%, P < 0.001). The need for any manipulation when placing the mask (1.6%, P = 0.01), presence of blood on the LMA mask (1.6%, P = 0.33), and frequency of sore throats 1 hour after surgery (21.9%, P = 0.14) were also lower in 90° rotation method than that in the other methods. Conclusion: The 90° rotation method had significantly higher success rate and lower failure rate regarding the mask placement compared to other three methods.

Comparison of intravenous sedation with propofol, dexmedetomidine and midazolam in double-J ureteral stent removal.

BACKGROUND: According to the favorable effects of combination therapy to provide better sedation during double-j stent removal and lack of studies investigating the sedative effect of propofol, dexmedetomidine, and midazolam during this procedure. This study aimed to compare the effects of intravenous sedation with propofol, dexmedetomidine and midazolam in double-J ureteral stent removal. METHODS: This double-blinded randomized clinical trial was conducted on 120 patients aged 18-72 who underwent double-J ureteral stent removal in Alzahra hospital, Isfahan, Iran from September to November 2021. Patients were randomly divided into 3 groups. In the first group, propofol was titrated with normal saline and was infused with a loading dose of 0.5 mg/kg and a maintenance dose of 1.5-2.5 mg/kg/h. In the second group, Dexmedetomidine was titrated with normal saline and was infused at a dose of 1 µg/kg within 10 min and then continued at 0.45-0.55 µg/kg. In third group, midazolam was titrated was infused with a loading dose of 0.05 mg/kg and a maintenance dose of 0.05 mg/kg/h. 50 mg of fentanyl was also infused in all the groups. If the patients did not reach the desired sedation level, 10 mg ketamine was infused as a rescue sedative agent for all three groups and repeated if needed in all groups. RESULTS: The current study was conducted on 120 patients who underwent double-J ureteral stent removal. The comparison of the sedative effect of midazolam, dexmedetomidine, and propofol showed significant differences among the three groups and was higher in the midazolam group (P=0.018). Between the three groups systolic blood pressure and mean arterial pressure was significantly lower in the propofol group (P=0.002). Heart rate was significantly lower in the dexmedetomidine group during both surgery and recovery time (P<0.001). There was no significant difference among the groups during surgery regarding oxygen saturation (P value =0.84). The intergroup comparison indicates that the mean score of surgeon satisfaction is significantly higher in the midazolam group (P-value =0.039). CONCLUSION: According to this study midazolam was superior to two other groups and was associated with deeper sedation and higher satisfaction among both patient and surgeon.

Comparative Study of the Effect of Two Different Doses of Dexmedetomidine to Prevent Emergence Agitation in Tonsillectomy in Children Aged 2 to 12 Years Old.

Background: Emergence agitation (EA) is one of the complications following anesthesia in pediatric surgery. Various drugs are used to prevent this complication, and one of them is dexmedetomidine. Choosing the right dose of this drug for the best efficiency is an important issue due to this complication.The main purpose of this study is to evaluate the prophylactic effect of intravenous dexmedetomidine in different doses in preventing EA after tonsillectomy in children. Materials and Methods: Our study was a double-blind clinical trial performed on 75 children ASAI, II candidates for tonsillectomy. Patients were divided into three groups. The group 1 received a dose of 0.6 µg/kg per hour and group 2 received a dose of 0.3 µg/kg per hour and group 3 was the control group. Then vital signs and observational pain score (OPS) and pediatric anesthesia emergence delirium (PAEDS) criteria were measured in patients. The collected data were analyzed by using SPSS software version 23 and non-parametric tests such as Friedman, Mann-Whitney. Results: According to the data analysis, mean blood pressure, mean heart rate, OPS and PAEDS score in group 1 were lower than other groups. Also, the average time of staying in recovery and extubation in group 1 was less than other groups. Conclusion: A dose of 0.6 µg/kg dexmedetomidine has a better effect on reducing EA (emergence agitation) after pediatric tonsillectomy.

Comparison of Success Rate and Safety of Nasotracheal Intubation by Conventional and Finger-Guided Method in Patients Undergoing Maxillofacial Surgery.

Background: Different techniques have been introduced to reduce the complications of nasotracheal intubation. The aim of this study was to compare the incidence of nasotracheal intubation complications in finger-guided and conventional methods. Materials and Methods: In this double-blind randomized trial study, 70 patients who were candidates for oral and maxillofacial surgery who required nasal intubation were included in the study finally of which 33 patients with conventional method and 35 patients with finger-guided tubes in the nasopharynx were analyzed at the end of the study. Variables such as success rate, hemodynamic response, and complications of intubation were compared between the two groups. Results: There was no significant difference between the two groups in terms of hemodynamic response to intubation (P > 0.05). There was a significant difference between the two groups in terms of success in tracheal intubation (P < 0.05). There was a significant difference between the two groups in terms of epistaxis immediately after intubation (P < 0.05). There was no significant difference between the two groups in terms of nasal turbine fractures (P > 0.05). However, the frequency of submucosal intubation in the conventional method was significantly higher than the other group (P = 0.02). Conclusion: Nasotracheal intubation using the finger guiding technique in the nasopharynx is associated with a higher success rate and less complications after intubation such as epistaxis and submucosal intubation compared to the conventional method.

The Effect of Tranexamic Acid Local Injection on Bleeding during and after Tonsillectomy: A Double-Blind Randomized Placebo-Controlled Trial.

Background: Tonsillectomy-related bleeding is one of the most prevalent and potentially fatal complications of this common surgical procedure. We aimed to assess the effect of tranexamic acid (TXA) local injection on bleeding during and after tonsillectomy. Methods: This double-blind, randomized placebo-controlled trial included 20 candidates for tonsillectomy referred to Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran, in 2022. The subjects were randomized into two groups. Ten patients received TXA on their left side and the other ten on their right side 10 min before surgery. Placebo was administered to the contralateral side. The primary outcome was the volume of blood loss during tonsillectomy and up to 24 hours post-tonsillectomy. The secondary outcomes were surgeon satisfaction (rated 0-10), hemodynamic complications (patients' heart rate (HR) and mean arterial pressure (MAP) were recorded every 10 min), and rebleeding. The duration of surgery was also noted. Results: The mean age of the patients was 21.35 ± 3.16 years, of whom 8 (30%) were male and 12 (60%) were female. there was no significant difference between groups in terms of HR and MAP at any time point. The median of surgery duration did not differ significantly between the two groups; however, the surgeon satisfaction with the procedure was significantly higher with TXA compared to placebo. None of the patients developed hemodynamic complications, and rebleeding did not occur in any of the subjects. Conclusions: TXA local injection was not superior to placebo in terms of bleeding control during and after tonsillectomy, hemodynamic complications, rebleeding, and surgery duration.

Conditions for Insertion of the Laryngeal Mask Airway in an Innovative Method vs the Classic Method.

Background: A laryngeal mask airway (LMA) is a simple and non-invasive device used to establish the airway and maintain ventilation and oxygenation during short-duration medical procedures. Objectives: This study aimed to compare the placement of an LMA using an innovative technique vs the classic method. Methods: This clinical trial was conducted at Faiz Hospital in Isfahan. Out of 110 candidates for elective eye surgery, 10 patients were excluded from the study as they did not meet the inclusion criteria. Ultimately, 100 patients were randomly allocated to 2 groups of 50 each. One group underwent LMA insertion using the classic method, while the other group underwent insertion using the face-to-face triple maneuver technique (FFTMT). Data, including laryngeal mask insertion conditions, hemodynamic responses, and clinical complications, were collected, entered into SPSS version 26, and analyzed. Results: There were no significant differences between the 2 groups in terms of laryngeal mask placement time (P = 0.061), number of attempts to place the LMA (P = 0.059), oropharyngeal leak pressure (OLP; P = 0.942), frequency of hoarseness (P > 0.99), or laryngospasm (P > 0.99). However, it is noteworthy that FFTMT appeared to provide easier placement of the LMA (P < 0.0001), required fewer attempts, and offered better quality of ventilation with a lower presence of blood on the cuff (P = 0.038). Conversely, the FFTMT group had a higher frequency of sore throat (P < 0.0001). Conclusions: The performance of LMA using FFTMT is comparable to the classic method. In procedures under general anesthesia where the surgeon has access to the patient's head and neck (such as cataract surgery), airway management with LMA using FFTMT (while maintaining the patient's sterile covering) appears to be effective in case of an emergency.

Comparison of Tranexamic acid, Remifentanil, and Hydralazine on the bleeding volume during Dacryocystorhinostomy surgery.

BACKGROUND: Bleeding in Dacryocystorhinostomy (DRC) limits the surgeon's sight and access. Tranexamic acid, Remifentanil, and Hydralazine reduce intraoperative blood loss. However, no study has been carried out to compare the efficacy of the latter drugs during DCR surgery. METHODS: Ninety healthy candidates for DCR surgery with chronic Dacryocystitis (aging 20-80) were randomly assigned in groups of 30 to receive low doses of Tranexamic acid (TXA) (10 mg/kg with a maximum dose of 1000 mg), Remifentanil (0.1 µ/kg), or Hydralazine (0.1 mg/kg). All drugs were infused over 15 minutes before the initiation of surgery. The primary outcome was the bleeding volume during the surgery and until 2 hours in recovery. This study was approved by the Iranian Registry of Clinical Trials with the code of IRCT20210614051574N10 (https://en.irct.ir/trial/62759). RESULTS: Thirty patients (mean age ± SD: 50.48±13.4) were investigated. Mean blood loss volume was lower in Remifentanil and Hydralazine groups compared with the TXA group (P<0.05); there was no significant difference (P>0.05) in bleeding volume between Remifentanil and Hydralazine groups (Tranexamic acid group: 146.83±91 ml, Remifentanil group: 77.6±52.1 ml, Hydralazine group: 80.0±48.7 ml, 95% confidence interval, P<0.05). CONCLUSION: Our results show that Remifentanil and Hydralazine are more effective than Tranexamic acid in bleeding control.

Assessment of Neck Characteristics for Laryngeal Mask Airway Size Selection in Patients Who Underwent an Elective Ocular Surgery; A Cross-Sectional Study.

Objective: To investigate the neck features for laryngeal mask airway (LMA) size selection. Methods: This cross-sectional study was conducted on 160 patients referred for elective surgeries to Feiz Hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran (April 2016 to September 2018). Patients underwent ventilation using LMA whose size was determined through a weighted-based approach. All of the patients' neck characteristics including circumference, thyromental distance, and opening mouth were measured. Ventilation factors were recorded including numbers of attempts for successful LMA insertion, quality of ventilation, and sealing. Results: Neck circumference and thyromental distance were significantly different with the size of LMA (p<0.0001 and p=0.005, respectively), but not mouth opening (p=0.21). Neck circumference, thyromental distance, and mouth opening were not significantly different with the times of insertion attempts (p>0.05 for all comparisons). However, the thyromental distance was significantly different with the quality ventilation status (p<0.0001). The total assessment of insertion attempts, ventilation efficacy and sealing was significantly different with the neck circumference (p<0.001), but thyromental distance did not show a significant difference (p>0.05). Conclusion: Findings demonstrated that neck circumference might be considered as an appropriate indicator for the selection of LMA size but neither the thyromental distance nor mouth opening. Further studies with a larger sample size are strongly recommended.

A Comparative Study of the Effect of Anesthesia Induction with the Use of Four Drug Combinations Including "Propofol," "Etomidate-Propofol," "Thiopental," and "Midazolam-Thiopental" on Hemodynamic Changes during the Insertion of Laryngeal Mask in Eye Surgery.

Background: This study aimed to compare the efficacies of four anesthetic induction drugs (thiopental, propofol, midazolam-thiopental, and etomidate-propofol) on cardiovascular response during laryngeal mask airway (LMA) placement in eye surgery. Materials and Methods: The present clinical trial study included 128 patients who were candidates for ophthalmic surgery in four groups. Patients in the first group were given a combination of midazolam (0.04 mg/kg) with thiopental (2.5 mg/kg) (Group T + M). We administered propofol alone (2.5 mg/kg) to patients in the second group (Group P). The third group received a combination of etomidate (0.1 mg/kg) with propofol (1 mg/kg) (ET + P group) and patients in the fourth group received thiopental drug (5 mg/kg) alone (Group T). Then, the stability of patients' hemodynamic parameters before anesthesia was evaluated and compared immediately after anesthesia, 1, 3, and 5 min after LMA placement. Results: There was no significant difference between the four groups in changes in oxygen saturation level (P > 0.05). Furthermore, the difference between decreased systolic blood pressure and diastolic blood pressure over time was not significant in 5 min in both Groups T + M and T (P > 0.05). In addition, the stability of these two groups was higher than the other two groups (P < 0.05) and the most unstable group was Group P. The changes pulse ratein the P group were significant (P < 0.05). Conclusion: According to the results of the current study, thiopental and Midazolam can be used as an effective induction compound to facilitate LMA insertion with higher hemodynamic stability compared to propofol alone, propofol and etomidate, and thiopental alone.

Effect of Intranasal Dexamethasone on the Incidence of Nausea and Vomiting After Adult Strabismus Surgery.

Objectives: Due to the high prevalence of postoperative nausea and vomiting (PONV), this study aimed to determine the preventive effect of intranasal dexamethasone on the incidence of nausea and vomiting after adult strabismus surgery. Methods: This randomized clinical trial study was performed on 72 patient candidates for strabismus surgery at Feiz University Hospital in Isfahan in 2020. Patients were divided into 2 groups of 36 with random allocation software and entered into the study. After induction of similar anesthesia, endotracheal intubation was performed in patients. Immediately after inflating the cuff, the first group (intranasal dexamethasone (ND)) received 1 mL of dexamethasone (4 mg) per nasal passage, and the second group (intranasal normal saline (NS)) received 1 mL of normal saline per nasal passage. Patients of the 2 groups were evaluated and compared at first 2 hours and 2 - 24 hours after surgery for the incidence and severity of nausea and vomiting, and pain after surgery. Data were analyzed using SPSS software version 23. Results: There were no significant differences in terms of age (P = 0.304), weight (P = 0.21), gender (P = 0.81), and American Society of Anesthesiologists (ASA) Physical Status class (P = 1) between the 2 groups. In the first 2 hours after surgery, the incidence of nausea (P = 0.034) and its severity (P = 0.019) was significantly lower in the ND group compared to the NS group. Also, 24 hours after surgery, the incidence of nausea (P = 0.38) and its severity (P = 0.55) were insignificantly lower in the ND group. Both groups showed no significant difference in the incidence of vomiting at 2 hours (P = 0.11) and 24 hours (P = 0.16) postoperative. Two hours after surgery, the incidence of pain (P = 0.001) and its severity (P < 0.001), and also 24 hours after surgery, the incidence of pain (P < 0.001) and its severity (P < 0.001) were significantly lower in the ND group. Getting ondansetron (P = 0.023) and pethidine (P < 0.001), extubation time (P < 0.001), and recovery time (P = 0.03) were significantly lower in the ND group. Patients' satisfaction was significantly higher in the ND group compared to the NS group (P = 0.031). Conclusions: The findings of the present study show that the intranasal use of dexamethasone with a dose of 8 mg compared to saline is associated with a decrease in PONV and postoperative pain, a decrease in the use of ondansetron and pethidine, and an increase in patient's satisfaction. Intranasal use of dexamethasone may be an effective and safe method, especially in cases where we do not have access to an intravenous line.

Selection of the optimal dosage of tranexamic acid to reduce blood loss during pediatric cleft palate surgery.

OBJECTIVE: The aim of the present study was to evaluate and select the optimal dosage of tranexamic acid (TXA) to reduce blood loss during cleft palate surgery in children. MATERIALS AND METHODS: This randomized double-blind clinical trial was performed on 80 children under 3 years of age that were candidates for cleft palate surgery. These children were divided into four groups as follows: the first, second, and third groups received 5, 7.5, and 10 mg/kg of TXA, respectively. Moreover, the fourth group was considered as the control group. Before induction of anesthesia and then every 15 min during the surgery, some parameters such as mean arterial pressure, heart rate, SpO2, and ETCO2 were recorded. Moreover, the amount of blood loss during the surgery, the level of surgeon's satisfaction, and incidence rate of complications were assessed and recorded. RESULTS: The amount of blood loss during the surgery in TXA groups receiving dosages of 5, 7.5, and 10 mg/kg with the means of 63.75 ± 10.62, 61.25 ± 15.03, and 61.00 ± 14.29, respectively, was significantly lower than that of the control group with the mean of 92.25 ± 19.83 (P < 0.001). Moreover, no significant difference was found between the three groups receiving TXA dosages in terms of the amount of blood loss, the level of surgeon's satisfaction (P > 0.05). CONCLUSION: According to the results of the present study, all three dosages of TXA had a significant role in reducing blood loss in cleft palate surgery. Given the potential for increased risk of side effects from the drug, it seems safe to use the minimal dosage of this drug to control and reduce blood loss during cleft palate surgery in children <3 years of age.

Effects of the Two Doses of Dexmedetomidine on Sedation, Agitation, and Bleeding During Pediatric Adenotonsillectomy.

BACKGROUND: Due to the importance of dexmedetomidine and its different dosages, here, we aimed to investigate and compare the effectiveness of the doses of 1 µg/kg and 2 µg/kg of dexmedetomidine in sedation, agitation, and bleeding in pediatrics undergoing adenotonsillectomy. METHODS: This double-blinded randomized clinical trial was performed on 105 pediatric patients that were candidates for adenotonsillectomy. Then, the patients were divided into three groups receiving dexmedetomidine at a dose of 2 µg/kg, diluted dexmedetomidine at 1 µg/kg, and normal saline. The drugs were administered 15 minutes before operations via the intravenous method. The duration of extubation, mean arterial pressure (MAP), heart rate (HR), and SPO2 in the recovery were recorded. We also collected data regarding patients' sedation and agitation every 15 minutes. RESULTS: Our data showed no significant differences between the groups of patients regarding MAP, HR, and SPO2. However, the mean sedation score was significantly higher in patients receiving dexmedetomidine (2 µg/kg), and this score was lowest in the control group at the time of entrance to the recovery room. The patients that received dexmedetomidine at a dose of 1 µg/kg had the lowest agitation score after 45 minutes of being in the recovery room, and the patients treated with dexmedetomidine at a dose of 2 µg/kg had the lowest agitation score after 60 minutes of being in the recovery compared to other groups of patients. CONCLUSIONS: The use of the doses of 1 µg/kg and 2 µg/kg of dexmedetomidine was associated with proper sedation and a significant reduction in agitation. The patients also had lower amounts of bleeding. We recommend that anesthesiologists should pay more attention to dexmedetomidine at a dose of 2 µg/kg, especially in pediatric surgical procedures.

Comparing the safety and efficacy of three different doses of atracurium in facilitating the insertion of laryngeal mask airway in patients undergoing phacoemulsification cataract surgery: A randomized clinical trial.

BACKGROUND: In this study, we aimed to evaluate the safety and efficacy of three different doses of atracurium on conditions of laryngeal mask airway (LMA) insertion, first-try success rate, and possible complications. MATERIALS AND METHODS: A total of 120 patient's ≥18 years old were randomly divided into three groups of 40. The study groups received fentanyl 2 µg/kg thiopental 5 mg/kg and atracurium in doses 0.2 mg/kg, 0.4 mg/kg, and 0.6 mg/kg, respectively, based on the patient group. The conditions of LMA insertion, hemodynamic responses, and complications were evaluated and compared in the groups. RESULTS: In the study groups, the LMA placement was difficult in 15%, 7.5%, and 2.5%, respectively (P = 0.13). There was no statistically significant difference among the groups regarding the success rate in the first attempt to the insertion of LMA. Of the three groups, 5%, 2.5%, and 2.5% had bleeding at the place of mask insertion (P = 0.77). 17.5%, 7.5%, and12.5% had sore throat, respectively (P = 0.4). No patient experienced laryngospasm during the study. Furthermore, changes in blood pressure, heart rate, and oxygen saturation were not significant in the three groups. CONCLUSION: All three doses of atracurium have similar effects on the condition of LMA insertion. Atracurium 0.4 mg/kg accompanied by higher success on LMA insertion in the first attempt and lower airway complications (bleeding and sore throat), increasing this dose had no significant effect on the success rate of LMA insertion.

Safety and efficacy of fentanyl versus pethidine in cataract surgery under propofol- based sedation: A double-blind randomized controlled clinical trial.

BACKGROUND: The study was aimed to evaluate the safety and efficacy of fentanyl and pethidine on the sedative quality of patients who underwent phacoemulsification cataract surgery with Propofol. MATERIALS AND METHODS: In this double-blind randomized controlled clinical trial, patients who were candidates for elective phacoemulsification surgery with topical anesthesia were enrolled. The selected patients were randomly allocated into the two groups for receiving sedation with Propofol-Pethidine (PP) or propofol-fentanyl (PF) combinations. Demographic characteristics, hemodynamic parameters before, during, and after the operation, sedation and pain scores, and patients' and surgeons' satisfaction scores were compared in the two studied groups. RESULTS: In this trial, 70 patients (35 patients in each group) have completed the study. Mean (standard deviation) operation time was 22.9 (6.8) and 25.46 (7.7) minutes in PF and PP groups (P = 0.118).Mean pain score in PF 0.46 (0.14) was significantly higher than PP groups 0.236 (0.06) (P = 0.011). The mean value of diastolic and systolic blood pressures, pulse rate, and mean arterial pressure dioxide were significantly decreased in both PF and PP groups (P Time < 0.001), although there was no significant difference between groups. CONCLUSION: Our findings indicated the equivalence effects on hemodynamic parameters for both pethidine and fentanyl in combination with propofol in which they could provide appropriate sedation and safe anesthesia with lower complications and acceptable patients' and surgeons' satisfaction.

Comparison of the Analgesic and Sedative Effects of Midazolam-Ketamine and Propofol-Sufentanil Combinations in Painful Procedures of Children with Haematologic Malignancy.

OBJECTIVE: Bone marrow aspiration and lumbar puncture play essential roles in the diagnosis and treatment of haematological disorders. These repeated invasive procedures lead to considerable pain and stress in children, which is emotionally stressful for their parents. This study aimed to compare the effectiveness and outcomes of two combinations of midazolam-ketamine (MK) and propofol-sufentanil (PS) in painful procedures of children with haematologic malignancy. METHODS: In this prospective, randomised, double-blind clinical trial, we enrolled 80 eligible patients with haematologic malignancy aged 2-14 years. We randomly allocated them to the MK and PS groups. We recorded and compared the level of sedation, pain severity, hemodynamic indices, the onset of effect, duration of recovery and complications during and after procedure in the two groups. We analysed the data using the SPSS software. We used Mann-Whitney U, independent t-test, chi-square and Fisher's exact tests to compare continuous and categorical variables. RESULTS: From initially enrolled patients, 68 patients completed the study (38 in PS and 30 in MK group). The levels of sedation and the mean score of pain intensity were significantly lower in the MK group than those in the PS group (p<0.05). Movements and the needs to repeat the dose were significantly lower in the MK group than those in the PS group (p<0.05). CONCLUSION: During bone marrow aspiration and lumbar puncture procedures in children with haematologic malignancy, the findings of this trial suggest that MK combination therapy provides better sedation and analgesia than PS.