Analgesic effects of intrathecal sufentanil added to lidocaine 5% in elective cesarean section.

The quality of subarachnoid block can be improved by adding opioids to the local anesthetics. We compared the analgesic effects of different doses of intrathecal sufentanil added to lidocaine %5 for elective cesarean section. This study was a prospective, randomized, double-blind, controlled trial. 90 pregnant women with ASA class I-II, scheduled for elective cesarean section under spinal anesthesia were enrolled in this study. Three groups were made of them by random; Group 1 (control group) was given lidocaine 5% (75 mg) and 2 ml of normal saline. Patients in Group 2 received lidocaine 5% (75 mg) and 5 micrograms sufentanil plus 1ml normal saline. Group 3 patients received lidocaine 5% (75 mg) and 10 micrograms sufentanil. Duration of sensory block and effective analgesia (need to analgesic) were measured. Opioid related side effects were recorded. Duration of sensory block and effective analgesia were prolonged in sufentanil groups in comparison of control group(50.3±4) that was significantly more in group 3 (128 ± 4) versus group 2 (58.3 ± 10)(P < 0.001) . There was mild to moderate respiratory depression in sufentanil groups which was more noted in group 3 (p < 0.001). No differences were detected in other side effects such as hypotension, nausea & vomiting. The addition of sufentanil 10 versus 5 micrograms to lidocaine 5% provided more duration of analgesia for cesarean delivery. So, the adding of 10 micrograms sufentanil to lidocaine 5% for cesarean section has more effective analgesia with minimum side effects.

The Effect of Low Tidal Volume Ventilation during Cardiopulmonary Bypass on Postoperative Pulmonary Function.

BACKGROUND: Postoperative pulmonary dysfunction is one of the most frequent complications after cardiac surgery and it is believed to result from the use of cardiopulmonary bypass (CPB). In this study, we investigated the effect of low tidal volume ventilation during CPB on postoperative gas exchange and lung mechanics. METHODS: This prospective randomized study included 100 patients undergoing elective coronary artery bypass grafting. In 50 patients, low tidal volume ventilation [tidal volume (TV) = 3 ml/kg, respiratory rate (RR) = 12/min, fraction of inspiratory oxygen (FIO(2))= 1.0, positive end expiratory pressure (PEEP) = 5 cmH(2)O] was applied during CPB (group I); and in the other 50 patients (group II), the lungs were open to the atmosphere without ventilation. Measurements were taken preoperatively, after CPB, and before discharge. RESULTS: Post-bypass PaO(2) (just after CPB 85 versus75) was higher significantly in group I (P value < 0.05). Decrease in postoperative forced expiratory volume in 1 second (25% versus 30%) and forced vital capacity (32% versus 35%) was less significant in group I. Also, time to extubation (5 hrs versus 5.5 hrs) was shorter in group I. CONCLUSION: Continued low tidal volume ventilation during CPB improved post-bypass oxygenation and lung mechanics.