Nitroglycerin Plus Morphine on Iv Patient Controlled Analgesia for Abdominal Surgery: The Effect on Postoperative Pain.

BACKGROUND: Some studies have reported the effect of nitroglycerin on the reduction of pain after surgery. OBJECTIVES: The primary goal of the current study was to evaluate the addition of nitroglycerin (as a nitric oxide donor) to morphine in patient-controlled analgesia. Besides, its effects on the reduction of pain and stability in hemodynamic indices after abdominal surgery are also investigated. METHODS: The current study was performed on 60 patients as candidates for abdominal surgery. Morphine (0.75 mg/mL) and nitroglycerin plus morphine (morphine 0.5 mg/mL + TNG 15 µg/mL) infusions were used for control and case groups, respectively, with the same induction of anesthesia. The severity of postoperative pain, hemodynamic indices of systolic blood pressure, diastolic pressure, heart rate, respiratory rate, and nausea were measured after surgery (immediately, 2, 6, 12, and 24 hours after surgery). RESULTS: The pain score decreased for both groups almost similarly. The mean systolic blood pressure was highly reduced in both groups. However, the mean diastolic blood pressure in the control group was considerably lower than that of the case group. Besides, the respiratory rate in the case group dramatically diminished and approached the normal value. CONCLUSIONS: Combined administration of nitroglycerin and morphine had no synergistic effects on reducing postoperative pain. However, it led to more stable hemodynamic indices and improved breathing, without any side effects.

A rare case of patent ductus arteriosus diagnosed during coronary artery bypass grafting operation in a 73-year-old man.

BACKGROUND: Although patent ductus arteriosus (PDA) is more prevalent among infants and children, it might be seen among adults as well. It is not usually seen among adults, since it is often diagnosed and treated in childhood. CASE REPORT: In the present case, a 73-year-old man referred to the hospital with symptoms including dyspnea, cold sweating, and chest pain with a burning nature which was lasting for 30 minutes. Angiography revealed coronary artery obstruction, so he became a coronary artery bypass grafting (CABG) candidate. Except for dilatation of the left atrium, no specific findings were reported in the patient's echocardiography report. When the pump was turned off by the surgeon, the patient's heart filled up and he was not able to get off the pump. Simultaneously, the patient started to have bloody respiratory secretions. With all that in mind, the surgeon suspected that he might suffer from a PDA, then he found an 8-mm PDA and closed it. Then, the patient was taken off the cardiorespiratory pump. CONCLUSION: Although PDA is more common among children and infants, it can be found among adults according to previous cases and our case as well. Since patients with PDA refer to physicians for other clinical issues, it is recommended to apply more precision in diagnostic methods such as taking a good history, echocardiography, and electrocardiogram (ECG). Moreover, it is recommended that if a patient has conditions similar to our patient, the surgeon must be sure of a possible PDA.

Comparison of Infusion of Propofol and Ketamine-Propofol Mixture (Ketofol) as Anesthetic Maintenance Agents on Blood Pressure of Patients Undergoing Orthopedic Leg Surgeries.

BACKGROUND: Some studies have reported the effects of anesthesia induction using a single propofol dose and low ketamine doses in short-term outpatient operations. OBJECTIVES: In this study, we aimed to evaluate the intra and post-operative hemodynamic effects of ketamine-propofol mixture (Ketofol) infusion in comparison with propofol infusion. METHODS: This study was performed on 54 class I and II of the American Society of Anesthesia patients aged 15 to 45 years who were candidates for leg fracture surgery. The patients were randomly assigned to propofol and ketofol groups. In the propofol and ketofol groups, propofol infusion (100 µg/kg/min) and propofol-ketamine infusion (50 µg/kg/min propofol + 25 µg/kg/min ketamine) were used for the maintenance of anesthesia, respectively. Heart rate and systolic, diastolic and mean blood pressure before, immediately after the induction of anesthesia and at 10-minute intervals were measured and recorded. Pain, nausea, and vomiting were recorded immediately after surgery and each 2 hours until 6 hours. RESULTS: Systolic, diastolic and mean blood pressure were significantly higher in the ketofol group than in the propofol group at 10 - 60 min intervals (P < 0.05). There was no significant difference, however, between the two groups in terms of the severity of nausea and pain and vomiting frequency. CONCLUSIONS: Infusion of hypnotic doses of ketofol leads to increase in diastolic and systolic blood pressure and improves blood pressure stability in addition to inducing more as compared with propofol infusion, but it leads to higher risk of nausea and vomiting.