Comparison of the effect of peritonsillar infiltration of tramadol vs dexmedetomidine on post-tonsillectomy pain.

INTRODUCTION: This study aimed to comparing the effect of peritonsillar infiltration of tramadol and dexmedetomidine in relieving post-tonsillectomy pain. METHODS: In this randomized double blinded clinical trial study, 90 children 5-12 years old undergoing tonsillectomy, involved. Induction of anesthesia was done by fentanyl 1 µg/kg, sodium thiopental 5 mg/kg and atracurium 0.5 mg/kg and intubation was done after 3 min. Anesthesia maintained by nitrous oxide 60% and oxygen 40% with isoflurane (1.2%). Tramadol 2 mg/kg in group A, dexmedetomidine 1 µg/kg in group B, and normal saline in group c were injected into the bed and anterior tonsillar pillar and surgery has begun after 3 min of injection. Time of surgery, all hemodynamic variables, pain intensity and degree of sedation were recorded and evaluated. RESULTS: The results showed that duration of the surgery (p value = 0.28) and duration of anesthesia (p value = 0.43) were not significantly different between the groups but pain score was significantly lower in dexmedetomidine group in comparison to tramadol and placebo group (p value = 0.001). The first time for analgesic request was longer in dexmedetomidine group (p value = 0.001) and Hemodynamic parameters were significantly lower in tramadol and dexmedetomidine group (p value = 0.001). Sedation level was not significantly different between tramadol and dexmedetomidine group (p value = 0.001). CONCLUSION: According to the results peritonsillar infiltration of dexmedetomidine is effective and safe in relieving post-tonsillectomy pain.

Comparing the efficacy of peritonsillar injection of bupivacaine and intravenous acetaminophen on post-tonsillectomy pain in children.

INTRODUCTION: In this study we aimed to compare the efficacy of peritonsillar injection of bupivacaine and intravenous acetaminophen on post-tonsillectomy pain in children. MATERIALS AND METHODS: In this randomized double-blind clinical trial study 60 children with ASA = I-II aged 5-12 years undergoing tonsillectomy were involved. The first group received bupivacaine at a dose of 0.1 mg/kg that was injected into the bed and the anterior crease of each tonsil. The second group was given intravenous acetaminophen at a dose of 12.5 mg/kg. The patient's pain score at 10, 30, 60 min after his/her admission to recovery room and 120, 240 and 360 min after the surgery was recorded using CHEOPS. Patient's sedation score, nausea or vomiting, the time of the first request for analgesia and the time of starting oral feeding were recorded and analyzed too. RESULTS: There was no significant differences in mean age (p value = 0.44), gender (p value = 0.79), weight (p value = 0.36), height (p value = 0.17), anesthesia duration (p.value = 0.85) and surgery duration (p.value = 0.73) between two groups. Postoperative pain was significantly less in the bupivacaine group at 240 and 360 min after the surgery. The mean sedation score was higher in the bupivacaine group but not significantly. There was no significant difference between groups regarding the nausea and vomiting, the first analgesics request time and the start time of oral feeding. CONCLUSION: According to the results of the present study, since administration of peritonsillar bupivacaine compared to acetaminophen had a better effect on managing postoperative pain and improving sedation and also since no complications were reported; therefore, peritonsillar infiltration with bupivacaine is suggested for pediatric tonsillectomy.

Comparing Efficacy of Propofol and Dexmedetomidine in Conscious Sedation During Stapedotomy Surgery.

Introduction: We decided to compare dexmedetomidine with propofol regarding several anesthetic and surgical aspects, during stapedotomy done under conscious sedation. Materials and Method: Thirty patients aged 20-50 years with (American Society of Anesthesiology) ASA class I-II, were assigned to two groups of propofol and dexmedetomidine using a random number table. In dexmedetomidine group, patients received dexmedetomidine infusion (0.5 µg/kg/h) and in the control group, propofol was administered (3 mg/kg/h).Time to reach the desired Ramsey Sedation Score (RSS) and time to reach Aldrete score ≥ 9; incidence of inadvertent movement and amnesia; as well as patients' and surgeons' level of satisfaction and degree of bleeding was recorded. Data on hemodynamic variables were monitored and recorded at several intervals. Results: The mean time taken to reach the RSS (2-4) was 10.3 ± 2.1 min in dexmedetomidine group and 3.1 ± 1.2 min in propofol group. Time to reach Aldrete score ≥ 9 for patients sedated with dexmedetomidine was 8.6 ± 2.1 min and for propofol group was 4.6 ± 1.4 min (p value < 0.05).There were also significant differences between two groups in terms of surgeon's satisfaction with sedation, and the amount of intra operative bleeding. Conclusion: According to the results of this study, it can be concluded that dexmedetomidine is a better choice for conscious sedation than propofol. However, the time to reach the required sedation in the dexmedetomidine group was significantly longer.

The Effect of Low-Dose of Propofol on the Respiratory Complications Immediately After Tracheal Extubation in Children Undergoing Tonsillectomy.

The aim of this study was to determine the effect of low-dose propofol on the respiratory complications immediately after tracheal extubation in children undergoing tonsillectomy. In this randomized double blinded clinical trial study, 70 children (2-12) years old with ASA class I undergoing elective tonsillectomy involved. General anesthesia was performed by the same anesthesiologist and in the same way. The patients were then intubated with oxygen after 3 min of ventilation. After the surgery and muscle relaxant injection and before extubation, 0.5 mg propofol/kg was injected into the intervention group. The control group received normal saline. Finally, the presence of post-extubation laryngospasm, cough and nausea and vomiting was recorded and all data analyzed between two groups. There was no significant difference in age (p value = 0.425), gender (p value = 0.851), cough (p value = 0.239), nausea (p value = 1) and weight (p value = 0.624) between two groups. There was a significant different in incidence of laryngospasm between two groups (p value = 0.04). It can be concluded that the administration of 0.5 mg/kg of propofol before extubation could prevent laryngospasm in patients undergoing tonsillectomy, without inducing any side effects.

Comparing the effect of dexmedetomidine and labetalol on hemodynamic variables in patients undergoing microlaryngoscopy.

INTRODUCTION: This study was conducted to compare the effect of dexmedetomidine and labetalol on hemodynamic variables in patients undergoing microlaryngoscopy. MATERIAL AND METHODS: In this randomized clinical trial study 70 patients undergoing microlaryngoscopy were involved. The patients were randomly assigned into two groups. Patients in dexmedetomidine group received 0.5 µg/kg of dexmedetomidine diluted in 100 ml of saline solution and the patients in the second group received 0.25 mg/kg of labetalol before anesthesia induction. At the beginning of the surgery, dexmedetomidine was infused at the dose of 0.4 µg/kg/h in the dexmedetomidine group, and labetalol at the dose of 1.8 mg/kg/h in the labetalol group. Patients' systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and heart rate at different times and anesthesia and surgery duration, recovery time and dose of prescribed propofol were recorded and compared between two groups. RESULTS: There was a significant difference in mean systolic blood pressure, mean diastolic blood pressure, mean arterial blood pressure and mean heart rate between two groups at different times (p value < 0.05). CONCLUSION: The results of this study indicated that dexmedetomidine had higher efficacy, compared to labetalol, in reducing diastolic blood pressure, systolic blood pressure, heart rate, and mean arterial blood pressure following microlaryngoscopy.

Comparing the Efficacy of Peritonsillar Injection of Tramadol With Honey in Controlling Post-Tonsillectomy Pain in Adults.

INTRODUCTION: The authors investigated the effect of honey on post-tonsillectomy pain and compare its efficacy with tramadol. METHODS: This clinical trial was performed on 60 patients with American Society of Anesthesia I and II aged between 18 and 55 years and underwent tonsillectomy. Induction of anesthesia was carried out using 2 mg/kg propofol and 0.5 atracurium following 1.5 µg/kg fentanyl administration. Group B was given tramadol at dose of 2 mg/kg and with volume of 4 mL and Group A was given normal saline with the same volume 2 mL of medications were injected using needle (25) into tonsil bed and anterior old of each tonsil by an anesthesiologist. Three minutes after injection, the surgery was performed by the same ENT residents for all patients. In the recovery room Group B received antibiotics and oral acetaminophen. Group A was given antibiotics, oral acetaminophen, and honey dissolved in 40 mL warm water every 6 hours from when the patient was fully awake. Patients in Group A were told to eat honey 3 times a day 7 days postoperatively. Pain was scored using Numeric Rating Scale at the time points of 2, 6, 12, and 24 hours as well as 3 and 7 days postoperatively. Moreover, the healing status and epithelialization degree of tonsillar bed were considered on 1 and 7 days after the surgery by ENT specialist. RESULTS: The mean of pain score was significantly higher in Group A within 24 hours postoperatively as compared with Group B (P < 0.01). The mean of pain score was lower in Group B after 3 and 7 days but this difference was not statistically significant (P > 0.05). Considering restoration status and epithelialization degree of tonsillar bed on the 1st and 7th days, there was no statistically significant difference between 2 groups; however, tonsillar bed healing process was better in Group B on the 7th day. CONCLUSION: The current investigation confirmed the positive impact of tramadol on post-tonsillectomy pain relief in adults. The authors also found that honey can be used as a complementary treatment along with acetaminophen and other analgesics for reducing post-tonsillectomy pain. Considering honey impact on wound healing and its anti-inflammatory effect, it is suggested for relieving complications after surgery.

Two Different Concentrations of Ketofol for Procedural Sedation and Analgesia in Closed Reduction of Nasal Fracture.

OBJECTIVES: Ketofol is a mixture of propofol and ketamine in various concentrations. It is accepted as a suitable combination in procedural sedation and analgesia. The mixture of propofol and ketamine with different respiratory and hemodynamic effects may result in fewer dose-related side effects and a probable synergistic effect. This study was designed to compare the adverse effects and quality of analgesia of 2 different intravenous concentrations of ketofol in patients undergoing closed reduction of the nose. METHODS: This randomized double-blinded study was conducted on 100 patients who underwent closed reduction of nose. The patients were divided into 2 groups of 50, and received either a combination of propofol/ketamine (1:1) (Group I) or propofol/ketamine (3:1) (Group II). Hemodynamic changes, including systolic blood pressure, diastolic blood pressure, heart rate and O2sat, and side effects such as hallucination, vomiting, coughing and apnea, were recorded. RESULTS: Data analysis showed that the demographic characteristics (age, height, and weight) were similar in 2 groups, and there were no significant differences between the 2 groups. There was no significant hemodynamic change between both groups. However, there was a decrease in hallucination and vomiting in the group that received higher concentration of ketofol (ketamine/propofol of 1:3). CONCLUSION: There was no significant hemodynamic change between both groups that received concentrations of 1:1 and 3:1 propofol /ketamine. However, there was a reduction in hallucination, vomiting, and recovery duration in the group that received higher concentration of propofol. In conclusion, increasing the concentration of propofol can be useful with fewer side effects and lower duration of recovery.

Effect of preoperative administration of intravenous paracetamol during cesarean surgery on hemodynamic variables relative to intubation, postoperative pain and neonatal apgar.

Selection of anesthetic drugs for cesarean section requires many considerations. Anesthetic drugs for this purpose must prevent hemodynamic stress due to tracheal intubation, while inducing neonatal complications. This study was conducted to determine the effects of paracetamol given before induction of anesthesia on cardiovascular responses to tracheal intubation and postoperative pain in the mother, and on neonatal Apgar score. This double-blind randomized placebo-controlled trial included 60 women in ASA I, without underlying diseases and fetal distress, who were candidates for elective cesarean section under general anesthesia. Patients were divided into two groups of 30 patients. Patients in the paracetamol group received 1 g intravenous (IV) paracetamol 20 min before the operation, while those in the placebo group received 1 cc normal saline at the same time. In both groups, anesthesia was induced by sodium thiopental and succinylcholine. Maternal systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) were measured before and immediately upon induction of anesthesia, and at first and fifth minute after tracheal intubation. Neonatal effects were assessed by Apgar score. Postoperative pain was assessed by use of the visual analog scale (VAS). The dose of analgesic used and the time of the first analgesic request by patients postoperatively were recorded. The SBP, DBP, MAP and HR were controlled significantly better in paracetamol group than in placebo group (P < 0.05). The mean 1-min and 5-min Apgar scores of neonates did not differ between the groups. The VAS pain score was significantly lower in paracetamol group than in placebo group at all measuring times (P < 0.05). Also, paracetamol caused later first analgesic request and lower dose of analgesic needed to control pain postoperatively (P < 0.05). In conclusion, the results of our study suggested IV paracetamol to be an efficacious agent to decrease hemodynamic responses to tracheal intubation, while providing better postoperative pain management without considerable neonatal complications in women undergoing cesarean section in general anesthesia.

The Effects of Propofol and Isoflurane on Blood Glucose during Abdominal Hysterectomy in Diabetic Patients.

BACKGROUND: Acute hyperglycemia in the perioperative period is associated with significantly increased complications. In few human studies the effects of propofol and inhalational anesthetic on the glucose metabolism were compared. In this study we evaluated the effect of propofol and isoflurane on blood glucose during abdominal hysterectomy in diabetic patients. METHODS: After approval by the Ethical Committee and written informed consent, thirty 35 to 65 years old diabetic women underwent for elective abdominal hysterectomy under general anesthesia were studied in this randomized single blind clinical trial study. The plasma glucose was maintained at 100 to 180 mg/dL during the operation. Anesthesia protocol was similar in two groups except maintenance of anesthesia that was with infusion of propofol in the propofol group and with isoflurane in the isoflurane group. Blood glucose level and the rate of insulin intake during surgery compared between two groups. RESULTS: Mean blood glucose before induction of anesthesia did not have significant difference between two groups, but 60 and 90 minutes after starting the operation blood glucose in the propofol group was significantly lower than isoflurane group. Also with using Repeated Measure test, two groups was significantly different according to blood glucose (P=0.045). Mean of administration of insulin during the surgery did not have significant difference between two groups by using repeated measure test and P=0.271. Also mean of bispectral index in different times during the surgery between two groups didn't have significant difference (P=0.35 repeated measure test). CONCLUSION: Blood glucose increased during maintenance of anesthesia with isoflurane compared to propofol during the surgery.

Effect of oral gabapentin on haemodynamic variables during microlaryngoscopic surgery.

BACKGROUND: Manipulation of the larynx, such as laryngoscopy and tracheal intubation, is associated with haemodynamic and cardiovascular responses. In microlaryngoscopic procedures, these responses are more severe than laryngoscopy for endotracheal intubation because in microlaryngoscopic surgeries laryngoscope fixes for a longer time (15-20 minutes compared to 15-30 seconds in tracheal intubation). This study was performed to evaluate the effect of 800 mg oral gabapentin on the haemodynamic variables during microlaryngoscopic surgery. METHODS: 30 patients aged 30-70 years, ASA physical status I or II, who underwent microlaryngeal surgery were included to the study. The night before surgery, 15 patients (group G) received 100 mg gabapentin and 15 patients (group P) received a placebo. Ninety minutes before the operation, they either received 800 mg gabapentin (group G), or received a placebo (group P). RESULTS: Heart rate, systolic, diastolic and mean arterial blood pressure were measured on the night before the procedure, the morning before the procedure, at arrival to the operating room as baseline, before and after induction, 1, 3 min after tracheal intubation, 1, 5, 15, 25 min after fixing laryngoscope, before laryngoscope removal, and 1 min after that. Analyses revealed that the systolic blood pressure was lower in group G after induction, 1 and 5 min after fixing laryngoscope and before removing the laryngoscope. Diastolic blood pressure in group G was lower at the time of arriving in the operating room, after induction, 1 min after fixing surgical laryngoscope and before removing the laryngoscope. Mean arterial pressure behaved similarly, and additionally it was lower at 5 min after fixing the laryngoscope. Heart rate was reduced at the time after induction, 1, 3 min after intubation, 5 min after fixing the laryngoscope and before laryngoscope removal in group G. Overall, in the group G, diastolic blood pressure and mean arterial pressure were lower in the first 15 min after microlaryngoscopy compared to group P but there was no difference in mean systolic blood pressure and mean heart rate. CONCLUSION: 800 mg oral gabapentin given 90 min before a procedure attenuates the rise of diastolic blood pressure and mean arterial blood pressure in the first 15 min after microlaryngoscopy surgery, but has no effect on systolic blood pressure or heart rate.

Reduced morphine consumption and pain severity with transdermal fentanyl patches following total knee arthroplasty.

PURPOSE: To determine the effects of transdermal fentanyl patches (TFPs) for postoperative analgesia in patients undergoing total knee arthroplasty (TKA) surgery. METHODS: A randomized, double-blind, controlled trial study of 40 ASA I-III patients undergoing TKA surgery was performed under general anaesthesia. Patients were randomly divided into two groups. Group I (n = 20) received two 25 µg TFPs placed on the laterals of chest wall approximately 12 h before induction of general anaesthesia. Group II, the control group (n = 20), received placebo patches of identical size. Postoperative pain at rest was assessed with visual analogue scale (VAS) at 0, 30 min and 2, 4, 6, 12, 24, 48 and 72 h. Total rescue consumption of morphine was estimated with patient control analgesia during the first 72 h after operation. The degree of active knee flexion and incidence of side effects were also evaluated. RESULTS: The VAS scores at 2, 4, 6, 12, 24, 48 and 72 h were significantly less in the group I compared to the group II (p < 0.05). Total morphine consumption was significantly less in group I than in group II (p < 0.05). No significant differences were found between the groups in the postoperative active knee flexion (n.s.). Side effects were similar between the groups. CONCLUSIONS: Transdermal fentanyl patches provide effective pain relief and decrease total rescue morphine consumption during the first 72 h after operation without additive side effects in patients undergoing TKA surgery.

Analgesic Effects of Intravenous Ketamine during Spinal Anesthesia in Pregnant Women Undergone Caesarean Section; A Randomized Clinical Trial.

BACKGROUND: Suitable analgesia after cesarean section helps mothers to be more comfortable and increases their mobility and ability to take better care of their infants. OBJECTIVES: Pain relief properties of ketamine prescription were assessed in women with elective cesarean section who underwent spinal anesthesia with low dose intravenous ketamine and midazolam and intravenous midazolam alone. PATIENTS AND METHODS: Sixty pregnant women scheduled for spinal anesthesia for cesarean section were randomized into two study groups. Ketamine (30 mg) + midazolam (1 mg = 2CC) or 1mg midazolam (2CC) alone, was given immediately after spinal anesthesia. Pain scores at first, second and third hours after CS operation, analgesic requirement and drug adverse effects were recorded in all patients. RESULTS: Ketamine group had significant pain relief properties in compare with control group in first hours after cesarean section (0.78 ± 1.09 vs. 1.72 ± 1.22, VAS score, P = 0.00). Total dose of meperidine consumption in women of ketamine group was significantly lower than women of control group (54.17 ± 12.86 vs. 74.44 ± 33.82 mg, P = 0.02). There were no significant drug side effects in participated patients. CONCLUSIONS: Intravenous low-dose ketamine combined with midazolam for sedation during spinal anesthesia for elective Caesarean section provides more effective and long lasting pain relief than control group.

Comparison of postoperative analgesic effect of tramadol and bupivacaine subcutaneous infiltration in patients undergoing cesarean section.

Cesarean section is associated with significant postoperative pain. The aim of this study was to evaluate the effects of tramadol versus bupivacaine administration at wound closure on postoperative pain relief in patients undergoing cesarean section. Sixty women undergoing cesarean deliveries were randomly assigned to receive either 10 mL of bupivacaine 0.5% (n = 30) or 50 mg of tramadol in 10 mL of normal saline (n = 30), both as local wound infiltration prior to skin closure at the end of operation. Postoperative pain was evaluated with a visual analogue scale (VAS: 0-10) at 1, 2 and 6 hours after operation. Time to first analgesic administration and analgesic consumption in 24 hours after operation were recorded and compared between the two groups. Data were analyzed by SPSS software version 15 and p < 0.05 was considered significant. The VAS score did not differ significantly between the two groups at 1 and 2 hours after cesarean section, but it was higher in bupivacaine group than tramadol group 6 hours after operation (p < 0.05; Fisher exact test). Postoperative consumption of analgesic was higher in bupivacaine group than tramadol group but the difference was not significant (p > 0.05; Fisher exact test). No side effects were reported in either group. This study showed that subcutaneous administration of tramadol provided analgesic effect equal to bupivacaine with longer pain relief after cesarean section.

Remifentanil at induction of general anesthesia for cesarean section: Double blind,randomized clinical trial / Remifentanilo en la inducción de la anestesia general para la cesárea: estudio clínico doble ciego, aleatorizado

Introduction: Remifentanil, with its rapid activity onset and short duration of action, may be more effective than other opioids for providing hemodynamic stability during obstetric anesthesia. However, there is some evidence of adverse effects on neonatal respiratory function. We investigated maternal and fetal effects of Remifentanil during cesarean section surgery. Methods: Eighteen women with singleton term pregnancies, and physical class status of I or II as defined by the American Society of Anesthesia (ASA), who were undergoing general anesthesia for semi-elective cesarean section were randomized into two groups (40 in each group) that received either an intravenous bolus of 0.5 µg/kg Remifentanil or the same dose of saline as a placebo. Maternal hemodynamic variables and neonatal umbilical artery pH and Apgar score at first and fifth min were evaluated in both groups. Results: Systolic and diastolic blood pressure were significantly lower after tracheal intubation and skin incision in the Remifentanil group as compared with the control group (p<0.05). There were no significant differences regarding heart rate between groups at any time (p> 0.05). Apgar scores at first and fifth min were not significantly different among groups (p>0.05). No neonate required assisted ventilation or naloxan administration. Conclusion: Remifentanil may be a safe and effective drug for the induction of general anesthesia and surgical stimulation without subsequent neonatal depression.

Introducción: El Remifentanilo, con su rápido comienzo de actividad y corta duración de acción, puede ser más eficaz que otros opioides para proporcionar la estabilidad hemodinámica durante la anestesia obstétrica. Sin embargo, hay alguna evidencia de efectos adversos sobre la función respiratoria neonatal. Se investigaron los efectos maternos y fetales de Remifentanilo durante la cirugía cesárea. Métodos: Dieciocho mujeres con embarazo de feto uno y con clasificación Asa I o II (sociedad americana de anestesiología) y que fueron sometidas a anestesia general para ces´rea semi eletiva, se dividieron aleatoriamente en dos grupos (40 mujeres en cada grupo) que recibieron un bolo intravenoso de 0.5 mm/Kg de remifentanil o en el grupo control la misma dosis de solución salina como placebo. Se evaluaron las variables hemodinámicas maternas y pH de la arteria umbilical neonatal y la puntuación de Apgar al primer y quinto minuto en ambos grupos. Resultados: La presión arterial sistólica y diastólica fueron significativamente más bajos después de la intubación traqueal y la incisión de la piel en el grupo Remifentanilo en comparación con el grupo control (p <0,05). No hubo diferencias significativas en cuanto a la frecuencia cardíaca entre los grupos en cualquier tiempo (p> 0,05). Las puntuaciones de Apgar a los minutos primero y quinto no fueron significativamente diferentes entre los grupos (p> 0,05). No neonato requiere ventilación asistida o administración naloxan. Conclusión: El Remifentanilo puede ser un fármaco seguro y eficaz para la inducción de la anestesia general y la estimulación quirúrgica sin depresión neonatal posterior.

Remifentanil at induction of general anesthesia for cesarean section: Double blind,randomized clinical trial.

INTRODUCTION: Remifentanil, with its rapid activity onset and short duration of action, may be more effective than other opioids for providing hemodynamic stability during obstetric anesthesia. However, there is some evidence of adverse effects on neonatal respiratory function. We investigated maternal and fetal effects of Remifentanil during cesarean section surgery. METHODS: Eighteen women with singleton term pregnancies, and physical class status of I or II as defined by the American Society of Anesthesia (ASA), who were undergoing general anesthesia for semi-elective cesarean section were randomized into two groups (40 in each group) that received either an intravenous bolus of 0.5 µg/kg Remifentanil or the same dose of saline as a placebo. Maternal hemodynamic variables and neonatal umbilical artery pH and Apgar score at first and fifth min were evaluated in both groups. RESULTS: Systolic and diastolic blood pressure were significantly lower after tracheal intubation and skin incision in the Remifentanil group as compared with the control group (p <0.05). There were no significant differences regarding heart rate between groups at any time (p > 0.05). Apgar scores at first and fifth min were not significantly different among groups (p>0.05). No neonate required assisted ventilation or naloxan administration. CONCLUSION: Remifentanil may be a safe and effective drug for the induction of general anesthesia and surgical stimulation without subsequent neonatal depression.

INTRODUCCIÓN: El Remifentanilo, con su rápido comienzo de actividad y corta duración de acción, puede ser más eficaz que otros opioides para proporcionar la estabilidad hemodinámica durante la anestesia obstétrica. Sin embargo, hay alguna evidencia de efectos adversos sobre la función respiratoria neonatal. Se investigaron los efectos maternos y fetales de Remifentanilo durante la cirugía cesárea. MÉTODOS: Dieciocho mujeres con embarazo de feto uno y con clasificación Asa I o II (sociedad americana de anestesiología) y que fueron sometidas a anestesia general para ces´rea semi eletiva, se dividieron aleatoriamente en dos grupos (40 mujeres en cada grupo) que recibieron un bolo intravenoso de 0.5 mm/Kg de remifentanil o en el grupo control la misma dosis de solución salina como placebo. Se evaluaron las variables hemodinámicas maternas y pH de la arteria umbilical neonatal y la puntuación de Apgar al primer y quinto minuto en ambos grupos. RESULTADOS: La presión arterial sistólica y diastólica fueron significativamente más bajos después de la intubación traqueal y la incisión de la piel en el grupo Remifentanilo en comparación con el grupo control (p <0.05). No hubo diferencias significativas en cuanto a la frecuencia cardíaca entre los grupos en cualquier tiempo (p> 0.05). Las puntuaciones de Apgar a los minutos primero y quinto no fueron significativamente diferentes entre los grupos (p> 0.05). No neonato requiere ventilación asistida o administración naloxan. CONCLUSIÓN: El Remifentanilo puede ser un fármaco seguro y eficaz para la inducción de la anestesia general y la estimulación quirúrgica sin depresión neonatal posterior.

Effect of oral low dose clonidine premedication on postoperative pain in patients undergoing abdominal hysterectomy: a randomized placebo controlled clinical trial.

UNLABELLED: This study evaluated the effect of oral low dose clonidine premedication on postoperative pain and hemodynamic status of the patients during abdominal hysterectomy under general anesthesia. METHODS: This study is a randomized, placebo controlled double-blinded clinical trial. After approval of the study protocol by the Ethics Committee 60 patients were recruited and written informed consents were obtained. Two hours before surgery, patients in the treatment group (n=30) received a single oral dose of 100 microgram of clonidine and those in the placebo group received an oral dose of placebo (n=30). The severity of postoperative pain was assessed at 2nd, 6th, 12th and 24th hours after the operation using the visual analog scoring system (VAS score). Also the total dose of administered analgesics during 24 hours after the surgery and the interval between the surgery and the first request of analgesic were compared between the two groups. Systolic blood pressure and pulse rate were recorded during the surgery and at the post anesthesia care unit. Drug related adverse effects were also evaluated. RESULTS: Postoperative pain VAS during 24 hours after the surgery was significantly (P=0.001) lower in clonidine group (3.86 +/- 0.89) compared to the placebo group (4.86 +/- 0.93). Also, the interval between surgery and the first request of analgesic in clonidine group was 4.13 +/- 3.27 hours on of longer duration (P=0.02) compared to 2.88 +/- 3.74 hours in placebo group. The mean heart rate and systolic blood pressure were lower in the clonidine group. CONCLUSION: A single oral 100 microg dose of clonidine administered 2 hours before abdominal hysterectomy significantly reduces the severity of postoperative pain.

Comparison of effects of ephedrine, lidocaine and ketamine with placebo on injection pain, hypotension and bradycardia due to propofol injection: a randomized placebo controlled clinical trial.

Propofol is a widely used anesthetic drug because of its minor complication and also its fast effect. One of most popular complication in using this drug is pain during injection that is more sever in new generation of its components (lipid-free microemulsion). Other complications of propofol are bradycardia and hypotension. This study compares 3 drugs with placebo in control of these complications of propofol. In this double blinded randomized placebo controlled trial 140 patient who were candidates for elective surgery were divided in 4 groups (35 patients in each groups) and drugs (ephedrine, lidocaine, ketamine and NaCl solution (as placebo) were tried on each group by a blinded technician and responses to drugs were evaluated under supervision of a blinded anesthesiologist. Pain after injection, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) were measured 5 times during anesthesia process of each patient. All gathered data were analyzed using t-test and Chi-square under SPSS software. Our data shows that in pain management all tested drugs can decrease pain significantly comparing with placebo (P=0.017). In control of hemodynamic parameters ephedrine could efficiently control SBP, DBP, MAP at the time 1 min after intubation. Based on our study ephedrine can be an appropriate suggestion for control of both pain and hemodynamic changes induced by propofol, although because of inconsistent result in other studies it is recommended to design a systematic review to draw a broader view on this issue.

Hemodynamic effects of intraocular epinephrine during cataract surgery: a double blinded placebo controlled randomized clinical trial.

OBJECTIVE: To evaluate hemodynamic effects of intraocular epinephrine irrigation in patients undergoing cataract surgery. MATERIALS AND METHODS: This study was conducted as a prospective double blinded clinical trial at the Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Eighty-eight patients of age 38-90 years undergoing were randomly allocated into two groups: Group E received intraocular irrigation fluid (balanced salt solution) with epinephrine 1:1000, 000, and group C received intraocular irrigation fluid (balanced salt solution) without epinephrine. Heart rate (HR), systolic and diastolic blood pressure (SBP, DBP) were measured before and at 5, 10, 15 minutes after starting intraocular infusion of epinephrine1:1000, 000 in both groups. RESULTS: HR and SBP were similar in the two groups at different time intervals. DBP was decreased at 5 minutes after epinephrine administration in the epinephrine group and increased at 10 and 15 minutes but there was no significant differences between the two groups. CONCLUSION: Intraocular infusion of epinephrine 1:1,000,000 can be used during cataract surgery without hemodynamic side effects and so is a safe and effective method for this purpose.

Comparison of peritonsillar infiltration effects of ketamine and tramadol on post tonsillectomy pain: a double-blinded randomized placebo-controlled clinical trial.

AIM: To assess the effect of peritonsillar infiltration of ketamine and tramadol on post tonsillectomy pain and compare the side effects. METHODS: The double-blind randomized clinical trial was performed on 126 patients aged 5-12 years who had been scheduled for elective tonsillectomy. The patients were randomly divided into 3 groups to receive either ketamine, tramadol, or placebo. They had American Society of Anesthesiologists physical status class I and II. All patients underwent the same method of anesthesia and surgical procedure. The three groups did not differ according to their age, sex, and duration of anesthesia and surgery. Post operative pain was evaluated using CHEOPS score. Other parameters such as the time to the first request for analgesic, hemodynamic elements, sedation score, nausea, vomiting, and hallucination were also assessed during 12 hours after surgery. RESULTS: Tramadol group had significantly lower pain scores (P=0.005), significantly longer time to the first request for analgesic (P=0.001), significantly shorter time to the beginning of liquid regimen (P=0.001), and lower hemodynamic parameters such as blood pressure (P=0.001) and heart rate (P=0.001) than other two groups. Ketamine group had significantly greater presence of hallucinations and negative behavior than tramadol and placebo groups. The groups did not differ significantly in the presence of nausea and vomiting. CONCLUSION: Preoperative peritonsillar infiltration of tramadol can decrease post-tonsillectomy pain, analgesic consumption, and the time to recovery without significant side effects.

Comparison of two doses of tranexamic acid on bleeding and surgery site quality during sinus endoscopy surgery.

BACKGROUND: One of the main concerns in sinus surgery is blood loss due to the high vasculature of the mucosa. Tranexamic acid (TA) is an antifibrinolytic agent which reduces bleeding following certain surgical procedures. MATERIAL AND METHODS: This randomized double-blinded clinical trial was performed on 70 patients with class I and II ASA (American Society of Anesthesiologists) who were scheduled for endoscopic sinus surgery under general anesthesia. The average ages of the patients were 18 to 50 years old. Thirty-five patients (group A) received 5 mg/Kg of TA, and another 35 patients (group B) received 15 mg/Kg of TA. The mean arterial pressure (MAP), diastolic blood pressure (DBP), systolic blood pressure (SBP) and heart rate (HR) were documented. Also, the amount of blood loss and satisfaction scores were obtained from the surgeon in 30th, 60th, 90th, 120th and 180th minutes. All the data was analyzed by SPSS-15 software with T-test. RESULTS: A total of 52 males and 18 females participated in the study. There were no significant differences between the mean age, MAP, DBP, SBP and HR during surgery between groups. Blood loss was 272.74 ± 25.77 mL 242.89 ± 51.77 mL in the group A and B respectively (P < 0.003). The surgeon was more satisfied with the surgical field of the group B than the group A (mean scores 4 (3-5) vs. 3 (1-5) respectively, P < 0.005). Surgery period and need for supplement drug to control bleeding in group B was significantly less than in group A (P < 0.05). But there was no significant difference between the two groups in terms of side effects. CONCLUSIONS: Administration of 15 mg/Kg TA intravenously is more effective than 5 mg TA to achieve hemostasis and improving the quality of surgical field, surgeon satisfaction, less surgery period and bleeding volume during endoscopic sinus surgery without any significant side effects.