RESUMO
BACKGROUND: Post-surgical pain is a physiological response to tissue trauma that produces unpleasant physiological effects with manifestations on various organic systems. OBJECTIVE: According to the effect of magnesium sulfate on the N-methyl-d-aspartate (NMDA) receptor, this study examined the effect of magnesium sulfate on the reduction of pain and the mean amount of narcotics consumed by patients after abdominal hysterectomies. METHODS: This double-blind clinical trial study was performed on 60 patients who had undergone abdominal hysterectomies in Shahid Sadoughi Hospital in Yazd, Iran, from 2013 to 2015. The patients were divided randomly into two groups of 30 members each. All of the patients received 2 mg of Midazolam and 2 mcg/kg of Fentanyl as the induction of anesthesia with propofol (2-2.5 mg/kg) and Atracurium 0.5 mg/kg was conducted. All of the patients received 5 mg of intravenous morphine 30 min after induction of anesthesia. Afterwards, the study group received 50 mg/kg of magnesium sulfate in 500 cm(3) of Ringer's serum during the 20 minutes, and 500 cm(3) of Ringer's serum was administered to the members of the placebo group. Visual analogue scale VAS scores were evaluated to reach the minimum difference of 0.8 in mean pain score. RESULTS: The results of this study indicated that the mean pain scores immediately after surgery and at 1, 2, 6, and 12 hr after surgery were lower in the study group than in the placebo group. The mean value of narcotic consumption at all measured time points was higher in the placebo group. No significant differences were found between two groups concerning drug complications. CONCLUSION: The results of this study indicated that the intravenous injection of magnesium sulfate can reduce pain, reduce morphine consumption, and reduce the side effects of morphine in patients after surgery. FUNDING: This study was funded by Shahid Sadoughi University of Medical Sciences, Yazd, Iran. CLINICAL TRIAL REGISTRATION: The trial was registered at the Thai Clinical Trials Registry (http://www.clinicaltrials.in.th) with the registration ID: TCTR20160308001.
RESUMO
BACKGROUND: There are two methods for ventilation in gynecological laparoscopy: volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV). OBJECTIVE: To compare the lung mechanics, hemodynamic response and arterial blood gas analysis and gas exchange of two modes of VCV and PCV using laryngeal mask airway (LMA) at different time intervals. MATERIALS AND METHODS: Sixty infertile women referred for diagnostic laparoscopy, based on ventilation mode, were randomly divided into two groups of VCV (tidal volume: 10 ml/kg) and PCV. In the PCV group, ventilation was initiated with a peak airway pressure (tidal volume: 10 ml/kg, upper limit: 35 cm H2O). In both groups, the arterial blood samples were taken in several time intervals (5, 10 and 15 min after LMA insertion) for blood gas evaluation. Also the lung mechanics parameters were continuously monitored and were recorded at different time intervals. RESULTS: There were no significant differences for patient's age, weight, height and BMI in two groups. The peak and plateau airway pressure were significantly higher in VCV group compared to PCV group 5 and 10 min after insertion of LMA. PaO2 was significantly higher after 10 and 15 min in VCV group compared to PCV group (p=0.005 and p=0.03, respectively). PaCO2 showed significant increase after 5 min in PCV group, but the differences were not significant after 10 and 15 min in two groups. The end tidal CO2 showed significant increase after 10 and 15 min in VCV compared to PCV group. CONCLUSION: Both VCV and PCV seem to be suitable for gynecological laparoscopy. However, airway pressures are significantly lower in PCV compared to VCV.
