Evaluation of Amino Acid Infusion preventive effect on Hypothermia during Spinal Anesthesia for Hip Arthroplasty.

Background: Hypothermia increases bleeding during surgery, risk of ischemic heart disease and postoperative wound infection. Intravenous amino acid increases cell synthesis and produces heat. Our goal was evaluating of the effect of amino acid on intraoperative hypothermia under spinal anesthesia. Methods: This is a randomized, double-blinded clinical trial that 36 adults undergoing Hip Arthroplasty were randomly assigned into two groups of 18 each. One group received Amino Acids solution (Aminoven 10%) 500ml (240ml/h) throughout spinal anesthesia, and control group received saline solution. We measured core body temperature, MAP and HR each 10 minutes, and also postoperative shivering, blood loss, operation time, postoperative BUN and Cr were compared in two groups. Results: Throughout surgery, the reduction in core temperature was more in the control group than the amino acids group (statistically not clinically). The decrease in core temperature was significantly larger in the controls (0.96°C ± 0.7°C) than in the amino acid patients (0.94°C ± 0.4°C), (P value= 0.02). Postoperative shivering was 73% in the controls regarding 11% in the amino acids patients. Overall, there were no significant statistical differences between other variables that we measured in two groups of patients. Conclusion: Amino acids infusion during spinal anesthesia exerted a thermogenic effect. Our findings showed hypothermia was less in the aminoacid group, and also postoperative shivering was more in the control group.

Central Retinal Artery Occlusion Associated with Sildenafil Overdose.

BACKGROUND: To report a patient with central retinal artery occlusion (CRAO) associated with sildenafil overdose. Case Presentation. A forty-two-year-old male presented three hours after sudden painless visual loss in the right eye. BCVA was counting finger in two meters, and relative afferent pupillary defect was positive. Fundus examination revealed retinal whiteness except in a limited area of papillomacular bundle and cherry red spot. He consumed two 100 mg film-coated sildenafil tablet (Vizarsin, Krka, d.d., Novo mesto, Slovenia) twelve hours apart, and the last one was six hours before visual loss. He was diagnosed with CRAO with cilioretinal artery sparing. Although we did not find any emboli, anterior chamber paracentesis was done. Four weeks later, BCVA improved to 20/80, with resolving of retinal edema. Cardiovascular, carotid arteries, and neurologic evaluations were negative for any predisposing factor. CONCLUSION: CRAO is a vision threatening condition that might be associated with the overdose of sildenafil.

Comparison of the effects of 2 ventilatory strategies using tidal volumes of 6 and 8 ml/kg on pulmonary shunt and alveolar dead space volume in upper abdominal cancers surgery.

Background: High tidal volume leads to inflammation, and low tidal volume leads to atelectasia and hypoxemia. This study was conducted to compare the effect of 6 mL/kg with positive end-expiratory pressure (PEEP) and 8 mL/kg without PEEP on pulmonary shunt and dead space volume. Methods: This clinical trial was done on 36 patients aged 20 to 65 years old with ASA I-II. They were candidates for upper abdominal surgery and divided randomly into 2 groups. One group were ventilated with the tidal volume = 8 mL/kg without PEEP (TV8). The other group received the tidal volume = 6 mL/kg with low PEEP = 5 cm H2O (TV6). Arterial and central venous blood gases were taken after intubation and 2 hours later. Additionally, the vital signs of the patients were checked every 30 minutes. Data analysis was performed using t test, chi-square test, and repeated measures analysis of variance with SPSS software, version 16 (SPSS Inc). P value less than.05 were meaningful. Results: There was no significant difference on the preanesthesia parameters. The pulmonary shunt was 13.5±0.1% and 18.6±0.2% in the groups TV6 and TV8, respectively (p=0.132), which slightly decreased after 2 hours in both groups without any significant difference (p=0.284). Prior to the ventilation, the ratios of dead space to tidal volume were 0.25±0.2 and 0.14±0.1 in the TV6 and TV8 groups, respectively (p=0.163), and after 2 hours, they were 0.23±0.11 and 0.16±0.1 in the TV6 and TV8 groups, respectively (p=0.271). There was no significant difference between the groups for blood pressure and peripheral and arterial oxygenation changes. Conclusion: The tidal volume of 6 mL/kg with the PEEP of 5 mmHg was similar to the tidal volume of 8 mL/kg without PEEP for hemodynamic and pulmonary changes (oxygenation, shunt, and dead space).

Clinical Trial Assessment of Intermittent and Continuous Infusion Dose of N-Acetylcysteine on Redox Status of the Body in Patients with Sepsis Admitted to the ICU.

PURPOSE: Conflicting results exist regarding the efficacy of N-acetyl cysteine (NAC) in sepsis treatment. A pivotal factor affecting the therapeutic potency of NAC in sepsis is timing and dosing of its infusion. We aimed to assess the effect of NAC on redox status of patients with sepsis and to compare its efficacy in intermittent and continuous infusion with the objective of developing the infusion regimen and optimizing the timing. MATERIALS AND METHODS: A prospective, randomized clinical trial was designed to compare the antioxidative effect of NAC in intermittent infusion group (IV: 25 mg/kg bolus and then 25 mg/kg/8 hours 3 times) and continuous infusion group (IV: 25 mg/kg bolus and then 75 mg/kg over 24 hours) in 60 critically ill patients with sepsis (20 patients in each group). Blood samples were collected immediately before and after intervention for total antioxidant capacity (TAC) and malondialdehyde (MDA) assessment. RESULTS: N-acetyl cysteine considerably increased TAC levels in both intermittent (0.68 ± 0.60; P value = .036) and continuous (0.69 ± 0.64; P value = .015) infusion groups when compared to placebo (0.61 ± 0.10); however, the difference in TAC levels between the intermittent and the continuous infusion did not reach statistical significance (P value = .942). Likewise, NAC treatment decreased MDA levels in both intermittent (19.45 ± 4.18; P value = 0.001) and continuous (22.47 ± 6.68; P value = .002) infusion groups when compared to placebo (31.76 ± 11.06), while the difference in MDA levels between the intermittent and the continuous infusion did not reach statistical significance (P value = .481). CONCLUSION: Our data confirmed the antioxidative effect of NAC treatment in patients with sepsis, with no significant difference in intermittent and continuous infusion.

Comparison of Spinal Anesthesia Quality Between Patients Addicted and Not Addicted to Opium.

PURPOSE: This study aimed to compare the quality of spinal anesthesia between opium-dependent and opium-naive patients. DESIGN: A case-control study. METHODS: Two groups of subjects including opium-dependent and opium-naive patients (30 per group) were enrolled. Spinal anesthesia was performed using 15 mg of bupivacaine. The level of anesthesia was assessed every minute for 10 min and then every 10 min for 180 min. Motor block was recorded at 10, 60, 120, and 180 minutes. The duration of anesthesia was recorded. FINDINGS: The mean duration of spinal anesthesia was significantly shorter in opium-dependent patients (101.45 ± 28.670) than in opium-naive patients (126.14 ± 24.206) (P = .003). The mean onset of sensory block was not significantly different between the two groups (4.14 ± 1.62 vs 3.69 ± 1.36, P = .259). CONCLUSIONS: Substance abuse affects the duration of spinal anesthesia, so it is recommended to use intravenous medications or higher doses of spinal marcaine for these patients.

The Effect of Spinal and General Anesthesia on Serum Lipid Peroxides and Total Antioxidant Capacity in Diabetic Patients with Lower Limb Amputation Surgery.

BACKGROUND: Anesthesia is performed in two major methods including regional and general.The aim of this study was to compare the effect of anesthesia method (spinal and general) on oxidative stress in diabetic patients underwent diabetic amputation surgery. METHODS: In this randomized control trial, 40 patients with diabetic foot who were candidate for foot amputation surgery at our academic hospital in 2013, were selected and divided into two groups based on anesthesia method. Lipid peroxide level and serum total antioxidant capacity (TAC) were measured before anesthesia induction and one hour after surgery. As the normal range, the findings obtained from 23 healthy volunteers were utilized. RESULTS: ean age was 54.9±11.21 and 52.4±11.23 years in the spinal anesthesia (SA) and the general anesthesia (GA) group, respectively (P=0.49). Serum TAC in GA group increased from 1.03±0.04 mM to 2.98±0.7 mM. In SA group, the increase of serum TAC from 1.22±0.11 mM to 3.42±0.5 mM was observed that indicated the increase of serum TAC in both groups was not significantly different (P=0.21). Serum Malondialdehyde (MDA) in GA and SA groups did not show a significant difference before surgery (31.14±3.9 mM vs. 29.06±2.49 mM in GA and SA groups, respectively) (P=0.31), while it was significantly different after surgery (23.14±2.6 mM and 19.24±2.7 mM in GA and SA groups, respectively) (P=0.03). CONCLUSION: lower limb amputation can help to control oxidative stress in diabetic patients; and considering serum MDA as a marker of oxidative stress, SA seems to be more effective to control this problem.

Foot drop after spinal anesthesia for cesarean section: a case report.

OBJECTIVE: Spinal anesthesia is the preferred anesthetic technique for cesarean section. Neurological complications are very rare and often transient after spinal anesthesia. CASE REPORT: In the present case, a 37-year-old woman was considered eligible for cesarean section due to fetal distress. She underwent spinal anesthesia with a 25-gauge pencil-point spinal needle. In the sitting position, 3 mL of 0.5% bupivacaine was injected following free flow of cerebrospinal fluid. The cesarean delivery was uneventful without severe and significant hemodynamic changes. After recovery, the patient complained of tingling and stiffness in the left leg, accompanied with movement disorders and foot drop. Lumbar magnetic resonance imaging was normal. After receiving 500 mg intravenous methylprednisolone daily for 72 hours, she was discharged from the hospital with no particular problems. CONCLUSION: Foot drop is a neurological disorder, which occurs following natural childbirth and spinal anesthesia due to direct needle trauma or local anesthetic toxicity. This complication is transient and usually resolves within a few days. In our patient, the neurological complication appeared after labor and anesthesia recovery, which was treated by corticosteroids and anti-inflammatory drugs, with no particular side effects.

[Reducing sore throat following laryngeal mask airway insertion: comparing lidocaine gel, saline, and washing mouth with the control group]. / Redução da dor de garganta após a inserção de máscara laríngea: comparação de gel de lidocaína, salina e lavagem da boca com o grupo controle.

BACKGROUND: Laryngeal mask airway is still accompanied by complications such as sore throat. In this study, effects of three methods of reducing postoperative sore throat were compared with the control group. METHODS: 240 patients with ASA I, II candidates for cataract surgery were randomly divided into four same groups. No supplementary method was used in the control group. In the second, third and fourth groups, lidocaine gel, washing cuff before insertion, and washing mouth before removing laryngeal mask airway were applied, respectively. Anesthesia induction was done with fentanyl, atracurium, and propofol and maintained with propofol infusion. The incidence of sore throat was evaluated during the recovery, 3-4h later and after 24h using verbal analog scale. The data were analyzed by t-test, analysis of variance and chi-square using SPSS V11.5. RESULTS: Age, gender, duration of surgery and cuff pressure were the same in all the four groups. Incidence of sore throat at recovery room was highest in the control group (43.3%) and lowest in the washing mouth group (25%). However, no significant statistical difference was observed between these four groups (recovery, p=0.30; discharge, p=0.31; examination, p=0.52). In this study, increased duration of operation had a significant relationship with the incidence of sore throat (p=0.041). CONCLUSION: Sore throat is a common postoperative problem, but no special method has been found completely efficient yet. In this study, cuff washing, lidocaine gel, and mouth washing before removing laryngeal mask airway were not helpful for sore throat.

Reducing sore throat following laryngeal mask airway insertion: comparing lidocaine gel, saline, and washing mouth with the control group / Redução da dor de garganta após a inserção de máscara laríngea: comparação de gel de lidocaína, salina e lavagem da boca com o grupo controle

BACKGROUND: Laryngeal mask airway is still accompanied by complications such as sore throat. In this study, effects of three methods of reducing postoperative sore throat were compared with the control group. METHODS: 240 patients with ASA I, II candidates for cataract surgery were randomly divided into four same groups. No supplementary method was used in the control group. In the second, third and fourth groups, lidocaine gel, washing cuff before insertion, and washing mouth before removing laryngeal mask airway were applied, respectively. Anesthesia induction was done with fentanyl, atracurium, and propofol and maintained with propofol infusion. The incidence of sore throat was evaluated during the recovery, 3-4 h later and after 24 h using verbal analog scale. The data were analyzed by t-test, analysis of variance and chi-square using SPSS V11.5. RESULTS: Age, gender, duration of surgery and cuff pressure were the same in all the four groups. Incidence of sore throat at recovery room was highest in the control group (43.3%) and lowest in the washing mouth group (25%). However, no significant statistical difference was observed between these four groups (recovery, p = 0.30; discharge, p = 0.31; examination, p = 0.52). In this study, increased duration of operation had a significant relationship with the incidence of sore throat (p = 0.041). CONCLUSION: Sore throat is a common postoperative problem, but no special method has been found completely efficient yet. In this study, cuff washing, lidocaine gel, and mouth washing before removing laryngeal mask airway were not helpful for sore throat.

JUSTIFICATIVA: A máscara laríngea ainda é relacionada a complicações como a dor de garganta. Neste estudo, os efeitos de três métodos para reduzir a dor de garganta, no período pós-operatório, foram comparados com o grupo controle. MÉTODOS: Duzentos e quarenta candidatos,com estado físico ASA I-II, foram aleatoriamente divididos em quatro grupos iguais para a cirurgia de catarata.com estado físico ASA I-II, candidatos para a cirurgia de catarata foram aleatoriamente divididos em quatro grupos iguais. Nenhum método complementar foi usado no grupo controle. No segundo, terceiro e quarto grupos, os métodos utilizados foram: Aplicação de gel de lidocaína, lavagem do manguito antes da inserção e lavagem da boca antes de remover a máscara laríngea, respectivamente. A anestesia foi induzida com fentanil, atracúrio e propofol e mantida com propofol. A incidência de dor de garganta foi avaliada durante a recuperação, 3-4 h depois e após 24 h usando uma escala verbal analógica. Teste-t, análise de variância e teste do qui-quadrado foram usados para a análise dos dados por meio do programa estatístico SPSS V11.5. RESULTADOS: Idade, gênero, tempo de cirurgia e pressão do manguito foram semelhantes em todos os quatro grupos. Na sala de recuperação, a incidência de dor de garganta foi maior no grupo controle (43,3%) e mais baixa no grupo lavagem da boca (25%). No entanto, não houve diferença estatisticamente significante entre os quatro grupos (recuperação, p = 0,30; alta, p = 0,31; exame, p = 0,52). Neste estudo, o tempo mais longo de cirurgia apresentou relação significativa com a incidência de dor de garganta (p = 0,041). CONCLUSÃO: Dor de garganta é um problema pós-operatório comum, mas nenhum método em especial foi considerado totalmente eficiente. Neste estudo, a lavagem do manguito, a aplicação de gel de lidocaína e a lavagem de boca antes de remover a máscara laríngea não foram úteis para evitar a dor de garganta.

Reducing sore throat following laryngeal mask airway insertion: comparing lidocaine gel, saline, and washing mouth with the control group.

BACKGROUND: Laryngeal mask airway is still accompanied by complications such as sore throat. In this study, effects of three methods of reducing postoperative sore throat were compared with the control group. METHODS: 240 patients with ASA I, II candidates for cataract surgery were randomly divided into four same groups. No supplementary method was used in the control group. In the second, third and fourth groups, lidocaine gel, washing cuff before insertion, and washing mouth before removing laryngeal mask airway were applied, respectively. Anesthesia induction was done with fentanyl, atracurium, and propofol and maintained with propofol infusion. The incidence of sore throat was evaluated during the recovery, 3-4h later and after 24h using verbal analog scale. The data were analyzed by t-test, analysis of variance and chi-square using SPSS V11.5. RESULTS: Age, gender, duration of surgery and cuff pressure were the same in all the four groups. Incidence of sore throat at recovery room was highest in the control group (43.3%) and lowest in the washing mouth group (25%). However, no significant statistical difference was observed between these four groups (recovery, p=0.30; discharge, p=0.31; examination, p=0.52). In this study, increased duration of operation had a significant relationship with the incidence of sore throat (p=0.041). CONCLUSION: Sore throat is a common postoperative problem, but no special method has been found completely efficient yet. In this study, cuff washing, lidocaine gel, and mouth washing before removing laryngeal mask airway were not helpful for sore throat.

Pharyngeal Packing during Rhinoplasty: Advantages and Disadvantages.

INTRODUCTION: Controversy remains as to the advantages and disadvantages of pharyngeal packing during septorhinoplasty. Our study investigated the effect of pharyngeal packing on postoperative nausea and vomiting and sore throat following this type of surgery or septorhinoplasty. MATERIALS AND METHODS: This clinical trial was performed on 90 American Society of Anesthesiologists (ASA) I or II patients who were candidates for septorhinoplasty. They were randomly divided into two groups. Patients in the study group had received pharyngeal packing while those in the control group had not. The incidence of nausea and vomiting and sore throat based on the visual analog scale (VAS) was evaluated postoperatively in the recovery room as well as at 2, 6 and 24 hours. RESULTS: The incidence of postoperative nausea and vomiting (PONV) was 12.3%, with no significant difference between the study and control groups. Sore throat was reported in 50.5% of cases overall (56.8% on pack group and 44.4% on control). Although the severity of pain was higher in the study group at all times, the incidence in the two groups did not differ significantly. CONCLUSION: The use of pharyngeal packing has no effect in reducing the incidence of nausea and vomiting and sore throat after surgery. Given that induced hypotension is used as the routine method of anesthesia in septorhinoplasty surgery, with a low incidence of hemorrhage and a high risk of unintended retention of pharyngeal packing, its routine use is not recommended for this procedure.

Effect of Ketamine on Post-Tonsillectomy Sedation and Pain Relief.

INTRODUCTION: Tonsillectomy is the one of the most common types of surgery in children, and is often accompanied by post-operative pain and discomfort. Methods of pain control such as use of non-steroidal anti-inflammatory drugs (NSAIDs), narcotics, and local anesthetics have been used, but each have their own particular side effects. In this study we investigated the effect of ketamine on post-operative sedation and pain relief. MATERIALS AND METHODS: A total of 50 children aged between 5 and 12 years who were candidates for tonsillectomy were divided into two groups. The study group received ketamine-midazolam (ketamine 1 mg/kg, midazolam 0.1 mg/kg) and the control group received midazolam (0.1 mg/kg) in the pre-operative period. The same methods of anesthesia induction and maintenance were used in all patients. Pain score was assessed using the Wong-Baker Faces Pain Rating scale and sedation was evaluated using the Riker Sedation-Agitation scale at the time of extubation as well as 5, 10, 15, and 30 minutes and 1, 2, and 6 hours after surgery. RESULTS: The two groups were similar in terms of age, weight, gender and duration of surgery. Pain after 15 and 30 minutes and agitation after 10 and 15 minutes following extubation were lower in the study group (ketamine-midazolam). Mean consumption and time of first request for analgesia after surgery as well as incidence of post-operative vomiting were similar in the two groups. CONCLUSION: Adding ketamine to midazolam in pre-operative of tonsillectomy reduces agitation and post-operative pain in the first 30 minutes after surgery.

Apneas in Infants with Postconceptional Age bellow 60 Weeks Undergoing Herniorrhaphy.

OBJECTIVE: Postoperative apnea is a major concern in infants undergoing surgery. In this study, we evaluated incidence and related factors for postoperative apnea in infants less than 60 weeks postconceptual age after herniorrhaphy. METHODS: One-hundred fifty infants with post conceptional age (PCA) less than 60 weeks who underwent elective herniorrhaphy were studied over eight months in 2012. General anesthesia was induced by sevoflurane and maintained by remifentanil, atracurium, and N2O 60%. Postoperatively, they were monitored for two hours in the recovery room and ten hours in the ward using pulse oximetry and nasal capnography. FINDINGS: Totally, 31 (20.7%) cases of postoperative apnea were reported. By comparing the patients, factors associated with postoperative apnea included postconceptional age, birth weight, and history of apnea, oxygen therapy, metabolic diseases, icterus, or cardiac disease. Twenty-seven (18%) apnea cases occurred in recovery room in infants with gestational age (GA) of 35.64±2.73 weeks, while only four (2.6%) patients of GA 36.02±2.0 weeks developed delayed apnea). CONCLUSION: In our study, the incidence of postoperative apnea following inguinal herniorrhaphy under general anesthesia in infants younger than 60 weeks PCA was 20.7%, which is considerable. We recommend longer surveillance and monitoring in recovery room for these infants with high-risk of postoperative apnea. This should be followed by evaluation of risk factors to determine the indication for elective intensive care unit transfer for longer-term monitoring of higher-risk patients.

Accidental intrathecal injection of magnesium sulfate for cesarean section.

Magnesium sulfate is used frequently in the operation room and risks of wrong injection should be considered. A woman with history of pseudocholinesterase enzyme deficiency in the previous surgery was referred for cesarean operation. Magnesium sulfate of 700 mg (3.5 ml of 20% solution) was accidentally administered in the subarachnoid space. First, the patient had warm sensation and cutaneous anesthesia, but due to deep tissue pain, general anesthesia was induced by thiopental and atracurium. After the surgery, muscle relaxation and lethargy remained. At 8-10 h later, muscle strength improved and train of four (TOF) reached over 0.85, and then the endotracheal tube was removed. The patient was evaluated during the hospital stay and on the anesthesia clinic. No neurological symptoms, headache or backache were reported. Due to availability of magnesium sulfate, we should be careful for inadvertent intravenous, spinal and epidural injection; therefore before injection must be double checked.

A comparison of Simplified Acute Physiology Score II, Acute Physiology and Chronic Health Evaluation II and Acute Physiology and Chronic Health Evaluation III scoring system in predicting mortality and length of stay at surgical intensive care unit.

BACKGROUND: In critically ill patients, several scoring systems have been developed over the last three decades. The Acute Physiology and Chronic Health Evaluation (APACHE) and the Simplified Acute Physiology Score (SAPS) are the most widely used scoring systems in the intensive care unit (ICU). The aim of this study was to assess the prognostic accuracy of SAPS II and APACHE II and APACHE III scoring systems in predicting short-term hospital mortality of surgical ICU patients. MATERIALS AND METHODS: Prospectively collected data from 202 patients admitted to Mashhad University Hospital postoperative ICU were analyzed. Calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test. Discrimination was evaluated by using the receiver operating characteristic (ROC) curves and area under a ROC curve (AUC). RESULT: Two hundred and two patients admitted on post-surgical ICU were evaluated. The mean SAPS II, APACHE II, and APACHE III scores for survivors were found to be significantly lower than of non-survivors. The calibration was best for APACHE II score. Discrimination was excellent for APACHE II (AUC: 0.828) score and acceptable for APACHE III (AUC: 0.782) and SAPS II (AUC: 0.778) scores. CONCLUSION: APACHE II provided better discrimination than APACHE III and SAPS II calibration was good at APACHE II and poor at APACHE III and SAPS II. Use of APACHE II was excellent in this post-surgical ICU.

Central Anticholinergic Syndrome due to Hypoxia-Induced Bradycardia in a Child with Difficult Intubation Undergoing Complete Dental Restoration: A Case Report.

Central anticholinergic syndrome (CAS) following general anesthesia (GA) is a well known syndrome in children and adults. Many cases of CAS have been previously reported in the literature. However, there are only two reports of post resuscitation CAS after administration of small doses of atropine. Hereby, we report a case of CAS in a child undergoing complete dental restoration under GA after receiving a small dose of atropine to reverse hypoxia induced bradycardia. Intraoperative events such as hypoxia or cardiac arrest may play a role as triggers for CAS. However, we cannot establish a causal relationship between the occurrence of CAS and such critical events.

Use of two Endotracheal Tubes to Perform Lung Isolation and One-Lung Ventilation in a Patient With Tracheostomy Stenosis: A Case Report.

INTRODUCTION: Lung isolation is a common technique used in thoracic surgery to prevent spillage to unaffected lung and to provide a better view for the surgeon. CASE PRESENTATION: A 41-year-old woman with a history of pharyngo-laryngo-oesophagectomy (PLO) and tracheostomy was a candidate for thoracic duct ligation because of chylothorax. Since the patient had tracheostmy stomal stenosis, two cuffed tracheal tubes (internal diameter = 4.5 mm) were used; one tube was placed in the right bronchus and the other tube in the left one by fiberoptic laryngoscopy in 10 minutes. Right lung was collapsed during the surgery for 3.5 hours with a slight decrease in oxygenation (SpO2 = 91%-93%) and with no evident hemodynamic change. Potential trauma from a double-lumen tube and a bronchial blocker as well as inaccessibility to a univent tube prevented us to use these standard methods in this case. CONCLUSIONS: This report presents a new method for lung isolation in specific cases and in the absence of certain equipment.

Efficacy of ephedrine in the prevention of vascular pain associated with different infusion rates of propofol.

CONTEXT: Vascular pain is a frequent and hypotension is most important complications of propofol administration. AIMS: The goal of this study is to evaluate frequency of vascular pain during rapid and slow injection of propofol and also effect of ephedrine for decreasing of vascular pain. MATERIALS AND METHODS: After approval of local ethical committee, 120 patients with American Society of Anesthesiologists status I (ASA I), who were candidates for cataract surgery, were divided randomly into three groups. The first group received 20 mg of lidocaine, and propofol 1% at 1 ml per 5 seconds (slow injection). The second and third groups received propofol at 10 ml per 5 seconds without lidocaine (rapid injection) and also in the third group, 10 mg of ephedrine were injected at first and vascular pain were evaluated with 5-point scale. STATISTICAL ANALYSIS: Data were analyzed with Statistical Package for the Social Sciences (SPSS) v16, Chi-square test, one-way analysis of variance (ANOVA), Kruskel-Wallis. P <0.05 was considered statistically significant. RESULTS: Demographic characteristics of the three groups were similar. The vascular pain was 52.5%, 40%, and 27.5% in first, second, and third group, respectively. The injection pain was more severe in the slow injection (P = 0.025), but was the same between two rapid groups (P = 0.76). Heart rate and blood pressure changes were similar between all groups (P = 0.45 and P = 0.58, respectively). CONCLUSION: Rapid propofol injection induced less vascular pain compared with slow injection, but 10 mg ephedrine was not more effective.

The effect of local injection of epinephrine and bupivacaine on post-tonsillectomy pain and bleeding.

INTRODUCTION: Tonsillectomy is one of the most common surgeries in the world and the most common problem is post-tonsillectomy pain and bleeding. The relief of postoperative pain helps increase early food intake and prevent secondary dehydration. One method for relieving pain is peritonsillar injection of epinephrine along with an anesthetic, which has been shown to produce variable results in previous studies. Study Deign: Prospective case-control study. SETTING: A tertiary referral centers with accredited otorhinolaryngology-head & neck surgery and anesthesiology department. MATERIALS AND METHODS: Patients under 15 years old, who were tonsillectomy candidates, were assigned into one of three groups: placebo injection, drug injection before tonsillectomy, and drug injection after tonsillectomy. The amount of bleeding, intensity of pain, and time of first post-operative food intake were evaluated during the first 18 hours post operation. RESULTS: The intensity of pain in the first 30 minutes after the operation was lower in the patients who received injections, but the difference was not significant during the first 18 hours. The intensity of pain on swallowing during the first 6 hours was also lower in the intervention groups as compared with the placebo group. The amount of bleeding during the first 30 minutes post operation was lower in the two groups who received injections, but after 30 minutes there was no difference. CONCLUSION: Injection of epinephrine and bupivacaine pre- or post- tonsillectomy is effective in reducing pain and bleeding. The treatment also decreases swallowing pain in the hours immediately after surgery.