Comparison of the effect of propofol and isoflurane on hemodynamic parameters and stress response hormones during Laparoscopic Cholecystectomy surgery.

Background and Aims: General anesthesia induces endocrine, immunologic, and metabolic responses. Anesthetic drugs affect endocrine system by changing the level of stress hormones and hemodynamic of the patient . The purpose of this study was to compare the effects of propofol and isoflurane on hemodynamic parameters and stress-induced hormones in laparoscopic cholecystectomy (LC) surgery. Material and Methods: Seventy patients of elective LC were included in this study. Patients were randomly divided into two equal groups of 35 patients; group P received propofol (70-120 µg/kg/min) and group I received isoflurane (mac: 1.28%) as anesthesia maintenance. The following parameters were monitored, checked, and recorded from preanesthesia period to 10 min after PACU entry according to a planned method: hemodynamic parameters (heart rate and mean atrial pressure), level of blood sugar, and serum epinephrine level. Results: Heart rate and mean atrial pressure changes did not show significant differences between the two groups in all stage (P > 0.05), but isoflurane group tolerated lower fluctuating changes. Blood glucose and serum epinephrine level rise in the isoflurane group were significantly higher than the propofol group (P < 0.05). Conclusion: Maintenance anesthesia by inhalation gas base on isoflurane has not shown a significant difference with total intravenous anesthesia base on propofol on hemodynamic parameter. However, propofol has a consistent effect on decreasing stress hormone and suggested for LC surgery.

Post-cesarean Delivery Analgesia Using Spinal Anesthesia: Ropivacaine-Fentanyl vs. Ropivacaine-Sufentanil.

Background: To improve the quality of intraoperative and postoperative analgesia during spinal anesthesia, intrathecal opioids are used as adjuvant drugs in combination with local anesthetics. Objectives: This study aimed to compare the intrathecal injection of ropivacaine-fentanyl with ropivacaine-sufentanil in terms of the duration of analgesia after cesarean section (CS). Methods: This randomized, double-blind clinical trial study was conducted on women referred to Imam Khomeini Hospital of Ahvaz City for elective CS in 2021. A total of 51 patients were randomly divided into 2 groups. The first group (n = 25) received ropivacaine (17.5 mg) + fentanyl (25 µg), while the second group (n = 26) received ropivacaine (17.5 mg) + sufentanil (2.5 µg) for spinal anesthesia. Eventually, several parameters were investigated, including the duration of sensory and motor block, duration of analgesia (based on the Visual Analog Scale (VAS)), hemodynamic parameters, and possible complications. Results: The duration of surgery (P = 0.059) and the duration of motor block (P = 0.962) were not significantly different between the 2 groups. The mean duration of analgesia (from the time of entering recovery to reaching VAS = 3) was 203.12 ± 72.93 and 207.46 ± 69.59 minutes in the fentanyl and sufentanil groups, respectively (P = 0.658). Systolic and diastolic blood pressure (SBP/DBP) drops in minute 5 were observed more frequently in the sufentanil group than in the fentanyl group (P = 0.027 and P = 0.002, respectively). At the other time points, however, no significant difference was observed between the 2 groups in terms of hemodynamic variables (P > 0.05). Finally, the frequency of pruritus was higher in the sufentanil group than in the fentanyl group (26.9% vs. 4.0%; P = 0.024). Conclusions: Adding fentanyl or sufentanil to intrathecal ropivacaine provides a similar duration of analgesia. However, fentanyl was associated with better hemodynamic stability and a lower incidence of pruritus.

Effect of Intravenous Dexmedetomidine on Shivering in Cesarean Section under Intrathecal Anesthesia: Randomized Clinical Trial.

Background: Shivering is one of the most common side effects after cesarean section (C-section) under spinal or epidural anesthesia. However, it is often not treated. Objectives: The aim of this study was to evaluate the effectiveness of intravenous dexmedetomidine (DEX) in the prevention of shivering after intrathecal anesthesia in women undergoing C-sections. Methods: This double-blind, placebo-controlled clinical trial was conducted on 80 women candidates for elective C-sections under intrathecal anesthesia who were referred to Imam Khomeini Governmental Hospital in Ahvaz, Iran, during 2020 - 2021. Patients were randomly divided into two groups of intravenous DEX (group D; 0.5 µg/kg) and normal saline (control, group C) and received the medications after umbilical cord clamping. All patients were evaluated during and after surgery for hemodynamic changes, the incidence and severity of shivering based on Chu and Tsai, side effects (e.g., nausea, vomiting), and sedation level based on the Ramsey scale. Results: The incidence of shivering in group C was significantly higher than in group D (P = 0.003). Moreover, the severity of shivering on minutes 20, 30, and 45 in group C was significantly higher than in group D (P < 0.05). The mean sedation score during minutes 10 - 30 in group D was significantly higher than in group C (P < 0.05). Heart rate was not significantly different between the two groups (P < 0.05). Systolic and diastolic blood pressure were higher in group D than in group C (P < 0.05). Conclusions: The administration of intravenous DEX effectively reduces the incidence and severity of shivering and provides appropriate sedation in patients undergoing C-sections, and it does not cause remarkable side effects.

Comparison of the Effect of Propofol and Dexmedetomidine on Hemodynamic Parameters and Stress Response Hormones During Laparoscopic Cholecystectomy Surgery.

BACKGROUND: General anesthesia induces endocrine, immunologic, and metabolic responses. Anesthetic drugs affect the endocrine system by changing the level of stress hormones and hemodynamic variables of the patient. OBJECTIVES: The purpose of this study was to compare the effects of propofol and dexmedetomidine on hemodynamic parameters and stress-induced hormones in laparoscopic cholecystectomy (LC) surgery. METHODS: Seventy patients of elective LC were included in this study. The patients were randomly assigned into two equal groups of propofol (75 µg/kg/min) and dexmedetomidine (0.5 µg/kg/hour) as anesthesia maintenance. Hemodynamic parameters (heart rate and mean atrial pressure), blood sugar, and serum epinephrine level were monitored and recorded from pre-anesthesia period to 10 min after entry to post-anesthesia care unit (PACU) according to a planned method. RESULTS: Heart rate and mean atrial pressure changes were significantly lower in dexmedetomidine group in all stages compared to propofol group (P < 0.001). Also, the rises in blood glucose and serum epinephrine levels in the dexmedetomidine group were significantly higher than in the propofol group (P < 0.001). CONCLUSIONS: Anesthesia maintenance by dexmedetomidine showed a significant difference in hemodynamic parameters in comparison with propofol. While dexmedetomidine had better effects on controlling hemodynamic parameters, propofol showed better effects on decreasing stress hormones, and it can be suggested for LC surgery.

The effect of low-level laser on postoperative pain after tibial fracture surgery: a double-blind controlled randomized clinical trial.

BACKGROUND: Postoperative pain is a common complication that can lead to serious morbidities and delayed recovery. OBJECTIVES: The aim of this study was to investigate the effect of low-level laser therapy on acute pain after tibial fracture surgery. PATIENTS AND METHODS: In this randomized clinical trial, 54 patients who were candidate for tibial fracture surgery were allocated randomly to two groups, namely, control and laser therapy. Both groups had the same type of surgery and technique of spinal anesthesia. Patients in laser group were treated with the combination of two lasers (GaALAs, 808 nm; and GaALInP, 650 nm) at the end of the surgery while control group received laser in turn-off mode with the same duration as laser group. Patients were evaluated for pain intensity according to the visual analogue scale (VAS) and the amount of analgesic use during 24 hours after surgery. RESULTS: Laser group experienced less pain intensity in comparison with control group at second, fourth, eighth, 12(th), and 24(th) hours after surgery (P Value < 0.05). In addition, the amount of consumed opioid in laser group was significantly less than the control group (51.62 ± 29.52 and 89.28 ± 35.54 mg, respectively; P Value, 0.008). CONCLUSIONS: Low Level Laser Therapy is a proper method to reduce postoperative pain because it is painless, safe, and noninvasive and is easily accepted by patients.

Analgesic effect of low dose subcutaneous ketamine administration before and after cesarean section.

BACKGROUND: Pain is considered as an importantissue after cesarean section. Multimodal approach to post cesarean pain management may not only enhance analgesia but also reduce side effects after the surgery. OBJECTIVES: This study was aimed to evaluate the clinical efficacy of subcutaneous injection of low dose ketamine at the incision site to reduce cesarean section pain. PATIENTS AND METHODS: Sixty patients, aged between 18 and 25 years old, scheduled for elective cesarean section, were enrolled to this double-blind randomized controlled trial study. Patients were divided into three groups of 20 patients each group one (k-pre) received 0.5 mg/kg ketamine before skin incision and normal saline after skin closure, group two (k-post) received normal saline before skin incision and 0.5 mg/kg ketamine after skin closure and group three (C) received normal saline before skin incision and after skin closure; subcutaneously at the incision site. The first analgesic request, the amount of analgesic and the pain intensity were evaluated for 24 hours. RESULTS: The first time analgesic requested was longer and the amount of analgesic used during the first 24 hours was significantly lower in groups K-pre and K-post compared with group C (P < 0.05). Pain intensity was significantly lower at 2, 4, 6 and 12 hours in groups K-pre and K-post compared with group C (P < 0.05). Nevertheless, pain intensity was not significantly different at 18 and 24 hours in group C (P > 0.05). The first requested time, total used amount of analgesicand pain intensity were not meaningfully different in K-pre and K-post groups (P > 0.05). CONCLUSIONS: Patients who were given ketamine before or after cesarean section subcutaneously at incision site had lower pain intensity and less analgesic consumption than patients who were given placebo.

The Effect of Inhalation of Aromatherapy Blend containing Lavender Essential Oil on Cesarean Postoperative Pain.

BACKGROUND: Pain is a major problem in patients after cesarean and medication such as aromatherapy which is a complementary therapy, in which the essences of the plants oils are used to reduce such undesirable conditions. OBJECTIVES: In this study, the effect of aromatherapy using Lavender (Lavandula) essential oil on cesarean postoperative pain was assessed. MATERIALS AND METHODS: In a triple blind, randomized placebo-controlled trial study, 60 pregnant women who were admitted to a general hospital for cesarean section, were divided randomly into two groups. After cesarean, the Lavender group inhaled about 3 drops of 10% Lavender oil essence and the placebo group inhaled 3 drops of placebo after the start of postoperative pain, four, eight and 12 hours later, for 5 minutes from the 10 cm distance. Patient's pain was measured by the VAS (Visual Analog Scale) score before and after each intervention, and vital sign, complications and level of satisfaction of every patient were recorded before and after aromatherapy. RESULTS: There was no statistically significant difference between groups in age, height, weight, and time to the first analgesic requirement. Patients in the Lavender group had less postoperative pain in four (P = 0.008), eight (P = 0.024) and 12 (P = 0.011) hours after first medication than the placebo group. The decreased heart rate and patients' level of satisfaction with analgesia were significantly higher in the Lavender group (P = 0.001). In the placebo group, the use of diclofenac suppositories for complete analgesia was also significantly higher than the Lavender group (P = 0.008). CONCLUSIONS: The inhaled Lavender essence may be used as a part of the multidisciplinary treatment of pain after cesarean section, but it is not recommended as the sole pain management.