anesthesia induction

One of the major challenges in adult surgery is hypertension. Hypertensive patient are in danger of myocardial ischemia, increasing blood pressure in recovery room, kidney injury and cerebral artery damage. Regarding the previously reported positive effect of alprazolam in decreasing this complication, we decided to evaluate its efficacy in hypertensive patients undergoing surgery under general anesthesia. The present randomized controlled trial was conducted in 2014 in Alzahra Hospital, Isfahan, Iran. Study subjects (age range between 54 and 76 years) were candidates for elective surgery under general anesthesia. Patients were randomly divided into 2 groups, intervention and control. Control group received no drug and intervention group received alprazolam tablet (0.5 mg) before the surgery. Systolic and diastolic blood pressure, heart rate, respiratory rate, pulse oximetere, and O2 saturation during the surgery and pain severity, extubation time, recovery time and the dose of analgesic drugs after the surgery were evaluated and compared between the groups. Increasing blood pressure in the first 40 minutes of surgery (P = 0.001), pain severity (P = 0.012) and the dose of analgesic drugs (P = 0.001) were significantly less in intervention group compared to the control group. According to our results, alprazolam has an optimal efficacy in controlling blood pressure in hypertensive patients undergoing surgery and reducing pain severity in recovery room. In the absence of contraindications, it could be used as a prophylactic treatment in this group of patients.

The presence of a child’s parents during the induction of anesthesia has always been a controversial issue. While early studies found that parental presence could reduce parents'' anxiety and increase cooperation of them. This study aimed to evaluate parental presence during children induction of anesthesia on a parent''s anxiety. This is randomized controlled trial research. 60 parent of Children 2 to 11 years undergoing surgery were randomly divided into experimental and control groups. Parents were present in the intervention group. Anxiety Inventory for parents Spilberger in two stages were examined، and finally SPSS/18 software and the chi- Square test، Fisher exact test، t test and t pair we were used for data analysis. The preoperative parental anxiety average scores between the two groups were not statistically significant difference. Parental postoperative anxiety average scores between the two groups had significant differences (p = 0. 035). As well there were no significant difference between parental anxiety levels and sample demographic characteristics of the two groups before and after surgery. Result showed that parental presence during induction of anesthesia to the child had no additive effects for reducing the parent''s anxiety; however، effective interventions to preparing and reducing of anxiety of childrens'' parents undergoing surgery should be done.

Nausea and vomiting are from the most common complications of surgery during recovery. Adenotonsillectomy is a common surgery among children, which can be followed by some complications such as nausea, vomiting, bleeding, and even death in some cases. There are some medical and nonmedical remedies to decrease nausea and vomiting. A nonmedical therapeutic procedure is reduction of abdominal pressure using oral gastric tube. This study aims to assess effects of gastric tube insertion during anesthesia induction on nausea and vomiting of adenotonsillectomized patients. This study was a clinical trial on 72 adenotonsillectomised children aged 6 to 12 years old in Shahid Montazeri hospital of Najaf-Abad. Patients were randomly divided to two groups of case group (36 Children with oral gastric tube) and controls group (36 children without oral gastric tube). Anesthesia method for both groups was similar. Frequency of nausea and vomiting were measured during the 24 hours following adenotonsillectomy. Data was analyzed using SPSS 15 and Mannwhithney U, Chi square, Spearman, Friedman and wilcoxon tests. Two groups were not significantly different regarding their demographic characteristics such as age, sex and weight (p>0.05). Frequencies of nausea and vomiting were significantly lower in the intervention group comparing to the control group in the first 2 hours in recovery room as well as in the first 2, 6, and 14 hours of patient attendance in the postsurgical ward (P ≤ 0/05). This study showed that the use of oral gastric tube during anesthesia induction can reduce nausea and vomiting after adenotonsillectomy.

In this prospective clinical trial the effects of propofol and thiopental sodium on hemodynamic variables were compared in parturients undergoing elective cesarean section. This study was a randomized single blinded clinical trial. After ethical committee approval and informed consent, seventy pregnant women 18-40 years old, ASA I, undergoing elective cesarean section with general anesthesia were studied. Any findings in mothers or neonates such as massive hemorrhage during surgery or neonatal anomalies that decreases the APGAR score in the neonate were excluded. The patients were randomly were divided into two groups, propofol (N=35) and sodium thiopental (N=35). In thiopental group, general anesthesia was induced by intravenous (IV) injection of sodium thiopental 5 mg/Kg and in propofol group, with propofol 2 mg/Kg. Trachea was intubated with the use of succinylcholine 1mg/kg and muscle relaxing during surgery was maintained with atracurium 0.5mg/Kg. Maintenance of anesthesia was similar in two groups with O2+N2O+ isoflurane 0.6 MAC. Maternal heart rate, systolic, diastolic and mean arterial blood pressure were measured in three points: before anesthesia induction, after intubation and after placenta delivery. Collected data were analyzed with SPSS 16 and p value<0.05 were considered significant. Maternal heart rate and systolic, diastolic and mean arterial blood pressure after intubation in thiopental group were significantly increased but maternal hemodynamic were stable in this time in propofol group. Because of the hemodynamic stability in the mother with propofol without any side effects on the neonates propofol can be used as alternative drug instead of sodium thiopental in the induction of anesthesia for cesarean section.

Induction of anesthesia in patients that undergo cardiac surgery has more risk than others, because of specific cardiovascular effects of the anesthetic drugs and the preoperative state of these patients, so the hemodynamic stability is very important in these patients. It seems that midazolam have less cardiovascular side effects than thiopentone. In this study, the effects of midazolam and thiopentone on cardiovascular system were compared. Sixty patients in ASA class 2,3 that underwent coronary artery bypass grafting were randomly divided into two groups, all patients were pretreated similarly. Anesthesia induction was performed by a bolus injection of midazolam (0.25 mg/kg)in first group and thiopentone (5 mg/kg) in second group, and succinylcholine (1.5mg/kg) in both groups. Their trachea were intubated. Heart beat rate and arterial blood pressure were measured in following times: before (base) and after anesthesia induction, during intubation and 3, 5 and 8 minutes after intubation. The data showed that administration of both drugs decreased blood pressure during induction of anesthesia and changed heart beat rate minimally. However after intubation, blood pressure and heart beat rate increased in both groups. But, midazolam had less effects than thiopentone. Hemodynamic effects of midazolam is similar to thiopentone. Midazolam is a water-soluble, safe and effective inductive anesthetic with short- term effects, much lesser venous irritation, and it can be used instead of thiopentone in patients with cardiac diseases or those patients which thiopentone is contraindicated for whom.