فهرست مطالب

Anesthesiology and Pain Medicine
Volume:11 Issue: 5, Oct 2021

  • تاریخ انتشار: 1400/09/02
  • تعداد عناوین: 18
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  • Alan D. Kaye, Varsha Allampalli, Paul Fisher, Aaron J. Kaye, Aaron Tran, Elyse M. Cornett, Farnad Imani, Amber N. Edinoff *, Soudabeh Djalali Motlagh*, Richard D. Urman Page 1

    Peripheral nerve blocks (PNB) have become standard of care for enhanced recovery pathways after surgery. For brachial plexus delivery of anesthesia, both supraclavicular (SC) and infraclavicular (IC) approaches have been shown to require less supplemental anesthesia, are performed more rapidly, have quicker onset time, and have lower rates of complications than other approaches (axillary, interscalene, etc.). Ultrasound-guidance is commonly utilized to improve outcomes, limit the need for deep sedation or general anesthesia, and reduce procedural complications. Given the SC and IC approaches are the most common approaches for brachial plexus blocks, the differences between the two have been critically evaluated in the present manuscript. Various studies have demonstrated slight favorability towards the IC approach from the standpoint of complications and safety. Two prospective RCTs found a higher incidence of complications in the SC approach – particularly Horner syndrome. The IC method appears to support a greater block distribution as well. Overall, both SC and IC brachial plexus nerve block approaches are the most effective and safe approaches, particularly under ultrasound-guidance. Given the success of the supraclavicular and infraclavicular blocks, these techniques are an important skill set for the anesthesiologist for intraoperative anesthesia and postoperative analgesia.

    Keywords: Regional Anesthesia, Ultrasound-Guided, Brachial Plexus, Peripheral Nerve Blocks, Infraclavicular, Supraclavicular
  • Aysa Rezabakhsh, Farnad Imani, Ata Mahmoodpoor, Maryam Soleimanpour, Kavous Shahsavarinia, Hassan Soleimanpour * Page 2

    To the best of our knowledge, aspirin (ASA) is known as a commonly used medication worldwide. Although the cardiovascular aspects of ASA are well-established, recently, it has been identified that ASA can yield multiple extra-cardiovascular therapeutic potencies in facing neurodegenerative disorders, various cancers, inflammatory responses, and the COVID-19 pandemic. In this review, we aimed to highlight the proven role of ASA administration in the variety of non-cardiovascular diseases, particularly in the field of anesthesiology.

    Keywords: Off-Label Uses, Extra-Cardiovascular Diseases, Clinical Applications, Aspirin
  • Dita Aditianingsih *, Jefferson Hidayat, Vivi Medina Ginting Page 3
    Background

    Cardiac index (CI; cardiac output indexed to body surface area) is routinely measured during kidney transplant surgery. Bioimpedance cardiometry is a transthoracic impedance as the non-invasive alternative for hemodynamic monitoring, using semi-invasive uncalibrated pulse wave or contour (UPC) analysis.

    Objectives

    We performed a cross-sectional observational study on 50 kidney transplant patients to compare the CI measurement agreement, concordance rate, and trending ability between bioimpedance and UPC analysis.

    Methods

    For each patient, CI was measured by bioimpedance analysis (ICONTM) and UPC analysis (EV1000TM) devices at three time points: after induction, during incision, and at reperfusion. The device measurement accuracy was assessed by the bias value, limit of agreement (LoA), and percentage error (PE) using Bland-Altman analyses. Trending ability was assessed by angular bias and polar concordance through four-quadrant and polar plot analyses.

    Results

    From each time point and pooled measurement, the correlation coefficients were 0.267, 0.327, 0.321, and 0.348. Bland-Altman analyses showed mean bias values of 1.18, 1.06, 1.48, and 1.30, LoA of -1.35 to 3.72, -1.39 to 3.51, -1.07 to 4.04, and -1.17 to 3.78, and PE of 82.21, 78.50, 68.74, and 74.58%, respectively. Polar plot analyses revealed angular bias values of -10.37º, -15.01º, -18.68º, and -12.62º, with radial LoA of 89.79º, 85.86º, 83.38º, and 87.82º, respectively. The four-quadrant plot concordance rates were 70.77, 67.35, 65.90, and 69.79%. These analyses showed poor agreement, weak concordance, and low trending ability of bioimpedance cardiometry to UPC analysis.

    Conclusions

    Bioimpedance and UPC analysis for CI measurements were not interchangeable in patients undergoing kidney transplant surgery. Cardiac index monitoring using bioimpedance cardiometry during kidney transplantation should be interpreted cautiously because it showed poor reliability due to low accuracy, precision, and trending ability for CI measurement.

    Keywords: Pulse Wave Analysis, Cardiac Output, Transthoracic Impedance, Intraoperative Monitoring, Kidney Transplantation
  • Zahra Rahimi, Mehrdad Masoudifar, Behzad Nazemroaya *, Haidar Almadi Page 4
    Background

    Spinal fusion surgery is often associated with heavy bleeding. Labetalol is one of the most effective drugs used to control bleeding in surgery.

    Objectives

    Here, we measured the effect of two therapeutic doses of labetalol on the amount of bleeding.

    Methods

    This is a randomized clinical trial that was performed in 2020-2021 in Al-Zahra hospital in Isfahan, Iran, on patients that were candidates for posterior spinal fusion surgery under general anesthesia. A total number of 64 patients were entered and randomized into two groups, one receiving labetalol at the dose of 2 mg/min and another group at 4 mg/min during surgery. The amount of bleeding in patients, heart rate, blood pressure, blood oxygen saturation, hypotension or bradycardia, and the mean length of stay in the recovery room were measured and compared between the groups.

    Results

    Extubation time (14 ± 4) and recovery time (76 ± 17) were significantly lower in patients that received labetalol (2 mg/min) compared to another group (21 ± 7 for intubation time and 116 ± 32 for recovery time (P < 0.001 for both items). Patients that received labetalol (4 mg/min) had significantly lower amounts of hemorrhage compared to other group (P = 0.001), and the surgeon's satisfaction was significantly higher in the second group (P = 0.001). The frequency of hypotension and bradycardia during the surgery were significantly higher among patients that received labetalol at the dose of 4 mg/min (P = 0.002 and P = 0.001, respectively). The patients in the group labetalol at 4 mg/min had also significantly lower systolic and diastolic blood pressure and lower mean arterial pressure (MAP) compared to the other group (P < 0.05).

    Conclusions

    Administration of labetalol at the dose of 4 mg/min had significantly desirable effects on hemodynamics that resulted in reduced bleeding volume and blood pressures compared to labetalol at the dose of 2 mg/min.

    Keywords: Spinal Fusion, Labetalol, Hemodynamics, Controlled Hypotension, Bleeding
  • Amir Shafa, Hastisadat Aledavud *, Hamidreza Shetabi, Sedige Shahhosseini Page 5
    Background

    Due to the importance of dexmedetomidine and its different dosages, here, we aimed to investigate and compare the effectiveness of the doses of 1 µg/kg and 2 µg/kg of dexmedetomidine in sedation, agitation, and bleeding in pediatrics undergoing adenotonsillectomy.

    Methods

    This double-blinded randomized clinical trial was performed on 105 pediatric patients that were candidates for adenotonsillectomy. Then, the patients were divided into three groups receiving dexmedetomidine at a dose of 2 µg/kg, diluted dexmedetomidine at 1 µg/kg, and normal saline. The drugs were administered 15 minutes before operations via the intravenous method. The duration of extubation, mean arterial pressure (MAP), heart rate (HR), and SPO2 in the recovery were recorded. We also collected data regarding patients’ sedation and agitation every 15 minutes.

    Results

    Our data showed no significant differences between the groups of patients regarding MAP, HR, and SPO2. However, the mean sedation score was significantly higher in patients receiving dexmedetomidine (2 µg/kg), and this score was lowest in the control group at the time of entrance to the recovery room. The patients that received dexmedetomidine at a dose of 1 µg/kg had the lowest agitation score after 45 minutes of being in the recovery room, and the patients treated with dexmedetomidine at a dose of 2 µg/kg had the lowest agitation score after 60 minutes of being in the recovery compared to other groups of patients.

    Conclusions

    The use of the doses of 1 µg/kg and 2 µg/kg of dexmedetomidine was associated with proper sedation and a significant reduction in agitation. The patients also had lower amounts of bleeding. We recommend that anesthesiologists should pay more attention to dexmedetomidine at a dose of 2 µg/kg, especially in pediatric surgical procedures.

    Keywords: Pediatrics, Tonsillectomy, Dexmedetomidine, Agitation, Sedation
  • Faranak Rokhtabnak, Soheila Sayad, Maryam Izadi, Soudabeh Djalali Motlagh *, Poupak Rahimzadeh Page 6
    Background

    Mastectomy is sometimes performed in transgender patients, which may damage the regional nerves such as the pectoral and intercostobrachial nerves, leading to postoperative pain. An ultrasound-guided nerve block can be used to track and block the nerves properly.

    Objectives

    This study aimed to compare the ultrasound-guided type-II pectoral nerve block with the blind (conventional) intercostal nerve block (ICNB) for pain control after breast tissue reconstruction surgery in transgender patients.

    Methods

    In the present single-blind randomized clinical trial, 47 patients were randomly divided into two groups: (A) Ultrasound-guided type-II pectoral nerve block (n = 23) and (B) blind intercostal nerve block (n = 24). After nerve block in both groups, pain intensity at 3, 6, 12, and 24 hours after surgery, upper limb paresthesia, frequency of nausea and vomiting, shortness of breath, hematoma, and the length of hospital stay were assessed.

    Results

    Patients who received the ultrasound-guided type-II pectoral nerve block had a greater reduction in pain intensity (24 h after surgery), opioid use (24 h after surgery), nausea, vomiting, and hospital stay than those who received ICNB, whereas the recovery time did not differ between the study groups.

    Conclusions

    The pectoral nerve block under ultrasound guidance, compared to the intercostal nerve block, in transgender patients can reduce the required dosage of opioids within 24 hours, pain intensity within 24 hours after surgery, the incidence of postoperative nausea, and vomiting, and the hospital stay of patients.

    Keywords: Ultrasound Guidance, Transgender, Pectoral Nerve Block, Mastectomy, Intercostal Nerve Block
  • Vali Imantalab, Mandana Mansour Ghanaie, Zahra Rafiei Sorouri, Ali Mohammadzadeh Jouryabi, Samaneh Ghazanfar Tehran, Haniyeh Sadat Fayazi, Gelareh Biazar *, Mehdi Noroozshamsi Page 7
    Background

     Inevitable prolonged fasting time before surgery leads to inflammatory reactions, surgery-related stress response, and consequently unfavorable outcomes; thus, developing strategies to mitigate these consequences is crucial.

    Objectives

    In this study, we evaluated the effect of ascorbic acid on stress response reduction in abdominal hysterectomy following prolonged fasting time.

    Methods

    Eligible women candidates for abdominal hysterectomy following prolonged fasting time were enrolled in the study and divided into 2 groups of vitamin C [group C; 1 g intravenously (IV) before surgery] and placebo (group P). Before induction of anesthesia, C-reactive protein (CRP), mean arterial pressure (MAP), heart rate (HR), and blood sugar (BS) were measured and compared between the 2 groups at 4-point times, 24 and 48 hours immediately after extubation.

    Results

    Finally, the data of 80 patients were included for the final analysis. A statistically significant difference was observed between the 2 groups in terms of CRP and BS values in T1 CRP serum levels; at the end of the study, CRP values were 0.5 ± 0.55 and 0.92 ± 0.69 in groups C and P, respectively (P = 0.012), and BS levels were 124.12 ± 18.11 and 152.0 ± 17.36 in groups C and P, respectively (P = 0.0001). However, this significant difference was not observed at T2 regarding CRP (P = 0.145) and BS (P = 0.135), as well as at T3 regarding CRP (P = 0.282) and BS (P = 0.213). However, according to both CRP and BS values, the trend of changes from T0 to T3 was significant in the 2 groups (P < 0.0001). Hemodynamic parameters were not significantly different between the 2 groups. No adverse event was reported in the 2 groups.

    Conclusions

    We found that ascorbic acid could induce short-term positive effects in abdominal hysterectomy following prolonged fasting time. Obviously, the optimal dosage, timing, and specific cases that benefit the most from this intervention should be investigated.

    Keywords: Vitamin C, Metabolic Stress Responses, Fasting, Hysterectomy
  • Syena Sarrafpour *, Jamal Hasoon, Ivan Urits, Omar Viswanath, Farnad Imani, Kamran Mahmoudi, Thomas T. Simopoulos, Jatinder Gill, Lynn Kohan Page 8
    Background

    Spinal cord stimulation (SCS) is an established treatment modality for neuropathic pain. Published guidelines exist to aid physicians in proper antibiotic use during and after spinal cord stimulation trials and implants. In this brief review, we present and analyze the current antibiotic practice patterns of clinicians.

    Methods

    The study protocol was reviewed and granted an exemption by an Institutional Review Board. The survey queried practice parameters in regards to spinal cord stimulation therapy. The American Society of Regional Anesthesia and Pain Medicine (ASRA) and Society of Interventional Spine (SIS) distributed the survey to their active members by emails with a web link to the survey.

    Results

    Our results indicate that 82% and 69% of physicians do not utilize nasal swabs for methicillin-sensitive Staphylococcus aureus (MSSA) or methicillin-resistant Staphylococcus aureus (MRSA), respectively, prior to SCS trial and implantation. During trials, 47% providers administer a single dose of antibiotics, 35% administer antibiotics for the duration of the trial, and 17% do not administer antibiotics. During implantation, 44% of physicians administer a single dose during the procedure, 11% administer antibiotics up to 24 hours, 24% administer antibiotics between 3-5 days, 14% administer antibiotics for more than 5 days, and 4% do not administer antibiotics.

    Conclusions

    Our study suggests a portion of pain physicians do not adhere to the Neuromodulation Appropriateness Consensus Committee (NACC) guidelines in regards to antibiotic administration for SCS trial and implantation. Further analysis and surveys would allow insight into common practices. More information and education would be beneficial to optimize peri-procedure antibiotic use to reduce infection risk and decrease antimicrobial resistance.

    Keywords: Nasal Swab, Antibiotics, Morbidity, Bacteria, Surgical Site Infections, Neuromodulation, Implantable Pulse Generator, Spinal Cord Stimulation
  • Yudai Iwasaki, Junji Shiotsuka *, Alan Kawarai Lefor, Masamitsu Sanui Page 9
    Background

    Sarcopenia is associated with poor outcomes in elderly patients. However, current surgical risk assessment tools for cardiovascular surgery do not include the impact of sarcopenia.

    Objectives

    This study aimed to assess whether the psoas muscle index, a numerical score used to assess sarcopenia, is associated with outcomes in elderly patients undergoing cardiovascular surgery.

    Methods

    This nested case-control study evaluated patients aged ≥ 75 years who underwent elective cardiovascular surgery and were admitted to the intensive care unit at Jichi Medical University, Saitama Medical Center between January 1, 2016 and March 31, 2017. The case group (poor outcomes) included patients who either died or were transferred to a rehabilitation facility postoperatively. The control group (good outcomes) included patients who were discharged postoperatively. Clinical factors likely to affect patient outcomes were assessed, and the characteristics of the two outcome groups were compared using logistic regression analysis.

    Results

    In total, 183 patients were evaluated; among them, 137 and 46 patients were categorized to the good and poor outcome groups, respectively. The psoas muscle index was significantly associated with outcome (odds ratio: 0.25; 95% confidence interval: 0.14 – 0.43; P < 0.001). A psoas muscle index cut-off of 3.24 had a specificity, sensitivity, positive predictive value, and negative predictive value of 0.86, 0.63, 0.58, and 0.87, respectively, for predicting worse outcome at discharge.

    Conclusions

    The psoas muscle index was strongly associated with discharge to home in patients aged ≥ 75 years who underwent elective cardiovascular surgery. This finding suggests that the psoas muscle index might be useful in identifying the eligibility of older patients for cardiovascular surgery.

    Keywords: Discharge to Home, Psoas Muscle, Sarcopenia, Frailty, Thoracic Surgery
  • Chrysanthi Batistaki *, Alia Ibrahim Madi, Agathi Karakosta, Georgia Kostopanagiotou, Chrysa Arvaniti Page 10
    Background

    Pulsed radiofrequency (PRF) of the occipital nerves has neuromodulative properties and is used for chronic pain management. However, its role in various types of chronic headaches has not been adequately investigated so far.

    Objectives

    Τhis was an observational, open-label, prospective study aiming to assess the efficacy of PRF of occipital nerves on various types of chronic headache management.

    Methods

    Patients with chronic headaches followed up at the pain management unit were scheduled for PRF of both occipital nerves after a positive diagnostic nerve block. PRF was applied following a standardized protocol at 42°C, and the number of headaches per month was assessed as a primary outcome at baseline (before treatment), as well as after 1, 3, and 6 months. Pain intensity during headache crises was recorded using the Numeric Rating Scale (NRS, 0 - 10),

    Results

    Fifty-seven patients suffering from chronic migraines, cluster headaches, tension-type headaches, and occipital neuralgia were studied. PRF significantly improved the number of headache episodes per month, as well as the pain intensity of the crises. The median number of headache episodes per month was significantly reduced in patients with migraine, from 14.5 to 4 after 1 month, and to 6.5 after 6 months. The same was seen for patients with clusters, who were also improved. A statistically significant reduction in NRS values over time was seen for all types of headaches.

    Conclusions

    PRF of the occipital nerves can lead to a reduction of the number of headache episodes per month, improving the intensity of pain during each episode.

    Keywords: Occipital Nerves, Pulsed Radiofrequency, Headache
  • Gelareh Biazar, Soheil Soltanipour, Ali Mohammadzadeh Jouryabi, Vali Imantalab, Bahram Naderi Nabi *, Zahra Rafiei Sorouri, Zahra Mirmoazen, Masoud Moafi Madani Page 11
    Background

    Recently, concerns about general anesthesia (GA)-related neurotoxicity has been growing in societies. Parents’ information obviously plays an important role to make right decision for elective surgeries on children aged under three years old.

    Objectives

    The aim of this survey was to evaluate the knowledge, attitude, and performance of pregnant women about the GA-related neurotoxicity in children aged under three years old.

    Methods

    This descriptive study was conducted at Alzahra Teaching Hospital in Guilan, Iran, during 2020. The eligible pregnant women admitted to this center were interviewed, and a questionnaire containing 10 items was filled out by the responsible resident of anesthesiology.

    Results

    In this research, a total of 361 pregnant women were enrolled and underwent a face-to-face interview. The mean age of the participants was 31.4 ± 7 years, 64.5% were living in urban areas, 82.5% were housewives, and 65.7% were multipara. Moreover, 83.7% of participants believed that receiving information in this regard was crucial, and 81.7% preferred physicians as the source of information. Only 8% of mothers had received information regarding the issue. A significant correlation was observed between the habitat, employment, the level of education, knowledge, and attitude status, and the source of receiving information.

    Conclusions

    According to our results, the knowledge, attitude, and performance of pregnant women were not optimal and needed to be improved through practical strategies.

    Keywords: Pregnant Women, Performance, Attitude, Knowledge, General Anesthesia Neurotoxicity
  • Hyojoong Kim *, Sung Hyun Shin, Myoung Jin Ko, Yei Heum Park, Ki Hwa Lee, Kyung Hoon Kim, Tae Kyun Kim Page 12
    Background

    When performing spinal anesthesia for cesarean section, it is important to determine the appropriate anesthetic dose as well as to predict the level of spinal anesthesia. In this study, it was hypothesized that some anthropometric measurements may be related to maximum sensory block and hemodynamic changes.

    Objectives

    The aim of this study are to find maternal anthropometric values that are correlate with the level of spinal anesthesia.

    Methods

    Maternal anthropometric measurements, including height, weight, supine and standing abdominal circumference (AC), and hip circumference, were recorded before spinal anesthesia for cesarean section. Spinal anesthesia was induced by administering 8 mg of 0.5% hyperbaric bupivacaine and 20 μg of fentanyl at the L3-L4 interspace. The level of sensory block was determined using pin-prick at 1, 5, 10, and 15 minutes after spinal anesthesia. The sensory block level and hemodynamic adverse events were analyzed in relationship to anthropometric measurements.

    Results

    The supine AC/height ratios significantly correlate with the maximal sensory block level at 5, 10, and 15 minutes after the injection of spinal anesthetic (P = 0.001, P < 0.001 and P < 0.001, respectively). Further, there were significant correlations between body mass index (BMI) and sensory block level at every assessment (P = 0.041, P = 0.002, P = 0.001 and P < 0.001, respectively). When comparing the groups with and without hypotension, BMI, weight, and supine AC/height ratio were found to be significantly higher in the group with hypotension (P = 0.002, P = 0.004 and P = 0.006, respectively).

    Conclusions

    We conclude that BMI and AC/height ratio correlate with the sensory block level of spinal anesthesia for cesarean section.

    Keywords: Spinal Anesthesia, Sensory Block, Hypotension, Hemodynamics, Fentanyl, Cesarean Section, Bupivacaine, Anthropometric Measurements, Anesthetics
  • Chandra M. Kumar *, Shashi B Vohra, Farnad Imani, Reza Farahmand Rad Page 13

    Brugada syndrome (BrS), a type of sudden arrhythmic unexpected death syndrome (SADS), is characterized by specific electrocardiogram (ECG) changes, a structurally normal heart, and susceptibility to life-threatening ventricular arrhythmias. General anesthesia (GA) is usually used for major surgery in patients with BrS due to concerns that some local anesthetic agents may precipitate critical arrhythmias. The majority of ophthalmic surgeries are successfully carried out under regional anesthesia (RA). The literature does not address the use of ophthalmic RA in patients with BrS except one report of peribulbar block for glaucoma surgery. This clinical case report and the liertature review suggests that for BrS patients presenting for vitreoretinal surgery, a sub-tenon block, with or without sedation may safely be used as a primary anaethestic technique.

    Keywords: Arrhythmia, Conscious Sedation, Bupivacaine, Lidocaine Vitreoretinal Surgery, Sub-Tenon’s Block, Ophthalmic Regional Anesthesia, Brugada Syndrome
  • Ali Reza Safarpour, Manoosh Mehrabi *, Firoozeh Tarkesh, Hadis Ashrafizadeh, AbbasaliKeshtkar, Hassan Askari, Danya Abazari, Afshin Amini, Reza Barati-Boldaji Page 15
    Objectives

    Post-dural Puncture Headache (PDPH) is prevalent among individuals undergoing lumbar punctures. The non-invasive effect of some drugs, such as aminophylline on PDPH has been investigated in several clinical studies. As there is no comprehensive systematic review and meta-analysis about the preventive and therapeutic effects of aminophylline on PDPH in the literature, the clinical effectiveness of this drug on the prevention and/or treatment of PDPH will be assessed in this study.

    Methods

    PubMed/MEDLINE, Embase, WoS (Clarivate Analytics), the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL Complete, Scopus, and Google Scholar as electronic databases will be precisely searched for clinical studies that assessed the effect of aminophylline on PDPH. Studies between 01-01-1980 and 30-06-2020 will be evaluated in this study, and there will not be any language restrictions. Contradictions between the reviewers within any phase of the study (screening, selecting, quality assessment, and data extraction) will be resolved by consensus; in case of unsolved disagreements, a third reviewer will eventually decide. The combination method will be applied according to the methodological resemblance in the selected articles using the Random Effect Model or the Fixed Effect Model. Also, for the included articles, forest plots will be drawn. For assessing statistical heterogeneity, the I2 statistic and the Q-statistic test will be applied. In addition, funnel plots will be used for assessing non-significant study effects and potential reporting bias. Furthermore, Egger’s and Begg’s tests will be done, and publication bias will be indicated by significant findings (P < 0.05).

    Conclusions

    It is expected that the results of this study will be of benefit to researchers and clinicians for managing PDPH, and will be reported in conferences and publications.

    Keywords: Aminophylline, Post-Dural Puncture Headache, Lumbar Puncture
  • Ali Ghomeishi, Ahmad Reza Mohtadi, Kaveh Behaeen, Sholeh Nesioonpour, NimaBakhtiari *, Farzad Khalvati Fahlyani Page 16
    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.

    Keywords: Hemodynamic Parameters, Dexmedetomidine, Laparoscopic Cholecystectomy, Propofol, Stress Hormones
  • Alireza Olapour, Mahboobe Rashidi *, Fatemeh Javaher Foroush, Reza Akhoondzadeh, Nastaran Hosseini Page 17
    Background

    Acute respiratory distress syndrome (ARDS) treatment is based on supportive care such as mechanical ventilation, prophylaxis of stress ulcer, prophylaxis of deep vein thrombosis (DVT), nutritional support, and treatment of underlying disease.

    Objectives

    We aimed to investigate the effects of nebulized heparin on weaning off intubated ARDS patients admitted to the intensive care unit (ICU).

    Methods

    In this double-blind clinical trial study, 60 patients with ARDS receiving routine care according to the ARDS protocol were randomly assigned into two groups: intervention group (receiving nebulized heparin 5000 u/BD for one week) and control group (receiving nebulized sterile water 2 cc/BD for one week). The respiratory index (PaO2/FiO2), pulmonary shunt percentage (measured by ABG), tidal volume, minute ventilation, admission duration in the ICU, and days of mechanical ventilation required were recorded for each patient for one week.

    Results

    There was no significant difference in demographic data between the two groups. Inhaled heparin in patients with ARDS could significantly increase the respiratory index (PaO2/FiO2) and decrease pulmonary shunt percentage, minute ventilation, and tidal volume. It also significantly reduced the number of admission days in the ICU and the need for mechanical ventilation.

    Conclusions

    The result of the present study showed that inhaled heparin in intubated ARDS patients admitted to the ICU improved respiratory and pulmonary status and reduced the need for mechanical ventilation and admission days in the ICU. Nebulizing heparin, as an anti-inflammatory and anti-coagulant agent, is an effective and safe medication for ARDS patients on mechanical ventilation.

    Keywords: Acute Respiratory Distress Syndrome, Heparin, Intensive Care Unit, Inhalation
  • Abbas Ahmadi, Seyed Yaser Foroghi Ghomi *, Sarah Lotf Page 18