Anesthesiology and Pain Medicine
Volume:2 Issue: 3, Mar 2013

Opium is a highly addictive agent and the most common narcotic often misused in Iran. The pharmacokinetic of anesthetic drugs in patients with opium addiction is one of the great challenges for anesthesiologists. Hemodynamic instability and postoperative side effects are of these challenges which should be managed correctly.. In this study we aimed to assess the effects of clonidine upon post anesthesia shivering and recovery time in patients with and without opium addiction after general anesthesia to decrease the subsequent complications related to the shivering and elongation of recovery time. Patients and In a randomized clinical trial، 160 patients candidates for elective leg fracture operations under general anesthesia were studied in four groups of 40 patients: Group1 (placebo1) were patients without addiction who got placebo 90 minutes before the operation. Group2 (placebo2) were patients with opium addiction which received placebo as group 1. Group3 (Clonidine1) patients without addiction who got clonidine 90 minutes before the operation and group4 (Clonidine2) who were opium addicted ones which received clonidine as premedication.. None of the patients with and without addiction in clonidine groups had shivering after the operation but in placebo groups shivering was observed and the difference between clonidine and placebo groups was statistically significant (P < 0. 01). Recovery time in clonidine groups of patients with and without addiction was less than placebo ones (both P < 0. 01) which the magnitude of difference was higher in opium addicted than non-addicted patients (P = 0. 04).. Premedication with clonidine in patients with and without opium addiction can be effective to decrease the incidence of shivering and recovery time after operation.

Central venous catheterization is done frequently in cardiac surgery and intensive care settings. Faulty positioning of the catheter can cause many complications.. The aim of our study was to study the average depth of insertion and formulate a general guideline through the right internal jugular vein (IJV).. Patients and The right IJV was cannulated over a period of four months and catheter tip positioning was guided by means of an intracardiac electrocardiogram (ECG). Insertion depth was registered at the position of maximum P wave amplitude and the catheter was fixed after withdrawing 2 cm. Pearson’s correlation coefficient was calculated to categorize any relationship between plots of distance versus patient’s height، and regression lines and equations were also calculated. Bland-Altman analysis of data was done to compare the old formulae with our derived formulae.. A total of 155 adult patients were studied. Distances measured were found to be highly correlated with a patient’s height، followed by body surface area (BSA) and weight. For right IJV cannulation in valvular surgeries in adults، the depth of insertion (cm) was (height in cm / 15) + 2 ± 1. 58 (SD) and in non-valvular surgeries in adults، it was (height in cm/15) + 1. 4 ± 1. 47 (SD). The bias was very small when the new formulae were compared to the existing formulae.. The devised formulae predicted the required depth of catheters thereby reducing the possibility of complications and need for radiographic confirmation.

Induction of anesthesia and endotracheal intubation often creates a period of hemodynamic instability in hypertensive patients. Endotracheal intubation of the trachea stimulates laryngeal and tracheal sensory receptors، resulting in a marked increase in the elaboration of sympathetic amines.. This trial aimed to evaluate and compare the efficacy of fentanyl and fentanyl plus lidocaine in attenuating the hemodynamic responses to laryngoscopy and endotracheal intubation in hypertensive patients.. Patients and We conducted a prospective، randomized، double-blind trial in 37 patients with hypertension in the Rasoul-Akram Hospital، Tehran، Iran، from March to December 2011. The patients were randomly divided into two groups (fentanyl group and fentanyl plus lidocaine group). The fentanyl group received 2 mcg/kg and the fentanyl plus lidocaine group received 1. 5mg lidocaine and 2mcg/kg fentanyl. Hemodynamic variables were recorded at baseline، after giving inductive anesthetic agents، and 1، 3 and 5 minutes after performing endotracheal intubation.. We evaluated 37 patients including 15 males (40. 54%) and 22 females (59. 46%)، with a mean age of 56. 08 ± 10. 85 years. There were no significant differences between the two groups regarding; heart rate، systolic blood pressure and diastolic blood pressure before induction، 3 minutes before intubation and 1، 3 and 5 minutes after intubation.. Fentanyl and fentanyl plus lidocaine effectively decreased the hemodynamic response to tracheal intubation، however، neither fentanyl nor fentanyl plus lidocaine، could inhibit all hemodynamic responses، moreover fentanyl plus lidocaine was not more effective than fentanyl alone.

To alleviate stinging pain in the skin entry area and visceral discomfort in patients who are undergoing ESWL.. This study was designed to investigate the effectiveness of the EMLA cream in combination with remifentanil patient-controlled analgesia (PCA) in patients undergoing ESWL treatment.. Patients and Sixty patients were divided into two double-blind randomized groups. Those in the first group were administered 3-5mm of EMLA 5% cream on a marked area; the second group received، as a placebo، a cream with no analgesic effect in the same amount. All patients were administered a remifentanil bolus with a PCA device. Arterial blood pressure، oxygen saturation، and respiratory rate were recorded throughout the procedure; postoperative side effects، agitation، and respiratory depression were measured after. Visual Analogue Scale (VAS) scores were taken preoperatively، perioperatively، directly postoperatively، and 60 minutes subsequent to finishing the procedure.. There were no statistically significant differences in the frequency of PCA demands and delivered boluses or among perioperative VAS. No significant side effects were noted. Patient satisfaction was recorded high in both groups.. EMLA cream offered no advantage over the placebo cream in patients undergoing ESWL with remifentanil PCA.

Caesarian section is a commonplace surgery in females for which spinal anesthesia is the preferred method. The local anesthetic medications used in the surgery are often associated with complications such as nausea، vomiting، dyspnea، hypotension، and bradycardia. In the present study، we decreased the dose of the anesthetic drug and added an opioid instead.. We tried to find an appropriate combination of medications required for optimal anesthesia with minimum complications.. Patients and One hundred twenty six candidates for C/S with first and second class ASA aged 18-35 years were randomly divided into three groups. All patients received sufentanil (2. 5 µg) and epinephrine (100µg) doses but the lidocaine doses were respectively 50 mg، 60 mg and 75 mg in the groups 1، 2 and 3. Complications including hypotension، bradycardia، dyspnea، nausea، vomiting، and anesthesia quality were recorded and statistically analyzed.. The level of anesthesia was significantly different between groups. By reducing the lidocaine dose، patients with anesthesia level under the nipple increased but the surgeon and the patient were satisfied with the results. Nausea، vomiting، and dyspnea was degraded by decreasing the lidocaine dose especially in the 50 mg group. The need to use ephedrine was directly associated with the lidocaine. However، the need to use atropine was not significantly different between groups. Pruritus was not significantly different as well.. It seems that reducing the lidocaine dose، when combined with sufentanil، decreases most complications of spinal anesthesia such as hypotension، dyspnea، nausea، and vomiting while preserving anesthesia quality.

Hypotension during spinal anesthesia is common and can lead to severe injuries and even death. Administration of crystalloid fluids is advised to prevent occurrence of hypotension; however its effectiveness is still the matter of arguments.. This study was designed to compare the effects of Ringer`s lactate and hydroxyethyl starch 6% on hemodynamic parameters after spinal anesthesia in patients undergoing orthopedic surgeries on lower limbs.. Patients and This randomized clinical trial was performed in Rasoul Akram Hospital، Tehran، Iran. 60 patients undergoing elective femoral fracture surgeries with spinal anesthesia were included in this study. Fitted patients were randomly divided into two equal groups. After entrance to the operation room and before spinal anesthesia، patients'' hemodynamic parameters including systolic blood pressure (SBP)، cardiac output (CO)، and cardiac index (CI) were evaluated using monitoring electro-velocimetry set. In both groups، spinal anesthesia was performed using needle no. 25 and 3 mL of marcaine 0. 5% in the sterile situation. None of the treatment group was aware of investigated group during the study.. The baseline values of mentioned variables did not show a significant difference between two groups using t-test (P > 0. 05). Also SBP، CI، and CO after intervention was not significantly different between two groups using t-test (P > 0. 05).. The result of present study on patients undergoing femoral fracture surgeries who received Hetastarch or Ringer`s lactate solutions showed that Hetastarch was not significantly more effective in compensation of hypotension induced by spinal anesthesia.

Ultrasound guidance for pain interventions is becoming increasing recognized as a useful imaging tool. One of the common interventions where it is gaining wider acceptance is during the performance of a stellate ganglion block. The following is a unique report where intravascular and neuronal injury occurred during the performance of an ultrasound guided stellate ganglion block followed by dysphagia. 41 year old male، with a diagnosis of complex regional pain syndrome، was referred to our clinic for further management. He underwent a diagnostic ultrasound guided stellate ganglion block after having tried conservative therapies. The stellate ganglion block provided him with complete pain relief for over five weeks. During a subsequent therapeutic stellate ganglion block، performed by an experienced pain medicine fellow with more than 50 ultrasound guided proceduresclinician، the patient developed a transient injury to the brachial plexus upon needle entry. Subsequent redirection and injection of an ml of injectate resulted in an intravascular injection producing tinnitus. After the tinnitus decreased، he underwent another stellate block using an out of plane approach without any further complications. Two days later، he reported chest and throat discomfort which resolved over the next few days possibly due to a retropharyngeal hematoma. He declined further interventions and was subsequently managed with 3 tablets of oxycodone a day. This report highlights the importance of vigilance and meticulous planning during the performance of ultrasound guided pain interventions.