فصلنامه آنستزیولوژی و مراقبتهای ویژه ایران
سال سی و پنجم شماره 1 (پیاپی 81، بهار 1392)

Postdural puncture headache (PDPH) is a common problem after neuroaxial block. Several policies have been forwarded for the treatment of PDPH including methylxanthine drugs. It seems that these drugs induce cerebral vasoconstriction and thus decreasing PDPH severity via adenosine receptors. This study aimed to evaluate the effect of methyl xanthine drugs on prevention of PDPH.

In a double blind randomized clinical trial, we evaluated 180 patients in three groups (n=60) undergoing spinal anesthesia for elective cesarean section in Motahhari hospital of Marvdasht-Fars province during 2011. After umbilical cord clamping, in first group aminophylline was injected slowly intravenously (1.5 mg/kg body weight).In placebo group (n=60) normal saline was injected intravenously: In the third group after one dose aminophylline intravenously, the patients received one tablet theophylline each 8 hours for 3 days. At the 1st, 4th, 24th and 48th hour after surgery, incidence of PDPH in each group evaluated.

The incidence of PDPH was significantly lower in first (n=2) and third group (n=2) compared with placebo group(n=8)at 24th hour post operation. At 48th hour post operation9, 8 and 19 patients suffered from PDPH in1st, 3rd and 2nd (placebo) group respectively, which was statistically significant. The incidence of PDPH in 3rd group was not less than the 1st group.

This study shows that intravenous administration of aminophylline significantly reduces the incidence of PDPH in cesarean section and we can use this regimen for prevention of PDPH.

Cosmetic surgery procedures because of prolonged use of induced hypotension, bleeding, and the relative hypovolemia, have special considerations. Some believe that prolonged intraoperative hypotension can cause myocardial ischemia and increase in troponin level in the absence of myocardial infarction and can occur only with small size cardionecrosis. Present study was designed to investigate the possibility of intraoperative myocardial ischemia with CPK-MB and troponin measurement after cosmetic surgery procedures to determine whether induced hypotension can cause an increased risk of intraoperative myocardial injury?

40 candidates for facial plastic surgery and rhinoplasty, ASA I- II patients, aged 17-45 years were included. Anesthesia protocol was similar in all patients. 6 hours after the end of surgery, in all patients troponin I and CPK-MB were measured and the results were compared.

CPK-MB and troponin I were in the normal range in all patients. Mean CPK-MB was 22.5±8.3 and mean troponin I was 0.29±0.26, Mean amount of bleeding= 213.75cc (maximum= 450cc and minimum= 100cc).

Face plastic surgery and the use of induced hypotension have no additional risk for myocardial ischemia, thus prevention of perioperative adverse events in these patients can prevent perioperative death and complications.

Propofol is one of the most common drugs used in anesthesia induction and the pain on intravenous injection is one of the most important propofol’s side effects. Therefore a lot of methods and drugs have been examined to reduce or eliminate this side effect. In this study the effects of fentanyl and ketamine in reducing of pain on intravenous injection of propofol are investigated.

This study was performed on 66 patients who were undergoing elective surgery in Ahwaz Imam Khomeini hospital in 2012. The intensity of propofol intravenous injection pain was measured after injection, recovery time, 6 and 12 hrs after injection by VRS. Result were analyzed by SPSS version 16 software using Chi square and Tukey HSD tests.

According to analysis of data, statistically significant differences in pain after injection of propofol were observed during recovery and at 6 hrs and 12 hrs after injection using VRS. The VRS score in Fentanyl group has a meaningful difference in comparison of other groups according to Tukey test (p<0.001).

Fentanyl was more effective than ketamine and normal saline group in reducing pain on injection of propofol.

Postoperative cognitive dysfunction including Agitation and delirium commonly occurs after cardiac surgery. Ketamine as a NMDA receptor antagonist exerts neuroprotective effects by preventing excitotoxic injury and apoptosis after cerebral ischemia and suppressing systemic inflamematory response to surgery.We studied the effect of intravenous Ketamine during open-heart surgery on post-operative agitation.

In a double blind clinical trial, 40 males at least 55 years undergoing open heart surgery were divided randomly into 2 groups: intervention group (received 0.5 mg/kg ketamine iv before sternotomy and repeated the same dose on the pomp during warming) and control group (the same volume of normal saline). After the end of surgery agitation was assessed by using SAS every 2 hours until 8th hour and then every 8 hours until 3 days.

Incidence of agitation on 2nd and 3rd days after operation was significantly lower in patients receiving ketamine compared with placebo group.

Intravenous ketamine administration during open-heart surgery can reduce post-operative agitation by its neuroprotective effect.

Maintenance of airway patency is very important and one of the responsibilities of the anesthesiologist is patency of the airway for maintaining lung ventilation. Endotracheal entubation has remained one of the crucial difficulties during elective and emergency surgical operations. Videolaryngoscope is a new modality among the airway management procedures. It has been used in various difficult airway conditions by providing a glottic view without an alignment of the oral, pharyngeal and laryngeal axes. The aim was to compare the two methods of videolaryngoscopy (VL) and direct laryngoscopy (DL) for airway management of patientscandidate for elective surgical operations.

This clinical trial was performed on 100 patients with an age range from 15 to 70 years, ASA class I and II. These patients were candidate for an elective scheduled operation under general anesthesia with endotracheal intubation. Assignment of patients to VL and DL was in an alternating sequence of one VL and next DL. For the patients candidate for direct DL with a number 3MacIntosh blade evaluation was done with the VL in order to define the glottic view grading, after this endotracheal intubation wasperformed with DL. Almost similarly in the group for VL intubation the first glottic view grading evaluation was done with a DL thereafter the second glottic view grading evaluation with the videolaryngoscope and then endotracheal intubation was performed with a videolaryngoscope in this group. The duration of intubation was recorded.

Evaluation of DL patient's airway revealed that 53 were airway grade I and 47 were grade>I. From the grade>I patients 29 had grade II, 16 grade III and 2 patients were grade IV. In the VL group 82 had grade I, 16 had grade II, one grade III and one grade IV. Assessment of the glottic view airway gradings revealed an improvement using the videolaryngoscope, which was as follows; grade II to grade I in 27 patients, grade III to grade II in 13 patients and grade IV to grade III in one patient. The mean gradings of the glotic airway views with VL was 1.21±0.49 and with DL1.61±0.81.There was a significant difference between the gradings of these two groups statistically. The mean time duration for intubation for VL group was 12.96±4.22 and for DL 10.06±1.95. The difference between the time duration of these two groups was not significant statistically.

In assessing the obtained results of the procedures done we can conclude that in viewing the glottic airway by using the VL in comparison with DL an improvement was seen and the difference between the gradings of both was significant. The time duration of intubation was not significantly longer for VL procedure group in our study.

Induction of anesthesia, laryngoscopy and endotracheal intubation can be associated with adverse hemodynamic responses. The aim of this study was to evaluate hemodynamic responses to laryngoscopy and endotracheal intubation after diazepam versus etomidate induction. One hundred and eighty ASA class I and II patients,aged 20-65 years,were enrolled in a randomized clinical trial (RCT),divided into diazepam and etomidate groups for induction of general anesthesia. Anesthesia was induced with either etomidate 0.3 mg/kg or diazepam 0.3 mg/kg. Hemodynamic informations of patients (systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate) were assessed in four stages (before induction of general anesthesia, after endotracheal intubation, 5 and 10 minutes after endotracheal intubation). Systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate indices had no significant difference between diazepam and etomidate groups. Diazepam when compared with etomidate for induction of anesthesia, laryngoscopy and endotracheal intubation, does not significantly modify the hemodynamic response therefore we recommend diazepam induction in necessary cases because of less costs and easy accessibility.

Different studies have shown the adverse effects of anesthetic agents effect on operating rooms personnel fertility, is a challenge in anesthes-iology and obstetrics. This study was carried out to determine pregnancy complications among hospital operating rooms personnel in Khoozestan province – Iran. In this case control study,we got 250 women working in operating rooms of governmental Khoozestan province hospital as case group and 250 women working in internal, pediatrics and obstetrics wards as control group.Pregnancy complications including infertility, preterm labor, fetal death, abortion, low birth weight, fetal anomaly, neonatal death were obtained using questionnaire. Data were analyzed using SPSS-16 software and chi-square test. Incidence of abortion was 18.7 in case group and 9.1% in control group respectively, infertility was 14.3% in case group and 3.6% in control group, this difference was significant (p< 0.05, p<0.001) but preterm birth, LBW, congenital anomaly, fetal death and ectopic pregnancy difference was not statistically significant. This study showed that the incidence of some pregnancy complications is similar between case and control groups but some other complication such as abortion and infertility is higher in operating room personnel than those of other wards.

For bladder catheterization which is essential in all of the ICU patients, folleys catheter is essential. The aim of catheterisation is complete drainage of urinary bladder. The folleys catheter has two lines, one for urine drainage and the other for balloon filling to prevent its unnecessary or accidental catheter exertaction.Materiala and All of the patients admitted for at least 15 days in the ICU ward of Khatamol- Anbia hospital during one year (99) were enroled in this study. The urinary catheter of all of them was manufactoral by SUPA (Iran). Urine residual volumes were measured by Bladder scan BVI 3000. The mean urine residual volumes in 3 consecutive measurements for each patient per day were 43-71 ml and the urinary catheter sizes were 6 to 20. According to repeated analysis variance of repeated measurements, there was not any significant relation between urine residual volume and duration of urinary catheterization (p=0.11). During the first 10 days there was not any significant relation between urine residual volume and urinary catheter size (0.05Conclusion