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Introduction: Thiopental  is  a  short  acting  drug  from  barbiturates  group, that  is  a  favorable  standard  anesthetic  for  induction  anesthesia  because  of  pharmacologic  effects. The  goal  of  this  study  was  to  determine  the  incidence  of  thrombophlebitis  with  thiopental  2.5%  and  5%.
Material  and  Method: Three  hundred  patients  in  ASA  class I  and  II  that  referred  to  one  of  the  college  for  elective  surgery  and  was  admitted  3  days  after  operative  and  was  allocated  in  equal  2  groups (n=150)  randomly.  One  group  received  thiopental  2.5%  4 mg/kg  and  the  other  group  received  thiopental  5% n 4mg/kg  from  one  of  the  Veins  of  dorsum  of  hand.
Results: The  incidence  of  phlebitis  in  this  study  was  1.33% (2  case  from  150  case)  in  first  group  and  2%  (3  case  from  150)  in  second  group.  In  both  groups  phlebitis  was  occurred  in  first  24  operative  period  and  2^nd  days  no  patient  had  not  phlebitis  in  infusion  site.
Conclusion: Thrombosis  was  not  observed  in  patients  in  both  groups.  Incidence  of  phlebitis  with  thiopental  5%  was  greater  than  thiopental  2.5%.

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  Introduction: Patients` staying in recovery unit is associated with risks and complications and is expensive. Decreasing the duration of staying can both increase patients` safety and decrease hospital costs. Laryngeal mask airway (LMA) as a new instrument has been widely used for airway management and in this study, its effect on recovery time is investigated.

  Materials and methods: In a double blind randomized controlled clinical trial, 62 ASA Ι & Π patients were divided into two equal groups. In one group laryngeal mask and in the other, tracheal tube was used. The anesthetic drugs were similar in both groups. Patients with upper airway infections, as well as patients undergoing thoracic and upper abdominal surgeries were excluded. Those with more than one hour duration of anesthesia and more than 30 seconds need for intubations were also excluded. Duration of anesthesia was measured in minutes. Duration of recovery staying (in minutes) and complications were also recorded. Data was analyzed using Chi Square and Mann Whitney U tests.

  Results: There were no significant differences in age, sex and mean time of anesthesia between the two groups. But mean recovery time in LMA group with 10.65 minutes and tracheal tube group with 16.71 minutes was significantly different (P=0.007). Two patients (6.45%) in LMA and 11 patients (35.48%) in tracheal tube group developed complications during recovery period which was a statistically significant difference (P = 0.004).

  Conclusion: Laryngeal mask airway, decreased recovery time and the number and severity of respiratory complications. Complications such as cough, laryngospasm, bronchospasm, and arterial hypoxemia were significantly less in patients with laryngeal mask airway compared to patients with tracheal tube, so the use of LMA is recommended.

 

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Introduction: As tonsillectomy operations are done in vicinity of airways, two important purposes in anesthesia are decreasing bleeding and recovery time. Because of common use of Halothane and its reported side effects, we managed a study for comparing these two factors in two methods of anesthesia with or without Halothane. Materials and Methods: In a single blinded clinical trial, 140 (4-12 years old) children undergoing tonsillectomy, were randomly allocated in two equal groups. In the control group maintenance was done with Halothane-N2O 50% but in the case group without Halothane plus hyperventilation (Liverpool technique). Bleeding volume was estimated according to preoperative and 6 hour's postoperative hematocrit. Recovery time was recorded in minutes. Data was ahalyzed using Mann-Whitney U, T, Leven and K-S tests. Results: There was not any significant difference in sex, age, and weight and operation duration in the two groups. Mean recovery time in the case group was 7.87 minutes and in the control group 15.59 minutes, which showed a significant difference (p=0.00001). Mean bleeding volume in the case group was 44.22 ml and in the control group 58.52 ml, which also showed a significant difference (p = 0.005). Conclusion: According to our study it seems that anesthesia with Halothane causes more bleeding and prolonged recovery time in comparison to Liverpool technique.

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Background: Preoperative anxiety is a common reaction in patients. Many techniques are used for alleviation of it, such as preoperative visit by the anesthetist, reassurance by a psychologist, and prescription of tranquilizer drugs. In this study we surveyed propofol compared to Midazolam on pre-operative anxiolysis. Methods and Materials: In randomized controlled double-blind clinical trial, 60 patient swith ASA class I candidates for elective abdominal operations were randomly allocated in 3 equal groups (propofol, midazolam and normal salin). Anxiety was measured with 2 different scales: visual analogue scale (VSA) and clinical global impression (CGI). Pulse rate (PR), blood pressure (BP), respiratory rate (RR), and saturation PO2 (SPO2) were measured before drug administration and 3 times after that in 2.5 min intervals. Results were analyzed with ANNOVA, repeated measures ANNOVA, TUKEY, and X2 tests. Results: There were no differences in demographic variables between groups. Both propofol and midazolam were more effective than placebo in anxiety reduction. Both drugs had equal effect (p>0.05). There was no significant difference in BP, PR, RR and SPO2 between two drugs. Conclusion: Both drugs were the same and more effective than placebo. Midazolam may be preferred for economical reasons.

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Background: Postoperative pain brings about undesirable effects such as medical complications, increased healthcare costs, and the need for opioids administration. The aim of this study was to determine the effect of low dose (0.15 mg/kg) ketamine in comparison with the placebo on postoperative pain and analgesics consumption after cesarean section. Materials and Methods: In a randomized clinical trial, 120 women undergoing elective cesarean section were randomly divided into case and control groups. Ketamine (0.15 mgkg-1) or an equal volume of normal saline were administered intravenously immediately after initiating spinal anesthesia to the case and control groups, respectively. The anesthesia and surgery techniques were the same for both groups. Data were analyzed using SPSS version 11. Results: Means of age in the case and control groups were 28.85±4.81 and 28.87 ±5.62 years, respectively. Analgesics consumption, pain scores, homodynamic signs, drowsiness of the mothers, and the neonates’ Apgar scores after cesarean section were similar in both groups and no significant differences were found between them (P>0.05). The mean of postoperative arterial pressure in the early hours in the ketamine group showed a significant decrease compared to the placebo group (P>0.03). The means of the first time of request for analgesics after surgery in the ketamine and placebo groups were 99.75±68.88 and 96.1±52.59 minutes, respectively (P>0.05). Conclusion: It seems that the administration of 0.15 mg/kg dose of ketamine (0.15mg/kg) does not have a significant impact on decreasing the postoperative pain in cesarean section. Therefore, in order to obtain the desirable analgesic effects of this drug, further studies should be conducted with greater doses of this drug and its use in combination with other opioids.

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Background: From an administrational point of view, patient satisfaction with healthcare, diagnosis, and rehabilitation services is highly important. The present study was done to evaluate the satisfaction of patients referring to the emergency departments of hospitals in Arak. Materials and Methods: This study was a descriptive-analytic, cross-sectional one which was carried out using a questionnaire. The collected data were analyzed by SPSS software and the related tests. Results: Overall, over the first period, 72.9% of the patients were satisfied with the services, whereas this level of satisfaction reached 73.3% in the second period. By comparison, levels of satisfaction with the physical environment (86.2%), health condition (85.9%), speed and accuracy of care provider (69.6%), the quality of information provision (23.1%), behavior of guards and staff (60.2%), facilities (60.1%), drug availability (66.4%), discharge and costs (51.6%), and consideration of religious issues (86.6%) in the emergency departments over the first period reached 87.4%, 84.1%, 69.7%, 25.6%, 61.7%,67.9%, 50.9%, and 88.1%, respectively over the second period. Conclusion: The findings of this study showed that patients’ satisfaction with emergency departments’ services was reasonable. The greatest dissatisfaction was related to costs, drugs, procedural problems, method of treatment, facilities, wait time, and insufficient information provision.

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Background: Laryngoscopes are one of the potential mediators of infection transmission due to their blades contact with oral mucous membranes. Using single-use plastic blades is a method of preventing infection transmission. The aim of this study is to compare the efficiency of single-use plastic and reusable metal laryngoscope blades in orotracheal intubation during the rapid- sequence induction of anesthesia Materials and Methods: In this clinical-trial, 310 patients, more than 10 years of age, who were candidates for elective surgery, were selected. After anesthesia induction, orotracheal intubation was done by either single-use plastic or reusable metal blades for patients. Duration of intubation and arterial oxygen saturation were recorded before and after intubation. Data analysis was done using SPSS software. Results: Orotracheal intubation was done successfully in all patients. Mean differences of intubation time from the standard upper limit were 1.42±8.19 and 13.1±4.22 seconds in the plastic and metal blades groups, respectively. Also, the mean of difference in oxygen saturation of the low 90% after intubation were 6.07±2.71 and 7.16±1.21 in plastic and metal blades groups, respectively. Both parameters indicated statistically significant differences. Conclusion: In rapid-sequence induction of anesthesia, by using single-use blades, both intubation time and arterial oxygen saturation drop will increase in comparison with metal blades. This will cause complications such as aspiration in the patients.

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Background: Metastasis or compress effect of adjacent tumors and thyroid neoplasms are the most common causes for airway obstruction which may lead to emergent intubation or tracheostomy due to respiratory distress. Case: A 61 year-old, female patient with history of papillary cell carcinoma with metastasis to lung, trachea and vocal cords was referred to our hospital with complaint of dyspnea. In the early hours of hospital admission the patient suffered from attacks of apnea and gasping, and initial efforts to control the airway were performed immediately which were not successful. Then it was decided to perform broncoscopy and tracheostomy to provide a safe airway. Conclusion: In the absence of adequate equipment and emergency respiratory situation, it is better to provide a secure airway immediately. For this purpose, we can use low depth of anesthesia without use of muscle relaxants.

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Background: The use of propofol alone for insertion of supraglottic devices can lead to undesirable events such as cough, gagging, and laryngeal spasm. Narcotic drugs are used to improve the insertion of these devices. In this study, the effect of two narcotics, remifentanyl and sufentanyl, on ease of insertion of two types of supraglottic airway devices were evaluated. Materials and Methods: In this clinical trial, 200 patients undergoing general anesthesia were divided into four groups through blocked randomization. Induction of anesthesia was performed using propofol 2.5 mg/kg. Then the first group received remifentanyl and laryngeal mask, the second group remifentanyl and SLIPA, the third group sufentanyl and laryngeal mask, and the fourth group sufentanyl and SLIPA. The amount of jaw opening, ease of insertion of supraglottic devices, cough, laryngospasm, gag reflex, heart rate, and arterial blood pressure were recorded one, three, and five minutes after insertion of supraglottic devices. Results: No significant differences were observed in the amount of jaw opening, ease of insertion of supraglottic devices, cough, laryngospasm, gag reflex, and hemodynamic parameters between the four groups. Conclusion: The results of our study indicated that for controlling airways using supraglottic devices, use of laryngeal mask or SLIPA in the presence of remifentanyl or sufentanyl have no priority over each other and do not lead to hemodynamicimpairement

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Background: Pain is a complex medical problem creating which inadequate control pain results adverse effects on the patients physiological, metabolic and mental conditions.The aim of this study was comparison effect of Ketamin-propofol with Alfentanil-propofol on creating analgesia and sedation during cystoscopy and comparing the side effects of two drugs and patient and physician satissfaction.

Materials and Methods: In this double- blind clinical trial 140 person who were candidate for cystoscopy were randomly divided into two groups The first group received 1mcg/kg alfentanil with 1mg/kg propofol and the second group received 0.5 mg/kg ketamin with 1mg/kg propofol. Sedation score ,pain score, time of cystoscopy and hemodynamic changes determined and data were analyzed by SPSS.

Results: The mean of sedation in alfetanil group was significantly more than ketamin group(p=0.001) . The mean of pain score in alfetanil group was significantly less than ketamin group( p=0.001) .The time of cystoscopy in cystoscopy in alfetanil group was significantly less than ketamin group (p=0.001).

Conclusion: Results showed that alfentanil-propofol compare to ketamin-propofol reduced pain score and increased time of sedation with less side effects during cystoscopy .So this study supports the preference alfentanil compare to ketamin.

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Background: Unpleasant side effect of awareness within general anesthesia is potentially an important concern in patients. The patient may sleep during anesthesia and feels the pain due to loss of pain suppression of sensory perception of pain during surgery. The aim of this study is to determine the effect of BIS monitoring on level of awareness during anesthesia in women undergoing elective caesarean section.

Materials and Methods: In this double-blind, randomized clinical trial, 214 ASAI–II patients, over 15 years of age, candidate for elective cesarean section were included in the study. Patients randomly divided to two groups of anesthesia with and without BIS monitoring. Patients were assessed for awareness within anesthesia immediately, 24 hours, and 3-6 days after operation.

Results: From 107 patients without BIS monitoring, 8 patients (7.4%) suffered from awareness during anesthesia and their awareness score was two and greater than two. While none of the patients in the BIS group experienced awareness during anesthesia. Level of awareness during anesthesia in the control group was significantly more than the BIS group (p<0.0000).

Conclusion: The incidence of awareness during anesthesia is significantly lower in BIS monitored group than the control group.

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Background: Atrial fibrillation (AF) is the most common complication after coronary artery bypass graft surgery (CABG). This complication causes an increase in morbidity and mortality after CABG and also increases the length of ICU stay and hospitalization. The aim of this study is to evaluate the prophylactic effect of amiodarone in reducing the incidence of post CABG atrial fibrillation.

Materials and Methods: In this clinical trial study, 204 patients, candidate for elective CABG, entered the study according to inclusion and exclusion criteria, and randomly divided into two equal groups. The case group received 300 mg of intravenous amiodarone before anesthesia induction and the control group received normal saline. Incidence of AF was recorded until 24 hours after CABG.

Results: The incidence of post CABG AF was 16 patients in the case group and 35 patients in the control group. Comparison of the frequency of AF between groups by Chi square analyses showed a significant difference (p=0.037) and the incidence of AF was significantly lower in the amiodarone group.

Conclusion: In total, amiodarone could significantly prevent the incidence of atrial fibrillation after coronary artery bypass surgery. In this study, patients took this medication only in the first 24 hours, while in some studies, this drug has been prescribed for even 14 days.

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Abstract

Background: Pain is a protective process in the body. There are different pathways for pain control in the central nervous system. Descending pain control system is one of pathways. The periaqueductal gray (PAG) is a structure known for its role in pain transmission and modulation. The aim of this study is to investigate the percent of interaction between the left and right PAG in unilateral left foot induced pain.

Materials and Methods: In this study, 60 rats (280+30g) in six groups were used (3test groups and 3 controls groups). In test groups, 0.5 microliter lidocaine was injected in the left PAG, right PAG or both to make local anesthesia. In control groups, 0.5 microliter of normal saline were injected. After 15 minutes, 50 microliter of 2.5% of formalin were injected subcutaneously to right hind paw of rats and nociception was detected in every 15 seconds for one hour.

Results: The induction of unilateral pain (left hind paw) in rats, can affect not only the ipsilateral but also the contralateral PAG nucleus.

Conclusion: This study showed that the left and right PAG nuclei have significant role on unidirectional nociception in formalin test in rats. The contralateral PAG, however, has a minor effect on nociception.