Alireza Kamali, Maryam Shokrpour, Khatereh Vatanpour,
Volume 15, Issue 5 (10-2012)
Abstract
Background: Pain is a complex problem, which can affect patients' physical and psychological condition. Inadequate postoperative pain control has adverse effects on the patients' physiological, metabolic and mental condition. Adding new supplement will increase the duration of analgesia. This study aimed to comparison of intratechal neostigmine and midazolam in increasing the time of postoperative analgesia. Materials and Methods: In this randomized double blind clinical trial, 60 patients with ASA class Ι, II who were candidate for elective colporrhaphy surgery under spinal anesthesia were randomly divided into 3 groups of 20 patients. All patients received hyperbaric lidocaine 5% and groups I received 1 mg midazolam, groups II received 50 μg Neostigmine and groups III received 0.5 cc normal saline additionally. Then according VAS pain score, postoperative painless duration and pain score were compared between groups by running SPSS software. Results: Mean of painless duration in the Midazolam, Neostigmine and control groups were 98.4±18.2, 74.5±32.6 and 64.5±9.9 minutes respectively which was significantly longer than in Midazolam group (p<0.001). The mean dose of requested analgesia in first 24 hours after surgery was significantly lower in Midazolam group (p<0.001). Conclusion: Inthrathecal midazolam and Neostigmine as a complementary medication to lidocaine 5% can increase painless duration in colporrhaphy surgery and midazolam is more effective than Neostigmine. Key Words : midazolam & Neostygmine , Spinal anesthesia, painless time , colporrhaphy
Hesamaldin Modir, Mohamad Khalili, Bijan Yazdi, Esmaeil Moshiri,
Volume 15, Issue 6 (11-2012)
Abstract
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
Hesamaldin Modir, Afsaneh Norouzi, Shirin Pazoki,
Volume 16, Issue 3 (6-2013)
Abstract
Background: Post-anesthetic shivering is the most common cause of patient discomfort during recovery with a prevalence of 5 to 65%. Post-anesthetic shivering can increase pain, oxygen consumption, and cardiac output. The aim of this study was to compare the efficacy of various classes of drugs for preventing post-anesthetic shivering.
Materials and Methods: In this double-blind clinical trial, patients undergoing elective laparotomy were randomly divided into six groups, 40 each. The patients, respectively, received hydrocortisone, ketamine, tramadol, magnesium sulfate, pethidine, and normal saline. All patients were observed for body temperature and shivering for 20 minutes after arrival to recovery room.
Results: Seventy patients in the pethidine group did not have shivering upon arrival to recovery room which was significantly higher than other groups (&chi2=0.00002). Also, the patients in the pethidine group did not shiver 10 and 20 minutes after arrival to recovery room that was significantly lower than other groups.
Conclusion: According to the results, it can be concluded that pethidine is more effective than other drugs in prevention of post-anesthetic shivering.
Seyedeh Masomeh Hosseini Valami , Seyed Abbas Hosseini Jahromi , Asghar Jabbari, Amir Javadi , Toktam Karim Zadeh ,
Volume 16, Issue 4 (7-2013)
Abstract
Background: Familiarity with different methods and medications in anesthesia and producing sufficient depth of anesthesia are very important in anesthesia practice. Due to the central analgesic and sedative effect of lidocaine in the presence of the sufficient blood level, it can be used for general anesthesia. This study was carried out to compare the effect of halothane with lidocaine infusion on BIS during maintenance of anesthesia.
Materials and Methods: In this randomized double-blind controlled clinical trial, 66 patients scheduled for elective inguinal herniorrahaphy were randomized into two equal groups. For maintenance, one group received halothane (1%) with O2-N2O and another group received lidocaine infusion (100 &mug/kg/min). BIS was checked every 5 minutes for half an hour. Statistical analysis of data was done by Chi-square and T-test through SPSS software. P-values less than 0.05 were considered meaningful.
Results: Mean of BIS was 65.72 in the lidocaine group and 56.7 in the halothane group during the first 30 minutes. There was a significant statistical difference between the two groups (p<0.05).
Conclusion: Mean of BIS in lidocaine group was higher than that in the halothane group. If this indicates the presence of a light level of anesthesia, increasing the dose of hypnotics and opioids leads to an increase in the depth of anesthesia. However, since there is not any device for monitoring the effect of opioids on the central nervous system and the level of anesthesia, simultaneous monitoring of BIS and hemodynamic parameters seems to be a more reasonable idea.
Afsaneh Norouzi, Mehri Jamilian, Mohammad Khalili, Alireza Kamali, Lora Melikof,
Volume 16, Issue 5 (8-2013)
Abstract
Background: Caesarean section is one of the most common gynecologic surgeries. Nausea and vomiting after pain is the most common side effect of surgeries, today, we most widely use of serotonin receptor antagonists, that are most effective antiemetic and have less side effect rather than other drug. Ondansetron is typical serotonin antagonists.
Materials and Methods: This is a randomized, double-blind clinical trial on 162 women undergoing cesarean section. 4mg intravenous ondansetron was given to first group and 8mg oral ondansetron was given to second group and thired group recived placebo. Blood pressure and heart rate were measured before and immediately after performing spinal and every 5 minute until 20 minute. Post operative nausea and vomiting and APGAR score were recorded after operation in recovery and 2, 4, and 6 houres after surgery.
Results: There was no significant difference among 3 groups according to age, gravidity, mean atrial pressure and heart rate before and during surgery. Nausea and vomiting in oral and intravenous groups at recovery, 2 and 4 hours after surgery were significantly less nausea and vomiting than placebo group (p<0.05). Whereas there was no significant difference between oral and intravenous groups.
Conclusion: It was concluded that using oral ondansetron with the same antiemetic effect is more convience to women undergoing cesarean section with spinal anesthesia.
Esmaeil Moshiri, Hesamedin Modir, Morteza Navabi, Mahdyieh Naziri,
Volume 17, Issue 1 (4-2014)
Abstract
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.
Fatemeh Shima Hadipourzadeh, Hamid Kaialha, Firoozeh Naderi,
Volume 17, Issue 1 (4-2014)
Abstract
Background: Intrathecal morphine side effect is Nausea & Vomiting after surgery. The aim of the study was to evaluate the effect of intrathecal atropine on PONV in patients receiving intrathecal morphine in lower limb surgeries.
Materials and Methods: In this clinical trial , 120 patients undergoing lower limb surgery were randomly divided into 2 groups . Experimental group received 0.1 mg (1cc) Intrathecal atropine and control group received 1cc saline 0.9% . PONV during the first 24 hours and hemodynamic changes in minute 3, 5, 10 and 15 after surgery in both groups were measured. Data were analyzed using SPSS software (verision14). independent t-test, repeated measures manova,and chi-square were used to compare comparison of variables.
Results: Hemodynamic cheanges before injection and 3, 5, 10 and 15 after injection in two groups was not significant (P>0.05). None of the patients in the intervention group were PONV, but 17 patients in the control group had PONV that this difference was statistically significant (p =0.000 ). Pain in the control group was great than intervention group while 26 patients in the control group and 14 patients in the intervention group had vas greater than 3 that this difference was statistically significant( P = 0.04).
Conclusion: Intrathecal atropine without interfering Hemodynamic and pain relief prevent nausea and vomiting caused by Intrathecal morphine in patients undergoing surgery to the lower limbs..
Bita Malekian Zadeh, Puran Hajian, Nahid Manuchehrian, Sedigheh Khazaei,
Volume 17, Issue 8 (11-2014)
Abstract
Background: Spinal anesthesia is an efficient method of providing intra operative analgesia and a safe alternative to general analgesia in many cesarean patients. Despite its advantages, SA is not free from adverse effects, which include unwanted cardiovascular events, in most cases: hypotension and bradycardia. Ondansetron is a 5HT3 receptor antagonist, with known efficacy on preventing nausea and vomiting. Maybe ondansetron given intravenously attenuates the fall of blood pressure and heart rate, by 5HT3 blocking in vagal nerve endings and effect on BJR.(Bezold jarish Reflex).
Materials and Methods: In this clinical trial 102 healthy pregnant women that were candidate for elective cesarean in hamedan fatemieh hospital during 3 months in 1390, studied. They were randomized into 2 groups: the ondansetron group, n= (51) received (4miligram) ondansetron intravenously before performing spinal anesthesia, and placebo group n= (51): received 2cc sterile water before spinal anesthesia. Spinal anesthesia was performed with hyperbaric bupivacaine (0.5%) 10 mg and sufentanil (5 µg) BP and HR were measured and recorded before and after anesthesia immediately. If hypotension happened, ephedrine 5- 10mg injected. Itching and nausea recorded every 10 min during operation by observation and question.
Results: There were no significant differences in SBP, DBP, MAP, HR and itching in both groups. Nausea and vomiting ,and mean consumed ephedrine was siginificantly different in both groups.(p=0.001, p=0.009).
Conclusion: Ondansetron given intravenously with antiemetic dose (4miligram), decreases mean consumed ephedrine and nausea and vomiting after spinal anesthesia, but doesn't have an influence on BP, HP and pruritus
Alireza Kamali, Maryam Shokrpour, Shirin Pazoki, Esmaeil Moshiri, Mohamadreza Taheri-Nejad, Niloofar Dadashpour, Majid Golestani Eraghi,
Volume 17, Issue 12 (3-2015)
Abstract
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.
Mohammad Reza Ghodraty, Alireza Pournajafian, Mohammad Niakan, Mohammad Zia Totonchi Ghorbani, Fatemeh Sadat Mazhari,
Volume 18, Issue 10 (1-2016)
Abstract
Background: Reducing the duration of the effect of sedatives and increasing their quality is one of the tasks of ICU staff. The aim of this study is to compare the sedative effects of these medications on neurosurgery patients under mechanical ventilation.
Materials and Methods: In this double-blind clinical trial, 70 patients requiring mechanical ventilation in neurosurgery ICU were enrolled. Patients were randomly assigned to one of remifentanil or fentanyl groups. The first group received 0.05 µg/kg/min remifentanil and the second group received 1 µg/kg/hr fentanyl infusion for sedation and analgesia in the first 24 hours. Sedation score, Minogue scale and hemodynamic parameters were evaluated throughout the study and at regular intervals.
Results: There was no significant statistical difference in demographic variables such as age, sex, and body weight between two groups. The results of this study showed a significant difference in sedation score (p=0.0001) and Minogue scale (p=0.0001) and both variables were lower in remifentanil group. Also, heart rate (p=0.011) and mean arterial blood pressure (p=0.007) were significantly higher in fentanyl group.
Conclusion: Generally, sedative effect of remifentanil has several relative advantages over older medication of fentanyl and causes more effective sedation and better control of hemodynamic parameters in patients under mechanical ventilation.
Mandana Mansourghanaei, Katayoun Haryalchi, Seyed Alaedin Asgari, Fatemeh Salamat, Mahdieh Zoghi,
Volume 18, Issue 11 (2-2016)
Abstract
Background: MgSo4 (magnesium sulfate) is the first therapeutic line for preeclampsia. Recently, there have been many debates on pain relief property on MgSo4. The purpose of this study is to evaluate the effect of MgSo4 on pain relief after cesarean in preeclampsia parturient
Materials and Methods: In this analytic and cross-sectional clinical trial study, 88 pregnant wowen with mild preeclampsia who received MgSo4 (14g loading dose and 5 g/4h maintenance dose) (n=88, P group), were compared with 88 normal pregnant women(n=88, N group), according to the duration of paim relief and the amount of diclofenac suppository consumption after cesarean section from March 2013 to October 2014. After cesarean section, the assessment of pain relief performed with NRS (numerical rating scale), and diclofenac consumption.
Results: P group had a longer analgesic duration than N group. NRS in P group was significantly longer than N group(6.89 ±3.34 vs. 3.55± 2.13 hr, p=0.0001). The dose of diclofenac suppository in P group was significantly lower than N group (225mg±147 vs. 365.9±92mg, p<0.0001).
Conclusion: Post cesarean pain in preeclamptic group was significantly lower than non-preeclamptic group. This finding is probabley because of MgSo4 administration in preeclamptic group.
Khosro Naghibi, Darioush Moradi Farsani, Babak Ali Kiaei, Anahita Hirmanpour,
Volume 19, Issue 2 (5-2016)
Abstract
Background: Due to high prevalence of vitrectomy surgery, and the importance of anesthetic technique in conducting an uncomplicated surgery, we decided to do this study.
Materials and Methods: This prospective randomized study was conducted on 80 patients 40-80 years old candidating deep vitrectomy sugery under general anesthesia that were categorized into II and III Class by American Society of Anesthesiologist (ASA). Patients were randomly allocated to two groups of 40 members. Anesthesia was induced in both groups in the same manner. For maintaining anesthesia, patients from I group receiVed 1.2% isofluran with 50% O2 in air at 4L/min and infusion of remifentanil (0.1 mg.kg-1.min-1). But in the P group, we used propofol up to 10mg/kg /hr with infusion of remifentanyl. Propofol and isoflurane in fusion was discontinued with the last surgical stitches, but remifentanil infusion continued in both groups until the eye was covered with shield. Hemodynamic variables were recorded just before the induction of anesthesia and in different time intervals till discharging of the patients from the recovery room. Then, data were compared.
Results: Results showed that there is a significant changes in propofol group compared to isofluran in deep vitrectomy surgery operations.
Conclusion: Hemodynamic changes are more significant in maintaining propofol anesthesia when compared with isoflurane.
Darioush Moradi Farsani, Babak Alikiaei, Fatemeh Hoseinzadeh,
Volume 20, Issue 2 (5-2017)
Abstract
Background: The aim of this study was to compare the efficacy of ondansetron, Midazolam and metoclopramide with placebo in preventing PONV following strabismus surgery.
Material and Methods: 160 patients were allocated with simple randomization in 4 groups of 40: group ON received Ondansetrone 0.05mg/kg, MT group received Metoclopramide 0.15mg/kg, MD group received Midazolam 0.03mg/kg intravenously and group CT received the solution of NaCl 0.9% as placebo infused with the same volume and the same manner 30 minutes before the end of surgery. The patients were evaluated for nausea, vomiting, need and dosage of anti-emetic drugs, time of liquid and solid diet tolerance, drug complications and satisfaction score for the initial 24 hours after anesthesia.
Results: The frequency of nausea (p-value = 0.001< 0.05) and vomiting (p-value=0.084>0.05) was lower in ON group and both of these complications were lower in MD group compared with MT and CT group. Use of rescue antiemetic was higher in MT and CT group (p-value = 0.001 < 0.05). Patient satisfaction was higher in ON group compared with other 3 groups (p-value=0.001<0.05).
Conclusion: Prophylactic use of Ondansetron is more effective with fewer side effects than Metoclopramide and Midazolam in the prevention of PONV following strabismus surgery. Furthermore, metoclopramide was less effective and was associated with more adverse effects.
Mojtaba Rahimi Varposhti, Darioush Moradi Farsani, Babak Ali Kiaei, Behzad Nazem Roaya, Seyed Hosein Moosavi,
Volume 20, Issue 3 (6-2017)
Abstract
Abstract
Background: The aim of this study is to evaluate the impact of preemptive adding topical Ketorolac to Tetracaine drop on pain intensity and hemodynamic parameters during and after cataract surgery.
Materials and Methods: Eighty patients scheduled for elective cataract surgery under sedation and topical anesthesia, were randomly allocated to two equal groups: group T received Tetracaine 0.5%, and group TK received Tetracaine with ketorolac eye drops. One drop of each ophthalmic drug was applied every 10 minutes from 30 minutes before surgery. Pain intensity and hemodynamic parameters were assessed just before starting the operation and 5, 10, 15and 20 minutes during the operation, and then 0, 5, 10, 15 and 20 minutes after arrival of the patient to the recovery room.
Results: Mean pain intensity was significantly lower in TK group (1 ± 0.128) compared with T group (2 ± 1.54) during the surgery (p = 0.003), but there was no significant difference between the two groups in this regard during the recovery time (p =0.157). The number of patients requiring additional analgesic was not significantly different between the groups. There was no significant difference between the two groups regarding hemodynamic parameters except at 20th minutes and 15th and 20th minutes (heart rate and respiratory rate) after arrival to the recovery room.
Conclusion: Preemptive adding topical Ketorolac to Tetracaine drop is more effective than Tetracaine alone to reduce pain during cataract surgery.
Darioush Moradi Farsani, Khosro Naghibi, Zahra Rezayinezhad,
Volume 20, Issue 7 (10-2017)
Abstract
Abstract
Background: Up to now, there is no single opinion on how to control pain after surgery and clinical research in this area has been continuing. This study aimed to compare the effect of intravenous Acetaminophen, Dexamethasone and placebo on postoperative pain after cataract surgery under sedation and topical anesthesia.
Materials and Methods: In a clinical trial study, 120 patients undergoing cataract surgery under sedation and topical anesthesia were distributed into three equal groups. 10 minutes before the end of surgery, the first group received 0.01 mg/kg Dexamethasone, the second group received 15 mg/kg Acetaminophen and third group received the same volume on normal saline as placebo. Pain intensity and additional analgesic consumption were assessed during operation and recovery and compared between the three groups.
Results: In the three groups of Acetaminophen, Dexamethasone and control groups, 6, 10 and 18 patients had postoperative headache (16.7%, 27% and 47.4% respectively) and there was a significant difference between the three groups(p=0.014). Also, pain intensity was significantly higher in control group compared with other two groups from 30 minutes after arrival to the recovery room until 24 h postoperatively (p<0.05). Also, the incidence of headache was higher in Dexamethasone group compared with Acetaminophen group, but there was no statistical difference between the two groups in this regard (p>0.05).
Conclusion: Intravenous Acetaminophen administration is more effective than Dexamethasone and placebo to reduce pain and analgesic requirements after cataract surgery.
Mojtaba Rahimi Varposhti, Darioush Moradi Farsani, Kamran Montazeri, Fatemeh Tanha,
Volume 20, Issue 8 (11-2017)
Abstract
Background:
This study aimed to compare the effect of cold eye irrigation solution (BSS) and viscoelastic gel with their combination in room temperature on the dosage of sedative drugs which we use in Phacoemulsification cataract surgery.
Material and methods:
190 patients scheduled for cataract surgery under sedation were randomly divided into two equal groups. During surgery we used cold (4c) and warm (room temperature) BSS and viscoelastic gel in the first and second group respectively. For all patients we started sedation with Midazolam and Fentanyl and in case we needed additional drug we used Sodium Thiopental till we reached desired sedation level. Ramsay sedation scores (before, during and after surgery) and total sedative drug consumption were evaluated and compared between two groups and at the end of the surgery we checked the satisfaction score of patients and surgeon about the quality of sedation.
Results:
The average dosage of Midazolam wasn’t significantly different between the two groups, while the average dosage of Sodium Thiopental was significantly lower in Cold group. Also the average time of which we reached desired Ramsay sedation score and the level of Ramsay score were significantly different between the two groups.
Conclusion:
Using cold BSS and viscoelastic gel in cataract surgery in comparison of their combination in room temperature will reduce the dosage of sedative drugs which we use during surgery and help us getting a more effective sedation and gaining both a satisfied patient and surgeon.
Darioush Moradi Farsani, Khosro Naghibi, Mojtaba Rahimi Varposhti, Bahador Malekipoor, Tahereh Fasihi,
Volume 20, Issue 9 (12-2017)
Abstract
Abstract
Background: Postoperative nausea and vomiting (PONV) is one of the most common complications in the patients undergoing strabismus surgery. The aim of current study was comparing supplemental 80% and 40% oxygen on reducing postoperative nausea and vomiting in the pediatrics undergoing strabismus surgery.
Materials and Methods: In this clinical trial study, 100 pediatric patients scheduled for strabismus surgery under general anesthesia were allocated randomly into two parallel supplemental 80% and 40% oxygen groups during surgery. PONV in patients was compared until 24hrs after operation.
Results: In the first 6hrs postoperatively, PONV in the supplemental 40% and 80% oxygen groups were 48.8% and 30.6% respectively, also were 20.8% and 12.2% in the 6 to 24hrs postoperatively. Therefore, there were no significant differences between both groups in regarding of PONV in 6hrs and 6 to 24hrs postoperatively (p values were 0.18 and 0.25, respectively).
Conclusion: According to our results, there is no any difference between 40% and 80% oxygen postoperatively in the pediatrics undergoing strabismus surgery.
Alireza Kholdebarin, Faranak Rokhtabnak, Mohammadreza Ghodraty, Alireza Pournajafian,
Volume 21, Issue 1 (4-2018)
Abstract
Abstract
Background: Hemodynamic changes during surgery are initially controlled by changes in dosage of anesthetics. Decreasing the dose of anesthetics in order to cope with hypotension during surgery may reduce the anesthetic depth and increases the chance of awareness. This study was designed to investigate the depth of anesthesia in patients whose anesthtics is prescribed by controlling blood pressure and is aimed to investigate the possibility of reducing the depth of anesthesia during surgery.
Materials and Methods: In this study, females candidate for hysterectomy underwent general anesthesia according to specific inclusion criteria enrolled in two types of intravenous (propofol) or inhaled (isoflurane) anesthesia. The dose of maintenance anesthetic drugs were increased or decreased during the operation by the anesthetist technician (blinded to the depth of anesthesia) according to specified protocol. At defined intervals, depth of anesthesia was recorded by the anesthetist . Mean of obtained data were analyzed.
Results: In addition to the weight and height similarity, there was no statistically significant difference in systolic, diastolic blood pressure and heart rate in two groups at intervals, between two groups. The median of recorded BIS, which showed depth of anesthesia, was not different in either of the two groups, and no patients during the operation reached the level of awakening and the number above 60.
Conclusion: The traditional method to control hemodynamic changes during surgery by changing the doses of maintenance drugs, does not result in severe changes in the depth of anesthesia and does not significantly increase the BIS to the awareness level.
Mohammadreza Ghodraty, Faranak Rokhtabnak, Alireza Kholdebarin, Alireza Pournajafian,
Volume 23, Issue 2 (5-2020)
Abstract
Background and Aim: Postoperative shivering is a common complication after recovering from anesthesia, and due to its subsequent side effects, its prevention and treatment is of special importance for anesthetists. In this study, the efficacy and onset of action of meperidine (which is a potential cause of hemodynamic and respiratory complications) in treatment of post-anesthesia shivering are compared with those of ondansetron.
Methods & Materials: In this clinical trial study, patients with post-anesthetic shivering during recovery were randomly divided into two groups of meperidine (n=27) and ondansetron (n=29). Their shivering scores were recorded every minute for up to 10 minutes. After this time, if patients did not improve, meperidine was used in both groups to treat shivering.
Ethical Considerations The study obtained its ethical approval from the Research Ethics Committee of Iran University of Medical Sciences and has been registered in Iranian Registry of Clinical Trials (IRCT201109224969N3).
Results: The number of patients completely treated at 10 minutes was higher in the meperidine group (P= 0.05), and the decrease in mean shivering score occurred faster in meperidine group (P= 0.047)
Conclusion: Although ondansetron has been shown to be effective in treatment of postoperative shivering, the effectiveness and onset of action of meperidine was clearly better.
Hesameddin Modir, Aidin Shakeri, Alireza Ghafouri, Gholamhassann Chaichi Nosrati, Shiva Alikhani, Ayda Khammari,
Volume 28, Issue 2 (4-2025)
Abstract
Introduction: Some intracranial surgeries must be performed while the patient is awake. Awake craniotomy is an intracranial surgical procedure in which the patient remains in a state of controlled consciousness while the surgery is performed. The aim of this study was to present a case of intracranial surgery to remove a tumor in the right frontal cortex using awake craniotomy.
Case Report: This report describes the anesthetic management of a 22-year-old male undergoing craniotomy with a fully awake technique. This was the first case of craniotomy performed entirely awake (from the beginning to the end of the operation) at Arak University of Medical Sciences and Valiasr Hospital in Arak, After preoperative preparation and evaluation, scalp nerve blocks targeting the cranial nerves innervating the scalp and head muscles were administered at specific sites. Mild sedation was provided using oxygen supplementation, followed by surgical incision. The lesion was examined intraoperatively while the patient remained awake, and the tumor was safely excised under full wakefulness. A combination of local and regional anesthesia and light intravenous sedation was utilized. Two types of local anesthetics, lidocaine 1.5% and bupivacaine 2.5%, were used for anesthesia, as well as intravenous sedatives and anesthetics such as propofol, remifentanil, and dexmedetomidine were administered for sedation. Throughout the operation, the patient was awake and breathing spontaneously, and the function of the brain nerves during the operation could be evaluated. Finally, the patient's surgery was performed without any complications and in stable condition, and the patient was transferred to the intensive care unit in good general condition, awake and fully alert.
Conclusions: Although maintaining analgesia and hemodynamic and adequate ventilation during fully awake craniotomy poses challenges, this technique is critical for intraoperative monitoring of cranial nerve function and preventing neurological deficits. By precisely administering scalp nerve blocks and carefully titrating sedatives (propofol, remifentanil, dexmedetomidine), we successfully performed the procedure under full wakefulness. With this method, potential surgical complications are prevented, and the patient also experiences satisfactory painlessness. Applying this technique was satisfactory for our patient.
