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Introduction: Sympathetic stimulation and pressor responses including tachycardia, hypertension and tachyarrhytmias caused by laryngoscopy and tracheal intubation may result in severe complications in susceptible patients. Opioid anesthetics are one of the several drugs used to attenuate this response but prolonged postoperative respiratory depression is the major complication distracting from their high dose administration which is nceded for complete amelioration of pressor response. In this study Alfentanyl, as a rapid acting and short duration opioid (without prolonged respiratory depression), was used in two different dosages for controlling of pressor response.
Materials and Methods: In a single blind, controlled clinical trial, 236 patients in the range of 18 to 70 years old), whom needing laryngoscopy and tracheal intubation were selected and randomly divided into two equal groups. First group received low (current) dose (15u gr/kg) Alfentanyl, and the other received high dose (450gr/kg), prior to laryngoscopy and tracheal intubation. Type and dosage of induction drugs were the same and matched in both groups. Blood pressure and heart rate were measured before intravenous induction and after intubation of the tracheal in all patients. Mercurial sphygmomanometer and pulse oximeter were used for these measurements. Incidence of such
complications as hypotention, muscle stiffness and neurologic hyper reactivity, were also measured. Data were analysed by Z distribution and Chi square tests.
Results: Alfentanyl was cffective in controlling pressor response in both groups. In the case of heart rate, the mean difference between two groups was not significant. There was a significant difference mean arterial pressure between two groups (p<0.05). In high dose group, incidence of complications was higher for severe hypotension (p<0.05), stiff chest syndrome (p<0.05), and neurologic hyperreactivity (p<0.05).
Conclusion: High dose of Alfentanyl is more efficient in controlling of pressor response than low dose of the drug. High dose administration also may results in some complications. In this study current dose of Alfentanyl is recommended for controlling of pressor response, but high dose may be used with some modification in the dose of induction agents.

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Introduction: Postoperative hypothermia is physiologically stressful by elevating blood pressure, heart rate and plasma catecholamine concentration. This study conducted to evaluate the effects of intravenous fluids temperature on perioperative hemodynamic situation. Materials and Methods: This was a randomized clinical trial study Perioperative pulse rate, blood pressure, intraoperative esophageal and skin temperature were measured in 60 volunteer patients undergoing orthopedic surgeries subjects randomly divided into two groups according to intraoperative IV fluids management. In 30 patients (hypothermia group) all IV fluids infused were at room temperature. In the other 30 patients (normothermia group) all IV fluids were warmed using and dry IV fluid warmer. Results: The core and skin temperature of hypothermia and normothermia group decreased significantly from induction of anesthesia toward end of surgery but its reduction was more in hypothermia group (P<0.005). Postoperative mean arterial blood pressure increased significantly more in hypothermia group versus normothermia group (P<0.005). Shivering was observed in 21 of 30 hypothermia and 11 of 30 normothermia group (p<0.005) and recovery time was significantly lower in normothermia group (36±5 vs. 26±3 min, P<0.005). Conclusion: Infusion of warm fluids helps to reduce the variation of postoperative mean arterial blood pressure, core and skin temperature, occurrence of shivering and recovery time.

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Introduction: Clonidine, as a premedicant in anesthesia, has a special role in decreasing anesthetic agents' dose and improving sedation. Because of its effects on body hemodynamics and electrolytes and the importance of these effects during anesthesia, we decided to investigate these side effects in this study. Materials and Methods: This is a double blind randomized clinical trial. Samples were 104 ASA Class Ι & Π, 20-40 years old patients, undergoing elective surgery and were divided equally into two groups (case and control). 90 minutes before induction of anesthesia, 5μg/kg Clonidine was given to the case and placebo to the control group orally. Blood samples were taken before and 4 hours after induction of anesthesia. Also 24 hours urine was collected and measured for volume and sodium and potassium concentrations. Data analysis was done using independent T test. Results: There wasn’t any significant difference between two groups in the mean concentration of blood sodium and potassium before and after taking the drug. But the mean sodium and potassium concentration in urine was significantly more in the case group (P = 0.022 and P = 0.003 respectively). The volume of 24 hours urine was also more in the case group (P = 0.008). Conclusion: Although Clonidine induces diuresis and increases sodium and potassium excretion, blood concentration of these electrolytes doesn’t change significantly.

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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.

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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 15^th and 20^th 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.