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.
Hesameddin Modir, Aidin Shakeri, Alireza Ghafouri, Gholamhassann Chaichi Nosrati, Shiva Alikhani, Ayda Khammari,
Volume 28, Issue 2 (4-2025)
Abstract
Background: Some intracranial surgeries must be performed while the patient is awake. Awake craniotomy is an intracranial surgical procedure in which the patient is kept in a state of relative 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 by awake craniotomy.
Case: In this report, anesthesia in craniotomy surgery with full wakefulness was investigated in a 22-year-old man. This patient, who was the first to perform a craniotomy with the fully awake method (from the beginning to the end of the operation) at Arak University of Medical Sciences and Valiasr Hospital in Arak, after preparing the patient and interviewing before the operation, Cranial nerve blocks related to the skin and head muscles (scalp block) were performed in the desired locations, and after providing mild sedation, surgical excision was given. The lesion was examined while awake and the surgery was performed while fully awake from the beginning to the end, and the patient's brain tumor was removed safely. A combination of local and regional anesthesia and light intravenous anesthesia was used in the patient. 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 used to relieve the patients. 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 completely favorable conditions, and the patient was transferred to the intensive care unit in a good general condition, awake and fully alert.
Conclusion: Although maintaining analgesia and hemodynamic and ventilation stability in fully awake craniotomy conditions is considered a challenge, but due to the necessity of performing this procedure due to the need to check the function of cranial nerves during the operation and to prevent any neurological and functional damage, using By carefully performing the desired nerve block in the scalp and prescribing a small amount of sedative medicine(propofol,remifentanil,dexmedetomidine), we were able to create a condition where the operation can be successfully performed while fully awake. In this method, the possible complications of surgery are prevented and a satisfactory analgesia is achieved for the patient. In this recent experience, both surgical complications are prevented and the patient and surgeon are satisfied during the operation. Performing this technique was satisfactory for our patient.
