Javad Amini-Saman; Shahla Mirzaeei; Yasamin Amini-Saman; Mitra Yari; sharmin rahmani
Volume 25, Issue 5 , 2023
Abstract
Background: Airway control problems are among the most prevalent causes of anesthesia-related mortality and morbidity. Some devices provide patients with adequate oxygen supply and ventilation during surgery by creating a safe airway in anesthetized patients. One of these devices is the laryngeal mask ...
Read More
Background: Airway control problems are among the most prevalent causes of anesthesia-related mortality and morbidity. Some devices provide patients with adequate oxygen supply and ventilation during surgery by creating a safe airway in anesthetized patients. One of these devices is the laryngeal mask airway (LMA). The compression and painful stimuli following the LMA cuff inflation can lead to hemodynamic changes. Diltiazem gel is used in the control and treatment of hypertension (HTN) and heart arrhythmia and is absorbed through the tracheal mucosa.
Objectives: By assuming that diltiazem gel is superior to other drugs used to prevent arrhythmias and hemodynamic changes during surgery, this study aimed to evaluate the effect of LMA impregnation with diltiazem gel, compared to lubricant gel.
Methods: This study was conducted as a double-blind, randomized clinical trial on 80 participants with HTN who were candidates for phacoemulsification (phaco) surgery in Imam Khomeini Hospital, Kermanshah, Iran. The participants were assigned to an intervention (LMA impregnated with diltiazem gel) and a control group (LMA impregnated with lubricant gel) through the block random method in the form of 40 blocks of 2 using a random-numbers table. Hemodynamic changes (systolic and diastolic blood pressure and heart rate) were measured before, immediately after, 5 min, and 15 min after intubation, during surgery every 15 min, upon entering the recovery unit, and 15 and 30 min after entering the recovery unit.
Results: The mean systolic and diastolic blood pressure in the intervention group showed a significant decrease, compared to that in the control group. A significant difference was also observed in the mean heart rate difference between the two study groups, but only at the beginning of the study (P<0.05). Additionally, according to the results of repeated measures analysis of variance, the mean of the measured variables showed a significant difference at different measurement times in the intervention group (P<0.05).
Conclusion: The findings supported the effectiveness of diltiazem gel in reducing blood pressure, especially in the final stages of surgery, decreasing the number of premature ventricular contractions, and controlling normal breathing. Therefore, specialists and surgeons can use diltiazem gel to control the hemodynamic status of patients.
Javad Amini-Saman; Mahrokh Alikhani; Mohammad Javad Nadersepahi; Sharmin Rahmani
Volume 25, Issue 3 , 2023
Abstract
Background: Hemodynamic instability, including hypotension and bradycardia, can occur due to spinal anesthesia by bupivacaine. However, it is possible to reduce the chance of hemodynamic changes by the reduction of the dose of bupivacaine and/or the addition of adjunctive agents.
Objective: This study ...
Read More
Background: Hemodynamic instability, including hypotension and bradycardia, can occur due to spinal anesthesia by bupivacaine. However, it is possible to reduce the chance of hemodynamic changes by the reduction of the dose of bupivacaine and/or the addition of adjunctive agents.
Objective: This study aimed to compare the effects of the addition of intrathecal dexmedetomidine and sufentanil to spinal anesthesia with bupivacaine in elective cesarean section (CS).
Methods: This prospective single-blinded randomized clinical trial with parallel groups was performed on 60 pregnant women who were candidates for elective CS in Imam Reza Hospital in Kermanshah, Iran. In addition to receiving 10 mg of hyperbaric bupivacaine 0.5%, they were randomly divided into two groups to receive intrathecal sufentanil 5 ?g (30 cases) or dexmedetomidine 5 ?g (30 cases). Changes in blood pressure, heart rate, and occurrence of side effects (e.g., nausea, vomiting, headache, and shivering) were recorded within 1 h after the injections. Moreover, the postoperative analgesia rate and duration (using a visual analog scale [VAS]) were recorded within the first 24 h after the completion of the CS. Headache severity (using a VAS) was also measured during the first week after CS.
Results: Patients declared their satisfaction with analgesia after surgery. No significant difference was found between the two groups in terms of heart rate and systolic and diastolic blood pressure changes during the first 60 min. Similarly, no significant difference was observed between the two groups in terms of the severity of incision pain in the first 24 h after CS surgery. On days 3, 4, and 5, none of the patients in the sufentanil and bupivacaine group had headaches (VAS=0), but patients in the dexmedetomidine and bupivacaine group had some degree of headache (P=0.040).
Conclusions: Based on the results, intrathecal administration of bupivacaine with either sufentanil or dexmedetomidine in CS did not have significantly different effects, except for slightly more severe headaches in the dexmedetomidine group. Therefore, no superiority of one drug over the other was observed for intrathecal administration with bupivacaine in CS.
