Middle East journal of anaesthesiology
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Middle East J Anaesthesiol · Jun 2004
Comparative StudyInduced preconditioning of cardiac performance in coronary bypass surgery--sevoflurane vs propofol.
Twenty ASA III and IV adult patients scheduled for elective coronary artery surgery were included in the study. Anesthesia was induced and maintained with either sevoflurane (sevoflurane group; n = 10) or propofol (propofol group; n = 10). All preoperative cardiac medications were continued until the morning of surgery. There were significant decreases in mean arterial blood pressure, cardiac index and ejection fraction after CPB in propofol group compared with sevoflurane. Further, the plasma creatine kinase myocardial isoenzyme concentrations were significantly higher in propofol group but did not approach the critical values needed for diagnosis of myocardial infarction. ⋯ It is concluded that, sevoflurane appears to be associated with better hemodynamic stability before and after CPB than propofol. This could be attributed to cardioprotective effect of sevoflurane during ischemia and reperfusion.
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Middle East J Anaesthesiol · Jun 2004
Randomized Controlled Trial Comparative Study Clinical TrialPropofol and sevoflurane during epidural/general anesthesia: comparison of early recovery characteristics and pain relief.
We investigated the early recovery characteristics and pain relief of adult patients during combined anesthesia with (epidural and general), either with propofol or sevoflurane for maintenance in major abdominal surgery. Twenty-two patients (ASA I-III) were enrolled in this randomized, prospective study. After fluid preloading, 10 ml of bupivacaine 0.5% + 5 ml of prilocaine 0.5% + 1 ml of fentanyl 50 microg mL(-1) were administered via an epidural catheter. ⋯ There weren't any statistical differences in regard to these, either. Except orientation time to place, the times of emergence and orientation to person, the pain scores and the analgesic requirements of the patients in both groups were similar. Propofol or sevoflurane did not offer any advantages for postoperative pain relief on behalf of either one when combined with epidural anesthesia.
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Middle East J Anaesthesiol · Jun 2004
Randomized Controlled Trial Clinical TrialComparison of serum cortisol level in open heart surgery--morphine versus sufentanil.
In open-heart surgery, cardiopulmonary bypass (CPB) can cause a rise in the level of stress hormones such as cortisol. Reducing this hormonal response is beneficial in the recovery period. Anesthetic agents and methods used in such operations have different effects on this response. In the present study two agents (morphine and sufentanil) routinely used for the cardiac surgery in Nemazi Hospital were compared regarding their effect on the serum cortisol levels. ⋯ Neither morphine nor sufentanil in the mentioned doses could reduce the endocrine response in the postoperative period, and thus have no preference, in cardiac surgery.
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We studied the pain control, narcotic side effects, and PCA utilization with intravenous PCA morphine during 24 hours post cesarean section period. Fifty-two consecutive women were included in the study. Each received subarachnoid block with hyperbaric bupivacain with addition of fentanyl. ⋯ Mean morphine consumption was 50 mg. The ratio between number of time PCA activated and dose received and pain score helped in managing the postoperative pain. Morphine IV-PCA, adequately replaces post cesarean section spinal (bupivacain-fentanyl) analgesia with fewer side effects.
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Middle East J Anaesthesiol · Jun 2004
Discomfort, awareness and recall in the intensive care-still a problem?
During surgery, anesthetists take extra care to prevent patient awareness done mainly under general anesthesia either by using inhalational or intravenous medications. However, patients in the ICU mainly those on ventilatory support with intubation and sedation, pass through lot of psychological stress and frustration. Most of the times this stress phenomenon is not documented in the general intensive care. This is the first report in our general ICU. ⋯ Our sedation and analgesia in the ICU is not enough to prevent unpleasant experiences, mainly those related to patient awareness. More work is still needed i.e. using sedation measuring systems, to improve our sedation and analgesia in the ICU.