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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After peribulbar block analgesia (PBA) instituted in the preoperative anesthetic room, patients are often anxious, developing increased heart rate (HR) and blood pressure (BP) upon their arrival to the operating room and during subsequent surgery. The efficacy of premedication in attenuating these stress responses has not been examined. A prospective audit was undertaken to examine the relationship between the premedication schedules most commonly prescribed at the King Khaled Eye Specialist Hospital and increases in HR and BP during surgery in response to the stress of surgery, and the requirements for intravenous (IV) benzodiazepine, opioid or NSAID medication to treat these increases, or any complaint of pain or positional discomfort on the operating table, respectively. ⋯ Each of the five premedication schedules described appear to confer similar effects on cardiovascular changes in anticipation of, and during, surgery, except that those given the lightest premedication, Group 1, showed greater increases in BP at the start of surgery than did those given the heaviest premedication, Group 5. The requirements in the operating room for IV medication were similar in the five premedication groups, and no greater benefit was discernible for any one of the five premedication schedules on the objective features assessed. These data suggest that simple oral premedication of hydroxyzine, with or without an H2 receptor antagonist and NSAID, may suffice as premedication in middle-aged to elderly patients undergoing anterior segment surgery.
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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.
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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.