Anesthesiology and pain medicine
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Opium is a highly addictive agent and the most common narcotic often misused in Iran. The pharmacokinetic of anesthetic drugs in patients with opium addiction is one of the great challenges for anesthesiologists. Hemodynamic instability and postoperative side effects are of these challenges which should be managed correctly. ⋯ Premedication with clonidine in patients with and without opium addiction can be effective to decrease the incidence of shivering and recovery time after operation.
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The incidence of transient neurologic symptoms (TNS) after spinal anesthesia with lidocaine is reported as high as 40%. ⋯ According to the results of this clinical study, spinal anesthesia with lidocaine, and the lithotomy position in surgery increased the risk of TNS.
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Caesarian section is a commonplace surgery in females for which spinal anesthesia is the preferred method. The local anesthetic medications used in the surgery are often associated with complications such as nausea, vomiting, dyspnea, hypotension, and bradycardia. In the present study, we decreased the dose of the anesthetic drug and added an opioid instead. ⋯ It seems that reducing the lidocaine dose, when combined with sufentanil, decreases most complications of spinal anesthesia such as hypotension, dyspnea, nausea, and vomiting while preserving anesthesia quality.
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Postoperative residual blockade, longer duration of action for neuromuscular blockade, and slower recovery were relatively common in elderly patients. ⋯ We hold the opinion that cisatracurium is safer in elderly patients compared to other drugs. We also concluded that the usage of TOF ratio together with clinical tests is suitable for assessment of neuromuscular recovery in these patients.