Archives of Anesthesiology and Critical Care
Volume:3 Issue: 2, Spring 2017

Fentanyl which is frequently used during cataract surgery has been found to induce cough. The aim of this study was to evaluate the effect of IV lidocaine and dexamethasone and different speeds of injection of fentanyl on cough induced by this drug.
In this randomized double blind clinical trial study, patients were allocated randomly to four groups to receive 1 mg.kg-1 lidocaine (group i), 0.1 mg.kg-1 dexamethasone (group II) and 5 cc normal saline as placebo (group III & IV) intravenously. Four minutes later, all patients were given 1.5 µg.kg-1 fentanyl intravenously. Fentanyl was administered within 15 seconds in group I-III and within 2 seconds in group IV. Incidence, number and intensity of cough were recorded. Heart rate and blood pressure were also recorded before administration of drug, 1 minute after administration of drug and 2 minutes after administration of fentanyl.
139 patients were evaluated. There was no significant difference in demographic features of groups including age, weight, gender and also heart rates and blood pressures. Incidence and intensity of cough was significantly higher in group IV while there was no statistically considerable difference between other groups.
This study demonstrated that slowing injection of fentanyl can effectively reduce the incidence of cough induced by drug; hereby administration of lidocaine or dexamethasone becomes unnecessary in this speed of injection. Additionally cough incidence after fentanyl injection is affected by patient's ethnicity.

from general and regional anesthesia. The incidence of this complication is reported to be 40-70% among patients. PAS occurrence depends on various factors such as age, gender and drugs used in anesthesia and surgery time. Granisetron is a serotonin 5HT3 receptor antagonist. Beneficial effects of such drugs have been shown in a limited number of studies. In this study, preventive effects of granisetron in prevention of shivering, nausea and vomiting following spinal anesthesia were evaluated in patients undergoing lower abdominal surgery.
One hundred and five patients aged 18-60 years and with ASA class I or II who were scheduled to undergo elective lower abdominal surgery under spinal anesthesia were studied in 3 groups of 35 patients. After spinal anesthesia, group L received low dose granisetron with a dose of 10μg/kg, group H received high dose granisetron with a dose of 40 μg/kg and group C received normal saline as placebo. After leaving the operating room, patients were monitored in terms of shivering occurrence, time and severity of it and incidence of nausea and vomiting.
Incidence of shivering, nausea and vomiting was significantly lower in group H than C. (P=0.009 and 0.008, respectively). However, there was no significant difference between L and C or L and H groups in terms of shivering, or nausea and vomiting occurrence. No side effects of granisetron were observed in the study.
High dose granisetron with dose of 40μg/kg significantly reduced the prevalence and severity of PAS and PONV in comparison to placebo.

Strabismus surgery under general anesthesia is one of the most common ophthalmic procedures in children with emergence delirium as an important post-operative complication. Additionally, postoperative pain is another important issue which is considered as a contributing factor to emergence delirium. We conducted a study to compare meperidine with paracetamol on postoperative pain and emergence delirium.
This double blind randomized clinical trial was carried out on 60 children underwent elective strabismus surgery under general anesthesia. Patients were randomly allocated in two groups of 30 that received intravenous meperidine (1mg/kg) or paracetamol (15 mg/kg). Severity of pain were assessed one minute after extubation and every 5 minutes up to 1 hour by using CHEOPS and PAED was used for assessment of emergence delirium by time interval of every 10 minutes up to 30 minutes. Other complications such as bronchospasm, laryngospasm, nausea and vomiting were also recorded.
Pain severity was significantly higher is in paracetamol group while in meperidine group no patients received additional fentanyl in recovery room and emergence delirium was lower 30 minutes after surgery.
Although meperidine and paracetamol are both effective in reducing incidence of emergence delirium and controlling postoperative pain after strabismus surgery, meperidine is significantly more efficient.

This study was designed to investigate the effect of intravenous magnesium sulfate on hemodynamic changes induced by pneumoperitoneum in patients undergoing laparoscopic cholecystectomy.
A randomized, placebo controlled study was performed on 52 ASA class I or II aged 20-70 years patients undergoing laparoscopic cholecystectomy with pneumoperitoneum with carbon dioxide. Before induction, Magnesium group received 50 mcg.kg-1 magnesium sulfate, within 10 minutes, in 100 ml of normal saline and control group received 100 ml normal saline. Hemodynamic variables were recorded before induction, before the infusion of magnesium sulfate, during intubation, during pneumoperitoneum and finally during extubation, every 10 minutes. Postoperative pain and other complications were recorded in post anesthesia care unit (PACU) also.
Variations in heart rate and mean arterial pressure between the two groups during pneumoperitoneum were not significantly different (P>0.05). Propofol consumption in the magnesium group compared with the control group was significantly decreased (P Magnesium sulfate reduces the amount of anesthetic drug (propofol), TNG and intraoperative blood pressure, during pneumoperitoneum induced by laparoscopy. The postoperative pain of laparoscopy and anesthesia side effects such as nausea, vomiting and shivering were blunted, with bolus administration of magnesium sulfate before induction of anesthesia.

Weaning from mechanical ventilation is one of the main stages of treatment as well as applying a tool that can predict the success in weaning is very important. This study aimed to evaluate the success rate of weaning from ventilator in patients admitted at the Intensive Care Unit (ICU) using Burn’s Wean Assessment Program (BWAP) checklist.
The present analytical cross-sectional study was carried out on 100 mechanical ventilation-dependent patients connected to the ventilator for more than 72 hours. All patients were selected by simple available sampling based on purposive sampling method and examined by BWAP checklist and were weaned from ventilator by obtaining scores over 18.
The total number of patients participating in the study was 100, 71 males and 29 females. There was no significant relationship between gender and success or failure of weaning process based on chi-square test (p Investigating preparation for weaning using Burn’s Scale is more useful for patients who had no prolonged hospitalization at ICU and ventilated through an endotracheal tube.

General anesthetic drugs produce extensive neuronal changes in the central nervous system by enhancing inhibitory and reducing excitatory neurotransmission. The major neurotransmitters, which are thought to play a role in anesthesia, are glutamate, serotonin, norepinephrine, dopamine, acetylcholine, and GABA. The knowledge of neurotransmitters and their receptors’ function is very important in perception of anesthesia in routines practice.
The purpose of this review article is to give an overview of the different types of neurotransmitters in CNS, classification of neurotransmitters and mechanism of action of various types of neurotransmitters and their receptors.

Intubating a patient with panfacial fractures is always a challenge to the anesthesiologist as both the anesthesiologist and the surgeon are essentially competing for the same space. The anesthetic management of a 19-year-old boy who presented with multiple maxillofacial injuries, pneumocephalus, and cerebral edema sustained during a road traffic accident has been described. He was posted for open reduction and internal fixation of the fractures, frontal sinus fracture elevation and basal repair which required access to scalp, mouth and the nose. As all the conventional modalities to secure airway seemed unsuitable, orotracheal intubation was done via submental route. Following intravenous induction the patient was intubated with a cuffed oral flexometallic tracheal tube. This was then modified to the submental route through a submental incision. The surgery proceeded uneventfully and the patient was extubated a day later in the ICU. He made a satisfactory recovery and the submental scar healed without complication or scarring. We briefly review the technique of submental intubation in adults which serves as an excellent alternative to tracheostomy.

Hypoxia is a major concern for human health. Multiple new techniques were proposed for tissue oxygenation in different variety of patients.
Clark Jr. et al. presenting their article titled “Fluorovent: A New Perfluorocarbon for Liquid Ventilation”, at a symposium in neonatology, in 1995, described the scientific importance for perfluorocarbons which would be ideally suited for use in liquid ventilation and artificial blood as well. In 1966, Clark published his article that demonstrated that spontaneously breathing mice could survive when submerged in perfluorocarbons (PFCs) under normobaric conditions. The first trial of liquid ventilation in preterm neonates in 1989 showed the feasibility and potential of liquid ventilation in humans [1]. So liquid ventilation became as an alternative ventilation strategy for respiratory distress.
The administration of perfluorocarbons in liquid form to the lungs has been associated with improved gas exchange, respiratory mechanics, and lung structure in different models of acute lung injury.
Because of the characteristically high density of this chemical group, liquid perfluorocarbon columns may also exert a mechanical effect in dependent lung zones, contributing to the opening of atelectatic areas and maintaining them open at end-expiration, as well as diverting pulmonary blood flow to nondependent lung zones. In addition, perfluorocarbons are able to attenuate the proinflammatory response during lung injury, which may improve pulmonary function and histologic findings. [2].
The preterm infant also experiences improvement in lung compliance and gas exchange within hours of partial liquid ventilation initiation, most likely due to reductions in surface tension and volume recruitment. Some investigators suggested that liquid ventilation could generate a “baby lung” effect, due to the migration of an incompressible liquid in the dependent lung and the resulting overdistension of the nondependent zones [3].
However, some clinical trials failed to demonstrate the ability of partial liquid ventilation to decrease morbidity in acute respiratory failure.
Due to some complications and morbidities, less invasive modes of PFC application have been developed, whereby PFC was either vaporized or aerosolized, especially using perfluorohexane vapor. Perfluorohexane has a relatively low molecular weight and unique physicochemical properties among the perfluorocarbons, particularly the relatively high vapor pressure which permits its administration in vapor form [4].
The administration of vaporized perfluorohexane is particularly interesting because of the ease of its application. This vapor is distributed directly to ventilated regions that may be damaged in respiratory distress syndrome. In addition, some adverse effects of filling the lungs with a liquid perfluorocarbon, as pneumothorax, and formation of liquothoraces, can be avoided in this approach [5].
Ventilation with oxygen vaporized perfluorohexane can facilitate some catastrophic situations in anesthesia field, for example this method can be used in the time of laryngeal laser surgeries, or bronchus anastomosis, for a short period of time to avoid hypoxia, or for acute treatment of burn victims. Oxygenation with perfluorohexane vapor can be used in the time of resuscitation, in the time of difficult intubation or for treatment of severe asthma.
Lung lavage associated with perfluorocarbons and antibiotics can be used to eradicate infectious and inflammatory debris from the airways. Oxygenated perfluorocarbons can also have some other useful application in medical practice. Treatment of helicobacter pylori can be facilitated by drinking this fluid. Necrotizing cholitis can be treated by enema of this fluid. Chronic or acute sinusitis or pilonidal sinus can be treated by injection of this fluid to the infected sinus. Induced hypothermia for brain protection can be performed by cold oxygenated liquid ventilation, but the heart muscle must be heated by a laser apparatus or other devices to avoid arrhythmia