محمدرضا خواجوی

Postoperative nausea and vomiting (PONV) is a very common side effect of intrathecal use of meperdine. Several drugs for preventing the PONV due to opioids are available currently; but none ofthem can be considered as gold standard. This study was designed to compare effects of haloperidol, metoclopramide and promethazine in preventing of PONV due to intrathecal use of meperidine. In a randomized clinical trial (RCT), effects of haloperidol, metoclopramide and promethazine in prventing PONV due to intrathecal use of meperidine were compared in 60 patients who had undergone orthopedic or urologic operations in Sina hospital from 2004 until 2006. In all patients spinal anesthesia protocol (100 mg lidocaine or 15 mg marcaine with 25 mg meperidine intrathecally) was the same. The patients were randomized to receive either haloperidol (2.5 mg IM, n=20) or metoclopramide (10 mg IM, n=20) or promethazine (25 mg IM, n=20). All the patients were evaluated for incidence of nausea and vomiting in definite intervals during first 24 hours after operation. The data were analyzed by SPSS with considering statistic level under 0.05. The prevalence of early nausea in haloperidol group (10%) was less in promethazine group (35%), and more in metoclopramide group (5%). Difference inearly nausea severity among study groups was statisitically significant (p=0.029). The prevalence of late nausea in study groups (5%) was the same, but severity of it was different. Only one patient in group had nausea in 12-24 hrs postoperation. The prevalence of early vomiting in haloperidol group (5%) was less in promethazine group (25%) (p=0.07) and the same in metoclopramide group (5%). The prevalence of late vomiting in haloperidol group (5%) was more in metoclopramide group (0) and the same in promethazine group (5%). None of patients in study groups had womiting in 12-24 hrs postoperation. For prevention of nausea and vomiting due to intrathecal meperidine in 0-4 hrs after initiation of surgery, metoclopramide and haloperidol are more effective than promethazine.

Negative pressure pulmonary edema is a disease may be caused following removing acute upper air way obstruction and cardiac negative pressure. Ït’s prevalence is observed in less than 0.03 of the patients undergoing general anaesthesia. This condition, some times occurs following removing chronic air way obstruction. The cases under study comprises 5 comprises 5 young men of 20 to 33 years age undergone hernioraphy operation of nose and organs in 1999 through 2002, at Ëbne Sina and Boali hospitals in Tehran and Sari respectively. These patients had laryngeospasm after removing the tube, but the obstruction was cured maximum within 2 minutes. But they suffered respiratory distress and NPPË up to 30 minutes after curing of obstruction, immediate proper treatment measures were undertaken and the patients were under observation in ÏÇÜ. Ïn case of any upper air way obstruction following anaesthesia and operation, need of promt and proper treatment and under observation of patients at least up to 6 hours after curing is proposed.

Background and Laser bean produces thin incision along with hemostasis, sterility and decreased postoperative complications, hence facilitate air way surgery, but due to proximity of endotracheal tube to operation site, the risk of occupying and burning of endotrachel tube and surrunding tissues in each surgery is about 0.5% to 1.5%. This study is about the complications arised by apnea technigue of general naesthesia and continued controlled ventilation with coated endothracheal tube, done in Tehran Âmir Âlam hospital in 1998-1999. Two groups of laser therapy candidates, each with 22 patients of 10 to 60 years of age and ÂSÂ 1 to 2 with less than 100kg weight, undergone anesthesia by the two above mentioned techniques. Both groups recieved the same anesthetic agent and mainteined in the same condition. Monitorings included electrocardiography (ËÇG, NÏBP) pulse oxymeter and capnograph. Hemodynamic changes were the same in both groups, hypoxia or arrythmia was not observed in any of the patients. Ïn the apnea technique operated patients, most of the surgical procdure was done in 2 to 3 a bneic episodes. Duration for each apnea was 2 to 4 minuts. Ïn the apnea technique group pet Ço2 was 38 to 47 mm Hg. Duration of laser therapy in apnea group was 9 to 10 minutes less than the coated tube group. Çonclusion: Çonsidering the results of this study, in the apnea technique group there was no hypoxia arrythmia and threatening prolonged hypocapnia. Due to omition of endotrachial tube from the laser field, laser therapy would be done without any risk of fire and is done in the shorter time. The surgon would do a good and non risky surgery.