Background & Objective: Several studies have shown that topical and intravenous Dexmedetomidine and Lidocaine can decrease pain and reduce consumption of analgesic drugs. However, Lidocaine may be accompanied with several side effects such as respiratory suppression, seizure, and cardiac arrhythmias. On the other hand, Dexmedetomidine has favorable properties such as low risk of apnea, analgesia, sympatholysis, and sedation. Therefore, the aim of this study was to compare the effects of nebulized Dexmedetomidine and nebulized Lidocaine on hemodynamic characteristics of the patients undergoing bronchoscopy. Materials & Methods: In the present randomized, double-blind study; 75 children (1-6 years old) undergoing fiber-optic bronchoscopy were allocated to three groups. Group 1 received nebulized solution containing 2 µg/kg of Dexmedetomidine. Group 2 received nebulized solution containing 4 mg/kg of Lidocaine 1%. Group 3 received nebulized solution containing 0.9% of normal saline as the control group. Heart rate, mean arterial blood pressure and SpO2, Bispectral Index (BIS) were measured and compared. BIS, indicating the depth of anesthesia was considered as a confounding factor. Statistical analysis was performed using SPSS 20. Results: The mean of arterial blood pressure and heart rate was significantly lower in group 1 compared to groups 2 and 3 during bronchoscopy (P<0.05). Blood oxygen saturation and sedation scores were significantly higher in group 1 compared to the other groups during bronchoscopy (P<0.05). Furthermore, the hemodynamic parameters were more stable in group 1 compared to the other groups during recovery. Conclusion: Premedication with nebulized Dexmedetomidine was significantly associated with more stable hemodynamic parameters and lower risk of side effects compared to nebulized Lidocaine in children undergoing fiberoptic bronchoscopy.

Background: Tracheal intubation is the most reliable way of securing an airway. Pediatric airway management is one of the significant challenges, especially for non-pediatric anesthesiologists. Early airway evaluation for detecting difficult intubation and preventing catastrophic events is necessary before anesthesia, especially in children. Objectives: Therefore, this study was done to compare some valuable adult predictors in children under two years of age. Methods: This prospective descriptive-analytical study was performed on 405 children under two years of age that were referred for elective surgery under general anesthesia with endotracheal intubation in Imam Hossein Hospital, Isfahan. Under sedation in a supine position, we measured items, including age, weight, height, stern omental distance (SMD), mouth opening (MO), neck circumference (NC), acromio-axillo-suprasternal notch index (AASI), and intubation difficulty scale score (IDS). An expert anesthesiologist did laryngoscopy and intubation, and difficult cases were recorded. Results: Our study showed that the frequency of difficult intubation with IDS > 4 was %16, and with IDS > 5 was %3. The variables, including age, weight, height, and SMD, significantly predicted difficult intubation. The cut-off points for age < 6 months, weight < 5/9 kg, height < 61 cm, and SMD < 5/3 cm were obtained, respectively. Other variables, such as MO, AASI, NC, and sex, were unreliable predictors for difficult intubation. Conclusions: We found that IDS > 4, age< 6-month, weight < 5/9 kg, and SMD < 5/3 cm are predictors for difficult intubation. It is helpful for the anesthesiologist to measure these predictions before anesthesia is started to find who has difficult intubation.

Background: Emergence agitation (EA) is one of the complications following anesthesia in pediatric surgery. Various drugs are used to prevent this complication, and one of them is dexmedetomidine. Choosing the right dose of this drug for the best efficiency is an important issue due to this complication.The main purpose of this study is to evaluate the prophylactic effect of intravenous dexmedetomidine in different doses in preventing EA after tonsillectomy in children. Materials and Methods: Our study was a double-blind clinical trial performed on 75 children ASAI, II candidates for tonsillectomy. Patients were divided into three groups. The group 1 received a dose of 0.6 μg/kg per hour and group 2 received a dose of 0.3 μg/kg per hour and group 3 was the control group. Then vital signs and observational pain score (OPS) and pediatric anesthesia emergence delirium (PAEDS) criteria were measured in patients. The collected data were analyzed by using SPSS software version 23 and non-parametric tests such as Friedman, Mann-Whitney. Results: According to the data analysis, mean blood pressure, mean heart rate, OPS and PAEDS score in group 1 were lower than other groups. Also, the average time of staying in recovery and extubation in group 1 was less than other groups. Conclusion: A dose of 0.6 μg/kg dexmedetomidine has a better effect on reducing EA (emergence agitation) after pediatric tonsillectomy.

Background:This study aimed to evaluate and compare the therapeutic effects of ephedrine and lidocaine in treatment of intraoperative hiccups in gynecologic surgery under sedation.Materials and Methods:This randomized clinical trial in Isfahan was done on fifty female patients referring to Shahid Beheshti Hospital who needed to have sedation for medical interventions and they afflicted hiccups during surgery or sedation. Patients divided into two groups of 25 randomly assigned to one of the two groups of ephedrine or lidocaine. Ephedrine group received 5 mg/kg of medicine, while the lidocaine group was under treatment with 1 mg/kg lidocaine. Patients were monitored about systolic and diastolic blood pressure, MAP, heart rate, duration of hiccup, frequency of betterment, duration of intervention, and recovery at 15-min intervals of surgery and recovery.Results:Hiccups were resolved in 14 cases (56%) in the lidocaine group, while the improvement of such problem was achieved in 24 cases (96%) in ephedrine group (P < 0.001), so that the two groups did not have any significant difference in terms of the time of onset but the stop time of hiccups (relative to its start time) in the ephedrine group with the mean value of (2.40 ± 1.16) was significantly lower than the lidocaine group with the mean of 19.64 ± 22.76 min (P = 0.014). In addition, no complications were observed in the two groups.Conclusion:Ephedrine has been more successful than lidocaine as a stimulant in controlling hiccups, and it has been able to suppress hiccups in a higher percentage of patients at a shorter time.