Background: Postoperative cognitive dysfunction (POCD) and delirium are common in the elderly patients, given the controversial results of previous studies about the impact of anesthesia type on the occurrence of these complications. Objectives: This study was planned to compare the effects of general and regional anesthesia on the prevalence of POCD and delirium. Methods: A single-blind non-randomized clinical trial. Setting was in two academic hospitals. Ninety-four patients over 50 years old scheduled for hip fracture fixation. Patients were divided into two groups to receive either general (GA) or spinal (SA) anesthesia. Both Mini-Mental State examination (MMSE) and Wechsler tests were used before the operation and 3 times postoperatively to assess the cognitive function and detect early POCD. The DSM-IV criteria were also used for the diagnosis of delirium. The incidence of delirium and POCD and their precipitating factors were compared between the two groups. Results: Ninety-four patients with a mean age of 67.12 years were studied. The overall prevalence of POCD and delirium was 17.02%; however, it was significantly higher in the GA group rather than the SA group, 29.7%, and 4.25%, respectively (P < 0.001). There was a significant relationship between age (P = 0.048), ASA class (P = 0.034), and educational level with the incidence of POCD, meaning that the probability of developing cognitive impairment decreases with patients’ higher level of education and lower ASA-physical status. Also, the rate of POCD in men was significantly higher than in women (P = 0.026). Conclusions: The finding of this study showed that, if there is no specific contraindication, neuraxial anesthesia may be preferred over general anesthesia in elderly patients.

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Background:To determine if the GlideScope® videolaryngoscope (GVL) could attenuate the hemodynamic responses to orotracheal intubation compared with conventional Macintosh laryngoscope.Objectives:The aim of this relatively large randomized trial was to compare the hemodynamic stress responses during laryngoscopy and tracheal intubation using GVL versus MCL amongst healthy adult individuals receiving general anesthesia for elective surgeries.Patients and Methods:Ninety five healthy adult patients with American Society of Anesthesiologists physical status class I or II that were scheduled for elective surgery under general anesthesia were randomly allocated to either Macintosh or GlideScope arms. All patients received a standardized protocol of general anesthesia. Hemodynamic changes associated with intubation were recorded before and at 1, 3 and 5 minutes after the intubation. The time taken to perform endotracheal intubation was also noted in both groups.Results:Immediately before laryngoscopy (pre-laryngoscopy), the values of all hemodynamic variables did not differ significantly between the two groups (All P values > 0.05). Blood pressures and HR values changed significantly over time within the groups. Time to intubation was significantly longer in the GlideScope (15.9 ± 6.7 seconds) than in the Macintosh group (7.8 ± 3.7 sec) (P< 0.001). However, there were no significant differences between the two groups in hemodynamic responses at all time points.Conclusions:The longer intubation time using GVL suggests that the benefit of GVL could become apparent if the time taken for orotracheal intubation could be decreased in GlideScope group.

ObjectiveThe current study aimed at comparing the efficacy of dexmedetomidine and magnesium sulfate to control blood pressure (BP) during rhinoplasty and the resultant effects on the quality of surgical field in terms of bleeding and visibility.MethodsThe current randomized, prospective, double-blind study was conducted on 60 patients aged 18 to 50 years classified as ASA (American Society of Anesthesiologists) physical status I who were candidates for rhinoplasty. Patients were randomly divided into 2 groups: (1) group Dex, received 1 µg/kg dexmedetomidine in 10 minutes before induction of anesthesia, followed by 0.4 - 0.6 µg/kg/hour during the maintenance of anesthesia, and (2) group Mg, received 40 mg/kg in 10 minutes before anesthesia induction followed by 10 - 15 mg/kg/hour during anesthesia maintenance. In both groups, the goal was to achieve a mean arterial pressure (MAP) of 60 - 70 mmHg. Hemodynamic variables, anesthetic, opioid, muscle relaxant requirements, and surgical field condition were recorded. Sedation score, time to reach modified Aldrete score ≥ 9, and adverse effects including nausea and vomiting (N&V) and shivering were recorded.ResultsControlled hypotension was achieved in both groups. There was no significant difference in MAP between the groups, but heart rate (HR) was significantly lower in the Dex group (P < 0.001), compared with that of the Mg group. Bleeding score was lower (P < 0.001) and surgeon’s satisfaction score was higher (P < 0.001) in the Dex group. More patients required fentanyl (P < 0.001) or nitroglycerin (P < 0.001) and the mean fentanyl (P = 0.005) or nitroglycerin (P < 0.001) required doses were higher in the Mg group. Patients in the Dex group required more frequent administration of cisatracurium (P = 0.004). Five patients in the Dex group versus no patients in the Mg group received atropine (P = 0.023). Ramsay sedation score and time to reach modified Aldrete score ≥ 9 were significantly higher in the Dex group (P < 0.001 and P < 0.001, respectively). The incidence rate of N&V and shivering were similar in both groups.ConclusionDexmedetomidine was more effective than magnesium to achieve controlled hypotension, and provide a favorable surgical field condition. However, dexmedetomidine also heightened the risk of induced bradycardia and prolonged sedation. These are 2 important points to consider when applying this drug as a hypotensive agent during operation.

BackgroundThe main important method for airway management during anesthesia is endotracheal intubation. Laryngeal mask airway (LMA) and supraglottic gel device (I-Gel) are considered alternatives to endotracheal tube.ObjectivesThis study sought to assess the success rate of airway management using LMA and I-Gel in elective orthopedic surgery.Patients and MethodsThis single-blinded randomized clinical trial was performed on 61 ASA Class 1 and 2 patients requiring minor orthopedic surgeries. Patients were randomly allocated to two groups of LMA and I-Gel. Supraglottic airway placement was categorized into three groups regarding the number of placement attempts, i.e. on the first, second, and third attempts. Unsuccessful placement on the third attempt was considered failure and endotracheal tube was used in such cases. The success rate, insertion time, and postoperative complications such as bleeding, sore throat, and hoarseness were recorded.ResultsIn the I-Gel group, the success rate was 66.7% for placement on the first attempt, 16.7% for the second, and 3.33% for the third attempt. In the LMA group, the success rates were 80.6% and 12.9% for the first and second attempts, respectively. Failure in placement occurred in four cases in the I-Gel and two cases in LMA groups. The mean insertion time was not significantly different between two groups (21.35 seconds in LMA versus 27.96 seconds in I-Gel, P = 0.2). The incidence of postoperative complications was not significantly different between study groups.ConclusionsI-Gel can be inserted as fast as LMA with adequate ventilation in patients and has no major airway complications. Therefore, it could be a good alternative to LMA in emergency airway management or general anesthesia.

of blood loss, urine output, fluid intake and surgeon' s satisfaction were recorded. Data was analyzed with SPSS version 13.0 and P values less than 0.05 were considered significant. RESULTS:Twenty patients in the MGS group and 19 patients in the REM group were studied. There was no difference between the two groups in the hemodynamic variables, blood loss, urine output, fluid requirement and surgeon's satisfaction for exposure. The target MAP was achieved in 75% of Mg and 58% of remifentanil groups. Although a higher number of patients in the REM group required nitroglycerin (42.1%) to reach the target MAP than those in the MGS group (25%), this difference was not statistically significant (P = 0.32). CONCLUSION:Our findings showed that in patients undergoing lumbar PSF surgery, remifentanil and MGS have a similar hypotensive effect and comparable amount of blood loss without any significant adverse effects.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Controlled hypotension; Magnesium sulfate; Remifentanil; Spine surgery; Blood loss Core tip: We conducted a relatively small sized prospective randomized clinical trial comparing intravenous infusion of remifentanil with magnesium in controlling blood pressure during posterior spine fusion in order to decrease the intraoperative blood loss. Our experiments showed no difference between the two administered regimens in reducing mean arterial blood pressure and intraoperative blood loss, and satisfaction of the operating surgeons. METHODS:In this randomized clinical trial, 40 patients with the American Society of Anesthesiologists Ⅰ and Ⅱ physical status undergoing lumbar PSF were randomized to receive remifentanil (REM) 0.15 μg/kg or MGS 50 mg/kg for controlled hypotension. The administering anesthesiologist was blinded to the medication. Continuous infusion was maintained at a fixed volume rate to deliver precalculated doses of either study drugs. All other aspects of anesthesia and surgery were similar in the two groups. The target mean arterial pressure (MAP) range used in this study was 60-70 mmHg. In the course of surgery, the hemodynamic variables, volume BRIEF ARTICLE

Background:Opioids have been traditionally used for postoperative pain control, but they have some unpleasant side effects such as respiratory depression or nausea. Some other analgesic drugs like non-steroidal anti-inflammatory drugs (NSAIDs) are also being used for pain management due to their fewer side effects.Objectives:The aim of our study was to compare the analgesic effects of paracetamol, an intravenous non-opioid analgesic and morphine infusion after elective laparotomy surgeries.Patients and Methods:This randomized clinical study was performed on 157 ASA (American Society of Anesthesiology) I-II patients, who were scheduled for elective laparotomy. These patients were managed by general anesthesia with TIVA technique in both groups and 150 patients were analyzed. Paracetamol (4 g/24 hours) in group 1 and morphine (20 mg/24 hours) in group 2 were administered by infusion pump after surgery. Postoperative pain evaluation was performed by visual analog scale (VAS) during several hours postoperatively. Meperidine was administered for patients complaining of pain with VAS > 3 and repeated if essential. Total doses of infused analgesics, were recorded following the surgery and compared. Analysis was performed on the basis of VAS findings and meperidine consumption.Results:There were no differences in demographic data between two groups. Significant difference in pain score was found between the two groups, in the first eight hours following operation (P value = 0.00), but not after 12 hours (P = 0.14) .The total dose of rescue drug (meperidine) and number of doses injected showed a meaningful difference between the two groups (P = 0.00). Also nausea, vomiting and itching showed a significant difference between the two groups and patients in morphine group, experienced higher levels of them.Conclusions:Paracetamol is not enough for postoperative pain relief in the first eight hour postoperatively, but it can reduce postoperative opioid need and is efficient enough for pain management as morphine after the first eight hours following surgery.

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