Background:In this study, we aim to identify the efficiency of propofol-remifentanil anesthesia in reducing the postoperative intensive-care unit stay in patients undergoing cardiac surgery in our center, without compromising the hemodynamic stability. Subject and Methods: Two hundred patients undergoing first time elective coronary artery bypass graft surgery were recruited in this single-centered, single-blinded, prospective and controlled study. Study patients were randomized into two treatment groups: group 1 (P-R; Propofol-Remifentanil) (n=100 patients) and group 2 (M-F; Midazolam-Fentanyl) (n=100 Patients). Clinical measurement of Mean arterial blood pressure and heart rate for each patient were recorded before (T1) and after (T2) induction of anesthesia; after sternotomy (T3) and before cardiopulmonary bypass (CPB) (T4). Time from cessation of anesthesia to tracheal extubation was also recorded (T5). Results: Comparing the hemodynamic parameters between the two groups at T1, T2, T3 and T4 set points revealed statistically significant difference (P < 0.5) in hemodynamic variables in all parameters measured apart from HR at T3. The mean recorded times from cessation of anesthesia to tracheal extubation (T5) were 99.32 minutes and 183.33 minutes in group 1 and 2, respectively. A statistically significant difference was noted between T5 in both groups (P value = 0.003). Conclusions: Our study has shown that Propofol-Remifentanil anesthesia helps to reduce the time interval between cessation of anesthesia and extubation and, by doing so, it can potentially reduce the postoperative ICU stay, without compromising hemodynamic stability. Duhok Med J 2017; 11 (1): 39-47.
Background and objective: Hypotensive attacks commonly occur during induction of anesthesia and can result in irreversible ischemic damages to the vital body organs. This study aimed to assess the effect of using ephedrine at low doses in controlling hemodynamic changes induced by anesthesia. Methods: A single centered single-blinded, prospective comparative study was conducted in Erbil cardiac center in periods between January 2018 and July 2018. A total of 150 patients with left ventricular ejection fraction <40% and age younger than 80 years were included in this study. They were divided into three main groups; the 1st group was the placebo group, the 2nd group received ephedrine at a dose of 0.035mg/kg body weight, and the 3rd group received ephedrine at a dose of 0.07 mg/kg body weight. Systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, and heart rate were reported in three different phases; before induction, two minutes after induction, and five minutes after induction of anesthesia. Results: In the placebo group, induction of anesthesia by 3mcg/Kg of remifentanil significantly reduces diastolic, systolic, and mean arterial pressure with P <0.001. At two minutes after using ephedrine at the dose of 0.035 mg/kg in the induction of anesthesia significantly increases the diastolic, systolic, and mean arterial pressure with P = 0.002, <0.001, and 0.007, respectively, and at five minutes after induction with P = 0.02, 0.03, and 0.04, respectively. Using ephedrine at a dose of 0.07mg/kg induction of anesthesia was found to significantly increase the diastolic, systolic, and mean arterial pressure with P <0.001 for all the readings. The heart rate was not significantly affected by using remifentanil alone or in combination with ephedrine during induction of anesthesia. Conclusion: Using ephedrine at different doses during induction of anesthesia with remifentanil in patients with low ejection fraction significantly prevents hypotensive attacks.
Background Failed back surgery syndrome (FBSS) is a frequently occurring disease following lumbar spinal surgery. It has also been named “post lumbar surgery syndrome,” and much research has been done. The patients share continued back and extremity pain following one or more spinal operations. It may be due to inadequate operations, operative complications, progression of degenerative processes, or a new pathology. Objectives To successfully use a steerable epidural catheter to treat ‘Failed Back Surgery Syndrome’ patients. Study Design a case series was carried out on 50 patients with FBSS. Methods Clinical data were collected from patients with FBSS, pain symptoms, MRI findings. (VAS) the visual analog scale has been used for pain degree evaluation, (ODI) Oswestry disability index was used for functional improvement evaluation. Percutaneous adhesiolysis under fluoroscopy guide has been performed, and the patients were assessed at one month and three months intervals from the day of the procedure. Results In comparing to baseline values, there was a significant decrease of the mean and median VAS after one month and three months of the intervention (p < 0.001). The same is for the ODI%, where it is clear that its median decreased from 48% to 22% after one month (p < 0.001) and to 8% after three months (p < 0.001). Conclusion Steerable epidural catheter was effective in FBSS treatment with improvement in pain and function.
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