Journal of Anesthesiology and Pain

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Abstract: Aims and Background: Tranexamic acid has been used to reduce blood loss and the need for blood transfusion in many surgeries. Traumatic mandibular surgeries can be associated with significant bleeding which affects the field of operation and creates difficulties for the surgeon. Therefore we decided to evaluate the effect of tranexamic acid on the amount of bleeding during traumatic mandibular surgeries. Methods and Materials: In this randomized double blinded clinical trail, 90 patients, scheduled for traumatic mandibular surgeries with ASA class I-II and aged between 18 to 40 years, were included. They were randomly assigned to each group (n=45). After induction of general anesthesia with the same plan they received tranexamic acid (10mg/kg) or equal volume of normal saline, intravenously. Intra operative bleeding, pre-op hemoglobin (Hb), hematocrit (Hct) concentration, post-op (after 6 hours) Hb and Hct concentration, rate of blood transfusion and the quality of surgical field were recorded for each patient. Then data analyisis was performed with (SPSS software version 16). Findings: Mean intraoperative bleeding in the tranexamic acid and placebo group were 80.44± 49.43ml and 183.0 ± 69.53ml, respectively (P=0.0001). Post-op decreasing rate of Hb and Hct were less in the tranexamic acid group vs. the control one(P=0.0001 for Hb , P=0.001 for Hct). The Quality of surgical field leading to the surgeon’s satisfaction was better in the tranexamic group than the control group. (P=0.0001). None of the patients needed blood transfusion. Adverse effects were not seen in any of the groups. Conclusions: Administration of IV tranexamic acid decreases the amount of bleeding during mandibular surgeries. Keywords: Tranexamic acid, Bleeding, Mandibular surgery, Hemoglobin, Hematocrit

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Case report: Severe burn injuries are associated with significant pathologic changes in nearly all of organ systems, among them are facial and airway injuries. Thus, one of the important points is airway management in head and facial burn injuries which lead to difficult or impossible tracheal intubation in these patients. In this study we introduce a 37 year-old man, who was burned with electricity and had contracture injuries in his face, hands, and circumorally. He was candidate for reconstructive lid surgery 84 days post-burn. Because of severe restriction in the mouth opening we intubated him Trans nasally with preservation of spontaneous breathing. In circumoral post burn injuries with restriction in mouth opening, it seems reasonable to intubate trachea with preservation of spontaneous breathing and extreme caution when using drugs especially when flexible fiberoptic bronchoscope is not available. In these situations, nasal tracheal intubation with head and neck movement by Glidescope could be useful as an alternative.

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Most cause of difficult intubation are anatomically disorders such as micrognathia, head and neck deformities, cervical spine disorders .Most of post-anesthetic harmful complications are due to airway management problems and hypoxemia. Therefore one of the most important points in the airway management is the appropriate selection of safe policy.
In this study we introduce a 79 – years old man, who was candidate for elective endoscopic dacriocystorhinostomy. He had congenital spastic torticollis. Finally we did successful awake fiberoptic-guided tracheal intubation with sedation.

In neck deformities and torticollis which airway anatomy is distorted, it seems reasonable to intubate trachea with sedation and preservation of spontaneous breathing by fiberoptic broncoscope.

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Background : The main purpose of sedation in patients under ocular surgery  is patients' preparing to stay calm during surgery .Inadequate or deep sedation  may lead to patient's  sudden movement  and subsequently serious complications .

Objectives : The main purpose of  this study is  compare the effects of Melatonin and Gabapentin on pain and anxiety  during cataract surgery under topical anesthesia.

Methods : This study was  a single  blinded  clinical trial conducted on 81 patients undergoing cataract surgery with topical anesthesia  in Amir-al-Momenin  Academic Hospital in 2014. Patients were randomly assigned into 3 groups:27 patients receiving 6 mg of melatonin tablet,27 patients receiving 600 mg of Gabapentin capsule, and 27 patients receiving placebo(control) 90 minutes pre -operative .In operation room, placebo group received 1 mg Midazolam intravenous, all  patients received 0.5 mic/kg Fentanyl .  The pain and anxiety were evaluated on premedication time(T1), in the operating room (T2), and post operative (T5).The sedation was evaluated at T1, T2, at the time topical anesthesia(T3), 15 minutes after the start of surgery (T4) and T5.

Results: In our study, there was not statistically significant difference in demographic variables )age, sex and coexisting disease ), the intensity of anxiety and pain in 90 minutes before surgery among the three groups of patients undergoing cataract surgery in the time intervals. It was found that in entering operating room and discharge from recovery, there was a statistically significant difference between mean pain intensity  among three groups (p=0.001 and p=0.0001).. In each of the time periods, studying the difference between the intensity of anxiety among the three groups of patients showed a significant difference at the time of entering the operating room between mean anxiety in the three groups (p=0.034). However, there was no significant difference among the mean anxiety of the three groups in recovery discharge time ( p=0.316).

Conclusion: The results show that pretreatment with Melatonin and Gabapentin  Midazolam decreased anxiety scores to the same extent of Midazolam. In addition, a single dose of Gabapentin or melatonin administered as pre- medication reduce pain intensity in the patients.

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Aim and background: Relieving preoperative anxiety is an important concern for the pediatric anesthesiologists. Anxiety can cause aggressive reactions and increases child’s restlessness. It might even make postoperative pain management impossible. Oral midazolam has been the most frequently used premedication in children. The purpose of this study was to evaluate preoperative sedative effects and anxiety level changes  by using intra nasal dexmedetomidine compared with intra nasal midazolam in children scheduled for elective surgery.

Methods and Materials: This double blind randomized clinical trial was done on sixty 2-8 years old ،ASA I _ II children scheduled for elective surgery in academic hospitals in Rasht ،Iran. Using random blocks the children were divided into 2 equal groups (group D and group M). Group D received 1µg/kg intranasal dexmedetomidine and group M received 2 mg/kg intranasal midazolam 30 minutes before entering OR. Preoperative sedation effects ،sing the Ramsy sedation score ،anxiety level changes،and recovery time were assessed and compared in two groups using Chi square ،t-test, KS and repeated measure statistical tests.

Findings: The study was done on 49 (81.7%) boys and 11 (18.3) girls with the mean age of 4.45±1.67 years. No statistical difference was seen between the two groups in sex ،age ،asal heart rate (HR) ،blood pressure (BP) and arterial O2 saturation (SpO2).  The sedation Ramsay score before administration of the drug and when entering the OR were not different between two groups، although it was lower in both groups at the time of entering OR. (p=0.009 for group D and p=0.000 for group M) The anxiety level before administering drug was the same in two groups (p=0.911) and decreased at the time of entering OR. (p=0.000 in both group D and M) Children receiving midazolam were less anxious when entering the OR (p=0.034), but there was no difference between two groups in recovery time (p=0.947)

Conclusions: Administration of intranasal midazolam and dexmedetomidine before surgery results in less anxiety. Although midazolam is superior to dexmedetomidine in reducing anxiety, dexmedetomidine causes less respiratory depression than midazolam.

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Aim and background: Intra operative bleeding is an inevitable complication of endoscopic sinus surgery (ESS), besides it is worring for both anesthesiologist and otolaryngologist. The aim of this study was the survey of relationship between tranexamic acid (TA) dose and the amount of bleeding and duration of surgery in patients with chronic rhinosinusitis. Methods and Materials: This randomized double-blinded clinical trial was performed on 100 patients with class I and II ASA )American Society of Anesthesiologists( who were scheduled for endoscopic sinus surgery under general anesthesia.50 patients )groupL( received 5 mg/kg of TA, and another 50 patients )groupH( received 10 mg/ kg of TA after tracheal intubation. Anesthesia plan was the same in both groups.Intra operative bleeding, systolic and diastolic blood pressure(BP), and heart rate (HR) at 15th, 30th, 60th, 120th, 150th minutes, surgeon satisfaction rate, duration of surgery, and complications were documented. Data was analyzed by SPSS-19 software. Findings: Statatistical analysis showed that there was no significant difference considering demographic data between the groups.Surgical time was not significantly different between the groups (p=0.83), but the mean blood loss amount based on mililiter and the percent of maximal allowable blood loss (MABL) were less in group H.And the surgical field  was better in group H. Conclusions: In this study it was shown that administration of 10 mg/kg TA intravenously has been effective to achieve less blood loss, and to improve the quality of surgical field during endoscopic sinus surgery without any significant side effects.