Tehran University Medical Journal

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The induction characteristic of halothane in nitrous oxide and oxygen were compared with halothane in oxygen alone and intravenous induction with thiopentum and succinylcholine.
Materials and Methods: A vital capacity technique was used for the gaseous induction groups using a mapleson F system and a 1-litre reservoir bag. four end points of anesthesia were recorded: time to cessation of hand grip, time to loss of eyelash reflex, time to jaw relaxation, and time to settled breathing after tracheal tube insertion .we also recorded sequential blood pressure and pulse rate , the incidence of adverse airway events and the acceptability of the induction technique .
Results: Induction with thiopentum and succinylcholine had a faster time to cessation of hand grip (p, 0.05) and jaw relaxation (p, 0.01). These differences disappeared with the final induction stage and halothane in nitrous oxide and oxygen had the faster time to regular settled breathing though this did not reach statistical significance. Cardiac stability was good and comparable in all groups.
Conclusion: These were few adverse airway events in any group and none caused oxygen saturation to fall below 96%. There was more excitation in the gaseous induction groups.

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Background: Total Intravenous Anesthesia (TIVA) compared to general anesthesia has some pits and falls. Many drugs have been employed for this anesthesia. Propofol is accounted as the last advent anesthetic drug. It belongs to alkyl phenol families and has been accounted one of the best choices for the continuous infusion. Invention of midazolam as the first water soluble benzodiazepine was also an important event in anesthesia and it can be used as continuous infusion for the anesthesia.

Materials and Methods: In this randomized controlled clinical trial, alfentanyl plus propofol or midazolam were used for TIVA anesthesia in 60 female patients undergoing Dilatation and Curettage (D&C) in Dr.Shariati hospital in March 2002 till March 2003. They were allocated reandomly in two group of alfentanyl plus propofol (propofol group) or alfentanyl plus midazolam (midazolam group)

Results: There was no significant difference in mean of age between propofol group and midazolam group (P>0.05), also There was no significant difference in preanesthesia condition such as blood pressure and heart rate between propofol group and midazolam group (p>0.05). After induction of anesthesia there was a gross blood pressure decrease in both group that it was greater in midazolam group (85 mmHg versus 73 mmHg, P<0.05 ) following this, there was an increase in heart rate in both groups that it was modest in propofol group (98 Beat/Sec versus 118 Beat/Sec, P<0.05). There was no significant difference in mean infused alfentanyl (P>0.05) also there was just one naloxane injection in midazolam group that have no significant difference between groups (P>0.05). Recovery room stay was significantly lower in propofol group (25 minutes versus 39 minutes, P<0.05).

Conclusion: The results of this study was similar to Vuyk et.al.In their study there was a significant lower recovery time estimated by psychomotor reflexes and there was significant lower drowsiness, place and time orientation time compared to midazolam group. Finally according to the results of this study it can be resulted that TIVA with propofol is more suitable than midazolam and it can lower hospitalization time and cost. In future studies using other narcotics and other narcotics-anesthetic compounds with various dose can be mentioned.

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Histiocytosis under general anesthesia. In these patients, depend on organs involvement and dysfunction, anesthesia technique and specific drugs should be selected.of langerhans cells consist of a range of clinical manifestations, including bone eosimophilic granuloma, Hand-Schuller-Chiristian syndrome and Letterer-Siwe disease. Definitive diagnosis is based on biopsy of involved tissues. This report describes anesthesia technique in a 2 years old girl for diagnostic biopsy

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Background: During general anesthesia in patients with mediastinal mass compression effect on the heart, great intra thoracic vessels, or tracheal tree can lead to decrease venous return, cardiovascular collapse or tracheal obstruction. These complications may be worsened after induction of general anesthesia or prescribing muscle relaxants.
Case report: A twenty one years old female with huge anterior mediastinal mass was a candidate for right sided thoracotomy. Compression effect on the adjacent structures has been reported in chest CT scan and in echocardiography. Awake oro-tracheal intubation was performed in sitting position. Then patient positioned to left lateral decubitus for thoracotomy During surgery asystole occured. We changed the position to remove compression effect on the heart and great vessels. Fortunately these maneuvers changed asystole to sinus rhythm.
Conclusion: Decreased thoracic muscular tone and removed spontaneous ventilation after muscle relaxant may threaten patient’s life. Change of patient’s position can remove the compression effect.

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Background: The incidence of inguinal hernia is 15 cases per 1,000 populations. The most common surgical methods of hernia repair are conventional open hernioplasty and laparoscopic hernioplasty. The advantages of laparoscopic hernioplasty are that the regional anatomy is observable, and bilateral herniorrhaphy can be performed at the same time. Since laparoscopic hernia is usually performed under general anesthesia, to shorten the length of hospital stay and to prevent complications, in this study, we evaluated the use of epidural anesthesia during hernioplasty.
Methods: This study included 20 male patients treated by a single surgeon. We recorded the PCO2 levels before, during and after surgery, as well as the pain and intra-abdominal pressure.
Results: Only one patient required conversion to general anesthesia. Three patients had hernia on the left side only, 14 patients on the right only and three patients had bilateral hernia. The PCO2 levels did not change (P=0.789). Fifty percent of patients had no postoperative pain. The median time to return to work or normal physical activity was 7 days.
Conclusion: Laparoscopic inguinal herniorrhaphy is a feasible alternative to open surgical hernia repair. Employing epidural anesthesia prevents the complications of general anesthesia. This method achieves a shorter hospital stay and time to return to normal activity, as well as reduction in pain. Controlled trials comparing laparoscopic and tension-free open herniorrhaphy are needed to further assess the relative benefits of this procedure.

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Background: Spinal anesthesia can be associated with hemodynamic changes and some other complications. The aim of this study was to evaluate the effect of adding fentanyl to lidocaine on the spinal anesthesia time and its complications for cesarean section.

Methods: Sixty pregnant women with gestational age of 37- 42 weeks and ASA physical status I and II undergoing elective cesarean section under spinal anesthesia were enrolled in a randomized double blinded clinical trial. They were randomly allocated to receive spinal anesthesia with lidocaine-normal saline (LS: 75 mg lidocaine 5% with 0.3 ml normal saline) lidocaine-fentanyl (LF) group (75 mg lidocaine 5% with 50 μg fentanyl). The duration of initiation of sensory block to achieve T4 level, time to return of sensory level to T12, time to first analgesic request, ephedrine requirement, nausea and vomiting during and after the surgery, pruritus, respirator depression, headache and apgar score of the new born  at 1st and 5th minutes were assessed.

Results: There was no significant difference between time to achieve T4 level, ephedrine dose, post operative nausea and vomiting (PONV), pruritus and headache in study groups. Time to return of sensory level to T12 was significantly longer in LF group (152.6±14.7 vs. 66.2±11.2 min, P=0.0009). Time to first analgesic request was also longer in LF group (164.2±20.8 vs. 68.1±11.3 min, P=0.0009). The incidence of nausea and vomiting during surgery was significantly more in LF group (20% vs. 0%, P=0.023). No case of respiratory depression was observed in groups.The 1st and 5th minute's apgar score were comparable between groups and were between 7 and 10.

Conclusions: Addition of fentanyl to intrathecal lidocaine in patients undergoing elective cesarean section results in increasing of the block duration and time to first analgesic request without significant maternal or neonatal side-effects, without effect on 1st and 5th minutes apgar score  with increasing the incidence of during surgery nausea and vomiting.

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Background: Remifentanil is known to produce side-effects of hypotension and bradycardia. In this study, we examine the effect of low-dose ketamine infusion on the heart rate and blood pressure of patients anesthetized with remifentanil.

Methods: In a randomized clinical trial, 54 patients aged 20-50 years old, with ASA physical status Ι, were studied in two groups (n=27), Ketamine- Remifentanil (K-R group) and Placebo- Remifentanil (P-R group). Exclusion criteria were ASA physical status >1, gastroesophageal reflux, tachycardia, bradycardia, systemic diseases, use of antihypertensive drugs, difficult intubations, risk of aspiration and contraindications of ketamine. Remifentanil was started at a rate of 0.5 µg. kg^-1. min^-1 and anesthesia was induced with thiopental sodium 2 mg.kg^-1. Maintenance of anesthesia included halothane and nitrous oxide/oxygen mixture. Remifentanil infusion was continued in both groups at a rate of 0.5 µg.kg^-1.min^-1. In the K-R group, ketamine was started with an infusion rate of 10 µg.kg^-1. min^-1, 10 minutes after intubation, while in the P-R group, normal saline was started with the same dose of remifentanil. Heart rate, systolic, diastolic and mean arterial blood pressure were measured and compared at 1, 3, 5, 10, 15, 20, 25 and 30 minutes.

Results: No significant differences were found between basic patient characteristics of mean of age, sex, weight, systolic, diastolic and mean arterial blood pressure and heart rate (p>0.2) in the two groups. However, the rate of systolic, diastolic and mean arterial blood pressure changes in the P-R group was significantly greater than that of the K-R group (p<0.006). Heart rate changes were similar between the two groups (p=0.6). Incident of severe hypotension (a decrease of more than 25% of the basic value) was less in the K-R group than that of the P-R group (11% vs. 89% p=0.000).

Conclusion: Low-dose ketamine infusion modulates the effect of remifentanil-induced hypotension and provides better hemodynamic stability during general anesthesia.

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Background: The risk of atherosclerosis and cancer is high in hemodialysis (HD) patients. There is evidence that HD causes oxidative stress. However, the causative factors of oxidative stress are unknown. It has been suggested that HD imposes an additional oxidative stress on patients with chronic renal failure by activation of granulocytes on dialyzer membranes resulting in an imbalance between oxidants and antioxidants. In this regard, a number of reports, either measuring specific analytes or enzymes, or estimating the total antioxidant activity of the plasma have given contradictory and inconclusive results. To investigate the oxidative stress status in Iranian HD patients, in this study, we evaluated GSH and FRAP levels along with Ca and pH in the blood of these patients.

Methods: Along with 20 healthy age and gender matched control subjects, 24 patients underwent dialysis, three times per week, for four hours in each session. Before and after dialysis, blood was taken for biochemical and liver function tests and to evaluate oxidative stress markers and measure Ca and pH levels.

Results: There was a significant decrease in FRAP and GSH levels after dialysis compared to those before treatment. Dialysis caused an increase in pH and Ca levels compared to levels in control subjects after dialysis.

Conclusion: In general, before dialysis, there is a balance between oxidants and antioxidants however, due to higher levels of oxidants as well as the possible binding of antioxidants to the dialyzer membrane during dialysis, an imbalance occurs. The instability in the balance of oxidants and antioxidants may be the major cause of cellular oxidative damage found in HD patients. This study indicates that there is a significant level of oxidative stress in renal chronic patients and this stress is augmented by dialysis. Antioxidant therapy should be considered in these patients.

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Background: Total spinal anesthesia is a complication of lumbar epidural anesthesia following undiagnosed subarachnoid or subdural injection of local anesthetic. Although many achondroplastic dwarfs have a normal spine, catheter insertion may be more problematic with a narrow epidural space making a subarachnoid tap more probable.  Other malformations associated with achondroplasia, such as prolapsed intervertebral discs, reduced interpedicular distance, shortened pedicles, and osteophyte formation, combined with a narrow epidural space may make identification of the space difficult and increases the risk of dural puncture. Furthermore, subarachnoid tap or dural puncture may be hard to recognize if a free flow of CSF is difficult to achieve due spinal stenosis. Yet, for those who meet the criteria, epidural regional anesthesia is frequently preferred over other forms, which often have more or more dangerous side effects in this type of patient.

Case report: A 22-year-old achondroplastic male dwarf patient was scheduled for pelvic mass resection and was considered a candidate for continuous epidural anesthesia. The anesthesia became complicated by total spinal anesthesia, which was reversed following supportive management for about two hours.

Conclusion: There is significant debate over the composition and volume of the test dose, especially for patients with achondroplasia. We nevertheless recommend repeated test-doses during the accomplishment of epidural anesthesia to exclude unintended intravascular, intrathecal or subdural injection, keeping in mind that a test dose of local anesthetic does not completely prevent complications.

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Background: The function of internal systems can be influenced significantly by hypernatremia, even anesthesia may be affected by this electrolyte imbalance. The aim of this study was to determine the effects of a single anesthetic dose of ketamine in an experimental rat model of chronic hypernatremia.
Methods: Sixty male Wistar rats, weighing 300(±20)g, were allocated randomly to three groups: the control group received drinking water and test groups 1 and 2 received 1% and 2% NaCl, respectively, for 144 hours. We measured the parameters of sensitivity to the ketamine injection (125mg/kg) including length of times to the inhibition of the righting reflex, inhibition of the response to painful stimulus and the times to the reappearance of the response to painful stimulus and recovery from anesthesia. We also determined the mortality rates during anesthesia.
Results: The times for inhibition of the righting reflex and response to painful stimulus for group 2 were significantly shorter than those for group 1 and the control group. The times for the reappearance of response to painful stimulus and full recovery from anesthesia in group 2 were significantly longer than those of group 1 and the control group.
Conclusions: Hypernatremia affects ketamine anesthesia in the rat, increasing the speed of passing through the different steps of anesthesia. The duration of ketamine efficacy increases, while recovery from anesthesia is significantly delayed.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 !mso]> ject classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui> Background: Chronic peritoneal dialysis is a safe method for the treatment of end-stage renal failure. Worldwide, patients on chronic peritoneal dialysis constititute approximately 15% of the total number of patients on dialysis. In Iran, very few people have access to chronic peritoneal dialysis, which is targeted by the Ministry of Health. This lack of access is primarily due to the high occurrence of mechanical complications. Improving catheterization procedures is an important way to extend the use of peritoneal dialysis in Iran. Thus, a prospective study was implemented to evaluate the outcome of a new laparoscopic technique for the insertion of peritoneal dialysis catheters under local anesthesia.
Methods: A total of 115 catheters (two-cuff, swan-necked, coiled) were inserted into the peritoneal cavity of 109 patients with end-stage chronic renal failure during a 16-month period. The method of insertion was a two-port laparoscopic technique with local anesthesia and sedation. All patients were followed for 12 to 28 months. We prospectively evaluated mechanical and infectious complications and survival rates of the catheters.
Results: The average age of the patients was 51.5 years (range: 15-84 years) 54.8% of these patients were female. The overall one-year and two-year catheter survival rates using this approach were 88% and 73%, respectively. Event-free catheter survival was 35%. The most common infectious and mechanical complications were peritonitis in 52 cases (45.2%) and temporary dialysate leakage in 10 cases (8.7%) respectively.
Conclusion: Laparoscopic insertion of peritoneal dialysis catheter with local anesthesia is a safe and simple procedure, giving reasonable rates of catheter survival and complications.

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Background: Acute hepatitis is upon serious complications of halothane usage, can be associated with 50% mortality in severe cases. Use of halothane as inhalational anesthetic or use of it for maintenance of anesthesia is restricted/ prohibited in USA and most European countries. The occurrence of icterus and elevated liver enzymes after halothane anesthesia may be due to the drug induced hepatitis.

Case report: we report a 28 year old woman with acute hepatitis after cesarean section under halothane anesthesia, fortunately discharged to home 40 days after that. Other causes of hepatitis became role out in the patient.

Results: The usage of halothane should be restricted/ prohibited in our country because of its potentially serious and fatal complications and so existence of more safe but expensive alternatives.

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Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: Successful brachial plexus blocks rely on proper techniques of nerve localization, needle placement, and local anesthetic injection. Standard approaches used today (elicitation of paresthesia or nerve-stimulated muscle contraction), unfortunately, are all "blind" techniques resulting in procedure-related pain and complications. Ultrasound guidance for brachial plexus blocks can potentially improve success and complication rates. This study presents the ultrasound-guided brachial plexus blocks for the first time in Iran in adults and pediatrics.
Methods: In this study ultrasound-guided brachial plexus blocks in 30 patients (25 adults & 5 pediatrics) scheduled for an elective upper extremity surgery, are introduced. Ultrasound imaging was used to identify the brachial plexus before the block, guide the block needle to reach target nerves, and visualize the pattern of local anesthetic spread. Needle position was further confirmed by nerve stimulation before injection. Besides basic variables, block approach, block time, postoperative analgesia duration (VAS<3 was considered as target pain control) opioid consumption during surgery, patient satisfaction and block related complications were reported.
Results: Mean adult age was 35.5±15 and in pediatric group was 5.2±4. Frequency of interscalene, supraclavicular, axillary approaches to brachial plexus in adults was 5, 7, 13 respectively. In pediatrics, only supraclavicular approach was accomplished. Mean postoperative analgesia time in adults was 8.5±4 and in pediatrics was 10.8±2. No block related complication were observed and no supplementary, were needed.

Conclusions: Real-time ultrasound imaging during brachial plexus blocks can facilitate nerve localization and needle placement and examine the pattern and extend of local anesthetic spread.

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Background: There are a number of reports regarding awareness during anesthesia and its risk factors. The aim of this study was to assess the frequency of awareness in elective abdominal surgery in opium abusers compared with non-abusers.
Methods: In a cross-sectional descriptive-analytical study, 120 patients were selected and were divided into two groups, opium addicts and non addicts, 60 patients in each. The patients were compared regarding clinical criteria during anesthesia. They were reviewed regarding the content of their answers to the study questionnaire, after a time interval of 24 hours postoperatively (after the surgery). To evaluate the awareness status after general anesthesia, a clinical assessment checklist was used and also, two questionnaires were used. These questionnaires were composed of open ended questions and were administered by one of the colleagues (they were not self administered questionnaires to increase the appropriateness of the answers)
Results: There was no differences between the two research groups regarding basic study variables (p>0.05). The clinical findings and the results of the interviews demonstrated more awareness in the opium abusers (p<0.001).
Conclusions: This study demonstrated a higher chance of awareness in the opium abusing patients when undergoing general anesthesia for the surgical operations involving the abdominal area. This study mentioned that a history of opium abuse can be added as a risk factor for awareness to the previous risk factors.

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Background: Patients who require surgery on the lower extremities are considered to be a high risk group from the point of anesthesia. This study was performed to compare sitting and lateral positions in spinal anesthesia method with hyperbaric bupivacaine 0.5% for hemodynamic status and analgesic period in patients under vascular surgery of the lower limbs in Imam-Khomeini Hospital Complex affiliated to Tehran University of Medical Sciences in 2009.

Methods: In this study 40 patients were divided into two groups of 20 to undergo spinal anesthesia with 3 ml of hyperbaric bupivacaine 0.5% injected into the subarachnoid space in sitting or lateral positions. The anesthesia was performed at T10 level and the hemodynamic status and analgesic periods were compared in the two groups.

Results: The changes in mean arterial blood pressure and systolic and diastolic blood pressures were different between the two groups (P<0.05). Except in the first and thirtieth minutes, the changes in heart rate (HR) were significantly different throughout the study between the two groups (P<0.04) and they were higher in sitting position. The duration of analgesia was significantly longer in lateral position (P<0.04) and the use of fluid was significantly larger in the sitting group (P<0.05).

Conclusion: According to the obtained results, the changes in hemodynamic variables were significantly lower in the group in lateral versus sitting position in patients undergoing spinal anesthesia with bupivacaine for vascular surgery of the lower limb.

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Background: Renal transplantation is the preferred therapeutic method for patients with end-stage renal disease. Patients with renal failure have significant associated medical conditions, such as cardiovascular disease. The suitable anesthesia for renal transplantation requires minimal toxicity for the transplanted organ, as well as sufficient pain relief and maintenance of optimal blood pressure and intravascular volume to keep renal functions. The aim of this study was to improve our experience of spinal anesthesia in patients undergoing renal transplantation.
Methods: Sixty consecutive patients scheduled for elective renal transplantation over a period of two years who consented for spinal anesthesia were enrolled in the study. Intraoperative hemodynamic, intravenous fluids and infused blood products, duration of surgery, urine output and arterial blood gas and intensity of pain score in the recovery room were monitored. We also noted intraoperative and postoperative complications.
Results: Spinal anesthesia was satisfactory in all, but in five patients they required supplementation with general anesthesia for excessively prolonged surgery. There were no significant intraoperative hemodynamic changes. The total intravenous fluid used during surgery was 65.15±7.2 mL/kg, the mean surgical time was 170±22 min. The mean of mean arterial pressure (MAP) during the operation was 98±12 mmhg. There was no significant acidosis at the end of the operation (PH=38±0.03). Also the mean intensity of pain was 4±2 in recovery and a few of patients suffered from bladder catheter bladder discomfort in the recovery room (8 patients).
Conclusion: Spinal anesthesia is a successful regional anesthetic technique in well selected patients for renal transplantation. A successful outcome in this technique is dependent on close intra-operative monitoring, optimization of intravascular fluid volume and keep the hemodynamic status in optimal range.

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Background: Pain is one of the greatest concerns of patients undergoing total knee arthroplasty (TKA) which is severe and intolerable within 72 hours post-surgery. Appropriate pain management is a key factor in patient's early mobilization, launching physiotherapy, less hospital length of stay and more importantly, patient's satisfaction. New studies with the infiltration of combined analgesic agents peri and intra-articularly has shown encouraging results in pain reduction, good clinical outcome and patient's satisfaction. The purpose of this study was to compare the analgesic effect of locally infiltrated analgesia (I) compared with single injection femoral nerve block (F) and its impact on pain relief, patient's satisfaction, morphine consumption and clinical outcome.

Methods: This research was a double-blind randomized clinical trial on 36 consecutive patients undergone TKA divided into group (F) in which the ipsilateral femoral nerve in the inguinal area was blocked by a single injection of 20 ml ropivacaine (10 mg/ml) and group (I) which a combination of ketorolac, ropivacaine and epinephrine was injected peri and intra-articularly on the knee during TKA. Pain intensity measured by visual analog scale (VAS), clinical outcome (based on range of motion), morphine consumption and patient's satisfaction of pain management after TKA were compared between the two groups.

Results: Pain intensity score (VAS) and Morphine consumption were statistically less in group I than group F during the first 6 hours and 24 hours post surgery respectively (P< 0.05) however, group F had 12-hour VAS score of 5 which was less than group (I) by 1 grade in pain scale (VAS) (P< 0.05). Other parameters were not statistically different in the two groups and patients' response to our pain management protocols proved to be satisfactory in both groups.

Conclusion: Lower level of pain and morphine consumption in group (I) during the first 24 hours post-surgery in contrast to group (F) and its ease of use by a surgeon intra-operatively, introduce local infiltration analgesia as an effective method to decrease the patient's pain and improve patient's satisfaction in early post-surgery period after total knee arthroplasty.

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Background: The Trigemino-cardiac reflex (TCR) has been studied as a phenomenon including bradycardia, arterial hypotension, apnea and gastric hypermotility during manipulation of the peripheral or central parts of the trigeminal nerve.
Case presentation: We report a case of a 26-year-old man undergoing surgery for a skull base extra axial tumor in right petrous bone suspected to metastasis of a previous renal cell carcinoma which had been treated four years ago. The patient presented with continuous and unilateral headache and difficulty in swallowing, sensory neural hearing loss, nasal speech and tongue deviation to left side. He underwent general anesthesia with standard monitoring and total intravenous anesthetic technique. The first episode of sudden onset bradycardia and hypotension related to surgical manipulation was detected intraoperatively in which the heart rate spontaneously returned to normal level once the surgical manipulation stopped. However, it repeated several times by beginning of tumor resection and manipulation in the region of trigeminal nerve. The intensity of bradycardia in subsequent episodes of TCR was relatively crescendo and had no fatigability. Finally, it was treated by administration of a single dose of atropine (0.5mg/IV) and did not happen again.
Conclusion: The risk of TCR should be considered in any neurosurgical intervention involving trigeminal nerve and its branches, especially at the skull base surgeries. The vigilance of the medical team and continuous intraoperative hemodynamic monitoring alerts the surgeons to interrupt surgical maneuvers upon the TCR occurrence, immediately.

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Background: Nowadays, new methods are emerging each month for a better operation with fewer complications. Laparoscopic surgery have remarkable advantages, Compared to open, such as smaller incision, less manipulation of the digestive system, less postoperative pain, fewer wound complication and faster discharge from the hospital. Therefore it is preferred by patients and surgeons and is replacing the traditional open surgical methods. However, any operation causes significant panic for patients and lack of knowledge about the surgical method is found to cause poor surgical outcomes, such as recovery time after the surgery we evaluated the effect of preoperative education on the recovery time of laparoscopic cholecystectomy candidates. Methods: This randomized clinical control trial was performed at Imam Khomeini and Alborz Hospitals in Karaj from February 2010 till January 2011. Using randomized sampling method, 100 female candidates for laparoscopic cholecystectomy were divided into two equal groups of case and control. The case group received detailed information about operating room’s condition, surgical equipment, anesthesia method, advantages and disadvantages of laparoscopic procedures, and patient’s role in self-care at recovery, whilst the control group received no education before the surgery. The two groups were compared regarding recovery time based on Aldrete modified checklist and mean time to reach the Aldrete consciousness score of 9 and the incidence of nausea was assessed among them. Results: The analysis showed that there was a significant difference between the mean time to reach Aldrete consciousness modified checklist score of 9 between the case and control group (18.04±3.87 vs. 29.66±5.44, respectively, P<0.001), therefore the case group had shorter recovery time than the control group. 10 of the case group (20%) and 3 of the control group (6%) had nausea after recovery (P=0.037, OR=0.255 (CI 95%: 0.066-0.992)). Conclusion: Preoperative education of patients can significantly decrease the recovery time after laparoscopic cholecystectomy surgery. Therefore, it is strongly recommended to include the preoperative education in routine care of laparoscopic cholecystectomy patients for better surgical outcomes.

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Background: Today Anesthesiologists occasionally face with bradycardia during gastric surgery and recognized this phenomenon as a vagal reflex. The objective of this study is finding of anesthesia risk factors for bradycardia and prevention of its hazardous complications during gastric surgeries. Methods: In this retrospective study, fifty patients undergoing laparatomy and gastric surgery in Sina hospital between September 2009 to September 2013. They had been anesthetized with propofol or thiopental and their maintenance was kept by isoflurane or propofol were enrolled. The age, gender, underlying diseases, drug history, chemotherapy, kind of surgery, heart rate variability, onset time of bradycardia and its complication during a period of four years was noted. Results: Of Fifty patients, 31 males and 19 females was enrolled in this study. The mean age of patients was 48±8.3 yr all patients had laparatomy under general anesthesia. The kind of surgery were mainly gasterectomy and gastrojejunostomy. The mean onset of episode bradycardia was 24.5±3.5 min after initiation of surgery incision, and most of the bradycardia was mild to moderate (47 patients) that with injection of atropine it resolved. There was no relationships between anesthetic drugs and anesthetic maintenance, age, gender, and incidence of bradycardia event during the surgery. The risk factors of bradycardia were, diabetes mellitus in seven patients, use of beta blockers in 17 patients in perioperative period and gastric cancer and chemotherapy (neoadjuant therapy) in three patients that lead to asystole, they were not response to standard treatment during surgery and lead to death. Conclusion: The history of gastric cancer and previous chemotherapy might be the only common factors that cause to bradycardia and irresponsible asystole during gastric surgery in these patients. It seems that only close monitoring and vigilant anesthesiologist require for treatment and prevention from adverse effect of such a sever bradycardia event.