Prevention of Bradycardia by Atropine Sulfate During Urological Laparoscopic Surgery A Randomized Controlled Trial

anesthesia for laparoscopy. The aim of this study was to evaluate the efficacy of atropine sulfate for prevention of bradyarrhythmia during laparoscopic surgery. Materials and Methods: Sixty-four candidates for urological laparoscopic surgery were randomly assigned into 2 groups to receive either atropine sulfate or hypertonic saline solution (as placebo), intravenously 3 minutes before induction of anesthesia for the laparoscopic procedure. Then, all of the patients underwent anesthesia intravenous sodium thiopental and atracurium, followed by isoflurane or halothane inhalation. Heart rate and blood pressure were recorded preoperatively in the recovery room, preoperatively in the operation room, after induction of anesthesia, after induction of pneumoperitoneum, and postoperatively. Results: A significant decreasing trend was seen in the heart rates during the operation in patients without atropine sulfate. Nine of 32 patients (28.1%) in this group developed bradycardia, while none of the patients with atropine sulfate prophylaxis had bradycardia perioperatively (P <.001). The mean decreases in systolic blood pressure between induction of anesthesia and pneumoperitoneum were 15.7 +/- 10.2 mm Hg in group 1 and 23.5 +/- 9.8 min Hg in group 2 (P <.001). The mean decreases in diastolic blood pressure between these two measurements were 8.7 +/- 5.2 min Hg in group 1 compared to 12.1 +/- 6.2 mm Hg in group 2 (P =.001). Conclusion: This study suggests that routine prophylaxis with an anticholinergic agent might be helpful in prevention of sinus bradycardia during urological laparoscopic surgery

Effects of Preemptive and Preventive intravenous Paracetamol on postoperative pain and opioid consumption in patients undergoing laparoscopic nephrectomy

Background: Adequate pain control is a goal in post operative recovery. However opioids provide good analgesic effects, their side effects such as postoperative nausea and vomiting (PONV) limit their administration. Intravenous Paracetamol as a safe and well tolerated drug with lower side effects can be used instead of opioids for pain management.Objectives: The aim of this study is to compare preemptive or preventive administration of paracetamol with placebo group to investigate its effects on pain control and opioid consumption in patients undergoing laparoscopic nephrectomy.Patients and Methods: Ninety patients were randomly divided to three groups. Preemptive group received 1 gr paracetamol in 100 ml normal saline 30 minutes before induction of anesthesia, Preventive group received 1 gr paracetamol in 100 ml normal saline before closure of the skin and placebo group just received 100 ml normal saline. Post surgical pain was assessed using Verbal Rating Scale (VRS). Pethidine 0.25 mg/kg was administered and repeated each 10 minutes to control pain. Pain scores, total dose of opioid and symptoms like nausea and vomiting were recorded. Results: Preemptive and Preventive groups had lower pain scores than placebo group. Opioid consumption and PONV were significantly higher in placebo group. No significant differences were observed between Preemptive and Preventive groups.Conclusion: IV Paracetamol can provide an adequate pain control with low side effects and may be an effective choice in management of post operative pain in patients undergoing laparoscopic nephrectom