Role of Magnesium Sulfate in Preventing Vasospasm and Maintaining Hemodynamic Stability in Patients Undergoing Endovascular Coiling for Brain Aneurysm

Introduction: Themaintenance of hemodynamic stability in brain aneurysm surgery has paramount clinical significance in order to prevent vasospasm in the patients with aneurysmal subarachnoid hemorrhage. Regarding this, the present study was conducted to assess the role of magnesium sulfate in preventing vasospasm and maintaining hemodynamic stability during endovascular coiling procedure for brain aneurysm. Materials and Methods: This double-blind clinical trial was conducted on 60 patients who were candidates for undergoing endovascular coiling for brain aneurysm. The patients were subjected to angiography through femoral artery catheterization. Then, they were randomly assigned into two treatment groups of case receiving magnesium sulfate and control administered normal saline. The vasospasm and hemodynamic status were measured and recorded during and following the surgery. Results: According to the results, no significant difference was observed between the two groups in terms of heart rate (p=0.98) and mean arterial pressure =p) 0.89(  one hour post-surgery. Furthermore, there was no statistical difference between the two groups regarding the use of nimodipine ( p=0.11). Nevertheless, the frequency of vasospasm was significantly lower in the patients receiving magnesium sulfate, during surgery (p=0.037) and after surgery (p=0.02), compared to those administered normal saline. Conclusion: As the findings indicated, magnesium sulfate could lower the incidence of vasospasm during and following the endovascular coiling procedure for brain aneurysm. Moreover, it resulted in no adverse effects on the hemodynamic status of the patients

Nausea and Vomiting after Septorhinoplasty Using Alfentanil or Remifentanil

Introduction: The aim of this study was to compare Alfentanil with Remifentanil regarding postoperative nausea and vomiting. Materials and Methods: In this double-blind randomized controlled trial, we studied 60 patients, between 17-48 years old with American Society of Anesthesiologists class I or II undergoing septorhinoplasty. The patients signed informed consent and then were randomly divided into two groups. Induction was started similarly in both groups using Midazolam, Propofol and Atracurium whereas group one Alfentanil group (AL group) received Alfentanil and group two Remifentanil group (R group) received Remifentanil. We used Alfentanil with Propofol in the AL group or Remifentanil with Propofol in the R group as maintenance drugs. We assessed nausea and vomiting with Visual Analogue Scale (VAS) from the extubation time until 24 hours after the surgery. We used ondansetrone to relieve nausea. Results: Our patients had a mean age of 25.7±5.4. 75% were female and 25% were male. Duration of surgery had a mean time of 167.5±15.8 minutes and there was not statistically any difference between the two groups. We assessed nausea and vomiting incidence and severity on Visual Analogue Scale score in 0-1 hour, 1-6 hours and 6-24 hours after surgery. The highest nausea and vomiting incidence was in 1-6 hours after the surgery and the two groups were statistically the same. Conclusion: Our results did not show a statistically significant difference between using Alfentanil and Remifentanil as induction and maintenance drugs, regarding nausea and vomiting in the 24 hours post operation period.

Comparison of Patient-Controlled Analgesia Using Morphine With and Without Paracetamol in Postoperative Pain Control

Introduction: Postoperative pain control plays a pivotal role in reducing postoperative complications, hospitality time, and increasing satisfaction. This study aimed to evaluate the effect of paracetamol on the pain and complications caused by gastrectomy. Materials and Methods: This randomized prospective study was conducted on 60 patients (two same group) who were candidate for gastrectomy in Imam Reza Hospital of Mashhad, Iran during August-September 2015. The first group received Patient-Controlled Analgesia (PCA) with morphine only, and in the second group, paracetamol (1 gram) infused with morphine every six hours. Level of pain, morphine intake, and side effects were evaluated in both groups. Results:No significant difference was observed in the four-scale score of pain in the patients (morphine group: 0.64±0.1, morphine-paracetamol group: 0.6±0.1) (P=0.72). During the first 24 hours after the surgery, the morphine group had lower consciousness level (2.3±0.2) compared to the morphine-paracetamol group (1.7±0.3) (P=0.001). Moreover, infusion of paracetamol with morphine to control the pain after gastrectomy reduced the need for morphine analgesia. Morphine intake was 21.4±7.7 in morphine group, while it was 14.3±5.8 in the morphine-paracetamol group within the first 24 hours after the surgery (P=0.001). However, this level had no significant effect on postoperative complications such as itching, nausea, and arterial oxygen saturation. Conclusion: According to the results of this study, intravenous paracetamol (one gram) administered every six hours with PCA using morphine could decrease morphine intake leading to better consciousness level during the first 24 hours after gastrectomy without further complications