Assessing the effects of dexmedetomidine and labetalol on changes in heart rate and blood pressure after laryngoscopy compared to a control group

Background: One of the objectives of a smooth laryngoscopy is to minimize hemodynamic changes. The goal of this study was to assess the effects of dexmedetomidine and labetalol on heart rate and blood pressure changes after laryngoscopy compared to a control group. Materials and Methods: This was a double-blind clinical trial conducted on 120 patients aged between 18 and 60 years, who were candidates for surgery, under general anesthesia, at Alzahra hospital in Isfahan during 2017-2018. Patients were randomly allocated to three groups of being administered dexmedetomidine or labetalol and a control group. The patient's age, weight, height, gender and clinical data including mean blood pressure (BP), heart rate, systolic BP, diastolic BP and oxygen saturation during 1, 3, 5 and 10 minutes after intubation were collected and analyzed using repeated measure analysis. Results: The average age of patients who were candidates for surgery was 42.62 +/- 1.40. 52 percent (63 patients) were male subjects. The results showed no significant difference in mean BP, diastolic BP, systolic BP or oxygen saturation (p>0.05) in the three groups. But the difference in heart rate between the three groups was statistically significant. The heart rate in the dexmedetomidine group was significantly lower than the labetalol and control groups (p=0.00). Conclusion: Results of the current study showed that using labetalol provided desirable hemodynamic stability compared to dexmedetomidine and caused less hemodynamic disturbances

Comparative study of the effect of two different doses of intravenous labetalol on the cardiovascular response to endotracheal extubation

Introduction: Providing a stable hemodynamic in extubation is important. We aimed to compare the effect of two different doses of intravenous labetalol on the cardiovascular response to endotracheal extubation. Methods: This double-blind randomized trial was performed in 2019-2020 in Isfahan on 72 patients under general anesthesia. Patients using Random Allocation software were divided into three groups and received 0.1 mg/ kg or 0.2 mg/kg labetalol and normal saline intravenously 10 min before extubation. Hemodynamic variables including heart rate (HR), Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and peripheral blood oxygen saturation(SPO2) was measured for each patient before induction of anesthesia and 1, 3, 5 and 10 minutes after extubation. Results: SBP changes were significantly different between the three groups at 1, 3, 5 minutes after extubation (P=0.036, P=0.009, P=0.005 respectively) unlike the other two groups, patients who received 0.2 mg/kg labetalol did not have an increase in DBP after extubation (P>0.05). DBP was significantly different between the three groups one minute after extubation (P=0.03). At minutes 1 and 3 following extubation, there was a significant difference in the MAP between the three groups. (P=0.029 and P=0.012 respectively). There was no significant difference between the three groups regarding heart rate (P>0.05). Conclusion: Tracheal extubation is usually associated with an increase in hemodynamic variables. Both doses of labetalol attenuate the hemodynamic response accompanying tracheal extubation. But labetalol 0.2 mg/kg in reducing hemodynamic response to extubation acted more effectively than labetalol 0.1mg/kg

Comparative Study of the Preemptive Dexmedetomidine Versus Ondansetron Effect in Post-Operative Nausea and Vomiting after Middle Ear Surgery

Background: Nausea and vomiting after operation has high prevalence and cause adverse effect. The aim of this study was to compare the effect of dexmedetomidine with ondansetron in prevention of post-operative nausea and vomiting (PONV) after middle ear surgery under general anesthesia.and saliva gas in traumatic patients under mechanical ventilation. Methods: This in this double-blinded clinical trial study, one hundred and sixty-two patients undergoing middle ear surgery under general anesthesia were randomly divided into three groups of 55 each: ondansetron (O), dexmedetomidine (D) and control (C). Group O received 0.1 mg/kg of ondansetron, Group D received 1 μg/kg/min of dexmedetomidine and Group C received 10 cc of normal saline 15 to 20 minutes before surgical incision. After that, the patients were examined in post-anesthesia care unit (PACU) and up to 24 hours after the operation in terms of PONV and other study variables. Results: The severity of nausea after operation based on VAS (visual analog scale) was significantly different between Group O (2.2±0.7) and Group D (3.9± 0.7) and Group C (5.15±1.3) (P= 0.04). The incidence of vomiting in the first 24h postoperatively was 14.8% in Group O, 46.3% in Group D and 88.8% in Group C (P= 0.003). Conclusion: Our study showed that ondansetron was better than dexmedetomidine for prevention of PONV after middle ear surgery

Effect of intravenous administration of atropine-neostigmine versus ondansetron in prevention postdural puncture headache in cesarean section under spinal: a randomized clinical trial

Background: More than one-third of women develop headaches in the first week after childbirth. Approximately 75% are benign primary headaches such as migraines or tension headaches. Others are secondary and include headaches of vascular origin or from hypertensive disease, infection, space-occupying lesions and dural puncture. Postdural Puncture Headache (PDPH) is a common and annoying complication of spinal anesthesia, especially in cesarean section. This study compares the impress of an Atropine-Neostigmine mixture and Ondansetron on Post Spinal Puncture Headaches in Cesarean sec. Methods: This triple-blinded controlled randomized clinical trial was conducted on 60 pregnant women candidates for cesarean section under spinal anesthesia, that was carried out from May 2021 to August 2021 at Behshti Medical and Education Center affiliated with Isfahan University of Medical Sciences. The study was approved by the Ethics Committee of the University (IR.MUI.REC.1400.009) and informed consent was obtained from the patients/legal guardians. This clinical trial was registered at www.irct.ir with identification code IRCT 20160307026950N39.  People were randomly assigned into three groups. A mixture of neostigmine (20 micrograms per kilogram) and atropine (10 micrograms per kilogram) in the first group and 4 mg of Ondansetron in the second group and a similar volume of normal saline in the control group were administered before surgery. Patients were followed up for headaches up to seven days after surgery. The severity of the headache was measured using the VAS scale. One-way analysis of variance (ANOVA) and non-parametric equivalent, Kruskal-Wallis, chi-square test, and repeated measure test were used to measure the relationship between the variables. Results:  Analysis of the data did not show a significant difference between the three groups in terms of headache severity (P=0.788), headache duration, (P=0.723), the time elapsed from lumbar puncturing to the occurrence of the first headache (P=0.653), and the frequency of attempts for correct spinal tap (P=0.685). Conclusion: none of our considered interventions had a noticeable impress on preventing or reducing PDPH in Cesarean section

Effects of perioperative use of two doses of magnesium sulfate infusion on intraoperative blood loss in patients undergoing lumbar spinal fusion surgery

Objective: In general, spinal fusion surgery causes heavy bleeding. The purpose of this study was to evaluate the use of two different doses of magnesium sulfate to control the bleeding in lumbar fusion surgery. Methods: This study was carried out as a randomized double-blinded clinical trial in 2020 in Al-Zahra hospital in Isfahan. The participants were 60 patients selected using inclusion and exclusion criteria and were randomly allocated into three groups. In the first group, 50 mg/kg and in the second group, 40 mg/kg magnesium sulfate was infused. The third group received normal saline. From the beginning of anesthesia, heart rate, diastolic and systolic blood pressure, respiratory rate and blood oxygen saturation percentage were monitored and logged every 30 minutes during the operation and recovery. The volume of bleeding during the operation was calculated by counting the number of gauzes used and the amount of suctioned blood during the operation. Other required information such as the duration of operation, duration of anesthesia, time of intubation and the time period of hospitalization and recovery were determined and recorded in all patients. We used independent t-test and repeated measure ANOVA tests to compare data between different time lines and also different groups. P value<0.05 was considered as significance threshold. The collected data were analyzed by using SPSS software version 23. Results: The group receiving 50 mg/kg magnesium sulfate had a significantly lower systolic blood pressure compared to other groups within 15, 30 and 45 minutes after the injections (P=0.04 for all). The pulse rate was significantly lower in the 50 mg/kg magnesium sulfate group compared to other groups within 15, 30 and 45 minutes after the injections (P<0.05 for all). Patients that received 50 mg/kg magnesium sulfate had a lower duration of surgery (P=0.007), lower duration of anesthesia (P=0.007), lower bleeding volume (P<0.001), lower fluid intake (P=0.01) and also lower transfused blood (P=0.01). The surgeons also had a significantly higher satisfaction with these patients (P=0.001). Conclusion: Injection of 50 mg/kg magnesium sulfate had a correlation with reduced blood pressure as well as bleeding volume compared to 40 mg/kg magnesium sulfate

The effect of delayed first feeding on growth and survival of yellowfin seabream (Acanthopagrus arabicus) larvae

The effect of different initial feeding times (48 h, 72 h, 96 h, and 120 h after hatching) and food deprivation on the point-of-no-return (PNR), survival, and growth of yellowfin seabream Acanthopagrus arabicus larvae were studied under controlled condition. Growth parameters were investigated by evaluating morphometric (head depth, body depth, gut height, musculature height, eye diameter, total length, yolk, and oil globule volume) and gravimetric (dry weight) indices. The larvae commenced to feed exogenously at the mouth opening stage on day 2 after hatching (DAH) and reached PNR between 6 and 7 DAH at 19–20 °C. The time of initial feeding significantly affected the larval growth. From 3 DAH until the end of the trial period at 15 DAH, the growth (all morphometric indices and dry weight) of larvae started which earlier initial feeding start (48 h and 72 h after hatching) were significantly higher than that of 96 h (P < 0.05). Growth parameters were measured until 9 DAH in the larvae commenced feeding at 120 h, since complete mortality was recorded after this sampling point (at 12 DAH). During this period, the larvae showed significantly lower morphometric indices and dry weight compared with larvae in other initial feeding time treatments (48 h, 72 h, and 96 h). Yolk absorption in yellowfin seabream larvae was completed on 4 DAH regardless of the variances in the time of first feeding. Likewise, the oil globule was completely utilized on 5 DAH in all initial feeding trials. No significant differences were noticed in yolk volume and oil globule absorption between different treatments. At the end of the trial at 15 DAH, the survival rate was significantly higher for larvae began first feeding at 48 h (35.67 ± 7.01%) and 72 h (36.48 ± 4.72%) when compared to 96 h first feeding larvae (13.10 ± 2.62%)(P < 0.05). The findings from the current study reveal that the first feeding of yellowfin seabream larvae can be initiated up to 72 h after hatching with no significant differences in growth and survival rate