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Objective: One of the most common complications in general anesthesia is the Emergence delirium (ED). Many agents have been studied for prevention of ED, among which propofol has been successfully used. However, there is no information about the optimal dosage of this agent considering the ultimate outcome and the adverse effects; therefore, aimed to assess in this study. Method: 70 children undergoing general anesthesia using propofol, fentanyl, and atracurium were assessed. Participants were allocated randomly to treatment with either propofol 1 mg/kg (n = 35) or 0.5 mg/kg (n = 35) by the end of the anesthesia. The Pediatric Anesthesia Emergence Delirium (PAED) Scale, Face, Legs, Activity, Cry, Consolability (FLACC) scale, and the University of Michigan Sedation Scale (UMSS) were assessed by 10-minute intervals. Post-anesthesia care unit (PACU) stay and adverse effects were registered and compared as well. Results: Duration of PACU stay (P < 0.001), PAED (P = 0.001), and UMSS (P = 0.003) were remarkably lower among low-dose propofol-treated children in the assessment at the 30th minute, while there were no significant differences in FLACC scores between the groups (P > 0.05). Apnea was found in a patient (2.85%) treated with high-dose propofol and decreased oxygen saturation was demonstrated in 5 (14.28%) and 2 (5.71%) participants in high- versus low-dose propofol. None of the patients experienced postoperative nausea and vomiting. Conclusion: Based on the current study, propofol 0.5 mg/kg by the end of anesthesia could efficiently prevent ED incidence and reduce time of PACU stay and adverse effects compared to a high dose of 1 mg/kg.

Background: Electroencephalography is a record of the electrical activity of the brain that is used to diagnose brain dysfunction and to determine the location of brain injury and to determine seizure activity. There is. The sedative medication used should not only have an effect on the brain’s electrical activity, but it also calms the baby. Since there have been no studies to compare the effects of intranasal oral hydrate and dexmedetomidine on sedation in children for electroencephalography, this study aimed to compare the effects of intranasal intravenous dexmedetomidine with intramuscular dexmedetomidine on electroencephalography in children. Methods: This clinical trial study was performed on 62 children candidates for electroencephalography in Imam Hossein Pediatric Hospital in Isfahan. Age, weight, and clinical data including sedation score, mean arterial pressure, respiratory rate, arterial oxygen saturation, and heart rate at pre-medication times, 15, 30, 45, and 60 minutes after drug administration. And analyzed. Results: The mean age of the children candidates for electroencephalography was 16.90 ± 1.32, out of which 35 (56.5%) were male. The results showed no significant difference between the two groups in terms of sedation, mean arterial pressure, respiratory rate, and percentage of arterial oxygen saturation (p> 0.05). But the difference between the two groups was statistically significant for the variable heart rate. Heart rate was significantly lower in group B (dexmedetomidine group) than in group A (oral chlorate hydrate group) (p-value = 0.032), and time as an influencing factor in changing mean sedimentation, mean arterial pressure, respiratory rate, and heart rate (p-value

Abstrect Presentation : 76-year-old female with hypertension, diabetes, and end stage renal disease on hemodialysis was sent to the emergency department for complaining of neck and jaw pain associated with hypotension during dialysis. Her electrocardiogram is shown in figure 1. Clearly, biphasic T waves can be seen in V2-V3. These T wave changes were not seen in her last EKG. (figure 2). She was asymptomatic in the emergency department and her troponins were negative. Her electrolytes were also within normal limits with normal vital signs. Her cardiovascular exam was unremarkable. Assessment : The patient remained asymptomatic in the emergency room with persistent negative troponins. However, the appearance of pericardial biphasic T waves in V2 and V3 seen on her presenting EKG was consistent with Type A Wellen's syndrome EKG (or initially described by Dr. Gerson as inverted U waves). Even though, she had no chest pain and was hemodynamically stable, the classic appearance of Wellen's syndrome EKG is of major concern needing immediate diagnosis and treatment. Diagnosis : Patients presenting with Wellen's syndrome EKGs are at a very high risk for anterior myocardial infarction requiring an invasive work up regardless of their hemodynamic stability or level of cardiac enzymes. They have usually high-grade proximal left anterior descending or left main coronary artery disease. Management : As she was at a very high risk for myocardial infarction based on her EKG, she was taken to the cardiac catheterization laboratory despite remaining asymptomatic in the emergency department and having normal cardiac enzymes. Her coronary angiogram showed severe three vessel coronary artery disease with involvement of her proximal left anterior descending artery as suspected (figure 3). She underwent successful coronary artery bypass grafting. After her surgery, she did well and did not experience any further episodes of hypotension or jaw pain during her dialysis.

Formally described by Prinzmetal and colleagues in 1959, variant angina represents a syndrome of resting angina that results from severe coronary artery vasospasm associated with ST elevation. The majority of patients respond to nitrates or calcium channel blockers. However, medical treatment-resistant vasospasm can occur in up to 20% of cases, thus requiring further interventions. We present a rare instance of coronary vasospasm associated with complete heart block resistant to medical therapy that was successfully treated with stenting. This case example is followed by a detailed review of the literature with regard to percutaneous or surgical coronary revascularization of patients with medically resistant vasospasm.

Summary Background Neostigmine is a spinal analgesic that could be a useful adjunct. This study was conducted to evaluate the postoperative analgesic efficacy and the safety of two low doses of intrathecal (IT) neostigmine in patients undergoing knee arthroscopy under spinal bupivacaine anaesthesia. Methods By using a double-blinded study design, 80 patients undergoing knee arthroscopy during spinal anaesthesia were divided into four groups: bupivacaine group (Group B) received 15 mg hyperbaric bupivacaine; bupivacaine + fentanyl group (Group BF) received 15 mg hyperbaric bupivacaine mixed with 25 μg fentanyl; bupivacaine + neostigmine group 1 (Group BN1) received 15 mg hyperbaric bupivacaine mixed with 25 μg neostigmine; bupivacaine + neostigmine group 2 (Group BN2) received 15 mg hyperbaric bupivacaine mixed with 35 μg neostigmine. The postoperative visual analog scale (VAS) and the incidence of adverse effects were recorded for 24 h after administration of study drugs. Results VAS scores were significantly lower in group BN2 compared with group B, group BF and group BN1 at 2, 4, 6, 12, and 24 h after operation (P Conclusion Our study showed that IT neostigmine (35 μg) enhanced bupivacaine spinal anaesthesia (15 mg) and produced prolonged postoperative analgesia for about 24 h without producing significant more adverse effects such as nausea and vomiting.

The prediction of significant left main or diffuse three‐vessel coronary artery disease is crucial in patients presenting with an acute coronary syndrome. ST‐segment elevation in aVR has been reported to be associated with left main coronary artery obstruction or severe diffuse coronary artery disease in acute coronary syndrome. Herein we report another cause for this ECG finding, that is diffuse ischemia not due to left main coronary artery obstruction or diffuse coronary artery disease but secondary to prolonged hypotension. Copyright © 2007 Wiley Periodicals, Inc.

No-reflow is a failure to restore normal coronary flow despite appropriate treatment of coronary obstruction. It is most commonly seen during interventions in saphenous vein grafts and is associated with poor outcome. The cause of no-reflow is complex and multifactorial. Various mechanisms including vasospasm and distal embolization of debris released during the intervention have been explained as the cause of no-reflow. Treatment to prevent or reverse no-reflow includes, but is not limited to, protective devices and intracoronary vasodilators. Intracoronary nicardipine seems to be the best option in preventing no-reflow regarding its minimal systemic side effects, modest negative inotropic and chronotropic effects, duration of action and feasibility of use. The goal of this manuscript is to review the effects of prophylactic intragraft nicardipine injection for prevention of no-reflow during saphenous vein graft intervention.

Since its introduction by Campeau in 1989, the transradial approach for coronary angiography has gained significant popularity among interventional cardiologists due to its lower access site complication rates, cost-effectiveness, and shorter hospital course. Although the transradial approach is much safer than the transfemoral approach, it has its own inherent rare complications including radial artery occlusion, thrombosis, nonocclusive radial artery injury, vasospasm, and compartment syndrome. Herein, we present an unusual case of entrapment and kinking of a catheter in the radial artery, which was successfully removed by using a gooseneck snare via the transfemoral route. The distal and proximal tips were then simultaneously rotated in opposite directions, allowing for the unkinking and removal of the catheter. To our knowledge, this is the first report of this rare complication.