Introduction and Objective. Laryngoscopy and intubation are accompanied by sympathetic responses. These transient responses appear as an increase in blood pressure and heart rate. In patients with cardiovascular problems, the hemodynamic changes may lead to life-threatening risks, such as heart ischemia, acute heart failure, and cerebrovascular events. Materials and Methods. This clinical trial was conducted on 90 patients, aged 30–70 years, who had heart surgery. The participants were categorized into three groups. Group D received 1 µg/kg intravenous dexmedetomidine in 10 minutes, group L received 1.5 mg/kg lidocaine (1%) 90 seconds before intubation, and group F received 2 µg/kg fentanyl. The vital signs (HR, SBP, DBP, and MAP) were measured before intubation and 1st, 3rd, 5th, and 10th minutes after intubation. Data were analyzed with SPSS 19 software (chi-square, one-way ANOVA, or Kruskal–Wallis). Results. The age (P=0.389) and gender distributions of patients were similar in all three groups. Dexmedetomidine significantly attenuated HR in the 3rd (P=0.001), 5th (P=0.001), and 10th (P=0.003) minutes after intervention. It also reduced the systolic blood pressure in the 5th (P=0.024) and 10th (P=0.006) minutes. This reduction was significantly higher in the dexmedetomidine group than that in the two other groups. In addition, dexmedetomidine caused a greater reduction in MAP in the 1st (P=0.048), 5th (P=0.0001), and 10th (P=0.0001) minutes. Discussion. All three medications were effective in controlling HR; however, dexmedetomidine caused bradycardia in the 3rd, 5th, and 10th minutes. Lidocaine resulted in an increase in MAP in the 1st minute after intubation; whereas, dexmedetomidine reduced MAP at the 5th and 10th minutes after intubation. Changes in blood pressure and mean arterial pressure in the fentanyl group was lower than the two other groups. Conclusion. As a result, dexmedetomidine was not suitable for hemodynamic control and led to hypotension and bradycardia; on the other hand, fentanyl was more effective than two other medications in patients undergoing cardiac surgery. This trial is registered with IRCT2017013132320N1.

Background: Intravenous regional anesthesia (IVRA) (or Bier's block) is the administration of a local anesthetic drug to an organ intravenously, when compressed by tourniquet. Simple use in outpatient and emergency settings, being regional instead of general anesthesia and having reasonable costs make IVRA most acceptable. Objectives: Nitroglycerine, as a safe and available medication, was evaluated by the current study in the search for better analgesia withlower complications that plays the role of a suitable adjuvant in regional anesthesia by lidocaine. Patients and Methods: Through a randomized controlled clinical trial, two types of anesthesia were used regionally for 70 cases of forearm surgery between 2010 and 2011. Elective cases of forearm surgery with American Society of Anesthesiologist (ASA) class I or II were enrolled in the study and were randomly divided to two groups of cases and controls. For the control group, lidocaine was used alone for IVRA while for the intervention group lidocaine as well as 200 µg of nitroglycerin was used through the procedure. Results: On average, sensory block started in 3.48 and 6.5 minutes, for the case and control groups, respectively. The mean motor block time was 4.18 and 6.98 minutes for the cases and controls, respectively. The groups differed in terms of times required for sensory and motor blocks. Recovery time was longer among cases (118.32 ± 7.8 minutes) when compared to the controls. Conclusions: Nitroglycerin at a dose range between 200 and 400 µg, as an adjunct for lidocaine, can evidently improve regional anesthesia, increase block recovery time and postpone the need for postoperative analgesics, especially opioids.