BackgroundThere are different methods used for anesthesia during a colonoscopy procedure.ObjectivesThe aim of this study was to compare the analgesic effect and hemodynamic changes due to dexmedetomidine and fentanyl during elective colonoscopy.MethodsThis double-blind clinical trial was conducted on 80 patients aged 20 - 70 years, candidates for elective colonoscopy, who were randomly divided into two equal groups. In the intervention group (group D), dexmedetomidine 1 mcg/kg was given 10 minutes before starting the colonoscopy and then, 0.5 mcg/kg/hour during colonoscopy was prescribed. In the control group (group F), fentanyl 0.5 mcg/kg was prescribed three minutes before starting the colonoscopy and then, the normal saline infusion was used as maintenance. Propofol 20 mg was prescribed as the rescue dose if needed (pain or severe discomfort during colonoscopy) during the procedure. Demographic and basic clinical data and blood pressure, heart rate, respiratory rate, peripheral oxygen saturation (SpO2), and pain score (based on the visual analogue scale) were recorded from the start of the colonoscopy (time 0) and every 5 minutes until the recovery.ResultsThe two groups had no significant difference in the duration of colonoscopy, colonoscopist’s satisfaction, and patients’ satisfaction (P > 0.05). The mean pain score during colonoscopy was lower in the dexmedetomidine group (P = 0.039). Heart rate was less in the dexmedetomidine group than in the fentanyl group and this difference was statistically significant. The mean arterial pressure had no difference between the two groups.ConclusionsThe results of the present study showed pain score was lower in the dexmedetomidine group than in the fentanyl group.

BackgroundEndoscopic retrograde cholangiopancreatography (ERCP) is a painful procedure that requires analgesia and sedation.ObjectivesIn this study, we compared the analgesic and sedative effects of propofol-ketamine versus propofol-fentanyl in patients undergoing ERCP.MethodsIn this clinical trial, 72 patients, aged 30 - 70 years old, who were candidates for ERCP were randomly divided into two groups. Before the start of ERCP, both groups received midazolam 0.5 - 1 mg. The intervention group (PK) received ketamine 0.5 mg/kg, and the control group (PF) received fentanyl 50 - 100 micrograms. All patients received propofol 0.5 mg/kg in a loading dose followed by 75 mcg/kg/minute in an infusion. The patients, the anesthesiologist, and the endoscopist were unaware of the medication regimen. Sedation and analgesia quality (based on a VAS), blood pressure, respiratory rate, heart rate, arterial oxygen saturation, recovery time (based on Aldrete scores), and endoscopist and patient satisfation were recorded.ResultsThe sedative effects were equal in the two groups (P > 0.05), but the analgesic effects were higher in the PF group than in the PK group (P < 0.05). The PK group had higher blood pressure levels in the eighth minute. Respiratory rate, heart rate, and arterial oxygen saturation showed no significant differences between the groups (P > 0.05). Endoscopist satisfaction, patient satisfaction, and recovery time showed no significant differences between the two groups (P > 0.05).ConclusionsThe results showed that the sedative effect of propofol-ketamine was equal to the propofol-fentanyl combination during ERCP. To prevent respiratory and hemodynamic complications during ERCP, the propofol-ketamine combination should be used in patients with underlying disease.

Background: Rigid bronchoscopy is often used to diagnose and treat the location of resection of the tracheal stenosis. It is a selective procedure for the dilatation of tracheal stenosis, especially when accompanied by respiratory distress. Objectives: We introduced patients who were diagnosed with tracheal stenosis and candidate for rigid bronchoscopy dilatation by the upper airway nerve blocks. Methods: This prospective observational study was conducted on 17 patients who underwent dilatation with rigid bronchoscopy in tracheal stenosis at Hospitals affiliated with Babol University of Medical Sciences from 2002 to 2017. The patients were given three nerve blocks, 6 bilateral superior laryngeal nerve block, bilateral glossopharyngeal nerve block, and recurrent laryngeal nerve block (transtracheal) before awake rigid bronchoscopy using 2% lidocaine. We evaluated the demographic data, the cause of tracheal stenosis, the quality of the airway nerve block (Intubation score), patients’ satisfaction from bronchoscopy and thoracic surgeons’ satisfaction. Complications of nerve blocks were recorded. Results: From 2002 to 2017, 17 patients (14 were male and 3 were) female with tracheal stenosis who were candidates for dilatation with bronchoscopy and accepted the upper nerve block were included. The quality of the block was acceptable in 16 (94%) patients. 15 patients received fentanyl, and only two patients did not need to intravenous sedation. The mean age of patients was 29.59 ± 11.59. The average satisfaction of the surgeon was 8.82 ± 1.13 and the satisfaction of patients with anesthesia was 8.89 ± 1.16. There was one serious complication (laryngospasm) in one patient. Conclusions: The upper airway nerve block method is a suitable anesthesia technique for patients with tracheal stenosis who are candidates for the tracheal dilatation with rigid bronoscopy, especially when the patient has respiratory distress and has not been evaluated before surgery.

Weaning the patient from mechanical ventilation is a major challenge for the intensivist. "Wean" means to separate gradually. The term "Liberation" is a better term since the patients can be more quickly removed from the ventilator based on their clinical conditions. In this review article, the initial required criteria to start and weaning methods from mechanical ventilation were evaluated based on various studies; and at the end, the protocol for separation of mechanical ventilation is recommended. Studies showed that prolonged mechanical ventilation is associated with ventilator-associated complications such as pneumonia, ventilator-induced lung injury and increased mortality. Making premature or delayed decision in weaning the patient from the ventilator increases the mortality rate. Studies also showed that using clinical parameters for weaning the patient from the ventilator is better than clinical judgments alone. Duration of weaning from the ventilator must be more than 40% of the duration of full support ventilation. The method of SIMV is not suitable for weaning from the ventilator, while spontaneous breathing test is more suitable. After improving oxygenation, first Fio2, PEEP, and then respiratory rate are reduced. Weaning from the ventilator starts early in the morning. The infusion of sedating medications should be discontinued and, if necessary, administered by bolus infusion. In case of intolerance, weaning from the ventilator will be postponed to 24 hours later.