Background:Side effects of spinal anesthesia are hypotension, bradycardia and shivering. Five-hydroxytriptamine (5-HT), a serotonergic receptor, may be an important factor associated with inducing the Bezold Jarish reflex (BJR) that may lead to the bradycardia and hypotension in the setting of decreased blood volume.Objectives:This study aimed to investigate the effect of intravenous administration of ondansetron, a 5-HT3 receptor antagonist, which could attenuate spinal-induced hypotension, bradycardia and shivering.Patients and Methods:Two hundred and ten patients aged 20-50 years old were scheduled for spinal anesthesia and were divided randomly into three equal groups. The control group received normal saline and intervention groups received 6 mg or 12 mg of intravenous ondansetron 5 minutes before spinal anesthesia. Mean arterial pressure (MAP), heart rate (HR), and shivering were recorded before and after spinal anesthesia every 5 minutes during first 20 minutes of surgery.Results:Demographic data were not statistically different among groups. HR was statistically different between the experimental groups and the control group. Ten patients (14%) in the control group had HR < 50 bpm, that required intravenous atropine compared to experimental groups (P =0.02). In the control group 12 (17%) patients had MAP < 80 mm Hg and required vasopressors compared to experimental groups (P = 0.04). There were no significant differences in MAP and HR between the experimental groups (P =0.06). Incidence of shivering in the control group was 45% (32.70) that was statistically more than experimental groups (P = 0.02).Conclusions:Administration of two different doses of intravenous ondansetron, 6 mg and 12 mg, significantly attenuates spinal induced hypotension, bradycardia and shivering compared to the control saline group. However, the hemodynamic profiles and shivering in experimental groups were not statistically different.

Background. After renal transplantation, postoperative pain is usually mild to moderate. Postoperative pain is a concern and administration of systemic analgesic may be difficult because of underlying co-morbidities and variable responses of the graft. The transversus abdominis plane (TAP) block is one of the different approaches for postoperative pain relief following abdominal surgeries. We evaluated analgesic efficacy of TAP block on early postoperative pain by numeric rating scale (NRS) and morphine consumption during the first 24 hours after kidney transplantation.

BackgroundOne of the main challenges in anesthesiology is difficult intubation. There are many anatomical parameters for evaluating the feasibility of tracheal intubation; one that can reliably predict a difficult intubation is the Cormack-Lehane classification obtained during direct laryngoscopy. This is an invasive procedure that cannot be performed in an awake patient or for pre-anesthetic airway assessments in patients with no prior history of tracheal intubation. Recently, ultrasound has been successfully used for several airway-related applications.ObjectivesThe aim of this study was to compare and correlate the ultrasound view of the larynx with the Mallampati classification before anesthesia and the Cormack-Lehane classification during direct laryngoscopy under general anesthesia.MethodsThis cross-sectional descriptive-analytic study included 53 ASA class I - III patients aged 18 - 70 years who were scheduled for tracheal intubation under general anesthesia. Before anesthesia, an oblique transverse ultrasound view of the airway was obtained; in addition, the total time taken to achieve the final plane, the depth of the pre-epiglottic space, and the distance from the epiglottis to the mid-point between the vocal cords were all recorded. The ultrasound measurements were then compared with the Mallampati class on the preoperative evaluation and with the Cormack-Lehane grade during direct laryngoscopy under general anesthesia.ResultsIt was observed that correlations between the pre-epiglottic space (PE) and Cormack-Lehane grades I, II, and III were weak. Correlations between the distance from the epiglottis to the vocal cords (E-VC) and Cormack-Lehane grades I, II, and III were also weak. The PE/E-VC ratio for correlations between the sonographic view and laryngoscopy had 87.5% sensitivity and 30% specificity. There was no correlation between Mallampati class and the PE/E-VC ratio (P = 0.566).ConclusionsOur study revealed weak correlation between PE/E-VC and Cormack-Lehane grade, with 87% sensitivity and 30% specificity. Therefore, we concluded that sonographic measurement criteria are not accurate in airway evaluations before anesthesia.