Background & Objectives : Laryngoscopy and tracheal intubation may lead to tachycardia, hypertension and dysrhythmia or myocardial ischemia. In this double blind study, the effects of midazolam and lidocaine on hemodynamic response to endotracheal intubation have been examined.

  Methods : 52 ASA class one patients, aged 20-50, who were candidate for elective inguinal hernia surgery with general anesthesia, were randomly assigned to two groups. All patients received normal saline or Ringer's lactate solution (5ml/kg) about 5-10 minutes before induction of anesthesia and were preoxygenated for 3 minutes. Group 1 received midazolam (0.05 mg/kg) and group 2 received lidocaine (1.5 mg/kg) during 3 minutes prior to intubation. Anesthesia was induced with fentanyl (100 µ g) and thiopental (5 mg/kg) and trachea was intubated by the aid of succinyl choline (1.5 mg/kg). Anesthesia was maintained with halothane (0.5-0.75%) and equal proportions of nitrous oxide and oxygen. Systolic and diastolic blood pressure, mean arterial pressure (MAP) and heart rate were recorded before premedication and intubation, as well as immediately two and five minutes after intubation. The data were analyzed by SPSS software using paired t-test.

  Results : After intubation�Systolic and diastolic blood pressure, MAP and heart rate increased in both groups compared to the baseline values. The difference in increasing diastolic blood pressure and MAP between the two groups was significant (p<0.05), but the difference in increasing systolic blood pressure and heart rate between two groups was not statistically significant. The increase in diastolic blood pressure and MAP in group 1 was significantly more than group 2 (p<0.05).

  Conclusion : Clinically, midazolam was as much effective as lidocaine in controlling response to intubations. Consequently it can be used as an alternative lidocaine in intubations. It has also other priorities such as amnesia, anti-anxiety and anti-agitation.

 Background and Objectives: Pre-eclampsia is one of the common causes of maternal mortality. A main problem with induction of general anesthesia in these patients is exagergted increase of blood presscure during laryngoscopy and intubation that is associateed with a significantly increased intracranial pressure with the risk of cerebral hemorrhage. There are some strategies to minimize extreme increase in blood pressure during laryngoscopy and intubation. The aim of this study was to evaluate the effect of Fentanyl-Droperidol combination (Talamonal) on reducing cardiovascular responses due to laryngoscopy and intubation in preeclamptic parturient.

 Methods: Thirty preeclamptic parturients who were admitted for emergency caesarean section under general anesthesia were studied. All patients had diastolic pressures sustained at ≥ 100 mmHg, and had received antihypertensive therapy. A standard general anesthesia was induced in all patients. Fentanyl-Droperidol combination was used only in the case group five minutes before induction of anesthesia.

 Results: Arterial pressure and heart rate increases, improved in approximately 86.6 % of the case group. The mean increase in systolic pressure, and heart rate following laryngoscopy and intubation was significantly different in two groups (P=0.0001). There was no significant difference in the mean Apgar score of the neonates at 1 and 5 minutes after delivery in two groups.

 Conclusion: Using Fentanyl-Droperidol Combination during induction of anesthesia produced a clinically significant decrease in sympathetic response to laryngoscopy and intubation in most mothers, without any adverse effect on the neonates.

 Background & Objectives: One of the most common ways in intubation without muscle relaxant is using propofol and remifentanil. The common practice is injection of remifentanil and then propofol. This occasionally produces severe hemodynamic changes. The aim of this study is to inject propofol followed by remifentanil for evaluating the effect of the order of injection on decreasing these complications.

 Methods: 40 patients with American Society of Anesthesia (ASA) class I-II, who underwent minor elective surgery with airway mallampati class I-II entered the study. Patients were randomized into 2 groups each with 20 patients. The first group received 2.5mg/kg propofol followed by 1.5 g/mg remifentanil while the second group received 1.5 g/mg remifentanil followed by 2.5 mg/kg propofol. Laryngoscopy and hemodynamic changes were compared in two groups.

 Resutls: There was no difference between two groups in laryngoscopy attempts (P=0.145) but the frequency of easy laryngoscopy in the first group (85%) was more than the second group (60%) (P=0.031). Systolic blood pressure changes after laryngoscopy in the first group (20 7.7 mmHg) was less than the second group (28 6.7 mmHg) (P=0.001). There was no statistical significant difference between two groups in diastolic blood pressure and heart rate changes (P=0.88, P=0.86 respectively).

 Conclusion: Administrations of propofol before remifentanil during anesthesia induction produces acceptable hemodynamic changes in patients.

  Background and Objectives: Laryngoscopy and tracheal intubation could lead to hemodynamic responses in the from of hypertension and tachycardia as well as arrhythmia and myocardial ischemia. This alterations can be life-threatening particularly in elderly people. This clinical trial compared the effects of two rapid-onset narcotics, Alfentanil and Remifentanil, on the hemodynamic responses to the induction and tracheal intubation in elderly patients.

  Methods: This double-blind clinical trial was conducted on 40 subjects aged 65 and above. They were candidate of cataract surgery under general anesthesia. The patients were randomly allocated to two groups of 20. The first group, was gaiven Alfentanil 10 m g/kg and for second group Remifentanil 0.5 m g/kg was injected prior to the induction of anesthesia. Both groups were similiar in the method of anesthesia except in narcotics. The first group was infused with Alfentanil 1 m g/kg/min and Remifentanil 0.1 m g/kg/min was used for the second group. Hemodynamic variations including heart rate, systolic, diastolic and mean arterial blood pressure were measured and recorded eight times (before induction, aften injection, after intubation and five times during anesthesia). Data were analyzed with SPSS software using descriptive and analytical statistics such as T-test, chi squre and ANOVA.

  Results: Immediately after injection of narcotic drugs, all hemodynamic variants decreased. Howerver diastolic blood pressure in Remifentantil group significantly more than Alfentanil group (P<0.05). After laryngoscopy and tracheal intubation all hemodynamic variants increased and slowly decreased in less than 10 minutes. Systolic, diastolic and mean arterial blood pressure decreased significantly in remifentanil group than alfentanil group (P<0.05). Although heart rate decreased during few minutes after intubation, there was not significant difference between two groups regarding this decrease (P>0.05). Ephedrin was used to treat severe hypotention in those under Remifentanil (11 patients) more than those under Alfentanil (4 patients) (P<0.05).

  Conclusions: According to the resukts of this study Remifentanil could prevent hemodynamic variation induced by laryngoscopy and treacheal intubation more than Alfentanil. However in some cases Remifentanil leads to hypotension during anesthesia. There is no important difference between two drugs in increasing heat rate after laryngoscopy and intubation.

  Background & Objectives: A common side effect associated with succinylcoline is postoperative myalgia. The pathogenesis of this myalgia is still unclear therefore there is no ideal method of decreasing the rate and severity of fasciculation and postoperative myalgia. The aim of this prospective and randomized study was to evaluate the influence of low-dose succinylcholine for tracheal intubation on the rate and severity of fasciculation and postoperative myalgia.

  Methods: In this study, 60 patients of ASA physical grading I or II were randomly entered into two groups of 30 patients each. One fasciculation was evaluated on the basis of Mingus and myalgia on the basis of Harvey Induction of anesthesia was performed with fentanyl/thiopentone, and then succinylcholine 1 mg/kg (control group) and 0.6 mg/kg (case group) were administered to patients for tracheal intubation.

  Results: There was not fasciculation in 50% (15 patients) of study group and on the rest no severe fasciculation occurred. Furthermore, the severity of fasciculation in the study group was significantly lower than that of control group (p<0.0001). In 16 (53.3%) patients of study group and 4 (13.3%) of control group myalgia were not occurred. Severity of myalgia was also significantly lower in study group than the control group (p<0.0001). Acceptable intubating conditions in all patients of two groups.

  Conclusion: Decreasing the dose of succinylcholine (from 1 mg/kg to 0.6 mg/kg) both provides acceptable intubation conditions, and reduces the rate and intensity of succinylcholine induced fasciculation and postoperative myalgia.