Publications by authors named "Alireza Kamali"

39 Publications

Comparison the Oral Premedication of Midazolam, Dexmedetomidine, and Melatonin for Children's Sedation and Ease of Separation from Parents before Anesthesia.

J Pediatr Neurosci 2020 Jul-Sep;15(3):231-237. Epub 2020 Nov 6.

Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran.

Background: Children's fear of surgery and preoperative separation from parents can contribute to anxiety and distress in children undergoing surgery. The study addressed the comparable efficacy of oral premedication of midazolam, dexmedetomidine, and melatonin to alleviate preoperative anxiety and easing the children's separation from parents.

Materials And Methods: A double-blinded trial enrolled three equal-sized groups of children ( = 153, aged 2-10 years) undergoing elective surgery who received oral midazolam, melatonin, and dexmedetomidine 30 min before induction. The observation sedation score, and ease of separation, acceptance of drug both preceding and following premedication administration were assessed and recorded every 5min till anesthesia induction.

Results: A significant difference was observed in the mean scores of sedation before premedication and after separation from parents, as well as in the degree of the separation when comparing between the midazolam and melatonin groups and the dexmedetomidine and melatonin groups ( < 0.001). The scores were significantly lower in the melatonin group than the other two groups, whereas no significant difference was found in those between the midazolam and dexmedetomidine groups, as well as in the acceptance of anesthesia induction between the midazolam and melatonin groups ( = 0.250). The differences were significant between the midazolam and dexmedetomidine groups ( = 0.002) and melatonin and dexmedetomidine groups ( < 0.001) and anesthesia induction was effective in the dexmedetomidine group than that in the other two groups.

Conclusion: Dexmedetomidine is more effective in acceptance of anesthesia induction. Furthermore, the midazolam and dexmedetomidine groups indicated better ease of separation and sedation scores than melatonin.
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http://dx.doi.org/10.4103/jpn.JPN_95_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847116PMC
November 2020

Comparison of the Effect of Dexmedetomidine and Remifentanil on Controlled Hypotension During Rhinoplasty: A Clinical Trial Study.

Int Tinnitus J 2021 Jan 25;24(2):60-64. Epub 2021 Jan 25.

Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran.

Introduction: One of the most important problems during cosmetic nose surgery is excessive bleeding. Controlled hypotension is an appropriate technique for reducing intraoperative bleeding as well as satisfactory and non-bloody surgical field. Different drugs, such as dexmedetomidine and remifentanil, are used to control hypotension. The aim of this study was to compare the effect of dexmedetomidine and remifentanil on the creation of control hypotension during rhinoplasty.

Material And Method: This study is a randomized, double-blind clinical trial which was performed on 60 patients randomly divided into two groups D (Dexmedetomidine) and R (Remifentanil). In group D (0.5 mg / kg / h) Dexmedetomidine infusion and in group R (50-100 μg / kg / h) Remifentanil infusion. The study groups were compared in terms of hemodynamics and intraoperative bleeding. The data obtained from completed questionnaires were analyzed using SPSS software, T-test and ANOVA statistical tests and were presented in tables and statistical charts.

Results: The results of this study showed that the mean MAP (Mean Arterial Pressure) was significantly lower in remifentanil group patients than in dexmedetomidine group, while the intraoperative bradycardia rate was different at various time.

Conclusion: During rhinoplasty surgery, both dexmedetomidine and remifentanil were effective in controlling hypotension and reducing intraoperative bleeding, but the effect of remifentanil was more pronounced than dexmedetomidine.
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http://dx.doi.org/10.5935/0946-5448.20200013DOI Listing
January 2021

The effect of tranexamic acid in reducing postoperative hemorrhage in patients undergoing coronary artery bypass graft.

Saudi J Anaesth 2020 Oct-Dec;14(4):431-435. Epub 2020 Sep 24.

Department of Anesthesiology and Critical Care, Student Research Committee, Arak University of Medical Sciences, Arak, Iran.

Introduction: Nowadays, cardiovascular diseases such as coronary heart disease are one of the most important causes of human mortality worldwide. Coronary artery bypass graft (CABG) surgery is a standard therapy approach for those suffering from coronary artery disease. Tranexamic acid (TXA), an antifibrinolytic drug, which, in turn, inhibits fibrinolysis, leading to the prevention of bleeding, thus, the present study aimed to evaluate the effect of topical TXA on bleeding reduction after coronary artery CABG.

Materials And Methods: In this study 62 patients were randomly divided into two groups of TXA and control. After surgery and removal from the cardiopulmonary pump, TXA (2 g) was injected locally into the mediastinum by the surgeon. In the second group (control) the same amount of normal saline (100 cc) was given. Data were analyzed by SPSS 19 software via the -test and Fisher's test.

Results: A significant difference was found between the 2 groups in terms of postoperative hemorrhage, packed cell volume, platelet transfusion, duration of surgery, and received FFP ( = 0.0001; = 0.01; = 0.0001; = 0.0001; = 0.0001), where were found to be lower in the TXA group than in the placebo group. There was no significant difference in age, sex, return to the operating room, and discharge.

Conclusion: The use of topical TXA in GABC significantly reduced postoperative hemorrhage, packed cell volume, platelet transfusion, and FFP after surgery. Besides, it had no significant effect on the return to the operating room and mortality.
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http://dx.doi.org/10.4103/sja.SJA_800_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796756PMC
September 2020

Change in saturation oxygen and hemodynamic responses by adding intrathecal dexmedetomidine vs. sufentanil to bupivacaine in patients undergoing dynamic hip screw operation: a randomized clinical trial.

Med Gas Res 2020 Oct-Dec;10(4):144-148

Students Research Committee, Arak University of Medical Sciences, Arak, Iran.

Sufentanil (SUF) and dexmedetomidine (DEX) are used as bupivacaine in the spinal technique that providing stable hemodynamic conditions with least side effects. This study aimed to compare the change in saturation oxygen and hemodynamic responses after intrathecal DEX and SUF as adjuvants to bupivacaine in patients undergoing dynamic hip screw. This clinical trial was conducted with 80 patients referring to Valiasr Hospital, Arak, Iran, who were randomly assigned to two groups (n = 40): DEX group (8 mg bupivacaine with 5 μg DEX) and SUF group (8 mg bupivacaine with 2.5 μg SUF). The pain severity was lower in DEX group at different hours and the systolic pressure and diastolic blood pressure were lower in DEX group than in SUF group after surgery. Saturation oxygen was generally lower and more stable in DEX group but there was no significant difference between two groups. The incidence of sensory and motor block was lower in DEX group than in SUF group, but the duration of assessment of sensory block was lower in SUF group than in DEX group. DEX relieves pain up to 24 hours postoperatively. Nevertheless, Care should be taken to avoid the DEX induced shivering in patients. The study was approved by Ethical Committee of Arak University of Medical Sciences by IR.ARAKMU.REC.1395.32 code on April 25, 2016 and was registered in Iranian Registry of Clinical Trials by code number: IRCT2017050220258N45 on August 4, 2017.
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http://dx.doi.org/10.4103/2045-9912.304220DOI Listing
December 2020

Effect of adding dexmedetomidine or remifentanil to thiopental in patients with mood disorder candidate for electroconvulsive therapy.

Eur J Transl Myol 2020 Sep 4;30(3):8877. Epub 2020 Aug 4.

Departmentof Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran.

Electroconvulsive therapy (ECT) is one of the appropriate treatments for many neuropsychiatric patients, especially those with mood disorders. Short-term complications of ECT include agitation and postictal. In this study, we compared the addition of dexmedetomidine or remifentanil to thiopental as the main anaesthetic used in ECT. In this double-blind randomised clinical trial, 90 patients with mood disorders (candidates for ECT) were divided into two groups based on their therapy: dexmedetomidine or remifentanil. In the first group (DG), patients were slowly injected intravenously with 0.5 μg/kg dexmedetomidine before induction of anesthesia. In the second group (GR), 100 μg of remifentanil was slowly injected intravenously.In addition, we collected demographic information such as respiratory rate, heart pulse rate, seizure time, mean of arterial blood pressure, recovery duration and the oxygen arterial saturation recorded after recovery. Data obtained were analysed by use of statistical software, SPSS-23. The mean age of both groups was approximately 37 years with the majority being men. There was no significant difference between the two groups in terms of age and sex, blood pressure, heart rate, duration of seizures and arterial oxygen saturation before ECT. The mean blood pressure and heart rate in the recovery group were lower in the dexmedetomidine group than in the remifentanil group and the hemodynamics in the dexmedetomidine group were more stable. The recovery time in the dexmedetomidine group was longer than that of the remifentanil group (p = 0.001). Both groups had approximately the same satisfaction and the rate of agitation after ECT was the same. Both remifentanil and dexmedetomidine as adjuvants lead to a decrease in patients' post-ECT hyperdynamic responses. In our study, we demonstrated that the effect of dexmedetomidine is greater than remifentanil. On the other hand, neither dexmedetomidine nor remifentanil had a negative effect on seizure duration, but dexmedetomidine significantly prolonged recovery time, when compared to remifentanil.
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http://dx.doi.org/10.4081/ejtm.2020.8877DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7582412PMC
September 2020

Spatial-temporal analysis of net primary production (NPP) and its relationship with climatic factors in Iran.

Environ Monit Assess 2020 Oct 21;192(11):718. Epub 2020 Oct 21.

Department of Physical Geography, University of Sistan and Baluchestan, P.O. Box: 987-98135, Zahedan, Iran.

Fluctuations of the climate variables have increased in the recent years. These fluctuations are different in each climatic region. Net primary production (NPP) indicating the plant growth and carbon stabilization over period of time is influenced by these fluctuations. Investigation of the variations in the NPP and analysis of its relationship with the climatic and environmental variables can play a key role in determining the effects of fluctuations of climatic variables on the NPP. Therefore, the present study was conducted to investigate the spatiotemporal changes in the NPP and its correlation with precipitation rate and temperature during 2000-2014 based on the annual NPP estimates determined by the moderate resolution imaging spectroradiometer (MODIS) sensor and precipitation and temperature data of the synoptic stations in eight climate regions in Iran. The slope of variations in the NPP was calculated in these climatic regions, and then, the changes in the NPP trend at two confidence levels of 95 and 99% were investigated based on the pixel-based method using the Mann-Kendall test. The sensitivity of NPP to climatic variables of temperature and precipitation was also estimated by calculating the correlation. The results showed the significant spatial distribution of NPP in the whole region under study indicating a declining trend from north to south and from west to east directions. The results also indicated the nonlinear variations in the temporal distribution of NPP. The annual mean NPP was found to follow the climatic boundaries in the climatic regions except for climate region 2, and region with the higher annual mean precipitation had higher annual mean NPP. Analysis of the trend by the Mann-Kendall method revealed that 3.2% of the pixels in the whole region followed a certain trend. Among the pixels, 70% of them followed a negative trend and the remaining 30% followed a positive trend. The greatest number of pixels with a certain trend was found in the Gulf of Oman coast climate region so that 93% of the pixels had a positive trend. The lowest number of pixels with a certain trend was observed in eastern Alborz foothills so that 87% of the pixels showed a negative trend. Slope variations of the NPP in the whole region varied from - 35 to 46 gC m year. The eastern plateau had the highest negative slope variations among the climate regions, and the highest positive slope variation of 42% was observed in the highlands climate region. In general, the precipitation rate and temperature showed a mean partial coefficient of 0.22 and 0.02, respectively, and the correlation between the NPP and temperature and precipitation was different in each climatic region. The temperature was negatively correlated with the NPP in four climatic regions with higher annual mean temperatures and in other climatic regions; it had a weak positive correlation. Therefore, the sensitivity of NPP to precipitation and temperature was different in each climatic region.
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http://dx.doi.org/10.1007/s10661-020-08667-7DOI Listing
October 2020

Comparison of the Effects of Haloperidol, Metoclopramide, Dexmedetomidine and Ginger on Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy.

J Med Life 2020 Apr-Jun;13(2):206-210

Department of Surgery, Arak University of Medical Sciences, Arak, Iran.

Nausea is a mental sensation of unease and discomfort before vomiting. Vomiting refers to the return of the contents of the upper gastrointestinal tract to the mouth caused by contractions of chest and abdomen muscles. Postoperative nausea and vomiting is an unpleasant experience with high treatment costs. Therefore, this study aimed to compare the effects of haloperidol, metoclopramide, dexmedetomidine, and ginger on postoperative nausea and vomiting after laparoscopy. This double-blind clinical trial was performed on all laparoscopy candidates at Valiasr hospital, Arak, Iran. The patients were randomly divided into four groups (haloperidol, metoclopramide, dexmedetomidine and ginger), and all patients underwent general anesthesia using fentanyl, midazolam, atracurium, and propofol. After intubation, tube fixation, and stable hemodynamic conditions, the patients received four ginger capsules with a hint of lemon. A group of patients received 25 μg of dexmedetomidine. In the Plasil group, 10 mg of metoclopramide was given 30 minutes before the completion of surgery. In addition, 0.5 cc of haloperidol (5 mg) was administered to a group of patients. Heart rate, blood pressure, and oxygen saturation were recorded from the beginning of surgery, every 15 minutes until the end of the surgery. Furthermore, the occurrence of nausea and vomiting was recorded during recovery, 2 and 4 hours after surgery. Data were then analyzed using the SPSS software v.23. Eighty-eight patients were enrolled in the study. The youngest and the oldest were 30 years and 70 years old, respectively, and the mean age was 48.02 ± 9.31 years. Moreover, the number of women in the four groups was higher than that of men. Blood pressure in the dexmedetomidine group was lower than the other four groups (P <0.05). The lowest heart rate was observed in the haloperidol group, while the highest heart rate was seen in the plasil group (P <0.05). The occurrence of vomiting and nausea was not significantly different between the four groups (P <0.05). Our results showed no significant difference in postoperative nausea and vomiting between the four drugs. Due to the hemodynamic changes induced by each drug, it is best to use these drugs based on the patient's condition. Ginger is also a herbal remedy that has fewer side effects, and this drug can be a good option for patients when there is no contraindication.
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http://dx.doi.org/10.25122/jml-2019-0070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378348PMC
September 2020

Clinical Comparison of Adding Sulfate Magnesium and Dexmedetomidine in Axillary Plexus Block for Prolonging the Duration of Sensory and Motor Block: Study Protocol for a Double-blind Randomized Clinical Trial.

Folia Med (Plovdiv) 2020 03;62(1):124-132

Arak University of Medical Sciences, Tehran, Iran.

Background: The purpose of this study was to compare the effect of magnesium sulfate adjunct to dexmedetomidine on increasing the duration of sensory and motor block in axillary block.

Materials And Methods: This study is a double-blind clinical trial. Ninety-nine patients were included in the study. They were undergoing forearm and hand surgery and were referred to Vali-e-Asr Hospital in Arak. The patients were divided into three groups. The first group received lidocaine (1.5%) and dexmedetomidine (0.5 μg/kg). The second group patients were given lidocaine (1.5%) plus magnesium. In the control group, lidocaine (1.5%) was adjusted to 35 cc with normal saline. The final volume was 35 cc in the three groups. Sensory and motor block and pain were measured and data were analyzed using SPSS v. 20. The final volume was 35 cc in the three groups.

Results: The sensory and motor block onset time and the stabilization time of the sensory and motor block in the magnesium sulfate group were lower (p<0/001). Pain in recovery, 2, 4, 6, 12, and 24 hours after surgery was lower in the magnesium sulfate group when compared with the dexmedetomidine group (p<0.001). The lowest dose of opioid was used in the dexmedetomidine group 24 hours after surgery (p<0.001).

Conclusion: The results showed that dexmedetomidine decreases pain. Magnesium sulfate increased the sensory and motor block onset time, and the sensory and motor block stabilization time, but dexmedetomidine increases the motor block duration.
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http://dx.doi.org/10.3897/folmed.62.e49805DOI Listing
March 2020

Comparing intravenous dexmedetomidine and clonidine in hemodynamic changes and block following spinal anesthesia with ropivacaine in lower limb orthopedic surgery: a randomized clinical trial.

Med Gas Res 2020 Jan-Mar;10(1):1-7

Department of Epidemiology, Arak University of Medical Sciences, Arak, Iran.

Dexmedetomidine (DEX) can prolong duration of anesthesia and shorten onset of sensory and motor block relative to clonidine. This study attempted to compare the efficacy of intravenous DEX and clonidine for hemodynamic changes and block after spinal anesthesia with ropivacaine in lower limb orthopedic surgery. In a double-blind randomized clinical trial, 120 patients undergoing spinal anesthesia in lower limb orthopedic surgery were recruited and divided into three groups using balanced block randomization: DEX group (n = 40; intravenous DEX 0.2 µg/kg), clonidine group (n = 40; intravenous clonidine 0.4 µg/kg), and placebo group (n = 40; intravenous normal saline 10 mL) in which pain scores were assessed using visual analogue scales (at recovery, and 2, 4, 6, and 12 hours after surgery) and time to achieve and onset of sensory and motor block. Statistically significant differences were found in mean arterial pressure among the groups at all times except baseline (P = 0.001), with a less mean arterial pressure and a prolonged duration of sensory and motor block (P = 0.001) in the DEX group where pain relieved in patients immediately after surgery and at above mentioned time points (P = 0.001). Simultaneous administration of intravenous DEX with ropivacaine for spinal anesthesia prolongs the duration of sensory and motor block and relieves postoperative pain, and however, can decrease blood pressure. Although intravenous DEX as an adjuvant can be helpful during spinal anesthesia with ropivacaine, it should be taken with caution owing to a lowering of mean arterial pressure in patients especially in the older adults. This study was approved by Ethical Committee of Arak University of Medical Sciences (No. IR.Arakmu.Rec.1395.450) in March, 2017, and the trial was registered and approved by the Iranian Registry of Clinical Trials (IRCT No. IRCT2017092020258N60) in 2017.
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http://dx.doi.org/10.4103/2045-9912.279977DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871933PMC
March 2020

Prevalence of Cesarean Section and Analysis of Neonatal Apgar Score and the Mean Time of Second Phase of Labor in Pregnant Women.

Med Arch 2019 Dec;73(6):399-403

Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran.

Introduction: The labor pain is probably the most severe pain a mother experiences in her lifetime and is usually severe and prolonged in women with pregnancy.

Aim: To evaluate the effects of labor epidural and spinal analgesia on the incidence of cesarean section in painless delivery.

Methods: This randomized clinical trial was conducted on pregnant women aged 37-42 weeks of pregnancy. Female candidates for painless labor were divided into two groups: Epidural Analgesia (EA) and Spinal Analgesia (SA). Patients in the labor epidural group underwent analgesia using marcaine and fentanyl and after fully assuring the normal hemodynamic status of the mother and fetal hearth rate (FHR), labor spinal analgesia was used for other group.

Results: The average age of mothers was 27.5 years, their mean gestational age was 39 weeks and their mean weight was determined to be 72 kg. Frequency of cesarean delivery in mothers was found as 12.9%. Significantly, the incidence of cesarean section in the labor epidural analgesia group was higher than the labor spinal analgesia group (P = 0.02). In addition, the mean second phase of delivery in the labor epidural analgesia group was significantly higher than the labor spinal analgesia group (P = 0.03). There was no significant in 1st and 5th min Apgar scores between groups in infants (8.6 and 9.6, respectively).

Conclusion: Labor epidural analgesia and labor spinal analgesia result in a significant reduction in pain due to normal delivery. Due to the similarity of Apgar and arterial blood gas (ABG) in neonates, labor epidural analgesia may serve as an alternative in childbirth delivery.
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http://dx.doi.org/10.5455/medarh.2019.73.399-403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7007604PMC
December 2019

An investigation into the effect of evening primrose in dilatation of cervix and pain during and after hysterosalpingography.

J Med Life 2019 Jul-Sep;12(3):284-289

Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran.

Hysterosalpingography is one of the essential diagnostic methods for examining women who have difficulty becoming pregnant. This procedure is somehow invasive and is associated with numerous complications such as allergic sensitivity, pain, abdominal cramps and shock. Therefore, this study aimed to investigate the effect of evening primrose on cervical length and pain during and after hysterosalpingography. In this double-blind clinical trial, 66 candidates for hysterosalpingography were randomly divided into two groups. A group received 1000 mg of evening primrose orally for two days prior to hysterosalpingography, while the control group received a placebo drug similar in size to evening primrose three days prior to hysterosalpingography. The pain level was recorded based on the Visual Analogue Scale (VAS), during tenaculum placement but also immediately and four hours after hysterosalpingography. Finally, the data were analyzed using SPSS (version 20). There was a significant difference between the two groups in terms of pain during insertion of speculum and injection of the contrast medium (p <0.05). Less pain was reported in the evening primrose group compared to placebo. There was no significant difference between the two groups in terms of the length and diameter of the cervix (p <0.05). Given the fact that it is a medicinal plant with no complications and can reduce pain during speculum insertion and during contrast medium injection, evening primrose seems to be a good drug for managing pain during hysterosalpingography.
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http://dx.doi.org/10.25122/jml-2019-0021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6814881PMC
December 2019

Addition of dexmedetomidine and neostigmine to 1.5 % lidocaine and triamcinolone for epidural block to reduce the duration of analgesia in patients suffering from chronic low back pain.

J Med Life 2019 Jul-Sep;12(3):260-265

Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran.

Lower back pain is one of the leading causes of disability in the world. The aim of this study was to evaluate the effect of supplementation of dexmedetomidine and neostigmine with lidocaine 1.5% and triamcinolone for epidural block in increasing the duration of analgesia among patients suffering from chronic low back pain. In this double-blind, randomized clinical trial, 33 patients with chronic low back pain were included in three groups of 11 patients for epidural blockage. Triamcinolone (40 mg/ml) was added to lidocaine 1.5% solution (2 cc/segment) for all three groups. In group N, neostigmine was used at a dose of 1 mg (mg), followed by group D (dexmedetomidine 35 μg [0.5 μg/kg]), and grou [ND (neostigmine 0.5 mg, and 35 μg dexmedetomidine, all of which were added to the triamcinolone and lidocaine solution in each group. Medications were injected into the epidural space using an interlaminar approach. Subsequently, scores of pain and duration of analgesia were recorded in questionnaires and analysed using SPSS version 23. One month after the injections, pain scores recorded in the N group were 7.6±1.4, followed by 5.88±1.2 in group D and 5.42 ±1.1 in group ND. Therefore, the pain scores were significantly higher in the neostigmine group than the other two groups (p = 0.02), but no significant difference was found between the two groups that received dexmedetomidine and a combination of dexmedetomidine + neostigmine. Three months after the injections, there was a significant difference in pain scores between the two groups (P = 0.01). Both neostigmine and dexmedetomidine were capable of reducing the pain of patients with chronic low back pain after epidural block. However, neostigmine's impact is lower compared to dexmedetomidine. The combination of the two drugs also reduced the pain scores of the patients after the intervention.
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http://dx.doi.org/10.25122/jml-2019-0043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6814888PMC
December 2019

The Efficacy Of Ginger And Doxedetomidine In Reducing Postoperative Nausea And Vomiting In Patients Undergoing Abdominal Hysterectomy.

Altern Ther Health Med 2020 Mar;26(2):28-33

Background: Nausea and vomiting are the most common complaints of patients after any general anesthesia, which are often accompanied by postoperative pain. Previous studies showed that ginger and dexmedmoidine can reduce postoperative nausea and vomiting. Therefore, the effectiveness of ginger was compared with dexmedmoidine for prevention of postoperative nausea and vomiting.

Methods: This randomized clinical trial study was performed on 92 patients who had abdominal hysterectomy in a double-blind evaluation. In this study, 92 patients were randomly divided into two equal groups of dexmedmotidine and ginger. In the ginger group, 1 gr of ginger was given orally before and after the anesthesia and in the second group, 25 mg of dexmedmotidine was slowly injected before surgery. Finally, after the operation, the questionnaire was completed for patients and the data obtained from the questionnaires were analyzed by SPSS19 software.

Results: There was a significant difference between the two groups of dexmodetomidine and ginger in terms of scorpion vomiting in recovery and 2 hours after operation. Vomiting scores were significantly lower in the ginger group than dexmodetomidine group (P = .02 and P = .03). However, no significant difference was defined between the two groups 4 hours after operation, and the scoring was reported to be zero in both groups. Moreover, a decreased level of nausea was observed in the ginger group as compared to the of dexmedetomidine group.

Conclusion: Both dexmedmotidine and ginger are effective in reducing postoperative nausea and vomiting. But the effect of ginger is greater than that of dexmodetomidine.
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March 2020

Investigations of Silymarine Effects on Prognosis of Patients With Severe and Moderate Traumatic Brain Injury.

Altern Ther Health Med 2020 Jul;26(4):8-13

Objective: The purpose of this study was to evaluate Silymarine effects on prognosis of patients with severe and moderate traumatic brain injury.

Study Design: This double blind, placebo-controlled clinical trial.

Setting: Valiasr hospital hospital in Arak, Iran.

Subjects And Methods: Research was performed among patients between 15 and 65 years of age with severe moderate (Glasgow Coma Scale score 9 to 12) and moderate (GCS 3 to 8) traumatic brain injury (TBI). Patients were divided into two groups (Each group: 40 patients). Patients assigned to the control groupwere receiving all standard treatments. Patients in case groups were administered 140 mg of silymarin every 8 hours for 7 days. We Checked the Glasgow Outcome Scale (GOS), GCS, age, gender, location, mechanism of trauma, site of accident and the incidence time of accident to arrival at emergency unite. Statistical analysis was conducted using SPSS (SPSS version 18; Chicago, IL).

Results: Our findings suggested that there was no a significant difference between intervention group and control in terms of parameters as GOS, GCS, age, gender, location, mechanism of trauma, and site of accident and the incidence time of accident to arrival at emergency unite (P > .05). Brain CT in two groups showed a significant difference (P = .002), where in the silymarin group there were more normal cases when comparing with control group.

Conclusions: Silymarin did not reveal a significant effect for improving prognosis of patients with moderate and severe TBI.
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July 2020

Addition of dexmedetomidine, tramadol and neostigmine to lidocaine 1.5% increasing the duration of postoperative analgesia in the lower abdominal pain surgery among children: A double-blinded randomized clinical study.

Med Gas Res 2019 Jul-Sep;9(3):110-114

Department of Surgery, Arak University of Medical Sciences, Arak, Iran.

Pain is a common complication after surgery. Insufficient control of postoperative pain has adverse effects on the physiological, metabolic and psychological state of the child. The use of local analgesics and anesthetics alone cannot produce complete anesthesia and intraoperative comfort. The addition of adjuvant drugs is commonly used to improve the quality of the block. Therefore, adding new supplements may increase the duration of analgesia. The aim of this study was to compare the addition of dexmedetomidine, tramadol and neostigmine to lidocaine 1.5% in increasing the duration of postoperative analgesia in the lower abdominal pain surgery in children aged 2-8 years. This double-blind randomized clinical trial was conducted on children candidate for lower abdominal surgery. The 96 patients were randomly divided into 3 groups including dexmedetomidine, neostigmine, and tramadol. For all children, 3 mg of midazolam was administered orally before entering the operating room. The patients underwent general anesthesia with 2 μg/kg fentanyl, 0.03 mg/kg midazolam, 0.5 mg/kg atracurium and 5-6 mg/kg thiopental. After determining the hiatus membrane, 2 mL syringes containing air and distilled water (each of which 1 mL) slowly entered the space. After eliminating caudal resistance, 1.5% lidocaine was injected at dose of 0.5 mL/kg. A total of 96 patients were enrolled in this study. The results revealed that pain scores in the dexmedetomidine group in recovery, 2, 6 and 12 hours after surgery were less than the other two groups. Furthermore, the tramadol group showed a lower score in comparison with the neostigmine group and the duration of analgesia in the dexmedetomidine group was more than the other two groups. In addition, the mean of analgesic at 24 hours after operation in the dexmedetomidine group was lower as compared to the other two groups, indicating the effect of dexmedetomidine as an adjuvant in increasing the duration of analgesia and reducing postoperative pain in patients along with lidocaine 1.5%. All three drugs (neostigmine, tramadol and dexmedetomidine drugs), along with other local anesthetic, increased the duration of analgesia and decreased postoperative pain in children. The effect of dexmedetomidine was greater than the other two drugs. The study was approved by the Ethics Committee of Arak University of Medical Sciences, Iran (approved No. IR.ARAKMU.REC.1396.112) on October 28, 2017, and registered at Iranian Registry of Clinical Trials (registration No. IRCT20141209020258N83) on August 29, 2018.
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http://dx.doi.org/10.4103/2045-9912.266984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6779012PMC
May 2020

Comparison of the effect of apotel and pregabalin on postoperative pain among patients undergoing lower limb orthopedic surgeries.

J Family Med Prim Care 2019 Jul;8(7):2405-2408

Department of Neurology, Arak University of Medical Sciences, Arak, Iran.

Introduction: Proper control of postoperative pain is one of the major challenges after surgery. Such pains result in physical complications, increased metabolism, exacerbations of underlying diseases, and increased blood pressure. The aim of the present study was to compare the effect of apotel and pregabalin on postoperative pain among patients undergoing lower limb surgery.

Materials And Methods: This study is a double-blind randomized clinical trial. About 75 patients undergoing lower limb orthopedic surgeries in Valiasr Hospital in Arak, Iran, were enrolled in the study. Patients were divided into three groups as follow: The first group received a 150-mg pregabalin capsule 2 h before the surgery. The placebo group received capsule that was replaced by starch. Furthermore, other group received 1 g of apotel in 200 mL of normal saline, 20 min before surgery. Pain at 2, 4, 12, and 24 h after surgery was recorded based on visual analogue scale. The amount of opioid use was recorded in the first 24 h in milligrams. Patient sedation was recorded by Ramsey Sedation Scale at 2, 6, 12, and 24 h after surgery. Finally, the data were analyzed using SPSS-20.

Results: Pain in the apotel group was found to be lower when comparing with other group in 2, 4, 12, and 24 h after surgery ( = 0.0001). Ramsey score was found to be more in the pregabalin group at 2.6, 12, and 24 h after surgery ( < 0.05). In addition, the lowest opioid use was in the apotel group ( = 0.0001).

Conclusion: Our findings revealed that apotel had a better effect on pain management, whereas pregabalin exhibited better effect on the sedation of patients.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_396_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691460PMC
July 2019

Comparison of hemodynamic changes of magnesium sulfate and dexmedetomidine for an axillary brachial plexus block.

J Family Med Prim Care 2019 Jul;8(7):2223-2228

Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran.

Introduction: Axillary brachial plexus block is used for anesthesia in hands and forearm surgery. The aim of this study was to compare the hemodynamic changes of magnesium sulfate and dexmedetomidine in axillary block.

Materials And Methods: This randomized, double-blind clinical trial was conducted on 99 patients undergoing a forearm and hand surgery at the Vali-Asr Hospital. Patients were divided into three groups. Dexmedetomidine group consisted of lidocaine 1.5% plus 0.5 μg/kg dexmedetomidine, magnesium sulfate group included lidocaine 1.5% plus 100 mg magnesium sulfate, and the control group received lidocaine 1.5% with normal saline. The final volume was divided into 35 groups in three groups. Blood pressure, heart rate, and oxygen saturation were measured every 5 minutes during surgery, and data were analyzed by SPSS 23.

Results: There was a statistically significant difference between the three groups in terms of the mean blood pressure during surgery ( < 0.05). At all times, blood pressure in the dexmedetomidine group was lower as compared to the other two groups. But in the 20 and 25 minutes, there was a relative increase in blood pressure. There was a significant difference between the three groups in terms of heart rate during surgery in minutes 20, 25, 65-100, and 110-120 ( < 0.05).

Conclusion: The final result showed that the blood pressure and heart rate of the dexmedetomidine group patients at different times were less than the other two groups.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_318_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691457PMC
July 2019

Effect of intramuscular hyoscine-n-butyl bromide on fallopian tube spasm and pain perception during and after hysterosalpingography in infertile women: A randomized single-blind controlled clinical trial.

Med J Islam Repub Iran 2019 16;33:31. Epub 2019 Apr 16.

Department of Biostatistics and Epidemiology, School of Medicine, Arak University of Medical Sciences, Arak, Iran.

Hysterosalpingography plays an important role in diagnostic work-up and treatment planning for infertile women. This procedure is usually uncomfortable and painful. The present study plans to investigate the effect of intramuscular Hyoscine-N-Butyl Bromide (HBB) on fallopian tube spasm and pain perception during and after hysterosalpingography (HSG) in infertile women. This randomized single-blind controlled clinical trial (IRCT2017021132455N2) was conducted on infertile women scheduled for HSG in one radiology clinic affiliated to Arak University of Medical Sciences between July and August 2017. Patients were selected by convenience sampling and were randomly assigned to HBB (n=50) and a control group (n=50). Women received 20 mg/1cc HBB intramuscularly in the intervention group, 30 minutes before the procedure. Women in the control group did not receive any medication. The patients were requested to complete the Numeric Pain Rating Scale after injection of the dye, and also 30 minutes following the end of the HSG. Presence or absence of tubal spasm was determined after checking the radiographic images. For the data analysis using SPSS version 18, descriptive statistics, and analytical tests such as independent sample t-test, Mann- Whitney test, chi-square or Fisher's exact tests and logistic regression and ANCOVA were used. Statistically significant differences were not observed in pain scores between the HBB and the control groups at the point of dye injection and 30 minutes after ending the HSG (p>0.05). Also, tubal spasm in the HBB group was lower than in the control group, but the differences were not statistically significant between the two groups (p=0.37). The use of intramuscular HBB before HSG has no advantage in reducing tubal spasm and the induced pain during dye injection and 30 minutes after the HSG procedure. Thus, we don't recommend HBB use before the HSG in order to relief from pain and spasm.
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http://dx.doi.org/10.34171/mjiri.33.31DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6708101PMC
April 2019

Comparison of midazolam and dexmedetomidine for pain relief during and after hysterosalpingography in women with infertility.

J Med Life 2019 Apr-Jun;12(2):173-177

Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran.

Patients feel uncomfortable with cervical manipulation, uterine distension and stimulation of peritoneum during hysterosalpingography (HSG) and experience lower abdominal pain during and after the procedure. Pain during the procedure has a negative effect on the adaptation of patients to treatment and physicians are trying to overcome this unpleasant situation. Therefore, the aim of this study was to compare the effect of midazolam and dexmedetomidine on reducing pain and spasm of fallopian tubes during and after HSG procedure in women with infertility. In a double-blind randomized controlled trial, 102 patients were randomly divided into two groups, midazolam and dexmedetomidine. The pain was recorded during injection and immediately after injection and 30 minutes after HSG, and then the complications of injection were recorded. Finally, the data were analyzed using SPSS version 20. Based on the results presented herein, no significant difference was found between the two groups in terms of vasovagal reaction, spasticity of the tube and the side of the spastic tube and uterine cavity anomalies (p <0.05). However, the pain showed a significant difference between the two groups during the injection, immediately or at 30 minutes after the procedure (p = 0.0001). The pain in the midazolam group was less than that of dexmedetomidine. Furthermore, there was no significant difference between the two groups regarding spasticity (p <0.05). There is a benefit in terms of pain reduction with the use of dexmedetomidine when comparing with midazolam injection. However, dexmedetomidine does not cause side effects in patients and can be used to reduce pain during injection.
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http://dx.doi.org/10.25122/jml-2019-0013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6685310PMC
October 2019

Premedication effect of melatonin on propofol induction dose for anesthesia, anxiety, orientation and sedation after abdominal surgery: a double-blinded randomized trial.

Med Gas Res 2019 Apr-Jun;9(2):62-67

Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran.

The present study addressed the effect of melatonin premedication on propofol induction dose for anesthesia in abdominal surgery. This is a double-blinded clinical trial in which abdominal surgery patients admitted to the Valiasr Hospital, Iran (n = 88) were enrolled and individually randomized into two groups: melatonin and placebo groups sublingually administered 3 mg of melatonin and placebo, respectively, 50 minutes before surgery. Their anxiety, orientation, and sedation were recorded before melatonin administration, anesthesia induction, and recovery, while we also recorded the propofol induction dose required for general anesthesia. Anxiety was seen less in the melatonin group than the placebo group (P < 0.05), whereas orientation was significantly different before anesthesia induction (P = 0.044) and sedation was the same before the induction (P = 0.044) and recovery (P = 0.049) in both groups, with a better efficiency in the melatonin group in which a lower dose of propofol was used (P = 0.002). The sedation, anxiety, and propofol dose used were lower in the melatonin group than the placebo group. The recommended dosage was 3 mg of melatonin once to achieve an anesthetic depth index or a bispectral index of 40. The study was approved by Ethical Committee of Arak University of Medical Sciences with IR.ARAKMU.REC.1395.432 code in July 2016, and the trial was registered in Iranian Registry of Clinical Trials with IRCT20141209020258N98 in September 2016.
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http://dx.doi.org/10.4103/2045-9912.260646DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6607868PMC
May 2020

Effect of different doses of intrathecal dexmedetomidine on hemodynamic parameters and block characteristics after ropivacaine spinal anesthesia in lower-limb orthopedic surgery: a randomized clinical trial.

Med Gas Res 2019 Apr-Jun;9(2):55-61

Department of Epidemiology, School of Health; Traditional and Complementary Medicine Research Center (TCMRC), Arak University of Medical Sciences, Arak, Iran.

The study aims to compare the efficacy of different doses of intrathecal dexmedetomidine on hemodynamic parameters and block characteristics after ropivacaine spinal anesthesia in lower-limb orthopedic surgery. In a double-blind trial, 90 patients undergoing spinal anesthesia for lower-limb orthopedic surgery were included and then randomly assigned to three groups; dexmedetomidine 5 μg/kg, dexmedetomidine 10 μg/kg and placebo. Blood pressure, heart rate, and oxygen saturation were recorded in the three groups at the first 15 minutes and then every 15 to 180 minutes at recovery by a resident anesthesiologist, as well as sensory-motor block onset. The visual analog scale scores for the assessment of pain were recorded at recovery, and 2, 4, 6, and 12 hours postoperatively and the data were analyzed by Stata software. The onset and time to achieve sensory block to ≥ T8 were faster in the 10 μg/kg dexmedetomidine group than the other groups (P = 0.001). The Bromage score was higher in the 10 μg/kg dexmedetomidine group (P = 0.0001) with lower pain score as compared with the 5 μg/kg dexmedetomidine and placebo groups (P = 0.0001). Therefore, an increase in dexmedetomidine hastens the onset of sensory-motor block but not causes side effects. This study was approved by the Ethical Committee of Arak University of Medical Sciences in 2017 (Ethical Code: IR.ARAKMU.REC.1396.37), and the trail was registered and approved by the Iranian Registry of Clinical Trials in 2017 (IRCT No. IRCT2017070614056N12).
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http://dx.doi.org/10.4103/2045-9912.260645DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6607861PMC
May 2020

Comparison of Topical and Subcutaneous Bupivacaine Infiltration with Subcutaneous Ketamine on Postoperative Pain in Total Abdominal Hysterectomy.

Med Arch 2019 Feb;73(1):15-18

Department of Gynecology, Arak University of Medical Sciences, Arak, Iran.

Introduction: Hysterectomy is one of the most common surgical procedures. Problems such as severe pelvic pain, irregular or heavy bleeding and uterine cancer from those that may be used to treat them no choice but to remove the uterus by surgery. Abdominal pain after abdominal hysterectomy, the most common complaints of patients undergoing this type of surgery is considered.

Aim: This study aimed to compare the effects of bupivacaine into the subcutaneous tissue and skin ketamine for pain control after surgery in patients undergoing abdominal hysterectomy was performed under general anesthesia.

Methods: This study is a randomized, double-blind clinical trial involving 99 women scheduled for TAH referred to tertiary centers was performed. Group A: 5 mL of 0.25% bupivacaine into the subcutaneous tissue and, Group II: 100 mg ketamine skin and subcutaneous tissue with cc5 volume injection, groups of three: cc5 distilled water was injected into the subcutaneous tissue and. The average duration of analgesia and pain and pain score were recorded.

Results: The average duration of analgesia in group K 65.1±8.8, in the bupivacaine group 65.4±8.7 and in the placebo group 57.6±5.5, which, according to P Value≤0.01 is a significant difference between the three groups were observed, so that the pain in the placebo group for a significant period of ketamine and bupivacaine groups is lower, while that between ketamine and bupivacaine in terms of the average duration of analgesia was no significant difference not.

Conclusion: The results of our study indicate that the use of bupivacaine and ketamine effective in reducing postoperative pain in patients undergoing abdominal hysterectomy tissue and further doses of ketamine and bupivacaine single dose resulted in a significant reduction of postoperative pain patients were compared to the placebo group.
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http://dx.doi.org/10.5455/medarh.2019.73.15-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6445620PMC
February 2019

Comparison of intradermal Dexmedmotidine and subcutaneous Ketamine for post-surgical pain management in patients with abdominal hysterectomy.

Eur J Transl Myol 2019 Jan 11;29(1):7873. Epub 2019 Jan 11.

Department of Anesthesiology, Arak University of Medical Sciences, Arak Iran.

Hysterectomy after cesarean section is the second most commonly used surgery for women in the United States. One of the most common problem after hysterectomy is pain. We decided to compare the effects of dexmedmotidine or ketamine on pain in patients by a double blind randomized clinical trial on 126 female candidates for abdominal hysterectomy in three groups of 42 persons referred to Taleghani hospital in Arak. For the first group, 50 micrograms of intradermal dexmedmotidine were injected, while in the second group, patients were injected with 100 mg of subcutaneous ketamine and the third group received 5 cc normal saline. Data were next analyzed by SPSS version 19. The mean age and body mass index of the patients were not significantly different in the three groups. The mean scores of pain during recovery of patients in ketamine, dexmedmotidine and placebo groups were 4.2±0.77, 2.6±0.89 and 1.3±0.87, respectively (p = 0.001). Scores of pain in patients at 4 and 8 hours after surgery showed also significant differences. In conclusion, ketamine and dexmedmotidine significantly reduce the severity of pain, but ketamine has a lower effect.
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http://dx.doi.org/10.4081/ejtm.2019.7873DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6460212PMC
January 2019

Evaluation the efficacy of prophylactic tamsulosin in preventing acute urinary retention and other obstructive urinary symptoms following colporrhaphy surgery.

J Family Med Prim Care 2019 Feb;8(2):722-727

Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran.

Background And Aim: Postoperative urinary retention (POUR) is defined as a disability in urinary excision after surgery. There are several strategies to prevent POUR, such as tamsulosin, which is a selective antagonist at alpha-1A and alpha-1B-adrenoceptors which reduces the bladder outlet resistance. The aim of this study was to investigate the efficacy of prophylactic tamsulosin in preventing acute urinary retention and other obstructive urinary symptoms following colporrhaphy surgery.

Materials And Methods: This study was a randomized, double-blind clinical trial. A total of 130 patients who were candidates for colporrhaphy were divided into two groups: the intervention group (65 subjects received 0.4 mg tamsulosin in a single dose at the time of sleeping) and the control group (65 subjects received placebo at the same time as the intervention group). The incidence of acute urinary retention and other obstructive urethral symptoms and the mean urination volume after catheterization were recorded 24 h after operation. Patients' demographic and clinical data were analyzed using SPSS version 20 software using Chi-square and Fisher's tests.

Results: There was a significant difference in the incidence of acute urinary retention, decrease in urine flow diameter, and the mean residual urine volume Post Void Residual (PVR) in the bladder, and the incidence of these symptoms decreased in the tamsulosin recipient group. The incidence of other symptoms of acute urinary retention was not significantly different when compared between both the groups.

Conclusion: It seems that the use of prophylactic tamsulosin is more effective in decreasing the incidence of acute urinary retention, decreasing the PVR in the bladder, and decreasing the diameter of the urine flow in patients after colporrhaphy.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_18_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6436324PMC
February 2019

Effects of Selenium Supplementation on Metabolic Status in Patients Undergoing for Coronary Artery Bypass Grafting (CABG) Surgery: a Randomized, Double-Blind, Placebo-Controlled Trial.

Biol Trace Elem Res 2019 Oct 14;191(2):331-337. Epub 2019 Jan 14.

Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Islamic Republic of Iran.

This study was carried out to evaluate the effects of selenium supplementation on glycemic control, lipid profiles, and biomarkers of inflammation and oxidative stress in patients undergoing for coronary artery bypass grafting (CABG) surgery. This randomized, double-blind, placebo-controlled trial was performed among 33 patients undergoing for CABG surgery, aged 40-85 years old. Subjects were randomly allocated into two groups to intake either 200 μg/day selenium supplements as selenium yeast (n = 17) or placebo (n = 16) for 4 weeks. Glycemic control, lipid profiles, and biomarkers of inflammation and oxidative stress were assessed at baseline and at the end of trial. After the 4-week intervention, selenium supplementation significantly decreased fasting plasma glucose (FPG) (β, 6.76 mg/dL; 95% CI, - 13.13, - 0.40; P = 0.03), insulin (β, - 1.14 μIU/mL; 95% CI, - 2.01, - 0.28; P = 0.01); homeostasis model of assessment-estimated insulin resistance (HOMA-IR) (β - 0.35; 95% CI, - 0.62, - 0.08; P = 0.01); and total-/HDL-cholesterol ratio (β - 0.31; 95% CI, - 0.51, - 0.09; P = 0.008); and significantly increased HDL-cholesterol levels (β, 2.72 mg/dL; 95% CI, 0.89, 4.55; P = 0.005) compared with the placebo. Moreover, selenium supplementation led to a significant reduction in high-sensitivity C-reactive protein (hs-CRP) (β, - 0.68 mg/L; 95% CI, - 1.18, - 0.17; P = 0.01) and malondialdehyde (MDA) (β, - 0.27 μmol/L; 95% CI, - 0.47, - 0.07; P = 0.009), and a significant elevation in total glutathione (GSH) levels (β, 77.33 μmol/L; 95% CI, 56.11, 98.55; P < 0.001) compared with the placebo. Selenium supplementation did not affect other metabolic profiles. Overall, our study demonstrated that selenium supplementation for 4 weeks to patients undergoing for CABG surgery had beneficial effects on FPG, insulin, HOMA-IR, total-/HDL-cholesterol ratio, HDL-cholesterol, hs-CRP, GSH, and MDA levels, but did not affect other metabolic profiles. Clinical trial registration number: http://www.irct.ir : IRCT2017090533941N22.
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http://dx.doi.org/10.1007/s12011-019-1636-7DOI Listing
October 2019

A comparative study on the prophylactic effects of paracetamol and dexmedetomidine for controlling hemodynamics during surgery and postoperative pain in patients with laparoscopic cholecystectomy.

Medicine (Baltimore) 2018 Dec;97(51):e13330

Department of Anesthesiology.

Background: Today, the ever-expanding technology is inevitably shadowing on all aspects of human life. This study was aimed to compare the prophylactic effects of paracetamol and dexmedetomidine for controlling hemodynamics during surgery and postoperative pain.

Methods: The study population consisted of 132 patients aged 18 to 70 years and from both genders, who were candidates for emergency cholecystectomy or elective surgery. Group A consisted of 66 patients who received dexmedetomidine, and Group B included 66 patients with paracetamol administration. The amount of postoperative pain was measured on the basis of visual analog scale, arterial blood pressure, as well as heart rate at recovery and 4, 12, and 24 hours after surgery.

Results: The mean age in the 2 groups was similar and almost equal to 52 years; there was no difference in the sex ratios in both groups (P > .05). Pain score in the paracetamol group was significantly lower than that in the dexmedetomidine group (P = .04); nevertheless, there were no group differences in the mean scores of pain during these hours (P > .05). The median opioid use in 24 hours after operation in the paracetamol group was lower when compared with that in the dexmedetomidine group, and the mean duration of analgesia in the paracetamol group was higher when comparing with dexmedetomidine group. Furthermore, in both groups, mean arterial pressure and preoperative PR interval were similar at various times.

Conclusion: The findings demonstrated that both regimens of drugs can control the hemodynamic status of patients during laparoscopic cholecystectomy, which provides effective postoperative analgesia for pain management.
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http://dx.doi.org/10.1097/MD.0000000000013330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6320191PMC
December 2018

A Comparison of the Effects of Dexmedetomidine and Propofol in Controlling the Hemodynamic Responses after Intubation: A Double-Blind, Randomized, Clinical Trial Study.

Open Access Maced J Med Sci 2018 Nov 10;6(11):2045-2050. Epub 2018 Nov 10.

Department of Emergency, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Aim: This study aimed to compare the effects of dexmedetomidine and propofol in controlling the hemodynamic response following intubation of patients' candidate intubation in the emergency department.

Methods: A total of 114 patients were randomly assigned to one of 2 groups to receive one of the following treatments: dexmedetomidine 0.4 µg/kg (Group D, n = 57) and propofol 1-1.5 mg/kg/h (Group P, n = 57). Hemodynamic data such as the systolic blood pressure, diastolic blood pressure, arterial oxygen saturation and heart rate (HR) were recorded from the entrance to operation room to 5, 10 and 15 min after tracheal intubation.

Results: Compared with group D, group P exhibited increases in mean arterial blood pressure (MAP), and systolic blood pressure significantly at all times and immediately after the endotracheal intubation. Moreover, the mean diastolic blood pressure changes due to tracheal intubation in group P were significantly more than group D immediately after the intubation. Furthermore, the mean heart rate changes immediately and 5 min after tracheal intubation was significantly higher in group P.

Conclusion: Our data suggest that the benefits of dexmedetomidine more than propofol in hemodynamic stability because propofol was associated with more variability in systolic/diastolic blood pressure, HR and MAP after endotracheal intubation.
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http://dx.doi.org/10.3889/oamjms.2018.385DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6290445PMC
November 2018

Comparison of Dexmedetomidine and Fentanyl as an Adjuvant to Lidocaine 5% for Spinal Anesthesia in Women Candidate for Elective Caesarean.

Open Access Maced J Med Sci 2018 Oct 23;6(10):1862-1867. Epub 2018 Oct 23.

Department of Gynecology, Arak University of Medical Sciences, Arak, Iran.

Aim: This study aimed to compare the effect of Dexmedetomidine and fentanyl as an adjuvant to lidocaine 5% in spinal anaesthesia to increase post-operative analgesia among women candidates for elective caesarean.

Methods: Eighty-four pregnant women candidates for caesarian were randomly divided into fentanyl and Dexmedetomidine groups. In the first group, 25 μg fentanyl was added to lidocaine 5% while in the second group, 0.5 μg per kilogram Dexmedetomidine was added to lidocaine 5%. After the operation, a pain score of the patients in recovery and within 4, 12 and 24 hours after the operation, the average length of analgesia and the average amount of the analgesics taken within 24 hours and after the operation were recorded.

Results: The average length of postoperative anaesthesia and the average amount of the drug taken within the first 24 hours after the operation in fentanyl group was more than the Dexmedetomidine group (P = 0.01). Shivering in Dexmedetomidine group was more common than what was observed in the fentanyl group (P = 0.001). Higher rates of nausea-vomiting were observed in the fentanyl group (P = 0.001).

Conclusions: Fentanyl results in a longer period of postoperative analgesia and less consumption of drugs after the operation. Fentanyl is recommended in caesarian.
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http://dx.doi.org/10.3889/oamjms.2018.365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236048PMC
October 2018

Investigation of the outcome of patients with hip fractures using vitamin D3.

Eur J Transl Myol 2018 Jul 27;28(3):7372. Epub 2018 Jul 27.

Department of Orthopedics, Arak University of Medical Sciences, Arak.

Hip fracture is one of the important health problems of human societies. The aim of this study was to investigate the outcome of patients with this fracture using vitamin D3. This double-blind clinical trial was performed on 100 patients with hip fractures who referred to Valiasr Hospital. All specimens were evaluated for vitamin D3. Group A have had vitamin D3 in the normal range and received a dose of 50,000 vitamin D3 as blouse. Group B included individuals with hip fractures that did not have normal vitamin D3 levels. In this group, individuals received a dose of 50,000 units vitamin D3 in the form of muscular blouse, and then 50,000 units of vitamin D3 were given orally each week up to 12 weeks after surgery. After surgery, both groups were examined clinically and radiologically for ulcer and fracture healing. Moreover, mortality was checked 2 weeks after surgery and each month until healing. There was no significant difference in radiographic examination in the two groups in the term of adhesion and fracture union (P <0.05). The formation of the union in the clinical examination 4 and 8 weeks after treatment in two groups showed significant difference. The formation of union in clinical presentation 4 weeks and 8 weeks after treatment in two groups showed significant difference (P = 0.005; P = 0.036). The results showed that a group with low vitamin D, but with supplementation, had more fracture union after 4 and 8 weeks after starting treatment. Vitamin D supplementation could improve patients' condition 4 and 8 weeks after treatment.
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http://dx.doi.org/10.4081/ejtm.2018.7372DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176387PMC
July 2018

Short-term complications of anesthetic technique used in hip fracture surgery in elderly people.

Eur J Transl Myol 2018 Jul 9;28(3):7355. Epub 2018 Aug 9.

Department of Orthopedics, Arak University of Medical Sciences, Arak, Iran.

Postoperative complications of fracture are one of the main problems in older patients with hip fracture. In this study, complications were observed 48 hours after surgery in different anesthetic procedures. This prospective cross sectional study was carried out over a 12-month period. All subjects over 55 years of age undergoing hip fracture surgery were selected for study with ASA class (American Society of Anesthesiology: one, two and three). After determining the vital signs in the operating room, anesthesia type (general, spinal and epidural) and various variables were recorded. It was observed that the spinal anesthesia method had the lowest level of postoperative disturbances of consciousness and had the shortest duration in terms of duration of time. On the other hand, general anesthesia was the least in terms of blood transfusion. Finally, epidural anesthetic method showed the least amount of pain 48 hours after operation and the least changes in blood pressure and heart rate.
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http://dx.doi.org/10.4081/ejtm.2018.7355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176388PMC
July 2018