Publications by authors named "Bahram Naderi Nabi"

30 Publications

  • Page 1 of 1

Ultrasound-Guided Lumbar Transforaminal Epidural Injections; A Single Center Fluoroscopic Validation Study.

Bull Emerg Trauma 2019 Jul;7(3):251-255

Department of Anesthesiology and Pain, Guilan University of Medical Sciences, Rasht, Guilan, Iran.

Objective: To investigate the success rate (technical precision) of ultrasound-guided lumbar transforaminal epidural steroid injection, which was validated by conventional fluoroscopic technique.

Methods: A total of 20 patients with unilateral single-level lumbar foraminal disc protrusion causing radiculopathy were enrolled. Using transforming route, the needle location was determined by an axial (transvers) view of the ultrasound with fluoroscopic confirmation. We determined the needle placement accuracy of ultrasound- guided lumbar transforaminal injections approach.

Results: The accuracy of ultrasound-guided interventions was 90% as confirmed by fluoroscopy. There were 2 failed cases at the L4-L5 level in the US-guided. The success rate in L5-S1 level was 100%, in L4-L5 level was 80% and in L3-L4 level was 100%. No complications were noted.

Conclusion: Ultrasound-guided lumbar transforaminal epidural injections are accurate and feasible in clinical setting with an accuracy of 90% and no complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.29252/beat-070307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681880PMC
July 2019

Effects of Acupressure on Fatigue in Patients with Cancer Who Underwent Chemotherapy.

J Acupunct Meridian Stud 2019 Aug 25;12(4):103-110. Epub 2019 Jul 25.

Social Determinants of Health Research Center (SDHRC), School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.

Fatigue is the commonest symptom in cancer patients; despite high levels of clinically significant persistent cancer-related fatigue, few treatments are currently available. The aim of this study was to evaluate the efficacy of acupressure on fatigue in patients with cancer who underwent chemotherapy. The study was designed as a randomized and controlled trial. Ninety samples were selected using the convenience sampling method, and random block sampling was used for allocation of groups (30 for each group). The three groups were similar by age and gender. The experimental group underwent acupressure at the Zusanli (ST-36), Hegu (LI-4), and Sanyingjiao (SP-6), whereas sham pressure was used in the placebo group and no intervention was applied in the control group; the level of fatigue of participants in three groups was calculated in three phases, before, during, and after chemotherapy. Data were analyzed using SPSS, version 22. The results showed that the mean of visual analog score of fatigue is significantly different in three groups at the end of chemotherapy (p = 0.021). The mean visual analog score of fatigue in the acupressure group was meaningfully lower than that in the control group after chemotherapy (p = 0.028). Results of this investigation showed that acupressure has short-term effectiveness on the cancer-related fatigue of patients undergoing chemotherapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jams.2019.07.003DOI Listing
August 2019

Effectiveness of acupressure on anxiety of children undergoing anesthesia.

Int J Adolesc Med Health 2019 May 3. Epub 2019 May 3.

Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran.

Background and objectives Tonsillectomy is one of the most commonly used pediatric surgeries with high stress levels for children and their parents. The present study was designed and implemented regarding the fact that limited studies have ever been carried out about the effects of complementary therapies such as acupressure on the preoperative anxiety levels in children throughout the world. Materials and methods Present study was a randomized clinical trial that was done in three groups with 144 children aged 5-12 years undergoing tonsillectomy. In present study, the children were allocated in three groups: intervention, control and sham. In the intervention group, the acupressure was applied on the Yintang point and in the sham group, was applied at a sham acupoint. No intervention was performed in the control group. Before and after intervention, the pediatric anxiety levels were measured using instruments. The results were analyzed using descriptive and inferential statistics such as the Kruskal-Wallis and Wilcoxon tests, chi-square (χ2) and analysis of variance (ANOVA) test. The significance level was considered p < 0.05. Results The total anxiety score in children was (70.39 ± 20.93) in the control group, (67.83 ± 16.78) in the intervention group and (71.40 ± 21.82) in the sham group, not significant difference (p > 0.05). The different in the overall anxiety score among children before intervention compare to after intervention was as following: Control group (-3 ± 17.46), intervention group (8.42 ± 32.98) and sham group (-4.32 ± 24.47). Conclusion Like other surgical procedures, the tonsillectomy has serious stress for children. Our study demonstrates that the acupressure has a significant effect on the level of preoperative anxiety in children undergoing surgery. Therefore, nurses can use this technique to reduce the pediatric anxiety.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/ijamh-2018-0177DOI Listing
May 2019

Does Adding Lidocaine to Intrathecal Bupivacaine Affect Hemodynamic Parameters during Hip Fracture Surgery?

Arch Bone Jt Surg 2018 Sep;6(5):390-396

Research performed at Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran.

Background: Hip fracture is one of the most common problems in elderly that needs surgical repair. As, the majority of these patients have chronic diseases, they are at increased risk of peri-operative mortality and morbidity. The purpose of this study was to evaluate spinal anesthesia with bupivacaine vs bupivacaine in combination with lidocaine in terms of hemodynamic changes in patients undergoing hip fracture surgery.

Methods: This double-blind clinical trial was conducted on 292 patients undergoing surgery for hip fracture under spinal anesthesia. Patients were allocated into two groups of B (10 mg of hyperbaric 0.5% Bupivacaine) and BL (5 mg hyperbaric Bupivacaine 0.5% plus 50 mg Lidocaine 5%). Sensory and motor block and hemodynamic changes were consecutively measured before spinal anesthesia (T0), immediately after spinal injection (T1), every 5 minutes for half an hour (T2- T7), and at 45 minutes (T8) and 60 minutes (T9) after injection.

Results: Patients in the two groups were homogeneous in demographic characteristics including age, sex, BMI, ASA Class, baseline blood pressure and heart rate. The onsets of sensory and motor blocks in group BL were faster than group B (). Also, the durations of sensory and motor blocks in group B were significantly longer than group BL ). The BL group had a significantly lower systolic blood pressure in all periods (). Although the heart rate in the BL group was lower than group B at all time points, this difference was only significant during T2-T3 ( and , respectively). Group BL had significantly more episodes of hypotension, bradycardia, nausea and vomiting (, , , and , respectively).

Conclusion: According to our findings, using Lidocaine 50 mg in combination with Bupivacaine 5 mg, compared with Bupivacaine 10 mg alone for spinal anesthesia in hip fracture fixation surgeries was associated with more hypotension and bradycardia. As a result, combination of Bupivacaine with Lidocaine at this dose is not recommended for induction of anesthesia in these patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6168228PMC
September 2018

Comparing the Effectiveness of Patient Control Analgesia Pump and Bolus Morphine in Controlling Pain After Cardiopulmonary Bypass Graft Surgery.

Anesth Pain Med 2017 Oct 14;7(5):e12756. Epub 2017 Oct 14.

Resident of Anesthesia, Anesthesiology and Critical Care Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran.

Background: Postoperative pain is a complex process commonly caused by surgical trauma. It is one of the major concerns of patients undergoing heart surgery. Despite new techniques and modern analgesic treatments, postoperative pain is still one of the most important controversial issues.

Methods: 68 patients scheduled for elective CABG with CPB were included in a prospective, double-blind clinical trial. They were randomly divided into two groups. One group received PCA pump including morphine (group P) with underlying infusion of 0.02 mg/kg/Qh, bolus dose of 1 mg, lockout time of 15 minutes, and a maximum of 4 bolus of 0.02 mg/kg for one hour and the other group received morphine bolus (group B). Three patients were excluded from the study, and 33 and 32 patients participated in the groups P and B, respectively. Variables including age, gender, pump time, aortic clamp time, duration of surgery, complications (nausea and vomiting, GI Bleeding, and hypoxia), level of pain based on VAS, opioid consumption, hemodynamic, and sedation status were measured in both groups.

Results: There was no significant difference between the groups regarding age, gender, pump time, clamp time, duration of surgery, complication, sedation score, and hemodynamic status in most of the assessment periods. By assessing the pain severity in the groups at different periods, results showed a significant difference between the groups except at enrollment, and a lower severity of pain was noted in the group P compared to the group B. The consumed opioid was significantly higher in the group P than in the group B. However, higher doses of diclofenac and paracetamol were administered in the group B compared to the group P.

Conclusions: Results showed that higher morphine would be used in patients with PCA pump after extubation following heart surgery, and this increased dose of opioid was associated with better pain control and lack of complication. Therefore, PCA pump with underlying infusion could be effectively used in patients undergoing CABG that are directly assessed in intensive care unite.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5812/aapm.12756DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903217PMC
October 2017

Comparing the Effect of Adding Fentanyl, Sufentanil, and Placebo with Intrathecal Bupivacaine on Duration of Analgesia and Complications of Spinal Anesthesia in Patients Undergoing Cesarean Section.

Anesth Pain Med 2017 Oct 27;7(5):e12738. Epub 2017 Aug 27.

Resident of Anesthesia, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran.

Background: Spinal anesthesia is the method of choice for most elective and emergency Cesarean sections. To increase the duration of anesthesia and improve the quality of analgesia during and after surgery, intrathecal opioids, as adjuvant drugs, are used in combination with local anesthetics.

Methods: This was a double-blind clinical trial performed on 99 patients. Women were divided into 3 groups of fentanyl, sufentanil, and placebo. For fentanyl group, 12.5 mg of bupivacaine and 25 micrograms of fentanyl; for sufentanil group, 12.5 mg of bupivacaine and 2.5 micrograms of sufentanil; and for placebo group, 12.5 mg of bupivacaine and a half mL of normal saline were injected in subarachnoid space. The sensory and motor block, hemodynamic status (mean blood pressure and heart rate), and probable complications were assessed.

Results: There was no significant difference between the groups in demographic characteristics. Durations of analgesia were, respectively, 314 ± 42.95, 312.5 ± 34.44, and 116.1 ± 42.24 minutes in the fentanyl, sufentanil, and placebo groups (P = 0.0001). Duration of sensory and motor block was higher in fentanyl and sufentanil groups compared with the placebo group. The highest duration of sensory and motor block was noted in sufentanil group (P = 0.0001). No significant difference was found between the groups in the hemodynamic parameters (P > 0.05). The frequency of itching in the fentanyl group was higher than sufentanil and placebo groups (P = 0.003). Also, shivering was higher in the placebo group compared with other groups (P = 0.036).

Conclusions: According to the results, adding 25 microgram fentanyl or 2.5 microgram sufentanil to intrathecal bupivacaine increased the duration of analgesia and provided hemodynamic stability with no major complication. As administering intrathecal fentanyl had a similar duration of analgesia like sufentanil with faster return of motor block and ambulation, it seems that it is a preferred additive for Cesarean section surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5812/aapm.12738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903220PMC
October 2017

Evaluation of Admission Indications, Clinical Characteristics and Outcomes of Obstetric Patients Admitted to the Intensive Care Unit of a Teaching Hospital Center: A Five-Year Retrospective Review.

Anesth Pain Med 2017 Jun 30;7(3):e13636. Epub 2017 May 30.

Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: Care of obstetric patients has always been a challenge for critical care physicians, because in addition to their complex pregnancy-related disease, fetal viability is considered.

Objectives: The aim of this study was to review the admission indications, clinical characteristics and outcomes of obstetric patients, admitted to the intensive care unit of Alzzahra teaching hospital affiliated to Guilan University of Medical Sciences, Rasht, Iran.

Methods: This retrospective cohort study was conducted on pregnant /post-partum (up to 6 weeks) patients admitted to the ICU over a 5-year period from April 2009 to April, 2014.

Results: Data from 1019 subjects were analyzed. Overall, 90.1% of the patients were admitted in the postpartum period. The most common indications for admission were pregnancy related hypertensive disorders (27.5%) and obstetric hemorrhage (13.5%). Epilepsy (5.4%) and cardiac disease (5.2%) were the most common non-obstetric indications.

Conclusions: Pregnancy-related hypertensive disorders and obstetric hemorrhage were the main reasons for admission, and epilepsy and cardiac disease were the most common non-obstetric indications. Efforts must be concentrated on increasing antenatal care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5812/aapm.13636DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5696879PMC
June 2017

The effect of acupressure on pain, anxiety, and the physiological indexes of patients with cancer undergoing bone marrow biopsy.

Complement Ther Clin Pract 2017 Nov 5;29:136-141. Epub 2017 Sep 5.

Anesthesiology Department, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran. Electronic address:

Objectives: This study aimed to determine the effect of acupressure on pain intensity, anxiety, and physiological indexes of patients with cancer undergoing bone marrow biopsy and aspiration.

Methods: The study was designed as a randomized, double-blinded, controlled trial. Ninety samples was selected using the convenience sampling method, then for allocation groups random block sampling was used (30 for each group). The three groups were similar by age and gender. LI4 and HT7 (Shen Men) acupressure points were examined for the intervention. Sham pressure was used in the placebo group while no intervention was applied in the control group.

Results: The results showed that the lowest average anxiety score (1.5 ± 0.5; P = 0.01) and the lowest average pain score (4.9 ± 0.8) after the intervention were related to the acupressure method (P = 0.001).

Conclusion: Cost effectiveness and short-term simple education make acupressure method useful in clinical settings for different illnesses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ctcp.2017.09.002DOI Listing
November 2017

Comparing the Effects of Isoflurane-Sufentanil Anesthesia and Propofol-Sufentanil Anesthesia on Serum Cortisol Levels in Open Heart Surgery with Cardiopulmonary Bypass.

Anesth Pain Med 2016 Dec 21;6(6):e42066. Epub 2016 Nov 21.

Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: Major surgeries such as open-heart surgery with cardiopulmonary bypass are associated with a complexity of stress response leading to post-operative complications. Studies have confirmed that anesthesia can mitigate the surgically induced stress response.

Objectives: The aim of this study was to compare the effects of propofol and isoflurane, both supplemented with Sufentanil, on the stress response in coronary artery bypass graft surgery with cardiopulmonary bypass, using cortisol as a biochemical marker.

Methods: This double-blind randomized clinical trial was conducted on 72 patients who underwent coronary artery bypass grafting (CABG) with cardiopulmonary bypass meeting the inclusion criteria. The subjects were randomly divided into two groups of isoflurane (n = 36) and propofol (n = 36) both supplemented with sufentanil. Serum cortisol levels were measured and compared between the groups; 30 minutes before the surgery (T0), at the end of the cardiopulmonary bypass (T1), and 24 hours after the surgery (T2).

Results: Compared to the baseline (T0), at the end of cardiopulmonary bypass (T1), both groups demonstrated a decrease in plasma cortisol levels with no statistical significant difference (P = 0.4). At T2 measuring time point, the level of plasma cortisol significantly increased in both groups (P = 0.02), however this increase was less in the Isoflurane group.

Conclusions: In CABG with cardiopulmonary bypass, using plasma cortisol level as a measure, Isoflurane-Sufentanil significantly reduces the stress response to the surgery, when compared to propofol-Sufentanil.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5812/aapm.42066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5560634PMC
December 2016

Effect of Selenium on Stress Response in Coronary Artery Bypass Graft Surgery: A Clinical Trial.

Anesth Pain Med 2017 Feb 9;7(1):e43864. Epub 2017 Jan 9.

Assistant Professor of Anesthesiology, Department of Anesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.

Background: In spite of significant improvements in surgical and anesthetic techniques, acute stress response to surgery remains a main cause of mortality and morbidity in coronary artery bypass graft (CABG) surgery patients. Therefore, doing research to find safe and effective modalities with more cardio protective properties seems necessary.

Objectives: In this study, we sought to determine whether intravenous injection of 600 μg Selenium (Se) prior to surgery would limit stress response measured by blood sugar.

Methods: This double blind clinical trial was conducted at a referral center of cardiac surgery affiliated to Guilan University of Medical Sciences (GUMS) from June 2015 to October 2015. 73 eligible patients candidate for elective isolated CABG surgery were enrolled in the trial. They were randomly allocated to either Se group (n = 36) receiving 600 μg Se prior to surgery or control group (n = 37). Our evaluation was based on blood sugar (BS) which was measured at four point times, including before induction of anesthesia (T0), at the end of CPB (T1), 24 hours (T2) and 48 hours (T3) after surgery.

Results: The data obtained from 73 patients in group S (n = 36) and group C (n = 37) were analyzed. There was no significant difference between the two groups regarding the baseline characteristics. In both groups, a sharp rise in BS levels was observed following CPB (P = 0.0001). Although the trend of BS changes was remarkable in both groups (P = 0.0001), there was no statistically significant difference between the groups at all point times including T0 (P = 0.45), T1 (P = 0.48), T2 (P = 0.92), and T3 (P = 0.42). Within the study time, our patients were monitored for any adverse effect but nothing was observed.

Conclusions: This investigation showed that intravenous single dose of 600 μg Se was safe in CABG patients, but had no positive effect on stress response to surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5812/aapm.43864DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5554419PMC
February 2017

Is Spinal Anesthesia with Low Dose Lidocaine Better than Sevoflorane Anesthesia in Patients Undergoing Hip Fracture Surgery.

Arch Bone Jt Surg 2017 Jul;5(4):226-230

Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran.

Background: To evaluate general anesthesia with sevoflurane vs spinal anesthesia with low dose lidocaine 5% on hemodynamics changes in patients undergoing hip fracture surgery.

Methods: In this randomized double blind trial 100 patients (50 patients in each group) older than 60 years under hip surgery were randomized in general anesthesia with sevoflurane and spinal anesthesia with lidocaine 5%. Hemodynamic changes including mean arterial pressure (MAP) and heart rate, blood loss, pain severity, nausea and vomiting and opioids consumption were compared in two groups.

Results: During surgery, difference between two groups regarding changes in mean arterial pressure was not significant, but the changes in heart rate were significantly different. Mean arterial pressure changes during recovery between two groups were significantly different. But there was no significant difference in heart rate changes. Bleeding in the sevoflurane group was significantly more than spinal group (513.ml vs. 365 ml). Moreover, AS Score, opioid consumption, and the nausea and vomiting in spinal anesthesia group was significantly lower than the sevoflurane group.

Conclusion: We showed that general anesthesia with sevoflurane and spinal anesthesia with low dose lidocaine 5% have comparable effects on hemodynamics changes in patients undergoing hip fracture surgery. However postoperative pain score, vomiting and morphine consumption in patients with spinal anesthesia were lower than general anesthesia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5592363PMC
July 2017

Does Tranexamic Acid Reduce Bleeding during Femoral Fracture Operation?

Arch Bone Jt Surg 2017 Mar;5(2):103-108

Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Poursina hospital, Rasht, Iran.

Background: Proximal Femoral shaft fractures are commonly associated with marked blood loss which can lead to postoperative acute anemia and some other complications. Tranexamic acid (TA) is an antifibrinolytic medication that reduces intra-and postoperative blood loss and transfusion requirements during some elective surgeries. The aim of this study is to evaluate the effect of intravenous Tranexamic acid (TA) on intraoperative blood loss and a subsequent need for transfusion in patients who were undergoing surgery for femoral shaft fractures in trauma setting.

Methods: Thirty-eight ASA grade I-II patients undergoing proximal femoral shaft fracture surgery with intra medullary nailing were included in this double blind randomized controlled clinical trial. They were allocated into two groups. Group I, the intervention group with eighteen patients received 15 mg/kg (TA) via intravenous infusion before surgical incision. Patients in the placebo group received an identical volume of normal saline. Hemoglobin level was measured four hours before and after the surgeries. Postoperative blood loss and hemoglobin change as well as transfusion rates and volumes were compared between the two groups.

Results: Mean Percentage fall in hemoglobin after surgery were 1.75±0.84 and 2.04±1.9 in the study and placebo groups, respectively (P=0.570). Hemoglobin loss was higher in the placebo group. Transfusion rates was lower in TA group (5.6%) compared to the placebo group (30%) (P=0.06). No significant difference in The Allowable Blood Loss during the surgery was found between the two groups (P=0.894).

Conclusion: Preoperative treatment with TA reduces postoperative blood loss and the need for blood transfusion during traumatic femoral fracture operation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410741PMC
March 2017

The Incidence and Predictors of Headache and Myalgia in Patients After Electroconvulsive Therapy (ECT).

Anesth Pain Med 2016 Jun 27;6(3):e33724. Epub 2016 Mar 27.

Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran.

Background: Electroconvulsive therapy (ECT) is a safe and effective mode of therapy for a wide variety of psychiatric disorders. However, it is associated with some disturbing side effects, such as nausea and vomiting, dental and tongue injury, confusion, dizziness, headache, and myalgia.

Objectives: The present study focused on the evaluation of myalgia and headache and their predictors after ECT.

Patients And Methods: A prospective analytical descriptive study was conducted from October 2014 to January 2015, in an academic hospital in northern Iran. Before sampling, the study was approved by the ethics committee of Guilan University of Medical Sciences. 621 patients with psychiatric disorders who were referred to Shafa hospital enrolled in the study. They were evaluated based on a verbal rating scale (4 point scales) 6 hours after ECT, regarding headache and myalgia side effects.

Results: 6 hours after ECT, 126 patients (21.9%) reported headaches, and 56 patients (9%) reported myalgia. The presence of headache or myalgia 6 hours after ECT was not correlated to the duration of convulsion, treatment sessions, sex, or age. But myalgia at 2 hours after treatment was correlated with sex (0.04). Sex, age, duration of seizure, and treatment sessions were not predictors of headache and myalgia 6 hours after ECT (log regression, enter mode). The intensity and frequency of headaches decreased during 6 hours after ECT (P = 0.0001 and P = 0.0001, respectively), and myalgia frequency decreased (P = 0.062) but the intensity increased (P = 0.87).

Conclusions: The results of the present study demonstrate that headache after ECT procedures was more common than myalgia, but it was mild, tolerable, and decreased within 6 hours of the treatment. It is also notable that we did not found any predictors for post-ECT headache and myalgia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5812/aapm.33724DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055710PMC
June 2016

Comparison of the Effects of Low-Dose Midazolam, Magnesium Sulfate, Remifentanil and Low-Dose Etomidate on Prevention of Etomidate-Induced Myoclonus in Orthopedic Surgeries.

Anesth Pain Med 2016 Apr 2;6(2):e35333. Epub 2016 Apr 2.

Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran.

Background: Etomidate is a potent hypnotic agent with several desirable advantages such as providing a stable cardiovascular profile with minimal respiratory adverse effects and better hemodynamic stability compared with other induction agents. This drug is associated, however, with myoclonic movements which is characterized by a sudden, brief muscle contractions as a disturbing side-effect.

Objectives: The present study was designed to compare the effectiveness of low- dose midazolam, magnesium sulfate, remifentanil and low-dose etomidate to suppress etomidate-induced myoclonus in orthopedic surgery.

Patients And Methods: A double-blind clinical trial study was conducted in an academic hospital from September 2014 to August 2015. Two hundred and eighty-four eligible patients, American society of anesthesiologists class I - II, scheduled for elective orthopedic surgery were randomly allocated into four equal groups (n = 71). They received premedication with intravenous low-dose midazolam 0.015 mg/kg, magnesium sulfate 30 mg/kg, remifentanil 1 μg/kg and low-dose etomidate 0.03 mg/kg two minutes before induction of anesthesia with 0.3 mg/kg intravenous etomidate. Then the incidence and intensity of myoclonus were evaluated on a scale of 0 - 3; 0 = no myoclonus; 1 = mild (movement at wrist); 2 = moderate (movement at arm only, elbow or shoulder); and 3 = severe, generalized response or movement in more than one extremity, within ninety seconds. Any adverse effect due to these premedication agents was recorded.

Results: The incidence and intensity of myoclonus were significantly lower in the low-dose etomidate group. The incidence rates of myoclonus were 51 (71.85%), 61 (85.9%), 30 (42.3%) and 41 (57.7%), and the percentages of patients who experienced grade III of myoclonus were 30 (58.8%), 32 (52.5%), 9 (30%) and 14 (34.1%) in the midazolam, magnesium sulfate, etomidate and remifentanil groups, respectively. The incidence and intensity of myoclonus were significantly lower in the low-dose etomidate group (P = 0.0001). No notable adverse effect was detected in our patients during the study period.

Conclusions: Intravenous etomidate 0.03 mg/kg prior to induction can effectively reduce the incidence and severity of myoclonus linked to etomidate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5812/aapm.35333DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4885461PMC
April 2016

Postoperative Pain After Abdominal Hysterectomy: A Randomized, Double-Blind, Controlled Trial Comparing the Effects of Tramadol and Gabapentin as Premedication.

Anesth Pain Med 2016 Feb 17;6(1):e32360. Epub 2016 Jan 17.

Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: Uncontrolled postoperative pain, characteristic to abdominal hysterectomy, results in multiple complications. One of the methods for controlling postoperative pain is preemptive analgesia. Gabapentin and tramadol are both used for this purpose.

Objectives: This study aims to compare the effects of tramadol and gabapentin, as premedication, in decreasing the pain after hysterectomy.

Patients And Methods: This clinical trial was performed on 120 eligible elective abdominal hysterectomy patients, divided in three groups of 40, receiving tramadol, gabapentin and placebo, respectively. Two hours before the surgery, the first group was given 300 mg gabapentin, the second one was given 100 mg tramadol, while the other group was given placebo, with 50 ml water. After the surgery, in case of visual analog pain scale (VAS) > 3, up to 3 mg of diclofenac suppository would be used. Pain score, nausea, vomiting, sedation, patient's satisfaction and the number of meperidine administered during 24 hours (1 - 4 - 8 - 12 - 16 - 20 - 24 hours) were recorded. If patients had VAS > 3, despite using diclofenac, intravenous meperidine (0.25 mg/kg) would be prescribed. Data were analyzed using SPSS 21 software, chi-square test, general linear model and repeated measurement.

Results: The three groups were similar regarding age and length of surgery (up to 2 hours). The average VAS, in the placebo group, was higher than in the other two groups (P = 0.0001) and the average received doses of meperidine during 24-hour time were considerably higher in placebo group, compared to the other two groups (55.62 mg in placebo, 18.75 mg in gabapentin and 17.5 mg in tramadol groups, P = 0.0001). Nausea, vomiting and sedation, in the tramadol group, were higher than in the other two groups, although they were not significant. Patients' dissatisfaction, in the placebo group, during initial hours, especially in the fourth hour, was higher (P = 0.0001). In the gabapentin and tramadol groups, the trend of changes in satisfaction score was similar. However, satisfaction in the gabapentin group, during the initial 4 hours was higher, in comparison to the tramadol group (P = 0.0001).

Conclusions: This study revealed that prescribing gabapentin or tramadol, as premedication, was effective in reducing postoperative pain, without any concerning side-effects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5812/aapm.32360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834422PMC
February 2016

A Survey on Transfusion Status in Orthopedic Surgery at a Trauma Center.

Arch Bone Jt Surg 2016 Jan;4(1):70-4

Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: Increased costs and mortality associated with inappropriate blood transfusions have led to investigations about blood request and blood transfusion techniques. We investigated the transfusion status in patients who underwent orthopedic surgery in Poursina Hospital (Rasht, Iran) to optimizing blood usage and determine if a scheduled transfusion program for every orthopedic surgery could improve blood transfusion management.

Method: In this descriptive-prospective study, all orthopedic surgeries in Poursina Hospital, Rasht, between April to June 2013 were reviewed. All patient information was recorded, including: demographics, type of surgery, hemoglobin level, cross-match test, duration of surgery, and blood loss, and transfusion. Based on the one-way ANOVA and independent samples test analysis, cross-match to transfusion ratio and transfusion possibility, the transfusion index, and maximal surgical blood order schedule were calculated to determine blood transfusion status.

Results: Among 872 selected orthopedic surgery candidates, 318 of them were cross-matched and among those, 114 patients received a blood transfusion. In this study, the cross-match to transfusion ratio was 6.4, transfusion possibility 36.47%, transfusion index 0.6, and maximal surgical blood order schedule 0.9.

Conclusion: We found that blood ordering was moderately higher than the standard; so it is highly recommended to focus on the knowledge of evidence based on transfusion and standard guidelines for blood transfusion to avoid over-ordering.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4733240PMC
January 2016

A Survey on the Effect of Oral Gabapentin on Hemodynamic Changes During Direct Laryngoscopy and Tracheal Intubation and Intraoperative Bleeding in Patients Undergoing Septorhinoplasty.

Anesth Pain Med 2015 Oct 24;5(5):e29705. Epub 2015 Oct 24.

Anesthesia Research Center, Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran.

Background: In patients undergoing septorhinoplasty, control of bleeding and hemodynamic variables is of great importance and laryngoscopy and tracheal intubation could be followed by a specific and transient increase in systemic blood pressure and heart rate.

Objectives: This study aimed to examine the effects of oral gabapentin on hemodynamic changes, during direct laryngoscopy, and the amount of bleeding in the patients undergoing septorhinoplasty.

Patients And Methods: In a double-blind clinical trial, 103 patients (American society of anesthesiologists class I, II) aged 18 - 45 years old, who were septorhinoplasty candidates, were randomly assigned into two groups, a 900 mg gabapentin group and placebo, in Amir-Al-Momenin academic hospital. The drug was prescribed to the patients orally, 2 hours before the operation. Anesthetic technique was similar for all the patients. Heart rate (HR), systolic (SBP) and diastolic blood pressures (DBP), mean arterial blood pressure (MAP), oxygen saturation percentage of arterial blood (SaO2), before induction of anesthesia, 3, 5, 10, and 15 minutes after the intubation and tracheal extubation, and the amount of bleeding during operation were measured. Statistical analysis was performed with the SPSS (v. 16) software.

Results: Variations in the HR, DBP and SaO2, in the specified time intervals, did not show any statistically significant difference, although variations in SBP were statistically significant (higher in gabapentin group). Regarding the average amount of bleeding volume, although there was a lower amount of bleeding in the gabapentin group, the difference was not statistically significant. Also, regarding the pain, there was no significant difference between the two groups in terms of visual analog scale (VAS) average and the received analgesic.

Conclusions: The present study showed that premedication with 900 mg gabapentin did not affect the hemodynamic changes induced by laryngoscopy and the amount of bleeding. However, the decreased amount of bleeding was observed in the gabapentin group.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5812/aapm.29705DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4644309PMC
October 2015

Comparison of Transcutaneous Electrical Nerve Stimulation and Pulsed Radiofrequency Sympathectomy for Treating Painful Diabetic Neuropathy.

Anesth Pain Med 2015 Oct 10;5(5):e29280. Epub 2015 Oct 10.

Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: Painful diabetic peripheral neuropathy (DPN) is a long-term complication of type 1 and type 2 diabetes that majorly impacts quality of life. Its prevalence increases with age and duration of diabetes. It is more common in patients who have suboptimal glycemic control over several years. Because DPN may be resistant to conventional treatments, it is common for patients to only have partial pain relief. Therefore, new therapeutic options are needed for the condition.

Objectives: The aim of the present study was to compare the efficacy of transcutaneous electrical nerve stimulation (TENS) and pulsed radiofrequency (PRF) lumbar sympathectomy in treating painful DPN.

Patients And Methods: Sixty-five patients with painful DPN refractory to conventional treatment were randomly and evenly assigned to either the TENS or PRF lumbar sympathectomy groups. Pain evaluations were based on the 10-point numerical rating scale (NRS). Subjects were followed for three months and had a total of four study visits (baseline and 1 week, 1 month, and 3 months after treatment).

Results: Sixty patients completed all study visits. In both groups, the NRS rating significantly decreased after treatment, with a marked pain reduction observed at the first follow-up evaluation. In the PRF group, the NRS decreased from 6.46 at baseline to 2.76 at the 1 week visit. One and 3 months after treatment, the NRS was 4.30 and 5.13, respectively (P < 0.0001). In the TENS group, the NRS decreased from 6.10 at baseline to 3.96 at the 1 week visit. One and 3 months after treatment, the NRS was 5.23 and 5.90, respectively (P < 0.0001). Unfortunately, the NRS steady increased almost back to baseline levels in the TENS group. The NRS only slightly increased during the follow-up period in the PRF group, but did not reach baseline levels.

Conclusions: Both TENS and PRF lumbar sympathectomy are promising pain relief treatments for painful DNP. However, PRF lumbar sympathectomy seems to have a superior efficacy. Further studies with a larger sample size and a longer follow-up period are needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5812/aapm.29280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4644305PMC
October 2015

Effect of Intravenous Intraoperative Esmolol on Pain Management Following Lower Limb Orthopedic Surgery.

Korean J Pain 2015 Jul 1;28(3):198-202. Epub 2015 Jul 1.

Qazvin University of Medical Sciences, Qazvin, Iran.

Background: Lack of proper control of acute postoperative pain often leads to lingering or chronic pain. Several studies have emphasized the role of beta-blockers in reducing postoperative pain. Esmolol is a selective short-acting beta-blocker that produces few side effects. The purpose of this study was to examine the effect of intravenous intraoperative esmolol on postoperative pain reduction following orthopedic leg fracture surgery.

Methods: In a clinical trial, 82 patients between 20-65 years of age with tibia fractures and American Society of Anesthesiologists (ASA) physical status I & II who underwent surgery were divided into two groups. Group A received esmolol and group B received normal saline. Postoperative pain was measured at three time points: entering the recovery unit, and at 3 h and 6 h following surgery, using the Visual Analogue Scale (VAS). A P value of < 0.05 was considered significant.

Results: Mean VAS scores at all three time points were significantly different between the two test groups (P = 0.02, P = 0.0001, and P = 0.0001, respectively). The consumption of pethidine was lower in group A than in group B (P = 0.004) and the duration of its effect was significantly longer in time (P = 0.026).

Conclusions: Intravenous intraoperative esmolol is effective in the reduction of postoperative pain following leg fracture surgery. It reduced opioid consumption following surgery and delayed patient requests for analgesics.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3344/kjp.2015.28.3.198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500784PMC
July 2015

The effect of magnesium sulfate on motor and sensory axillary plexus blockade.

Anesth Pain Med 2015 Feb 1;5(1):e21943. Epub 2015 Feb 1.

Anesthesiology Research Centre, Guilan University of Medical Sciences, Rasht, Iran.

Background: Magnesium is a physiologic cation that blocks neuromuscular transmission and does not allow the nerve to be stimulated.

Objectives: This study investigates the effect of adding magnesium sulfate to lidocaine to extend the duration of sensory and motor blocks of the axillary plexus in orthopedic surgeries of the upper extremities.

Patients And Methods: This controlled randomized double-blind study was performed on patients who were candidates for orthopedic surgery of the upper extremities. A total of 60 patients between 18-60 years with ASA Class 1 or 2 participated in the study. One group received lidocaine (5 mg/kg) with magnesium sulfate 20% (3 mL) as the case group, while the second group received lidocaine (5 mg/kg) with normal saline (3 mL) as a placebo to block the axillary plexus using the trans-arterial technique. The duration of the sensory and motor block of the axillary plexus was monitored and evaluated using the pinprick and modified Bromage scale.

Results: A total of 60 patients were included in the study with 30 patients having received lidocaine plus magnesium and the other 30 patients having received lidocaine plus normal saline. The mean sensory block duration in the case group was 248.83 ± 18.36 and in control group was 204.67 ± 22.62. The mean motor block duration in the case group was 207.0 ± 16.64 and in control group was 147.33 ± 21.52 (both P < 0.0001). The mean onset of sensory block in case group was 15.5 ± 3.79 and the onset block in control group was 10.33 ± 4.13 (P < 0.0001). The mean onset of motor block in case group was 20.66 ± 4.09 and the onset block in control group was 19.73 ± 26.18 (P < 0.848).

Conclusions: The addition of magnesium sulfate to lidocaine increased the duration of motor and sensory axillary block in the upper extremities during surgeries when compared to the use of lidocaine alone.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5812/aapm.21943DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363737PMC
February 2015

Hemodynamic and Arterial Blood Gas Parameters during Cemented Hip Hemiarthroplasty in Elderly Patients.

Arch Bone Jt Surg 2014 Sep 15;2(3):163-7. Epub 2014 Sep 15.

Mehran Soleimanha MD, Ahmad Reza Mirbolook MD, Mohsen Mardani-Kivi MD, Department of Orthopedics, Guilan University of Medical Science, Rasht, Iran.

Background: Patients undergoing cemented hip hemiarthroplasty may develop bone cement implantation syndrome (BCIS) which is a leading cause of intraoperative complications. The purpose of this study was to evaluate cardiovascular changes during cemented hip hemiarthroplasty in elderly patients.

Methods: Cemented hip hemiarthroplasty was performed on 72 patients with femoral neck fracture. All patients were catheterized with a radial artery catheter to assess mean arterial pressure (MAP) and arterial blood gas (ABG) in these time points: just before cementation, just after cementation (0th), 5 min (5th) and 10 min (10th) after cementation, and at the end of surgery (END). Also, systolic and diastolic blood pressure (SBP & DBP), heart rate and any arrhythmia or cardiac arrest was evaluated.

Results: Seventy-two patients (33 females, 39 males; mean age: 66.8±7 years) were evaluated. All parameters changed during cementation with a significant drop in MAP, SBP, and DBP immediately after cementation and pH and base excess decreased significantly (P<0.001) with no changes in O2 saturation. Mean heart rate rose until the 5th and then decreased dramatically with no bradycardia presentation. During cementation, 12 patients showed arrhythmia, but no cardiac-arrest was observed.

Conclusions: Under strict observation of a anesthesiology care team, hemiarthroplasty can be a safe method for femoral neck fracture in elderly osteoporotic patients without severe cardiopulmonary compromise.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4225020PMC
September 2014

Comparing the effects of morphine sulfate and diclofenac suppositories on postoperative pain in coronary artery bypass graft patients.

Anesth Pain Med 2014 Oct 21;4(4):e19423. Epub 2014 Sep 21.

Cardiac Surgery Department, Guilan University of Medical Sciences, Rasht, Iran.

Background: Simple and efficient way of pain management after Coronary Artery Bypass Graft (CABG) surgery is an important aspect of patients' care.

Objectives: This study aimed to compare the effects of morphine and diclofenac suppositories on postoperative pain management.

Patients And Methods: In this double-blinded clinical trial study, 120 patients aged 30-65 years old, undergone CABG, were equally divided into two groups of A (morphine) and B (diclofenac). All patients were anesthetized with intravenous fentanyl 10 μg/kg, etomidate 0.2 mg/kg and cisatracurium 0.2 mg/kg. Anesthesia was maintained with oxygen 50% and air 50%, propofol 50 μg/kg/min, fentanyl 1-2 μg/kg/h and atracurium 0.6 mg/kg/h. Analgesics were administered after the operation at intensive care unit (ICU) and Visual Analogue Score (VAS) was evaluated in both groups in 4-hour intervals after extubation for 24 hours. After extubation in case of VAS > 3, morphine suppository 10 mg (group A) or diclofenac suppository 50 mg (group B) was administered for patients.

Results: No significant statistical relationship was found between the two groups regarding gender, age, BMI, paracetamol consumption, length of operation time, cardiopulmonary bypass pump (CPB) time, and stay time at ICU (P Value ≥ 0.05). Total dosage of used morphine was 22 ± 8.3 mg in each patient and total dosage of used diclofenac was 94 ± 32.01 mg. Average variation of VAS at measured intervals was significant (P Value ≤ 0.0001), but these variations were not significantly different when comparing the two groups (P Value = 0.023).

Conclusions: Both morphine and diclofenac suppositories reduced pain significantly and similarly after CABG surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5812/aapm.19423DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4205802PMC
October 2014

Predicting difficulty score for spinal anesthesia in transurethral lithotripsy surgery.

Anesth Pain Med 2014 Oct 9;4(4):e16244. Epub 2014 Sep 9.

Urology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Background: Spinal anesthesia (SA) is the most common regional anesthesia (RA) conducted for many surgical procedures.

Objectives: The current study aimed to predict the difficulty score of SA, by which to reduce the complications and ultimately improve the anesthesia quality.

Materials And Methods: Transurethral Lithotripsy (TUL) surgery candidates were enrolled in this observational study from 2010 to 2011. Before SA, the patient`s demographic information along with the Body Mass Index (BMI), lumbar spinous process status, spinal deformity, radiological signs of lumbar vertebrae, and a history of spinal surgery or difficult SA were recorded, then the patients underwent SA in L3-L4 interspinous process space. Information about Cerebrospinal Fluid (CSF) visibility at the first attempt (easy SA) and the times of trying with shifting in that space or trying the second space (moderate SA) and the third space (difficult SA) were recorded. Multinominal regression and relative operating characteristic (ROC) curve were used for statistical analysis.

Results: Hundred and one patients were enrolled. Of these patients, 50 (49.5%) underwent SA by the first attempt of the first space, in 36 patients (35.6%) it was moderate and in 15 patients (14.9%) it was difficult. There was no significant relationship between difficulty score of SA and gender, age, height, and history of previous difficult SA. But there was a significant relationship between difficulty score of SA and lumbar spinous process status (P =0.0001), radiological profile of the lumbar spine (P = 0.0001), the status of lumbar deformity (P = 0.007), and BMI (P = 0.006). Then using the ROC curve to predict the difficult SA, the cutoff point was 8.5 with 86.7% and 86% sensitivity and specificity, respectively.

Conclusions: It seems that considering the clinical examination of patients before SA focusing on lumbar spinous process status, presence of lumbar deformity, calculation of BMI and radiological signs of lumbar vertebrae can be helpful in predicting SA difficulty.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5812/aapm.16244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4199214PMC
October 2014

Electroconvulsive therapy-related cognitive impairment and choice of anesthesia: the tipping point.

J ECT 2015 Jun;31(2):101-4

From the *Guilan University of Medical Science Anesthesiology Research Center; †Shafa Hospital; ‡SHKUMS Department of Anesthesiology; and §Department of Psychiatry, Guilan University of Medical Science.

Introduction: Electroconvulsive therapy (ECT) is among the most effective treatments of several life-threatening psychiatric disorder. Despite effective therapy, ECT-induced seizure could cause several adverse effects including cognitive disorders and memory impairment. Drugs such as thiopental, which have been prescribed for anesthesia required for ECT, are known as drugs with cognitive effects. This pilot randomized clinical trial tried to assess the feasibility of using a lower dose of thiopental in combination with remifentanil instead of a higher challenging dose of a single drug with cognitive side effects such as thiopental. We evaluated post-ECT cognitive impairment in patients who received remifentanil-thiopental compared with thiopental-placebo group.

Patients And Methods: One hundred twenty patients with psychiatric disorders between the ages of 18 and 60 years were enrolled. The patients were randomized into 2 groups who received either thiopental sodium (4 mg/kg) and remifentanil (1 μg/kg) or thiopental sodium (3 mg/kg, placebo). The psychiatric patients were examined using mini-mental state examination in terms of the cognitive deficits before ECT as well as 5 and 24 hours after ECT. Statistical analyses were done using Statistical Package for the Social Sciences version 16. Unpaired t test, χ2 test, and analysis of variance were used to determine the association of variables.

Results: All the patients completed the trial. There were no reports of adverse effects. In terms of depth of anesthesia measured by bispectral index, no significant difference was observed. Regarding mini-mental state examination scores, the difference was not statistically significant.

Conclusions: Depth of anesthesia was similar between the groups.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/YCT.0000000000000187DOI Listing
June 2015

The effect of intravenous magnesium sulfate on laryngospasm after elective adenotonsillectomy surgery in children.

Anesth Pain Med 2014 Feb 28;4(1):e15960. Epub 2014 Feb 28.

Department of Anesthesia and Intensive Cares, Guilan University of Medical Sciences, Rasht, Iran.

Background: Laryngospasm is the protective reflex of tracheobronchial tree against secretions and hemorrhage. This reflex is more prevalent in adenotonsillectomy in the presence of light anesthesia, which can lead to obstruction of airway, complications, and mortality. Different methods have been studied for preventing this complication; however, none of them could reliably prevent it.

Objectives: The objective was to assess the effect of magnesium sulfate on laryngospasm and coughing after adenotonsillectomy.

Patients And Methods: Seventy children with three to 12 years of age and ASA classes I and II, who were candidates for adenotonsillectomy, were recruited in this randomized clinical trial. The study group received 15 mg/kg intravenous magnesium sulfate and the control group received 0.9% normal saline with the same volume, 2 minutes after tracheal intubation via intravenous infusion for 20 minutes. After removing the endotracheal tube in the recovery room, the patients were assessed at minutes zero, 15, and 30in terms of laryngospasm and coughing. The assessment was based on four-point scale of severity of these complications and saturation percentage of arterial oxygen in operating and recovery room. After collecting the data, results were analyzed with the SPSS 16 software anda P value < 0.05 was considered statistically significant.

Results: Laryngospasm was not found in the magnesium sulfate group; however, its incidencewas5.7% in the control group. The incidence rates of coughs were 17.1% and 40% in the magnesium sulfate group and in the control group, respectively, which had no statistically significant differences.

Conclusions: Intravenous magnesium sulfate with dose of 15 mg/kg could not prevent laryngospasm and coughing after removal of the endotracheal tube in patients undergoing adenotonsillectomy; however, it reduced coughing and laryngospasm in the magnesium sulfate group compared with the control group.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5812/aapm.15960DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3961025PMC
February 2014

Comparing the duration of the analgesic effects of intravenous and rectal acetaminophen following tonsillectomy in children.

Anesth Pain Med 2014 Feb 6;4(1):e13175. Epub 2014 Feb 6.

Anesthesia Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: Postoperative pain control (especially, after adenotonsillectomy) has a very important effect on recovery time, hospitalization duration, hemodynamic disorders, bleeding, nausea, vomiting and medical costs.

Objectives: The aim of this study was to investigate and compare the effects of intravenous and rectal acetaminophen on controlling post-adenotonsillectomy pain in children, and duration of their analgesic effects.

Patients And Methods: In this randomized double-blinded clinical trial, 96 children aged 4 - 10 years old with ASA physical status I or II who were candidates for adenotonsillectomy surgery in Amir-al-Momenin Hospital, Rasht, Iran were entered into the study and randomly divided into two equal groups. Anesthesia in both groups was induced injecting fentanyl-thiopental and at racurium; afterwards is of lurane was used to maintain anesthesia. After anesthesia induction, one group received intravenous and the other one, rectal acetaminophen, and were later compared based on CHIPPS criteria.

Results: Data analysis indicated a significant relationship between reduction of postoperative pain and the use of intravenous or rectal acetaminophen (P = 0.0001); in group receiving IV acetaminophen, only 10.4% of patients had no pain whereas in group receiving rectal acetaminophen, this number reached 43.8%. Also, on 4 and 6 hour time intervals, pain in rectal acetaminophen receiving group was less than that in IV acetaminophen receiving group (P < 0.05). Demand for additional analgesic medication in rectal acetaminophen receiving group was less than that in IV group (P = 0.0001).

Conclusions: Post-operative pain in rectal acetaminophen group was less than that in intravenous acetaminophen group, and rectal acetaminophen group demanded their first additional analgesic medication later.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5812/aapm.13175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3961018PMC
February 2014

Magnesium sulfate and sufentanil for patient-controlled analgesia in orthopedic surgery.

Anesth Pain Med 2014 Feb 28;4(1):e11334. Epub 2014 Feb 28.

Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: Postoperative analgesia is one of the concerns of anesthesiologists and patients. Systemic opioid administration is the gold standard in reducing the severe pain after the surgery but some side effects prevent the use of adequate dosage of opioids.

Objectives: The aim of this study was to evaluate the result of adding magnesium sulphate to sufentanil in patient-controlled intravenous analgesia (PCIA) system.

Patients And Methods: In this randomized clinical trial, 60 patients candidate for lower limb orthopedic surgery were recruited in Poursina Medical Center for six months. They were randomly classified in two group of patient-controlled intravenous analgesia for postoperative pain control, one was group S [(sufentanil) (n = 30)] and the other was group S + M [(magnesium sulphate/sufentanil) (n = 30)]. The drug infusion rate was 5 mL/h. Each mL of solution in group S contained 1 mcg of sufentanil and in group M + S, 1 mcg of sufentanil and 200 mcg magnesium sulphate, respectively. Pain score, sedation score, satisfaction score, nausea and vomiting score were evaluated 6, 12, 24, 36 and 48 hours after surgery.

Results: The demographic data between two groups were not significantly different. The pain scores after 6, 12 and 24 hours in S and S + M groups were significantly different. But the comparison of Visual Analogue Scale (VAS) scores after 36 and 48 hours didn't show significant differences (P < 0.001). Comparison of the sedation, nausea and vomiting scores between two groups did not show any difference. But the number of patient's satisfaction in S + M group was more than S group which suggests significant differences (P < 0.05).

Conclusions: This study showed that magnesium sulphate added to sufentanil through PCIA is an effective method to alleviate pain in patients undergoing lower limb orthopedic surgery. Moreover, we found fewer side effects on magnesium-sufentanil regimen in terms of in nausea, vomiting, and sedation; and patients' satisfaction in this regimen was more rather than that in the regiment of sufentanil alone.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5812/aapm.11334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3961029PMC
February 2014

Comparison of surgical conditions during propofol or isoflurane anesthesia for endoscopic sinus surgery.

Anesth Pain Med 2013 Sep 1;3(2):234-8. Epub 2013 Sep 1.

Anesthesia Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: The Anesthesia planning is an important and determining factor in the amount of intraoperative hemorrhage, which can affect the rate of intraoperative and postoperative complications.

Objectives: In this study we used two different anesthesia techniques in functional endoscopic sinus surgery (FESS) and compared the amount of hemorrhage in the two groups.

Patients And Methods: In a single-blind clinical trial, 44 patients with ASA class I and II candidate for FESS in Amir-Al-Momenin hospital in Rasht were entered the study and divided into two equal groups randomly. In both groups anesthesia was induced with propofol, remifentanil and cis. atracurium and then, infusion of propofol - remifentanil in the first group and isoflurane plus Remifentanil infusion in the second group was used for maintenance of anesthesia. Systolic blood pressure was maintained about 90 mmHg. Then on the basis of maximum allowable blood loss (MABL) formula, we calculated the percentage of hemorrhage. Finally the patients' hemorrhage was categorized into three groups (< 10%, 10-20%, > 20%). The surgeon's satisfaction from surgical field was calculated according to the Visual Analogue Scale. Then the data was statistically analyzed with T- test.

Results: There were meaningful differences between average of hemorrhage (propofol group = 155cc, and Isoflurane group = 291.3cc; P = 0.003), and surgeon's satisfaction (propofol group = 1.9 and Isoflurane group = 2.95; P = 0.007).

Conclusions: The amount of hemorrhage in propofol group was less than Isoflurane group and the field condition was better in propofol group than the Isoflurane group.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5812/aapm.9891DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3833048PMC
September 2013

Propofol is Effective to Depress Fentanyl-Induced Cough during Induction of Anesthesia.

Anesth Pain Med 2013 26;2(4):170-3. Epub 2013 Mar 26.

Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran.

Background: Various attempts have been made to reduce the incidence of fentanyl-induced cough during anesthesia induction. We hypothesized that an appropriate dose of propofol might suppress fentanyl-induced cough.

Objectives: A study had been designed to observe the effects of propofol on a fentanyl-induced cough during anesthesia induction.

Patients And Methods: We performed a randomized, double-blind study to evaluate the effect of the pre-emptive use of minimal dose intravenous propofol (20 mg) on the incidence of cough caused by a larger bolus of intravenous fentanyl. Group 1 patients were given fentanyl at a dosage of 4 µg/kg. Group 2 received 4µg/kg fentanyl and 20 mg propofol. The two groups were evaluated in 0, 5 and 10 second intervals following the injection of fentanyl.

Results: Mean age, weight, and, height was 35 ± 10.45, 67.99 ± 10.92, and 165.33 ± 31.84 respectively. The incidence of fentanyl induced cough was 29 (74.4%) in placebo group compared with 10 (25.6%) in the propofol group. There was a significant difference in the incidence and severity of cough between group 1 and 2 (P < 0.0001). This study also showed that propofol could decrease cough incidence in patients who smoke.

Conclusions: Priming dose of propofol (20mg) one minute prior to fentanyl injection was effective in suppressing a fentanyl-induced cough.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5812/aapm.8383DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821139PMC
November 2013

Celecoxib as a pre-emptive analgesia after arthroscopic knee surgery; a triple-blinded randomized controlled trial.

Arch Orthop Trauma Surg 2013 Nov 17;133(11):1561-6. Epub 2013 Sep 17.

Orthopedic Department, Guilan University of Medical Sciences, Rasht, Iran.

Background: Pre-emptive analgesia not only controls pain but also may result in the reduction of opioid consumption and related side effects following orthopedic surgeries. The purpose of the present study was to examine the therapeutic effects of celecoxib in reducing pain following the arthroscopic knee surgeries: anterior cruciate ligament (ACL) reconstruction and partial meniscectomy.

Materials And Methods: In this triple-blinded, randomized, placebo-controlled clinical trial, celecoxib 400 mg and identical placebo were administered, 2 h prior to operation, to 130 patient candidates for undergoing knee arthroscopic surgery of either isolated meniscectomy or ACL reconstruction. Pain intensity, 24 h opioid consumption and the related side effects were measured at 6 and 24 h post operation.

Results: The patients in both groups were similar with regards to demographic characteristics such as age, gender and body mass index. The results of the study indicated that the pain intensity and opioid consumption were lower in both subgroups (meniscectomy and ACL-R) in celecoxib group at 6 and 24 h post operation (P < 0.0001). The side effects of analgesics such as nausea and vomiting, sedation, and dizziness were not significantly different between the two groups (P > 0.05).

Conclusion: It seems that celecoxib as a pre-emptive analgesia agent is effective in decreasing acute postoperative pain and 24 h opioid consumption in patients undergoing arthroscopic knee surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00402-013-1852-0DOI Listing
November 2013