Publications by authors named "Mohammad Reza Khajavi"

51 Publications

Nasogastric tube insertion in intubated patients with the guide of wire rope: A prospective randomised controlled study.

Int J Clin Pract 2021 Jun 12:e14508. Epub 2021 Jun 12.

Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Nasogastric tube (NGT) insertion is sometimes required in intubated patients. NGTs are prone to kink and coil during blind insertion. We hypothesised that wire rope guide-assisted NGT insertion with chin lift can significantly improve the first-attempt success rate over the conventional technique during its insertion in intubated patients.

Objective: Mean time to successful insertion of NGT, the failure rate of NGT insertion in the first attempt, the failure rate of NGT insertion in the second attempt and overall failure rate were assessed along with the incidence of any complications.

Method: This prospective clinical trial conducted 100 adult patients presenting for abdominal surgery under general anaesthesia. These patients were randomised to an experimental technique of Wire rope guide with chin lift (wire group) or a control technique of head flexion (control group) for insertion of the NGT.

Results: The first-attempt success rate was 98% in wire group compared with 74% in the control group (P = .001). Thus, the first-attempt failure rate was 2% in wire group compared with 26% in the control group (P = .001). The median time required to insert the NGT was significantly shorter in wire group (35.3 ± 4.8 vs 61.5 ± 6.2 seconds, P = .001). The incidences of kinking/coiling, bleeding, and moderate injuries were significantly lower in wire group.

Conclusion: The use of rope wire guide for correct positioning of the NGT in intubated patients is less time-consuming with the high first-attempt success rate and lower incidence of procedure-related injuries compared to the conventional method.
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http://dx.doi.org/10.1111/ijcp.14508DOI Listing
June 2021

Prophylactic administration of diphenhydramine/paracetamol reduced emergence agitation and postoperative pain following maxillofacial surgeries: a randomized controlled trial.

Eur Arch Otorhinolaryngol 2021 May 27. Epub 2021 May 27.

Department of Oral and Maxillofacial Surgery, Dental School, Tehran University of Medical Sciences, Tehran, Iran.

Background: Emergence agitation after maxillofacial surgeries is an anxious and problematic complication for the surgeon and anesthesiologist that may lead to self-extubation, haemorrhage, and surgical destruction. In this study, we investigated the effects of preemptive administration of diphenhydramine on emergence agitation and quality of recovery after maxillofacial surgery in adult patients.

Methods: Eighty-five patients undergoing maxillofacial surgery were randomized into two groups. The diphenhydramine group (Group D, n = 40) received diphenhydramine premedication 0.5 mg/kg before anesthesia induction, while the control group (Group C, n = 40) received volume-matched normal saline as a placebo. Before incision, all patients receive 0.1 mg/kg morphine sulfate slowly intravenously within 5 min. Continuous infusion of remifentanil 0.2 μg/kg/h and inhalation of isoflurane was maintained during the anesthesia period. Paracetamol 1 g was infused 15 min before extubation. We evaluated the incidence of agitation during the extubation period after general anesthesia, hemodynamic parameters, and recovery characteristics during the postoperative period.

Results: During extubation time, the incidence of emergence agitation was lower in Group D than in Group C (16% vs. 49%, P = 0.041). The time from isoflurane discontinuation to extubation (7.7 min in Group D vs. 6.8 min in Group C, P = 0.082) was not different. Grade of cough during emergence, the severity of pain, analgesic requirements, and hemodynamic changes were lower in group D compared with Group C.

Conclusions: Preemptive administration of diphenhydramine provided smooth emergence from anesthesia. It also improved the quality of recovery after maxillofacial surgery.

Trial Registration Number: This study was registered at http://irct.ir (registration number IRCT20130304012695N3).
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http://dx.doi.org/10.1007/s00405-021-06904-4DOI Listing
May 2021

The Efficacy of Intraoperative Ketamine-Haloperidol for Prevention of Catheter-related Bladder Discomfort After Lumbar Spinal Stenosis Surgery.

Oman Med J 2019 May;34(3):212-217

Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: Catheterization of urinary bladder during surgery frequently leads to agitation of the patient in the recovery room, especially in those patients who remain catheterized after gaining consciousness. We hypothesized that administration of a combination of ketamine-haloperidol (KH) before urinary catheterization would reduce the incidence of catheter-related bladder discomfort (CRBD) while reducing some adverse effects of ketamine in the postoperative period.

Methods: A total of 119 male patients who underwent lumbar spinal stenosis surgery were randomized into three groups. The KH group consisted of 39 patients who received KH just before urinary catheterization. The second arm of the study including 40 patients who received pethidine-haloperidol (PH). The control (C) group consisted of 40 patients who received normal saline as a placebo. We sought to determine the incidence and severity of CRBD at arrival in recovery and one, six, and 24 hours after.

Results: The incidence of CRBD upon arrival in the recovery room was 17.9% in the KH group, and 52.5% and 55% in the PH and C groups, respectively. The incidence of CRBD was significantly lower in the KH group at arrival in the recovery room. The severity of CRBD was lower in the KH group at one and six hours of surgery ( < 0.007). There was no significant difference 24 hours after surgery.

Conclusions: Intravenous administration of KH before urinary catheterization effectively decreases the incidence and severity of postoperative CRBD while reducing adverse effects attributed to ketamine.
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http://dx.doi.org/10.5001/omj.2019.41DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505337PMC
May 2019

Low-dose preoperative pregabalin improves postoperative pain management in septorhinoplasty surgery: a double-blind randomized clinical trial.

Eur Arch Otorhinolaryngol 2019 Aug 4;276(8):2243-2249. Epub 2019 May 4.

Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To evaluate the efficacy of single low dose (75 mg) preoperative pregabalin in reducing post-operative pain of septorhinoplasty.

Methods: A double blind single center Randomized controlled trial based on block randomization. In the pregabalin group (PG) 34 participants received 75 mg pregabalin orally one hour before anesthesia induction while in control group (CG) 34 participants received a placebo. Pain and sedation were repeatedly measured with Visual Analouge Scale (VAS) and Riker Sedation-Agitation Scale (RSAS) respectively, 0.5, 1, 2, 6, 24 hours postextubation. Cumulative doses of fentanyl and ibuprofen received in both groups were compared.

Results: Thirty-two of the participants in PG and 33 of the participants in CG completed the study. The Mean VAS pain score was less in PG versus CG 30 min postoperatively (2.30 ± 1.30 vs. 4.85 ± 1.17), one hour (2.28 ± 0.92 vs. 4.27 ± 0.78), two hours (2.11 ± 0.88 vs. 3.60 ± 0.61) and six hours (1.47 0.62 vs. 2.76 ± 0.91) but not 24-hours postoperatively (0.84 ± 0.62 vs. 1.09 ± 0.92). Participants in the PG were less agitated during early post-extubation period (at 10 min: RSAS 3.93 ± 0.43 vs. 4.42 ± 0.50) and more alert during the first hour post-extubation (at 60 min: RSAS 3.90 ± 0.29 vs. 3.36 ± 0.69). The total dose of rescue fentanyl and ibuprofen was lower in the PG compared to the CG.

Conclusions: A single dose of 75 mg pregabalin is very effective for pain control after septorhinoplasty procedure when administered one hour before anesthesia induction. Side effects are rare and opioid sparing was noted.

Trial Registration: Clinical trial number: IRCT2017043033706N1.
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http://dx.doi.org/10.1007/s00405-019-05448-yDOI Listing
August 2019

Half Saline-Bicarbonate Solution as Intraoperative Fluid Replacement Therapy Leads to Less Acidosis and Better Early Renal Function During Deceased-Donor Transplant.

Exp Clin Transplant 2020 02 17;18(1):34-38. Epub 2019 Apr 17.

From the Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: Normal saline is the most common crystalloid solution that is used in renal transplant surgery. In this study, our aim was to determine the effects of a combination of half saline and bicarbonate versus normal saline as a routine solution.

Materials And Methods: For this double-blind random-ized clinical trial, we enrolled 100 adult patients undergoing kidney transplant. Patients were divided into 2 groups: those who received normal saline and those who received half saline and bicarbonate infusion as fluid replacement therapy during renal transplant. All patients received about 40 mL/kg of crystalloids during surgery. Serial creatinine con-centrations (primary outcomes) were compared between groups at 1, 2, 3, and 7 days after surgery. Urine output (secondary outcome) was compared between groups at recovery and at 6 and 24 hours after surgery. In addition, base excess, chloride, and sodium levels were measured before and 6 hours after surgery. Each liter of half saline-bircarbonate, which is relatively isoosmotic to human plasma, was composed of 70 mEq bicarbonate, 77 mEq chloride, and 147 mEq sodium.

Results: Patients who received half saline-bicarbonate had significantly lower postoperative creatinine levels at all time points than patients who received normal saline (P = .019). Serum chloride and sodium levels (P = .001) were significantly higher and base excess (P = .007) was significantly lower in the normal saline group at 6 hours after transplant. At all time points, urine output levels were significantly higher in the half saline-bicarbonate group (P = .001).

Conclusions: The use of half saline-bicarbonate was associated with better early graft function compared with normal saline in the first 7 days after transplant.
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http://dx.doi.org/10.6002/ect.2018.0328DOI Listing
February 2020

Preemptive Effect of Intraurethral Instillation of Ketamine-lidocaine Gel on Postoperative Catheter-related Bladder Discomfort after Lumbar Spine Surgery.

Asian J Neurosurg 2018 Oct-Dec;13(4):1057-1060

Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: Catheter-related bladder discomfort (CRBD) is one of the main reasons of agitation after surgery, leading to urgency and frequency during recovery. Ketamine has been used as an effective drug for reducing the signs and severity of this problem. We hypothesized that intraurethral instillation of ketamine-lidocaine gel before urinary catheterization can reduce the incidence of CRBD in the postoperative period.

Materials And Methods: A total of 136 male patients, who underwent two-level laminectomy/discectomy were enrolled in this randomized clinical trial. Patients were randomized into the two groups before urinary catheterization. The ketamine group received urethral lubrication with 5 mL xylocaine jelly (2%) in conjunction with 2 mL (100 mg) ketamine. Patients in control group received urethral lubrication with 5 mL xylocaine jelly (2%) in conjunction with 2 mL distilled water. The primary outcome was the incidence of CRBD. CRBD was assessed using four-stage criteria when arriving in the recovery room and at 1, 2, and 6 h after surgery. Postsurgical pain and the number of sedatives given and opioid requirement were also the secondary outcomes in this study.

Results: Intraurethral instillation of ketamine-lidocaine gel reduced the incidence of CRBD at recovery ( < 0.001) along with a reduction in the severity of CRBD ( < 0.05) during the 1 and 2 visit compared with control group. The mean pain intensity score (visual analog scale) and opioid requirement to relieve postsurgical pain were lower in the ketamine group during all the study timepoints from recovery and after transfer to the ward ( < 0.008). A higher rate of sedation (72% vs. 11%) also was seen at recovery period in the ketamine group ( < 0.008).

Conclusion: Intraurethral instillation of ketamine-lidocaine gel before bladder catheterization is an effective technique for reducing the incidence and severity of postoperative CRBD.
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http://dx.doi.org/10.4103/ajns.AJNS_314_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208219PMC
November 2018

Comparison of Arterial Oxygenation Following Head-Down and Head-Up Laparoscopic Surgery.

Anesth Pain Med 2017 Dec 29;7(6):e58366. Epub 2017 Nov 29.

Associated Professor, Tehran University of Medical Sciences, Tehran, Iran.

Background: Regarding the role of gas entry in abdomen and cardiorespiratory effects, the ability of anesthesiologists would be challenged in laparoscopic surgeries. Considering few studies in this area and the relevance of the subject, this study was performed to compare the arterial oxygen alterations before operation in comparison with after surgery between laparoscopic cholecystectomy and ovarian cystectomy.

Methods: In this prospective cohort, 70 consecutive women aged from 20 to 60 years who were candidate for laparoscopic cholecystectomy (n = 35) and ovarian cystectomy (n = 35) with reverse (20 degrees) and direct (30 degrees) Trendelenburg positions, respectively, with ASA class I or II were enrolled. After intubation and before operation, for the first time, the arterial blood gas from radial artery in supine position was obtained for laboratory assessment. Then, the second blood sample was collected from radial artery in supine position and sent to the lab to be assessed with the same device after 30 minutes from surgery termination. The measured variables from arterial blood gas were arterial partial pressure of oxygen (PaO) and Oxygen saturation (SpO) alterations.

Results: Total PaO was higher in the first measurement. The higher values of PaO in cholecystectomy (upward) than in ovarian cystectomy (downward) were not significant in univariate (P = 0.060) and multivariate analysis (P = 0.654). Furthermore, higher values of SpO in cholecystectomy (upward) than in ovarian cystectomy (downward) were not significant in univariate (P = 0.412) and multivariate analysis (P = 0.984).

Conclusions: In general, based on the results of this study, the values of PaO in cholecystectomy (upward) were not significantly higher than the values in cystectomy (downward) in laparoscopic surgeries when measured 30 minutes after surgery.
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http://dx.doi.org/10.5812/aapm.58366DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903378PMC
December 2017

Comparison Effect of Promethazine/Dexamethasone and Metoclopramide /Dexamethasone on Postoperative Nausea and Vomiting after Laparascopic Gastric Placation: A Randomized Clinical Trial.

Anesth Pain Med 2017 Aug 22;7(4):e57810. Epub 2017 Jul 22.

MD, Department of Anesthesiology, Tehran University of Medical Sciences, Sina Hospital, Hassan Abad Square, Tehran, Iran.

Background: Laparoscopic gastric plication (LGP) is a technique in the restrictive category of bariatric procedures that reduces the gastric volume and increases intragastric pressure. Nausea and vomiting are the most common complications after this procedure. The goal of this research is to compare the combined effect of promethazine/dexamethasone versus Metoclopramide/ dexamethasone on the prevention of nausea and vomiting after LGP.

Methods: In recovery, the patients were divided into two groups, the Metoclopramide group which was given Metoclopramide 10 mg plus dexamethasone 4 mg/8 hours intravenous for 48 hours, and the promethazine group which was given promethazine 50 mg /12 hours, intramuscular for the first 24 hours and then promethazine 25 mg/12 hours for the next 24 hours plus dexamethasone 4 mg/8 hours intravenous for 48 hours. The frequency of nausea and vomiting, number of reflux episodes, frequency of epigastric fullness, and the duration of walking around q12 hours were recorded in the first 48 hours post-operation.

Results: Eighty patients were enrolled into the study. Promethazine group were found to significantly reduce the incidence of PONV in the first 24 hours compared with the other group (41% vs. 97.5%), relative risk = 0.042 [95% CI = 0.006, 0.299]. The mean numbers of epigastric fullness and severity of epigastria pain were lower in the promethazine group (P = 0.01) and the total opioid requirement was also reduced in promethazine group (32.1 ± 2.6 VS .68.5 ± 4.6 mg). However, the patients in the promethazine group were more sedated, which caused the duration of walking q12 hours in this group to decrease.

Conclusions: In morbidly obese patients undergoing laparoscopic gastric plication, promethazine/dexametasone was more effective than Metoclopramide/dexametasone in preventing and reducing the incidence of nausea, epigastric fullness, and reflux. That combination was also more effective than Metoclopramide in reducing the severity of epigastric pain.
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http://dx.doi.org/10.5812/aapm.57810DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5712203PMC
August 2017

An Assessment of Intubation Skill Training in Novice Anesthesiology Residents of Tehran University of Medical Sciences With the Use of Mannequins.

Anesth Pain Med 2016 Dec 19;6(6):e39184. Epub 2016 Sep 19.

Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences (TUMS), Sina Hospital, Tehran, Iran.

Background: The goal of this study was to evaluate the impact of intubation skill training involving the use of mannequins on novice anesthesiology residents in a knowledge, attitudes, and practices designed study in which three different types of evaluation were implemented.

Methods: All first-year anesthesiology residents (24) of Sina Hospital, affiliated to the Tehran University of Medical Sciences, were invited to participate in an intubating skills training course. The program comprised two theoretical and three practical sessions, lasting a total of 16 hours over four days. Faculty assessment of residents' practices was carried out using the questionnaire results, measured using a Likert scale, as the primary outcome. An improvement in the theoretical knowledge of the novice anesthesiology residents (using the Likert scale) and their attitudes towards the educational course in general (via a multiple choice question examination), were also evaluated.

Results: The mean score following faculty assessment of the residents' practical skills was 4.6 out of 5.0 (92%) [standard deviation (SD) of 0.13]. The mean score with respect to the attitudes of the residents was 4.8 out of 5.0 (96%) (SD of 0.16). The overall mean theoretical score of the residents improved significantly upon completion of the training program (P = 0.001).

Conclusions: Our results suggest that the personnel in the five participating faculties were highly satisfied with the practical performance of the residents, who were found to hold good attitudes towards the program as a whole.
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http://dx.doi.org/10.5812/aapm.39184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5560575PMC
December 2016

Prognostic Value of Hemoglobin Concentration and Graft Vein Blood Oxygenation on Renal Transplant Outcomes.

Exp Clin Transplant 2018 08 30;16(4):407-409. Epub 2017 Sep 30.

Urology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran.

Objective: Our objective was to investigate vein blood gas levels in the transplanted kidney during surgery as a predictive factor for delayed graft function after renal transplant.

Materials And Methods: Sixty patients with renal transplant were enrolled in our study from January 2015 to January 2016. After vessels were declamped posttransplant, blood samples from the transplanted kidney veins were taken and acidosis and oxygenation in these samples were measured. Patients were classified based on acidosis and oxygenation of grafted vein and also hemoglobin concentration. We compared delayed graft function in recipients with acidosis versus normal pH, hypoxia versus normal oxygenation, and hemoglobin less than 10 g/dL versus more than 10 g/dL.

Results: Of 60 patients, 6 (10%) experienced delayed graft function and needed hemodialysis. All patients needing hemodialysis were in the acidotic and hypoxic patient groups. Five of six recipients with delayed graft function had hemoglobin concentration < 10 g/dL. Hospital stay was significantly longer in patients with hypoxia, acidosis, and anemia.

Conclusions: Vein blood gas measurements of the grafted renal vein during surgery can be easily obtained and applied as a prognostic factor for delayed graft function.
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http://dx.doi.org/10.6002/ect.2016.0370DOI Listing
August 2018

The effect of nephrostomy tract infiltration of ketamine on postoperative pain and peak expiratory flow rate in patients undergoing tubeless percutaneous nephrolithotomy: a prospective randomized clinical trial.

Urolithiasis 2017 Dec 12;45(6):591-595. Epub 2017 Mar 12.

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

Ketamine, as a systemic and local analgesic, has been used to reduce postoperative pain in many studies. The present study was designed to assess the analgesic efficacy of nephrostomy tract infiltration of ketamine in postoperative pain after tubeless percutaneous nephrolithotomy (PCNL). Sixty-six patients with renal stone who were candidates for PCNL were randomized to two groups with 33 patients in each group. In group K, 20 mL saline solution containing 1.5 mg/kg ketamine was infiltrated into the nephrostomy tract and in group C, 20 mL saline solution was infiltrated into the nephrostomy tract at the end of surgery. The postoperative pain scores, sedation scores, time to first rescue analgesia, rescue analgesic requirement, peak expiratory flow rate (PEF), and hemodynamic parameters were compared between two groups. Sixty-six patients with a mean age of 45.29 ± 15 years and an age range of 18-60 years participated in this study. There was no significant difference in the demographic data and duration of surgery between the two groups. The mean VAS scores were significantly lower in the intervention group compared with the control group at the recovery, and 4 and 6 h postoperatively (p = 0.001). The mean time to first rescue analgesia in the postoperative period was significantly lower in the control group (64.5 ± 8.1 min) compared with the intervention group (122 ± 18.4 min). The trend of first opioid administration was significantly lower in the ketamine group p < 0.009. There was no significant differences in PEF between the two groups in the postoperative period (p = 0.622). In conclusion infiltration of ketamine into the nephrostomy tract provides superior analgesic and sedative effects in PCNL surgery without significant changes in PEF.
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http://dx.doi.org/10.1007/s00240-017-0971-4DOI Listing
December 2017

Effects of combined prokinetic administration on gastric emptying in critically ill patients.

Arab J Gastroenterol 2017 Mar 3;18(1):30-34. Epub 2017 Mar 3.

Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Background And Study Aims: Combination of prokinetic drugs with different mechanisms of action is frequently used when feeding intolerance is not improved with a single agent. In this study, we evaluated the effect of combined infusion of neostigmine and metoclopramide on gastric passage in critically ill patients in the intensive care unit (ICU).

Patients And Methods: This study is a randomized double-blind controlled trial in 90 patients between 20 and 60years of age who were under mechanical ventilation and had gastric residual volumes (GRVs) >120mL 3h after the last lavage. Patients were randomly assigned to one of the following three groups: intravenous neostigmine 2.5mg, intravenous metoclopramide 20mg, and combination of both agents at the mentioned doses. Gastric volume aspiration was first performed before starting the study and then at 3, 6, 9, and 12h after the infusion of study drugs was finished. Increase in gastric lavage was defined as an aspiration volume of >120mL.

Results: In total, 86 cases in the three groups completed the treatment (all 90 patients included in the study were analysed according to an intention-to-treat approach). There was no significant difference detected at baseline in age, intubation duration, albumin, haemoglobin, haematocrit, total leucocytic count (WBC), Na, K, Mg, and sequential organ failure assessment score between the study groups. In the combination group, 96.7% of patients showed GRV improvement (GRV<120cc), whereas in the metoclopramide and neostigmine groups, 50% and 43.3% of the patients, respectively, showed improvement (p<0.001). The frequency of overall adverse effects in the metoclopramide, neostigmine, and combination groups were 3.3%, 16.7%, and 10%, respectively (p=0.28).

Conclusions: The present results suggested that combination therapy with metoclopramide and neostigmine decreases GRV in critically ill patients with a higher efficacy than monotherapies.
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http://dx.doi.org/10.1016/j.ajg.2017.01.007DOI Listing
March 2017

Combined Ketamine-Tramadol Subcutaneous Wound Infiltration for Multimodal Postoperative Analgesia: A Double-Blinded, Randomized Controlled Trial after Renal Surgery.

Anesth Pain Med 2016 Oct 26;6(5):e37778. Epub 2016 Jul 26.

Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: Pain is an important consideration after renal surgery. A multimodal approach to postoperative pain management could enhance analgesia by risking fewer side effects after surgery.

Objectives: The aim of this study was to evaluate the clinical efficacy of the subcutaneous infiltration of ketamine and tramadol at the incision site to reduce postoperative pain.

Methods: Sixty-four patients between 18 and 80 years old who were scheduled for elective renal surgery were enrolled in a double-blind randomized controlled study. At the end of the surgery, patients were divided into four groups with 16 patients in each group: the saline group, who were treated with 10 mL of saline solution; the K group, who were treated with 1 mg/kg etamine in 10 mL of saline solution; the T group, who were treated with 1 mg/kg tramadol in 10 mL of saline solution; and the K/T group, who were treated with 0.5 mg/kg ketamine with 0.5 mg/kg tramadol in 10 mL of saline solution. In each group, the solution was infiltrated subcutaneously at the incision site. The postoperative pain scores and rescue analgesic consumption of the patients in each group were recorded for 24 hours and compared. The primary goal of the study was to compare the results of patients treated with a combined ketamine and tramadol subcutaneous wound infiltration, patients treated with a tramadol subcutaneous wound infiltration, and patients treated with a ketamine subcutaneous wound infiltration.

Results: Sixty-four patients were enrolled in the study. Pain intensity and cumulative meperidine consumption were significantly lower in the K/T group (27 mg; 95% confidence interval, 25.2 - 53.2) in comparison with the group that received a saline infusion during the first 24 hours after surgery (P < 0.001). The sedation score of the K, T, and K/T groups were significantly higher than the saline group (P < 0.001).

Conclusions: The combined subcutaneous infiltration of ketamine and tramadol at the incision site produces better analgesia and an opioid-sparing effect during the first 24 hours when compared with the control group and the groups that received a subcutaneous infiltration of only ketamine or tramadol.
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http://dx.doi.org/10.5812/aapm.37778DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5101596PMC
October 2016

Multimodal Analgesia With Ketamine or Tramadol in Combination With Intravenous Paracetamol After Renal Surgery.

Nephrourol Mon 2016 Jul 7;8(4):e36491. Epub 2016 Jun 7.

Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran.

Background: Opioids are generally the preferred analgesic agents during the early postoperative period.

Objectives: The present study was designed to assess and compare the multimodal analgesic effects of ketamine and tramadol in combination with intravenous acetaminophen after renal surgery.

Patients And Methods: This randomized, double-blinded, clinical trial was conducted on 80 consecutive patients undergoing various types of kidney surgeries in Sina hospital in Tehran in 2014 - 2016. After extubation, the patients were randomly assigned to receive intravenous paracetamol (1 gr) plus tramadol (0.7 mg/kg) (PT group) or paracetamol (1 gr) plus ketamine (0.5 mg/kg) (PK group) within ten minutes. Pain severity was assessed by the visual analog scale (VAS), and the level of agitation was assessed by the Ramsey sedation scale (RSS). Morphine consumption was assessed within the first six hours after drug injection, and hemodynamic parameters were assessed at 5, 10, and 20 minutes after infusion, at the time of transfer from recovery to the ward, and also at one and six hours after transfer to the ward.

Results: Postoperative pain scores were significantly lower in the PK group than in the PT group during all study time points. The mean dose of morphine needed at recovery in the PK group was lower compared with the PT group (0.47 ± 0.94 mg versus 1.50 ± 1.35 mg/P = 0.001). The level of agitation based on the RSS score was significantly lower in the PK group than in the PT group at 10 and 20 minutes after drug administration. The total postoperative complication rate in the PK group was lower than in the PT group (20% versus 53.3%, P = 0.007). In this regard, catheter bladder discomfort was more frequent in the PT group than in the PK group (43.3% versus 3.3%, P < 0.001).

Conclusions: The combination of intravenous paracetamol 1 gr and ketamine 0.5 mg/kg resulted in an overall reduction in pain scores, decreased postoperative analgesic requirements, and lower agitation score compared with intravenous paracetamol 1 gr and tramadol 0.7 mg/kg for patients undergoing renal surgery.
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http://dx.doi.org/10.5812/numonthly.36491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5039960PMC
July 2016

Analgesic Efficacy of Nephrostomy Tract inFiltration of Bupivacaine and Ketamine after Tubeless Percutaneous Nephrolithotomy: A Prospective Randomized Trial.

Iran J Pharm Res 2016 ;15(2):619-26

Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Background: Recently, the use of ketamine as a systemic and local analgesic drug in reducing post-operative pain is studied more frequently.

Objectives: The aim of the present study was to assess the analgesic efficacy of IV ketamine injection inaddition to nephrostomy tract infiltration of ketamine-bupivacaine on postoperative pain relief after tubeless percutaneous nephrolithotomy (PCNL).

Patients And Methods: Patients (n = 100), with renal stone who were candidates for PCNL were randomized to five groups with 20 cases in each: Group C, 10 mL of saline solution was infiltrated into the nephrostomy tract; Group B, 10 mL of 0.25% bupivacaine was infiltrated into the nephrostomy tract; Group BK1, 10 mL of 0.25% bupivacaine plus 0.5 mg/kg ketamine was infiltrated into the nephrostomy tract; Group BK2, 10 mL of 0.25% bupivacaine plus 1.5 mg/kg ketamine was infiltrated into the nephrostomy tract; Group K, 10 mL of saline solution containing 0.5 mg/kg ketamine was intravenously administered. Post-operative pain scores were compared between groups as the primary objective. Comparison of Sedation Scores, rescue analgesic consumption, time to the first rescue analgesics administration, hemodynamic and SpO2 values were regarded as the secondary objective.

Results: Mean VAS scores in the first 30 min and total analgesic consumption in the first 24 h of post-operative period were significantly lower in groups BK1 and BK2 in comparison with the other groups (P < 0.05). Also, time to first rescue analgesics administration was longer in the same groups (P < 0.05).

Conclusions: Infiltration of ketamine plus bupivacaine provides superior analgesic effects in PCNL surgery compared with other methods.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5018291PMC
September 2016

Effects of Ropivacaine on Postoperative Pain and Peak Expiratory Flow Rate in Patients Undergoing Percutaneous Nephrolithotomy.

Nephrourol Mon 2015 Nov 29;7(6):e30973. Epub 2015 Nov 29.

Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran.

Background: Postoperative analgesic effects of ropivacaine have been demonstrated in various surgical procedures; however, its beneficial effect on postoperative pain relief and ability to breathe out air in urological surgeries, particularly in local interventions such as percutaneous nephrolithotomy (PCNL), has remained uncertain.

Objectives: The aim of this study was to assess the efficacy of ropivacaine on postoperative pain severity and peak expiratory flow (PEF) in patients undergoing PCNL procedure.

Patients And Methods: This randomized double-blinded clinical trial was performed on 55 consecutive adult patients aged 15 to 60 years who underwent Tubeless PCNL surgery. The patients were randomly assigned to instill 30 mL of ropivacaine 0.2% or 30 mL of isotonic saline with the same protocol. The parameters of visual analogue scale (VAS) (for assessment of pain severity) and PEF (for assessment of ability to breathe out air) were measured 4 and 6 hours after completing the procedure. Moreover, the amounts of opioids or analgesics administered within 6 hours after the operation were recorded.

Results: We found no difference in the mean pain severity score between the case and control groups 4 hours (P = 0.332) and 6 hours (P = 0.830) after the operation. The mean PEF at baseline was similar in case and control groups (P = 0.738). Moreover, no difference was revealed in PEF index 4 hours (P = 0.398) and 6 hours (P = 0.335) after PCNL between the groups. The mean VAS scores 4 hours after the operation slightly decreased 2 hours later (P < 0.001) in the both groups. Moreover, in the both groups, a sudden decrease in PEF index was observed within 4 hours after the operation and increased with a mild gradient for the next 2 hours. No difference was found in the amount of postoperative analgesic used in the both groups.

Conclusions: Instillation of ropivacaine 0.2% (30 mL) within tubeless PCNL surgery does not have a significant effect on postoperative pain relief and improvement of PEF within 6 hours after the operation.
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http://dx.doi.org/10.5812/numonthly.30973DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4744633PMC
November 2015

Comparison of aPTT and CT Parameter of the ROTEM Test to Monitor Heparin Anti-Coagulation Effect in ICU Patients: an Observational Study.

Acta Med Iran 2015 Oct;53(10):643-6

Department of Anesthesiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Heparin is frequently used in different clinical settings to reduce the coagulating ability of the blood. Because of probable adverse effects owing to heparin therapy and regarding variability of patients' responses to heparin, which make it very unreliable, it seems prudent to monitor meticulously its effects on the human body. There are a lot of laboratory tests to watch its effects on the body for example; aPTT and ROTEM are the most widely used tests that are performed today. We aimed to compare the aPTT test results against changes of CT parameter of the ROTEM test due to heparin administration. This study was conducted on 45 critically ill patients who needed to receive heparin according to their clinical status. All patients received 550 to 1500 unit heparin per hour (on average 17.5 unit heparin per kilogram weight). While the patients were under infusion of heparin, two blood samples (5 ml) were taken from a newly established cubital vein, just five hours after commencement of heparin therapy. One sample was used for aPTT and the other one for ROTEM. The correlation between aPTT and the changes of CT parameter of the ROTEM with heparin dosage and infusion was the primary outcome. The correlation between heparin therapy and the changes of other parameters like MCF, CFT, and a number of platelets were the secondary outcome of the study. The only significant correlation was between changes of CT and aPTT (P=0.000). The other variables were not correlated. Changes of CT parameter of ROTEM test can be used for monitoring of reduced coagulability during heparin infusion instead of aPTT test.
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October 2015

The Comparison of Procalcitonin Guidance Administer Antibiotics with Empiric Antibiotic Therapy in Critically Ill Patients Admitted in Intensive Care Unit.

Acta Med Iran 2015 ;53(9):562-7

Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

The empiric antibiotic therapy can result in antibiotic overuse, development of bacterial resistance and increasing costs in critically ill patients. The aim of the present study was to evaluate the effect of procalcitonin (PCT) guide treatment on antibiotic use and clinical outcomes of patients admitted to intensive care unit (ICU) with systemic inflammatory response syndrome (SIRS). A total of 60 patients were enrolled in this study and randomly divided into two groups, cases that underwent antibiotic treatment based on serum level of PCT as PCT group (n=30) and patients who undergoing antibiotic empiric therapy as control group (n=30). Our primary endpoint was the use of antibiotic treatment. Additional endpoints were changed in clinical status and early mortality. Antibiotics use was lower in PCT group compared to control group (P=0.03). Current data showed that difference in SOFA score from the first day to the second day after admitting patients in ICU did not significantly differ (P=0.88). Patients in PCT group had a significantly shorter median ICU stay, four days versus six days (P=0.01). However, hospital stay was not statistically significant different between two groups, 20 days versus 22 days (P=0.23). Early mortality was similar between two groups. PCT guidance administers antibiotics reduce antibiotics exposure and length of ICU stay, and we found no differences in clinical outcomes and early mortality rates between the two studied groups.
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May 2016

Effects of laparoscopic gastric plication (LGP) in patients with type 2 diabetes, one year follow-up.

J Diabetes Metab Disord 2015 17;14:60. Epub 2015 Jul 17.

Department of Anesthesiology, Tehran University of Medical Sciences, Sina Hospital, Hassan Abad Square, Tehran, Zip code: 1136746911 Iran.

Background: Obesity is a major risk factor for the development of type 2 diabetes mellitus. Surgery is one of the most effective treatments for morbid obesity. In a prospective cohort study, we examined the effects of Laparoscopic Gastric Plication (LGP) as a new restrictive technique on remission of type 2 diabetes mellitus.

Methods: During six years of study from June 2007 through December 2013, 62 patients who underwent bariatric surgery were recruited for our study to determine the effects of weight loss. Sixty patients with diabetes mellitus type 2 were selected for a one year follow up period. The amount of weight loss, Fasting Blood Sugar (FBS), changes in the lipid profile, HbA1c and blood pressure were assessed during this period. The primary outcomes were safety and the percentage of patients experiencing diabetes remission.

Results: Sixty patients with the mean age of 39.7 ± 12.8 years, ranging from 18 to 62 years, were enrolled in the study for an average 12 months of follow up. The maximal weight loss of 57 kg was achieved at average after six months. FBS significantly decreased during this period, and after one year, remission of diabetes was achieved in 92 % of patients. In five patients, diabetes was controlled with decrease in taking oral medications.

Conclusions: Laparoscopic Gastric Plication (LGP) resulted in significant and sustained weight loss with minimal physiologic changes in gastrointestinal tract and ameliorated blood glucose control of type 2 diabetes in morbid obese patients.
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http://dx.doi.org/10.1186/s40200-015-0188-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504399PMC
July 2015

Intrarectal Lidocaine-Diltiazem-Meperidine Gel for Transrectal Ultrasound Guided Prostate Biopsy.

Anesth Pain Med 2015 Jun 22;5(3):e22568. Epub 2015 Jun 22.

Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: TRUS-guided needle biopsy of the prostate gland is the current standard method used for diagnosis of prostate cancer. Pain control during this procedure is through the use of i.v. sedation or local anaesthetic (LA), depending on clinician preference.

Objectives: The aim of this study was to evaluate the effectiveness of intrarectal lidocaine, lidocaine-diltiazem and lidocaine-meperidine-diltiazem gel for anesthetizing transrectal ultrasound guided prostate biopsy.

Patients And Methods: In a randomized double-blind clinical trial, 100 consecutive patients were divided into three groups. The patients received one of the gels before transrectal ultrasound guided prostate needle biopsy: group A, intrarectal and perianal lidocaine, gel 1 g; group B, intrarectal lidocaine gel, 1 g, + perianal diltiazem, 1 g; group C, intrarectal lidocaine gel, 1 g, + meperidine, 25 mg, and perianal diltiazem, 1 g. Visual analog pain scale was used to estimate pain during probe insertion and biopsy. Heart rate and blood pressure during probe insertion and biopsy were recorded too.

Results: The mean of visual analog pain scale was 4.5 in group A, 3.5 in group B, and 2.0 in group C during probe insertion (P value = 0.01). The mean of visual analog pain scale was 5.1 in group A, 3.5 group B, and 2.5 in group C during biopsy (P value = 0.001). The groups were comparable for patients' age, weight, serum prostate-specific antigen (PSA), and prostate size (P > 0.05). No side effects of meperidine and lidocaine including drowsiness, dizziness, tinnitus and light-headedness or requiring assistance for activity were noted.

Conclusions: Lidocaine-meperidine-diltiazem gel provides significantly better pain control than lidocaine-diltiazem gel and lidocaine gel alone during transrectal ultrasound guided prostate biopsy and probe insertion. This mixture gel is safe, easy to administer and well accepted by patients.
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http://dx.doi.org/10.5812/aapm.5(3)2015.22568DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4493733PMC
June 2015

Prophylactic administration of fibrinogen concentrate in perioperative period of total hip arthroplasty: a randomized clinical trial study.

Acta Med Iran 2014 ;52(11):804-10

Department of Anesthesiology and Critical Care, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

According to limitations in blood product resources and to prevent unnecessary transfusions and afterwards complications in perioperative period of total hip arthroplasty, authors administered fibrinogen concentrate in a pilot randomized clinical trial to evaluate bleeding and need to blood transfusion in preoperative period. Thirty patients (3-75 years old) with ASA physical status class I or II and candidate for total hip arthroplasty consequently enrolled in this study and randomly assigned into two groups: taking fibrinogen concentrate and control. Two groups were similar in serum concentration of fibrinogen, hemoglobin, and platelet preoperatively. After induction of general anesthesia 30 mg/kg fibrinogen concentrate was administered in the fibrinogen group. Blood loss, need to blood transfusion and probable complications were compared between two groups. The mean operation time was 3.3 ± 0.8 hours in the fibrinogen group and 2.8 ± 0.6 hours in the placebo group, and this difference was statistically significant (P=0.04). There was a significant correlation between operation time and blood loss during surgery (P=0.002). The mean transfused blood products in the fibrinogen and control group was 0.8 ± 1.01 units and 1.06 ± 1.2 units respectively (P=0.53). The mean of perioperative blood loss was 976 ± 553 ml in the fibrinogen group and 1100 ± 350 ml in the control group, but this difference was not significant between two groups. By adjusting time factor for two groups, we identified that the patients in fibrinogen group had lower perioperative bleeding after adjusting time factor for two groups (P=0.046). None of the patients had complications related to fibrinogen concentrate administration. The prophylactic administration of fibrinogen concentrate was safe and effective in reducing bleeding in the perioperative period of total hip arthroplasty.
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July 2015

Postoperative sore throat after laryngoscopy with macintosh or glide scope video laryngoscope blade in normal airway patients.

Anesth Pain Med 2014 Feb 16;4(1):e15136. Epub 2014 Feb 16.

Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: The Glide Scope videolaryngoscope provides a suitable view for intubation, with less force required.

Objectives: The present study was conducted, to compare postoperative sore throat and hoarseness after laryngoscopy and intubation, by Macintosh blade or Glide Scope video laryngoscope in normal airway patients.

Patients And Methods: Three hundred patients were randomly allocated into two groups of 150: Macintosh blade laryngoscope or Glide Scope video laryngoscope. The patients were evaluated for 48 hours for sore throat and hoarseness by an interview.

Results: The incidence and severity of sore throat in the Glide Scope group, at 6, 24 and 48 hours after the operation, were significantly lower than in the Macintosh laryngoscope group. In addition, the incidence of hoarseness in the Glide Scope group, at 6 and 24 hours after the operation, were significantly lower than in the Macintosh laryngoscope group. The incidence and severity of sore throat in men, at 6 and 24 hours after the operation, were significantly lower than in the women.

Conclusions: The incidence and severity of sore throat and hoarseness after tracheal intubation by Glide Scope were lower than in the Macintosh laryngoscope. The incidence and severity of sore throat were increased by intubation and longer operation times.
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http://dx.doi.org/10.5812/aapm.15136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3961026PMC
February 2014

Magnesium Can Decrease Postoperative Physiological Ileus and Postoperative Pain in Major non Laparoscopic Gastrointestinal Surgeries: A Randomized Controlled Trial.

Anesth Pain Med 2014 Feb 6;4(1):e12750. Epub 2013 Dec 6.

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

Background: Magnesium is an antagonist of (N-methyl D-Aspartate) NMDA receptor and its related canals, and may affect perceived pain.

Objectives: The aim of this study was to evaluate the impact of intravenous magnesium on the hemodynamic parameters, analgesic consumption and ileus.

Patients And Methods: A randomized, double blind, placebo controlled study was performed. Thirty two patients of ASA I or II, scheduled for major gastrointestinal (GI) surgery, were divided into magnesium and control groups. Magnesium group received a bolus of 40 mg/kg of magnesium sulphate, followed by a continuous perfusion of 10 mg/kg/h for the intraoperative hours. Postoperative analgesia was ensured by Morphine patient-controlled analgesia (PCA). The patients were evaluated by Intraoperative hemodynamic parameters, the postoperative pain by numeral rating scale (NRS), and the total dose of intraoperative and postoperative analgesic consumption. Postoperative hemodynamic, respiratory parameters, physiological gastrointestinal obstruction (ileus), and side effects were also recorded.

Results: The study included 14 males and 18 females. Age range of patients was 17 to 55 years old. The average age in the magnesium group was 41.33 ± 10.06 years and45.13 ± 11.74 years in control group. Mean arterial pressure (MAP) of magnesium group decreased during the operation but increased in control group (P < 0.001), and systemic vascular resistance (SVR) of magnesium group decreased during the operation also (P < 0.02) but increased in control group. Postoperative cumulative Morphine consumption in magnesium group, was significantly in lower level (P = 0.026). For NRS, severe pain was significantly lower, in magnesium group, at all intervals of postoperative evaluations, but moderate and mild pain were not lower significantly. Duration of postoperative ileus was 2.3 ± 0.5 days in magnesium group, and 4.2 ± 0.6 days in control group (P = 0.01).

Conclusions: Intravenous magnesium reduces postoperative ileus, postoperative severe pain and intra/post operative analgesic requirements in patients after major GI surgery. No side effects of magnesium in these doses were seen, so it seems to be beneficial along with routine general anesthesia in major GI surgeries.
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http://dx.doi.org/10.5812/aapm.12750DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3961038PMC
February 2014

Inadvertent intrathecal injection of large dose magnesium sulfate.

Saudi J Anaesth 2013 Oct;7(4):464-6

Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Sina Hospital, Tehran, Iran.

The case is a 35-year-old man who underwent spinal anesthesia for emergency strangulated inguinal hernia repair. About five minutes after 3 ml intrathecal drug injection, the patient suffered respiratory distress, bradycardia, hypotension and loss of consciousness. The patient was rapidly intubated and crystalloid infusion and epinephrine drip were established. Thereafter, he was admitted in intensive care unit. Search for the cause revealed us that 3 ml of magnesium sulfate (50%) was injected mistakenly for spinal anesthesia. Two days later, he was extubated and on the fifth day, he was discharged from the hospital without an obvious evidence of complication.
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http://dx.doi.org/10.4103/1658-354X.121049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858701PMC
October 2013

Thyromental height: a new clinical test for prediction of difficult laryngoscopy.

Anesth Analg 2013 Dec;117(6):1347-51

From the Department of Anesthesiology, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

Background: The incidence of difficult laryngoscopy is reported in the range of 1.5% to 20%. We hypothesized that there is a close association between the occurrence of difficult laryngoscopy and the height between the anterior borders of the mentum and thyroid cartilage, while the patient lies supine with her/his mouth closed. We have termed this the "thyromental height test" (TMHT). Our aim in this study was to determine its utility in predicting difficult laryngoscopy.

Methods: Three hundred fourteen consecutive male and female patients aged ≥ 16 years scheduled to undergo general anesthesia were invited to participate. Airway assessments were performed with the modified Mallampati test, thyromental distance and sternomental distance, and TMHT in the preoperative clinic. Afterward, Cormack and Lehane grade of laryngoscopy views was assessed during intubation. The laryngoscopist was unaware of airway assessments. As a primary end point, the validity and prediction indexes for the TMHT were calculated. Calculation of validity indexes for the 3 other methods of airway assessment was a secondary objective of this study.

Results: The optimal sensitivity and specificity values were in the range of 47.46 to 51.02 mm. To facilitate clinical application, a cutoff value equal to 50 mm was chosen. TMHT was more accurate than the other tests (all P < 0.0001).

Conclusions: The TMHT appears to be a more accurate predictor of difficult laryngoscopy than the existing anatomical measurements.
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http://dx.doi.org/10.1213/ANE.0b013e3182a8c734DOI Listing
December 2013

The effect of needle type, duration of surgery and position of the patient on the risk of transient neurologic symptoms.

Anesth Pain Med 2013 26;2(4):154-8. Epub 2013 Mar 26.

Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: The incidence of transient neurologic symptoms (TNS) after spinal anesthesia with lidocaine is reported as high as 40%.

Objectives: This prospective clinical trial was designed to determine the incidence of TNS in patients who underwent spinal anesthesia with two different needles, in two different surgical positions.

Patients And Methods: The present randomized clinical trial was conducted on 250 patients (ASA I-II), who were candidates for surgery in supine or lithotomy positions. According to the needle type (Sprotte or Quincke) and local anesthetics (lidocaine and bupivacaine) all patients were randomly divided into four groups. After performing spinal anesthesia in sitting position, the position was changed into supine or lithotomy, according to surgical procedure. The patients were observed for complications of spinal anesthesia during the first five post-operative days. The primary end-point for this trial was to recognize the incidence of TNS among the four groups. Our secondary objective was to evaluate the effect of patient's position, needle type, and duration of surgery on the development of TNS following spinal anesthesia.

Results: TNS was most commonly observed when lidocaine was used as anesthetic drug (P = 0.003). The impact of needle type, was not significant (P = 0.7). According to multivariate analysis, the duration of surgery was significantly lower in cases suffering from TNS (P = 0.04). Also, the risk of TNS increased following surgeries performed in lithotomy position (P = 0.00).

Conclusions: According to the results of this clinical study, spinal anesthesia with lidocaine, and the lithotomy position in surgery increased the risk of TNS.
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http://dx.doi.org/10.5812/aapm.6916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821142PMC
November 2013

Postoperative gabapentin to prevent postoperative pain: a randomized clinical trial.

Anesth Pain Med 2012 13;2(2):77-80. Epub 2012 Sep 13.

Department of Anesthesiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, IR Iran.

Background: Gabapentin is an anticonvulsant that has postoperative analgesic effects but there are limited studies on its postoperative administration.

Objectives: The present study was conducted to evaluate the effect of the postoperative oral gabapentin on pain and morphine consumption.

Patients And Methods: In a double blind, randomized study, 64 patients undergoing internal fixation of tibia under spinal anesthesia were randomly assigned to receive oral gabapentin or placebo immediately after the surgery. Pain scores were recorded at time points of 2, 12 and 24 hours postoperatively using visual analog scale (VAS). Time duration from the end of surgery until morphine administration and total morphine requirement in the first 24 hours were recorded.

Results: The estimated duration of surgeries was 120-150 minutes. VAS score was not significantly different between the two groups at 2, 12 and 24 hours after surgery. There was no significant morphine consumption difference between the groups.

Conclusions: Our study showed no significant analgesic efficacy of oral gabapentin 300 mg immediately after tibia internal fixation surgery under spinal anesthesia at time points of 2, 12 and 24 hours postoperatively.
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http://dx.doi.org/10.5812/aapm.4744DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821121PMC
November 2013

Trigeminocardiac reflex in neurosurgical practice: An observational prospective study.

Surg Neurol Int 2013 18;4:116. Epub 2013 Sep 18.

Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: Considering wide variations regarding the incidence of trigeminocardiac reflex (TCR) during cranial neurosurgical procedures, and paucity of reliable data, we intended to design a prospective study to determine the incidence of TCR in patients undergoing standard general anesthesia for surgery of supra/infra-tentorial cranial and skull base lesions.

Methods: A total of 190 consecutive patients candidate for elective surgery of supra-tentorial, infra-tentorial, and skull base lesions were enrolled. All the patients were operated in the neurosurgical operating room of a university-affiliated teaching hospital. All surgeries were performed using sufficient depth of anesthesia achieved by titration of propofol-alfentanil mixture, adjusted according to target Cerebral State Index (CSI) values (40-60). All episodes of bradycardia and hypotension indicating the occurrence of TCR during the surgery (sudden decrease of more than 20% from the previous level) were recorded.

Results: Four patients, two female and two male, developed episodes of TCR during surgery (4/190; 2.1%). Three patients showed one episode of TCR just at the end of operation when the skin sutures were applied while CSI values were 70-77 and in the last case, when small tumor samples were taken from just beneath the lateral wall of the cavernous sinus TCR episode was seen while the CSI value was 51.

Conclusion: TCR is a rare phenomenon during brain surgeries when patient is anesthetized using standard techniques. Keeping the adequate depth of anesthesia using CSI monitoring method may be an advisable strategy during whole period of a neurosurgical procedure.
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http://dx.doi.org/10.4103/2152-7806.118340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3784954PMC
October 2013

General anesthesia versus combined epidural/general anesthesia for elective lumbar spine disc surgery: A randomized clinical trial comparing the impact of the two methods upon the outcome variables.

Surg Neurol Int 2013 19;4:105. Epub 2013 Aug 19.

Department of Anaesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: General anesthesia (GA) is the most frequently used technique for lumbar spine disc surgery. The aim of this study was to compare the intraoperative variables and postoperative outcome after GA and combined general/epidural anesthesia (CEG) in patients undergoing elective lumbar spine disk surgery.

Methods: Eighty patients who underwent one or two level of laminectomy/discectomy during a 2 year period were enrolled in this randomized controlled trial (RCT). They were randomly selected to undergo GA or CEG. The data recorded during surgery were: The patients' heart rate (HR), mean arterial blood pressure (MABP), amount of blood loss, and the medication used during anesthesia. The severity of pain score, total analgesic consumption, and complications were recorded in the postoperative period.

Results: The MABP, HR, blood loss, and anesthetic medication were significantly lower in CEG group in comparison with that of GA group. In the postoperative period, the pain score and total analgesic requirement was lower in the CEG group and less complication were encountered in this group.

Conclusion: The results of this study revealed that CEG have some advantages over GA in reducing the blood loss and anesthetic medication during the operation and it is also more effective in control of pain with fewer complications during the postoperative period.
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http://dx.doi.org/10.4103/2152-7806.116683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3766856PMC
September 2013

Impact of subcutaneous infiltration of 0.5% bupivacaine on post-operative C-reactive protein serum titer after craniotomy surgery.

Med J Islam Repub Iran 2013 Feb;27(1):1-6

Associate Professor of Anesthesiology, Tehran University of Medical Sciences, Sina Hospital, Tehran, Iran.

Background: Tissue injuries may provoke neuro-hormonal response which in turn may lead to release of inflammatory cytokines. We hypothesize that block of afferent sensory pathways by infiltration of 0.5% bupivacaine in the scalp may decrease neuro-hormonal response in the neurosurgical patient.

Methods: After obtaining informed consent, forty ASA physical statuses I, II, or III patients between the ages of 18 and 65 years were enrolled randomly into two equal groups to receive either 20 ml of 0.5% bupivacaine (group A) or 20 ml of 0.9% normal saline as a placebo (group B) in the site of pin insertion and scalp incision. As the primary outcome we checked serum C-reactive protein (CRP) levels before implementation of noxious stimulus, 24h, and 48h after the end of surgery to compare these values between groups. In addition, mean arterial pressure (MAP) and heart rate (HR) were checked at baseline (after the induction of anesthesia), one minute after pin fixation and 5, 10, and 15 minute after skin incision and the recorded values were compared between groups.

Results: No significant difference was found between serum CRP levels of the two groups. Comparison of mean HR between groups shows no significant difference. The mean of MAP was significantly lower in the group A in comparison with the group B (p< 0.001).

Conclusion: The results of this study confirm that 0.5% bupivacaine scalp infiltration before skull-pin holder fixation and skin incision could not decrease post-operative C-reactive protein level.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3592936PMC
February 2013
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