Publications by authors named "Mohammad-Hossein Eghbal"

13 Publications

  • Page 1 of 1

Magnesium Therapy Improves Rotational Thromboelastometry Findings Prior to Liver Transplantation: A Randomized Clinical Trial.

Indian J Hematol Blood Transfus 2020 Jul 24;36(3):505-511. Epub 2020 Feb 24.

Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

An important challenge during orthotopic liver transplantation (OLT) is optimal coagulation management. There are diverse studies regarding effect of Mg sulfate on coagulation system. This study evaluates the impact of Mg sulfate on the coagulation parameters of the rotational thromboelastometry (ROTEM) in patients about to undergo OLT. In this randomized clinical trial, 60 patients who were going to undergo OLT were randomly allocated into two groups. In the Mg group, the patients received a 1.5 g infusion of Mg 5 min before the surgical incision. In the control group, patients received a physiological saline instead of Mg. Plasma Mg levels before and after the infusions were measured in both groups. Also, three ROTEM tests: EXTEM, INTEM and FIBTEM were performed before and after the infusions. Baseline mean plasma magnesium levels were within normal range in the control and Mg groups: 2.06 and 2.18 mg/dl, respectively. After magnesium therapy, the mean plasma Mg level in the Mg group increased to 2.78 mg/dl in compared to the control group that was 2.01 mg/dl ( < 0.000). Mean value of the clotting time (CT) in the magnesium group were significantly decreased from 129.50 ± 7.76, 381.86 ± 8.51 and 114.26 ± 6.80 to 86.13 ± 3.4, 209.33 ± 6.68 and 81.56 ± 5.01 in the EXTEM, INTEM, and FIBTEM respectively after intervention in the Mg group ( = 0.001). Among patients with end-stage liver diseases who have ROTEM evidence of hypocoagulability, magnesium could correct CT parameter of the ROTEM tests.
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http://dx.doi.org/10.1007/s12288-020-01260-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326873PMC
July 2020

Preconditioning Effect of Remifentanil Versus Fentanyl in Prevalence of Early Graft Dysfunction in Patients After Liver Transplant: A Randomized Clinical Trial.

Exp Clin Transplant 2020 10 6;18(5):598-604. Epub 2020 Jul 6.

From the Department of Anesthesia, Nemazee Hospital, Shiraz, Fars, Iran.

Objectives: One of the most prevalent complications of orthotopic liver transplant is primary graft dysfunction. Recent studies have shown the preconditioning effect of remifentanil on animal livers but not human livers. Here, we compared the preconditioning effects of remifentanil and fentanyl in orthotopic liver transplant in human patients.

Materials And Methods: In this double-blind clinical trial, 100 patients who underwent liver transplant from deceased donors were randomly allocated into 2 groups. Patients in the remifentanil group received remifentanil infusion, and those in the fentanyl group received fentanyl infusion during maintenance of anesthesia. Serum aminotransferase levels, prothrombin time (international normalized ratio), partial thrombin time, arterial blood gas levels, and renal function tests were evaluated over 7 days posttransplant. Intensive care unit stay and hospitalization were also recorded.

Results: The median peak alanine aminotransferase level during 7 days after transplant was 2100 U/L (interquartile range, 1230-3220) in the remifentanil group and 3815 U/L (interquartile range, 2385-5675) in the fentanyl group (P = .048). Metabolic acidosis, renal state, prothrombin time (international normalized ratio), and partial thrombin time were similar in both groups (P > .05). Durations of stay in the intensive care unit and hospital were not significantly different between the 2 groups (P = .75 and P = .23, respectively). Overall, the clinical outcomes were similar in the remifentanil and fentanyl groups (P > .05).

Conclusions: We found that remifentanil and fentanyl were not different with regard to their preconditioning effects and graft protection in orthotopic liver transplant recipients.
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http://dx.doi.org/10.6002/ect.2019.0014DOI Listing
October 2020

Successful Surgical Separation of Thoraco-Omphalopagus Symmetrical Conjoined Twins in Iran: Two Case Reports.

Iran J Med Sci 2020 Mar;45(2):143-147

Student Research Committee, Department of Otorhinolaryngology, Shiraz University of Medical Science, Shiraz, Iran.

Conjoined twins are derived from the division of a single fertilized ovum; a phenomenon accompanied with multiple congenital anomalies. Such twins are identical, of the same sex, and more likely to be female. Most twins die during the embryonic period, and only 18% survive longer than 24 hours. There are complex anomalies in thoraco-omphalopagus twins that makes them unlikely to live long enough to undergo separation. Treatment of this uncommon condition presents both surgical and anesthetic challenges. The management of rare anomalies is difficult even for skilled surgeons. Therefore, it is logical to use the knowledge gained from previous experiences. We herein present the first successful surgical separation of two pairs of thoraco-omphalopagus conjoined twins at the Pediatric Surgery Center of Namazi Hospital (Shiraz, Iran). In both cases, the neonates had separate hearts and common pericardium. Contrast-enhanced computed tomography of two sets of twins showed fusion of sternum, pericardium, diaphragm, and left lobe of liver. Critical steps of the surgical separation were identified and contingency plans were made for possible partial liver donation and cross-circulation between twins. The separation procedure and reconstruction of the abdominal wall were successfully performed. Both pairs of twins, now 6- and 8-year-old, are healthy and have normal growth and are under follow-up.
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http://dx.doi.org/10.30476/ijms.2019.81060.DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071550PMC
March 2020

The Impact of Preoperative Variables on Intraoperative Blood Loss and Transfusion Requirements During Orthotopic Liver Transplant.

Exp Clin Transplant 2019 08 12;17(4):507-512. Epub 2017 Oct 12.

From the Department of Anesthesiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Objectives: Liver transplant traditionally and potentially is associated with the risk of massive blood loss and transfusion, which can adversely affect transplant outcomes. Many variables influence the amount of bleeding, and these can be categorized as patient related, surgery related, and graft related. We aimed to assess the effects of these variables on the amount of bleeding and transfusion during liver transplant; predicting the risk of massive blood loss can help transplant teams to select and manage patients more effectively.

Materials And Methods: We retrospectively studied 754 patients who underwent liver transplant from 2013 to 2016 and analyzed more than 20 variables that could influence the volume of blood loss and packed cell transfusion.

Results: We found that at least 4 variables are strongly and independently correlated with blood loss volume: age, Model for End-Stage Liver Disease score, warm ischemia time, and total bilirubin. Furthermore, intraoperative blood loss had a weak but clinically important correlation with the underlying disease (ie, the cause of liver cirrhosis). Some variables, including international normalized ratio, platelet count, albumin, serum urea nitrogen, creatinine level, sodium level, and the amount of ascites, could be considered as 'dependent' and weak predictors of massive blood loss. Sex of patient, cold ischemia time, surgery technique, and history of previous abdominal surgery were not correlated with the amount of bleeding.

Conclusions: With the use of the variables identified, we can properly select patients and surgical teams and promptly use modalities for decreasing and managing blood loss.
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http://dx.doi.org/10.6002/ect.2016.0325DOI Listing
August 2019

Glaucoma Surgery in Pregnancy: A Case Series and Literature Review.

Iran J Med Sci 2016 Sep;41(5):437-45

Glaucoma Service, Wills Eye Institute, Jefferson Medical College, Philadelphia, USA.

Glaucoma management in pregnant patients is a real challenge, especially when the glaucoma is not controlled with medications. We report the results of 6 incisional glaucoma surgeries for the management of medically uncontrolled glaucoma patients during pregnancy. This retrospective, case series was conducted on the 6 eyes of 3pregnant patients with uncontrolled glaucoma using maximum tolerable medications. Details of the glaucoma surgical management of these patients as well as their postoperative care and pregnancy and clinical outcomes on longitudinal follow-up are discussed. All 3 patients had juvenile open-angle glaucoma and were on various anti-glaucoma medications, including oral acetazolamide. The first case described underwent trabeculectomy without antimetabolites in both eyes because of uncontrolled intraocular pressure with topical medications. The surgery was done with topical lidocaine jelly and subconjunctival lidocaine during the second and third trimesters. The second patient had an Ahmed valve implantation in both eyes during the second and third trimesters because of uncontrolled IOP with topical medications and no response to selective laser trabeculoplasty. Surgery was done with topical tetracaine and subconjunctival and sub-Tenon's lidocaine. The third case had a Baerveldt valve implantation under general anesthesia in the second trimester. In selected pregnant glaucoma patients with medically uncontrolled intraocular pressure threatening vision, incisional surgery may lead to good outcomes for the patient with no risk for the fetus.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967489PMC
September 2016

Comparing the Duration of Spinal Anesthesia Induced With Bupivacaine and a Bupivacaince-Lidocaine Combination in Trans-Urethral Resection of the Prostate (TURP).

Anesth Pain Med 2015 Aug 22;5(4):e25675. Epub 2015 Aug 22.

Student Research Committee, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Spinal anesthesia is a safe anesthetic mode for transurethral prostate resection (TUPR). There are several studies assessing the effect of bupivacaine, lonely or accompanied by other drugs, on short duration operations. However, there is controversy regarding the exact combination.

Objectives: The aim of the study was to compare the effects of spinal anesthesia with bupivacaine and low dose lidocaine with bupivacaine alone on postoperative pain in those undergoing transurethral resection of prostate (TURP).

Materials And Methods: This was a randomized clinical trial performed in Shiraz university of medical sciences during one year. Eighty men scheduled for TURP were randomly assigned to receive spinal anesthesia with 1.5 mL bupivacaine 0.6% and 0.6 mL Lidocaine 1% or spinal anesthesia with 1.5 mL bupivacaine 0.5% in combination with 0.6 mL normal saline. The primary endpoint was the time lag between induction of spinal anesthesia and reaching the highest spinal block level. We also recorded the duration of spinal block declining to L1 level, operation duration and the admission duration.

Results: Both study groups were comparable regarding the baseline characteristics. We did not find any difference between the two study groups regarding the duration of anesthetic block reaching the maximum level (P = 0.433) and duration of decreasing it to L1 (P = 0.189). The course of postoperative recovery and duration of hospital admission were also comparable between the groups (P = 0.661).

Conclusions: Lidocaine does not have additive effects on duration and quality of spinal anesthesia with bupivacaine in those undergoing TURP.
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http://dx.doi.org/10.5812/aapm.25675DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604291PMC
August 2015

Effect of mannitol on postreperfusion cardiac output and central venous oxygen saturation during orthotopic liver transplant: a double-blind randomized clinical trial.

Prog Transplant 2014 Jun;24(2):121-5

Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Context: Attenuating postreperfusion syndrome during orthotopic liver transplant is very important for transplant anesthesiologists because of the syndrome's complications. Oxygen-derived free radicals play an important role in the genesis of postreperfusion syndrome, but the effect of mannitol (a free radical scavenger) on attenuating the syndrome is unclear.OBJECTIVES-To investigate the effectiveness of infusing mannitol during the anhepatic phase in preventing postreperfusion syndrome, as indicated by postreperfusion cardiac output and central venous oxygen saturation.

Design: In a randomized clinical trial, 53 patients who had undergone orthotopic liver transplant were allocated to 2 groups. During the anhepatic phase, patients in the mannitol group received 1g/kg mannitol, whereas those in the control group received physiological saline. Mean arterial pressure, cardiac output, and central venous oxygen saturation were measured before and after the portal vein was declamped. Serum levels of sodium and potassium were recorded at baseline and after portal vein declamping.Setting-Shiraz Organ Transplant Center, Shiraz, Iran.

Results: In the mannitol group, no significant change was found in mean arterial pressure, cardiac output, and central venous oxygen saturation before and after declamping of the portal vein (P= .78, P= .59, and P= .83, respectively). However, after declamping in the control group, mean arterial pressure, cardiac output, and central venous oxygen saturation were significantly lower than before declamping (P=.003, P=.001, and P<.001, respectively). No significant change in serum levels of sodium and potassium from baseline to after declamping were found in either group.

Conclusion: Infusion of mannitol 1 g/kg during the anhepatic phase was effective in attenuating postreperfusion syndrome without stress about hyperkalemia or hyponatremia during anesthesia.
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http://dx.doi.org/10.7182/pit2014483DOI Listing
June 2014

The Effect of Intraoperative Restricted Normal Saline during Orthotopic Liver Transplantation on Amount of Administered Sodium Bicarbonate.

Iran J Med Sci 2014 May;39(3):247-53

Shiraz Anesthesiology and Critical Care Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran;

Background: Severe metabolic acidosis occurs during orthotopic liver transplantation (OLT) particularly during the anhepatic phase. Although NaHCO3 is considered as the current standard therapy, there are numerous adverse effects. The aim of this study was to determine whether the restricted use of normal saline during anesthesia could reduce the need for NaHCO3.

Methods: In this study we enrolled 75 patients with end-stage liver disease who underwent OLT from February 2010 until September 2010 at the Shiraz Organ Transplantation Center. Fluid management of two different transplant anesthetics were compared. The effect of restricted normal saline fluid was compared with non-restricted normal saline fluid on hemodynamic and acid-base parameters at three times during OLT: after the skin incision (T1), 15 min before reperfusion (T2), and 5 min after reperfusion (T3).

Results: There were no significant differences in demographic characteristics of the donors and recipients (P>0.05). In the restricted normal saline group there was significantly lower central venous pressure (CVP) than in the non-restricted normal saline group (P=0.002). No significant differences were noted in the other hemodynamic parameters between the two groups (P>0.05). In the non-restricted normal saline group arterial blood pH (P=0.01) and HCO3 (P=0.0001) were significantly less than the restricted normal saline group. The NaHCO3 requirement before reperfusion was significantly more than with the restricted normal saline group (P=0.001).

Conclusion: Restricted normal saline administration during OLT reduced the severity of metabolic acidosis and the need for NaHCO3 during the anhepatic phase.

Trial Registration Number: IRCT2013110711662N5.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4027003PMC
May 2014

Comparison larygeal mask airway with the endotracheal tube for the external dacryocystorhionostomy surgery. A randomized clinical trial.

Middle East J Anaesthesiol 2013 Oct;22(3):283-8

Background: General anesthesia (GA) is considered the gold standard for external dacryocystorhinostomy (DCR) surgery. There are few reports about laryngeal mask airway (LMA) use in DCR surgery. The aim of this study was to compare the use of endotracheal intubation (ETT) vs LMA for airway management during DCR surgery.

Methods: Ninety patients were randomized to two groups. In the group C, ETT and in the group L, classic LMA was used to maintain and protect the airway during the procedure. Hemodynamic data before, after intubation or LMA insertion and after skin incisions were recorded. Coughing and straining at the end of anesthesia and postoperative nausea and vomiting (PONV) were recorded.

Results: In the group L, the mean arterial pressure and the heart rate after LMA insertion and after the skin incisions were significantly lower than the group C (p < 0.05). Furthermore, incidence of coughing, straining at the end of anesthesia and PONV was lower in the group L than the group C (p < 0.05).

Conclusion: LMA can be used in external DCR, to decrease the hemodynamic changes, to decrease coughing, straining at the end of anesthesia and the incidence of PONV.
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October 2013

Ketamine improves postoperative pain and emergence agitation following adenotonsillectomy in children. A randomized clinical trial.

Middle East J Anaesthesiol 2013 Jun;22(2):155-60

Shiraz Anesthesiology and Intensive Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Management of postoperative pain and emergence agitation following adenotonsillectomy in pediatrics has been a major challenge for anesthesiologists. Although analgesic sparing effect of ketamine has been studied during tonsillectomy in pediatrics, there is a lot of controversy about its efficacy. Present study was designed to evaluate the effect of intravenous low dose ketamine (0.25 mg/kg) during induction of anesthesia on postoperative pain and emergence agitation following adenotonsillectomy in children.

Methods: In this randomized clinical trial 66 children aged 5 to 15 years who underwent elective adenotonsillectomy were randomly allocated into two groups. Patients in the control group received 5 ml of normal saline while patients in the ketamine group received 0.25 mg/kg of ketamine in 5 ml volume during induction of anesthesia. After termination of surgeries and transferring the patients to recovery, emergence agitation, pain score, paracetamol requirements and incidence of postoperative nausea & vomiting were assessed every hour for 6 hours.

Results: Emergence agitation score was significantly lower in the ketamine group (P = 0.002). Pain score at all hours was lower in the ketamine group than the control group (P < 0.05). The requirements for intravenous paracetamol were significantly lower in the ketamine group (P = 0.0036). There was no difference in the incidence of postoperative nausea and vomiting between the two groups (P = 0.99).

Conclusion: Low-dose ketamine during induction of anesthesia improves emergence agitation and postoperative pain following adenotonsillectomy in children.
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June 2013

Electro-acupuncture stimulation at acupoints reduced the severity of hypotension during anesthesia in patients undergoing liver transplantation.

J Acupunct Meridian Stud 2012 Feb 7;5(1):11-4. Epub 2011 Dec 7.

Shiraz Anesthesiology and Intensive Care Research Center, Shiraz University of Medical Science, Shiraz, Iran.

Background: Patients with end-stage liver diseases who undergo liver transplantation may suffer from hypotension related to the liver disease itself or related to the surgical procedure. Because electro-acupuncture (EA) at the Neiguan (PC-6) and the Jianshi (PC-5) points influences hemodynamics, we hypothesize that electro-acupuncture at the traditionally used acupuncture points will reduce the severity of hypotension in patients who undergo liver transplantation.

Methods: Forty patients with end-stage liver disease who underwent orthotropic deceased donor liver transplantation were randomized into two groups. The norepinephrine (NE) group received norepinephrine as a vasoconstrictor, and the electro-acupuncture group received EA at the PC-5 and the PC-6 points for treatment of hypotension during anesthesia for the liver transplantation. The patients were monitored, during the three stages of liver transplantation by using hemodynamic parameters.

Results: During the three stages of liver transplantation, there were no significant differences in the hemodynamic measurements including the mean arterial pressure, heart rate and central venous pressure between the two groups (p>0.05).

Conclusions: Electro-acupuncture at the acupuncture points reduced the severity and the incidence of hypotension during anesthesia for liver transplantation.
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http://dx.doi.org/10.1016/j.jams.2011.11.001DOI Listing
February 2012

The effect of addition of low dose atracurium to local anesthetic in retrobulbar block for cataract surgery.

Middle East J Anaesthesiol 2010 Feb;20(4):535-8

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

Background: Addition of some neuromuscular blockers to local anesthetics proved to be effective in improving the quality of anesthesia in different regional techniques. This study was carried out to determine whether the addition of low-dose atracurium to a local anesthetic has any effect on the onset and duration of akinesia in retrobulbar block.

Patients And Methods: This study was conducted on sixty-four unpremedicated, ASA I or 11 patients scheduled for cataract surgery under local anesthesia. The patients were assigned to one of the two treatment groups in a randomized, double-blind manner. The case group received 2 ml of 2% lidocaine (40 mg) and 0.5 mL atracurium (5 mg). The control group received 2 ml of 2% lidocaine (40 mg) and 0.5 ml 0.9% NaCl. The onset of akinesia (the inability to move the eye in all four directions) was scored as 0 to 2:0, no akinesia; 1, partial akinesia; and 2, complete akinesia. The onset and duration of akinesia and also adverse effects and complications of each method were recorded throughout the study.

Results: In 4 out of 64 patients, complete akinesia was not achieved and statistical analysis was done on 60 others with complete akinesia. With regard to age, sex, weight, and duration of the surgery, there were no significant differences between the case and control groups. The onset of complete akinesia was quicker and duration longer in the case group than in the control group. The onset of complete block was 4.7 +/- 1.1 minutes in the case group and 6.9 +/- 0.96 minutes in the control group (P < 0.001). The duration of akinesia was 104.07 +/- 17.6 minutes in the case group and 87.1 +/- 16.2 minutes in the control group (P < 0.001).

Conclusion: This study demonstrated that atracurium had a local action on the extraocular muscles. It shortened the onset period of retrobulbar block, prolonged its duration, and provided excellent surgical conditions without any specific complications.
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February 2010

A simple way to achieve the routine position for phacoemulsification in a patient with marked thoracic kyphosis.

J Ophthalmic Vis Res 2009 Oct;4(4):253-5

Khalili Hospital, Shiraz Medical University, Shiraz, Iran.

Purpose: To introduce a simple way for achieving the routine position for phacoemulsification in a patient with a marked thoracic kyphosis.

Case Report: A 74-year-old man with marked thoracic kyphosis and visually significant cataracts presented for surgery; he was unable to lie flat due to the severe deformity. The best possible surgical position was achieved by placing a chair with an adjustable top between a standard operating table and another small table. The wheels of the table and the chair were securely immobilized by adhesive tape. The space between the operating table and the small table was filled with rolled towels and covered with a blanket. The patient lay down with his head placed on the small table while the kyphotic portion of his thorax fitted into the free space between the small table and the operating table. The variable top of the chair allowed adjusting the space in order to accommodate his kyphotic thorax. Successful temporal approach phacoemulsification was performed comfortably while the patient lay in the standard position required for cataract surgery.

Conclusion: It is possible to position patients with thoracic problems on a standard operating table using readily available equipment in the operating theater.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498863PMC
October 2009