فهرست مطالب عظیم هنرمند

This study aimed to compare the preventive effect of two different doses of dexmedetomidine infusion compared to the control group on the incidence of cough and respiratory complications during tracheal tube removal.

105 patients undergoing tracheal intubation were divided into three groups of 35 people, and in the three mentioned groups, at the end of the procedure, ten minutes before the tracheal tube was removed, the patients of group one received 0.5 μg/kg dexmedetomidine bolus and then 0.3 μg/kg infusion, group two 0.5 μg/kg dexmedetomidine bolus and then 0.5 μg/kg infusion and group three 10 minutes before leaving the endotracheal tube normal saline with equal volume of group one and two as bolus and then with equal volume of other two groups They received it as an infusion and the frequency and severity of cough and hemodynamic parameters were evaluated and compared in three groups.

33 (31.4%) developed cough, of which 7 (20%) were from the dexmedetomidine 0.5 group, 9 people (25.7%) were from the dexmedetomidine 0.3 group, and 17 (48.6%) were from the control group. There was a significant difference in the cough frequency among the three groups (P = 0.024). In terms of severity, 10 (30.3%) patients had severe coughs, 2 (22.2%) were from the dexmedetomidine 0.3 group and 8 (47.1%) were from the control group. There was no case of severe cough in the dexmedetomidine 0.5 group. There was a significant difference in the cough severity among the three groups (P = 0.009).

An infusion dose of 0.5 μg/kg of dexmedetomidine followed by a bolus dose of 0.5 μg/kg of dexmedetomidine is associated with a decrease in the incidence and severity of cough after surgery and with more stable hemodynamics of patients.

Laparoscopic cholecystectomy has been accepted as a safe and gold-standard procedure in the world and has many advantages. However, one of the common complications after laparoscopic cholecystectomy is chronic and sometimes very severe pain. Considering the patients' need to control postoperative pain with drugs that have the least possible side effects, as well as limited studies on the effect of painkillers on pain caused by laparoscopic cholecystectomy, the purpose of this study is to compare the preemptive effect of two drugs. Apotel and ketorolac were used for the first time in patients undergoing laparoscopic cholecystectomy.

This study was conducted as a three-blind randomized clinical trial on 90 patients aged 18 to 68 years, with ASA class one and two, who underwent general anesthesia for cholecystectomy.

The findings of this study show generally, the need for narcotics after cholecystectomy surgery in patients under anesthesia with ketorolac was less than in Apotel and the control group. These findings were also confirmed in patients' pain intensity and patients' satisfaction, so patients' satisfaction in Ketorolac and then Apotel group was higher compared to the control group, which is in line with previous studies in this field.

Therefore, it seems that the overall need for narcotics was lower in the ketorolac group than in Apotel and lower in Apotel than in control.

Due to the high prevalence of complications during and after laryngoscopy, especially hemodynamic disturbances, and the absence of a suitable solution for preventing these complications, this study was conducted to compare the effect of“Ketamine-Midazolam-Sufentanil” with “Etomidate-Sufentanil” combinations on changes in heart rate and blood pressure after laryngoscopy and endotracheal intubation.

In this controlled, triple-blind randomized clinical trial, 96 laryngoscopy candidate patients were divided into three groups of 32 members and were given “Ketamine-Midazolam-Sufentanil” (KMS), “Etomidate-Sufentanil” (ES) and” Etomidate-Normal Saline” (NS) respectively before laryngoscopy.Hemodynamic parameter changes at baseline and 1,3,5and 10 minutes after laryngoscopy, were measured and compared between the 3 groups.

During the study, the 3 groups KMS, ES, and NS had 0%, 15.6% and, 3.1% bradycardia respectively (p value = 0.024). Changes in systolic blood pressure were significantly different in the 3 groups (p value = 0.043). However, the incidence of tachycardia, hypertension, and hypotension were not significantly different among the 3 groups.

Results of this study showed that using the “Ketamine-Midazolam-Sufentanil” combination before laryngoscopy can reduce hemodynamic disturbances during and after laryngoscopy. Patients who receive this drug combination seem to have more desirable hemodynamic stability during and after laryngoscopy

Tonsils are lymphoid tissues of the body's defense system that surround the pharynx and prevent the entry of microbes through inhalation. Tonsillectomy is the final treatment for enlarged tonsils and is one of the most common procedures in the ear, throat and nose. To prevent and improve postoperative complications, various methods are used, including lidocaine and dexmedetomidine injections. The aim of this study was to compare the effects of intravenous infusions of lidocaine and dexmedetomidine on the rate and severity of immediate complications after tonsillectomy surgery.

This study was conducted as a prospective, triple-blind, randomized clinical trial on 96 patients who were candidates for tonsillectomy under general anesthesia at Al-Zahra Hospital, Isfahan, Iran. The patients had informed consents and met the conditions to enter the study. 30 minutes before induction of anesthesia, patients were randomly assigned to one of three groups receiving lidocaine, dexmedetomidine, or placebo. All patients were examined for intraoperative bleeding, laryngospasm in the first 2 hours after the operation, and laryngitis in the first 24 hours after the operation. SPSS version 26 software was used for statistical analysis.

The findings of this research indicated that at 45, 75 and, 90 minutes after recovery, the mean score of pain and at 15-90 minutes in terms of anxiety was significantly different from the rest in at least one of the three groups (P<0.05). Systolic blood pressure (SBP) and arterial oxygen blood pressure in minutes 30 to 90, as well as Diastolic blood pressure (DBP) in minutes 60, 75 and 90, showed a significant difference between the three studied groups (P<0.05). There was no significant difference between the incidences of laryngospasm in the groups. However, there was a significant difference between the incidences of bronchospasm in all three groups. In terms of factors such as cough and nausea, no significant differences were observed in the studied groups. However, the average amount of bleeding in surgery, the recovery time and, the first time to tolerate liquids and solids in at least one group were significantly different from the others.

Overall, both dexmedetomidine and lidocaine are effective in reducing heart rate, SBP, Per Os (PO), and bleeding, and also increase arterial oxygen pressure, while respiratory rate, laryngospasm, bronchospasm, cough, nausea and extubation time were not significantly different between the three study groups.

Double lumen tube (DLT) is used in lung surgeries. Classically, the patient should undergo fiberoptic bronchoscopy (FOB) to confirm the location of the DLT and its proper function. However, the sensitivity of ultrasound and clinical methods in diagnosing the correct position of DLT has not yet been definitively determined. This study was designed to assess the accuracy of point-of-care ultrasound and auscultation versus Fiberoptic Bronchoscope in determining the position of the Double-Lumen Tube.

This cross-sectional study of diagnostic value measurement type was conducted on patients who were candidates for double lumen implantation. After induction of anesthesia, DLT with the appropriate size was implanted, and then the position of DLT was evaluated. In the first step, the lungs were examined by auscultation, then the ultrasound was performed, and two signs of lung pulse sign and lung sliding sign were examined as signs of normal lung and ventilated lung. FOB was performed by an anesthesiologist. At the end, by opening the chest after surgery, the surgeon's opinion about the quality of lung collapse was recorded.

In our study, the correct placement of the tube was correct in 37 cases and wrong in 3 cases, which were checked and corrected by FOB. Vital signs of the patients were stable before and during the operation. There were no problems with anesthesia during the surgery. Diagnostic sensitivity of lung auscultation clinical examination was 64.9% and chest ultrasound was 91.9%. The sensitivity of ultrasound compared to auscultation was not significant (P=0.242), but there was a clinically significant difference in the positive predictive value of the two, so that the positive predictive value of lung auscultation was 88.9% and lung ultrasound was 91.9%. In terms of surgeon satisfaction level, 22 cases (59.5%) had excellent satisfaction and 15 cases (40.5%) had moderate satisfaction. The sensitivity of ultrasound was not significant in comparison with the surgeon's satisfaction.

Ultrasound can be a good substitute for FOB. Although ultrasound cannot have all the functions of FOB, but having advantages such as lower cost, speed of operation, and non-invasiveness, makes it more practical than FOB.

Propofol is one of the most common anesthetic drugs. Painful injection with a reported prevalence of 28 to 90% in various studies is one of the problems of taking Propofol. The present study investigated the effect of performing the Valsalva maneuver and tourniquet twisting on pain intensity and hemodynamic changes.

This clinical trial was performed on 105 patients under general anesthesia with propofol that was randomly divided into three groups Valsalva, tourniquet, and control. Pain caused by propofol injection was evaluated using the withdrawal response score from 0 (painless) to 3. Hemodynamic parameters including blood pressure (systolic, diastolic, mean arterial), heart rate, and oxygen saturation level have been measured too.

Statistical analysis showed that there was no significant relationship between the distribution of pain intensity among the three groups, however the frequency of people with moderate pain intensity and painless in the tourniquet and Valsalva groups increased significantly compared to the control group. There was also a significant correlation between blood pressure systolic, diastolic, mean arterial (P=0.0001), and heart rate (P=0.013) in the three groups, and no significant difference was observed between oxygen saturation levels in the three groups (P=0.102). Mean blood pressure in the Valsalva group and heart rate in the tourniquet group is higher than in other groups.

Valsalva maneuvering and tourniquet twisting reduce the pain caused by propofol injection, with the difference that the mean blood pressure in the Valsalva group is greater than that in the tourniquet group

Postoperative nausea and vomiting is a common complication of anesthesia. The aim of this study was to compare the effect of midazolam, ondansetron and their combination in prevention of nausea and vomiting after strabismus surgery.

In this randomized double-blind clinical trial, 140 patients undergoing strabismus surgery were divided into four groups (n=35 per group). The patients received midazolam 0.75 mg/kg (M), ondansetron 4 mg (O), midazolam 0.75 mg/kg + ondansetron 4 mg (MO), and saline 0.9% iv. (S) before anesthesia. Follow-up was done in the first 24 hours after surgery and incidence and severity of nausea and vomiting and other postoperative complications were compared between the four groups.

In this study, 10 patients (37%) in group S, 6 (19.4%) in group O, 8 (28.6%) in group M, and 2 (6.3%) in group MO developed nausea indicating significant differences between the four groups (P=0.019). The study showed no significant differences between the groups in incidence of vomiting (P= 0.18); 6 patients (22.2%) in group S, 5 (16.1%) in group O, 4 (14.3%) in group M, and 1 patient (3.1%) in group MO had vomiting. The severity of postoperative nausea and vomiting was significantly different between the four groups and group MO was found to have less severe nausea and vomiting two hours (P= 0.009) and 24 hours after surgery (P< 0.001).

Combination of midazolam and ondansetron reduces the incidence of postoperative nausea and vomiting compared to midazolam or ondansetron alone and leads to greater patient satisfaction. According to the higher effect of MO and lack of adverse effects on hemodynamic parameters it is recommended in patients undergoing strabismus surgery.

Hypotension and bradycardia are among the common side effects of spinal anesthesia. The effect of ondansetron on the reduction of hypotension and bradycardia caused by spinal anesthesia has been studied considering its antagonistic effect on the Bezold–Jarisch reflex. The present study was conducted to determine the effectiveness of two different doses of intravenous ondansetron on the reduction of the incidence of hypotension and bradycardia among candidates for elective caesarean section under spinal anesthesia.

This double-blind clinical trial was conducted in Shahid Beheshti Hospital in Isfahan in 2020 and included 90 patients aged 18 to 45 years in full-term pregnancy who were candidates for elective caesarean section in three groups of 30. 5 minutes before spinal anesthesia, 6 and 8 mg of ondansetron were injected in the first and second groups, respectively, and normal saline was injected in the third group. Vital signs were examined every 15 minutes during surgery and during recovery, and the incidence of hemodynamic disorders, nausea and vomiting was compared between the three groups.

There was no significant difference between the three groups in terms of demographic and baseline variables, blood pressure (systolic, diastolic and mean arterial pressure), heart rate, ephedrine intake and incidence of hemodynamic disorders. The frequency of nausea during recovery was significantly different between the three groups (p=0.035); 12 people in the ondansetron 6 mg group, 12 people in the ondansetron 8 mg group and 21 people in the control group had nausea during recovery (40%, 40%, and 70%, respectively). The frequency of vomiting in recovery was significantly different between the three groups (p=0.002); 5 people in the ondansetron 6 mg group, 1 person in the ondansetron 8 mg group, and 12 people in the control group experienced vomiting during recovery (16.7%, 3.3%, and 40%, respectively).

The results of this study showed that administration of ondansetron at 6 and 8 mg doses in caesarean section under spinal anesthesia has no significant effect in reducing the incidence of hypotension, bradycardia, and administration of ephedrine and atropine. However, it is associated with a reduction in the incidence of nausea and vomiting in the recovery room (ondansetron 8 mg is more effective than 6 mg).

Postoperative nausea and vomiting is a common complication after surgery that no single theory has been expressed as to the cause of this complication so far. The aim of this study was to determine the relationship between PaCO2and nausea, vomiting and pain after laparoscopic cholecystectomy.

In this cross-sectional study, 88 patients in Alzahra hospital, underwent laparoscopic cholecystectomy were selected and the level of pre and postoperative PaCO2, as well as duration of postoperative nausea, incidence of vomiting, and severity of postoperative pain was assessed. The correlation between PaCO2, HCO3 and PH with these postoperative complications were evaluated. The patients’ data were analyzed by using Chi-square, t-test, Pearson correlation, Paired t-test and Repeated Measure ANOVA tests. P value < 0.05 was considered statistically significant.

The correlation between duration of nausea and PaCO2levels before and after surgery was 0.05 and 0.04, respectively, which was not statistically significant (p value = 0.63 and p value = 0.72, respectively). In addition, the correlation between PaCO2level and severity of postoperative pain was 0.2 (p value = 0.07), which was not statistically significant.

The findings of the present study showed that PaCO2level has not statistically significant effect on duration of postoperative nausea, incidence of vomiting, and severity of postoperative pain.

Electroconvulsive therapy (ECT) is an appropriate way in treatment of major depression. ECT is usually associated with acute hyperdynamic responses. The aim of this study was to investigate the effect of dexmedetomidine on changes in heart rate and blood pressure after induction of anesthesia with thiopental sodium in children treated with ECT.

 In this study, 60 children who were candidates for ECT were randomly divided into two groups, who received dexmedetomidine (2 µg/kg) or normal salin 0.9% (1 mg) before ECT. Hemodynamic changes were recorded at 1, 3, 5, and 10 minutes after intubation.

 After intervention, the incidence of alteration in arterial oxygen saturation, tachycardia and bradycardia, any change in blood pressure, and heart rate was not significantly different between two groups. The mean duration of induced seizure was not significantly different between the two groups, but return of breathing and recovery time were significantly higher in the intervention group (P < 0.001).

Administration of 2 µg/kg dexmedetomidine in children receiving ECT did not significantly alter hemodynamic parameters such as arterial oxygen saturation, blood pressure, heart rate, and complications in comparison with controls; hence it increased return of breathing and recovery time compared to control group.

This study aimed to compare the anti-shivering effects of 100 mg and 200 mg oral celecoxib with control group undergoing orthopedic lower extremity surgeries under spinal anesthesia.

In a randomized double-blinded clinical trial study that was conducted at Ayatollah Kashani hospital in Isfahan, Iran, the patients undergoing elective orthopedic surgery of the lower extremity under spinal anesthesia with class 1 stage based on the American Society of Anesthesiologists (ASA) scale, were evaluated. The first group received placebo tablets, the second group received 100 mg oral celecoxib, and the third group received 200 mg oral celecoxib 3 hours prior to spinal anesthesia. Incidence and intensity of shivering was compared 10 minutes after the anesthesia, and every 15 minutes until the end of surgery in all three groups.

A significant difference was observed between the three groups at all periods of time (P < 0.05). The group receiving 200 mg celecoxib experienced the less shivering.

A dose of 200 mg oral celecoxib was reported to be more effective on shivering during and after the orthopedic lower extremity surgery in patients under spinal anesthesia as compared to 100 mg oral celecoxib and the control group.

Electroconvulsive therapy (ECT) is used to treat generalized seizures in psychiatric diseases. The aim of this study was to evaluate the effect of adding dexmedetomidine to ketamine on heart rate and blood pressure changes in in psychiatric patients undergoing electroconvulsive therapy (ECT)

In this randomized, double-blind randomized clinical trial, taken place at the Alzahra Subspecialty Medical Center (Isfahan, Iran) between 2018- 2019. Fifty patients who were candidate for undergoing ECT entered the study and were divided into two groups namely A and B. The group A received a package containing 0.5 mg/kg succinylcholine and 1.5 mg/kg ketamine plus 0.1 mg/kg dexmedetomidine, and the group B received a medicine package containing 0.5 mg/kg succinylcholine and 1.5 mg/kg ketamine plus normal saline. The hemodynamic variables and side effects of the two drug classes were evaluated and compared to each other.

The durations of spontaneous respiratory recovery from seizure termination, end seizure to complete consciousness and recovery in the group A was significantly lower than the group B (P<0.001). However, the mean of systolic blood pressure and mean arterial blood pressure after the end of seizure was significantly less in the group A than the group B, but the mean of SPO2 in the fifth minute in the group B was significantly lower than the group A. However, the frequency of nausea and muscle pain in the group B was significantly higher than the group A.

The addition of dexmedetomidine to ketamine in the candidate patients for ECT can shorten the duration of seizure, recovery time, respiratory depression, and also reduce complications such as nausea, muscle pain and oxygen depletion.

Hemodynamic disorders is a common and serious complication during endotracheal intubation with various suggested preventive methods; but there is no consensus. The aim of this study was to determine the effect of three different doses of sufentanil on heart rate and blood pressure changes after laryngoscopy and endotracheal intubation, and to compare it with the control group.

In a double-blind clinical trial study, 128 patients undergoing surgery with general anesthesia were randomly divided into 4 groups of 32. In the first group, as the control group, the drug was not injected, and the other three groups received 0.1, 0.2, and 0.3 µg/kg sufentanil, respectively, which was injected before laryngoscopy. Hemodynamic parameters were determined at 0, 1, 3, 5, and 10 minutes after laryngoscopy, and were compared between the four groups.

The trend of blood pressure changes during laryngoscopy was significantly different between the four groups; but the changes in heart rate and oxygen saturation were not different between the groups. Changes in the level of hemodynamic parameters showed that the group receiving 0.3 µg/kg sufentanil had higher stability during the laryngoscopy.

Dosage of 0.3 µg/kg sufentanil appears to be associated with favorable hemodynamic stability of patients during laryngoscopy and endotracheal tube insertion.

Nowadays, electroconvulsive therapy (ECT) is considered as an effective treatment for psychological disorders. The ECT, and induced seizure, stimulates cardiovascular system through parasympathetic system and then sympathetic stimulation. Therefore, heart rate and blood pressure increase significantly to the extent that may cause ischemia and coronary diseases in high-risk patients. In the current study, the effects of two different doses of labetalol treatment on hemodynamic changes during ETC were compared.

The current cross-sectional randomized clinical trial study was conducted on 36 patients underwent two sessions of ECT. Each time, they were randomly treated with one of the labetalol doses of 0.2 or 0.4 mg/kg. Furthermore, all the patients were treated with 0.5 mg/kg succinylcholine and 2 mg/kg sodium thiopental. Blood pressure, heart rate, oxygen saturation, recovery duration, time of spontaneous respiration return following ECT, and dose-related complications were recorded in two groups and compared.

Comparison of two groups presented no statistical differences regarding mean arterial, systolic, and diastolic blood pressure; while nausea and vomiting occurred less in low-dose-treated group (P = 0.020).

 Both doses of 0.2 and 0.4 mg/kg labetalol could make a stable hemodynamic without affecting the quality and duration of the seizure in negative manner; but low dose of labetalol was accompanied with fewer adverse effects.

Nowadays, electroconvulsive therapy (ECT) is an efficient treatment of psychological disorders. The basis of a successful ECT is induction of a seizure with purposeful intensity, quality, and duration. Thus, an appropriate anesthetic agent is required. The current study compared the efficacy of remifentanil versus ketamine add-on therapy to propofol on hemodynamic change and seizure duration in ECT.

The current cross-sectional clinical trial study was conducted on 40 patients under ECT in years 2017-18. Patients were randomly treated with each of the combination therapies as they were randomly treated with one for the first session of ECT, and with the later for the second session. Combinations of anesthesia included treatment with propofol-remifentanil versus propofol-ketamine. Furthermore, all patients received 0.5 mg/kg of succinylcholine and 0.5 mg/kg of propofol. Blood pressure, pulse rate, oxygen saturation, recovery duration, and time of spontaneous respiration following ECT, as well as complications, were recorded and compared.

Two assessed groups were not statistically different regarding systolic (P = 0.180) and diastolic blood pressure (P = 0.920), mean arterial pressure (P = 0.360), oxygen saturation (P > 0.999), and spontaneous respiration in recovery (P = 0.950). Tachycardia incidence (P < 0.001) and duration of recovery stay (P = 0.040) was significantly higher in propofol-ketamine group. Furthermore, nausea and vomiting was more in propofol-ketamine group (8 cases versus 2 cases; P = 0.080). The mean seizure duration was 36.12 ± 7.74 seconds propofol-ketamine and 30.07 ± 5.13 seconds in propofol-remifentanil group with a significant difference (P < 0.001).

Based on findings of the current study, combination of propofol-remifentanil was superior to combination of propofol-ketamine regarding seizure duration, hemodynamic stability, and less adverse effects. Due to limited number of studies comparing mentioned remedies, further studies are recommended.

The purpose of this study was to compare the effect of thiopental sodium-midazolam combination on the stress response and hemodynamic changes between tracheal intubation and laryngeal mask airway insertion during airway management. In this clinical trial study, 70 patients ASA 1, 2 candidates for elective surgery were randomly divided into two groups of tracheal intubation and laryngeal airway mask insertion. Hemodynamic variables including mean arterial pressure, heart rate, and arterial oxygen saturation were measured and compared between the two groups before and after intubation. There was no significant difference between the two groups in regard to demographic data (age, sex, height, and weight), heart rate, mean arterial pressure and arterial oxygen saturation at 1 and 3 minutes after induction of anesthesia and 1, 3, 5 and 10 minutes after intubation. (P> 0.05). But there were significant differences between the two groups in relation to heart rate at 1 and 3 minutes after intubation, so that heart rate at these times was significantly higher in the intubation group than in the laryngeal airway mask group (P <0.05). Based on the findings of this study, use of thiopental sodium midazolam combination was effective and safe and attenuated the stress response to airway management with resultant minimal changes in the heart rate and blood pressure.

Considering the importance of shivering, as an important complication in patients after spinal anesthesia, in this study, we determined that the effectiveness of injection of three drugs dexamethasone, midazolam, and ondansetron, alone or in combination, on the shivering of patients. In this clinical trial study, 179 patients undergoing lower limb orthopedic surgeries referring to Kashani hospital, Isfahan, Iran, during the years 2006 to 2007 entered the study. Patients were divided into 5 groups receiving midazolam, ondansetron, dexamethasone, the combination of three drugs, and placebo. The severity of shivering and hemodynamic information were evaluated in patients. There was no significant difference between the groups according to the central and peripheral temperature at the time before the anesthesia and at 5, 10, 15, 20, 25, and 30 minutes after it (P > 0.050). There was a significant difference between the groups based on the severity of shivering during the first, second, third, and fourth fifteen minutes (P < 0.001); so that the shivering intensity was higher in the placebo group, and there was a significant difference between the other groups as well. (P < 0.001). Combination of the three drugs midazolam, dexamethasone, and ondansetron in orthopedic surgeries with spinal anesthesia can be associated with controlling of shivering.

This study aimed to compare the ability of predicting difficult intubation by six indexes of thyromental height (TMH), acromioaxillary-suprasternal notch index (AASI), modified mallampati test (MMT), upper lip biting test (ULBT), height to thyromental distance ratio (RHTMD), and neck circumference to thyromental height ratio (NC/TMH) in patients undergoing general anesthesia. In this cross-sectional study, 600 patients undergoing surgeries were selected, and difficult laryngoscopy was evaluated using above the six tests. The cut-of-point and diagnostic values were determined in comparison with Cormack-Lehane index. The NC/TMH test had the highest sensitivity (80.6%) and AASI had the highest specificity (94.8%). Moreover, among the six testes, NC/TMH had the highest positive predictive value (PPV), and ULBT had highest negative predictive value (NPV). ULBT had the highest positive likelihood ratio and TMH had the highest negative likelihood ratio. Compared with the other tests, NC/TMH, AASI, and TMH had better diagnostic values for evaluating airway, and can be used to detect difficult laryngoscopy.

Nowadays, various methods are used to determine the difficulty of laryngoscopy. In this study, we aimed to compare the performance of the acromioaxillosuprasternal notch index (AASI) with the old anatomical criteria of the head and neck in predicting difficult laryngoscopy in pediatrics surgical procedures requiring tracheal intubation under general anesthesia. In this cross-sectional study, 379 children undergoing general anesthesia and intubation were divided into two groups based on easy (grades 1 and 2) and difficult (grades 3 and 4) laryngoscopy based on the score of Cormack-Lehane. The systems of thyromental distance, the ratio of height-to-thyromental distance (RHTMD), Upper lip bite test (ULBT), the circumference of the neck, and AASI were assessed and compared in predicting the difficulty of laryngoscopy. The laryngoscopic view was difficult in 48 patients (38 with grade 3 and 10 with grade 4). There was no significant difference between the two types of difficult and easy laryngoscopy based on thyromental distance, neck circumference, RHTMD, and AASI methods (P > 0.050); but there was a significant difference between two easy and difficult laryngoscopies based on ULBT and MMT methods (P < 0.050). The sensitivity of RHTMD, AASI, and neck circumference was 31.2, 47.9, and 51.1 percent, respectively, and specificity of them was 52.7, 45.6, and 48.9 percent, respectively. The neck circumference and then ASSI method is better than the RHTMD method, and the MMT method is better than the ULBT method in order to determine difficult laryngoscopy in children.

Coughing and sore throat are among the most common complications of intubation. Variety of drugs have been experimented to reduce these complications, but the information in this regard is limited and controversial. The current study compared intracuff alkalinized lidocaine, intravenous lidocaine, and a control group. This was a randomized controlled double-blinded clinical trial study on 99 patients undergoing intubation. Patients were randomly divided into three equal groups, intracuff alkalinized lidocaine, intravenous lidocaine, and control group, in them, the cuff was filled with air till pressure reached under 30 cmH2O. Cough frequency and sore throat severity were assessed and compared based on visual analog scale (VAS) immediately after extubation, and within 15 minutes, 1, 2, 3, 12, and 24 hours after extubation. Comparison of sore throat among 3 groups in different times showed no difference (P > 0.050); but within 24 hours decreased in all three groups of intracuff alkalinized lidocaine (P < 0.001), intravenous lidocaine (P < 0.001), and control (P = 0.001). Sore throat severity decreased significantly in all three groups during a period of 24 hours (P < 0.050). Comparison of cough frequency immediately after extubation (P = 0.005) and within 24 hours (P = 0.007) was significantly less in intracuff alkalinized lidocaine group. Within 24 hours, the frequency of coughing decreased significantly in all three groups of intracuff alkalinized lidocaine (P = 0.040), intravenous lidocaine (P = 0.001), and control (P = 0.002). Based on the current study, there was no difference among alkalinized intracuff lidocaine, intravenous lidocaine, and control group in the reduction of sore throat, but to reduce cough, alkalinized lidocaine was significantly influential.

  Sore throat is a common complication following surgery. The aim of this study was to determine the preventive effect of magnesium sulfate gargle, ketamine glucose gargle or dexamethasone intravenous injection on postoperative sore throat in patients undergoing general anesthesia and to compare it with the control group. In a clinical trial study, four groups of 35 patients undergoing surgery were treated with gargling 40 mg ketamine dissolved in 30 ml normal saline, gargling 40 mg of magnesium sulfate dissolved in 320 ml normal saline, or intravenous injection of 8 mg dexamethasone and gargling 320 ml normal saline half an hour before the surgery. The incidence and severity of postoperative sore throat were compared between the four groups. Findings: The frequency of postoperative sore throat was significantly different in four groups of magnesium sulfate (21.4%), ketamine (16.1%), dexamethasone (24.2%), and control (42.9%) (P = 0.024). But the severity of sore throat did not differ significantly between the groups (P = 0.210). The use of preoperative magnesium sulfate as gargle reduces the incidence of postoperative sore throat, decreases drug intake, and increases the first time of drug intake compared with ketamine gargle and intravenous dexamethasone. Therefore, the use of magnesium sulfate gargle seems preferable to dexamethasone injections and ketamine.

Postoperative shivering is a common complication of surgical procedures under spinal anesthesia. The aim of this study was to determine the preventive effect of different doses of tramadol injection on shivering during and after lumbar orthopedic surgery under spinal anesthesia as compared to control group.

In a clinical trial study, 128 patients underwent lower limb orthopedic surgery in 4 groups of 32 patients received 0.5, 0.75, and 1 mg/kg, tramadol and normal saline with equal volume, 5 minutes before spinal anesthesia. The incidence of postoperative shivering was compared in four groups. Findings: A total of 11 patients suffered from postoperative shivering, 1 (6.2%), 2 (1/5), and 1 (2.6%) received tramadol 0.5, 0.75, and 1 mg/kg, respectively, and 7 (17.9%) were of the control group. The incidence of shivering in the control group was significantly higher than other groups (P = 0.021).

In this study, all three doses of 0.5, 0.75, and 1 mg/kg of tramadol were effective in preventing postoperative shivering, but the dose of 1 mg/kg was more effective. Therefore, a dose of 1 mg/kg tramadol seems to be a more appropriate dose for controlling postoperative shivering.

This study aimed to compare premedication with sodium thiopental, magnesium sulfate, midazolam, prime etomidate dosage, remifentanil, and normal saline on decreasing myoclonus incidence and pain induced by anesthesia with etomidate.
In a clinical trial study, 162 patients who were candidates for anesthesia were randomly entered in 6 equal groups. Two minutes before induction of anesthesia, patients were treated with intravenous thiopental, magnesium sulfate, midazolam, remifentanil, prime etomidate dosage, or normal saline. Pain, myoclonus, and complications were determined and compared between the groups.
Findings: Intensity of myoclonus was not significantly different between the six groups at zero, 10, and 15 minutes after anesthesia. But at 5th minute, midazolam (0.51) and fentanyl (0.81) groups had the lowest and magnesium sulfate (1.88) and prime etomidate dosage (1.77) groups had the highest myoclonus; the difference between the groups was significant (P = 0.002).
It seems that administration of midazolam with etomidate is the best choice for anesthesia. Therefore, it is recommended that this drug be used in combination with etomidate to induce anesthesia in patients. More studies are recommended.

Previous studies showed that dexamethasone and ondansetron had effect on preventing shivering in surgeries under spinal anesthesia but comparison of the two drugs was not studied. This study aimed to compare preemptive effect of intratechal fentanyl with intravenous ondansetron, dexamethasone, and dexamethasone plus ondansetron on shivering during surgeries under spinal anesthesia with bupivacaine.
In a clinical trial study, 185 patients under surgeries with spinal anesthesia were randomly divided in 5 groups of receiving 25 µg intratechal fentanyl, 4 mg intravenous ondansetron, 0.1 mg/kg intravenous dexamethasone, 0.1 mg/kg intravenous dexamethasone plus 4 mg intravenous ondansetron, and 4 ml intravenous normal saline in a bolus dose. The incidence of shivering during surgery was compared between the 5 groups.
Findings: Mean shivering scale during surgery and recovery time in control, dexamethasone plus ondansetron, ondansetron alone, dexamethasone alone, and fentanyl groups were 1.30 ± 0.33, 1.01 ± 0.04, 1.15 ± 0.20, 1.04 ± 0.07 and 1.12 ± 0.15, respectively. Shivering intensity in control group was higher and in dexamethasone plus ondansetron was lower than others significantly (P Using dexamethasone plus ondansetron have more effect on decreasing shivering during and after the surgery. In addition, this compound has not adverse effect on hemodynamic parameters.

Despite improved outcomes after cardiac operations, delirium is a common neurologic complication after cardiac surgery. In this study, we aimed to investigate the association of postoperative delirium and mean arterial pressure (MAP) during cardiopulmonary pump in patients after coronary artery bypass graft (CABG).
100 inpatients submitted to coronary artery bypass graft were evaluated prior to and after surgery. In order to investigate the association between mean arterial pressure and incidence of delirium, data were collected at pre intra, and postoperative periods. The patients were examined for delirium using Mini-Mental State Examination (MMSE).
Findings: Preoperative delirium was detected in 34 patients (34%) and 74 patients (74%) had postoperative delirium. There was a significant positive correlation between total score of MMSE and mean arterial pressure during cardiopulmonary pump (r = .22, P = 0.02). Furthermore, there was a significant correlation between total score of MMSE and O2 saturation (r = .22, P = 0.03).
Present study suggests associations between incidence of postoperative delirium and mean arterial pressure and O2 saturation during cardiopulmonary pump. Maintaining mean arterial pressure and O2 saturation of blood at physiologic levels during cardiopulmonary pump may be associated with less early postoperative delirium and cognitive dysfunction.