afshin jafarzadeh

Bloodless surgical field obtained by controlled hypotension reduces the bleeding, the surgical time and improves outcome of rhinoplasty and other facial plastic surgeries.Since acupuncture is used for epistaxis, this study was designed to investigate its effectiveness in reducingthe bleeding in open rhinoplasty.

In a triple-blinded randomized clinical trial, 88 patients with ASA I and II physical status, aged between 20 –48 years, who were candidates of open rhinoplasty were enrolled in the study.After randomization, 44 patients were assigned to each group of acupuncture or control. They were given identical anesthesia. In addition to the hemodynamic monitoring, blood loss was assessed in all patients and compared between the two groups.

There were statistically significant differences between two groups in terms of the amount of bleeding (P = 0.001) and surgeon satisfaction (P = 0.010). Coagulation indicators were similar in both groups (All P > 0.05). Mean SBP and DBP, average HR and average MAP in both acupuncture and control groups did not show significant differences (All P > 0.05). Adverse events such as bradycardia or hypotension requiring treatment were not seen.

Our findings demonstrated that acupuncture could reduce bleeding during rhinoplasty without side effects.

Burnout syndrome (BOS) is a common occupational disease amongst medical physicians; especially anesthesiologists. BOS is known to result in increased expenditure of the healthcare system and decreased patient satisfaction. In order to substitute for good conduct by its medical staff, Tehran University of Medical University established its own guidelines on professionalism as a substitute for professional conduct amongst its personnel. Learning and practicing professionalism is not only a requirement to be competent as a specialist, but also it results in increasing healthcare quality and patient satisfaction. There is a lack of studies on the relationship between BOS and professionalism. Determination of the relationships between professionalism and BOS among TUMS anesthesiology residents.

In this cross-sectional study all anesthesiology residents completed three forms (demographic checklist, Maslach Burnout Inventory (MBI), and professionalism self-conduct). The results were primarily analyzed using STATA 14.0 and relationships were established via linear and binary regression.

About 44 percent of residents met criteria for BOS. The risk of developing BOS was significantly higher for residents who adhered to the principles of respect and altruism and for residents training in one of our surveyed hospitals; whereas the risk of developing BOS would be reduced by increasing age and adherence to the principles of justice Burnout subscales scores concerning emotional exhaustion and personal accomplishment were significantly related with higher self-reported scores of altruism and honesty-integrity respectively.

The chances of developing BOS could be enhanced by inadequate practice in the field of professional ethics. Therefor the importance of learning and competent practice of professionalism must be acknowledged. Age and professional climate were the most important demographic variables related to BOS in anesthesiology residents.

During the COVID-19 pandemic, burnout of healthcare workers, including anesthetists, has become a critical issue. This study aimed to provide a practical framework for decreasing and preventing burnout among anesthesiology residents through preserving their good mental health.

Since the onset of the COVID-19 outbreak, anesthesiology residents have been members of medical teams with the attending staff, senior residents, and partner residents. Besides, the following measures were taken to reduce burnout: providing financial support for the attending staff to procure personal protective equipment (PPE), rearrangement of work schedules to reduce the workload, holding training sessions in virtual meetings, and improving the social network system for reducing burnout.

The interventional program could help anesthesiology residents to adapt to or cope with the healthcare system status and also prevent burnout. Moreover, development of empathy, integrity, and cohesion in the healthcare system motivated the staff to comply with the principles of medical professionalism.

During the current health crisis due to COVID-19, it is essential to implement specific interventional and training programs for decreasing or preventing burnout among healthcare workers.

The change in patients' positions has a bold effect on the ventilation and hemodynamic parameters during surgery. In this study, we evaluated the changes in hemodynamic and ventilator values resulting from conversions in the position of patients under the thoracotomy from supine to lateral position and vice versa, to determine the most favourable position with the best hemodynamic stability and ventilation conditions.

In this pre and that post interventional clinical trial, 50 patients scheduled for thoracotomy were included. Following general anesthesia induction and 5 minutes later, hemodynamic data before thoracotomy and after the surgical intervention was measured, the patient was placed in the supine position and all hemodynamic data were recorded. Then, the position of the patient was slightly changed to the lateral recumbent position. Then, at the end of the surgery, the position was changed to supine.

Regarding the change in study indices (including HR, SBP, DBP, MAP, SVV, CO, and PVI), changes in supine to lateral status led to only a decrease in systolic blood pressure, diastolic blood pressure, and mean blood pressure and other indicators did not show a statistically significant change. Similarly, the change in the above indices by changing the lateral to the supine state was only an increase in systolic blood pressure, diastolic blood pressure, mean blood pressure, and other data remained unchanged.

Changing the position of patients during surgical thoracotomy from supine to lateral position or vice versa is associated only with significant changes in patient's blood pressure and has no significant effect on other ventilatory and cardiovascular parameters.

Our goal was to compare two common methods including auscultation and Fiber-Optic Bronchoscopy (FOB) in confirming the correct placement of Double-Lumen Tube (DLT). Seventy six patients were enrolled. After DLT insertion, clinical verification was made by auscultation, then FOB was applied. At lateral decubitus, the position of DLT was rechecked by auscultation, and then by FOB. The incorrect position including malposition and misplacement were compared between two routine methods of auscultation and FOB. After blind intubation, 21.1% of DLTs were considered to be in an incorrect position. Meanwhile, FOB showed that 46.1% of DLTs were not placed correctly. Among all the patients, 53.9% of DLTs were in the optimal position. Misplacement was diagnosed in 35.5% and malposition in 10.5% of the patients. After positioning to the lateral decubitus, using auscultation, we found that 5.3% of tubes were dislocated, but according to FOB, it was 10.5%. The agreement coefficient between auscultation and FOB was 0.42 in the supine position and 0.64 in lateral position. Our results showed that although FOB needs more time to check the position of DLT, it should be used to confirm the exact position of DLT.

 The aim of this study was to assess the quality of the surgical field, amount of blood loss, and duration of surgery following induced hypotension with labetalol, nitroglycerin, and high dose propofol in patients undergoing FESS under general anesthesia.

One hundred and eight patients scheduled for FESS under general anesthesia were recruited in this randomized trial and were allocated to one of the three study groups: 1) Nitroglycerine (NTG) group: nitroglycerine with a dose of 2-5 μg/kg/min was administered; 2) Labetalol (LAB) group: an IV bolus dose of labetalol (20 mg) was injected at first and then IV infusion of labetalol at a rate of 1-2 mg/min; 3) High dose propofol plus normal saline (0.5-1 ml/min) group. Hemodynamic variables and the amount of bleeding were recorded intraoperatively and the surgeons' satisfaction was asked following each surgery considering the surgical field quality using a 5-item Likert scale.

The average blood loss (ml) in patients in the LAB group was significantly less than patients in NTG and high dose propofol groups (127 ml vs 198 and 145 ml, respectively) (p- value=0.001) and the surgeons expressed greater satisfaction with the surgical field quality in the LAB group (p- value=0.001).

Labetalol infusion may be a safe and effective method for induction of controlled hypotension to provide a comparatively bloodless field. High dose propofol may be a second choice if labetalol is not available.

Pruritus is a troublesome side effect of intrathecal opioids. Midazolam can reinforce GABA-mediated inhibition of the medullary dorsal horn neurons, and thus theoretically has potential to suppress opioid-induced pruritus.
This prospective double-blinded randomized trial aimed at comparing the effects of propofol, midazolam, and a combination of the two on the prevention of pruritus induced by intrathecal sufentanil.
Eighty-four patients undergoing spinal anesthesia with 3 mL hyperbaric bupivacaine 0.5% and 5 μg sufentanil (1 mL) were randomly allocated to one of the three study groups: Group 1, who were administered 20 mg intravenous (IV) propofol bolus, then 50 μg/kg/min IV infusion; Group 2, who were administered 0.03 mg/kg IV midazolam bolus, then 0.02 mg/kg/h IV infusion; and Group 3, who were administered 10 mg IV propofol and 0.015 mg/kg IV midazolam bolus, then 25 μg/kg/min propofol and 0.01 mg/kg/h midazolam IV infusion. The incidence rates and severity of pruritus were assessed intraoperatively and postoperatively for 24 hours.
The Ramsay Sedation Score was highest for the propofol group throughout the duration of the anesthetic process. Overall, 17 patients in the propofol group (60.7%), eight patients in the midazolam group (28.6%), and nine patients in the propofol-midazolam group (32.1%) developed pruritus (P = 0.027). Intraoperative pruritus was observed in seven patients in the propofol group (25%), two patients in the midazolam group (7.1%), and five patients in the midazolam-propofol group (17.9%) (P = 0.196). Postoperative pruritus developed in 12 patients in the propofol group (42.9%), six patients in the midazolam group (21.4%), and four patients in the midazolam-propofol group (14.3%) (P = 0.041). There was no significant difference between the groups with respect to the severity of pruritus (P > 0.05).
This study showed that in comparison with propofol, the administration of 0.03 mg/kg IV midazolam bolus followed by 0.02 mg/kg/h could be more effective in the prevention of intrathecal sufentanil-induced pruritus without increasing sedation and other side effects.

The aim of this study was to assess the effect of premedication with intravenous midazolam or fentanyl on anxiety and hemodynamic changes following spinal anesthesia in pregnant women
145 pregnant women scheduled for cesarean section were randomly recruited into three study groups in this randomized clinical trial. The severity of anxiety in all women were assessed using Depression Anxiety Stress Scales (DASS) at the time of entrance to the operating room. In first group (group Midazolam) 1 mg midazolam (in 1 ml volume), in second group (group Fentanyl) 50 µg fentanyl (in 1 ml volume) and in third group (group control) , 1 ml normal saline were administered intravenously before preparing for anesthesia and then spinal anesthesia was done for all women in lateral position. Variables such as age, body mass index, duration of surgery, level of sensory block, gravidity, Apgar score, heart rate, systolic, diastolic and mean arterial pressure before spinal anesthesia and then after every minutes until 5 minutes and then every 5 minutes until the end of surgery were recorded for all patients. Data were analyzed using SPSS (version 22).
Demographic variables, duration of surgery and Apgar score of neonates were not different between study groups. Women in three group were not different with respect to incidence of hypotension and bradycardia needed to treatment. The incidence of hypotension and bradycardia in patients with severe anxiety were statistically different between control and midazolam groups, but the same difference was not seen in patients with mild, moderate and very severe anxiety.
In this study, we showed that intravenous midazolam before spinal anesthesia for cesarean section can decrease the incidence of hypotension and bradycardia in patients with severe anxiety without any risk for mother and her neonate.

Deliberate hypotension is a strategy that reduces intraoperative bleeding and increases the speed of surgery in otolaryngology procedures. Magnesium (Mg) sulfate is a vasodilator agent that reduces intraoperative hypnotic requirements and in combination with analgesic agents, it reduces intraoperative and postoperative pain. In this study we evaluated the use of intravenous Mg sulfate for inducing deliberate hypotension in rhinoplasty. Sixty ASA I, II patients aged between 18 to 45, scheduled for rhinoplasty were recruited into a randomized clinical trial. Patients were randomly assigned into placebo (group P) and Mg sulfate (group M) groups. For patients in group M, 40m/kg Mg sulfate was administered before induction and continued with 15mg/kg/hr infusion during the operation. Patients of group P received normal saline as placebo. In each group mean arterial pressure (MAP), mean heart rate, amount of bleeding, anesthetic agents, opioid requirement and duration of surgery were recorded. The incidence of nausea, vomiting, shivering and the score of pain were recorded in post-operative period in both groups. Patients in group M had lower MAP (P= 0.0001), less intraoperative bleeding (P=0.0001), lower anesthetic agents (P=0.0001) and opioid consumption (P=0.001), and shorter duration of procedure (P=0.0001). Mean heart rate was lower in group P (P=0.001). Moreover, surgeon`s satisfaction was more in group P (P=0.001).They also had less incidence of post-operative nausea and vomiting (P=0.008), shivering (P=0.001) and lower pain scores postoperatively (P=0.0001). Magnesium sulfate can be a useful drug to induce controlled hypotension in rhinoplasty surgery. By employing this agent patients have better anesthetic condition and recovery profile

To study the role of preoperative intravenous magnesium sulphate in decreasing post-cesarean pain and opioid requirement during first 24hrs.In a double blind randomized clinical trial, prior to induction of general anesthesia, fifty elective cesarean candidates were randomly assigned to one of the two groups of placebo or magnesium sulfate. After surgery visual analogue scale (VAS) and infused morphine by PCA during 24 hrs were recorded. The data were analyzed by mann-Whitney -test, analysis of variance, and student t- test.VAS was significantly lower among patients in the magnesium sulphate group at intervals of 1st, 6th & 12th hours after cesarean section (C/S) with the mean scales of (48.9± 19.6 VS 74.7± 18.4), (42.1± 0.9 VS 58.3± 16.5) and (25.2± 6.1VS 30± 8.1) respectively and p-value of <0.001, 0.002 and 0.05 respectively. However at 24 hrs there was no significant difference in VAS with mean VAS scales of 22.6± 4.5 VS 23.6± 4.9 and p-value of 0.49. The dose of infused Morphine during 24 hrs was significantly less in the magnesium sulphate group than the placebo group with the means of 4.36± 1.4 VS 7.02± 1.9 mg respectively (p<0.001).Administration of bolus 50 mg/kg magnesium sulphate prior to induction of general anesthesia may significantly decreased the morphine requirement during immediate post operative period and can be recommended as one of the modalities of post-operative pain control in the pregnant patients.