badiozaman radpay

Hospitalization in intensive care units results tactile deprivation, which may cause level of consciousness and physiologic imbalance. Foot tactile stimulation can influence the level of consciousness in comatose patients. The aim of this study was to examine the effects of foot tactile stimulation on level of consciousness and physiological parameters in comatose patients admitted to the intensive care unit. 

This randomized clinical trial was conducted on 60 patients with coma who were hospitalized in the intensive care units of Shohadaye Tajrish Hospital in Tehran in 2019. The subjects were assigned in two groups of experimental and control, by using randomize blocked allocation. In experimental group, feet, ankles and soles of patients were touched for 10 minutes twice a day for three days (morning and evening). The level of consciousness was recorded using Glasgow Coma Scale. The level of consciousness and physiological parameters (blood pressure, respiratory rate, and pulse rate) were recorded from the 1st to 3th day of admission (before, immediately, 30 min after intervention). Data were analyzed using descriptive and inferential statistics and analyzed using SPSS- v 20.

According to the results, foot tactile stimulation significantly decreased physiological parameters in the experimental group each therapeutic session (P < 0.05). Moreover, Multivariate analysis revealed a significant difference between experimental and control groups in level of consciousness at all-time points (P<0.05).

The foot tactile stimulation could increase the level of consciousness and stability of physiological parameters in comatose patients. it should be recommended for increasing level of consciousness in comatose patients., if it is administered frequently for long term

Sturge-Weber syndrome (SWS) is a very rare congenital disorder that is manifested by facial capillary malformation (port wine stain) which may be associated with capillary – venous malformations affecting many parts such as the brain, eyes facial skin and mucosa and also airways. In this report we present an unusual 28 years old female case of SWS that presented with signs and symptoms of sudden increased intra ocular pressure (exacerbation of glaucoma) and manifestations of facial and airway involvement. A discussion about anesthetic and airway management of such patient follow the case presentation.

Dexmedetomidine is a potent and highly specific α2-adrenoreceptor agonist that induces sedative and analgesic effects over a short-term period. As a result of these benefits, dexmedetomidine may be a better alternative than other available drugs for keeping the patient’s cognition state in an acceptable condition after outpatient ophthalmic surgeries..
This randomized study was conducted to compare the sedative effects of dexmedetomidine and remifentanil on the cognitive state of patients who have undergone cataract surgery..
Patients and A total of 100 patients who were candidates for cataract surgery under local anesthesia received either dexmedetomidine (50 patients; D group) or remifentanil (50 patients; R group) in a double-blind, randomized study. The baseline cardiovascular status and mini mental state examination (MMSE) score for each patient were recorded. As a loading dose, dexmedetomidine (0.5 µg/kg) and remifentanil (0.1 µg/kg) were infused at 10 minutes and 5 minutes before topical anesthesia, respectively. Subsequently, the maintenance dose was administered at 0.2 µg/kg/hour and 0.05 µg/kg/minutes in the D and R groups, respectively. The surgical procedure was begun when the bispectral index (BIS) reached 70 - 80. MMSE test was done at a postanesthetic care unit (PACU) 120 minutes after the discontinuation of the drug..
There was no statistically significant difference between the MMSE scores of the two groups before surgery (P = 0.6), but the MMSE test conducted at the PACU revealed significantly better cognitive outcomes in the D group than in the R group in patients younger and older than 65 years (P = 0.03 and P = 0.0001, respectively)..
This study revealed that dexmedetomidine may be a suitable agent for sedation in cataract surgery because it results in a more favorable postoperative cognitive status than remifentanil. Likewise, dexmedetomidine had no significant adverse effects on cardiovascular or respiratory systems..

Sulfur Mustard (SM) is an alkylating agent that has been used as a chemical warfare gas during World War II and by Iraqi army in the Iran-Iraq conflict between 1983 and 1988. SM can cause serious organ damages especially ocular, neurologic, coetaneous, bone marrow and pulmonary complications. On the other hand dexmedetomidine is a α2 agonist with sedative and analgesic effect with a short duration half-life. Considering these benefits, usage of dexmedetomidine would be a good choice in ophthalmic outpatient’s surgeries to keep the cognition state in an acceptable condition comparing with other available drugs especially in patients with concurrent chemical burn injury.
After informed consent, patients with inclusion criteria were randomly divided in to two groups: dexmedetomidine (group D, n=50) and Remifentanil (group R, n=50). Cardiovascular signs, Mini Mental State Examination (MMSE) score were recorded as baseline. Patients received respectively dexmedetomidine by infusion with a loading dose of 0.5µg/kg (during 10 minutes) in group D. The maintenance dose of 0.2µg/kg/hr was then started. Loading dose of remifentanil was given by 0.1µg/kg (during 10 minutes); 5 minutes before local anesthesia in group R and maintenance dose of 0.05µg/kg/min was then started. In Post Anesthesia Care Unit (PACU) after 120 minutes of stopping drug infusions n-back and MMSE tests were performed.
The MMSE score had no statistically difference between two groups before surgery (in subgroup age>=65 P= 0.5, and in subgroup age=65 and age=65 P The result of n-back and MMSE revealed that the cognition state improves better in patients receiving dexmedetomidine comparing with those of remifentanil. Dexmedetomidine is safe for protecting the cognition state especially in patients with borderline respiratory reserve due to chemical burn injury.

Mucormycosis is a serious fungal infection caused by the filamentous fungi of the mucorales order of the class of zygomycetes. Mucormycosis is classically defined as an opportunistic fatal infection. In this report we explain a 49 years old woman with palato-orbital tract as a sequel of rhino cerebral mucormycosis and end stage renal disease candidate for kidney transplantation. Difficulties in airway management as well as inducing and maintaining anesthesia was our main concern.

Malnutrition is very common among chronically hospitalized patients, especially those in the intensive care unit (ICU). Identifying the patients at risk and providing suitable nutritional support can prevent and/or overcome malnutrition in them. Total parenteral nutrition (TPN) and partial parenteral nutrition (PPN) are two common routes to deliver nutrition to hospitalized patients. We conducted a multicenter, prospective double blind randomized controlled trial to evaluate the benefits and compare their adverse effects of each method.
97 patients were enrolled and divided into two groups based on the inclusion criteria. Serum protein, serum albumin, serum transferrin, and total lymphocyte count were measured on days 7 and 14.
We did not find any statistically significant differences in clinical status or laboratory values between the two groups but there were significant improvements in measured lab values between days 7 and 14 (p This study shows that both TPN and PPN can be used safely in chronic ICU patients to provide nutritional support and prevent catabolic state among chronic critically ill patients. We need to develop precise selection criteria in order to choose the patients who would benefit the most from TPN and PPN. In addition, appropriate laboratory markers are needed to monitor the metabolic requirements of the patients and assess their progress.

Chronic low back pain is among a wide spread musculoskeletal conditions that is related to disability with high economy cost. There are several treatment modalities for controlling chronic low back pain (CLBP), among them high intensity laser therapy (HILT) and epidural blocks (EB) use more commonly. This study aimed to evaluate the benefits and hazards of each of these two methods. We designed a randomized controlled double blind study during 24 months.101 patients divided in 2 groups (52 in EB and 49 in HILT group). Pain intensity was assessed by using faces pain scales (FPS) and LINKERT questionarie's before procedure and during one, four, 12, and 24 weeks after beginning the procedures. There were no differences between two groups in FPS lumber tenderness, straight leg rising test (SLRT), paresthesia, deep tendon reflex (DTR), and imaging changes. Motor problems seem was less in HILT group comparing EB. This study showed both EB and HILT approaches can control the pain intensity and motor activities in CLBP patients. Future studies will clarify the precise importance of each these methods.

Familial Dysautonomia (FD) is a rare hereditary syndrome which is an autosomal recessive trait that typically affects Jewish children. Important signs and symptoms of the disorder include; diminished pain perception, absence of overflow tears, hypotonia, fainting cardiac arrhythmias and autonomic crisis.Cases Report: In this article we reported 3 cases of FD syndrome which had presented for surgical operation followed by a discussion about general care of these patients as well as Anesthesia considerations.

In patients with myasthenia gravis, anesthesia for tracheal resection and reconstruction surgery is a serious challenge; due to post-surgical considerable risk for mechanical ventilatory support. Postoperative positive pressure ventilation and an endotracheal cuff pressure may cause anastomosis dehiscence after surgery.In this case report, we discuss the usage of a non-relaxant, total intravenous anesthesia technique to decrease the risk of post-surgical ventilatory support, in a case of tracheal resection surgery of a myasthenia gravis patient with post intubation subglottic stenosis.

We report our initial experience with a heart-lung transplant operation performed on a 12- year- old girl with Eisenmenger syndrome at Masih Daneshvari Teaching Hospital in Tehran, in 2009. We also outline the operative indications, anesthetic management, and postoperative complications of heart-lung transplantation. We hope that this issue on transplantation may provide an encouraging prospect for patients with end-stage cardiopulmonary disorders in Iran.

Laryngoscopy and intubation incur hemodynamic changes like increase in heart rate, arterial blood pressure, pulmonary artery pressure, wedge capillary pressure and arrhythmias. Anesthesiologists are continually in search of ways to alleviate such complications. Several medicinal methods have been suggested that serve the purpose including the administration of intravenous magnesium sulfate to minimize these unfavorable responses. This study compares the effects of intravenous administration of lidocaine and magnesium sulfate on unwanted hemodynamic responses following laryngoscopy and intubation in elective surgery candidates. This randomized double-blind clinical trial was conducted on 60 ASA-I and ASA-II candidates who received 60 mg/kg (based on Lean Body Mass) magnesium sulfate or lidocaine randomly before intubation. Values of systolic and diastolic blood pressures, mean arterial pressure, and heart rate were recorded for both groups during the 5 minutes following administration, and compared with baseline values. In both groups, systolic blood pressure increased compared to the baseline value. However, there was a significant difference between the two groups as this increase occurred within the first 3 minutes in the lidocaine group, while within the first minute in the magnesium sulfate group. The increase in diastolic blood pressure was not significant. But there was a significant difference in the mean arterial pressure increase between the two groups since in the magnesium sulfate group this increase occurred in the first minute whereas in the lidocaine group it occurred during the first two minutes. There was no significant difference in the heart rates after intubation between the two groups. Magnesium sulfate is more effective than lidocaine in controlling hemodynamics, although it may increase the heart rate.

Pulmonary alveolar proteinosis (PAP) is a rare disease in children, characterized by intra-alveolar accumulation of large amounts of surfactant proteins, which severely reduce gas exchange. Whole lung lavage (WLL) is the preferred technique for the treatment of severe PAP. This report presents nine pediatric cases with advanced PAP who underwent WLL under general anesthesia during a 9 year period. One patient was treated with multiple unilateral WLL without employing cardiopulmonary bypass (CPB) and eight cases were treated by simultaneous lavage of both lungs using partial CPB. Our experience suggested that partial CPB was useful to support oxygenation during WLL in small children with severe PAP in whom lung separation and selective lavaging of each lung were impracticable.

To study the simultaneous effects of prone position and anesthesia on intraocular pressure (IOP) and the time impact on post anesthesia visual loss development in percutaneous nephrolithotomy (PCNL). Twenty patients who were candidates for PCNL were recruited in this study. Intraocular pressure was measured in five occasions:1. Base line; 2. Ten minutes after anesthesia (Supine-I); 3. Ten minutes after position change to prone (Prone-I); 4. At the end of the operation (Prone-II); and 5. Ten minutes after position change to supine (Supine-II). The data were analyzed by SPSS software using repeated measures ANOVA and paired t test. The participants consisted of 17 (85%) men and 3 (15%) women, with the mean age of 44 years. The duration of the prone position was 79.75 ± 22.73 minutes. Intraocular pressure changed significantly in five positions (P =. 000). It was lower in supine-I than baseline, higher in prone-I than base line and supine-I, lower in supine-II than prone-II, and highest in prone-II (P =. 000). There was a linear relationship between IOP and prone position duration (r = 0.67; P =. 001). Intraocular pressure dropped significantly after anesthesia and increased in prone position. There was a linear relationship between IOP rise and the prone position duration, doubled within two hours. Therefore, in PCNL carried out in prone position, it is recommended to observe safety measures and necessary precautions for IOP rise and possible post anesthesia visual loss, particularly in glaucoma

Background and The incidence of postanesthesia shivering varies between 5 and 65 % and patients report it as one of the leading cause of discomfort after operation. Ït may also induce a variety of physiological consequences such as increased oxygen consumption and cardiac output. This study was performed to find out the incidence of postanesthesia shivering in women and to report the influence of several clinical variables on its incidence. This prospective observational study was carried out on 448 female patients who underwent gynecologic operations under general، regional or sedation anesthesia techniques at Tehran Javaheri hospital over a period of 7 months in 2005. The incidence of postanesthesia shivering was assessed in these patients. Âlso، several clinical variables including patients’ demographics، surgical and anesthetic data as well as preoperative and postoperative core temperatures were recorded. Ôf 448 women، 83 (18. 5%) experienced shivering. The minor versus major and moderate operations، as well as the conscious sedation versus general and spinal anesthesia techniques significantly reduced the incidence of postanesthesia shivering. While the use of halothane and N2Ô for maintanance of general anesthesia، and intravenous administration of atropine and prostigmine to antagonize the muscle relaxants، as well as the intraoperative administration of larger volumes of intravenous crystalloid solutions were associated with increased postanesthesia shivering. Çonclusion: The use of halothane for maintenance of general anesthesia، the intraoperative administration of larger crystalloid volumes and applying spinal anesthesia technique، increase the risk of postanesthesia shivering، while no correlation was found between hypothermia and the occurrence of shivering.