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فهرست مطالب نویسنده:

bita malekianzadeh

  • Alireza Ebrahimsoltani, Mehrdad Goudarzi, Anahid Maleki, Bita Malekianzadeh
    Background

    Preoperative anxiety in children is a common problem that can affect the anesthesia and postoperative period. Numerous methods, mainly pharmacological ones, have been used for controlling preoperative stress. Acupressure is a simple, noninvasive, and cost-effective method that has been used as a perioperative medicine for controlling pain or preventing postoperative nausea and vomiting. The present study aimed to comparatively investigate the effect of acupressure and oral midazolam on preoperative anxiety control.

    Methods

    76 patients were randomly included in the study before surgery. Whereas in one group, 0.5 mg/kg oral midazolam was prescribed 15 minutes before the induction, in another group, acupressure of EXHN-3 point was applied for 15 minutes. In both groups, the patients’ separation anxiety level, Ramsay score, recovery length, and RN satisfaction factor were recorded and compared.

    Results

    Children aged 1–7 years received either oral midazolam or acupressure. Although the children in the midazolam group had lower rates of preoperative anxiety and showed easier separation from their parents, the difference was not statistically significant P= (0.076). Ramsay sedation scale, was compared in the two groups. The overall difference was not statistically significant. The satisfaction of the PACU nurse was recorded using a 4-point scale. The two groups were statistically comparable in this regard (P=0.155). The only variable with a significant difference between the two groups was the mean recovery time, which was significantly shorter in acupressure group (P<0.001).

    Conclusion

    Acupressure can reduce preoperative anxiety in children; however, this effect is less than the effect of oral midazolam.

    Keywords: Preoperative Anxiety, Midazolam, Children, Ying Tang Point
  • Nima Nazari, Mehrdad Goudarzi, Ashkan Taghizadeh, Hojatollah Raji, Bita Malekianzadeh
    Background

    Herniorrhaphy is the most common inguinal surgery in children. Several methods such as caudal block, ilioinguinal iliohypogastric block, and wound infiltration have been studied for postoperative pain management in these patients. Caudal block is common in pediatrics. However, ilioinguinal iliohypogastric block is effective and less invasive. Previous studies have shown different comparative results regarding these blocks. This study compares the analgesic effect of caudal and bilateral ilioinguinal iliohypogastric block with ropivacaine in children.

    Methods

    This study is a randomized double-blind clinical trial. A total number of 66 patients aged between 1-7 years that volunteered for bilateral inguinal hernia repair were randomly assigned to two groups. After general anesthesia, caudal block with 1cc/kg ropivacaine 0.2% was performed for 33 patients and sonography-guided ilioinguinal iliohypogastric block with 0.1 cc/kg ropivacaine for each side was considered for another group. Hemodynamic parameters (systolic blood pressure, diastolic blood pressure, and heart rate) during anesthesia, pain score (CHEOPS), delirium score (PAED), nurses’ satisfaction score (RN), need for additional narcotic, recovery time, and complications were compared in these two groups.

    Results

    There was no statistically significant difference between the two groups in terms of hemodynamic parameters during the anesthesia process. Furthermore, the two groups had no statistically significant difference in CHEOPS score (6.27 in ilioinguinal block and 5.70 in caudal block, P=0.061), PAED score (5.64 vs 5.30, P=0.144), and RN satisfaction score. However, the need for narcotics, mean recovery time, and block complications were comparable in two groups.

    Conclusion

    Caudal block and ilioinguinal block are equally effective for post herniorrhaphy pain and emergence agitation management in pediatrics. Additionally, no differences were observed in complications. It is recommended that the study be performed with a larger sample size.

    Keywords: Caudal Block, Ilioinguinal Block, Children, Herniorrhaphy
  • Bita Malekianzadeh, Saghar Samimi Sadeh, Babak Eslami, Abbas Ostadalipour, Parastou Ariana, Nima Nazari

    With the increasing number of pediatric surgeries and the transfer of caregiving roles to parents, appropriate preparation and reduction of their stress levels for proper care of children before and after surgery is essential. If parental anxiety can be reduced through various methods, not only can it improve parental performance and their comfort, but it can also prevent the impact of anxiety on the child. Therefore, we aimed to investigate the effect of educational film presentation on the anxiety level of mothers visiting the obstetric anesthesia clinic at the Children's Medical Center in 2020. This study was a randomized double-blind controlled trial conducted as an intervention. Sampling was done randomly, and the study population consisted of two groups of 38 individuals, whose children were candidates for MRI. The intervention group watched the educational film, while the second group served as the control group. Subsequently, their anxiety levels were assessed and compared using the Beck Anxiety Inventory. The data were entered into SPSS Ver. 21 software and analyzed accordingly. The mean age of mothers in this study was 33.41 years with a standard deviation of 7 years. The mean age of children was 3.79 years with a standard deviation of 3.4 years. Among the children, 30 were girls (39.5%) and 46 were boys (60.5%). The mean age of girls was 4.35 years with a standard deviation of 4.16 years, while the mean age of boys was 3.433 years with a standard deviation of 2.787 years. Overall, 39 participants (50.6%) watched the educational film, while 38 participants (49.4%) were in the control group. The mean score of anxiety level according to the Beck Anxiety Inventory (BAI) was 9.47 with a standard deviation of 9.77. The level of anxiety was significantly higher in the intervention group who watched the educational film compared to the control group (P=0.012). The results of the present study indicated that parental anxiety increased after watching the educational video on anesthesia methods. It is recommended that alternative strategies be considered for reducing parental anxiety in future studies.

    Keywords: Educational Film Presentation, Maternal Anxiety, Pediatric Anesthesia
  • Ali Dabbagh *, Seyyedeh Narjes Ahmadizadeh, Faranak Behnaz, Kamal Fani, Mahshid Ghasemi, Reza Goharani, Alireza Jahangirifard, Bita Malekianzadeh, Nilofar Massoudi, Elham Memary, Mohammadreza Moshari, Sassan Sabouri, Sara Salaarian, Parissa Sezari
    Background

    Faculty Development Programs (FDPs) aim to improve the academic careers of faculty members. This study was designed to assess the attitudes of faculty members and the impact of FDP on their academic improvement.

    Methods

    12 faculty members took part in the research from 2016 to 2019. Using a Delphi method, an open secure questionnaire was provided to 12 junior faculty members in the Department of Anesthesia, Critical Care (DACC), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran. Then, the keywords of the latter were analyzed, leading to a 32-item closed-answer questionnaire, filled out by the same participants. Also, the impact of the study was assessed using bibliometric improvement indices.

    Results

    Both the response rate and participation rate were 100%. Approximately all the participants considered FDP an advantageous and promising academic program. 65 percent of the participants had academic improvement, from “Assistant Professor” to “Associate Professor” rank. Besides, the cumulative number of citations to the participants had a 16.2 times improvement. Both latter results were significantly higher than the mean improvement of the cohort faculty members in the DACC, SBMU.

    Conclusion

    Faculty members of DACC, SBMU had positive attitudes towards FDP and described it as “a well-designed multilateral academic teamwork, thriving ethical, educational, managerial and research-related capacities”. Also, objective improvement in some academic indices was observed. In many academic environments including developing countries, FDPs are effective scientific investment methods.

    Keywords: Anesthesia, Bibliometrics, Critical Care, Delphi Technique, Developing Countries, Formycin Diphosphate, Humans, Iran, Optimism, Questionnaires, Surveys
  • Afsaneh Sadeghi Sadeghi, Bita Malekianzadeh, Narges Ahmadizadeh, Alireza Mahdavi *
    BackgroundBleeding is one of the most common complications of craniosynostosis surgery, which its appropriate management is associated with better post-operative outcomes. The aim of this retrospective study was to evaluate the visual estimated blood loss in intraoperative management of infants with craniosynostosis surgery.
    Materials and MethodsThis retrospective study was performed on 200 patients who underwent craniocinostosis surgery and hospitalized in intensive care unit (ICU) at Mofid Hospital, Tehran, Iran, from July 2015 to June 2017. Data collecting was done using a self-made checklist and from patient's medical record. Required data include age, gender, method of anesthesia, and arterial blood gas (ABG), hemoglobin (Hb), and platelet (Plt) changes during surgery, volume of administered blood and fluid were recorded and evaluated. Data analysis using SPSS software (version 22.0).
    ResultsAmong the patients, 59% (n=118) were boys, the mean age of patients was 13.3 ± 13.52 months. Anesthesia technics were total intravenous anesthesia (TIVA) (15.5%, n= 31), and inhalation or mixed (84.5%, n=169). Patients received 992.02 ± 468 ml fluid and 205.86± 100 ml blood, before surgery.There was no significant difference between preoperative Hb and first Hb in pediatric intensive care unit (PICU) (p=0.12). However, preoperative and first Plt in PICU were different (p=0.000). Also, last Hb in ABG (10.5±1.90), and the first Hb in PICU showed no significant difference (r=0.088, p=0.219).
    ConclusionAccording the results, visual assessment and correction of blood loss with hemoglobin measurement and by experienced anesthesiologist was a reliable and safe method in patients with craniosynostosis surgery and feasible in every operating room.
    Keywords: Blood loss, Craniosynostosis, Hemoglobin, Surgical
  • Alireza Mahdavi, Bita Malekianzadeh, Afsaneh Sadeghi Sadeghi *
    Background
    Intracranial pressure (ICP) control is one of the anesthesiologist challenges in craniosynostosis repair surgery, especially in multiple sutures involvement. The aim of this study was comparing the effect of two anesthesia methods including inhalation with hyperventilation and total intravenous anesthesia (TIVA) on ICP control and surgeon satisfaction in pediatrics with craniosynostosis surgery.
    Materials And Methods
    In this randomized clinical trial study, 40 pediatric patients with American society of anesthesiologists (ASA) І-ІІ, 6 months to 2 years old were included. All of the patients were scheduled for craniosynostosis repair at Mofid Children Hospital, Tehran, Iran, in May 2016 to January 2017. The patients were randomly divided into two groups. In hyperventilation group, patients received isoflurane for maintenance of anesthesia and hyperventilation (Paco2=25-30 mmHg) established during surgery. The total intravenous anesthesia (TIVA) group received propofol infusion for anesthesia maintenance and Paco2 was maintained 35 mmHg. Intra cranial pressure (ICP) was assessed by surgeon using a 4-point scale. Hemodynamic (mean arterial pressure and heart rate) changes and blood loss were compared between hyperventilation and TIVA groups.
    Results
    The mean age of patients in hyperventilation group was 10.9±3.25 months and in TIVA group was 8.7 ± 2063 months (p=0.11). Fourteen (70%) patients in hyperventilation group and 6 (30%) patients in TIVA group were male (p=0.74). A significant difference was seen in ICP control and surgical condition between hyperventilation and TIVA groups (p=0.032). ICP was controlled better in hyperventilation group. There was no difference in hemodynamic parameters and blood loss between hyperventilation and TIVA groups (p>0.05).
    Conclusion
    This study showed inhalation anesthesia with hyperventilation was more effective than TIVA on ICP control in craniosynostosis surgery.
    Keywords: Craniosynostosis, Intracranial pressure, Hyperventilation, Total intravenous anesthesia
  • Alireza Mahdavi, Seyed Sajad Razavi, Bita Malekianzadeh, Afsaneh Sadeghi *
    Background
    The present study was performed with the aim of comparing the peak inspiratory pressure and lung dynamic compliance between a classic laryngeal mask airway (LMA) and an endotracheal tube in children under mechanical ventilation.
    Materials And Methods
    In this study, 30 children aged 1 to 7 years with a physical condition of ASA I–II who were admitted for operations to repair inguinal hernias, hydroceles, or hypospadias were randomly enrolled. After induction of anesthesia, the appropriate laryngeal mask was used for each patient and they were placed under pressure-controlled mechanical ventilation. The peak inspiratory pressure was adjusted and recorded to obtain an appropriate tidal volume, then the laryngeal mask was removed and the appropriate size uncuffed endotracheal tube was inserted and the patient was placed again under controlled mechanical ventilation. The required settings were adjusted and peak inspiratory pressure and tidal volume were measured and recorded by the ventilator. Dynamic compliance was also calculated in both cases using the appropriate formula.
    Results
    The results showed that peak inspiratory pressure (PIP) with the use of LMA in children under mechanical ventilation was less than the PIP with the use of an endotracheal tube (p0.05). Also, the pulmonary dynamic compliance with a laryngeal mask was greater than the use of an endotracheal tube (p0.05).
    Conclusion
    A laryngeal mask airway due to its low airway resistance and high dynamic compliance is an acceptable alternative to a tracheal tube during mechanical ventilation and it can be a good alternative to the endotracheal tube, especially during mechanical ventilation of children, in whom avoidance of barotrauma is desirable.
    Keywords: Dynamic compliance, Inspiratory pressure, Endotracheal tube, Classical laryngeal mask airway
  • Pouran Hajian, Bita Malekianzadeh, Maryam Davoudi
    Background
    Several methods are used for the prevention or decreasing the incidence of spinal anesthesia hemodynamic complications. Ondansetron is a 5HT3 receptor antagonist with known efficacy on preventing nausea and vomiting and probably on intrathecal opioid-induced pruritus. The present study aims to evaluate the effects of intravenous Ondansetron on the attenuation of blood pressure and heart rate, by 5HT3 blocking in vagal nerve endings and effect on Bezold Jarish reflex.
    Material and
    Methods
    One hundred and two candidates for elective cesarean section were randomized into 2 groups of 51 cases, the Ondansetron group received 4mg Ondansetron intravenously before performing spinal anesthesia, and placebo group received 2cc sterile water. Hypotension was defined: Systolic blood pressure less than 100 MmHg or fall more than 20% from primary BP which was treated by administration of Ephedrine in case of any. In both groups, Ondansetron effect was studied on hypotension occurrence, bradycardia, consumed Ephedrine amount, pruritus, nausea and vomiting.
    Results
    There were no statistically significant differences in systolic/diastolic blood pressure, Mean Arterial Pressure, heart rate and pruritus in both groups (P=0.081).Nausea and vomiting in the first 10 minutes after spinal anesthesia were lesser in Ondansetron group (P= 0.001). Mean consumed Ephedrine was significantly lesser in Ondansetron group (5.8 mg in Ondansetron and 10.7 mg in placebo group, P=0.009).
    Conclusion
    Ondansetron given intravenously with antiemetic dose (4 mg) decreases mean consumed Ephedrine and nausea and vomiting after spinal anesthesia, but does not have an influence on blood pressure, heart rate and pruritus.
    Keywords: Anesthesia, Spinal, Cesarean Section, Hemodynamics, Ondansetron
  • مریم غلامی مهرآبادی، شراره خسروی *، کورش رضایی، بیتا ملکیان زاده، منصور قربانپور، اعظم مسلمی، حسین سرمدیان
    زمینه و هدف
    پنومونی وابسته به ونتیلاتور جز شایع ترین عفونت های بیمارستانی در بخش مراقبت های ویژه است. یکی از روش های مراقبتی که می تواند بر کاهش پنومونی وابسته به ونتیلاتور موثر باشد، دهانشویه است. پژوهش حاضر با هدف تعیین تاثیر دهانشویه اکیناسه بر شیوع پنومونی وابسته به ونتیلاتور در بیماران بخش های مراقبت ویژه صورت گرفت.
    مواد و روش ها
    این مطالعه یک کارآزمایی بالینی است که جامعه آماری آن را بیماران دارای لوله تراشه بستری در بخش های مراقبت ویژه بیمارستان های آموزشی شهر اراک در سال 1393 تشکیل دادند. 70 بیمار به روش هدفمند وارد مطالعه شده و به صورت تصادفی در دو گروه مداخله و کنترل قرار گرفتند. گروه مداخله دو بار در روز دهانشویه اکیناسه و گروه کنترل دوبار در روز دهانشویه با نرمال سالین دریافت کردند. میزان بروز پنومونی با استفاده از معیار امتیاز بالینی عفونت ریوی (CPIS) قبل از مداخله و روز پنجم مداخله مورد بررسی قرار گرفت. اطلاعات با استفاده از آزمون های آماری کای دو، تی مستقل و آزمون دقیق فیشر تحت نرم افزار آماری 16 SPSS تجزیه و تحلیل شدند.
    یافته ها
    شیوع پنومونی وابسته به ونتیلاتور در گروه نرمال سالین 60 درصد و در گروه اکیناسه 4/ 51درصد بود. آزمون آماری کای دو تفاوت معنی داری را بین دو گروه نشان نداد.
    نتیجه گیری
    بر اساس یافته ها اکیناسه تا حدودی می تواند میزان بروز پنومونی در بیماران وابسته به ونتیلاتور را کاهش دهد، اما انجام تحقیقات بیشتری در این زمینه ضروری است.
    کلید واژگان: مراقبت ویژه، دهانشویه، اکیناسه، نرمال سالین، پنومونی وابسته به ونتیلاتور
    Maryam Gholami Mehrabadi, Sharareh Khosravi *, Koorosh Rezaie, Bita Malekianzadeh, Mansoor Ghorbanpoor, Azam Moslemi, Hossein Sarmadian
    Background And Objective
    Ventilator associated pneumonia (VAP) is one of the most prevalent hospital infections in intensive care units. Mouthwash is one of the caring procedures which can be effective in decreasing the rate of VAP. The present study was conducted to determine the effect of Echinacea mouthwash on prevalence of ventilator associated pneumonia in intensive care units.
    Materials And Method
    In this clinical trial study, population was the intubated patients in intensive care units of educational hospitals in Arak in 2014. 70 patients were selected purposively and then were randomly allocated into two intervention and control groups, In intervention group, mouthwash with Echinacea and in control group with normal saline was done twice daily. The rate of VAP was assessed by Clinical Pulmonary Infection Scale (CPIS), before and on the fifth day of intervention. Data were analyzed by Chi square, independent T-test and fisher’s exact test through using SPSS16.
    Results
    prevalence of Ventilator associated pneumonia was 60 percent in normal saline and 51.4 percent in Echinacea group; buth the Chi square test didn’t show significant difference between two groups.
    Conclusion
    According to results, Echinacea can relatively decrease the rate of VAP in ventilated patients, but more investigations in this area are essential.
    Keywords: Intensive care, Mouthwash, Echinacea, Normal saline Ventilator, Associated, Pneumonia
  • بیتا ملکیان زاده*، پوران حاجیان، ناهید منوچهریان، صدیقه خزایی
    زمینه و هدف
    بی حسی نخاعی یک روش موثر برای فراهم آوردن بی حسی حین عمل و یک جایگزین مناسب برای بی هوشی عمومی بیماران سزارینی است. علی رغم مزیت هایی آن، دارای اثرات جانبی مثل عوارض قلبی، عروقی و غیره است. اندانسترون یک آنتاگونیست گیرنده 5HT3 با اثرات شناخته شده روی پیش گیری از تهوع و استفراغ و ممکن است با بلوک کردن گیرنده 5HT3 در انتهای عصبی واگ و اثر بر رفلکس بزولد جاریش (BJR)، باعث پیش گیری از افت فشار خون و ضربان قلب شود.
    مواد و روش ها
    در این مطالعه کارآزمایی بالینی، 102 زن باردار سالم کاندید سزارین الکتیو مراجعه کننده به بیمارستان فاطمیه همدان طی سه ماه در سال 1390 وارد مطالعه شدند. به طور تصادفی در 2 گروه اندانسترون (4 میلی گرم داخل وریدی) و گروه پلاسبو (2 میلی لیتر آب مقطر) قرار گرفتند. فشار خون و ضربان قلب بلافاصله قبل و پس از انجام بی حسی نخاعی اندازه گیری و ثبت شدند در صورت افت فشار خون 10-5 میلی گرم افدرین تجویز می شد. خارش و تهوع هر 10 دقیقه طی عمل با مشاهده و پرسش از بیمار ثبت شدند.
    یافته ها
    تفاوت واضحی در میزان فشار خون وخارش در دو گروه وجود نداشت. در دو گروه مورد مطالعه از نظر تهوع، استفراغ و میزان مصرف افدرین اختلاف آماری معنی دار مشاهده شد: (به ترتیب p=0.001 و p=0.009).
    نتیجه گیری
    اندانسترون وریدی با دوز ضد تهوع (4 میلی گرم) میزان متوسط افدرین مصرفی و بروز تهوع استفراغ پس از بی حسی نخاعی را کاهش داد ولی روی فشار خون و ضربان قلب و خارش تاثیر نداشت.
    کلید واژگان: بی حسی نخاعی، اندانسترون، افت فشار خون، افت ضربان قلب
    Bita Malekianzadeh *, Puran Hajian, Nahid Manuchehrian, Sidegheh Khazaei
    Background
    Spinal anesthesia is an efficient method of providing intra operative analgesia and a safe alternative to general analgesia in many cesarean patients. Despite its advantages, SA is not free from adverse effects, which include unwanted cardiovascular events, in most cases: hypotension and bradycardia. Ondansetron is a 5HT3 receptor antagonist, with known efficacy on preventing nausea and vomiting. Maybe ondansetron given intravenously attenuates the fall of blood pressure and heart rate, by 5HT3 blocking in vagal nerve endings and effect on BJR.(Bezold jarish Reflex).
    Materials And Methods
    In this clinical trial 102 healthy pregnant women that were candidate for elective cesarean in hamedan fatemieh hospital during 3 months in 1390, studied. They were randomized into 2 groups: the ondansetron group, n= (51) received (4miligram) ondansetron intravenously before performing spinal anesthesia, and placebo group n= (51): received 2cc sterile water before spinal anesthesia. Spinal anesthesia was performed with hyperbaric bupivacaine (0/5Percent) 10 mg and sufentanil (5 µg(BP and HR were measured and recorded before and after anesthesia immediately. If hypotension happened, ephedrine 5- 10mg injected. Itching and nausea recorded every 10 min during operation by observation and question.
    Results
    There were no significant differences in SBP, DBP, MAP, HR and itching in both groups. Nausea and vomiting, and mean consumed ephedrine was siginificantly different in both groups.(p=0.001, p=0.009).
    Conclusion
    Ondansetron given intravenously with antiemetic dose (4miligram), decreases mean consumed ephedrine and nausea and vomiting after spinal anesthesia, but doesnt have an influence on BP, HP and pruritus
    Keywords: Spinal anesthesia, Ondansetron, Hypotension, Bradycardia
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