mahtab poor zamany nejat kermany

Controlling the respiratory complications of anesthesia in children is one of the most challenging situations. The present study aimed to compare intravenous and inhalation anesthesia in respiratory adverse events in children under 7 with upper respiratory tract infection (URTI). All children with URTI referring to Labbafinejad hospital in Tehran for emergency surgery were randomly divided into two groups. The first group received Total Intra-Venous Anesthesia (TIVA) inducer and maintenance, and the second group received inhalation (Sevoflurane). The two groups were compared in terms of respiratory events at different times Laryngeal Mask Airway (LMA) implantation time, interoperation, LMA removal, and recovery). There were significant differences between the groups (p-value < 0.05) (1) before induction in terms of using respiratory sub-muscles, (2) during LMA implantation in terms of oxygen saturation percentage, stridor, cyanosis, laryngospasm, bronchospasm, and the presence of breath hold, (3) during LMA removal in terms of oxygen saturation percentage, cyanosis, laryngospasm, and bronchospasm, (4) after LMA removal in terms of stridor, cyanosis, the use of respiratory sub-muscles, persistent cough, and breath hold, and (5) in the Post-Anesthesia Care Unit (PACU) in terms of stridor and persistent cough. in children with URTI, who have undergone emergency surgery, due to less PRAE in the intravenous method with Propofol, the use of TIVA method can reduce the risk of related adverse events.

Percutaneous nephrolithotomy (PCNL) is the preferred surgical treatment in many cases of kidney stones which is performed in different positions such as prone, lateral, and supine. This study was designed to evaluate whether patient position (lateral versus . prone) has an effect on the need for analgesia and onset of pain after surgery.

Patient with confirmed kidney stones (size ? 2 cm) who were candidates for PCNL were enrolled in this study. The required biochemical analyses were performed preoperatively. All patients  underwent spinal anesthesia by the same anesthesiologists and then were randomly divided into two separate groups as lateral (L) and prone (P) positions. The operations’ start and end time, required time for proper access into target calyces, additional need for analgesic or cardiac drugs, duration of analgesia, and onset of pain after PCNL were carefully recorded and then compared between the two groups.

In total, 51 patients were evaluated of whom 39 were men and 12 were women. Mean duration of analgesia after PCNL surgery in P group (173 ± 8 min) was significantly longer than in L group (147±12 min) (P = .001). Furthermore, the amount of ephedrine usage in L group (3.6 ± 1.5mg) was significantly lower than in the P group (16.4 ± 12mg), suggesting more hemodynamic variations in the P group during the operation.

Our randomized control trial study shows that choosing the optimal position in the PCNL technique depends on  patient's condition. If hemodynamic control is of matter to the anesthesiologist, then lateral position is more appropriate. However, if control of pain and longer time of analgesia are important,  prone position may be preferred.

Sturge-Weber syndrome (SWS) is a neurocutaneous disorder, characterized by leptomeningeal angiomas involving the oral cavity, trachea, larynx, and face. Herein, we present a case of vitrectomy in a seven-year-old boy with SWS. The patient showed hemangioma on the left side of his face, as well as mental retardation and epilepsy. Preoperative examination revealed no apparent hemangioma in the oral cavity, pharynx, larynx, or trachea. However, he was predicted to have difficult airway intubation, as the oral cavity was smaller than the normal size. The minimum Mallampati score was 3-4 due to macroglossia. First, we applied awake intubation, but he failed to follow the commands. We proceeded to general anesthesia with propofol and did not use any muscle relaxants to maintain spontaneous breathing. A laryngeal mask airway was inserted to minimize any harm to possible oral angiomas. The patient was hemodynamically stable and extubated without any complications, such as bleeding or respiratory problems.

Oculocardiac reflex (OCR) is a life threatening, possible complication of corrective strabismus surgery and is more common among the pediatric patients. Sevoflurane and Propofol are the most commonly used agents in pediatric surgery. This study aimed to compare the effect of these two agents on oculocardiac reflex during corrective strabismus surgery in pediatrics patients. A total of 89 children were divided in two groups and no significant demographic data difference was between the two groups. Group 1 (n=45) received sevoflurane 6-8% as induction agent followed by 2-3% for maintenance, group 2 (n=44) was injected with propofol 3mg/kg as induction agent followed by 200µg/kg/min infusion as the maintenance dose, bispectral index (BIS) was kept 40-60 in both groups. Oculocardiac reflex was compared between the two groups. Incidence of OCR of group 1was showed a significant decrease. Sevoflurane reduced the incidence of OCR. Sevoflurane may be the agent of choice in corrective strabismus surgery, compared to propofol.

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.

To determine the frequency of phantom limb sensation (PLS) and phantom limb pain (PLP) in children and young adults suffering landmine-related amputation.
All youths with amputation due to landmine explosions participated in this study. The proportions of patients with phantom limb sensation/pain, intensity and frequency of pain were reported. Chi square test was used to examine the relationship between variables. Comparison of PLP and PLS between upper and lower amputation was done by unpaired t-test.
There were 38 male and 3 female with the mean age of 15.8±2.4yr. The mean interval between injury and follow-up was 90.7±39.6 months. Twelve (44.4%) upper limb amputees and 11 (26.8%) lower limb amputees had PLS. Nine (33.3%) upper limb amputees and 7 (17.1%) lower limb amputees experienced PLP. Of 27 upper limb amputees, 6 (14.6%) and among 15 lower limb amputees, 6 (14.6%) had both PLS and PLP. One case suffered amputation of upper and lower limbs and was experiencing PLS and PLP in both parts. PLS had a significant difference between the upper and lower amputated groups. Significant relationship was observed between age of casualty and duration of injury with PLP.
Phantom limb sensation and pain in young survivors of landmine explosions appear to be common, even years after amputation.

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.

Anxiety is one of the important factors which could bring problems late delayed discharge for patients and medical staff. There are still controversies about the effects of information on anxiety related to anesthesia. One group of researcher believes that education can reduce anxiety and the other group doesnt believe it. In this study, the effect of an anesthesia film was studied. In this study we used 30 minutes video information that was produced based on American Society of Anesthesiologists protocol on education. We divided 70 urologic patients into two groups. In case group (27 patients) a questioner of (HADS) was filled in before and after film broadcasting. In control group (43) patient the questioners were filled following entering to and before exit from preoperative clinic. In control group (43) 26 patients and in the case group (27) 15 patients were anxious before video show in contrast with 22 patients in control group and 13 patients in case group after video show. (p=0.24) Video information had no obvious effect in reducing anxiety due to anesthesia of moderate risk surgeries.