mohammadreza pipelzadeh
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Background
The benefit of sequential compression device (SCD) for the prevention of hypotension after spinal anesthesia in cesarean sections has not been determined.
ObjectivesIn this study, an attempt was made to determine whether SCD can prevent hemodynamic changes following spinal anesthesia for cesarean sections.
MethodsIn a prospective clinical trial, 76 parturient women undergoing elective cesarean sections under spinal anesthesia were randomly divided into SCD or control groups. The maternal hemodynamic changes within 75 min after spinal anesthesia, nausea, vomiting, and neonatal Apgar score at 1 and 5 min were compared between the groups.
ResultsThere were no significant differences between the groups in the patients’ characteristics, maximum sensory block, skin incision to delivery time, spinal anesthesia to delivery time (min), and the total duration of surgery. Concerning heart rate changes, RM ANOVA showed a significant difference in the effect of time, groups, and the interaction of the two factors (P < 0.0001, P < 0.0001, and P < 0.0001, respectively). Tukey post hoc test showed that 3 min after spinal anesthesia, diastolic blood pressure was significantly higher in the SCD group than in the control group (P < 0.05). The SCD group had meaningfully lower rates of nausea (P = 0.005) and vomiting (P = 0.001) than the control group. The SCD group also demonstrated a significantly lower mean ephedrine dosage per patient (4.1 mg against 17.1 mg, P = 0.001). However, no significant difference was observed between the groups in terms of neonatal Apgar scores at 1 and 5 minutes.
ConclusionsThis study showed that SCD could reduce extensive changes in diastolic blood pressure as an important hemodynamic parameter and the incidence of nausea and vomiting. Thus, SCD can be used in spinal anesthesia care practices for elective cesarean sections.
Keywords: Cesarean Section, Spinal Anesthesia, Hemodynamic Changes, Sequential Compression Device -
BackgroundActive muscular trigger points (aMTPs) presenting with radiating pain can interfere in diagnosis and treatment of patients suffering from lumbosacral radiculopathy.ObjectivesWe aimed to diagnose and evaluate the trigger point therapy on the outcome of pain in patients with lumbosacral radiculopathy.Materials And MethodsA total of 98 patients were enrolled suffered with chronic pain andlumbosacral radiculopathy at L4-L5 and L5-S1 who were candidates of non-surgical management. All patients received conservative modalities, including bed rest, non-steroidal anti-inflammatory agents (NSAID), and physiotherapy. These treatments continued for a week. Patients were examined for the presence of trigger points in their lower extremities. Those who had trigger points were divided into 2 groups (TP and N). Patients in TP group underwent trigger point injection therapy. No further therapy was done for the N group. Pain scores and straight leg raise (SLR) test in both groups were collected and analyzed on the seventh and 10th days of the therapy. Results were analyzed by paired t test and chi-square test.ResultsOut of 98 patients, 64 had trigger points. Thirty-two patients were assigned to each group. Pain scores (Mean ± SD) in TP group was 7.12 ± 1.13 and in N group was 6.7 ± 1.16, P = 0.196. Following the treatment, pain scores were 2.4 ± 1.5 in TP group and 4.06 ± 1.76 in N group P = 0.008. SLR test became negative in all patients in TP group but only in 6 (19%) patients in N group, P = 0.001.ConclusionsResults show that trigger point injection therapy in patients suffering from chronic lumbosacral radiculopathy with trigger points can significantly improve their recovery, and conservative therapy may not be adequate.Keywords: Trigger Point, Radiculopathy, Low Back Pain
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PurposeThe aim of this study was to select the best calibration model for determination of propofol plasma concentration by high-performance liquid chromatography method.MethodsDetermination of propofol in plasma after deproteinization with acetonitrile containing thymol (as internal standard) was carried out on a C18 column with a mixture of acetonitrile and trifluoroacetic acid 0.1% (60:40) as mobile phase which delivered at the flow rate of 1.2 mL/minute. Fluorescence detection was done at the excitation and emission wavelengths of 276 and 310 nm, respectively. After fitting different equations to the calibration data using weighted regression, the adequacy of models were assessed by lack-of-fit test, significance of all model parameters, adjusted coefficient of determination (R2adjusted) and by measuring the predictive performance with median relative prediction error and median absolute relative prediction error of the validation data set.ResultsThe best model was a linear equation without intercept with median relative prediction error and median absolute relative prediction error of 4.0 and 9.4%, respectively in the range of 10-5000 ng/mL. The method showed good accuracy and precision.ConclusionThe presented statistical framework could be used to choose the best model for heteroscedastic calibration data for analytes like propofol with wide range of expected concentration.Keywords: Propofol, High, performance liquid chromatography, Calibration, Heteroscedasticty, Weighted least squares regression
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زمینه و هدفبیدار شدن از بیهوشی و خارج کردن لوله تراشه می تواند با سرفه، آژیتاسیون و تغییرات همودینامیک همراه باشد. بیدار شدن آرام از بیهوشی با حداقل تغییرات همودینامیک به ویژه در بیماران قلبی- عروقی حایز اهمیت است. رمیفنتانیل ممکن است این پاسخ ها را کاهش دهد لذا ما اثرات ادامه انفوزیون رمیفنتانیل را بر روی مشخصه های ریکاوری مثل سرفه و پاسخ های قلبی عروقی پس از بیهوشی عمومی بررسی کردیم.مواد و روش هادر یک مطالعه آینده نگر، دوسوکور تصادفی 60 بیمار بالغ 40-18 سال تحت جراحی بینی با بیهوشی بر پایه رمیفنتانیل مورد مطالعه قرار گرفتند. طی فاز بیدار شدن از بیهوشی در گروه درمان 1 دوز رمیفنتانیل از 1-1/0 میکروگرم به ازای هر کیلوگرم در دقیقه به 02/0 میکروگرم به ازای هر کیلوگرم در دقیقه و در گروه درمان 2 به 05/0 میکروگرم به ازای هر کیلوگرم در دقیقه کاهش یافت در حالی که در گروه کنترل انفوزیون رمیفنتانیل قطع شد و برای حفظ شرایط یکسان در این گروه انفوزیون پلاسبو (نرمال سالین) جایگزین رمیفنتانیل شد.یافته هاطی فاز بیدار شدن از بیهوشی، شیوع و شدت سرفه در هر دو گروه نسبت به گروه کنترل کمتر بود. همچنین هر دو گروه ضربان قلب آهسته تری نسبت به گروه کنترل داشتند. میزان فشار خون سیستمیک در گروه درمان 1 با گروه کنترل تفاوتی نداشت ولی در گروه درمان 2 نسبت به دو گروه دیگر کمتر بود. زمان بیدار شدن از بیهوشی و خارج کردن لوله تراشه در گروه درمان 2 نسبت به دو گروه دیگر افزایش یافته بود.
انفوزیون رمیفنتانیل با دوز 05/0 میکروگرم به ازای هر کیلوگرم در دقیقه شیوع و شدت سرفه، تا ریکاوری و افزایش فشارخون سیستمیک در زمان بیدار شدن از بیهوشی را کاهش می دهد ولی زمان بیدار شدن از بیهوشی را طولانی می کند. در حالیکه انفوزیون رمیفنتانیل با دوز 02/0 میکروگرم به ازای هر کیلوگرم در دقیقه بدون آنکه زمان بیدار شدن از بیهوشی را طولانی کند تنها روی سرفه و ضربان قلب موثر است.
کلید واژگان: رمیفنتانیل، بیدار شدن از بیهوشی، لوله تراشه، تغییرات همودینامیکAim andBackgroundEmergence from general anesthesia can be associated with coughing، agitation، and hemodynamic disturbances. Remifentanil may attenuate these response، so we examined the effects of maintaining a remifentanil infusion in the recovery room، on recovery profiles such as coughing and cardiovascular responses after general anesthesia. Methods and Materials: In a prospective، double-blinded، randomized trial، we enrolled 60 adult patients undergoing nasal surgery with remifentanil-based anesthesia. During the emergence phase، the infusion rate of remifentanil was reduced to 0. 02 micro/kg/min in treatment group 1 and to 0. 05 micro/kg/min in treatment group 2، whereas in the control group remifentail was discontinued and placebo was started instead.FindingsDuring emergence، both of the treatment groups had a significantly lower incidence and severity of coughing and slower heart rate. The mean systolic blood pressure (MAP) in the treatment group 2 was significantly lower compared with the other groups، but the awakening or extubation time was prolonged in this group، whereas time interval to awakening and tracheal extubation was similar between the control group and treatment group 1.ConclusionsMaintaining a low-dose remifentanil infusion during emergence did not prolong awakening but reduced heart rate and the incidence and severity of coughing due to the endotracheal tube، whereas high-dose remifentanil infusion reduced the hemodynamic changes and coughing associated with tracheal extubation while significantly delaying the extubation time.Keywords: Remifentanil, Emergence, Tracheal tube, Hemdynamic changes -
BackgroundLaceration of the hand extensor tendons is common in the upper extremities, causing soft tissue trauma. These tendons, because of their superficial location and lying adjacent to bones, have a greater tendency to be injured than flexor tendons.ObjectivesThe aim of this study was to determine the results of primary repairs of lacerated extensor tendons of the fingers, with respect to the zone of injury, and also whether the results are different according to the anatomical zone in which they occur.Patients andMethodsDuring a period of two years and four months, 32 patients with open wounds and lacerated extensor tendons of the hand were hospitalized and underwent surgery. Repairs were done by a modified Kessler technique using 0 - 4 nylon suture. After repairing, the wrist was splinted for four weeks. Patients were followed-up for 12 months and the results were evaluated according to the Miller’s scoring system.ResultsA total of 72 extensor tendons were repaired. The mean age of the patients was 24.6 years. The best results were obtained in zones; 3 and 5 (84% and 88% respectively),and the worst results were seen in zones: 1, 2 and 4, P = 0.01. Wound infections or re-ruptures were not seen.ConclusionsRepair of extensor tendon cuts on the dorsal surface of the hand and forearm were associated with better results in zones: 3 and 5 than in zones;1, 2 and 4.Repair by the modified Kessler suture method provides proper stability at the site of the tendon cut.Keywords: Extensor Tendon Injuries, Hand Injury, Lacerations
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IntroductionThe upper abdominal operations change postoperative pulmonary function tests. The postoperative pulmonary function tests are restrictive substantially. Peak Expiratory Flow (PEF) decrease in the restrictive lung disease. Laparoscopy causes physiologic changes in the respiratory system too and diaphragmatic function is impaired extensively after laparoscopy. The factors that cause aggravation of restrictive lung disorders increase postoperative lung complications.Materials And MethodsIn this randomized clinical trial thirty patients were ASA class I, II suffering from chronic cholecystitis due to gall stone allocated randomly into group I (open cholecystectomy with 15 patients) and group II (laparoscopic cholecystectomy with 15 patients). The PEF was measured one day before operation and in recovery room and 24 and 48 hours postoperatively in semisitting position. Collected data was analysed by SPSS. 17 software using t test, chi square test and analysis of variance. A p value <0.05 was considered as significant.ResultsNo difference was demonstrated between two groups with respect to their gender, age, ASA class, BMI and smoking (p> 0.05). Preoperative PEF in the group I (OC) was 353±34 (lit/min) and in the group II (LC) was 351±39 (lit/min) and without significant difference between groups (p= 0.92). The PEF on recovery, at 24 and 48 hours postoperative showed 52%, 48% and 42% reduction in the group I (OC) and 41%, 27% and 12% reduction in the group II (LC) respectively (p= 0.0001).ConclusionPulmonary function after laparoscopic cholecystectomy is impaired extensively but lesser than after open cholecystectomy. Pulmonary function impairment after open cholecystectomy increases till 24 hours after postoperative period but pulmonary function improves extensively 24 hours after operation in laparoscopic cholecystectomy.Keywords: Laparoscopic cholecystectomy, postoperative pulmonary function, peak expiratory flow
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An in vitro study on the role of intracellular calcium ions in healing of excisional wound in rabbit was undertaken. We employed two drugs namely, glibenclamide and nitroglycerin that are topically applied in vivo to modulate the activity of intracellular calcium. Our model consisted of a 15 ´ 15 mm excisional wound. Seven groups of New Zealand rabbits were used. The first three groups served as untreated, Vaseline- and lubricating jell vehicle-treated as controls. The remaining groups received topically 0.5 g of nitroglycerine (2 % in Vaseline base) or glibenclamide (1, 2 and 4% in lubricating jell) on the day of excision and continued for 11 days. Using wound surface area measurement, complemented with measurement of the breaking strength and histological assessment, the results showed that inhibition of intracellular calcium ion had a favorable effect on wound healing. The mean wound half-lives and breaking strength were significant and concentration dependently reduced in glibenclamide-treated group. In contrast, in nitroglycerin-treated group the rate of wound healing and breaking strength were increased relative to untreated control and Vaseline treated groups. Histological findings revealed more organized collagen fibers and angiogenesis in nitroglycerin-treated wounds. The present study demonstrated that intracellular calcium ion has an important role on the overall process of wound healing. This information may be utilized in further studies to assess its role in healing of human wounds
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