nasim nikoubakht

Hip fractures are a critical issue among the elderly, often resulting from osteoporosis, and pose a significant global health challenge. With an estimated 10 million cases annually, the complexity of anesthesia choice is heightened by the elderly's prevalent comorbidities. This retrospective cohort study, conducted at Rasool Akram Hospital from April 2017 to April 2021, investigates the 30-day postoperative mortality rates in over 50 patients undergoing hip fracture surgery. It compares outcomes between general and neuraxial anesthesia and examines the influence of comorbidities and fracture types on mortality. The study encompassed 437 patients, with a notable difference in mortality rates: 5.6% for general anesthesia versus 13.8% for neuraxial anesthesia (P = 0.006). A propensity for neuraxial anesthesia was observed in patients over 75 and those with cardiac conditions (P = 0.004 and P = 0.006, respectively). Smokers and patients with intertrochanteric fractures also exhibited higher mortality under neuraxial anesthesia. The mortality rates did not significantly vary among neuraxial anesthesia subtypes. The anesthesia method significantly impacts the 30-day mortality rate in elderly hip fracture patients with comorbidities. General anesthesia is associated with lower mortality than neuraxial anesthesia. These findings highlight the importance of meticulous preoperative evaluation and tailored anesthesia strategies to enhance patient outcomes. The study advocates for personalized care to navigate the complexities of anesthesia selection and improve surgical success rates in this vulnerable population.

Evaluating pain after surgery is particularly important in children due to their limited ability to communicate effectively. The intensity, duration, and threshold of pain make it challenging to assess in this age group.

The aim of this study was to compare the effects of ultrasound-guided caudal block at different timings on children's pain and drug consumption during unilateral knee osteotomy surgery.

In a randomized clinical trial, fifty patients were randomly included in the study. The patients were children aged 2 - 6 years, candidates for unilateral osteotomy surgery under general anesthesia with total IV anesthesia (TIVA). The patients were divided into two groups based on the timing of the caudal block: The first group received the block after induction, and the second group received it after surgery and before extubation.

There was no statistically significant difference between the two groups in terms of the average amount of Propofol and narcotic consumption during recovery at different time points (P > 0.05). However, significant differences in pain levels were observed during the operation at 60 minutes (P-value < 0.001) and 120 minutes (P-value = 0.006) between the two groups. Pain scores at the start of recovery and at 2, 4, 6, 12, and 24 hours postoperatively were significantly lower in the second group than in the first group. Additionally, the mean difference in Bispectral Index (BIS) at 60 minutes between the two groups was significant (P-value = 0.003), but there was no significant difference at 120 minutes (P-value = 0.896). The second group consistently had significantly lower pain levels than the first group at all times.

Based on the results of this study, patients who received a caudal block had lower pain scores, and performing the block before extubation had more beneficial effects on postoperative pain management in children undergoing osteotomy surgery than performing it after induction.

There is a growing trend in drug addiction around the world. Addiction is defined as the inability to control the use of a drug, and has a highly variable clinical course. The aim of this study is to investigate both the depth of anesthesia with the help of BIS (Bispectral Index  Score) as well as the amount of anesthetic required during anesthesia on narcotics users and healthy individuals aged 18 to 65 years under elective hip fracture surgery.

In this study, patients undergoing elective hip fracture surgery referred to the operating room of Rasool Akram Hospital in 2019 were evaluated. Patients were examined in one of the two groups: 1.drug addicts and 2.non-addicts. The variables measured include demographic variables,  BIS, heart rate, systolic blood pressure, diastolic blood pressure, and the percentage increase in propofol and remifentanil, and recorded in two groups at 0, 15, 30 minutes after the start of the incision.

forty five patients in two groups of addicts (22) and non-addictcs (23) were studied. The Bispectral Index  Score( BIS) at minute 0, 15, and 30 after the surgery in the addicted group were more than the non-addicted group; however, the differences were not significant (P>0.05). Heart rate, systolic blood pressure, and diastolic blood pressure at minute 0, 15, and 30 of the surgery were higher among the patients in the addicted group compared to the non-addicted group, but the differences were not significant (P>0.05). The dose of propofol and remifentanil at the first fifteen minutes of surgery was significantly higher in the addicted group patients than among the non-addicted group (P<0.05). However, there was no significant difference between the dose of propofol and Remifentanil at the start of incision, 15 minutes after the start of incision, up until 30 minutes after. The total dose of propofol and Remifentanil in patients in the two groups was not significant difference (P>0.05). There was no significant difference between the frequency of patients in the two groups because of increasing the dose of propofol or Remifentanyl during the first 30 minutes of the start of the incision (P>0.05).

The depth of anesthesia can be controlled with the help of BIS during anesthesia in addicts and the required anesthetic can be reduced by controlling BIS in addicts during anesthesia.

 Tracheal intubation is a common technique used to secure a patient’s airway, which is crucial in anesthesia. Successful tracheal intubation depends on various factors, including the assessment of the patient’s airway before the procedure. In recent years, scoring systems, such as LEMON (an acronym for the assessment of the airway’s appearance, identification of any dental issues, evaluation of Mallampati classification, assessment of airway obstruction, and examination of neck mobility) and intubation difficulty scale (IDS) have gained attention. This study aimed to investigate the relationship between the LEMON criteria and IDS in tracheal intubation. The goal was to provide valuable insights that can assist medical professionals in optimizing their approach to airway management by analyzing clinical data, assessing patient outcomes, and evaluating the consistency between these scoring systems.

 This study was based on a descriptive-analytical study involving a group of patients requiring intubation. This study examined 105 patients scheduled for elective surgeries, aged between 19 and 60 years, without specific underlying diseases, such as laryngeal cancer, temporomandibular joint stiffness, or significant tongue enlargement, and with a body mass index (BMI) below 40 kg/m². Initially, expert anesthesiologists assessed the patients using the LEMON criteria, and then the degree of intubation difficulty was measured using the IDS scoring system. Finally, these two criteria were compared.

 In this study, there was a significant correlation between the LEMON score and the IDS score (P < 0.001). The difficult intubation group (IDS score higher than 0) had higher LEMON scores (with the highest score equal to 4) than the non-difficult intubation group (IDS score of 0) (P = 0.017). The average LEMON and IDS scores were 3.11 and 1.35, respectively. Among the participants, 96.2% had an intubation difficulty score of ≤ 5; nevertheless, 3.8% had a score of > 5. Additionally, limited neck mobility emerged as the sole independent predictor of intubation difficulty (P = 0.002, odds ratio = 6.152).

 The LEMON score is associated with difficult intubation in adult patients requiring intubation.

 Chronic residual pain after total knee arthroplasty (TKA) is one of the challenges of postoperative pain management. Duloxetine, by controlling neuropathic pain, and pregabalin, by affecting nociceptors, can effectively manage postoperative pain.

 This study aimed to compare the effect of perioperative oral duloxetine and pregabalin in pain management after knee arthroplasty.

 In this clinical trial, 60 patients scheduled for TKA under spinal anesthesia were randomly assigned to one of three groups A (pregabalin 75 mg), B (duloxetine 30 mg), and C (placebo). Drugs were administered 90 minutes before, 12, and 24 hours after surgery. The visual analog scale (VAS) score for pain, the first analgesic request time, postoperative analgesic consumption (i.v. paracetamol), and WOMAC score six months after surgery were recorded.

 The VAS score and analgesic consumption 48 hours after TKA in groups A and B significantly decreased compared to the placebo (P < 0.05). The first analgesic request time was longer in groups A and B than in group C (P < 0.05). While the differences were statistically significant, they are most likely not clinically significant. The WOMAC score before and six months after arthroplasty did not differ between the groups (P > 0.05).

 Perioperative oral pregabalin and duloxetine similarly reduce pain and the need for analgesic consumption within 48 hours after TKA but do not affect knee mobility status.

 Delivery pain is the most unbearable pain and can be relieved with intrathecal opioids. This study aimed to investigate the effect of intrathecal sufentanil for painless delivery on labor progress and neonatal outcomes in pregnant women.

 This was a single-arm observational cohort study on 1055 pregnant women candidates for vaginal delivery with spinal analgesia referred to the Akbarabadi Hospital. First, 0.1 µg/kg of intrathecal sufentanil was used, and maternal blood pressure and maternal and fetal heart rates were recorded after analgesia. During delivery, the mothers were monitored for nausea, pruritus, motor block, apnea, urinary retention, or the possibility of an emergency cesarean section. The duration of the analgesia, the duration of the second stages of labor, and the mother's pain scores were recorded based on the Visual Analogue Scale (VAS). 1- and 5-minute Apgar scores and Arterial Blood Gas (ABG) of the umbilical cord were also recorded.

 The most common station was -3 for 723 women, followed by -2 for 229 women. Fifty-two women underwent cesarean section, and fetal distress was the most common reason for cesarean section (57.7%). The mean time for initiating analgesia was 5.93 ± 2.87 minutes, and the mean visual analog scale was 1.08 ± 0.16. The mean Apgar was 9.0 ± 0.47; the mean weight at birth was 2917.39 ± 449.90 gr; PH was 7.31 ± 2.03; HCO3 was 22.67 ± 3.08mEq/liter, and PaCo2 was 43.36 ± 7.06 mmHg. Regarding complications, the patients just developed itching (n = 78), and hypotension, bradycardia, apnea, and decreased consciousness were overlooked.

 Intrathecal sufentanil is safe and efficient in painless delivery, resulting in normal Apgar and normal PH with no specific side-effect.

Various studies have shown the benefits of using glucocorticoids following surgery. However, side effects associated with drug administration have been investigated sufficiently. We aimed to evaluate the effects of different doses of dexamethasone on blood glucose concentration in patients undergoing elective abdominal surgery.

This double-blind clinical trial design study was conducted among 90 candidates of elective abdominal surgery referred to RasoolAkram Medical Complex in Tehran ,Iran, 2017-218. Patients included two groups of intervention: group I, received 4 mg dexamethasone; group II, received 8-10 mg dexamethasone; and group III (control group), received ondansetron after induction of general anesthesia. Data were analyzed using ANOVA, Kruskal-Wallis test, and repeated measures. α=0.05 was considered as a statistically significant level.

The highest increase in blood glucose concentrations in all three groups occurred in the first 6 hours after the surgery. The lowest intensity of pain in all the groups occurred in the first 24 hours after the surgery. All the groups showed statistically significant changes in blood glucose concentration and pain intensity. Comparing among the mean blood glucose concentrations over time, there were statistically significant changes in time and group/time (p<0.001). Comparing the mean intensity of pain over time, statistically, significant changes were observed in time and group / time (p<0.001).

In general, change trends in blood glucose concentration and pain intensity could be dependent on the medication used and its dose, as well as the time of drug administration. Changes in blood glucose levels in the control group can be attributed to metabolic changes caused by surgical trauma.

The economic burden of the treatment of hip fracture would be enormous, especially in countries like Iran with an aging population and limited financial resources. The choice of anesthetic technique for hip fracture surgery is controversial. We conducted this retrospective 4 year study to evaluate the effect of regional versus general anesthesia on the length of hospital stay and the cost of hospitalization in an academic governmental setting.

We reviewed the medical records of 751 adult patients who underwent a surgery for intertrochanteric or femoral neck fracture since 2008 to 2012 in a University hospital located in Tehran, Iran. Data regarding days of hospital stay and total direct hospitalization costs as well as patients’ demographics were analyzed based on the type of planned anesthesia. The source of data collection was local electronic database.

Neuraxial anesthesia was associated with less hospital stay and costs in patients with intertrochanteric fracture surgery. The advantage of neuraxial over general anesthesia was not statistically significant in patients with femoral neck fracture.

Neuraxial anesthesia followed by meticulous postoperative pain control may reduce the hospitalization period and costs of hip fracture treatment. This is especially true for the patients with intertrochanteric fracture.

 The prevalence of obesity is increasing worldwide, and anesthesiologists are facing challenges in the airway management of such patients. Excessive adipose tissue influences pharyngeal spaces and affects the laryngoscopic grade. Standard ramp positioning is time-consuming and difficult to prepare, and requires expensive equipment.

 The aim of this study was to compare the standard ramp position with the proposed low-cost and easily accessible modified ramp position in laryngoscopic view during the intubation of patients with morbid obesity.

 In this single-blind clinical trial, 84 patients candidate for bariatric surgery at Rasoul Akram Hospital in 2020 were assigned to the rapid airway management positioner (RAMP) (R) and new modified RAMP (MR) groups by the block randomization method. The laryngoscopic view of the glottis based on the Cormack-Lehane scale, ventilation quality, duration of intubation, intubation attempts, oxygen saturation at the end of intubation, and the need for backward, upward, rightward pressure (BURP) maneuver for successful intubation were recorded. Normal distribution tests and Mann-Whitney and Kruskal-Wallis tests were used to analyze the data.

 The results showed no significant differences between the two groups regarding ventilation score, laryngoscopy grade, number of intubation attempts, duration of intubation, and the need for BURP maneuvers during intubation (P > 0.05).

 The two methods are not significantly different, and the new modified ramp position can be used with more ease and availability and less cost.

Coronavirus disease 2019, known as COVID-19, was first identified in Wuhan, China, in December 2019 and became a pandemic on Mar 11, according to the World Health Organization report. In the epidemic of COVID-19, many patients admitted to hospitals for other reasons may be silent carriers of COVID-19 and have the risk of infecting medical personnel. Thus, meticulous personal protection measures should be considered in suspicious patients, especially when close contact with the patient’s airway is anticipated. We introduce two airway trauma patients suspected of COVID-19 who required emergency tracheostomy. Patient one was a 29-year-old man who suffered facial trauma following a car accident. A chest CT scan showed peripheral ground-glass opacities suggestive for COVID-19. The second patient was a young elevator mechanic who experienced maxillofacial trauma after an elevator crash. The methods of anesthesia and airway protection and safety precautions are described.

Postoperative pain has many adverse effects and if not properly controlled, it can cause a wide range of problems.

The purpose of this study is to compare the results of using ketamine and apotel infusion pumps to control pain after posterior fusion surgery.

In this clinical trial study, 72 patients hospitalized for posterior spine fusion surgery were randomly assigned into two groups, including ketamine infusion pumps (ketamin group) and apotel infusion pumps (apotel group). In the ketamin group, 0.2 mg/kg/h of ketamine was infused to by a pain pump with normal saline to 100 cc. In the apotel group, apotel was used instead of ketamine. The rate of pain was evaluated in recovery, and at 6, 12, 18, 24, and 48 hours after the surgery, based on VAS criteria. The rate of sedation was recorded based on Ramsy score.

There was no significant difference between age, sex, BMI, underlying diseases, and smoking in patients with posterior spinal fusion surgery between the groups. Postoperative pain score was significantly lower in the patients with posterior fusion surgery at 6, 12, 18, 24, and 48 hours in the ketamin group compared to the apotel group (P < 0.001). Patients’ satisfaction with the analgesia was significantly higher in the patients at 24 hours (P = 0.001) and 48 hours (P = 0.04) in the ketamine group compared to the apotel. With regards to the Ramsy scores of the patients with posterior fusion surgery, there was no significant difference between the groups (P = 0.16).

The use of a ketamine infusion pump can be more effective than an apotel infusion pump to control pain after posterior fusion surgery.

Spinal anesthesia is used as a common anesthetic technique in many routine and outpatient surgeries.

The aim of this study was to determine the effect of phenylephrine on maternal hemodynamic changes during spinal anesthesia for cesarean delivery.

This double-blind randomized controlled trial was conducted on 116 pregnant women candidate for the elective cesarean section through spinal anesthesia in the Shahid Akbarabadi Hospital, Tehran in 2019. The eligible women were randomly divided into the intervention (phenylephrine; n = 58) and control (normal saline; n = 58) groups. The data collection tool was a checklist, including the demographic and clinical variables, such as age, height, weight, body mass index, gravid, gestational age, Apgar score of 1 and 5, systolic blood pressure, diastolic blood pressure, heart rate, mean arterial pressure, SPO2, PH of the umbilical cord, PCO2, HCO3, base excess, nausea, and vomiting. Data were analyzed using SPSS 24 software and P value < 0.05 was considered as significant.

The intervention and control groups showed a significant difference in terms of the PH of the umbilical cord, PCO2, and nausea and vomiting (P value < 0.05). The results of the repeated measure ANOVA test showed a significant statistical difference between the intervention and control groups at different time points in terms of arterial pressure, systolic and diastolic blood pressures (P value < 0.05).

Phenylephrine is effective in the prevention of some complications, like reducing mean arterial pressure, systolic and diastolic blood pressures, nausea, and vomiting during spinal anesthesia for cesarean delivery. Therefore, these drugs can be used based on maternal hemodynamic status during spinal anesthesia for cesarean delivery

Acupuncture has been used for more than two thousand years as part of traditional Chinese medicine.

This randomized prospective clinical trial aimed to compare the effect of acupuncture on K1 (Yongquan) and DU26
(Renghong) with acupuncture on K1 (Yongquan) and DU25 (Suliao), with sham acupuncture on the recovery time of general anesthesia.

The patients (51) were randomly assigned to three groups: (A) acupuncture on K1 and DU26, (B) acupuncture on K1 and
DU25, and (C) sham acupuncture. In each group, at the end of surgery acupuncture was performed accordingly for twenty minutes and the Bispectral Index (BIS) values at end of surgery, 5th minute, 10th minute, 15th minute and 20th minute as well as time of extubation and time of eye opening after the end of surgery were evaluated.

BIS study at 5th minute, 10th minute and 15th minute after the end of surgery in the groups revealed a significant difference between sham acupuncture group and both A and B acupuncture groups, which was higher in groups A and B in comparison with sham acupuncture group. Time of opening eyes and time of extubation after the end of surgery between group A and sham acupuncture group differed significantly, which was earlier in group A. There was no significant difference between group B and sham acupuncture group in terms of eye opening and extubation time.

Acupuncture on K1 andDU26accelerates restoring of consciousness and shortens of eye opening and extubation after
general anesthesia, but on K1 and DU25 only speeds up retrieving of consciousness without significant effect on time of eye opening or extubation after general anesthesia.

Postoperative pain is a major complication in patients undergoing eye surgery. N-methyl-D-aspartate (NMDA) receptor antagonists are widely used to manage postoperative pains. Dextromethorphan, as an NMDA antagonist, is commonly used as an oral drug. This study was conducted to evaluate the effect of Dextromethorphan on post-operation pain and sedative effect in comparison to placebo. A double-blinded, placebo-controlled, randomized clinical trial, upon 60 patients undergoing vitrectomy surgery was done. Thirty patients received 30 mg oral Dextromethorphan before the operation, and 30 patients received a placebo. Post-operation pain and sedation were evaluated after zero, one, two, and six hours. Post-operation pain was significantly lower in patients who received Dextromethorphan at zero, one, and two hours after operation (P < 0.001); however, not at six hours after operation (P = 0.11). Sedative effect was higher in the Dextromethorphan group at zero (P = 0.03) and one hour (P = 0.01) after operation. Prescribing oral Dextromethorphan before a vitrectomy surgery could reduce postoperative pain. It also has postoperative sedation effects.

Memantine is an N-methyl-D-Aspartate (NMDA) antagonist. By transferring acute postoperative pain, the NMDA channels may lead to active excess and neuropathic pain. This study attempted to investigate the effect of preoperative use of single oral dose of memantine in controlling Dacryocystorhinostomy (DCR) postoperative pain.
A double-blind clinical trial was conducted on 60 patients undergoing DCR. On arrival at the operating room, the memantine group received 20 mg of oral memantine and the control group received placebo. The severities of pain by visual analogue scale (VAS) and sedation by Ramsy Scale were measured immediately 1, 2, and 6 hours after the operation. The drug’s side effects were recorded.
The pain scores of patients in the recovery in 1, 2, and 6 hours after operation were significantly lower in the memantine group than the placebo group (P The oral single-dose 20 mg of memantine administered before DCR can reduce postoperative pain compared with placebo.

Remifentanil is a narcotic drug used in anaesthesia for establishment of hemodynamic stability. The purpose of this study was to compare the effects of remifentanil and fentanyl on urine excretion.
In a randomized clinical trial, 60 patients, who were candidates for elective surgery for lumbar posterior spinal fusion, were divided randomly into two groups of 30 as remifentanil – propofol (R) and fentanyl- propofol (F). Maintenance of anaesthesia drugs in group R included 100 mcg/kg/min propofol and 0.5- 0.25 mcg/kg/min remifentanil. It included 100 mcg/kg/min propofol and 5- 0.5 mcg/kg/min fentanyl in group F. Vital signs and urine output were recorded every half an hour.
The mean age of patients was 49.5± 12.7 years. Urine output in group R showed significantly greater reduction than in group F (p Urine output in patients undergoing lumbar posterior spinal fusion who received remifentanil was less compared to the fentanyl group.

Pain after laparoscopic gastric bypass surgery (LGBP) is a major problem. Gabapentin is an anticonvulsant drug that can be effective in postoperative pain control.. This study examined the effect of preoperative administration of gabapentin on reducing pain after LGBP in patients with morbid obesity..Patients and This randomized clinical trial was performed in Hazrat Rasoul Akram Medical Center in Tehran. A total of 60 patients undergoing LGBP were randomly allocated into two groups; one group received 100 mg of oral gabapentin and the other group received placebo. Pain was evaluated at recovery time, and at the first, second, fourth and sixth hour of surgery by visual analog scale. The number and dose of opioid use after surgery and incidence of postoperative complications, such as nausea and vomiting, agitation, and headache, were also recorded.. The mean pain score in the group receiving gabapentin was significantly lower than the placebo group (P < 0.001). Indications and dose of opioid consumption between the two groups were not statistically significant. Incidence of nausea/vomiting (P = 0.028) as well as agitation (P = 0.037) was significantly lower in the gabapentin group.. Administration of gabapentin before surgery can reduce pain after LGBP. Furthermore, it is not accompanied by significant short-term adverse effects..