فهرست مطالب reza safaeian

Children with sensorineural hearing loss are at risk of cardiac electrophysiologic abnormalities. Inhalational Sevoflurane induction in these children can cause QT prolongation.

In order to evaluate the safety of inhalational induction of anesthesia with sevoflurane in children with sensorineural hearing loss, who are candidates for cochlear implant, its electrophysiologic effects was compared with intravenous induction of anesthesia with propofol.

In this double-blind randomized clinical trial, 61 children aged between one and eighteen years old, who were candidates for cochlear implantation, were randomly allocated to groups receiving anesthesia with sevoflurane (n = 32) or propofol (n = 29) for induction of anesthesia. Two 12-leads ECG were taken from all of patients before and after induction and QTc, Tp-e interval, and JTc were measured and compared.

Two cases, who had pre-induction QTc longer than 500 ms were excluded from the study. Patients had similar age (102.58  87 versus 101.46  67 months, P = 0.95) and gender (males: 48.3% versus 56.3%, P = 0.53) distribution. The researchers observed significant post induction difference in QTc values between these groups (propofol 422.5  40, sevoflurane 445.0  29, P = 0.016). There was no significant difference in the percent QTc and Tp-e changes in propofol and sevoflurane groups. Greater percentage of patients with increased Tp-e interval (> 100 ms) in the sevoflurane group than the propofol group was also seen. There was no significant long QTc difference (QTc > 500msor more than 60msincrease from baseline) after induction of anesthesia in the sevoflurane group compared to the propofol group (15.6% versus 13.8%, P = 0.84).

After electrophysiological evaluations in children with sensorineural hearing loss, in patients whose pre-induction QTc is not longer than 500 ms, propofol seems safer than inhalational sevoflurane for induction of anesthesia.

Awake oral flexible fiberoptic intubation (AFOI) is used in patients with expected difficult airways. Different drugs have been used for sedation and yet we need to define ideal drug with proper sedation and safety, less changes in hemodynamic stability and less airway compromise. We aimed to compare the efficacy of dexmedetomidine with fentanyl and midazolam during AFOI. In this randomized clinical trial, 52 patients undergoing elective surgery and candidate for AFOI were randomly allocated to two groups. First group received 1mcg/kg of dexmedetomidine in 10 minutes and then infusion of 0.5 mcg/kg/h and second group received 2 mcg/kg fentanyl and then 1 mg midazolam. Hemodynamic variables, O2 saturation (SpO2) were evaluated before and after sedation and after intubation. Ramsey sedation scale (RSS) and patient’s tolerance were evaluated during bronchoscopy and intubation. Lower heart rate after intubation (p=0.008) and higher SpO2 before sedation (p<0.001) and after intubation (p=0.02) were observed in dexmedetomidine group compared to fentanyl group. The need for propofol for further sedation was comparable between groups (11.5% vs. 7.7%, respectively; p=0.63). Both groups had comparable RSS and tolerance during intubation. Dexmedetomidine compared to fentanyl and midazolam had comparable sedation with better hemodynamic stability and O2 saturation during AFOI.

Gabapentin is popular analgesic adjuvants for improving postoperative pain management. The aim of this study was to compare the preventive effects of pre-emptive oxycodone and gabapentin on acute pain after elective abdominal hysterectomy. One hundred patients undergoing abdominal hysterectomy were randomly assigned to oxycodone group received 10 mg of oxycodone and gabapentin group received 10 mg of gabapentin 1 hour before surgery. The anesthetic technique was standardized, and the postoperative assessments included the amount of meperidine consumption, PONV and VAS for postoperative pain at arrival to recovery, 6, 12 and 24 h after surgery. Bleeding loss assessed during surgery. Postoperative pain scores were significantly lower in the gabapentin group compared with the oxycodone group. (P=0.0001) The total meperidine used in the gabapentin group was significantly less than in the oxycodone group. Postoperative nausea and vomiting (PONV) and blood loss during surgery were significantly decreased in gabapentin group. Based on the results of this study, Pre-emptive use of gabapentin 1200 mg orally, significantly decreases postoperative pain and PONV, rescues analgesic requirements and also bleeding loss during surgery in patients who undergo abdominal hysterectomy. Significant side effects were not observed.

Long surgery causes hypothermia and increased bleeding and can increase the arterial blood lactate levels during anesthesia. It causes cellular hypoxia and its complications. Considering the core temperature of the patient during surgery it can prevent hypoxia. This study aimed to compare the effects of different temperatures on the core temperature and the concentrations of lactate in patients who were candidate for posterior spine fusion surgery under general intravenous anesthesia.
In this clinical trial study, 60 patients with ASA II risk undergoing spine fusion surgery referred to Rasoul Akram hospital from 2015 were studied. Patients were divided in two groups of receiving temperature of 36 ° and 40 ° C during operation. Demographic data as well as information before anesthesia, after surgery, as well as recovery was gathered in the check list. Data then were entered to the statistical software SPSS v. 16 and analyzed.
The mean age of patients was 49.14 (SD= 12.97) years. Pre-operation O2 Saturation had significant difference between the two groups (p value = 0.015). Trend of Hb, HCT, HR, SBP, O2 Sat, operating room temperature, pH, arterial HCO3, arterial O2 pressure, arterial blood lactate, degree of arterial blood saturation and arterial access base in 36ºC group (p value In bleeding and low blood pressure and hypothermia, the level of serum lactate is more than 3.5 meq/L, which is caused by cellular hypoxia. In our study in two temperatures during operation lactate level was low because of longer time of operation that shows loss of hypoxia and high level of consciousness and less complication. Also time of waking up was more rapid. So as lactate level was low, prophylaxis of hypoxia is more.

Aim and Pulmonary aspiration of gastric contents is one of the most important complications of general anesthesia. Prevention and specially management of this complication are still both challenging subjects for all anesthesiologists. In this case report beside case presentation we will discuss about comprehensive guidelines for prevention and management of this event.Case report: This study presents a case of milk aspiration in a 6-year-old boy during induction of anesthesia for an elective surgery, which occurred because of incorrect parent-reported information about fasting time of the child. The operation has been continued after appropriate interventions and drainage of the milk. After the operation, he was extubated in the operating room and then was moved to the recovery room with O2 saturation of 95% on room air. After two day's stay in the pediatric intensive care unit (PICU), the patient was transferred to the pediatric ward with stable physiologic conditions.

Aims and This study aimed to compare Rabeprazole with ranitidine on decreasing epigastric pain in patients undergoing vitrectomy surgery in Rasoul-e-Akram hospital during 1391-1392. This study was a double-blinded randomized controlled trial on patients undergoing vitrectomy. Patients were divided into three groups receiving: Rabeprazole (20 mg), Ranitidine (150 mg) and both (20 mg Rabeprazole plus 150 mg ranitidine). After surgery patients were asked about epigastric pain, heartburn, regurgitation, nausea and vomiting. Patients were compared based on these variables. In this study 105 patients with average age of 67.55 years (SD=9.87) were included and divided into three groups, each containing 35 patients. In Rabeprazole group, 8(22.9%), 7(20%), and 4(11.4%) patients had regurgitation at 1, 2 and 4 hours after surgery, respectively. In Ranitidine group this amount was 5(14.3%), 3(8.6%) and 2(5.7%). In the third group this changed to 3(8.6%), 2(5.7%) and 3(8.6%), respectively which was not significantly different among the three groups (P value> 0.05). Pain severity after surgery at different hours, was decreased significantly in all groups (P value<0.001) but this was not significantly different among them (P Value= 0.15). This study shows that using Ranitidine and Rabeprazole simultaneously or Ranitidine alone decreases pain and regurgitation after elective surgery more than using Rabeprazole alone. Using both of these is effective in decreasing pain after surgery.

Aims and Airway hyperactivity is one of the most important complications of tracheal extubation. This study was designed to compare the efficacy of intravenous acetaminophen as an alternative to remifentanil on airway response to tracheal tubes during and at the end of anesthesia in functional endoscopic sinus surgery. Methods and materials: This study was conducted as a double blind clinical trial on 70 patients 20 to 60 years old, candidate for endoscopic sinus surgery, in Rasoul-Akram hospital. They were randomly allocated into two groups: the Paracetamol (n=35) and the remifentanil (n=35) groups. Remifentanil infusion with a dose of 0 /1μg/kg/min was administered for both groups during anesthesia. Since the beginning of inserting the nose tampon until extubation, remifentanil infusion (0/1 μg/kg/min) was continued in group I, and in group II in the last 20 minutes of surgery, remifentanil infusion was discontinued and intravenous injection of acetaminophen was begun. Incidece of Cough, Arterial blood pressure, and heart rate were recorded. There was no significant difference in the incidence rate of cough during extubation between the two groups (P=0.7). M ean arterial pressure (MAP) v ariation, was significantly lower in the remifentanil group (P<0.001). Variations in heart rate were similar in both groups (P=0.74). Using intravenous acetaminophen has the same effect as remifentanil in controling airway reflexes after endoscopic sinus surgery as well as reducing symptoms such as restlessness and changes in heart rate.

Aims and Although controversial, many studies have shown effectiveness of colloid loading as a substitute for crystalloids on reducing the incidence of hypotension in spinal anesthesia. This study was conducted to compare the effects of three intravenous fluid regimens on hemodynamic changes following spinal anesthesia in cesarean section. The regimens included 6% Hydroxy ethyl starch 130/0.4 (HES) as a colloid and two crystalloids (lactated ringer’s solution and sodium chloride 0.9%). Methods and Materials: In a double-blind clinical trial, 90 otherwise healthy parturients candidate for elective caesarean section, were randomly allocated to receive lactated ringer’s solution (1000 ml), sodium chloride 0.9% (1000 ml) or HES (7.5 mL/Kg) as preloading before spinal anesthesia. Hemodynamic parameters including blood pressure and heart rate, umbilical cord blood pH and the neonatal Apgar score were compared among the three groups. There was no difference in the basic hemodynamic measurements among the three groups. The incidence of hypotension and the required dose of ephedrine were lower in HES group (p=0.008). There was no significant difference in umbilical cord blood PH or Apgar scores among the intervention groups. Preloading with HES is more effective than crystalloids in preventing hypotension after spinal anesthesia without leading to a significant difference in Apgar score and umblical cord blood pH.

Hemodynamic stability and blood loss reduction are subjects to further consideration in patients undergoing percutaneous nephrolithotomy (PNCL). This study compared the preference of spinal anaesthesia (SA) or general anaesthesia (GA) in respect to mentioned concerns.Patients and In this randomized clinical trial, 59 patients who underwent PCNL divided into SA and GA groups. 15-20 mg from intra-thecal bupivacaine 0.5%, and premedication of 0.01-0.02 mg from midazolam, were given to patients in SA group (n = 29). Patients in GA group (n = 30) received premedication of 1-2 µg/kg from fentanyl and 0.01-0.02 mg/kg from midazolam, and intravenously anaesthetized with 100 µg/kg/min of propofol and 0.5 mg/kg of atracurium, given by continuous infusion and N2O/O2 50%. Mean arterial pressure (MAP) and heart rate were recorded intra-operatively and during recovery. MAP and heart rate show no significant differences at designated time points between two groups (P > 0.05). Surgery time, anesthesia time, bleeding volume, and analgesic intake were significantly reduced in SA group (P < 0.05). It seems that, in patients undergoing PNCL, SA is as effective and safe as GA. Patients who undergo PNCL under SA require smaller amounts of analgesic dose and show hemodynamic stability during surgery and recovery time. Also, SA technique provides decreased blood loss and shortened surgery as well as anesthesia times compared to GA..

Hemodynamic stability and blood loss reduction are subjects to further consideration in patients undergoing percutaneous nephrolithotomy (PNCL).. This study compared the preference of spinal anaesthesia (SA) or general anaesthesia (GA) in respect to mentioned concerns..Patients and In this randomized clinical trial, 59 patients who underwent PCNL divided into SA and GA groups. 15-20 mg from intra-thecal bupivacaine 0.5%, and premedication of 0.01-0.02 mg from midazolam, were given to patients in SA group (n = 29). Patients in GA group (n = 30) received premedication of 1-2 µg/kg from fentanyl and 0.01-0.02 mg/kg from midazolam, and intravenously anaesthetized with 100 µg/kg/min of propofol and 0.5 mg/kg of atracurium, given by continuous infusion and N2O/O2 50%. Mean arterial pressure (MAP) and heart rate were recorded intra-operatively and during recovery.. MAP and heart rate show no significant differences at designated time points between two groups (P > 0.05). Surgery time, anesthesia time, bleeding volume, and analgesic intake were significantly reduced in SA group (P < 0.05).. It seems that, in patients undergoing PNCL, SA is as effective and safe as GA. Patients who undergo PNCL under SA require smaller amounts of analgesic dose and show hemodynamic stability during surgery and recovery time. Also, SA technique provides decreased blood loss and shortened surgery as well as anesthesia times compared to GA..