فصلنامه آنستزیولوژی و مراقبتهای ویژه ایران
سال سی و هفتم شماره 4 (پیاپی 92، زمستان 1394)

Nausea and vomiting after surgery takes place in20-30% of patients and these two together are the second most common complains of patients after surgery. We perform this study hoping that use of proper intravascular fluids has a role in decreasing nausea and vomiting after surgery.
This clinical trial study was performed on 60 female patients who aged between 20 to 60 years old and with score 1 and 2 of ASA who underwent diagnostic laparoscopy under general anesthesia. Fluids were injected 15 minutes before general anesthesia in all patients. We used 10ml/kg of ringer lactate in crystalloid group, and 10m l/kg voluven in colloid group. Incidence frequency of nausea and vomiting during recovery was recorded and collected in special formes of this study.
According to p-value= 0.121 in Chi-square test which is more than 0.05, nausea variant was not significantly different in two groups. The two study groups were assessed and compared about vomiting incidence which according to p-value=0.136 they did not have any statically significant difference.
In this study we used from voluven to increase intravascular volume which had no statically significant difference in incidence of nausea and vomiting comparing to other group which we used ringer lactate in it.

Regional anesthesia today is the method of choice for the disease in a surgery. In keeping with this type of anesthesia, appropriate sedation reduced patient fear and anxiety and raises the quality of Regional anesthesia. For several years, various methods of Sedation have been used that the substantial progress has made over time. In this study, we have tried to satisfy surgeons and patients during surgery in patients who had received sedation with the Patient Control Sedation (PCS) method.
In this study, seventy-two patients with ASA class I and II selected who were volunteers for surgery with cataract (feco). Patients were divided into 2 groups of 36 people randomly. First, for each patient, an IV was inserted and 500 cc of normal saline was injected. Propofol at doses of 20 µg/kg/min and Remifentanil at doses 0.02 µg/kg/min administered to patient that start sedation was 5 min before local injection. In case of request of the patient as Bolus with five minutes lock out time, sedation drug included 0.15 µg/kg Remifentanil and 50 µg/kg Propofol injected. According to the training that was given before operation, in separate group if the patient felt pain during the surgery with raising left hand to receive Remifentanil and if felt anxiety with raising right hand received Propofol. Patients in the combination group either pain or anxiety with hands up anyone who received the drug at the same time. Therefore, by failing to inform the patient of the injection, single blind study was conducted.
Satisfaction of the surgeon, anesthesia technicians and patients in both methods were non-significant differences in the separate group, the number of requests for analgesic was 2 times more than the number of requesting for sedative. In terms of the number of patients requesting drug and the number of applicants, there was no significant differences between two groups. Although the amount of Remifentanil used in the two groups showed non-significant difference, in the combination group total dose of Propofol was significantly higher than separate group
By taking fewer amounts of analgesic and same sedative in both groups, separate groups as the combination group could be an effective way. In terms of the surgeon, patient satisfaction, anesthesia, technicians, and security techniques used in both groups, there was no significant difference.

Dexmedetomidine has been used differently as a component ofpain management and resulted in various outcomes. Ketamine was effective in pain relief of opioid addicts. In this study we compared low bolus ketamine and dexmedetomidine injection on pain outcomes of addict patients undergoing laparoscopic nephrectomy.
One hundred and seven addict patients candidate for laparoscopicnephrectomywereenrolled. They should havehad daily opioid consumption for at least 6 weeks. They were randomly allocated to receive ketamine (group K) or dexmedetomidine(group D). Both groups received nearly the same anesthetic protocol with remifentanil infusion. Intra-operative remifentanil requirement (primary outcome), post-operative opioid consumption and opioid complications (secondary outcomes) were compared between groups.
Opioid requirement was significantly different between groups. Intraoperative remifentanil consumption in group K was 496±34 µg while 580±108 µg in group D (P Intra and postoperative opioid consumption was statistically significantly reduced by ketamine compared to dexmedetomidine.

Hemodynamic changes during cesarean section surgery are important issues that can lead to serious morbidities and delayed recovery. The intravenous laser blood irradiation is a biological therapeutic methods that seems suitable to intervene in the system of basis regulation by a connection to the CNS and the endocrine glandes and the other systemes.
The aim of the study was to evaluate the effects of intravenous laser irradiation of blood (ILIB) on system hemodynamics in elective cesarean section surgery.
In this randomized clinical trial 70 patients candidate for elective cesarean section were divided randomly into two groups of control and laser. Both groups had a similar type of surgery and the same technique of spinal anesthesia. Patients in laser group were conducted by Trans cutaneous Blood Laser Irradiation ( Trans-cut BLI) through the cubital venous line by a portable laser probe designed by Canadian optic &laser center with GaALInP: 650nm for 10 minute at the end of the surgery while the control group received placebo laser immediately after incision suture.The changes in cardiac rhythm, hemodynamic parameters including heart rate, blood pressure, SpO2 were measured before and after the laser irradiation on 0, 15 ,30,45, and 60 minutes.
This study showed that there was no deterioration effect on hemodynamic Parameters such as blood pressure, heart rate and Spo2 saturation.
Conclusions and clinical relevance: This study showed that transcutaneous blood laser irradiation is a safe method without any side effect to add anesthetic procedure.There was no deterioration effect on hemodynamic parameters.

Venous thrombosis is the result of a blood clot in a vein wall inflammatory response followed the thrombosis occurs in the deep veins may cause pulmonary embolism, especially if they feel threatened and will require more attention.
To determine the prevalence of factors, including smoking, surgery, taking certain medications in the disease as a risk factor is present.
The study is a case study includes 71 patients due to inflammation of one or both lower extremity deep venous embolism diagnosis Trmbv to visit hospitals or specialized clinics were tested after testing and the final diagnosis often includes Doppler vascular and D-dimer test was. Memo records in the questionnaire and the data preparation was estimated results through the application spss win.
The prevalence of smokers in this study 31 patients (43.7%) and non-smokers, 40 (53.3%), respectively. According to the results obtained in this study failed intervention alone is seen smoking and other factors also can not be listed as serious and decisive factor in creating effective Mbvlyzm Trmbv then other factors such as genetic blood coagulation disorders should be investigated be.

Laryngoscopy and intubation during general anesthesia is a painful stimulation that causes hypertension and tachycardia. Hypertension and tachycardia may induce arrhythmias and myocardial infarction in an ischemic heart. The aim of this study was to compare the hemodynamic effects of tracheal intubation through using the Macintosh and Miller laryngoscopy blades.
This study is a clinical trial performed at the University of Hormoozgan Medical Sciences during 2013-2015. A total of 203 patients candidates for elective were randomly divided into Macintosh laryngoscope blade (n=103) and Miller laryngoscope blade (n=100) groups. Hemodynamic parameters were measured at the baseline, after induction and before intubation, immediately after intubation and minutes of one, three and five after intubation measure were recorded. After recording patient data, statistical data analysis was performed using SPSS version 19. ChiSquare and T-Test and Repeated ANOVA statistical tests were used. The values of P The demographic variables were similar. Mallampati scores and laryngoscopy grades were similar in both groups. The duration of laryngoscopy in Macintosh was significantly shorter than Miller (P = 0.001). The mean systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and heart rate only at times; immediately, one and three minutes after intubation in Miller's group was significantly more than the Macintosh group.
Because the time for laryngoscopy and hemodynamic changes with a Miller blade was less than the Macintosh blade we concluded that the Miller blade showed a better profile and performance.

Anxiety is the most common physiological and psychological response to pain in burn patients, which can affect their physical and mental performance. This study aimed to determine the association between pain and anxiety of death in burn patients was performed.
This cross-sectional study in the burn ward of Imam Khomeini University of Medical Sciences, Kermanshah. 103 patients in burn units for women and men were randomly selected and examined. The data from questionnaires blesky (1999) the level of death anxiety and anxiety in burn patients and a numerical rating scale were used to measure pain. The data collected by statistical software SPSS 18, Spearman correlation coefficient test and regression test at 5% level were analyzed.
According to the study, the severity of acute pain and the anxiety of death in the first and second weeks there is a significant relationship, There is also the third and fourth week. The results predict death anxiety by pain, the model can explain 54/6 percent of the variance in pain intensity was a significant predictor for death anxiety.
The results of this study can be concluded that the treatment and care of burn patients Drdhad control should emphasize the anxiety of death in these patients.

STEMI with primary treatment as angioplasty , thrombolysis, aspirin and statins have decreased. However, it still can be considered a significant cause of mortality in STEMI. The patient was a 82-year-old man RLQ pain and diagnose incarsereted inguinal hernia. The patient had a history of uncontrolled diabete mellitus and cardiovascularstatus was unknown.The ECG 12 leads to surgery, STEMI was diagnosed and admitted in CCU. Heparin, aspirin and atorvastatin began for him. 24 hours later, he was transferred to the operating room. Because pulmonary disease and aging was decided to epidural anesthesia. The operation was successful and the patient was discharged after 8 days. Angiography was not performed due to lack of patient satisfaction.