فصلنامه آنستزیولوژی و مراقبتهای ویژه ایران
سال چهل و یکم شماره 2 (پیاپی 106، تابستان 1398)

Transurethral Resection of Bladder Tumor surgery is often managed by Spinal Anesthesia. This procedure sometimes due to direct electrical stimulation of Adductor muscles especially in lateral bladder masses may cause complications such as bladder perforation. In these cases other supplementary methods like peripheral nerve blocks may be needed.

124 patients enrolled in this prospective descriptive study to assess the incidence of adductor muscles spasm and bladder wall perforation. All the patients with bladder masses who needed TURT surgery in Shohada - e -Tajrish hospital participated in this study.

Only 8 patients (6/3%) of 124 participants who received spinal anesthesia with obturator nerve block had adductor muscles contraction and in 79% (1 patient) bladder perforation occurred.

In comparison to other studies with success rate of 89 to 100 percent, our study with conventional blind method showed 93/7% proper obturator nerve block. Anesthesiologist’s expertise and skillfulness play an important role in this matter. The proper use of adjunct instruments such as nerve locator and ultrasonography can improve success rate and decrease complications.

Proper analgesia after cesarean section helps mothers feel more comfortable and increases the mobility and ability of the mother to better care than the newborn. The purpose of this study was to compare the effect of subcutaneous infiltration of bupivacaine and diluted subcutaneous ketamine on post-operative pain after cesarean section of general anesthesia.

In this double-blind randomized clinical trial study, 60 mothers who were candidates for elective cesarean section under general anesthesia were enrolled. 30 mothers were randomly assigned to group (A) undergoing subcutaneous injection of 4 cc bupivacaine diluted to 10 cc and 30 mothers in group (B) who underwent subcutaneous injection of 50 mg of ketamine diluted to 10 cc, was injected subcutaneously at the site of the cesarean section at the end of the operation. The pain score of 1, 6 and 12 hours after surgery was compared in two groups by VAS. In the event of the VAS more than or equal to 5 at any time, diclofenac 100 mg suppositories was given in the absence of response, was prescribed intravenous pethidine50mg. The dose and frequency of receiving suppositories and drug dose were counted and recored in a pre-determined questionnaire. Data were analyzed by SPSS software version 20.

Side effects in two groups including nausea, vomit, Delusion, shiver and vertigo were not significant in the first 12 hours in both groups. The mean VAS at 1, 6 and 12 hours postoperatively was significantly lower in the ketamine group than in the bupivacaine group. Mean VAS scores of patients during the first 12 hours in the ketamin group was 1.00± 0.69 and in the bupivacaine group was 2.03± 1.18 which was significant with P-value = 0.00. The mean duration of analgesia in the diluted ketamine group was significantly more than the diluted bupivacaine group. The mean dose of diclofenac suppository in both bupivacaine and ketamine groups was2.83± 0.91 and2.20± 0.76 respectively and p-value = 0.005.the rete of intake of pain reliever in the ketamine recipient group was lower than the group receiving bupivacaine.

Independent variables were similar in both groups p-value<0/05. Ketamine reduced pain at 1,6,12 hours after surgery. Nausea, vomit, Delusion, shiver and vertigo are similar in both groups. Subcutaneous injection of diluted ketamine is recommended in elective cesarean section.

Upper gastrointestinal endoscopy is a widely used method for the diagnosis and treatment of upper gastrointestinal diseases, but it is necessary to identify patients with less complicated drugs. The aim of this study was to compare the sedative effect of two medicinal compounds midazolam-fentanyl with midazolam-propofol in patients with upper gastrointestinal endoscopy .

This study was performed on 147 patients with upper gastrointestinal endoscopy (70 in midazolam-fentanyl group and 77 in midazolam-propofol group). Patients were randomly divided into two groups. The target drugs were prescribed and vital signs and sedation were recorded. Chi-square and Mann-Whitney tests were used to compare the data .

The results of the present study showed that the frequency of deeper sedation with higher satisfaction in the midazolam / propofol group was significantly higher than the midazolam / fentanyl group but on the other hand, the frequency of apnea in the midazolam / propofol group was more than the other group .

Given the prevalence of endoscopy in Iran and the need for safe sedation for patients with higher efficacy, it is suggested that midazolam / propofol combination be used for patient sedation and should not be used only in patients with poor prognosis for apnea. This method was used to sedate patients .

This study was conducted to benefit and utilize the scientific and experimental achievements of military medicine during eight years of holy defense. The practical purpose of this study is to accurately record the performance and experiences of military medicine practitioners for valid reference. The comprehensiveness of this study in presenting military medicine practice in the field of health has not been observed in case studies.

The research method is a combination of library study, field research through oral questioning and interviewing, and the use of diary notes written in the course of events. Accurate recording of events by imagination, recording dates and names, observing time sequences, medical scheduling in medical centers from the beginning to the end of the sacred defense are the characteristics and contents of these notes which are considered as a rich source of value.

The pre-war form of health was officially present in army units, but military medicine was an emerging entity that emerged from the heart of sacred defense. The active involvement of the health sector in the sacred defense became a source of enormous impact. Holding meetings and conferences, organizing specialist forces, setting up training centers and specialized scientific committees, establishing and promoting field hospitals, developing dozens of effective prevention and treatment protocols and guidelines, unremitting efforts to realize a resilient economy and maintain human capital are among the achievements of military medicine. Although, during the decades leading up to the imposed war, medical schools were not properly trained on war-related medical issues, the combat physician was able to properly and scientifically deal with war-related health issues and the emerging issue of defense against chemical warfare in Iran. Supply or logistics of blood and all kinds of blood products were among the duties that the organization was well placed to perform.

The deliberate practice of military medicine in supervising the provision and supply of healthy and healthy food and water prevented any epidemics and general outbreaks of disease on the fronts. With the establishment of a specialized scientific committee, military medicine was able to develop the required comprehensive scientific and scientific style sheets and protocols based on the prevention and treatment of illnesses and the treatment of injuries and injuries and with the

Psychiatric symptoms are common in many cancer patients, especially in those with advanced cancer. Several factors including stress of cancer diagnosis, the effect of central nervous system (CNS) tumors, neurotoxicity from immune reaction to non-CNS tumors and adverse effects of cancer chemotherapy or radiotherapy may contribute to psychiatric comorbidity. Psychiatric symptoms are spectrum from mild symptoms like fatigue to sever disorders like anxiety disorder or mood disorders. Sometimes psychological adverse effect of treatment like anger or anxiety or worry are more severe than medical adverse effects like nausea and hair loss. Most common distress in these patients is hopelessness that lead to decrease coping strategies. Powerful coping strategies can help patients to tolerance well. Because several specialists contribute in treatment of end stage patients, so increase knowledge of treatment team about psychological status and correct empathy can help to improve patients’ general health.

The study addressed the comparative hemodynamic and analgesic effects of subcutaneous dexmedetomidine versus marcaine 0.5% on herniorrhaphy scheduled patients, as well as postoperative pain management.

This double-blind trial enrolled three groups of patients (N=120) scheduled for herniorrhaphy at Valiasr Hospital (Arak, Iran): (i) MAR-DEX group, receiving marcaine 0.5% (5 mg) + dexmedetomidine (1 mcg/kg), (ii) MAR group, marcaine 0.5% (5 mg), and (iii) PBO group, placebo, subcutaneously. We measured vital signs (BP/HR/SaO2), as well as pain scores (using the visual analog scale) at recovery and certain time points (1, 2, 4, 6, 12, 24 hrs post-op), and the overall opioid administered postoperatively and side effects. This was afterward followed by an SPSS (20) analysis.

Lower pain was revealed in the MAR-DEX group and higher one in the PBO group (p = 0.0001), whereas the lowest opioid use was observed in the MAR-DEX group (p = 0.0001).

Adding dexmedetomidine had benefits of relieving pain and reducing opioid use without any side effects.

Todays, one of the most common problems in selective surgery is excessive blood ordering and requirement. MSBOS is a program designed to improve the proportion of requests for blood transfusions in selective surgery that has received much attention in recent years.

In a retrospective study,834 records of patients over 18 years of age who underwent 15 elective surgeries at Shahid Madani Hospital in Karaj in 1396 was reviewed and 3 indicators, crossmatch to transfusion ratio (C/T ratio), probability of blood administration (T%) and blood administration index (TI) were extracted.The surgeries were in 3 categories : elective orthopedic surgeries (fracture of femur, humerus, calf, forearm and total knee joint replacement), elective neurosurgeries (lumbar and neck fusion, chronic subdural hematoma and Brain Tumor surgeries) and elective general surgeries (Intestinal resection anastomosis, open cholecystectomy, laparoscopic cholecystectomy , thyroidectomy, bronchoscopy and skin graft in burned patients).

The crossmatched to transfusion ratio (C/T ratio) was 3.97 in all surgeries and less than 2.5 in femoral fracture, chronic subdural hematoma, brain tumor, and skin graft surgeries. In these surgeries the TI index was greater than 0.5 and T% index was more than 30%.

According to the results of this study and similar researches, the preparation of MSBOS (maximum surgical blood ordering schedule) tables as a model for requesting blood can lead to reduction in amount of blood ordering and crossmatch requirement.