فصلنامه آنستزیولوژی و مراقبتهای ویژه ایران
سال چهل و یکم شماره 3 (پیاپی 107، پاییز 1398)

Postoperative nausea and vomiting (PONV) is an outcome that is very important to patients; patients often rate PONV worse than postoperative pain. Etomidate is the choice drug that is used to induce anesthesia in high risk and major vascular surgeries. Major side effects of etomidate is PONV and suppression of hypophysis pituitary adrenal axis. Current study was designed to evaluate the effect of the ondansetron and aprepitant vs. dexamethasone and with metoclopramide on PONV in patients underwent major vascular surgeries.

120 patients enrolled in this study and randomly divided into 2 groups. Group 1 (DM) received dexamethasone 8 mg and 10 mg metoclopramide and group 2 (OA) recieved aprepitant 80 mg and ondansetron 4 mg. the rate of PONV was compared between groups.

There were 26 and 12 cases with nausea in the (DM) and (OA) groups, respectively, over the first 3 hours postoperatively. Also, 4 patients in the (DM) group experienced vomiting, while no patient in the (OA) group seen with vomiting. There were statistically meaningful differences between two groups in the means of nausea and vomiting (p=0.031 & 0.043).

use of Ondansetron-Aprepitant combination is an efficient antiemetic protocol to reduce the rate of PONV in patients receiving etomidate for major surgeries. Potentially, it is more potent in prevention of vomiting than nausea. ondansetron and aprepitant are more appropriate in the prevention of the PONV comparing with dexamethasone and metoclopramid

Breast pain, called as Mastalgia, is one of the most common womens’ concern which led to seek for health and wellness counselors. In the many of cases the mastalgia is caused by mood disorders, which lead to unnecessary diagnostic tests and eventually increasing health burden. Prevention and treatment of mood disorders may effectively decrease the mastalgia in a non-surgical manner. In the current study we have investigated the effect of treating mood disorders in the elimination of mastalgia women with breast pain.

This cross-sectional study was performed on 255 women aged 20 to 50 years with breast pain referred to the breast clinic of Imam Hossein Hospital in Tehran March to July 2019. The demographic characteristics such as age, occupation, number of children and mood characteristics such as anxiety, depression and sleep disorders were assessed by a home made questionnaire. Moreover, the patients were received medications for two weeks based on the type of disorder. Thereafter, the presence of mastalgia were checked by direct interview. Statistical analysis was performed by SPSS software (version 21). The p value less than 0.05 was considered significant.

The highest and lowest recovery rate were seen in the Oxazepam and Fluoxetine, respectively. There was no significant correlation between the drug type and recovery rate (p-value = 0.84). The recovery percentage in all groups were relatively similar. Totally 6.69 percent of patients were treated.

In general, it can be concluded that medications according to the type of mood disorder in patients with mastalgia can be effective, so the inclusion of medications to reduce anxiety, depression and obsession should be a part of the treatment protocol in these patients.

Traffic accidents are one of the most important human health hazards worldwide and the second leading cause of death in Iran.In order to control and reduce the number of accidents and traffic accidents, we must have accurate information about them. The purpose of this study was to determine the epidemiological outcome of traffic accidents in pre-hospital emergency.

This retrospective cross-sectional study that was done in 2016 in Bojnourd. Data collected from 2870 patient by check List of demographic and variables relating to accidents from the trauma center and hospital Imam Ali from 2012 to 2016. SPSS 20 software was used for data analysis.

Study shows that %74.2 were male and other were female. Accidents and injuries were more prevalent in 18-24 years’ age group (%25.2). Most of the injuries were motorcyclists (% 37.5). Most of the accidents occurred in the summer 10439(36.1%) and in Shahrivar and the lowest in Azar and Dey.

The results of the study showed that most of the Injured of traffic accidents are young men and mainly in car and motorcycle riders and most of the traffic accidents happen in summer, Therefore, it is suggested that in the necessary planning in order to reduce the occurrence of traffic accidents, more attention should be paid to youth age groups and high-risk months

The study addressed the comparable effects of premedication with dexmedetomidine, remifentanil and labetalol before electroconvulsive therapy (ECT) on hemodynamic responses and seizure duration in psychotic patients.

A double-blinded trial recruited four randomized groups of patients undergoing ECT (N=144): the DEX, LAB, REM, and NS, receiving 0.5 μg/kg dexmedetomidine and 0.2 mg/kg labetalol, 1 μg/kg remifentanil, and 20 ml normal saline, respectively, whose mean arterial pressure (MAP), HR, and SPO2 were recorded every 5 minutes until the patient was transferred to the department. Besides, the recovery time, seizure duration, and satisfaction were recorded, afterward followed by SPSS [20] data analysis .

BP/HR were lower in the DEX (p=0.0001) with the longest recovery time (p=0.0001), while the time was lower in the REM. The first group showed shorter seizure duration, lower selected

   Dexmedetomidine   with   high   patient   satisfaction   and   no   need   for   hemodynamic   abnormalities requiring treatment can be a viable option in patients undergoing electroconvulsive therapy, although  it  may  slightly  increase  recovery  time,  and  remifentanil  is  also  a  good  option  for  induction  of  ECT.  Patients'  satisfaction  with  it  is  second  only  to  dexmedetomidine,  and  our  study  did  not  produce  a  hemodynamic  disorder  requiring  treatment.  Therefore,  we  believe  that  either  of  these  drugs  may  be  a  good option for use in ECT, depending on the diagnosis of the anesthesiologist.energy (p=0.0001), and the highest satisfaction (p=0.0001)

This study was conducted to benefit from the experiences and achievements of martial health over eight years of sacred defense and to use it as a valid, qualitative, educational, and operational document in health units, martial arts schools, and other target groups. This research is a way to retain martial arts practice and experiences to teach future learners about difficult and critical situations and is an important tool to critique problems and provide solutions to them, prevent and minimize injuries, injuries and Emergency casualties, implementation of the repeated emphasis of the Imam and the Supreme Leader in recording sacred defense incidents and preventing them from being forgotten. The comprehensiveness of this study in providing martial health practice in the field of health has not been observed in case studies.

The research method is a mixture of library study and daily journal notes written by Dr. Evaz Heydarpour Shahrezai during the events. Accurate recording of details of how events occur beyond imagination, cause of events, deficiencies, problems, disasters, unceasing efforts to deal with epidemics and contagious diseases, time, place, and names of persons who are the primary contributors to this work, wonderful and worthwhile. In addition, the researcher used field research through oral questioning and interviewing to combine data and recordings, which incorporated the 'associative' element, and provided an important and comprehensive part of martial health practice with careful, detailed, and credible retention has presented the events.

The onset of the imposed war caused disruption of people's lives and caused numerous health problems in the region. As a result, huge numbers of people in the war-torn areas of Khorramshahr, Abadan, Ahwaz, Dezful, Susangerd, Shoosh and rural areas around these cities and people from Ilam and Kermanshah have been forced to leave their homes and settlements, mainly in related provinces and elsewhere. In such a critical situation, the risk of epidemics and infectious diseases was high. In order to prevent the risk of epidemic outbreaks and diseases with health preference, the IRGC began to develop practical guidelines based on scientific principles of training and implementation in military units and providing health services. Behind the fronts, including: Pre-deployment warrior health examination, health education and vaccination against contagious diseases, creating a healthy environment, monitoring the provision and supply of healthy food and water and many other services. In addition to ensuring the military's effectiveness, it can prevent heat-shock and epidemics and communicable diseases.

During the eight years of the imposed war, the field of martial health played an effective role in maintaining and protecting the warriors' health. The courteous operation of this unit has prevented any outbreaks and spread of disease across the front.

Atelectasis is a common event among multiple trauma patients which different approaches are being used for its management such as positive pressure ventilation, chest physiotherapy, coughing and early ambulation. Although using fiberoptic bronchoscope for irrigation and drainage of secretions and mucus plugs is well known, it is not used commonly. In this report we represent a case of pulmonary atelectasis following multiple trauma who dramatically responded to therapeutic fiberoptic bronchoscopy in such a short period.

Vocal cord paralysis following surgery especially after 4th ventricle and brain stem surgeries is a great concern for anesthesiologist and intensivist. On time tracheostomy has a substantial role in their management and reanimation. Here we report postoperative bilateral vocal cord paralysis in a child undergoing 4th ventricle tumor surgery.