فصلنامه بیهوشی و درد
سال ششم شماره 2 (تابستان 1394)

Aim and Arterial tourniquets are used widely for extremity orthopedic surgeries with regional or general anesthesia to reduce blood loss، but the harmful effect of ischemia and reperfusion is not clear yet. In this clinical trial 40 patients scheduled for lower extremity surgery with pneumatic tourniquet were randomized into 2 groups: a remote ischemic preconditioning (RIP group، n=20)، in which patients received three “5 minutes” cycles of ischemia، alternating with 5 minutes of reperfusion before extended use of tourniquet and a control group (n=19). Hemodynamic variables prior to inflation of tourniquet and every 30 minutes during the surgery and 10 minutes after tourniquet deflation and arterial blood gas sample prior to and after surgery were compared between groups. In comparison with the baseline values، systemic blood pressure was increased in all patients، however in control group it was significantly more than baseline values and also higher than the RIP group (p=0. 03 and p=0. 032 respectively). There was no significant change in heart rate and O2 saturation and Spontaneous respiratory rate between the groups and in comparison with baseline values. Tourniquet application in limb surgery can cause hemodynamic changes and remote ischemic preconditioning can not attenuate these effects such as variation of blood pressure، heart rate and changes of respiatory rate and arterial O2 saturation. However RIP can reduce inceases in systolic blood pressure and acidosis.

Aim and Electroconvulsive therapy(ECT) is one of the most effective and prompt therapies for severe psychotic issues. This study aims to distinguish the impact of age, disease and medications on the seizure caused by ECT. Methods and Materials: 123 patients were studied and categorized according to their age, psychotic disorder and medications (anti-psychotics, anti-depressive or both of them). The correlation of these variants with seizure duration were discussed in every session of ECT.The seizure duration was recorded based on clinical convulsion and EEG parameters. The failure or success of ECT was evaluated by seizure time measurement to be less or greater than 20 sec, respectively. There was no significant difference observed between men and women in regards to the average seizure duration in different sessions (6 sessions) (P=0.25).There was either no significant difference observed in seizure duration in various sessions between patients under and above 40 years of ag (P=0.45). Again no significant difference was seen in seizure duration among patients with psychotic and mood disorders or between patients using anti-psychotic or anti- psychotic and anti- depressant drugs for therapy, respectively (P=0.38 and P=0.14). Accurate knowledge about patients who are candidate to receive Electroconvulsive Therapy is very important. Type of psychologic disorder, type of drug protocol and the number of sessions of ECT, all are the factors which should be considered in every ECT procedure.

Aim and The alpha-2 agonist dexmedetomidine, a potent sedative and analgesic by its central sympatholytic action, promotes hemodynamic stability. However it is unknown whether the recovery from anesthesia would be delayed with continuous infusion of dexmedetomidine because of its sedative effect. The aim of present study is to assess the effect of intravenous dexmedetomidine on postoperative recovery in elective posterior spinal fusion surgery. Forty patients were randomly divided into two equal groups; group R (remifentanil) received fentanyl 2 μg/kg + remifentanil 0.1 μg/kg and group D (dexmedetomidine) recieved fentanyl 2 μg/kg + dexmedetomidine 0.1 μg/kg over 10 min as premedication prior to induction. All of them received propofol 2mg/kg and Cis-Atracurium 0.2mg/kg for induction and then group R received remifentanil 0.1 μg/kg/min and group D had dexmedetomidine 0.1 μg/kg/h, both with propofol 100 μg/kg/min and Atracurium as intravenous infusion. Postoperative recovery was assessed by Aldrete’s score just at extubation, and every 10 min thereafter in recovery room. There was no significant difference in hemodynamic variables and the trend of Aldrete’s score between two groups. Aldrete’s score in group R was significantly higher than group D in the first evaluation in recovery room and 10 min after that (p<0.05). There was no significant delay in recovery time of group D patients. Sedative consumption and postoperative analgesic demand were insignificantly lower in group D. Dexmedetomidine maintains hemodynamic stability without significant delay in recovery time after general anesthesia in comparison with remifentanil. This property can make it as an alternative option for opioid medications.

Aim and Headache is one of the most common complaints of patients and it has different causes. Migraine and Tension headaches are among the most common types of headache. Depression, sleep problems and low resilience are much more seen in patients with migraine and tension-type headaches. Methods and Materials: This is a case-control study; the studied sample consists of 44 patients with tensiontype headache diagnosis, and 42 patients with migraine headache selected among those referred to Headache clinics and clinics in Tabriz University of Medical Sciences in Iran. Also 43 healthy individuals matched with the other two groups according to age, gender and educational level were included.The Beck depression scale, Pittsburgh sleep quality index and Connor resilience scale were used. Data were analyzed using multivariable analysis of variance (MANOVA). There were significant differences in depression, sleep quality, and resilience mean scores between both groups of patients (migraine and tension-type headaches) with healthy individuals (P< 0.01). Mean depression score and sleep quality in patients with migraine headache were higher than the other two groups (2/41 ± 18/80 for depression and 3/30 ± 12/33 for sleep quality). Mean resilience in patients with migraine headache was lower than the other group of patients and the control group (3/04 ± 35/80). Considering significant correlation between migraine and tension type headache (TTH) with depression, sleep problems and low resilience evaluation of psychological aspect of these patients is necessary for quick treatment.

Aims and One of the problems that patients with coronary artery bypass surgery encounter is pain that can have undesirable consequences. This research aims to investigate the effects of foot reflexology massage on pain in patients undergoing coronary artery bypass surgery. This clinical trial was performed on 52 patients after coronary artery bypass surgery. Data collection instruments included a demographic questionnaire, and numeric rating scale for pain score. The patients were randomly assigned into two groups of experimental and control groups. Foot reflexology was performed for 30 min in the experimental group. Pain levels were measured before and after intervention. The control group did not receive any intervention and pain was measured twice within 30 minutes. The mean pain score was not statistically different between the groups before intervention (P=0.228). However the difference in pain scores between the two groups after intervention was statistically significant (P=0.004).Patients in the intervention group had significantly decreased pain after the foot reflexology massage (P=0.000). This study showed that foot reflexology massage can be used as an effective, safe and cost-effective nursing intervention in reducing pain in patients undergoing coronary artery bypass surgery Keyword: coronary artery bypass, pain, foot reflexology massage Corresponding Author: Fatemeh Rigi, Master of science in Nursing, Faculty member of Nursing & Midwifery College of Iranshar University Of Medical Science, Iranshahr.

Aims and Uncontrolled postoperative pain may increase patients’ mortality and morbidity. One way to control postoperative pain is by using narcotics with patient controlled intravenous analgesia (PCIA) method. Some investigators try to use many drugs in combination with narcotics in order to come over the side effects and tolerance to them in special groups of patients. We tried to compare different doses of Ketamine in combination with Morphine and Midazolam as PCIA for control of postoperative pain in patients with history of opioid addiction. In a double blind clinical trial, 120 patients undergoing lower limb orthopedic surgery with history of opioid consumption, were randomized to receive PCIA of Morphine 20 mg + Midazolam 10mg± Ketamine 50 or 100 mg daily, for 48h after surgery. Pain scores as VAS and sedative level as Ramsay scale and other possible side effects such as nausea and vomiting, and any rescue doses of analgesics were evaluated at 2, 6,24,36,48 hours after initiation of PCIA. Considering pain acuity, groups with PCIA containing Ketamine in addition to Morphine and Midazolam, showed significant decrease in pain score. However, there was no difference in sedation score between the groups. There was a significant decrease in the number of rescue doses of analgesics in groups with PCIA containing Ketamine compared with the other group. There was no difference in any evaluation between the groups with PCIA containing 50 mg or 100mg Ketamine. A better control of pain was achieved in opioid addict patients with the addition of Ketamin either 50 or 100 mg to PCIA pump compared to the control group with PCIA containing Midazolam and Morphine.

Aims and Pain after surgery is a major problem for patients with fractures of the femur or hip. We studied the effect of Bupivacaine at a concentration of 0.2% and 0.3% in fascia iliac block on postoperative pain. The study was a Randomized double-blinded clinical trial. A total of 48 patients who had femur or hip fracture underwent fasia iliac block. Patients were randomly assigned to two groups receiving Bupivacaine at a concentration of 0.2% and 0.3%, respectively. Then the two groups were compared in terms of pain and satisfaction with pain control and intensity of motor block. Postoperative pain score in 0.3% group was significantly lower than 0.2%(p< 0.001) while the patient satisfaction of pain control and intensity of motor block were significantly higher in Group 0.2% (p=0.04). Onset of analgesia had no significant difference between the two groups. Bupivacaine with concentration of 0.3% in fascia iliac block could further decrease the pain score after hip or femoral fracture surgery; however patient satisfaction with pain control and intensity of motor block were higher with 0.2. % concentration of Bupivacaine.

Aims and The aim of the present study is prediction of depression in elderly patients with rheumatoid arthritis based on perception of pain and quality of sleep and it examines the mediating role of pain catastrophizing as a model. Few investigations have been reported regarding this subject. Also some limited results are still uncertain. Methods and materials: Research design was Correlation and study population including all elderly patients with rheumatoid arthritis in Hafez rheumatology clinic at Shiraz. For this purpose, 150 patients participated in the study via convenient sampling. Research Tools included Geriatric Depression Scale, the McGill pain questionnaire, the Pittsburgh Sleep Quality Index and Pain Catastrophizing Scale. In order to analyze the data, the path analysis by AMOS and the stepwise multiple regressions by SPSS were used. The results indicated that perception of pain and quality of sleep significantly predict pain catastrophizing and depression. The proposed model shows that perception of pain and quality of sleep with mediating role of pain catastrophizing can significantly predict depression. The finding of this study showed that we can prevent depression by special therapies such as: Cognitive- Behavior Therapy and Acceptance- Commitment Therapy for improving quality of sleep, reducing pain and controlling catastrophizing thought in these patients.

Aim and Beta thalassemia major is a hematologic autosomal recessive syndrome. Many anesthetic problems were noted in these patients like difficult intubation, coagulopathies and cardiomyopathies. In this case report, we describe a patient with Beta thalassemia major and intra cranial lipoma. Case report: A 36 year old woman, known case of Beta thalassemia major, was candidate for elective craniotomy for intracranial lipoma. She had marked deformities in maxillofacial bones and it caused difficult intubation. For this reason intubation was performed with fiber optic laryngoscope. Beta thalassemia major patients have difficult air way because of hypertrophic bone marrow due to marked facial and mandibular bone deformities and we must consider these problems for anesthesia management.