فهرست مطالب ریحانک طلاکوب

The most common method of anesthesia in Cesarean section is spinal anesthesia (SA). Post-Dural puncture headache (PDPH) is one of the complications of SA. The aim of this study was to evaluate the effect of intravenous administration of atropine and neostigmine in prevention of PDPH following Cesarean section.

This study was performed in 62 candidates of elective Cesarean section with SA in Isfahan Shahid Beheshti Hospital. Patients were randomly assigned into the two groups (n= 31 per group) using Random Allocation Software. After umbilical cord clamping, experimental group received neostigmine 0.5 mg and atropine 0.5 mg (i.v.), while the control group received 10 ml i.v. infusion of normal saline. The incidence and severity of headache were compared between the two groups in the first 48 hours and followed up for one week.

In this study, one patient in experimental group (3.2%) and five patients in control group (16.1%) reported PDPH which can be clinically important (P=0.195). Headache was seen in two patients (1 in each group) at recovery and in four at ward in control group (P=0.11). The mean severity of headache was 5 and 4.2±0.45 in experimental group and control group, respectively (P= 0.18). The interval between spinal anesthesia and first onset of headache was one hour in experimental group and 20.8 ± 11.1 hours in control group (P=0.18).

According to the present study, the neostigmine (0.5mg) + atropine (0.5mg) is associated with a non- significant reduction in the incidence of headache and its severity after spinal anesthesia that are clinically important. 

Due to the need to prevention of postoperative pain after mastoidectomy-tympanoplasty, the present study was performed to evaluate the preemptive effect of adding morphine to topical lidocaine on postoperative pain intensity.

In this double-blind clinical trial study, 80 patients who were candidates for elective mastoidectomy- tympanoplasty surgery were randomly divided into two groups of 40; the first group underwent local anesthesia with lidocaine, and the second group underwent local anesthesia with lidocaine with morphine. Patients were evaluated for hemodynamic parameters, postoperative pain intensity during surgery and recovery and 24 hours after surgery, and the findings were compared between the two groups.

Evaluation of patients' pain intensity in recovery and ward showed that at the time of patients' recovery and two hours after surgery, the intervention group had a lower intensity; but in 12 and 24 hours after surgery, no significant difference was seen between the two groups. In the intragroup study, pain intensity significantly reduced in both groups, but the rate of pain reduction in the intervention group was significantly higher. The trend of changes in hemodynamic parameters during surgery and length stay in recovery was not significantly different between the two groups.

Addition of morphine to topical lidocaine reduces the postoperative mastoidectomy-tympanoplasty surgery, while topical use of this drug has no effect on patients' hemodynamics, longer recovery, and extubating time.

Of the most common complications occur after anesthesia with intubation is postoperative sore throat, coughing after extubation, and hoarseness. Today, the use of dexamethasone before surgery is effective in controlling these complications. Therefore, the purpose of this study was to compare the prophylactic effect of two different methods of administration of dexamethasone (intracuff and intrsvenous) on sore throat and cough after surgery. In this clinical trial study, 96 patients undergoing general anesthesia and intubation were randomly assigned into three groups. The first group received 4 mg intravenous dexamethasone, the second group received 4 mg intracuff dexamethasone, and the third group received placebo. The frequency of cough and the severity of a sore throat were evaluated in three groups. There was no significant difference between the three groups based on hemodynamic variables (P > 0.05), but the cough rate in the first and second groups was significantly lower than the control group (P < 0.01). Moreover, the mean of the severity of sore throat in recovery and 1 hour after surgery in the first and second groups were significantly lower than the control group (P < 0.01). However, there was no difference between the groups based on the severity of sore throat within 24 hours after surgery (P > 0.05). Using intravenous and intracuff dexamethasone before surgery can reduce the amount of cough and the severity of sore throat in patients.

Postoperative sore throat after extubation is a common complication after surgery following general anesthesia. Several methods have been proposed, such as the use of intracuff dexamethasone to control these complications, but there is not always a standard method for it. The purpose of this study was to compare the precautionary effect of two different doses of intracuff dexamethasone (4 and 8 mg) on postoperative sore throat and cough. In this clinical trial study, 90 patients underwent general anesthesia with intubation were included. Patients were randomly divided into three groups. The first group received 4 mg, and the second one, 8 mg dexamethasone, and the third, physiologic serum in the form of intracuff before intubation. Postoperative sore throat and cough were compared between the three groups. The mean intensity of postoperative sore throat at recovery, and 1 and 24 hours later, and the number of coughing in recovery in the first and second groups was significantly lower than the placebo group (P < 0.05). On the other hand, there was no significant difference between the first and second groups based on postoperative sore throat and cough (P > 0.05). Moreover, there was no significant difference between the three groups based on demographic data. The use of intracuff dexamethasone in doses of 4 and 8 mg has a beneficial effect on reducing complications after extubation, such as sore throat and postoperative cough, and there is no difference between the two doses in reducing these complications.

The incidence of fentanyl-induced cough (FIC) during induction of general anesthesia is 28-65%. Therefore, prevention of this complication is required. In this study, the effects of propofol and dexamethasone on the frequency and severity of fentanyl-induced cough were assessed in patients undergoing general anesthesia.
During a double-blind, randomized clinical trial study, 99 patients aged 18-64 years with classes I and II of American Society of Anesthesiologists (ASA) classification, who were undergoing general anesthesia with fentanyl, were investigated. Patients were randomly divided equally into 3 groups receiving propofol (1.5 mg/kg), dexamethasone (0.1 mg/kg), and placebo (5 ml normal saline). All drugs were administered 1 minute before administration of 2.5 µg/kg fentanyl. Vital signs, and frequency and intensity of cough were measured and recorded. Statistical analysis was performed using one-way ANOVA and Kruskal-wallis tests.
Findings: The incidence of fentanyl-induced cough was 27.3%, 78.8%, and 84.8% in propofol, dexamethasone, and placebo groups, respectively (P It seems that administration of low-dose propofol (10 mg) can reduce the frequency and intensity of fentanyl-induced cough during induction of general anesthesia.

Intravenous (IV) administration of fentanyl during induction of general anesthesia often elicits cough, with frequency of 18% to 80%. Therefore, in this study, we aimed to compare the effects of ketamine and dexamethasone on decreasing cough in patients undergoing general anesthesia with fentanyl.
During a double-blind randomized clinical trial study, 99 patients aged 18-64 years with class I and II based on the scale of American Society of Anesthesiologists (ASA) who were undergoing general anesthesia with fentanyl were investigated. Patients were randomly divided equally into 3 groups receiving ketamine (0.5 mg/kg), dexamethasone (0.1 mg/kg), and placebo (5 ml normal saline). All drugs were administered 1 minute before administration of 2.5 µg/kg fentanyl. Vital signs, and frequency and intensity of cough were measured and recorded. Statistical analysis was performed using one-way ANOVA and Kruskal-Wallis tests.
Findings: The frequency of cough was significantly lower in the ketamine group (81.8%) compared with dexamethasone (90.9%) and placebo (93.1%) groups (P = 0.03). The intensity of cough was significantly lower in the ketamine group (mild: 18.2%; moderate: 78.8%; severe: 3.0%) compared with placebo group (mild: 9.1%, moderate: 72.7%; severe: 18.2%) (P = 0.04). Furthermore, there were significant differences between the three groups in variations of systolic blood pressure, diastolic blood pressure, and heart rate (P Administration of low-dose ketamine can effectively reduce frequency and intensity of fentanyl-induced cough during anesthesia in patients undergoing general anesthesia.

This study aimed to compare the effect of intravenous dexamethasone, ondansetron, and ketamine in preventing postoperative shivering in patients undergoing cesarean section under general anesthesia.
A random, double-blind clinical trial was carried out on 160 patients with class I or II of American Society of Anesthesiologists (ASA) scale, undergoing cesarean with general anesthesia. They were divided into four groups of patients receiving ondansetron, dexamethasone, ketamine, and placebo. Applying the formula, the sample size consisted of 40 patients in each group. Data were analyzed using analysis of variance (ANOVA), frequency table, and chi-square test at the significant level of P less than 0.05.
Findings: There was a significant difference in the level of shivering at four times of entering recovery, and 10th, 20th, and 70th minutes in recovery between the four groups (P 0.050 for all).
Prescribing dexamethasone, ondansetron, and ketamine was equally effective in preventing postoperative shivering.

Hoarseness is a common complication after tracheal intubation. The aim of this study was to investigate the correlation between hoarseness after tracheal intubation with some demographic and clinical characteristics of patients undergoing elective surgery in Alzahra hospital, Isfahan, Iran.
This descriptive-prospective analytic study conducted on 98 patients (mean age: 38.7 ± 13.4 years, gender: 53.2% were women) undergoing elective surgery and had eligible criteria for the study. The correlations between intubation complication (hoarseness) and some demographic data [sex, age, weight, height, and body mass index (BMI)] and clinical characteristics (duration intubation, type of surgery, and tube size) were studied. Data were collected 72 hours after the surgery and analyzed using SPSS software.
Findings: In this study, 98 patients with a mean intubation time of 165.5 minutes were studied. Straining during extubation (55.1%), hoarseness (25.5 %), cough (7.1%), and sore throat (7.1%) were prevalent intubation complications, respectively. The correlations between duration of intubation (P = 0.027), and type of surgery (P = 0.040) with hoarseness were statistically significant. But there was not significant correlation between age, height, weight, tracheal tube size, and body mass index with hoarseness (P ≥ 0.050).
The results indicate significant correlation between hoarseness and duration of intubation and type of surgery.

Spinal anesthesia is a popular anesthetic technique in laminectomy due to less complication and more satisfaction of patients and surgeons. In this technique, duration and quality of block is important to control postoperative pain. The aim of this study was to evaluate the effect of adding two different doses of magnesium sulfate to bupivacaine on block characteristics and postoperative pain in laminectomy under spinal anesthesia.
In a prospective clinical trial study, 120 candidates of elective laminectomy under spinal anesthesia with bupivacaine were randomly divided to three groups of receiving 50 mg magnesium sulfate (M50), 100 mg magnesium sulfate (M100) and normal saline (N). The onset and duration of sensory and motor block, maximum level of block, time of analgesic requirement and its dose were measured and recorded.
Findings: The mean onset time of sensory block in M50 (16.9 ± 4.0 minutes) and M100 (18.5 ± 2.4 minutes) were significantly more than control group (12.6 ± 3.57 minutes). The duration of sensory block was 89.80 ± 12.79, 116.50 ± 12.00, and 119.00 ± 18.50 minutes in control, M50, and M100 groups, respectively, with significant difference. Mean onset time of motor block in both M50 (11.80 ± 4.20 minutes) and M100 (12.6 ± 3.80 minutes) groups and were significantly more than control group (9.40 ± 3.33 minutes). The pain intensity was significantly more in control group. The mean time of first analgesic requirement and its total dose were significantly lower in M100 than other groups (P 0.050 for all)
Adding 100 mg intrathecal magnesium sulfate in comparison with 50 mg provides more acceptation effects such as less sensation of pain, less analgesic consumption and prolonged first time of analgesic requirement with no significant side effect.

Getting out of the anesthesia occurs with stimulation of sympathetic system and increasing in patient's pulse and blood pressure. Various methods are used to control the blood pressure and heart rate, but there is no single method, so far. This study aimed to compare the effects of morphine and diltiazem of blood pressure and pulse rate in recovery time among the patients underwent craniotomy. In a double-blind clinical trial study during 2012-2013, 60 patients who were candidates for craniotomy were selected and divided in two groups of 30. The first group received 60 mg diltiazem and the second group received 0.1 mg/kg morphine. During 4 hours after the surgery, the hemodynamic variables were checked and compared between the two groups. Before the operation, the mean systolic blood pressure was 120.6 ± 12.5 and 126.8 ± 18.7 mmHg in morphine and diltiazem groups, respectively (P = 0.560). 4 hours after the drug consumption, mean systolic blood pressure was 130.6 ± 13.2 and 100.4 ± 16.2 mmHg in morphine and diltiazem groups, respectively (P < 0.001). During the follow-up period in recovery room, there was no significant difference between the blood pressure and heart rate between the two groups; but 4 hours after the drug consumption, systolic and diastolic blood pressure was significantly lower in the diltiazem group. During the study, there was no significant difference in heart rates between the two groups. According to the results of the study, using diltiazem led to better control of blood pressure during craniotomy with little side effects. So, it can be used safely in patients under craniotomy.

Traumatic brain injury is one of the important problems of world health with high mortality; probably, simultaneous hyperglycemia can intensify the harmful effects. Since there is no unique opinion in this regard, we aimed to study the effect of blood glucose at before, during and after operation on outcome of patients with traumatic brain injury.

A hundred patients with traumatic brain injury were studied during a prospective clinical trial study. We divided patients according to their preoperative blood glucose level to two groups of normo- and hyperglycemic. We measured and recorded blood glucose level during and after operation, in addition to the heart rate, blood pressure, saturation of oxygen (SpO2), duration of mechanical ventilation and outcome of patients in both groups.

Heart rate was significantly higher at 15th (P = 0.027), 60th (P = 0.018), 105th (P = 0.010) minutes and in recovery room (P = 0.006) in hyperglycemic patients; but as a general, the changes in heart rates were not significant in both groups (P = 0.610). There was no difference in SpO2 at different times. The mean arterial pressure (MAP) was higher at 45th (P = 0.025) and 60th (P = 0.016) minutes during the surgery; but as a general, there were no significant difference in MAP between the two groups (P = 0.850). Duration of mechanical ventilation was significantly longer in hyperglycemic patients (P = 0.009).

According to our findings, elevated blood glucose patients with traumatic brain injury may results in some intraoperative hemodynamic changes and affect their outcome. Therefore, monitoring of blood glucose in these patients is suggested.

Mechanical ventilation affects heart and hemodynamic function. Nitroglycerine (NG) and Na Nitroprusside (NPS) are used to apply as deliberate hypotension by decreasing the preload and afterload of heart, respectively. This study was evaluated the effects of different tidal volumes on a few hemodynamic components during these kinds of controlled hypotension. In a double-blind clinical trial, 60 anesthesia patients were randomly selected during mechanical ventilation with different tidal volumes (5, 10 & 15 cc/kg) for ten minutes before and after controlled hypotension which induced by NG or NPS. Changes of some hemodynamic components were measured and analyzed. Before hypotension, the cardiac output (CO) decreased from 3.35±0.35 to 3.05±0.65 and from 3.51±0.34 to 3.06±0.56 lit/min in NG and NPS groups, respectively (p<0.000) and stroke volume (SV) decreased from 35.26±3.43 to 17.42±4.36 and 36.28±3.04 to 18.71±5.05 cc respectively (p<0.000) by increasing the tidal volume from 5 to 15 cc/kg. During controlled hypotension by increasing the tidal volume from 5 to 15 cc/kg, the CO decreased from 2.84±0.73 to 2.57±0.64 in NG group and increased from 4.26±0.56 to 4.57±0.81 lit/min in NPS group (p<0.000) and SV decreased from 15.86±4.62 to 13.46±4.29 in NG group and enhanced from 18.75±5.52 to 19.58±5.42 cc in NPS group (p<0.028). The results of this study showed that the cardiac output was decreased by increasing the tidal volume during mechanical ventilation and controlled hypotension by NG while it was increased in NPS group. The decrease of stroke volume in NG group was greater than NPS group by increasing the tidal volume.

We evaluated the correlation between intracranial pressure (ICP) measured by Schiotz tonometer and computed tomography (CT) scan findings in craniotomy patients. This cross-sectional study was performed in Alzahra Hospital in Isfahan from 2010 to 2011. We included the elective craniotomy patients aged 18-64 years with the American Society of Anesthesiologists (ASA) physical status I or II. After being evaluated by CT scan، ICP was studied with Schiotz tonometer in Burr hole before dura opening. 58 patients (mean age: 44. 37 ± 11. 53 years) scheduled for elective craniotomy were included in the study. There were 36 males (62. 1%) and 22 females (37. 9%). The results showed significant correlation between ICP measured by Schiotz tonometer and by CT scan (r = 0. 913، P < 0. 001). This study showed that Schiotz tonometer could consider as a safe and reliable alternative to CT scan in ICP evaluation.

Adrenal bleeding in trauma, sepsis and other clinical complications is among the most common mechanism for functional adrenal insufficiency. The aim of this study was to evaluate the prevalence of functional adrenal insufficiency in patients with coagulation disorder in the intensive care unit (ICU) of Alzahra Hospital, Isfahan, Iran in 2008-2010. This descriptive study was performed on 80 patients (aged 18-65 years) in the ICU of Alzahra Hospital. After obtaining informed consents, blood samples of patients were tested for cortisol levels and coagulation factors on the first, third, 7th and 14th days. The data was collected in a checklist and then analyzed by chi-square test, t-test and one-way analysis of variance (ANOVA) in SPSS18. There were 39 (48.8%) females and 41 (51.2%) males among the 80 studied patients. Mean coagulation disorders was 5.3 ± 2.1 in men and 4.08 ± 1.97 in women. There was a relation between coagulation disorder and sex (P = 0.009). Our results also showed a relation between coagulation disorder and functional adrenal insufficiency. We found a relation between coagulation disorder and functional adrenal insufficiency

Hemorrhoidectomy is usually associated with severe pain in the immediate postoperative period. Today, a number of local blockages and sedatives are used to reduce this pain. However, so far, no specific method is recommended for this purpose. Therefore, the aim of this study was to investigate the efficacy of the ischioanal fossa block, in reduction of postoperative pain and analgesic requirements. This clinical-trial study was performed on eighty candidates of elective hemorrhoidectomy. Patients were randomly assigned to either case (receiving ischioananl fossa block) or control (no ischioananl fossa block). All aspects of surgery and anesthesia were standardized. In the postoperative period, analgesia was maintained with pethedine. Pain was assessed using VAS (Visual analogue scale) at 0 (arousal), 4, 12 and, 24 hours after operations. The time interval for the first request of analgesia and the total amount of analgesic consumption were recorded. There was no statistical difference between the two groups with respect to age, sex, weight, and duration of operation. The pain score of the case and the control group was 2.65±0.92 and 4.93±1.09, respectively (p<0.05). Also, the pain score at 0, 4, 12, and 24 hrs post operation was significantly lower in the case than that in the control group (p<0.05). The time interval for request of the first analgesic was significantly longer in the case group (8 hr versus 1.5 hrs) (p<0.05). Total dose of pethedine consumption was statistically different between the two groups (p<0.05). Based on the results, the administration of ischiorectal fossa block and bupivacain before the operation resulted in a significant decrease in postoperative pain and analgesia requirements. Therefore, this method is recommended.

Preemptive analgesia is one of the pain sedative methods which is based on the blocking of pain receptor before any painful stimulation. Ketamine is a NMDA (N-Methyl D-Aspartate) receptor blocker, which has been used to reduce central sensitization. This study was performed to evaluate the preemptive effect of low dose ketamine (0.5 mg/kg, i.v.) on postoperative pain of cholecystectomy. In this study, sixty patients aged 30-60 years, with Anesthesia Society of America Scoring I or II (ASA I or II), candidate for elective cholecystectomy were randomly divided into two groups. The same operation and general anesthetic methods were used for the two groups. The patients in group1 received 0.5 mg/kg ketamine, 20 min. before surgical incision and normal saline (the same volume), 20 min. after the operation. The patients of group 2, received normal saline (0.5 mg/kg) 20 min. before surgical incision and ketamine (0.5 mg/kg) 20 min. after that. In the postoperative period, analgesia was maintained with pethidine Using Visual Analogue Scale (VAS), pain was measured at 0 (arousal), 6, 12 and 24 hrs after the operation. The time interval for the first request of analgesia and the total amount of analgesic consumption during 24 hrs were reported. The data was analyzed using t and c2 tests. The mean value of pain intensity at 0, 6, 12 and 24 hrs after the operation in group 1 (3.24±0.97) was significantly less that that of the group 2 (4.18±1.09) (p<0.05). The time interval to request the first analgesic supplement was longer in the group 1 than that in the group 2 (31.12 min versus 18.12 min; p<0.05). Also, the total pethidine consumption was significantly different between two groups (p<0.05). Based on our results, using pre-incisional ketamine (1 mg/kg) has more preemptive effect on reducing pain and analgesia requirement after cholecystectomy compared to those of post-operative ketamine.