فهرست مطالب مرضیه بیگم خضری

Curettage is one of the most common gynecological surgeries in women. Its complication is pain which increases dissatisfaction in patients. Therefore, it is necessary to find a way to treat this complication. This study was performed with aim to compare the effects of three methods of using lidocaine gel in the cervix, intrauterine injection of lidocaine, and a combination of two methods to reduce pain during curettage.

This clinical trial study was performed in 2017 on 120 patients candidates for curettage in Qazvin Kosar Hospital. Patients were randomly divided into three groups of topical lidocaine gel in the cervix, intrauterine injection of lidocaine and a combination of these two methods, and the drugs were prescribed before curettage. Vital signs and pain were recorded in patients and other information was collected by completing the questionnaire. Data analysis was performed using statistical software (version 22) and chi-square and ANOVA tests. P<0.05 was considered statistically significant.

The intrauterine and intra cervical injection of lidocaine (0.3±0.72) and then injection of intra cervical lidocaine (0.45±0.84) alone significantly reduced pain during curettage in women (P=0.04). On the other hand, no severe hemodynamic changes were observed in these patients. No complications such as nausea and vomiting and no instability of vital signs were observed in any of the groups (P>0.05).

Intrauterine administration along with addition of topical lidocaine gel to the cervix can be used as a simple, low-cost, and safe method as to control pain during and after curettage.

Nowadays, conventional analgesic agents that are usually used for pain killing after cesarean sections do not provide enough analgesia with infrequent serious side effects. Lidocaine has been suggested as an adjuvant analgesic agent for postoperative pain relief. We designed this randomized double-blind, placebo-controlled study to evaluate the analgesic efficacy of intravenous (IV) lidocaine in patients undergoing a cesarean section under spinal anesthesia.

Eighty patients undergoing elective cesarean section under spinal anesthesia were randomly divided into two groups to receive intravenous 1.5 mg/kg of lidocaine 2% bolus 15 minutes prior to spinal anesthesia followed by an intravenous infusion of 1.5 mg/kg/h for 60 minutes (L group) or 0.9% sodium chloride (C group) in a double-blind fashion. The time until the first request for an analgesic, the duration of sensory and motor blockade, hemodynamic variables and adverse events were recorded.

The difference in sensory (95% CI 10.18 to 18.01; P≤0.001) and motor (95% CI 35.50 to 50.19; P≤0.001) blockade durations between groups L and C were significant. Similarly, the mean time until the first analgesic request was longer in group L (175.37±21.43) than in group C (157.12±15.25); the difference between the two groups was significant (95% CI9.95 to 26.54; P<0.001).

Intravenous lidocaine given as a supplementary agent in patients undergoing cesarean section under spinal anesthesia prolonged the duration of the sensory and motor blockade of spinal anesthesia and delayed the first analgesic request by patients without hemodynamic disturbance, respiratory depression and compromising the fetus.

Electroconvulsive therapy (ECT) is the main therapeutic technique in psychiatric diseases. The use of anesthesia for ECT is necessary. In these patients, selection of anesthesia with minimal hemodynamic changes is very important. The aim of this study was to compare the hemodynamic effects of two anesthetics including sodium thiopental and propofol in patients undergoing ECT. This study was performed on 84 patients (50 males and 34 females) who were anesthetized for ECT in 22- Bahaman Hospital, Qazvin University of Medical Sciences (QUMS). Initially, the hemodynamic status of patients was recorded. Then, they randomly received either sodium thiopental or propofol as an anesthetic and succinylcholine as a muscle relaxant. Hemodynamic changes, including systolic and diastolic blood pressure, pulse rate in the 1, 3 and 10 minutes after ECT, as well as seizure duration and recovery time were recorded. The data were analyzed by SPSS v.20 using independent t-test. the sodium thiopental group, showed the highest changes in systolic and diastolic blood pressure and heart rate in the third minute (45%, 64% and 26% respectively). In the propofol group, the highest systolic, diastolic and mean arterial blood pressure changes were 55%, 64% and 43% respectively, at the 10th minute, but the highest pulse rate (33%) occurred in the 3rd minute. The blood pressure changes were significant between the two groups (p<0.05). The post-shock seizure duration was less with sodium thiopental, but recovery from anesthesia was shorter with propofol (p<0.05). Our findings showed that in the anesthetic required for electroshock, sodium thiopental had a slightly better hemodynamic stability than propofol. Therefore, it seems appropriate to use it as an anesthetic for ECT.

Uterine rupture in pregnancy is rare and often could be life threatening and catastrophic. Myomectomy is one of very common surgeries in gynecology, performed as the vaginal, abdominal and laparoscopic surgeries. Pregnancies occured after abdominal and laparoscopic myomectomy are high risk for uterine rapture.

Case: 

Patient was a 28 Years old female, pregnant woman at the 20 wks of gestational age with abdominal pain and a history of abdominal myomectomy 6 yrs ago. Uterus was ruptured and fetus in amniotic sac was found in abdominal cavity.

Early diagnosis of uterine rupture after myomectomy can save patients from death.

Midazolam is one of the most commonly used benzodiazepines in anesthesia that has recently been considered as an analgesic in intrathecal block. The aim of this study was to determine the effects of adding midazolam to intrathecal bupivacaine on the pain after cesarean section. This clinical trial was conducted in 60 patients undergoing cesarean section with spinal anesthesia in 2009. The patients were randomly allocated to two groups. One group received 10 mg bupivacaine plus 0. 02 mg/kg m idazolam intrathecally while other group recieved 10 mg bupivacaine plus 0. 5 ml distilled water intrathecally. The duration of anesthesia، time of the first analgesic request، and total consumption of analgesic in the first 24 hours after cesarean section were recorded. Data were analyzed using T-test، Mann Whitney U test and Wilcoxon test and chi-square test. Duration of anesthesia in the patients receiving midazolam was significantly longer than the control patients (209 min vs. 192 min). The mean time of the first analgesic request was also significantly longer in the patients receiving midazolam compared to the control patients (283 min vs. 235 min). Total analgesic consumption in 24 hours after surgery was significantly lower in the midazolam group compared to the control group (2 times vs. 2. 5 times). With regards to the results، adding 0. 02 mg/kg intrathecal midazolam to bupivacaine increased duration of anesthesia and time of the first analgesic request following cesarean section compared to bupivacaine alone.

Control of the pain and bleeding after cesarean can reduce postoperative complications and increase the ability of the mothers to optimize the care for their babies. The aim of this study was to investigate the role of tranexamic acid in combination with diclofenac in decreasing blood loss and pain after cesarean section. In this clinical trial, 210 women undergoing cesarean were divided into 3 groups: the first group received tranexamic and diclofenac suppository; the second group tranexamic and placebo suppository and the third group diclofenac suppository and 2 mL of normal saline injection. The time for first need of analgesia, the analgesic dose 24 hours after surgery and the net amount of bleeding were measured and also hemoglobin measured 12 hours after surgery were compared with the pre-operative Hb. There was a significant difference in analgesic consumption among the groups received tranexamic, diclofenac and both drugs. Also, the analgesic consumption in the group received tranexamic was higher than the other groups. Moreover, the time to first analgesic request in the tranexamic group was shorter than the other two groups and the amount of bleeding in the diclofenac group was higher than the other two groups, this difference was statistically significant. However, no significant difference was seen between the groups in mean hemoglobin. Combined tranexamic acid and diclofenac can reduce the amount of blood loss and pain after cesarean.

Postoperative shivering is a complication of general anesthesia. Shivering increases cardiac output, oxygen demand, and postoperative surgical incision's pain. The aim of this study was to evaluate the effect of Diclofenac Na suppository on postoperative shivering. This was a case-control study performed on 140 women who were divided into two equal groups of 70 members each and marked as case and control groups. The case group received diclofenac Na supp 100mg, ten minute before the induction of anesthesia whereas the control group was given no such medication. Axillary temperature was measured before the induction and 1 hr after the extubation. Data were analyzed by SPSS and chi-square test. The incidence of shivering in case and control groups were (%27.1) and (%48.1), respectively. There was a significant difference between two groups (P=0.014). The mean temperature changes in case and control groups were (-0.18ºC±0.02ºC) and (-0.29ºC±0.029ºC), respectively. The difference between two groups was found to be significant, statistically (P=0.004). Our findings showed that diclofenac Na supp has the potential to effectively decrease the postoperative shivering while maintaining the body temperature more stable.

Airways responses during extubation can lead to coughing, laryngospasm and hypertension. The aim of this study was to compare the effects of intratracheal and intravenous lidocaine on airway responses and cardiovascular effects during extubation. This clinical trail was preformed on sixty 15-60 year old patients undergoing general or gynecological surgery, who were class I and II based on the classification of the American Society of Anesthesiology. Three minutes before the end of surgery and at the same time stopping the anesthetic gases, lidocaine was administered 1.5mg/kg intravenous or intratracheal. The number of bucking and coughs till extubation, number of cough till 30 minuets after extubation, the interval between stopping the anesthetic gases and extubation and also heart rate and blood pressures were recorded. Data were analyzed by SPSS version 16 using chi-square and t-tests at the significant level of P<0.05. The mean times for extubation in intravenous and intratracheal lidocaine group were 11.3±3.6 and 11.7±4 minuets, respectively (P=0.71). There were no significant differences in numbers of bucking (P=0.19) and numbers of cough (P=0.97) between the two groups. No significant differences were observed in cardiovascular variables between the two groups. The effects of intravenous or intratracheal administration of lidocaine on the rate of bucking, cough and the time for extubation at the end of general anesthesia were similar.

The aim of this study was to compare the intensity of pain and hemodynamic changes during propofol injection when pretreatment is performed with ephedrine and lidocaine. In a randomized double blind clinical trial (IRCT: 2766) in Shahid Rajaee Hospital during the year 2009, 99 patients with ASA physical status I and II, aged 20 to 50 years were recruited. The patients were planned to undergo elective surgeries under general anesthesia and had no history of cardiocascular, neurologic, or allergic diseases. The subjects were randomly assigned into three groups to receive 40mg intravenous lidocaine (group L), 30μg/kg ephedrine (group E) or 2ml normal saline (group P). After one minute, 2mg/kg propofol was injected into a dorsal hand vein. Pain was assessed using face pain scale (FPS). Arterial blood pressure and heart rate were also recorded before induction, just before intubation, and one minute after intubation. Hemodynamic changes and also the incidence and intensity of pain in group L were less than the other groups. The patients in group L had significantly lower FPS compared with group P (P=0.004) and patients in group E had lower FPS compared with group P; however, the difference was not statistically significant (P=0.247). Pretreatment with a small dose of ephedrine (30μg/kg) reduces the incidence and intensity of propofol induced pain. Although lidocaine is more effective, ephedrine results in a more stable hemodynamic status.

Nausea and vomiting after surgery and anesthesia, cause longer stay of the patient in recovery room and also leads to complications such as electrolyte disturbances, dehydration, hemorrhage from the site of sutures and pulmonary aspiration. This study compared the preventive effect of metoclopramide and low-dose propofol on nausea and vomiting after cesarean section.. In this double blind clinical trial, 120 candidate patients for cesarean section (C/S) were randomly divided into two groups. The age range of patients was 17 to 34 years and all were in ASA class 1 and 2. Anesthesia induced in the same condition for all patients. 3 minutes before the end of surgery, all inhaled drugs were stopped and in one group, propofol (0.5 mg/kg) and in the other group, metoclopramide (0.2 mg/kg) was administered. All the patients had been controlled for nausea and vomiting up to 6 hours post-operation. Data were analyzed by means of SPSS, using t-test and chi-square at the significant level of P<0.05. There was no significant difference on age, weight and duration of surgery between the two groups. The frequency of vomiting in 1 hour after surgery in propofol treatment group (16.7%) was significantly less than metoclopramide treatment group (55%) (P<0.0001). However, there was no significant difference in 2-6 hours after surgery (36.7% and 51.7% respectively, P>0.05). Frequency of nausea in propofol treatment group in the first (30%) and 2-6 hours (36.7%) after surgery was significantly lower than the metoclopramide group(60% and 58.3%, respectively; P<0.01). Propofol (0.5 mg/kg) in the prophylaxis of nausea and vomiting in the first hour after C/S was more effective than metoclopramide. Moreover, its effect on lowering the frequency of nausea in the 2-6 hours postoperative was more than metoclopramide.