مقالات رزومه دکتر توحید کرمی

 Maternal mortality is one of the most important health issues worldwide. Therefore, the current study aimed to determine the causes of maternal mortality in West Azarbaijan-Iran province during 2013-2020.

 In this retrospective cross-sectional study, demographic data and information on maternal deaths (based on the Pregnancy Mortality Surveillance System) were obtained from the treatment deputy of Urmia University of Medical Sciences. The data were collected and analyzed in the West Azarbaijan-Iran province during the 2013-2020 years.

 Over seven years, 102 maternal deaths occurred. The frequency of direct, indirect, and unknown causes of maternal mortality was 35.28%, 60.8%, and 3.92% respectively. Among direct causes, the leading cause of maternal mortality was hemorrhage (23.52%) and sepsis was the next order (7.84%). In indirect causes, brain diseases had the highest frequency (18.9%). Gestational age, place, and technique of delivery were highly related to the death causes (p<0.05). The mother's age (OR: 1.14, 95% CI: 0.51-2.52), being rural (OR:1.34, 95% CI: 0.57-3.15), and having a history of diseases (OR:1.31, 95% CI: 0.59-2.89) were positively associated with the risk of infant’s mortality. While the gestational age (>37w) (OR:0.047, 95% CI: 0.013-0.18, P<0.001) and high education level (OR: 0.64, 95% CI: 0.27-1.57, P=0.33) were inversely correlated with an increased risk of infant mortality.

Direct and indirect causes of hemorrhage were the most common cause of maternal death.  Gestational age, delivery place, and technique of delivery were significantly associated with the type of death causes.

The Laryngeal Mask Airway (LMA) has traditionally become an alternative device for airway management. This clinical trial compared two standard and lateral techniques in inserting laryngeal masks in pediatric airway management. This single-blind clinical trial study was conducted on pediatrics aged 2-6 years who were candidates for elective inguinal herniorrhaphy with ASA I and II under general anesthesia. The pediatrics were randomly assigned to either the standard or lateral methods according to the random number table. The time required to insert LMA and airway pressure as well as the number of attempts to insert in both groups were measured. Data analysis was performed using SPSS version 25; the significance level was less than 0.05. Chest movement and mean airway pressure had no significant difference in both groups (p>0.05). The mean LMA insertion time in the lateral and standard methods was 22.94±7.89 and 65±15.27 seconds, respectively (p=0.001). There was no case of mucosal damage in the lateral method, but ten children had mucosal damage in the standard technique (p=0.001). In the lateral method, LMA was inserted for the first time in 32 pediatrics (94.1%) and two pediatrics (5.9%) in the second time but in the standard group, LMA was inserted in the second time in 11 pediatrics (32.4%) (p=0.006). The lateral method for inserting LMA is practically easy, requires less effort, and has the least complications. Another advantage of the lateral method compared to the standard technique is that inserting a finger into the pharyngeal cavity is unnecessary.

Pelvic fractures are associated with a lot of pain.

This study aimed to compare pericapsular nerve and fascia iliaca block analgesia in the positioning of patients with femoral neck fractures for neuraxial anesthesia.

In this double-blind clinical trial study, 50 patients (each group as a pilot: 25 patients) who were candidates for femoral neck fracture surgery were referred to Imam Khomeini Hospital in Urmia. They were randomly assigned (using random allocation software) to 2 groups, including pericapsular block and fascia iliaca block. Visual Analogue Scale (VAS) was used to evaluate analgesia. The pain level of the patients was checked before the block, 10 minutes after the block, and before positioning for neuraxial anesthesia.

Regarding gender, 38% (N = 19) were female, and 62% (N = 31) were male. The mean age of the patients was 57.38 ± 8.49 years without a significant difference between the 2 groups (P = 0.315). The mean body mass index of the patients was 26.44 ± 3.77 kg/m2 without a significant difference between the 2 groups (P = 0.243). The mean pain 10 minutes after the block was 1.72 ± 0.73 in the pericapsular group and 3.92 ± 0.86 in the fascia iliaca group (P < 0.001). The mean difference in pain was investigated before and after the block in the pericapsular and fascia iliaca groups (P < 0.001). Ten minutes after the block, the pain intensity was different in the pericapsular group and in the fascia iliaca. Moreover, there was no pain in the moderate classification in the pericapsular treatment group, while 16 patients (64%) had moderate pain in the fascia iliaca group. The differences were statistically significant (P < 0.001).

This study shows that the pericapsular block may provide better analgesia for positioning in comparison to the fascia iliaca block in patients with femoral neck fractures.

Spinal anesthesia is the common method in outpatient surgeries, which has complications suchas back pain. We aimed to evaluate the relationship between low back pain (LBP) with spinal anesthesia and itsrelated factors in patients undergoing urological surgery.

In this cross-sectional study, 1000 patients undergoing urological surgery were en-rolled. The severity of LBP was measured using the VAS (visual analog scale) pain on the 1st day, the 1st week,and the 1st month postoperatively. Patients’ age, sex, and the duration of surgery were collected. data analysiswas performed using SPSS software, version 17.

Of the 1000 patients undergoing urological surgery, 636 (63.6%) patients and 364 (36.5%) patients un-derwent spinal and general anesthesia, respectively. In patients under general anesthesia, the LBP prevalencewas higher than in patients under spinal anesthesia on the 1st week and the 1st month after surgery (P<0.05).So, the LBP prevalence was as follows: on the 1st day (general anesthesia: 14.5% vs spinal anesthesia: 24.1%,p=0.09), at the 1st week (general anesthesia: 24.9% vs spinal anesthesia:13.5%, P=0.001) and the1th month (gen-eral anesthesia: 13.8% vs spinal anesthesia: 4%, P=0.001). On 1st day and 1st week after surgery, the rate of LBPwas significantly higher in the >45-year age group than in the age group less than 45 years (P<0.05). The painrate was higher in patients who had surgery duration of more than 2.5 hours in all three time periods (P=0.001).

Although the LBP prevalence on 1st day after surgery in patients undergoing urological surgeriesunder spinal anesthesia was higher than in patients who underwent general anesthesia, there was a significantdecrease in pain levels during the first week and month following the surgery in patients under spinal anesthesia.Older age and longer duration of surgery were related factors to pain

 Caudal block is a common, safe, and effective anesthetic technique for lower abdominal, urological, and lower extremity surgeries in pediatrics.

 This study aimed to evaluate the cardiovascular effects of adjuvant epinephrine in the caudal block on heart rate and blood pressure changes in children.

 This double-blind, randomized clinical trial was performed on 60 children who underwent elective infra-umbilical surgeries. They were under general anesthesia with midazolam, fentanyl, lidocaine, and propofol. The patients were ventilated through laryngeal mask airway (LMA), and anesthesia was maintained with sevoflurane in O2 and N2O mixture. The intervention group received a caudal block with 0.2% bupivacaine and 1/200000 epinephrine (1 mL/kg), while the control group received a caudal block without epinephrine. Heart rate, blood pressure, and ECG were monitored before the block and in the first, fifth, and 20th minutes after surgery.

 The two groups showed no statistically significant differences in demographics and systolic and diastolic blood pressures. However, sinus arrhythmia was more prevalent in the study group in the first minute after the block (P < 0.001). No differences were observed in the incidence of arrhythmia in the fifth and 20th minutes after the block.

 It appears that epinephrine as an adjuvant to the caudal block does not have long-lasting effects after the block, except sinus tachycardia in the first minute. Considering that no changes in blood pressure and other hemodynamic parameters were observed, it seems that epinephrine can be used safely in the caudal block in pediatric patients.

Prune belly syndrome (PBS) is a rare congenital disorder, consists of three symptoms: anterior abdominal muscle deficiency, cryptorchidism, and genitourinary malformation. These patients have cardiovascular and musculoskeletal abnormalities, mental retardation, chest deformities, and scoliosis that lead to pulmonary dysfunction. Anesthesia plan in patient needs to rule out any anomalies. For airway management, Laryngeal mask airway (LMA) should be preferred to avoid the use of muscle relaxants. The use of short-acting anesthetics can accelerate recovery from anesthesia. To reduce postoperative pain, regional techniques are preferred. We report a 6-month- old boy with PBS, and its airway management and anesthesia during surgery.

Background:

 The aim of this study was to evaluate the effect of preoperative oral carbohydrate on the perioperative agitation in pediatrics with elective herniorrhaphy.

Materials and Methods:

 In this randomized clinical trial study, 120 pediatrics, 6 months to 10 years-old who underwent elective herniorrhaphy were admitted. Sixty pediatrics in the intervention group received 5 ml/kg of 20% dextrose solution manufactured by Samen Company as carbohydrate beverage exactly 2 hours before surgery and the control group (n=60) received distilled water. The perioperative agitation score was calculated as follows. Score 1: quiet, silent child, score 2: mild but agitated, score 3: medium aggression, and score 4: severe agitation measured before surgery, at recovery, 5, 15 and 30 minutes after intervention. Also, the incidence of nausea and vomiting was recorded in each group.

Results :

Of the 60 pediatrics in the intervention group, 54 patients were quiet and silent at the time of entry into the operating room, and 6 patients had mild agitation; in the control group, 7 patients were quiet and silent, 41 patients were mild but agitated, and 12 were moderate. There was a significant difference in agitation between the two groups (P = 0.001). Five minutes after surgery, 54 patients scored 1, 6 patients scored 2 in the control group, 27 patients scored 1 and 33 patients scored 2. There was a significant difference between agitations of children 5 minutes after intervention in the two groups.

Conclusion :

Five ml/kg of 20% dextrose solution as carbohydrate beverage exactly 2 hours before anesthesia may lead to parental satisfaction and improvement in positive behavior of pediatrics at anesthesia induction and wake up from anesthesia.

Xeroderma pigmentosum (XP) is a rare genetic disorder with a recessive autosomal inheritance. It appears that total intravenous anesthesia (TIVA) is more appropriate than inhalational anesthesia as a method for maintaining general anesthesia for XP patients and airway manipulation must be performed as little and as noninvasively as possible. The aim of this report was to evaluate the specific considerations for airway management and anesthesia in these patients. .

Inguinal hernia are more frequent in male infants with an increased incidence in twins .Prematurity is a risk factor. Premature infants have particularly high incidence of inguinal hernias, approximately 11.5 % of patients have a family history. During open repair of hernia under general anesthesia, there is a high incidence of apnea in the preterm infants. Caudal anesthesia can be quite effective in providing anesthesia and analgesia.Three two-months-old babies (3.5-4 kg) born at 35 weeks’ gestation presented for inguinal hernia repair, simultaneously. They were undergone bilateral inguinal hernia repair with single shot awake caudal anaesthesia.

Following advances of Intensive Care medicine and widespread administration of mechanical ventilation, tracheostomy has become one of the indispensable surgical procedures. During this research we tried to assess and compare two main strategies for doing tracheostomy: Surgically Created Tracheostomy (SCT) and Percutaneous Dilatational Tracheostomy (PDT). In a randomized clinical trial, 60 cases of patients who were admitted in Intensive Care Unit (ICU) and needed tracheostomy during their stay were enrolled. Patients were randomly divided into two groups. SCT technique was considered for the first group and PDT for the second one. Demographic characteristics, associated and underlying diseases, type and duration of procedure, duration of receiving mechanical ventilation and ICU stay, expenses and complications of tracheostomy including bleeding, subcutaneous emphysema, pneumothorax, stomal infection and airway loss were all recorded during study and compared between both groups. There were significant differences between two groups of patients in terms of duration of receiving mechanical ventilation (P=0.04), duration of tracheostomy procedure (P=0.001) and procedure expenses (P=0.04). There was no significant difference between two groups in terms of age and gender of patients, duration of ICU stay and complications of tracheostomy including copious bleeding, stomal infection, subcutaneous emphysema and airway. According to the results of our study and similar researches, it can be concluded that PDT can be considered as the preferred procedure in cautiously selected patients during their ICU stay.