فهرست مطالب arvin barzanji

Choosing an appropriate anesthetic agent for induction and maintenance of anesthesia is very important in hemodynamic stability and pain control. The aim of this study was to compare the effects of ketamine-remifentanil combination with ketamine-propofol combination on pain, agitation and hemodynamic changes during closed reduction of nasal fracture.

This single-blind clinical trial included 80 patients between 16 and 18 years of age with ASA1 physical status who had undergone closed reduction for nasal fracture. Patients in the group 1 received 0.75 mg/kg ketamine and 2µ/kg remifentanil and group 2 received 0.75 mg/kg ketamine and 1.5 mg/kg propofol to induce anesthesia. Hemodynamic changes (heart rate, systolic and diastolic blood pressure), pain intensity, agitation, as well as nausea and vomiting and changes in arterial hemoglobin oxygen saturation during surgery were evaluated immediately after induction of anesthesia and after surgery every 15 minutes for 2 hours.

Based on the statistical analysis of the patients' data, the mean heart rate and pain intensity scores in the ketamine-remifentanil group were significantly lower than those in the ketamine-propofol group (P <0.05). Mean systolic and diastolic blood pressure and RASS scores in the two groups did not show any statistically significant differences (P> 0.05). The incidence of nausea was higher in the ketamine-remifentanil group and the decrease in oxygen saturation was higher in the ketamine-propofol group (P <0.05). There was no statistically significant difference between the two groups in regard to incidence of vomiting (P> 0.05).

Based on the results of this study, it seems that use of ketamine-remifentanil combination in comparison to ketamine-propofol in closed reduction of nasal fracture is associated with greater hemodynamic stability, higher analgesic effect and fewer complications.

Nausea and vomiting is a common complication after gynecological surgeries, especially laparoscopy, which can lead to discomfort and restlessness in the patients. The aim of the study was to compare the effect of ondansetron–dexamethasone and metoclopramide–dexamethasone on postoperative nausea and vomiting following gynecological laparoscopy.

In this double‑blind clinical trial, 68 females scheduled for gynecological laparoscopy and age range of 18–40 years were randomly divided into two groups. Group OD received ondansetron 4 mg plus dexamethasone 8 mg and group MD received metoclopramide 10 mg plus dexamethasone 8 mg, 15 min before the end of surgery. The incidence of nausea and vomiting and need for rescue medication was assessed during the recovery period, as well as at 2, 4, 6, 12, and 24 h after surgery. The data were analyzed using STATA software version 12 and a significance level of <0.05 was considered in this research.

The incidence of nausea in ondansetron and metoclopramide groups was 23.3% and 33.3%, respectively, and the frequency of vomiting was 10% and 16.6%, respectively, which showed no significant difference (P > 0.05). The highest incidence of nausea and vomiting in patients belonged to the metoclopramide group inside 4–6 h after surgery.

Our study showed that no significant difference was observed in the incidence of nausea and vomiting between ondansetron–dexamethasone and metoclopramide–dexamethasone groups following laparoscopic gynecological surgery; however, the number of patients with nausea and vomiting was lower in the ondansetron–dexamethasone group

Triage becomes necessary when resources and time are not sufficient to provide the best possible services to all patients. This condition is more common in situations with a large number of casualties, like infectious epidemics. What is apparent is that, in the case of a widespread outbreak of infectious disease, hospitals are on the front lines of infected patient admission and treatment. Since the training of health‑care workers is one of the most important pillars of preventive measures in controlling this pandemic, this study was conducted with the aim of expressing the principles of triage of infectious disease epidemic with a COVID‑19 approach.

The aim of this study was to compare the analgesic effects of pregabalin and ketamine on reducing pain after abdominal hysterectomy.

In this double-blind clinical trial, one hundred forty ASA I and II patients of age range 30-60 years scheduled for abdominal hysterectomy undergoing general anesthesia in 2018, were randomly divided into 4 equal groups. Pregabalin group received 300 mg oral pregabalin, ketamine group received 0.3 mg/kg of intravenous ketamine, and pregabalin- ketamine group received the combination of the two-above medication, and placebo group received the placebo and saline. Patients were evaluated for pain intensity according to the visual analogue scale (VAS) at 2, 4, 6, 12, 18, and 24 hours after surgery. Also, the need for analgesic drugs and the frequency of repetitions were also recorded. Statistical analysis was performed using STATA, Version 14. A p- value less than 0.05 was considered statistically significant.

In the pregabalin and pregabalin-ketamine groups, pain in the first 6 hours after the end of operation was significantly less than the other two groups (p<0.05), but there was no significant difference between the 4 groups at 18 and 24 hours after surgery. The need for analgesic medications in the pregabalin group was lower than in other groups (p<0.05).

The results of this study show that the administration of oral pregabalin with and without intravenous ketamine before abdominal hysterectomy can decrease postoperative pain and reduce the need for analgesia.

Anesthesia management has always been challenging in cardiac patients, especially patients with cardiomyopathy. There are a variety of cardiomyopathies such as unclassified cardiomyopathy as a complex type that can occur in many forms like left ventricular noncompaction (LVNC) that is an uncommon primary genetic cardiomyopathy typified by noticeable trabeculation of the left ventricular (LV) wall and intertrabecular recesses. We report anesthesia management in a 53-year-old female patient who admitted to the hospital for the transureteral lithotripsy surgery due to dysuria and urolithiasis with a medical history, and echocardiographic examination indicated the diagnosis of hypertension and unclassified cardiomyopathy (LVNC).

job involvement and intention to leave job are important feedbacks of work. The purpose of this study was to investigate the relationship between job involvement and intention to leave job among anesthetist employed in Sanandaj hospitals in 2017.

In this descriptive-analytical study, 90 anesthetist working in Sanandaj hospitals were enrolled in the study. Data were collected from the Kanongo Job Anxiety Questionnaire, Attwod and Hinshaw Vacancy Forecasting Questionnaire and demographic and occupational information questionnaire. Version 23 of SPSS software was used for data analysis. Data were analyzed using descriptive statistics, independent t-test and chi-square test.

The mean and standard deviation of job involvement and intention to leave job were 2±0.056 and 2±0.063, respectively. Also, the results showed that there is a significant relationship between job involvement and intention to leave job with all demographic and occupational variables (p <0.05).

Considering the low level of job involvement and the high intention to leave job in anesthetist, rooting and planning is recommended by the authorities.

Detecting pain is crucial in sedated and mechanically ventilated patients, as they are unable to communicate verbally..
This study aimed to compare Bispectral index (BIS) monitoring with the Critical-care pain observation tool (CPOT) and vital signs for pain assessment during painful procedures in intubated adult patients after cardiac surgery..
Seventy consecutive patients who underwent cardiac surgery (coronary artery bypass graft or valvular surgery) were enrolled in the study. Pain evaluations were performed early after the operation in the intubated and sedated patients by using BIS and CPOT, and also checking the vital signs. The pain assessments were done at three different times: 1) baseline (immediately before any painful procedure, including tracheal suctioning or changing the patient’s position), 2) during any painful procedure, and 3) five minutes after the procedure (recovery time)..
The mean values for CPOT, BIS, and mean arterial pressure (MAP) scores were significantly different at different times; they were increased during suctioning or changing position, and decreased five minutes after these procedures (CPOT: 3.98 ± 1.65 versus 1.31 ± 1.07, respectively (P ≤ 0.0001); BIS: 84.94 ± 10.52 versus 63.48 ± 12.17, respectively (P ≤ 0.0001); MAP: 92.88 ± 15.37 versus 89.77 ± 14.72, respectively (P = 0.003)). Change in heart rate (HR) was not significant over time (95.68 ± 16.78 versus 93.61 ± 16.56, respectively; P = 0.34). CPOT scores were significantly positively correlated with BIS at baseline, during painful stimulation, and at recovery time, but were not correlated with HR or MAP, except at baseline. BIS scores were significantly correlated with MAP but not with HR..
It appears that BIS monitoring can be used for pain assessment along with the CPOT tool in intubated patients, and it is much more sensitive than monitoring of hemodynamic changes. BIS monitoring can be used more efficiently in intubated patients under deep sedation in the ICU..