elham memary

Faculty Development Programs (FDPs) aim to improve the academic careers of faculty members. This study was designed to assess the attitudes of faculty members and the impact of FDP on their academic improvement.

12 faculty members took part in the research from 2016 to 2019. Using a Delphi method, an open secure questionnaire was provided to 12 junior faculty members in the Department of Anesthesia, Critical Care (DACC), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran. Then, the keywords of the latter were analyzed, leading to a 32-item closed-answer questionnaire, filled out by the same participants. Also, the impact of the study was assessed using bibliometric improvement indices.

Both the response rate and participation rate were 100%. Approximately all the participants considered FDP an advantageous and promising academic program. 65 percent of the participants had academic improvement, from “Assistant Professor” to “Associate Professor” rank. Besides, the cumulative number of citations to the participants had a 16.2 times improvement. Both latter results were significantly higher than the mean improvement of the cohort faculty members in the DACC, SBMU.

Faculty members of DACC, SBMU had positive attitudes towards FDP and described it as “a well-designed multilateral academic teamwork, thriving ethical, educational, managerial and research-related capacities”. Also, objective improvement in some academic indices was observed. In many academic environments including developing countries, FDPs are effective scientific investment methods.

 Clavicle fractures account for over one-third of shoulder injuries and up to 3.3% of all fractures in adults. While the majority of these fractures can be managed non-surgically, there are instances where surgical intervention is performed. Regional anesthesia (RA) can be a preferred alternative to general anesthesia (GA) to avoid complications and high costs in this surgery. Moreover, the identification of the most optimal approach for RA remains challenging.

 This study aimed to compare the efficacy of interscalene block (ISB) with and without superficial cervical plexus block (SCPB) as an anesthetic technique for clavicular fracture operation.

 This double-blinded, non-inferiority clinical trial was conducted on 120 patients randomly divided into 2 groups: One receiving ISB and the other receiving ISB with SCPB. The primary outcome was defined as the conversion to GA. Various factors were recorded, including surgery duration, nerve block initiation, analgesics required in the postanesthesia care unit (PACU), and sedation during surgery. Pain was evaluated using the Visual Analog Scale (VAS) in PACU. SPSS version 26 was used for statistical analysis, performing descriptive analysis, Student’s t-tests, and Mann-Whitney U tests to compare non-parametric variables between the 2 groups. Statistically significant results had a P value of less than 0.05.

 A total of 120 patients were randomly divided into 2 equal groups, each consisting of 50 males and 10 females. The mean age of intervention and case groups were 37.23 ± 13.30 and 38.43 ± 11.95 years, respectively. After performing statistical tests (Student's t-test and Mann-Whitney U test), there was no significant difference in the initiation time of nerve block, surgery initiation time, surgery duration, the amount of required sedation, VAS scores, and meperidine consumption (P > 0.05). None of the patients in both groups required conversion to GA.

 The primary goal was achieved in all included cases, and no patients required conversion to GA. The efficacy of ISB is the same whether or not it is combined with a SCPB. Interscalene block is an alternative RA approach for clavicle fractures. Thus, ISB alone is as efficient as when used in combination with SCPB.

Induction of anesthesia for emergency procedures, without prior gastric preparation and incom-plete fasting, is associated with the risk of reflux of stomach contents and aspiration. This study aimed to eval-uate the effect of intravenous (IV ) metoclopramide administration on gastric emptying in opium users, candi-date for procedural sedation and analgesia (PSA).

In the present case-control study, opium-dependent(case) and non-dependent (control) patients in need of PSA were administered with 10 mg IV metoclopramideafter undergoing gastric ultrasonography for determination of its area and contents. Then, 30 minutes after theadministration of metoclopramide, the area and contents of the stomach were measured again and comparedwith the measures obtained before the intervention.

135 patients were evaluated in three groups of 45,including the case, control, and placebo groups. The three groups were similar regarding mean age (p = 0.068),sex (p = 0.067), weight (p = 0.596), height (p = 0.671), body mass index (BMI) (p = 0.877), duration of fasting (p =0.596), and type of gastric contents (p = 0.124). Mean antral cross-sectional area (CSA) of the study participantsin the case, control, and placebo groups before the administration of the drug was 8.49 ± 1.40, 8.31 ± 2.56, and6.56 ± 1.72 cm2, respectively. Mean gastric area in the case (p < 0.001) and control (p < 0.001) groups had signifi-cantly decreased after the intervention. Mean antral gastric grade of gastric contents in the case (p < 0.001) andcontrol (p < 0.001) groups had significantly decreased after the intervention.

It seems that meto-clopramide administration in opium users in need of PSA leads to a significant decrease in mean gastric areaand increases gastric emptying.

We compared the effect of intravenous (IV) administration of dexamethasone versus dexmedetomidine alongside the subarachnoid injection of Bupivacaine in terms of spinal anesthesia (SA) quality in opium-addicted patients.

This parallel randomized clinical trial (RCT) was conducted on opium-addicted patients aged 18 to 65 with The American Society of Anesthesiologists (ASA) class of I/II candidates for surgery under SA. In one group, dexmedetomidine at a dose of 0.5 μg/kg body weight was injected intravenously 10 minutes before surgery and then at a dose of 0.5 μg/kg body weight during surgery. In another group, 8 mg dexamethasone was injected intravenously 10 minutes before surgery, and then normal saline at a rate of 0.5 μg/kg/h was infused during surgery. The primary outcomes were the onset of sensory block, the onset of motor block, the regression of two levels of sensory block, and the duration of motor block. The secondary outcomes were total analgesia time and the time to the first analgesia requirement.

Totally, 57 patients divided into two groups were included in the final analysis. The results showed that the two groups differed significantly in none of the assessed baseline variables (P > 0.05). The mean duration between performing SA and the onset of sensory block in the Dexamethasone and Dexmedetomidine groups was 4.8 ± 2.2 and 4.2 ± 1.9 minutes, respectively (P = 0.290). The mean duration between performing SA and the onset of motor block in the dexamethasone and dexmedetomidine groups was 5.9 ± 2.6 and 5.1 ± 2.3 minutes, respectively (P = 0.251). The mean duration between performing SA and the regression of two levels of sensory block in the dexamethasone and dexmedetomidine groups was 63.6 ± 27.7 and 82.0 ± 17.1 minutes, respectively (P = 0.004). The mean duration of motor block in the dexamethasone and dexmedetomidine groups was 75.0 ± 32.1 and 97.5 ± 19.4 minutes, respectively (P = 0.377). The mean total analgesia time in the dexamethasone and dexmedetomidine groups was 86.9 ± 32.9 and 109.3 ± 16.3 minutes, respectively (P = 0.002). The mean duration between performing SA and the first requirement for analgesic agent administration in the dexamethasone and dexmedetomidine groups was 206.21 ± 93.19 and 267.86 ± 76.02 minutes, respectively (P = 0.008).

It seems that the quality of spinal anesthesia in opium-addicted patients who received concurrent IV dexmedetomidine was better than that of those who received concurrent IV dexamethasone.

Low pressure laparoscopic cholecystectomy has been advocated due to reduction in postoperative pain, ventilation problems, hemodynamic complications, and potential for reduction in surgical events. No reported data have been found focusing on the effects of low-pressure laparoscopic cholecystectomy on intracranial pressure (ICP). The aim of this study was to investigate the effect of low-pressure laparoscopic cholecystectomy on intracranial pressure measured by optic nerve sheath diameter (ONSD) in Imam Hossein Medical Center, Tehran, Iran.  

The patients classified as American Society of Anesthesiologists physical status I or II undergoing elective laparoscopic cholecystectomy due to benign gallbladder disease were randomly assigned to low-pressure laparoscopy (LPL) group or normal pressure laparoscopy group (NPL). ONSD was measured at 3 different times: (1) before induction of anesthesia; (2) after initiation of gas insufflation; and (3) after the termination of gas insufflation. The collected data were entered into SPSS software (V 24). Data were demonstrated with frequency (percentage) or mean ± standard deviation. We used the Mann-Whitney test to compare the means of continuous variables. The Friedman test was used to compare the mean of variables over time in each of the 2 groups. The significance level in all analyses was considered at ˂0.05.  

ONSD after the termination of gas insufflation was significantly lower in the LPL group with the mean of 4.97±0.83 mm than the NPL group with the mean of 5.62±1.32 mm (p=0.018).  ONSD before induction of anesthesia or immediately after gas insufflation did not differ significantly between LPL and NPL groups. Duration of anesthesia and surgery, mean arterial pressure, the total dose of propofol (p=0.600), and fentanyl (p=0.201) did not show significant differences between the 2 groups.  

ONSD was lower with low-pressure laparoscopic cholecystectomy after the termination of gas insufflation, which emphasized the neural protective effect of low intraperitoneal pressure. Further studies are needed to evaluate this diagnostic tool in different populations, especially in patients with increased ICP undergoing laparoscopic interventions.

Although several numbers of the common anesthetic drugs are frequently used in breast cancer (BC) surgery, their possible effects on the behavior of cancer cells are still unknown.

The main objective of the present study was to examine the effect of administered lidocaine versus fentanyl during BC surgery on the apoptosis index of BC cells in-vitro.

Patients with BC with the same grade of cancer and American Society of Anesthesiologists (ASA) score I–III, who underwent surgery were randomly divided into 2 groups of lidocaine and fentanyl infusion based on the analgesic drugs they received. Blood samples were drawn before and after the surgery and then cells from the BC cell line (MCF-7) were exposed to them at 24, 48, and 72 hours post-culture. Flow cytometry was performed to measure the mean percentage of apoptosis index; To investigate the cells’ viability, 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was also applied.

Sixty patients were enrolled. Quantitative cell death analysis revealed that the proportion of apoptotic cells in both lidocaine and fentanyl groups significantly increased when the cells were treated with post-operation sera compared to pre-operation sera exposure at various time intervals. In both groups, intra-group cell death analysis showed that there was not any statistically significant difference among the cultured cells exposed to pre-operation sera at various interval times (P < 0.001) with respect to apoptosis and cell viability.

The study findings proposed that lidocaine infusion can reach the apoptosis index of BC cells in-vitro, as much as that fentanyl did; and both drugs had significant effects.

This study was performed to determine and compare the ED90 of prophylactic oxytocin (OX) infusion after delivery of the placenta during cesarean section (CS) in low- and high-risk parturients for uterine atony.

This experimental study was a single-blind and dose-response study using a 9:1 biased-coin sequential allocation method to estimate the ED90 of prophylactic infusion of OX in women with high and low risk for uterine atony who underwent CS. The total administrated OX dose of each patient was determined in the two study groups. The primary outcome was the ED90 for desirable uterine tone based on the opinion of the in-charge obstetrician. The number of subjects receiving supplemental uterotonics was compared.

In the low-risk group, three (3.7%), out of the 41 parturients, did not achieve a satisfactory suitable response to OX dose of 9; on the other hand, 24 high-risk parturients (58%) did not achieve a satisfactory and reasonable response to OX dose of 9. The OX ED90 was significantly greater for the high risk-group (11.55 units, 10.39-14.86) than the low-risk group (8.13 units, 8.31-9.56). Fisher’s exact probability test showed a significant difference in ED90 of OX between the two groups (P=0.02).

The present study results showed that the mean ED90 of OX in low-risk parturients was significantly lower than that of high-risk ones. We suggest differentiation between low-risk and high-risk parturients in the guidelines of OX administration.

 Breast cancer (BC) is the most frequent cause of cancer death in women. The thoracic pectoral nerve (PECS) block has been described as the gold standard analgesic modality for BC surgery. It has been previously reported that PECS is associated with decreased BC recurrence post-mastectomy. Although several anesthetic drugs and techniques are used in surgical oncology, their effects on the behavior of cancer cells are yet to be known and the key question of whether the anesthetic technique affects cancer outcome remains unresolved.

 Since anesthetic drugs and techniques and post-operative pain may affect BC recurrence, this study aimed to determine whether the anesthetic choice and technique, PECS II block, affects in vitro apoptosis of the MDA-MB-231 BC cell line.

 Twenty-two female BC patients, 20 to 75-years-old, with the same pathologic grades were included in this study. The patients were randomly divided into two groups. The first group received propofol general anesthesia (PGA) associated with PECS and the second group received standard PGA. Blood was sampled pre and post-operation from all patients. The sera were isolated and then exposed to the MDA-MB-231 human BC cell line. The mean percentage of apoptosis indices was analyzed by flow cytometry using Annexin V-fluorescein isothiocyanate 24 hours after treatment with patients’ sera.

 A significant decrease was seen in the mean viability percentage of BC cell line in the PECS group, besides a significant increase in the mean percentage of necrosis and late apoptosis indices compared to the control group after exposure to sera collected from patients post-operation. Intra-group analysis of the control group showed that the exposure of the tumoral cell to post-operation sera resulted in a significant increase in the mean percentage of necrosis and late apoptosis index compared to pre-operation sera exposure. In the PECS group, the exposure of the tumoral cell to post-operation sera resulted in a significant increase in the mean percentage of cell viability and late apoptosis index compared to pre-operation sera exposure.

 In conclusion, anesthesia and BC surgery may induce apoptosis indices in the MDA-MB-231 human BC cell line. We also found that sera collected from PECS II block patients with BC could induce more apoptosis in the MDA-MB-231 cell line compared to collected sera from systemic analgesia alone after BC surgery.

Aspiration is one of the important complications of general anesthesia, although infrequent as well as accompanying high morbidity and mortality. The volume of gastric content is considered as a risk factor in this regard. Therefore, it is normally mostly recommend to consider proper fasting time before induction of general anesthesia.

This study was conducted to assess the effect of metoclopramide on reducing gastric contents in patients with incomplete fasting before induction of general anesthesia.

This quasi-experimental study was conducted on patients with urgent surgical indications with incomplete NPO time. Every other patient received metoclopramide or placebo. Patients in the intervention group received 10 mg (2 ml) of intravenous metoclopramide, and patients in the control group received 2 ml of distilled water as a placebo. Patients in both groups underwent ultrasonography before starting surgery by an expert radiologist to calculate gastric antral grade (GAG) and cross-sectional antral area (CSA). These measurements were then taken for the second time 30 minutes after intervention, before starting the surgery. The values were compared statistically.

The data of 60 patients were analyzed, of which 30 were in each group. The mean age, body mass index, type of the last consumed food (solid or fluid), NPO time in the two groups were not significantly different (P value > 0.05). The number of patients in the metoclopramide group with higher GAG (P value = 0.001) and the mean CSA (P value = 0.004) before the intervention was more than the control group. The GAG and mean CSA after intervention were not significantly different between the two groups; but the mean difference of decrease in CSA in the metoclopramide group was more than the control group (4.3 vs. 0.99; P value = 0.001), and changes of GAG after intervention to lower levels in the metoclopramide group was more than the control group (P value < 0.05).

In the current study in which ultrasonographic indexes, including GAG and CSA, were assessed as a suboptimal gastric emptying test method, it was found that metoclopramide could accelerate gastric emptying compared to placebo in patients with incomplete fasting before induction of general anesthesia.

Benson’s relaxation (BR) technique is a suitable non-pharmacological approach to reduce preoperative anxiety (PA).

This study aimed to investigate the effect of BR therapy on PA and the induction and maintenance dose of propofol during cataract surgery (CS).

Seventy-two patients were randomly divided into two experiments or BR and control groups. The Amsterdam and Spielberger State-Trait Anxiety inventory (STAI) scores were used to assess PA directly two days and a half-hour before the CS. The control group did not receive any preoperation intervention or relaxation. Benson’s relaxation method was performed three times, each time for 20 minutes, including two days before surgery, a night before surgery, and an hour before the surgery in the presence of a researcher by an audio file. The induction and maintenance dose of anesthetic drug was recorded and compared between the two groups.

The mean propofol consumption was significantly reduced during the induction of anesthesia in the intervention group compared to the control group (0.99 ± 0.29 versus 1.29 ± 0.49; P = 0.005) as well as the maintenance of anesthesia (84.66 ± 17.98 versus 108.33 ± 34.38, P = 0.001). The results of the post-intervention Amsterdam anxiety score showed a significant decrease in the intervention group compared to the control group (P = 0.032, F = 9.61, Eta2 = 0.12). The control group showed a higher Spielberger state score compared to the intervention group as well as the Spielberger trait (P < 0.001, F = 14.78, Eta2 = 0.18).

The BR method effectively reduces the level of PA in patients undergoing CS. Moreover, it reduces the need for anesthetic drug, propofol, during surgery.

To decrease postoperative pain (PP) control, opioid requirement, and outcome improvement, regional anesthesia or preoperative analgesia is routinely performed as an alternative to general anesthesia. Thoracic wall nerve blocks, such as the pectoral nerves (PECS) block have recently become popular for preoperative pain control in patients undergoing breast cancer (BC) surgery.

The current study was designed to evaluate the effect of PECS anesthesia on the fentanyl and propofol consumption, as well as time to the first request to analgesia in the patients with BC surgery.

A total of 22 women aged 20 to 75 years old with biopsy-proven BC were randomized to receive either propofol general anesthesia with PECS or total intravenous anesthesia without PECS in a randomized clinical trial. Total propofol and fentanyl dose and time to the first request for postoperative analgesia were assessed and compared in both groups.

The obtained data showed no significant difference in the total dose of fentanyl and propofol between the two groups. However, the PECS group showed a significant increase in time to the first request for postoperative analgesia.

The PECS block in combination with general anesthesia for BC surgery significantly increased time to the first request to analgesia and was effective for reducing PP in the recovery room. PECS block combined with general anesthesia did not reduce the intraoperative use of fentanyl and propofol compared with the control group injected with normal saline.

Although rare, but it is very important to understand that intubation will be difficult for which of the patients. Some scoring systems are available in this regard that influenced by many factors such as body anthropometric factors. This study was conducted to investigate the relationship between Mallampati score, biting the upper lip as well as 2-3-3 maneuver with body anthropometric factors in different population of society. This cross-sectional study was conducted during the years 2014-2015 in Yazd, Iran. The subjects using simple randomized sampling method, and they were included in study after obtaining their informed consent. Demographic (age and gender) as well as anthropometric parameters of body, including weight, height, neck, waist circumference, hip circumference, body mass index (BMI) and waist-to-hip ratio (WHR) were collected in a pre-prepared checklist. Then, Mallampati score, biting the upper lip score, maneuver 2-3-3 were examined and calculated by researchers. The results of these examinations were recorded for each person in checklist. In this study, 498 people with mean age of 42.1 ± 16.1 were enrolled (51% female). Based on results of this study, although all three methods significantly correlated with age but none had any relation with gender. Significant relationship was found between upper lip biting and Mallampati score and all body anthropometric factors evaluated in this study (p < 0.05). By increasing the mean of these factors, Mallampati score increases, while this relationship is reverse in the case of height. In addition, significant correlation was found between maneuver 2-3-3 and weight, height, waist circumference, hip circumference and BMI, while it showed no correlation with neck circumference (p = 0.328) and WHR (p = 0.121). Based on findings of current study, it is likely that upper lip biting test and Mallampati score have significant relation with all body anthropometric factors evaluated in this study. But maneuver 2-3-3 has no correlation with neck circumference and WHR.

Currently, using various combinations of narcotic and analgesic drugs has received attention for induction of sedation and analgesia due to their synergy in controlling pain and anxiety. The present study was designed with the aim of comparing dexmedetomidine-fentanyl combination with midazolam-fentanyl in this regard. In this randomized clinical trial, patients diagnosed with distal radius fracture who had visited the emergency department (ED) were allocated to either the group receiving the combination of fentanyl-midazolam or the one receiving dexmedetomidine-fentanyl for procedural sedation and analgesia (PSA) and were compared regarding analgesic characteristics, time to recovery and side effects. 80 patients with the mean age of 42.08 ± 12.17 (18 - 60) years were randomly allocated to 2 groups of 40 (83.80% male). The 2 groups did not have a significant difference regarding baseline characteristics as well as pain severity. Mean pain score at the time of procedure was 3.47 ± 1.37 in dexmedetomidine and 2.85 ± 1.05 in midazolam group (p = 0.025). In addition, time to recovery in dexmedetomidine and midazolam groups was 6.60 ± 1.86 minutes and 12.70 ± 1.70 minutes, respectively (p < 0.001). Out of the 9 patients who experienced treatment failure, 8 (88.90%) patients were in dexmedetomidine group and 1 (11.10%) was in midazolam group (p = 0.029). Absolute risk increase rate of treatment failure in case of using dexmedetomidine instead of midazolam was 17.50% (95%CI: 4.19 – 30.81) and number needed to harm was 6.00 (95% CI: 3.20 – 23.80). Although the combination of dexmedetomidine-fentanyl had a shorter time to recovery compared to midazolam-fentanyl for induction of sedation and analgesia, the treatment failure rate in case of using dexmedetomidine with 1 µg/kg increased 17.5% and about 1 out of each 6 patients needed a rescue dose.

Need for procedural sedation and analgesia (PSA) is felt in emergency department (ED) more and more each day. This study aimed to compare the effectiveness of low-dose fentanyl, propofol, midazolam, ketamine and lidocaine combination with regular dose of propofol and fentanyl combination for induction of deep sedation. In this single-blind clinical trial, candidate patients for sedation and analgesia aged more than 15 and less than 60 years old, with pain score ≥6 were allocated to one of the groups using block randomization and were compared regarding onset of action, recovery time, and probable side effects. 125 patients with the mean age of 37.8 ± 14.3 years were randomly allocated to each group. 100% of the patients in group 1 (5 drugs) and 56.5% of the patients in group 2 (2 drugs) were deeply sedated in the 3rd minute after injection. The 2 groups were significantly different regarding onset of action (p = 0.440), recovery time (p = 0.018), and treatment failure (p < 0.001). Low-dose fentanyl, propofol, midazolam, ketamine and lidocaine combination was more successful in induction of deep sedation compared to regular dose of propofol and fentanyl combination. Recovery time was a little longer in this group and both groups were similar regarding drug side effects and effect on vital signs.

There are limited available scientific sources of data and rare controlled studies to guide the anesthesiologist regarding preoperative analgesic care in opioid addict patients, despite the increasing prevalence of opioid dependency.
In the present study, we aimed to evaluate the effect of using Dexmedetomidine (Dex) during femoral neck surgery on the postoperative analgesic consumption in opium addict patients.
Patients and The present study is a double-blind randomized clinical trial. Patients suffering from femoral neck fracture with a history of opium addiction who were candidates for surgery under spinal anesthesia were included. After induction of spinal anesthesia using hyperbaric bupivacaine, either Dex or normal saline was infused for patients. Dex with a dose of 0.5 µg/kg/h in the intervention group and normal saline with a dose of 0.5 cc/kg/h in the control group was administered. After the surgery, pain intensity of the patients in recovery was assessed in 10-minute intervals based on visual analog scale (VAS) until 2 hours postoperatively. Time to pain and the total amount of opium consumption for pain control in 24 hours postoperatively were calculated and compared between the 2 groups.
Finally, 25 patients in each group were studied. Demographic and baseline characteristics of the patients in the 2 groups were not significantly different. Mean morphine consumption in recovery until 2 hours postoperatively showed no significant difference between Dex and control groups (P = 0.24). However, the mean opioid use during 24 hours postoperatively was significantly difference and it was lower in the group receiving Dex infusion (P It is likely that intravenous Dex infusion during femoral neck fracture surgery under spinal anesthesia can lead to the less opioid use throughout the 24 hours postoperatively in opium addict patients.

Pain is a frequent complaint of patients who are referred to the emergency department (ED), which is ignored or mismanaged and, almost always, approached in terms of determining the cause of pain instead of pain management. Pain management is a challenging issue in the ED. This study was conducted to determine the effect of emergency resident’s education about pain assessment and pain-relief drugs in the improvement in pain management.
A clinical audit was carried out during the year 2015 in the ED of Imam Hossein Hospital, Tehran, Iran. All patients over 16-year-old who had been complaining of pain or another complaint that included pain were eligible. Data were collected using a preformed checklist. One senior emergency medicine resident was responsible for filling the checklist. In the first phase, patients were enrolled into the study and were divided into two groups according to whether they had or did not have a pain management order. In the second phase, the first- and second-year emergency medicine residents were trained during the various classes that they were required to attend, through a workshop conducted by experienced professors, and based on existing valid guidelines. In the third phase, patients were enrolled into the study, and the same checklists were completed.
A total of 803 patients (401 before training and 402 after) were assessed. The mean age of the patients before and after training of the residents was 59.19 ± 44.45 and 40.24 ± 19.40 years, respectively. Table 1 illustrates the demographic information of patients that were not significantly different before and after the training period (p > 0.05). The most common cause of pain was soft tissue injury, both before (36.3%) and after training (34.3%). The most frequent drug that was administered for pain control was morphine, both before (62.5%) and after (41.4%) training. Although the number of patients with moderate pain intensity was higher during the after-training period, pain control quality was described to be better in this group and success rate of pain control was significantly increased after training (p Findings from the present study showed that there was a significant deficiency in pain management of the admitted patients, and the most common reason for this was the physician's fear of the drug’s side effects. However, significant progress was seen after the training regarding pain management process in ED.

The use of patient-controlled analgesia (PCA) has increased in recent years. Data regarding PCA’s usefulness following anorectal surgery are equivocal, and it still needs to be further studied and discussed. Therefore, the current study was conducted to compare PCA with pudendal nerve block (PNB) for pain management in patients undergoing anorectal surgery.

Patients candidate for elective anorectal surgery under general anaesthesia were considered eligible. Prior to the surgery, the patients were divided into PCA and PNB groups. PNB was performed at the end of the surgery just before extubation. PCA was initiated in the recovery room. The patients’ pain scores were recorded based on an 11-point numerical rating scale (NRS) at 2, 6, 12, and 24 hours into the post-operative period. The total dose of morphine sulfate consumed, the overall satisfaction, and any side effects were recorded.

100 patients with a mean age of 44.55 ± 11.45 years were enrolled (71% male). Both methods resulted in effective pain control. The difference in the consumed doses of morphine was not statistically significant (P = 0.2). The PNB group patients were more satisfied than those in the PCA group (8.6 ± 1.9 vs. 7.3 ± 2.2; P = 0.037). The recorded side effects were significantly higher in the PCA group (P < 0.001).

Although both morphine-contained PCA and PNB with Marcaine resulted in effective pain control following anorectal surgery, it is likely that local anaesthesia with Marcaine is accompanied by fewer side effects and more satisfaction.

Spontaneous adrenal hematoma is a very rare condition and its prevalence has been reported to be about 1% in previous studies. Although various causes have been proposed to explain its incidence in existing case reports, the etiology and pathology of this condition is still not known. The present study presents a case of spontaneous adrenal hematoma in a pregnant 31 year old woman without history of trauma or other probable risk factors of hemorrhage, presenting to the emergency department with chief complaint of pain in the right flank. Diagnostic measures, imaging and laparotomy, confirmed the diagnosis of spontaneous adrenal hematoma for her.

A 25-year-old man underwent an excision of a thigh mass under general anesthesia without any complication. After the operation, he developed oxygen desaturation requiring a jaw thrust maneuver. A rapidly expanding hematoma on the right side of the neck was formed shortly after the application of the maneuver. The patient was returned to the operation room for a neck exploration. Damage to the facial artery and vein was noted. Further evaluations confirmed the diagnosis of Neurofibromatosis type 1 (NF-1). It is recommended that considering the probable risk of arising hematoma in NF-1 patients, application of jaw thrust maneuver should be performed meticulously.

Intravenous lidocaine has anti-inflammatory role and analgesic properties, and is able to reduce the need for opioids during and after surgery. This study was conducted with the aim of evaluating the effect of intravenous (IV) lidocaine infusion during general anesthesia on levels of inflammatory factors according to Glasgow prognostic score in breast cancer surgery candidates.
The present study is a randomized clinical trial. 63 patients with breast cancer, who were candidates of mastectomy elective surgery, were included. The patients were allocated to 2 groups using a random numbers table. After inducing anesthesia similarly for all the patients using midazolam 0.02 mg/kg, fentanyl 2-4 µg/kg, propofol 1-2 mg/kg and atracurium 0.5 mg/kg, the first group received 1.5 mg/kg/hr IV lidocaine and in the second group, the same volume of normal saline was infused intravenously. Glasgow prognostic score was calculated before surgery and also 6, 24, and 48 hours and 14 days after surgery. Required data were gathered via a checklist. To statistically analyze the data, SPSS software version 20 was used. To compare qualitative variables, Fisher’s exact test, and to compare means of quantitative data, independent t-test was applied. In addition, for comparing C reactive protein, albumin, and Glasgow prognostic score measures between the 2 groups; generalized mixed model regression analysis was used. Significance level was considered to be p A total of 63 women with breast cancer, with the mean age of 49.25 ± 9.32 years, were included. 28 of them were allocated to lidocaine group and 35 were in the control group. Mean age was 48.61 ± 9.26 years in lidocaine group and 49.89 ± 9.38 years in control group (p=0.591). Additionally, there was no statistically significant difference between the 2 groups regarding incision size (p=1.000) and duration of surgery (p=0.752). Using mixed model regression analysis and after adjusting the effect of baseline measures of variables, a significant difference was not detected between the groups regarding their Glasgow prognostic score during the follow-up time (p=0.122).
Based on the results of this study, IV infusion of lidocaine during general anesthesia did not have a significant effect on the level of inflammatory factors according to Glasgow prognostic score in patients who were candidates of breast cancer surgery.

This double-blind randomized clinical trial aimed at comparing the effect of intranasal desmopressin with that of intravenous ketorolac in pain management of patients with renal colic referring to the emergency department.
The patients were randomly divided to two groups. One group received intravenous ketorolac 30 mg and intranasal normal saline, while, the other one received intranasal desmopressin 40 μg and 1 mL of intravenous distilled water. The patients’ pain was evaluated using the visual analog scale at the time of admission, 10, 30, and 60 minutes after drug administration.
Overall, 40 patients with mean age of 32.53 ± 6.91 participated in this study. Gender ratio (P = 0.288), mean age (P = 0.165), and mean pain score on arrival (P = 0.694) had no significant difference. The mean pain scores, 10, 30, and 60 minutes after drug administration in the ketorolac group was significantly lower than the desmopressin group, and decreased more rapidly (P It is likely for desmopressin to be less efficacious than ketorolac, and desmopressin leads to a significant alleviation of pain in patients with renal colic.

The aim of this study was to evaluate the correlation between malampathy score, upper lip bite test and 3-3-2 maneuver with anthropometric factors of body in people.
This cross-sectional study was carried out during 2014-2015 in Yazd, Iran. Samples were selected from the whole population using simple randomization and were included in the study after giving informed consent. Baseline and demographic data including age, sex, and anthropometric factors of their body such as weight, height, neck circumference, waist circumference, hip circumference, body mass index (BMI), and waist to hip ratio were gathered in a pre-designed checklist. Then malampathy score, upper lip bite score, and 3-3-2 maneuver were evaluated and recorded by the researcher.
498 people with the mean age of 42.1 ± 16.1 were studied (51% female). In total, 168 (69%) of the studied men and 182 (72%) of the studied women had a BMI higher than 25. 74 (39%) of the men had a waist to hip ratio over 0.93 and 152 (60%) of the women had a waist to hip ratio over 0.81. Results of the upper lip bite test was a score of 3 in 10 (2%) people, result of malampathy test was a score of 3 or 4 in 152 (31%) participants and result of 3-3-2 maneuver showed an abnormal condition in 20 (4%), which indicate the probability of difficult intubation. With an increase in age, based on all 3 methods, the probability of difficult intratracheal intubation rises (p 0.05). There was a significant correlation between malampathy score and upper lip biting with all anthropometric factors of the body. 3-3-2 rule also significantly correlated with weight, height, waist circumference, hip circumference, and BMI, but not with neck circumference (p = 0.328) or waist to hip ratio (p = 0.121).
It seems that with an increase in age, based on all 3 methods, the probability of difficult intratracheal intubation rises. However, none of the 3 methods of intratracheal intubation difficulty evaluation have a significant correlation with sex. In addition, according to the results of the current study, a significant correlation exists between upper lip biting and malampathy score with all anthropometric factors of the body assessed in this study. Yet, 3-3-2 maneuver does not have a significant correlation with neck circumference or waist to hip ratio.

A 25-year-old Afghan male was presented to the emergency department with femoral shaft fracture following fall from the height. The patient was subjected to femoral nerve block and general anesthesia. First try for performing nerve block led to vascular puncture. Therefore, the needle was removed and re-inserted 1 cm lateral to first puncture site and DEX injected slowly with aspiration check after every 5 mL to avoid intravascular injection. Immediately after injection, heart rate dropped to 40, blood pressure decreased to 85/50 mmHg and the BIS dropped to 30. Because of not spontaneous resolving the situation atropine and ephedrine were ordered that resulted to regain hemodynamic stability.
It is likely that vascular puncture during peripheral nerve block can lead to some adverse events that need to be monitored precisely.

This study was performed with the aim of comparing the dosage of opioid consumption for induction and maintenance of anesthesia in people with and without sleep disorder.
In this cohort study for patients who candidate for cataract surgery, Pittsburgh sleep quality questionnaire was completed and based on the results, patients were divided into 2 groups of normal, and sleep disorder. The same protocol was used for induction and maintenance of anesthesia in all patients. Total dose of fentanyl consumption was calculated and recorded.
70 patients with the mean age of 63.8 ± 10.7 years were entered (67.1% female). Demographic and baseline characteristics of the patients were not significantly different between normal and sleep disorder groups. Fentanyl consumption for induction and maintenance of anesthesia were lower in the sleep disorder group compared to the normal group, but the difference was not statistically significant (p Based on the findings of this study, it seems that although patients with sleep disorders need a lower dose of opioids for induction and maintenance of anesthesia during surgery, compared to those who are normal in this regard, the difference is not statistically significant.

The choice of anesthetic technique in patients with osteogenesis imperfecta (OI) can be a challenge for anesthesiologists and must be adjusted based on specific circumstances and abnormalities. We report our anesthetic technique in an OI patient to emphasize this point, and to frame a discussion of this subject. According to the accessible data, we report one of the rare OI patients who have undergone spinal anesthesia for emergency surgery..
The patient was a 21-year-old female with OI type IV, who was admitted due to severe anal pain. The surgeon decided to perform an emergency reduction of a prolapsed rectum, with late permanent fixation. Considering the circumstances, we decided to perform spinal anesthesia for the operation, which lasted for 30 minutes. The patient underwent rectal prolapse reduction via rectosigmoidoscopy, of up to 25 cm of rectum. She was transferred to the post-anesthesia care unit after her vital signs were stabilized. After gaining lower extremity strength, she was transferred to the surgery ward. The next day, she was discharged from the hospital..
Although most authors believe that general anesthesia following fiberoptic intubation is the preferred method for OI patients, it is likely that spinal anesthesia is acceptable in such patients. Although it is technically difficult, the procedure can be performed by expert anesthesiologists..