فهرست مطالب hamid reza faiz

 World Health Organization (WHO) declared that the outbreak of COVID-19 constituted a public health emergency of global concern.

 Owing to limited data on critically ill patients admitted to ICU, we aimed to describe the clinical characteristics and prognosis of these patients based on ventilatory variables and clinical features.

 In this retrospective study, 45 critically ill patients with laboratory-confirmed COVID-19 who were admitted to Intensive Care Unit (ICU) wards of the hospital from April 8 to May 9, 2020, were enrolled. Medical files of the patients were reviewed, and demographic and clinical characteristics, laboratory data, lung CT scan findings, causes of intubation, and outcomes of the patients were all collected.

 The median age of the patients was 67 years (range 22 to 91), 64% were men, and hypertension was the most common comorbidity. History of close contact with previously confirmed patients was positive in 62.2% of the patients. The mean time from symptom onset to hospital admission was 5.98 ± 2.93 days. The most common symptoms at the onset of illness were dyspnea (95.6%), and gastrointestinal symptoms (22.2%) were rare. The average length of the intubation was 4.84 ± 3.28 days. The distribution of intubation causes in the deceased patients was significantly more than the recovered patients (P = 0.031). The mean score of lung CT involvement in deaths (370.26 ± 207.50) was significantly higher than the recovered patients (235.71 ± 81.21) (P = 0.042). Length of the intubation had a statistically direct correlation with respiratory rate (P = 0.03).

 Most of the critically ill patients admitted to ICU were older men and had poor outcomes with a high mortality rate. Furthermore, the score of chest CT involvement and respiratory rate are important prognostic factors in determining the severity of the illness, requiring ventilatory support, and outcome.
 

Electroconvulsive therapy (ECT) is an effective treatment in major depressive disorder (MDD). Earlier studies suggest that ketamine has antidepressive effects and prolongs seizure duration in favor of therapeutic efficacy of ECT. A great concern with the use of ketamine is its possible adverse hemodynamic effects during ECT. This study was conducted to compare the hemodynamic effect and seizure duration between ketamine and sodium thiopental, a common anesthetic in ECT.

In a cross-over clinical trial, 26 patients of either sex with MDD who were candidates for ECT therapy in a university hospital were enrolled. A total of 13 patients received induction with ketamine in the first session and thiopental for the second. The sequence of treatments was vice versa in the other group. The followings were measured in all patients: blood pressure, heart rate, and oxygen saturation before induction, immediately after induction, at 1, 2, 4, and 10 minutes postinduction, and after recovery from anesthesia. Also, seizure duration, recovery time, and complications of treatments were measured. Chi square test and student t test were used for categorical data and numerical data, respectively. P values < 0.05 were considered statistically significant. Analyses were performed with SPSS software version 21.0.

Heart rate, systolic and diastolic blood pressure, oxygen saturation, and recovery time were comparable between groups. Mean duration of convulsion in patients who received ketamine was significantly more than those who received STP (36±11 vs 28±9 s, p=0.001). Myalgia was less common in patients who received ketamine rather than sodium thiopental (11.5 vs 46.2%, p=0.014).

Ketamine prolongs seizure duration with no deleterious effects on hemodynamic parameters. Considering the antidepressant effects of ketamine, it may be a better choice, compared to thiopental sodium, for MDD patients.

Post-hysterectomy pain is extremely annoying and using transverse abdominis plane (TAP) block can be a useful method to manage postoperative pain, but its duration of effect is challenging. Magnesium sulfate increases, in some cases, the effects of local anesthetics on the peripheral nerve blocks.
The current study aimed at investigating the effects of adding magnesium sulfate to ropivacaine in the transverse abdominis plane block after hysterectomy.
The current randomized, double blind, clinical trial, to manage postoperative pain, was conducted on a total of 60 patients, 30 - 60 years old, ASA (American Society of Anesthesiologists) class I-II undergone elective abdominal hysterectomy candidates to receive ultrasound-guided bilateral transverse abdominis abdominis plane (TAP) blocks. Patients with coagulation disorders, infection, history of any addiction, sensitivity to the local anesthetics and magnesium sulfate were excluded. The subjects were equally allocated into two groups, the control group, ropivacaine plus normal saline (R), and the study group, ropivacaine plus magnesium sulfate (RM). The injection contained 19 mL ropivacaine 0.2% plus 1 mL normal saline in the group R, and 19 mL ropivacaine 0.2% plus 1 mL magnesium sulfate 50% in the RM group on each side. As well as the patients’ characteristics, the level of pain score (visual analogue scale = VAS), rescue analgesic demand (diclofenac suppository), and possible adverse effects were evaluated at 1, 2, 6, 12, and 24 hours after the operation in the two groups.
The mean pain scores of the patients at the first hour after surgery were 5.7 ± 0.9 and 5.9 ± 1.1 in R and RM groups, respectively. The scores reached 2.9 ± 0.5 and 2.7 ± 0.4 at the second hour after surgery (the first post-block measurement) and 3.1 ± 0.7 and 2.8 ± 0.7 within the next 24 hours, respectively. Although the pain scores were generally lower at all hours in the RM group, none was statistically significant. The rescue analgesic consumption gradually increased in the two groups, and it was less in the study group than in the control group in the first hours after the block (second hour after surgery); however, it was not statistically significant. No adverse effects were observed in the two groups.
Results of the current study suggested that the addition of magnesium sulfate to ropivacaine in TAP block does not affect the post-hysterectomy pain.

Aim and Femoral nerve block is the common method for controlling pain after knee surgery, but it is not the only knee nerve and so always does not provide successful block. Another innervation of the knee is from obturator nerve.
In this double-blind study, 60 patients whom have undergone elective arthroscopic knee surgery randomly divided into 2 groups of equal number; The femoral nerve block group and obturator nerve block group that. Then after the block patients were evaluated for pain with VAS. Also satisfaction scale was inquired [based on the excellent (1), good (2) moderate (3) and dissatisfied (4)]. Data was analyzed with SPSS 20 software.
Findings: Pain was measured at rest in the femoral block, which at all hours showed less scores than obturator block except for measuring at 24 hours. And at 0, 3 and 6 hours after block this difference was statistically significant (at time 0 P value = 0.048 and at 3 and 6 The study showed that patients undergoing femoral nerve block have less pain and greater satisfaction scores compared with patients that were under obturator block. Although, VAS in both groups was in an acceptable level of analgesia after surgery.

Postoperative pain is one of the most important complications encountered after surgery. A number of options are available for treating pain following surgery. One of those options is the use of intravenous patient-controlled analgesia (PCA). Ketamine is an anesthetic drug relieving pain with its NMDA receptor antagonistic effect. This study is aiming at better pain management after abdominal surgery; the effects of adding ketamine to intravenous fentanyl plus acetaminophen PCA were evaluated.Patients and In a double-blind randomized clinical trial 100 patients, ASA I or II, 20 - 60 years old were divided into two groups. These patients were abdominal surgery candidates. In order to control postoperative pain in the control group an IV patient-control analgesia (PCA) containing fentanyl 10 μg/mL plus acetaminophen 10 mg/mL was instructed to be used for the patients, but the patients in ketamine group received ketamine 0.5 mg/mL plus control group PCA content. During the first 48 hours after surgery, ketamine patients were evaluated every 8 hours (at rest, while moving and coughing) to determine their pain scores using VAS scale, sedation score, additional analgesics, nausea and vomiting. There were no significant demographic differences between two groups. Pain scores (at rest, while moving and coughing) during the first 48 hours were not significantly different between two groups (P values = 0.361, 0.367 and 0.204, respectively). Nausea scores were significantly lower in the ketamine group (P = 0.026). The addition of ketamine to intravenous fentanyl plus acetaminophen PCA had not extra effects in relieving post abdominal surgery pain.

Postoperative pain is one of the most important complications encountered after surgery. A number of options are available for treating pain following surgery. One of those options is the use of intravenous patient-controlled analgesia (PCA). Ketamine is an anesthetic drug relieving pain with its NMDA receptor antagonistic effect.. This study is aiming at better pain management after abdominal surgery; the effects of adding ketamine to intravenous fentanyl plus acetaminophen PCA were evaluated..Patients and In a double-blind randomized clinical trial 100 patients, ASA I or II, 20 - 60 years old were divided into two groups. These patients were abdominal surgery candidates. In order to control postoperative pain in the control group an IV patient-control analgesia (PCA) containing fentanyl 10 μg/mL plus acetaminophen 10 mg/mL was instructed to be used for the patients, but the patients in ketamine group received ketamine 0.5 mg/mL plus control group PCA content. During the first 48 hours after surgery, ketamine patients were evaluated every 8 hours (at rest, while moving and coughing) to determine their pain scores using VAS scale, sedation score, additional analgesics, nausea and vomiting.. There were no significant demographic differences between two groups. Pain scores (at rest, while moving and coughing) during the first 48 hours were not significantly different between two groups (P values = 0.361, 0.367 and 0.204, respectively). Nausea scores were significantly lower in the ketamine group (P = 0.026).. The addition of ketamine to intravenous fentanyl plus acetaminophen PCA had not extra effects in relieving post abdominal surgery pain..

Pain is one of the greatest concerns of patients undergoing total knee arthroplasty (TKA); which is severe and intolerable within 72 hours post-surgery. Appropriate pain management is a key factor in patient''s early mobilization، launching physiotherapy، less hospital length of stay and more importantly، patient''s satisfaction. New studies with the infiltration of combined analgesic agents peri and intra-articularly has shown encouraging results in pain reduction، good clinical outcome and patient''s satisfaction. The purpose of this study was to compare the analgesic effect of locally infiltrated analgesia (I) compared with single injection femoral nerve block (F) and its impact on pain relief، patient''s satisfaction، morphine consumption and clinical outcome. This research was a double-blind randomized clinical trial on 36 consecutive patients undergone TKA divided into group (F) in which the ipsilateral femoral nerve in the inguinal area was blocked by a single injection of 20 ml ropivacaine (10 mg/ml) and group (I) which a combination of ketorolac، ropivacaine and epinephrine was injected peri and intra-articularly on the knee during TKA. Pain intensity measured by visual analog scale (VAS)، clinical outcome (based on range of motion)، morphine consumption and patient''s satisfaction of pain management after TKA were compared between the two groups. Pain intensity score (VAS) and Morphine consumption were statistically less in group I than group F during the first 6 hours and 24 hours post surgery respectively (P< 0. 05); however، group F had 12-hour VAS score of 5 which was less than group (I) by 1 grade in pain scale (VAS) (P< 0. 05). Other parameters were not statistically different in the two groups and patients'' response to our pain management protocols proved to be satisfactory in both groups. Lower level of pain and morphine consumption in group (I) during the first 24 hours post-surgery in contrast to group (F) and its ease of use by a surgeon intra-operatively، introduce local infiltration analgesia as an effective method to decrease the patient''s pain and improve patient''s satisfaction in early post-surgery period after total knee arthroplasty.

The aim of this study is comparing ACTH changes in epidural and intravenous analgesia technique after lower limb orthopedic surgery. In a randomized clinical trial in Hazrat Rasool Akram Hospital during 1387-88، 60 patients candidate for surgery on the lower extremities were randomly allocated to receive either postoperative analgesia with epidural analgesia (PCEA) or IV analgesia (PCIA). Measurement of ACTH levels and Visual analogue scale (VAS) was performed in four relief phases including at the time of arrival to the operating room، immediately after surgery and 12 hours after intravenous pump functionary and 24 hours after surgery were recorded. The mean level of ACTH and VAS، 24 hours and 12 hours after surgery in the PCEA group were less than PCIA. Ramsey Sedation Score (RSS) in PCEA group at these intervals was more than PCIA cases. It seems that PCEA relieves pain more effectively than PCIA method. However، the proper method of anesthesia for each patient as well as patients'' preferences should be considered in selecting the method of postoperative analgesia.