m.r. khajavi

continuous body temperature monitoring during anesthesia in children is very important.  Hypothermia in children results in increased morbidity and mortality. Measurement point of the core body temperature are not easily accessible. the purpose of this study was to measure skin temperature over the carotid artery and compare it with the nasopharynx.

Totally, 84 patients within the age range of 2 - 10 years, undergoing elective surgery, were selected. Temperature skin over carotid artery and nasopharynx was measured during anesthesia.  Then mean temperature of these points was compared which each other and the effects of age, sex and weight change of temperature during anesthesia were evaluated.

The mean age of patients was 5.4 ± 2.6 years s. 37% of patients were female and 63% were male. The mean weight was 20 ± 7 kg. The mean duration of surgery was 60.45±6.65min. Temperature of skin and nasopharynx was decreased during surgery as after 60 min the deference between skin over carotid artery and nasopharyngeal area was 1°c. Variables of the mean nasopharyngeal temperature, mean carotid temperature, age, sex and weight were entered into the regression model. The model’s coefficients for age and sex were not significant. But body weight has a significant effect on carotid skin temperature.

Skin temperature over the carotid artery, with a simple correction factor of +1 °C, provides a viable noninvasive estimate of nasopharyngeal temperature in children during elective surgery with a general anesthetic.

 Perivalvular and valve involvement are prevalent in patients with end-stage renal disease (ESRD), especially in younger patients compared with normal population. Kidney transplantation improves the prognosis of these patients. Patients with cardiac valvular disease is also be improved following kidney transplantation.

 To evaluate the impact of renal transplantation on the severity of mitral regurgitation (MR).

 We studied 95 kidney transplantation candidates in Sina Hospital. The patients underwent echocardiography preoperatively and at the 3rd, 6th, and 12th months post-operatively.

 Pre-operatively, the average MR fraction was 30%; MR volume 30 mL/beat; mitral valve mean gradient 1.8 mm Hg; mitral valve area 4.6 cm2; and mitral annular size 3 cm. No significant difference was observed among the measurements made at the 3rd, 6th, and 12th months post-operatively.

 There was no significant association between the variables measured pre- and post-operatively. The reason might be the fact that patients with ESRD in Iran do not have to expect long transplant waiting lists and dialysis cannot affect their heart adversely.

Reperfusion injury and the acid-base status of the transplant are important factors affecting post-transplantation graft function.
We hypothesized that infusing hypertonic saline (HS) or tight control of acid-base status of the blood rushing through renal graft using sodium bicarbonate may have beneficial effects on early graft function.
Candidates for deceased-donor kidney transplant were randomized into three groups. HS group (n=33) received 50 mL/kg normal saline (NS) titrated during operation plus 4 mL/kg of 5% HS just within graft reperfusion phase; bicarbonate group (n=37) was administered 60 mL/kg NS while their metabolic acidosis (base excess ≤‑5 mEq/L) was tightly corrected every 30 min with sodium bicarbonate; and a control group (n=36) that received 60 mL/kg normal saline while they were administered sodium bicarbonate only, if they encountered severe metabolic acidosis (base excess ≤‑15 mEq/L). The primary outcome was defined as early post-operative renal function evaluated based on serial serum creatinine levels. The study was registered in Iranian Registry of Clinical Trials (IRCT2013122815841N19).
Post-operative early graft function improved significantly during the first 3 days in the intervention groups (p Timely administration of HS or tight control of metabolic acidosis with sodium bicarbonate infusion improve early renal function during renal transplant surgery.

Background and the purpose of the study: Opioids are usually used in regional anesthesia, with or without local anesthetics to improve the regional block or postoperative pain control. Since no data are available on fentanyl's effect on the onset time of lidocaine interscalene anesthesia, the purpose of this study was to examine its effect on the onset time of sensory and motor blockade during interscalene anesthesia. In a prospective, randomized, double-blind study, ninety patients scheduled for elective shoulder, arm and forearm surgeries under an interscalene brachial plexus block. They were randomly allocated to receive either 30 ml of 1.5 % lidocaine with 1.5 ml of isotonic saline (control group, n = 39) or 30 ml of 1.5% lidocaine with 1.5 ml (75µg) of fentanyl (fentanyl group,n=41). Then the onset time of sensory and motor blockades of the shoulder, arm and forearm were evaluated every 60 sec. The onset time of the sensory and motor blockades was defined as the time between the last injection and the total abolition of the pinprick response and complete paralysis. The duration of sensory blocks were considered as the time interval between the administration of the local anesthetic and the first postoperative pain sensation. Ten patients were excluded because of unsuccessful blockade or unbearable pain during the surgery. The onset time of the sensory block was significantly faster in the fentanyl group (186.54± 62.71sec) compared with the control group (289.51± 81.22, P < 0.01). The onset times of the motor block up to complete paralysis in forearm flexion was significantly faster in the fentanyl group (260.61± 119.91sec) than the control group (367.08± 162.43sec, P < 0.01) There was no difference in the duration of the sensory block between two groups. Results of the study showed that the combination of 75 µg fentanyl and 1.5% lidocaine solution accelerated the onset of sensory and motor blockade during interscalene anesthesia.

The effect of Positive End Expiratory Pressure (PEEP) on the hepatic elimination of low to moderate extraction ratio drugs has not been clearly defined. We prospectively investigated the effect of PEEP on the clearance of theophylline in 30 (20 males and 10 females) intubated critically ill adult patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). The Mean (±SD) age was 57±17 years, creatinine clearance 86±36 ml/min, serum albumin 3.2±0.57 mg/dl and the median APACHE (acute physiology and chronic health evaluation) II score was 25 (with a range of 16 to 34). Critically ill patients who had met the diagnostic criteria for ALI/ARDS were enrolled on PEEP in low (5-9 cmH2O) and high (10-15 cmH2O) levels. All patients received the ordered dose of aminophylline infusion (3 mg/kg over 30 min and then 15 mg/h) after 2 h of initiating PEEP. Blood samples were collected after the loading dose, 2 and 6 h the aminophylline continuous infusion. Vital signs were recorded before and after 2 h of PEEP and each blood sampling interval. Cirrhotic patients and those who had received any drug which could interact with the metabolism and clearance of theophylline, were not included. The Mean(±SD) value of the pharmacokinetic key parameters of theophylline in high (n=17) and low (n=13) PEEP groups were as follows: Vd=0.42(±0.15) L/kg and 0.54(±0.13) L/kg, clearance = 0.035(±0.024) L/h/kg and 0.056 (±0.025) L/h/kg. Mean measured theophylline concentrations following loading dose were 7.08 mg/L and 5.09 mg/L. The calculated volume of distribution (P<0.03), clearance (P<0.05) and theophylline serum concentration (P<0.05), in high versus low peep group, were found to be significantly different. Positive ventilation tends to reduce Vd and clearance of theophylline in critically ill patients.