فهرست مطالب mahmood akhlaghi

Laparoscopic cholecystectomy is a procedure of choice for treatment of chronic cholecystitis. Intensity of pain following this procedure in the first 24 hours after surgery is very high and is intolerable for many patients. The aim of this study was comparison of bupivacaine and hydrocortisone topical instillation in gallbladder bed for pain relief after laparoscopic cholecystectomy in patient with chronic cholecystitis. This single blind clinical trial was done in patients who underwent laparoscopic cholecystectomy due to chronic cholecystitis in Ayatollah Kashani hospital of Shahre- Kord in 2017. Sampling of patients was convenient method. Patients were divided into three groups: A group: 100 mg hydrocortisone group: 20 mL of bupivacaine solution 0.5% and C group: 20 ml of normal saline without medication. Pain was measured using VAS scale in the recovery room and 6 and 18 hours after surgery and if VAS score was more than 5, patients received 30 mg pethidine Stat. In this study the mean VAS scale in the recovery room and 6 hours after surgery had not significant difference between the groups. But VAS scale of 18 hours after surgery had a significant difference among the three groups. So that the VAS scale in the hydrocortisone group lesser than the control group and bupivacaine 0.5% group (p =0.009). In general, during this study, all three groups, pain intensity was significantly reduced. The satisfaction of patients in the three groups were similar (p =0.969). Regarding amount of nausea after surgery, 26.7% of hydrocortisone group, 20% of bupivacaine group 0.5%, and 23.3% of control group had postoperative nausea (p =0.830). In all three groups no headaches were reported. In this study, postoperative pain intensity in all three groups during the third phase of the study was reduced. And the use of hydrocortisone in laparoscopic cholecystectomy reduced the pain intensity in 18 hours after surgery significantly compared with the control group and bupivacaine 0.5%.

Airway assessment is fundamental skill for anesthesiologists and failure to maintain a patient’s airway is the tremendous cause of anesthesia-related morbidity and mortality. None of the tests which have recommended for predicting difficult intubation stands out to be the best clinical test or have high diagnostic accuracy. Our study aimed to determine the utility of a new test as “laryngoscopic exam test (LET)” in predicting difficult intubation. Three hundred and eleven patients aged 16-60 years participated and completed the study. Airway assessment was carried out with modified Mallampati test, upper lip bit test and LET preoperatively, and Cormack and Lehane's grading of laryngoscopy were assessed during intubation as a gold standard, and difficult laryngoscopy was considered as Cormack and Lehane's grade ΙΙΙ or ΙV of laryngoscopic view. The incidence of difficult intubation was 6.1%. The LET showed higher sensitivity, specificity, and accuracy (P

Anisocoria during anesthesia is very rare, but may indicate life-threatening neurologic injuries and create tremendous condition. A 23-year-old male patient was anesthetized with fentanyl and propofol. Thirty minutes after inducing anesthesia, unilateral mydriasis was detected. The duration of surgery was shortened for prompt evaluation of the pupils. At the end of the operation neither vision problem nor obvious anisocoria was detected in the recovery room. Ophthalmological and neurological consultations revealed no pathological finding and the patient was discharged. Evaluation of the size of the patient's pupils before operation would mitigate the fearful condition resulted from anisocoria.

Prolonged QT interval may lead to serious arrhythmias and ventricular fibrillation, hence prevention of the QT-interval prolongation is crucial for physicians. The aim of this study was to assess the influence of intravenous lidocaine on the QTc interval resulting from spinal anesthesia with bupivacaine. In a randomized double blind trial, fifty male patients with mean age of 70.38 and ASA physical status ΙΙ, who underwent spinal anesthesia for elective orthopedic lower limb surgical procedures, were assessed. Our subjects were divided into two groups, patients randomly received intravenously either 1.5 mg/kg lidocaine 2% as test group (n=25), or 0.05 ml/kg isotonic sodium chloride as control group (n=25), just before inducing of spinal anesthesia. Spinal anesthesia was performed in the sitting position with 3 ml of 0.5% hyperbaric bupivacaine. Values of the QTc interval, heart rate, and arterial blood pressure were measured before spinal anesthesia as well as 1, 5, 15, and 30 minutes after spinal anesthesia. With respect to the within-group values, statistically significant prolongation of the QTc interval as well as hemodynamic variability were detected in the measured times after blockade. There was no statistical difference between two groups according to hemodynamic parameters and the duration of the QTc interval before spinal anesthesia and times after spinal block with bupivacaine. Administration of intravenous lidocaine may not prevent the prolongation of the QTc interval and hemodynamic changes resulting from spinal anesthesia with hyperbaric bupivacaine, in elderly subjects.

Background and Traditional lecture-based teaching has been long used to transit theoretical knowledge to the participants. Due to some problems of this didactic approach, some believe that integration within an active method is more valuable in nursing education. In this study, we hypothesized that integrating lecture-based teaching within clerkship course would enhance nurse-anesthesia students’ knowledge. A prospective randomized study was conducted. Twenty four students of two-year nurse-anesthesia participated in the study. All of the students received either didactic lectures or integrated lectures within clerkship course during a four-month semester of their educational curriculum. Their knowledge of anesthesia course was assessed at the end of the course using Wilcoxon Rank test. The integrated method improved students’ final scores at the end of the semester (p=0.004). Moreover, their scores was much better when taxonomy-2 questions were compared (p=0.001). Incorporating didactic lecture within anesthesia clerkship course improves participants’ knowledge of anesthesia course.

Postoperative shivering is a common complication of anesthesia. Some studies reported that hemodilution induced anemia can reduce postoperative shivering. In this study, we evaluated the correlation between the hemoglobin index and changes on post anesthesia shivering. In a descriptive-analytical study, 117 patients aged 16-60 years were participated. Preoperative and postoperative hemoglobin index was measured. The level of hemoglobin was evaluated in 3 steps; before operation, 1 and 6 hours after operation. Postoperative shivering was evaluated by Crossly-staging. The collected data were analyzed by SPSS 17.00 software, using repeated measures analysis of variances and Spearman correlation tests. From the total of 117 patients, 21 patients (17.9%) demonstrated postoperative shivering. The mean hemoglobin levels in patients with and without shivering before the operation were found 14.70±2.38 and 15.14±2.25 mg/dl, respectively (P>0.05). After the operation, the mean hemoglobin levels in two groups were 13.28±2.36 and 13.64±2.05, respectively (P>0.05). Finally, measuring hemoglobin levels in both groups six hours after the operation, were found 13.08±2.2.10 and 13.52±2.49, respectively (P>0.05). No correlation was observed between the hemoglobin levels and shivering stages (P=0.085). According to results of this study, there is no correlation between hemoglobin level and postoperative shivering.

Premedication is widely used in pediatric anesthesia to reduce emotional trauma and ensure smooth induction. The aim of our study was to investigate and compare the efficacy of orally administered valeric versus that of promethazine as a premedication in pediatric patients. We performed a prospective study in 58 children, 1 to 8 years of age, with average of 3.8 years; randomly allocated into two groups. The valeric group received 0.25 cc/kg and the promethazine group received 0.5 mg/kg oral promethazine. The preoperative sedation. Anxiolysis and mask acceptance scores were evaluated separately on a four-point scale, with ease of parental separation, based on the presence or lack of crying, were evaluated on a standard scale questionnaire. Neither medication showed acceptable sedation, with no significant difference in sedation score between the two groups (p=0.715). Anxiolysis and mask acceptance using either valeric or promethazine were acceptable, with valeric performing significantly better than promethazine (p=0.028 and p=0.036 respectively). Ease of parental separation was seen in both groups without significant difference (p=0.265) and no major adverse effects, such as apnea, occurred in either group. Orally valeric is more effective than promethazine in anxiolysis and mask acceptace. Although they both can ease separation anxiety in children before surgery, we found neither drug to be acceptables for sedation.

Nowadays writing an essay is very important to represent scientific achievements providing that the principles of rhetorical patterns would be considered. The present study aimed to compare the structural variations in English abstracts of Persian and English journals in the area of medical sciences. In this analytical-descriptive study, 64 medical article abstracts (32 in Iranian journals, 32 in international journals) were analyzed and compared on the basis of Swales’ model. Furthermore detailed analysis was done on the Introduction section regarding CARS (Create- a- Research- Space) model proposed by Swales. The IMRC (Introduction, Methods, Results, Conclusion) sequence was considered as the structural conventions for the analysis. Data were analyzed using Chi square and Fisher tests. The results showed that while all translated abstracts considered IMRC sequence, the original ones did not considered it completely. In the introduction section, there was a significant difference, in writing the aim of the study and it was found more in translated abstracts compared to the original ones (P<0.001). In addition, there was a significant difference in using the Material and Methods section between the two groups of abstracts but pro translated abstracts (P<0.01). Both groups of abstracts were identical in the Results and Conclusion sections. The results showed that the translated abstracts from Persian to English in medical articles more closely reflected the criteria of scientific writing structure than the abstracts excerpted from the original English articles.

Objective- Evaluation of the effect of different fasting times on the quality of propofol total intravenous anesthesia (TIVA) and recovery features.Design- Experimental prospective design.Animals- Fifteen lambs.Procedures- Fifteen lambs that anesthetized for carotid translocation surgery were included in this current study and allocated in to three groups randomly. In Group 1, food was withheld for 24 hours, with free access to the water. In Group 2 and 3 the food withhold time was 48 and 72 hours. In all animals the anaesthesia were induced by propofol (5 mg/kg) and maintained by continuous propofol infusion 0.41-0.45 mg/kg/hr for 60 minutes. Heart rate (HR) and respiratory rate (RR), rectal temperature (Temp) and invasive systolic (SAP), diastolic (DAP) and mean arterial pressure (MAP) were measured during anaesthesia. Time to first swallowing attempt, time to lift the head and time to standing were recorded by videoing the animals. Results- Although the longest recovery times were recorded in group 3 but no significant difference were recorded between groups under study in all measured parameters. The only significant finding was the number of animals that were regurgitated during anaesthesia that was significantly higher in group 3.Conclusion and Clinical Relevance- Long food withdrawal could not alter different recovery times but regarding to higher regurgitation in group three and lower quality of anaesthesia in this group it seems that the best results were in group one.

Thalassemia is the most common hereditary chronic anemia in human. It causes terrible effects on psychological health condition of family members, especially mothers. Due to the advantages and a very few side effects of group therapy, the current study aimed at determining the effects of group therapy on mental health condition of the thalassemic patients’ mothers. A clinical trial was conducted on 60 mothers of thalassemic patients in Hajar hospital of Shahrekord medical university and Seieed Al Shohada hospital in Farsan. At the beginning of the study all mothers were administered a demographic and mental health questionnaire (GHQ28) and among those who scored higher than 23, were randomly designated to the experimental and control groups. In the treatment period of the study the participants in the experimental group attended 8 weekly sessions of group therapy. Data were analyzed using ANOVA, t-test, paired t-test, and Pearson Correlation. Before the experiment there was no significant difference between the two groups of subjects in both questionnaires in all dimensions (P>0.05). After the treatment period a significant difference was observed between the two groups in all dimensions of mental health (P<0.05). The results also showed that there was no correlation between demographic variables and mental health conditions. The results of this study showed that group therapy has a considerable positive effect on recovery and improvement of mental health of mothers of the chronic patients, like thalassemia in all dimensions.

Postoperative pain causes various problems such as medical complications, excess cost and administration of opioid drugs. Although previous studies have shown the preventive effect of ketamine on postoperative pain, the administered dose was high (over 1mg/kg), which may cause adverse effects. The aim of this study was to assess the effect of low dose (0.5 mg/kg) of ketamin on postoperative pain. Sixty women that were candidate for elective cesarean section were recruited for our study and were divided randomly into two groups of case and control. Sixty seconds before operation, case and control groups received 0.5 mg/kg ketamine or placebo, respectively. Techniques of anesthesia and surgery were the same. Pain severity was assessed by McGill pain questionnaire, at 4 visits (the first at recovery then every 6 hours). Case patients showed a lower mean pain score (P<0.05, t-test). This study suggests that low dose of ketamine is an effective drug for postoperative pain, which could be considered as an alternative of its high dose.

Two of the side effects of the spinal anesthesia for caesarian are the hypotension of mother and bradycardia of the fetus. The aim of this study was to assess the safety and efficacy of intramuscular (i.m.) ephedrine for prevention of the hypotension associated with the spinal anesthesia. Ninety patients undergoing elective caesarian section under spinal anesthesia, were assigned to three groups in a randomized clinical trial study. Group 1, “control group” didn receive ephedrine, while case groups “group 2 and group 3” received 25 mg and 50 mg ephedrine (i.m.) 5 minutes before the spinal anesthesia respectively. The mean arterial pressure (MAP) was recorded at 1, 5, 15 and 30 minutes after spinal anesthesia, and the differences of these mean arterial pressures (DMAP) from that of 5 minutes before spinal anesthesia were calculated. The MAP and the differences were significantly different between the three groups. We concluded that 50 mg ephedrine prevents hypotension during 30 minutes after the spinal anesthesia, but 25 mg ephedrine prevents hypotension only at 5 minutes after the spinal anesthesia. Therefore 50 mg ephedrine could be used to prevent mother’s hypotention during spinal anesthesia.

Laryngospasm, laryngitis and bleeding are the most serious complications after tonsillectomy. In this study, the frequency of these complications and their correlation with age, sex and application of lidocaine jelly has been assessed. The sample consisted of 100 patients aged from 5 to15 years undergoing tonsillectomy in Resalat hospital of Shahrekord, during 6 months. The subjects were divided randomly into two groups. Case group intubated with 2% lidocaine gel via the endotracheal tube, and control group intubated without lidocaine gel. Laryngospasm, laryngitis and bleeding were recorded during the first postoperative day. The incidence of laryngospasm and laryngitis was 8% and 17% respectively. There were no correlations between these problems and age or sex. The incidence of bleeding was 16% that was higher in older and female patients. The endotracheal tube lubrication with 2% lidocaine gel attenuated laryngospasm during recovery after tonsillectomy in children but it was not effective on laryngitis and bleeding. The application of lidocaine gelly after tonsilectomy for prevention of laryngospasm is recomended.