فهرست مطالب mirmohammadtaghi mortazavi

Given that no study has so far carefully examined the effects and benefits of crystalloids on the hemodynamic status and events during the surgery for lower limb orthopedic surgeries, the current study aimed to compare fluid therapy with normal saline (NS), Ringer (R), and Ringer’s lactate (RL) during anesthesia on the hemodynamic status and events during lower limb elective orthopedic surgeries.

This cross-sectional descriptive study was conducted in 2019 with the participation of 270 patients (three groups each including 90 subjects) who were scheduled for an elective lower limb orthopedic surgery in Imam Reza hospital of Tabriz. Patients received one of these serums of NS, R, and RL. Electrolytes were measured before and after the surgery. Finally, data were analyzed using ANOVA and chi-square tests.

Based on the results, there was no significant difference between the three groups in terms of hemoglobin, hematocrit, sodium, calcium, potassium, chlorine, albumin, creatinine, urea, bicarbonate, pH, and arterial oxygen levels (P>0.05), and RL serum had the least effect on all factors.

In general, the administration of NS, R, and RL in lower limb orthopedic surgeries did not result in significant differences although RL had the least adverse effects and was associated with better results.

Uncertainty about the effect of age on the success rate of laryngeal mask airway (LMA) insertion led us to conduct the present study to evaluate the success rate of LMA in airway management in different age groups.

A total of 183 patients, who were admitted to Shohada hospital (Tabriz, Iran) during 2018-2019, were enrolled in this descriptive, cross-sectional, prospective study. The patients were selected through the convenience sampling method and divided into 4 age groups. After anesthesia, patients were compared in terms of duration and number of LMA insertion attempts and LMA insertion complications. The data were analyzed using SPSS20 through one-way ANOVA and the Chi-square test at P<0.05).

There were significant statistical differences between different age groups regarding resistance against LMA insertion (P=0.008) so that insertion was most comfortable and easy in the first attempt in the adult group compared to other groups. However, no significant statistical difference was observed between different groups in terms of the rate of air leakage (P=0.129), the duration of successful LMA insertion (P=0.119), and the number of LMA insertion attempts (P=0.091). Regarding LMA insertion complications, laryngospasm was significantly higher in the middle-age and aged group (P=0.009), and blood observation on LMA was significantly higher in the pre-school and child group (P=0.005).

According to the results of this study, no difference was found between different groups in terms of successful LMA insertion and post LMA insertion complications.

Use of tampons is one of the most common ways to treat epistaxis. This single Randomized clinical trial aimed to assess the efficiency of tranexamic acid (TA) in controlling different types of bleeding. From 2019 to 2020, 120 patients with epistaxis, referred to the Imam Reza Hospital(Tabriz-Iran) emergency department, and were treated. The patients were randomly divided into control (tampon) and intervention (TA) groups. The control group received tetracycline-impregnated tampon, while TA-impregnated gauze was used for the intervention group. The mean time needed to stop bleeding was significantly higher (p=0.011) in the control group (18.59±2.33 Min) than in the intervention group (09.33±1.47 Min). In most patients in the intervention group bleeding stopped in less than 10 minutes; while in the control group. Bleeding in the majority of patients ceased within 10 to 20 minutes (p=0.01). The results indicate the beneficial effects of TA, as a drug with relatively low side effects in reducing bleeding time in patients with epistaxis. Thus, it can be used as a complementary drug, along with packing to stop bleeding.

The quality of recovery can affect the results of abdominal hysterectomy although this effect is unknown in different methods of anesthesia. Therefore, the present study was conducted to compare general anesthesia (GA) and spinal anesthesia (SA) methods on the quality of the recovery of patients with selective abdominal hysterectomy in patients visiting the largest women’s disease hospital in Northwestern Iran.

This cross-sectional descriptive study was conducted with the participation of 350 patients with abdominal hysterectomy, who were selected by convenience sampling in Al-Zahra hospital, Tabriz, Iran in 2019. Demographic data, visual pain scale, hemodynamic status, and Aldrete-Kroulik index were recorded for each patient. Data were analyzed using Mann-Whitney, t-test, multivariate regression, and Kolmogorov-Simonov tests in SPSS 20, and P<0.05 was considered statistically significant.

In the hemodynamic status, it was found that the SA group was more stable than the GA group but this difference was not significant (P>0.05). Regarding the need for pethidine, the results revealed that the mean (± standard deviation) of the GA group was significantly higher (35.14 ± 10.14) than that of the SA group (20.15 ± 05.25, P=0.039) while there were no significant differences between the two groups in the use of the antiemetic drug (P=0.203). Finally, the evaluations of the quality of recovery showed that the mean±) SD) of the quality of recovery in SA patients was significantly higher compared to GA patients (P=0.015).

In general, the quality of recovery was higher in the SA compared to the GA regarding abdominal hysterectomy

Cardiac injury is one of the significant perioperative complications in major orthopedic surgeries and its early diagnosis is useful in the reduction of postoperative comorbidity. The cardiac troponin is a sensitive and specific biomarker for detecting this damage. The aim of this study was to evaluate the levels of perioperative cardiac troponin I (cTnI) before and after arthroplasty in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). The effects of related variables and probable major cardiac complications were evaluated in this study. For one year, in a prospective, cross-sectional study, the serum levels of cTnI before and 48 hours after arthroplasty were evaluated in 52 patients. Possible contributing factors including age, gender, body mass index (BMI), daily activity, history of hospitalization due to cardiovascular diseases, underlying illness, and medications were recorded. The Chi-square test, Pearson correlation, and Spearman test were used to examine the relationship between variables. The mean cTnI increased significantly after arthroplasty (P < 0.001). There was no significant relationship between age (P = 0.708), gender (P = 0.225), BMI (P = 0.195), daily activity (0.441), underlying illness (P = 0.244), and cTnI levels after arthroplasty. Linear regression showed BMI was significantly correlated with troponin changes (P = 0.006). Five patients had heart palpitations and one had chest pain, but none of the patients had any findings in favor of cardiac injury. cTnI levels after THA and TKA increased significantly, but this elevation was in the normal range. In addition, none of them had a new cardiac complication after arthroplasty.

The prevalence of obesity has substantially increased all over the world in the past decades and anesthesiologists more commonly encounter these patients. Excess cervical adipose tissues can result in the narrowing of the pharyngeal opening and affect laryngoscopic grade.
To evaluate the effect of manual caudal and cervical displacement of cervical adipose tissue on laryngoscopic view of morbid obese patients.
A total of 70 patients with a BMI ≥ 35 were enrolled in this study. All patients were placed in the ramp position. Manual caudal and downward displacement of cervical adipose tissue was performed by an anesthesiologist. Laryngoscopy was performed by an anesthesiologist before and after manual displacement. The anesthesiologist was blinded as we had drawn a curtain, therefore, he could not recognize if the maneuver was being performed or not. Thyromental distance, upper lip bite test, hyomental distance, and BMI were recorded for all patients.
Age, weight, and BMI didn’t have any significant relation with difficult intubation. There was a significant relationship between difficult intubation and thyromental distance, upper lip bite test, Mallampati score, and hyomentaldistance (P: 0.01, 0.04, 0.001, and 0.005, respectively). Cormack-Lehane grade significantly improved after the maneuver (P: 0.001).
Preparation and appropriate management of airway is very important for morbid obese patients. Manual caudal and downward displacement of adipose tissue has a significant effect on the improvement of laryngoscopic view in morbid obese patients. Therefore, ramped position or manual and caudal displacement of chest wall fat tissue can be added to "standard" preoperative airway assessment.

Post-dural puncture headache is one of the common complications after neuraxial anesthesia. Some researchers have used corticosteroids for treatment of this complication.
We decided to study the prophylactic effect of administering intravenous hydrocortisone before spinal anesthesia in reducing the incidence and intensity of headache after surgery.
This randomized, double-blind, placebo-controlled trial was carried out in 80 patients undergoing abdominal and lower limb surgery without other health problem (ASA I). We randomly put 40 participants in the placebo group and 40 in the hydrocortisone group for study. The placebo group received 2 ml placebo and hydrocortisone group received 2 ml (100 mg) intravenous hydrocortisone. The incidence of PDPH on the recovery, 12, 24, 48 hours and 7 days after surgery was studied, and the severity of PDPH was assessed using a visual analog scale (VAS).
The mean intensity of headache in hydrocortisone group after recovery in the first 12, 24 and 48 hours and the first week of surgery were 0.0, 1.27, 2.35, 2.28 and 0.97 mm whereas in placebo group they were 0.0, 2.02, 3.02, 2.92 and 1.47 mm. The difference of headache intensity between two groups was not significant (P=1, P=0.231, P=0.344 ,P=0.351, and P= 0.302). The difference of incidence rate between two groups was not significant (P= 1, P=0,502, P=0.633, P=0,579 and p= 0,576).
The results indicated that prophylactic administration of 100 mg hydrocortisone did not have any protective effect against post dural puncture headache.

Surgery of upper part of femor in elderly patients can be due to the fracture of femoral neck, shaft and arthroplasty. Hemodynamic changes and complications of the anesthesia are among the major concerns. The aim of this study was to compare the hemodynamic changes in low dose isoflurane with propofol in upper femoral surgeries in elderly patients. This prospective clinical trial study was done on 60 patients over 65 year-old elderly patients with ASA physical status of I and II that were candidate for upper femoral surgery in two groups (inhalational: isoflurane 0.5-0.6 MAC) and (total intravenous anesthesia with propofol 50-100 mic/kg/min). Hemodynamic changes were compared in these groups with the same anesthetic depth (HR-SBP-DBP-MBP-SaO₂). There was no significant difference in heart rate, age or sex between two groups. In isoflurane group SBP on 20 and 25th minutes and DBP and MBP on 20, 25 and 35th minutes were significantly higher than propofol group. In propofol group SaO₂ was significantly more than isoflurane group on induction, start of surgery and on 5, 25, 35 and 45th minutes of surgery. In anesthesia with the same Bi-Spectral Index, isoflurane provides more stable hemodynamic parameters than propofol.

Backgrounds and Recognizing the complications of rhinoplasty is important for both surgeon and patient. The aim of the present study was to evaluate the prevalence of complications after rhinoplastic surgery. In this study that was done between 2003-2005 patients who were admitted for rhinoplasty were observed for their hemodynamic changes، respiratory problems and other complications of rhinoplasty during a 24 – month period (2003-2005). Methods of anesthesia were similar in all patients. Data were collected using a check list and analyzed by SPSS. 15 software Two hundred and two patients، [78 (38/6%) males and 124 (61/4%) females] were enrolled in the study. There was no detectable complication in 131 patients. Different complications were seen in 68 patients. Twenty-one (10/ 4%) of patients experienced tachycardia and 7 (3/46%) of patients had arrhythmia during their surgery and hospitalsty. According to the results of this study، there are some complications such as tachycardia and arrhythmia، during postoperative period of rhinoplastic surgery.