nazli karami

Endotracheal intubation is a potentially high-risk aerosol-generating procedure. So, an intubation box (I-Box) is designed for personal protection during intubation. This study aimed to compare the outcomes of endotracheal intubation with and without an I-box in COVID-19 patients.

In this study, 60 COVID-19 patients (30 patients in each group) with and without I-box groups were included. outcomes of intubation including duration of intubation, first-pass success intubation, suitable visibility of airways, restriction of movement in the neck, the need to surface maneuvering of the airway, and the number of attempts for successful intubation were compared between the two groups.

The time of intubation was significantly longer in the I-box group (15.27±2.6 seconds) than without the I-box group (8.37±1.3 seconds) (p<0.001). All patients (100%) were intubated in the first attempt in the without I-box group while the rate of first-pass success intubation was 50% in the I-box group (p <0.001). The visibility of the airway was significantly better in the without I-box group than the I-box group (without I-box: 23 patients (76.7%), I-box: 15 patients (50%), p= 0.032). The frequency of need to optimizing maneuver of the airway was in without and with I-box was 23.3% and 50% respectively (p=0.032).

However, the I-box as a physical barrier can protect healthcare workers but its use increased the time to intubation and the number of attempts for successful intubation and reduced the rate of first-pass success intubation and visibility.

 Maternal mortality is one of the most important health issues worldwide. Therefore, the current study aimed to determine the causes of maternal mortality in West Azarbaijan-Iran province during 2013-2020.

 In this retrospective cross-sectional study, demographic data and information on maternal deaths (based on the Pregnancy Mortality Surveillance System) were obtained from the treatment deputy of Urmia University of Medical Sciences. The data were collected and analyzed in the West Azarbaijan-Iran province during the 2013-2020 years.

 Over seven years, 102 maternal deaths occurred. The frequency of direct, indirect, and unknown causes of maternal mortality was 35.28%, 60.8%, and 3.92% respectively. Among direct causes, the leading cause of maternal mortality was hemorrhage (23.52%) and sepsis was the next order (7.84%). In indirect causes, brain diseases had the highest frequency (18.9%). Gestational age, place, and technique of delivery were highly related to the death causes (p<0.05). The mother's age (OR: 1.14, 95% CI: 0.51-2.52), being rural (OR:1.34, 95% CI: 0.57-3.15), and having a history of diseases (OR:1.31, 95% CI: 0.59-2.89) were positively associated with the risk of infant’s mortality. While the gestational age (>37w) (OR:0.047, 95% CI: 0.013-0.18, P<0.001) and high education level (OR: 0.64, 95% CI: 0.27-1.57, P=0.33) were inversely correlated with an increased risk of infant mortality.

Direct and indirect causes of hemorrhage were the most common cause of maternal death.  Gestational age, delivery place, and technique of delivery were significantly associated with the type of death causes.

Laparoscopic surgery has been developed recently. In this method, CO2 is insufflated in peritoneal space, rises intra-abdominal pressure, and causes hemodynamic changes. Capnography and non-invasive end-tidal CO2 (ETCO2) measurement are the most important and helpful monitoring methods.

In this semi-experimental study, 60 patients candidated for laparoscopic gynecological surgery were included. After induction of anesthesia by the same method, end-tidal CO2 monitoring was performed using capnography. Mean arterial pressure (MAP), and heart rate (HR) of the patients were measured in these intervals: Immediately after intratracheal intubation, before blowing CO2 into the abdominal cavity, immediately after blowing CO2 into the abdominal cavity, 10 minutes and 20 minutes after blowing gas into the abdominal cavity, 10 minutes after CO2 gas exits the abdominal cavity, and before extubation of the patient.

ETCO2, MAP, and HR in the 10th and 20th minutes after gas blowing, as well as before extubation were statistically higher compared to other times (P <0.05).

According to the present study, it was concluded that end-tidal CO2 changes during laparoscopic surgery are helpful in the early diagnosis of complications, and the highest increase in end-tidal CO2 and hemodynamic changes are evident in the 10th and 20th minutes after blowing CO2 into the abdominal cavity.

Nausea and vomiting are common complications in women undergoing cesarean section with spinal anesthesia. This study aimed to compare the propofol, dexamethasone, and ondansetron effects on nausea and vomiting. In this double-blind randomized clinical trial study, 120 women aged 15 to 35 years candidates for cesarean section under spinal anesthesia were enrolled. Patients were randomly divided into four groups (three-drug groups and the control group). Patients received 0.05 mg /kg ondansetron (group O), 0.1 mg /kg dexamethasone (group D), 0.2 mg/kg propofol (group P) and normal saline in controls (group C). Nausea and vomiting in recovery and 6 hours after surgery compared between groups. In recovery and 6 hours after surgery, both nausea and vomiting were the highest in group C while they were lowest in group O. the frequency of nausea was 11(36.7%) in both recovery and 6 hours after surgery and the frequency of vomiting was 12(40%) and 10(33.3%) in the recovery and 6 hours after surgery respectively. Among the three drug groups, nausea and vomiting were higher in group D in both recovery rooms and 6 hours after surgery.  The frequency of vomiting was 10 (33.3%) and 5 (16.7%) in recovery and 6 hours after surgery in group D respectively. these differences were statistically significant between the four groups (p<0.05). The preventive effect of dexamethasone is not very useful in both periods. Therefore, it can be recommended that in the short period after surgery, propofol has a beneficial effect in preventing postoperative nausea and vomiting.

Background:

 The aim of this study was to evaluate the effect of preoperative oral carbohydrate on the perioperative agitation in pediatrics with elective herniorrhaphy.

Materials and Methods:

 In this randomized clinical trial study, 120 pediatrics, 6 months to 10 years-old who underwent elective herniorrhaphy were admitted. Sixty pediatrics in the intervention group received 5 ml/kg of 20% dextrose solution manufactured by Samen Company as carbohydrate beverage exactly 2 hours before surgery and the control group (n=60) received distilled water. The perioperative agitation score was calculated as follows. Score 1: quiet, silent child, score 2: mild but agitated, score 3: medium aggression, and score 4: severe agitation measured before surgery, at recovery, 5, 15 and 30 minutes after intervention. Also, the incidence of nausea and vomiting was recorded in each group.

Results :

Of the 60 pediatrics in the intervention group, 54 patients were quiet and silent at the time of entry into the operating room, and 6 patients had mild agitation; in the control group, 7 patients were quiet and silent, 41 patients were mild but agitated, and 12 were moderate. There was a significant difference in agitation between the two groups (P = 0.001). Five minutes after surgery, 54 patients scored 1, 6 patients scored 2 in the control group, 27 patients scored 1 and 33 patients scored 2. There was a significant difference between agitations of children 5 minutes after intervention in the two groups.

Conclusion :

Five ml/kg of 20% dextrose solution as carbohydrate beverage exactly 2 hours before anesthesia may lead to parental satisfaction and improvement in positive behavior of pediatrics at anesthesia induction and wake up from anesthesia.

Postoperative shivering is one of the common complications of surgery in the recovery room, with an incidence rate of about 50-60% in various reports. Postoperative chills usually result in unwanted hypothermia during operation.

In this study, patients were divided randomly (after selecting one of 32 card containing coatings) into intervention group (n=45) and the placebo group (n=45). This was done by anesthesiologist who had no intervention in the study, and anesthesiologist and patients did not receive information about the drugs received and the examination of chills and severity of chills was performed by a person who was not aware of the way of study.

There was a significant difference in the frequency of shivering between the intervention group (fentanyl) and the placebo group (without fentanyl) (p <0.001). There was no significant difference regarding severity of shivering between the intervention group and the placebo group (p = 450.0). There was no significant difference in vomiting between the intervention group and the placebo group (p=.184). There was a significant difference between the intervention group and the placebo group (p = 0.003) with regard to nausea. Because vomiting was only recovered in the placebo group (without fentanyl), there were 2 patients and in the intervention group (fentanyl), vomiting was not recovered at all. Therefore, no significant difference was observed regarding frequency of vomiting between the intervention group and the placebo group. There was no significant difference in the vomiting time between the intervention group and the placebo group (p = 0.69). There was a significant difference between the intervention group and the placebo group regarding pruritus (p <0.001).

Most of the patients who received fentanyl had less shivering during surgery and recovery than those who did not receive fentanyl, and most of the patients who received fentanyl had less nausea during operation and recovery than those who did not receive fentanyl and those who received fentanyl have had more pruritus during operation and recovery than those who did not receive fentanyl. Also, taking fentanyl is effective in itching during surgery and recovery.

Postpartum hemorrhage is one of the life-threatening complications after labor and cesarean section. Its prevalence is 6 percent. Metratonia is the most common cause of this complication. Some medications can prevent it. Oxytocin is the most common uterine vasoconstrictor and is used routinely after delivery for decreasing hemorrhage. The aim of this study is to compare hemodynamic changes of oxytocin infusion under general anesthesia with spinal anesthesia in elective cesarean section.

In this observational study, 120 pregnant patients with ASA I and II candidate for elective cesarean section were enrolled in two groups randomly. In one group, general anesthesia and in the other group spinal anesthesia was performed. The  heart rate, systolic, diastolic, and mean arterial pressure of patients were recorded every minute until delivery. After umbilical cord clamping and infusion of 30 units dose of oxytocin, the hemodynamic parameters were evaluated every 3 minutes for 30 minutes. 

Until the delivery, the heart rate, systolic, diastolic, and mean arterial pressure of patients were higher in the general anesthesia group (p=0.002). After beginning oxytocin infusion, these parameters were different in two groups and were higher in the group under general anesthesia. But only the difference of systolic blood pressures was significant (p=0.01)

We can conclude that in the cesarean section, the type of anesthesia impression on hemodynamic changes due to oxytocin infusion is only observed on systolic blood pressure and there is no significant difference in other hemodynamic parameters.

Arterial pressure is one of the most important physiological variables and often needs to be monitored repeatedly or continuously in perioperative period. Arterial pressure monitoring is one of the standard monitoring in operating room. During general anesthesia, blood pressure can be measured by using a noninvasive arterial pressure method or continuous invasive arterial pressure by an invasive arterial line. Comparison of invasive measurements in the patient’s candidate to esophagectomy has not been assessed. The aim of this study was to compare invasive and noninvasive blood pressure in these patients.

In a prospective, cross-sectional, observational study, 42 hemodynamically stable patients candidate for esophagectomy under general anesthesia in supine position were evaluated at Urmia Imam Khomeini Hospital operating room from June 2017 to April 2018. The patients had American Society of Anesthesiologists (ASA) physical status II or III and the patients who had complete heart block and marked arterial blood pressure differences greater than 10  mmHg in the two arms were excluded. After induction of anesthesia and patients monitoring, the radial artery was cannulated for invasive blood pressure monitoring and noninvasive blood pressure was measured via the arm cuff on the other hand at the four-time intervals: after radial artery cannulation (T1), during release of esophagus (T2), during anastomosis (T3) and at the end of operation (T4).

The mean difference between indirect and direct systolic blood pressure was 0.85±2.93, -8.42±2.9, 6.50±3.60 and 2.67±2.6 mmHg and for diastolic blood pressure was 3.53±2.67, 4.57±2.22, 2.10±2.58 and 1.03±1.53 mmHg respectively, at the T1 to T4. At the all-time intervals, there were no statistically differences between systolic and diastolic blood pressure measurement regarding invasive and noninvasive blood pressure (P=0.77)

Noninvasive arterial blood pressure showed acceptable agreement with invasive measurements for systolic, diastolic and mean pressure. According to fhe finding of this study, there were no statistical differences between systolic and diastolic blood pressure measurement regarding invasive and noninvasive blood pressure and these two methods can be used in selected patients.

Emergence from general anesthesia and removing of tracheal tube can be associated with coughing, agitation, and hemodynamic disturbances. Dexmedetomidine is an alpha two adrenoceptor agonist that has effective sedation with less cardiovascular unstability and respiratory depression and may be useful for extubation and prevention of hemodynamic response during tracheal tube removing. The aim of this study was to evaluate the effect of dexmedetomidine on hemodynamic responses during endotracheal extubation and sedation level in recovery room.

In an analytical study, fifty women aged 20-50 years old candidate to cholecystectomy under general anesthesia and tracheal intubation were entered randomly to this study in two groups (no. 25) at Imam Khomeini Hospital, Urmia, Iran, and under support of Urmia University of Medical Sciences Urmia, Iran, from May 2017 to May 2018. Ten minutes before end of surgery, 0.8 µg/kg dexmedetomidine in the study group and for the other patients in control group normal saline as placebo were infused over ten minutes. During the emergence phase, blood pressure, heart rate and oxygen saturation were recorded at 0,1,2,3 and 5 minutes after extubation. Also, sedation index was evaluated via the Ramsay sedation score and recorded at recovery room.

Heart rate, systolic blood pressure and diastolic blood pressure in patient with infusion of dexmedetomidine were lower significantly at 1,2,3 and 5 minutes after extubation than control group. Data for heart rate, systolic and diastolic pressure, at min 1 after extubation were 81±6 vs. 88±9, 120.64±13.21 vs. 137.52±11.06, 72.84±8.32 vs. 81.36±9.26 in dexmedetomidine and control groups respectively. Data for heart rate, systolic and diastolic pressure, at min 5 after extubation were 73±6 vs. 80±8, 110.64±10.68 vs. 119.88±10.01, 69.84±8.32 vs. 73.48±5.13 in study and control groups, respectively. As well as 80% of the patients in dexmedetomidine group had satisfactory sedation and cooperation in compare to the 28% in control group (P=0.001).

Intravenous infusion of 0.8 µg/kg dexmedetomidine 10 minutes before extubation of endotracheal tube and during emergence, facilitate extubation and lead to hemodynamic stability and satisfactory sedation.

Tracheal intubation with a cuffed tube for the administration of general anesthesia is routine. The cuff of the endotracheal tube is inflated with air to achieve an adequate seal to prevent aspiration and leakage of air and anesthetic gases. Whereas over-inflation can decrease the mucosal perfusion, leading to pressure necrosis and nerve palsies. This study aimed to evaluate the change in ETT cuff pressure by changing the position from supine to prone and lateral decubitus without head movement.

During this prospective analytical study, fifty-five patients candidate for surgery under general anesthesia with lateral or prone positions were enrolled. The initial base pressure of the ETT cuff was measured, and the cuff pressure was subsequently adjusted to a normal range. The cuff pressure then was measured after applying the prone or lateral positions and at the end of operation when the patient had the supine position.

The cuff pressure increased significantly after changing position from supine to prone (27.06±2 vs. 36.87 ± 9 cmH2O, p < 0.001). Also, significant increase in cuff pressure was also observed after changing position from supine to lateral decubitus (27.95 ±3 vs. 40.81 ± 10 cmH2O, p < 0.001).

The position change from supine to prone and supine to lateral decubitus without head movement can cause an increase in the endotracheal tube cuff pressure. The necessity of routine monitoring of cuff pressure in these patients is recommended.

The most straightforward method of ascertaining arterial PO2, PCO2, and other components of blood gas is to measure them directly from a blood sample. In situations in which arterial puncture cannot be achieved or may be technically difficult, the venous blood sample can be used.
In a prospective analytical study, 80 patients undergoing mechanical ventilation after open-heart surgery in the intensive care unit were evaluated. Simultaneous, matched arterial and central venous blood gas samples were taken from radial artery line and central vein, respectively, when the ABG (arterial blood gases) assessment was needed. Arterial and central venous blood samples were analyzed and data were expressed as mean and ± SD.
The Pearson correlation coefficient for pH, PCO2, HCO3, and SatO2 was 0.898, 0.940, 0.840, and 0.567, respectively. There was a significant correlation between arterial and central venous values of pH, PCO2, and HCO3 (P The central venous PCO2, pH, and HCO3 measured during mechanical ventilation in the intensive care unit approximate arterial values closely enough to permit the estimation of the adequacy of ventilation and acid-base status. The central venous Sat O2 does not reliably parallel the arterial Sat O2. In conclusion, venous blood sampling can potentially reduce the requirement for ABG sampling in special situations.

Chronic use of renin-angiotensin system (RAS) antagonists (angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor antagonists (ARAS)) can cause hypotension during anesthesia. In some studies hemodynamic instability, including hypotension and its effects on the clinical outcome in patients treated with these drugs during coronary artery bypass graft (CABG) and need to excessive vasoactive drugs in these patient population, has been described. The aim of this study was to evaluate the effect of chronic consumption of ACEIs and ARAS on blood pressure and inotrope consumption during coronary artery bypass graft under cardiopulmonary bypass.
A total of 200 patients undergoing coronary artery bypass graft surgery, who were treated with either ARAS or ACEIs (n = 100) over at least 2 months, or who were not treated with any RAS antagonists (control group, n = 100) were enrolled. The mean arterial blood pressure, central venous pressure, and need for vasoactive drugs, were measured after induction of anesthesia (T1) before cardiopulmonary bypass (T2) and after separation from (CPB), (T3).
There were no significant differences regarding the mean arterial pressure (case group: T1: 84 ± 7 mmHg, T2: 77 ± 6 mmHg, T3: 83 ± 8 mmHg), (control group: T1: 85 ± 7 mmHg, T2: 81 ± 7 mmHg, T3:84 ± 6 mmHg) between two groups (P > 0.05). Also there were no significant differences regarding mean central venous pressure, mean heart rate, and vasoactive drug consumption between the two groups during the time of intervals.
We found that preoperative (RAS) antagonist’s continuation have not profound hemodynamic changes during coronary artery bypass graft under cardiopulmonary bypass and so we conclude that omitting these drugs before surgery did not have a sufficient advantage to be recommended routinely.

Anxiety and emergence agitation are major challenges for anesthesiologists in pediatric anesthesia. Parental presence during induction of anesthesia can be used to treat pre-induction anxiety and emergence agitation in children. The aim of this study was to evaluate the effect of mother presence during induction of anesthesia on emergence of agitation after strabismus surgery
In this prospective randomized clinical trial, 40 candidates for strabismus surgery aged 2-7 years were divided into study and control group. Pain and sedation were assessed in the post-anesthesia care unit using FACEs pain rating scale and Ramsay sedation scale, respectively.
Patients in the study group had significantly higher Ramsay sedation scores compared with the control group (2.1±.7 vs. 1.2±.4; p=0.04). There was no statistically significant difference regarding postoperative FACES in pain rating scale among two study groups.
Parental presence during induction of anesthesia can reduce emergence behavior and agitation in selected children undergoing general anesthesia.

Tracheal intubation and direct laryngoscopy are powerful noxious stimuli that can elicit sever hemodynamic responses. These hemodynamic responses should be attenuated by appropriate use of premedication, smooth induction of anesthesia and rapid tracheal intubation. Gabapentin and pregabalin have been suggested in several studies to be efficient. Gabapentin is an antiepileptic drug and a structural analogue of gamma-Aminobutyric acid (GABA) but it does not act through GABA receptors and pregabalin, is also an antiepileptic agent. The aim of this study was to compare the effect of gabapentin and pregabalin as premedication for attenuation of hemodynamic response to laryngoscopy and endotracheal intubation.
In a prospective double blinded randomized clinical trial, during April 2015 to March 2016 in Urmia Imam Khomeini Hospital, a total of ninety normotensive adult consented patients, candidate to elective abdominal surgery aged 20-50 years, American Society of Anesthesiologist (ASA) class I, of both gender were randomized into three groups. Patients in group I received oral placebo, group II received oral gabapentin 900 mg and group III patients received oral pregabalin 150 mg two hours prior to induction of anesthesia. Anesthetic technique was same in three groups and all groups were assessed for hemodynamic changes such as heart rate, systolic blood pressure and diastolic blood pressure, after the premedication, before and after induction of anesthesia, and 1, 3 and 5 minutes. after laryngoscopy and tracheal intubation.
Significant increase in heart rate and systolic blood pressure and diastolic arterial pressure was observed in placebo group after tracheal intubation, while statistically significant attenuation of hemodynamic changes was seen in gabapentin and pregabalin groups. (P=0.001) No adverse outcome was reported in the study groups.
Oral gabapentin premedication is effective for control of hemodynamic pressor response of laryngoscopy and tracheal intubation. The study data showed that the pregabalin have the same effect. Pregabalin and gabapentin are both useful and safe for control of hemodynamic pressor response as premedication.

Nausea and vomiting during spinal anesthesia for elective cesarean delivery is a common finding and may occur in up to 80% of patients. The aim of the present study was to compare efficacy of using intravenous midazolam alone, ondansetron, and midazolam in combination with ondansetron for prevention of nausea and vomiting during and after cesarean delivery in parturient that underwent spinal anesthesia.
In a double-blind study, 126 women undergoing elective caesarean section under spinal anesthesia (using 0.5% bupivacaine 12.5 mg) were allocated randomly to receive midazolam 2 mg (n=42), ondansetron 4 mg (n=42) or midazolam and ondansetron (n=42) after the clamping umbilical cord. The frequency of nausea and vomiting during and after surgery in recovery room were recorded.
The frequency of intraoperative nausea and vomiting was lower in the O (28.6, 7.1%) and MO (26.2, 16.7%) groups compared with M (50, 31%) group (P=0.04, P=0.006). The frequency of nausea and vomiting after surgery in recovery room was lower in the O (4.8, 19 %) and MO (11.9, 7.1%) groups compared with M(38.1, 23,8 %) group (P=0.01, P=0.03). Metoclopramide consumption was lower in O and MO groups compared with M group (P=0.02). There was no difference in mean arterial pressure and pulse rate between three groups during the surgery at times measured.
A bolus dose of midazolam (2 mg) was not effective than ondansetron (4mg) and ondansetron plus midazolam (O 4 and M 2 mg) for the prevention of nausea and vomiting in parturient patients undergoing cesarean section with spinal anesthesia during and after surgery in recovery room; however, further studies are needed.

Pediatric patients show various reactions during emergence from general anesthesia. Many cases of emergence agitation after anesthesia have been reported and pain was suggested as a major contributing factor. The purpose of this study was to evaluate the effect of sub-Tenon lidocaine injection on emergence agitation and pain in children after strabismus surgery.
In a randomized clinical trial, 40 children, aged 5-10 years, who were scheduled for strabismus surgery, were enrolled. Children were randomized two groups and at the end of surgery, the surgeon injected 1 ml of 2% lidocaine into the sub-Tenon space in study group and in control didn’t inject any drug. Pain and sedation were assessed in the post-anesthesia care unit using FACEs pain rating scale and Ramsay sedation scale respectively.
Patients in the sub-Tenon's lidocaine group had significantly lower pain scores in compare to control group (2.8±0.6 vs 4.6±1.7; p=0.0001). Ramsay sedation scores also were higher in sub-Tenon's lidocaine group (2.7±1.2 vs 1.2±0.4; p=0.0001)
In children undergoing strabismus surgery, sub-Tenon's block provides more effective analgesia and sedation.

Aim and Nausea and vomiting after surgery takes place in20-30% of patients and these two together are the second most common complains of patients after surgery. We perform this study hoping that use of proper intravascular fluids has a role in decreasing nausea and vomiting after surgery.
Methods and Materials: This clinical trial study was performed on 60 female patients who aged between 20 to 60 years old and with score 1 and 2 of ASA who underwent diagnostic laparoscopy under general anesthesia. Fluids were injected 15 minutes before general anesthesia in all patients. We used 10ml/kg of ringer lactate in crystalloid group, and 10ml/kg voluven in colloid group. Incidence Frequency of nausea and vomiting during recovery was recorded and collected in special formes of this study.
Findings: According to p-value= 0.121 in Chi-square test which is more than 0.05, nausea variant was not significantly different in two groups. The two study groups were assessed and compared about vomiting incidence which according to p-value=0.136 they did not have any statically significant difference.
In this study we used from voluven to increase intravascular volume which had no statically significant difference in incidence of nausea and vomiting comparing to other group which we used ringer lactate in it.

Although intraspinal opioid has been presented to be effective in providing analgesia after cesarean delivery, pruritus as a side-effect remains a common cause of dissatisfaction. We undertook a study to assess the efficacy of ondansetron for treatment or prophylaxis of intrathecal fentanyl-induced pruritus. The role of ondansetron has been studied in preventing pruritus but the results have been contradictory.
We randomized 110 patients undergoing elective cesarean section using spinal anesthesia with Marcaine 10 mg plus fentanyl 25 µg and into a double-blinded trial to receive ondansetron 4 mg (study group) or placebo (control or placebo group) after clamping of umbilical cord. Intra and post-operative itching, nausea and vomiting, and shivering in the recovery room were registered.
Forty percent of the patients in the placebo group and 23.6% in the ondansetron group had itching intraoperative (P=0.04). The incidence of post-operative itching was 38.2%, 21.8% in placebo and ondansetron groups, respectively (P=0.04). The patients reported less intra and post-operative nausea and vomiting in the ondansetron group than in the placebo group (P=0.01). There was no difference in the incidence of shivering between two groups.
This study showed that the prophylactic ondansetron reduced itching, nausea and vomiting intra and postoperative caused by intrathecal fentanyl with marcaine

Aims and Postoperative sore throat (POST) is an undesirable complaint after orotracheal intubation. Magnesium is a noncompetitive N-methyl-D-aspartate receptor antagonist thought to be involved in the modulation of pain. The present study aimed to investigate the effect of preoperative administration of intravenous magnesium on POST.
Methods and Materials:Seventy two patients undergoing lumbar laminectomy surgery were randomly allocated into two groups. They either received saline (control) or 40 mg/kg magnesium intravenously after intubation in 30 minutes. Patients were assessed for incidence of POST and postoperative cough at recovery room postoperatively.
Findings: The incidence of POST during recovery state was higher in the control group than the magnesium group (P=0.04). The highest incidence of post operative cough occurred in the control group in recovery room after surgery (P=0.03). The highest stability of hemodynamics was seen in the magnesium group.
The administration of intravenous magnesium in 30 minute preoperatively after intubation is effective to reduce both incidence of POST and postoperative cough in the postoperative period in recovery.

Aims and Sore throat, cough and hoarseness of voice are common postoperative complications in patients who undergo tracheal intubation for surgical procedures and such complications can be distressing to the patients even more than postoperative pain. The aim of this study was to determine the efficacy of the endotracheal tube cuff lubrication with lubricant jell before intubation on postoperative sore throat and hoarseness. In a prospective, randomized, double blind, controlled clinical trial, eighty ASA class I and II patients undergoing elective surgeries under general orotracheal anesthesia were randomized into two groups: water soluble gel, and control groups. Visual analogue scale (VAS) for sore throat and the incidence of hoarseness in each group at the end of general anesthesia and at 1, 12, and 24 h after operation were evaluated.: Main VAS scores for sore throat 1 h after anesthesia were 3.30± 2.11 cm in the control group and 1.10 ± 1.48cm in the lubricated group.(p=0.0001) VAS scores 12 h after operation were 2.3 ± 2 cm in the control group and 0.55 ± 1.06 cm in the lubricated group.(p=0.001). VAS scores 24 h after operation were 1.05 ± 1.41 cm in the control group and 0.27 ± 0.64 cm in the lubricated group.(p=0.001) However, there was no hoarseness among the groups. Tracheal tube cuff lubrication with a water-soluble gel before anesthesia reduces severity of sore throat.

Emergence from general anesthesia can be associated with coughing, agitation, and hemodynamic disturbances. Remifentanil may attenuate these responses. We have examined the effect of remifentanil on the hemodynamic response to the emergence from anesthesia and tracheal extubation. In a double-blind, randomized trial, we enrolled 50 adult patients undergoing abdominal surgery. All patients received a standard general anesthetic comprising propofol, atracurium and 1% isoflurane with 50% nitrous oxide in oxygen. At the end of surgery, a bolus dose of remifentanil 0.2 microgram/kg (n = 25) or saline placebo (n = 25) was given and tracheal extubation was performed when standard criteria were achieved. Arterial pressure and heart rate were measured non-invasively, immediately after tracheal extubation and then at 1-min intervals. Remifentanil attenuated the increase in both systolic and diastolic arterial pressure and heart rate after extubation compared to the control group. No differences in SpO2, cough and laryngospasm were observed between two groups. Use of a low-dose remifentanil has clinically acceptable effect in blunting the cardiovascular changes induced by tracheal extubation.changes induced by tracheal extubation.

Aim of the study was to evaluate the HIV and hepatitis C virus (HCV) coinfection and associated risk behaviors among Injection Drug Users in Detention, Tehran, Iran. A cross-sectional survey included 499 male Injection Drug Users arrested by police during a predetermined police sweep in Tehran (February, 2006). At the temporary detention center, they were screened using a urine test and a physical examination for injection marks. Those who were identified as injectors were sent to the rehabilitation center for 3 months. A questionnaire was filled out for each individual by interview. Blood specimens were collected for HIV and HCV testing. The variables associated with HIV/HCV coinfection at a significance level of P<0.10 were considered in multivariate analysis. Of the 417 participants, 100 (24.0%) had HIV/HCV coinfection (95%CI 19.9 – 28.4). Factors independently associated with HIV/HCV coinfection included history of using opioid in jail, and age (P<0.05).There were not any association between other demographic characteristics (marital status, birthplace, residence, and education), type and years of drug abuse, age of first injection, years of injection, sharing needles inside and outside of jail, injection in jail, history of tattooing, any sexual behavior, and history of sexually transmitted diseases with HIV/HCV coinfection (P>0.05). This study supports that incarceration is contributing to the increased spread of HIV/HCV coinfection. So, there is urgent need for effective harm reduction programs, particularly among incarcerated Injection Drug Users.

We measured the prevalence of HBV surface antigen (HBsAg) among male injection drug users (IDUs) in Detention, Tehran, Iran. A cross-sectional survey included 499 male IDUs arrested by police during a predetermined police sweep in Tehran (February, 2006). A questionnaire was filled out for each individual. Blood specimens were collected for HBsAg testing. Prevalence of HBsAg was 5.8% (95% CI 3.6-7.9). The majority of chronic HBV infections, 69.2%, were among adults age 25 to 34 years. The high prevalence of HBsAg highlights the need for special efforts to increase vaccination among adult populations at risk for HBV infection in order to reducing continuing transmission and stave off future high burden of disease.