tohid karami

Post-operative shivering after spinal anesthesia is a common issue in women undergoing cesarean section, then its management is necessary to increase patients’ satisfaction. Therefore, the current study aimed to compare the prophylactic effect of Granisetron and meperidine on post-spinal shivering in elective cesarean section.

In this double-blinded clinical trial study, 100 women under elective cesarean section using block randomization were divided into two groups. The spinal anesthesia was performed in all women with 10 mg hyperbaric bupivacaine 0.5 %. Then, after the birth of the baby, the patients received 0.04 mg/kg Granisetron or 0.4 mg/kg meperidine intravenously. Mean Arterial Pressure (MAP), Heart Rate (HR), and percentage of arterial blood oxygen saturation (SpO2) were measured before intervention and 60 minutes after surgery using a standard monitoring device. Shivering was evaluated 30 minutes after the surgery in the recovery room according to the clinical examinations.

The changes in hemodynamics parameters were similar between the two groups. There was a statistically significant difference in the rate of shivering between the two groups. The rate of shivering in the Granisetron group was higher than in the meperidine group. Thus, 13 patients (26%) and 5 patients (10%) had shivering in the Granisetron and meperidine groups, respectively (p=0.037).

Granisetron was not more effective than meperidine as routine treatment in preventing shivering after spinal anesthesia in women under elective cesarean section.

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.

The Laryngeal Mask Airway (LMA) has traditionally become an alternative device for airway management. This clinical trial compared two standard and lateral techniques in inserting laryngeal masks in pediatric airway management. This single-blind clinical trial study was conducted on pediatrics aged 2-6 years who were candidates for elective inguinal herniorrhaphy with ASA I and II under general anesthesia. The pediatrics were randomly assigned to either the standard or lateral methods according to the random number table. The time required to insert LMA and airway pressure as well as the number of attempts to insert in both groups were measured. Data analysis was performed using SPSS version 25; the significance level was less than 0.05. Chest movement and mean airway pressure had no significant difference in both groups (p>0.05). The mean LMA insertion time in the lateral and standard methods was 22.94±7.89 and 65±15.27 seconds, respectively (p=0.001). There was no case of mucosal damage in the lateral method, but ten children had mucosal damage in the standard technique (p=0.001). In the lateral method, LMA was inserted for the first time in 32 pediatrics (94.1%) and two pediatrics (5.9%) in the second time but in the standard group, LMA was inserted in the second time in 11 pediatrics (32.4%) (p=0.006). The lateral method for inserting LMA is practically easy, requires less effort, and has the least complications. Another advantage of the lateral method compared to the standard technique is that inserting a finger into the pharyngeal cavity is unnecessary.

For hernia surgery and to induce general anesthesia in children, pediatric venipuncture is needed. The venipuncture process in the children can lead to damage (destroy) of the vein due to many reasons, including fear, restlessness and the child's excessive movements. The aim of this study was to compare the results of inhalation anesthesia in children undergoing inguinal hernia repair surgery under general anesthesia.

In this randomized, single-blinded, prospective clinical trial study, 70 children aged 2 to 6 years who volunteered for inguinal herniorrhaphy were divided into two groups of 35 people in the children's operating room of Shahid Motahari Medical Training Center in Urmia. In the intervention group, peripheral venous catheterization was performed with induction of inhalation anesthesia by 8% soflurane along with oxygen and nitrous oxide, but in the control group, peripheral venous catheterization was performed without induction of inhalation anesthesia and awake. Randomization of intervention and control groups was done with Random Allocation software. Chi-square test was used to compare the frequency of studied variables between two groups. Independent t-test was used to compare the average intensity of restlessness between the two groups. Data analysis was done using SPSS 20 software and the significance level was considered less than 0.05.

The average time of intravenous insertion in the group receiving soflurane was 25.03 ± 21.996 and in the group not receiving soflurane was 254.21 ± 154.913. The difference in the average time of intravenous insertion of the patients in the study between the two groups receiving soflurane and not receiving soflurane was statistically significant, and this average value was much higher in the group not receiving soflurane than in the group receiving soflurane. There was a significant difference between the two groups in the variable of intravenous insertion time (P=0.0001).

Children induced with soflurane need more sedative drugs such as midazolam or combination of midazolam with other drugs. In terms of nausea and vomiting, soflurane has little nausea-causing properties, although is more common in soflurane compared to some drugs such as propofol.

Spinal anesthesia is the common method in outpatient surgeries, which has complications suchas back pain. We aimed to evaluate the relationship between low back pain (LBP) with spinal anesthesia and itsrelated factors in patients undergoing urological surgery.

In this cross-sectional study, 1000 patients undergoing urological surgery were en-rolled. The severity of LBP was measured using the VAS (visual analog scale) pain on the 1st day, the 1st week,and the 1st month postoperatively. Patients’ age, sex, and the duration of surgery were collected. data analysiswas performed using SPSS software, version 17.

Of the 1000 patients undergoing urological surgery, 636 (63.6%) patients and 364 (36.5%) patients un-derwent spinal and general anesthesia, respectively. In patients under general anesthesia, the LBP prevalencewas higher than in patients under spinal anesthesia on the 1st week and the 1st month after surgery (P<0.05).So, the LBP prevalence was as follows: on the 1st day (general anesthesia: 14.5% vs spinal anesthesia: 24.1%,p=0.09), at the 1st week (general anesthesia: 24.9% vs spinal anesthesia:13.5%, P=0.001) and the1th month (gen-eral anesthesia: 13.8% vs spinal anesthesia: 4%, P=0.001). On 1st day and 1st week after surgery, the rate of LBPwas significantly higher in the >45-year age group than in the age group less than 45 years (P<0.05). The painrate was higher in patients who had surgery duration of more than 2.5 hours in all three time periods (P=0.001).

Although the LBP prevalence on 1st day after surgery in patients undergoing urological surgeriesunder spinal anesthesia was higher than in patients who underwent general anesthesia, there was a significantdecrease in pain levels during the first week and month following the surgery in patients under spinal anesthesia.Older age and longer duration of surgery were related factors to pain

 Caudal block is a common, safe, and effective anesthetic technique for lower abdominal, urological, and lower extremity surgeries in pediatrics.

 This study aimed to evaluate the cardiovascular effects of adjuvant epinephrine in the caudal block on heart rate and blood pressure changes in children.

 This double-blind, randomized clinical trial was performed on 60 children who underwent elective infra-umbilical surgeries. They were under general anesthesia with midazolam, fentanyl, lidocaine, and propofol. The patients were ventilated through laryngeal mask airway (LMA), and anesthesia was maintained with sevoflurane in O2 and N2O mixture. The intervention group received a caudal block with 0.2% bupivacaine and 1/200000 epinephrine (1 mL/kg), while the control group received a caudal block without epinephrine. Heart rate, blood pressure, and ECG were monitored before the block and in the first, fifth, and 20th minutes after surgery.

 The two groups showed no statistically significant differences in demographics and systolic and diastolic blood pressures. However, sinus arrhythmia was more prevalent in the study group in the first minute after the block (P < 0.001). No differences were observed in the incidence of arrhythmia in the fifth and 20th minutes after the block.

 It appears that epinephrine as an adjuvant to the caudal block does not have long-lasting effects after the block, except sinus tachycardia in the first minute. Considering that no changes in blood pressure and other hemodynamic parameters were observed, it seems that epinephrine can be used safely in the caudal block in pediatric patients.

Delirium can be dangerous for the patient and worsen the patient's prognosis. This study aimed to investigating the the delirium frequency and its outcomes after urologic surgeries admitted to Intensive Care Unit of Urmia Imam Khomeini Hospital.

In this Descriptive-cross-sectional study, whole 680 patients undergoing urology surgery who were admitted to the special care department of Imam Khomeini Hospital in Urmia during 2018-2019 were included. Demographic characteristics, underlying diseases, duration of mechanical ventilation, duration of hospitalization in the intensive care unit, duration of hospitalization, mortality and delirium were extracted from patient files and analyzed using SPSS version 23 software. The significance level in this study was considered 0.05.

12 patients (1.8%) had delirium. The average length of mechanical ventilation, length of stay in the hospital and in the intensive care unit was significantly higher in patients with delirium than in patients without delirium (p<0.05).

Psychosis has a relatively rare prevalence. However, in order to reduce it, the length of hospitalization should be reduced.

 

Tracheal intubation is frequently performed in operating room. Over inflation of the endotracheal tube cuff is a risk factor for tracheal ischemia and subsequent complications. On the other hand inadequate cuff pressure increases the risk of aspiration of gastric contents. In this study, the endotracheal tube cuff pressure filled by the anesthesia team has been compared.

 

In this cross-sectional study, we assessed the tracheal tube cuff inflation pressure among 80 anesthesiologists, nurses of anesthesia, and anesthesiology assistants using a manometer. High-volume, low-pressure tubes were used for intubation in all patients. The anesthesiologists and other personnel were not informed of the planned study.

The average pressure generated by inflating the endotracheal tube cuff among anesthesiologists and senior anesthesia assistants, junior nurses with 1 to 15 years of experience in anesthesia, senior nurses with 15-30 years of experience in anesthesia and, junior anesthesia assistants were 49.24±24, 70.8±29, 56.8±20 and 73.5±29 mmHg, respectively.

There is a tendency to over inflation of endotracheal tube cuffs in all anesthesia team. Palpation in order to assess the adequacy of cuff inflation is not sufficient and anesthesia providers should consider using devices such as manometers to facilitate safe inflation and accurate measurement of endotracheal tube cuff pressure.

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.

Prune belly syndrome (PBS) is a rare congenital disorder, consists of three symptoms: anterior abdominal muscle deficiency, cryptorchidism, and genitourinary malformation. These patients have cardiovascular and musculoskeletal abnormalities, mental retardation, chest deformities, and scoliosis that lead to pulmonary dysfunction. Anesthesia plan in patient needs to rule out any anomalies. For airway management, Laryngeal mask airway (LMA) should be preferred to avoid the use of muscle relaxants. The use of short-acting anesthetics can accelerate recovery from anesthesia. To reduce postoperative pain, regional techniques are preferred. We report a 6-month- old boy with PBS, and its airway management and anesthesia during surgery.

 Acid–base abnormalities are common in critically ill patients. Our ability to describe acid–base disorders must be precise. The aim of this study to investigate the incidence and type of perioperative metabolic disturbances and electrolyte abnormality in patients undergoing coronary artery bypass graft surgery.

 This was a prospective, observational study, performed in a university-affiliated hospital. 62 patients undergoing coronary artery bypass graft surgery were included in the study. After operation the patients were transferred to cardiac intensive care unit and electrolytes and acid-base variables were recorded. The primary endpoint of the study was the incidence of metabolic alkalemia or acidemia. Metabolic alkalemia was defined as PH >7.45 and BE >+3. Metabolic acidemia was defined as PH <7.35 and BE <-3.

 From 62 patients 34 (54.8 %) had normal acid base analysis. Respiratory alkalosis, metabolic acidosis and alkalosis were occurred in 20 (32.3), 6 (9.7 %) and 2 (3.2) of subjects respectively. Respiratory acidosis is not seen.

 Regardless of normal subjects, respiratory alkalosis occurred more frequently than other acid base disorders in patients after coronary artery bypass graft surgery.

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.

Xeroderma pigmentosum (XP) is a rare genetic disorder with a recessive autosomal inheritance. It appears that total intravenous anesthesia (TIVA) is more appropriate than inhalational anesthesia as a method for maintaining general anesthesia for XP patients and airway manipulation must be performed as little and as noninvasively as possible. The aim of this report was to evaluate the specific considerations for airway management and anesthesia in these patients. .

Inguinal hernia are more frequent in male infants with an increased incidence in twins .Prematurity is a risk factor. Premature infants have particularly high incidence of inguinal hernias, approximately 11.5 % of patients have a family history. During open repair of hernia under general anesthesia, there is a high incidence of apnea in the preterm infants. Caudal anesthesia can be quite effective in providing anesthesia and analgesia.Three two-months-old babies (3.5-4 kg) born at 35 weeks’ gestation presented for inguinal hernia repair, simultaneously. They were undergone bilateral inguinal hernia repair with single shot awake caudal anaesthesia.

Following advances of Intensive Care medicine and widespread administration of mechanical ventilation, tracheostomy has become one of the indispensable surgical procedures. During this research we tried to assess and compare two main strategies for doing tracheostomy: Surgically Created Tracheostomy (SCT) and Percutaneous Dilatational Tracheostomy (PDT). In a randomized clinical trial, 60 cases of patients who were admitted in Intensive Care Unit (ICU) and needed tracheostomy during their stay were enrolled. Patients were randomly divided into two groups. SCT technique was considered for the first group and PDT for the second one. Demographic characteristics, associated and underlying diseases, type and duration of procedure, duration of receiving mechanical ventilation and ICU stay, expenses and complications of tracheostomy including bleeding, subcutaneous emphysema, pneumothorax, stomal infection and airway loss were all recorded during study and compared between both groups. There were significant differences between two groups of patients in terms of duration of receiving mechanical ventilation (P=0.04), duration of tracheostomy procedure (P=0.001) and procedure expenses (P=0.04). There was no significant difference between two groups in terms of age and gender of patients, duration of ICU stay and complications of tracheostomy including copious bleeding, stomal infection, subcutaneous emphysema and airway. According to the results of our study and similar researches, it can be concluded that PDT can be considered as the preferred procedure in cautiously selected patients during their ICU stay.