جستجوی مقالات مرتبط با کلیدواژه "زمان ریکاوری" در نشریات گروه "پزشکی"

Resistant Status Epilepticus (RSE) is one of the most common neurological emergencies in children. So far, there is no definitive treatment for resistant Status epilepticus refractory to benzodiazepines or other anticonvulsants. Different protocols have been introduced as the second line of treatment after benzodiazepines, which include phenytoin, sodium valproate, levotiracetam, barbiturates, and propofol. In case of failure of the first-line (benzodiazepines) or second-line (other anticonvulsants) ketamine with a bolus dose of 1 mg/kg and then an infusion of 2 mg/kg/h up to a maximum of 7 mg/kg/h along with other drugs is recommended. Ketamine is a non-competitive N-Methyl- D-Aspartate (NMDA) receptor antagonist, which controls seizures with neuron-protective effects and anti-inflammatory and anti-epileptic properties in the second and third lines. We reviewed the literature to demonstrate the potential role of ketamin as an advanced second and thirdline agent in the treatment of RSE and we concluded that the best way to treat resistant status epilepticus is to start treatment on time, use multiple drugs instead of one drug, and choose drugs with neuron protective effects with the least side effects. Therefore, using ketamine with other drugs seems to be effective for seizure control.

Hypothermia is a common complication during anesthesia and surgery which leads to complications such as shivering, delay in recovery, and prolonged hospital stay. Therefore, the aim of this study was to determine the effect of hypothermia prevention program on shivering and recovery time in patients undergoing abdominal surgery.

This single-blind clinical trial was performed in 80 patients who met the inclusion criteria and were randomly assigned to either an intervention group that received hypothermia prevention program (using warm prep solution, warm serum during surgery, and hot water bag to retain heat in recovery) or a control group. The patients were evaluated for shivering and recovery time. Data analysis was performed in SPSS V21 using t-test and Chi-square.

According to findings, temperature changes were different over time between the two groups (P=0.001). In control group, 82.5% had shivering, while in intervention group only 7.5% experienced shivering (P= 0.001). Recovery time was also significantly lower in intervention group (P= 0.001).

Due to the complications of hypothermia, implementing a hypothermia prevention program can greatly prevent the chills, shorten recovery time, and lower the risk of other complications. Therefore, it is recommended as a low-cost and effective care program in patients undergoing major surgeries such as abdomen and thorax and also in surgical practices of elderly patients.
 
(Clinical Trials Registry Number: IRCT20200304046691N1)

Electroconvulsive Therapy (ECT), as a treatment in psychiatric disorders has changed over the years. Nowadays, using hypnotic and muscle relaxant drugs are important part of ECT. Following ECT there are major changes in hemodynamic indices, making the cardiovascular and cerebral events as potential outcomes especially in elderly so the scientist is researching to find better ways to control hemodynamic changes with minimal effect on convulsion duration and recovery time in ECT candidates. The ideal medication is the one which controls hemodynamic indices but does not affect the convulsion and recovery time so different drugs tested. In this study we decided to evaluate the effect of Esmolol.
Methods and Materials: Forty patient’s candidate for ECT were randomly assigned into two groups of Esmolol (E) and placebo (P). Anesthetic drugs were the same in both groups, in E group patients received 100 mg of bolus intravenous esmolol and in P group they received equal volume of normal saline just before ECT. Patients were under close monitoring during and after procedure and the hemodynamic indices, convulsion time and duration of recovery recorded for each patient.
We found a meaningful difference in heart rate and blood pressure in both groups in 1PstP, 3PrdP and 5PthP minutes after ECT (P Esmolol could provide stable hemodynamic indices in ECT candidates without affecting the convulsion time and recovery duration (P>0/05).

Subconjunctival block (SCB) had been reported to be useful for strabismus surgery, laser cyclophotocoagulation, and glaucoma surgery. The aim of this study was to evaluate the efficacy of adding SCB to intravenous sedation and topical anesthesia for phacoemulsification surgery. After the approval from the institutional ethics committee and obtaining written consents from the patients, 64 adults scheduled for phacoemulsification were enrolled in this double-blind clinical trial. The subjects were randomly allocated to two equal groups of case and control. All patients received similar preoperative preparation, intravenous sedation (1.5 µg/kg fentanyl and 0.15 mg/kg ketamine), and topical anesthesia (0.05% tetracaine) before surgery. Intraoperative additional fentanyl and ketamine was administered as needed. The cases received SCB with 0.1 ml of bupivacaine 0.5% at the site of incision. The controls received equal volume of balanced salt solution. Patient cooperation and satisfaction, severity of intraoperative pain, additional drug requirement, postoperative nausea and vomiting, recovery time and surgeon satisfaction were determined and recorded. Data was analyzed using t-test, and chi-square, Fisher’s exact, and Mann-Whitney tests. P < 0.05 was considered significant. Demographic data was similar in the two groups. The frequency of excellent patient satisfaction was 28 (87.5%) in the case group and 15 (46.9%) in the control group. The corresponding values were 25 (78.1%) and 18 (56.3%) for patient cooperation and 24 (75.0%) and 19 (59.4%) for surgeon satisfaction (P < 0.05). Intraoperative additional fentanyl requirement, intra- and postoperative severity of pain, and recovery time were significantly lower in the case group than in the control group. This study showed that adding subconjunctival block to intravenous sedation and topical anesthesia in phacoemulsification surgery may enhance patients’ comfort and the conditions of the operation.

Patients` staying in recovery unit is associated with risks and complications and is expensive. Decreasing the duration of staying can both increase patients` safety and decrease hospital costs. Laryngeal mask airway (LMA) as a new instrument has been widely used for airway management and in this study, its effect on recovery time is investigated. In a double blind randomized controlled clinical trial, 62 ASA Ι & Π patients were divided into two equal groups. In one group laryngeal mask and in the other, tracheal tube was used. The anesthetic drugs were similar in both groups. Patients with upper airway infections, as well as patients undergoing thoracic and upper abdominal surgeries were excluded. Those with more than one hour duration of anesthesia and more than 30 seconds need for intubations were also excluded. Duration of anesthesia was measured in minutes. Duration of recovery staying (in minutes) and complications were also recorded. Data was analyzed using Chi Square and Mann Whitney U tests. There were no significant differences in age, sex and mean time of anesthesia between the two groups. But mean recovery time in LMA group with 10.65 minutes and tracheal tube group with 16.71 minutes was significantly different (P=0.007). Two patients (6.45%) in LMA and 11 patients (35.48%) in tracheal tube group developed complications during recovery period which was a statistically significant difference (P = 0.004). Laryngeal mask airway, decreased recovery time and the number and severity of respiratory complications. Complications such as cough, laryngospasm, bronchospasm, and arterial hypoxemia were significantly less in patients with laryngeal mask airway compared to patients with tracheal tube, so the use of LMA is recommended.

Postoperative hypothermia is physiologically stressful by elevating blood pressure, heart rate and plasma catecholamine concentration. This study conducted to evaluate the effects of intravenous fluids temperature on perioperative hemodynamic situation.

This was a randomized clinical trial study Perioperative pulse rate, blood pressure, intraoperative esophageal and skin temperature were measured in 60 volunteer patients undergoing orthopedic surgeries subjects randomly divided into two groups according to intraoperative IV fluids management. In 30 patients (hypothermia group) all IV fluids infused were at room temperature. In the other 30 patients (normothermia group) all IV fluids were warmed using and dry IV fluid warmer.

The core and skin temperature of hypothermia and normothermia group decreased significantly from induction of anesthesia toward end of surgery but its reduction was more in hypothermia group (P<0.005). Postoperative mean arterial blood pressure increased significantly more in hypothermia group versus normothermia group (P<0.005). Shivering was observed in 21 of 30 hypothermia and 11 of 30 normothermia group (p<0.005) and recovery time was significantly lower in normothermia group (36±5 vs. 26±3 min, P<0.005).

Infusion of warm fluids helps to reduce the variation of postoperative mean arterial blood pressure, core and skin temperature, occurrence of shivering and recovery time.