Mehrnoush Toufan Tabrizi, Saeed Mohammadzadeh Gharebaghi, Leili Pourafkari, Afshin Habibzadeh, Parastoo Chaichi, Elham Delir Abdollahi,
Volume 17, Issue 12 (3-2015)
Abstract
Background: Heart failure with normal ejection fraction (HFNEF) is commonly seen in adults. It is possible that old patients with HFNEF have severe clinical status. The aim of current study is to evaluate clinical and echocardiographic findings in old patients compared to young patients with HFNEF.
Materials and Methods: In this cross-sectional analytical study, 126 patients with HFNEF were evaluated in two groups of patients &ge60 years old (n=52) and <60 years old (n=74) for demographic, clinical and echocardiographic findings.
Results: Patients &ge60 years old had significantly more hyperlipidemia, less hypertension and more FC II. Patients &ge60 years old also had significantly larger septal wall thickness, lower end diastolic and systolic volume, end systolic diameter, E/A ratio and septal E’, lower diastolic dysfunction grade, higher left ventricle ejection fraction, left atrial volume index, E/E’ ratio and deceleration time compared to patients <60 years old.
Conclusion: Old patients with HFNEF have different clinical and echocardiographic findings compared to younger patients which are indicative of the disease severity in some cases. So, exact evaluation of the patients could be helpful in early diagnosis of these patients and providing an adequate treatment.
Hesameddin Modir, Aidin Shakeri, Alireza Ghafouri, Gholamhassann Chaichi Nosrati, Shiva Alikhani, Ayda Khammari,
Volume 28, Issue 2 (4-2025)
Abstract
Introduction: Some intracranial surgeries must be performed while the patient is awake. Awake craniotomy is an intracranial surgical procedure in which the patient remains in a state of controlled consciousness while the surgery is performed. The aim of this study was to present a case of intracranial surgery to remove a tumor in the right frontal cortex using awake craniotomy.
Case Report: This report describes the anesthetic management of a 22-year-old male undergoing craniotomy with a fully awake technique. This was the first case of craniotomy performed entirely awake (from the beginning to the end of the operation) at Arak University of Medical Sciences and Valiasr Hospital in Arak, After preoperative preparation and evaluation, scalp nerve blocks targeting the cranial nerves innervating the scalp and head muscles were administered at specific sites. Mild sedation was provided using oxygen supplementation, followed by surgical incision. The lesion was examined intraoperatively while the patient remained awake, and the tumor was safely excised under full wakefulness. A combination of local and regional anesthesia and light intravenous sedation was utilized. Two types of local anesthetics, lidocaine 1.5% and bupivacaine 2.5%, were used for anesthesia, as well as intravenous sedatives and anesthetics such as propofol, remifentanil, and dexmedetomidine were administered for sedation. Throughout the operation, the patient was awake and breathing spontaneously, and the function of the brain nerves during the operation could be evaluated. Finally, the patient's surgery was performed without any complications and in stable condition, and the patient was transferred to the intensive care unit in good general condition, awake and fully alert.
Conclusions: Although maintaining analgesia and hemodynamic and adequate ventilation during fully awake craniotomy poses challenges, this technique is critical for intraoperative monitoring of cranial nerve function and preventing neurological deficits. By precisely administering scalp nerve blocks and carefully titrating sedatives (propofol, remifentanil, dexmedetomidine), we successfully performed the procedure under full wakefulness. With this method, potential surgical complications are prevented, and the patient also experiences satisfactory painlessness. Applying this technique was satisfactory for our patient.
