Mandana Mansourghanaei, Katayoun Haryalchi, Seyed Alaedin Asgari, Fatemeh Salamat, Mahdieh Zoghi,
Volume 18, Issue 11 (2-2016)
Abstract
Background: MgSo4 (magnesium sulfate) is the first therapeutic line for preeclampsia. Recently, there have been many debates on pain relief property on MgSo4. The purpose of this study is to evaluate the effect of MgSo4 on pain relief after cesarean in preeclampsia parturient
Materials and Methods: In this analytic and cross-sectional clinical trial study, 88 pregnant wowen with mild preeclampsia who received MgSo4 (14g loading dose and 5 g/4h maintenance dose) (n=88, P group), were compared with 88 normal pregnant women(n=88, N group), according to the duration of paim relief and the amount of diclofenac suppository consumption after cesarean section from March 2013 to October 2014. After cesarean section, the assessment of pain relief performed with NRS (numerical rating scale), and diclofenac consumption.
Results: P group had a longer analgesic duration than N group. NRS in P group was significantly longer than N group(6.89 ±3.34 vs. 3.55± 2.13 hr, p=0.0001). The dose of diclofenac suppository in P group was significantly lower than N group (225mg±147 vs. 365.9±92mg, p<0.0001).
Conclusion: Post cesarean pain in preeclamptic group was significantly lower than non-preeclamptic group. This finding is probabley because of MgSo4 administration in preeclamptic group.
Khosro Naghibi, Darioush Moradi Farsani, Babak Ali Kiaei, Anahita Hirmanpour,
Volume 19, Issue 2 (5-2016)
Abstract
Background: Due to high prevalence of vitrectomy surgery, and the importance of anesthetic technique in conducting an uncomplicated surgery, we decided to do this study.
Materials and Methods: This prospective randomized study was conducted on 80 patients 40-80 years old candidating deep vitrectomy sugery under general anesthesia that were categorized into II and III Class by American Society of Anesthesiologist (ASA). Patients were randomly allocated to two groups of 40 members. Anesthesia was induced in both groups in the same manner. For maintaining anesthesia, patients from I group receiVed 1.2% isofluran with 50% O2 in air at 4L/min and infusion of remifentanil (0.1 mg.kg-1.min-1). But in the P group, we used propofol up to 10mg/kg /hr with infusion of remifentanyl. Propofol and isoflurane in fusion was discontinued with the last surgical stitches, but remifentanil infusion continued in both groups until the eye was covered with shield. Hemodynamic variables were recorded just before the induction of anesthesia and in different time intervals till discharging of the patients from the recovery room. Then, data were compared.
Results: Results showed that there is a significant changes in propofol group compared to isofluran in deep vitrectomy surgery operations.
Conclusion: Hemodynamic changes are more significant in maintaining propofol anesthesia when compared with isoflurane.
Darioush Moradi Farsani, Babak Alikiaei, Fatemeh Hoseinzadeh,
Volume 20, Issue 2 (5-2017)
Abstract
Background: The aim of this study was to compare the efficacy of ondansetron, Midazolam and metoclopramide with placebo in preventing PONV following strabismus surgery.
Material and Methods: 160 patients were allocated with simple randomization in 4 groups of 40: group ON received Ondansetrone 0.05mg/kg, MT group received Metoclopramide 0.15mg/kg, MD group received Midazolam 0.03mg/kg intravenously and group CT received the solution of NaCl 0.9% as placebo infused with the same volume and the same manner 30 minutes before the end of surgery. The patients were evaluated for nausea, vomiting, need and dosage of anti-emetic drugs, time of liquid and solid diet tolerance, drug complications and satisfaction score for the initial 24 hours after anesthesia.
Results: The frequency of nausea (p-value = 0.001< 0.05) and vomiting (p-value=0.084>0.05) was lower in ON group and both of these complications were lower in MD group compared with MT and CT group. Use of rescue antiemetic was higher in MT and CT group (p-value = 0.001 < 0.05). Patient satisfaction was higher in ON group compared with other 3 groups (p-value=0.001<0.05).
Conclusion: Prophylactic use of Ondansetron is more effective with fewer side effects than Metoclopramide and Midazolam in the prevention of PONV following strabismus surgery. Furthermore, metoclopramide was less effective and was associated with more adverse effects.
Mojtaba Rahimi Varposhti, Darioush Moradi Farsani, Babak Ali Kiaei, Behzad Nazem Roaya, Seyed Hosein Moosavi,
Volume 20, Issue 3 (6-2017)
Abstract
Abstract
Background: The aim of this study is to evaluate the impact of preemptive adding topical Ketorolac to Tetracaine drop on pain intensity and hemodynamic parameters during and after cataract surgery.
Materials and Methods: Eighty patients scheduled for elective cataract surgery under sedation and topical anesthesia, were randomly allocated to two equal groups: group T received Tetracaine 0.5%, and group TK received Tetracaine with ketorolac eye drops. One drop of each ophthalmic drug was applied every 10 minutes from 30 minutes before surgery. Pain intensity and hemodynamic parameters were assessed just before starting the operation and 5, 10, 15and 20 minutes during the operation, and then 0, 5, 10, 15 and 20 minutes after arrival of the patient to the recovery room.
Results: Mean pain intensity was significantly lower in TK group (1 ± 0.128) compared with T group (2 ± 1.54) during the surgery (p = 0.003), but there was no significant difference between the two groups in this regard during the recovery time (p =0.157). The number of patients requiring additional analgesic was not significantly different between the groups. There was no significant difference between the two groups regarding hemodynamic parameters except at 20th minutes and 15th and 20th minutes (heart rate and respiratory rate) after arrival to the recovery room.
Conclusion: Preemptive adding topical Ketorolac to Tetracaine drop is more effective than Tetracaine alone to reduce pain during cataract surgery.
Darioush Moradi Farsani, Khosro Naghibi, Zahra Rezayinezhad,
Volume 20, Issue 7 (10-2017)
Abstract
Abstract
Background: Up to now, there is no single opinion on how to control pain after surgery and clinical research in this area has been continuing. This study aimed to compare the effect of intravenous Acetaminophen, Dexamethasone and placebo on postoperative pain after cataract surgery under sedation and topical anesthesia.
Materials and Methods: In a clinical trial study, 120 patients undergoing cataract surgery under sedation and topical anesthesia were distributed into three equal groups. 10 minutes before the end of surgery, the first group received 0.01 mg/kg Dexamethasone, the second group received 15 mg/kg Acetaminophen and third group received the same volume on normal saline as placebo. Pain intensity and additional analgesic consumption were assessed during operation and recovery and compared between the three groups.
Results: In the three groups of Acetaminophen, Dexamethasone and control groups, 6, 10 and 18 patients had postoperative headache (16.7%, 27% and 47.4% respectively) and there was a significant difference between the three groups(p=0.014). Also, pain intensity was significantly higher in control group compared with other two groups from 30 minutes after arrival to the recovery room until 24 h postoperatively (p<0.05). Also, the incidence of headache was higher in Dexamethasone group compared with Acetaminophen group, but there was no statistical difference between the two groups in this regard (p>0.05).
Conclusion: Intravenous Acetaminophen administration is more effective than Dexamethasone and placebo to reduce pain and analgesic requirements after cataract surgery.
Mojtaba Rahimi Varposhti, Darioush Moradi Farsani, Kamran Montazeri, Fatemeh Tanha,
Volume 20, Issue 8 (11-2017)
Abstract
Background:
This study aimed to compare the effect of cold eye irrigation solution (BSS) and viscoelastic gel with their combination in room temperature on the dosage of sedative drugs which we use in Phacoemulsification cataract surgery.
Material and methods:
190 patients scheduled for cataract surgery under sedation were randomly divided into two equal groups. During surgery we used cold (4c) and warm (room temperature) BSS and viscoelastic gel in the first and second group respectively. For all patients we started sedation with Midazolam and Fentanyl and in case we needed additional drug we used Sodium Thiopental till we reached desired sedation level. Ramsay sedation scores (before, during and after surgery) and total sedative drug consumption were evaluated and compared between two groups and at the end of the surgery we checked the satisfaction score of patients and surgeon about the quality of sedation.
Results:
The average dosage of Midazolam wasn’t significantly different between the two groups, while the average dosage of Sodium Thiopental was significantly lower in Cold group. Also the average time of which we reached desired Ramsay sedation score and the level of Ramsay score were significantly different between the two groups.
Conclusion:
Using cold BSS and viscoelastic gel in cataract surgery in comparison of their combination in room temperature will reduce the dosage of sedative drugs which we use during surgery and help us getting a more effective sedation and gaining both a satisfied patient and surgeon.
Darioush Moradi Farsani, Khosro Naghibi, Mojtaba Rahimi Varposhti, Bahador Malekipoor, Tahereh Fasihi,
Volume 20, Issue 9 (12-2017)
Abstract
Abstract
Background: Postoperative nausea and vomiting (PONV) is one of the most common complications in the patients undergoing strabismus surgery. The aim of current study was comparing supplemental 80% and 40% oxygen on reducing postoperative nausea and vomiting in the pediatrics undergoing strabismus surgery.
Materials and Methods: In this clinical trial study, 100 pediatric patients scheduled for strabismus surgery under general anesthesia were allocated randomly into two parallel supplemental 80% and 40% oxygen groups during surgery. PONV in patients was compared until 24hrs after operation.
Results: In the first 6hrs postoperatively, PONV in the supplemental 40% and 80% oxygen groups were 48.8% and 30.6% respectively, also were 20.8% and 12.2% in the 6 to 24hrs postoperatively. Therefore, there were no significant differences between both groups in regarding of PONV in 6hrs and 6 to 24hrs postoperatively (p values were 0.18 and 0.25, respectively).
Conclusion: According to our results, there is no any difference between 40% and 80% oxygen postoperatively in the pediatrics undergoing strabismus surgery.
Alireza Kholdebarin, Faranak Rokhtabnak, Mohammadreza Ghodraty, Alireza Pournajafian,
Volume 21, Issue 1 (4-2018)
Abstract
Abstract
Background: Hemodynamic changes during surgery are initially controlled by changes in dosage of anesthetics. Decreasing the dose of anesthetics in order to cope with hypotension during surgery may reduce the anesthetic depth and increases the chance of awareness. This study was designed to investigate the depth of anesthesia in patients whose anesthtics is prescribed by controlling blood pressure and is aimed to investigate the possibility of reducing the depth of anesthesia during surgery.
Materials and Methods: In this study, females candidate for hysterectomy underwent general anesthesia according to specific inclusion criteria enrolled in two types of intravenous (propofol) or inhaled (isoflurane) anesthesia. The dose of maintenance anesthetic drugs were increased or decreased during the operation by the anesthetist technician (blinded to the depth of anesthesia) according to specified protocol. At defined intervals, depth of anesthesia was recorded by the anesthetist . Mean of obtained data were analyzed.
Results: In addition to the weight and height similarity, there was no statistically significant difference in systolic, diastolic blood pressure and heart rate in two groups at intervals, between two groups. The median of recorded BIS, which showed depth of anesthesia, was not different in either of the two groups, and no patients during the operation reached the level of awakening and the number above 60.
Conclusion: The traditional method to control hemodynamic changes during surgery by changing the doses of maintenance drugs, does not result in severe changes in the depth of anesthesia and does not significantly increase the BIS to the awareness level.
Mohammadreza Ghodraty, Faranak Rokhtabnak, Alireza Kholdebarin, Alireza Pournajafian,
Volume 23, Issue 2 (5-2020)
Abstract
Background and Aim: Postoperative shivering is a common complication after recovering from anesthesia, and due to its subsequent side effects, its prevention and treatment is of special importance for anesthetists. In this study, the efficacy and onset of action of meperidine (which is a potential cause of hemodynamic and respiratory complications) in treatment of post-anesthesia shivering are compared with those of ondansetron.
Methods & Materials: In this clinical trial study, patients with post-anesthetic shivering during recovery were randomly divided into two groups of meperidine (n=27) and ondansetron (n=29). Their shivering scores were recorded every minute for up to 10 minutes. After this time, if patients did not improve, meperidine was used in both groups to treat shivering.
Ethical Considerations The study obtained its ethical approval from the Research Ethics Committee of Iran University of Medical Sciences and has been registered in Iranian Registry of Clinical Trials (IRCT201109224969N3).
Results: The number of patients completely treated at 10 minutes was higher in the meperidine group (P= 0.05), and the decrease in mean shivering score occurred faster in meperidine group (P= 0.047)
Conclusion: Although ondansetron has been shown to be effective in treatment of postoperative shivering, the effectiveness and onset of action of meperidine was clearly better.
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.
