No Abstract

Background: Laparoscopic gastric plication (LGP) is a technique in the restrictive category of bariatric procedures that reduces the gastric volume. Nausea and vomiting are the most common complications after this procedure.
The goal of this research is to determine the preventive effective dose of promethazine on postoperative nausea and vomiting (PONV) after laparascopic gastric placation.
Methods: After induction of general anesthesia the patients were divided into two groups, the promethazine 50mg group, which was given promethazine 50mg IM plus dexamethasone 8mg IV and the promethazine 25mg group, which was given promethazine 25mg IM plus dexamethasone 4mg IV. The primary endpoints were the incidence and intensity of nausea and vomiting, and severity of abdominal pain score in postoperative periods.
Results: Sixty-four morbid obese patients were enrolled into the study. Promethazine50mg group was found to significantly reduce the incidence of PONV in the first 12hrs compared with the other group, (21.87% vs37.5%, P=0/068). At the same time the intensity of PONV in base of numeric rating scale was lower in promethazine 50mg group compared to another group (2.63±0.85 vs4.65± 1.23, P=0/089). The mean severity of abdominal pain was higher in promethazine 25mg group, thus these patients needed more analgesia in comparison with another group.
Conclusion: In morbidly obese patients undergoing laparoscopic gastric plication, prophylactive administration of dexamethasone8mg and promethazine 50mg was more effective in the first 12 hours after surgery in reducing the incidence of PONV, and severity of abdominal pain.

Background: The aim of this study was to evaluate the effect of two injections doses of magnesium sulfate for controlling and reducing hemodynamic changes caused by laryngoscopy and endotracheal intubation in pregnant women who were candidates for caesarean section with general anesthesia.
Methods: In this controlled randomized double-blind clinical trial, 165 pregnant women who were candidates for caesarean section were allocated into three groups of receiving 40mg/kg of magnesium sulfate (M1 group), 60 mg/kg of magnesium sulfate (M2 group) and placebo (P group) before induction of anesthesia. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean of arterial pressure (MAP), heart rate (HR) and arterial oxygen saturation (SPO2) were measured and recorded at the baseline (before the induction), right before the intubation and 1, 3, 5 and 10 minutes after laryngoscopy and endotracheal intubation. The Apgar score of the neonates was also measured and recorded 1 and 5 minutes after delivery.
Results: The mean of changes in systolic blood pressure and mean of arterial pressure showed a significant difference between the M1 and M2 groups with the placebo group right before the intubation and 1, 3 and 10 minutes after laryngoscopy. The mean of changes in heart rate was specifically significant 1, 5 and 10 minutes after intubation in the M2 group (p< 0.05). The Apgar score of neonates had no significant difference 1 and 5 minutes after delivery (p> 0.05).
Conclusion: For inducing anesthesia in pregnant women, using 60 mg/kg of magnesium sulfate decreased the hemodynamic changes after laryngoscopy and endotracheal intubation and it had no adverse effect on the Apgar score of the neonates.

Background: Long surgery causes hypothermia and increased bleeding and can increase the arterial blood lactate levels during anesthesia. It causes cellular hypoxia and its complications. Considering the core temperature of the patient during surgery it can prevent hypoxia. This study aimed to compare the effects of different temperatures on the core temperature and the concentrations of lactate in patients who were candidate for posterior spine fusion surgery under general intravenous anesthesia.
Methods: In this clinical trial study, 60 patients with ASA II risk undergoing spine fusion surgery referred to Rasoul Akram hospital from 2015 were studied. Patients were divided in two groups of receiving temperature of 36 ° and 40 ° C during operation. Demographic data as well as information before anesthesia, after surgery, as well as recovery was gathered in the check list. Data then were entered to the statistical software SPSS v. 16 and analyzed.
Results: The mean age of patients was 49.14 (SD= 12.97) years. Pre-operation O2 Saturation had significant difference between the two groups (p value = 0.015). Trend of Hb, HCT, HR, SBP, O2 Sat, operating room temperature, pH, arterial HCO3, arterial O2 pressure, arterial blood lactate, degree of arterial blood saturation and arterial access base in 36ºC group (p value <0.05). Trend of Hb, HCT, HR, SBP, O2 Sat, operating room temperature, pH, HCO3 level of arterial pressure, arterial O2, arterial CO2 pressure, degree of saturation of arterial blood and arterial access was statistically significant in 40ºC group (p value <0.05).
Conclusion: In bleeding and low blood pressure and hypothermia, the level of serum lactate is more than 3.5 meq/L, which is caused by cellular hypoxia. In our study in two temperatures during operation lactate level was low because of longer time of operation that shows loss of hypoxia and high level of consciousness and less complication. Also time of waking up was more rapid. So as lactate level was low, prophylaxis of hypoxia is more.

Background: Electroconvulsive therapy (ECT) is usually given to people with severe depression which has not responded to other forms of treatment such as anti-depressants. ECT may be accompanied by potentially significant medical complications including prolonged seizures, prolonged apnea, or cardiac or pulmonary complications. Modification of ECT with brief anesthesia and muscle relaxants should be accomplished. Present prospective randomized study is designed to compare Thiopental Sodium and Etomidate for their effect on hemodynamics, seizure duration, respiratory arrest, and recovery after electroconvulsive therapy and various adverse effects on Sick children in ECT.
Methods: A total of 64 patients with psychiatric disorder were examined in a prospective randomized double-blind study. The patients were randomly divided into two groups as group T (n= 32, Thiopental sodium 2 mg kg^-1), and group E (n = 32, Etomidate 0.1 mgkg^-1).
effects of etomidate versus thiopental in electroconvulsive therapy on cardiovascular system parameters (heart rate, blood pressure, and blood oxygenation), seizure variables, adverse effects and recovery variables were recorded at every session, on prespecified time points, and the findings were used in this evaluation.
The methods used were descriptive study, cross tabs, Chi-square test, independent sample t-test, paired sample t-test, Fisher and repeated measure analysis of variance (ANOVA). It should be noted, the results are statistically significant at 95% has been mentioned.
Results: Both groups were comparable in sex, weight and ASA physical status, with no statistically significant differences (p > 0.05). There was no difference in the Systolic blood pressure (DBP) between the two groups.
Patients in etomidate group showed little change in mean Diastolic blood pressure 5th minutes after ETC (DBP5) and mean arterial pressure 5th minutes after ETC (MAP5), and heart rate 1th minutes after ETC (HR1), arterial blood oxygen saturation 1 and 5 minutes after ETC, compared to thiopental (p> 0.05).
Based on statistical analysis, the relative superiority of etomidate compared to thiopental the anesthetic induction in the treatment of ECT, was seen in Four variables, duration of seizures, Recovery time, Reach verbal response after seizure and apnea durations (Back spontaneous breathing after a seizure).
In addition, Pain on injection, nausea and vomiting and Myoclonus was more in etomidate group while Muscular pain activity was higher in thiopental group (p> 0.05).
Conclusion: It seems that etomidate compared with thiopental has no conflict with ECT therapeutic effects in psychiatric patients. In addition, it probably can be used as a safe and effective drug for controlling ECT-induced hemodynamic changes and seizure variables. Drawback etomidate Compared with thiopental had a high incidence of myoclonus, Pain at injection site and nausea and vomiting.

Background: Anesthesiology residents are susceptible to different mood and anxiety disorders. The aim of this research was to determine and compare stress coping styles and clinical performances in anesthesiology residents with type D and Non-D personality.
Methods: This is a causative – comparative research. Anesthesiology residents at academic department of anesthesiology in Tehran university of medical science(TUMS) consisting of Shariati, Emam Khomeini and Sina Hospitals completed the CISS (coping inventory for stressful situations, ANDLER & PARKER, 1990) and DS-14 (Type D personality) questionnaires.
Clinical performance of participants was evaluated by faculty with GRF (Global Rating Format), DOPS (Direct Observation of Procedural Skills) and OSCE (Objectively Structured Clinical Examination) scores.
For evaluating research hypothesis, data was analyzed with Pierson correlation coefficient and single and multivariate analysis of variance.
Results: Research results demonstrated that type D personality anesthesiology residents use emotional and avoidance- social diversion coping style more than non-D ones. Interestingly, task-oriented coping style was not statistically different in two groups.
Clinical performance composed of OSCE, DOPS and GRF scores was also higher in non-D personality participants.
Conclusion: Based on our results in this research, type D personality affect negatively on clinical performance and coping styles in anesthesiology residents.
So it is rational to identify type D personality residents to educate them how to deal with negative affects and social avoidance in order to promote their clinical performance.

Awake intubation is the choice for airway management in anticipated difficult airway (DA), which means establishing airway without induction of deep sedation; however, in cases where sedation is precarious, decision in emergency situations, success in awake intubation is dependent on proper regional airway block. A 21 year old man with bilateral temporo-mandibular ankyolosis and a 25 years old female with mandibular hypoplasia suspected of having Pierre Robin syndrome were candidate for elective facial plastic surgery. Case one was intubated by flexible fiberoptic bronchoscope and case two with retrograde intubation. In DA with mandibular problem, awake intubation is indicated under regional airway block and topicalization.