Background: Tranexamic acid competitively inhibits the activation of plasminogen and is thus effective in reducing blood loss during surgery. This study aimed to compare the effects of tranexamic acid and hypotension with remifentanil on blood loss during cleft palate repair. 
Methods: This clinical trial study recruited 74 patients in Imam Hossein Hospital, Isfahan, Iran, during 2016-17. Children under three years of age who were candidates for cleft palate repair were randomly divided into two groups. The first group received an intravenous infusion of remifentanil (0.1 μg/kg/min) after the induction of anesthesia. In the second group, an intravenous injection of 10 mg/kg tranexamic acid was slowly administered. The amount of blood loss and post-anesthesia care unit (PACU) stay duration were the main measured variables.
Results: The mean blood loss was 76.44 ± 14.7 and 57.76 ± 14.16 ml in the remifentanil and tranexamic acid groups, respectively (P < 0.001). The mean duration of PACU stay was 64.59 ± 5.5 and 46.35 ± 4.4 minutes in the mentioned groups, respectively (P < 0.001).
Conclusion: There were no significant differences between the two groups in terms of demographic and baseline characteristics. According to our findings, tranexamic acid was more effective than remifentanil in decreasing intraoperative blood loss and PACU stay.

Background: The level and time block in patients undergoing spinal anesthesia are affected by a variety of demographic factors (e.g., age, gender, height, weight, body mass index [BMI] and the amount of cerebrospinal fluid). Although the influence of BMI in spinal anesthesia is still a matter of controversy, the aim of this study was to determine the relationship between BMI and time of spinal block anesthesia in herniorrhaphy patients.
Methods: One hundred and eighty patients, who had undergone an inguinal herniorrhaphy operation, were divided into two groups—obese (BMI ≥30kg/m2) and non-obese (BMI<30kg/m2). Demographic characteristics, operation time, anesthesia time, time sensory and motor block and changes in hemodynamics were compared between the two groups. The evaluation of spinal block height was recorded with the help of a pin-prick test and Bromage Scale after the administration of bupivacaine.
Results: Body weight, height and BMI showed significant differences in the two groups and the time to reach sensory block T10 was significantly shorter in the group of obese patients. The time for recovery of sensory and motor block was longer in the obese group than in the non-obese group. Moreover, there were differences in the pattern of blood pressure of the two groups during surgery.
Conclusion: The results of this study showed a correlation between BMI and the time of spinal block anesthesia. Furthermore, the maximum motor and sensory block specified in obese patients happens faster and the analgesic duration could be prolonged in patients with a higher BMI.

Introduction: By consideration of clinical predictors and true way for transfer of patient from the operating room (OR), it can be prevented of complications and be reduced mortality rate.Thus, the study aimed to investigate clinical predictors of admitted cases from OR to ICU.
Method: In this study250 patients were transferred to ICU.data such as underlying diseases, prior reservation for transferring to ICU, unexpected decision for transferring, problems in OR, multi-trauma, and other effective causes of transferring were analyzed.
Results: Of 250 subjects, 144(57.6%) were male.The four major causes of admission to ICU follow as trauma(43.6%), respiratory problems(20.4%), bleeding (19.6%)and postoperative care (16.4%). The most common causes in traumatic patients included brain trauma (60 cases), multiple trauma (32 cases), and abdominal trauma (8 cases).
Conclusion: The viewpoint of an anesthesiologist for selection of patient who requires to receiving critical care services is also necessary.

Background: Endoscopy is a diagnostic and therapeutic method with a high risk of nausea and vomiting. Considering the lack of adequate studies on the prevention of postoperative nausea and vomiting after endoscopy in children, this study was conducted to compare the effects of ondansetron, dexamethasone and a combination of these drugs on the reduction of nausea and vomiting in children aged 1 to 12 years undergoing upper gastrointestinal endoscopy.
Methods: In this double-blind, randomized clinical trial, 146 children aged 1 to 12 years, undergoing upper gastrointestinal endoscopy were randomly allocated to four groups of 36. Before endoscopy, the groups received 0.1 mg / kg of ondansetron, 0.2 mg / kg dexamethasone, a combination of the two drugs and placebo, respectively.
Results: According to the results of our study, children who underwent upper GI endoscopy, administration of ondansetron plus dexamethasone was associated with a significantly lower frequency of nausea in all assessment time points. However, the difference between the groups was significant only on admission to recovery and the 15 minutes after admission to recovery (P<0.001).
Conclusion: The results of our study indicated that in children undergoing endoscopy, the use of ondansetron plus dexamethasone is associated with reduction in the incidence of nausea and vomiting, and the use of the combination does not cause significant side effects compared to ondansetron, dexamethasone or placebo, separately.

Background: This is a prospective randomized blinded clinical trial comparing the efficacy and safety of labetalol and nitroglycerin for the management of intraoperative hypertension in ambulatory surgical patients who underwent cataract surgery.
Methods: A total of 80 hypertensive patients (systolic blood pressure> 200 mmHg or diastolic blood pressure>100 mmHg) who had increased blood pressure during cataract surgery under topical anesthesia were reviewed. Patients were randomized to receive nitroglycerin (group N, n=40) or labetalol (group L, n=40). The initial dose of nitroglycerin was a bolus of 2 µg/kg and repeat dose of 1ug/kg intravenously every 5 minutes. Labetalol was administered as a bolus of 5 mg followed by 5 mg intravenously as needed every five minutes up to maximum dose of 1 mg/kg.
Results: Systolic blood pressure decreased from 21.4±8.6 mm Hg (200 to 260 mm Hg) to 18.8±6.4 mm Hg with administration of nitroglycerin. Labetalol reduced systolic blood pressure from 21.4±6.7 mm Hg (201 to 258 mm Hg) to 17.6±11.6 (p=0.02). Nitroglycerin increased baseline heart rate from 68±8 beats/min to 82±6 beats/min (p=0.04), however, in the labetalol group heart rate reduced from control 72±6 to 64±9 beats/min (P<0.05). The hypotension episode was 18 (45%) cases in the nitroglycerin group and 2 (5%) cases in the labetalol group respectively (p<0.05). The mean of systolic blood pressure during their stay in the recovery room in nitroglycerin group was 20.7±9.6 mm Hg and in labetalol group was 18.5±10.2 mm Hg (p<0.05).
Conclusion: Nitroglycerin may produce reflex tachycardia and episode of hypotension especially in elderly patients intraoperatively. Labetalol is a safe and effective antihypertensive agent for management of increased blood pressure during cataract surgery with topical anesthesia.

This research is a method review type, comparative study between the effects of General anesthesia versus those of spinal anesthesia during caesarean section on the newborns and the mother undergoing cesarean section. The variables considered in the study included patient family history, patient medical history, status of patient during pregnancy, age of patient, and emergency or planned cesarean. Both general and spinal methods of anesthesia had differing results in multiple aspects and effects both during and after the surgery. However, pros of spinal anesthesia topped those of general anesthesia and is therefore the more favorable method of anesthesia

Regional anesthesia is an expanding subspecialty and is gaining increasing popularity due to its significant benefits over general anesthesia if appropriately accomplished, which includes superior intraoperative pain control, attenuation of the surgical stress response, minimal systemic impairment, lower incidence of postoperative nausea and vomiting, excellent localized postoperative analgesia, and decreased hospital cost and stay. Needle conduction guide toward the targets always has a great importance. The most commonly used local anesthetics include lidocaine, ropivacaine, bupivacaine, and mepivacaine. The type of local anesthetic, the concentration, the volume administered, and the location of the block will affect the onset, duration and depth /type of block. Due to ineffectivity of neuraxial block in upper limbs, upper extremity blocks may be considered as the sole substitute or supersede method of anesthesia for upper limb surgeries.

Color Doppler ultrasound-guided regional block like brachial plexus block lately changed other anesthesia and analgesia practice because of the accuracy and simplicity of practice to view the anatomy of blood vessels and nerves. With color Doppler ultrasound-guided regional block you can follow needle track to nerves and prevent any vessel puncture. It can be the standard for any regional block. The patient was a 64 years Iranian who had diabetes mellitus and hypertension and planned as an urgent right upper limb amputation surgery. Because of the acute exacerbation of COPD due to pneumonia we decided to use regional anesthesia for this patient. On the first physical examination there was no peripheral pulse in patient’s right hand. With ultra-sonographic color Doppler the pulselessness of right hand artery were monitored. With the anatomic and awareness of grey-scaled ultrasonography the nerves and vessels were found. Axillary brachial plexus block with guidance of grey-scaled ultrasonography were done and the surgery was successfully performed and patient transferred to ICU for post operation care after surgery.