Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 3 3 2017 05 15 363 364 EN Alireza Ahmadi Department of Anesthesiology, Imam Reza Anesthesiology Center, Kermanshah University of Medical Sciences, Kermanshah, Iran Abbas Ahmadi Department of Anesthesiology, Imam Reza Anesthesiology Center, Kermanshah University of Medical Sciences, Kermanshah, Iran 2016 11 28 2017 04 17 Hypercapnia is a frequent event but severe hypercapnia is a harmful complication of general anesthesia. A 6 month old Iranian baby boy who had an appendicitis under general anesthesia exhibited severe hypercapnia during surgery. Arterial blood gas revealed a PCO2 of 95mmHg. Troubleshooting immediately were taken but the level of CO2 did not decline. Under that situation by elevating fresh gas flow to twice or three times the hypercapnia decreased and by adjusting FGF we could reach the best end tidal PCO2 and paco2. https://aacc.tums.ac.ir/index.php/aacc/article/view/100 https://aacc.tums.ac.ir/index.php/aacc/article/download/100/286

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 3 3 2017 06 12 338 341 EN Alireza Saliminia Department of Anesthesiology, Pain and Critical Care, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Omid Azimaraghi Department of Anesthesiology, Pain and Critical Care, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Maryam Ghadimi Research Development Center, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Naieemeh Kaafi Kang Research Development Center, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Ali Movafegh Department of Anesthesiology, Pain and Critical Care, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2017 04 14 2017 06 06 Background: The incidence of coughing following extubation can result in a number of undesirable side effects. Therefore, the development of antitussive premedication may be desirable. Methods: In this study, 138 patients were randomized into two groups to receive either oral Passiflora incarnata (500 mg, PassipyTM IranDarouk) (n = 69) or placebo (n = 69) as premedication, 120 min before surgery. After extubation, all patients were observed to record the incidence of coughing during a 15 minute period. Hemodynamic variables were recorded before induction of anesthesia, 1 minute following intubation, and 5 minutes after extubation. Results: The demographic characteristics of patients, ASA physical status, duration of surgery, hemodynamic variables were similar in the two groups. The incidence of cough following extubation was significantly lower in the passiflora group compared to the control group (P <0.001). Conclusion: In outpatient surgery, administration of oral Passiflora incarnata as a premedication reduces incidence of coughing following extubation. https://aacc.tums.ac.ir/index.php/aacc/article/view/118 https://aacc.tums.ac.ir/index.php/aacc/article/download/118/278

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 3 3 2017 06 12 342 347 EN Anahita Hirmanpour Anesthesiology and Critical Care Research Center ,Isfahan University of Medical Sciences, Isfahan, Iran. Reihanak Talakoub Anesthesiology and Critical Care Research Center ,Isfahan University of Medical Sciences, Isfahan, Iran. Mohammadreza Safavi Anesthesiology and Critical Care Research Center ,Isfahan University of Medical Sciences, Isfahan, Iran. Azim Honarmand Anesthesiology and Critical Care Research Center ,Isfahan University of Medical Sciences, Isfahan, Iran. Amir Shafa Anesthesiology and Critical Care Research Center ,Isfahan University of Medical Sciences, Isfahan, Iran. Kamelia Emamdoost Anesthesiology and Critical Care Research Center ,Isfahan University of Medical Sciences, Isfahan, Iran. 2017 04 17 2017 06 06 Background: Propofol causes a high incidence of pain during intravenous injection. The aim of this study was to compare incidence and severity of injection pain following the administration of two different formulations of Propofol with and without 10mg Lidocaine in female patients. Methods: One hundred ASA (American Society of Anesthesiologists) grade I and II patients, planned to undergo gynecologic surgery under general anesthesia, were included in four groups of 25 in a prospectively, randomized and double-blind study. Group A received Propofol 1%+10mg lidocaine (1cc of lidocaine1%), Group B received Propofol 1%+ 1cc preservative-free saline, Group C received Lipuropropofol +10mg lidocaine (1cc of lidocaine1%) and Group D received Lipuropropofol+1cc preservative-free saline. Injection pain was assessed using the McCrirrick and Hunter scale. Results: No differences were found in the mean age, weight and given dose of propofol administered between all groups (P>0.05). Comparison of groups revealed significant difference in pain scores between groups (mean pain scores, GroupA:2.84 ± 0.850 vs. GroupB:3.16 ± 0.800 vs. GroupC:1.8±0.866 vs. GroupD:2.12±0.833 points). Conclusion: The highest pain scores were found in the propofol1% without lidocaine use while lipuropropofol plus lidocaine had the lowest pain scores. We recommend premixing 10 mg of lidocaine to Lipuropropofolfor preventing or mitigation of propofol injection pain compared to Lipuropropofol alone or propofol1% with lidocaine. https://aacc.tums.ac.ir/index.php/aacc/article/view/119 https://aacc.tums.ac.ir/index.php/aacc/article/download/119/282

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 3 3 2017 06 12 348 353 EN Seyed Reza Mazloom Department of Nursing, Mashhad University of Medical sciences, Mashhad, Iran Fatemeh Navidi Department of Anesthesiology, Tehran University of Medical sciences, Tehran, Iran Fatemeh Hajimohammadi Department of Anesthesiology, Tehran University of Medical sciences, Tehran, Iran Behrooz Amirzargar Department of Otolaryngology Head and Neck Surgery, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran Bahram Ali Ghanbari Hashemabadi Department of Education and Psychology, Mashhad University of Medical sciences, Mashhad, Iran Mohammad Reza Majidi Department of Otolaryngology Head and Neck Surgery, Mashhad University of Medical sciences, Mashhad, Iran Reza Jalaeian Department of Anesthesiology, Mashhad University of Medical sciences, Mashhad, Iran Mehrdad Behzadi Department of Anesthesiology, Tehran University of Medical sciences, Tehran, Iran Mehrdad Jafari Department of Otolaryngology Head and Neck Surgery, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran 2017 05 18 2017 06 12 Background: Patients often name post-operative pain as the most horrifying aspect of the surgery. The purpose of this study was to evaluate the effect of communication with patients on post-operative pain and agitation in the patients recovering from endoscopic sinus surgery. Methods: This was a randomized clinical trial. Sixty patients scheduled for endoscopic sinus surgery were randomly allocated to control and intervention groups (30 patients in each group). A supportive and informative session was established for 20-30 minutes in two stages for the intervention group while the control group received routine information. After surgery, pain and agitation were assessed using the non-verbal pain scale, visual analog scale and Riker's sedation-agitation score. Results: The average pain scores in the recovery room by non-verbal pain scale and visual analog scale were (3.4±1.6) and (6.2±3.0) for the control group and (1.2±1.5) and (3.0±3.3) for the intervention group, respectively (P≤0.001). The average agitation score in the recovery room for the control group and the intervention group were (4.6±0.6) and (4.1±0.3), respectively (P=0.008). Conclusion: The results demonstrate that simple communication techniques before the surgery can be effective in reducing post-operative pain and agitation in patients recovering from endoscopic sinus surgery. This clinical trial was registered from IRCT with registration number IRCT201404278589N3.   https://aacc.tums.ac.ir/index.php/aacc/article/view/124 https://aacc.tums.ac.ir/index.php/aacc/article/download/124/280

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 3 3 2017 06 18 354 358 EN Gholamreza Movasaghi Department of Anaesthesiology and Critical Care, Shahid Hashemi Nezhad Urology Hospital, Iran University of Medical Sciences, Tehran, Iran. Mahmoud Reza Mohaghegh Dolatabadi Department of Anaesthesiology and Critical Care, Shahid Hashemi Nezhad Urology Hospital, Iran University of Medical Sciences, Tehran, Iran. Fatemeh Sadat Mostafavi Mobasher Department of Anesthesiology and Critical Care, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Valiollah Hassani Department of Anesthesiology and Critical Care, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Masoud Ghorbanlo Department of Anaesthesiology and Critical Care, Shahid Hashemi Nezhad Urology Hospital, Iran University of Medical Sciences, Tehran, Iran. Mehrdad Mesbah Kiaee Department of Anaesthesiology and Critical Care, Shahid Hashemi Nezhad Urology Hospital, Iran University of Medical Sciences, Tehran, Iran. Zahra Sadat Koleini Department of Anesthesiology and Critical Care, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Giti Fotohi Department of Anesthesiology and Critical Care, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran 2017 05 21 2017 06 12 Background: Percutaneous Nephro Lithotomy (PCNL) is an efficient treatment for complicated, large and staghorn calculi. Optimal pain control has long been a concern for the surgeons and the anesthesiologist. The pivotal aim of this study is to evaluate the effects of intravenous lidocaine infusion on pain levels, sedation score, foley catheter tolerance and level of nausea and vomiting in patients undergoing the procedure. Methods: In a randomized parallel group double blind clinical trial, 60 patients with ASA physical class I candidate for PCNL were enrolled in the study. During the operation, group A patients received 1mg/kg/hr infusion of intravenous lidocaine infusion while group B patients received normal saline infusion as placebo. Results: Patients receiving lidocaine infusion had better foley catheter tolerance compared to the placebo group. Similarly VAS pain scores in the PACU were 2.5 ± 1.7 in group A versus 3.7 ± 1.2 in group B was observed to be higher in the placebo group leading to significant difference. (p= 0.03) One hour after surgery 4 (23%) and 26 (87%) of the patients in group A were drowsy and alert, while the results in group B were 13 (77%) and 6 (20%) respectively. Conclusion: The results of our study demonstrates significant difference in sedation score (15 minutes and one hour after surgery) and foley catheter tolerance in patients who received lidocaine infusion through PCNL surgery. In addition, patients receiving lidocaine infusion convey better pain scores after surgery. https://aacc.tums.ac.ir/index.php/aacc/article/view/125 https://aacc.tums.ac.ir/index.php/aacc/article/download/125/281

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 3 3 2017 06 18 359 362 EN Shahram Seyfi Associated of Anesthesiology and Critical Care Medicine, Clinical research development unit of Rouhani Hospital, Babol University of Medical Science, Babol, Iran Shahrbanoo Latifii Associated of Anesthesiology and Critical Care Medicine, Clinical research development unit of Rouhani Hospital, Babol University of Medical Science, Babol, Iran Seyed Taghi Hamidian Associated of Anesthesiology and Critical Care Medicine, Clinical research development unit of Rouhani Hospital, Babol University of Medical Science, Babol, Iran Farbod Zahedi Tajrishi Associated of Anesthesiology and Critical Care Medicine, Clinical research development unit of Rouhani Hospital, Babol University of Medical Science, Babol, Iran 2017 03 07 Background: It is recommended to start nutrition early in critically ill patients and the preferred method to do so is enteral nutrition which in most cases is achieved by inserting a feeding tube during the first 24 hours. These tubes are placed blindly so the tip of the tube can be placed in different locations. The authors had predicted that placing the tip of the feeding tube in various locations could produce different results in terms of the prevalence of ventilator-associated pneumonia. Methods: We performed this cross-sectional study on 147 patients admitted to the intensive care unit of the Rohani hospital and intubated for at least 5 days receiving enteral feeding via nasogastric (NGT) or gastric tube. Patients were divided into two groups based on the location of the tip of the feeding tube- esophagus or stomach. They were compared in terms of early ventilator-associated pneumonia (VAP) within the first 3-5 days and nasogastric complications such as bleeding, sinusitis and obstruction of the feeding tube. Results: Based on our findings, VAP occurred in 12.2%of the patients. This rate was 9.6% when we placed the nasogastric tube into the stomach and 27.2% when in the esophagus. This difference between the two groups was statistically and clinically significant, while the rate of bleeding, sinusitis and nasogastric tube obstruction was the same between them. Conclusion: The rate of VAP is significantly different when we feed the patients by a nasogastric tube inserted into the stomach (9.6%) and when we do so by placing the tube into the esophagus (27.2%). https://aacc.tums.ac.ir/index.php/aacc/article/view/115 https://aacc.tums.ac.ir/index.php/aacc/article/download/115/284