Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 4 2 2018 04 29 444 447 EN Sussan Soltani Mohammadi Department of Anesthesiology and Critical Care, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Zahra Gholamhosseinzadeh Tabasi Department of Anesthesiology, Tehran University of Medical Sciences, Dr Shariati hospital, Tehran, Iran. 2018 01 08 2018 03 10 Background: Postoperative nausea and vomiting (PONV) is an unpleasant and distressing complication after abdominal surgeries. We conducted a study to compare the efficacy of Ondansetron-Dexamethasone combination with ondansetron alone on PONV after abdominal surgeries under general anesthesia. Methods: Two hundred patients undergoing elective abdominal surgeries under general anesthesia were allocated into two equal groups and anesthetised with the same technique. In one group combination of 8mg dexamethasone (2ml) and 4mg ondansetron (2ml) and in the other group ondansetron plus normal saline with the same volume was injected ten minutes before induction of anesthesia. PONV at recovery and during the first 24 hours after surgery were compared between the study groups. Results: Twenty-two patients in ondansetron group and nine patients in ondansetron plus dexamethasone group had PONV respectively at first hour in recovery room (P=0.01). Eight patients in ondansetron group and no patient in ondansetron plus dexamethasone group had PONV at first 24 hours after surgery in the ward (P=0.007). In ondansetron group 21 patients and in combination group 7 patients needed intravenous metoclopramide as rescue medication for treatment of PONV in recovery (P=0.02). Two patients in ondansetron group needed intravenous rescue medication for treatment of PONV in the ward (P=0.01). Conclusion: Dexamethasone plus ondansetron was more effective than ondansetron alone in preventing postoperative nausea and vomiting in patients undergoing elective abdominal surgeries. https://aacc.tums.ac.ir/index.php/aacc/article/view/176 https://aacc.tums.ac.ir/index.php/aacc/article/download/176/320

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 4 2 2018 04 29 448 454 EN Fariborz Mehrani Department of Anesthesiology, Faculty of Paramedicine, Tehran University of Medical Sciences, Tehran, Iran. Mahsa Fadaee Department of Anesthesiology, Faculty of Paramedicine, Tehran University of Medical Sciences, Tehran, Iran. Sahar Sadat Dehghan Manshadi Department of Anesthesiology, Faculty of Paramedicine, Tehran University of Medical Sciences, Tehran, Iran. Parisa Gozali kalansara Department of Anesthesiology, Faculty of Paramedicine, Tehran University of Medical Sciences, Tehran, Iran. Kosar Ahmadi Department of Anesthesiology, Faculty of Paramedicine, Tehran University of Medical Sciences, Tehran, Iran. Amirhossein Orandi Department of Anesthesiology and Critical Care, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Jayran Zebardast Deputy of Affairs, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Ali-Akbar Nejatisafa Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran. Saeed Khorramnia Department of Anesthesiology and Critical Care, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Negar Eftekhar Department of Anesthesiology and Critical Care, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Hossein Majedi Department of Anesthesiology and Critical Care, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2017 12 08 2018 03 10 Background: Low Back Pain (LBP) is a common musculoskeletal disorder which may have an occupational or non-occupational etiology and is seen in many health care providers. It is an important cause of morbidity and workplace absence. Various factors may result in LBP but the role of occupational stress and anxiety personality disorder is still unclear. Methods: Face-to-face interviews were conducted with 58 anesthesiologists working in the hospitals of Tehran University of Medical Sciences to evaluate the occurrence of LBP in the first year of work. The probable causes of LBP and the level of anxiety were assessed using a questionnaire designed for this purpose, based on Spielberger state-trait anxiety inventory (STAI), and the results were analyzed. Results: Of 58 participants, 44 (75.9%) were men and 14 (24.1%) were women. The mean age of the participants was 45.6±6.3 years. Twenty-four of 58 participants (41.4%) reported LBP in the first year of work. Six participants (10.3%) did not have anxiety state but had LBP in the first year of work. Eighteen subjects (31%) with mild to severe anxiety state also had LBP in the first year of work. Nine anesthesiologists (15.5%) did not have anxiety trait but had LBP in the first year of work. Fifteen participants (25.8%) had mild to severe anxiety trait and had LBP in the first year of work. In general, 24 of 58 participants (41.4%) with an anxiety score of 47.52 (moderate level of anxiety) had LBP, and 34 of 58 participants with an anxiety score of 41.01 (moderate level of anxiety) did not have LBP. There was a significant correlation between the occurrence of LBP and the level of anxiety (P=0.014). The personality type, smoking, history of psychiatric disorders, occupational satisfaction, communication with colleagues, sleep quality, history of LBP during work years, especially in the first year, duration of LBP, stress in the first year of work, and weekly hours of exercise had a significant association with anxiety (P<0.05). Conclusion: LBP is a multi factorial disorder of human. It seems that LBP can be related to stress and mechanical factors. https://aacc.tums.ac.ir/index.php/aacc/article/view/174 https://aacc.tums.ac.ir/index.php/aacc/article/download/174/321

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 4 2 2018 04 29 455 458 EN Mohammad Reza Khajavi Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Saba Bahari Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Reza Shariat Moharari Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Pejman Pourfakhr Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Farhad Etezadi Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Farsad Imani Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2018 04 15 2018 04 29 Background: Postoperative acute pain management after maxillofacial surgery due to severity of pain and limitations of opioids use in these patients is of particular importance. The aim of this study was to evaluate the analgesic effect of oral gabapentin and clonidine combination and opioids requirements after surgery. Methods: This study was a randomized clinical trial (RCT) on 70 patients (18-55 yr old ASAI to II) undergoing various types of Orthognathic surgeries in Sina hospital affiliated to Tehran University of Medical Sciences, Tehran, Iran in 2016. The patients were randomly divided in two groups. Both groups received 1 gr (IV acetaminophen) 0.5 hour before the end of surgery. The control group received placebo and gabapentin/clonidine group received 300 mg gabapentin and clonidine 0.2mg orally 60 minutes before the induction of anesthesia. The pain severity score (assessed by VAS scale, the level of sedation (assessed by Sedation Agitation Scale), opioids requirement, nausea and vomiting were recorded in the post anesthesia care unit (PACU) 5 10, 20, 30 minutes and 3 hours after surgery. For rescue pain management intravenous morphine was administered. Results: Seventy patients were enrolled in this study. Gabapentin/ Clonidine increase extubation time (20.3±9.3min) (P<0.05) compared to control group (14.8±6.2 min). Gabapentin/ Clonidine decline the pain intensity, level of agitation and morphine requirement in the early minutes in recovery room. The incidence of PONV was also lower in gabapentin/clonidine group (5.7%) compared to control group (14.7%) p=0.005. Conclusion: Premedication of oral gabapentin/ Clonidine increases extubation time and sedation score in patients recovering from Orthognathic surgery and could reduce postoperative pain scores and opioids consumption in recovery room. https://aacc.tums.ac.ir/index.php/aacc/article/view/180 https://aacc.tums.ac.ir/index.php/aacc/article/download/180/322

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 4 2 2018 04 29 459 463 EN Nahid Manouchehrian Department of Anesthesiology, Clinical Research Development Unit of Fatemi Hospital, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Mehdi Sanatkar Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran, Iran. Hossein Kimiaei Asadi Department of Anesthesiology, Clinical Research Development Unit of Fatemi Hospital, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Elahe Soleimani Hamadan University of Medical Sciences, Hamadan, Iran. Abbas Moradi Hamadan University of Medical Sciences, Hamadan, Iran. 2018 04 18 2018 04 29 Background: Shivering is rhythmic vibratory motions in one or more group of muscle that caused after general or local anesthesia. Prevention and early treatment of Shivering lead to not conflict with patient monitoring and also reduce cardio-respiratory and metabolic side effects in patients. The aim of this study is comparing effect of ketamine and hydrocortisone on reducing post spinal shivering. Methods: In this prospective study, 150 pregnant women randomly were divided into three groups after Spinal anesthesia. Patients received 3cc hydrocortisone (2 mg/kg, A group), 3cc ketamine (0.5 mg/kg, B group) and 3cc normal saline (%0.9, C group) intravenously in 10-15 S duration after umbilical cord clamping. In all patients systolic and diastolic pressure, mean arterial pressure, heart rate, oxygen saturation level and body temperature were recorded before anesthesia and then every minute for 5 minutes, every 5 minutes for 15 minutes, every 10 minutes until the end of surgery. Also sedation score, hallucination, nausea and vomiting, intensity of shivering and using amount of pethidine and ephedrine were recorded in questionnaire. Results: All three groups were similar in basic blood pressure, sensory and motor level. The rate of shivering in hydrocortisone group was significantly lower than control group (P=0.000). The rate of shivering in ketamine group was significantly lower than control group (P=0.00). Also the rate of shivering in hydrocortisone group was significantly higher than ketamine group (P=0.004). Conclusion: Intravenous Hydrocortisone and ketamine are effective in reducing shivering occurring after spinal anesthesia in the cesarean surgery, however ketamine is significantly more effective than hydrocortisone in shivering control. https://aacc.tums.ac.ir/index.php/aacc/article/view/183 https://aacc.tums.ac.ir/index.php/aacc/article/download/183/323

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 4 2 2018 04 29 464 467 EN Seyed Taghi Hashemi Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Babak Alikiaii Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Samira Ghasemi Medical School, Isfahan University of Medical Sciences, Isfahan, Iran. 2017 11 16 2018 04 09 Background: There is no known biomarker to predict the mortality risk in patients undergoing dialysis in the intensive care unit (ICU). Therefore, the current study aimed to determine the diagnostic value of troponin I and T in this respect. Methods: This prospective study included 70 patients, admitted to the intensive care unit, during 2016-2017, who need hemodialysis. In these participants, the serum levels of troponin T and I were measured and the result of treatment was recorded in the patient’s profile whether it was improvement or death. Finally, we analyzed the diagnostic value of troponin T and I was predict the mortality in these patients in SPSS software version 20 through the Rock analysis. Results: The mean of troponin I and T levels in alive patients were 0.47±0.11 ng/ml and 0.67±0.15 ng/ml, respectively and in dead were 0.49±0.23 ng/ml and 1.06 ± 0.36 ng/ml, respectively. There was no significant difference between alive and dead patients in the mean of both troponins levels (P value> 0.05). On the other hand, Rock analysis also demonstrated that statistically these two biomarkers did not have any significant diagnostic value to predict mortality (P value> 0.05). Conclusion: According to the results, it is conceivable that troponin I and T are not proper biomarkers to predict the mortality in patients undergoing dialysis in ICU and these biomarkers do not have a proper sensitivity and specificity for this purpose. https://aacc.tums.ac.ir/index.php/aacc/article/view/167 https://aacc.tums.ac.ir/index.php/aacc/article/download/167/324

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 4 2 2018 04 30 468 476 EN Zahid Hussain Khan Professor of Anesthesiology and Critical Care, Deputy for Research, Department of Anesthesiology and Critical Care, Imam Khomeini Medical Complex, Tehran University of Medical Sciences, Tehran, Iran. Kasra Karvandian Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Jayran Zebardast Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Hussein Ali Hussein Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2017 07 28 2018 03 10 Intraoperative fluid equilibrium is a decisive matter in perioperative anesthesia management, because most of evaluation studies consider intraoperative fluid administration as a major participating agent in improving or worsening patient outcomes after surgery and it revolves within the responsibility of an anesthesiologist. The unrsity, Tehran, Iran Mohammad Mehdi Sepehri Professor of Healthcare Systems Engineering, Faculty of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, Iran 2019 08 22 2019 09 25 Background: Quality of Intensive care has got more attention in case of the high cost of healthcare and the potential for harm. Poor-quality care causes high cost and quality improvement initiatives in the ICU lead to an improvement in outcomes as well as a decrease in costs. One of the crucial tools that allow physicians and nurses to monitor change in a quality improvement effort is the development of an electronic database for data collection and reporting. The objective of Intensive Care Registries is to create a high-quality registry of patients through a collaboration of academic health centers performing uniform data collection with the purpose of improving the quality and accuracy of healthcare decisions and provide a data-driven clinical decision support system for critical care medicine. Methods: This article reviews real-world data sources in healthcare and considers registry as the main tool to address health services and outcomes research questions in critical care, and briefly describes objective, inputs and outputs of intensive care registries. As it can be comprehended from library research, the combination of patient clinical care data, quality parameters, and ICU operating costs, integrated into an electronic database, provides a valuable tool for quality improvement and overall efficiency of offered care. Results: Using Big Data effectively within ICUs for supporting clinical decision making can lead to predict numerous diseases and help to discover new patterns in healthcare. The ability to process multiple high-speed clinical data streams from multiple centers could dramatically improve both healthcare efficiency and patient outcomes. Conclusion: To gain this goal, developing reliable and standardized health analytics platforms as well as quality improvement processes that translate analytical results into new clinical guidelines, is recommended. https://aacc.tums.ac.ir/index.php/aacc/article/view/253

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 6 1 2019 12 30 41 49 EN Abbas Heydari Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Aliakbar Keykha Mashhad University of Medical Sciences, Mashhad, Iran. 2019 07 23 2019 09 15 Background: With regard to critical illness and stress, medication side effects, decreased appetite, and increased nausea and vomiting; patients admitted to intensive care units (ICUs) are at particular risk of malnutrition. Feeding behavior i.e. time and method in these patients has still remained as an unresolved issue. Thus; enteral and parenteral nutrition, with their own benefits and complications, are two commonly used methods for such individuals. The present systematic review was to compare the effects of enteral and parenteral nutrition in patients admitted to ICUs. Methods: This systematic review investigated a total number of 1642 articles on nutrition methods in ICU patients during 2010-2019 using keywords of “enteral nutrition, parenteral nutrition solutions, parenteral nutrition, critical care outcomes, critical illness, intensive care unit, and ICU” in the databases of SID, Iranmedex, MEDLIB-ED, PubMed, Scopus, Medline, Embase, Cochrane, Web of Science, and Google Scholar; and finally, 15 articles were analyzed in relation to the research objectives. Results: Studies indicated that patient mortality was not different in enteral and parenteral nutrition groups. The incidence rate of infectious complications was also reported higher in parenteral nutrition group. However, there was no significant difference in the incidence rate of infections in studies meeting total standards for parenteral nutrition. Besides, there was no significant difference between the duration of undergoing mechanical ventilation and hospitalization time in both groups. Furthermore, the incidence rate of hypoglycemia was higher in enteral nutrition group; but serum protein levels had much better status compared with those in parenteral nutrition group. Conclusion: If standards for infusion are observed and provided that rates of infectious complications are reduced, patients can benefit from starting parenteral nutrition immediately after admission to ICUs in the absence of enteral method. https://aacc.tums.ac.ir/index.php/aacc/article/view/245

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 6 1 2019 12 30