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 understanding of fluid physiology in the human body, clinical features of available intravenous fluid, and nature of surgery indeed will contribute to the success plan of management. Maintaining of patients’ physiological milieu by preserving normal extracellular volume, adequate tissue perfusion, and a balanced acid base condition are the main goals of intraoperative fluid infusion. This review was conducted to overview fundamental basics of fluid therapy during the intraoperative period. Due to the dearth of supporting data for appropriate volume and the available definitions of restrictive and liberal are diffident, the polemic about which particular method of volume expansion still exists. Colloid versus crystalloid controversy in surgical patients is still going on and this would again be encouraged to be a topic for many clinical trials in the future. The current findings’ trend prefers guided and restricted intraoperative fluid therapy with isotonic balanced crystalloids because such fluids are cost effective and have fewer side effects than other fluids. https://aacc.tums.ac.ir/index.php/aacc/article/view/140 https://aacc.tums.ac.ir/index.php/aacc/article/download/140/326

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 4 2 2018 04 30 477 480 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. Imam Hussain Khafaji Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2017 07 24 2018 03 10 Both neuraxial anesthesia and general anesthesia are used for lower limb surgery. And because of the complications that occur with this type of surgery, we searched in this narrative review the effectiveness and safety of neuraxial anesthesia versus general anesthesia for lower limb surgery. We included randomized controlled trials comparing neuroaxial anesthesia (spinal or epidural anesthesia) versus general anesthesia in adults (35 years or older) with lower-limb surgery. https://aacc.tums.ac.ir/index.php/aacc/article/view/139 https://aacc.tums.ac.ir/index.php/aacc/article/download/139/327

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 4 2 2018 04 29 481 482 EN Ebrahim Espahbodi Department of Anesthesiology and Critical Care, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran. Anahid Maleki Department of Anesthesiology and Critical Care, Medical Center of Children Hospital, Tehran University of Medical Sciences, Tehran, Iran. Abbas Ostad Alipour Department of Anesthesiology and Critical Care, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran. Amir Abbas Yaghooti Department of Anesthesiology and Critical Care, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran. Alireza Tak Zare Department of Anesthesiology and Critical Care, Medical Center of Children Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mehdi Sanatkar Department of Anesthesiology and Critical Care, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2018 04 15 2018 04 29 letterer siwe disease is a rare disease and anesthesia management of patient with this disease is very challenging because of multiorgans involvement and poor information about anesthesia. We manage a child with this disease was refered to operating room for humerous bone fracture surgery. https://aacc.tums.ac.ir/index.php/aacc/article/view/181 https://aacc.tums.ac.ir/index.php/aacc/article/download/181/325