Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 7 1 2021 02 01 1 6 Reihanak Talakoub Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Keyvan Bagheri Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Mitra Jabalameli Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Fahimeh Salehi Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Hamidreza Shetabi Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. 2020 10 04 2020 10 21 Background: Sore throat, cough and hoarseness after tracheal extubation are common complications after surgery. Due to the proven effect of dexamethasone on reducing these complications, in this study, we compared the prophylactic effect of intravenous dexamethasone and dexamethasone gargle on sore throat and cough after extubation. Methods: In this clinical trial study, 96 patients between the ages of 18-64 years who underwent elective surgery and intubation under general anesthesia were randomly divided into three groups, respectively, the first group received 6 mg dexamethasone gargle. The second group received 6 mg intravenous dexamethasone and the third group received normal saline. The frequency of cough and sore throat were assessed and compared in these three groups. Results: There was no significant difference between the three groups based on hemodynamic variables and demographic data (P> 0.05). The frequency of cough in the first (1.54± 2.82) and second (1.57±2.73) groups was less than the third group (1.79±3.14), but this difference was not statistically significant (P>0.66). The mean severity of sore throat in the second group and then in the first group was lower at the time of entry into recovery and 2 hours after surgery, than the third group. (P <0.005) Also, the mean severity of sore throat in the second group and then the first group in 24 hours after surgery was significantly lower than the third group. (P <0.005). Conclusion: Prophylactic single-dose intravenous dexamethasone is more effective than dexamethasone gargle in reducing sore throat due to endotracheal intubation. Also, gargling and intravenous injection of dexamethasone, both are effective in reducing postoperative cough without any side effects after extubation. https://aacc.tums.ac.ir/index.php/aacc/article/view/309 https://aacc.tums.ac.ir/index.php/aacc/article/download/309/491

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 7 1 2021 02 01 7 11 Kavous Shahsavarinia Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Aydin Mahmoud Alilou Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran Sevil Mahmoud Alilou Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran Parinaz Mahmoud Alilou Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran Afshin Gharekhani Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran. Neda Gilani Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran. 2020 10 10 2020 11 22 Background: The current study aimed to evaluate the predictive value of mortality in patients admitted to the Intensive Care Unit (ICU) through the emergency department and based on Quick Sequential Organ Failure Assessment (qSOFA), National Early Warning Score (NEWS) and NEWS2 criteria. Methods: In this cross-sectional study, all patients referred to the emergency department with a need of admission to ICU for any reason, were evaluated. Demographic data such as age and sex were recorded for data collection. Also, the main diagnosis, length of stay and hospitalization outcome along with data related to qSOFA, NEWS and NEWS2 indices were included in the researcher's checklist. Results: Of 89 included patients, 52 (58.4%) were male and 37 (41.6%) were female, with mean age of 60.25±20.8. Our findings indicated that qSOFA is a good predictor for mortality in non-traumatic patients so that qSOFA has 48% sensitivity and 100% specificity in the diagnosis of mortality in non-trauma patients. NEWS also has a sensitivity of 72% and a specificity of 71.4% in the diagnosis of non-traumatic mortality. And NEWS2 has 72% sensitivity and 78.6% specificity in non-traumatic mortality diagnosis. Conclusion: Our findings suggested that the sensitivity and specificity of qSOFA, NEWS and NEWS2 in predicting the mortality of non-traumatic patients who were admitted in emergency departments and hospitalized in ICU, are high and reliablen. https://aacc.tums.ac.ir/index.php/aacc/article/view/310 https://aacc.tums.ac.ir/index.php/aacc/article/download/310/492

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 7 1 2021 02 01 12 18 Nahid Manouchehrian Department of Anesthesiology, Fatemi Medical Center, Hamadan University of Medical Sciences,Hamadan, Iran. Hossein Kimiaei Asadi Department of Anesthesiology, Beasat Medical Center, Hamadan University of Medical Sciences,Hamadan, Iran. Soghra Rabiei Department of Obstetrics and Gynecology, Fatemi Medical Center, Hamadan University of Medical Sciences, Hamadan, Iran. Abbas Moradi Medical Sciences Faculty, Hamadan University of Medical Sciences, Hamadan, Iran. Mansoure Nosrati Medical Sciences Faculty, Hamadan University of Medical Sciences, Hamadan, Iran. 2020 10 17 2020 11 22 Background: The pain of childbirth is the most severe pain that a woman experiences. This study aimed to compare the effect of epidural bolus and epidural continuous infusion of lidocaine %1 on pain and progress of vaginal delivery and motor function in labor epidural analgesia. Methods: This randomized clinical trial was conducted on 50 pregnant women aged between 18-45 years. They were randomly assigned into two groups of bolus injections of lidocaine1% and continuous infusion using an epidural approach. The evaluated variables included systolic and diastolic blood pressures, mean arterial pressure, pain score, heart rate, satisfaction rate, nausea, vomiting, itching, the progress of delivery, and the level of motor and sensory block. The collected data were analyzed in SPSS software (Version 21). P-value less than 0.05 was considered statistically significant. Results: Two groups were similar in age. There were no significant differences between two groups in terms of mean diastolic blood pressure, incidence of hypotension and C/S rate (P> 0.005). Mean arterial pressure, sedation score and neonatal Apgar scores in the first and fifth minutes in the continuous group were significantly lower than the bolus group. Pain score (VAS) in the bolus group) 2.55±1.04 (was significantly lower than infusion group (5.22±2.50). The length of the first and second stages of labor in the bolus group (42.28 and 34.12) was less than continuous infusion (47.04 and 47.00) (P< 0.005). Conclusion: In women undergoing epidural analgesia, epidural bolus injection of lidocaine 1% is associated with greater analgesia and satisfaction than continuous infusion. https://aacc.tums.ac.ir/index.php/aacc/article/view/311 https://aacc.tums.ac.ir/index.php/aacc/article/download/311/493

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 7 1 2021 02 01 19 24 Farhad Sorri Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran Farshad Hashemian Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran Shahin Hajialikhani Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran Mohammad Hossein Bakhshaei Department of Cardiovascular Anesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran 2020 10 17 2020 11 22 Background: Pain is an unpleasant sensation in the body or mind. Uncontrolled pain can increase mortality and morbidity with its negative physiological effects. Effective pain management especially in emergency conditions is essential to keep the patient in optimal conditions and to achieve good clinical results. As most of the injured and traumatic conscious patients with acute pain in emergency situations, need control and perfect pain management during transfer to hospital essential to feel satisfied and improve the quality of service and to decrease mortality and morbidity. Due to some limitation to use opioid drugs in pre-hospital systems, the goal of this study was to evaluate the efficacy of non-opioids drugs in different doses on pre-hospital emergency traumatic conscious patients. Methods: Infusion of 1 gr IV acetaminophen and 30 mg IV ketorolac were studied separately and in combination 500 mg acetaminophen and 15 mg ketorolac on 95 patients in three separate groups in the pre-hospital pain control system. Patient pain score was collected at 5 intervals. Results: The results showed that there was no significant difference between the three groups in pain scores reduction finally (p> 0.05). The rate of pain reduction in emergency department is very important and these criteria was significant (p< 0.05). Conclusion: The results of this study suggest that the combination of ketorolac and acetaminophen reduces pain more rapidly than either alone. According to our findings we suggest a combination of apotel and ketorolac is injected in advance in moderate to severe conscious traumatic patient before any change in the position of patients if there are not any contraindications. https://aacc.tums.ac.ir/index.php/aacc/article/view/312 https://aacc.tums.ac.ir/index.php/aacc/article/download/312/494

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 7 1 2021 02 01 25 32 Leila Sayadi Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences. Tehran. Iran. Ebrahim Khadem Department of Persian Medicine, School of Persian Medicine, Tehran University of Medical Sciences Elnaz Nasiri School of Nursing and Midwifery, Tehran university of Medical Sciences, Tehran. Iran. 2020 12 11 2021 01 02 Background: Thirst is a prevalent problem among patients in intensive care unit. This study aimed to compare the effects of menthol-cold water and psyllium on thirst and xerostomia among patients in intensive care unit. Methods: This randomized controlled trial was conducted in 2018–2019. Participants were 132 patients consecutively recruited from the intensive care units of two teaching hospitals, Tehran, Iran. They were randomly allocated to either a menthol-cold water, a psyllium, or a control group (44 patients in each group). Participants in the menthol-cold water and the psyllium groups received mouth wash with respectively menthol-cold water and psyllium in two fifteen-minute rounds with a thirty-minute interval. A visual analogue scale was used to assess thirst severity, distress, and xerostomia before and after each round of mouth wash. Data were analyzed through non-parametric statistical tests. Results: There were no significant differences among the groups respecting baseline characteristics, thirst severity and distress, and xerostomia. However, among-group differences respecting thirst severity, distress, and xerostomia were statistically significant after the intervention (P < 0.001). Mouth wash with psyllium was associated with significantly greater reduction in thirst severity, distress, and xerostomia compared with mouth wash with menthol-cold water (P< 0.001). Conclusion: Both menthol-cold water and psyllium are effective in reducing thirst and xerostomia among patients in intensive care unit, though the effectiveness of psyllium is significantly greater than menthol-cold water. Educating nurses about thirst and xerostomia assessment and herbal remedies for their management may help them effectively manage their patients’ thirst and xerostomia. https://aacc.tums.ac.ir/index.php/aacc/article/view/320 https://aacc.tums.ac.ir/index.php/aacc/article/download/320/495

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 7 1 2021 02 03 33 37 Manijeh Yusefi Moghadam Department of Anesthesiology, School Medicine, Student Research Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran. Arezoo Davarinia Motlagh Quchan Department of Paramedicine School, Sabzevar University of Medical Sciences, Sabzevar, Iran. Mitra Eftekhariyazdi Department of Obstetrics and Gynecology, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran. Sedighe Khalili-Shomia Departmen of Surgical Technology, Faculty of Paramedical School, Golestan University of Medical Sciences, Gorgan, Iran. 2020 12 12 2021 01 02 Background: The Apgar score of newborn babies is a determining factor involved with mortality of newborns after birth. Regarding the disagreement on advantages and possible disadvantages of propofol and thiopental in the available references, the study was triggered with the aim of analyzing effects of two mentioned drugs on babies’ Apgar score. Methods: In this double-blind clinical trial, a total of 100 healthy women who volunteered to undertake cesarean operation were selected and then divided randomly into two equal groups using statistical blocking. One group was treated by propofol while other one was treated by thiopental. The prescribed drugs for both groups were identical. Babies’ Apgar score 1 and 5 minutes after birth and recovery period and some of the critical maternal parameters after operation were recorded. The obtained data were analyzed by SPSS 19 software. Results: Apgar score I minute 1 (p=0.317) and Apgar score in minute 5 (p=1.00) for propofol group were not different meaningfully. The groups had significant differences in the indices such as first systolic (P=0.00) and diastolic (P=0.00) pressure in recovery, last diastolic pressure in recovery (P=0.001) and duration of postoperative recovery (P=0.001). Statistical analysis of nausea and vomit in both groups showed that they are lower in propofol group rather than the thiopental group (p=0.000). Conclusion: Propofol and thiopental did not differ significantly in Apgar score, but it seems that propofol can be a better option to induce anesthesia for an elective cesarean operation. https://aacc.tums.ac.ir/index.php/aacc/article/view/321 https://aacc.tums.ac.ir/index.php/aacc/article/download/321/496

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 7 1 Alka Gupta Department of Anaesthesiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India. 2022 01 28 2022 02 28 Background: The study is a double-blind randomized trial aiming to compare intravenous midazolam and dexmedetomidine as premedication for sedation and anxiety control in controlled hypertensive patients undergoing elective surgery under general anaesthesia. Methods: The patients who met the inclusion criteria were randomly divided into two groups of 50 patients each. Thirty minutes prior to induction, Group 1 patients received midazolam 0.02mg/kg i.v and Group 2 patients received dexmedetomidine 1mcg/kg i.v in 100 ml normal saline over 10 minutes. Preoperative sedation and anxiety levels and vital parameters (heart rate, blood pressure, respiratory rate, arterial oxygen saturation) were assessed for 30 min at every 5 minutes interval. Results: Preoperative sedation was found to be better with dexmedetomidine as compared to midazolam. Decrease in anxiety was comparable in both the groups. Significant fall in heart rate was observed in dexmedetomidine group but it was within the acceptable limits for age. Mean arterial pressure was comparable in both the groups. There was no statistical difference between the groups with respect to respiratory rate and arterial oxygen saturation. Conclusion: Dexmedetomidine provides better sedation and good anxiety control with better maintainence of hemodynamic parameters as compared to midazolam. Thus it is a safe and effective drug to be used for premedication in controlled hypertensive patients. https://aacc.tums.ac.ir/index.php/aacc/article/view/474

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 4 2022 07 29 339 342 Jemea Bonaventure Faculty of Medicine and Biomedical Sciences, Department of Anesthesia and Intensive Care, Yaounde University Hospital Center, University of Yaoundé 1, Yaounde, Cameroon. Nga Nomo Serge Higher Institute of Medical Technology, Department of Anesthesia, Intensive Care and Emergency Medicine, Yaounde-Essos Hospital Center, University of Douala, Douala, Cameroon. Iroume Cristella Faculty of Medicine and Biomedical Sciences, Department of Anesthesia and Intensive Care, Yaounde University Hospital Center, University of Yaoundé 1, Yaounde, Cameroon. Kuitchet Aristide Faculty of Medicine and Biomedical Sciences, Department of Anesthesia And Intensive Care, Maroua Regional Hospital, University of Ngaoundere, Ngaoundere, Cameroon. Djomo Dominique Faculty of Health Sciences, Departement of Anesthesia and Intensive Care, University of Buea, Gyneco-Obstetric Hospital of Douala, Douala, Cameroon. Binyom René Higher Institute of Medical Technology, Department of Anesthesia, Intensive Care and Emergency Medicine, Yaounde-Essos Hospital Center, University of Douala, Douala, Cameroon. Nkoumou Samson Faculty of Health Sciences, Departement of Anesthesia and Intensive Care, University of Buea, Gyneco-Obstetric Hospital of Douala, Douala, Cameroon. 2022 01 26 2022 02 01 Recent scientific studies support the safe use of lidocaïne with adrenaline for anesthesia of the extremities (fingers, toes, nose, ear, penis), these studies push back the myth that advises against the use of local anesthetic substances with adrenaline in these areas [1-3]. Ingrown toenail is a common condition of the big toe. Surgery is often necessary. Ingrown toenail surgery is relatively straightforward and is usually performed under local anesthesia [3]. We report here a rare case of hallux necrosis secondary to local anesthesia by lidocaine 2% with adrenaline. The objective of this presentation is to warn practitioners about the observance of precautions before using local anesthetics with adrenaline for anesthetic procedures of the extremities. https://aacc.tums.ac.ir/index.php/aacc/article/view/472

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 4 2022 07 29 295 297 Seyed Sadegh Sadrossadat Department of Anesthesiology and Intensive Therapy, University of Szeged, Semmelweis u. 6, Szeged 6725, Hungary. 2022 07 24 Background: Non-invasive mechanical ventilation is one of the most used organ support measures in critical care medicine. Hemet interface has been implemented in everyday practice at ICUs later than classic means of delivery for NIV including face mask. We used helmet interface for first time at ICU and recorded CPAP setting and outcome. Methods: Helmet was used for 9 patients and any complication or side effects were recorded. Also nurses first experience of using the helmet has recorded in a survey. Results: No skin lesion, vomiting, and air leaking were recorded. Also none of the patients complained about claustrophobia, dyspnea, pain, or feeling hot while the helmet was in use. In addition, nursing was easier while using a helmet than it was with face mask. Conclusion: The overall first time use of helmet interface in our department gave us a positive feedback, but more data need to be collected for more effective way of applying  NIV and specifically helmet interface. https://aacc.tums.ac.ir/index.php/aacc/article/view/612

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 4 2022 07 29 298 302 Saima Gayas SDH Kangan, Ganderbal, Jammu and Kashmir, India. Marina Mustafa MMC Watlar, Ganderbal, Jammu and Kashmir, India Bilqees Amin District Hospital, Ganderbal, Jammu and Kashmir, India 2022 01 30 2022 02 28 Background: The complexity of Second-stage caesarean is due to its deep engagement of the fetal head. 2nd stage cesarean section is also associated with increased maternal and neonatal complications. To see how caesarean sections done in the second vs first phases of labor affect maternal and perinatal outcomes. Methods: It was a one-year observational research that took place in our hospital. This study enlisted the participation of 300 women. For various reasons, 100 women received second-stage caesarean sections, whereas 200 women got first-stage caesarean sections. Results: Women who had a caesarean birth in the second stage of labour had a higher risk of maternal morbidity, according to our findings. Fetal injury during birth (5.5 percent vs. 2.0 percent), FSB (4.5 percent vs. 2.25 percent), admission to the neonatal intensive care unit (18.0 percent vs. 12.5%), neonatal sepsis (3.5 percent vs. 1.5 percent), and early neonatal mortality (3.5 percent vs. 1.5 percent) were all higher (2.0 percent vs. 2.25 percent). Conclusion: The most common complications associated with 2nd stage caesarean delivery were intraoperative bleeding, adhesion, bladder damage, caesarian hysterectomy, perinatal hypoxia, FSB, birth trauma, NICU hospitalisation, and poor Apgar score. https://aacc.tums.ac.ir/index.php/aacc/article/view/476

Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 8 4 2022 07 29 303 309 Mehdi Fathi Department of Anesthesia, Faculty of Medical Sciences, Mashhad University of Medical Science, Mashhad, Iran. Mandana Hosseinzadeh Mashih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mehraveh Sadeghi Ivraghi Department of Medicine, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. Mahmood Hoseinzadeh Maleki Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Lida Jarahi Department of Community Medicine and Public Health, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Horieh Pakniat Department of Perfusion Technology, Faculty of Medical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran. Elnaz Bakhtiary Department of Anesthesia, Faculty of Medical Sciences, Iran University of Medical Science, Tehran, Iran. Zahra Ahmadi Hasanabad Department of Perfusion Technology, Faculty of Medical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran. 2022 01 11 2022 02 01 Background: Cardiopulmonary bypass (CBP) prime solution in pediatric heart surgeries is critical to avoid adverse effects resulting from dilution of coagulation factors, red blood cells, and other plasma protein. This study aimed to evaluate clinical and laboratory outcomes of administration of albumin and fresh frozen plasma (FFP) in CPB prime solution in children candidates for arterial switch surgery. Methods: This cross-sectional study was performed on 30 transposition of the great arteries (TGA) patients, candidates for the arterial switch in Tehran Children's Medical Center, Iran. As CBP prime solution, 15 patients received albumin (1 gr/kg Albumin 20%) and 15 patients received FFP (15 cc/kg). also, clinical and laboratory parameters were measured in different intervals. The statistical analysis were performed by SPSS v.20. Results: The volume platelet infusion in the ICU was higher in FFP-received patients (40.00 ±20.70 ml) than albumin-received patients (26.67 ±25.82 ml; p-value =0.01). Upon entry into ICU, the mean of Hb and Hct in FFP-received patients (11.55 ±0.64 g/l and 34.44 ±2.44 %) was significantly higher than patients who received albumin (11.08 ±0.87 g/l and 31.44 ±3.97 %; p-value =0.04 for both). Upon entry into ICU and also 48 hours after admission into the ICU, the Cr level in the FFP-received group (median: 19 mg/dl) was significantly higher than the albumin-received group (median: 12 mg/dl; p-value =0.03). Conclusion: FFP in CPB prime solution reduces the hemostatic complications and infusion of blood products, as well as to stabilizes Hb and Htc. Therefore, FFP is more suitable as CPB prime solution.