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Introduction: Shivering following spinal anesthesia is caused by a disturbance in body temperature regulation that increases tissue oxygen consumption and cardiopulmonary activity. So far, various methods have been used to reduce and treat it. Magnesium sulfate is a common drug used in pregnant women that also has anti-shivering properties. This study was performed with aim to compare the effectiveness of intravenous magnesium sulfate with bolus infusion in the prevention of shivering after cesarean section. Methods: This interventional clinical trial study was performed in 2017 on 300 pregnant women with term pregnancy, singleton pregnancy, and ASA class I clinical anesthesia in the United States who underwent elective cesarean section at Ayatollah Rouhani Hospital in Babol. The subjects were divided into 3 groups who immediately after spinal anesthesia received 30-minute infusion of magnesium sulfate, bolus injection of magnesium sulfate and normal saline, respectively. P< 0.05 was considered statistically significant. Results: Overall, shivering in 30, 60, 75 and 90 minutes were significantly lower in the magnesium sulfate infusion group than the bolus and control injection groups, (p=0.018) for the infusion group and (p=0.038) for the bolus group. Conclusion: The prevalence of shivering significantly reduced by injection of magnesium sulfate. Compared to the method of administration of magnesium sulfate, administration of the drug by infusion within 30 minutes to reduce the incidence of shivering was significantly superior to the bolus administration of the drug and is recommended in patients with a previous history of intraoperative shivering.

Background: Coronary artery bypass graft surgery (CABG) may have systemic effects on the body organs as liver. The purpose of present study was to evaluate changes in liver function tests(LFT) after on-pump CABG surgery and risk factors associated with LFT changes.Also, the incidence of acute liver injury after on-pump CABG is determined. Methods: 385 patients who underwent on-pump CABG surgery were randomly selected.Preoperative and intraoperative risk factors were obtained from their medical records .Postoperative liver function tests at 24, 48 and 72 hours following surgery and discharge time were compared with the preoperative ones. A univariate linear regression analysis was used to assess the possible relationships between these changes and the preoperative and intraoperative risk factors. Result: Statisitcal analysis revealed direct and significant relationship between LFT changes and pump time, aortic cross-clamp clamp time and use of intra-aortic balloon pump(IABP). Also a medical history of previous myocardia infarction was significantly related to the changes in direct bilirubin in the first 48 hours following surgery.level of preoperative left ventricle ejection fraction,smoking and using opium had significant correlation with postoperative AST changes in different days.In 12.9% of patients, the aminotransferases levels increased to more than three folds over normal upper limit but the probability for incidence of acute ischemic liver injury (transient increase in aminotransferases to over 500IU/L) was 0.77%. Conclusion: Using techniques to reduce clamp and pump time when possible is important during CABG. Probable liver injuries post inserting IABP should be expected for appropriate monitoring and treatment.

Background: Clopidogrel in combination with aspirin increases bleeding, allogeneic red cell transfusion and reoperation rates after CABG. Tranexamic acid, an antifibrinolytic agent, has been approved for use in cardiac surgery to reduce bleeding. In the present study, we evaluated the impact of tranexamic acid on the transfusion and post-operative blood loss after CABG in patients treated with clopidogrel less than 5 days before surgery. Methods: This study was a prospective, randomized, double-blinded clinical trial. Patients undergoing on-pump CABG with their last dose of clopidogrel and aspirin less than 5 days preoperatively were randomly assigned to receive tranexamic acid (10 mg/kg before surgical incision and 10 mg/kg after protamine neutralization) or a corresponding volume of saline solution. The incidence of allogeneic red cell transfusion and 48h postoperative blood loss were recorded. Results: The average volume of blood loss was 776.92±459.81mL for the TXA group and 1075.00±670.91mL for the control group (P=0.03) in the patients with clopidogrel exposure within 48 h before surgery. The average volume of blood loss was not different between two groups in the patients with clopidogrel exposure within 5 days before surgery and also transfusion rate. Conclusion: The result of this study shows that tranexamic acid reduced blood loss in the patients with clopidogrel exposure within 48 h before surgery. So, it is better that we use tranexamic acid before surgery in all patients.

Background: Spinal anesthesia is the common choice for anesthesia in lower abdomen surgery and intrathecal adjutants have gained popularity with the aim of prolonging the duration of block, quality of block and post operation pain control. The purpose of this study was to evaluate the effects of adding dexmedetomidine to hyperbaric bupivacaine in lower abdominal surgery under spinal anesthesia. The main outcomes were considered pain score, duration of analgesia, hemodynamic changes and adverse side effects like nausea and vomiting. Methods: This double-blind randomized clinical trial was conducted on one hundred patients between 18 to 65 years old scheduled for lower abdominal surgery. Fifty patients were randomly allocated to receive either 12.5mg hyperbaric bupivacaine (2.5cc) plus 5µgr dexmedetomidine (0.5cc) intrathecally while fifty patients received either 12.5mg hyperbaric bupivacaine (2.5cc) and 0.5cc Saline 0.9% intrathecally. Results: Vital sign parameters like heart rate, blood pressure and oxygen saturation levels were registered in the normal range in both groups. The average duration of the onset of pain (230±86 min) in bupivacaine group was significantly (p≤0.000) less than dexmedetomidine group (495±138 minutes). The severity of pain at all times in dexmedetomidine group was significantly (p

Background: The post-dural puncture headache (PDPH) is a common complication in spinal anesthesia. Headache may occure seven days after dural puncture. The headache may be worsened in sitting position and be better in supine position. PDPH is common in younger and tall people. The incidence rate of PDPH related to the size of spinal needle and the number of try and decrease with small, cutting needle and less puncture try. PDPH is a well-known iatrogenic complication of spinal anesthesia, which continues to be a major problem. In this study, we assessed the effect of intravenous aminophylline on prevention of post-spinal anesthesia headache in who were elective for cesarean sections. Methods: This double-blind randomized clinical trial was conducted on 140 women with 18 to 35 years old and American Society of Anesthesiologists Classification (ASA Class) I and II undergoing spinal anesthesia in elective cesarean section. Patients were randomly divided into two groups called case and control. After umbilical cord clamping 1 mg/kg aminophylline dissolved in 100 cc normal saline was infused to the case group but only 100 cc normal saline was infused for the control group. Patient's blood pressure and heart rate were recorded before spinal anesthesia, immediately after spinal anesthesia, after uterine incision and umbilical cord clamping, after drug injection and then every five minutes. The incidence of headache was assessed at 4, 8, 24, 48 and 72 hours after the surgery. Results: Although severity and duration of headache in case group was more than in control group, no meaningful difference was found between two groups. The mean changes in systolic blood pressure were greater in control group (P

Background: Prolonged mechanical ventilation and the need for tracheal intubation are the main indication of tracheostomy. This procedure can be done, in two ways: surgical tracheostomy or percutaneous tracheostomy. In this study, surgical tracheostomy was compared with percutaneous method in the intensive care unit. Methods: This clinical trial study was performed on 61 patients admitted to the intensive care unit of Ayatollah Rohani Hospital of Babol University of Medical Sciences from April 14, 2013 to April 14, 2016. In the first group (44 cases), tracheostomy was performed in percutaneous (PDT) and in the second group (17 patients) surgically. The early complications and waiting time (intubation to tracheostomy) for tracheostomy were compared in two groups. All data were analyzed by SPSS software, ver. 22 (Armonk, NY, USA), Analysis of variance (ANOVA) and P values of less than 0.05 were considered significant. Results: The mean age of the patients was 59.87±8.15 years. The mean age of the male patients was 59.66±6.35 years and the female patients were 60.35±6.41 years. In this study, the average waiting time (time from intubation to tracheostomy) was 14.19 days in the PDT group and 20.69 days in the tracheostomy group, with a significant difference between the two groups (P= 0.001). The incidence of preoperative bleeding after surgery was five cases (8.2%). In the PDT group, two cases (3/3%) and the surgical group was three cases (4.9%) and the two groups did not have a significant difference (P= 0.46). The incidence of wound infection (during the period of admission and up to ten days later) in two groups was two patients (3.3%), one case (1.6%) In the PDT group, and one case (1.6%) in a surgical group and the two groups did not have a significant difference (P= 0.43). Other complications such a subcutaneous emphysema and posterior tracheal wall trauma and rupture was not shown in both groups. Conclusion: The findings of this study showed that the complications (bleeding and wound infections) did not differ between the two groups. Due to the lower waiting time and the lack of need for patient transfer outside of the intensive care unit, percutaneous tracheostomy can be a safe alternative to the surgical tracheostomy.

Background and purpose: Postoperative pain is a common problem after hysterectomy. The purpose of this study was to compare the effect of general anesthesia and spinal anesthesia on pain intensity and hemodynamic changes after abdominal hysterectomy. Materials and methods: This clinical trial was performed in 100 women, ASA class I and II, 35 to 70 years of age, and candidate for abdominal hysterectomy. Patients were randomly divided into two groups: spinal anesthesia with bupivacaine and general anesthesia with isoflurane. The pain was assessed based on the visual analogue scale (VAS) at rest, after coughing at the time of recovery admission, and at 6, 24 and 48 hours after surgery. Postoperative hemodynamic changes were assessed in recovery every 5 minutes for half an hour. Data analysis was done applying T-test, Mann-Whitney, and Chi-Square tests. P-value less than 0.05 was considered significant. Results: The mean scores for pain in rest and coughing at the time of recovery admission in the spinal anesthesia group were 0.10±0.46 and 0.40 ± 1.12, and in the general anesthesia group were 3.44±1.40 and 5.88±1.79, respectively (P

Introduction: Hemorrhage and drop in hemoglobin (Hb) and hematocrit (Hct) levels are the major complications of hysterectomy. This study was conducted to compare the effect of different anesthetic techniques on post-operative Hb and Hct levels following abdominal hysterectomy. Materials and Methods: This randomized clinical trial was performed on 100 women aged between 35 and 70 years old in 2013. They were classified as classes I and II according to the American Society of Anesthesiology physical status classification and were candidates for abdominal hysterectomy due to benign causes. The patients were assigned into two groups of spinal and general anesthesia (50 patients per group). The pre- and 24 h post-operative levels of Hb and Hct and systolic and diastolic blood pressure during surgery were recorded 5, 10, 15, 20, 25, 30, 40, 50, and 60 min after the onset of general and spinal anesthesia. Data analysis was performed using t-test, Mann-Whitney U and Chi-squared tests by SPSS software, version 22. P-value less than 0.05 was considered statistically significant. Results: There was no significant different regarding age, the duration of anesthesia and surgery, mean pre-operative levels of Hb and Hct (P>0.05). The mean post-operative levels of Hb were 9.64±1.12 mg/dl and 10.24±1.11 mg/dl with general and spinal anesthesia, respectively. Moreover, the post-operative levels of Hct were 29.83±3.21% and 32.45±3.05% with the spinal and general anesthesia, respectively (P=0.009 and P

Background: Since there is a lack of research on postoperative anticoagulation protocol in patients undergoing coronary artery bypass graft (CABG) / coronary endarterectomy (CE), we recommend a new protocol for anticoagulation in these patients. Methods: In this double-blind randomized clinical trial study, 52 patients undergoing CABG / CE entered the study and were divided into two groups. In group 1, the patients were given warfarin(international normalized ratio (INR) between 2-3) together with 80 mg aspirin daily for 3 months. In group 2, the patients were given 75 mg plavix daily together with 80 mg aspirin daily for 3 months. We evaluated patients with electrocardiography, echocardiography and checking ceratin phosphokinase MB and troponin I in the several stages. The data were analysed SPSS Version18 software. Results: There was no significant difference between pre and post-operative Ejection fraction in patients with plavix (P=0.21) and warfarin (P=0.316) regimen. However, wall mrotion score was significantly better in clopidogrel – aspirin patients in late (3 months) post operation (p

Background: Intravenous regional anesthesia is a simple and reliable method for upper extremity surgery. In order to increase the quality of blocks and reduce the amount of pain, many drugs are used with lidocaine. In this study, the effect of ketorolac-lidocaine in intravenous regional anesthesia was investigated. Methods: 40 patients undergoing elective upper limb with America Society of Anesthesiologists class I and II were selected and randomly divided into two groups. The first group of 20 patients received 200 mg of lidocaine, and the second group, 200 mg of lidocaine with 20 mg of ketorolac. In both groups, the drug was diluted to 40 ml. In both groups, the onset of sensory block, onset of tourniquet pain, the onset of pain after opening the tourniquet, score of postoperative pain and analgesic prescription in the first 24 hours, during 1, 6, 12 and 24 hours were studied. A measure of the quality of analgesia was evaluated by VAS. Results: The mean onset of tourniquet pain in the two groups was not significantly different (P=0.443). In the ketorolac group, the onset of pain after opening the tourniquet was significantly longer than lidocaine group (p

Introduction: Post-operative sore throat and cough are common complications of endotracheal intubation. These conditions may be very distressing for the patient and may lead to unpleasant memories. This study was performed in order to determine whether beclomethasone and lidocaine spray could reduce the frequency of post-operative sore throat and hoarseness after tracheal extubation. Materials and Methods: Ninety women (18–60 years of age) with an American Society of Anesthesiologists (ASA) physical status I or II and undergoing elective mastoidectomy were randomized into three groups of 30 patients. The endotracheal tubes in each group were sprayed with 50% beclomethasone, 10% lidocaine hydrochloride, or normal saline (control group) before endotracheal intubation. Patients were examined for sore throat (none, mild, moderate, or severe), cough, and hoarseness at 1 and 24 h after extubation. Results: There was a significantly lower incidence and severity of post-operative sore throat in the beclomethasone group than the lidocaine and control groups (P

Introduction: Endotracheal intubation is essential during general anesthesia and muscle relaxant drugs provide ideal conditions for this purpose. The objective of this study was to evaluate the intubating condition of remifentanil combined with propofol without muscle relaxant. Materials and Methods: In this prospective randomized study, 60 children aged 3-12 years, American Society of Anesthesiologists physical status I and II were included. All the children were premedicated with 0.05 mg/kg midazolam and 1.5 mg/kg lidocaine 5 min before the induction of anesthesia with 3 mg/kg propofol. Then, they were allocated randomly to receive either 2 μg/kg remifentanil (group R) or 1.5 mg/kg succinylcholine (group S). Tracheal intubation was attempted 90 s after the administration of propofol. The quality of intubation was assessed by using Copenhagen score based on jaw relaxation, ease of laryngoscopy, position of vocal cord, coughing and limb movement. Heart rate and blood pressure were recorded before and after induction, and 1, 3, 5 min after intubation. Results: There was no significant difference in intubating condition between the two groups (P = 0.11). Intubation condition was excellent in 26 of 30 (86.7%) patients in the group R compared with 30 (100%) patients in the group S. We observed significant difference in heart rate and systolic blood pressure over time between two groups (P = 0.02, P = 0.03 respectively). After intubation, we had higher heart rate and systolic blood pressure with a significant difference in group S compared with group R (P = 0.006, P = 0.018). None of the children had a chest rigidity, laryngospasm, and hypoxia. Conclusions: In premedicated children, propofol-remifentanil combination provides adequate conditions for tracheal intubation that is comparable with succinylcholine. Hemodynamic response to laryngoscopy and tracheal intubation was controlled better in group R.

Abstract Background: The combination of propofol-fentanyl for sedation during colonoscopy is characterized by the frequent incidence of side effects. Etomidate-fentanyl provides fewer hemodynamic and respiratory complications. The aim of our study was to compare the safety and efficacy of propofol-fentanyl and etomidate-fentanyl for conscious sedation in elective colonoscopy. Methods: This double-blind clinical trial was conducted on 90 patients aged between 18 and 55 years old who were candidates for elective colonoscopy. Patients were randomized to receive sedation with fentanyl plus propofol or etomidate. Two minutes after injecting 1 micro/kg of fentanyl, the patients received propofol (0.5 mg/kg followed 25 micro/kg/min) or etomidate (0.1 mg/kg followed 15 micro/kg/min). Pulse rate, mean arterial blood pressure, respiratory rate, and saturation of peripheral oxygen (SPO2) were monitored. Indeed, the patient and colonoscopist satisfaction, the recovery time, sedation and pain score in both groups were assessed. Results: Sedation score in propofol group was higher. Pain score as well as the physician and patient satisfaction showed no significant difference in two study groups. Hemodynamic changes and arterial saturation were the same in both groups. The duration of recovery was 1.27±0.82 minutes in the etomidate group whereas, it was 2.57±2.46 minutes in the propofol group (P=0.001). Hospital discharge in the propofol group was 5.53±4.67 minutes and in the etomidate group was 2.68±3.14 minutes (p=0.001). Conclusion: The combination of fentanyl and etomidate provides an acceptable alternative to sedation with fentanyl and propofol with the advantage of significantly faster recovery time, which are of relevance in the outpatient setting.

Background: Opioid-induced side effects such as nausea and vomiting and pruritus are common and may be more debilitating than pain itself. We performed a study to assess the efficacy of dexamethasone in reducing postoperative nausea, vomiting, and pruritus in patients receiving neuraxial anesthesia with meperidine. Methods: Fifty-two women undergoing cesarean section were enrolled in the study. The control group and dexamethasone group received intravenously normal saline and dexamethasone, respectively, before spinal anesthesia. The occurrence of postoperative nausea, vomiting, and pruritus was assessed for 24 h in both groups. Results: The overall incidence of nausea and vomiting during the 24 h follow-up period was 37% and 22.2% for group saline and 20% and 12% for group dexamethasone, respectively (P=0.175, 0.469). The incidence of pruritus was not significantly different between the two groups. Pruritus severity was significantly less in the dexamethasone group than in the saline group (P=0.019). Conclusion: Prophylactic dexamethasone does not reduce the incidence of subarachnoid meperidine-induced nausea, vomiting, and pruritus in women undergoing cesarean delivery.

BACKGROUND AND OBJECTIVE: Intravenous regional anesthesia (IVRA) is a simple and reliable method for upper extremity injuries. Different additives have been combined with local anesthetics to improve block quality, decrease tourniquet pain and postoperative analgesia in IVRA. This study was performed to evaluate the effect of nitroglycerine on tourniquet pain and intraoperative analgesia when added to lidocaine for IV regional anesthesia. METHODS: In a clinical trial, 50 patients with upper extremity injury were scheduled for IVRA, randomly allocated into two groups. They were unified by age and gender. Under identical condition, control group received a total dose of 200 mg lidocaine diluted with saline (40 cc) and study group received 200 mg lidocaine plus 200 µg nitroglycerine diluted with saline (40 cc). Anesthesia quality, tourniquet pain and opioid requirement were measured during surgery. After the tourniquet deflation, time to first analgesic requirement was noted. FINDINGS: Intraoperative pain scores were not different between two groups and fentanyl requirement was similar. The onset of tourniquet pain was similar in case (21.96±3.87 min) and control group (21.12±3.33 min) (p=0.41). Analgesia time and time of initial analgesic requirement after tourniquet deflation was 54.4±9.95 min in control group and 60.40±10.17 min in case group (p=0.625). CONCLUSION: Addition of nitroglycerine to lidocaine was not improved the quality of IVRA, postoperative analgesia and opioid requirements in patients undergoing hand surgery.