1
|
Haghighi M, Soltanipour S, Farzi F, Mansour Ghanaie M, Biazar G, Malekzadeh A, Tayefeh Ashrafiyeh M. The utero-tonic effects of low dose intravenous ketamine in cesarean section under spinal anesthesia; A randomized double-blind clinical trial. Caspian J Intern Med 2023; 14:218-225. [PMID: 37223287 PMCID: PMC10201121 DOI: 10.22088/cjim.14.2.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/09/2022] [Accepted: 03/05/2022] [Indexed: 05/25/2023]
Abstract
Background Recently, the prevalence of cesarean section (CS) has been on the rise and the proper uterine tone is an important issue. We investigated the effects of intravenous (IV) ketamine on intraoperative bleeding and the need for oxytocin in CS under spinal anesthesia (SA). Methods This study, took place at Alzahra hospital during 2020. Pregnant women candidate for elective CS under SA were divided into two groups of ketamine and placebo. In group K, after umbilical cord clamping, 0.25 mg/kg ketamine and in group P 2ccs normal saline was injected. Mean arterial pressure and heart rate were recorded at baseline, before and 5 minutes after cord clamping and at the end of the surgery. The drop in hemoglobin values, the administrated units of oxytocin and side effects were also recorded. Results No significant difference was found in terms of patients' demographic data (P ≥ 0.05). The mean units of administrated oxytocin in group K was 34.61±6.63 and in group P; 48.47±12.15, which was significantly different (P=0.0001). The drop in Hb was less in group K, however not statistically significant (P=0.094). The need for methergine was significantly higher in group P (P=0.0001). The mean HR was significantly higher in group P (P=0.027), however, no significant difference was observed regarding the MAP (P=0.064). The incidence of hallucination (4.8%) and nystagmus (21%) was significantly higher in group K (P= 0.0001), but nausea and vomiting were more significant in group P (P= 0.027). Conclusion Prophylactic administration of low-dose ketamine in CS under S.A could significantly reduce the administrated oxytocin units and the need for additional utero-tonics and was associated with less drop in Hb values.
Collapse
Affiliation(s)
- Mohammad Haghighi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra hospital, Guilan University of Medical Sciences , Rasht, Iran
| | - Soheil Soltanipour
- Department of Community Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Farnoush Farzi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra hospital, Guilan University of Medical Sciences , Rasht, Iran
| | - Mandana Mansour Ghanaie
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Al-Zahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Gelareh Biazar
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra hospital, Guilan University of Medical Sciences , Rasht, Iran
| | - Azadeh Malekzadeh
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra hospital, Guilan University of Medical Sciences , Rasht, Iran
| | - Mahin Tayefeh Ashrafiyeh
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra hospital, Guilan University of Medical Sciences , Rasht, Iran
| |
Collapse
|
2
|
Biazar G, Farzi F, Ghazanfar Tehran S, Shahrokhi Rad R, Habibi MR, Khosousi Sani M, Chohdary A, Yaghoobi A, Mirmansouri L. Comparing the Effectiveness of Metoclopramide, Low Dose of Propofol, Ondansetron, and Magnesium Sulfate on Propofol Injection Pain: A Double-Blind Clinical Trial. Crescent J Med Biol Sci 2022. [DOI: 10.34172/cjmb.2022.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Objectives: Despite a variety of strategies, propofol injection pain (PIP) is still one of the most distressing adverse effects of the drug. This study aimed to compare the effectiveness of metoclopramide, low dose of propofol, magnesium sulfate, and ondansetron in the prevention of PIP. Materials and Methods: This double-blind clinical trial was conducted at Al-Zahra hospital an academic and referral center affiliated with Guilan University of Medical Sciences, Rasht, Iran. A total of 120 eligible women candidates for elective gynecologic surgeries were divided into four equal groups of magnesium sulfate (30 mg/kg), ondansetron (4 mg), metoclopramide (10 mg), and propofol (15 mg). The primary outcome of this study was to decrease the pain severity of propofol injection. Results: The participants’ demographic characteristics, including age, American Society of Anesthesiologists classification, and body mass index, had no significant differences between the four groups. A significant decrease in heart rate and mean arterial pressure were observed in four groups; however, the difference was insignificant. The mean pain intensity in the magnesium sulfate group was 1.57 ± 0.9, ondansetron 1.37 ± 0.89, metoclopramide 0.95 ± 0.93, and in propofol group was 1.25 ± 1.1 (P=0.036). Conclusions: Metoclopramide could appropriately alleviate PIP. Considering some additional advantages, including antiemetic properties, preventing esophageal reflux, and less risk of postoperative ileus, this drug could be a safe and acceptable choice.
Collapse
Affiliation(s)
- Gelareh Biazar
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Farnoush Farzi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Samaneh Ghazanfar Tehran
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Reyhaneh Shahrokhi Rad
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Reza Habibi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahsa Khosousi Sani
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Al-Zahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Amer Chohdary
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Alireza Yaghoobi
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ladan Mirmansouri
- Student Research Committee, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
3
|
Farzi F, Soltanipour S, Sedighinejad A, Mirmansouri A, Naderi Nabi B, Delpasand K, Biazar G, Karimzad Hagh S, Mirmansouri L. Knowledge and Attitude of the Faculty Members and Residents of Guilan University Towards Medical Errors, Barriers, and Predisposing Factors. IJMTFM 2021. [DOI: 10.32598/ijmtfm.v12i1.35824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Patient safety is among the main goals in a health system. Medical errors are considered a significant threat to patient safety. An effective strategy to reduce this risk is reporting these errors even when the patient is not affected. This study investigated the main barriers to reporting medical errors and related factors. Methods: This cross-sectional descriptive study was conducted in academic hospitals afflicted with Guilan University of Medical Sciences (GUMS) in 2020. University faculty members and residents enrolled in the survey, and a questionnaire was filled out via a face-to-face interview by the responsible resident of anesthesiology. Results: Overall, 366 individuals, 156 faculty members, and 210 residents completed the questionnaires. Overall, 271 (74.2%), 134 (85.9%) faculty members, and 137 (65.6%) residents, the main barrier to report medical errors was concerning legal consequences. Furthermore, the other important factors were concerning losing job credit (63.4%) and losing the patient’s trust (61.2%). Moreover, the main predisposing factors of medical errors were high workload and a large number of patients (83.3%), long work shifts, and physicians fatigue (80.8%). High job stress and the lack of feeling of support from higher authorities (70.5%), and the lack of adequate equipment and appropriate medical facilities (56%) were the most related factors based on their perspective. Conclusion: According to the obtained findings, the main barrier to reporting medical errors was legal consequences. Moreover, the main predisposing factors were high workload, many patients, long working shifts, and physicians’ fatigue. Attempts should be made to plan programs to improve the current conditions.
Collapse
|
4
|
Farzi F, Soltanipour S, Sedighinejad A, Mirmansouri A, Naderi Nabi B, Delpasand K, Biazar G, Karimzad Hagh S, Mirmansouri L. Knowledge and Attitude of the Faculty Members and Residents of Guilan University Towards Medical Errors, Barriers, and Predisposing Factors. IJMTFM 2021. [DOI: 10.32598/ijmtfm.vi.35824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Patient safety is among the main goals in a health system. Medical errors are considered a significant threat to patient safety. An effective strategy to reduce this risk is reporting these errors even when the patient is not affected. This study investigated the main barriers to reporting medical errors and related factors. Methods: This cross-sectional descriptive study was conducted in academic hospitals afflicted with Guilan University of Medical Sciences (GUMS) in 2020. University faculty members and residents enrolled in the survey, and a questionnaire was filled out via a face-to-face interview by the responsible resident of anesthesiology. Results: Overall, 366 individuals, 156 faculty members, and 210 residents completed the questionnaires. Overall, 271 (74.2%), 134 (85.9%) faculty members, and 137 (65.6%) residents, the main barrier to report medical errors was concerning legal consequences. Furthermore, the other important factors were concerning losing job credit (63.4%) and losing the patient’s trust (61.2%). Moreover, the main predisposing factors of medical errors were high workload and a large number of patients (83.3%), long work shifts, and physicians fatigue (80.8%). High job stress and the lack of feeling of support from higher authorities (70.5%), and the lack of adequate equipment and appropriate medical facilities (56%) were the most related factors based on their perspective. Conclusion: According to the obtained findings, the main barrier to reporting medical errors was legal consequences. Moreover, the main predisposing factors were high workload, many patients, long working shifts, and physicians’ fatigue. Attempts should be made to plan programs to improve the current conditions.
Collapse
|
5
|
Khoshrang H, Emir Alavi C, Rimaz S, Mirmansouri A, Farzi F, Biazar G, Atrkarroushan Z, Sabet Khadem N. Efficacy of intranasal ketamine and midazolam for pediatric sedation: A double-blind, randomized clinical trial. Caspian J Intern Med 2021; 12:539-543. [PMID: 34820060 PMCID: PMC8590412 DOI: 10.22088/cjim.12.4.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/01/2020] [Accepted: 12/26/2020] [Indexed: 10/31/2022]
Abstract
BACKGROUND Pediatric patients feel significant fear and anxiety when undergoing surgeries. The ideal drug and its administration route have not been found yet. The aim of this study was to compare the efficacy and safety of intranasal (IN) ketamine and midazolam as premedication in children. METHODS We studied 71 eligible pediatric patients undergoing elective urologic surgeries, aged 2 to 6 years. The degree of sedation and separation scores was compared between the two groups. Additionally, hemodynamic parameters, before premedication, after induction of anesthesia, and during surgery were documented and compared between two groups. Postoperatively, any side effect was recorded as well. RESULTS Finally, the data from 71 children were analyzed. Recovery time was significantly longer in group K (ketamine) compared to group M (midazolam); 27.86±4.42 vs 38.19± 6.67 minutes respectively (P=0.01). No significant difference was observed in terms of sedation score between two groups of K & M; 3.29±0.78 vs 3 ±0.71 respectively (P=0.17), and not regarding separation score; 2.51±0.61 & 2.31±0.52 respectively (P=0.01). Vital signs were kept within the physiological limits in both groups with no marked fluctuations. CONCLUSION To produce sedation in young children, both midazolam and ketamine were effective and safe by IN route.
Collapse
Affiliation(s)
- Hossein Khoshrang
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences , Rasht, Iran
| | - Cyrus Emir Alavi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences , Rasht, Iran
| | - Siamak Rimaz
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences , Rasht, Iran
| | - Ali Mirmansouri
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences , Rasht, Iran
| | - Farnoush Farzi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences , Rasht, Iran
| | - Gelareh Biazar
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences , Rasht, Iran,Correspondence: Gelareh Biazar, Anesthesiology Research Center, Al-zahra Hospital, Guilan University of Medical Sciences, Namjoo Street, Rasht, 4144654839, Iran. E-mail: , Tel: 0098 1333369328, Fax: 0098 1333369024
| | | | | |
Collapse
|
6
|
Biazar G, Farzi F, Chaibakhsh Y, Habibi MR, Khosousi Sani M, Mirmansouri L. Successful Management of a Suspected Case of Meperidine-Induced Anaphylaxis in Cesarean Delivery. Anesth Pain Med 2020; 10:e104796. [PMID: 34150563 PMCID: PMC8207837 DOI: 10.5812/aapm.104796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/16/2020] [Accepted: 07/17/2020] [Indexed: 01/03/2023] Open
Abstract
Introduction Meperidine is known as the gold standard drug for shivering after spinal anesthesia (SA). This drug has been used widely and safely during the Cesarean Section (CS). Case Presentation This case report presents an anaphylaxis reaction to a single intravenous dose of 25 mg meperidine, aiming to control shivering during CS under SA a few minutes after surgical incision. Conclusions The condition was well managed with timely intervention. This rare fetal reaction to meperidine is worthy of reporting to make the medical team aware of the potential risks of anaphylaxis due to many routine safe drugs.
Collapse
Affiliation(s)
- Gelareh Biazar
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Farnoush Farzi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding Author: Department of Anesthesiology, Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences, P.O. Box: 4144654839, Rasht, Iran.
| | - Yasmin Chaibakhsh
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Reza Habibi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahsa Khosousi Sani
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Al-Zahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ladan Mirmansouri
- Student Research Committee, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
7
|
Farzi F, Mehrafza M, Mirmansouri A, Sorouri ZZ, Roushan ZA, Raoufi A, Shalkohi R, Samadnia S, Hosseini A. Hemodynamic parameters and reproductive outcome after intracytoplasmic sperm injection and fresh embryo transfer in patients undergoing oocyte retrieval with general anesthesia using fentanyl, remifentanil or alfentanil - A randomized clinical trial. Taiwan J Obstet Gynecol 2019; 58:536-540. [PMID: 31307747 DOI: 10.1016/j.tjog.2019.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Anesthesia for assisted reproductive technology is very important to provide less stressful and painful environment for patients, with minimal side effects on oocytes. In the present study, we aimed to evaluate hemodynamic parameters, recovery time and intracytoplasmic sperm injection (ICSI) outcome among patients underwent anesthesia with fentanyl, remifentanil or alfentanil. MATERIAL AND METHODS This randomized double-blinded clinical trial was conducted in patients undergoing anesthesia for transvaginal ultrasound guided oocyte retrieval (TUGOR). Patients were randomly allocated to alfentanil (A; 15 μg/kg), fentanyl (F; 1.5 μg/kg) or remifentanil (R; 1.5 μg/kg) groups. RESULTS Three hundred forty patients were assessed for eligibility and randomized for transvaginal oocyte retrieval following general anesthesia and 105 were lost to follow up. No statistically significant differences were noted among groups regarding basic characteristics. Although, time to respond to verbal command was significantly different among groups (A: 1.99 ± 1.64, F: 2.56 ± 1.72, R: 1.78 ± 1.34, P = 0.014). There were no significant differences among groups with respect to the first and second postoperative pain intensity, patient satisfaction, pre-induction and post-induction systolic and diastolic blood pressure (BP). Terminal systolic (A: 101.61 ± 9.15, F: 105.29 ± 12.61, R: 102 ± 12.91, P = 0.01) and diastolic (A: 59.97 ± 9, F: 65.63 ± 9.13, R: 63.69 ± 11.01, P = 0.003) BP was significantly different among groups. The fertilization rate was significantly different among groups (A: 51.6%, F: 54.4%, R: 62.2%, P = 0.018). Implantation rate, biochemical and clinical pregnancy rate was similar among groups. CONCLUSIONS The results of present study demonstrated that all three opioids have the same efficiency, in regards to patient satisfaction and pregnancy outcome. However, Anesthesia with alfentanil compared with fentanyl and remifentanil, seems to be inferior for TUGOR due to higher effect on fertilization rate and less hemodynamic stability. REGISTRATION NUMBER IRCT201410258677N4.
Collapse
Affiliation(s)
- Farnoush Farzi
- Anesthesia Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Namjoo Street, Rasht, Iran.
| | - Marzieh Mehrafza
- Mehr Fertility Research Center, Mehr Medical Institute, Guilan University of Medical Sciences, Ershad St., Shahid Ansari Blvd., Rasht, Iran.
| | - Ali Mirmansouri
- Anesthesia Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Namjoo Street, Rasht, Iran.
| | - Ziba Zahiri Sorouri
- Anesthesia Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Namjoo Street, Rasht, Iran.
| | - Zahra Atrkar Roushan
- Anesthesia Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Namjoo Street, Rasht, Iran.
| | - Azadeh Raoufi
- Mehr Fertility Research Center, Mehr Medical Institute, Guilan University of Medical Sciences, Ershad St., Shahid Ansari Blvd., Rasht, Iran.
| | - Reyhane Shalkohi
- Mehr Fertility Research Center, Mehr Medical Institute, Guilan University of Medical Sciences, Ershad St., Shahid Ansari Blvd., Rasht, Iran.
| | - Sajedeh Samadnia
- Mehr Fertility Research Center, Mehr Medical Institute, Guilan University of Medical Sciences, Ershad St., Shahid Ansari Blvd., Rasht, Iran.
| | - Ahmad Hosseini
- Mehr Fertility Research Center, Mehr Medical Institute, Guilan University of Medical Sciences, Ershad St., Shahid Ansari Blvd., Rasht, Iran.
| |
Collapse
|
8
|
Biazar G, Delpasand K, Farzi F, Sedighinejad A, Mirmansouri A, Atrkarroushan Z. Breaking Bad News: A Valid Concern among Clinicians. Iran J Psychiatry 2019; 14:198-202. [PMID: 31598122 PMCID: PMC6778609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 12/09/2018] [Accepted: 12/20/2018] [Indexed: 11/03/2022]
Abstract
Objective: Delivering bad news is the duty of specialist physicians. However, they find it very difficult due to insufficient experience. In this study, the way faculty and residents of Guilan University of Medical Sciences (GUMS) delivered bad news to the patients was investigated. Method : This study was conducted at hospitals affiliated to GUMS during 2017. A questionnaire containing 18 items on environmental and psychical support was filled through a face to face interview. The first 10 questions evaluated psychical support and the next eight environmental supports. The scoring of each question ranged from 10 to 50, with 10 indicating "never" and 50 "always". Results: According to the analysis of 235 questionnaires, only 32 (13.6%) of the participants had been taught to deliver bad news and 195(83%) felt they need educational courses. Also, 40 (17%) believed that they had enough ability to deliver these massages. No significant differences were observed among physicians who had taken teaching courses in breaking bad news to patients. Conclusion: This study revealed that educational courses to improve physicians' communication skill to break bad news to patients are strongly warranted.
Collapse
Affiliation(s)
- Gelareh Biazar
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Kourosh Delpasand
- Department of Medical Ethics, Guilan University of Medical Sciences, Rasht, Iran
| | - Farnoush Farzi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Abbas Sedighinejad
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Mirmansouri
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Atrkarroushan
- Department of Statistics, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
9
|
Farzi F, Mirmansouri A, Naderi Nabi B, Atrkar Roushan Z, Ghazanfar Tehran S, Nematollahi Sani M, Makhlooghi Azad S, Nemati M. Comparing the Effect of Adding Fentanyl, Sufentanil, and Placebo with Intrathecal Bupivacaine on Duration of Analgesia and Complications of Spinal Anesthesia in Patients Undergoing Cesarean Section. Anesth Pain Med 2017; 7:e12738. [PMID: 29696107 PMCID: PMC5903220 DOI: 10.5812/aapm.12738] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/07/2017] [Accepted: 08/07/2017] [Indexed: 01/21/2023] Open
Abstract
Background Spinal anesthesia is the method of choice for most elective and emergency Cesarean sections. To increase the duration of anesthesia and improve the quality of analgesia during and after surgery, intrathecal opioids, as adjuvant drugs, are used in combination with local anesthetics. Methods This was a double-blind clinical trial performed on 99 patients. Women were divided into 3 groups of fentanyl, sufentanil, and placebo. For fentanyl group, 12.5 mg of bupivacaine and 25 micrograms of fentanyl; for sufentanil group, 12.5 mg of bupivacaine and 2.5 micrograms of sufentanil; and for placebo group, 12.5 mg of bupivacaine and a half mL of normal saline were injected in subarachnoid space. The sensory and motor block, hemodynamic status (mean blood pressure and heart rate), and probable complications were assessed. Results There was no significant difference between the groups in demographic characteristics. Durations of analgesia were, respectively, 314 ± 42.95, 312.5 ± 34.44, and 116.1 ± 42.24 minutes in the fentanyl, sufentanil, and placebo groups (P = 0.0001). Duration of sensory and motor block was higher in fentanyl and sufentanil groups compared with the placebo group. The highest duration of sensory and motor block was noted in sufentanil group (P = 0.0001). No significant difference was found between the groups in the hemodynamic parameters (P > 0.05). The frequency of itching in the fentanyl group was higher than sufentanil and placebo groups (P = 0.003). Also, shivering was higher in the placebo group compared with other groups (P = 0.036). Conclusions According to the results, adding 25 microgram fentanyl or 2.5 microgram sufentanil to intrathecal bupivacaine increased the duration of analgesia and provided hemodynamic stability with no major complication. As administering intrathecal fentanyl had a similar duration of analgesia like sufentanil with faster return of motor block and ambulation, it seems that it is a preferred additive for Cesarean section surgery.
Collapse
Affiliation(s)
- Farnoush Farzi
- Associate Professor of Anesthesiology, Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Ali Mirmansouri
- Associate Professor of Anesthesiology, Anesthesiology Research Center, Department of Anesthesiology, Heshmat Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Corresponding author: Ali Mirmansouri, MD, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran. Tel: +98-9111315314, E-mail:
| | - Bahram Naderi Nabi
- Associate Professor of Anesthesiology, Anesthesiology Research Center, Department of Anesthesiology, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Zahra Atrkar Roushan
- Assistant Professor of Statistics, Department of Statistics, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Samaneh Ghazanfar Tehran
- Assistant Professor of Anesthesiology, Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Mona Nematollahi Sani
- Resident of Anesthesia, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Soodabe Makhlooghi Azad
- Resident of Anesthesia, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Maryam Nemati
- Resident of Anesthesia, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| |
Collapse
|
10
|
Farzi F, Mirmansouri A, Atrkar Roshan Z, Naderi Nabi B, Biazar G, Yazdipaz S. Evaluation of Admission Indications, Clinical Characteristics and Outcomes of Obstetric Patients Admitted to the Intensive Care Unit of a Teaching Hospital Center: A Five-Year Retrospective Review. Anesth Pain Med 2017; 7:e13636. [PMID: 29181330 PMCID: PMC5696879 DOI: 10.5812/aapm.13636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 03/01/2017] [Accepted: 04/22/2017] [Indexed: 11/16/2022] Open
Abstract
Background Care of obstetric patients has always been a challenge for critical care physicians, because in addition to their complex pregnancy-related disease, fetal viability is considered. Objectives The aim of this study was to review the admission indications, clinical characteristics and outcomes of obstetric patients, admitted to the intensive care unit of Alzzahra teaching hospital affiliated to Guilan University of Medical Sciences, Rasht, Iran. Methods This retrospective cohort study was conducted on pregnant /post-partum (up to 6 weeks) patients admitted to the ICU over a 5-year period from April 2009 to April, 2014. Results Data from 1019 subjects were analyzed. Overall, 90.1% of the patients were admitted in the postpartum period. The most common indications for admission were pregnancy related hypertensive disorders (27.5%) and obstetric hemorrhage (13.5%). Epilepsy (5.4%) and cardiac disease (5.2%) were the most common non-obstetric indications. Conclusions Pregnancy-related hypertensive disorders and obstetric hemorrhage were the main reasons for admission, and epilepsy and cardiac disease were the most common non-obstetric indications. Efforts must be concentrated on increasing antenatal care.
Collapse
Affiliation(s)
- Farnoush Farzi
- Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Mirmansouri
- Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding author: Ali Mirmansouri, Anesthesiology Research Center, Velayat Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran. Tel: +98-9111315314, E-mail:
| | - Zahra Atrkar Roshan
- Department of Statistically, Guilan University of Medical Sciences, Rasht, Iran
| | - Bahram Naderi Nabi
- Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Gelareh Biazar
- Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Shima Yazdipaz
- Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
11
|
Mirmansouri A, Imantalab V, Mohammadzadeh Jouryabi A, Kanani G, Naderi Nabi B, Farzi F, Biazar G, Ghazanfar Tehran S, Tarbiat M. Effect of Selenium on Stress Response in Coronary Artery Bypass Graft Surgery: A Clinical Trial. Anesth Pain Med 2017; 7:e43864. [PMID: 28920049 PMCID: PMC5554419 DOI: 10.5812/aapm.43864] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/25/2016] [Accepted: 01/03/2017] [Indexed: 12/17/2022] Open
Abstract
Background In spite of significant improvements in surgical and anesthetic techniques, acute stress response to surgery remains a main cause of mortality and morbidity in coronary artery bypass graft (CABG) surgery patients. Therefore, doing research to find safe and effective modalities with more cardio protective properties seems necessary. Objectives In this study, we sought to determine whether intravenous injection of 600 μg Selenium (Se) prior to surgery would limit stress response measured by blood sugar. Methods This double blind clinical trial was conducted at a referral center of cardiac surgery affiliated to Guilan University of Medical Sciences (GUMS) from June 2015 to October 2015. 73 eligible patients candidate for elective isolated CABG surgery were enrolled in the trial. They were randomly allocated to either Se group (n = 36) receiving 600 μg Se prior to surgery or control group (n = 37). Our evaluation was based on blood sugar (BS) which was measured at four point times, including before induction of anesthesia (T0), at the end of CPB (T1), 24 hours (T2) and 48 hours (T3) after surgery. Results The data obtained from 73 patients in group S (n = 36) and group C (n = 37) were analyzed. There was no significant difference between the two groups regarding the baseline characteristics. In both groups, a sharp rise in BS levels was observed following CPB (P = 0.0001). Although the trend of BS changes was remarkable in both groups (P = 0.0001), there was no statistically significant difference between the groups at all point times including T0 (P = 0.45), T1 (P = 0.48), T2 (P = 0.92), and T3 (P = 0.42). Within the study time, our patients were monitored for any adverse effect but nothing was observed. Conclusions This investigation showed that intravenous single dose of 600 μg Se was safe in CABG patients, but had no positive effect on stress response to surgery.
Collapse
Affiliation(s)
- Ali Mirmansouri
- Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Vali Imantalab
- Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Ali Mohammadzadeh Jouryabi
- Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Gholamreza Kanani
- Department of Cardaic Surgery, Assistant Professor of Cardiac Surgery, Guilan University of Medical Sciences, Rasht, Iran
| | - Bahram Naderi Nabi
- Associate Professor of Anesthesiology, Fellowship of Anesthesia and Pain (FIPP), Anesthesiology Department, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Farnoush Farzi
- Associate Professor of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Gelareh Biazar
- Assistant Professor of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Corresponding author: Gelareh Biazar, Assistant Professor of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran, E-mail:
| | - Samaneh Ghazanfar Tehran
- Assistant Professor of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Masoud Tarbiat
- Assistant Professor of Anesthesiology, Department of Anesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| |
Collapse
|
12
|
Mirmansoori A, Farzi F, Sedighinejad A, Imantalab V, mohammadzadeh A, Atrkar Roushan Z, Ghazanfar Tehran S, Nemati M, Dehghan A. The Effect of Desmopressin on the Amount of Bleeding in Patients Undergoing Coronary Artery Bypass Graft Surgery with a Cardiopulmonary Bypass Pump After Taking Anti-Platelet Medicine. Anesth Pain Med 2016; 6:e39226. [PMID: 27847701 PMCID: PMC5101425 DOI: 10.5812/aapm.39226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 06/05/2016] [Accepted: 06/22/2016] [Indexed: 02/03/2023] Open
Abstract
Background Coronary artery bypass grafting (CABG) is a common surgical intervention at the end-stages of coronary artery occlusion disease. Despite the effectiveness of CABG, it may have particular complications, such as bleeding during and after surgery. So far, there have been many drugs used to reduce bleeding. Objectives This study aimed at investigating the effects of desmopressin on the amount of bleeding in patients undergoing CABG with a cardiopulmonary bypass pump (CPBP) who were taking anti-platelet medicine. Methods One hundred patients scheduled for elective CABG with a CPBP were included in a prospective, placebo-controlled, double-blinded clinical trial study. They were randomly divided into two groups. One group received desmopressin (40 μg) and the other group received a placebo (isotonic saline). Seven patients were excluded from the study, and 47 and 46 patients participated in the desmopressin and control groups, respectively. The methods of monitoring and the anesthetic techniques were similar in both groups, and all surgeries were performed by one surgeon. Variables including age, gender, pump time, aortic clamp time, duration of surgery, complications (e.g., nausea and vomiting, blood pressure changes), the necessity to receive blood products, and coagulation tests (prothrombin time, partial thromboplastin time, international normalized ratio, and bleeding time) were assessed. Data were statistically analyzed with SPSS software version 17. Results There was no significant difference between the groups regarding age, gender, pump time, clamp time, duration of surgery, complications, and the changes in hemoglobin and coagulation test measurements (P > 0.05). No significant difference was noted between the groups regarding the rate of bleeding after surgery (359.3 ± 266.2 in group D vs. 406.3 ± 341.6 in group P (control group); P = 0.208). However, the platelet changes after surgery in both groups were significantly different. The analysis revealed that the rate of thrombocytopenia after surgery was higher in the control group (P = 0.012). Conclusions Our study showed that desmopressin could not reduce the amount of blood loss after CABG. Also, desmopressin did not have a significant effect on coagulation status. Therefore, based on the results of our study, it seems that the use of this medication cannot be a helpful for patients with any indication for CABG.
Collapse
Affiliation(s)
- Ali Mirmansoori
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Farnoush Farzi
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding author: Farnoush Farzi, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran. Tel: +98-9113311653, Fax: +98-1333369024, E-mail:
| | - Abbas Sedighinejad
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Vali Imantalab
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali mohammadzadeh
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | | | - Maryam Nemati
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Afsaneh Dehghan
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
13
|
Farzi F, Naderi Nabi B, Mirmansouri A, Fakoor F, Atrkar Roshan Z, Biazar G, Zarei T. Postoperative Pain After Abdominal Hysterectomy: A Randomized, Double-Blind, Controlled Trial Comparing the Effects of Tramadol and Gabapentin as Premedication. Anesth Pain Med 2016; 6:e32360. [PMID: 27110531 PMCID: PMC4834422 DOI: 10.5812/aapm.32360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 09/08/2015] [Accepted: 10/19/2015] [Indexed: 12/20/2022] Open
Abstract
Background: Uncontrolled postoperative pain, characteristic to abdominal hysterectomy, results in multiple complications. One of the methods for controlling postoperative pain is preemptive analgesia. Gabapentin and tramadol are both used for this purpose. Objectives: This study aims to compare the effects of tramadol and gabapentin, as premedication, in decreasing the pain after hysterectomy. Patients and Methods: This clinical trial was performed on 120 eligible elective abdominal hysterectomy patients, divided in three groups of 40, receiving tramadol, gabapentin and placebo, respectively. Two hours before the surgery, the first group was given 300 mg gabapentin, the second one was given 100 mg tramadol, while the other group was given placebo, with 50 ml water. After the surgery, in case of visual analog pain scale (VAS) > 3, up to 3 mg of diclofenac suppository would be used. Pain score, nausea, vomiting, sedation, patient’s satisfaction and the number of meperidine administered during 24 hours (1 - 4 - 8 - 12 - 16 - 20 - 24 hours) were recorded. If patients had VAS > 3, despite using diclofenac, intravenous meperidine (0.25 mg/kg) would be prescribed. Data were analyzed using SPSS 21 software, chi-square test, general linear model and repeated measurement. Results: The three groups were similar regarding age and length of surgery (up to 2 hours). The average VAS, in the placebo group, was higher than in the other two groups (P = 0.0001) and the average received doses of meperidine during 24-hour time were considerably higher in placebo group, compared to the other two groups (55.62 mg in placebo, 18.75 mg in gabapentin and 17.5 mg in tramadol groups, P = 0.0001). Nausea, vomiting and sedation, in the tramadol group, were higher than in the other two groups, although they were not significant. Patients’ dissatisfaction, in the placebo group, during initial hours, especially in the fourth hour, was higher (P = 0.0001). In the gabapentin and tramadol groups, the trend of changes in satisfaction score was similar. However, satisfaction in the gabapentin group, during the initial 4 hours was higher, in comparison to the tramadol group (P = 0.0001). Conclusions: This study revealed that prescribing gabapentin or tramadol, as premedication, was effective in reducing postoperative pain, without any concerning side-effects.
Collapse
Affiliation(s)
- Farnoush Farzi
- Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Bahram Naderi Nabi
- Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Mirmansouri
- Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding author: Ali Mirmansouri, Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran. Tel: +98-9111315314, E-mail:
| | - Fereshteh Fakoor
- Department of Obstetrics and Genecology, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Gelareh Biazar
- Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Tayyebeh Zarei
- Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
14
|
Farzi F, Haddadi S, Ebrahimpour N, Atrkar Roshan Z, Faghih Habibi A, Mirmansouri A, Parvizi A, Naderi Nabi B, Khanjanian G. A Survey on the Effect of Oral Gabapentin on Hemodynamic Changes During Direct Laryngoscopy and Tracheal Intubation and Intraoperative Bleeding in Patients Undergoing Septorhinoplasty. Anesth Pain Med 2015; 5:e29705. [PMID: 26587408 PMCID: PMC4644309 DOI: 10.5812/aapm.29705] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/29/2015] [Accepted: 08/03/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In patients undergoing septorhinoplasty, control of bleeding and hemodynamic variables is of great importance and laryngoscopy and tracheal intubation could be followed by a specific and transient increase in systemic blood pressure and heart rate. OBJECTIVES This study aimed to examine the effects of oral gabapentin on hemodynamic changes, during direct laryngoscopy, and the amount of bleeding in the patients undergoing septorhinoplasty. PATIENTS AND METHODS In a double-blind clinical trial, 103 patients (American society of anesthesiologists class I, II) aged 18 - 45 years old, who were septorhinoplasty candidates, were randomly assigned into two groups, a 900 mg gabapentin group and placebo, in Amir-Al-Momenin academic hospital. The drug was prescribed to the patients orally, 2 hours before the operation. Anesthetic technique was similar for all the patients. Heart rate (HR), systolic (SBP) and diastolic blood pressures (DBP), mean arterial blood pressure (MAP), oxygen saturation percentage of arterial blood (SaO2), before induction of anesthesia, 3, 5, 10, and 15 minutes after the intubation and tracheal extubation, and the amount of bleeding during operation were measured. Statistical analysis was performed with the SPSS (v. 16) software. RESULTS Variations in the HR, DBP and SaO2, in the specified time intervals, did not show any statistically significant difference, although variations in SBP were statistically significant (higher in gabapentin group). Regarding the average amount of bleeding volume, although there was a lower amount of bleeding in the gabapentin group, the difference was not statistically significant. Also, regarding the pain, there was no significant difference between the two groups in terms of visual analog scale (VAS) average and the received analgesic. CONCLUSIONS The present study showed that premedication with 900 mg gabapentin did not affect the hemodynamic changes induced by laryngoscopy and the amount of bleeding. However, the decreased amount of bleeding was observed in the gabapentin group.
Collapse
Affiliation(s)
- Farnoush Farzi
- Anesthesia Research Center, Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran
| | - Soudabeh Haddadi
- Anesthesia Research Center, Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding author: Soudabeh Haddadi, Anesthesia Research Center, Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran. Tel: +98-9111323739, E-mail:
| | - Neda Ebrahimpour
- Anesthesia Research Center, Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Atrkar Roshan
- Anesthesia Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Faghih Habibi
- Otolaryngology Department, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Mirmansouri
- Anesthesia Research Center, Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran
| | - Arman Parvizi
- Anesthesia Research Center, Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran
| | - Bahram Naderi Nabi
- Anesthesia Research Center, Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran
| | - Gita Khanjanian
- Anesthesia Research Center, Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
15
|
Farzi F, Abdollahzadeh M, Faraji R, Chavoushi T. Seizure in Pregnancy Following Cerebral Venous Sinus Thrombosis. Anesth Pain Med 2015; 5:e26866. [PMID: 26161329 PMCID: PMC4493738 DOI: 10.5812/aapm.26866v2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/07/2015] [Accepted: 04/22/2015] [Indexed: 12/26/2022] Open
Abstract
Introduction: Seizure involves less than 1% of pregnancies; however it is associated with increased maternal and fetal complications. Cerebral venous sinus thrombosis is a rare, but potentially life-threatening cause of seizure during pregnancy, presenting primarily as seizure in 12% - 31.9% of cases. Pregnancy and puerperium are known as the risk factors of cerebral venous sinus thrombosis. Case Presentation: Here is presented a case of seizure after delivery by cesarean section in an otherwise healthy woman. The final diagnosis was cerebral venous sinus thrombosis probably due to hypercoagulable state in pregnancy. Conclusions: If seizure occurs during the peripartum period, along with providing complete cardiovascular and respiratory support, advanced diagnostic measures are needed and cerebral venous sinus thrombosis should be considered as a possible diagnosis.
Collapse
Affiliation(s)
- Farnoush Farzi
- Department of Anesthesiology, Reproductive Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding author: Farnoush Farzi, Department of Anesthesiology, Reproductive Health Research Center, Guilan University of Medical Sciences, Rasht, Iran. Tel: +98-9113311653, Fax: +98-1333325624, E-mail:
| | - Mehrsima Abdollahzadeh
- Department of Anesthesiology, Reproductive Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Roya Faraji
- Department of Obstetrics and Gynecology, Reproductive Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Tahereh Chavoushi
- Department of Anesthesiology, Reproductive Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
16
|
Imantalab V, Mirmansouri A, Sedighinejad A, Naderi Nabi B, Farzi F, Atamanesh H, Nassiri N. Comparing the effects of morphine sulfate and diclofenac suppositories on postoperative pain in coronary artery bypass graft patients. Anesth Pain Med 2014; 4:e19423. [PMID: 25346897 PMCID: PMC4205802 DOI: 10.5812/aapm.19423] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 05/12/2014] [Accepted: 08/18/2014] [Indexed: 12/31/2022] Open
Abstract
Background: Simple and efficient way of pain management after Coronary Artery Bypass Graft (CABG) surgery is an important aspect of patients' care. Objectives: This study aimed to compare the effects of morphine and diclofenac suppositories on postoperative pain management. Patients and Methods: In this double-blinded clinical trial study, 120 patients aged 30-65 years old, undergone CABG, were equally divided into two groups of A (morphine) and B (diclofenac). All patients were anesthetized with intravenous fentanyl 10 μg/kg, etomidate 0.2 mg/kg and cisatracurium 0.2 mg/kg. Anesthesia was maintained with oxygen 50% and air 50%, propofol 50 μg/kg/min, fentanyl 1-2 μg/kg/h and atracurium 0.6 mg/kg/h. Analgesics were administered after the operation at intensive care unit (ICU) and Visual Analogue Score (VAS) was evaluated in both groups in 4-hour intervals after extubation for 24 hours. After extubation in case of VAS > 3, morphine suppository 10 mg (group A) or diclofenac suppository 50 mg (group B) was administered for patients. Results: No significant statistical relationship was found between the two groups regarding gender, age, BMI, paracetamol consumption, length of operation time, cardiopulmonary bypass pump (CPB) time, and stay time at ICU (P Value ≥ 0.05). Total dosage of used morphine was 22 ± 8.3 mg in each patient and total dosage of used diclofenac was 94 ± 32.01 mg. Average variation of VAS at measured intervals was significant (P Value ≤ 0.0001), but these variations were not significantly different when comparing the two groups (P Value = 0.023). Conclusions: Both morphine and diclofenac suppositories reduced pain significantly and similarly after CABG surgery.
Collapse
Affiliation(s)
- Vali Imantalab
- Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Mirmansouri
- Anesthesia Research Center, Dr. Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding author: Ali Mirmansouri, Anesthesia Research Center, Dr. Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran. Tel: +98-9111315314, Fax: +98-1316668718,, E-mail:
| | - Abbas Sedighinejad
- Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran
| | - Bahram Naderi Nabi
- Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran
| | - Farnoush Farzi
- Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran
| | - Hadi Atamanesh
- Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran
| | - Nassir Nassiri
- Cardiac Surgery Department, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
17
|
Farzi F, Mirmansouri A, Forghanparast K, Heydarzadeh A, Abdollahzadeh M, Jahanyar Moghadam F. Addition of intrathecal fentanyl or meperidine to lidocaine and epinephrine for spinal anesthesia in elective cesarean delivery. Anesth Pain Med 2014; 4:e14081. [PMID: 24701418 PMCID: PMC3961034 DOI: 10.5812/aapm.14081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/11/2013] [Accepted: 09/21/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A common and useful approach to pain management is administration of neuraxial opioids. OBJECTIVES Whether addition of fentanyl or meperidine to lidocaine and epinephrine for spinal anesthesia in elective cesarean delivery has any effects on duration of postoperative pain. PATIENTS AND METHODS This was a clinical trial, conducted on 195 pregnant women candidates for elective cesarean section. All patients were in ASA classes I, and II aged 17-45 years, and were randomly allocated to three groups named as meperidine (P), fentanyl (F), and placebo (S). In the three groups (P, F, and S), 25 mg meperidine, 25 µg fentanyl and 0.5 mL saline with lidocaine and epinephrine were injected into the subarachnoid space for spinal anesthesia, respectively. Perioperative complications and Apgar scores were recorded. Duration of analgesia was measured from the end of operation for 24 hours by using VAS. The first VAS≥4 was recorded as the end of the painless period. Characteristics of sensory and motor block were assessed. Statistical analysis was performed with SPSS software. RESULTS The mean duration of analgesia with meperidine, fentanyl or placebo were 9.46 ± 0.6, 6.27 ± 0.45, 2.06 ± 0.13 hours, respectively (P < 0.0001). There was significant difference between the group P and the other groups. Patients on meperidine had faster, longer and higher sensory block (P < 0.0001) and faster and longer motor block (P < 0.0001). Frequency of sedation in the group F was more than the others (P < 0.026). There was no difference in Apgar scores between the three groups (P < 0.45). CONCLUSIONS Addition of meperidine or fentanyl to lidocaine and epinephrine solution increases the duration of postoperative analgesia in cesarean section. Meperidine is a recommended adjuvant according to longer duration of analgesia and lower complications.
Collapse
Affiliation(s)
- Farnoush Farzi
- Deaprtment of Anesthesiology, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Mirmansouri
- Deaprtment of Anesthesiology, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding author: Ali Mirmansouri, Reproductive Health Research Center, Al-Zahra Hospital, Guilan University of Medical Sciences, Namjoo Street, Rasht, Iran. Tel: +98-9111315314, Fax: +98-1313222021, E-mail:
| | | | - Abtin Heydarzadeh
- Department of Community Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | | | | |
Collapse
|