1
|
Djalalimotlagh S, Mohaghegh MR, Ghodraty MR, Shafeinia A, Rokhtabnak F, Alinia T, Tavakoli F. Comparison of Fat-Free Mass and Ideal Body Weight Scalar for Anesthetic Induction Dose of Propofol in Patients with Morbid Obesity: A Double-Blind, Randomized Clinical Trial. Anesth Pain Med 2023; 13:e140027. [PMID: 38666228 PMCID: PMC11041816 DOI: 10.5812/aapm-140027] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/12/2023] [Accepted: 11/18/2023] [Indexed: 04/28/2024] Open
Abstract
Background Obesity is a growing problem worldwide and can affect both the pharmacodynamics and pharmacokinetics of various drugs, including anesthetics, resulting in the under-or overdosing of certain drugs. There is no consensus on the ideal dosing regimen for obese populations. Objectives In this study, 2 weight-based dosing of propofol used for induction of anesthesia were compared in terms of the onset of action time, adequacy of anesthesia, and effects on hemodynamic indices (eg, heart rate [HR] and blood pressure). Methods In this randomized, double-blind clinical trial, 40 patients with morbid obesity (MO) scheduled for bariatric surgery with body mass index (BMI) > 35, age 18 - 59 years, American Society of Anesthesiologists physical status (ASA-PS) II and III were randomly divided into 2 groups, using block randomization method, to receive 2 mg/kg of propofol for induction of anesthesia based on either fat-free mass (FFM) group or ideal body weight (IBW) group. The primary outcome was the time duration to reach the bispectral index (BIS) ≤ 60. Time to the disappearance of eyelash reflex, signs of inadequate anesthesia (ie, BIS > 60, straining during intubation, or eye-opening), requirements for additional doses, and hemodynamic indices (including HR and mean arterial pressure [MAP]) were also compared. Results The mean time to reach BIS ≤ 60 was 134.1 s in the FFM group and 148.7 s in the IBW group. This difference was not statistically significant (P = 0.334). The time of disappearance of eyelash reflex was also not significantly different between the study groups (P = 0.814). However, 2 patients in the FFM group and 8 patients in the IBW group showed signs of inadequate anesthesia and required additional doses. This difference was statistically significant (P = 0.032). Hemodynamic variables, before and 2 min after propofol induction dose administration were comparable between the study groups (P = 0.520, P = 0.327, P = 0.847, P = 0.516 for pre-intervention MAP, post-intervention MAP, pre-intervention HR, and post-intervention HR, respectively). Conclusions Propofol dosing, based on FFM and IBW, for induction of anesthesia, provides comparable onset time of action and hemodynamic effects; however, in terms of the adequacy of anesthesia, the dosing based on FFM is more favorable compared to the dosing based on IBW.
Collapse
Affiliation(s)
- Soudabeh Djalalimotlagh
- Department of Anesthesiology, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Reza Mohaghegh
- Department of Anesthesiology, Hashemi Nezhad Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Ghodraty
- Department of Anesthesiology, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amineh Shafeinia
- Department of Anesthesiology, Akbar Abadi Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Faranak Rokhtabnak
- Department of Anesthesiology, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Tina Alinia
- Department of Emergency, Shohada Salamat Hospital, School of Medicine, Iran University of Medical Sciences, Malard, Iran
| | - Farnoosh Tavakoli
- Department of Anesthesiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
2
|
Jamshidi K, Mirzaei A, Bagherifard A, Jahansouz A, Mohaghegh MR. Does the adherence of distal femur parosteal osteosarcoma to the neurovascular bundle increase the rate of local recurrences? Orthop Traumatol Surg Res 2022; 108:103220. [PMID: 35093566 DOI: 10.1016/j.otsr.2022.103220] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/16/2021] [Accepted: 07/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Proximity of tumor to the neurovascular bundle (NVB) makes achieving a wide margin difficult. In low-grade parosteal osteosarcoma (POS), it is not clear whether adherence of tumor to NVB increases the rate of local recurrence (LR). In this study, we evaluated whether tumor adherence to the NVB increases the risk of LR in low-grade POS of the distal femur? HYPOTHESIS We hypothesized that if the thin neurovascular barrier (the adventitia of the vessels and the epineurium of the nerve) prevents tumor penetration, the rate of LR should be comparable between the lesions with and without a continuous layer of healthy fatty tissue between the tumor and NVB. MATERIALS AND METHODS In a retrospective survey, 30 patients with low-grade POS of the posterior aspect of the distal femur were evaluated for the proximity of mass to NVB. Based on the proximal to distal T1 axial MRI sections, the tumors were divided into two groups including the tumors with an uninterrupted (group A) and interrupted (group B) rim of fatty tissue between the mass and NVB. The rate of LR was compared between the two study groups. The concordance of MRI in detecting NVB adherence was checked with pathology specimen. RESULTS Using MRI, we identified 16 cases in group A and 14 cases in group B. The MRI status of fatty rim was concordant with pathology specimen in 96.4% of cases. The mean follow-up period of the two groups was not statistically different (117±27.6 vs. 105.8±29.4 months, respectively, p=0.29). The other baseline characteristics of the two groups were statistically comparable, as well. The rate of LR was 12.5% (2 out of 16 patients) in group A and 14.3% (2 out of 14 patients) in group B (95% CI: 0.142-9.586, p=0.87). The 10-year recurrence-free survival was 87.5% for group A and 85.7% for group B (p=0.9). DISCUSSION The absence of a continuous rim of fatty tissue between the tumor and NVB in MRI does not increase the risk of LR in low-grade POS of the distal femur. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Khodamorad Jamshidi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Jahansouz
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Reza Mohaghegh
- Anesthesiology and Critical Care Department, Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
3
|
Jamshidi K, Bagherifard A, Mohaghegh MR, Mirzaei A. Fibular strut allograft or bone cement for reconstruction after curettage of a giant cell tumour of the proximal femur : a retrospective cohort study. Bone Joint J 2022; 104-B:297-301. [PMID: 35094576 DOI: 10.1302/0301-620x.104b2.bjj-2021-1322.r1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Giant cell tumours (GCTs) of the proximal femur are rare, and there is no consensus about the best method of filling the defect left by curettage. In this study, we compared the outcome of using a fibular strut allograft and bone cement to reconstruct the bone defect after extended curettage of a GCT of the proximal femur. METHODS In a retrospective study, we reviewed 26 patients with a GCT of the proximal femur in whom the bone defect had been filled with either a fibular strut allograft (n = 12) or bone cement (n = 14). Their demographic details and oncological and nononcological complications were retrieved from their medical records. Limb function was assessed using the Musculoskeletal Tumor Society (MSTS) score. RESULTS Mean follow-up was 116 months (SD 59.2; 48 to 240) for the fibular strut allograft group and 113 months (SD 43.7; 60 to 192) for the bone cement group (p = 0.391). The rate of recurrence was not significantly different between the two groups (25% vs 21.4%). The rate of nononcological complications was 16.7% in the strut allograft group and 42.8% in the bone cement group. Degenerative joint disease was the most frequent nononcological complication in the cement group. The mean MSTS score of the patients was 92.4% (SD 11.5%; 73.3% to 100.0%) in the fibular strut allograft group and 74.2% (SD 10.5%; 66.7% to 96.7%) in the bone cement group (p < 0.001). CONCLUSION Given the similar rate of recurrence and a lower rate of nononcological complications, fibular strut grafting could be recommended as a method of reconstructing the bone defect left by curettage of a GCT of the proximal femur. Cite this article: Bone Joint J 2022;104-B(2):297-301.
Collapse
Affiliation(s)
- Khodamorad Jamshidi
- Bone and Joint Reconstruction Research Center Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Reza Mohaghegh
- Anesthesiology and Critical Care Department, Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
4
|
Shavaleh R, Motevalian SA, Mahdavi N, Haddadi M, Mohaghegh MR, Hamedi Z. Epidemiological study of hospitalized road traffic injuries in Iran 2011. Med J Islam Repub Iran 2018; 32:50. [PMID: 30159301 PMCID: PMC6108239 DOI: 10.14196/mjiri.32.50] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 01/22/2017] [Indexed: 11/25/2022] Open
Abstract
Background: In Iran, Road Traffic Injuries (RTIs) is the second-leading cause of deaths, and the first leading cause of disabilityadjusted life year, and has one of the highest rates of death (32.1 per 100 000 population) all over the world. This study's aim was to investigate the epidemiological pattern and underlying components of hospitalized RTIs in 31 provinces of Iran in 2011. Methods: This study conducted on all hospitalized RTIs during one-year period (March 21, 2011 to March 21, 2012). Data extracted from a hospital-based traffic injury registration system. According to a national law passed in 2005, all hospital expenses of traffic injuries should be covered by ministry of health based on governmental tariffs. The medical costs of eligible patients will be paid to the hospitals only if the patient data are sent to the above mentioned database. Statistical analysis was performed using SPSS v.16 (SPSS Inc., Chicago, USA), and spatial maps are provided using GIS 10.2. Descriptive statistics and t-test were used to compare means. World (WHO 2000-2025) standard population used to calculate age-adjusted incidence rate. All statistical tests were performed at the 5% level of statistical significance. Results: There were 322,064 injured cases recorded in the registration system during the study period. The national age-adjusted incidence rate of RTIs was 405 per 100,000 population. The highest incidence rates were in the age group of 15-29 years (643 per 100,000 population), followed by 30-44 year age groups (401 per 100,000 population). The incidence rate in men was 3.36 times more than women. Motorcyclist were the most frequent type of road users (39.2%) who involved in RTIs, followed by passengers (28.9%) and pedestrians (20.0%). Head injuries were among the most affected part of the body which occurred in 27.2% of the patients. The proportion of urban crashes was 60.7%. Conclusion: The results of this study indicated that the majority of RTI occurred on motorcyclists and head injuries was the most commonly affected body part. Therefore, in order to reduce motorcycle accidents and avoiding head injury among them, stricter law enforcement is urgently needed for helmet use and promotion of safety behaviors among motorcycle riders.
Collapse
Affiliation(s)
- Rasoul Shavaleh
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Abbas Motevalian
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Nader Mahdavi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mashyaneh Haddadi
- Injury Prevention & Safety Promotion Department, Disaster & Emergency Management Center, Ministry of Health & Medical Education, Tehran, Iran
| | - Mahmoud Reza Mohaghegh
- Anesthesia and Critical Care Department, Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Hamedi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
Kiaei MM, Mohaghegh MR, Movaseghi G, Ghorbanlo M. Enteral diclofenac controls pain and reduces intravenous injection during extracorporeal shock wave lithotripsy. Eur J Transl Myol 2018; 28:7353. [PMID: 29991983 PMCID: PMC6036311 DOI: 10.4081/ejtm.2018.7353] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 02/16/2018] [Revised: 02/22/2018] [Accepted: 02/24/2018] [Indexed: 11/23/2022] Open
Abstract
Urinary system stones are the third most common disease of urinary system following urinary infection and prostate pathology. Extracorporeal shockwave lithotripsy (ESWL) is one of the methods used to treat Urolithiasis where shockwaves are transmitted through skin and body organs and crush the stones into small pieces. This is a painful procedure which usually requires analgesics. Each analgesic drug has its own advantages and disadvantages. The present research seeks to study the effectiveness of using diclofenac suppository in order to control pain and reduce need for venous drugs during ESWL procedure. This is a double blind clinical trial. 158 patients resorting to Shahid Hasheminezhad Specialized Center for ESWL were randomly selected to take part in this projects with due consideration of inclusion criteria. The patients were equally divided into the S (diclofenac suppository) and A (placebo) groups. 2 diclofenac suppositories were used in the S group 20 minutes prior to beginning ESWL. Then, ESWL was carried out in supine position using fluoroscopic conduction with standard method. The present research has studied pain scale of patients, operator’s and patient’s satisfaction during the operation and patient’s hemodynamic parameters in three phases prior to, during, and after ESWL. SPSS v.17 was used to study the data and Chi-Square Tests and Repeated Measure ANOVA were used to analyze the results. The level of significance in the present research was set to P-value < 0.05.A review of pain scales across both groups showed that using diclofenac suppository has a significant influence in reducing the pain scale and, hence, need for venous drugs (P-value < 0.05). No significant difference was observed between the two groups in terms of heart beat and blood pressure changes in various times (P-value > 0.05). The results also report different satisfaction levels for patients and operators across the two groups (diclofenac suppository and placebo) (P-value < 0.05). Higher satisfaction levels were observed among both patients and operators in the group receiving diclofenac suppository. A general look at the data yields the conclusion that receiving pain killers (diclofenac suppository) before starting ESWL plays a more efficient role in reducing pain scales of patients and enhancing operators’ satisfaction..
Collapse
Affiliation(s)
- Mehrdad Mesbah Kiaei
- Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Reza Mohaghegh
- Department of Anesthesia and Critical Care, Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Movaseghi
- Department of Anesthesia and Critical Care, Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Ghorbanlo
- Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
Ghorbanlo M, Mohaghegh MR, Yazdanian F, Mesbah M, Totonchi Z. A Comparison Between the Hemodynamic Effects of Cisatracurium and Atracurium in Patient with Low Function of Left Ventricle who are Candidate for Open Heart Surgery. Med Arch 2018; 70:265-268. [PMID: 27703286 PMCID: PMC5034980 DOI: 10.5455/medarh.2016.70.265-268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 05/25/2016] [Accepted: 07/15/2016] [Indexed: 11/03/2022] Open
Abstract
Background: The need for muscle relaxants in general anesthesia in different surgeries including cardiac surgeries, and the type of relaxant to be used considering its different hemodynamic effects on patients with heart disease can be of considerable importance. In this study, the hemodynamic effects of two muscle relaxants, Cisatracurium and Atracurium in patients whit low function of left ventricle who are candidate for open heart surgery have been considered. Method: This study has been designed as a randomized prospective double-blind clinical trial. The target population included all adult patients with heart disease whose ejection fraction reported by echocardiography or cardiac catheterization was 35% or less before the surgery, and were candidate for open heart surgery in Shahid Rajaei Heart Center. Taking into account the inclusion and exclusion criteria, the patients were randomly placed in two groups of 30 people each. In the induction stage, all the patients received midazolam, etomidate, and one of the considered muscle relaxant, either 0.2 mg/kg of cisatracurium or 0.5mg/kg of Atracurium within one minute. In the maintenance stage of anesthesia, the patients were administered by infusion of midazolam, sufentanil and the same muscle relaxant used in the induction stage. The hemodynamic indexes were recorded and evaluated in different stages of anesthesia and surgery as well as prior to transfer to ICU. Results: In regard with descriptive indexes (age and sex distributions, premedication with cardiac drugs, ejection fraction before surgery, basic disease) there was no statistically significant difference between the groups. Conclusions: The significant difference of hemodynamic indexes between the two groups of this study, and the need for hemodynamic stability in all stages of surgery for patients with low function of left ventricle who are candidate for open heart surgery, proves that administering Cisatracurium as the muscle relaxant is advantageous and better.
Collapse
Affiliation(s)
- Masoud Ghorbanlo
- Hasheminejad Kidey Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Reza Mohaghegh
- Anesthesia and Critical Care Department, Hasheminejad Kidey Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Forozan Yazdanian
- Rajaie Cardiovascular Medical & Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Mesbah
- Hasheminejad Kidey Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ziya Totonchi
- Rajaie Cardiovascular Medical & Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
7
|
Totonchi Z, Salajegheh S, Mohaghegh MR, Kiaei M, Shirvani M, Ghorbanlo M. Hemodynamic effect of intravenous lidocaine during aortic cannulation in cardiac surgery. Interv Med Appl Sci 2017. [DOI: 10.1556/1646.9.2017.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ziya Totonchi
- Rajaie Cardiovascular Medical & Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shirin Salajegheh
- Shafa Hospital, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahmoud Reza Mohaghegh
- Department of Anesthesiology and Pain Medicine, Hasheminejad Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - MehrdadMesbah Kiaei
- Department of Anesthesiology and Pain Medicine, Hasheminejad Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Masoud Ghorbanlo
- Department of Anesthesiology and Pain Medicine, Hasheminejad Hospital, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|