[show abstract][hide abstract] ABSTRACT: There is a considerable rate of fertility failure and this causes a great burden of untoward effects for patients. Usually a considerable number of these patients undergo anesthesia for their treatment.
This study was designed to compare the effects of general and spinal anesthesia on these patients.
In a randomized clinical trial, after taking informed written consent from the patients, 200 patients entered the study; 100 in each. During a 2 year period, women aged 20 to 40 years entered the study (one group receiving spinal anesthesia and the other, receiving general anesthesia). Ovum retrieval protocols were the same. Nonparametric and parametric analyses were used for data analysis. P value less than 0.05 was considered significant.
There was no difference between the two groups regarding demographic variables. 15 of 100 patients (15%) in the general anesthesia group and 27 of 100 patients (27%) in the spinal anesthesia group had successful pregnancy after IVF; so, spinal anesthesia increased significantly the chance of IVF success (P value < 0.001; Chi Square).
The results of this study demonstrated that spinal anesthesia increased the chance of fertilization success.
Anesthesiology and pain medicine. 09/2013; 3(2):239-242.
[show abstract][hide abstract] ABSTRACT: INTRODUCTION: Nowadays, many patients undergo coronary artery bypass grafting (CABG) with a cardiopulmonary bypass (CPB); while a number of therapeutic agents have been used to suppress its related inflammatory process. Magnesium sulfate (MgSO4) solution has been used as an anti-inflammatory agent. Among the cardiac biomarkers, N-terminal pro brain natriuretic peptide (NT Pro-BNP) is one of the most widely recognized. We performed this study to assess the effect of MgSO4 solution on NT Pro-BNP levels in patients undergoing CABG with CPB. MATERIALS AND METHODS: In a double-blind clinical trial, after IRB approval for ethical considerations, during a 12-month period, 88 adult patients aged 40-70 years qualified for the study after inclusion and exclusion criteria were considered. After random allocation of the patients between the two groups, anesthesia, surgical procedure, cardiopulmonary bypass (CPB) methods, and postoperative care were made as similar as possible; however, one group received a MgSO4 infusion (15 mg/kg/h) and the other group saline (placebo). Pre- and post-operative levels of NT Pro-BNP were assessed using an electrochemical luminescence immunoassay in an Elecsys 2010 (Roche, Indianapolis, IN, USA). The results were compared using a Student's t-test. A P value less than 5 % was considered significant. RESULTS: The MgSO4 group had shorter postoperative mechanical ventilation, lower postoperative morphine requirements and lower postoperative pain scores. Also, 24 h postoperative NT Pro-BNP levels were significantly lower in the MgSO4 group. CONCLUSION: Administration of MgSO4 in elective CABG with CPB can decrease the postoperative NT Pro-BNP levels; also, it decreases their time of postoperative mechanical ventilation.
Journal of Anesthesia 05/2013; · 0.87 Impact Factor
[show abstract][hide abstract] ABSTRACT: The modern practice of anesthesia is highly dependent ona group of anesthetic drugs which many of them are metabolized in the liver.
The liver, of course, usually tolerates this burden. However, this is not always an unbroken rule. Anesthetic induced apoptosis has gained great concern during the last years; especially considering the neurologic system.
However, we have evidence that there is some concern regarding their effects on the liver cells. Fortunately not all the anesthetics are blamed and even some could be used safely, based on the available evidence.
Besides, there are some novel agents, yet under research, which could affect the future of anesthetic agents' fate regarding their hepatic effects.
[show abstract][hide abstract] ABSTRACT: Opium is a highly addictive agent and the most common narcotic often misused in Iran. The pharmacokinetic of anesthetic drugs in patients with opium addiction is one of the great challenges for anesthesiologists. Hemodynamic instability and postoperative side effects are of these challenges which should be managed correctly.
In this study we aimed to assess the effects of clonidine upon post anesthesia shivering and recovery time in patients with and without opium addiction after general anesthesia to decrease the subsequent complications related to the shivering and elongation of recovery time.
In a randomized clinical trial, 160 patients candidates for elective leg fracture operations under general anesthesia were studied in four groups of 40 patients: Group 1 (placebo 1) were patients without addiction who got placebo 90 minutes before the operation. Group 2 (placebo 2) were patients with opium addiction which received placebo as group 1. Group 3 (Clonidine 1) patients without addiction who got clonidine 90 minutes before the operation and group 4 (Clonidine 2) who were opium addicted ones which received clonidine as premedication.
None of the patients with and without addiction in clonidine groups had shivering after the operation but in placebo groups shivering was observed and the difference between clonidine and placebo groups was statistically significant (P < 0.01). Recovery time in clonidine groups of patients with and without addiction was less than placebo ones (both P < 0.01) which the magnitude of difference was higher in opium addicted than non-addicted patients (P = 0.04).
Premedication with clonidine in patients with and without opium addiction can be effective to decrease the incidence of shivering and recovery time after operation.
Anesthesiology and pain medicine. 01/2013; 2(3):107-10.
[show abstract][hide abstract] ABSTRACT: There are a number of adjuvants to be used for local anesthetics in spinal block. The aim of this study was to demonstrate the possible effect of intrathecal midazolam compared with bupivacaine as adjuvants in spinal anesthesia with bupivacaine in chronic opium abuses.
In a double blind, randomized clinical trial, 90 opium abuser patients undergoing lower limb orthopedic surgery were selected and randomly assigned into 3 groups (30 cases each). The patients received 15 mg plain bupivacaine, or 15 mg bupivacaine plus 25 mcg fentanyl or 15 mg bupivacaine plus 1 mg midazolam, intrathecally.
The duration of anesthesia was much longer in the bupivacaine-midazolam group than the bupivacaine-fentanyl group; both were longer than the plain bupivacaine group (P < 0.05).
Subarachnoid injection of adjuvant midazolam or fentanyl with plain 0.5% bupivacaine in opium abusers in lower limb orthopedic surgery increases the duration of sensory block. Therefore midazolam is more effective than fentanyl in such cases.
Korean journal of anesthesiology 12/2012; 63(6):521-6.
[show abstract][hide abstract] ABSTRACT: This study was done to compare the analgesic effects of "magnesium plus lidocaine", "paracetamol plus lidocaine", and "placebo plus lidocaine" on block characteristics for intravenous regional anesthesia (IVRA) in patients undergoing upper extremity orthopedic surgery.
In a double-blind, placebo-controlled randomized clinical trial, 90 patients were selected and entered randomly into three study groups after applying the inclusion and exclusion criteria. Time to start of the sensory and motor block were measured separately and also the duration of these two block types were measured. Post-op pain assessment was measured using a numeric rating scale. Venous samples were checked and compared regarding blood gas and pH measurements.
The time from drug injection to sensory block onset was the shortest in the magnesium plus lidocaine group; the time from drug injection to the time of motor block onset was the shortest in the lidocaine plus magnesium group; the duration of the motor block was the longest in the lidocaine plus magnesium group.
Addition of magnesium lidocaine in patients undergoing upper extremity orthopedic operations using IVRA decreases significantly the time gap between drug administration and the start of the block; also, this drug combination increases the IVRA block length, while paracetamol does not have such a significant effect.
International journal of preventive medicine 09/2012; 3(9):616-21.
[show abstract][hide abstract] ABSTRACT: Clonidine, an alpha-2 adrenergic agonist, increases the quality of perioperative sedation and analgesia with a few side effects. This study was designed to assess the effect of clonidine premedication on the anesthesics used for elective below knee surgeries in opium abusers and non-abusers.
In a randomized clinical trial, 160 patients were selected and assigned into four groups. Eighty patients among the opium abusers were divided randomly into clonidine and no clonidine groups, with 40 patients in each, and 80 among the non-abusers were again divided randomly into clonidine and no clonidine groups, with 40 patients in each group. All were anesthetized for elective orthopedic operation using the same predetermined method. The total administered dose of propofol and other variables were compared.
THE TOTAL PROPOFOL DOSE IN A DECREASING ORDER WAS AS FOLLOWS: Abuser patients receiving placebo (862 ± 351 mg), non-abuser patients receiving placebo (806 ± 348 mg), abuser patients receiving clonidine (472 ± 175 mg), and non-abuser patients receiving clonidine (448 ± 160 mg). Hence, a statistically significant difference was observed among the four study groups (P value for ANOVA = 0.0001).
Adding clonidine as a preoperative medication decreases the patient's anesthetic needs; this decrease was even more considerable on the anesthetic needs than the effect of opium abuse history on anesthetic dose.
Journal of research in medical sciences 08/2012; 17(8):728-731. · 0.68 Impact Factor
[show abstract][hide abstract] ABSTRACT: Repeated implantation failure (RIF) is a worldwide health problem that imposes a great deal of cost on patients and health care system. Vitamin D(3) has been proposed to have positive impact on the process of implantation. The present study was performed to compare the effect of 1,25-dihydroxy vitamin D(3) (1,25(OH)(2)D(3)) on cytokine production by endometrial cells of women with RIF and healthy fertile controls. Whole endometrial cells (WECs) and endometrial stromal cells (ESCs) from RIF and normal fertile women were treated with 1,25(OH)(2)D(3). The levels of IL-10, TGF-β, IFNγ, Il-6, IL-8 and IL-17 in culture supernatants were assayed by ELISA. Also, ability of the cells from both groups to produce 1,25(OH)(2)D(3) was evaluated and compared. 1,25(OH)(2)D(3) down-regulated cytokine production in WECs from both groups except for IL-8 which was upraised. Similar trends were also observed in ESCs except up-regulation of TGF-β in RIF group. Endometrial cells of both groups had comparable capacity to produce 1,25(OH)(2)D(3). Based on the minimal differential immunoregulatory effect of vitamin D(3) on endometrial cells from RIF and control women, it may be suggested that circulating levels of maternal vitamin D(3) be the subject of further investigation.
[show abstract][hide abstract] ABSTRACT: We aimed to compare the analgesic effects of low-dose intravenous ketamine with the effects of diclofenac suppositories in acute postoperative pain management in women undergoing gynecologic laparoscopic surgery under general anesthesia.
In a double-blind, randomized clinical trial, 80 patients were selected and entered the study. After the induction of general anesthesia, one group received 0.15 mg/kg intravenous ketamine and the other group received a 100-mg rectal diclofenac suppository. The two groups were compared regarding acute pain scores, postoperative morphine requirements, and untoward complications.
Pain scores and morphine requirements were lower in the rectal diclofenac suppository group at the 1st, 3rd, and 6th postoperative hours. Higher incidences of postoperative nausea and vomiting (PONV), delusions, and oral secretions were observed in the ketamine group.
Diclofenac 100-mg suppositories were more effective in suppressing acute pain than 0.15 mg/kg intravenous ketamine in women undergoing elective gynecologic laparoscopy, with fewer untoward complications.
Journal of Anesthesia 05/2012; 26(5):732-7. · 0.87 Impact Factor
[show abstract][hide abstract] ABSTRACT: Diabetes is one of the most common causes of delayed wound healing. Low-level laser therapy (LLLT) are one of the therapeutic modalities used for the treatment of wounds. The aim of present study is to evaluate the effect of LLLT in experimentally-induced diabetic rats. Two full thickness skin incisions were made on dorsal regions of each rat. The wounds were randomly divided into laser-treated and placebo. Laser-treated wounds of the healthy (non-diabetic) animals were submitted to a pulsed-infrared 890nm laser with an 80Hz frequency and 0.03J/cm(2) for each wound point in the first healthy group and 0.2J/cm(2) in the second healthy group. Laser-treated wounds of the diabetic animals received the same pulsed-infrared laser treatments as the second group for each wound point. On day 15, a sample from each wound was extracted and submitted for tensile strength evaluation. Laser irradiation with 0.03J/cm(2) significantly decreased the maximum load for wound repair in healthy rats (p=0.015). Laser irradiation with 0.2J/cm(2) significantly increased the maximum load in wounds from the healthy control (p=0.021) and diabetic (p<001) groups. Laser treatments with a pulsed infrared laser at 0.2J/cm(2) significantly accelerated wound healing in both healthy and diabetic rats.
Journal of photochemistry and photobiology. B, Biology 03/2012; 111:1-8. · 1.87 Impact Factor
[show abstract][hide abstract] ABSTRACT: The anaesthetic agent halothane is still widely used in developing countries including the Islamic Republic of Iran because of its low price. Because of halothane-induced hepatitis, a rare complication, it has been replaced by other inhalation anaesthetics in Western countries; it has been suggested by some Iranian professionals that the Islamic Republic of Iran should do the same. We evaluated various dimensions of this replacement through a literature review to assess the incidence of halothane-induced hepatitis and costs of anaesthetics in the country. We also conducted a questionnaire survey of 30 anaesthesiology/gastroenterology experts about their views on the subject. The results indicate that the incidence of halothane hepatitis in the Islamic Republic of Iran is very low and could mostly be avoided by strict adherence to guidelines. Complete withdrawal of halothane in the Islamic Republic of Iran might not be appropriate at present. Comprehensive cost-effectiveness studies are needed before a decision is made on complete replacement of halothane with other anaesthetics.
Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ 02/2012; 18(2):159-64.
[show abstract][hide abstract] ABSTRACT: The aim of this study was to clarify the efficacy of perioperative glucose-insulin-potassium (GIK) infusion on preoperative and postoperative N-terminal (NT)-pro-brain natriuretic peptide (BNP) concentrations in patients with a low ejection fraction undergoing isolated on-pump coronary artery bypass graft (CABG) surgery.
A double-blind, randomized, controlled study.
Modarres Hospital, Tehran, Islamic Republic of Iran.
Sixty-six patients with a low ejection fraction who required coronary artery surgery were selected.
Patients were allocated to a GIK (n = 36) or a control (n = 30) group. The GIK group received GIK solution (500 mL of dextrose in water (DW) 10% + 40 U of regular insulin + 40 mEq of KCl, and 2 g of MgSO(4)) at a rate of 1 mL/kg/h for 10 hours preoperatively and until the removal of the aortic cross-clamp. The control group received half saline solution as placebo with an equivalent infusion rate during the same interval.
Serum NT-proBNP levels were measured before starting the GIK, at the time of anesthesia induction, and 24 hours after surgery. The primary outcome measures were preoperative and postoperative NT-proBNP level. The amount of elevation in postoperative NT-proBNP concentrations was less prominent in the GIK group than in the control group (2,601 ± 1,799 pg/mL v 4,732 ± 4,127 pg/mL; p = 0.02). The patients in the GIK group were extubated sooner (495 ± 92 minutes) than the control group (774 ± 224 minutes; p = 0.002). The overall extubation time was 606 ± 177 minutes. Delayed requirement for mechanical ventilation was significantly more in the controls compared with the GIK group (45.8% v 13.9%, p = 0.004).
GIK is of value in the reduction of post-cardiac surgery NT-proBNP elevation. Thus, its infusion should have a protective effect in patients with low ejection fraction undergoing CABG surgery. Further studies may prove GIK infusion benefits in high-risk CABG surgery patients optimize outcome.
Journal of cardiothoracic and vascular anesthesia 01/2012; 26(4):631-6. · 1.06 Impact Factor
[show abstract][hide abstract] ABSTRACT: One of the most common health problems are diseases of the cardiovascular system with a great bulk of disease burden; while a considerable number of cardiac patients undergo cardiac surgery; cardiac surgical procedures with cardiopulmonary bypass (CPB) are nowadays among the top list of surgical procedures. More than half of a century has passed since the introduction of total cardiopulmonary bypass (CPB). One of the main untoward effects of CPB is systemic inflammation; causing an "acute phase reaction" responsible for the production of other unwanted postoperative complications. The humoral and cellular components of the immune system are among the main parts of these compensatory mechanisms. There are a number of therapeutic agents used to suppress this inflammatory process. Since CPB is composed of a multitude of items, there are many studies assessing the possible methods and therapeutics for prevention or treatment of inflammation in patients undergoing CPB. According to a conventional classification, the anti-inflammatory methods are classified as either pharmacologic strategies or technical strategies. The pharmacologic strategies are those with the usage of one or more therapeutic agents; while the technical strategies are those that try to modify the CPB techniques. However, in this manuscript, the main pharmacological strategies are discussed.
Iranian journal of pharmaceutical research (IJPR) 01/2012; 11(3):705-14. · 0.54 Impact Factor
[show abstract][hide abstract] ABSTRACT: There is evidence that opium addiction has immunosuppressant effects. Coronary artery disease (CAD) is a condition resulted from atherosclerosis which is dependent on the immune response.
To evaluate plasma levels of interleukin-6 and interleukin-1Ra in 30 patients with three-vessel coronary artery disease, ejection fraction of more than 35% and to evaluate their changes after prognostic treadmill test in 15 opium addicted and 15 non-addicted patients.
The participants underwent prognostic treadmill test and plasma levels of interleukin-6 (IL-6) and interleukin-1Ra (IL-1Ra) were evaluated with ELISA method before, just after and 4 hours after the test.
IL-1Ra (2183 pg/ml) tended to decrease over time in the opium addicted group (1372 pg/ml after prognostic treadmill test and 1034 pg/ml 4 hours after that), although such decrease did not reach the statistical significance. IL-1Ra levels were significantly higher in opium addicted than in non addicted patients. Opium addiction had no significant effect on IL-6 changes.
Consumption of opium in CAD patients is associated with higher IL-1Ra levels.
PLoS ONE 01/2012; 7(9):e44939. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: Nowadays, coronary artery bypass grafting (CABG) is considered to be one of the most common surgical procedures. This procedure has been the main topic in many clinical research studies, which have assessed the effect of the procedure on patients' outcomes. Like other surgical procedures, this procedure is also accompanied by a number of unwanted complications, including those of the respiratory system. Since the respiratory system plays an integral role in defining the clinical outcome of patients, improvements in studies that can assess and predict clinical outcomes of the respiratory system, assume greater importance. There are a number of predictive models which can assess patients in the preoperative period and introduce a number of risk factors, which could be considered as prognostic factors for patients undergoing CABG. The respiratory system is among the clinical systems that are assessed in many prediction scoring systems. This review assesses the main studies which have evaluated the possible risk factors for postoperative respiratory mortality and morbidity, in patients undergoing CABG.
Anesthesiology and pain medicine. 01/2012; 2(2):60-65.
[show abstract][hide abstract] ABSTRACT: Background: Repeated Implantation Failure (RIF) is one of the most intricate obstacles in assisted reproduction. The cytokine and chemokine composition of uterine cavity seem to play important roles in the implantation process. Objective: To compare the cytokine profile in the endometrium of normal fertile women and those with repeated implantation failure. Methods: After enzymatic digestion of endometrial tissues, whole endometrial cells and endometrial stromal cells from RIF and normal fertile women were cultivated and stimulated for cytokine secretion. The levels of IL-10, TGF-β, IFN-γ, IL-6, IL-8 and IL-17 in culture supernatants of the two groups were assayed by ELISA and compared together. Results: Endometrial stromal cells and whole endometrial cells of normal fertile women produced higher levels of IL-6, IL-8 and TGF-β compared to RIF group, although this difference was statistically significant only in endometrial stromal cells (p=0.005, 0.002 and 0.001, respectively). In addition, endometrial stromal cells of normal fertile women produced lower levels of IL-10 in comparison with RIF group (p=0.005). Conclusion: Disturbances in cytokine production at the feto-maternal interface could be a cause of implantation failure. A pro-inflammatory cytokine milieu seems to be pivotal for successful implantation.
Iranian journal of immunology: IJI 12/2011; 8(4):201-8.
[show abstract][hide abstract] ABSTRACT: A number of elective coronary artery bypass graft (CABG) surgery patients have impaired underlying left ventricular function (poor ejection fraction). This study was performed to compare the effect of postoperative oral carvedilol versus metoprolol on left ventricular ejection fraction (LVEF) after CABG compared with metoprolol. In a double-blind clinical trial, 60 patients with coronary artery disease, aged 35 to 65 years, who had an ejection fraction of 15% to 35% were included. Either carvedilol or metoprolol was administered the day after CABG. The patients were evaluated by the same cardiologist 14 days before and 2 and 6 months after elective CABG. The results demonstrated better improvements in LVEF in the carvedilol group. No difference regarding postoperative arrhythmias or mortality was detected. The results suggest that carvedilol may exert more of an improved myocardial effect than metoprolol for the low ejection fraction patients undergoing CABG in the early postoperative months.
Journal of perianesthesia nursing: official journal of the American Society of PeriAnesthesia Nurses / American Society of PeriAnesthesia Nurses 12/2011; 26(6):384-7.
[show abstract][hide abstract] ABSTRACT: Chronic opium exposure leads to altered response to opioid compounds. The aim of this study was to assess the behavioral effects of opium tolerance on the analgesic effects of intrathecal lidocaine in rats.
Twenty-four adult male Sprague Dawley rats with intrathecal (IT) catheters were divided into 3 groups of 8. The first group was morphine tolerant and received IT lidocaine (ML). Rats in the second group were not morphine tolerant and received IT lidocaine (L), while the third group consisted of not morphine tolerant rats that received IT placebo. Tail flick test was done and maximal possible antinociceptive effects (MPAE) were compared using analysis of variance (ANOVA).
While percent of MPAE significantly increased in the L group, it had a significant reduction in the ML group (P < 0.001).
After intrathecal lidocaine administration, a hyperalgesic response was seen in morphine tolerant rats and an analgesic response was seen in the lidocaine group.
Journal of research in medical sciences 10/2011; 16(10):1361-5. · 0.68 Impact Factor