Rasoul Azarfarin

Iran University of Medical Sciences · Department of Anesthesiology

Introduction Hypertrophic obstructive cardiomyopathy (HOCM) is a hereditary heart muscle disorder characterized by significant myocardial hypertrophy. we assessed perioperative and long-term follow-up data of Iranian HOCM patients who underwent SM in 2 pioneering centers. Methods Clinical data of patients with HOCM septal myectomy are collected. T...

Background Zero‐balance ultrafiltration (Z‐BUF) is considered a significant method during cardiopulmonary bypass (CPB), and has always received support regarding its key role in monitoring electrolyte abnormalities including potassium and sodium derangements and managing them which occur commonly during CPB. With Z‐BUF procedure’s impact on control...

Cardiovascular diseases are culpable for the majority of mortalities the world over, hence the significance of advances in preventive medicine and imaging. Cardiovascular imaging constitutes the cornerstone of not only early but also precise diagnoses. Indeed, advanced imaging enables cardiologists to make efficacious management plans for various h...

Background: Percutaneous dilatational tracheostomy (PDT) is the most commonly used minimally invasive procedure in patients with prolonged mechanical ventilation. However, during the procedure withdrawal, the endotracheal tube (ET) may cause substantial gas leak and sometimes the airway could be lost, and the patient exposed to severe hypoxemia. I...

Introduction: Cardiac troponin is one of the heart biomarkers and its high levels correlates with a high risk of cardiomyocytes damage. This study aimed to compare sevoflurane and isoflurane effect on troponin levels in patients undergoing cardiac surgery. Methods: We systematically searched for RCTs which had been published in Cochrane library, P...

Background: Cardiopulmonary bypass (CPB) requirement in infants presents a unique challenge because of the large prime volume-to-blood volume ratio. Packed red blood cells (PRBCs) tend to deteriorate with long-term storage owing to their unphysiological composition and osmolality. Given that blood priming is inevitable in neonates, it is suggested...

Background: This study aimed to compare sedation characteristics of dexmedetomidine (Dex) and propofol during transesophageal echocardiography (TEE) in cardiac patients. Methods: This clinical trial was conducted on 65 cardiac patients, who underwent TEE in a referral heart hospital. The patients were randomly divided into two groups: Dex (n = 3...

Introduction: Pediatric Cardiopulmonary Bypass (CPB) circuit invariably requires priming with Packed Red Blood Cells (PRBCs). Metabolic composition of stored PRBCs is unphysiological. Commencement of PRBC primed CPB leads to rapid transfusion of massive metabolic load. This predisposes pediatric patients to the risk of complications such as electro...

Noninvasive hemoglobin (Hb)-monitoring devices are new inventions in pulse oximeter systems that show hemoglobin levels continuously. The aim of this systematic review and meta-analysis was to evaluate the accuracy and precision of noninvasive versus standard central laboratory Hb measurements in the operating room. We systematically searched multi...

Background: A prolonged hospital stay causes bed occupancy rates and increases hospital costs. This study aimed to determine the factors affecting the ICU length of stay after coronary artery bypass graft surgery (CABG).

Blood priming is needed for cardiopulmonary bypass (CPB) in neonates and infants to avoid exceeding hemodilution; however, transfusion‐related inflammation affects post‐CPB outcomes in infant open‐heart surgery. Procalcitonin, a newly detected inflammatory moderator and a sensitive parameter for predicting pulmonary dysfunction secondary to CPB, ri...

Background: The use of short-acting anesthetics, muscle relaxation, and anesthesia depth monitoring allows maintaining sufficient anesthesia depth, fast recovery, and extubation of the patients in the operating room (OR). We evaluated the feasibility of extubation in the OR in cardiac surgery. Methods: This clinical trial was performed on 100 ad...

Background: The aim of the present study was to investigate the relationship between maximum clot firmness (MCF) in rotational thromboelastometry (ROTEM®) and postoperative bleeding in patients on clopidogrel after emergency coronary artery bypass graft surgery (CABG). Methods: This observational study recruited 60 patients posted for emergency...

Nowadays, an anesthesiologist must have adequate knowledge about all organ systems of a patient especially in critical situations in the operating room, intensive care unit, or emergency room. Considering the rapidly growing numbers of cardiovascular medications and interventions and also the sophisticated cardiovascular procedures for progressivel...

Background: Application of negative pressure on chest tubes is one of the most common methods for management of chest tubes drainage after cardio-thoracic surgeries. However, the effect of this measure on long-term outcome of these patients and especially on postoperative pleural effusions is not thoroughly evaluated. For this reason, we designed a...

Background: Coronary artery bypass graft surgery (CABG) is a common surgical operation usually performed under cardiopulmonary bypass. Although the relationship between the transfusion of blood products during and after surgery with the incidence of arrhythmia has been studied, contradictory results have been achieved. In the current study, we inve...

Background: Family members of patients undergoing surgical or interventional procedures are prone to anxiety while awaiting the outcome. What can even increase such anxiety is receiving inadequate information about the patient’s status from the nursing staff. Educating nurses about the means and ways to alleviate anxiety among the family members of...

Background: Management and evaluation of pain in children can be challenging due to difficulties in expression and verbalization. The imperative role of nurses in the assessment and management of pain should be considered. The aim of this study was to evaluate the role of the education of ICU nurses in pain assessment and measurement in order to re...

Transesophageal echocardiography (TEE) is a minimal invasive diagnostic tool performed for a growing number of patients in echocardiography departments and intensive care units. Such as other semi-invasive procedures, TEE requires some degrees of sedation to achieve better patient safety and comfort and operator convenience. Given the potential min...

Background: Long intervals of del Nido (DN) solution administration, 90 minutes, may result in rewarming of the myocardial tissue and elevate metabolic demand and hypoxia. This will potentially increase inflammatory response due to ischemia-reperfusion injury. We conducted this study to compare the inflammatory response between patients receiving...

Background This study aimed to test the beneficial effect of grape seed extract (GSE) (Vitis vinifera) and Vitamin C in oxidative stress and reperfusion injury induced by cardiopulmonary bypass (CPB) in coronary artery bypass surgery. Patients and Methods In this randomized trial, 87 patients undergoing elective and isolated coronary bypass surger...

Background: This research was conducted to investigate the effects of a nursing supportive program on anxiety and stress levels in the family members of patients admitted to the intensivee care unit (ICU) after cardiac surgery. Methods: This research was a quasi-experimental study. A control group and an intervention group (each = 35), both compris...

Background: All intraoperative strategies that may assist an anesthesiologist with lowering the blood transfusion rate must be considered. We assessed the efficacy of the 30° head-up position at the end of cardiopulmonary bypass (CPB) in returning CPB reservoir blood to patients, reducing the transfusion rate, and conferring hemodynamic stability a...

Background: Sleep disturbances are common following coronary artery bypass graft surgery (CABG). Nowadays, nonmedical therapies are considered along with medical therapies for sleep disturbances. The aim of this study was to evaluate the effects of acupressure on sleep quality in patients after CABG. Methods: This randomized controlled trial assign...

Background: Hemodynamic changes are among the side effects of diagnostic cardiovascular procedures. Hypothesizing that the anxiolytic effects of lavender oil inhalation could alleviate anxiety among patients undergoing diagnostic cardiovascular modalities, we conducted the present study on patients undergoing coronary angiography with the aim of as...

Background: Pulmonary complications following cardiac valvular surgery are common and contribute to increased rate of hospi- tal stay, morbidity and mortality. This study was conducted to determine the incidence of pulmonary complications after cardiac valvular surgery and to investigate perioperative clinical factors for postoperative pulmonary co...

Objectives The aim of the present study was to assess and compare the sociodemographic characteristics and clinical features of patients referring to a university hospital’s pain clinic with chronic ( ≥ 12 weeks) and subacute pain ( < 12 weeks). Methods In this cross-sectional study, 426 patients were included. Demographic variables including educ...

Background: Detecting pain is crucial in sedated and mechanically ventilated patients, as they are unable to communicate verbally. Objectives: This study aimed to compare Bispectral index (BIS) monitoring with the Critical-care pain observation tool (CPOT) and vital signs for pain assessment during painful procedures in intubated adult patients...

Background: Patient-prosthesis mismatch (PPM) after aortic valve replacement (AVR) is the subject of continuing debate in the cardiac surgery field. Objectives: The aim of this study was to evaluate the frequency and severity of patient-prosthesis mismatch (PPM) and the functional status of patients undergoing aortic valve replacement (AVR) usin...

Background: Critical-care patients are at higher risk of untreated pain, because they are often unable to communicate owing to altered mental status, tracheal intubation and sedation. Objectives: This study compared two pain assessment tools on tracheal intubated critically ill patients in a cardiac post-anesthesia care unit, who were unable to...

Background: Appropriate treatment methods lead to a reduced rate of mortality and morbidity, and an improved quality of life, in patients with multi-vessel coronary artery disease. Objectives: In this study, we compared short and long-term outcomes of coronary artery bypass grafting (CABG) versus medical therapy in patients 80 years of age and o...

Background: Invasive and continuous blood pressure (BP) monitoring is crucial after cardiac surgery. Accuracy of BP measurement mostly depends on patency of arterial catheter and acceptable waveform. Heparinized saline flush usually used for this purpose may be accompanied by potential heparin adverse effects. Objectives: The aim of this study w...

Background: The aim of the present study is to compare the success rate and complications of caudal epidural bupivacaine alone or in combination with intravenous (IV) midazolam and ketamine in awake infants undergoing lower abdominal surgery. Materials and Methods: In this double-blind, clinical trial study, 90 infants (aged below 3 months and wei...

Background: Heparinized saline solution is used to prevent occlusion in the arterial catheters and central venous pressure monitoring catheters. Even at low dose, heparin administration can be associated with serious complications. Normal saline solution can maintain patency of arterial catheters and central venous pressure monitoring catheters....

Various methods have been suggested to prevent hemodynamic instability caused by propofol and adverse effects caused by etomidate induction. The current study evaluated hemodynamic effects of propofol-ketamine mixture in comparison to etomidate-midazolam mixture during anesthesia induction. The aim of this study was to evaluate the hemodynamic effe...

Patency of the revascularization conduit is an essential predictor of long-standing survival after coronary artery bypass grafting. We have conducted this study to compare the mid-term patency rates of radial artery (RA), left internal thoracic artery (LITA) and also saphenous vein (SV) grafts in asymptomatic patients following coronary artery bypa...

Background: Adherence to blood storage, preparation, and administration standards has an important role in preventing blood-transfusion errors. In addition, the blood-transfusion rate following open-heart surgery is quite high. The aim of this study was to assess the adherence to hemovigilance standards on blood storage, preparation, and administra...

Unnecessary perioperative transfusions are likely to be related to increased morbidity and additional costs in cardiac surgery. The aim of this study was to evaluate the blood transfusion practice during and after adult cardiac surgery in a referral university hospital in Iran. In a descriptive study, we collected data from 153 adult patients under...

There are different risk factors that affect the intensive care unit (ICU) stay after cardiac surgery. The aim of this study was to evaluate possible risk factors influencing prolonged ICU stay in a large referral hospital. We conducted a case-control study to determinate causes of prolonged ICU stay in 280 adult patients undergoing cardiac surgery...

In this review we addressed the various analgesic techniques in cardiac surgery, especially regional methods such as thoracic epidural anesthesia (TEA). There are many techniques available for management of postoperative pain after cardiac operation including intravenous administration of analgesic drugs, infiltration of local anesthetics, nerve bl...

Percutaneous pulmonary balloon valvuloplasty (PBV) remains the treatment of choice for pulmonary stenosis (PS). This procedure is effective, safe and gives excellent results. Pulmonary artery (PA) dissection is a rare complication of PBV. This report is a case of an asymptomatic 17-year-old male with a history of PBV due to severe PS dating back to...

Advances in medical, interventional, and surgical care of patients with congenital heart disease (CHD) over the past five decades have led to the survival of this population group to adulthood. Consequently, the number of adults with CHD is expected to exceed that of the related pediatric population. Most of these patients will need cardiac or nonc...

Mucopolysaccharidoses (MPSs) are a group of heredity storage diseases, transmitted in an autosomal recessive manner, associated with the accumulation of glycosaminoglycans (GAGs) in various tissues and organs. The concerned patients have multiple concomitant hereditary anomalies. Considering the craniofacial abnormality in these patients, airway ma...

Tracheal intubation can be associated with considerable hemodynamic changes, particularly in patients with uncontrolled hypertension. The GlideScope(®) video-laryngoscope (GVL) is a novel video laryngoscope that does not need direct exposure of the vocal cords, and it can also produce lower hemodynamic changes due to lower degrees of trauma and sti...

Now-a-days truncus arteriosus has been known as "common arterial trunk" (CAT) and is an uncommon congenital cardiac defect presenting in about 1-3% congenital heart disease. Environmental and genetic factors effects on incidence of CAT and other conotruncal anomalies. The majority patients with CAT and 22q11 deletion have other anomalies such as hy...

[This corrects the article on p. 79 in vol. 3.].

In this review we addressed the various analgesic techniques in cardiac surgery, especially regional methods such as thoracic epidural anesthesia (TEA). There are many techniques available for management of postoperative pain after cardiac operation including intravenous administration of analgesic drugs, infiltration of local anesthetics, nerve bl...

Cornelia de Lange syndrome (CdLS) is a rare multiple congenital abnormalities with dominantly inherited and developmental delay. Regarding craniofacial deformities in these patients, airway management may be challenging for anesthesiologists. In these patients, pre-anesthetic evaluation must be done with exact assessment of the airway, including ph...

Evaluating left atrium volume is a good way to estimate prognosis in acute myocardial infarction patients because it indicates to time and severity of diastolic dysfunction and longer-term results of acute myocardial infarction. The present study aims at evaluating the effect of left atrium volume on patients' prognosis following acute myocardial i...

To explore the significance of platelet parameters, including mean platelet volume, platelet count and other haematological indices, in patients of acute coronary syndrome. In this one-year retrospective cross-sectional study in 2010, a total of 631 patients were enrolled at the Cardiovascular Research Institute, Tabriz University of Medical Scienc...

Background: Recently, assessment of the atrial motion and deformation indices obtained via Doppler myocardial imaging (DMI) has been proposed as a new method of exploring the atrial function.Objective: Our aim was to assess the right atrial (RA) regional function using myocardial velocities, strain, and strain rate imaging (SRI) and compare it with...

Propose: Our aim was to determine which criterion- hyperglycemia or high levels of glycosylated hemoglobin (HbA1C) is more associated with increased mortality and morbidity after coronary artery bypass graft (CABG). Methods: Two hundred and sixteen patients who underwent elective CABG were enrolled in this prospective study. In order to compare...

Tracheostomy was first described by Greco-Roman physicians, including Paulus of Aegina. Medieval Islamic clinicians extended the Greco-Roman ideas with substantial contributions to the field of surgery, including tracheostomy. Although Al-Zahrawi (936–1013 CE) stated that he had not heard or read of any Islamic physicians having performed tracheost...

Coronary artery disease (CAD) is accountable for more than 30% of deaths worldwide and is, thus, deemed the most important factor in terms of disease burden around the globe. This study aimed to evaluate CAD and its risk factors in hospitalized patients in the East Azerbaijan Province, northwest Iran, from 2006 to 2007. Data on 18.323 patients hosp...

Tracheostomy was first described by Greco-Roman physicians, including Paulus of Aegina. Medieval Islamic clinicians extended the Greco-Roman ideas with substantial contributions to the field of surgery, including tracheostomy. Although Al-Zahrawi (936-1013 CE) stated that he had not heard or read of any Islamic physicians having performed tracheost...

Different additives have been used to prolong regional blockade. We designed a prospective, randomized, double-blind, controlled clinical trial to evaluate the effect of dexamethasone added to bupivacaine-fentanyl on the duration of postoperative analgesia via epidural catheterization. Seventy two adult patients scheduled for elective abdominal or...

Reintubation in patients after cardiac surgery is associated with undesirable consequences. The purpose of the present study was to identify variables that could predict reintubation necessity in this group of patients. We performed a prospective study in 1000 consecutive adult patients undergoing cardiac surgery with cardiopulmonary bypass. The pa...

Background: There is a controversy over using either smaller- or larger-size endotracheal tubes (ETT) in children undergoing cardiac surgery, and some anesthesiologists prefer to use ETT sizes different from the formula-based sizes. The aim of the present study was to compare proper-size cuffed ETT in children undergoing cardiac vs noncardiac surg...

Background: Different additives have been used to prolong regional blockade. We designed a prospective, randomized, double-blind, controlled clinical trial to evaluate the effect of dexamethasone added to bupivacaine-fentanyl on the duration of postoperative analgesia via epidural catheterization.

Background: Coronary artery disease (CAD) is accountable for more than 30% of deaths worldwide and is, thus, deemed the most important factor in terms of disease burden around the globe. This study aimed to evaluate CAD and its risk factors in hospitalized patients in the East Azerbaijan Province, northwest Iran, from 2006 to 2007. Methods: Data on...

Introduction- Ischemic mitral regurgitation (MR) is frequently seen after the first acute STelevation myocardial infarction (MI) and is an independent predictive factor for long-term cardiovascular mortality after MI. Timing and severity of MR after MI is relevant to the location and extent of MI. We sought to evaluate the severity of post-MI ische...

Many previous studies have investigated the influence of gender on coronary artery bypass grafting surgery (CABG) outcomes. Despite the great volume of reports on this issue, it is still not clear whether it is the gender of the patient or pre-existing comorbid conditions that is the best predictor for the different outcomes seen between men and wo...

Diabetes mellitus (DM) is associated with serious complications including macro- and microvascular problems such as diabetic retinopathy. Coronary involvement in diabetic patients is believed to be a consequence of microvascular complications. However, the available data are inconclusive and scarce. This study aimed to evaluate the probable associa...

We introduce a 28-year-old woman with Thalassemia major whose clinical assessment, including two-dimensional Doppler echocardiography demonstrated severe left ventricular hypertrophy with severe biventricular enlargement and systolic dysfunction as well as severe diastolic dysfunction. We hereby address these issues from an echocardiographic point...

EAT is an independent factor in coronary artery disease (CAD). The objective of the current study was to define an echocardiographic cut-off point for EAT and to determine its diagnostic value in predicting the increase in CAD risk. Two hundred patients underwent coronary artery angiography for diagnosis of CAD and transthoracic echocardiography fo...

The aim of this study was to evaluate intraocular pressure (IOP) and hemodynamic responses following insertion of laryngeal mask airway (LMA) or endotracheal tube (ETT) after anesthesia induction with propofol and remifentanil in cataract surgery. In a randomized controlled study, 50 adults scheduled for elective cataract extraction procedure under...

In the current study, we evaluated the effect of anthropometric indices on ejection fraction following first acute anterior myocardial infarction. In an analytic-cross sectional study, 50 patients with acute anterior myocardial infarction and abnormal anthropometric indices (Body Mass Index (BMI) ≥ 30, Waist Hip Ratio (WHR) ≥ 1 and ≥ 0.85 in males...