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Background and Objective: Using of laryngeal mask air way (LMA) was recommended for air way management in short duration elective surgeries. One of its side effects is the increasing of secretion of air way and subsequently laryngospasm. Anticholinergic drugs (hyoscine NBB and atropine) have been administrated to reduce of these side effects. This study was carried out to compare the atropin and hyoscine n-butylbromide (NBB) on hemodynamic and nausea and vomiting in anesthesia with laryngeal mask air way. Materials and Methods: In this randomized double- blind control trials, 100 patients (20-50 years) with class 1 and class 2 of Anesthesia, have been operated less than one hour under general anesthesia with LMA during 2007-08 in Beheshti hospital. These patients were divided to 2 groups every other one randomly with equal persons. After controlling the base of heart rate (HR) and mean arterial pressure (MAP), both groups was administrated to premed according weight. Then 0.5mg/5ml atropine to the first group and 10mg/5ml hyoscine NBB (Buscopan) to the second group was injected and hemodynamic was controlled after two minutes. Anesthesia with thiopental sodium was induced and LMA was inserted. Then hemodynamic was controlled during the time. The amount of secretions of air way was investigated according to the numbers of suction at the end of surgery and after removing of LMA. The severity of postoperative nausea and vomiting was assessed with attention to need of patients to antiemetic until 6 hours. Data was analyzed statistically. Results: Antiemetic effect of atropin and hyoscine n-butylbromide (NBB) was similar. With mild secretions, moderate and sever antisialague effect of hyoscine NBB was 80%, 18% and 2% and in atropine group was 72%, 22% and 6% retrospectively. Heart rate increase (less of 20%) without rising MAP was obsered in two groups. Conclusion: This study showed that the effects of hyoscine and atropine in decreasing airway secretions, nausea and vomiting is similar.

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Background and Objective: Cardiac arrest is responsible for half of the death cases, which is preventable in rapid and effective cardiopulmonary resuscitation (CPR). During the last years, a great amount of progress has occurred in this field, but there is still a lack of enough data for CPR. The aim of this study was to assess and compare the survival rate of patients undergoing CPR in two university hospitals in Tehran, Iran. Materials and Methods: In this retrospective analytical study, the survival rate of 178 patients undergoing CPR in the emergency department of two university hospitals (Taleghani and Shaheed Modarres) were assessed and compared during 2005. The related variables including the time delay for CPR, the time length for CPR and the outcome of CPR were analyzed. Results: 24 hours after the cardiac arrest, 7 cases of 54 (13%) survived in Taleghani hospital and 33 of 124 (26.6%) survived in Shaheed Modarres hospital (P<0.05). Conclusion: This study showed that the rate of short term survival of patients after CPR is similar to other parts of country but lower than the other parts of the world.

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Background and Objective: Post dural puncture headache (PDPH) is a relatively common complication in spinal anesthesia. Several regimens had explained for treatment of this problem. The aim of this study was to determine the effect of intravenous single dose of Aminophylline (1.5mg/kg/body weight) on the incidence of PDPH in cesarean section under spinal anesthesia. Materials and Methods: In a double blind randomized trial study, 120 patients undergone spinal anesthesia for the elective cesarean section in Motahhari hospital of Marvdasht in Fars province in south of Iran during 2008. After umbilical cord clamping 1.5mg/kg/body weight of Aminophylline injected slowly and intravenously in 60 patients. In placebo group (n=60) normal saline injected intravenously. At the 1st, 4th, 24th and 48th hour after surgery, PDPH in patients were evaluated. Results: The incidence of PDPH was significantly lower in cases compared with controls during the first 24 hours post operation (5% vs. 31.7%, P<0.001). Incidence of PDPH in case and control groups after 48 hours was 5% and 23.3% respectively (P<0.004). Conclusion: This study revealed that the intravenous single dose of Aminophylline (1.5mg/kg/body weight) significantly reduced PDPH after spinal anesthesia in cesarean section.

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Background and Objective: Critical illness diaphragmatic neuromyopathy are significant  causes of weakness, morbidity and prolong mechanical ventilation among critically ill patients under mechanical ventilation. It is important determine the true initial time of neuromyopathic changes associated with critically ventilated patients. Based on new electrodiagnostic studies, electrophysiological studies of diaphragm and phrenic nerve, as an important muscle and nerve in ventilation, compared with other evaluating methods, have specific importance. This study was done to evaluate of the diaphragmatic myopathy onset time among mechanically ventilated patients using electrophysiological method.

Materials and Methods: This descripvtive study was performed on 56 mechanically ventilated patients in intensive care unit without primary neuromuscular disease in Tabriz Imam Khomeini hospital in West of Iran between 2004-06 years. Electromyography (EMG) and nerve conduction velocity test were performed in the 4^th and then in 4 days intervals.

Results: In 56 patients EMG and NCV performed at 4 and 8 days after mechanical ventilation, none of them had any evidence in favor of diaphragmatic myopathy. During the course of study, EMG were done on 24 patients in 12^th days , that in three of them (12.5%), mild myopathy were reported. From 18 patients, considered in 16^th days, only five (31.25%) of them showed mild myopathy. From 10 (100%) reminder patients, in 20^th day, all of them had mild to moderate myopathy.

Conclusion: According to these results, minimum duration of the diaphragmatic weakness onset time in mechanically ventilated patients with diverse causes in general critical care ward were 12 days and increased with prolonged time of mechanical ventilation.

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Background and Objective: Hemodynamic alteration and hypotension due to spinal anesthesia can reduce tissue perfusion and increase ischemic risk, myocardial infraction, renal failures spinal damages and even deep veins thrombosis. This study was designed to compare pharmaceutical effects of ephedrine, atropine and mucosal phenilephrin on hemodynamic alteration of women during spinal anesthesia in cesarean section. Materials and Methods: This randomized clinical and double blind study was done on 90 singleton pregnant women with ASA I and II class .the subjects gone elective cesarean section and allocated into three groups. subjects were received 500 ml ringer lactate before spinal anesthesia. Subjects in group I, II and III first received 0.1 mg/kg atropine (IV) 0.01mg/kg ephedrine and 100µgr phenilephrin (mucosal) prior spinal anesthesia, respectively. Hemodaynamic indexes including blood pressure, heart Rate, oxygen saturation and drug side effects were determined every 5 minutes interval through the surgery. Data was analyzed by using SPSS-11.5, Chi-Square and ANOVA tests. Results: Hemodaynamic indexes were changed during study, but three medicine showed similar effect on heart Rate, blood pressure and changes of oxygen saturation (P<0.05). There was a significant differences among three groups for dosage of extra ephedrine to control of blood pressure (P<0.05). This increase dosage of extra ephedrine was 56.7%,20% and in ephedrine, phenilephrin and atropine groups,respectively. Nosia rate was 6.7%, 50% and 46.7% in phenilephrin, atropine and ephedrine groups, respectively (P<0.05). Conclusion: This study showed that to prevent of blood pressure drop following spinal anestasia atropine, phenilephrin and ephedrine can be prescribed, but ephedrine is recommended for lowering the rate of nosia.

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Background and Objective: Post pain operative is common and a major complication which lead to numerous dangerous effects in various organs. The purpose of this study was to determine the effect of methocarbamol on postoperative pain following cholecystectomy. Materials and Methods: In a randomized, double – blind clinical trail study 60 ASA I, II patient in two group (n=30 in each group) between 30-50 years old and weigh lower of 100kg undergone general anesthesia for cholecystectomy. Elective surgery was selected in Besat Hospital, Sanandaj, Iran during 2008. Both group did not receive premedication and under similar condition of general anesthesia. Interventional group received 500mg Methocarbamol intravenus slowly and the control group received 5ml placebo slowly after operation. The pain score were measured by visual anesthesia scale (VAS) on the 1, 3, 6, 12 and 24 hours after operation and if necessitated narcotics (PRN, VAS>4) were prescribed. Data were analyzed using SPSS-16, ANOVA, Chi-Square and student’s t-tests. Results: There were no significant differences between two groups in terms of age, gender. The mean of score pain was lower for interventional group at 6.24 hours after operation (P<0.05). But no significant differences was observed at 1, 3 and 12 hours. The prescribe narcotic in interventional group was lower compared to controls (P<0.05). Conclusion: According to analgesic effects and low prescribe narcotics, it is suggested to use methocarbamol after operative due to analgesic effect.

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Background and Objective: Previous studies suggest a correlation of central venous pressure (CVP) and peripheral venous pressure (PVP) in different surgeries. CVP is one of essential monitoring during coronary arterial bypass graft (CABG). Canulation of peripheral venous catheter and PVP measurement is easier, whit less complication. This study was done to compare the central venous and peripheral venous pressures in the antecubital region in coronary arterial bypass graft surgery. Materials and Methods: This descriptive analytical study was done on 84 patients with American society of anesthesiology III with CABG surgery in Shafa hospital, Kerman, Iran during 2007. The technique of anesthesia was the same in all patients. CVP and PVP were measured every 20 minutes intervals before, on and after cardio-pulmonary pump. Data were analyzed using STAT-10, ANOVA and linear regression tests. Results: A total of 750 simultaneous measurements of CVP and PVP were recorded in all patients. The mean of CVP before of pump was 6.8±0.9 and the mean of PVP was 8.8±1. The mean difference between CVP and PVP was ±2 mmHg and this difference was significant (P<0.05). The mean of CVP on pump was 3.9±1 and the mean on PVP was 7.6±1. The mean difference of these two changeable was ±3.7 mmHg. This difference was significant (P<0.05). The mean of CVP after of pump was 6.5±1 and the mean of PVP was 8.5±1. The mean difference this two changeable was ±2 mmHg and this difference was significant (P<0.05). Conclusion: PVP and CVP are related with each other on cardio-pulmonary pump even in severe hemodynamic condition. PVP and CVP changes are synchronized and PVP is a helpful clinical alternative for estimation of CVP.

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Background and Objective: Post-operative nausea vomiting (PONV) and laryngospasm are the most common of complication following surgery. This study was conducted to compare the incidence of laryngospasm and PONV after pediatric infra umbilical surgery using two anesthetic methods: control ventilation and spontaneous respiration. Materials and Methods: This double-blind clinical trial study was conducted on 192 children with 2-7 year-old undergoing infra-umbilical surgery of ASA-I class with the estimated operation period of an hour in Tehran pediatric hospital, Tehran-Iran during 2009-10. The patients were randomly divided into two groups: controlled ventilation and spontaneous respiration. After anesthetization, Atracurium was injected to the control ventilation (CV) group and anesthesia continued with mechanical ventilation. For the patients of the second group (spontaneous respiration/SR), after the gradual increase of the dose of halothane and certainty of the optimal depth of anesthesia, patients were intubated to allow spontaneous respiration. After intubation, all patients were anesthetized with Halothane 1-2% and the N2O/O2. The rate of nausea, vomiting, laryngospasm, excessive post-operative discharge was recorded. Data were analyzed using SPSS-13, student’s t-test, chi-square and Fisher’s exact tests. Results: Post-operative nausea was non significantly higher in CV group (8%) than SR (6.52%). The rate of vomiting was higher in CV (16%) as compared to SR group (2.17%). (P<0.001, RR=8.57, CI: 1.91-38.41). The rate of laryngospasm at the end of the surgery was higher in CV group (15.21%) as compared to SR group (26%) (P<0.02, RR= 0.94, CI: 0.05-1.77). The rate of excessive discharge at the end of the surgery was significantly higher in CV group (52%) in comparison with SR group (11.95%) (P<0.001, RR=0.94, CI: 0.05-1.77). Conclusion: This study showed that in infra-umbilical surgeries in a period of less than an hour the incidence of post-operative vomiting and laryngospasm is higher in control ventilation group than spontaneous respiration group, which might be due to the injection of neostigmine to counter-act the effects of muscle relaxants.

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Background and Objective: Nausea and vomiting are common complications after surgery which creates spasm, hypoxia and pulmonary aspiration. This study was done to determine the effect of ondansetrone, metoclopramide associated with dexamethasone on postoperative nausea and vomiting in cholecystectomy surgery using Laparoscopic method. Methods: In this double blind clinical trial study, 100 patients with ASA class I and II undergoing laparoscopic cholecystectomy divided randomly into two groups. The patients in the first group were received metoclopramide (10mg/kg/bw) with dexamethasone (8mg/kg/bw) and the second group were received ondansetron (4mg/kg/bw) with dexamethasone (8mg/kg/bw) intravenously 5 min before the final stage of surgery. Premedication and induction of anesthesia in patients were equal 5 minutes to 4 hours after surgery, postoperative nausea and vomiting were recorded for each patient. Results: The rate of nausea in the first and the second groups were recorded 38% and 28%, respectively. The rate of vomiting in the first and the second groups were recorded 30% and 16%, respectively. These values were not significant. Conclusion: Ondansetron with dexamethasone non significantly reduced postoperative nausea and vomiting after laparoscopic cholecystectomy in comparison with metoclopramide with dexamethasone.

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Airway pressure release ventilation (APRV) is a new mode of ventilation. APRV is used in the acute respiratory distress syndrome when the low tidal volume strategy was not responding to assisted controlled mandatory ventilation (ACMV). Four cases of acute respiratory distress syndrome and severe life threatening hypoxia with ACMV whom were successfully managed with APRV are reported in this article. Although hypoxemia patients were treated by APRV method but eventually two patients died.

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Background and Objective: Electro convulsion therapy (ECT) is one of the most common ways for treatment of psychiatric disorders. The aim of this study was to compare the effect of Propofol, Etomidate, and Thiopental on seizure and recovery duration following ECT.
Methods: In this clinical trial study, 90 patients diagnosed with a psychiatric disorder by a psychiatrist, who need to be treated by ECT in 5 Azar hospital, Gorgan, north Iran. The patients were randomly divided into the three groups by simple random allocation method. Interventions included standard monitoring and pre-oxygenation with 100% FiO2 for 3 minutes for all patients in three groups. Anesthesia of the patients in the first, second, and third group was done with Thiopental (1.5 mg/kg), Propofol (0.6 mg/kg), and Etomidate (0.1 mg/kg), respectively. Administration of Succinyl Colin (0.5 mg/kg) as muscle relaxant and Atropine for prevention of bradycardia was uesd in all patients. Duration of seizure and recovery; changes in hemodynamic status including heart rate (HR) and mean arterial pressure (MAP); and amount of charge for ECT were recorded for each subject.
Results: Mean of seizure duration in Thiopental, Propofol, and Etomidate groups were 43.72±11.81, 35.74±10.58 and 45.81±17.26 seconds, respectively (P<0.05). Amount of charge for ECT in 3 sessions of treatment and changes of HR were not different between the 3 groups. Changes of MAP in the Propofol group was significantly less than other two groups (P<0.05). Recovery time following ECT was the least in Etomidate group in comparison with Thiopental and Propofol (P<0.05).
Conclusion: Ethomidate and Thiopental had the same effect on increasing seizure duration. However, due to the significant reduction in recovery time compared with Thiopental, Ethomidate may be considered as the best choice.

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Background and Objective: Control of postoperative pain is one of the most important stages in the recovery of patients after surgery. This study was done to compare the effectiveness of combined Ondansetron and Apotel on the post-operative pain after surgery of upper limb fractures.
Methods: This double blind clinical trial study was done on 50 individual (41 male and 9 female) with upper limb fractures referring to 5 Azar hospital in Gorgan northern Iran during 2017. Patients were assigned (block randomization) into control and intervention groups. After the end of operation in the recovery phase, both groups received pain PCA (Patient Controlled Analgesia). In control group, the pain pump consisted of 2 grams of Apotel and in the intervention group; the pain pump consisted of 2 grams Apotel and 8 mg of ondansetron. Visual Analogue Score (VAS) was evaluated in both groups after surgery for 24 hours. Pain score of patients compared in the 2 groups during the 3 time intervals after surgery.
Results: 4 hours after upper limb fracture surgery, the mean pain was significantly decreased in the intervention group (3.20±0.707) compared to control group (3.64±0.569) (P<0.05). 12 hours after upper limb fracture surgery The Mean pain, in the intervention group (1.88±0.927) was significantly reduced in compare to control group (2.64±1.186) (P<0.05). 24 hours after upper limb fracture surgery, The Mean pain was significantly reduced in the intervention group (1.40±0.645) in compare to control group (2.08±0.997) (P<0.05).
Conclusion: This study showed that administration of compination of Apotele and Ondansetron in post-operative pain of upper limb fractures is effective than apotele alone.

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Background and Objective: Appropriate analgesia after surgery helps patients feel more comfortable and increase the mobility of them. The purpose of this study was to compare the effect of subcutaneous injection of Ketamine and Lidocaine in reducing postoperative pain in patients undergoing elective inguinal hernia surgery under general anesthesia.
Methods: This double blinded, randomized clinical trial study was done on 60 patients undergoing elective inguinal hernia under general anesthesia. Subjects were randomly assigned into three groups including control, Ketamine and Lidocaine groups. Subjects in Ketamine group were received infiltration of subcutaneous Ketamine 0.5 mg/kg/bw after closure of surgical incision. Subjects in Lidocaine group were received infiltration of subcutaneous Lidocaine 1 mg/kg/bw at the time of wound suturing. Subjects in control group did not receive Ketamine and Lidocaine. The visual analogue scale (VAS) of pain and vital signs were continuously assessed. If VAS≥3, 100 mg diclofenac suppository was administered and if there were no response, 30 mg intravenous pethidine was also administered. The complications, including hallucination, nystagmus, nausea, vomiting and drowsiness in patients were also recorded.
Results: The mean VAS at 1, 2 hours after surgery were significantly lower in the Ketamine and Lidocaine group in compared to control group (P<0.05). No significant adverse effect was observed in the Ketamine group.
Conclusion: For reduction of pain, administration of subcutaneous Ketamine is recommended due to no adverse effect and anti analgesic effect of Ketamine is similar to Lidocaine.

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Background and Objective: Pain after tonsillectomy is one of the most common complications. This study was done to compare the effect of Gabapentin and promethazine as premedication to reduce pain after tonsillectomy.
Methods: This clinical trial study was performed on 104 patients aged 7-15 years who were candidate for tonsillectomy. Patients were randomly divided into gabapentin and promethazine groups. The first group received oral gabapentin 20 mg/kg/bw, and the second group was treated with promethazine syrup 0.5 mg/kg/bw one hour before anesthesia. Pain score was recorded based on the MOPS index and recorded and compared during 3, 6, 12, and 24 hours after surgery.
Results: The mean±SD of pain severity in the intervention group with promethazine at 3, 6, 12 and 24 hours after surgery were 1.35±0.84, 0.9±0.87, 0.25±0.52, 0.04±0.19, respectively. Pain severity was 1.58±0.98, 1.13±0.91, 0.69±0.27, and 0.06±0.24 in gabapentin group, respectively. There was no significant difference between pain score of two groups in 3, 6, 12 and 24 hours after surgery.
Conclusion: Gabapentin and promethazine as premedication have a similar analgesic effect in patients after tonsillectomy.

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Background and Objective: Propofol is one of the most commonly used drugs in anesthesia with the pain during an injection is a side effect of this drug. This study was conducted to compare the effect of Lidocaine, Magnesium Sulfate, and Ketamine on reducing pain caused by intravenous injection of Propofol in patients Undergoing surgery.
Methods: In this double-blind randomized clinical trial study, 80 patients aged 18 to 65 years were randomly blocked and assigned into four groups including Lidocaine, Ketamine, Magnesium Sulfate and Normal Saline. The pain was measured with the Ambesh Score. Hemodynamic changes of patients were evaluated in 1, 3, and 5 minutes.
Results: The patients in Lidocaine, Ketamine, and Magnesium Sulfate groups with 75%, 70%, and 55%, respectively, did not feel pain after Propofol injection compared to Normal Saline group (25%) (P<0.05). The mean time trend of Systolic and diastolic blood pressure and mean arterial blood pressure between the studied groups were significant (P<0.05).
Conclusion: The use of Lidocaine or Ketamine during Propofol injection can be effective in reducing pain during injection in patients undergo surgery.

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Background and Objective: Ventilator-associated pneumonia (VAP) is an important complication in intensive care unit (ICU) patients with endotracheal intubation. Finding potential early indicators of this condition can aid in reducing the disease burden. We aimed to investigate the relationship between VAP occurrence and serum levels of C-reactive protein (CRP), procalcitonin (PCT), and hemoglobin (Hgb) during ICU hospitalization of brain trauma patients.
Method: This descriptive-analytical study was carried out on brain trauma patients (99 male, 39 female), referring to the 5th Azar hospital in Gorgan, Iran, in the course of 2017. The patients were hospitalized in ICU with endotracheal intubation and mechanical ventilation. The diagnosis of VAP was confirmed by a 12-score rating based on chest radiographs, body temperature, white blood cell count, and sputum culture. After admission, serum CRP, PCT, and Hgb were documented daily for 6 days.
Results: According to the diagnostic criteria, VAP was confirmed in 41 patients (30%). Serum CRP and PCT levels on the 6th-day post-admission were significantly associated with VAP diagnosis, while Hgb levels did not differ significantly between VAP and non-VAP patients. Serum levels of CRP, PCT, and Hgb on the 6th day were not associated with age or sex.
Conclusion: Our results indicate that serum CRP and PCT levels are associated with the occurrence of VAP in ICU patients receiving mechanical ventilation. Therefore, these biomarkers could be utilized to warn physicians about the possibility of VAP, thereby reducing mortality rate and hospitalization length.
 

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Background and Objective: Lidocaine is the most effective anesthetic and a valuable drug for nerve pain control and management. Dexamethasone is commonly used to prevent postoperative nausea and vomiting. Dexamethasone, together with a local anesthetic, enhances the peripheral nerve block. Therefore, this study was conducted to compare the duration of anesthesia and analgesia effects after surgery in 2 anesthesia methods.
Methods: This descriptive-analytical study was conducted on 50 patients aged 18 to 70 years who were candidates for orthopedic surgery and visited the 5th Azar Medical Training Center, Gorgan, Iran during 2021. The sample was selected via convenience sampling and by checking the inclusion criteria. In group 1, 10 ml of Lidocaine 1%, and in group 2, 8 ml of 1% Lidocaine and 2 ml of dexamethasone were used as infiltration in the operation site. The average onset of analgesia and the duration of analgesia as well as postoperative pain between both anesthesia methods were determined and compared with the visual analog scale.
Results: The average duration of anesthetic effect was significantly higher in group 2 (P<0.05). In addition, the average pain duration of the patients of group 2 had a downward trend from the time of entry to when they exited the recovery room (P<0.05).
Conclusion: The combination of dexamethasone and Lidocaine increased the duration of finger nerve block effect and analgesia after surgery.