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Eşfahān, Iran

Ranieri D.,Sao Paulo State University | Neubauer A.G.,Anesthesiologist | Ranieri D.M.,Federal University of Sao Paulo | Ranieri D.M.,Vale do Itajai University | Junior P.D.N.,Sao Paulo State University
Revista Brasileira de Anestesiologia | Year: 2012

Background and objectives: Tracheal intubation associated with airway operations can cause complications such as laryngospasm, bronchospasm and periods of reduced oxygen saturation. Such complications are frequently reported during adenotonsillectomies, a procedure that by nature increases the incidence of airway complications. The objective of this study was to compare the occurrence of respiratory problems during adenotonsillectomies while using either a disposable laryngeal mask airway (LMA) or an endotracheal tube (TT). Methods: We evaluated 204 pediatric patients undergoing general anesthesia for adenotonsillectomies. The patients were randomly allocated into either the tracheal intubation group (TT, n=100) or the laryngeal mask airway group (LMA, n=104). It was measured the level of oxygen saturation by pulse oximetry (SpO2) after the induction of anesthesia (SpO2-1), after establishing the operative field (SpO2-2), at the end of the surgical procedure (SpO2-3), three minutes after the removal of the contained breathing apparatus (SpO2-4) and upon admission to the post-anesthesia care unit (SpO2-5). All respiratory complications were recorded. Results: The mean SpO2 values and standard deviations for the TT and LMA groups were as follows: SpO2-1: 98.9±1.0 and 98.7±0.8 (p>0.25), SpO2-2: 97.4±1.0 and 94.9±4.3 (p<0.001), SpO2-3: 96.9±1.1 and 97.2±1.1 (p=0.037), SpO2-4: 91.7±9.0 and 95.2±2.2 (p<0.001) and SpO2-5: 94.0±2.1 and 95.8±2.6 (p<0.001), respectively. In the LMA group, 12 patients required some maneuvering to fix positioning and leaks during surgery. In four patients, the LMA had to be replaced with a TT. Respiratory complications were similar between groups. Conclusions: Performing adenotonsillectomies in pediatric patients using a LMA resulted in a lower intraoperative SpO2, compared to using a TT. In some cases, the LMA had to be replaced with an endotracheal tube. Although the surgery may be performed with LMA, the use of a TT is preferred for safety. © 2012 Elsevier Editora Ltda.


Tabaeizavareh M.H.,Isfahan University of Medical Sciences | Omranifard M.,Isfahan University of Medical Sciences | Moalemi A.,Anesthesiologist
Pakistan Journal of Medical Sciences | Year: 2012

Objective: Coadministration of verapamil with local anesthetics could potentiate the sensory block of peripheral nerve, increase the duration of sensory nerve block and reduce postoperative pain and analgesic consumption. The aim of this study was to investigate the effect of verapamil as an adjuvant with bupivacaine on level of sensory block, post-operative pain and analgesic consumption among patients undergone elective surgery in Isfahan. Methodology: In this prospective randomized interventional clinical double-blind study ASA physical status I or II male patients referred for elective lower abdominal surgery were enrolled. They randomized in group A (20cc of 0.5% bupivacaine plus 5 mg verapamil) and B(20cc of 0.5% bupivacaine plus 2cc normal saline). The sensory level block, postoperative pain, opioid consumption and vomiting and nausa and hemodynamic state was recorded and compared in two groups. Results: Sixty two patients were studied. Mean of the sensory level block 20 minutes after stating epidural anesthesia and immediately after surgery, postoperative pain score, opioid consumption and nausea and vomiting and fluid intake was not significantly different in two groups (P>0.05). Mean of systolic and diastolic blood pressure and pulse rate changes was not significantly different in two groups (P>0.05). Conclusion: Verapamil as an adjuvant with bupivacaine could not significantly increase the level of sensory block and attenuate post-operative pain and analgesic consumption and hemodynamic condition of the patients. For more accurate results it is recommended to determine the effect of different dose of verapamil in larger sample size of the patients. Studying the effect of other Ca channel blockers would be favorable in this regard.


De Assuncao Braga A.D.F.,University of Campinas | Silva Braga F.S.D.,University of Campinas | Braga Poterio G.M.,University of Campinas | Fachini Frias J.A.,Anesthesiologist | And 2 more authors.
Revista Brasileira de Anestesiologia | Year: 2013

Background and objective: Different drugs, including hypnotics, may influence the pharmacodynamic effects of neuromuscular blockers (NMB). The aim of this study was to evaluate the influence of propofol and etomidate on cisatracurium-induced neuromuscular blockade. Method: We included 60 patients, ASA I and II, undergoing elective surgery under general anesthesia in the study and randomly allocated them into two groups, according to their hypnotic drug: GI (propofol) and GII (etomidate). Patients received intramuscular (IM) midazolam (0.1mg.kg-1) as premedication and we performed induction with propofol (2.5mg.kg-1) or etomidate (0.3mg.kg1), preceded by fentanyl (250mg) and followed by cisatracurium (0.1mg.kg-1). The patients were ventilated with 100% oxygen until obtaining a reduction of 95% or more in the adductor pollicis response amplitude, with subsequent laryngoscopy and tracheal intubation. Neuromuscular function was monitored by acceleromyograhpy. We evaluated the onset of action of cisatracurium, tracheal intubation conditions, and hemodynamic repercussions. Results: The mean time and standard deviations of cisatracurium onset were: GI (86.6. ±. 14.3. s) and GII (116.9. ±. 11.6. s), with a significant difference (p. <. 0, 0001). Intubation conditions were acceptable in 100% of GI and 53.3% of GII patients (p. <. 0.0001). Conclusion: Induction of neuromuscular blockade with cisatracurium was faster, with better intubation conditions in patients receiving propofol compared to those receiving etomidate, without hemodynamic repercussions. © 2013 Elsevier Editora Ltda.


Bayat F.,Cardiovascular Anesthesia fellowship | Aghdaii N.,Tehran University of Medical Sciences | Farivar F.,Cardiovascular Anesthesia fellowship | Bayat A.,Anesthesiologist | And 2 more authors.
Annals of Thoracic and Cardiovascular Surgery | Year: 2013

Purpose: to assess the early hemodynamic changes after elective mitral valve replacement (MVR) in patients with severe and mild pulmonary arterial hypertension (PAH). Methods: a total of 45 consecutive patients, who were candidate for elective MVR, were enrolled in this prospective observational study. Patients were divided into two groups based on the absence (group A, 20 patients) or presence (group B, 25 patients) of severe pulmonary artery hypertension (PAH) defined as systolic pulmonary artery pressure ≥50 mmHg measuring by catheterization. MVR was performed using standard cardiopulmonary bypass (CBD) technique. The hemodynamic and arterial blood gas assessments were carried out at baseline before the induction of general anesthesia, in the operating room immediately after MVR, and then continued after stabilization of hemodynamic status with 2 hr interval up to24 hours. Results: The mean CPB and aortic cross-clamp times were similar in two groups (95.3 ± 49.5 and 61.8 ± 36.3 minutes in group A and 103.1 ± 34.7and 61.9 ± 20.0 minutes in group B). In group A, the mean PAP showed an increase immediately after the operation (from 40.4 ± 7.3 to 43.10 ± 6.2 mmHg) and then decreased significantly to 32.5 ± 3.9 mmHg (P <0.05). In group B, the mean PAP showed no significant reduction immediately after MVR, but it decreased significantly below the range of severe PAP over the first 24 hours. Conclusion: MVR is safe and effective even in patients with severe PAH. The anesthetic technique and postoperative cares can be useful in improving the outcome in such patients. © 2012 The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery. All rights reserved.


Falavigna A.,University of Caxias do Sul | Righesso O.,Orthopedist | Volquind D.,Anesthesiologist | Bueno Salgado K.,Federal University of Health Sciences, Porto Alegre | Teles A.R.,University of Caxias do Sul
Acta Neurochirurgica | Year: 2010

Background: Paragangliomas are tumors that arise from the paraganglion system, which is a component of the neuroendocrine system. Approximately 10% are located in the extra-adrenal paraganglion system. Paragangliomas of the spine, however, are rare. They usually present as an intradural tumor in the cauda equina. There are only three reports of primary intraosseous paragangliomas of the sacrum. Case description: A 69-year-old man presented with low back pain and urinary incontinence. Imaging revealed a large intraosseous mass at S2, S3 and S4. Surgical resection was accomplished through a posterior midline incision exposing the spine from L5 to the coccyx. The tumor was located in the extradural space. It was friable, grayish and bleeding. Total tumor removal was performed, with normal bone margins. Follow-up at 2 years showed complete resolution of the preoperative symptoms and no evidence of local recurrence. Conclusion: Although rare, the possibility of paraganglioma should be included in the differential diagnosis of sacral tumors. The majority of the spinal paragangliomas are benign, slowly growing tumors with low proliferative activity. Despite these characteristics, local recurrence has been reported in cases of both macroscopically total and subtotal resection. Postoperative radiation therapy for patients with incomplete excision may not prevent recurrence, so gross tumor removal should be the goal of surgery. © 2009 Springer-Verlag.

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