Showing 10 results for Mahoori
Beigmohamadi M T, Khan Z H, Mahoori A R,
Volume 65, Issue 11 (1 2008)
Abstract
Background: Remifentanil is known to produce side-effects of hypotension and bradycardia. In this study, we examine the effect of low-dose ketamine infusion on the heart rate and blood pressure of patients anesthetized with remifentanil.
Methods: In a randomized clinical trial, 54 patients aged 20-50 years old, with ASA physical status Ι, were studied in two groups (n=27), Ketamine- Remifentanil (K-R group) and Placebo- Remifentanil (P-R group). Exclusion criteria were ASA physical status >1, gastroesophageal reflux, tachycardia, bradycardia, systemic diseases, use of antihypertensive drugs, difficult intubations, risk of aspiration and contraindications of ketamine. Remifentanil was started at a rate of 0.5 µg. kg-1. min-1 and anesthesia was induced with thiopental sodium 2 mg.kg-1. Maintenance of anesthesia included halothane and nitrous oxide/oxygen mixture. Remifentanil infusion was continued in both groups at a rate of 0.5 µg.kg-1.min-1. In the K-R group, ketamine was started with an infusion rate of 10 µg.kg-1. min-1, 10 minutes after intubation, while in the P-R group, normal saline was started with the same dose of remifentanil. Heart rate, systolic, diastolic and mean arterial blood pressure were measured and compared at 1, 3, 5, 10, 15, 20, 25 and 30 minutes.
Results: No significant differences were found between basic patient characteristics of mean of age, sex, weight, systolic, diastolic and mean arterial blood pressure and heart rate (p>0.2) in the two groups. However, the rate of systolic, diastolic and mean arterial blood pressure changes in the P-R group was significantly greater than that of the K-R group (p<0.006). Heart rate changes were similar between the two groups (p=0.6). Incident of severe hypotension (a decrease of more than 25% of the basic value) was less in the K-R group than that of the P-R group (11% vs. 89% p=0.000).
Conclusion: Low-dose ketamine infusion modulates the effect of remifentanil-induced hypotension and provides better hemodynamic stability during general anesthesia.
Ebrahim Hassani , Rasoul Farasatkish , Evaz Heydarpour , Mohammadzia Totoonchi , Alireza Mahoori ,
Volume 67, Issue 9 (6 2009)
Abstract
Background: Measuring end tidal carbon dioxide (ETCo2) is one of the methods used for estimating arterial carbon dioxide (PaCo2) during general anesthesia. ETCo2 measurements maybe obviate the need for repeating arterial puncture for determination of arterial PaCo2. This study performed to determine the accuracy of ETCo2 levels as a measure of PaCo2 levels in patients undergoing coronary artery bypass graft and also to evaluate variation of the gradient between PaCo2 and ETCo2, peri- cardiopulmonary bypass operation. Methods: In a prospective, cross-sectional study, a total of 40 patients with age 57±11 (35-73) years old undergoing coronary artery bypass graft were enrolled. ETCo2 levels (mmHg) were recorded using side stream capnography at the time of arterial blood gas sampling, before (T0) and after (T1) cardiopulmonary bypass. Results: Mean P(a-ET)Co2 at T0 was 4.3±4.4mmHg, with the mean PaCo2, 33±6mmHg and mean ETCo2, 29±5mmHg and these values at T1 were 4.5±4.1mmHg, 33±5mmHg and 29±2mmHg respectively. There was no variation of the mean gradient (PaCo2-PETCo2) during, before and after cardiopulmonary bypass (p>0.870). Significant correlation was found between ETCo2 and PaCo2 at T0 and T1 (r=0.754 and 0.685respectively and p=0.001). Conclusion: Capnography is a non- invasive and a safe technique for determining arterial PCo2 and for measurements of ETCo2 that correlate well with PaCo2 values in healthy patients undergoing coronary artery bypass graft. ETCo2 measurements maybe sufficient measures of PaCo2 in selected patients and obviate the need for repeatingarterial blood gas determination. Further study is warranted.
Mahoori A, Noroozinia H, Hassani E, Motargemzadeh G, Sadeghi A,
Volume 68, Issue 5 (6 2010)
Abstract
Background: The Bispectral Index (BIS) is an EEG-derived value that measures the sedative and hypnotic component of the anesthetic state. The effects of age on the bispectral index have not been well documented. The objective of the present study was to determine the influence of age on hypnotic requirement and bispectral index in awake and in patients with sedation induced by midazolam.
Methods: Eighty patients were enrolled in this prospective observational study. The patients in study group were aged more than 70 years, and the age in control group ranged 20-40 years. Baseline recording of BIS was taken in awake patients in two groups for few minutes. Five minutes after administration of 0.02 mg/kg IV midazolam the BIS value also was taken and recorded.
Results: In the study group, patients had a mean base BIS 94±3 compared with 97.3±1 in the control group (p< 0.0001). Five minutes after administration of 0.02 mg/kg midazolam the value were 80.9±6 and 90.4±3 respectively (p< 0.0001).
Conclusion: When BIS is used as a monitor of hypnosis in the elderly, we recommend that a baseline recording be taken before induction for a few minutes to alert the anesthesia provider to the possibility of low initial values. Further studies are needed to verify if the recommended range of 50-60 of BIS during clinical anesthesia is also adequate in the elderly with low initial baseline BIS or if this range needs adjusting in view of reduced initial BIS value.
Noroozinia H, Mahoori A, Hassani E, Akhbari P,
Volume 69, Issue 3 (5 2011)
Abstract
Background: Non-steroidal anti-inflammatory drugs (NSADs) and opioids are
frequently administered to relieve postoperative pain. Uncontrolled postoperative pain may produce a range of detrimental acute and chronic health consequences and increase mortality and morbidity. Practically, the analgesic efficacy of opioids is typically limited by the development of tolerance to them or by opioid-related side- effects such as nausea, vomiting, sedation or respiratory depression. This study aims to assess the effects of suppository diclofenac on post-herniorrhaphy pain management. Methods: In this prospective double-blind clinical trial, 60 patients who were candidate for the surgical repair of inguinal hernia were divided into two groups. Patients in group A received 100 mg of suppository diclofenac and patients in group B 50 mg of pethidine after the induction of anesthesia and before surgical incision. Postoperative pain assessment was done by an unbiased observer on the arrival of patients in the recovery room, using a 10-cm visual analogue scale (VAS) at 2-hour intervals for 6 hours.
Results: Pain relief was similar in the two groups (P=0.3). Patients in group B required more analgesia two hours post-operatively (P=0.03), while patients in group A had more favorable results regarding pain control (P<0.05). Statistically, there was no difference
between the two groups at other intervals. The occurrence of nausea and vomiting was
similar in both groups. No respiratory depression was observed in the patients. Conclusion: Preventive analgesia with 100 mg of suppository diclofenac after anesthesia induction for herniorrhaphy produced effective postoperative analgesia with minimum side-effects
Pourghassem J, Mahoori A, Akhbari P,
Volume 69, Issue 10 (5 2012)
Abstract
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Background: Oral
metronidazole has been previously demonstrated to decrease postoperative pain
after open hemorrhoidectomy. The aim of this study was to evaluate the effect
of topical metronidazole in reducing postoperative pain of hemorrhoidectomy.
Methods : In this double-blind, clinical trial forty 20- to 40-year old male patients were scheduled for hemorrhoidectomy under
spinal anesthesia at the Imam Khomeini Hospital in Urmia, Iran from April to
September 2010. The participants were assigned to receive topical metronidazole (n=20) or placebo (n=20). Pain intensity was assessed
using
a visual analog scale (VAS), the time of first narcotic request and morphine administrations were also
recorded.
Results : The VAS scores were lower in metronidazole than the control group but this
difference was not statistically significant, except after 24 hr post-surgically. Morphine administration
in the first 24 hr was lower in the metronidazole group (P<0.05).
Conclusion: Although metronidazole
could not prolong the time of first analgesic request, but application of
metronidazole gel is associated with lower analgesic requirement.
Hassani Ebrahim, Mahoori Alireza, Mehdizadeh Hamid, Noroozinia Heydar, Aghdashi Mir Mousa, Saeidi Mohammad,
Volume 70, Issue 3 (4 2012)
Abstract
Background: Perioperative administration of tranexamic acid (TA), decreases bleeding and the need for transfusion after cardiac procedures. Hence, the results may vary in different clinical settings and the most appropriate timing to get the best results is unclear. The primary objectives of the present study were to determine the efficacy of TA in decreasing chest tube drainage, the need for perioperative allogeneic transfusions and the best timing for TA administration following primary, elective, coronary artery bypass grafting (CABG) in patients with a low baseline risk of postoperative bleeding.
Methods: In this double-blind, prospective, placebo-controlled clinical trial in Seiedoshohada Hospital during 2011-2012, we evaluated 150 patients scheduled for elective, primary coronary revascularization. They were randomly divided into three groups. Group B received tranexamic 10 mg/kg prior to, Group A received tranexamic acid 10 mg/kg after cardiopulmonary bypass and group C received an equivalent volume of saline solution. Blood requirement and postoperative chest tube drainage were recorded.
Results: The placebo group (group C) had a greater postoperative blood loss 12 h after surgery (501±288 vs. 395±184 in group B and 353±181 mL in group A, P=0.004). The placebo group also had greater postoperative total blood loss (800±347 vs. 614±276 in group B and 577±228 mL in group A, P=0.001). There was a significant increase in allogeneic blood requirement in the placebo group (P=0.001).
Conclusion: For elective, first time coronary artery bypass surgery, a single dose of tranexamic acid before or after cardiopulmonary bypass is equally effective.
Alireza Mahoori , Ebrahim Hassani , Heydar Noroozinia , Behzad Sinaei , Elham Esmaeili ,
Volume 71, Issue 5 (August 2013)
Abstract
Background: Pulseoximetry is widely used in the critical care setting, currently used to guide therapeutic interventions. Few studies have evaluated the accuracy of SPO2 (puls-eoximetry oxygen saturation) in intensive care unit after cardiac surgery. Our objective was to compare pulseoximetry with arterial oxygen saturation (SaO2) during clinical routine in such patients, and to examine the effect of mild acidosis on this relationship.
Methods: In an observational prospective study 80 patients were evaluated in intensive care unit after cardiac surgery. SPO2 was recorded and compared with SaO2 obtained by blood gas analysis. One or serial arterial blood gas analyses (ABGs) were performed via a radial artery line while a reliable pulseoximeter signal was present. One hundred thirty seven samples were collected and for each blood gas analyses, SaO2 and SPO2 we recorded.
Results: O2 saturation as a marker of peripheral perfusion was measured by Pulseoxim-etry (SPO2). The mean difference between arterial oxygen saturation and pulseoximetry oxygen saturation was 0.12%±1.6%. A total of 137 paired readings demonstrated good correlation (r=0.754 P<0.0001) between changes in SPO2 and those in SaO2 in samples with normal hemoglobin. Also in forty seven samples with mild acidosis, paired readings demonstrated good correlation (r=0.799 P<0.0001) and the mean difference between SaO2 and SPO2 was 0.05%±1.5%.
Conclusion: Data showed that in patients with stable hemodynamic and good signal quality, changes in pulseoximetry oxygen saturation reliably predict equivalent changes in arterial oxygen saturation. Mild acidosis doesn’t alter the relation between SPO2 and SaO2 to any clinically important extent. In conclusion, the pulse oximeter is useful to monitor oxygen saturation in patients with stable hemodynamic.
Alireza Mahoori , Ebrahim Hassani , Nazli Karami , Mehrdad Azizpoure ,
Volume 75, Issue 5 (August 2017)
Abstract
Background: Tracheal intubation and direct laryngoscopy are powerful noxious stimuli that can elicit sever hemodynamic responses. These hemodynamic responses should be attenuated by appropriate use of premedication, smooth induction of anesthesia and rapid tracheal intubation. Gabapentin and pregabalin have been suggested in several studies to be efficient. Gabapentin is an antiepileptic drug and a structural analogue of gamma-Aminobutyric acid (GABA) but it does not act through GABA receptors and pregabalin, is also an antiepileptic agent. The aim of this study was to compare the effect of gabapentin and pregabalin as premedication for attenuation of hemodynamic response to laryngoscopy and endotracheal intubation.
Methods: In a prospective double blinded randomized clinical trial, during April 2015 to March 2016 in Urmia Imam Khomeini Hospital, a total of ninety normotensive adult consented patients, candidate to elective abdominal surgery aged 20-50 years, American Society of Anesthesiologist (ASA) class I, of both gender were randomized into three groups. Patients in group I received oral placebo, group II received oral gabapentin 900 mg and group III patients received oral pregabalin 150 mg two hours prior to induction of anesthesia. Anesthetic technique was same in three groups and all groups were assessed for hemodynamic changes such as heart rate, systolic blood pressure and diastolic blood pressure, after the premedication, before and after induction of anesthesia, and 1, 3 and 5 minutes. after laryngoscopy and tracheal intubation.
Results: Significant increase in heart rate and systolic blood pressure and diastolic arterial pressure was observed in placebo group after tracheal intubation, while statistically significant attenuation of hemodynamic changes was seen in gabapentin and pregabalin groups. (P=0.001) No adverse outcome was reported in the study groups.
Conclusion: Oral gabapentin premedication is effective for control of hemodynamic pressor response of laryngoscopy and tracheal intubation. The study data showed that the pregabalin have the same effect. Pregabalin and gabapentin are both useful and safe for control of hemodynamic pressor response as premedication.
Alireza Mahoori, Nazli Karami , Seyedeh Zahra Karimi Sarabi ,
Volume 77, Issue 9 (December 2019)
Abstract
Background: Emergence from general anesthesia and removing of tracheal tube can be associated with coughing, agitation, and hemodynamic disturbances. Dexmedetomidine is an alpha two adrenoceptor agonist that has effective sedation with less cardiovascular unstability and respiratory depression and may be useful for extubation and prevention of hemodynamic response during tracheal tube removing. The aim of this study was to evaluate the effect of dexmedetomidine on hemodynamic responses during endotracheal extubation and sedation level in recovery room.
Methods: In an analytical study, fifty women aged 20-50 years old candidate to cholecystectomy under general anesthesia and tracheal intubation were entered randomly to this study in two groups (no. 25) at Imam Khomeini Hospital, Urmia, Iran, and under support of Urmia University of Medical Sciences Urmia, Iran, from May 2017 to May 2018. Ten minutes before end of surgery, 0.8 µg/kg dexmedetomidine in the study group and for the other patients in control group normal saline as placebo were infused over ten minutes. During the emergence phase, blood pressure, heart rate and oxygen saturation were recorded at 0,1,2,3 and 5 minutes after extubation. Also, sedation index was evaluated via the Ramsay sedation score and recorded at recovery room.
Results: Heart rate, systolic blood pressure and diastolic blood pressure in patient with infusion of dexmedetomidine were lower significantly at 1,2,3 and 5 minutes after extubation than control group. Data for heart rate, systolic and diastolic pressure, at min 1 after extubation were 81±6 vs. 88±9, 120.64±13.21 vs. 137.52±11.06, 72.84±8.32 vs. 81.36±9.26 in dexmedetomidine and control groups respectively. Data for heart rate, systolic and diastolic pressure, at min 5 after extubation were 73±6 vs. 80±8, 110.64±10.68 vs. 119.88±10.01, 69.84±8.32 vs. 73.48±5.13 in study and control groups, respectively. As well as 80% of the patients in dexmedetomidine group had satisfactory sedation and cooperation in compare to the 28% in control group (P=0.001).
Conclusion: Intravenous infusion of 0.8 µg/kg dexmedetomidine 10 minutes before extubation of endotracheal tube and during emergence, facilitate extubation and lead to hemodynamic stability and satisfactory sedation.
Alireza Mahoori , Nazli Karami , Shabnam Saeifar ,
Volume 77, Issue 12 (March 2020)
Abstract
Background: Arterial pressure is one of the most important physiological variables and often needs to be monitored repeatedly or continuously in perioperative period. Arterial pressure monitoring is one of the standard monitoring in operating room. During general anesthesia, blood pressure can be measured by using a noninvasive arterial pressure method or continuous invasive arterial pressure by an invasive arterial line. Comparison of invasive measurements in the patient’s candidate to esophagectomy has not been assessed. The aim of this study was to compare invasive and noninvasive blood pressure in these patients.
Methods: In a prospective, cross-sectional, observational study, 42 hemodynamically stable patients candidate for esophagectomy under general anesthesia in supine position were evaluated at Urmia Imam Khomeini Hospital operating room from June 2017 to April 2018. The patients had American Society of Anesthesiologists (ASA) physical status II or III and the patients who had complete heart block and marked arterial blood pressure differences greater than 10 mmHg in the two arms were excluded. After induction of anesthesia and patients monitoring, the radial artery was cannulated for invasive blood pressure monitoring and noninvasive blood pressure was measured via the arm cuff on the other hand at the four-time intervals: after radial artery cannulation (T1), during release of esophagus (T2), during anastomosis (T3) and at the end of operation (T4).
Results: The mean difference between indirect and direct systolic blood pressure was 0.85±2.93, -8.42±2.9, 6.50±3.60 and 2.67±2.6 mmHg and for diastolic blood pressure was 3.53±2.67, 4.57±2.22, 2.10±2.58 and 1.03±1.53 mmHg respectively, at the T1 to T4. At the all-time intervals, there were no statistically differences between systolic and diastolic blood pressure measurement regarding invasive and noninvasive blood pressure (P=0.77)
Conclusion: Noninvasive arterial blood pressure showed acceptable agreement with invasive measurements for systolic, diastolic and mean pressure. According to fhe finding of this study, there were no statistical differences between systolic and diastolic blood pressure measurement regarding invasive and noninvasive blood pressure and these two methods can be used in selected patients.
