سال:1398 | دوره: | شماره: |تعداد مقالات:7

Lifelong learning process is recommended for all health care providers, while emphasis is always on the routine procedures or the most frequently used parts of knowledge (1). As anesthesiologists encounter drug administration more than any other specialty in medicine, this field seems to be partly neglected in continuing medical education...

Background: Surgical stresses can reduce the activity level of antioxidant enzymes. The brain is one of the vital organs of the body and yet vulnerable to oxidative damage. Considering the antioxidative effects of anesthetics, this study aimed to compare the effect of isoflurane and propofol on the serum levels of catalase, glutathione peroxidase and superoxide dismutase in patients who experienced craniotomy due to supratentorial tumor. Methods and materials: This randomized clinical trial was performed on 40 patients with supratentorial tumor craniotomy in Loghman Hakim hospital in Tehran (capital city of Iran), who were randomly assigned to receive propofol and isoflurane. Data were collected using a questionnaire including age, sex, serum glutathione peroxidase level, serum superoxide dismutase level, serum catalase levels, duration of surgery, and fentanyl. Data were analyzed using SPSS-21 software, Chi-Square, Paired T-test, ANOVA, independent t-test, Kruskal-Wallis and Wilcoxon tests. Results: Increasing in serum catalase level after surgery was significant in propofol group (p=0. 002), but not significant in isoflurane group. Reduction of serum glutathione peroxidase level after surgery was significant in the isoflurane group (p=0. 003), but not significant in propofol group. Reduction of serum level of superoxide dismutase after surgery was not significant in both groups. Serum levels of catalase, glutathione and superoxide dismutase were not significantly correlated with age, sex, fentanyl and duration of surgery. Conclusion: The study showed that serum catalase levels increased in the propofol group after surgery. However, serum glutathione peroxidase levels decreased in the isoflurane group after surgery. Changes in serum level of superoxide dismutase after surgery were not related to the type of anesthetic drug.

Background: L-carnitine seems to be able to prevent complications after heart surgery using Cardiopulmonary bypass (CPB) and the adverse effects of pump usage. This study aimed to evaluates the effects of L-carnitine on cardiac biomarkers and operation characteristics after coronary artery bypass graft (CABG) surgery. Methods and materials: In this randomized triple-blinded, sixty patients undergoing elective CABG surgery were divided into three equal groups to receive 2gr oral L-carnitine (group A), 5gr oral L-carnitine (group B) and placebo (group C) 2 hours before surgery. IL-6, creatinine, and high sensitivity C-reactive protein (HS– CRP) levels, CK-MB, cardiac troponin and inotrope administration in ICU or after CPB were recorded for all patients at baseline levels and at 8 or 24 hours postoperatively. Results: There was an evidence of a significant difference in CPK-MB level and number of red blood cell packed used in group A was lower than group C (p<0. 05). The cardiac troponin level 8 hours after surgery significantly decreased in two treatment groups in comparison to group C (p<0. 05). The need for inotropic support after weaning from CPB, in B group was statistically higher than C group (p=0. 021). Conclusion: Although L-carnitine adjunct therapy appears not to be associated with IL-6 and HS– CRP levels, it had beneficial effects on cardiac troponin and CPK-MB levels.

Background: Arterial blood sampling is among the basic standards in critically ill patients. The aim of this study was to examine an inventive sampling device in facilitating arterial blood sampling in comparison to the conventional method using an insulin syringe. Methods and materials: This randomized interventional clinical trial was performed on 100 patients admitted to Qaem and Imam Reza Hospitals in Mashhad in 2016 for whom two arterial blood gas (ABG) samples were indicated. The patients were randomly selected by the visiting operator on a daily basis. The operator visited the hospital on certain days and took two samples from the selected patients. Results: The patients' mean age was 45. 31± 16. 15 years. In the insulin syringe group, venous blood gas sampling was in 24% and arterial sample in 76%. In the designed device group, same figures were 12. 1% and 87. 9%, respectively. Sampling score (p=0. 01), unsuccessful attempts with and without needle removal from the skin (p=0. 01), and need for vertical and horizontal needle displacement for sampling (p=0. 01) were significantly differed between the two groups. Localized swelling score and its size, localized bruising, palpable arterial spasm and the spasm duration was significantly less for the inventive device (p<0. 05). Satisfaction score of patients and operator were significantly higher in the device group (p=0. 01). Conclusion: The study device had desirable function in facilitating and accelerating arterial blood sampling. Its application can be further approved by future studies.

Background: the effect of three drugs; Ketorolac, Paracetamol and Parecoxib, on patients undergoing lower extremities orthopedic surgeries were compared regarding their analgesic effects. Materials and methods: 140 patients undergoing lower extremities orthopedic surgery were assigned in four groups: 35 patients in each. In Parecoxib group, 20 mg of the drug was infused in 20 minutes and then 60 mg of Parecoxib was added to the pump and the rest of the pump was filled with normal saline up to100 ml. In Ketorolac group, 15 mg Ketorolac was infused in 20 minutes and then, 45 mg of Ketorolac was added into the pump and the rest of the pump was filled with normal saline up to 100 ml. In Paracetamol group 500 mg Paracetamol was infused in 20 minutes and then 1500 mg of Paracetamol was added into the pump and the rest of the pump was filled with normal saline up to 100 ml. In the placebo group, infusion pump was filled with 100 ml of normal saline. Results: Pain score was not significantly different between Paracetamol and placebo groups. Six hours after operation, only the difference in the mean pain scores between Parecoxib and placebo groups was significant. However, 12 and 18 hours after operation, the mean pain score in Parecoxib group was significantly lower than Paracetamol and placebo groups (p<0. 05). Nevertheless, 24 hours after operation, the mean pain score in Parecoxib and Ketorolac groups were significantly lower than placebo group (p<0. 05). Conclusion: The results showed that Parecoxib could be used for postoperative pain management in orthopedic lower limb surgeries. Ketorolac and Paracetamol could reduce morphine requirements in similar patterns.

Psoriasis is a systemic inflammatory skin disease affecting up to 3% of the population. Skin lesions are symmetric erythematous papules and plaques with sharp demarcation covered with silvery white scales in scalp, elbows, knees, fingers and sacral areas. Metabolic diseases such as obesity and diabetes are more common in psoriatic patients. Strong evidence suggests T lymphocyte based immunogenesis and an increased amount of proinflammatory cytokines including IL-1, IL-6, IL-8 and TNF-alpha were detected in psoriatic plaques. We report a 51-year-old male patient with a history of psoriasis for 30 years scheduled for coronary artery bypass grafting surgery and discuss the anesthetic implications in such patients.

Dear Editor, There is a substantial fret over drug addiction in Malaysia due to the close geographical proximity to other Southeast Asian countries that are known to produce a massive number of adulterous drugs (1). It is saddening to know that the utmost frequently misused drugs here in this country comprises of cannabis, heroine, and methamphetamine (METH). In addition to this, METH has been particularly expanded its popularity here in Malaysia (2). METH is derived from amphetamine that has more psychotropic properties and it produced an immense kind of indication that includes irritability, hyperawareness, physical hostility and psychomotor distress. This phenylethylamine is a strong psychostimulant that produces both addiction and dependence (3)...