Introduction: Everyday, millions of people around the world go through phlebotomy, either to donate blood or for therapeutic intention. The most important worrisome adverse effects are HEMODYNAMIC alterations. In this study, HEMODYNAMIC CHANGES following blood donation were assessed. Methods & Materials: Three hundred laborers who donated blood voluntarily were enrolled in this study. Blood pressure (BP) and pulse rate were measured before the procedure, ten minutes afterwards, and one week following phlebotomy. Hemoglobin (Hgb) and hematocrit (Hct) were also determined prior to and one week after phlebotomy. Finally, results before and after donation were compared with each other. Results: 242 volunteers had normal BP and 58 were hypertensive. The mean systolic blood pressures (SBP) before phlebotomy, ten minutes after the procedure, and one week later were 120, 117, and 122 mmHg, respectively. During the same periods of time, t~e mean of diastolic blood pressures (DBP) were 77 , 78 and 78mmHg , in order, while pulse rates on average were 80 , 82 and 76 beats/minute. None of the aforementioned CHANGES were clinically significant. After one week, Hgb decreased by about 0.3 g/dl (P<0.001) and Hct declined on average of 1.7 (P<0.001). Forty six individuals had high DBP and one week after donation, their DBP was reduced by 7 mmHg. Age, body mass index and smoking did not have any significant effect on HEMODYNAMIC status. Conclusion: HEMODYNAMIC CHANGES in healthy blood donors were not clinically significant. It seems that DBP drops desirably in hypertensive individuals. This needs to be evaluated more carefully in future studies.

Background: Laryngoscopy and endotracheal intubation are critical procedures and if the anthropometric indices of the patient leading to difficult intubation are not considered before the procedure, it can be accompanied by serious complications. One of the most practical concepts suggested about difficult intubation, is Cormack and Lehane criteria used in most medical centers.However, there is not any valuable study demonstrate the effect of anthropometric indices in difficult intubation and the immediate prediction of its complications. This study aimed to evaluate the correlation of anthropometric indices and HEMODYNAMIC CHANGES after laryngoscopy and endotracheal intubation.Methods: This descriptive-analytic study was carried out in 2012 in Kashani hospital, Isfahan, Iran. 130 patients with fulfilling inclusion criteria were entered the study. The recorded data included age, weight, height, neck circumference, waist-to-hip ratio and body mass index. The difficulty of intubation was assessed when the patient was completely unconscious. The predictive role of obesity indices in difficult intubation and the cardiovascular CHANGES after intubation was assessed using receiver operating characteristic (ROC) curve.Findings: The best cut-off point for body mass index (BMI) was 26.56; according to this cut-off point, the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of BMI were 100, 38.84, 10.8 and 91.1 percent, respectively. The best cut-off point for neck circumference was 38; according to this cut-off point, the sensitivity, specificity, PPV and NPV of neck circumference were 7.85, 2.28, 2.45, 1.91 percent, respectively.Conclusion: BMI, neck circumference and waist-to-hip ratio are valuable in assessing difficult intubation and their value is mostly due to NPV. Therefore, we can achieve a significant NPV and sensitivity in assessment of difficult intubation by considering all these indices.

OBJECTIVE: For several surgical procedures spinal anesthesia is preferred to general anesthesia. However some of its most important effects are reducing blood pressure (hypotension) and heart rate. In this study, we evaluated the effect of prophylactic intramuscular ephedrine before spinal anesthesia. METHODS: This study was conducted on 100 cases in A.S.A class, I (American society of anesthesiologists) between 20-60 years old who had no co-existing disease. They were randomly divided into two groups (each with 50 cases). The test group received 2Smg (%5ml) intramuscular ephedrine 10-15 minutes before spinal anesthesia & the subjects in control group received 5ml normal saline (0.9% ) as placebo. After receiving 500ml Ringer's solution, spinal anesthesia with 2cc lidocaine %5 was done. Heart rate, systolic & diastolic blood pressure have been measured seven times before ephedrine or placebo injection, before spinal anesthesia & during the procedure at the 2nd, 5th, 15th, 30th & 4Sth minutes. Then data were recorded & compared. FINDINGS: In this study, those who received prophylactic ephedrine had a raised heart rate & blood pressure before spinal anesthesia, but this rise was not more than %10 of the baseline & there was no need to treat their hypotention or reduced heart rate during anesthesia or the operation. But %28 of control group has received ephedrine for treatment of hypotention & %36 of them received atropine to manage bradycardia. After statistical analysis & comparing of these two groups, we have seen that the range of fall of heart rate, systolic & diastolic blood pressure in the study group was narrower than that in control group & their differences were meaningful (p=0.000). CONCLUSION: The results show that the patients who have received intramuscular ephedrine before spinal anesthesia, have a rather higher level of HEMODYNAMIC stability. Therefore, in patients for whom HEMODYNAMIC CHANGES, specially a reduced blood pressure is dangerous such as those with a heart disease, old patients or those undergoing caesarean section using of this method could be useful.          

To compare intubating conditions and HEMODYNAMIC CHANGES between Bonfils Intubation Fiberscope and Macintosh laryngoscopy without administering neuromuscular blocking drugs (NMBDs). METHODS: In this randomized controlled trial, 80 male and female patients, scheduled for elective surgery, aged 15 to 60 years, ASA class II or I, non-obese, non smokers, without anticipated difficult intubation; were randomly allocated into two groups of 40: Bonfils and Macintosh. Following adequate hydration and preoxygenation, midazolam 0.03 mg.kg-1 was administered, followed by intravenous alfentanil 20 mg.kg-1, lidocaine 1.0 mg.kg-1, and propofol 2 mg.kg-1 sequentially. Trachea was then intubated using Bonfils Intubation Fiberscope in the Bonfils group and conventional Macintosh laryngoscopy in the Macintosh group. Intubating condition, mean arterial blood pressure, heart rate, pulse oximetry, and success rate were measured. RESULTS: Clinically acceptable intubating condition scores did not differ significantly between the groups (P=0.465). Compared to the baseline values, heart rate rose significantly after intubation only in the Macintosh group (P<0.001). Although mean arterial blood pressure increased immediately after intubation in the Macintosh group (P=0.022), its post-intubation values were significantly less than baseline in both groups (P<0.001). Intubation time took much longer in the Bonfils group (40 s) than the Macintosh group (11 s), P<0.001. In the absence of NMBDs, Bonfils Intubation Fiberscope compares well with Macintosh laryngoscopy in terms of success rate and intubating conditions, but with less mechanical stress and HEMODYNAMIC compromise and longer intubation time.

Introduction: Electroconvulsive therapy (ECT) is an effective treatment for many psychological disorders, mainly major depression and schizophrenia which is often associated with some complications such as hypertension, tachycardia arrhythmia and even myocardial infarction.Various methods have been used for prevention or control of these cardiovascular side effects. The aim of this study was evaluating the effect of oral clonidine as premedication on HEMODYNAMIC response after ECT.Methods: This double-blind clinical trial was performed on 100 patients aged 15-50 years with ASA I and II who were candidates for ECT.Prior to ECT, patients were randomly divided to 2 equal groups. The first group (N =50) received oral clonidine and the second group (N =50) received placebo as premedication. After baseline measurement of heart rate, systolic and diastolic blood pressures, similar induction of anesthesia was done in both groups. Then ECT was induced. The patient’s heart rate, systolic and diastolic blood pressures were measured again 2 minutes after termination of convulsion. Data was analyzed by t-test p<0.05 was considered statistically significant. Results: Regarding age, sex and baseline HEMODYNAMIC parameters, the patients were similar in both groups. Mean systolic and diastolic blood pressures after ECT were significantly lower in clonidine group (p < 0.05), but there was no significant difference between heart rate after ECT in the two groups.Conclusion: According to these results, we recommend usage of clonidine as premedication before ECT.

BACKGROUND AND OBJECTIVE: Corticosteroids have been used for pregnant women for fetal lung maturation but there are many controversies about their effects and side-effects, the aim of this study was to determine the effects of betamethasone on the HEMODYNAMIC CHANGES (heart rate and blood pressure) in pregnant women.METHODS: This clinical trial study performed on 100 pregnant women at risk of preterm delivery between 24-34 weeks of gestation in Yahyanejad hospital in Babol (2006). Betamethasone was injected 12 mg (2 doses with 12 hours interval, IM) and systolic blood pressure, diastolic blood pressure and heart rate were measured before injection (2 times with 5 minute interval) and after first and second dose injection (after each dose 2 times with 2 hours interval). The data were analyzed by SPSS soft ware and compared.FINDINGS: The mean age of our patients was 24.2±4.7 years (16-40 years). The mean gestational age of our patients was 32.4 ± 2.6 weeks. The mean average of maternal heart rate after first dose of betamethasone administration (85.2± 8.2) was significantly higher than before treatment (84±8.2) (p=0.033). But there was no significantlydifference between the mean average of maternal systolic and diastolic blood pressure before and after each dose administration.CONCLUSION: Our results show that betamethasone don't have any significant effect on systolic and diastolic blood pressure CHANGES in pregnant women but it may increase the mean of maternal heart rate after first dose of injection that this change is transient. Betamethasone has no significant effect on the HEMODYNAMIC CHANGES in mother.

Background: The management of trauma patients is often difficult. The American college of surgeons suggests using advanced trauma life support (ATLS) measures. ATLS is regarded as the gold standard for the resuscitation of cases with acute life threatening injuries.Objectives: To assess the change in base excess (BE) values and central venous pressure (CVP) one and six hours after injection of 1000 cc normal saline in trauma patients admitted to the ICU.Patients and Methods: According to the inclusion and exclusion criteria, patients were randomly selected to participate in the project. Inclusion criteria included trauma patients admitted to the ICU with a CVP line and who had indication for hydration. In trauma patients, at the zero time period, BP, PR, RR and CVP were measured, and a blood gas test was used to assess Hb, pH, BE, PO2, HCO3 and PCO2. Then 1000 cc of normal saline was injected, and after one and six hours, the same values were re-evaluated.Results: The mean age of the patients was 38.1±3.9 (range 15 - 60). The mean duration of hospitalization was 7.4±4.4 (range 1- 21) days. The mean ISS for these patients was 14.33±5.3. BE CHANGES in both groups of patients, based on Hb primary division, showed a significant difference (P£0.05). The results showed that there was no significant relation between the measured ISS and the CHANGES in base values (P≥0.05).Conclusions: According to our results, the infusion of one liter normal saline will cause a statistically significant decrease only in BD, after one hour, in patients with moderate to severe ISS. The CHANGES in SBP, PR, CVP and also pH, HCO3 and Hb were not statistically remarkable.

Introduction: Laryngoscopy and intubation during general anesthesia is a painful stimulation that causes hypertension and tachycardia. Hypertension and tachycardia may induce arrhythmias and myocardial infarction in an ischemic heart. The aim of this study was to compare the HEMODYNAMIC effects of tracheal intubation through using the Macintosh and Miller laryngoscopy blades.Materials and methods: This study is a clinical trial performed at the University of Hormoozgan Medical Sciences during 2013-2015. A total of 203 patients candidates for elective were randomly divided into Macintosh laryngoscope blade (n=103) and Miller laryngoscope blade (n=100) groups. HEMODYNAMIC parameters were measured at the baseline, after induction and before intubation, immediately after intubation and minutes of one, three and five after intubation measure were recorded. After recording patient data, statistical data analysis was performed using SPSS version 19. Chi-Square and T-Test and Repeated ANOVA statistical tests were used. The values of P<0.05 was considered significant.Results: The demographic variables were similar. Mallampati scores and laryngoscopy grades were similar in both groups. The duration of laryngoscopy in Macintosh was significantly shorter than Miller (P=0.001). The mean systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and heart rate only at times; immediately, one and three minutes after intubation in Miller's group was significantly more than the Macintosh group.Conclusion: Because the time for laryngoscopy and HEMODYNAMIC CHANGES with a Miller blade was less than the Macintosh blade we concluded that the Miller blade showed a better profile and performance.