Introduction: Increasing use of regional anesthesia instead of general anesthesia may be the most important factor in decreasing anesthetic difficulties (e.g. difficult intubations, aspiration pneumonia, and analgesic side effect) in caesarean section. Quality of regional anesthesia is improved by adding morphine, fentanyl and sufentanil. The function of Epinephrine is dose-dependent. For instance, in small dosage, it has stimulating effects on Beta1 and Beta2 causing venous stasis to minimize. However, in large doses, Epinephrine’s Alfa adrenergic is dominant. This study aimed at investigating the potential HEMODYNAMIC effects of adding Epinephrine to lidocaine during spinal anesthesia on expecting mothers who are candidates of caesarean section.Materials and Methods: This study was a prospective, randomized, double-blind, controlled trial on 100 pregnant women who were candidates for caesarean section with ASA class I, II in the year of 1387.The subjects of the study were divided into two groups, (1) and (2) on the basis of the randomized digital table as follows: Group 1: 80 mg lidocaine 5% +2 micro gram sufentanil Group2: 80 mg lidocaine 5%+2 micro gram sufentanyl+0.2 mg (0.2cc) Epinephrine. Both groups received the drugs intrathecally. Vital signs such as systolic and diastolic blood pressure, pulse rate and SPO2 were recorded both before the anesthesia and thereafter every 5 minutes until the end of the operation. The measuring procedure continued during and after the recovery stage. Besides, the side effects and the drugs needed were recorded.Results: According to the findings in this study, there weren't any significant differences between the two groups in terms of age, weight, ASA, NPO timing and the previous surgery. There weren't any significant differences between the two groups of the study in terms of systolic and diastolic blood pressure, either. However, some hypotension was noted in Adrenaline group. Also, there weren't any significant differences in PR but some bradycardia was seen in Adrenaline group, too. There weren't any significant differences in SPO2 and side effects (nausea, vomiting, dysphagia, respiratory disorder, shivering) between the two groups.Conclusion: Adding Epinephrine to Lidocaine 5% increased the duration of spinal aesthesia in caesarean section whereas no significant difference was observed in terms of HEMODYNAMIC and side effects. Nevertheless, regarding the emergence of hypotension and bradycardia observed in the Adrenaline group, no matter how rare, close control of HEMODYNAMIC in this group is essential.

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: Among the indices able to replace invasive central venous pressure (CVP) measurement for patients with acute decompensated heart failure (ADHF) the diameters of the inferior vena cava (IVC) and their respiratory fluctuations, so-called IVC collapsibility index (IVCCI), measured by echocardiography, have recently gained ground as a quite reliable proxy of CVP.Objectives: The aims of our study were to compare three different ways of evaluating cardiac overload by using the IVC diameters and/or respiratory fluctuations and by calculating the inter-method agreementPatients and Methods: Medical records of patients hospitalized for right or bi-ventricular acute decompensated heart failure from January to December 2013 were retrospectively evaluated. The predictive significance of the IVC expiratory diameter and IVC collapsibility index (IVCCI) was analyzed using three different methods, namely a) the criteria for the indirect estimate of right atrial pressure by Rudski et al. (J Am Soc Echocardiogr. 2010), b) the categorization into three IVCCI classes by Stawicki et al. (J Am Coll Surg. 2009), and c) the subdivision based on the value of the maximum IVC diameter by Pellicori et al. (JACC Cardiovasc Imaging. 2013).Results: Among forty-seven enrolled patients, those classified as affected by persistent congestion were 22 (46.8%) using Rudski’s criteria, or 16 (34%) using Stawicki’s criteria, or 13 (27.6%) using Pellicori’s criteria. The inter-rater agreement was rather poor by comparing Rudski’s criteria with those of Stawicki (Cohen’s kappa=0.369, 95% CI 0.197 to 0.54), as well as by comparing Rudski’s criteria with those of Pellicori (Cohen’s kappa=0.299, 95% CI 0.135 to 0.462). Further, a substantially unsatisfactory concordance was also found for Stawicki’s criteria compared to those of Pellicori (Cohen’s kappa=0.468, 95% CI 0.187 to 0.75).Conclusions: The abovementioned IVC ultrasonographic criteria for HEMODYNAMIC congestion appear clearly inconsistent. Alternatively, a sequential or simultaneous combination of clinical scores of congestion, IVC ultrasonographic indices, and circulating levels of natriuretic peptides could be warranted.

Background Electroconvulsive therapy (ECT) is a safe and practical treatment method for patients with severe, refractory, or emergency psychiatric disorders. However, ECT is often associated with HEMODYNAMIC fluctuations. Objective This study aims to investigate the patterns of HEMODYNAMIC changes in patients undergoing ECT. Methods This longitudinal study was conducted in Shafa Hospital, a referral and academic center in Rasht City, Iran, in 2020. The HEMODYNAMIC parameters, including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded before the induction of anesthesia (T0), 1 min after the induction of anesthesia (T1), 1 min after the seizure (T2), and 15 min after the wakefulness (T3). The trend of changes of these parameters was compared in the above-mentioned time intervals. Results The data from 126 patients were analyzed. Most of the cases were diagnosed with a psychotic disorder of schizophrenia (59. 5%) and a minority had major depression (14. 3%). Meanwhile, 15. 9% of the patients suffered from comorbidities. In terms of SBP, DBP, and MAP, the trend of changes was significant (P=0. 0001) at four measurement point times, but this was not true for HR (P=0. 74). However, all changes in the HEMODYNAMIC parameters were kept in the normal range. Conclusion Our study showed that despite the fluctuations in the HEMODYNAMIC parameters during ECT, patient management was acceptable as a result of the teamwork and appropriate interaction of psychiatric and anesthesia teams.

Background: General anesthesia could be accompanied by changes in HEMODYNAMIC parameters (arterial blood pressure, heart rate, rhythm, central venous pressure, and venous blood pressure) that would result in altered intracranial pressure. In deep anesthesia the brain perfusion is dependent on blood pressure. The present study was conducted to determine the effects of neurosurgery on HEMODYNAMIC parameters in Naghavi Hospital in Kashan. Materials and methods: This quasi-experimental study was performed on 112 patients. Systolic and diastolic blood pressure, and cardiac rhythm and rate were measured. Then the influence of sex, age, type of operation, duration of surgery and patients position on aforementioned parameters were evaluated. Results: The study population included 70 males and 42 females, most of whom aged ≥40 years. HEMODYNAMIC changes were more apparent among males. Meanwhile, age of ≥40 years, spinal surgery, prone position, and operations of more than 2-hour duration were associated with greater HEMODYNAMIC changes. Changes in systolic and diastolic blood pressure during induction was significantly differed regarding the duration of operation and patients position. Conclusion: HEMODYNAMIC changes are common in neurosurgical operations. These are different according to the type and duration of surgery and patients position. Further studies are highly recommended.