Browsing by Author "Alireza Pournajafian"

Now showing 1 - 9 of 9
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    Analgesic Effects of Paracetamol and Morphine After Elective Laparotomy Surgeries
    (Brieflands, 2014-05-01) Mahzad Alimian; Alireza Pournajafian; Alireza Kholdebarin; Mohammadreza Ghodraty; Faranak Rokhtabnak; Payman Yazdkhasti
    Background: Opioids have been traditionally used for postoperative pain control, but they have some unpleasant side effects such as respiratory depression or nausea. Some other analgesic drugs like non-steroidal anti-inflammatory drugs (NSAIDs) are also being used for pain management due to their fewer side effects. Objectives: The aim of our study was to compare the analgesic effects of paracetamol, an intravenous non-opioid analgesic and morphine infusion after elective laparotomy surgeries. Patients and Methods: This randomized clinical study was performed on 157 ASA (American Society of Anesthesiology) I-II patients, who were scheduled for elective laparotomy. These patients were managed by general anesthesia with TIVA technique in both groups and 150 patients were analyzed. Paracetamol (4 g/24 hours) in group 1 and morphine (20 mg/24 hours) in group 2 were administered by infusion pump after surgery. Postoperative pain evaluation was performed by visual analog scale (VAS) during several hours postoperatively. Meperidine was administered for patients complaining of pain with VAS > 3 and repeated if essential. Total doses of infused analgesics, were recorded following the surgery and compared. Analysis was performed on the basis of VAS findings and meperidine consumption. Results: There were no differences in demographic data between two groups. Significant difference in pain score was found between the two groups, in the first eight hours following operation (P value = 0.00), but not after 12 hours (P = 0.14) .The total dose of rescue drug (meperidine) and number of doses injected showed a meaningful difference between the two groups (P = 0.00). Also nausea, vomiting and itching showed a significant difference between the two groups and patients in morphine group, experienced higher levels of them. Conclusions: Paracetamol is not enough for postoperative pain relief in the first eight hour postoperatively, but it can reduce postoperative opioid need and is efficient enough for pain management as morphine after the first eight hours following surgery.
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    Anesthetic Management for Lower Limb Fracture in Severe Aortic Valve Stenosis and Fat Embolism: A Case Report and Review of Literature
    (Brieflands, 2014-05-01) Faranak Rokhtabnak; Mohammad Mahdi Zamani; Alireza Kholdebarin; Alireza Pournajafian; Mohammad Reza Ghodraty
    Introduction: Anesthesia in severe aortic stenosis, which describes a valve surface area less than 1 cm2, can result in rapid clinical deterioration and patient mortality. These patients may require treatment for aortic stenosis before any surgical intervention. In suitable patients percutaneous balloon aortic valvutomy appears to carry lower risk, but in emergency situations, it is important to determine which kind of anesthesia technique has the lowest risk for these patients, without any cardiac intervention. Case Presentation: In this case report, we present a patient who had tibia and fibula fractures and a symptomatic severe critical aortic stenosis which was diagnosed during a preoperative visit. The patient had exertional dyspnea, palpitations and fainting history, but he had not received any medical therapy before the present admission. During hospitalization and preoperative evaluation, a fat embolism occurred and the patient was admitted to the intensive care unit. Immediately after his recovery, we successfully managed the tibia and fibula fracture fixation without any cardiac intervention. Conclusions: Our anesthesia method was sciatic and femoral nerve block under double ultrasonic and nerve stimulator guidance.
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    Comparing the Effect of Adaptive Support Ventilation (ASV) and Synchronized Intermittent Mandatory Ventilation (SIMV) on Respiratory Parameters in Neurosurgical ICU Patients
    (Brieflands, 2016-12-01) Mohammadreza Ghodrati; Alireza Pournajafian; Ali Khatibi; Mohammad Niakan; Mohammad Hosein Hemadi; Mohammad Mahdi Zamani
    Background: Various modes of mechanical ventilation have different effects on respiratory variables. Lack of patients’ neuro-ventilatory coordination and increasing the work of breathing are major disadvantages in mechanically ventilated patients. Objectives: This study is conducted to compare the respiratory parameters differences in Adaptive support ventilation (ASV) and synchronized intermittent mandatory ventilation (SIMV) modes in neurosurgical ICU patients. Methods: In a crossover study, patients under mechanical ventilation in neurosurgical ICU were enrolled. The patients alternatively experienced two types of ventilations for 30 minutes (adaptive support ventilation and synchronized intermittent mandatory ventilation). The respiratory parameters (tidal volume, respiratory rate, airway pressure, lung compliance, end-tidal carbon dioxide, peripheral oxygenation and respiratory dead space), hemodynamic variables, every 10 minutes and arterial blood gas analysis at the end of each 30 minutes were recorded. Results were compared and analyzed with SPSS v.19. Results: Sixty patients were involved in this study. In ASV mode, values including peak airway pressure (P-peak), end-tidal carbon dioxide (EtCO2), tidal volume and respiratory dead space were significantly lower than SIMV mode. Although the mean value for dynamic compliance had no significant difference in the two types of ventilation, it was better in ASV mode. Conclusions: ASV mode compared with SIMV mode can lead to improve lung compliance and respiratory dead space.
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    Comparing the Effect of Preoperative Administration of Melatonin and Passiflora incarnata on Postoperative Cognitive Disorders in Adult Patients Undergoing Elective Surgery
    (Brieflands, 2017-02-28) Faranak Rokhtabnak; Mohammad Reza Ghodraty; Alireza Kholdebarin; Ali Khatibi; Seyedeh Somayeh Seyed Alizadeh; Zahra Sadat Koleini; Mohammad Mahdi Zamani; Alireza Pournajafian
    Background: Anxiety is a preoperative complication, which most patients encounter. The use of a premedication to reduce preoperative anxiety with minimal cognitive impairment is crucial. Objectives: This study was conducted to compare the sedative effect of preoperative melatonin and Passiflora incarnata in patients undergoing elective surgery regarding their potential for postoperative cognitive disorders. Methods: In this clinical trial, 52 patients American society of anesthesiologists grade (ASA) I and II of both genders were selected to receive either Passiflora incarnata (1000 mg nature made) (n = 26) or melatonin (6 mg) (n = 26) as premedication one hour before surgery. Post-operative pain was evaluated using the visual analogue scale (VAS). Patient’s anxiety and cognitive dysfunction was evaluated with the Ramsey score and the digital symbol substitution test (DSST), respectively. All tests were carried out and evaluated at arrival in the operating room, before induction and before discharge from the post anesthesia care unit (PACU). Results: There were no statistically differences between groups in VAS (P > 0.05). However, the mean score of pain was higher in the melatonin group compared to the Pssiflora incarnata group when discharged from the PACU (27.63 vs. 25.37). The anxiety scores were statistically significant in both drugs (P = 0.001), however higher sedation scores was caused by premedication with melatonin (P = 0.003 vs. 0.008). Regarding the DSST, there was a significant difference between the two groups one hour before the surgery (P = 0.04) and at the time of discharge from the PACU (P = 0.007). When evaluating each group, the Passiflora incarnata group revealed a significant difference (P = 0.003). Conclusions: Our findings show that premedication with Passiflora incarnata reduces anxiety as well as Melatonin. However, Melatonin causes less cognitive impairment compared to Passiflora incarnata.
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    Controlled Hypotension During Rhinoplasty: A Comparison of Dexmedetomidine with Magnesium Sulfate
    (Brieflands, 2017-12-30) Faranak Rokhtabnak; Soudabeh Djalali Motlagh; Mohamadreza Ghodraty; Alireza Pournajafian; Mojtaba Maleki Delarestaghi; Arash Tehrani Banihashemi; Zeinab Araghi
    Objective: The current study aimed at comparing the efficacy of dexmedetomidine and magnesium sulfate to control blood pressure (BP) during rhinoplasty and the resultant effects on the quality of surgical field in terms of bleeding and visibility. Methods: The current randomized, prospective, double-blind study was conducted on 60 patients aged 18 to 50 years classified as ASA (American Society of Anesthesiologists) physical status I who were candidates for rhinoplasty. Patients were randomly divided into 2 groups: (1) group Dex, received 1 µg/kg dexmedetomidine in 10 minutes before induction of anesthesia, followed by 0.4 - 0.6 µg/kg/hour during the maintenance of anesthesia, and (2) group Mg, received 40 mg/kg in 10 minutes before anesthesia induction followed by 10 - 15 mg/kg/hour during anesthesia maintenance. In both groups, the goal was to achieve a mean arterial pressure (MAP) of 60 - 70 mmHg. Hemodynamic variables, anesthetic, opioid, muscle relaxant requirements, and surgical field condition were recorded. Sedation score, time to reach modified Aldrete score ≥ 9, and adverse effects including nausea and vomiting (N&V) and shivering were recorded. Results: Controlled hypotension was achieved in both groups. There was no significant difference in MAP between the groups, but heart rate (HR) was significantly lower in the Dex group (P < 0.001), compared with that of the Mg group. Bleeding score was lower (P < 0.001) and surgeon’s satisfaction score was higher (P < 0.001) in the Dex group. More patients required fentanyl (P < 0.001) or nitroglycerin (P < 0.001) and the mean fentanyl (P = 0.005) or nitroglycerin (P < 0.001) required doses were higher in the Mg group. Patients in the Dex group required more frequent administration of cisatracurium (P = 0.004). Five patients in the Dex group versus no patients in the Mg group received atropine (P = 0.023). Ramsay sedation score and time to reach modified Aldrete score ≥ 9 were significantly higher in the Dex group (P < 0.001 and P < 0.001, respectively). The incidence rate of N&V and shivering were similar in both groups. Conclusion: Dexmedetomidine was more effective than magnesium to achieve controlled hypotension, and provide a favorable surgical field condition. However, dexmedetomidine also heightened the risk of induced bradycardia and prolonged sedation. These are 2 important points to consider when applying this drug as a hypotensive agent during operation.
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    Effect of Intraoperative Hypertension on Postoperative Pain Severity After Abdominal Hysterectomy: A Randomized Controlled Trial
    (Brieflands, 2018-08-31) Alireza Kholdebarin; Reza Salehi; Soudabeh Djalali Motlagh; Mahnaz Fateh Boroumand; Zahra Sadat Koleini; Alireza Pournajafian
    Background: Pain is a common complain after surgeries, which leads to severe complications. Objectives: Elucidating the effect of intraoperative hypertension on post-operative pain after hysterectomy was the main aim of the current study. Methods: In this randomized controlled clinical trial that was conducted at Firoozgar Hospital, Tehran, Iran, 78 candidates for hysterectomy with past medical history of hypertension were randomly allocated to two groups. In group A, blood pressure was maintained in the range of stage 1 by dose adjustment of the anesthetic drugs. However, in group B, blood pressure was maintained in the normal range (SBP ≤ 120, DBP ≤ 80), by administration of anesthetic drugs and TNG drip. Preoperative and intra operative data (hematocrit, blood pressure, heart rate, operating time, and blood loss) and recovery data, including blood pressure, heart rate, pain score at two, four, six, 12, and 24 hours using VAS (after surgery), and pain relief medicine requirements after 24 hours were recorded for all patients and analyzed by SPSS 22.0. Results: Systolic and diastolic blood pressure before surgery did not show any significant differences (P ≥ 0.05). A significant decrease was found in systolic (P ≤ 0.001) and diastolic (P ≤ 0.014) blood pressure during surgery between groups. Comparing VAS and the need for pain relief drugs revealed no significant differences. However, a reduction of pain score was observed in the hypertensive group from the 2nd to 24th hour after surgery. Conclusions: No significant differences were shown between pain score and opioid requirement after surgery in hypertensive patients compared to normotensive during abdominal hysterectomy.
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    The Effect of Pneumoperitoneum-induced Hypertension During Laparoscopic Cholecystectomy Under General Anesthesia on Postoperative Pain: A Randomized Clinical Trial
    (Brieflands, 2021-12-31) Alireza Pournajafian; Ali Khatibi; Behrooz Zaman; Amir Pourabbasi
    Background: Acute postoperative pain is a significant cause of morbidities. This study aimed to evaluate the effect of intraoperative blood pressure during laparoscopic cholecystectomy under general anesthesia on postoperative pain in patients without underlying disorders. Methods: In this randomized clinical trial, 72 patients undergoing general anesthesia for elective laparoscopic cholecystectomy were randomly assigned into two groups: Group A with higher than baseline preoperative blood pressure (MAP allowed to increase up to 20% higher than baseline MAP by inducing pneumoperitoneum) and group B with normal to low blood pressure (MAP deliberately controlled at a tight limit from normal baseline MAP values to 20% less than baseline by titrating TNG infusion). The Visual Analog Scale (VAS) after 2, 8, 12, and 24 hours of surgery, and the total dose of meperidine used to manage postoperative pain were recorded and compared between the two groups. Results: The pain scores in group A were significantly lower than group B (P = 0.001). The postoperative analgesia request time was different between the two groups (P = 0.53). During the first 24 hours, the total meperidine consumption dose in group A was significantly lower than in group B (P = 0.001). Conclusions: High intraoperative blood pressure may affect the postoperative pain after laparoscopic cholecystectomy and lead to less postoperative pain score and analgesic requirements.
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    Effects of the Preoperative Administration of Fibrinogen on Intraoperative Bleeding in Pelvic Surgeries
    (Brieflands, 2023-04-30) Alireza Pournajafian; Faranak Rokhtabnak; Seyed Alireza Seyed Siamdoust; Majid Charousaee
    Background: Orthopedic surgeries are frequently complicated with a high amount of intra-operative hemorrhage, and this bleeding has a direct effect on the results of these operations. Objectives: This study evaluated the effect of preoperative administration of fibrinogen on intraoperative bleeding in pelvic surgeries. Methods: This study was a double-blinded, randomized clinical trial. Forty-two patients were randomly divided into two groups of fibrinogen and placebo. Hemoglobin, platelet, and fibrinogen levels were measured in all patients before surgery. In the intervention group, the patients received 1 gr. of fibrinogen after the induction of anesthesia. In the control group, the patients received the same volume of normal saline. All data on bleeding, transfused blood, blood pressure, duration of surgery, hemoglobin, platelet, and fibrinogen levels were recorded during a 24-hour period after surgery. Results: There was no significant difference in terms of age and sex between the groups (P > 0.05). There was no significant difference between hemoglobin, blood transfusion rate, international normalization ratio (INR), prothrombin time (PT), and partial thromboplastin time (PTT) in the two study groups (P > 0.05). Patients' bleeding rate was significantly lower in the fibrinogen group (1328.57 ± 227.8 mL) than in the placebo group (1610 ± 479.58 mL) (P < 0.05). However, there was no significant difference between serum levels of fibrinogen before and after surgery in both groups (P > 0.05). Conclusions: Although prophylactic injection of fibrinogen did not decrease the rate of blood transfusion to the patients in pelvic surgeries, it resulted in a significant bleeding reduction.
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    Success Rate of Airway Devices Insertion: Laryngeal Mask Airway Versus Supraglottic Gel Device
    (Brieflands, 2015-04-01) Alireza Pournajafian; Mahzad Alimian; Faranak Rokhtabnak; Mohammadreza Ghodraty; Mozhgan Mojri
    Background: The main important method for airway management during anesthesia is endotracheal intubation. Laryngeal mask airway (LMA) and supraglottic gel device (I-Gel) are considered alternatives to endotracheal tube. Objectives: This study sought to assess the success rate of airway management using LMA and I-Gel in elective orthopedic surgery. Patients and Methods: This single-blinded randomized clinical trial was performed on 61 ASA Class 1 and 2 patients requiring minor orthopedic surgeries. Patients were randomly allocated to two groups of LMA and I-Gel. Supraglottic airway placement was categorized into three groups regarding the number of placement attempts, i.e. on the first, second, and third attempts. Unsuccessful placement on the third attempt was considered failure and endotracheal tube was used in such cases. The success rate, insertion time, and postoperative complications such as bleeding, sore throat, and hoarseness were recorded. Results: In the I-Gel group, the success rate was 66.7% for placement on the first attempt, 16.7% for the second, and 3.33% for the third attempt. In the LMA group, the success rates were 80.6% and 12.9% for the first and second attempts, respectively. Failure in placement occurred in four cases in the I-Gel and two cases in LMA groups. The mean insertion time was not significantly different between two groups (21.35 seconds in LMA versus 27.96 seconds in I-Gel, P = 0.2). The incidence of postoperative complications was not significantly different between study groups. Conclusions: I-Gel can be inserted as fast as LMA with adequate ventilation in patients and has no major airway complications. Therefore, it could be a good alternative to LMA in emergency airway management or general anesthesia.