Brieflands Library :: Browsing by Author "Mahzad Alimian"

Browsing by Author "Mahzad Alimian"

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Adding Dexmedetomidine to Bupivacaine in Ultrasound-guided Thoracic Paravertebral Block for Pain Management after Upper Abdominal Surgery: A Double-blind Randomized Controlled Trial
(Brieflands, 2021-12-31) Mahzad Alimian; Farnad Imani; Poupak Rahimzadeh; Seyed Hamid Reza Faiz; Leila Bahari-Sejahrood; Arthur C. Hertling
Background: Paravertebral blocks are one of the possible postoperative pain management modalities after laparotomy. Adjuvants to local anesthetics, including alpha agonists, have been shown to lead to better pain relief and increased duration of analgesia. Objectives: The aim of this study is to examine the effect of adding dexmedetomidine to bupivacaine for ultrasound-guided paravertebral blocks in laparotomy. Methods: In this double-blind, randomized controlled trial (RCT), we enrolled 42 patients scheduled for T6 to T8 thoracic paravertebral block (TPVB) for analgesia after laparotomy. The patients were randomly assigned into two groups of BD (bupivacaine 2.5 mg/mL 20 mL plus dexmedetomidine 100 µg) and B (bupivacaine 20 mL alone). Following surgery, intravenous fentanyl patient-controlled analgesia was initiated. The numerical rating scale (NRS) for pain, sedation score, total analgesic consumption, time to first analgesic requirement, side effects (such as nausea and vomiting), respiratory depression, and patients’ satisfaction during the first 48 hours of evaluation were compared in the two groups. Results: Pain scores and mean total analgesic consumption at the first 48 hours in the BD group were significantly lower than Group B (P = 0.03 and P < 0.001, respectively). The time of first analgesic request was significantly longer in BD group (P < 0.001). Sedation scores and side effects did not differ significantly between the two groups. Conclusions: Adding dexmedetomidine to bupivacaine for TPVB after laparotomy yielded better postoperative pain management without significant complications.
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.
Comparison of Effects of Stress and Midazolam on Retrograde and Anterograde Amnesia in Patients Undergoing General Anesthesia
(Brieflands, 2023-02-28) Ali Akbar Jafarian; Ali Khatibi; Mehrdad Mesbah Kiaei; Mahmood-Reza Alebouyeh; Mahzad Alimian; Azadeh Habibi; Saied Amniati
Background: The identification of different factors affecting anesthesia and physiological changes during anesthesia can be effective in improving the quality of anesthesia. Midazolam is a benzodiazepine that has been used for many years for sedation under anesthesia. Stress is also an important factor affecting memory and other physiological changes, such as blood pressure and heart rate. Objectives: his study aimed to investigate the effects of stress on retrograde and anterograde amnesia among patients undergoing general anesthesia. Methods: This multi-center, parallel, stratified, randomized controlled trial was performed on patients undergoing non-emergency abdominal laparotomy. The patients were divided into high- and low-stress groups according to the Amsterdam Preoperative Anxiety and Information Scale. Then, both groups were randomly divided into three subgroups receiving 0, 0.02, or 0.04 mg/kg of midazolam. Recall cards were shown to patients at 4 minutes, 2 minutes, and immediately before injection to determine retrograde amnesia and at 2 minutes, 4 minutes, and 6 minutes after injection to determine anterograde amnesia. Hemodynamic changes were recorded during intubation. The chi-square and multiple regression tests were used to analyze the data. Results: Midazolam injection was associated with the development of anterograde amnesia in all groups (P < 0.05); however, it had no effect on the development of retrograde amnesia (P < 0.05). Midazolam could decrease the systolic and diastolic blood pressure and heart rate during intubation (P < 0.05). Stress also caused retrograde amnesia in patients (P < 0.05); nevertheless, it had no effect on anterograde amnesia (P > 0.05). Stress and midazolam injection could not affect the oxygen levels during intubation. Conclusions: The results showed that midazolam injection could induce anterograde amnesia, hypotension, and heart rate; nonetheless, it had no effect on retrograde amnesia. Stress was associated with retrograde amnesia and increased heart rate; however, it was not associated with anterograde amnesia.
Comparison of Perioperative Pregabalin and Duloxetine for Pain Management After Total Knee Arthroplasty: A Double-Blind Clinical Trial
(Brieflands, 2023-02-28) Farnad Imani; Azadeh Emami; Mahzad Alimian; Nasim Nikoubakht; Niloofar Khosravi; Mehdi Rajabi; Arthur Christopher Hertling
Background: Chronic residual pain after total knee arthroplasty (TKA) is one of the challenges of postoperative pain management. Duloxetine, by controlling neuropathic pain, and pregabalin, by affecting nociceptors, can effectively manage postoperative pain. Objectives: This study aimed to compare the effect of perioperative oral duloxetine and pregabalin in pain management after knee arthroplasty. Methods: In this clinical trial, 60 patients scheduled for TKA under spinal anesthesia were randomly assigned to one of three groups A (pregabalin 75 mg), B (duloxetine 30 mg), and C (placebo). Drugs were administered 90 minutes before, 12, and 24 hours after surgery. The visual analog scale (VAS) score for pain, the first analgesic request time, postoperative analgesic consumption (i.v. paracetamol), and WOMAC score six months after surgery were recorded. Results: The VAS score and analgesic consumption 48 hours after TKA in groups A and B significantly decreased compared to the placebo (P < 0.05). The first analgesic request time was longer in groups A and B than in group C (P < 0.05). While the differences were statistically significant, they are most likely not clinically significant. The WOMAC score before and six months after arthroplasty did not differ between the groups (P > 0.05). Conclusions: Perioperative oral pregabalin and duloxetine similarly reduce pain and the need for analgesic consumption within 48 hours after TKA but do not affect knee mobility status.
Comparison of Preoperative and Postoperative Ultrasound-Guided Caudal Block Analgesia for Lower Limb Surgeries in Pediatrics: A Randomized Controlled Trials
(Brieflands, 2025-02-28) Nasim Nikoubakht; Amine Shafeinia; Fatemeh Ahmadi; Mahzad Alimian
Background: Evaluating pain after surgery is particularly important in children due to their limited ability to communicate effectively. The intensity, duration, and threshold of pain make it challenging to assess in this age group. Objectives: The aim of this study was to compare the effects of ultrasound-guided caudal block at different timings on children's pain and drug consumption during unilateral knee osteotomy surgery. Methods: In a randomized clinical trial, fifty patients were randomly included in the study. The patients were children aged 2 - 6 years, candidates for unilateral osteotomy surgery under general anesthesia with total IV anesthesia (TIVA). The patients were divided into two groups based on the timing of the caudal block: The first group received the block after induction, and the second group received it after surgery and before extubation. Results: There was no statistically significant difference between the two groups in terms of the average amount of Propofol and narcotic consumption during recovery at different time points (P > 0.05). However, significant differences in pain levels were observed during the operation at 60 minutes (P-value < 0.001) and 120 minutes (P-value = 0.006) between the two groups. Pain scores at the start of recovery and at 2, 4, 6, 12, and 24 hours postoperatively were significantly lower in the second group than in the first group. Additionally, the mean difference in Bispectral Index (BIS) at 60 minutes between the two groups was significant (P-value = 0.003), but there was no significant difference at 120 minutes (P-value = 0.896). The second group consistently had significantly lower pain levels than the first group at all times. Conclusions: Based on the results of this study, patients who received a caudal block had lower pain scores, and performing the block before extubation had more beneficial effects on postoperative pain management in children undergoing osteotomy surgery than performing it after induction.
Comparison of Pressure and Volume-Controlled Mechanical Ventilation in Laparoscopic Bariatric Surgery: A Randomized Crossover Trial
(Brieflands, 2022-04-30) Alireza Pournajafian; Elmira Sakhaeyan; Faranak Rokhtabnak; Mahzad Alimian; Amirhossein Ghodrati; Minoo Jolousi; Mohammad Reza Ghodraty
Background: The number of patients with obesity undergoing various surgeries is increasing annually, and ventilation problems are highly prevalent in these patients. Objectives: We aimed to evaluate ventilation effectiveness with pressure-controlled (PC) and volume-controlled (VC) ventilation modes during laparoscopic bariatric surgery. Methods: In this open-label randomized crossover clinical trial, 40 adult patients with morbid obesity candidates for laparoscopic bariatric surgery were assigned to VC-PC or PC-VC groups. Each patient received both ventilation modes sequentially for 15 min during laparoscopic surgery in a random sequence. Every 5 min, exhaled tidal volume, peak and mean airway pressure, oxygen saturation, heart rate, mean arterial pressure, and end-tidal CO2 were recorded. Blood gas analysis was done at the end of 15 min. Dynamic compliance, PaO2/FiO2 ratio, P (A-a) O2 gradient, respiratory dead space, and PaCO2-ETCO2 gradient were calculated according to the obtained results. Results: The study included 40 patients with a mean age of 35.13 ± 9.06 years. There were no significant differences in peak and mean airway pressure, dynamic compliance, and hemodynamic parameters (P > 0.05). There was no significant difference between the two ventilation modes in pH, PaCO2, PaO2, PaO2/FIO2, dead space volume, and D (A-a) O2 at different time intervals (P > 0.05). Conclusions: If low tidal volumes are used during adult laparoscopic bariatric surgery, mechanical ventilation with PC mode is not superior to VC mode.
Comparison of RAMP and New Modified RAMP Positioning in Laryngoscopic View During Intubation in Patients with Morbid Obesity: A Randomized Clinical Trial
(Brieflands, 2021-06-30) Mahzad Alimian; Behrooz Zaman; Seyed Alireza Seyed Siamdoust; Nasim Nikoubakht; Ramin Rounasi
Background: The prevalence of obesity is increasing worldwide, and anesthesiologists are facing challenges in the airway management of such patients. Excessive adipose tissue influences pharyngeal spaces and affects the laryngoscopic grade. Standard ramp positioning is time-consuming and difficult to prepare, and requires expensive equipment. Objectives: The aim of this study was to compare the standard ramp position with the proposed low-cost and easily accessible modified ramp position in laryngoscopic view during the intubation of patients with morbid obesity. Methods: In this single-blind clinical trial, 84 patients candidate for bariatric surgery at Rasoul Akram Hospital in 2020 were assigned to the rapid airway management positioner (RAMP) (R) and new modified RAMP (MR) groups by the block randomization method. The laryngoscopic view of the glottis based on the Cormack-Lehane scale, ventilation quality, duration of intubation, intubation attempts, oxygen saturation at the end of intubation, and the need for backward, upward, rightward pressure (BURP) maneuver for successful intubation were recorded. Normal distribution tests and Mann-Whitney and Kruskal-Wallis tests were used to analyze the data. Results: The results showed no significant differences between the two groups regarding ventilation score, laryngoscopy grade, number of intubation attempts, duration of intubation, and the need for BURP maneuvers during intubation (P > 0.05). Conclusions: The two methods are not significantly different, and the new modified ramp position can be used with more ease and availability and less cost.
Comparison of the Effect of Intercostobrachial Nerve Block with and Without Ultrasound Guidance on Tourniquet Pain After Axillary Block of Brachial Plexus: A Randomized Clinical Trial
(Brieflands, 2023-04-30) Seyed Alireza Seyed Siamdoust; Behrooz Zaman; Samad Noorizad; Mahzad Alimian; Mona Barekati
Background: A tourniquet is used to control bleeding in the surgical field. Because part of the inner arm is innervated by the intercostobrachial nerve (ICBN), a tourniquet can cause intolerable pain. Objectives: The present study aimed to compare the effect of ICBN block with and without ultrasound (US) guidance on tourniquet pain after axillary block. Methods: This study was performed on 60 patients who were candidates for surgery. The patients were divided into 3 groups: the control group (n = 22), the traditional ICBN (TICBN) blockade group (n = 19), and the US-guided ICBN blockade group (n = 19). After the intervention, the duration of the onset and intensity of pain was recorded for all patients according to the Numeric Rating Scale (NRS). Data analysis was performed using SPSS. Results: No significant differences were observed in demographic variables between the 3 groups (P > 0.05). The pain intensity in the TICBN blockade (P = 0.001) and US-guided ICBN blockade (P = 0.001) groups was significantly less than in the control group. The mean duration of pain onset was significantly higher in the TICBN blockade (P = 0.021) and US-guided ICBN blockade (P = 0.013) groups than in the control group. No significant difference was observed in the mean of pain intensity (P = 0.48) and the mean duration of pain onset (P = 0.44) between the US-guided ICBN blockade and TICBN blockade groups. Conclusions: The pain caused by a tourniquet can be managed by ICBN block during hand and forearm surgery. It is recommended to use US guidance for more success and safety.
Comparison of the Effects of Propofol and Sevoflurane on QT Interval in Pediatrics Undergoing Cochlear Implantation: A Randomized Clinical Trial Study
(Brieflands, 2019-08-31) Reza Safaeian; Valiollah Hassani; Masood Mohseni; Aslan Ahmadi; Haleh Ashraf; Gholamreza Movaseghi; Mahzad Alimian; Elham Mohebi; Zahra Sadat Koleini; Shayesteh Pourkand
Background: Children with sensorineural hearing loss are at risk of cardiac electrophysiologic abnormalities. Inhalational Sevoflurane induction in these children can cause QT prolongation. Objectives: In order to evaluate the safety of inhalational induction of anesthesia with sevoflurane in children with sensorineural hearing loss, who are candidates for cochlear implant, its electrophysiologic effects was compared with intravenous induction of anesthesia with propofol. Methods: In this double-blind randomized clinical trial, 61 children aged between one and eighteen years old, who were candidates for cochlear implantation, were randomly allocated to groups receiving anesthesia with sevoflurane (n = 32) or propofol (n = 29) for induction of anesthesia. Two 12-leads ECG were taken from all of patients before and after induction and QTc, Tp-e interval, and JTc were measured and compared. Results: Two cases, who had pre-induction QTc longer than 500 ms were excluded from the study. Patients had similar age (102.58 ± 87 versus 101.46 ± 67 months, P = 0.95) and gender (males: 48.3% versus 56.3%, P = 0.53) distribution. The researchers observed significant post induction difference in QTc values between these groups (propofol 422.5 ± 40, sevoflurane 445.0 ± 29, P = 0.016). There was no significant difference in the percent QTc and Tp-e changes in propofol and sevoflurane groups. Greater percentage of patients with increased Tp-e interval (> 100 ms) in the sevoflurane group than the propofol group was also seen. There was no significant long QTc difference (QTc > 500 ms or more than 60 ms increase from baseline) after induction of anesthesia in the sevoflurane group compared to the propofol group (15.6% versus 13.8%, P = 0.84). Conclusions: After electrophysiological evaluations in children with sensorineural hearing loss, in patients whose pre-induction QTc is not longer than 500 ms, propofol seems safer than inhalational sevoflurane for induction of anesthesia.
The Effect of Different Doses of Intrathecal Hyperbaric Bupivacaine Plus Sufentanil in Spinal Anesthesia for Cesarean Sections
(Brieflands, 2017-12-30) Mahzad Alimian; Masood Mohseni; Seyed Hamid Reza Faiz; Alireza Rajabi
Background: Decreasing side effects and improving the quality of block in caesarean sections by appropriate dosage of local anesthetics and adjuvants could play an important role in the safe management of cesarean section. The present study aimed at comparing the effects of 3 different doses of intrathecal hyperbaric bupivacaine injected with a fixed dose of sufentanil in cesarean sections. Methods: In a double- blind randomized clinical trial, 105 candidates of elective cesarean section were randomly assigned into 3 groups of 8, 9, and 10 mg of intrathecal bupivacaine plus sufentanil 2.5 µg. The maximum level of sensory block, the intensity of motor block, and vital signs were measured at regular intervals. The incidence of hypotension and bradycardia were also recorded. Results: No significant difference was found between the maximum level of sensory block and the intensity of motor block in 3 groups. The incidences of hypotension and bradycardia as well as administration of atropine and ephedrine were comparable among the 3 groups (P > 0.05). Conclusions: According to similar effects of different doses of bupivacaine, administration of lower doses of bupivacaine (8mg) is more reasonable for spinal anesthesia for cesarean section.
The Effect of Propofol Infusion Before Administration of Its Bolus Dose on Propofol Injection Pain and Serum Complement C3 Levels; A Randomized Clinical Trial
(Brieflands, 2019-11-27) Behrooz Zaman; Samad Noorizad; Seydalireza Seyed Siamdoust; Mahzad Alimian; Sara Parak
Background: Pain on injection with propofol is still a major problem associated with anesthesia. Several factors involved in this event have been studied with respect to their pain attenuating effects. Objectives: The purpose of this study was to evaluate the effect of propofol infusion before administration of its bolus dose of propofol on the resulted pain at its induction dose and on serum complement C3 levels. Methods: This clinical trial was performed on patients undergoing surgery under general anesthesia divided into three groups, including A (without intervention), B (propofol infusion at a dose of 50 µg/kg/min before anesthesia induction), and C (propofol infusion at a dose of 100 µg/kg/min 100 before anesthesia induction). During anesthesia induction by propofol, the presence, absence or severity of pain was determined using the Numerical Rating Pain Scale. Serum complement C3 levels were measured and their relationships with pain scores were compared between three groups. The data were analyzed using SPSS V. 22 software. Results: There were significant differences in the mean pain scores between three groups (P < 0.05). However, no significant difference in the mean pain scores was observed between the groups B and C (P > 0.05). The mean and standard deviation of the differences in complement C3 values in the three groups before and after injection were 72.15 ± 14.9, 27.65 ± 9.82, and 18.95 ± 4.68, respectively, which demonstrated a significant difference between three groups (P < 0.05). However, the difference in complement C3 values between the groups B and C was not significant (P > 0.05). Conclusions: According to the obtained results, the low doses of infused propofol, 2 minutes before administration of its bolus dose, seems to have a considerable attenuating effect on its pain score.
Effects of adding dexmedetomidine to lidocaine on the onset and duration of axillary block for upper extremity surgeries
(Brieflands, 2017-12-31) Behrooz Zaman; Samad Noorizad; Seyed Alireza Seyed Siamdoust; Seyed Hassan Etemadi; Sina Askarian Omran; Mahzad Alimian
Introduction: Dexmedetomidine, which is an alpha 2 agonist, reduces the transmission of pain signals and has an independent inhibitory effect on nerve action potential. The purpose of this study was to examine the effects of adding dexmedetomidine to lidocaine in an axillary block.
Effects of Liberal Versus Restrictive Fluid Therapy on Renal Function Indices in Laparoscopic Bariatric Surgery
(Brieflands, 2020-10-31) Mahzad Alimian; Masood Mohseni; Omid Moradi Moghadam; Seyed Alireza Seyed Siamdoust; Javad Moazzami
Background: Earlier studies have suggested the liberal administration of fluids in favor of reducing the risk of rhabdomyolysis in obese patients, but the results are conflicting. Objectives: The present study aimed at comparing the effects of liberal and restrictive fluid therapy on renal indices in laparoscopic gastric bypass surgery. Methods: In a double-blinded randomized clinical trial, 72 candidates of bariatric surgery were randomly assigned into two groups of restrictive and liberal fluid therapy. Indices, including BUN, creatinine, creatine kinase, GFR, and urine output were measured before and 24 hours after the surgery. The clinical trial was registered at IRCT.ir under code IRCT20170109031852N3. Results: There was no significant difference in BUN, creatinine, creatinine kinase, and GFR indices between the two groups of liberal and restrictive fluid therapy both before and 24 hours after surgery (P > 0.05). Intragroup comparisons before and after surgery revealed that BUN decreased in both groups after the surgery (P < 0.05). Also, creatinine and GFR values improved in patients who received a liberal fluid regimen, whereas these indices remained statistically unchanged in the restrictive group before and 24 hours after the surgery (P > 0.05). Conclusions: Two methods of liberal and restrictive fluid therapy have comparable effects on traditional renal functional indices in laparoscopic bariatric surgery. The clinical significance of observed differences in outcomes should be investigated in further studies. The use of early biomarkers of acute kidney injury is warranted.
Evaluation of Adding Dexmedetomidine to Ropivacaine in Pediatric Caudal Epidural Block: A Randomized, Double-blinded Clinical Trial
(Brieflands, 2021-02-28) Farnad Imani; Reza Farahmand Rad; Reza Salehi; Mahzad Alimian; Zahra Mirbolook Jalali; Amir Mansouri; Nader D. Nader
Background: Caudal block is one of the methods of pain management performed following lower abdominal surgery, though having its own limitations. Objectives: In the present study, the effects and side effects of adding dexmedetomidine to ropivacaine in the caudal epidural block were investigated in children after lower abdominal surgery. Methods: In this randomized, double-blinded clinical trial, 46 children aged three to six years were divided into two groups to perform a caudal block following lower abdominal surgery under general anesthesia. The injectable solution contained ropivacaine in the R group (1 mL/kg ropivacaine 0.2%), as the control group, and dexmedetomidine (2 µg/kg) and ropivacaine 0.2% (1 mL/kg) in the DR group. The pain score (modified CHEOPS score), duration of analgesia, amount of analgesia consumed (i.v. paracetamol), hemodynamic changes, and possible adverse effects were assessed at one, two, and six hours in both groups. Results: The pain score at one and two hours showed no significant difference between the two study groups (P > 0.05). In the DR group, however, the pain score at the sixth hour was significantly lower, and the duration of analgesia was longer (P = 0.001). The amount of analgesic consumption was also lower in the DR group (P = 0.001). However, there was no significant difference in systolic blood pressure and heart rate (P < 0.05), in the case of diastolic blood pressure, a significant difference (P < 0.05) was seen (DR group lower than the R group). There was no statistically significant difference between the study groups in the duration of surgery, recovery time, and side effects (P < 0.05). Conclusions: In the present study, the addition of dexmedetomidine to ropivacaine in the caudal epidural blockade improved postoperative analgesia without significant adverse effects in pediatric patients.
Postoperative Respiratory Complications of Laryngeal Mask Airway and Tracheal Tube in Ear, Nose and Throat Operations
(Brieflands, 2015-08-01) Reza Safaeian; Valiollah Hassani; Gholamreza Movasaghi; Mahzad Alimian; Hamid Reza Faiz
Background: Supraglottic devices could be used to reduce postoperative respiratory complications, but there are few studies focused on their use in more prolonged surgeries. Objectives: In this study, we compared postoperative respiratory complications in patients with prolonged ear, nose and throat (ENT) surgeries, whose airways were controlled with tracheal tube or laryngeal mask airway (LMA). Materials and Methods: In a randomized control trial (RCT), 171 candidates of prolonged ENT surgeries were randomly assigned into two groups. In group one (n = 85) LMA and in group two (n = 86) endotracheal tube were used for airway control. The incidences of four postoperative respiratory complications including sore throat, hoarseness, cough and shortness of breath in immediate postoperative period were measured and compared among patients of each group. Results: Sore throat was recorded in 32.9% of patients with LMA and 44.2% of intubated patients, but it was not statistically significant (Fisher’s Exact test = 0.158). Hoarseness was recorded in 3.5% of patients with LMA and 24.4% of intubated patients (Fisher’s Exact test = 0.000). In 1.2% of patients with LMA cough was recorded; it was also seen in 7% of the intubated patients (Fisher’s Exact test = 0.005). Shortness of breath was mentioned by two intubated patients (2.3%) and in patient with LMA we did not record this complication. Conclusions: LMA in prolonged ENT surgeries was associated with reduced respiratory complications.
Relationship Between Airway Examination with LEMON Criteria and Difficulty of Tracheal Intubation with IDS Criteria
(Brieflands, 2023-12-31) Pooya Derakhshan; Nasim Nikoubakht; Mahzad Alimian; Sadaf Mohammadi
Background: Tracheal intubation is a common technique used to secure a patient’s airway, which is crucial in anesthesia. Successful tracheal intubation depends on various factors, including the assessment of the patient’s airway before the procedure. In recent years, scoring systems, such as LEMON (an acronym for the assessment of the airway’s appearance, identification of any dental issues, evaluation of Mallampati classification, assessment of airway obstruction, and examination of neck mobility) and intubation difficulty scale (IDS) have gained attention. This study aimed to investigate the relationship between the LEMON criteria and IDS in tracheal intubation. The goal was to provide valuable insights that can assist medical professionals in optimizing their approach to airway management by analyzing clinical data, assessing patient outcomes, and evaluating the consistency between these scoring systems. Methods: This study was based on a descriptive-analytical study involving a group of patients requiring intubation. This study examined 105 patients scheduled for elective surgeries, aged between 19 and 60 years, without specific underlying diseases, such as laryngeal cancer, temporomandibular joint stiffness, or significant tongue enlargement, and with a body mass index (BMI) below 40 kg/m². Initially, expert anesthesiologists assessed the patients using the LEMON criteria, and then the degree of intubation difficulty was measured using the IDS scoring system. Finally, these two criteria were compared. Results: In this study, there was a significant correlation between the LEMON score and the IDS score (P < 0.001). The difficult intubation group (IDS score higher than 0) had higher LEMON scores (with the highest score equal to 4) than the non-difficult intubation group (IDS score of 0) (P = 0.017). The average LEMON and IDS scores were 3.11 and 1.35, respectively. Among the participants, 96.2% had an intubation difficulty score of ≤ 5; nevertheless, 3.8% had a score of > 5. Additionally, limited neck mobility emerged as the sole independent predictor of intubation difficulty (P = 0.002, odds ratio = 6.152). Conclusions: The LEMON score is associated with difficult intubation in adult patients requiring intubation.
Remote Ischemic Preconditioning In Lower Limb Surgery; The Hemodynamic And Respiratory Effects
(Brieflands, 2016-09-30) Fatemeh Jamshidi; Saeid-reza Entezari; Mahzad Alimian; Alireza Siamdoust; zahar sadat koleini; Masood Mohseni
Aim and Background: Remote Ischemic Preconditioning introduces brief episodes of ischemia and reperfusion which reduces long term ischemia in orthopaedic surgery. The aim of this study was to evaluate hemodynamic and respiratory effects of remote ischemic preconditioning in lower extremity orthopaedic surgeries.Methods: In this clinical trial 40 patients scheduled for lower extremity surgery with pneumatic tourniquet were randomly allocated to remote ischemic preconditioning (RIP group, n=20) and control group (n=19). Patients in RIP group received three ?5 minutes? cycles of ischemia, alternating with 5 minutes of reperfusion before extended use of tourniquet. Hemodynamic variables prior to inflation of tourniquet, every 30 minutes during the surgery and 10 minutes after tourniquet deflation and also arterial blood gas sample prior to and after surgery were recorded and compared between groups.Results: During operation blood pressure dropped in the RIP group and variations in heart rate, respiratory rate and pulse oximeter measurements after surgical tourniquet release were not significantly different between two groups. Changes in blood gas parameters were significantly less pronounced in the RIP group.Conclusion: Remote ischemic preconditioning may not attenuate most of the adverse effects of surgical tourniquet deflation including variations in heart rate, respiratory rate and arterial oxygen saturation as well as blood pressure drops. However, RIP may reduce increases in systolic blood pressure and acidosis following tourniquet application.Key Words: Remote Ischemic Preconditioning; Orthopedic, surgery, blood pressure, tourniquet, oxygenation
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.

Browsing by Author "Mahzad Alimian"

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