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The Effects of Topical Metronidazole on Post-Hemorrhoidectomy Pain: A Brief Report
Pourghassem J,Mahoori A,Akhbari P
Tehran University Medical Journal , 2012,
Abstract: Background: Oral metronidazole has been previously demonstrated to decrease postoperative pain after open hemorrhoidectomy. The aim of this study was to evaluate the effect of topical metronidazole in reducing postoperative pain of hemorrhoidectomy.Methods : In this double-blind, clinical trial forty 20- to 40-year old male patients were scheduled for hemorrhoidectomy under spinal anesthesia at the Imam Khomeini Hospital in Urmia, Iran from April to September 2010. The participants were assigned to receive topical metronidazole (n=20) or placebo (n=20). Pain intensity was assessed using a visual analog scale (VAS), the time of first narcotic request and morphine administrations were also recorded. Results : The VAS scores were lower in metronidazole than the control group but this difference was not statistically significant, except after 24 hr post-surgically. Morphine administration in the first 24 hr was lower in the metronidazole group (P<0.05).Conclusion: Although metronidazole could not prolong the time of first analgesic request, but application of metronidazole gel is associated with lower analgesic requirement.
Diclofenac suppository versus intramuscular pethidine in post herniorrhaphy pain relief
Noroozinia H,Mahoori A,Hassani E,Akhbari P
Tehran University Medical Journal , 2011,
Abstract: "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Non-steroidal anti-inflammatory drugs (NSADs) and opioids are frequently administered to relieve postoperative pain. Uncontrolled postoperative pain may produce a range of detrimental acute and chronic health consequences and increase mortality and morbidity. Practically, the analgesic efficacy of opioids is typically limited by the development of tolerance to them or by opioid-related side-effects such as nausea, vomiting, sedation or respiratory depression. This study aims to assess the effects of suppository diclofenac on post-herniorrhaphy pain management."n"nMethods: In this prospective double-blind clinical trial, 60 patients who were candidate for the surgical repair of inguinal hernia were divided into two groups. Patients in group A received 100 mg of suppository diclofenac and patients in group B 50 mg of pethidine after the induction of anesthesia and before surgical incision. Postoperative pain assessment was done by an unbiased observer on the arrival of patients in the recovery room, using a 10-cm visual analogue scale (VAS( at 2-hour intervals for 6 hours."n"nResults: Pain relief was similar in the two groups (P=0.3). Patients in group B required more analgesia two hours post-operatively (P=0.03), while patients in group A had more favorable results regarding pain control (P<0.05). Statistically, there was no difference between the two groups at other intervals. The occurrence of nausea and vomiting was similar in both groups. No respiratory depression was observed in the patients."n"nConclusion: Preventive analgesia with 100 mg of suppository diclofenac after anesthesia induction for herniorrhaphy produced effective postoperative analgesia with minimum side-effects.
The effect of aging on bispectral index before and after sedation: a prospective study
Mahoori A,Noroozinia H,Hassani E,Motargemzadeh G
Tehran University Medical Journal , 2010,
Abstract: "nBackground: The Bispectral Index (BIS) is an EEG-derived value that measures the sedative and hypnotic component of the anesthetic state. The effects of age on the bispectral index have not been well documented. The objective of the present study was to determine the influence of age on hypnotic requirement and bispectral index in awake and in patients with sedation induced by midazolam. "n"nMethods: Eighty patients were enrolled in this prospective observational study. The patients in study group were aged more than 70 years, and the age in control group ranged 20-40 years. Baseline recording of BIS was taken in awake patients in two groups for few minutes. Five minutes after administration of 0.02 mg/kg IV midazolam the BIS value also was taken and recorded. "n"nResults: In the study group, patients had a mean base BIS 94±3 compared with 97.3±1 in the control group (p< 0.0001). Five minutes after administration of 0.02 mg/kg midazolam the value were 80.9±6 and 90.4±3 respectively (p< 0.0001). "n"nConclusion: When BIS is used as a monitor of hypnosis in the elderly, we recommend that a baseline recording be taken before induction for a few minutes to alert the anesthesia provider to the possibility of low initial values. Further studies are needed to verify if the recommended range of 50-60 of BIS during clinical anesthesia is also adequate in the elderly with low initial baseline BIS or if this range needs adjusting in view of reduced initial BIS value.
The Effects Of Tranexamic Acid On Postoperative Bleeding In Coronary Artery Bypass Graft Surgery
E Hassani,A Mahoori,H Mehdizadeh,H Noroozinia
Tehran University Medical Journal , 2012,
Abstract: Background: Perioperative administration of tranexamic acid (TA), decreases bleeding and the need for transfusion after cardiac procedures. Hence, the results may vary in different clinical settings and the most appropriate timing to get the best results is unclear. The primary objectives of the present study were to determine the efficacy of TA in decreasing chest tube drainage, the need for perioperative allogeneic transfusions and the best timing for TA administration following primary, elective, coronary artery bypass grafting (CABG) in patients with a low baseline risk of postoperative bleeding. Methods: In this double-blind, prospective, placebo-controlled clinical trial in Seiedoshohada Hospital during 2011-2012, we evaluated 150 patients scheduled for elective, primary coronary revascularization. They were randomly divided into three groups. Group B received tranexamic 10 mg/kg prior to, Group A received tranexamic acid 10 mg/kg after cardiopulmonary bypass and group C received an equivalent volume of saline solution. Blood requirement and postoperative chest tube drainage were recorded. Results: The placebo group (group C) had a greater postoperative blood loss 12 h after surgery (501±288 vs. 395±184 in group B and 353±181 mL in group A, P=0.004). The placebo group also had greater postoperative total blood loss (800±347 vs. 614±276 in group B and 577±228 mL in group A, P=0.001). There was a significant increase in allogeneic blood requirement in the placebo group (P=0.001). Conclusion: For elective, first time coronary artery bypass surgery, a single dose of tranexamic acid before or after cardiopulmonary bypass is equally effective.
The effect of low-dose ketamine infusion on the remifentanil induced hemodynamic changes during general anesthesia
Beigmohamadi M T,Khan Z H,Mahoori A R
Tehran University Medical Journal , 2008,
Abstract: Background: Remifentanil is known to produce side-effects of hypotension and bradycardia. In this study, we examine the effect of low-dose ketamine infusion on the heart rate and blood pressure of patients anesthetized with remifentanil.Methods: In a randomized clinical trial, 54 patients aged 20-50 years old, with ASA physical status Ι, were studied in two groups (n=27), Ketamine- Remifentanil (K-R group) and Placebo- Remifentanil (P-R group). Exclusion criteria were ASA physical status >1, gastroesophageal reflux, tachycardia, bradycardia, systemic diseases, use of antihypertensive drugs, difficult intubations, risk of aspiration and contraindications of ketamine. Remifentanil was started at a rate of 0.5 μg. kg-1. min-1 and anesthesia was induced with thiopental sodium 2 mg.kg-1. Maintenance of anesthesia included halothane and nitrous oxide/oxygen mixture. Remifentanil infusion was continued in both groups at a rate of 0.5 μg.kg-1.min-1. In the K-R group, ketamine was started with an infusion rate of 10 μg.kg-1. min-1, 10 minutes after intubation, while in the P-R group, normal saline was started with the same dose of remifentanil. Heart rate, systolic, diastolic and mean arterial blood pressure were measured and compared at 1, 3, 5, 10, 15, 20, 25 and 30 minutes.Results: No significant differences were found between basic patient characteristics of mean of age, sex, weight, systolic, diastolic and mean arterial blood pressure and heart rate (p>0.2) in the two groups. However, the rate of systolic, diastolic and mean arterial blood pressure changes in the P-R group was significantly greater than that of the K-R group (p<0.006). Heart rate changes were similar between the two groups (p=0.6). Incident of severe hypotension (a decrease of more than 25% of the basic value) was less in the K-R group than that of the P-R group (11% vs. 89%; p=0.000).Conclusion: Low-dose ketamine infusion modulates the effect of remifentanil-induced hypotension and provides better hemodynamic stability during general anesthesia.
Determination of Rate of Hearing Changes After Spinal Anesthesia
H Noroozinia,F Heshmati,A Hassani Afshar,AR Mahoori
Journal of Shahid Sadoughi University of Medical Sciences , 2008,
Abstract: Introduction: Hearing loss after surgery is reported rarely. Its prevalence rate is different and reported to be between 3-92%. Hearing loss is often subclinical and not diagnosed without audiometry. The aim of this study was to determine rate of hearing changes after spinal anesthesia in patients undergoing surgery with spinal anesthesia. Methods: In this descriptive study, forty male patients scheduled for repair of inguinal hernia under spinal anesthesia were selected by simple sampling method. Before surgery, audiometry was performed for both the ears of the patients. Audiomatery was performed again by the audiometry specialist on day one, five, fifteen and two months after surgery. Results: Hearing loss was observed in 13 (32.5%) patients. Hearing loss in 12 patients (92%) was in low hearing frequency range and 1 patient (8%) was in mid hearing frequency. Hearing loss in 8 patients (61%) was ipsilateral and in 5 patients (39%) was bilateral. Hearing loss in 9 patients (69%) on 5th day and 2 patients (5/15%) on 15th day resolved spontaneously. Conclusion: Results of this study conformed that hearing loss after spinal anesthesia is not a serious problem and can resolve spontaneously. It seems that there is relationship between hearing loss and headache.
The Effect of Body Mass Index on Relapse of Pilonidal Sinus Disease in Adult Patients
Jalal Poorghasem,Alireza Mahoori
Zahedan Journal of Research in Medical Sciences , 2012,
Abstract: Background: Pilonidal disease occurs either as a secreting sinus or in the form of an acute abscess in the coccygeal area and is an underlying cyst associated with granulomatous and fibrosis tissue which commonly contains heaps of hair, for which inherited and acquisitive hypotheses are proposed. Body mass index (BMI) is the objective indicator of obesity according to height and weight. This study aims to examine the relationship between BMI and the role of obesity in development and relapse of pilonidal cyst disease.Materials and Methods: This retrospective cross-sectional study examined 126 patients with primary or recurrent pilonidal sinus within a year. A separate questionnaire was formed and recorded in the computer for each patient based on the disease type and body mass index.Results: One hundred out of 126 studied patients (79.4%) underwent primary Pilonidal Sinus surgery and 26 patients (20.6) had recurrent Pilonidal sinus surgery. 36 patients (28.6) were female and 90 patients (71.4%) were male. Among patients with recurrent Pilonidal sinus, 18 patients (69.2%) had BMI above 30 and 8 patients (30.8%) had BMI of 25 to 30 kg/m2. The patients whose BMI was estimated to be 20 to 25 or less than 20 kg/ m2 per square meter, had no recurrence of disease. Conclusion: In this study, high BMI was associated with relapse of pilonidal sinus disease. Supporting the previous studies, the incidence of disease in this study was also higher in young adults.
Prevalence of selected sexually and blood-borne infections in Injecting drug abuser inmates of bandar abbas and roodan correction facilities, Iran, 2002
Davoodian, Parivash;Dadvand, Habib;Mahoori, Khatereh;Amoozandeh, Alireza;Salavati, Alborz;
Brazilian Journal of Infectious Diseases , 2009, DOI: 10.1590/S1413-86702009000500008
Abstract: human immunodeficiency virus (hiv) and other blood borne viral infections like hepatitis b virus (hbv) and hepatitis c virus (hcv) are major health issues especially in young and growing population of developing countries. all around the globe correctional facilities are known as potential source of spreading such disease. during summer 2002, hiv, hcv antibodies, hepatitis b surface (hbs) antigen and rapid plasma reagin (rpr) test were checked in venous blood samples of 252 injecting drug abuser prisoners from correctional facilities in southern iran. overall hiv, hcv and hbv infection rate was 15.1% (38/249), 64.8% (163/249), and 4.7% (12/249), respectively. hcv infection rate of hiv positive cases was 94% (35/38). all rpr results were negative. duration of previous drug abuse and imprisonment were correlated with hiv and hcv infection (p value = 0.0003 and 0.015 & p value =0.02 and 0.02). considering the higher prevalence of hiv and hcv infection in correctional facilities compared to general population of iran, warrants immediate multidisciplinary approaches targeted at controlling further spread of these infections primarily among prisoners and secondarily preventing them to act as carrier to general population.
Evaluation of the effect of added fentanyl to hyperbaric bupivacaine for spinal anesthesia
Mina Jafari-Javid,Farhad Heshmati,MirMoosa Agdashi,Alireza Mahoori
Zahedan Journal of Research in Medical Sciences , 2011,
Abstract: Background: Potentiating the effect of the intrathecal local anesthetics by intrathecal injection of opiods for intra-abdominal surgeries is known. The objective of this study is to investigate the pain-relieving effects of intrathecal fentanyl to bupivacaine in elective caesarean surgery.Materials and Method: In a double blind clinical trial 60 patients candidate for elective cesarean section. They were studied in two groups. Cases in the control group received 12.5 mg of bupivacaine and in the study group received 8 mg of bupivacaine and 20 μg fentanyl. The parameters taken into consideration were hemodynamic stability, visceral pain, nausea and vomiting, intraoperative shivering, the amount of intraoperative administered dose of fentanyl and ephedrine and postoperative pain. Results: The average blood pressure changes after 5, 10, 20, 60 minutes were lower in the study group. Shivering and ephedrine dose during operation were lower in study group and statistically significant respectively (p=0.01, p=0.001, respectively). Duration of analgesia after operation increased from (115.5±7.5 min) in control group to (138.5±9.9 min) in study group, but the quality of analgesia during peritoneal manipulation did not change. Pulse rate and vomiting during operation were not statistically different between two groups.Conclusion: Reduction of local anesthetic dose with adding fentanyl may cause hemodynamic stability, increasing the postoperative pain-free time, decrease shivering and vasopressor consumption in spinal anesthesia and reduction of the amount of blood pressure drop during elective cesarean surgery
Evaluation of the Effectiveness of Lidocaine Infusion in Reduction of Postoperative Pain
F Heshmati,H Noroozinia,R Abbasivash,AR Mahoori
Journal of Shahid Sadoughi University of Medical Sciences , 2006,
Abstract: Introduction: Postoperative pain is an acute pain related to size and site of operation, patient's psychologic and physiological condition, degree of manipulation and damage of tissues. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Administration of opioids is one of the common techniques for postoperative pain management, but complications related to opioids leads to use of other methods for pain control. In this study we evaluated the effect of low dose lidocaine infusion for postoperative pain control. Methods: In this study, 30 patients were randomized in two study and control groups under similar conditions. In study group, administration of lidocaine 1% (1.5mg/kg followed by 1.5 mg/ kg /h infusion) was started 30 minutes before operation, and continued 1hour after operation. In control group, normal saline (placebo) was used. After 24hours, pain of patients and systemic analgesic consumption was assessed and analyzed. Results: Results showed that infusion of low dose lidocaine does not reduce postoperative pain and amount of morphine consumption 24hours after operation. Conclusion: Difference in results of this study and other similar investigations can result from difference in design and selected surgical procedures. Also, lack of medical and research equipments such as appropriate PCA (Patient Controlled Analgesia) and measurement of blood levels of lidocaine were limitations of this study.
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