1 2228-6659 Iranian Society Of Regional Anesthesia And Pain Medicine 5198 Special The hemodynamic and respiratory effects of Remote Ischemic Preconditioning on patients undergoing lower limb orthopaedic surgery mohseni masood b c alimian mahzad d siamdoost alireza e jamshidi fatemeh f b medicine c medicine d medicine e medicine f medicine 1 7 2015 6 2 1 10 04 04 2015 12 05 2015 Aim and Background: Arterial tourniquets are used widely for extremity orthopedic surgeries with regional or general anesthesia to reduce blood loss, but the harmful effect of ischemia and reperfusion is not clear yet. Materials and Methods: In this clinical trial 40 patients scheduled for lower extremity surgery with pneumatic tourniquet were randomized into 2 groups: a remote ischemic preconditioning (RIP group, n=20), in which patients received three “5 minutes” cycles of ischemia, alternating with 5 minutes of reperfusion before extended use of tourniquet and a control group (n=19). Hemodynamic variables prior to inflation of tourniquet and every 30 minutes during the surgery and 10 minutes after tourniquet deflation and arterial blood gas sample prior to and after surgery were compared between groups. Findings: In comparison with the baseline values, systemic blood pressure was increased in all patients, however in control group it was significantly more than baseline values and also higher than the RIP group (p=0.03 and p=0.032 respectively). There was no significant change in heart rate and O2 saturation and Spontaneous respiratory rate between the groups and in comparison with baseline values. Conclusion: Tourniquet application in limb surgery can cause hemodynamic changes and remote ischemic preconditioning can not attenuate these effects such as variation of blood pressure, heart rate and changes of respiatory rate and arterial O2 saturation. However RIP can reduce inceases in systolic blood pressure and acidosis. Keywords: Hemodynamics, Ischemic preconditioning, Ischemia-reperfusion, Orthopedic Surgery, Tourniquet
5204 Special Effective factors in peripheral seizure production in patients undergoing Electroconvulsive Therapy from anesthesia perspective haghighi mohammad g CHAVOSHI TAHEREH h ghazanfar tehran samaneh i khanjanian gita j soleimani robabeh k NEMATLLAHY MONA l MIRZABABAE SAMIRA m montazeri batool n g rasht/gums/arc h rasht/gums/arc i rasht/gums/arc j rasht/gums/arc k GUMS l rasht/gums/arc m rasht/gums/arc n rasht/gums/arc 1 7 2015 6 2 11 20 27 04 2015 01 06 2015 Aim and Background: Electroconvulsive therapy(ECT) is one of the most effective and prompt therapies forsevere psychotic issues. This study aims to distinguish the impact of age, disease and medications on the seizurecaused by ECT.Methods and Materials: 123 patients were studied and categorized according to their age, psychotic disorderand medications (anti-psychotics, anti-depressive or both of them). The correlation of these variants with seizureduration were discussed in every session of ECT.The seizure duration was recorded based on clinical convulsionand EEG parameters. The failure or success of ECT was evaluated by seizure time measurement to be less orgreater than 20 sec, respectively.Findings: There was no significant difference observed between men and women in regards to the averageseizure duration in different sessions (6 sessions) (P=0.25).There was either no significant difference observedin seizure duration in various sessions between patients under and above 40 years of age(P=0.45). Againno significant difference was seen in seizure duration among patients with psychotic and mood disorders orbetween patients using anti-psychotic or anti- psychotic and anti- depressant drugs for therapy, respectively(P=0.38 and P=0.14).Conclusions: Accurate knowledge about patients who are candidate to receive Electroconvulsive Therapy isvery important. Type of psychologic disorder, type of drug protocol and the number of sessions of ECT, all arethe factors which should be considered in every ECT procedure.Keywords: Electroconvulsive therapy, seizure duration, success rate 5203 Anesthesia pharmacology Comparing the effect of dexmedetomidine and remifentanil on recovery time of patients undergoing posterior spinal fusion surgery. Alimyan Mahzad o Zaman Behrooz p Mohaghegh Mohammad Reza Kholdebarin Ali Reza Pourbakhshandeh Arash Kazemtori Elahe o Iran University of Medical Sciences, Rasoul e Akram hospital, Tehran, Iran. p Iran University of Medical Sciences, Rasoul e Akram hospital, Tehran, Iran. Iran University of Medical Sciences, Rasoul e Akram hospital, Tehran, Iran. Iran University of Medical Sciences, Firoozgar hospital, Tehran, Iran. Iran University of Medical Sciences, Rasoul e Akram hospital, Tehran, Iran. Shahid Beheshti University of Medical Sciences, Rasoul e Akram hospital, Tehran, Iran. 1 7 2015 6 2 21 31 20 04 2015 24 05 2015 Aim and Background: The alpha-2 agonist dexmedetomidine, a potent sedative and analgesic by its central sympatholytic action, promotes hemodynamic stability. However it is unknown whether the recovery from anesthesia would be delayed with continuous infusion of dexmedetomidine because of its sedative effect. The aim of present study is to assess the effect of intravenous dexmedetomidine on postoperative recovery in elective posterior spinal fusion surgery. Materials and Methods: Forty patients were randomly divided into two equal groups group R (remifentanil) received fentanyl 2 &mu;g/kg + remifentanil 0.1 &mu;g/kg and group D (dexmedetomidine) recieved fentanyl 2 &mu;g/kg + dexmedetomidine 0.1 &mu;g/kg over 10 min as premedication prior to induction. All of them received propofol 2mg/kg and Cis-Atracurium 0.2mg/kg for induction and then group R received remifentanil 0.1 &mu;g/kg/min and group D had dexmedetomidine 0.1 &mu;g/kg/h, both with propofol 100 &mu;g/kg/min and Atracurium as intravenous infusion. Postoperative recovery was assessed by Aldrete’s score just at extubation, and every 10 min thereafter in recovery room. Findings: There was no significant difference in hemodynamic variables and the trend of Aldrete’s score between two groups. Aldrete’s score in group R was significantly higher than group D in the first evaluation in recovery room and 10 min after that (p<0.05). There was no significant delay in recovery time of group D patients. Sedative consumption and postoperative analgesic demand were insignificantly lower in group D. Conclusion: Dexmedetomidine maintains hemodynamic stability without significant delay in recovery time after general anesthesia in comparison with remifentanil. This property can make it as an alternative option for opioid medications. Keywords: Aldrete score, Dexmedetomidine, Haemodynamics, Recovery, Remifentanil. 5193 Special Comparing the mean score of Depression, sleep quality and resiliency in patients with Migraine and Tension type headaches with healthy individuals akbarzadeh davoud rajabzadeh akbar aminibayrami hasan mohamadzadeh ali 1 7 2015 6 2 32 41 05 02 2015 23 04 2015 Aim and Background: Headache is one of the most common complaints of patients and it has different causes .Migraine and Tension headaches are among the most common types of headache. Depression, sleep problems and low resilience are much more seen in patients with migraine and tension-type headaches. Methods and Materials: This is a case-control study the studied sample consists of 44 patients with tensiontype headache diagnosis, and 42 patients with migraine headache selected among those referred to Headache clinics and clinics in Tabriz University of Medical Sciences in Iran. Also 43 healthy individuals matched with the other two groups according to age, gender and educational level were included.The Beck depression scale, Pittsburgh sleep quality index and Connor resilience scale were used. Data were analyzed using multivariable analysis of variance (MANOVA). Findings: There were significant differences in depression, sleep quality, and resilience mean scores between both groups of patients (migraine and tension-type headaches) with healthy individuals (P< 0.01). Mean depression score and sleep quality in patients with migraine headache were higher than the other two groups (2/41 ± 18/80 for depression and 3/30 ± 12/33 for sleep quality). Mean resilience in patients with migraine headache was lower than the other group of patients and the control group (3/04 ± 35/80). Conclusions: Considering significant correlation between migraine and tension type headache (TTH) with depression, sleep problems and low resilience evaluation of psychological aspect of these patients is necessary for quick treatment. Keywords: Depression, Sleep Quality, Resilience, Migraine Type Headaches, Tension-type Headache 5185 Acute pain managment Effect of foot reflexology massage on pain in patients undergoing coronary bypass surgery rigi Fatemeh feizi aram zainab Naseri Mohsen salehi Shahyad University of Medical Sciences of Iranshahr University of Medical Sciences of Iranshahr University of Medical Sciences of Iranshahr 1 7 2015 6 2 42 49 17 12 2014 31 05 2015 Aims and Background: One of the problems that patients with coronary artery bypass surgery encounter is pain that can have undesirable consequences. This research aims to investigate the effects of foot reflexology massage on pain in patients undergoing coronary artery bypass surgery. Materials and methods: This clinical trial was performed on 52 patients after coronary artery bypass surgery. Data collection instruments included a demographic questionnaire, and numeric rating scale for pain score. The patients were randomly assigned into two groups of experimental and control groups. Foot reflexology was performed for 30 min in the experimental group. Pain levels were measured before and after intervention. The control group did not receive any intervention and pain was measured twice within 30 minutes. Findings: The mean pain score was not statistically different between the groups before intervention (P=0.228). However the difference in pain scores between the two groups after intervention was statistically significant (P=0.004).Patients in the intervention group had significantly decreased pain after the foot reflexology massage (P=0.000). Conclusions: This study showed that foot reflexology massage can be used as an effective, safe and cost-effective nursing intervention in reducing pain in patients undergoing coronary artery bypass surgery Keyword: coronary artery bypass, pain, foot reflexology massage Corresponding Author: Fatemeh Rigi, Master of science in Nursing, Faculty member of Nursing & Midwifery College of Iranshar University Of Medical Science, Iranshahr. Email: f.rigi2011@ gmail .com Rigi F, Feizi A, Amirian Z, Nasdri M, Salehi S. [Effect of foot reflexology massage on pain in patients undergoing coronary bypass surgery (Persian)]. JAP 20155(4):42-49. Effect of foot reflexology massage on pain in patients undergoing coronary bypass surgery Please cite 5208 Acute pain managment Effect of adding Ketamin to the combination of Morphine and Midazolam in opioid tolerant patients on post operative pain Entezari Said reza Imani Farnad Abdollahzadeh Baghaie Alireza 1 7 2015 6 2 50 58 10 05 2015 30 05 2015 Aims and Background: Uncontrolled postoperative pain may increase patients’ mortality and morbidity. One way to control postoperative pain is by using narcotics with patient controlled intravenous analgesia (PCIA) method. Some investigators try to use many drugs in combination with narcotics in order to come over the side effects and tolerance to them in special groups of patients. We tried to compare different doses of Ketamine in combination with Morphine and Midazolam as PCIA for control of postoperative pain in patients with history of opioid addiction. Materials and Methods: In a double blind clinical trial, 120 patients undergoing lower limb orthopedic surgery with history of opioid consumption, were randomized to receive PCIA of Morphine 20 mg + Midazolam 10mg± Ketamine 50 or 100 mg daily, for 48h after surgery. Pain scores as VAS and sedative level as Ramsay scale and other possible side effects such as nausea and vomiting, and any rescue doses of analgesics were evaluated at 2, 6,24,36,48 hours after initiation of PCIA. Findings: Considering pain acuity, groups with PCIA containing Ketamine in addition to Morphine and Midazolam, showed significant decrease in pain score. However, there was no difference in sedation score between the groups. There was a significant decrease in the number of rescue doses of analgesics in groups with PCIA containing Ketamine compared with the other group. There was no difference in any evaluation between the groups with PCIA containing 50 mg or 100mg Ketamine. Conclusions: A better control of pain was achieved in opioid addict patients with the addition of Ketamin either 50 or 100 mg to PCIA pump compared to the control group with PCIA containing Midazolam and Morphine. Keywords: Post operative pain, opioid addiction, Ketamine, PCIA 5202 Regional anesthesia Comparison between the effect of 0.2% and 0.3% Bupivacaine in fascia iliac block on postoperative pain in patients with femoral or hip fracture Imani Farnad Rahimzadeh Poupak Faiz Seyed Hamid Reza Sayarifard Azadeh Alebouyeh Mahmoud Reza Entezary Saeed Reza sayarifard sara Hazrat Rasul Medical Complex, Iran University of Medical Sciences Hazrat Rasul Medical Complex, Iran University of Medical Sciences Hazrat Rasul Medical Complex, Iran University of Medical Sciences Tehran University of Medical Sciences. Hazrat Rasul Medical Complex, Iran University of Medical Sciences Hazrat Rasul Medical Complex, Iran University of Medical Sciences Hazrat Rasul Medical Complex, Iran University of Medical Sciences 1 7 2015 6 2 59 68 18 04 2015 04 06 2015 Aims and Background: Pain after surgery is a major problem for patients with fractures of the femur or hip. We studied the effect of Bupivacaine at a concentration of 0.2% and 0.3% in fascia iliac block on postoperative pain. Materials and Methods: The study was a Randomized double-blinded clinical trial. A total of 48 patients who had femur or hip fracture underwent fasia iliac block. Patients were randomly assigned to two groups receiving Bupivacaine at a concentration of 0.2% and 0.3%, respectively. Then the two groups were compared in terms of pain and satisfaction with pain control and intensity of motor block. Findings: Postoperative pain score in 0.3% group was significantly lower than 0.2%(p< 0.001) while the patient satisfaction of pain control and intensity of motor block were significantly higher in Group 0.2% (p=0.04). Onset of analgesia had no significant difference between the two groups. Conclusion: Bupivacaine with concentration of 0.3% in fascia iliac block could further decrease the pain score after hip or femoral fracture surgery however patient satisfaction with pain control and intensity of motor block were higher with 0.2. % concentration of Bupivacaine. Keywords: Bupivacaine, fascia iliac block, postoperative pain 5206 Special Prediction of depression based on perception of pain and quality of sleep due to pain catastrophizing in elderly patient with rheumatoid arthritis vesal mina Mollazade Javad Taghavi MohamadReza Nazarinia MohamadAli Shiraz University Shiraz University Shiraz University Shiraz university of Medical science 1 7 2015 6 2 69 80 28 04 2015 04 06 2015 Aims and Background: The aim of the present study is prediction of depression in elderly patients with rheumatoid arthritis based on perception of pain and quality of sleep and it examines the mediating role of pain catastrophizing as a model. Few investigations have been reported regarding this subject. Also some limited results are still uncertain. Methods and materials: Research design was Correlation and study population including all elderly patients with rheumatoid arthritis in Hafez rheumatology clinic at Shiraz. For this purpose, 150 patients participated in the study via convenient sampling. Research Tools included Geriatric Depression Scale, the McGill pain questionnaire, the Pittsburgh Sleep Quality Index and Pain Catastrophizing Scale. In order to analyze the data, the path analysis by AMOS and the stepwise multiple regressions by SPSS were used. Findings: The results indicated that perception of pain and quality of sleep significantly predict pain catastrophizing and depression. The proposed model shows that perception of pain and quality of sleep with mediating role of pain catastrophizing can significantly predict depression. Conclusions: The finding of this study showed that we can prevent depression by special therapies such as: Cognitive- Behavior Therapy and Acceptance- Commitment Therapy for improving quality of sleep, reducing pain and controlling catastrophizing thought in these patients. Keywords: Perception of pain, Quality of sleep, Pain catastrophizing, Depression, Rheumatoid Arthritis. 5187 Neuroanesthesia Anesthesia management in rare case of beta thalassemia major patient under craniotomy for intracranial lipomas Derakhshan Pooya Karbasi Seyyed Hasan Sekhavati Azade Birjand University of Medical sciences Birjand University of Medical sciences Birjand University of Medical sciences 1 7 2015 6 2 81 86 13 01 2015 29 04 2015 Aim and Background: Beta thalassemia major is a hematologic autosomal recessive syndrome. Many anesthetic problems were noted in these patients like difficult intubation, coagulopathies and cardiomyopathies. In this case report, we describe a patient with Beta thalassemia major and intra cranial lipoma. Case report: A 36 year old woman, known case of Beta thalassemia major, was candidate for elective craniotomy for intracranial lipoma. She had marked deformities in maxillofacial bones and it caused difficult intubation. For this reason intubation was performed with fiber optic laryngoscope. Beta thalassemia major patients have difficult air way because of hypertrophic bone marrow due to marked facial and mandibular bone deformities and we must consider these problems for anesthesia management. Keywords: Intracranial lipoma, Beta thalassemia major, difficult intubation, Anesthesia management