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Farbood A, Sahmeddini MA, Jalilpour Aghdam M, Eghbal M, Ariafar A, Narouie B, Momeni H. Sudden cardiovascular collapse during the TUL procedure: A case series. Urologia 2024; 91:232-236. [PMID: 37873763 DOI: 10.1177/03915603231208116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Although ureteroscopy is a minimally invasive procedure, there have been reports of some minor and major complications, from self-limited to complicated events such as ureteral avulsion, urosepsis, and even death due to cerebrovascular accidents and deep vein thrombosis. Herein, we aim to report seven patients who presented with cardiovascular collapse during ureteroscopy in a 19-year period from January 2002 to January 2021.
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Affiliation(s)
- Arash Farbood
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Sahmeddini
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Jalilpour Aghdam
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadhossein Eghbal
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Ariafar
- Urology Oncology Research Center, Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behzad Narouie
- Department of Urology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hamidreza Momeni
- Department of Urology, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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2
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Jokar M, Sahmeddini MA, Zand F, Rezaee R, Bashiri A. Development and evaluation of an anesthesia module for electronic medical records in the operating room: an applied developmental study. BMC Anesthesiol 2023; 23:378. [PMID: 37978350 PMCID: PMC10655453 DOI: 10.1186/s12871-023-02335-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023] Open
Abstract
Developing an anesthesia module in the operating room is one of the significant steps toward the implementation of electronic medical records (EMR) in health care centers. This study aimed to develop and evaluate the web based-anesthesia module of an electronic medical record Sciences, in the operating room of the Namazi Medical Training Center of Shiraz University of Medical Iran. This developmental and applied study was conducted in steps including determining the functional and non-functional requirements, designing and implementing the anesthesia module, and usability evaluation. 3 anesthesiologists, 3 anesthesiologist assistants, and 12 anesthetist nurses were included in the study as a research community. React.js, Node.js programming language to program this module, Mongo dB database, and Windows server for data management and USE standard questionnaire were used. In the anesthesia module, software quality features were determined as functional requirements and non-functional requirements included 286 data elements in 25 categories (demographic information, surgery information, laboratory results, patient graphs, consults, consent letter, physical examinations, medication history, family disease records, social record, past medical history, type of anesthesia, anesthesia induction method, airway management, monitoring, anesthesia chart, blood and fluids, blood gases, tourniquets and warmers, accessories, positions, neuromuscular reversal, transfer the patient from the operating room, complications of anesthesia and, seal/ signature). Also, after implementing the anesthesia module, results of the usability evaluation showed that 69.1% of the users agreed with the use of this module in the operating room and considered it user-friendly.
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Affiliation(s)
- Marjan Jokar
- Department of Health Information Management, School of Health Management and Information Sciences, Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Sahmeddini
- Department of Anesthesiology, School of Medicine, Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farid Zand
- Department of Anesthesiology, School of Medicine, Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rita Rezaee
- Department of Health Information Management, School of Health Management and Information Sciences, Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azadeh Bashiri
- Department of Health Information Management, School of Health Management and Information Sciences, Health Human Resources Research Center, Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Naderi-Boldaji V, Banifatemi M, Zandi R, Eghbal MH, Nematollahi M, Sahmeddini MA. Incidence and root causes of surgery cancellations at an academic medical center in Iran: a retrospective cohort study on 29,978 elective surgical cases. Patient Saf Surg 2023; 17:24. [PMID: 37674216 PMCID: PMC10481593 DOI: 10.1186/s13037-023-00377-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023] Open
Abstract
INTRODUCTION Canceling scheduled surgeries on the day of surgery places a heavy burden on healthcare providers and has psychological, social, and financial consequences on patients and their families. This study aimed to investigate the main reasons for cancellations of elective procedures and provide appropriate recommendations to reduce the rate of such avoidable cancellations. METHODS Data were collected retrospectively from all consecutive elective cases scheduled for various elective surgeries from January 1, 2020 to March 31, 2022 at Namazi Teaching Hospital, a major referral center in southern Iran with a capacity of 938 beds. Daily data were collected on the number of planned electives, cancellations, and reasons for cancellations. Surgical cancellation reasons were categorized as patient-related, surgeon-related, hospital/system-related, and anesthesia-related. Data were expressed as frequency (percentage) and analyzed with SPSS version 19 software. RESULTS The cancellation rate on surgery day for elective procedures in all fields was 6.3%. The highest cancellation rate was related to minor surgeries (19%), followed by urology (8%), pediatrics (7%), and plastic surgery (7%). The most common reasons for cancellation were patients not suitable for the procedure (37%), followed by patients who did not follow instructions (10%), lack of time (10.5%), and equipment/supplies problems (10%), and refusal to consent (6%). CONCLUSIONS According to this study, patients' unsuitability for surgery, non-compliance with instructions, lack of time, and problems with equipment/supplies are the main reasons for canceling surgery. Proper preoperative assessment and preparation of patients and improved communication between medical teams and patients reduce the cancellation of booked surgeries.
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Affiliation(s)
- Vida Naderi-Boldaji
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Banifatemi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Raheleh Zandi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Eghbal
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Milad Nematollahi
- Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Sahmeddini
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Dehghanpisheh L, Sahmeddini MA, Kaboodkhani R, Samadi K, Khademi S, Rafati Z, Abbasi S, Abbasi R. Efficacy of Isoflurane-Remifentanil versus Propofol-Remifentanil on Controlled Hypotension and Surgeon Satisfaction in Rhinoplasty: A Single-Blind Clinical Trial Study. Iran J Med Sci 2023; 48:379-384. [PMID: 37456209 PMCID: PMC10349152 DOI: 10.30476/ijms.2022.94781.2608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/15/2022] [Accepted: 07/10/2022] [Indexed: 07/18/2023]
Abstract
Background Rhinoplasty is a complex but popular surgery in Iran. The main complications of the surgery are post-operative bleeding and nasal septal hematoma due to poor intra-operative controlled hypertension. This study aimed to compare the efficacy of isoflurane-remifentanil (I-R) versus propofol-remifentanil (P-R) to induce controlled hypotension and to assess surgeon satisfaction with each of these combinations during rhinoplasty. Methods In 2020-2021, a single-blind clinical study was conducted on 98 patients aged 18-50 years undergoing rhinoplasty at Mother and Child Hospital (Shiraz, Iran). Patients were randomly divided into P-R (n=48) and I-R (n=50) groups. Changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were assessed during surgery and in the recovery room. A questionnaire was used to evaluate the level of surgeon satisfaction. Data were analyzed using independent samples t test, Chi-square test, and repeated measures ANOVA with SPSS software. P<0.05 was considered statistically significant. Results Five minutes after anesthesia induction, the P-R combination had a greater effect on reducing SBP (P=0.010), DBP (P=0.007), MAP (P=0.003), and HR (P=0.026) than I-R. However, from the 40th minute to the end of surgery and after 30 minutes of recovery, the I-R combination had a slightly better effect on blood pressure reduction than P-R. There was no difference in surgeon satisfaction with either of the two drug combinations. Conclusion Both P-R and I-R combinations are recommended to induce hypotension during rhinoplasty. However, I-R is more effective than P-R in inducing the desired controlled hypotension.
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Affiliation(s)
- Laleh Dehghanpisheh
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Sahmeddini
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Kaboodkhani
- Otolaryngology Research Center, Department of Otorhinolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kazem Samadi
- Department of Anesthesiology, Shahid Dastgheib Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Khademi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Rafati
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sanaz Abbasi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Razieh Abbasi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Tehran SG, Khosravi MB, Sahmeddini MA, Eghbal MH, Asmarian N, Khalili F, Vatankhah P. Comparing the effect of administering gelatin-low dose albumin versus albumin on renal function in liver transplantation: A randomized clinical trial. Clin Transplant 2022; 36:e14791. [PMID: 35950553 DOI: 10.1111/ctr.14791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 07/24/2022] [Accepted: 08/07/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common complication after liver transplantation (LT) that is independently associated with an increased risk of morbidity and mortality. This study aimed to evaluate the effects of administering gelatin-low dose albumin versus albumin on renal function and other early outcomes in LT. METHODS This randomized controlled clinical trial was conducted on 140 patients undergoing LT from brain death donors. Patients were randomly assigned to two groups: albumin or modified gelatin with albumin. Blood samples were collected before (T0) and on the first (T1), second (T2), third (T3), fifth (T4), and last day of hospitalization (T5) after LT for the detection of laboratory parameters, including renal and liver function tests. RESULTS The incidence of AKT on the basis of RIFLE criteria was 31.42% in the gelatin group (R: 59.10%, I: 36.40%, and F: 4.50%) and 25.71% in the albumin group (R: 66.70%, I: 27.80%, and F: 5.50%) (p = .845). Two patients in the gelatin and one in the albumin groups required renal replacement therapy (RRT). There was no significant difference between groups when the trends of changes in renal and liver function parameters were assessed during the study period (T0-T5). Furthermore, the incidence of complications was similar across groups. CONCLUSION This study showed that modified gelatin could be used without inappropriate outcomes on renal function in patients with normal preoperative kidney function tests undergoing LT.
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Affiliation(s)
- Samaneh Ghazanfar Tehran
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran.,Shiraz Transplant Center, Abu-Alisina Hospital, Shiraz University of Medical Science, Shiraz, Iran
| | - Mohammad Bagher Khosravi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Sahmeddini
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Eghbal
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naeimehossadat Asmarian
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Khalili
- Shiraz Transplant Center, Abu-Alisina Hospital, Shiraz University of Medical Science, Shiraz, Iran.,Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pooya Vatankhah
- Shiraz Transplant Center, Abu-Alisina Hospital, Shiraz University of Medical Science, Shiraz, Iran
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Nikoupour H, Bagher Khosravi M, Vatankhah P, Shafiekhani M, Shamsaeefar A, Arasteh P, Hossein Anbardar M, Hossein Eghbal M, Sahmeddini MA, Khalili F, Firoozifar M, Ghazanfar Tehran S, Nikeghbalian S. Intestinal Transplantation in a Country Without Home Parenteral Nutrition: The Largest Report from the Middle East. Turk J Gastroenterol 2022; 33:793-802. [PMID: 35788430 PMCID: PMC9524485 DOI: 10.5152/tjg.2022.21708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: Many regions of the world, especially middle- and low-income countries, lack facilities for home parenteral nutrition and thus cannot follow existing guidelines for intestinal transplantation. Herein, we report our experiences with treatment protocols, intraoperative management, and early postoperative outcomes among patients undergoing either isolated intestinal transplantation or multivisceral transplantation in our center. Methods: During a 1-year period from March 2019 to March 2020, a total of 9 intestinal transplantations including 6 isolated intestinal transplantations and 3 multivisceral transplantations were performed in our center. We reported on donor selection strategies, surgical treatment, anesthesiology care and protocols for total parenteral nutrition, immunosuppression regimen, and pathology evaluation. Results: Mean (standard deviation) age of patients was 37.5 ± 12.5 years. The majority of patients were females (7/9). The median (interquartile range) waiting time for patients from diagnosis to transplantation was 79 (34, 164) days. Our 7-day survey of the amount of fluid therapy after transplantation revealed that the greatest need for fluid therapy was seen on the second postoperative day. After transplantation, 2 patients showed a total of 3 episodes of severe rejection, 1 of which was antibody-mediated. The 1-year survival was 66.6% and the 2-year survival was 44.5% in our study population. The median (interquartile range) time to death was 157 (26.5, 382) days. The most common cause of death was sepsis in our series (3/5). Conclusion: Acceptable outcomes can be obtained with intestinal transplantation in countries without home parenteral nutrition by application of specific treatment protocols.
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Affiliation(s)
- Hamed Nikoupour
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Pooya Vatankhah
- Corresponding authors: Pooya Vatankhah, e-mail: ; Mojtaba Shafiekhani, e-mail:
| | - Mojtaba Shafiekhani
- Corresponding authors: Pooya Vatankhah, e-mail: ; Mojtaba Shafiekhani, e-mail:
| | | | | | | | - Mohammad Hossein Eghbal
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Fatemeh Khalili
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Firoozifar
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samaneh Ghazanfar Tehran
- Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences Alzahra Hospital, Rasht, Iran
| | - Saman Nikeghbalian
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Hadavi SMR, Eghbal MH, Kaboodkhani R, Alizadeh N, Sahmeddini MA. Comparison of pregabalin with magnesium sulfate in the prevention of remifentanil‐induced hyperalgesia in patients undergoing rhinoplasty: A randomized clinical trial. Laryngoscope Investig Otolaryngol 2022; 7:1360-1366. [PMID: 36258848 PMCID: PMC9575120 DOI: 10.1002/lio2.905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/28/2022] [Accepted: 08/15/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Seyed Mohammad Reza Hadavi
- Shiraz Anesthesiology and Intensive Care Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Mohammad Hossein Eghbal
- Shiraz Anesthesiology and Intensive Care Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Reza Kaboodkhani
- Otorhinolaryngology Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Narges Alizadeh
- Shiraz Anesthesiology and Intensive Care Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Mohammad Ali Sahmeddini
- Shiraz Anesthesiology and Intensive Care Research Center Shiraz University of Medical Sciences Shiraz Iran
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Sahmeddini MA, Tehran SG, Khosravi MB, Eghbal MH, Asmarian N, Khalili F, Vatankhah P, Izadi S. Correction to: Risk factors of the post-reperfusion syndrome during orthotopic liver transplantation: a clinical observational study. BMC Anesthesiol 2022; 22:102. [PMID: 35410122 PMCID: PMC8996405 DOI: 10.1186/s12871-022-01645-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Mohammad Ali Sahmeddini
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samaneh Ghazanfar Tehran
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran.
| | - Mohammad Bagher Khosravi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Eghbal
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naeimehossadat Asmarian
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Khalili
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pooya Vatankhah
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Somayeh Izadi
- Shiraz Transplant Center, Abu-Alisina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Sahmeddini MA, Tehran SG, Khosravi MB, Eghbal MH, Asmarian N, Khalili F, Vatankhah P, Izadi S. Risk factors of the post-reperfusion syndrome during orthotopic liver transplantation: a clinical observational study. BMC Anesthesiol 2022; 22:89. [PMID: 35366808 PMCID: PMC8976299 DOI: 10.1186/s12871-022-01635-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/28/2022] [Indexed: 02/07/2023] Open
Abstract
Background Post reperfusion syndrome (PRS) is a relatively common and life-threatening complication during orthotopic liver transplantation (OLT). It is associated with poor patient and transplanted liver outcomes. Objective This study aimed to compare the risk factors of PRS during OLT. Design Clinical-epidemiological observational retrospective study. Setting We gathered the records of patients who underwent OLT in 3 years, from May 22, 2016, to May 22, 2019, in Namazi and Bu-Ali Sina organ transplantation hospitals. Patients In this study, we assessed 1182 patients who underwent OLT. Patients were divided into two groups based on the presence or absence of PRS. Main outcome measures Diagnosing the predictors of PRS was the primary outcome of this study. Results Results showed that age > 60 years, Child-Pugh scores C, higher Model End Stage liver disease score, and preoperative sodium < 130 mmol/l (parameters of the liver recipient), increase in cold ischemic time (the donors’ parameters), and the classical technique (the surgical parameters) were the strong predictors of PRS. Conclusions The results indicated that underlying liver disease was not the predictor of PRS in the presence of other risk factors; therefore, clinicians have to consider these risk factors in patients undergoing OLT. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01635-3.
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10
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Emami S, Panah A, Hakimi SS, Sahmeddini MA. Effect of Caffeine on the Acceleration of Emergence from General Anesthesia with Inhalation Anesthetics in Children Undergoing Inguinal Herniorrhaphy: A Randomized Clinical Trial. Iran J Med Sci 2022; 47:107-113. [PMID: 35291434 PMCID: PMC8919303 DOI: 10.30476/ijms.2021.87688.1818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/14/2020] [Accepted: 01/23/2021] [Indexed: 11/19/2022]
Abstract
Background Awakening following general anesthesia (GA) is one of the most important concerns of anesthesiologists in their daily work. Previous studies on adult humans found that caffeine could accelerate awakening after anesthesia. This study aimed to determine whether or not caffeine can accelerate awakening after anesthesia in children undergoing inguinal herniorrhaphy under GA. Methods In this randomized clinical trial, we enrolled 18 children undergoing inguinal herniorrhaphy under GA with inhaled anesthetics from June 2019 to September 2019 in the tertiary hospital affiliated with Shiraz University of Medical Sciences (Shiraz, Iran). These children were randomly allocated to two groups. In group A, the children received intravenous caffeine (10 mg/Kg) at the end of the surgery, and in group B, the children received intravenous normal saline at the end of the surgery. The primary outcome was laryngeal mask airway (LMA) removal time at the end of anesthesia. Intra-operative hemodynamic data and side effects such as nausea, vomiting, dysrhythmia, cyanosis, and seizures in the recovery room were recorded and compared between the two groups. We used the independent-samples t test, Fisher's exact test, and repeated measures ANOVA for analyzing the data. P values<0.05 were considered statistically significant. Results There were no significant differences in terms of demographic characteristics and hemodynamic data between the two groups. Furthermore, the time from the induction of anesthesia to laryngeal mask removal was 44.77±7.87 min in the placebo group and 44.55±10.68 min in the caffeine group. Therefore, there was no significant difference between the two groups (P=0.961). Conclusion In children undergoing inguinal herniorrhaphy under GA, 10 mg/Kg of caffeine could not accelerate awakening from GA. However, caffeine did not increase the blood pressure and heart rate in the children, and no significant side effects were observed. Trial Registration Number IRCT20190511043550N1.
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Affiliation(s)
- Soodabeh Emami
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ashkan Panah
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Shaheen Hakimi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Sahmeddini
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Khosravi MB, Naderi-Boldaji V, Khalili F, Sahmeddini MA, Eghbal MH, Vatankhah P, Nikoupour H, Shamsaeefar A, Ghazanfar Tehran S. Anesthesia Aspects of Multivisceral Transplantation: A Case Series Study. Int J Organ Transplant Med 2022; 13:71-77. [PMID: 37641733 PMCID: PMC10460526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Background Multi-visceral transplantation (MvTx) usually refers to the transplantation of more than three intra-abdominal organs. A successful MvTx requires strong multidisciplinary teamwork of transplant surgeons, anesthesiologists, and intensivists. Case presentation We present five cases of MvTx with a history of short bowel syndrome admitted to the Abu-Ali Sina Hospital, Shiraz, Iran from May 2019 to January 2020 and describe anesthetic considerations in MvTx. Subjects were identified (4F/1M) with a mean age of 43 years old (range 35-51). The most frequent cause of intestinal failure was portal vein thrombosis, followed by bowel gangrene and short bowel syndrome. The mean ±SD duration of the operation was 360±60 min. The bleeding volume was approximately 2600±1474 cc, and 4±1 bags of packed red blood cells were transfused. Sepsis was the main cause of death in our series. Conclusion Careful preoperative planning, vigilant intraoperative anesthetic management, and prevention of postoperative infection are imperative to achieve the best outcomes.
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Affiliation(s)
- M B Khosravi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - V Naderi-Boldaji
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - F Khalili
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M A Sahmeddini
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M H Eghbal
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - P Vatankhah
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H Nikoupour
- Abo-Ali Sina Organ Transplant Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A Shamsaeefar
- Abo-Ali Sina Organ Transplant Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S Ghazanfar Tehran
- Anesthesiology and Critical Care Research Center, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
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Faramarzi M, Roosta S, Eghbal MH, Nouri Rahmatabadi B, Faramarzi A, Mohammadi‐Samani S, Shishegar M, Sahmeddini MA. Comparison of celecoxib and acetaminophen for pain relief in pediatric day case tonsillectomy: A randomized double-blind study. Laryngoscope Investig Otolaryngol 2021; 6:1307-1315. [PMID: 34938867 PMCID: PMC8665471 DOI: 10.1002/lio2.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/26/2021] [Accepted: 10/14/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Post-tonsillectomy pain is a common morbidity in children. The aim of this study was to compare the efficacy of celecoxib with acetaminophen on pain relief in pediatric day-case tonsillectomy. METHODS We compared the analgesic effect of celecoxib (99 patients) with acetaminophen (100 patients) for the management of post-tonsillectomy pain. Post-tonsillectomy pain score was evaluated three times a day for 7 days. In addition, the incidence of post-tonsillectomy bleeding and the rate of patients who returned to regular diet were evaluated. RESULTS In the first day, we observed lower mean pain score in the celecoxib group, than the acetaminophen group (P = 0.013). The overall pain score in other days was not significantly different between the two groups. In the celecoxib group, more patients resumed regular amount of oral intake within the first 3 days. Also, the rate of post-tonsillectomy bleeding in the two groups was not statistically different. CONCLUSION We recommend celecoxib as a more suitable choice than acetaminophen for post-tonsillectomy pain management in the first day and resuming regular diet within 3 days.Level of Evidence: 1b.
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Affiliation(s)
- Mohammad Faramarzi
- Department of Otorhinolaryngology – Head & Neck surgeryShiraz University of Medical SciencesShirazIran
- Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| | - Sareh Roosta
- Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Mohammad Hossein Eghbal
- Shiraz Anesthesiology and Critical Care Research CenterShiraz University of Medical SciencesShirazIran
| | - Bahar Nouri Rahmatabadi
- Shiraz Anesthesiology and Critical Care Research CenterShiraz University of Medical SciencesShirazIran
| | - Ali Faramarzi
- Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | | | - Mahmood Shishegar
- Department of Otorhinolaryngology – Head & Neck surgeryShiraz University of Medical SciencesShirazIran
- Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| | - Mohammad Ali Sahmeddini
- Shiraz Anesthesiology and Critical Care Research CenterShiraz University of Medical SciencesShirazIran
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Jowkar S, Khosravi MB, Sahmeddini MA, Eghbal MH, Samadi K. Preconditioning Effect of Remifentanil Versus Fentanyl in Prevalence of Early Graft Dysfunction in Patients After Liver Transplant: A Randomized Clinical Trial. EXP CLIN TRANSPLANT 2020; 18:598-604. [PMID: 32635883 DOI: 10.6002/ect.2019.0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES One of the most prevalent complications of orthotopic liver transplant is primary graft dysfunction. Recent studies have shown the preconditioning effect of remifentanil on animal livers but not human livers. Here, we compared the preconditioning effects of remifentanil and fentanyl in orthotopic liver transplant in human patients. MATERIALS AND METHODS In this double-blind clinical trial, 100 patients who underwent liver transplant from deceased donors were randomly allocated into 2 groups. Patients in the remifentanil group received remifentanil infusion, and those in the fentanyl group received fentanyl infusion during maintenance of anesthesia. Serum aminotransferase levels, prothrombin time (international normalized ratio), partial thrombin time, arterial blood gas levels, and renal function tests were evaluated over 7 days posttransplant. Intensive care unit stay and hospitalization were also recorded. RESULTS The median peak alanine aminotransferase level during 7 days after transplant was 2100 U/L (interquartile range, 1230-3220) in the remifentanil group and 3815 U/L (interquartile range, 2385-5675) in the fentanyl group (P = .048). Metabolic acidosis, renal state, prothrombin time (international normalized ratio), and partial thrombin time were similar in both groups (P > .05). Durations of stay in the intensive care unit and hospital were not significantly different between the 2 groups (P = .75 and P = .23, respectively). Overall, the clinical outcomes were similar in the remifentanil and fentanyl groups (P > .05). CONCLUSIONS We found that remifentanil and fentanyl were not different with regard to their preconditioning effects and graft protection in orthotopic liver transplant recipients.
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Affiliation(s)
- Sanaz Jowkar
- From the Department of Anesthesia, Nemazee Hospital, Shiraz, Fars, Iran
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Sahmeddini MA, Panah A, Ghanbari A. Effects of Low-dose Propofol or Ketamine on Coughing at Emergence from Anesthesia in Children Undergoing Tonsillectomy. Cureus 2020; 12:e7842. [PMID: 32483493 PMCID: PMC7253079 DOI: 10.7759/cureus.7842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/26/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Coughing is commonly observed during emergence from general anesthesia. In children, smooth emergence from anesthesia, especially after tonsillectomy, is crucial. In this study, we compared the effect of low-dose ketamine or propofol on emergence coughing in children undergoing tonsillectomy. Methods In this randomized clinical trial, 90 children undergoing tonsillectomy were randomly allocated into two groups: children in group A received 0.5-mg/kg propofol and children in group B received 0.5-mg/kg ketamine, at the end of anesthesia. The incidence and severity of cough, postoperative sedation, nausea, and vomiting, and pain score were recorded and compared. Results The incidence of no cough at emergence from anesthesia was 82.2% in the propofol group and 15.5% in the ketamine group (P = 0.00). Children in the ketamine group exhibited postoperative pain but were more sedated compared with those in the propofol group (P > 0.05). The incidence of postoperative nausea and vomiting was lower in the propofol group (P < 0.05). Conclusions At the end of general anesthesia with isoflurane in children undergoing tonsillectomy, 0.5-mg/kg propofol is more effective than 0.5-mg/kg ketamine in reducing cough response upon emergence from anesthesia, with a lower incidence of nausea and vomiting, as well as lower sedation in children.
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Affiliation(s)
- Mohammad Ali Sahmeddini
- Anesthesiology, Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, IRN
| | - Ashkan Panah
- Anesthesiology, Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, IRN
| | - Alireza Ghanbari
- Anesthesiology, Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, IRN
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Bahador A, Nikeghbalain S, Foroughi M, Beizavi Z, Sahmeddini MA, Eghbal MH, Vafaei H, Malekhosseini SA, Bahador M. Successful Surgical Separation of Thoraco-Omphalopagus Symmetrical Conjoined Twins in Iran: Two Case Reports. Iran J Med Sci 2020; 45:143-147. [PMID: 32210492 PMCID: PMC7071550 DOI: 10.30476/ijms.2019.81060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Conjoined twins are derived from the division of a single fertilized ovum; a phenomenon accompanied with multiple congenital anomalies. Such twins are identical, of the same sex, and more likely to be female. Most twins die during the embryonic period, and only 18% survive longer than 24 hours. There are complex anomalies in thoraco-omphalopagus twins that makes them unlikely to live long enough to undergo separation. Treatment of this uncommon condition presents both surgical and anesthetic challenges. The management of rare anomalies is difficult even for skilled surgeons. Therefore, it is logical to use the knowledge gained from previous experiences. We herein present the first successful surgical separation of two pairs of thoraco-omphalopagus conjoined twins at the Pediatric Surgery Center of Namazi Hospital (Shiraz, Iran). In both cases, the neonates had separate hearts and common pericardium. Contrast-enhanced computed tomography of two sets of twins showed fusion of sternum, pericardium, diaphragm, and left lobe of liver. Critical steps of the surgical separation were identified and contingency plans were made for possible partial liver donation and cross-circulation between twins. The separation procedure and reconstruction of the abdominal wall were successfully performed. Both pairs of twins, now 6- and 8-year-old, are healthy and have normal growth and are under follow-up.
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Affiliation(s)
- Ali Bahador
- Department of Pediatric Surgery, Namazee Hospital, Shiraz University of Medical Science, Shiraz, Iran
| | - Saman Nikeghbalain
- Shiraz Transplant Medical Center, Namazee Hospital, Shiraz University of Medical Science, Shiraz, Iran
| | - Mehdi Foroughi
- Department of Pediatric Surgery, Namazee Hospital, Shiraz University of Medical Science, Shiraz, Iran
| | - Zahra Beizavi
- General Surgery Resident, Department of General Surgery, Shiraz University of Medical Science, Shiraz, Iran
| | - Mohammad Ali Sahmeddini
- Shiraz Anesthesiology and Clinical Care Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Mohammad Hossein Eghbal
- Shiraz Anesthesiology and Clinical Care Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Homeira Vafaei
- Maternal Fetal Medicine Research Center, Perinatology Ward, Shiraz University of Medical Science, Shiraz, Iran
| | - Seyyed Ali Malekhosseini
- Shiraz Transplant Medical Center, Namazee Hospital, Shiraz University of Medical Science, Shiraz, Iran
| | - Mohsen Bahador
- Student Research Committee, Department of Otorhinolaryngology, Shiraz University of Medical Science, Shiraz, Iran
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Sahmeddini MA, Khosravi MB, Seyedi M, Hematfar Z, Abbasi S, Farbood A. Comparison of Magnesium Sulfate and Tramadol as an Adjuvant to Intravenous Regional Anesthesia for Upper Extremity Surgeries. Anesth Pain Med 2017; 7:e57102. [PMID: 29696122 PMCID: PMC5903376 DOI: 10.5812/aapm.57102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 12/16/2017] [Accepted: 12/24/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Intravenous Regional Anesthesia (IVRA) is a simple efficient method for providing regional anesthesia of the limbs. However, it has some limitations such as lack of postoperative analgesia. OBJECTIVES This study aimed to compare the analgesic effects of magnesium sulfate and tramadol when added to lidocaine used for IVRA in upper limb surgery. METHODS In this double - blind randomized clinical trial, 69 patients who underwent elective upper limb surgery with IVRA were randomly allocated into 3 groups. Patients in group A, received IVRA with 0.5% lidocaine and tramadol 100 mg, in group B received IVRA with 0.5% lidocaine and magnesium sulfate 1.5 g, while in group C patients received IVRA with 0.5% lidocaine and normal saline. The onset of sensory block and the duration of postoperative analgesia pain intensity were noted in each patient. Furthermore, the incidence of postoperative nausea and vomiting, respiratory depression, and skin rash were recorded. RESULTS Duration of postoperative analgesia was more prolong in the tramadol group than other groups (P = 0.01). Also, the total amount of morphine consumption in the group A, group B, and C was 8.91 ± 5.81, 11.95 ± 4.81, 16.72 ± 4.07 mg, respectively, which was significantly lower in the tramadol group in comparison to the other groups (P = 0.01). CONCLUSIONS It seems that adding tramadol as an adjuvant to lidocaine during IVRA in comparison to magnesium sulfate increases duration of postoperative analgesia and decreases analgesic consumption without increasing opioid-related side effects.
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Affiliation(s)
- Mohammad Ali Sahmeddini
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Bagher Khosravi
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoome Seyedi
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Hematfar
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedighe Abbasi
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Farbood
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Eghbal MH, Samadi K, Khosravi MB, Sahmeddini MA, Ghaffaripoor S, Ghorbani M, Shokrizadeh S. The Impact of Preoperative Variables on Intraoperative Blood Loss and Transfusion Requirements During Orthotopic Liver Transplant. EXP CLIN TRANSPLANT 2017; 17:507-512. [PMID: 29025385 DOI: 10.6002/ect.2016.0325] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Liver transplant traditionally and potentially is associated with the risk of massive blood loss and transfusion, which can adversely affect transplant outcomes. Many variables influence the amount of bleeding, and these can be categorized as patient related, surgery related, and graft related. We aimed to assess the effects of these variables on the amount of bleeding and transfusion during liver transplant; predicting the risk of massive blood loss can help transplant teams to select and manage patients more effectively. MATERIALS AND METHODS We retrospectively studied 754 patients who underwent liver transplant from 2013 to 2016 and analyzed more than 20 variables that could influence the volume of blood loss and packed cell transfusion. RESULTS We found that at least 4 variables are strongly and independently correlated with blood loss volume: age, Model for End-Stage Liver Disease score, warm ischemia time, and total bilirubin. Furthermore, intraoperative blood loss had a weak but clinically important correlation with the underlying disease (ie, the cause of liver cirrhosis). Some variables, including international normalized ratio, platelet count, albumin, serum urea nitrogen, creatinine level, sodium level, and the amount of ascites, could be considered as 'dependent' and weak predictors of massive blood loss. Sex of patient, cold ischemia time, surgery technique, and history of previous abdominal surgery were not correlated with the amount of bleeding. CONCLUSIONS With the use of the variables identified, we can properly select patients and surgical teams and promptly use modalities for decreasing and managing blood loss.
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Affiliation(s)
- Mohammad Hossein Eghbal
- From the Department of Anesthesiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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18
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Vakily A, Parsaei H, Movahhedi MM, Sahmeddini MA. A System for Continuous Estimating and Monitoring Cardiac Output via Arterial Waveform Analysis. J Biomed Phys Eng 2017; 7:181-190. [PMID: 28580340 PMCID: PMC5447255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 03/08/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND Cardiac output (CO) is the total volume of blood pumped by the heart per minute and is a function of heart rate and stroke volume. CO is one of the most important parameters for monitoring cardiac function, estimating global oxygen delivery and understanding the causes of high blood pressure. Hence, measuring CO has always been a matter of interest to researchers and clinicians. Several methods have been developed for this purpose, but a majority of them are either invasive, too expensive or need special expertise and experience. Besides, they are not usually risk free and have consequences. OBJECTIVE Here, a semi-invasive system was designed and developed for continuous CO measurement via analyzing and processing arterial pulse waves. RESULTS Quantitative evaluation of developed CO estimation system was performed using 7 signals. It showed that it has an acceptable average error of (6.5%) in estimating CO. In addition, this system has the ability to consistently estimate this parameter and to provide a CO versus time curve that assists in tracking changes of CO. Moreover, the system provides such curve for systolic blood pressure, diastolic blood pressure, average blood pressure, heart rate and stroke volume. CONCLUSION Evaluation of the results showed that the developed system is capable of accurately estimating CO. The curves which the system provides for important parameters may be valuable in monitoring hemodynamic status of high-risk surgical patients and critically ill patients in Intensive Care Units (ICU). Therefore, it could be a suitable system for monitoring hemodynamic status of critically ill patients.
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Affiliation(s)
- A Vakily
- Department of Medical Physics and Engineering, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H Parsaei
- Department of Medical Physics and Engineering, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M M Movahhedi
- Department of Medical Physics and Engineering, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M A Sahmeddini
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Sahmeddini MA, Azemati S, Motlagh EM. Local Infiltration of Tramadol versus Bupivacaine for Post Cesarean Section Pain Control: A Double-Blind Randomized Study. Iran J Med Sci 2017; 42:235-241. [PMID: 28533571 PMCID: PMC5429491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Postoperative pain control after cesarean section (C/S) is important because inadequate postoperative pain control can result in a prolonged hospital stay. In this study, we compared postoperative somatic wound pain control between patients receiving tramadol and bupivacaine, infiltrated at the wound site. METHODS In this randomized clinical trial, 98 patients, eligible for elective C/S under general anesthesia, were randomly allocated to 2 groups. Before wound closure, 20 cc of 0.025% bupivacaine and 2 mg/kg of tramadol, diluted to 20 cc, were infiltrated at the wound site in groups A and B, respectively. After surgery, the pain score was measured using the visual analogue scale (VAS). Additionally, 24-hour total morphine consumption, nausea and vomiting, and respiratory depression were compared after 2, 4, 8, 16, and 24 hours between the 2 groups. The data were analyzed using SPSS with the Student independent t test, χ2 test, Fisher exact test, and repeated measure test. RESULTS Postoperatively, there was no significant difference between these 2 groups in their VAS scores until 16 hours (P>0.05). However, at the 16th and 24th hours, the mean VAS scores were 3.20±2.24 and 2.51±2.55 in the bupivacaine group and 2.51±0.99 and 1.40±0.88 in the tramadol group, respectively (P<0.05). There was no difference in nausea and vomiting during the 24-hour period between the 2 groups. Also, no respiratory depression was detected in the both groups. CONCLUSION Local infiltration of tramadol (2 mg/kg) at the incision site of C/S was effective in somatic wound pain relief without significant complications. TRIAL REGISTRATION NUMBER IRCT2013070111662N2.
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Affiliation(s)
- Mohammad Ali Sahmeddini
- Department of Anesthesiology, Shiraz Anesthesiology and Intensive Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Mohammad Ali Sahmeddini, MD; Shiraz Anesthesiology and Critical Care Research Center; Shiraz University of Medical Sciences, Shiraz, Iran Tel\Fax: +98 71 36474270
| | - Simin Azemati
- Department of Anesthesiology, Shiraz Anesthesiology and Intensive Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ehsan Masoudi Motlagh
- Department of Anesthesiology, Shiraz Anesthesiology and Intensive Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Chohedri A, Raeesi Estabragh R, Eghbal MH, Sahmeddini MA, Eftekharian H, Shahabifar R. Comparing the Duration of Spinal Anesthesia Induced With Bupivacaine and a Bupivacaince-Lidocaine Combination in Trans-Urethral Resection of the Prostate (TURP). Anesth Pain Med 2015; 5:e25675. [PMID: 26478863 PMCID: PMC4604291 DOI: 10.5812/aapm.25675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 04/04/2015] [Accepted: 04/28/2015] [Indexed: 11/16/2022] Open
Abstract
Background: Spinal anesthesia is a safe anesthetic mode for transurethral prostate resection (TUPR). There are several studies assessing the effect of bupivacaine, lonely or accompanied by other drugs, on short duration operations. However, there is controversy regarding the exact combination. Objectives: The aim of the study was to compare the effects of spinal anesthesia with bupivacaine and low dose lidocaine with bupivacaine alone on postoperative pain in those undergoing transurethral resection of prostate (TURP). Materials and Methods: This was a randomized clinical trial performed in Shiraz university of medical sciences during one year. Eighty men scheduled for TURP were randomly assigned to receive spinal anesthesia with 1.5 mL bupivacaine 0.6% and 0.6 mL Lidocaine 1% or spinal anesthesia with 1.5 mL bupivacaine 0.5% in combination with 0.6 mL normal saline. The primary endpoint was the time lag between induction of spinal anesthesia and reaching the highest spinal block level. We also recorded the duration of spinal block declining to L1 level, operation duration and the admission duration. Results: Both study groups were comparable regarding the baseline characteristics. We did not find any difference between the two study groups regarding the duration of anesthetic block reaching the maximum level (P = 0.433) and duration of decreasing it to L1 (P = 0.189). The course of postoperative recovery and duration of hospital admission were also comparable between the groups (P = 0.661). Conclusions: Lidocaine does not have additive effects on duration and quality of spinal anesthesia with bupivacaine in those undergoing TURP.
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Affiliation(s)
- Abdolhamid Chohedri
- Shiraz Anesthesiology and Critical Care Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Raeesi Estabragh
- Shiraz Anesthesiology and Critical Care Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
- Corresponding author: Reza Raeesi Estabragh, Shiraz Anesthesiology and Critical Care Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. Tel: +98-9376609727, Fax: +98-7136474270, E-mail:
| | - Mohammad Hossein Eghbal
- Shiraz Anesthesiology and Critical Care Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Sahmeddini
- Shiraz Anesthesiology and Critical Care Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamidreza Eftekharian
- Department of Oral and Maxillofacial Surgery, Shahid Rajaei Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramita Shahabifar
- Student Research Committee, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Sahmeddini MA, Zahiri S, Khosravi MB, Ghaffaripour S, Eghbal MH, Shokrizadeh S. Effect of mannitol on postreperfusion cardiac output and central venous oxygen saturation during orthotopic liver transplant: a double-blind randomized clinical trial. Prog Transplant 2014; 24:121-5. [PMID: 24919727 DOI: 10.7182/pit2014483] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Attenuating postreperfusion syndrome during orthotopic liver transplant is very important for transplant anesthesiologists because of the syndrome's complications. Oxygen-derived free radicals play an important role in the genesis of postreperfusion syndrome, but the effect of mannitol (a free radical scavenger) on attenuating the syndrome is unclear.OBJECTIVES-To investigate the effectiveness of infusing mannitol during the anhepatic phase in preventing postreperfusion syndrome, as indicated by postreperfusion cardiac output and central venous oxygen saturation. DESIGN In a randomized clinical trial, 53 patients who had undergone orthotopic liver transplant were allocated to 2 groups. During the anhepatic phase, patients in the mannitol group received 1g/kg mannitol, whereas those in the control group received physiological saline. Mean arterial pressure, cardiac output, and central venous oxygen saturation were measured before and after the portal vein was declamped. Serum levels of sodium and potassium were recorded at baseline and after portal vein declamping.Setting-Shiraz Organ Transplant Center, Shiraz, Iran. RESULTS In the mannitol group, no significant change was found in mean arterial pressure, cardiac output, and central venous oxygen saturation before and after declamping of the portal vein (P= .78, P= .59, and P= .83, respectively). However, after declamping in the control group, mean arterial pressure, cardiac output, and central venous oxygen saturation were significantly lower than before declamping (P=.003, P=.001, and P<.001, respectively). No significant change in serum levels of sodium and potassium from baseline to after declamping were found in either group. CONCLUSION Infusion of mannitol 1 g/kg during the anhepatic phase was effective in attenuating postreperfusion syndrome without stress about hyperkalemia or hyponatremia during anesthesia.
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Affiliation(s)
- Mohammad Ali Sahmeddini
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Siamak Zahiri
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Bagher Khosravi
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sina Ghaffaripour
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Eghbal
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sakine Shokrizadeh
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Sedigh-Ardekani M, Sahmeddini MA, Sattarahmady N, Mirkhani H. Lactic acidosis treatment by nanomole level of spermidine in an animal model. Regul Toxicol Pharmacol 2014; 70:514-8. [PMID: 25201010 DOI: 10.1016/j.yrtph.2014.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 08/16/2014] [Accepted: 08/31/2014] [Indexed: 11/16/2022]
Abstract
Lactic acidosis occurs in a number of clinical conditions, e.g. in surgeries, orthotopic liver transplant, and anesthetic agent administration, which has deleterious effects on the patient's survival. The most rational therapy for these patients, the sodium bicarbonate administration, cannot prevent those accompanying deficiencies and may actually be harmful. In addition, tromethamine adjusts the blood pH, it does not affect the lactate accumulation. Therefore, discovery of a therapeutic agent is still a major unsolved problem. In this study, the rats were divided into different groups and lactic acidosis type B was induced in them. Then, the effect of different injection doses of spermidine (0-20nmol) on lactic acidosis was analyzed by measuring the lactate level and pH in the rat blood samples. The results showed that spermidine effectively and simultaneously inhibited the lactate and pyruvate accumulations, and also adjusted the pH of bloodstream. On the other hand, it has been shown (Damuni et al., 1984; Rahmatullah and Roche, 1988) that spermidine increases the activity of phosphatase, leading to prevention of lactate accumulation. The results indicate that administration of only nanomole level of spermidine may be the best treatment in the liver transplant and other patients suffering from lactic acidosis type B.
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Affiliation(s)
- Mozhgan Sedigh-Ardekani
- Department of Medical Physics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Nanomedicine, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran; Pharmaceutical Science Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Sahmeddini
- Shiraz Anesthesiology and Intensive Care Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naghmeh Sattarahmady
- Department of Medical Physics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Nanomedicine, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran; Nanomedicine and Nanobiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Hossein Mirkhani
- Department of Pharmacology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Nanomedicine and Nanobiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Sahmeddini MA, Janatmakan F, Khosravi MB, Ghaffaripour S, Eghbal MH, Shokrizadeh S. The Effect of Intraoperative Restricted Normal Saline during Orthotopic Liver Transplantation on Amount of Administered Sodium Bicarbonate. Iran J Med Sci 2014; 39:247-53. [PMID: 24850981 PMCID: PMC4027003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 11/30/2013] [Accepted: 01/05/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Severe metabolic acidosis occurs during orthotopic liver transplantation (OLT) particularly during the anhepatic phase. Although NaHCO3 is considered as the current standard therapy, there are numerous adverse effects. The aim of this study was to determine whether the restricted use of normal saline during anesthesia could reduce the need for NaHCO3. METHODS In this study we enrolled 75 patients with end-stage liver disease who underwent OLT from February 2010 until September 2010 at the Shiraz Organ Transplantation Center. Fluid management of two different transplant anesthetics were compared. The effect of restricted normal saline fluid was compared with non-restricted normal saline fluid on hemodynamic and acid-base parameters at three times during OLT: after the skin incision (T1), 15 min before reperfusion (T2), and 5 min after reperfusion (T3). RESULTS There were no significant differences in demographic characteristics of the donors and recipients (P>0.05). In the restricted normal saline group there was significantly lower central venous pressure (CVP) than in the non-restricted normal saline group (P=0.002). No significant differences were noted in the other hemodynamic parameters between the two groups (P>0.05). In the non-restricted normal saline group arterial blood pH (P=0.01) and HCO3 (P=0.0001) were significantly less than the restricted normal saline group. The NaHCO3 requirement before reperfusion was significantly more than with the restricted normal saline group (P=0.001). CONCLUSION Restricted normal saline administration during OLT reduced the severity of metabolic acidosis and the need for NaHCO3 during the anhepatic phase. TRIAL REGISTRATION NUMBER IRCT2013110711662N5.
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Affiliation(s)
- Mohammad Ali Sahmeddini
- Shiraz Anesthesiology and Critical Care Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran;
| | - Farahzad Janatmakan
- Department of Anesthesiology and Critical Care, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Bagher Khosravi
- Shiraz Anesthesiology and Critical Care Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran;
| | - Sina Ghaffaripour
- Shiraz Anesthesiology and Critical Care Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran;
| | - Mohammad Hossein Eghbal
- Shiraz Anesthesiology and Critical Care Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran;
| | - Sakine Shokrizadeh
- Shiraz Anesthesiology and Critical Care Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran;
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Khosravi MB, Firoozifar M, Ghaffaripour S, Sahmeddini MA, Eghbal MH. Response to letter to the editor: early outcomes of liver transplants in patients receiving organs from hypernatremic donors. EXP CLIN TRANSPLANT 2014; 12:170. [PMID: 24702150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Mohammad Bagher Khosravi
- Department of Anesthesiology and Critical Care, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
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Khosravi MB, Azemati S, Sahmeddini MA. Gabapentin versus naproxen in the management of failed back surgery syndrome; a randomized controlled trial. Acta Anaesthesiol Belg 2014; 65:31-37. [PMID: 24988825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Gabapentin is an analogue of the gamma amino butyric acid (GABA), which regulates the conductance of calcium channels. In this study, we compared the efficacy of gabapentin the one of naproxen in the treatment of failed laminectomy syndrome. In this controlled trial, patients who had had elective lumbar discectomy or spinal fusion surgery more than one year ago, and complaining about leg and back pain in spite of different medical therapy were randomly assigned to receive naproxen (control group) or gabapentin. Gabapentin was started at a daily dose of 300 mg. This dose was increased by 300 mg at the end of each week up to a maximum dose of 1800 mg. Naproxen, which was administered at an initial daily dose of 250 mg, was increased similarly to the maximum 1500 mg. Patients were then followed up for the next 6 consecutive months. Back and leg pains were compared between the two groups at 9 consecutive time points, namely 0, 2, 4, 6, 8, 12, 16, 20 and 32 weeks after starting the treatment. The Visual Analog Scale (VAS) score of the back pain was significantly reduced when a 600 mg daily dose of gabapentin was reached (P < 0.001). At a dose of 1800 mg, the decrease in back pain amounted 20.5%. Naproxen-treated patients did not show significant improvement in back pain. Leg pain as similarly assessed by a VAS significantly decreased when a 1200 mg dose of gabapentin was attained (P < 0.008). At 1800 mg, the reduction in VAS was 39.2%. Naproxen-treated patients had a 7.7% pain reduction at 6th week, when using the maximum daily dose of 1500 mg (P < 0.04), but the pain increased thereafter. We conclude that Gabapentin, at a maximum daily dose of 1800 mg, is significantly more efficient than naproxen at treating persistent pain after spinal surgeries.
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Ghaffaripour S, Mahmoudi H, Sahmeddini MA, Alipour A, Chohedri A. Music can effectively reduce pain perception in women rather than men. Pak J Med Sci 2013; 29:128-31. [PMID: 24353523 PMCID: PMC3809207 DOI: 10.12669/pjms.291.2947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 09/25/2012] [Accepted: 11/15/2012] [Indexed: 12/21/2022] Open
Abstract
Objective: Nowadays music is used to decrease pain and increase relaxation in clinical settings. It is hypothesized that music can affect women more easily than men. We assessed the effect of two types of music (Iranian folkloric and preferred music) on pain tolerance and pain rating in cold pressor test. Methodology: A consecutive sample of 50 healthy Iranian medical students was enrolled. They reported pain tolerance and pain rating in cold pressor test in three different musical conditions served as the outcome measures. The results were analyzed with repeated measurement analysis of variance. Result: Mean tolerance time was significantly higher in preferred music compared to Iranian folkloric music (F (1,48) =25.44, p=0.0001) and no music (F(1,48)=3.51, p=0.0001) conditions. There was a significant interaction when tolerance time in no music condition was compared to preferred music condition, regarding sex; Tolerance time increased more in females (F(1,48)=5.53, p=0.023). The results also indicated that pain ratings, regardless of sex, were different in three musical conditions (F(1.7,81.34)=15.37, p=0.0001). Conclusion: Music distracted attention from pain and Women can be impressed and distracted more easily by music.
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Affiliation(s)
- Sina Ghaffaripour
- Sina Ghaffaripour, MD, Shiraz Anesthesiology and Critical Care Medicine Research Center, Anesthesiology Department
| | - Hilda Mahmoudi
- Hilda Mahmoudi, MD, MPH, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Sahmeddini
- Mohammad Ali Sahmeddini, MD, Shiraz Anesthesiology and Critical Care Medicine Research Center, Anesthesiology Department
| | - Abbas Alipour
- Abbas Alipour, MD, Nutrition and Health School, Epidemiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolhamid Chohedri
- Abdolhamid Chohedri, MD, Shiraz Anesthesiology and Critical Care Medicine Research Center, Anesthesiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
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Shahbazi S, Khademi S, Shafa M, Joybar R, Hadibarhaghtalab M, Sahmeddini MA. Serum Lactate Is not Correlated with Mixed or Central Venous Oxygen Saturation for Detecting Tissue Hypo Perfusion During Coronary Artery Bypass Graft Surgery: A Prospective Observational Study. Int Cardiovasc Res J 2013; 7:130-4. [PMID: 24757637 PMCID: PMC3987443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 10/02/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Effective assessment of tissue perfusion is highly important during Coronary Artery Bypass Graft (CABG). Mixed venous O2 saturation (Svo2) is one of the best and routinely used markers of tissue perfusion. However, this method is costly and leads to considerable complications. Thus, the present study aimed to determine whether the Svo2 can be substituted with central venous saturation (Scvo2) and if there is any correlation between lactate level and Svo2. METHODS This prospective observational study was conducted on 62 patients scheduled for CABG. After induction and maintenance of anesthesia, blood samples drawn from central venous, pulmonary artery, and radial artery were used to measure Scvo2, Svo2 and serum lactate level respectively before and after Cardio Pulmonary Bypass (CPB). Pearson's correlation test was used to determine the correlation between Svo2 and Scvo2 as well as between Svo2 and serum lactate level. Besides, P < 0.05 was considered as statistically significant. RESULTS Overall, 62 Patients, 33 males (53.2%) and 29 females (46.8%) were enrolled into the present study. The most common coexisting illness was hypertension detected in 33 patients (53.2%) followed by hypercholesterolemia in 28 ones (44.4%). In this study, Svo2 was positively correlated with Scvo2 (r = 0.63, P < 0.001). However, no correlation was found between Svo2 and lactate (r = 0.124, P = 0.348). CONCLUSIONS In summary, Scvo2 is considered as the best substitute of Svo2 for detecting tissue hypo perfusion during CPB. Although the lactate level had been considered as an appropriate marker of tissue perfusion and ischemia, it was not correlated to Svo2 during CABG.
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Affiliation(s)
- Shahrbano Shahbazi
- Shiraz Anesthesiology and Intensive Care Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Saeed Khademi
- Shiraz Anesthesiology and Intensive Care Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran,Corresponding author: Saeed Khademi, Shiraz Anesthesiology and Intensive Care Research Center,Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel/Fax: +98-7116474270, E-mail:
| | - Masih Shafa
- Department of Cardiac Surgery, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Reza Joybar
- Shiraz Anesthesiology and Intensive Care Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | | | - Mohammad Ali Sahmeddini
- Shiraz Anesthesiology and Intensive Care Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
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Shahbazi S, Panah A, Sahmeddini MA. Evaluation of factors influencing liver function test in on-pump coronary artery bypass graft surgery. Iran J Med Sci 2013; 38:308-13. [PMID: 24293784 PMCID: PMC3838982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 11/11/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Liver dysfunction during on-pump coronary artery bypass graft surgery (CABG) is a rare complication but is associated with significant morbidity and mortality. The ability to identify high-risk patients may be helpful in planning appropriate management strategies. We aimed to evaluate the factors influencing liver function tests during on-pump CABG. METHODS In 146 patients scheduled for on-pump CABG, the liver function test was done preoperatively and on the first postoperative day. Some preoperative and intraoperative risk factors were checked and then the postoperative liver function tests were compared with the preoperative ones. Probable relationships between these changes and the preoperative and intraoperative risk factors were studied. RESULTS A medical history of diabetes had a significant relationship with the changes in direct bilirubin. Preoperative central venous pressure had a significant relationship with the changes in aspartate aminotransferase and alanine aminotransferase. Use of intra-aortic balloon pump and duration of aortic cross-clamp were significantly related to the changes in the liver function tests except for alanine aminotransferase and alkaline phosphatase. CONCLUSION It seems that the techniques for the reduction of cardiopulmonary bypass and aortic cross-clamp duration may be useful to protect liver function. We recommend that a larger population of patients be studied to confirm these findings.
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Eghbal MH, Sahmeddini MA. Comparison larygeal mask airway with the endotracheal tube for the external dacryocystorhionostomy surgery. A randomized clinical trial. Middle East J Anaesthesiol 2013; 22:283-288. [PMID: 24649784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND General anesthesia (GA) is considered the gold standard for external dacryocystorhinostomy (DCR) surgery. There are few reports about laryngeal mask airway (LMA) use in DCR surgery. The aim of this study was to compare the use of endotracheal intubation (ETT) vs LMA for airway management during DCR surgery. METHODS Ninety patients were randomized to two groups. In the group C, ETT and in the group L, classic LMA was used to maintain and protect the airway during the procedure. Hemodynamic data before, after intubation or LMA insertion and after skin incisions were recorded. Coughing and straining at the end of anesthesia and postoperative nausea and vomiting (PONV) were recorded. RESULTS In the group L, the mean arterial pressure and the heart rate after LMA insertion and after the skin incisions were significantly lower than the group C (p < 0.05). Furthermore, incidence of coughing, straining at the end of anesthesia and PONV was lower in the group L than the group C (p < 0.05). CONCLUSION LMA can be used in external DCR, to decrease the hemodynamic changes, to decrease coughing, straining at the end of anesthesia and the incidence of PONV.
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Sahmeddini MA, Amini A, Naderi N. The effect of octreotide on urine output during orthotopic liver transplantation and early postoperative renal function; a randomized, double-blind, placebo-controlled trial. Hepat Mon 2013; 13:e12787. [PMID: 24282425 PMCID: PMC3830523 DOI: 10.5812/hepatmon.12787] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/31/2013] [Accepted: 08/21/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Maintenance of the adequate intraoperative renal perfusion is very important during Orthotopic Liver Transplantation (OLT) to prevent acute renal failure. OBJECTIVES For the first time, this study was designed to survey the effects of octreotide on urine output during anesthesia for OLT and early postoperative renal function. PATIENTS AND METHODS In this randomized double-blind placebo controlled clinical trial, 79 of 89 patients who underwent OLT and fulfilled the study requirement were randomly allocated into two groups. In the octreotide group, the patients received octreotide infusion from the start of the operation. On the other hand, the control group patients received physiologic saline infusion instead of octreotide. The Mean Arterial Pressure (MAP), heart rate, urine output, norepinephrine usage, and dosage during the three stages of OLT, and baseline and postoperative creatinine were recorded and compared between the two groups. RESULTS No significant differences were found between the two groups regarding the demographic characteristics and graft factors (P > 0.05). However, urine output and MAP during the three stages of OLT were significantly higher in the octreotide group compared to the control group (P < 0.05). Moreover, no significant difference was observed between the two groups regarding baseline as well as postoperative creatinine (P > 0.05). CONCLUSIONS The results demonstrated that octreotide infusion during anesthesia for OLT not only augmented the vasoconstriction effect of norepinephrine to increase MAP, but also maintained better renal perfusion and urine output during the operation.
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Affiliation(s)
- Mohammad Ali Sahmeddini
- Shiraz Anesthesiology and Intensive Care Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding author: Mohammad Ali Sahmeddini, Shiraz Anesthesiology and Intensive Care Research Center, Namazi Hospital, Shiraz, IR Iran. Tel: +98-7116474270, Fax: +98-7116474270, E-mail:
| | - Afshin Amini
- Shiraz Anesthesiology and Intensive Care Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Nima Naderi
- Shiraz Anesthesiology and Intensive Care Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
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Eghbal MH, Taregh S, Amin A, Sahmeddini MA. Ketamine improves postoperative pain and emergence agitation following adenotonsillectomy in children. A randomized clinical trial. Middle East J Anaesthesiol 2013; 22:155-160. [PMID: 24180163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Management of postoperative pain and emergence agitation following adenotonsillectomy in pediatrics has been a major challenge for anesthesiologists. Although analgesic sparing effect of ketamine has been studied during tonsillectomy in pediatrics, there is a lot of controversy about its efficacy. Present study was designed to evaluate the effect of intravenous low dose ketamine (0.25 mg/kg) during induction of anesthesia on postoperative pain and emergence agitation following adenotonsillectomy in children. METHODS In this randomized clinical trial 66 children aged 5 to 15 years who underwent elective adenotonsillectomy were randomly allocated into two groups. Patients in the control group received 5 ml of normal saline while patients in the ketamine group received 0.25 mg/kg of ketamine in 5 ml volume during induction of anesthesia. After termination of surgeries and transferring the patients to recovery, emergence agitation, pain score, paracetamol requirements and incidence of postoperative nausea & vomiting were assessed every hour for 6 hours. RESULTS Emergence agitation score was significantly lower in the ketamine group (P = 0.002). Pain score at all hours was lower in the ketamine group than the control group (P < 0.05). The requirements for intravenous paracetamol were significantly lower in the ketamine group (P = 0.0036). There was no difference in the incidence of postoperative nausea and vomiting between the two groups (P = 0.99). CONCLUSION Low-dose ketamine during induction of anesthesia improves emergence agitation and postoperative pain following adenotonsillectomy in children.
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Affiliation(s)
- Mohammad Hossein Eghbal
- Shiraz Anesthesiology and Intensive Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Khosravi MB, Firoozifar M, Ghaffaripour S, Sahmeddini MA, Eghbal MH. Early outcomes of liver transplants in patients receiving organs from hypernatremic donors. EXP CLIN TRANSPLANT 2013; 11:537-40. [PMID: 23534482 DOI: 10.6002/ect.2012.0274] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Uncorrected hypernatremia in organ donors has been associated with poor graft or patient survival during liver transplants. However, recent studies have found no association between the donor serum sodium and transplant outcome. This study sought to show the negative effect donor hypernatremia has on initial liver allograft function. This is the first study to investigate international normalized ratio and renal factors of patients with normal and those with hypernatremic donor livers. MATERIALS AND METHODS This study was conducted at the Shiraz Transplant Research Center in Shiraz, Iran, between May 2009, and July 2011. Four hundred seven consecutive adult orthotopic liver transplants were performed at the University of Shiraz Medical Center. RESULTS There were 93 donors in the group with hypernatremia with terminal serum sodium of 155 mEq/L or greater (group 1), and 314 with terminal serum sodium less than 155 mEq/L (group 2). Posttransplant data after 5 days showed that aspartate aminotransferase, alanine aminotransferase, international normalized ratio, and kidney function did not differ between the groups. CONCLUSIONS Hypernatremia is the most important complication after brain death. Previous studies have suggested donor hypernatremia results in a greater incidence of early postoperative graft dysfunction in liver transplant and is considered one of the extended criteria donor. However, in recent years, this hypothesis has been questioned. Our study shows no difference between patients' initial results of liver and kidney functioning with normal and hypernatremic donor livers. This is the first study to investigate international normalized ratio as a fundamental factor in defining early allograft dysfunction and renal factors between patients with normal and hypernatremic donor's livers.
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Affiliation(s)
- Mohammad Bagher Khosravi
- Shiraz University of Medical Sciences, Department of Anesthesiology and Critical Care, Anesthesiology and Critical Care Research Center, Nemazi Hospital, Shiraz, Iran
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Sahmeddini MA, Khosravi MB. Severe Acute Hyperkalemia during Pre-Anhepatic Stage in Cadaveric Orthotopic Liver Transplantation. Iran J Med Sci 2012; 37:208-10. [PMID: 23115456 PMCID: PMC3470090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 05/12/2012] [Accepted: 07/01/2012] [Indexed: 10/25/2022]
Abstract
A serious hazard to patients during orthotopic liver transplantation is hyperkalemia. Although the most frequent and hazardous hyperkalemia occurs immediately after reperfusion of the newly transplanted liver, morbid hyperkalemia could happen in the other phases during orthotopic liver transplantation. However, pre-anhepatic hyperkalemia during orthotopic liver transplantation is rare. This report describes one such patient, who without transfusion, developed severe hyperkalemia during pre-anhepatic phase. The variations in serum potassium concentration of the present case indicate that it is necessary to take care of the changes of serum potassium concentration not only during reperfusion but also during the other phases of the liver transplantation.
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Sahmeddini MA, Eghbal MH, Khosravi MB, Ghaffaripour S, Janatmakan F, Shokrizade S. Electro-acupuncture Stimulation at Acupoints Reduced the Severity of Hypotension During Anesthesia in Patients Undergoing Liver Transplantation. J Acupunct Meridian Stud 2012; 5:11-4. [DOI: 10.1016/j.jams.2011.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Revised: 08/21/2011] [Accepted: 08/29/2011] [Indexed: 01/17/2023] Open
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Ghaffaripour S, Mahmoudi H, Khosravi MB, Sahmeddini MA, Eghbal H, Sattari H, Kazemi K, Malekhosseini SA. Preoperative factors as predictors of blood product transfusion requirements in orthotopic liver transplantation. Prog Transplant 2011. [PMID: 21977887 DOI: 10.7182/prtr.21.3.7kq304t4680wgh06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Intraoperative transfusion can affect the chance of graft survival in liver transplantation, a complicated operation with massive blood loss. Verification of factors that are predictive of intraoperative blood loss and transfusion increases the quality of anesthesia management. OBJECTIVE To assess use of blood and blood products between 2002 and 2008 and to evaluate factors associated with blood loss and requirement for blood products in adult patients undergoing orthotopic liver transplantation via piggyback technique. DESIGN Medical charts and anesthesia records from 261 eligible adult recipients of an orthotopic liver transplant between March 2002 and May 2008 were reviewed. SETTING Shiraz Liver Transplantation Center, the only active liver transplantation center in Iran. MAIN OUTCOME MEASURES Potential influencing factors in blood loss and transfusion, including sex, preoperative hemoglobin level, international normalized ratio, primary diagnosis, platelet count, creatinine level, Model for End-Stage Liver Disease (MELD) score, central venous pressure, and total anesthesia time, were measured and subjected to multivariable analysis. RESULTS Mean blood loss was 54.2 (SD, 47.9) mL/kg, the mean (SD) for amounts of blood products transfused was 25.3 (19.5) mL/kg for packed red blood cells, 2.6 (3.3) units for fresh frozen plasma, and 1.7 (3.1) units for platelets. Seven recipients (2.7%) underwent transplantation without intraoperative transfusion of red blood cells, whereas 25 patients (9.6%) received more than 10 units of red blood cells intraoperatively. Multivariable analysis showed that no preoperative factor was a predictor of blood loss or requirement for intraoperative transfusion. Transfusion of fresh frozen plasma and packed red blood cells was significantly lower in 2005, 2006, 2007, and 2008 than in 2003 to 2004 (P < .001).
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Ghaffaripour S, Mahmoudi H, Khosravi MB, Sahmeddini MA, Eghbal H, Sattari H, Kazemi K, Malekhosseini SA. Preoperative Factors as Predictors of Blood Product Transfusion Requirements in Orthotopic Liver Transplantation. Prog Transplant 2011; 21:254-9. [DOI: 10.1177/152692481102100311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ghafaripour S, Sahmeddini MA, Lahsaee SM, Khosravi MB, Sattari H, Nikeghbalian S, Shokrizadeh S, Malekhosseine SA. Hypotension after reperfusion in liver transplantation: histidine-tryptophan-ketoglutarate versus University of Wisconsin solution. Prog Transplant 2010. [PMID: 20929110 DOI: 10.7182/prtr.20.3.18g6j4h7685k0050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The greatest hemodynamic instability during orthotopic liver transplantation occurs at graft reperfusion. Many factors have been implicated. PURPOSE To compare hemodynamic changes after reperfusion in grafted livers preserved with histidine-tryptophan-ketoglutarate (HTK) solution versus grafted livers preserved with University of Wisconsin (UW) solution. METHODS In this prospective study, we randomly divided 89 patients who underwent deceased donor liver transplantation into 2 groups: the UW group and the HTK group. The HTK group was further divided into 2 subgroups: flushed and not flushed before reperfusion. The patients were monitored with hemodynamic and metabolic parameters at 3 times: after the skin incision, 5 minutes before reperfusion, and 5 minutes after reperfusion. RESULTS Hemodynamic parameters in the UW group had not changed significantly at 5 minutes before reperfusion or 5 minutes after reperfusion (P = .45), and the incidence of hypotension after reperfusion in the UW group was 20%. In both HTK groups, the mean arterial pressure 5 minutes after reperfusion was significantly lower than at 5 minutes before reperfusion (P = .002); the incidence of hypotension after reperfusion in the nonflushed HTK group was 83.3% and in the flushed HTK group, 65.5%. CONCLUSIONS The incidence of hypotension after reperfusion is greater if HTK solution rather than UW solution is used. Flushing of grafted livers preserved with HTK solution might eliminate some vasoactive substances found in HTK solution.
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Affiliation(s)
- S Ghafaripour
- Shiraz Organ Transplantation Center, Shiraz Medical University, Shiraz, Iran
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Sahmeddini MA, Fazelzadeh A. Does auricular acupuncture reduce postoperative vomiting after cholecystectomy? J Altern Complement Med 2009; 14:1275-9. [PMID: 19130635 DOI: 10.1089/acm.2008.0264] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To find the efficacy of auricular acupuncture for the prevention of postoperative nausea and vomiting after cholecystectomy. MATERIALS AND METHODS One hundred (100) female patients undergoing transabdominal cholecystectomy were randomly allocated to two groups of 50 (auricular acupuncture treatment group and nontreatment group) in order to test the effectiveness of auricular acupuncture. Statistical significance (p < 0.05) was determined using an unpaired t-test for age, weight, height, and duration of anesthesia; a chi-square test was used to analyze the incidence of vomiting. RESULTS There was no significant difference in age, weight, height, or duration of anesthesia among the two groups of patients. There was a significant difference between the control and auricular acupuncture treatment groups in the incidence of vomiting 24 hours after surgery (66% and 0%, respectively, p < 0.01). No noteworthy side effects from treatment were observed. CONCLUSION Auricular acupuncture is effective in reducing vomiting following transabdominal cholecystectomy in female patients.
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Affiliation(s)
- Mohammad Ali Sahmeddini
- Department of Anaesthesiology, Shiraz University of Medical Sciences, Faghihi Hospital, Shiraz, Iran.
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