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Background & objectives: Electroconvulsive therapy (ECT) is the main therapeutic technique in psychiatric diseases. The use of anesthesia for ECT is necessary. In these patients, selection of anesthesia with minimal hemodynamic changes is very important. The aim of this study was to compare the hemodynamic effects of two anesthetics including sodium thiopental and propofol in patients undergoing ECT.
Methods: This study was performed on 84 patients (50 males and 34 females) who were anesthetized for ECT in 22- Bahaman Hospital, Qazvin University of Medical Sciences (QUMS). Initially, the hemodynamic status of patients was recorded. Then, they randomly received either sodium thiopental or propofol as an anesthetic and succinylcholine as a muscle relaxant. Hemodynamic changes, including systolic and diastolic blood pressure, pulse rate in the 1, 3 and 10 minutes after ECT, as well as seizure duration and recovery time were recorded. The data were analyzed by SPSS v.20 using independent t-test.
Results: the sodium thiopental group, showed the highest changes in systolic and diastolic blood pressure and heart rate in the third minute (45%, 64% and 26% respectively). In the propofol group, the highest systolic, diastolic and mean arterial blood pressure changes were 55%, 64% and 43% respectively, at the 10th minute, but the highest pulse rate (33%) occurred in the 3rd minute. The blood pressure changes were significant between the two groups (p<0.05). The post-shock seizure duration was less with sodium thiopental, but recovery from anesthesia was shorter with propofol (p<0.05).
Conclusion: Our findings showed that in the anesthetic required for electroshock, sodium thiopental had a slightly better hemodynamic stability than propofol. Therefore, it seems appropriate to use it as an anesthetic for ECT.
 

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Background & objectives: Local systemic filling pressure measurement can be used to determine other hemodynamic parameters such as venous return and the stressed volume. The aim of the present study was to evaluate the relationship between local systemic filling pressures and central venous pressure.
Methods: In this study, candidate patients of cardiac surgery in Imam Khomeini hospital of Ardabil, in the first half of the 1397, were chosen and studied by their satisfaction, then an intra-arterial catheter inserted to the upper limb, a tourniquet closed to the same arm.  The arterial pressure measured during the surgery. Central vein pressure was also measured simultaneously. Finally, other variables obtained from transesophageal echocardiography and demographic data were recorded in each patient's checklist.
Results: 43 patients (71.7%) were man and 17 (28.3%) were women. The Mean CVP, MSFP, CO, and CI were 8.3±4.5 mmHg, 17.0±6.1, 3.27±1.1, and 1.89±0.7, respectively. Ten patients (16.7%) had mild heart failure, 42 patients (70%) had a moderate heart failure and 8 patients (13.3%) had severe heart failure. There were positive and significant relationship between CVP and MSFP (r=0.478: p=0.001). The EF status has no significant effects on CVP with SBP, DBP, MAP, CO and CI. There was significant and reverse correlation between PSF value with CO, and CI in severe heart failure (p<0.05).
Conclusion: we concluded that the local MSFP is a good and valuable substitute for CVP measurement, especially in severe heart failure

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Background & objectives: The use of controlled hypotension is important to reduce bleeding in some surgeries. This study aimed to determine the effects of dexmedetomidine (DEX) and labetalol for induced hypotension in maxillofacial fractures surgery.
Methods: In this triple-blind randomized controlled clinical trial study, the patients with maxillofacial fractures were randomly divided into two groups: group 1. Dexmedetomidine (DEX) (bolus dose: 1μg/kg and maintenance dose: 0.3-0.5 μg/kg/h) and group 2. Labetalol (bolus dose: 0.3mg/kg and maintenance dose: 0.2-0.5 mg/kg/h). The patient's hemodynamic indices (including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded at various surgical intervals. Finally, the surgeon's satisfaction (from 1-6 points) was evaluated. Data were analyzed using SPSS 19 software.
Results: The MAP, SBP, and DBP were significantly higher in the DEX group than the Labetalol group especially at 30 and 90 minutes after the bolus. The mean HR was significantly lower in the DEX group than Labetalol during the recovery period. The surgeon's satisfaction in the Labetalol group was significantly higher than the DEX group.
Conclusion: Based on the results, labetalol offers a better hemodynamics conditions than DEX during surgery and also lead to greater overall surgeon satisfaction.

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Background & objectives: The aim of this study was to evaluate the effects of preventive administration of ketamine, fentanyl and paracetamol on pain intensity and hemodynamic parameters after deep vitrectomy.
Methods: In this clinical trial, 80 candidates of deep vitrectomy surgery were randomly assigned into 4 groups (1-4) and received 0.5 mg / kg ketamine, 2 μg / kg fentanyl, 10 mg/kg of paracetamol and equivolume of normal saline respectively intravenous infusion during the last 15 minutes of surgery. Pain intensity and hemodynamic parameters were recorded and analyzed.
Results: Pain intensity was significantly higher in placebo group during the first 4 hours after operation (p<0.01), but no significant differences were observed between the study groups at 8 and 24 hours after operation in this regard. There were no significant differences between the three intervention groups in terms of pain intensity during the study. Also there were no significant differences between the 4 study groups regarding to hemodynamic parameters.
Conclusion: The use of each of the three intervention drugs significantly reduced the pain intensity compared to the control group without any hemodynamic derangement.

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Background & Objective: Bleeding is a common complication during heart surgery, and management of heparin and protamine consumption during operation affects hemeostasis. The dosage of protamine sulfate is variable based on the amount of heparin used and studies have reported different results. The aim of this study was to evaluate the effect of protamine sulfate administration after cardiac surgery on the drainage of the patient's blood secretions.
Methods: In this retrospective cross- sectional study, required data from 120 medical records patients, from 2011 to 2020 undergoing heart surgery, for example CABG, was extracted and examined. Patients were grouped (60 people in each group) and compared based on protamine sulfate intake and not receiving it, in the intensive care unit and body mass index, age, sex, ACT values ​​and blood drainage rate.
Results: 76 (63.37%) patients were male and 44 (36.66%) patients were female. Most patients were in the age range of 50-70 years and most patients were overweight. Blood drainage in the protamine group was significantly lower than the control group. There was no statistically significant difference between the two groups in terms of ACT values. Blood drainage in the protamine group was significantly lower in normal BMI and overweight individuals than in the control group. The amount of blood drained in the protamine group in women and in people over 70 years was significantly lower than the control group.
Conclusion: despite previous studies, our study showed a reduction in the amount of postoperative bleeding following re-prescribing of protamine sulfate in the intensive care unit, which eliminated the effect of heparin and the coagulation disorder caused by heparin. The limitations of the present study included patients under 12 years of age, patients weighing more than 120 kg, and patients requiring hypothermia treatment less than 28 Cº.
 

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Background & Objectives: Early warning scores are commonly used by hospital care teams to assess patients and diagnose early signs of their deterioration and initiate further treatment. Due to the existing studies and the lack of sufficient evidence for burned patients, we decided to investigate the value of initial NEWS and MEWS in predicting mortality in burned patients.
Methods: After obtaining permission from the Ethics Committee of TUMS, patients who were candidates for hospitalization in the burn wards of Sina Hospital from July to March 1998 were included. All demographic information including age, sex, APACHE Type of discharge, comorbidities, percentage of burns, initial hospitalization in the burn ward, type and time of initiation and duration of antibiotic use, amount of serum and NEWS and MEWS scores for all patients were enrolled immediately after admission to the ward as well as before discharge from the ward. Data were analyzed after registration in SPSS software version 23.
Results: In this study, 80 cases of burned patients were studied with a mean age of 37.94±18.85 years. The initial NEWS and MEWS indices have a good ability to diagnose burned patients (Area=0.79 and 0.78, p<0.001). The best cut- point based on the Youden index, for the initial NEWS and MEWS indices were obtained at 4.50 and 1.50, respectively.
Conclusion: In this study, for the first time, NEWS and MEWS were examined in predicting mortality in burned patients and it was found that these criteria can predict the prognosis of burned patients.
 

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