To Compare Efficacy of Hypnosis and Intravenous Sedation in Controlling of Important Variables of Vital Signs and Evaluate the Patient Anxiety Before and after Topical Anesthesia in Ophthalmic Surgery

Background: Stress is one of the most important problems among preoperative patients. In order to reduce these signs and symptoms, some medications are used for patients. The aim of this study was to compare the efficacy of hypnosis to intravenous sedation on controlling the important variables of vital signs and to evaluate the patient anxiety before and after regional or topical anesthesia in ophthalmic surgery.Materials and Methods: This study was designed as a double-blind stratified randomized clinical trial.  Hypnotism was administered to hypnotism group, and midazolam, fentanyl, and propofol were given intravenously to the IV sedation group. The patients were monitored and the baseline variables consisted of mean arterial pressure, pulse rate, respiratory rate, and O2 saturation were registered every 15 minutes during surgery. Patient anxiety was measured via Spielbeger`s State Anxiety Index (STAI) score before and after surgery.Results: 90 patients were participated in the study, with 50% (n=45) assigned to hypnosis group and 50% (N=45) assigned to IV sedation group. Patients characteristics, including age, gender, and body mass index (BMI) duration of surgery were similar among the groups (P>0.05). Spielbeger`s State Anxiety Index (STAI) score before and after surgery were not significantly different in both groups (P>0.05). Heart rate, respiratory rate, mean arterial pressure were lower among hypnosis group as well as this group had higher O2 saturation during surgery (P<0.05).Conclusion: Hypnosis can be an effective means of controlling vital signs at different intervals of starting the ophthalmic surgery compared to intravenous sedation. In the hypnosis group anxiety was similar to IV sedation group, but O2 saturation was more desirable.

Incompatible Blood Transfusion as a Result of a Well-Known Human Error; a Case Report

Blood product transfusion is a double-edged sword; it can be lifesaving in many circumstances, yet life-threatening serious complications may occur. Although transfusion-related reactions have decreased over the years as a result of hemovigilance networks all over the world, human errors still remain an important concern.  In this case report, we describe a patient undergoing elective spinal surgery who received an incompatible blood product. Then we will describe measures to mitigate such errors

Pneumocephalus After Dural Puncture During Epidural Analgesia: A Case Report

Lumbar epidural anesthesia commonly used to control post-operation pain. The ‘loss-of- resistance’ to air technique (LORA) generally engaged in the appreciation of the epidural space. One of the rare but serious side effects of this technique is pneumocephalus. We report a case of sudden frontal and parietal headache after a dural puncture during the performance of epidural analgesia using the LOR to air technique

Real-Time Video-assisted Intraoperative Neuromonitoring in Vestibular Schwannoma Surgery, 10-year Experience in a Referral Center of Excellence in Iran

Background: Vestibular schwannoma (VS) is an extra-axial, benign tumor mostly located in the cerebellopontine angle. The goal of VS surgery is gross total resection of the tumor along with preservation of the cranial nerves’ function. Intraoperative nerve monitoring is mainly rewarding in VS surgery. Method: This Cohort study was done retrospectively and prospectively from 2011-2021. Patients were divided into two groups; group one (n=19) underwent resection of the tumor with intraoperative neuromonitoring and group two underwent resection of the tumor without neuromonitoring based on patients’ ability to economically afford neuromonitoring. In the neuromonitoring group, Somatosensory Evoked Potential (SSEP) was evaluated and recorded throughout the whole surgery.  Motor Evoked Potential (MEP) was recorded at regular intervals as well. We compared tumor size, hemorrhage volume during surgery, length of surgery, and facial nerve preservation (HB score), with one-year follow-up. Result: Facial nerve (FN) anatomical preservation rates were 100% and 75% in the neuromonitoring and control groups, respectively. The Gross Total Resection (GTR) rate in group one was 78.9%. The Subtotal Resection (STR) and Partial Resection (PR) rates in procedures without neuromonitoring were 50.0% and 12.5%, respectively. The House-Brackman (HB) level was good in all patients in group one, while 68.8% of patients in the control group had poor HB. Conclusion: Intraoperative Neuromonitoring (IONM) in VS surgery helps increase anatomical nerve preservation rate and FN outcome. The coordination of a anatomically trained neurophysiologist along with real-time video-assisted nerve monitoring avoids and lowers any delay in nerve recognition

Anesthetic Management in a Patient With Surgical Excision of Spinal Cords Hydatid Cyst: A Case Report

Echinococcosis granulosus is the leading cause of spinal hydatid disease. Hydatidosis of the bone happens in 0.5%-3% of all the cases: the involvement in the vertebral column is 50%. In the endemic areas, one of the common causes of spinal cord compression is hydatid disease, and the diagnosis may remain obscure until specifying symptoms ensuing from complications due to root and cord compression. We present a case of recurrent spinal cords hydatid cyst in a 44 years old patient because it occurs rarely, and anesthetic management in such cases has never evaluated before.

Termination of pregnancy in a twin pregnant patient with COVID-19

In this article, we present a pregnant case suspected of COVID-19 with underlying symptoms of respiratory distress; which was referred to Shohada-e-Tajrish Hospital. Due to the progressive decrease of O2 saturation, the medical team decided to terminate the pregnancy to save the patient's life. Despite all these efforts including pharmaceutical agents, the patient passed away

Anesthetic Management “Arnold Chiari Malformation” in the well-known Case of Cystic Fibrosis

Cystic fibrosis (CF) is a genetic disease resulting from a chlorine channel defect with autosomal recessive show, a physical and functional disorder in the transport of chlorine (Cl) through the plasma membrane in epithelial cells in organs such as the lungs, pancreas, liver, intestines, sweat glands, and epididymis. These cases are important for their perioperative respiratory complications. We present an anesthesia method conducted on a 24-year-old men CF case receiving general anesthesia for Arnold Chiari malformation surgery

Effect of Dexmedetomidine on Transcription Factors and Inflammatory Cytokines in Elective Aortic Aneurysm Repair Surgery

Background: Aortic clamping during abdominal aortic aneurysm repair surgery leads to complications such as systemic inflammatory response (SIRS) and dysfunction in various vital organs. This study aimed to investigate the effect of dexmedetomidine infusion on transcription factors and inflammatory cytokines during elective open abdominal aortic aneurysm repair surgery. Materials and Methods: A prospective, clinical trial performed on patients with abdominal aortic aneurysm surgery, which were divided into two groups (dexmedetomidine, 8 patients and control, 12 patients). Demographic characteristics, biochemical laboratory variables, fluid and blood transfusions during surgery, and levels of inflammatory cytokines and expression of inflammatory genes were evaluated and compared in both groups. Results: There were no significant differences between the two groups regarding demographic characteristics, biochemical laboratory variables, fluids, and blood transfusions during surgery (P> 0.05). The level of inflammatory cytokines and the expression of inflammatory genes in both groups decreased significantly after surgery (P <0.05). However, the level of inflammatory cytokines and the expression of inflammatory genes in the dexmedetomidine group were significantly lower at the end of the surgery (P <0.05). Conclusion: In abdominal aortic aneurysm surgery, dexmedetomidine could significantly reduce complications of clamping during surgery, which may result in hemodynamic stability and prevent significant inflammatory response to surgical stress and organ damage following ischemia-reperfusion damage

Airway management in a case of expanding neck hematoma after carotid endarterectomy

Background: Respiratory obstruction is a fatal complication following carotid endarterectomy, which caused direct compression of trachea secondary to venous and lymphatic congestion.Cases Report: In this study, we report a complicated case of carotid endarterectomy   that required emergency intubation in difficult circumstance due to progressing hematoma and soft tissue edema.Conclusion: we report a case of hematoma and edema causing compromised airway following carotid endarterectomy (CEA), in which quick action to decompress the hematoma and prepare a secure airway lead to successful outcome

Cerebral Protection During Coronary Artery Bypasses Grafting in Bilateral Total Internal Carotids Occlusion: Case Report

Introduction: The best management for the patient with coronary artery disease (CAD) that requires emergent coronary bypass graft surgery (CABG) with bilateral total internal carotid artery occlusions previously reported. Here we report two successful cases of CABG with additional occlusion in the circle of Willis anterior or posterior communicating artery “incomplete cow” with onpump technique and cerebral protection considerations. Case Presentation: Bilateral carotid artery occlusion, coronary artery disease, and emergency operation with cardiopulmonary bypass are associated with increased stroke, especially when there is one additional occlusion of the cerebral artery in the circle of Willis. Routine preoperative carotid artery sonography and selective carotid angiography revealed bilateral total carotid occlusion in both cases in addition, CT-angiography also confirmed occlusions of right posterior communicating in the first case and left posterior communicating artery in the second case. Collateral circulation feeding in the intracranial circulations originated mainly from the vertebrobasilar system (compensatory phase) preoperative physical examinations showed no neurological deficit. Operation was done successfully with moderate hypothermia and different cerebral protection considerations and postoperative courses were uneventful and patients discharged from hospital seven days post operation. Conclusions: Anesthesia should consider hemodynamic management and avoid significant tachycardia or bradycardia and severe hypertension or hypotension