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Novel chalcone sulfonamide derivatives were synthesized starting from benzophenones and aldehydes in 3 steps. Also, (E)-3-(4-chlorophenyl)-1-(4-methoxyphenyl)prop-2-en-1-one was converted to different pyrazoline in four steps. The synthesis of sulfonamides was carried out under solvent-free conditions at room temperature and the products were obtained in high purity after a simple work-up without using any chromatography method for purification. All of the products were evaluated for their in vitro antibacterial activity against Staphylococcus aureus and Escherichia coli.

Background Bleeding is one of the most common complications of craniosynostosis surgery, which its appropriate management is associated with better post-operative outcomes. The aim of this retrospective study was to evaluate the visual estimated blood loss in intraoperative management of infants with craniosynostosis surgery. Materials and Methods This retrospective study was performed on 200 patients who underwent craniocinostosis surgery and hospitalized in intensive care unit (ICU) at Mofid Hospital, Tehran, Iran, from July 2015 to June 2017. Data collecting was done using a self-made checklist and from patients' medical record. Required data include age, gender, method of anesthesia, and arterial blood gas (ABG), hemoglobin (Hb), and platelet (Plt) changes during surgery, volume of administered blood and fluid were recorded and evaluated. Data analysis using SPSS software (version 22.0). Results Among the patients, 59% (n=118) were boys, the mean age of patients was 13.3 ± 13.52 months. Anesthesia technics were total intravenous anesthesia (TIVA) (15.5%, n= 31), and inhalation or mixed (84.5%, n=169). Patients received 992.02 ± 468 ml fluid and 205.86± 100 ml blood, before surgery.There was no significant difference between preoperative Hb and first Hb in pediatric intensive care unit (PICU) (p=0.12). However, preoperative and first Plt in PICU were different (p=0.000). Also, last Hb in ABG (10.5±1.90), and the first Hb in PICU showed no significant difference (r=0.088, p=0.219). Conclusion According the results, visual assessment and correction of blood loss with hemoglobin measurement and by experienced anesthesiologist was a reliable and safe method in patients with craniosynostosis surgery and feasible in every operating room.

Background Central venous catheter (CVC) is used for measuring hemodynamic variables, transfusion of blood, fluids and medications when peripheral vascular lack sufficiency. Unfortunately CVC is associated with many complications ranging from anxiety and discomfort for the patient to severe mechanical side effects such as arterial lacerations, pleural and pericardial injury as well as infection and thrombosis. This study aimed to survey of a practical approach to central venous catheterization in pediatric patients. Materials and Methods In this retrospective and descriptive study, rate of success and complications of central venous catheterization by the anesthesia team for the hospitalized children 0-15 years from 2009 to 2016 years at Mofid Children Hospital, Tehran-Iran, were investigated. Advancement of catheters tips in pleural space; peritoneal cavity and pericardium were recognized by rat tail blood flow as a practical approach which was proved by chest X- ray. Successful rate and complications of inserting CVC were collected by researchers using medical records of the patients. Results There were 2,385 (53%) female and 2,115 (47%) male patients. Patient’s age ranged from 1 month to 10 years, mean 12.25±6.45 months. About 4,500 patients who underwent central venous catheterization were investigated that 815 patients (18%) had improper catheterization in the internal jugular and 374 patients (8%) had accidental arterial injury and 160 patients (3%) had accidental pleural injury. Accidental pleural injury were recognized by rat tail blood flow in the liquid column connected to the catheter to the patient's bedside and all of them was proven by taking control image. Conclusion Using rat tail blood flow as a practical approach to central venous catheterization in pediatric patients can be associated with prevention of the plural injury and subsequent pneumothorax and hemothorax.

Background: Intracranial pressure (ICP) control is one of the anesthesiologist challenges in craniosynostosis repair surgery, especially in multiple sutures involvement. The aim of this study was comparing the effect of two anesthesia methods including inhalation with hyperventilation and total intravenous anesthesia (TIVA) on ICP control and surgeon satisfaction in pediatrics with craniosynostosis surgery. Materials and Methods: In this randomized clinical trial study, 40 pediatric patients with American society of anesthesiologists (ASA) І-ІІ, 6 months to 2 years old were included. All of the patients were scheduled for craniosynostosis repair at Mofid Children Hospital, Tehran, Iran, in May 2016 to January 2017. The patients were randomly divided into two groups. In hyperventilation group, patients received isoflurane for maintenance of anesthesia and hyperventilation (Paco2=25-30 mmHg) established during surgery. The total intravenous anesthesia (TIVA) group received propofol infusion for anesthesia maintenance and Paco2 was maintained 35 mmHg. Intra cranial pressure (ICP) was assessed by surgeon using a 4-point scale. Hemodynamic (mean arterial pressure and heart rate) changes and blood loss were compared between hyperventilation and TIVA groups. Results: The mean age of patients in hyperventilation group was 10.9±3.25 months and in TIVA group was 8.7 ± 2063 months (p=0.11). Fourteen (70%) patients in hyperventilation group and 6 (30%) patients in TIVA group were male (p=0.74). A significant difference was seen in ICP control and surgical condition between hyperventilation and TIVA groups (p=0.032). ICP was controlled better in hyperventilation group. There was no difference in hemodynamic parameters and blood loss between hyperventilation and TIVA groups (p>0.05). Conclusion: This study showed inhalation anesthesia with hyperventilation was more effective than TIVA on ICP control in craniosynostosis surgery.

Background Although both methods of spontaneous respiration and controlled ventilation during anesthesia are safe and effective for managing children with foreign body aspiration, there is no consensus from the literature as to which technique is optimal. This study aimed to determine the outcomes of anesthetic techniques in pediatric rigid bronchoscopy for foreign body removal. Materials and Methods In this retrospective cross sectional study, all children underwent rigid bronchoscopy for managing foreign body aspiration at Mofid hospital, Tehran, Iran from 2009 to 2015 were enrolled. Data gathering was done by a surgical technologist and using a structured checklist. The measured variables included gender, age, weight, and duration of anesthesia, duration of bronchoscopy, hospitalization in intensive care unit (ICU), and recovery time, and possible major and minor complications. Results Totally, 159 patients were assessed of whom 10 (6.5%) were maintained spontaneous respiration and 149 (99.35%) were given muscle relaxant. The mean ± standard deviation (SD) age of subjects was 27.21 ± 24.40 months, and also 61% (n=97) were male. The two groups did not differ in terms of age, gender and weight (p>0.05). Patients with controlled ventilation had a similar duration of anesthesia, duration of bronchoscopy, hospitalization in ICU, recovery time, and complications with the patients who had spontaneous respiration during bronchoscopy (p > 0.05). Conclusion Patients with spontaneous respiration and controlled ventilation during rigid bronchoscopy have a same outcome during and after the procedure. However, we strongly recommend further study in this regard.

Afsaneh Sadeghi, Ahmad Khaleghnejad Tabari, Alireza Mahdavi, Sara Salarian, Seyed Sajjad Razavi Department of Anesthesiology, Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Introduction: Anesthesia induction is a stressful event for children and their parents, and may have potentially harmful consequences on the patient’s physiological and mental situation. Stressful anesthesia induction has psychological adverse effects that recur with repeated anesthesia, can lead to increased pediatric discomfort during the recovery period, and may even induce reactionary postoperative behavior. A randomized controlled trial was performed to assess the impact of parental presence during induction of anesthesia (PPIA) on preoperative anxiety of pediatric patients and their parents at three different times, cooperation of child with anesthesiologist at induction of anesthesia, and parental satisfaction.Patients and methods: A total of 96 pediatric patients undergoing elective minor surgery (ASA 1–2) were randomly divided into two groups. Both groups received oral midazolam (0.5mg/kg)at least 20 minutes before surgery, but in the PPIA group, the parents were also present in the operating room until loss of consciousness of child at anesthesia induction. Anxiety in the patients (as measured by the modified Yale Preoperative Anxiety Scale [mYPAS]) and parents (as measured by the State and Trait Anxiety Inventory [STAI]), the Induction Compliance Checklist (ICC), and parental satisfaction (as measured by visual analog scale) were assessed. Results: There was no significant difference in the mean anxiety scores (mYPAS) of participants in the control and PPIA groups at ward T0 and upon arrival to operating room T1 (P>0.05). However, between the PPIA and control groups, mean mYPAS score was different at the time of induction of anesthesia T2 (35.5±16.6 vs 59.8±22.4; P

Background: Emergence Agitation (EA) is a dissociated state of consciousness characterized by irritability, uncompromising stance, and inconsolability. The etiology of EA is not completely understood. Dexmedetomidine is a highly selective α2-adrenoreceptor agonist with sedative and analgesic properties, which has been used to reduce the incidence of EA. We aimed to assess the efficacy of early versus late administration of dexmedetomidine on EA in children undergoing oral surgery. Methods: A randomized, parallel, double-blind clinical trial was conducted at Mofid Children’s Hospital affiliated to Shahid Beheshti University of Medical Sciences (Tehran, Iran) from November 2016 to March 2017. A total of 81 children, who underwent adenotonsillectomy or cleft palate repair surgery were enrolled in the study. Based on simple randomization, the children were assigned to two groups, namely early (group A, n=41) and late (group B, n=40) administration of dexmedetomidine. Intra-operative and postoperative hemodynamic variables, extubation time, post-anesthesia care unit (PACU) length of stay, and the scores on Ramsay sedation scale and FLACC pain scale were measured and compared. The data were analyzed using SPSS software (version 20.0), and P

Background: Exposure to noise is an important safety and health problem in many industries. The rail transport industry is one of the industries involved with this problem due to the variety of equipment and its scope. The present study aimed to evaluate noise pollution and determine the sources of noise at Mashhad railway station. Methods: In this descriptive-analytic study in 2014, the departments with noise pollution were identified and studied based on an initial assessment of all parts of the railway station. Noise was measured in ten departments and units. The environmental and local noise was measured by calibrated sound level meter Model CEL485 in A and C networks according to ISO9612 and ISO 11200 standards. Then the collected data entered and analyzed in Surfer V.10 and Excel software. Results: The results of noise measurement showed that the average sound pressure level in units of Diesel GM, repair shop, refueling station, Diesel Siemens, and platform 3 was in hazard range. The results of measurement of the average sound pressure level in departments and units and the isosonic mappings drawn by Surfer V.10 software as well as the results of the average noise level in GM diesel showed that GM diesel (with LP=87.60 dB (A)) is the main source of noise at Mashhad railway station. The results of this study showed that diesel engines, gearboxes, moving trains, and beeps are the main noise generator components in GM diesel. The highest mean sound pressure level among these components was related to the diesel engine with an average sound pressure level of 87.60 dB (A). In general, the average sound pressure level of this diesel was 95.45 dB in the dominant frequency of 63 Hz. Conclusion: Based on the result of this study, GM diesel plays a major role in transporting at Mashhad railway station, accordingly the design and implementation of technical control measures such as chamber and enclosure of noise generator components are essential to reduce the average sound pressure level.

Background: Anesthesiology plays a major role in developing preoperative patient care. As the field of anesthesiology improves, the options to apply better anesthetic procedures emerge. Furthermore, Neuraxial anesthesia increases the chances of better outcome for the patients. However, neuraxial anesthesia has not become yet the favorite choice of anesthesia method by all physicians and patients. Objectives: The aim of present study was to assess elective orthopedic trauma patient’s preference on the choice of anesthesia method and their primary reasons for their choices. Methods: Overall, 170 adult patients underwent elective orthopedic surgery after encountering various orthopedic traumas. It is important to note that the patients entered the study in a prospective cross sectional manner during a period of six months. A structured questionnaire consisting of two parts was used to interview the patients. The first part included the demographic data and the preferred anesthesia technique and the reasons for supporting these techniques. The second part was designed to assess the level of knowledge regarding the anesthesia methods. Results: Amongst 171 patients, 104 (60.8%) chose regional anesthesia (RA) in comparison to 67 (39.2%), who preferred general anesthesia (GA). The correlation between age and choice of anesthesia was significant (P = 0.001). Level of education did not affect the preferred choice of anesthesia (P = 0.651) nor the satisfaction score (P = 0.363). The satisfaction score with respect to received anesthesia was 9.29 ± 1.03 in the RA group and 8.7 ± 1.29 in the GA patients (P = 0.004). Conclusions: The current findings suggested that regional anesthesia was the most preferred satisfactory technique among orthopedic patients, especially older patients.

Background: There are various techniques for treatment of proximal hypospadias disease.Surgical correction is often associated with complications. Proximal hypospadias can be repaired by Duckett or Bracka two-stage repair procedure. This study was to evaluate the outcomes, complications and long term follow-up of these two techniques in our referral hospital. Methods: From January 2006 to January 2015 totally 1550 cases of hypospadias were diagnosed in our hospital, of which 164 patients with high type hypospadias underwent Duckett (78 cases) and modified Bracka (86 cases) surgical repair procedures. Sufficient data were analyzed for age at operation, type of pathology, chordee type, number of operations, complications, outcomes and follow-up. Results: One hundred sixty four cases with a mean age of 2.70 ± 2.6 (range 0.5 - 13) years underwent proximal hypospadias repair. Follow up ran in average to 5 (range 1 - 10) years.Chordee was seen in 19 (11.58%) cases which 15 (78.9%) cases released and 4 (21.1%) corrected by dorsal Nesbit plication. Fifteen of 164 (9.1%) cases had meatal stenosis: 5 in Bracka and 10 in Duckett group, all of which were repaired by dilatation. Six patients in Duckett group and only one in Bracka series had urethrocutaneous fistula. One case in Bracka group and five cases in Duckett series underwent re-operation. Conclusions: Our study shows that proximal hypospadias repair with modified Bracka procedure has significantly a lower complication rate, also a better and more cosmetic outcome than Duckett technique.

Introduction: Rapid-onset obesity with hypoventilation, hypothalamic dysfunction, and autonomic dysregulation (ROHHAD) is a rare disease. To date, there have been only few reported cases of ROHHAD syndrome. Case Presentation: We report a 5-year-old- Iranian girl who had normal growth and development until her 4th year of life. At that time, the patient developed weight gain, constipation, coldness in the extremities, and hyperhidrosis. She first presented to our children’s hospital with a suspected mediastinal mass on chest radiography. After surgery and resection of the mass (a ganglioneuroblastoma), extubation was unsuccessful, with tachycardia and hypertension occurring after each attempt. After 48 days in the ICU, we were still unable to wean her from mechanical ventilation. Finally, based on the rapid weight gain, hypoventilation, hypothalamic dysfunction, and signs of autonomic dysregulation, the patient was diagnosed with ROHHAD syndrome. Conclusions: Only a few case reports have described ROHHAD syndrome, and it is therefore difficult to manage. In children with rapid and early-onset obesity associated with hypothalamic-pituitary endocrine dysfunction, ROHHAD syndrome should be considered in the differential diagnosis.

Summary Background: Limited duration of analgesia is among the limitations of single caudal injection with local anesthetics. Therefore, the purpose of this study was to evaluate the effectiveness and safety of bupivacaine in combination with either neostigmine or tramadol for caudal block in children undergoing inguinal herniorrhaphy. Methods: In a double-blinded randomized trial, sixty children undergoing inguinal herniorrhaphy were enrolled to receive a caudal block with either 0.25% bupivacaine (1 ml·kg−1) with neostigmine (2 μg·kg−1) (group BN) or tramadol (1 mg·kg−1) (group BT). Hemodynamic variables, pain and sedation scores, additional analgesic requirements, and side effects were compared between two groups. Results: Duration of analgesia was longer in group BT (17.30 ± 8.24 h) compared with group BN (13.98 ± 10.03 h) (P = 0.03). Total consumption of rescue analgesic was significantly lower in group BT compared with group BN (P = 0.04). There were no significant differences in heart rate, mean arterial pressure, and oxygen saturation between groups. Adverse effects excluding the vomiting were not observed in any patients. Conclusion: In conclusion, tramadol (1 mg·kg−1) compared with neostigmine (2 μg·kg−1) might provide both prolonged duration of analgesia and extended time to first analgesic in caudal block.

Insufficient control of post-thoracotomy pain can produce breathing dysfunction and long term staying in neonatal intensive care unit (NICU). It can increase the incidence of pulmonary complications such as atelectasis, pneumonia and respiratory failure. The aim of this study was to determine the analgesic effect of continuous extrapleural nerve block, using ropivacaine, in neonates younger than 7 days old with esophageal atersia (EA) and the incidence of atelectasis and duration of hospitalization in NICU. For this purpose, from February 2007 till January 2009 in Mofid children’s hospital, 68 neonates under 7 days old whom were candidate for thoracotomy due to esophageal atresia were, randomly divided into two groups in a controlled clinical trial. The cases received extrapleural infusion of ropivacaine 0.5% (0.1 mL/kg/h for 48 h) and controls received acetaminophen 20 mg/kg three times a day via the rectal route. Hemodynamically unstable patients and those who suffered from hospital infections were excluded from the study. After the surgery, all patients had spontaneous breathing without endotracheal tube and stable hemodynamic in NICU. Pain level was determined for each neonate, based on the neonatal infant pain scale (NIPS) grading. The incidence of atelectasis in the first 48 h after operation and throughout the NICU staying were also determined. Results showed that there were no significant difference in the mean age, sex proportions and mean weight between the two groups. The mean pain score in the group received ropivacaine (1.9 ± 0.7) was significantly less than the control group (5.2 ± 0.6) (p < 0.001). Five percent of cases (n = 1) and 100% of the control group (n=20) had pain scores equal or greater than 3 (p < 0.001). The incidence of atelectasis among cases was less than the control group (35% vs. 65% respectively; p = 0.58). Duration of hospitalization in the case group (12 ± 5.6 days) had no significant difference from the control group (13.6 ± 4.8 days) (p = 0.3) In conclusion, the results showed that continuous extrapleural infusion of ropivacaine reduces the pain noticeably and atelectasis relatively, after thoracotomy in neonates younger than 7 days suffering from EA, compared to the acetaminophen group.

Objective Posterior urethral valves (PUV) are the most common cause of bladder outlet obstruction in infancy that impair renal and bladder function. This study was planned to evaluate and record the various clinical presentations and management, complications, and surgical management and long-term outcome of PUV. Methods In a retrospective study, 98 patients who have been treated for PUV are evaluated in Mofid Children's Hospital from January 2007 to December 2012. Detailed history taken and paraclinical examinations were performed in each patient and diagnosis was confirmed by voiding-cysto-urethrography (VCUG). PUV had been ablated in 62 patients by electric hook, and diversion was performed in 42 (42.85%) cases. Data were analyzed by SPSS software version18. Findings Totally 98 patients with mean age at diagnosis 62 (±13) days were included in this study. Fifty seven cases had been catheterized within one to 6 days of life (mean age one day), PUV was ablated in 62 patients by electric hook, and diversion was performed in 42 cases. The most common symptom in our group was dribbling poor stream 51% and urinary tract infection (UTI) 40.8%. There was vesico-ureteral-reflux (VUR) in 61.2%, and hydronephrosis in 82.6%. Most common associated anomaly was kidney anomalies (multicystic kidney disease and renal agenesis/dysplasia) in 8 (8.2%) patients. Twenty patients had prenatal diagnosis of PUV. Complication occurred in three (3.1%) patients. Mortality occurred in 5 (5.1%) patients. Mean follow-up period was 3.4±1.2 years (1.5 months to 5 years). Conclusion Urinary drainage by feeding tube in early days of infancy, followed by valve ablation is the best treatment in PUV, and urinary diversion improves the outcome. VCUG is still the gold-standard imaging modality for documenting PUVs. The factors like renal dysplasia and UTI have their role in final outcome.

Background: Opium is a highly addictive agent and the most common narcotic often misused in Iran. The pharmacokinetic of anesthetic drugs in patients with opium addiction is one of the great challenges for anesthesiologists. Hemodynamic instability and postoperative side effects are of these challenges which should be managed correctly. Objectives: In this study we aimed to assess the effects of clonidine upon post anesthesia shivering and recovery time in patients with and without opium addiction after general anesthesia to decrease the subsequent complications related to the shivering and elongation of recovery time.\r\n Patients and Methods: In a randomized clinical trial, 160 patients candidates for elective leg fracture operations under general anesthesia were studied in four groups of 40 patients: Group 1 (placebo 1) were patients without addiction who got placebo 90 minutes before the operation. Group 2 (placebo 2) were patients with opium addiction which received placebo as group 1. Group 3 (Clonidine 1) patients without addiction who got clonidine 90 minutes before the operation and group 4 (Clonidine 2) who were opium addicted ones which received clonidine as premedication. Results: None of the patients with and without addiction in clonidine groups had shivering after the operation but in placebo groups shivering was observed and the difference between clonidine and placebo groups was statistically significant (P < 0.01). Recovery time in clonidine groups of patients with and without addiction was less than placebo ones (both P < 0.01) which the magnitude of difference was higher in opium addicted than non-addicted patients (P = 0.04). Conclusions: Premedication with clonidine in patients with and without opium addiction can be effective to decrease the incidence of shivering and recovery time after operation.

Limited duration of analgesia is among the limitations of single caudal injection with local anesthetics. Therefore, the purpose of this study was to evaluate the effectiveness and safety of bupivacaine in combination with either neostigmine or tramadol for caudal block in children undergoing inguinal herniorrhaphy.In a double-blinded randomized trial, sixty children undergoing inguinal herniorrhaphy were enrolled to receive a caudal block with either 0.25% bupivacaine (1 ml x kg(-1)) with neostigmine (2 microg x kg(-1)) (group BN) or tramadol (1 mg x kg(-1)) (group BT). Hemodynamic variables, pain and sedation scores, additional analgesic requirements, and side effects were compared between two groups.Duration of analgesia was longer in group BT (17.30 +/- 8.24 h) compared with group BN (13.98 +/- 10.03 h) (P = 0.03). Total consumption of rescue analgesic was significantly lower in group BT compared with group BN (P = 0.04). There were no significant differences in heart rate, mean arterial pressure, and oxygen saturation between groups. Adverse effects excluding the vomiting were not observed in any patients.In conclusion, tramadol (1 mg x kg(-1)) compared with neostigmine (2 microg x kg(-1)) might provide both prolonged duration of analgesia and extended time to first analgesic in caudal block.